Search results for: close loop

Authors: Christine Wiesenthal

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This paper asks how to read a particularly vexed and complicated life writing text. For over half a century, the wartime journals of Ruth Andreas Friedrich (1901-1977) circulated as among a handful of more or less authoritative and “authentic” first-hand accounts of German resistance under Hitler. A professional journalist, Andreas Friedrich is remembered today largely through her publications at the war’s end, which appeared in English as Berlin Underground (published by Henry Holt in 1947), just before their publication in Germany as Der Schattenmann “The Shadow Man” (also in 1947). A British edition by the now obscure Latimer House Limited (London) followed in 1948; it is based closely on but is not identical to, the Henry Holt American edition, which in turn differs significantly from its German counterpart. Both Berlin Underground and Der Schattenmann figure Andreas-Friedrich as a key figure in an anti-fascist cell that operated in Berlin under the code name “Uncle Emil,” and provide a riveting account of political terror, opportunism, and dissent under the Nazi regime. Recent scholars have, however, begun to raise fascinating and controversial questions about Andreas-Friedrich’s own writing/reconstruction process in compiling the journals and about her highly selective curatorial role and claims. The apparent absence of any surviving original manuscript for Andreas-Friedrich’s journals amplifies the questions around them. Crucially, so too does the role of the translator of the English editions of Berlin Underground, the enigmatic June Barrows Mussey, a subject that has thus far gone virtually unnoticed and which this paper will focus on. Mussey, a prolific American translator, simultaneously cultivated a career as a professional magician, publishing a number of books on that subject under the alias Henry Hay. While the record indicates that Mussey attempted to compartmentalize his professional life, research into the publishing and translation history of Berlin Underground suggests that the two roles converge in the fact of the translator’s invisibility, by effacing the traces of his own hand and leaving unmarked his own significant textual interventions, Mussey, in effect, edited, abridged, and altered Andreas Friedrich’s journals for the second time. In fact, it could be said that while the fictitious “Uncle Emil” is positioned as “the shadow man” of the German edition, Mussey himself also emerges as precisely that in the English rendering of the journals. The implications of Mussey’s translation of Andreas Friedrich’s journals are one of the most important un-examined gaps in the shadowy publishing history of Berlin Underground, a history full of “tricks” (Mussey’s words) and illusions of transparency. Based largely on archival research of unpublished materials and methods of close reading and comparative analysis, this study will seek to convey some preliminary insights and exploratory work and frame questions toward what is ultimately envisioned as an experimental project in poetic historiography. As this work is still in the early stages, it would be especially welcome to have the opportunity provided by this conference to connect with a community of life writing colleagues who might help think through some of the challenges and possibilities that lie ahead.

Keywords: women’s wartime diaries, translation studies, auto/biographical theory, politics of life writing

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Authors: Biva Samadder, Samita Manna

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India is a melting pot of races, tribes, castes and communities. The population of India can be roughly branched into the huge majority of “Civilized” Indians of the Plains and the minority of Tribal population of the hill area and the forest who constituting almost 16 percent of total population of India. The Kirat community composed of four ethnic tribes: Limbu, Lepcha, Dhimal, and Rai. These Kirat people were found to be rich in indigenous knowledge, skill and practices especially for the use on medicinal plants and livelihood purposes. The “Mundhum" is the oral scripture or the “Bible of the Limbus” which serves as the canon of the codes of the Limbu socialization, their moral values and the very orientation of their lifestyle. From birth till death the Limbus are disciplined in the life with full of religious rituals, traditions and culture governed by community norms with a rich legacy of indigenous knowledge and traditional practices. The present study has been conducted using both secondary as well as primary data by applying social methodology consisting of the social survey, questionnaire, interviews and observations in the Kalimpong Block-I of Darjeeling District of west Bengal of India, which is a heterogeneous zone in terms of its ethnic composition and where the Limbus are pre-dominantly concentrated. Due to their close contact with other caste and communities Limbus are now adjusted with the changing situation by borrowing some cultural traits from the other communities and changes that have taken place in their cultural practices, religious beliefs, economic aspects, languages and in social roles and relationships which is bringing the change in their material culture. Limbu language is placed in the Tibeto- Burman Language category. But due to the political and cultural domination of educationally sound and numerically dominant Bengali race, the different communities in this area forced to come under the one umbrella of the Nepali or Gorkhali nation (nation-people). Their respective identities had to be submerged in order to constitute as a strong force to resist Nepali domination and ensure their common survival. As Nepali is a lingua-franca of the area knowing and speaking Nepali language helps them in procuring economic and occupational facilities. Ironically, present day younger generation does not feel comfortable speaking in their own Limbu tongue. The traditional knowledge about medicinal plants, healing, and health culture is found to be wear away due to the lack of interest of young generation. Not only poverty, along with exclusion due to policies they are in the phase of extinction, but their capabilities are ignored and not documented and preserved especially in the case of Limbus who having a great cultural heritage of an oral tradition. Attempts have been made to discuss the persistence and changes in socioeconomic pattern of life in relation to the social structure, material culture, cultural practices, social relationships, indigenous technology, ethos and their values and belief system.

Keywords: changing social relationship, cultural transition, identity, indigenous knowledge, language

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Authors: A. Maso, C. Bellissimo, G. Facchinetti, N. Milani, D. Panzin, D. Pogliana, L. Garlaschelli, L. Rivaroli, S. Rivaroli, M. Zurek, J. Konin

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15 year-old female karate athlete experienced two unilateral patella dislocations: one contact and one non-contact. This challenged her from competing as planned at the regional and national competitions as a result of her inability to perform at a high level. Despite these injuries and other complicated factors, she was able to modify her training timeline and successfully perform, winning third at the National Cup. Initial pain numeric rating scale 8/10 during karate training isometric figures, taking the stairs, long walking, a positive rasp test, palpation pain on the lateral patella joint 9/10, pain performing open kinetic chain 0°-45° and close kinetic chain 30°-90°, tensor fascia lata, vastus lateralis, psoas muscles retraction/stiffness. Foot hyper pronation, internally rotated femur, and knee flexion 15° were the postural findings. Exercise prescription for three days/week for three weeks to include exercise-based rehabilitation and soft tissue mobilization with massage and foam rolling. After three weeks, the pain was improved during activity daily living 5/10, and soft tissue stiffness decreased. An additional four weeks of exercise-based rehabilitation was continued. At this time, axial x-rays and TA-GT TAC were taken, and an orthopaedic medical check was recommended to continue conservative treatment. At week seven, she performed 2/4 karate position technique without pain and 2/4 with pain. An isokinetic test was performed at week 12, demonstrating a 10% strength deficit and 6% resistance deficit both to the left hamstrings. Moreover, an 8% strength and resistance surplus to the left quadriceps was found. No pain was present during activity, daily living and sports activity, allowing a return to play training to begin. A plan for the return to play framework collaborated with her trainer, her father, a physiotherapist, a sports scientist, an osteopath, and a nutritionist. Within 4 and 5 months, both non-athlete and athlete movement quality analysis tests were performed. The plan agreed to establish a return to play goal of 7 months and the highest level return to competition goal of 9 months from the start of rehabilitation. This included three days/week of training and repeated testing of movement quality before return to competition with detectable improvements from 77% to 93%. Beginning goals of the rehabilitation plan included the importance of a team approach. The patient’s father and trainer were important to collaborate with to assure a safe and timely return to competition. The possibility of achieving the goals was strongly related to orthopaedic decision-making and progress during the first weeks of rehabilitation. Without complications or setbacks, the patient can successfully return to her highest level of competition. The patient returned to participation after five months of rehabilitation and training, and then she returned to competition at the national level in nine months. The successful return was the result of a team approach and a compliant patient with clear goals.

Keywords: karate, knee, performance, rehabilitation

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Authors: A. Casale, J. Alessi, C. N. Bianchi, G. Bozzini, M. Brunoldi, V. Cappanera, P. Corvisiero, G. Fanciulli, D. Grosso, N. Magnoli, A. Mandich, C. Melchiorre, C. Morri, P. Povero, N. Stasi, M. Taiuti, G. Viano, M. Wurtz

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This work describes a real-time algorithm for detecting, tracking and classifying single motorboats, developed using the acoustic data recorded by a hydrophone array within the framework of EU LIFE + project ARION (LIFE09NAT/IT/000190). The project aims to improve the conservation status of bottlenose dolphins through a real-time simultaneous monitoring of their population and surface ship traffic. A Passive Acoustic Monitoring (PAM) system is installed on two autonomous permanent marine buoys, located close to the boundaries of the Marine Protected Area (MPA) of Portofino (Ligurian Sea- Italy). Detecting surface ships is also a necessity in many other sensible areas, such as wind farms, oil platforms, and harbours. A PAM system could be an effective alternative to the usual monitoring systems, as radar or active sonar, for localizing unauthorized ship presence or illegal activities, with the advantage of not revealing its presence. Each ARION buoy consists of a particular type of structure, named meda elastica (elastic beacon) composed of a main pole, about 30-meter length, emerging for 7 meters, anchored to a mooring of 30 tons at 90 m depth by an anti-twist steel wire. Each buoy is equipped with a floating element and a hydrophone tetrahedron array, whose raw data are send via a Wi-Fi bridge to a ground station where real-time analysis is performed. Bottlenose dolphin detection algorithm and ship monitoring algorithm are operating in parallel and in real time. Three modules were developed and commissioned for ship monitoring. The first is the detection algorithm, based on Time Difference Of Arrival (TDOA) measurements, i.e., the evaluation of angular direction of the target respect to each buoy and the triangulation for obtaining the target position. The second is the tracking algorithm, based on a Kalman filter, i.e., the estimate of the real course and speed of the target through a predictor filter. At last, the classification algorithm is based on the DEMON method, i.e., the extraction of the acoustic signature of single vessels. The following results were obtained; the detection algorithm succeeded in evaluating the bearing angle with respect to each buoy and the position of the target, with an uncertainty of 2 degrees and a maximum range of 2.5 km. The tracking algorithm succeeded in reconstructing the real vessel courses and estimating the speed with an accuracy of 20% respect to the Automatic Identification System (AIS) signals. The classification algorithm succeeded in isolating the acoustic signature of single vessels, demonstrating its temporal stability and the consistency of both buoys results. As reference, the results were compared with the Hilbert transform of single channel signals. The algorithm for tracking multiple targets is ready to be developed, thanks to the modularity of the single ship algorithm: the classification module will enumerate and identify all targets present in the study area; for each of them, the detection module and the tracking module will be applied to monitor their course.

Keywords: acoustic-noise, bottlenose-dolphin, hydrophone, motorboat

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Authors: Krzysztof Skiba, Zbigniew Czyz, Ksenia Siadkowska, Piotr Borowiec

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The article presents selected concepts of technologies that use intelligent materials in aircraft in order to improve their performance. Most of the research focuses on solutions that improve the performance of fixed wing aircraft due to related to their previously dominant market share. Recently, the development of the rotorcraft has been intensive, so there are not only helicopters but also gyroplanes and unmanned aerial vehicles using rotors and vertical take-off and landing. There are many different technologies to change a shape of the aircraft or its elements. Piezoelectric, deformable actuator systems can be applied in the system of an active control of vibration dampening in the aircraft tail structure. Wires made of shape memory alloys (SMA) could be used instead of hydraulic cylinders in the rear part of the aircraft flap. The aircraft made of intelligent materials (piezoelectrics and SMA) is one of the NASA projects which provide the possibility of changing a wing shape coefficient by 200%, a wing surface by 50%, and wing deflections by 20 degrees. Active surfaces made of shape memory alloys could be used to control swirls in the flowing stream. An intelligent control system for helicopter blades is a method for the active adaptation of blades to flight conditions and the reduction of vibrations caused by the rotor. Shape memory alloys are capable of recovering their pre-programmed shapes. They are divided into three groups: nickel-titanium-based, copper-based, and ferromagnetic. Due to the strongest shape memory effect and the best vibration damping ability, a Ni-Ti alloy is the most commercially important. The subject of this work was to prepare a conceptual design of a rotor blade with SMA actuators. The scope of work included 3D design of the supporting rotor blade, 3D design of beams enabling to change the geometry by changing the angle of rotation and FEM (Finite Element Method) analysis. The FEM analysis was performed using NX 12 software in the Pre/Post module, which includes extended finite element modeling tools and visualizations of the obtained results. Calculations are presented for two versions of the blade girders. For FEM analysis, three types of materials were used for comparison purposes (ABS, aluminium alloy 7057, steel C45). The analysis of internal stresses and extreme displacements of crossbars edges was carried out. The internal stresses in all materials were close to the yield point in the solution of girder no. 1. For girder no. 2 solution, the value of stresses decreased by about 45%. As a result of the displacement analysis, it was found that the best solution was the ABS girder no. 1. The displacement of about 0.5 mm was obtained, which resulted in turning the crossbars (upper and lower) by an angle equal to 3.59 degrees. This is the largest deviation of all the tests. The smallest deviation was obtained for beam no. 2 made of steel. The displacement value of the second girder solution was approximately 30% lower than the first solution. Acknowledgement: This work has been financed by the Polish National Centre for Research and Development under the LIDER program, Grant Agreement No. LIDER/45/0177/L-9/17/NCBR/2018.

Keywords: aircraft, helicopters, shape memory alloy, SMA, smart material, unmanned aerial vehicle, UAV

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Authors: S. Sharma, Gaballa Aqeelah, Tawfig Alghbaili, Ali Elmessmari

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There were abrupt discontinuities in the Brute Stack in the northernmost locations during the acquisition of 2D (2007) and 3D (2021) seismic data in the northwest region of the Ghadames Basin, Libya. In both campaigns, complete fluid circulation loss was seen in these regions during up-hole drilling. Geophysics, sedimentology and shallow subsurface geology were all integrated to look into what was causing the seismic signal to disappear at shallow depths. The Upper Cretaceous Nalut Formation is the near-surface or surface formation in the studied area. It is distinguished by abnormally high resistivity in all the neighboring wells. The Nalut Formation in all the nearby wells from the present study and previous outcrop study suggests lithology of dolomite and chert/flint in nodular or layered forms. There are also reports of karstic caverns, vugs, and thick cracks, which all work together to produce the high resistivity. Four up-hole samples that were analyzed for microfacies revealed a near-coastal to tidal environment. Algal (Chara) infested deposits up to 30 feet thick and monotonous, very porous, are seen in two up-hole sediments; these deposits are interpreted to be scattered, continental algal travertine mounds. Chert/flint, dolomite, and calcite in varying amounts are confirmed by XRD analysis. Regional tracking of the high resistivity of the Nalut Formation, which is thought to be connected to the sea level drop that created the paleokarst layer, is possible. It is abruptly overlain by a blanket marine transgressive deposit caused by rapid sea level rise, which is a regional, relatively high radioactive layer of argillaceous limestone. The examined area's close proximity to the mountainous, E-W trending ridges of northern Libya made it easier for recent freshwater circulation, which later enhanced cavern development and mineralization in the paleokarst layer. Seismic signal loss at shallow depth is caused by extremely heterogeneous mineralogy of pore- filling or lack thereof. Scattering effect of shallow karstic layer on seismic signal has been well documented. Higher velocity inflection points at shallower depths in the northern part and deeper intervals in the southern part, in both cases at Nalut level, demonstrate the layer's influence on the seismic signal. During the Permian-Carboniferous, the Ghadames Basin underwent uplift and extensive erosion, which resulted in this karstic layer of the Nalut Formation uplifted to a shallow depth in the northern part of the studied area weakening the acoustic signal, whereas in the southern part of the 3D acquisition area the Nalut Formation remained at the deeper interval without affecting the seismic signal. Results from actions taken during seismic processing to deal with this signal loss are visible and have improved. This study recommends using denser spacing or dynamite to circumvent the karst layer in a comparable geographic area in order to prevent signal loss at lesser depths.

Keywords: well logging, seismic data acquisition, sesimic data processing, up-holes

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Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu

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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.

Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma

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Authors: Sabina Auhunas

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These days in Ukraine, Open Science dramatically develops for the sake of scientists of all branches, providing an opportunity to take a more close look on the studies by foreign scientists, as well as to deliver their own scientific data to national and international journals. However, when it comes to the generalization of data on science activities by Ukrainian scientists, these data are often integrated into E-systems that operate inconsistent and barely related information sources. In order to resolve these issues, developed countries productively use E-systems, designed to store and manage research data, such as Current Research Information Systems that enable combining uncompiled data obtained from different sources. An algorithm for selecting SARS-CoV-2 research articles was designed, by means of which we collected the set of papers published by Ukrainian scientists and uploaded by August 1, 2020. Resulting metadata (document type, open access status, citation count, h-index, most cited documents, international research funding, author counts, the bibliographic relationship of journals) were taken from Scopus and Web of Science databases. The study also considered the info from COVID-19/SARS-CoV-2-related documents published from December 2019 to September 2020, directly from documents published by authors depending on territorial affiliation to Ukraine. These databases are enabled to get the necessary information for bibliometric analysis and necessary details: copyright, which may not be available in other databases (e.g., Science Direct). Search criteria and results for each online database were considered according to the WHO classification of the virus and the disease caused by this virus and represented (Table 1). First, we identified 89 research papers that provided us with the final data set after consolidation and removing duplication; however, only 56 papers were used for the analysis. The total number of documents by results from the WoS database came out at 21641 documents (48 affiliated to Ukraine among them) in the Scopus database came out at 32478 documents (41 affiliated to Ukraine among them). According to the publication activity of Ukrainian scientists, the following areas prevailed: Education, educational research (9 documents, 20.58%); Social Sciences, interdisciplinary (6 documents, 11.76%) and Economics (4 documents, 8.82%). The highest publication activity by institution types was reported in the Ministry of Education and Science of Ukraine (its percent of published scientific papers equals 36% or 7 documents), Danylo Halytsky Lviv National Medical University goes next (5 documents, 15%) and P. L. Shupyk National Medical Academy of Postgraduate Education (4 documents, 12%). Basically, research activities by Ukrainian scientists were funded by 5 entities: Belgian Development Cooperation, the National Institutes of Health (NIH, U.S.), The United States Department of Health & Human Services, grant from the Whitney and Betty MacMillan Center for International and Area Studies at Yale, a grant from the Yale Women Faculty Forum. Based on the results of the analysis, we obtained a set of published articles and preprints to be assessed on the variety of features in upcoming studies, including citation count, most cited documents, a bibliographic relationship of journals, reference linking. Further research on the development of the national scientific E-database continues using brand new analytical methods.

Keywords: content analysis, COVID-19, scientometrics, text mining

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Authors: Anne Tetens, Susan Andersen, Lars Ole Bonde, Pia Jeppesen, Katrine Rich Madsen

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Background: The World Health Organization (WHO) has emphasized the critical need for feasible and effective school-based mental health promotion interventions. High-quality music education in school has been suggested to promote well-being, inclusion, and positive relations, which are essential for children’s mental health. This study explores the potential of choir singing as a distinct approach to enhance children’s mental health within the school setting. ‘Everyone Can Sing’ is a class-based mental health promotion intervention for children in grades 0-3 (ages 5-10) in Danish primary school, which integrates choir singing into the students’ normal school schedule twice a week to promote mental health through the increase of school well-being, class coherence and social inclusion. The intervention uses trained choir leaders to lead the lessons in close collaboration with the class teacher, placing a distinct emphasis on well-being and the inclusive aspect of musical expression through body and voice. Aim: The aim of the study is to evaluate the feasibility of the Everyone Can Sing intervention with the specific objective to assess implementation and changes in mental health parameters, including school well-being, class coherence and social inclusion. Methodologies: The study is a feasibility study of a one-year intervention, which started in January 2024 and is being implemented in grades 0-3 (ages 5-10) across three different Danish primary schools. It is designed according to a mixed methods approach, including both quantitative and qualitative methods. Baseline questionnaires were obtained from students, parents and teachers, and follow-up is planned at 12 months. Participant observations of class choir and individual and group interviews with students, teachers, choir leaders, and school management are collected during the intervention period. The study uses the validated ‘Strengths and Difficulties Questionnaire’ for parent- and teacher-reports. The student questionnaire, which assesses school well-being, class coherence, social inclusion and indicators of mental health, was developed and validated for this study. Participant observations and interviews provide in-depth insights into the implementation process and participants’ experiences of the mental health-promoting potential of the intervention. Findings: The study included 41 classes across three schools (N=904) and questionnaire data from students (n=845, = 93%), teachers (n=890, = 98%), and parents (n=608, = 67%) at baseline. Follow-up data will be obtained in January 2025. While collection and analyses of data are still ongoing, preliminary implementation findings based on interviews and observations indicate high levels of engagement and acceptability. At 6 months into the intervention period, the study protocol is on track and suggests that the intervention is well-received. Further findings and analyses will be presented. The final results of the study will be used to decide whether the AKS intervention should proceed to a future, full-size effectiveness trial, return to refinement of the intervention or the evaluation design, or stop. Contributions: This study will provide valuable insights into new approaches to school-based mental health promotion initiatives. If feasible, the vision is to implement the intervention or elements of it in primary schools across all five Danish regions, potentially lowering the mental health burden.

Keywords: child mental health, early childhood, mental health promotion, mixed methods research, school-based intervention.

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Authors: Thaminda Liyanage, Chamila Shamika Kurukulasuriya

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Introduction: Morbid obesity has been successfully treated with bariatric surgery for over 60 years. Although operative procedures have improved and associated complications have reduced substantially, surgery still carries the risk of post-operative malabsorption, malnutrition and a range of gastrointestinal disorders. Overweight by itself can impair libido in both sexes and cause erectile dysfunction in males by inducing a state of hypogonadotropic hypogonadism, proportional to the degree of obesity. Impact of weight reduction on libido and sexual activity remains controversial, however it is broadly accepted that weight loss improves sexual drive. Zinc deficiency, subsequent to malabsorption, may lead to impaired testosterone synthesis in men while excessive and/or rapid weight loss in females may result in reversible amenorrhoea leading to sub-fertility. Methods: We describe a 37 year old male, 6 years post Roux-en-Y gastric bypass surgery, who presented with erectile dysfunction, loss of libido, worsening fatigue and generalized weakness for 4 months. He also complained of constipation and frequent muscle cramps but denied having headache, vomiting or visual disturbances. Patient had lost 38 kg of body weight post gastric bypass surgery over four years {135kg (BMI 42.6 kg/m2) to 97 kg (BMI 30.6 kg/m2)} and the weight had been stable for past two years. He had no recognised co-morbidities at the time of the surgery and noted marked improvement in general wellbeing, physical fitness and psychological confident post surgery, up until four months before presentation. Clinical examination revealed dry pale skin with normal body hair distribution, no thyroid nodules or goitre, normal size testicles and normal neurological examination with no visual field defects or diplopia. He had low serum testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), T3, T4, thyroid stimulating hormone (TSH), insulin like growth factor 1 (IGF-1) and 24-hour urine cortisol levels. Serum cortisol demonstrated an appropriate rise to ACTH stimulation test but growth hormone (GH) failed increase on insulin tolerance test. Other biochemical and haematological studies were normal, except for low zinc and folate with minimally raised liver enzymes. MRI scan of the head confirmed a solid pituitary mass with no mass effect on optic chiasm. Results: In this patient clinical, biochemical and radiological findings were consistent with anterior pituitary dysfunction. However, there were no features of raised intracranial pressure or neurological compromise. He was commenced on appropriate home replacement therapy and referred for neurosurgical evaluation. Patient reported marked improvement in his symptoms, specially libido and erectile dysfunction, on subsequent follow up visits. Conclusion: Sexual dysfunction coupled with non specific constitutional symptoms has multiple aetiologies. Clinical symptoms out of proportion to nutritional deficiencies post bariatric surgery should be thoroughly investigated. Close long term follow up is crucial for overall success.

Keywords: obesity, bariatric surgery, erectile dysfunction, loss of libido

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Authors: James Brown, Stella Kortekaas, Ian Finnie, George Zhang, Christine Devine, Neil Healy

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The use of GIS as an analysis tool for engineering decision making is now best practice in the offshore industry. GIS enables multidisciplinary data integration, analysis and visualisation which allows the presentation of large and intricate datasets in a simple map-interface accessible to all project stakeholders. Presenting integrated geoscience and geotechnical data in GIS enables decision makers to be well-informed. This paper is a successful case study of how GIS spatial analysis techniques were applied to help select the most favourable pipeline route. Routing a pipeline through any natural environment has numerous obstacles, whether they be topographical, geological, engineering or financial. Where the pipeline is subjected to external hydrostatic water pressure and is carrying pressurised hydrocarbons, the requirement to safely route the pipeline through hazardous terrain becomes absolutely paramount. This study illustrates how the application of modern, GIS-based pipeline routing techniques enabled the identification of a single most-favourable pipeline route crossing of a challenging seabed terrain. Conventional approaches to pipeline route determination focus on manual avoidance of primary constraints whilst endeavouring to minimise route length. Such an approach is qualitative, subjective and is liable to bias towards the discipline and expertise that is involved in the routing process. For very short routes traversing benign seabed topography in shallow water this approach may be sufficient, but for deepwater geohazardous sites, the need for an automated, multi-criteria, and quantitative approach is essential. This study combined multiple routing constraints using modern least-cost-routing algorithms deployed in GIS, hitherto unachievable with conventional approaches. The least-cost-routing procedure begins with the assignment of geocost across the study area. Geocost is defined as a numerical penalty score representing hazard posed by each routing constraint (e.g. slope angle, rugosity, vulnerability to debris flows) to the pipeline. All geocosted routing constraints are combined to generate a composite geocost map that is used to compute the least geocost route between two defined terminals. The analyses were applied to select the most favourable pipeline route for a potential gas development in deep water. The study area is geologically complex with a series of incised, potentially active, canyons carved into a steep escarpment, with evidence of extensive debris flows. A similar debris flow in the future could cause significant damage to a poorly-placed pipeline. Protruding inter-canyon spurs offer lower-gradient options for ascending an escarpment but the vulnerability of periodic failure of these spurs is not well understood. Close collaboration between geoscientists, pipeline engineers, geotechnical engineers and of course the gas export pipeline operator guided the analyses and assignment of geocosts. Shorter route length, less severe slope angles, and geohazard avoidance were the primary drivers in identifying the most favourable route.

Keywords: geocost, geohazard, pipeline route determination, pipeline route optimisation, spatial analysis

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Authors: Bryana Woodard, Monica Mitchell, Kasey Harry, Ebony Washington, Megan Harris, Marcia Boyd, Regina Lynch, Daphene Baines, Surbi Bankar

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Introduction: African Americans experience mental health illnesses (i.e., depression, anxiety, etc.) at higher rates than their white counterparts. Despite this, they utilize mental health resources less and have lower mental health literacy, perhaps due to cultural barriers- including but not limited to mistrust. Research acknowledges African Americans’ close ties to community networks, identifying these linkages as key to establishing comfort and trust. Similarly, the church has historically been a space that creates unity and community among African Americans. Studies show that longstanding academic-community partnerships with organizations, such as churches and faith-based entities, have the capability to effectively address health and mental health barriers and needs in African Americans. The importance of implementing faith-based approaches is supported in the literature, however few empirical studies exist. This project describes the First Ladies for Health and Cincinnati Children's Hospital Medical Center (CCHMC) Partnership (FLFH-CCHMC Partnership) and the implementation and assessment of an annual Mental Health Symposium, the overall aim of which was to increase mental health awareness and decrease stigma in African American communities. Methods: The specific goals of the FLFH Mental Health Symposium were to (1) Collaborate with trusted partners to build trust with community participants; (2) Increase mental health literacy and decrease mental health stigma; (3) Understand the barriers to improving mental health and improving trust; (4) Assess the short-term outcomes two months following the symposium. Data were collected through post-event and follow-up surveys using a mixed methods approach. Results: More than 100 participants attended each year with over 350 total participants over three years. 98.7% of participants were African American, 86.67% female, 11.6% male, and 11.6% LGBTQ+/non-binary; 10.5% of participants were teens, with the remainder aged 20 to 80 plus. The event was successful in achieving its goals: (1a) Eleven different speakers from 8 community and church organizations presented; (1b) 93% of participants rated the overall symposium as very good or excellent (2a) Mental health literacy significantly increased each year with over 90% of participants reporting improvement in their “understanding” and “awareness of mental health (2b) Participants 'personal stigma surrounding mental health illness decreased each year with 92.3% of participants reporting changes in their “willingness to talk about and share” mental health challenges; (3) Barriers to mental health care were identified and included social stigma, lack of trust, and the cost of care. Data were used to develop priorities and an action plan for the FLFH-CCHMC Mental Health Partnership; (4) Follow-up data showed that participants sustained benefits of the FLFH Symposium and took actionable steps (e.g., meditation, referrals, etc.). Additional quantitative and qualitative data will be shared. Conclusions: Lower rates of mental health literacy and higher rates of stigma among participants in this initiative demonstrate the importance of mental health providers building trust and partnerships in communities. Working with faith-based entities provides an opportunity to mitigate and address mental health equity in African American communities.

Keywords: community psychology, faith-based, african-american, culturally competent care, mental health equity

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Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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Authors: Rachid Essamoud, Abdelkrim Afenzar, Ahmed Belqadi

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During the Early Mesozoic, the northwestern part of the African continent was affected by initial fracturing associated with the early stages of the opening of the Central Atlantic (Atlantic Rift). During this rifting phase, the Moroccan Meseta experienced an extensive tectonic regime. This extension favored the formation of a set of rift-type basins, including the Mohammedia-Benslimane-ElGara-Berrechid basin. Thus, it is essential to know the nature of the deposits in this basin and their evolution over time as well as their relationship with the basaltic effusion of the Central Atlantic Magmatic Province (CAMP). These deposits are subdivided into two large series: The Lower clay-salt series attributed to the Triassic and the Upper clay-salt series attributed to the Liassic. The two series are separated by the Upper Triassic-Lower Liassic basaltic complex. The detailed sedimentological analysis made it possible to characterize four mega-sequences, fifteen types of facies and eight architectural elements and facies associations in the Triassic series. A progressive decrease observed in paleo-slope over time led to the evolution of the paleoenvironment from a proximal system of alluvial fans to a braided fluvial style, then to an anastomosed system. These environments eventually evolved into an alluvial plain associated with a coastal plain where playa lakes, mudflats and lagoons had developed. The pure and massive halitic facies at the top of the series probably indicate an evolution of the depositional environment towards a shallow subtidal environment. The presence of these evaporites indicates a climate that favored their precipitation, in this case, a fairly hot and humid climate. The sedimentological analysis of the supra-basaltic part shows that during the Lower Liassic, the paleopente after basaltic effusion remained weak with distal environments. The faciological analysis revealed the presence of four major sandstone, silty, clayey and evaporitic lithofacies organized in two mega-sequences: the sedimentation of the first rock-salt mega-sequence took place in a brine depression system free, followed by saline mudflats under continental influences. The upper clay mega-sequence displays facies documenting sea level fluctuations from the final transgression of the Tethys or the opening Atlantic. Saliferous sedimentation is therefore favored from the Upper Triassic, but experienced a sudden rupture by the emission of basaltic flows which are interstratified in the azoic salt clays of very shallow seas. This basaltic emission which belongs to the CAMP would come from a fissural volcanism probably carried out through transfer faults located in the NW and SE of the basin. Their emplacement is probably subaquatic to subaerial. From a chronological and paleogeographic point of view, this main volcanism, dated between the Upper Triassic and the Lower Liassic (180-200 MA), is linked to the fragmentation of Pangea and managed by a progressive expansion triggered in the West in close relation with the initial phases of Central Atlantic rifting and seems to coincide with the major mass extinction at the Triassic-Jurassic boundary.

Keywords: Basalt, CAMP, Liassic, sedimentology, Triassic, Morocco

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Authors: Michael Sonne Kristensen, Frank Loesche, James Foster, Elif Ozcan, Judy Edworthy

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Auditory alarms play an integral role in intensive care nurses’ daily work. Most medical devices in the intensive care unit (ICU) are designed to produce alarm sounds in order to make nurses aware of immediate or prospective safety risks. The utilisation of sound as a carrier of crucial patient information is highly dependent on nurses’ presence - both physically and mentally. For ICU nurses, especially the ones who work with stationary alarm devices at the patient bed space, it is a challenge to display ‘appropriate’ alarm responses at all times as they have to navigate with great flexibility in a complex work environment. While being primarily responsible for a small number of allocated patients they are often required to engage with other nurses’ patients, relatives, and colleagues at different locations inside and outside the unit. This work explores the social strategies used by a team of nurses to comprehend and react to the information conveyed by the alarms in the ICU. Two main research questions guide the study: To what extent do alarms from a patient bed space reach the relevant responsible nurse by direct auditory exposure? By which means do responsible nurses get informed about their patients’ alarms when not directly exposed to the alarms? A comprehensive video-ethnographic field study was carried out to capture and evaluate alarm-related events in an ICU. The study involved close collaboration with four nurses who wore eye-level cameras and ear-level binaural audio recorders during several work shifts. At all time the entire unit was monitored by multiple video and audio recorders. From a data set of hundreds of hours of recorded material information about the nurses’ location, social interaction, and alarm exposure at any point in time was coded in a multi-channel replay-interface. The data shows that responsible nurses’ direct exposure and awareness of the alarms of their allocated patients vary significantly depending on work load, social relationships, and the location of the patient’s bed space. Distributed listening is deliberately employed by the nursing team as a social strategy to respond adequately to alarms, but the patterns of information flow prompted by alarm-related events are not uniform. Auditory Spatiotemporal Trajectory (AST) is proposed as a methodological label to designate the integration of temporal, spatial and auditory load information. As a mixed-method metrics it provides tangible evidence of how nurses’ individual alarm-related experiences differ from one another and from stationary points in the ICU. Furthermore, it is used to demonstrate how alarm-related information reaches the individual nurse through principles of social and distributed cognition, and how that information relates to the actual alarm event. Thereby it bridges a long-standing gap in the literature on medical alarm utilisation between, on the one hand, initiatives to measure objective data of the medical sound environment without consideration for any human experience, and, on the other hand, initiatives to study subjective experiences of the medical sound environment without detailed evidence of the objective characteristics of the environment.

Keywords: auditory spatiotemporal trajectory, medical alarms, social cognition, video-ethography

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Authors: Nikola Toshikj, Michel Ramonda, Sylvain Catrouillet, Jean-Jacques Robin, Sebastien Blanquer

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Biodegradable and biocompatible block copolymers have risen as the golden materials in both medical and environmental applications. Moreover, if their architecture is of controlled manner, higher applications can be foreseen. In the meantime, organocatalytic ROP has been promoted as more rapid and immaculate route, compared to the traditional organometallic catalysis, towards efficient synthesis of block copolymer architectures. Therefore, herein we report novel organocatalytic pathway with guanidine molecules (TBD) for supported synthesis of trimethylene carbonate initiated by poly(caprolactone) as pre-polymer. Pristine PTMC-b-PCL-b-PTMC block copolymer structure, without any residual products and clear desired block proportions, was achieved under 1.5 hours at room temperature and verified by NMR spectroscopies and size-exclusion chromatography. Besides, when elaborating block copolymer films, further stability and amelioration of mechanical properties can be achieved via additional reticulation step of precedently methacrylated block copolymers. Subsequently, stimulated by the insufficient studies on the phase-separation/crystallinity relationship in these semi-crystalline block copolymer systems, their intrinsic thermal and morphology properties were investigated by differential scanning calorimetry and atomic force microscopy. Firstly, by DSC measurements, the block copolymers with χABN values superior to 20 presented two distinct glass transition temperatures, close to the ones of the respecting homopolymers, demonstrating an initial indication of a phase-separated system. In the interim, the existence of the crystalline phase was supported by the presence of melting temperature. As expected, the crystallinity driven phase-separated morphology predominated in the AFM analysis of the block copolymers. Neither crosslinking at melted state, hence creation of a dense polymer network, disturbed the crystallinity phenomena. However, the later revealed as sensible to rapid liquid nitrogen quenching directly from the melted state. Therefore, AFM analysis of liquid nitrogen quenched and crosslinked block copolymer films demonstrated a thermodynamically driven phase-separation clearly predominating over the originally crystalline one. These AFM films remained stable with their morphology unchanged even after 4 months at room temperature. However, as demonstrated by DSC analysis once rising the temperature above the melting temperature of the PCL block, neither the crosslinking nor the liquid nitrogen quenching shattered the semi-crystalline network, while the access to thermodynamical phase-separated structures was possible for temperatures under the poly (caprolactone) melting point. Precisely this coexistence of dual crosslinked/crystalline networks in the same copolymer structure allowed us to establish, for the first time, the shape-memory properties in such materials, as verified by thermomechanical analysis. Moreover, the response temperature to the material original shape depended on the block copolymer emplacement, hence PTMC or PCL as end-block. Therefore, it has been possible to reach a block copolymer with transition temperature around 40°C thus opening potential real-life medical applications. In conclusion, the initial study of phase-separation/crystallinity relationship in PTMC-b-PCL-b-PTMC block copolymers lead to the discovery of novel shape memory materials with superior properties, widely demanded in modern-life applications.

Keywords: biodegradable block copolymers, organocatalytic ROP, self-assembly, shape-memory

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Authors: Nancy Mackin

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Historically, architects from Aalto to Gaudi to Wright have looked to the architectural knowledge of long-resident peoples for forms and structural principles specifically adapted to the regional climate, geology, materials availability, and culture. In this research, structures traditionally built by Inuit peoples in a remote region of the Canadian high Arctic provides a folio of architectural ideas that are increasingly relevant during these times of escalating carbon emissions and climate change. ‘Green architecture from the Thawing Arctic’ researches, draws, models, and reconstructs traditional buildings of Inuit (Eskimo) peoples in three remote, often inaccessible Arctic communities. Structures verified in pre-contact oral history and early written history are first recorded in architectural drawings, then modeled and, with the participation of Inuit young people, local scientists, and Elders, reconstructed as emergency shelters. Three full-sized building types are constructed: a driftwood and turf-clad A-frame (spring/summer); a stone/bone/turf house with inwardly spiraling walls and a fan-shaped floor plan (autumn); and a parabolic/catenary arch-shaped dome from willow, turf, and skins (autumn/winter). Each reconstruction is filmed and featured in a short video. Communities found that the reconstructed buildings and the method of involving young people and Elders in the reconstructions have on-going usefulness, as follows: 1) The reconstructions provide emergency shelters, particularly needed as climate change worsens storms, floods, and freeze-thaw cycles and scientists and food harvesters who must work out of the land become stranded more frequently; 2) People from the communities re-learned from their Elders how to use materials from close at hand to construct impromptu shelters; 3) Forms from tradition, such as windbreaks at entrances and using levels to trap warmth within winter buildings, can be adapted and used in modern community buildings and housing; and 4) The project initiates much-needed educational and employment opportunities in the applied sciences (engineering and architecture), construction, and climate change monitoring, all offered in a culturally-responsive way. Elders, architects, scientists, and young people added innovations to the traditions as they worked, thereby suggesting new sustainable, culturally-meaningful building forms and materials combinations that can be used for modern buildings. Adding to the growing interest in bio-mimicry, participants looked at properties of Arctic and subarctic materials such as moss (insulation), shrub bark (waterproofing), and willow withes (parabolic and catenary arched forms). ‘Green Architecture from the Thawing Arctic’ demonstrates the effective, useful architectural oeuvre of a resilient northern people. The research parallels efforts elsewhere in the world to revitalize long-resident peoples’ architectural knowledge, in the interests of designing sustainable buildings that reflect culture, heritage, and identity.

Keywords: architectural culture and identity, climate change, forms from nature, Inuit architecture, locally sourced biodegradable materials, traditional architectural knowledge, traditional Inuit knowledge

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Authors: H. A. J. Nguyen, V. A. Pham

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RE:SOUNDING is an ongoing research project and artwork seeking to return the sound and knowledge of Dong Son bronze drums back to contemporary musicians. Colonial collections of ethnographic instruments are problematic in how they commit acts of conceptual, cultural, and acoustic silencing. The collection (or more honestly), the plagiarism, and pillaging of these instruments have systemically separated them from living and breathing cultures. This includes diasporic communities, who have come to resettle in close proximity - but still have little access - to the museums and galleries that display their cultural objects. Despite recent attempts to 'open up' and 'recognise' the tensions and violence of these ethnographic collections, many museums continue to structurally organize and reproduce knowledge with the same procedural distance and limitations of imperial condescension. Impatient with the slowness of these museums, our diaspora led collaborations participated in the opaque economy of the auction market to gain access and begin the process of digitally recording and archiving the actual sounds of the ancient Dong Son drum. This self-directed, self-initiated artwork not only acoustically reinvigorated an ancient instrument but redistributed these sonic materials back to contemporary musicians, composers, and their diasporic communities throughout Vietnam, South East Asia, and Australia. Our methodologies not only highlight the persistent inflexibility of museum infrastructures but demand that museums refrain from their paternalistic practice of risk-averse ownership, to seriously engage with new technologies and political formations that require all public institutions to be held accountable for the ethical and intellectual viability of their colonial collections. The integrated and practical resolve of diasporic artists and their communities are more than capable of working with new technologies to reclaim and reinvigorate what is culturally and spiritually theirs. The motivation to rematriate – as opposed to merely repatriate – the acoustic legacies of these instruments to contemporary musicians and artists is a new model for decolonial and restorative practices. Exposing the inadequacies of western scholarship that continues to treat these instruments as discreet, disembodied, and detached artifacts, these collaborative strategies have thus far produced a wealth of new knowledge – new to the west perhaps – but not that new to these, our own communities. This includes the little-acknowledged fact that the Dong Son drum were political instruments of war and technology, rather than their simplistic description in the museum and western academia as agrarian instruments of fertility and harvest. Through the collective and continued sharing of knowledge and sound materials produced from this research, these drums are gaining a contemporary relevance beyond the cultural silencing of the museum display cabinet. Acknowledgement: We acknowledge the Wurundjeri and Boon Wurrung of the Kulin Nation and the Gadigal of the Eora Nation where we began this project. We pay our respects to the Peoples, Lands, Traditional Custodians, Practices, and Creator Ancestors of these Great Nations, as well as those First Nations peoples throughout Australia, Vietnam, and Indonesia, where this research continues, and upon whose stolen lands and waterways were never ceded.

Keywords: acoustic archaeology, decolonisation, museum collections, rematriation, repatriation, Dong Son, experimental music, digital recording

Procedia PDF Downloads 151

Authors: Ousmane Sarr

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The Senegalese coasts have high productivity of fishery resources due to the frequency of intense up-welling system that occurs along its coast, caused by the maritime trade winds making its waters nutrients rich. Fishing plays a primordial role in Senegal's socioeconomic plans and food security. However, a global diagnosis of the Senegalese maritime fishing sector has highlighted the challenges this sector encounters. Among these concerns, some significant stocks, a priority target for artisanal fishing, need further assessment. If no efforts are made in this direction, most stock will be overexploited or even in decline. It is in this context that this research was initiated. This investigation aimed to apply a multi-modal approach (LBB, Catch-only-based CMSY model and its most recent version (CMSY++); JABBA, and JABBA-Select) to assess the stock of Atlantic bonito, Sarda sarda (Bloch, 1793) in the Senegalese Exclusive Economic Zone (SEEZ). Available catch, effort, and size data from Atlantic bonito over 15 years (2004-2018) were used to calculate the nominal and standardized CPUE, size-frequency distribution, and length at retentions (50 % and 95 % selectivity) of the species. These relevant results were employed as input parameters for stock assessment models mentioned above to define the stock status of this species in this region of the Atlantic Ocean. The LBB model indicated an Atlantic bonito healthy stock status with B/BMSY values ranging from 1.3 to 1.6 and B/B0 values varying from 0.47 to 0.61 of the main scenarios performed (BON_AFG_CL, BON_GN_Length, and BON_PS_Length). The results estimated by LBB are consistent with those obtained by CMSY. The CMSY model results demonstrate that the SEEZ Atlantic bonito stock is in a sound condition in the final year of the main scenarios analyzed (BON, BON-bt, BON-GN-bt, and BON-PS-bt) with sustainable relative stock biomass (B2018/BMSY = 1.13 to 1.3) and fishing pressure levels (F2018/FMSY= 0.52 to 1.43). The B/BMSY and F/FMSY results for the JABBA model ranged between 2.01 to 2.14 and 0.47 to 0.33, respectively. In contrast, The estimated B/BMSY and F/FMSY for JABBA-Select ranged from 1.91 to 1.92 and 0.52 to 0.54. The Kobe plots results of the base case scenarios ranged from 75% to 89% probability in the green area, indicating sustainable fishing pressure and an Atlantic bonito healthy stock size capable of producing high yields close to the MSY. Based on the stock assessment results, this study highlighted scientific advice for temporary management measures. This study suggests an improvement of the selectivity parameters of longlines and purse seines and a temporary prohibition of the use of sleeping nets in the fishery for the Atlantic bonito stock in the SEEZ based on the results of the length-base models. Although these actions are temporary, they can be essential to reduce or avoid intense pressure on the Atlantic bonito stock in the SEEZ. However, it is necessary to establish harvest control rules to provide coherent and solid scientific information that leads to appropriate decision-making for rational and sustainable exploitation of Atlantic bonito in the SEEZ and the Eastern Atlantic Ocean.

Keywords: multi-model approach, stock assessment, atlantic bonito, healthy stock, sustainable, SEEZ, temporary management measures

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Authors: Brooklyn Rushton, Michelle Rutty, Natalie Knowles, Daniel Scott

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As people are increasingly on the search for extraordinary experiences and connections with nature, adventure tourism is experiencing significant growth and providing tourists with life-changing experiences. Unlike built attraction-based tourism, adventure tourism relies entirely on natural heritage, which leaves communities dependent on adventure tourism extremely vulnerable to environmental and climatic changes. A growing body of evidence suggests that global climate change will influence the future of adventure tourism and mountain outdoor recreation opportunities on a global scale. Across Canada, more specifically, climate change is broadly anticipated to present risks for winter-snow sports, while opportunities are anticipated to arise for green season activities. These broad seasonal shifts do not account for the indirect impacts of climate change on adventure tourism, such as the cost of adaptation or the increase of natural hazards and the associated likelihood of accidents. While some research has examined the impact of climate change on natural environments that adventure tourism relies on, a very small body of research has specifically focused on guides’ perspectives or included hard adventure tourism activities. The guiding industry is unique, as guides are trained through an elegant blend of art and science to make decisions based on experience, observation, and intuition. While quantitative research can monitor change in natural environments, guides local knowledge can provide eye-witness accounts and outline what environmental changes mean for the future sustainability of adventure tourism. This research will capture the extensive knowledge of mountain guides to better understand the implications of climate change for mountain adventure and potential adaptive responses for the adventure tourism industry. This study uses a structured online survey with open and close-ended questions that will be administered using Qualtrics (an online survey platform). This survey is disseminated to current members of the Association of Canadian Mountain Guides (ACMG). Participation in this study will be exclusive to members of the ACMG operating in the outdoor guiding streams. The 25 survey questions are organized into four sections: demographic and professional operation (9 questions), physical change (4 questions), climate change perception (6 questions), and climate change adaptation (6 questions). How mountain guides perceive and respond to climate change is important knowledge for the future of the expanding adventure tourism industry. Results from this study are expected to provide important information to mountain destinations on climate change vulnerability and adaptive capacity. Expected results of this study include guides insight into: (1) experience-safety relevant observed physical changes in guided regions (i.e. glacial coverage, permafrost coverage, precipitation, temperature, and slope instability) (2) changes in hazards within the guiding environment (i.e. avalanches, rockfall, icefall, forest fires, flooding, and extreme weather events), (3) existing and potential adaptation strategies, and (4) key information and other barriers for adaptation. By gaining insight from the knowledge of mountain guides, this research can help the tourism industry at large understand climate risk and create adaptation strategies to ensure the resiliency of the adventure tourism industry.

Keywords: adventure tourism, climate change, environmental change, mountain hazards

Procedia PDF Downloads 192

Authors: Thanthrige Thiunuwan Priyathilaka, Don Anushka Sandaruwan Elvitigala, Bong-Soo Lim, Hyung-Bok Jeong, Jehee Lee

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Toll like receptors (TLRs) are a phylogeneticaly conserved family of pattern recognition receptors, which participates in the host immune responses against various pathogens and pathogen derived mitogen. TLR21, a non-mammalian type, is almost restricted to the fish species even though those can be identified rarely in avians and amphibians. Herein, this study was carried out to identify and characterize TLR21 from rock bream (Oplegnathus fasciatus) designated as RbTLR21, at transcriptional and genomic level. In this study, the full length cDNA and genomic sequence of RbTLR21 was identified using previously constructed cDNA sequence database and BAC library, respectively. Identified RbTLR21 sequence was characterized using several bioinformatics tools. The quantitative real time PCR (qPCR) experiment was conducted to determine tissue specific expressional distribution of RbTLR21. Further, transcriptional modulation of RbTLR21 upon the stimulation with Streptococcus iniae (S. iniae), rock bream iridovirus (RBIV) and Edwardsiella tarda (E. tarda) was analyzed in spleen tissues. The complete coding sequence of RbTLR21 was 2919 bp in length which can encode a protein consisting of 973 amino acid residues with molecular mass of 112 kDa and theoretical isoelectric point of 8.6. The anticipated protein sequence resembled a typical TLR domain architecture including C-terminal ectodomain with 16 leucine rich repeats, a transmembrane domain, cytoplasmic TIR domain and signal peptide with 23 amino acid residues. Moreover, protein folding pattern prediction of RbTLR21 exhibited well-structured and folded ectodomain, transmembrane domain and cytoplasmc TIR domain. According to the pair wise sequence analysis data, RbTLR21 showed closest homology with orange-spotted grouper (Epinephelus coioides) TLR21with 76.9% amino acid identity. Furthermore, our phylogenetic analysis revealed that RbTLR21 shows a close evolutionary relationship with its ortholog from Danio rerio. Genomic structure of RbTLR21 consisted of single exon similar to its ortholog of zebra fish. Sevaral putative transcription factor binding sites were also identified in 5ʹ flanking region of RbTLR21. The RBTLR 21 was ubiquitously expressed in all the tissues we tested. Relatively, high expression levels were found in spleen, liver and blood tissues. Upon induction with rock bream iridovirus, RbTLR21 expression was upregulated at the early phase of post induction period even though RbTLR21 expression level was fluctuated at the latter phase of post induction period. Post Edwardsiella tarda injection, RbTLR transcripts were upregulated throughout the experiment. Similarly, Streptococcus iniae induction exhibited significant upregulations of RbTLR21 mRNA expression in the spleen tissues. Collectively, our findings suggest that RbTLR21 is indeed a homolog of TLR21 family members and RbTLR21 may be involved in host immune responses against bacterial and DNA viral infections.

Keywords: rock bream, toll like receptor 21 (TLR21), pattern recognition receptor, genomic characterization

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Authors: Shagufta Jabeen, Faez J. Firdaus Abdullah, Zunita Zakaria, Nurulfiza M. Isa, Yung C. Tan, Wai Y. Yee, Abdul R. Omar

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Pasteurella multocida (PM) is an important veterinary opportunistic pathogen particularly associated with septicemic pasteurellosis, pneumonic pasteurellosis and hemorrhagic septicemia in cattle and buffaloes. P. multocida serotype A has been reported to cause fatal pneumonia and septicemia. Pasteurella multocida subspecies multocida of serotype A Malaysian isolate PMTB2.1 was first isolated from buffaloes died of septicemia. In this study, the genome of P. multocida strain PMTB2.1 was sequenced using third-generation sequencing technology, PacBio RS2 system and analyzed bioinformatically via de novo analysis followed by in-depth analysis based on comparative genomics. Bioinformatics analysis based on de novo assembly of PacBio raw reads generated 3 contigs followed by gap filling of aligned contigs with PCR sequencing, generated a single contiguous circular chromosome with a genomic size of 2,315,138 bp and a GC content of approximately 40.32% (Accession number CP007205). The PMTB2.1 genome comprised of 2,176 protein-coding sequences, 6 rRNA operons and 56 tRNA and 4 ncRNAs sequences. The comparative genome sequence analysis of PMTB2.1 with nine complete genomes which include Actinobacillus pleuropneumoniae, Haemophilus parasuis, Escherichia coli and five P. multocida complete genome sequences including, PM70, PM36950, PMHN06, PM3480, PMHB01 and PMTB2.1 was carried out based on OrthoMCL analysis and Venn diagram. The analysis showed that 282 CDs (13%) are unique to PMTB2.1and 1,125 CDs with orthologs in all. This reflects overall close relationship of these bacteria and supports the classification in the Gamma subdivision of the Proteobacteria. In addition, genomic distance analysis among all nine genomes indicated that PMTB2.1 is closely related with other five Pasteurella species with genomic distance less than 0.13. Synteny analysis shows subtle differences in genetic structures among different P.multocida indicating the dynamics of frequent gene transfer events among different P. multocida strains. However, PM3480 and PM70 exhibited exceptionally large structural variation since they were swine and chicken isolates. Furthermore, genomic structure of PMTB2.1 is more resembling that of PM36950 with a genomic size difference of approximately 34,380 kb (smaller than PM36950) and strain-specific Integrative and Conjugative Elements (ICE) which was found only in PM36950 is absent in PMTB2.1. Meanwhile, two intact prophages sequences of approximately 62 kb were found to be present only in PMTB2.1. One of phage is similar to transposable phage SfMu. The phylogenomic tree was constructed and rooted with E. coli, A. pleuropneumoniae and H. parasuis based on OrthoMCL analysis. The genomes of P. multocida strain PMTB2.1 were clustered with bovine isolates of P. multocida strain PM36950 and PMHB01 and were separated from avian isolate PM70 and swine isolates PM3480 and PMHN06 and are distant from Actinobacillus and Haemophilus. Previous studies based on Single Nucleotide Polymorphism (SNPs) and Multilocus Sequence Typing (MLST) unable to show a clear phylogenetic relatedness between Pasteurella multocida and the different host. In conclusion, this study has provided insight on the genomic structure of PMTB2.1 in terms of potential genes that can function as virulence factors for future study in elucidating the mechanisms behind the ability of the bacteria in causing diseases in susceptible animals.

Keywords: comparative genomics, DNA sequencing, phage, phylogenomics

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Authors: Vishal Kumar, Soumitra Satapathi

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Föster Resonance Energy Transfer (FRET) is a powerful technique used to probe close-range molecular interactions. Physically, the FRET phenomenon manifests as a dipole–dipole interaction between closely juxtaposed fluorescent molecules (10–100 Å). Our effort is to employ this FRET technique to make a prototype device for highly sensitive detection of environment pollutant. Among the most common environmental pollutants, nitroaromatic compounds (NACs) are of particular interest because of their durability and toxicity. That’s why, sensitive and selective detection of small amounts of nitroaromatic explosives, in particular, 2,4,6-trinitrophenol (TNP), 2,4-dinitrotoluene (DNT) and 2,4,6-trinitrotoluene (TNT) has been a critical challenge due to the increasing threat of explosive-based terrorism and the need of environmental monitoring of drinking and waste water. In addition, the excessive utilization of TNP in several other areas such as burn ointment, pesticides, glass and the leather industry resulted in environmental accumulation, and is eventually contaminating the soil and aquatic systems. To the date, high number of elegant methods, including fluorimetry, gas chromatography, mass, ion-mobility and Raman spectrometry have been successfully applied for explosive detection. Among these efforts, fluorescence-quenching methods based on the mechanism of FRET show good assembly flexibility, high selectivity and sensitivity. Here, we report a FRET-based sensor system for the highly selective detection of NACs, such as TNP, DNT and TNT. The sensor system is composed of a copolymer Poly [(N,N-dimethylacrylamide)-co-(Boc-Trp-EMA)] (RP) bearing tryptophan derivative in the side chain as donor and dansyl tagged copolymer P(MMA-co-Dansyl-Ala-HEMA) (DCP) as an acceptor. Initially, the inherent fluorescence of RP copolymer is quenched by non-radiative energy transfer to DCP which only happens once the two molecules are within Förster critical distance (R0). The excellent spectral overlap (Jλ= 6.08×10¹⁴ nm⁴M⁻¹cm⁻¹) between donors’ (RP) emission profile and acceptors’ (DCP) absorption profile makes them an exciting and efficient FRET pair i.e. further confirmed by the high rate of energy transfer from RP to DCP i.e. 0.87 ns⁻¹ and lifetime measurement by time correlated single photon counting (TCSPC) to validate the 64% FRET efficiency. This FRET pair exhibited a specific fluorescence response to NACs such as DNT, TNT and TNP with 5.4, 2.3 and 0.4 µM LODs, respectively. The detection of NACs occurs with high sensitivity by photoluminescence quenching of FRET signal induced by photo-induced electron transfer (PET) from electron-rich FRET pair to electron-deficient NAC molecules. The estimated stern-volmer constant (KSV) values for DNT, TNT and TNP are 6.9 × 10³, 7.0 × 10³ and 1.6 × 104 M⁻¹, respectively. The mechanistic details of molecular interactions are established by time-resolved fluorescence, steady-state fluorescence and absorption spectroscopy confirmed that the sensing process is of mixed type, i.e. both dynamic and static quenching as lifetime of FRET system (0.73 ns) is reduced to 0.55, 0.57 and 0.61 ns DNT, TNT and TNP, respectively. In summary, the simplicity and sensitivity of this novel FRET sensor opens up the possibility of designing optical sensor of various NACs in one single platform for developing multimodal sensor for environmental monitoring and future field based study.

Keywords: FRET, nitroaromatic, stern-Volmer constant, tryptophan and dansyl tagged copolymer

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Authors: Carolyn Hatch, Laurent Simon

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Urban mobility and the transportation industry are undergoing a transformation, shifting from an auto production-consumption model that has dominated since the early 20th century towards new forms of personal and shared multi-modality [1]. This is shaped by key forces such as climate change, which has induced a shift in production and consumption patterns and efforts to decarbonize and improve transport services through, for instance, the integration of vehicle automation, electrification and mobility sharing [2]. Advanced innovation practices and platforms for experimentation and validation of new mobility products and services that are increasingly complex and multi-stakeholder-oriented are shaping this new world of mobility. Transportation hubs – such as airports - are emblematic of these disruptive forces playing out in the mobility industry. Airports are emerging as the core of innovation ecosystems on and around contemporary mobility issues, and increasingly recognized as complex public/private nodes operating in many societal dimensions [3,4]. These include urban development, sustainability transitions, digital experimentation, customer experience, infrastructure development and data exploitation (for instance, airports generate massive and often untapped data flows, with significant potential for use, commercialization and social benefit). Yet airport innovation practices have not been well documented in the innovation literature. This paper addresses this gap by proposing a model of airport innovation that aims to equip airport stakeholders to respond to these new and complex innovation needs in practice. The methodology involves: 1 – a literature review bringing together key research and theory on airport innovation management, open innovation and innovation ecosystems in order to evaluate airport practices through an innovation lens; 2 – an international benchmarking of leading airports and their innovation practices, including such examples as Aéroports de Paris, Schipol in Amsterdam, Changi in Singapore, and others; and 3 – semi-structured interviews with airport managers on key aspects of organizational practice, facilitated through a close partnership with the Airport Council International (ACI), a major stakeholder in this research project. Preliminary results find that the most successful airports are those that have shifted to a multi-stakeholder, platform ecosystem model of innovation. The recent entrance of new actors in airports (Google, Amazon, Accor, Vinci, Airbnb and others) have forced the opening of organizational boundaries to share and exchange knowledge with a broader set of ecosystem players. This has also led to new forms of governance and intermediation by airport actors to connect complex, highly distributed knowledge, along with new kinds of inter-organizational collaboration, co-creation and collective ideation processes. Leading airports in the case study have demonstrated a unique capacity to force traditionally siloed activities to “think together”, “explore together” and “act together”, to share data, contribute expertise and pioneer new governance approaches and collaborative practices. In so doing, they have successfully integrated these many disruptive change pathways and forced their implementation and coordination towards innovative mobility outcomes, with positive societal, environmental and economic impacts. This research has implications for: 1 - innovation theory, 2 - urban and transport policy, and 3 - organizational practice - within the mobility industry and across the economy.

Keywords: airport management, ecosystem, innovation, mobility, platform, transport hubs

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Authors: Cátia Gonçalves, Teresa Nunes, Inês Pina, Ana Vicente, C. Alves, Felix Charvet, Daniel Neves, A. Matos

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The production of charcoal relies on rudimentary technologies using traditional brick kilns. Charcoal is produced under pyrolysis conditions: breaking down the chemical structure of biomass under high temperature in the absence of air. The amount of the pyrolysis products (charcoal, pyroligneous extract, and flue gas) depends on various parameters, including temperature, time, pressure, kiln design, and wood characteristics like the moisture content. This activity is recognized for its inefficiency and high pollution levels, but it is poorly characterized. This activity is widely distributed and is a vital economic activity in certain regions of Portugal, playing a relevant role in the management of woody residues. The location of the units establishes the biomass used for charcoal production. The Portalegre district, in the Alto Alentejo region (Portugal), is a good example, essentially with rural characteristics, with a predominant farming, agricultural, and forestry profile, and with a significant charcoal production activity. In this district, a recent inventory identifies almost 50 charcoal production units, equivalent to more than 450 kilns, of which 80% appear to be in operation. A field campaign was designed with the objective of determining the composition of the emissions released during a charcoal production cycle. A total of 30 samples of particulate matter and 20 gas samples in Tedlar bags were collected. Particulate and gas samplings were performed in parallel, 2 in the morning and 2 in the afternoon, alternating the inlet heads (PM₁₀ and PM₂.₅), in the particulate sampler. The gas and particulate samples were collected in the plume as close as the emission chimney point. The biomass (dry basis) used in the carbonization process was a mixture of cork oak (77 wt.%), holm oak (7 wt.%), stumps (11 wt.%), and charred wood (5 wt.%) from previous carbonization processes. A cylindrical batch kiln (80 m³) with 4.5 m diameter and 5 m of height was used in this study. The composition of the gases was determined by gas chromatography, while the particulate samples (PM₁₀, PM₂.₅) were subjected to different analytical techniques (thermo-optical transmission technique, ion chromatography, HPAE-PAD, and GC-MS after solvent extraction) after prior gravimetric determination, to study their organic and inorganic constituents. The charcoal production cycle presents widely varying operating conditions, which will be reflected in the composition of gases and particles produced and emitted throughout the process. The concentration of PM₁₀ and PM₂.₅ in the plume was calculated, ranging between 0.003 and 0.293 g m⁻³, and 0.004 and 0.292 g m⁻³, respectively. Total carbon, inorganic ions, and sugars account, in average, for PM10 and PM₂.₅, 65 % and 56 %, 2.8 % and 2.3 %, 1.27 %, and 1.21 %, respectively. The organic fraction studied until now includes more than 30 aliphatic compounds and 20 PAHs. The emission factors of particulate matter to produce charcoal in the traditional kiln were 33 g/kg (wooddb) and 27 g/kg (wooddb) for PM₁₀ and PM₂.₅, respectively. With the data obtained in this study, it is possible to fill the lack of information about the environmental impact of the traditional charcoal production in Portugal. Acknowledgment: Authors thanks to FCT – Portuguese Science Foundation, I.P. and to Ministry of Science, Technology and Higher Education of Portugal for financial support within the scope of the project CHARCLEAN (PCIF/GVB/0179/2017) and CESAM (UIDP/50017/2020 + UIDB/50017/2020).

Keywords: brick kilns, charcoal, emission factors, PAHs, total carbon

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Authors: Jill Hanass-Hancock, Bradley Carpenter, Samantha Willan, Kristin Dunkle

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Access to quality health care for persons with disabilities is the litmus test in our strive toward universal health coverage. Persons with disabilities experience a variety of health disparities related to increased health risks, greater socioeconomic challenges, and persistent ableism in the provision of health care. In low- and middle-income countries, the support needed to address the diverse needs of persons with disabilities and close the gaps in inclusive and accessible health care can appear overwhelming to staff with little knowledge and tools available. An action-orientated disability inclusion toolkit for health facilities was developed through consensus-building consultations and field testing in South Africa. The co-creation of the toolkit followed a bottom-up approach with healthcare staff and persons with disabilities in two developmental cycles. In cycle one, a disability facility assessment tool was developed to increase awareness of disability accessibility and service delivery gaps in primary healthcare services in a simple and action-orientated way. In cycle two, an intervention menu was created, enabling staff to respond to identified gaps and improve accessibility and inclusion. Each cycle followed five distinct steps of development: a review of needs and existing tools, design of the draft tool, consensus discussion to adapt the tool, pilot-testing and adaptation of the tool, and identification of the next steps. The continued consultations, adaptations, and field-testing allowed the team to discuss and test several adaptations while co-creating a meaningful and feasible toolkit with healthcare staff and persons with disabilities. This approach led to a simplified tool design with ‘key elements’ needed to achieve universal health coverage: universal design of health facilities, reasonable accommodation, health care worker training, and care pathway linkages. The toolkit was adapted for paper or digital data entry, produces automated, instant facility reports, and has easy-to-use training guides and online modules. The cyclic approach enabled the team to respond to emerging needs. The pilot testing of the facility assessment tool revealed that healthcare workers took significant actions to change their facilities after an assessment. However, staff needed information on how to improve disability accessibility and inclusion, where to acquire accredited training, and how to improve disability data collection, referrals, and follow-up. Hence, intervention options were needed for each ‘key element’. In consultation with representatives from the health and disability sectors, tangible and feasible solutions/interventions were identified. This process included the development of immediate/low-cost and long-term solutions. The approach gained buy-in from both sectors, who called for including the toolkit in the standard quality assessments for South Africa’s health care services. Furthermore, the process identified tangible solutions for each ‘key element’ and highlighted where research and development are urgently needed. The cyclic and consultative approach enabled the development of a feasible facility assessment tool and a complementary intervention menu, moving facilities toward universal health coverage for and persons with disabilities in low- or better-resourced contexts while identifying gaps in the availability of interventions.

Keywords: public health, disability, accessibility, inclusive health care, universal health coverage

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Authors: Mansoor Mohammed Abdu Al-Gabali

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This paper addresses the growing interest among non-Arab individuals in understanding the realities of Arab peoples and their cultures. The global media, particularly after the September 11 attacks, has contributed to negative and misrepresentative portrayals of Arabs. The paper aims to critically analyze various representations of identity, culture, and politics in the works of three contemporary Arab and Arab-American women writers. By exploring the perspectives and attitudes of these writers, the paper aims to challenge and rectify the misrepresentation created by the media and foster mutual understanding between Arab and American societies. Research Aim: The aim of this research is to examine the writings of Arab and Arab-American women in order to highlight the strengths and awareness of Arab cultures. It seeks to show how these writers create spaces for responding to the misrepresentation perpetuated by the media. The research contributes to bridging the gaps between Arab and American societies and fostering better mutual understanding. Methodology: This paper adopts a multidisciplinary approach, drawing on theoretical concepts from cultural studies. It also utilizes an inductive historical methodology to trace the works under study. The combination of these approaches allows for a comprehensive analysis of the representations of Arab peoples and cultures. Findings: The paper argues that the writings of Arab and Arab-American women demonstrate a multiplicity of perspectives and attitudes toward contemporary issues. It highlights the richness and diversity of their writing, as well as the connections they make between different periods of history and various sites of representation. The paper concludes that these writings transcend personal stories to incorporate broader national and global dialogues, emphasizing the commonalities shared by humanity and the socially contextualized issues that deserve respect. Theoretical Importance: This research holds theoretical importance in the field of cultural studies. It builds upon the works of scholars such as Jack Shaeen and Evelyn Alsultany, that have documented and critiqued the negative media representations of Arabs. By examining the writings of Arab and Arab-American women, this paper contributes to the theoretical understanding of cultural responses to media misrepresentation and the creation of spaces for mutual understanding. Data Collection and Analysis Procedures: The data collection for this research involved a thorough examination and analysis of the selected works by Elmaz Abinader, Diana Abu-Jaber, and Rajaa Al-Sanea. These works were scrutinized to identify the unique ways in which they tackled contemporary issues prevalent in Arab and Arab-American societies. Through close textual analysis and the application of cultural theories, the researchers were able to discern the underlying themes and messages conveyed in the writings. Question Addressed: The primary question addressed in this research is, "How do the writings of Arab and Arab-American women respond to the misrepresentation of Arab cultures in the media?" By exploring this question, the paper aims to shed light on the strengths and awareness of Arab cultures and to promote a more comprehensive understanding between Arabs and non-Arabs. Conclusion: This research concludes that the writings of Arab and Arab-American women serve as mediators between Arab and American cultures in response to the misrepresentation created by the media. These writings go beyond personal narratives, addressing broader social and cultural issues and seeking to highlight the commonalities shared by all human beings. The paper emphasizes the need for mutual respect and understanding in order to bridge the gaps between Arab and American societies and rectify the negative images that have been perpetuated in the media.

Keywords: Arabs, films, media, negotiation

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Authors: Rajeswari Raguraman, Sowmya Parameswaran, Krishnakumar Subramanian, Jagat Kanwar, Rupinder Kanwar

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Background: Tumor microenvironment has been implicated in several cancers to regulate cell growth, invasion and metastasis culminating in outcome of therapy. Tumor stroma consists of multiple cell types that are in constant cross-talk with the tumor cells to favour a pro-tumorigenic environment. Not much is known about the existence of tumor microenvironment in the pediatric intraocular malignancy, Retinoblastoma (RB). In the present study, we aim to understand the multiple stromal cellular subtypes and tumor stromal interactions expressed in RB tumors. Materials and Methods: Immunohistochemistry for stromal cell markers CD31, CD68, alpha-smooth muscle (α-SMA), vimentin and glial fibrillary acidic protein (GFAP) was performed on formalin fixed paraffin embedded tissues sections of RB (n=12). The differential expression of stromal target molecules; fibroblast activation protein (FAP), tenascin-C (TNC), osteopontin (SPP1), bone marrow stromal antigen 2 (BST2), stromal derived factor 2 and 4 (SDF2 and SDF4) in primary RB tumors (n=20) and normal retina (n=5) was studied by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and Western blotting. The differential expression was correlated with the histopathological features of RB. The interaction between RB cell lines (Weri-Rb-1, NCC-RbC-51) and Bone marrow stromal cells (BMSC) was also studied using direct co-culture and indirect co-culture methods. The functional effect of the co-culture methods on the RB cells was evaluated by invasion and proliferation assays. Global gene expression was studied by using Affymetrix 3’ IVT microarray. Pathway prediction was performed using KEGG and the key molecules were validated using qRT-PCR. Results: The immunohistochemistry revealed the presence of several stromal cell types such as endothelial cells (CD31+;Vim+/-); macrophages (CD68+;Vim+/-); Fibroblasts (Vim+; CD31-;CD68- );myofibroblasts (α-SMA+/ Vim+) and invading retinal astrocytes/ differentiated retinal glia (GFAP+; Vim+). A characteristic distribution of these stromal cell types was observed in the tumor microenvironment, with endothelial cells predominantly seen in blood vessels and macrophages near actively proliferating tumor or necrotic areas. Retinal astrocytes and glia were predominant near the optic nerve regions in invasive tumors with sparse distribution in tumor foci. Fibroblasts were widely distributed with rare evidence of myofibroblasts in the tumor. Both gene and protein expression revealed statistically significant (P<0.05) up-regulation of FAP, TNC and BST2 in primary RB tumors compared to the normal retina. Co-culture of BMSC with RB cells promoted invasion and proliferation of RB cells in direct and indirect contact methods respectively. Direct co-culture of RB cell lines with BMSC resulted in gene expression changes in ECM-receptor interaction, focal adhesion, IL-8 and TGF-β signaling pathways associated with cancer. In contrast, various metabolic pathways such a glucose, fructose and amino acid metabolism were significantly altered under the indirect co-culture condition. Conclusion: The study suggests that the close interaction between RB cells and the stroma might be involved in RB tumor invasion and progression which is likely to be mediated by ECM-receptor interactions and secretory factors. Targeting the tumor stroma would be an attractive option for redesigning treatment strategies for RB.

Keywords: gene expression profiles, retinoblastoma, stromal cells, tumor microenvironment

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Authors: Humaira Saeed Malik, Salma Saad

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Introduction: Fowler's syndrome, first described by Clare Fowler in 1985, is a rare urological condition characterized by difficulty in urination due to the abnormal function of the urethral sphincter. It predominantly affects young women and leads to chronic urinary retention. The main concern in managing this condition is ensuring regular bladder emptying. Clam cystoplasty is a bladder augmentation surgery in which the bladder is clam-shelled open, and a segment of the intestine is used to increase the bladder's capacity and reduce bladder pressure. The Mitrofanoff procedure, a surgical creation of a continent urinary diversion, is often performed in patients with Fowler's syndrome who require long-term catheterization. This procedure involves creating a conduit (from the appendix or a segment of the small intestine) between the bladder and the skin, allowing for intermittent self-catheterization to manage urinary retention. Study: This case study examines a 39-year-old gravida 3, para 0+2 woman with a BMI of 40, Fowler's syndrome, type I diabetes, and post-traumatic stress disorder (PTSD), presenting at Dumfries and Galloway Royal Infirmary at 8 weeks of gestation. Diagnosed with Fowler's syndrome at 23, . A sacral nerve stimulator (SNS) device was initially placed but was subsequently removed after one year due to malfunction caused by trauma, subsequently she had undergone clam cystoplasty and the Mitrofanoff procedure for bladder management. Her pregnancy was complicated by vaginal bleeding at 10 weeks, treated with progesterone pessaries, and a urinary tract infection at 14 weeks, managed with antibiotics. Despite these challenges, she continued self-catheterization through the Mitrofanoff stoma and was placed on prophylactic antibiotics. Her diabetes was well-controlled on insulin, and a 20-week fetal anomaly scan was normal. The multidisciplinary team, including an obstetrician and a urologist, planned for serial growth scans and the initiation of low molecular weight heparin (LMWH) from 28 weeks due to the intermediate risk of venous thromboembolism (VTE) and to continue six weeks after delivery. A planned cesarean delivery at 37 weeks was arranged, with an MRI scan scheduled later in the pregnancy to assist in surgical planning, ensuring the preservation of the Mitrofanoff stoma's function. The surgery will occur in an elective setting and include a consultant urologist. Conclusion: Pregnancy in women with Fowler's syndrome who have undergone Clam cystoplasty and the Mitrofanoff procedure is rare, and management requires careful planning and a multidisciplinary approach. This case highlights the importance of individualized care plans and close monitoring of both mother and fetus. The patient's risk of recurrent UTIs, coupled with her diabetes and high BMI, necessitated coordinated care across specialties to ensure the best possible outcomes. The Mitrofanoff procedure proved effective in managing her urinary retention, allowing her to maintain self-catheterization during pregnancy. The multidisciplinary team approach was crucial in addressing her complex medical needs, involving obstetrics, urology, and endocrinology. This case adds valuable information to the limited literature on pregnancy management in patients with Fowler's syndrome who have undergone the Mitrofanoff procedure, highlighting the need for comprehensive, individualized care and the involvement of a multidisciplinary team to achieve the best results.

Keywords: fowler's syndrome, clam cystoplasty, mitrofanoff procedure, pregnancy

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Authors: Agnes Simone

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A 52-year-old male with unknown psychiatric and medical history was brought to the Psychiatric Emergency Room by ambulance directly from jail. He had been detained for three weeks for possession of a firearm while intoxicated. On initial evaluation, the patient was unable to provide a reliable history. He presented with odd jerking movements of his extremities and catatonic features, including mutism and stupor. His vital signs were stable. Patient was transferred to the medical emergency department for work-up of altered mental status. Due to suspicion for opioid overdose, the patient was given naloxone (Narcan) with no improvement. Laboratory work-up included complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, vitamin B12, folate, magnesium, rapid plasma reagin, HIV, blood alcohol level, aspirin, and Tylenol blood levels, urine drug screen, and urinalysis, which were all negative. CT head and chest X-Ray were also negative. With this negative work-up, the medical team concluded there was no organic etiology and requested inpatient psychiatric admission. Upon re-evaluation by psychiatry, it was evident that the patient continued to have an altered mental status. Of note, the medical team did not include substance withdrawal in the differential diagnosis due to stable vital signs and a negative urine drug screen. The psychiatry team decided to check California's prescription drug monitoring program (CURES) and discovered that the patient was prescribed benzodiazepine alprazolam (Xanax) 2mg BID, a sedative-hypnotic, and hydrocodone/acetaminophen 10mg/325mg (Norco) QID, an opioid. After a thorough chart review, his daughter's contact information was found, and she confirmed his benzodiazepine and opioid use, with recent escalation and misuse. It was determined that the patient was experiencing alprazolam withdrawal, given this collateral information, his current symptoms, negative urine drug screen, and recent abrupt discontinuation of medications while incarcerated. After admission to the medical unit and two doses of alprazolam 2mg, the patient's mental status, alertness, and orientation improved, but he had no memory of the events that led to his hospitalization. He was discharged with a limited supply of alprazolam and a close follow-up to arrange a taper. Accompanying this case report, a qualitative review of presentations with alprazolam withdrawal was completed. This case and the review highlights: (1) Alprazolam withdrawal can occur at low doses and within just one week of use. (2) Alprazolam withdrawal can present without any vital sign instability. (3) Alprazolam withdrawal does not respond to short-acting benzodiazepines but does respond to certain long-acting benzodiazepines due to its unique chemical structure. (4) Alprazolam withdrawal is distinct from and more severe than other benzodiazepine withdrawals. This case highlights (1) the importance of physician utilization of drug-monitoring programs. This case, in particular, relied on California's drug monitoring program. (2) The importance of obtaining collateral information, especially in cases in which the patient is unable to provide a reliable history. (3) The importance of including substance intoxication and withdrawal in the differential diagnosis even when there is a negative urine drug screen. Toxidrome of withdrawal can be delayed. (4) The importance of discussing addiction and withdrawal risks of medications with patients.

Keywords: addiction risk of benzodiazepines, alprazolam withdrawal, altered mental status, benzodiazepines, drug monitoring programs, sedative-hypnotics, substance use disorder

Procedia PDF Downloads 138