Search results for: relative regional total energy
Commenced in January 2007
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Edition: International
Paper Count: 19229

Search results for: relative regional total energy

1289 Lessons from Patients Expired due to Severe Head Injuries Treated in Intensive Care Unit of Lady Reading Hospital Peshawar

Authors: Mumtaz Ali, Hamzullah Khan, Khalid Khanzada, Shahid Ayub, Aurangzeb Wazir

Abstract:

Objective: To analyse the death of patients treated in neuro-surgical ICU for severe head injuries from different perspectives. The evaluation of the data so obtained to help improve the health care delivery to this group of patients in ICU. Study Design: It is a descriptive study based on retrospective analysis of patients presenting to neuro-surgical ICU in Lady Reading Hospital, Peshawar. Study Duration: It covered the period between 1st January 2009 to 31st December 2009. Material and Methods: The Clinical record of all the patients presenting with the clinical radiological and surgical features of severe head injuries, who expired in neuro-surgical ICU was collected. A separate proforma which mentioned age, sex, time of arrival and death, causes of head injuries, the radiological features, the clinical parameters, the surgical and non surgical treatment given was used. The average duration of stay and the demographic and domiciliary representation of these patients was noted. The record was analyzed accordingly for discussion and recommendations. Results: Out of the total 112 (n-112) patients who expired in one year in the neuro-surgical ICU the young adults made up the majority 64 (57.14%) followed by children, 34 (30.35%) and then the elderly age group: 10 (8.92%). Road traffic accidents were the major cause of presentation, 75 (66.96%) followed by history of fall; 23 (20.53%) and then the fire arm injuries; 13 (11.60%). The predominant CT scan features of these patients on presentation was cerebral edema, and midline shift (diffuse neuronal injuries). 46 (41.07%) followed by cerebral contusions. 28 (25%). The correctable surgical causes were present only in 18 patients (16.07%) and the majority 94 (83.92%) were given conservative management. Of the 69 (n=69) patients in which CT scan was repeated; 62 (89.85%) showed worsening of the initial CT scan abnormalities while in 7 cases (10.14%) the features were static. Among the non surgical cases both ventilatory therapy in 7 (6.25%) and tracheostomy in 39 (34.82%) failed to change the outcome. The maximum stay in the neuro ICU leading upto the death was 48 hours in 35 (31.25%) cases followed by 31 (27.67%) cases in 24 hours; 24 (21.42%) in one week and 16 (14.28%) in 72 hours. Only 6 (5.35%) patients survived more than a week. Patients were received from almost all the districts of NWFP except. The Hazara division. There were some Afghan refugees as well. Conclusion: Mortality following the head injuries is alarmingly high despite repeated claims about the professional and administrative improvement. Even places like ICU could not change the out come according to the desired aims and objectives in the present set up. A rethinking is needed both at the individual and institutional level among the concerned quarters with a clear aim at the more scientific grounds. Only then one can achieve the desired results.

Keywords: Glasgow Coma Scale, pediatrics, geriatrics, Peshawar

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1288 The Potential Involvement of Platelet Indices in Insulin Resistance in Morbid Obese Children

Authors: Orkide Donma, Mustafa M. Donma

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Association between insulin resistance (IR) and hematological parameters has long been a matter of interest. Within this context, body mass index (BMI), red blood cells, white blood cells and platelets were involved in this discussion. Parameters related to platelets associated with IR may be useful indicators for the identification of IR. Platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) are being questioned for their possible association with IR. The aim of this study was to investigate the association between platelet (PLT) count as well as PLT indices and the surrogate indices used to determine IR in morbid obese (MO) children. A total of 167 children participated in the study. Three groups were constituted. The number of cases was 34, 97 and 36 children in the normal BMI, MO and metabolic syndrome (MetS) groups, respectively. Sex- and age-dependent BMI-based percentile tables prepared by World Health Organization were used for the definition of morbid obesity. MetS criteria were determined. BMI values, homeostatic model assessment for IR (HOMA-IR), alanine transaminase-to-aspartate transaminase ratio (ALT/AST) and diagnostic obesity notation model assessment laboratory (DONMA-lab) index values were computed. PLT count and indices were analyzed using automated hematology analyzer. Data were collected for statistical analysis using SPSS for Windows. Arithmetic mean and standard deviation were calculated. Mean values of PLT-related parameters in both control and study groups were compared by one-way ANOVA followed by Tukey post hoc tests to determine whether a significant difference exists among the groups. The correlation analyses between PLT as well as IR indices were performed. Statistically significant difference was accepted as p-value < 0.05. Increased values were detected for PLT (p < 0.01) and PCT (p > 0.05) in MO group compared to those observed in children with N-BMI. Significant increases for PLT (p < 0.01) and PCT (p < 0.05) were observed in MetS group in comparison with the values obtained in children with N-BMI (p < 0.01). Significantly lower MPV and PDW values were obtained in MO group compared to the control group (p < 0.01). HOMA-IR (p < 0.05), DONMA-lab index (p < 0.001) and ALT/AST (p < 0.001) values in MO and MetS groups were significantly increased compared to the N-BMI group. On the other hand, DONMA-lab index values also differed between MO and MetS groups (p < 0.001). In the MO group, PLT was negatively correlated with MPV and PDW values. These correlations were not observed in the N-BMI group. None of the IR indices exhibited a correlation with PLT and PLT indices in the N-BMI group. HOMA-IR showed significant correlations both with PLT and PCT in the MO group. All of the three IR indices were well-correlated with each other in all groups. These findings point out the missing link between IR and PLT activation. In conclusion, PLT and PCT may be related to IR in addition to their identities as hemostasis markers during morbid obesity. Our findings have suggested that DONMA-lab index appears as the best surrogate marker for IR due to its discriminative feature between morbid obesity and MetS.

Keywords: children, insulin resistance, metabolic syndrome, plateletcrit, platelet indices

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1287 Turkish Validation of the Nursing Outcomes for Urinary Incontinence and Their Sensitivities on Nursing Interventions

Authors: Dercan Gencbas, Hatice Bebis, Sue Moorhead

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In the nursing process, many of the nursing classification systems were created to be used in international. From these, NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). In this direction, the main objective of this study is to establish a model for caregivers in hospitals and communities in Turkey and to ensure that nursing outputs are assessed by NOC-based measures. There are many scales to measure Urinary Incontinence (UI), which is very common in children, in old age, vaginal birth, NOC scales are ideal for use in the nursing process for comprehensive and holistic assessment, with surveys available. For this reason, the purpose of this study is to evaluate the validity of the NOC outputs and indicators used for UI NANDA-I. This research is a methodological study. In addition to the validity of scale indicators in the study, how much they will contribute to recovery after the nursing intervention was assessed by experts. Scope validations have been applied and calculated according to Fehring 1987 work model. According to this, nursing inclusion criteria and scores were determined. For example, if experts have at least four years of clinical experience, their score was 4 points or have at least one year of the nursing classification system, their score was 1 point. The experts were a publication experience about nursing classification, their score was 1 point, or have a doctoral degree in nursing, their score was 2 points. If the expert has a master degree, their score was 1 point. Total of 55 experts rated Fehring as a “senior degree” with a score of 90 according to the expert scoring. The nursing interventions to be applied were asked to what extent these indicators would contribute to recovery. For coverage validity tailored to Fehring's model, each NOC and NOC indicator from specialists was asked to score between 1-5. Score for the significance of indicators was from 1=no precaution to 5=very important. After the expert opinion, these weighted scores obtained for each NOC and NOC indicator were classified as 0.8 critical, 0.8 > 0.5 complements, > 0.5 are excluded. In the NANDA-I / NOC / NIC system (guideline), 5 NOCs proposed for nursing diagnoses for UI were proposed. These outputs are; Urinary Continence, Urinary Elimination, Tissue Integrity, Self CareToileting, Medication Response. After the scales are translated into Turkish, the weighted average of the scores obtained from specialists for the coverage of all 5 NOCs and the contribution of nursing initiatives exceeded 0.8. After the opinions of the experts, 79 of the 82 indicators were calculated as critical, 3 of the indicators were calculated as supplemental. Because of 0.5 > was not obtained, no substance was removed. All NOC outputs were identified as valid and usable scales in Turkey. In this study, five NOC outcomes were verified for the evaluation of the output of individuals who have received nursing knowledge of UI and variant types. Nurses in Turkey can benefit from the outputs of the NOC scale to perform the care of the elderly incontinence.

Keywords: nursing outcomes, content validity, nursing diagnosis, urinary incontinence

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1286 Fabrication and Characterisation of Additive Manufactured Ti-6Al-4V Parts by Laser Powder Bed Fusion Technique

Authors: Norica Godja, Andreas Schindel, Luka Payrits, Zsolt Pasztor, Bálint Hegedüs, Petr Homola, Jan Horňas, Jiří Běhal, Roman Ruzek, Martin Holzleitner, Sascha Senck

Abstract:

In order to reduce fuel consumption and CO₂ emissions in the aviation sector, innovative solutions are being sought to reduce the weight of aircraft, including additive manufacturing (AM). Of particular importance are the excellent mechanical properties that are required for aircraft structures. Ti6Al4V alloys, with their high mechanical properties in relation to weight, can reduce the weight of aircraft structures compared to structures made of steel and aluminium. Currently, conventional processes such as casting and CNC machining are used to obtain the desired structures, resulting in high raw material removal, which in turn leads to higher costs and impacts the environment. Additive manufacturing (AM) offers advantages in terms of weight, lead time, design, and functionality and enables the realisation of alternative geometric shapes with high mechanical properties. However, there are currently technological shortcomings that have led to AM not being approved for structural components with high safety requirements. An assessment of damage tolerance for AM parts is required, and quality control needs to be improved. Pores and other defects cannot be completely avoided at present, but they should be kept to a minimum during manufacture. The mechanical properties of the manufactured parts can be further improved by various treatments. The influence of different treatment methods (heat treatment, CNC milling, electropolishing, chemical polishing) and operating parameters were investigated by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX), X-ray diffraction (XRD), electron backscatter diffraction (EBSD) and measurements with a focused ion beam (FIB), taking into account surface roughness, possible anomalies in the chemical composition of the surface and possible cracks. The results of the characterisation of the constructed and treated samples are discussed and presented in this paper. These results were generated within the framework of the 3TANIUM project, which is financed by EU with the contract number 101007830.

Keywords: Ti6Al4V alloys, laser powder bed fusion, damage tolerance, heat treatment, electropolishing, potential cracking

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1285 The Role of Autophagy Modulation in Angiotensin-II Induced Hypertrophy

Authors: Kitti Szoke, Laszlo Szoke, Attila Czompa, Arpad Tosaki, Istvan Lekli

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Autophagy plays an important role in cardiac hypertrophy, which is one of the most common causes of heart failure in the world. This self-degradative catabolic process, responsible for protein quality control, balancing sources of energy at critical times, and elimination of damaged organelles. The autophagic activity can be triggered by starvation, oxidative stress, or pharmacological agents, like rapamycin. This induced autophagy can promote cell survival during starvation or pathological stress. In this study, it is investigated the effect of the induced autophagic process on angiotensin induced hypertrophic H9c2 cells. In our study, it is used H9c2 cells as an in vitro model. To induce hypertrophy, cells were treated with 10000 nM angiotensin-II, and to activate autophagy, 100 nM rapamycin treatment was used. The following groups were formed: 1: control, 2: 10000 nM AT-II, 3: 100 nM rapamycin, 4: 100 nM rapamycin pretreatment then 10000 nM AT-II. The cell viability was examined via MTT (cell proliferation assay) assay. The cells were stained with rhodamine-conjugated phalloidin and DAPI to visualize F-actin filaments and cell nuclei then the cell size alteration was examined in a fluorescence microscope. Furthermore, the expression levels of autophagic and apoptotic proteins such as Beclin-1, p62, LC3B-II, Cleaved Caspase-3 were evaluated by Western blot. MTT assay result suggests that the used pharmaceutical agents in the tested concentrations did not have a toxic effect; however, at group 3, a slight decrement was detected in cell viability. In response to AT-II treatment, a significant increase was detected in the cell size; cells became hypertrophic. However, rapamycin pretreatment slightly reduced the cell size compared to group 2. Western blot results showed that AT-II treatment-induced autophagy, because the increased expression of Beclin-1, p62, LC3B-II were observed. However, due to the incomplete autophagy, the apoptotic Cleaved Caspase-3 expression also increased. Rapamycin pretreatment up-regulated Beclin-1 and LC3B-II, down-regulated p62 and Cleaved Caspase-3, indicating that rapamycin-induced autophagy can restore the normal autophagic flux. Taken together, our results suggest that rapamycin activated autophagy reduces angiotensin-II induced hypertrophy.

Keywords: angiotensin-II, autophagy, H9c2 cell line, hypertrophy, rapamycin

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1284 A Report of 5-Months-Old Baby with Balanced Chromosomal Rearrangements along with Phenotypic Abnormalities

Authors: Mohit Kumar, Beklashwar Salona, Shiv Murti, Mukesh Singh

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We report here a case of five-months old male baby, born as second child of non-consanguineous parents with no considerable history of genetic abnormality which was referred to our cytogenetic laboratory for chromosomal analysis. Physical dysmorphic facial features including mongoloid face, cleft palate, simian crease, and developmental delay were observed. We present this case with unique balanced autosomal translocation of t(3;10)(p21;p13). The risk of phenotypic abnormalities based on de novo balanced translocation was estimated to be 7%. The association of balanced chromosomal rearrangement with Down syndrome features such as multiple congenital anomalies, facial dysmorphism and congenital heart anomalies are very rare in a 5-months old male child. Trisomy-21 is not uncommon in chromosomal abnormality with the birth defect and balanced translocations are frequently observed in patients with secondary infertility or recurrent spontaneous abortion (RSA). Two ml heparinized peripheral blood cells cultured in RPMI-1640 for 72 hours supplemented with 20% fetal bovine serum, phytohemagglutinin (PHA), and antibiotics were used for chromosomal analysis. A total 30 metaphases images were captured using Olympus-BX51 microscope and analyzed using Bio-view karyotyping software through GTG-banding (G bands by trypsin and Giemsa) according to International System for Human Cytogenetic Nomenclature 2016. The results showed balanced translocation between short arm of chromosome # 3 and short arm of chromosome # 10. The karyotype of the child was found to be 46,XY,t(3;10)(p21; p13). Chromosomal abnormalities are one of the major causes of birth defect in new born babies. Also, balanced translocations are frequently observed in patients with secondary infertility or recurrent spontaneous abortion. The index case presented with dysmorphic facial features and had a balanced translocation 46,XY,t(3;10)(p21;p13). This translocation with break points at (p21; p13) has not been reported in the literature in a child with facial dysmorphism. To the best of our knowledge, this is the first report of novel balanced translocation t(3;10) with break points in a child with dysmorphic features. We found balanced chromosomal translocation instead of any trisomy or unbalanced aberrations along with some phenotypic abnormalities. Therefore, we suggest that such novel balanced translocation with abnormal phenotype should be reported in order to enable the pathologist, pediatrician, and gynecologist to have a better insight into the intricacies of chromosomal abnormalities and their associated phenotypic features. We hypothesized that dysmorphic features as seen in this case may be the result of change in the pattern of genes located at the breakpoint area in balanced translocations or may be due to deletion or mutation of genes located on the p-arm of chromosome # 3 and p-arm of chromosome # 10.

Keywords: balanced translocation, karyotyping, phenotypic abnormalities, facial dimorphisms

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1283 Oral Supplementation of Sweet Orange Extract “Citrus Sinensis” as Substitute for Synthetic Vitamin C on Transported Pullets in Humid Tropics

Authors: Mathew O. Ayoola, Foluke Aderemi, Tunde E. Lawal, Opeyemi Oladejo, Micheal A. Abiola

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Food animals reared for meat require transportation during their life cycle. The transportation procedures could initiate stressors capable of disrupting the physiological homeostasis. Such stressors associated with transportation may include; loading and unloading, crowding, environmental temperature, fear, vehicle motion/vibration, feed / water deprivation, and length of travel. This may cause oxidative stress and damage to excess free radicals or reactive oxygen species (ROS). In recent years, the application of natural products as a substitute for synthetic electrolytes and tranquilizers as anti-stress agents during the transportation is yet under investigation. Sweet orange, a predominant fruit in humid tropics, has been reported to have a good content of vitamin C (Ascorbic acid). Vitamin C, which is an active ingredient in orange juice, plays a major role in the biosynthesis of Corticosterone, a hormone that enhances energy supply during transportation and heat stress. Ninety-six, 15weeks, Isa brown pullets were allotted to four (4) oral treatments; sterile water (T1), synthetic vit C (T2), 30ml orange/liter of water (T3), 50ml orange/1 liter (T4). Physiological parameters; body temperature (BTC), rectal temperature (RTC), respiratory rate (RR), and panting rate (PR) were measured pre and post-transportation. The birds were transported with a specialized vehicle for a distance of 50km at a speed of 60 km/hr. The average environmental THI and within the vehicle was 81.8 and 74.6, respectively, and the average wind speed was 11km/hr. Treatments and periods had a significant (p>0.05) effect on all the physiological parameters investigated. Birds on T1 are significantly (p<0.05) different as compared to T2, T3, and T4. Values recorded post-transportation are significantly (p<0.05) higher as compared to pre-transportation for all parameters. In conclusion, this study showed that transportation as a stressor can affect the physiological homeostasis of pullets. Oral supplementation of electrolytes or tranquilizers is essential as an anti-stress during transportation. The application of the organic product in form of sweet orange could serve as a suitable alternative for the synthetic vitamin C.

Keywords: physiological, pullets, sweet orange, transportation stress, and vitamin C

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1282 Acetic Acid Adsorption and Decomposition on Pt(111): Comparisons to Ni(111)

Authors: Lotanna Ezeonu, Jason P. Robbins, Ziyu Tang, Xiaofang Yang, Bruce E. Koel, Simon G. Podkolzin

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The interaction of organic molecules with metal surfaces is of interest in numerous technological applications, such as catalysis, bone replacement, and biosensors. Acetic acid is one of the main products of bio-oils produced from the pyrolysis of hemicellulosic feedstocks. However, their high oxygen content makes them unsuitable for use as fuels. Hydrodeoxygenation is a proven technique for catalytic deoxygenation of bio-oils. An understanding of the energetics and control of the bond-breaking sequences of biomass-derived oxygenates on metal surfaces will enable a guided optimization of existing catalysts and the development of more active/selective processes for biomass transformations to fuels. Such investigations have been carried out with the aid of ultrahigh vacuum and its concomitant techniques. The high catalytic activity of platinum in biomass-derived oxygenate transformations has sparked a lot of interest. We herein exploit infrared reflection absorption spectroscopy(IRAS), temperature-programmed desorption(TPD), and density functional theory(DFT) to study the adsorption and decomposition of acetic acid on a Pt(111) surface, which was then compared with Ni(111), a model non-noble metal. We found that acetic acid adsorbs molecularly on the Pt(111) surface, interacting through the lone pair of electrons of one oxygen atomat 90 K. At 140 K, the molecular form is still predominant, with some dissociative adsorption (in the form of acetate and hydrogen). Annealing to 193 K led to complete dehydrogenation of molecular acetic acid species leaving adsorbed acetate. At 440 K, decomposition of the acetate species occurs via decarbonylation and decarboxylation as evidenced by desorption peaks for H₂,CO, CO₂ and CHX fragments (x=1, 2) in theTPD.The assignments for the experimental IR peaks were made using visualization of the DFT-calculated vibrational modes. The results showed that acetate adsorbs in a bridged bidentate (μ²η²(O,O)) configuration. The coexistence of linear and bridge bonded CO was also predicted by the DFT results. Similar molecular acid adsorption energy was predicted in the case of Ni(111) whereas a significant difference was found for acetate adsorption.

Keywords: acetic acid, platinum, nickel, infared-absorption spectrocopy, temperature programmed desorption, density functional theory

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1281 Studies on the Histomorphometry of the Digestive Tract and Associated Digestive Glands in Ostrich (Struthio camelus) with Gender and Progressing Age in Pakistan

Authors: Zaima Umar, Anas S. Qureshi, Adeel Sarfraz, Saqib Umar, Talha Umar, Muhammad Usman

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Ostrich has been a good source of food and income for people across the world. To get a better understanding of health and health-related problems, the knowledge of its digestive system is of utmost importance. The present study was conducted to determine the morphological and histometrical variations in the digestive system and associated glands of ostrich (Struthio camelus) as regard to the gender and progressive age. A total of 40 apparently healthy ostriches of both genders and two progressive age groups; young one (less than two year, group A); and adult (2-15 years, group B) in equal number were used in this study. Digestive organs including tongue, esophagus, proventriculus, gizzard, small and large intestines and associated glands like liver and pancreas were collected immediately after slaughtering the birds. The organs of the digestive system and associated glands of each group were studied grossly and histologically. Grossly colour, shape consistency, weight and various dimensions (length, width, and circumference) of organs of the digestive tract and associated glands were recorded. The mean (± SEM) of all gross anatomical parameters in group A were significantly (p ≤ 0.01) different from that of group B. For microscopic studies, 1-2 cm tissue samples of organs of the digestive system and associated glands were taken. The tissue was marked and fixed in the neutral buffer formaldehyde solution for histological studies. After fixation, the sections of 5-7 µm were cut and stained by haematoxylin and eosin stain. All the layers (epithelium, lamina propria, lamina muscularis, submucosa and tunica muscularis) were measured (µm) with the help of automated computer software Image J®. The results of this study provide valuable information on the gender and age-related histological and histometrical variations in the digestive organs of ostrich (Struthio camelus). The microscopic studies of different parts of the digestive system revealed highly significant differences (p ≤ 0.01) among the two groups. The esophagus was lined by non-keratinized stratified squamous epithelium. The duodenum, jejunum, and ileum showed similar histological structures. Statistical analysis revealed significant (p ≤ 0.05) increase in the thickness of different tunics of the gastrointestinal tract in adult birds (up to 15 years) as compared with young ones (less than two years). Therefore, it can be concluded that there is a gradual but consistent growth in the observed digestive organs mimicking that of other poultry species and may be helpful in determining the growth pattern in this bird. However, there is a need to record the changes at closer time intervals.

Keywords: ostrich, digestive system, histomorphometry, grossly

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1280 Development of Stretchable Woven Fabrics with Auxetic Behaviour

Authors: Adeel Zulifqar, Hong Hu

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Auxetic fabrics are a special kind of textile materials which possess negative Poisson’s ratio. Opposite to most of the conventional fabrics, auxetic fabrics get bigger in the transversal direction when stretched or get smaller when compressed. Auxetic fabrics are superior to conventional fabrics because of their counterintuitive properties, such as enhanced porosity under the extension, excellent formability to a curved surface and high energy absorption ability. Up till today, auxetic fabrics have been produced based on two approaches. The first approach involves using auxetic fibre or yarn and weaving technology to fabricate auxetic fabrics. The other method to fabricate the auxetic fabrics is by using non-auxetic yarns. This method has gained extraordinary curiosity of researcher in recent years. This method is based on realizing auxetic geometries into the fabric structure. In the woven fabric structure auxetic geometries can be realized by creating a differential shrinkage phenomenon into the fabric structural unit cell. This phenomenon can be created by using loose and tight weave combinations within the unit cell of interlacement pattern along with elastic and non-elastic yarns. Upon relaxation, the unit cell of interlacement pattern acquires a non-uniform shrinkage profile due to different shrinkage properties of loose and tight weaves in designed pattern, and the auxetic geometry is realized. The development of uni-stretch auxetic woven fabrics and bi-stretch auxetic woven fabrics by using this method has already been reported. This study reports the development of another kind of bi-stretch auxetic woven fabric. The fabric is first designed by transforming the auxetic geometry into interlacement pattern and then fabricated, using the available conventional weaving technology and non-auxetic elastic and non-elastic yarns. The tensile tests confirmed that the developed bi-stretch auxetic woven fabrics exhibit negative Poisson’s ratio over a wide range of tensile strain. Therefore, it can be concluded that the auxetic geometry can be realized into the woven fabric structure by creating the phenomenon of differential shrinkage and bi-stretch woven fabrics made of non-auxetic yarns having auxetic behavior and stretchability are possible can be obtained. Acknowledgement: This work was supported by the Research Grants Council of Hong Kong Special Administrative Region Government (grant number 15205514).

Keywords: auxetic, differential shrinkage, negative Poisson's ratio, weaving, stretchable

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1279 Management of Meskit (Prosopis juliflora) Tree in Oman: The Case of Using Meskit (Prosopis juliflora) Pods for Feeding Omani Sheep

Authors: S. Al-Khalasi, O. Mahgoub, H. Yaakub

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This study evaluated the use of raw or processed Prosopis juliflora (Meskit) pods as a major ingredient in a formulated ration to provide an alternative non-conventional concentrate for livestock feeding in Oman. Dry Meskit pods were reduced to lengths of 0.5- 1.0 cm to ensure thorough mixing into three diets. Meskit pods were subjected to two types of treatments; roasting and soaking. They were roasted at 150оC for 30 minutes using a locally-made roasting device (40 kg barrel container rotated by electric motor and heated by flame gas cooker). Chopped pods were soaked in tap water for 24 hours and dried for 2 days under the sun with frequent turning. The Meskit-pod-based diets (MPBD) were formulated and pelleted from 500 g/kg ground Meskit pods, 240 g/kg wheat bran, 200 g/kg barley grain, 50 g/kg local dried sardines and 10 g/kg of salt. Twenty four 10 months-old intact Omani male lambs with average body weight of 27.3 kg (± 0.5 kg) were used in a feeding trial for 84 days. They were divided (on body weight basis) and allocated to four diet combination groups. These were: Rhodes grass hay (RGH) plus a general ruminant concentrate (GRC); RGH plus raw Meskit pods (RMP) based concentrate; RGH plus roasted Meskit pods (ROMP) based concentrate; RGH plus soaked Meskit pods (SMP) based concentrate Daily feed intakes and bi-weekly body weights were recorded. MPBD had higher contents of crude protein (CP), acid detergent fibre (ADF) and neutral detergent fibre (NDF) than the GRC. Animals fed various types of MPBD did not show signs of ill health. There was a significant effect of feeding ROMP on the performance of Omani sheep compared to RMP and SMP. The ROMP fed animals had similar performance to those fed the GRC in terms of feed intake, body weight gain and feed conversion ratio (FCR).This study indicated that roasted Meskit pods based diet may be used instead of the commercial concentrate for feeding Omani sheep without adverse effects on performance. It offers a cheap alternative source of protein and energy for feeding Omani sheep. Also, it might help in solving the spread impact of Meskit trees, maintain the ecosystem and helping in preserving the local tree species.

Keywords: growth, Meskit, Omani sheep, Prosopis juliflora

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1278 Monoallelic and Biallelic Deletions of 13q14 in a Group of 36 CLL Patients Investigated by CGH Haematological Cancer and SNP Array (8x60K)

Authors: B. Grygalewicz, R. Woroniecka, J. Rygier, K. Borkowska, A. Labak, B. Nowakowska, B. Pienkowska-Grela

Abstract:

Introduction: Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the Western world. Hemizygous and or homozygous loss at 13q14 occur in more than half of cases and constitute the most frequent chromosomal abnormality in CLL. It is believed that deletions 13q14 play a role in CLL pathogenesis. Two microRNA genes miR-15a and miR- 16-1 are targets of 13q14 deletions and plays a tumor suppressor role by targeting antiapoptotic BCL2 gene. Deletion size, as a single change detected in FISH analysis, has haprognostic significance. Patients with small deletions, without RB1 gene involvement, have the best prognosis and the longest overall survival time (OS 133 months). In patients with bigger deletion region, containing RB1 gene, prognosis drops to intermediate, like in patients with normal karyotype and without changes in FISH with overall survival 111 months. Aim: Precise delineation of 13q14 deletions regions in two groups of CLL patients, with mono- and biallelic deletions and qualifications of their prognostic significance. Methods: Detection of 13q14 deletions was performed by FISH analysis with CLL probe panel (D13S319, LAMP1, TP53, ATM, CEP-12). Accurate deletion size detection was performed by CGH Haematological Cancer and SNP array (8x60K). Results: Our investigated group of CLL patients with the 13q14 deletion, detected by FISH analysis, comprised two groups: 18 patients with monoallelic deletions and 18 patients with biallelic deletions. In FISH analysis, in the monoallelic group the range of cells with deletion, was 43% to 97%, while in biallelic group deletion was detected in 11% to 94% of cells. Microarray analysis revealed precise deletion regions. In the monoallelic group, the range of size was 348,12 Kb to 34,82 Mb, with median deletion size 7,93 Mb. In biallelic group discrepancy of total deletions, size was 135,27 Kb to 33,33 Mb, with median deletion size 2,52 Mb. The median size of smaller deletion regions on one copy chromosome 13 was 1,08 Mb while the average region of bigger deletion on the second chromosome 13 was 4,04 Mb. In the monoallelic group, in 8/18 deletion region covered RB1 gene. In the biallelic group, in 4/18 cases, revealed deletion on one copy of biallelic deletion and in 2/18 showed deletion of RB1 gene on both deleted 13q14 regions. All minimal deleted regions included miR-15a and miR-16-1 genes. Genetic results will be correlated with clinical data. Conclusions: Application of CGH microarrays technique in CLL allows accurately delineate the size of 13q14 deletion regions, what have a prognostic value. All deleted regions included miR15a and miR-16-1, what confirms the essential role of these genes in CLL pathogenesis. In our investigated groups of CLL patients with mono- and biallelic 13q14 deletions, patients with biallelic deletion presented smaller deletion sizes (2,52 Mb vs 7,93 Mb), what is connected with better prognosis.

Keywords: CLL, deletion 13q14, CGH microarrays, SNP array

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1277 Applying Quadrant Analysis in Identifying Business-to-Business Customer-Driven Improvement Opportunities in Third Party Logistics Industry

Authors: Luay Jum'a

Abstract:

Many challenges are facing third-party logistics (3PL) providers in the domestic and global markets which create a volatile decision making environment. All these challenges such as managing changes in consumer behaviour, demanding expectations from customers and time compressions have turned into complex problems for 3PL providers. Since the movement towards increased outsourcing outpaces movement towards insourcing, the need to achieve a competitive advantage over competitors in 3PL market increases. This trend continues to grow over the years and as a result, areas of strengths and improvements are highlighted through the analysis of the LSQ factors that lead to B2B customers’ satisfaction which become a priority for 3PL companies. Consequently, 3PL companies are increasingly focusing on the most important issues from the perspective of their customers and relying more on this value of information in making their managerial decisions. Therefore, this study is concerned with providing guidance for improving logistics service quality (LSQ) levels in the context of 3PL industry in Jordan. The study focused on the most important factors in LSQ and used a managerial tool that guides 3PL companies in making LSQ improvements based on a quadrant analysis of two main dimensions: LSQ declared importance and LSQ inferred importance. Although, a considerable amount of research has been conducted to investigate the relationship between logistics service quality (LSQ) and customer satisfaction, there remains a lack of developing managerial tools to aid in the process of LSQ improvement decision-making. Moreover, the main advantage for the companies to use 3PL service providers as a trend is due to the realised percentage of cost reduction on the total cost of logistics operations and the incremental improvement in customer service. In this regard, having a managerial tool that help 3PL service providers in managing the LSQ factors portfolio effectively and efficiently would be a great investment for service providers. One way of suggesting LSQ improvement actions for 3PL service providers is via the adoption of analysis tools that perform attribute categorisation such as Importance–Performance matrix. In mind of the above, it can be stated that the use of quadrant analysis will provide a valuable opportunity for 3PL service providers to identify improvement opportunities as customer service attributes or factors importance are identified in two different techniques that complete each other. Moreover, the data were collected through conducting a survey and 293 questionnaires were returned from business-to-business (B2B) customers of 3PL companies in Jordan. The results showed that the LSQ factors vary in their importance and 3PL companies should focus on some LSQ factors more than other factors. Moreover, ordering procedures, timeliness/responsiveness LSQ factors considered being crucial in 3PL businesses and therefore they need to have more focus and development by 3PL service providers in the Jordanian market.

Keywords: logistics service quality, managerial decisions, quadrant analysis, third party logistics service provider

Procedia PDF Downloads 124
1276 Is Obesity Associated with CKD-(unknown) in Sri Lanka? A Protocol for a Cross Sectional Survey

Authors: Thaminda Liyanage, Anuga Liyanage, Chamila Kurukulasuriya, Sidath Bandara

Abstract:

Background: The burden of chronic kidney disease (CKD) is growing rapidly around the world, particularly in Asia. Over the last two decades Sri Lanka has experienced an epidemic of CKD with ever growing number of patients pursuing medical care due to CKD and its complications, specially in the “Mahaweli” river basin in north central region of the island nation. This was apparently a new form of CKD which was not attributable to conventional risk factors such as diabetes mellitus, hypertension or infection and widely termed as “CKD-unknown” or “CKDu”. In the past decade a number of small scale studies were conducted to determine the aetiology, prevalence and complications of CKDu in North Central region. These hospital-based studies did not provide an accurate estimate of the problem as merely 10% or less of the people with CKD are aware of their diagnosis even in developed countries with better access to medical care. Interestingly, similar observations were made on the changing epidemiology of obesity in the region but no formal study was conducted to date to determine the magnitude of obesity burden. Moreover, if increasing obesity in the region is associated with CKD epidemic is yet to be explored. Methods: We will conduct an area wide cross sectional survey among all adult residents of the “Mahaweli” development project area 5, in the North Central Province of Sri Lanka. We will collect relevant medical history, anthropometric measurements, blood and urine for hematological and biochemical analysis. We expect a participation rate of 75%-85% of all eligible participants. Participation in the study is voluntary, there will be no incentives provided for participation. Every analysis will be conducted in a central laboratory and data will be stored securely. We will calculate the prevalence of obesity and chronic kidney disease, overall and by stage using total number of participants as the denominator and report per 1000 population. The association of obesity and CKD will be assessed with regression models and will be adjusted for potential confounding factors and stratified by potential effect modifiers where appropriate. Results: This study will provide accurate information on the prevalence of obesity and CKD in the region. Furthermore, this will explore the association between obesity and CKD, although causation may not be confirmed. Conclusion: Obesity and CKD are increasingly recognized as major public health problems in Sri Lanka. Clearly, documenting the magnitude of the problem is the essential first step. Our study will provide this vital information enabling the government to plan a coordinated response to tackle both obesity and CKD in the region.

Keywords: BMI, Chronic Kidney Disease, obesity, Sri Lanka

Procedia PDF Downloads 268
1275 On the Other Side of Shining Mercury: In Silico Prediction of Cold Stabilizing Mutations in Serine Endopeptidase from Bacillus lentus

Authors: Debamitra Chakravorty, Pratap K. Parida

Abstract:

Cold-adapted proteases enhance wash performance in low-temperature laundry resulting in a reduction in energy consumption and wear of textiles and are also used in the dehairing process in leather industries. Unfortunately, the possible drawbacks of using cold-adapted proteases are their instability at higher temperatures. Therefore, proteases with broad temperature stability are required. Unfortunately, wild-type cold-adapted proteases exhibit instability at higher temperatures and thus have low shelf lives. Therefore, attempts to engineer cold-adapted proteases by protein engineering were made previously by directed evolution and random mutagenesis. The lacuna is the time, capital, and labour involved to obtain these variants are very demanding and challenging. Therefore, rational engineering for cold stability without compromising an enzyme's optimum pH and temperature for activity is the current requirement. In this work, mutations were rationally designed with the aid of high throughput computational methodology of network analysis, evolutionary conservation scores, and molecular dynamics simulations for Savinase from Bacillus lentus with the intention of rendering the mutants cold stable without affecting their temperature and pH optimum for activity. Further, an attempt was made to incorporate a mutation in the most stable mutant rationally obtained by this method to introduce oxidative stability in the mutant. Such enzymes are desired in detergents with bleaching agents. In silico analysis by performing 300 ns molecular dynamics simulations at 5 different temperatures revealed that these three mutants were found to be better in cold stability compared to the wild type Savinase from Bacillus lentus. Conclusively, this work shows that cold adaptation without losing optimum temperature and pH stability and additionally stability from oxidative damage can be rationally designed by in silico enzyme engineering. The key findings of this work were first, the in silico data of H5 (cold stable savinase) used as a control in this work, corroborated with its reported wet lab temperature stability data. Secondly, three cold stable mutants of Savinase from Bacillus lentus were rationally identified. Lastly, a mutation which will stabilize savinase against oxidative damage was additionally identified.

Keywords: cold stability, molecular dynamics simulations, protein engineering, rational design

Procedia PDF Downloads 132
1274 Satellite Data to Understand Changes in Carbon Dioxide for Surface Mining and Green Zone

Authors: Carla Palencia-Aguilar

Abstract:

In order to attain the 2050’s zero emissions goal, it is necessary to know the carbon dioxide changes over time either from pollution to attenuations in the mining industry versus at green zones to establish real goals and redirect efforts to reduce greenhouse effects. Two methods were used to compute the amount of CO2 tons in specific mining zones in Colombia. The former by means of NPP with MODIS MOD17A3HGF from years 2000 to 2021. The latter by using MODIS MYD021KM bands 33 to 36 with maximum values of 644 data points distributed in 7 sites corresponding to surface mineral mining of: coal, nickel, iron and limestone. The green zones selected were located at the proximities of the studied sites, but further than 1 km to avoid information overlapping. Year 2012 was selected for method 2 to compare the results with data provided by the Colombian government to determine range of values. Some data was compared with 2022 MODIS energy values and converted to kton of CO2 by using the Greenhouse Gas Equivalencies Calculator by EPA. The results showed that Nickel mining was the least pollutant with 81 kton of CO2 e.q on average and maximum of 102 kton of CO2 e.q. per year, with green zones attenuating carbon dioxide in 103 kton of CO2 on average and 125 kton maximum per year in the last 22 years. Following Nickel, there was Coal with average kton of CO2 per year of 152 and maximum of 188, values very similar to the subjacent green zones with average and maximum kton of CO2 of 157 and 190 respectively. Iron had similar results with respect to 3 Limestone sites with average values of 287 kton of CO2 for mining and 310 kton for green zones, and maximum values of 310 kton for iron mining and 356 kton for green zones. One of the limestone sites exceeded the other sites with an average value of 441 kton per year and maximum of 490 kton per year, eventhough it had higher attenuation by green zones than a close Limestore site (3.5 Km apart): 371 kton versus 281 kton on average and maximum 416 kton versus 323 kton, such vegetation contribution is not enough, meaning that manufacturing process should be improved for the most pollutant site. By comparing bands 33 to 36 for years 2012 and 2022 from January to August, it can be seen that on average the kton of CO2 were similar for mining sites and green zones; showing an average yearly balance of carbon dioxide emissions and attenuation. However, efforts on improving manufacturing process are needed to overcome the carbon dioxide effects specially during emissions’ peaks because surrounding vegetation cannot fully attenuate it.

Keywords: carbon dioxide, MODIS, surface mining, vegetation

Procedia PDF Downloads 95
1273 The Historical Background of Physical Changing Towards Ancient Mosques in Aceh, Indonesia

Authors: Karima Adilla

Abstract:

Aceh province, into which Islam convinced to have entered Indonesia in the 12th Century before spreading throughout the archipelago and the rest of Southeast Asia, has several early Islamic mosques that still exist until today. However, due to some circumstances, the restoration and rehabilitation towards those mosques have been made in some periods, while the background was diverse. Concerning this, the research will examine the physical changing aspects of 3 prominent historical mosques in Aceh Besar and Banda Aceh; those are, Indrapuri Mosque, Baiturrahman Grand Mosque, and Baiturrahim Mosque built coincided with the beginning of Islam’s development in Aceh and regarded as eventful mosques. The existence of Indrapuri Mosque built on the remains of the Lamuri Kingdom’s temple is a historical trace that there was Hindu-Buddhist civilization in Aceh before Islam entered and became the majority religion about 98% from Aceh total population. Also, there was the Dutch who colonialized Aceh behind the existence of two famous mosques in Aceh, namely Baiturrahman Grand Mosque and Baiturrahim Mosque, as the colonizer also assisted to rebuild those 2 sacred Mosques to quell the anger of the Acehnese people because their mosque was burnt by the Dutch. Interestingly, despite underwent a long history successively since the rise of Islam after the Hindu-Buddhist kingdom had collapsed, colonialization, conflict, in Aceh, and even experienced the earthquake and tsunami disaster in 2004, those mosques still exist. Therefore, those mosques have been considered as historical silent witnesses. However, it was not merely those reasons that led the mosques underwent several physical changes, otherwise economic, political, social, cultural and religious factors were also highly influential. Instead of directly illustrating the physical changing of those three mosques, this research intends to identify under what condition the physical appearance continuously changing during the sultanate era, the colonial period until post-independent in terms of the architectural style, detail elements, design philosophy, and how the remnants buildings act as medium to bridge the history. A framework will use qualitative research methods by collecting actual data of the mosque's physical change figures through field studies, investigations, library studies and interviews. This research aims to define every trace of historical issues embedded in the physical changing of those mosques as they are intertwined in collecting historical proof. Thus, the result will reveal the characteristic interrelation between history, the mosque architectural style in a certain period, the physical changes background and its impact. Eventually, this research will also explicate a clear inference of each mosque’s role in representing history in Aceh Besar and Banda Aceh specifically, as well as Aceh generally through architectural design concepts.

Keywords: Aceh ancient mosques, Aceh history, Islamic architecture, physical changing

Procedia PDF Downloads 131
1272 Factors Influencing Family Resilience and Quality of Life in Pediatric Cancer Patients and Their Caregivers: A Cluster Analysis

Authors: Li Wang, Dan Shu, Shiguang Pang, Lixiu Wang, Bing Xiang Yang, Qian Liu

Abstract:

Background: Cancer is one of the most severe diseases in childhood; long-term treatment and its side effects significantly impact the patient's physical, psychological, social functioning and quality of life while also placing substantial physical and psychological burdens on caregivers and families. Family resilience is crucial for children with cancer, helping them cope better with the disease and supporting the family in facing challenges together. As a family-level variable, family resilience requires information from multiple family members. However, to our best knowledge, there is currently no research investigating family resilience from both the perspectives of pediatric cancer patients and their caregivers. Therefore, this study aims to investigate the family resilience and quality of life of pediatric cancer patients from a patient–caregiver dyadic perspective. Methods: A total of 149 dyads of patients diagnosed with pediatric cancer patients and their principal caregivers were recruited from oncology departments of 4 tertiary hospitals in Wuhan and Taiyuan, China. All participants completed questionnaires that identified their demographic and clinical characteristics as well as assessed their family resilience and quality of life for both the patients and their caregivers. K-means cluster analysis was used to identify different clusters of family resilience based on the reports from patients and caregivers. Multivariate logistic regression and linear regression are used to analyze the factors influencing family resilience and quality of life, as well as the relationship between the two. Results: Three clusters of family resilience were identified: a cluster of high family resilience (HR), a cluster of low family resilience (LR), and a cluster of discrepant family resilience (DR). Most (67.1%) families fell into the cluster with low resilience. Characteristics such as the types of caregivers perceived social support of the patient were different among the three clusters. Compared to the LR group, families where the mother is the caregiver and where the patient has high social support are more likely to be assigned to the HR. The quality of life for caregivers was consistently highest in the HR cluster and lowest in the LR cluster. The patient's quality of life is not related to family resilience. In the linear regression analysis of the patient's quality of life, patients who are the first-born have higher quality of life, while those living with their parents have lower quality of life. The participants' characteristics were not associated with the quality of life for caregivers. Conclusions: In most families, family resilience was low. Families with maternal caregivers and patients receiving high levels of social support are more inclined to be higher levels of family resilience. Family resilience was linked to the quality of life of caregivers of pediatric cancer patients. The clinical implications of this findings suggest that healthcare and social support organizations should prioritize and support the participation of mothers in caregiving responsibilities. Furthermore, they should assist families in accessing social support to enhance family resilience. This study also emphasizes the importance of promoting family resilience for enhancing family health and happiness, as well as improving the quality of life for caregivers.

Keywords: pediatric cancer, cluster analysis, family resilience, quality of life

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1271 Phytoremediation of Heavy Metals by the Perennial Tussock Chrysopogon Zizanioides Grown on Zn and Cd Contaminated Soil Amended with Biochar

Authors: Dhritilekha Deka, Deepak Patwa, Ravi K., Archana M. Nair

Abstract:

Bioaccumulation of heavy metal contaminants due to intense anthropogenic interference degrades the environment and ecosystem functions. Conventional physicochemical methods involve energy-intensive and costly methodologies. Phytoremediation, on the other hand, provides an efficient nature-based strategy for the reclamation of heavy metal-contaminated sites. However, the slow process and adaptation to high-concentration contaminant sequestration often limit the efficiency of the method. This necessitates natural amendments such as biochar to improve phytoextraction and stabilize the green cover. Biochar is a highly porous structure with high carbon sequestration potential and containing negatively charged functional groups that provide binding sites for the positively charged metals. This study aims to develop and determine the synergy between sugarcane bagasse biochar content and phytoremediation. A 60-day pot experiment using perennial tussock vetiver grass (Chrysopogon zizanioides) was conducted for different biochar contents of 1%, 2%, and 4% for the removal of cadmium and zinc. A concentration of 500 ppm is maintained for the amended and unamended control (CK) samples. The survival rates of the plants, biomass production, and leaf area index were measured for the plant growth characteristics. Results indicate a visible change in the plant growth and the heavy metal concentration with the biochar content. The bioconcentration factor (BCF) in the plant improved significantly for the 4% biochar content by 57% in comparison to the control CK treatment in Cd-treated soils. The Zn soils indicated the highest reduction in the metal concentration by 50% in the 2% amended samples and an increase in the BCF in all the amended samples. The translocation from the rhizosphere to the shoots was low but not dependent on the amendment content and varied for each contaminant type. The root-to-shoot ratio indicates higher values compared to the control samples. The enhanced tolerance capacities can be attributed to the nutrients released by the biochar in the soil. The study reveals the high potential of biochar as a phytoremediation amendment, but its effect is dependent on the soil and heavy metal and accumulator species.

Keywords: phytoextraction, biochar, heavy metals, chrysopogon zizanioides, bioaccumulation factor

Procedia PDF Downloads 60
1270 Social Enterprises in India: Conceptualization and Challenges

Authors: Prajakta Khare

Abstract:

There is a huge number of social enterprises operating in India, across all enterprise sizes and forms addressing diverse social issues. Some cases such as such as Aravind eye care, Narayana Hridalaya, SEWA have been studied extensively in management literature and are known cases in social entrepreneurship. But there are several smaller social enterprises in India that are not called so per se due to the lack of understanding of the concept. There is a lack of academic research on social entrepreneurship in India and the term ‘social entrepreneurship’ is not yet widely known in the country, even by people working in this field as was found by this study. The present study aims to identify the most prominent form of social enterprises in India, the profile of the entrepreneurs, challenges faced, the lessons (theory and practices) emerging from their functioning and finally the factors contributing to the enterprises’ success. This is a preliminary exploratory study using primary data from 30 social enterprises in India. The study used snow ball sampling and a qualitative analysis. Data was collected from founders of social enterprises through written structured questionnaires, open-ended interviews and field visits to enterprises. The sample covered enterprises across sectors such as environment, affordable education, children’s rights, rain water harvesting, women empowerment etc. The interview questions focused on founder’s background and motivation, qualifications, funding, challenges, founder’s understanding and perspectives on social entrepreneurship, government support, linkages with other organizations etc. apart from several others. The interviews were conducted across 3 languages - Hindi, Marathi, English and were then translated and transcribed. 50% of founders were women and 65% of the total founders were highly qualified with a MBA, PhD or MBBS. The most important challenge faced by these entrepreneurs is recruiting skilled people. When asked about their understanding of the term, founders had diverse perspectives. Also, their understandings about the term social enterprise and social entrepreneur were extremely varied. Some founders identified the terms with doing something good for the society, some thought that every business can be called a social enterprise. 35% of the founders were not aware of the term social entrepreneur/ social entrepreneurship. They said that they could identify themselves as social entrepreneurs after discussions with the researcher. The general perception in India is that ‘NGOs are corrupt’- fighting against this perception to secure funds is also another problem as pointed out by some founders. There are unique challenges that social entrepreneurs in India face, as the political, social, economic environment around them is rapidly changing; and getting adequate support from the government is a problem. The research in its subsequent stages aims to clarify existing, missing and new definitions of the term to provide deeper insights in the terminology and issues relating to Social Entrepreneurship in India.

Keywords: challenges, India, social entrepreneurship, social entrepreneurs

Procedia PDF Downloads 466
1269 Role of Platelet Volume Indices in Diabetes Related Vascular Angiopathies

Authors: Mitakshara Sharma, S. K. Nema, Sanjeev Narang

Abstract:

Diabetes mellitus (DM) is a group of metabolic disorders characterized by metabolic abnormalities, chronic hyperglycaemia and long term macrovascular & microvascular complications. Vascular complications are due to platelet hyperactivity and dysfunction, increased inflammation, altered coagulation and endothelial dysfunction. Large proportion of patients with Type II DM suffers from preventable vascular angiopathies, and there is need to develop risk factor modifications and interventions to reduce impact of complications. These complications are attributed to platelet activation, recognised by increase in Platelet Volume Indices (PVI) including Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). The current study is prospective analytical study conducted over 2 years. Out of 1100 individuals, 930 individuals fulfilled inclusion criteria and were segregated into three groups on basis of glycosylated haemoglobin (HbA1C): - (a) Diabetic, (b) Non-Diabetic and (c) Subjects with Impaired fasting glucose (IFG) with 300 individuals in IFG and non-diabetic groups & 330 individuals in diabetic group. Further, diabetic group was divided into two groups on the basis of presence or absence of known diabetes related vascular complications. Samples for HbA1c and PVI were collected using Ethylene diamine tetraacetic acid (EDTA) as anticoagulant and processed on SYSMEX-X-800i autoanalyser. The study revealed gradual increase in PVI from non-diabetics to IFG to diabetics. PVI were markedly increased in diabetic patients. MPV and PDW of diabetics, IFG and non diabetics were (17.60 ± 2.04)fl, (11.76 ± 0.73)fl, (9.93 ± 0.64)fl and (19.17 ± 1.48)fl, (15.49 ± 0.67)fl, (10.59 ± 0.67)fl respectively with a significant p value 0.00 and a significant positive correlation (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). MPV & PDW of subjects with diabetes related complications were higher as compared to those without them and were (17.51±0.39)fl & (15.14 ± 1.04)fl and (20.09 ± 0.98) fl & (18.96 ± 0.83)fl respectively with a significant p value 0.00. There was a significant positive correlation between PVI and duration of diabetes across the groups (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). However, a significant negative correlation was found between glycaemic levels and total platelet count (PC- HbA1c r =-0.164). This is multi-parameter and comprehensive study with an adequately powered study design. It can be concluded from our study that PVI are extremely useful and important indicators of impending vascular complications in all patients with deranged glycaemic control. Introduction of automated cell counters has facilitated the availability of PVI as routine parameters. PVI is a useful means for identifying larger & active platelets which play important role in development of micro and macro angiopathic complications of diabetes leading to mortality and morbidity. PVI can be used as cost effective markers to predict and prevent impending vascular events in patients with Diabetes mellitus especially in developing countries like India. PVI, if incorporated into protocols for management of diabetes, could revolutionize care and curtail the ever increasing cost of patient management.

Keywords: diabetes, IFG, HbA1C, MPV, PDW, PVI

Procedia PDF Downloads 256
1268 Nano-Sized Iron Oxides/ZnMe Layered Double Hydroxides as Highly Efficient Fenton-Like Catalysts for Degrading Specific Pharmaceutical Agents

Authors: Marius Sebastian Secula, Mihaela Darie, Gabriela Carja

Abstract:

Persistent organic pollutant discharged by various industries or urban regions into the aquatic ecosystems represent a serious threat to fauna and human health. The endocrine disrupting compounds are known to have toxic effects even at very low values of concentration. The anti-inflammatory agent Ibuprofen is an endocrine disrupting compound and is considered as model pollutant in the present study. The use of light energy to accomplish the latest requirements concerning wastewater discharge demands highly-performant and robust photo-catalysts. Many efforts have been paid to obtain efficient photo-responsive materials. Among the promising photo-catalysts, layered double hydroxides (LDHs) attracted significant consideration especially due to their composition flexibility, high surface area and tailored redox features. This work presents Fe(II) self-supported on ZnMeLDHs (Me =Al3+, Fe3+) as novel efficient photo-catalysts for Fenton-like catalysis. The co-precipitation method was used to prepare ZnAlLDH, ZnFeAlLDH and ZnCrLDH (Zn2+/Me3+ = 2 molar ratio). Fe(II) was self-supported on the LDHs matrices by using the reconstruction method, at two different values of weight concentration. X-ray diffraction (XRD), thermogravimetric analysis (TG/DTG), Fourier transform infrared (FTIR) and transmission electron microscopy (TEM) were used to investigate the structural, textural, and micromorphology of the catalysts. The Fe(II)/ZnMeLDHs nano-hybrids were tested for the degradation of a model pharmaceutical agent, the anti-inflammatory agent ibuprofen, by photocatalysis and photo-Fenton catalysis, respectively. The results point out that the embedment Fe(II) into ZnFeAlLDH and ZnCrLDH lead to a slight enhancement of ibuprofen degradation by light irradiation, whereas in case of ZnAlLDH, the degradation process is relatively low. A remarkable enhancement of ibuprofen degradation was found in the case of Fe(II)/ZnMeLDHs by photo-Fenton process. Acknowledgements: This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS - UEFISCDI, project number PN-II-RU-TE-2014-4-0405.

Keywords: layered double hydroxide, heterogeneous Fenton, micropollutant, photocatalysis

Procedia PDF Downloads 292
1267 Analysis of the Savings Behaviour of Rice Farmers in Tiaong, Quezon, Philippines

Authors: Angelika Kris D. Dalangin, Cesar B. Quicoy

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Rice farming is a major source of livelihood and employment in the Philippines, but it requires a substantial amount of capital. Capital may come from income (farm, non-farm, and off-farm), savings and credit. However, rice farmers suffer from lack of capital due to high costs of inputs and low productivity. Capital insufficiency, coupled with low productivity, hindered them to meet their basic household and production needs. Hence, they resorted to borrowing money, mostly from informal lenders who charge very high interest rates. As another source of capital, savings can help rice farmers meet their basic needs for both the household and the farm. However, information is inadequate whether the farmers save or not, as well as, why they do not depend on savings to augment their lack of capital. Thus, it is worth analyzing how rice farmers saved. The study revealed, using the actual savings which is the difference between the household income and expenditure, that about three-fourths (72%) of the total number of farmers interviewed are savers. However, when they were asked whether they are savers or not, more than half of them considered themselves as non-savers. This gap shows that there are many farmers who think that they do not have savings at all; hence they continue to borrow money and do not depend on savings to augment their lack of capital. The study also identified the forms of savings, saving motives, and savings utilization among rice farmers. Results revealed that, for the past 12 months, most of the farmers saved cash at home for liquidity purposes while others deposited cash in banks and/or saved their money in the form of livestock. Among the most important reasons of farmers for saving are for daily household expenses, for building a house, for emergency purposes, for retirement, and for their next production. Furthermore, the study assessed the factors affecting the rice farmers’ savings behaviour using logistic regression. Results showed that the factors found to be significant were presence of non-farm income, per capita net farm income, and per capita household expense. The presence of non-farm income and per capita net farm income positively affects the farmers’ savings behaviour. On the other hand, per capita household expenses have negative effect. The effect, however, of per capita net farm income and household expenses is very negligible because of the very small chance that the farmer is a saver. Generally, income and expenditure were proved to be significant factors that affect the savings behaviour of the rice farmers. However, most farmers could not save regularly due to low farm income and high household and farm expenditures. Thus, it is highly recommended that government should develop programs or implement policies that will create more jobs for the farmers and their family members. In addition, programs and policies should be implemented to increase farm productivity and income.

Keywords: agricultural economics, agricultural finance, binary logistic regression, logit, Philippines, Quezon, rice farmers, savings, savings behaviour

Procedia PDF Downloads 222
1266 Time to Retire Rubber Crumb: How Soft Fall Playgrounds are Threatening Australia’s Great Barrier Reef

Authors: Michelle Blewitt, Scott P. Wilson, Heidi Tait, Juniper Riordan

Abstract:

Rubber crumb is a physical and chemical pollutant of concern for the environment and human health, warranting immediate investigations into its pathways to the environment and potential impacts. This emerging microplastic is created by shredding end-of-life tyres into ‘rubber crumb’ particles between 1-5mm used on synthetic turf fields and soft-fall playgrounds as a solution to intensifying tyre waste worldwide. Despite having known toxic and carcinogenic properties, studies into the transportation pathways and movement patterns of rubber crumbs from these surfaces remain in their infancy. To address this deficit, AUSMAP, the Australian Microplastic Assessment Project, in partnership with the Tangaroa Blue Foundation, conducted a study to quantify crumb loss from soft-fall surfaces. To our best knowledge, this is the first of its kind, with funding for the audits being provided by the Australian Government’s Reef Trust. Sampling occurred at 12 soft-fall playgrounds within the Great Barrier Reef Catchment Area on Australia’s North-East coast, in close proximity to the United Nations World Heritage Listed Reef. Samples were collected over a 12-month period using randomized sediment cores at 0, 2 and 4 meters away from the playground edge along a 20-meter transect. This approach facilitated two objectives pertaining to particle movement: to establish that crumb loss is occurring and that it decreases with distance from the soft-fall surface. Rubber crumb abundance was expressed as a total value and used to determine an expected average of rubber crumb loss per m2. An Analysis of Variance (ANOVA) was used to compare the differences in crumb abundance at each interval from the playground. Site characteristics, including surrounding sediment type, playground age, degree of ultra-violet exposure and amount of foot traffic, were additionally recorded for the comparison. Preliminary findings indicate that crumb is being lost at considerable rates from soft-fall playgrounds in the region, emphasizing an urgent need to further examine it as a potential source of aquatic pollution, soil contamination and threat to individuals who regularly utilize these surfaces. Additional implications for the future of rubber crumbs as a fit-for-purpose recycling initiative will be discussed with regard to industry, governments and the economic burden of surface maintenance and/ or replacement.

Keywords: microplastics, toxic rubber crumb, litter pathways, marine environment

Procedia PDF Downloads 88
1265 Evaluation of Antidiabetic Activity of a Combination Extract of Nigella Sativa & Cinnamomum Cassia in Streptozotocin Induced Type-I Diabetic Rats

Authors: Ginpreet Kaur, Mohammad Yasir Usmani, Mohammed Kamil Khan

Abstract:

Diabetes mellitus is a disease with a high global burden and results in significant morbidity and mortality. In India, the number of people suffering with diabetes is expected to rise from 19 to 57 million in 2025. At present, interest in herbal remedies is growing to reduce the side effects associated with conventional dosage form like oral hypoglycemic agents and insulin for the treatment of diabetes mellitus. Our aim was to investigate the antidiabetic activities of combinatorial extract of N. sativa & C. cassia in Streptozotocin induced type-I Diabetic Rats. Thus, the present study was undertaken to screen postprandial glucose excursion potential through α- glucosidase inhibitory activity (In Vitro) and effect of combinatorial extract of N. sativa & C. cassia in Streptozotocin induced type-I Diabetic Rats (In Vivo). In addition changes in body weight, plasma glucose, lipid profile and kidney profile were also determined. The IC50 values for both extract and Acarbose was calculated by extrapolation method. Combinatorial extract of N. sativa & C. cassia at different dosages (100 and 200 mg/kg orally) and Metformin (50 mg/kg orally) as the standard drug was administered for 28 days and then biochemical estimation, body weights and OGTT (Oral glucose tolerance test) were determined. Histopathological studies were also performed on kidney and pancreatic tissue. In In-Vitro the combinatorial extract shows much more inhibiting effect than the individual extracts. The results reveals that combinatorial extract of N. sativa & C. cassia has shown significant decrease in plasma glucose (p<0.0001), total cholesterol and LDL levels when compared with the STZ group The decreasing level of BUN and creatinine revealed the protection of N. sativa & C. cassia extracts against nephropathy associated with diabetes. Combination of N. sativa & C. cassia significantly improved glucose tolerance to exogenously administered glucose (2 g/kg) after 60, 90 and 120 min interval on OGTT in high dose streptozotocin induced diabetic rats compared with the untreated control group. Histopathological studies shown that treatment with N. sativa & C. cassia extract alone and in combination restored pancreatic tissue integrity and was able to regenerate the STZ damaged pancreatic β cells. Thus, the present study reveals that combination of N. sativa & C. cassia extract has significant α- glucosidase inhibitory activity and thus has great potential as a new source for diabetes treatment.

Keywords: lipid levels, OGTT, diabetes, herbs, glucosidase

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1264 Exposure to Radon on Air in Tourist Caves in Bulgaria

Authors: Bistra Kunovska, Kremena Ivanova, Jana Djounova, Desislava Djunakova, Zdenka Stojanovska

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The carcinogenic effects of radon as a radioactive noble gas have been studied and show a strong correlation between radon exposure and lung cancer occurrence, even in the case of low radon levels. The major part of the natural radiation dose in humans is received by inhaling radon and its progenies, which originates from the decay chain of U-238. Indoor radon poses a substantial threat to human health when build-up occurs in confined spaces such as homes, mines and caves and the risk increases with the duration of radon exposure and is proportional to both the radon concentration and the time of exposure. Tourist caves are a case of special environmental conditions that may be affected by high radon concentration. Tourist caves are a recognized danger in terms of radon exposure to cave workers (guides, employees working in shops built above the cave entrances, etc.), but due to the sensitive nature of the cave environment, high concentrations cannot be easily removed. Forced ventilation of the air in the caves is considered unthinkable due to the possible harmful effects on the microclimate, flora and fauna. The risks to human health posed by exposure to elevated radon levels in caves are not well documented. Various studies around the world often detail very high concentrations of radon in caves and exposure of employees but without a follow-up assessment of the overall impact on human health. This study was developed in the implementation of a national project to assess the potential health effects caused by exposure to elevated levels of radon in buildings with public access under the National Science Fund of Bulgaria, in the framework of grant No КП-06-Н23/1/07.12.2018. The purpose of the work is to assess the radon level in Bulgarian caves and the exposure of the visitors and workers. The number of caves (sampling size) was calculated for simple random selection from total available caves 65 (sampling population) are 13 caves with confidence level 95 % and confidence interval (margin of error) approximately 25 %. A measurement of the radon concentration in air at specific locations in caves was done by using CR-39 type nuclear track-etch detectors that were placed by the participants in the research team. Despite the fact that all of the caves were formed in karst rocks, the radon levels were rather different from each other (97–7575 Bq/m3). An assessment of the influence of the orientation of the caves in the earth's surface (horizontal, inclined, vertical) on the radon concentration was performed. Evaluation of health hazards and radon risk exposure causing by inhaling the radon and its daughter products in each surveyed caves was done. Reducing the time spent in the cave has been recommended in order to decrease the exposure of workers.

Keywords: tourist caves, radon concentration, exposure, Bulgaria

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1263 The Higher Education Accreditation Foreign Experience for Ukraine

Authors: Dmytro Symak

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The experience in other countries shows that, the role of accreditation of higher education as one of the types of quality assurance process for providing educational services increases. This was the experience of highly developed countries such as USA, Canada, France, Germany, because without proper quality assurance process is impossible to achieve a successful future of the nation and the state. In most countries, the function of Higher Education Accreditation performs public authorities, in particular, such as the Ministry of Education. In the US, however, the quality assurance process is independent on the government and implemented by private non-governmental organization - the Council of Higher Education Accreditation. In France, the main body that carries out accreditation of higher education is the Ministry of National Education. As part of the Bologna process is the mutual recognition and accreditation of degrees. While higher education institutions issue diplomas, but the ministry could award the title. This is the main level of accreditation awarded automatically by state universities. In total, there are in France next major level of accreditation of higher education: - accreditation for a visa: Accreditation second level; - recognition of accreditation: accreditation of third level. In some areas of education to accreditation ministry should adopt formal recommendations on specific organs. But there are also some exceptions. Thus, the French educational institutions, mainly large Business School, looking for non-French accreditation. These include, for example, the Association to Advance Collegiate Schools of Business, the Association of MBAs, the European Foundation for Management Development, the European Quality Improvement System, a prestigious EFMD Programme accreditation system. Noteworthy also German accreditation system of education. The primary here is a Conference of Ministers of Education and Culture of land in the Federal Republic of Germany (Kultusministerkonferenz or CCM) was established in 1948 by agreement between the States of the Federal Republic of Germany. Among its main responsibilities is to ensure quality and continuity of development in higher education. In Germany, the program of bachelors and masters must be accredited in accordance with Resolution Kultusministerkonerenz. In Ukraine Higher Education Accreditation carried out the Ministry of Education, Youth and Sports of Ukraine under four main levels. Ukraine's legislation on higher education based on the Constitution Ukraine consists of the laws of Ukraine ‘On osvititu’ ‘On scientific and technical activity’, ‘On Higher osvititu’ and other legal acts and is entirely within the competence of the state. This leads to considerable centralization and bureaucratization of the process. Thus, analysis of expertise shined can conclude that reforming the system of accreditation and quality of higher education in Ukraine to its integration into the global space requires solving a number of problems in the following areas: improving the system of state certification and licensing; optimizing the network of higher education institutions; creating both governmental and non-governmental organizations to monitor the process of higher education in Ukraine and so on.

Keywords: higher education, accreditation, decentralization, education institutions

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1262 Efficacy of Preimplantation Genetic Screening in Women with a Spontaneous Abortion History with Eukaryotic or Aneuploidy Abortus

Authors: Jayeon Kim, Eunjung Yu, Taeki Yoon

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Most spontaneous miscarriage is believed to be a consequence of embryo aneuploidies. Transferring eukaryotic embryos selected by PGS is expected to decrease the miscarriage rate. Current PGS indications include advanced maternal age, recurrent pregnancy loss, repeated implantation failure. Recently, use of PGS for healthy women without above indications for the purpose of improving in vitro fertilization (IVF) outcomes is on the rise. However, it is still controversy about the beneficial effect of PGS in this population, especially, in women with a history of no more than 2 miscarriages or miscarriage of eukaryotic abortus. This study aimed to investigate if karyotyping result of abortus is a good indicator of preimplantation genetic screening (PGS) in subsequent IVF cycle in women with a history of spontaneous abortion. A single-center retrospective cohort study was performed. Women who had spontaneous abortion(s) (less than 3) and dilatation and evacuation, and subsequent IVF from January 2016 to November 2016 were included. Their medical information was extracted from the charts. Clinical pregnancy was defined as presence of a gestational sac with fetal heart beat detected on ultrasound in week 7. Statistical analysis was performed using SPSS software. Total 234 women were included. 121 out of 234 (51.7%) underwent karyotyping of the abortus, and 113 did not have the abortus karyotyped. Embryo biopsy was performed on 3 or 5 days after oocyte retrieval, followed by embryo transfer (ET) on a fresh or frozen cycle. The biopsied materials were subjected to microarray comparative genomic hybridization. Clinical pregnancy rate per ET was compared between PGS and non-PGS group in each study group. Patients were grouped by two criteria: karyotype of the abortus from previous miscarriage (unknown fetal karyotype (n=89, Group 1), eukaryotic abortus (n=36, Group 2) or aneuploidy abortus (n=67, Group 3)), and pursuing PGS in subsequent IVF cycle (pursuing PGS (PGS group, n=105) or not pursuing PGS (non-PGS group, n=87)). The PGS group was significantly older and had higher number of retrieved oocytes and prior miscarriages compared to non-PGS group. There were no differences in BMI and AMH level between those two groups. In PGS group, the mean number of transferable embryos (eukaryotic embryo) was 1.3 ± 0.7, 1.5 ± 0.5 and 1.4 ± 0.5, respectively (p = 0.049). In 42 cases, ET was cancelled because all embryos biopsied turned out to be abnormal. In all three groups (group 1, 2, and 3), clinical pregnancy rates were not statistically different between PGS and non-PGS group (Group 1: 48.8% vs. 52.2% (p=0.858), Group 2: 70% vs. 73.1% (p=0.730), Group 3: 42.3% vs. 46.7% (p=0.640), in PGS and non-PGS group, respectively). In both groups who had miscarriage with eukaryotic and aneuploidy abortus, the clinical pregnancy rate between IVF cycles with and without PGS was not different. When we compare miscarriage and ongoing pregnancy rate, there were no significant differences between PGS and non-PGS group in all three groups. Our results show that the routine application of PGS in women who had less than 3 miscarriages would not be beneficial, even in cases that previous miscarriage had been caused by fetal aneuploidy.

Keywords: preimplantation genetic diagnosis, miscarriage, kpryotyping, in vitro fertilization

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1261 Access to Education and Adopted Identity of the Rohingya Amid Government Restrictions in Bangladesh

Authors: Ishrat Zakia Sultana

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The consistent persecution, ethnic cleansing, and genocide against the Rohingya in Burma resulted four major influxes of the Rohingya people to the neighboring country Bangladesh. After the latest influx of October 2016 and August 2017, the total number of Rohingya in Bangladesh stands somewhere between 900,000 to over one million, placing Bangladesh much ahead with the number of refugees compared to Dadaab and Kakuma in Kenya, Bidibidi in Uganda and Zaatari in Jordan. While Bangladesh received recognition and appreciation for receiving a huge number of the Rohingya, one of the fundamental human rights of the Rohingya – education – has never been fulfilled in Bangladesh. The Ministry of Disaster Management and Relief of the government of Bangladesh has been looking after the Rohingya and managing various programs for the Rohingya. On its website, the Ministry claims that it provides the basic supports/services to the Rohingya, including providing education. In practice, however, education for the Rohingya include only the provisions for registered Rohingya refugees – who are a very small number of populations among the entire Rohingya hosted in Bangladesh – and that is only up to grade 7 within the registered camps at Teknaf and Ukhia of Cox’s Bazar district of the country. There is no answer of the question, ‘What’s next’? Although refugees in Canada, Sudan, Turkey and other countries have been allowed to go to mainstream schools, Rohingya refugees in Bangladesh are not allowed to do so legally. Due to the lack of proof of nationality of the Rohingya, the government of Bangladesh imposes restrictions on their access to Bangladeshi schools. However, despite their vulnerability and statelessness, many Rohingyas are desperate to pursue education outside the camps and find their own way not only within Cox’s Bazar but also even in the capital city of the country. But they must hide their refugee identity to accomplish this. My research aims to explore how they manage to get admission amid government restrictions on their access to education in the mainstream institutions in Bangladesh. It will reveal how Rohingya people use adopted identity to get access to education in Bangladesh, and how they apply their own techniques to achieve their goals without having government approved identity. This research examined the strategies the Rohingya applied to manage documents related to their identity to ensure their admission to Bangladeshi education institutions – in schools, colleges, and universities. The research employed a qualitative approach. It used semi structured individual interviews and Focused Group Discussions (FGDs) with 20 male and female Rohingya refugees who are 18 years old and above, and have enrolled in Bangladeshi education institutions with adopted identity. Also I interviewed 5 local community members and policy makers to understand their perceptions and roles in this process. The findings of this research will allow the policy makers to rethink the outcomes of the restrictions on Rohingya’s education in Bangladesh, the ramifications of the denial of Rohingya’s access to education, and initiate policy dialogues on how to allow Rohingya refugees to pursue education in Bangladesh in legal way.

Keywords: Rohingya, Refugee, Bangladesh, Education

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1260 Denial among Women Living with Cancer: An Exploratory Study to Understand the Consequences of Cancer and the Denial Mechanism

Authors: Judith Partouche-Sebban, Saeedeh Rezaee Vessal

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Because of the rising number of new cases of cancer, especially among women, it is more than essential to better understand how women experience cancer in order to bring them adapted to support and care and enhance their well-being and patient experience. Cancer stands for a traumatic experience in which the diagnosis, its medical treatments, and the related side effects lead to deep physical and psychological changes that may arouse considerable stress and anxiety. In order to reduce these negative emotions, women tend to use various defense mechanisms, among which denial has been defined as the most frequent mechanism used by breast cancer patients. This study aims to better understand the consequences of the experience of cancer and their link with the adoption of a denial strategy. The empirical research was done among female cancer survivors in France. Since the topic of this study is relatively unexplored, a qualitative methodology and open-ended interviews were employed. In total, 25 semi-directive interviews were conducted with a female with different cancers, different stages of treatment, and different ages. A systematic inductive method was performed to analyze data. The content analysis enabled to highlight three different denial-related behaviors among women with cancer, which serve a self-protective function. First, women who expressed high levels of anxiety confessed they tended to completely deny the existence of their cancer immediately after the diagnosis of their illness. These women mainly exhibit many fears and a deep distrust toward the medical context and professionals. This coping mechanism is defined by the patient as being unconscious. Second, other women deliberately decided to deny partial information about their cancer, whether this information is related to the stages of the illness, the emotional consequences, or the behavioral consequences of the illness. These women use this strategy as a way to avoid the reality of the illness and its impact on the different aspects of their life as if cancer does not exist. Third, some women tend to reinterpret and give meaning to their cancer as a way to reduce its impact on their life. To this end, they may use magical thinking or positive reframing, or reinterpretation. Because denial may lead to delays in medical treatments, this topic deserves a deep investigation, especially in the context of oncology. As denial is defined as a specific defense mechanism, this study contributes to the existing literature in service marketing which focuses on emotions and emotional regulation in healthcare services which is a crucial issue. Moreover, this study has several managerial implications for healthcare professionals who interact with patients in order to implement better care and support for the patients.

Keywords: cancer, coping mechanisms, denial, healthcare services

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