Search results for: dental treatment

Authors: M. H. Rajikin, S. M. M. Syairah, A. R. Sharaniza

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Effects of nicotine on pre-partum body weight and preimplantation embryonic development has been reported previously. Present study was conducted to determine the effects of annatto (Bixa orellana)-derived delta-tocotrienol (TCT) (with presence of 10% gamma-TCT isomer) on the nicotine-induced reduction in body weight and 8-cell embryonic growth in mice. Twenty four 6-8 weeks old (23-25g) female balb/c mice were randomly divided into four groups (G1-G4; n=6). Those groups were subjected to the following treatments for 7 consecutive days: G1 (control) were gavaged with 0.1 ml tocopherol stripped corn oil, G2 was subcutaneously (s.c.) injected with 3 mg/kg/day of nicotine, G3 received concurrent treatment of nicotine (3 mg/kg/day) and 60 mg/kg/day of δ-TCT mixture (contains 90% delta & 10% gamma isomers) and G4 was given 60 mg/kg/day of δ-TCT mixture alone. Body weights were recorded daily during the treatment. On Day 8, females were superovulated with 5 IU Pregnant Mare’s Serum Gonadotropin (PMSG) for 48 hours followed with 5 IU human Chorionic Gonadotropin (hCG) before mated with males at the ratio of 1:1. Females were sacrificed by cervical dislocation for embryo collection 48 hours post-coitum. Collected embryos were cultured in vitro. Results showed that throughout Day 1 to Day 7, the body weight of nicotine treated group (G2) was significantly lower (p<0.05) than that of G1, G3 and G4. Intervention with δ-TCT mixture (G3) managed to increase the body weight close to the control group. This is also observed in the group treated with δ-TCT mixture alone (G4). The development of 8-cell embryos following in vitro culture (IVC) was totally inhibited in G2. Intervention with δ-TCT mixture (G3) resulted in the production of 8-cell embryos, although it was not up to that of the control group. Treatment with δ-TCT mixture alone (G4) caused significant increase in the average number of produced 8-cell embryo compared to G1. Present data indicated that δ-TCT mixture was able to reverse the body weight loss in nicotine treated mice and the development of 8-cell embryos was also improved.

Keywords: δ-tocotrienol, body weight, nicotine, preimplantation embryonic development

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Authors: Perla Elizabeth Jimarez Rocha, Carolina Daniela Tejeda Franco, Arturo Minor Martínez, Annel Gomez Coello

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One of the biggest problems in developing new therapies for the management and treatment of voice disorders is the difficulty of objectively evaluating the results of each treatment. A system was proposed that captures and records voice signals, in addition to analyzing the vocal quality (fundamental frequency, zero crossings, energy, and amplitude spectrum), as well as the subglottic pressure (cm H2O) during the sustained phonation of the vowel / a /; a recording system is implemented, as well as an interactive system that records information on subglottic pressure. In Mexico City, a control group of 31 patients with phoniatric pathology is proposed; non-invasive tests were performed for these most common vocal pathologies (Nodules, Polyps, Irritative Laryngitis, Ventricular Dysphonia, Laryngeal Cancer, Dysphonia, and Dysphagia). The most common pathology was irritative laryngitis (32%), followed by vocal fold paralysis (unilateral and bilateral,19.4 %). We take into consideration men and women in the pathological groups due to the physiological difference. They were separated in gender by the difference in the morphology of the respiratory tract.

Keywords: amplitude spectrum, energy, fundamental frequency, subglottic pressure, zero crossings

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Authors: Mohammad W. Dewan, Jahangir Alam, Khurshida Sharmin

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Synthetic fibers (carbon, glass, aramid, etc.) are generally utilized to make composite materials for better mechanical and thermal properties. However, they are expensive and non-biodegradable. In the perspective of Bangladesh, jute fibers are available, inexpensive, and comprising good mechanical properties. The improved properties (i.e., low cost, low density, eco-friendly) of natural fibers have made them a promising reinforcement in hybrid composites without sacrificing mechanical properties. In this study, jute and e-glass fiber reinforced hybrid composite materials are fabricated utilizing hand lay-up followed by a compression molding technique. Room temperature cured two-part epoxy resin is used as a matrix. Approximate 6-7 mm thick composite panels are fabricated utilizing 17 layers of woven glass and jute fibers with different fiber layering sequences- only jute, only glass, glass, and jute alternatively (g/j/g/j---) and 4 glass - 9 jute – 4 glass (4g-9j-4g). The fabricated composite panels are analyzed through fiber volume calculation, tensile test, bending test, and water absorption test. The hybridization of jute and glass fiber results in better tensile, bending, and water absorption properties than only jute fiber-reinforced composites, but inferior properties as compared to only glass fiber reinforced composites. Among different fiber layering sequences, 4g-9j-4g fibers layering sequence resulted in better tensile, bending, and water absorption properties. The effect of chemical treatment on the woven jute fiber and chopped glass microfiber infusion are also investigated in this study. Chemically treated jute fiber and 2 wt. % chopped glass microfiber infused hybrid composite shows about 12% improvements in flexural strength as compared to untreated and no micro-fiber infused hybrid composite panel. However, fiber chemical treatment and micro-filler do not have a significant effect on tensile strength.

Keywords: compression molding, chemical treatment, hybrid composites, mechanical properties

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Authors: Aly Kassem, Eman Sapet, Eman Abdelbaset, Hosam Mahmoud

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Objective: Hypertension is an important public health challenge being one of the most common worldwide disease-affecting human. Our aim is to study the clinical characteristics, therapeutic regimens, treatment compliance, and risk factors in a sector of of hypertensive patients at Sohag City. Subject and Methods: A cross sectional study; conducted in Sohag city; it involved 520 patients; males (45.7 %) and females (54.3 %). Their ages ranged between 35-85 years. BP measurements, BMI, blood glucose, Serum creatinine, urine analysis, serum Lipids, blood picture and ECG were done all the studied patients. Results: Hypertension presented more between non-smokers (72.55%), females (54.3%), educated patients (50.99%) and patients with low SES (54.9%). CAD presented in (51.63%) of patients, while laboratory investigations showed hyperglycaemia in (28.7%), anemia in (18.3%), high serum creatinine level in (8.49%) and proteinuria in (10.45%) of patient. Adequate BP control was achieved in (49.67%); older patients had lower adequacy of BP control in spite of the extensive use of multiple-drug therapy. Most hypertensive patients had more than one coexistent CV risk factor. Aging, being a female (54.3%), DM (32.3%), family history of hypertension (28.7%), family history of CAD (25.4%), and obesity (10%) were the common contributing risk factors. ACE-inhibitors were prescribed in (58.16%), Beta-blockers in (34.64%) of the patients. Monotherapy was prescribed for (41.17%) of the patients. (75.81%) of patients had regular use of their drug regimens. (49.67%) only of patients had their condition under control, the number of drugs was inversely related to BP control. Conclusion: Hypertensive patients in Sohag city had a profile of high CV risks, and poor blood pressure control particularly in the elderly. A multidisciplinary approach for routine clinical check-up, follow-up, physicians and patients training, prescribing simple once-daily regimens and encouraging life style modifications are recommended. Anti hypertensives, hypertension, elderly patients, risk factors, treatment compliance.

Keywords: anti hypertensives, hypertension, elderly patients, risk factors, treatment compliance

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Authors: Petros Gkotsis, Giorgos Stratidis, Manassis Mitrakas, Anastasios Zouboulis

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This study investigates the use of original and pre-polymerized iron (Fe) reagents compared to the commonly applied polyaluminum chloride (PACl) coagulant for surface water treatment. Applicable coagulants included both ferric chloride (FeCl₃) and ferric sulfate (Fe₂(SO₄)₃) and their pre-polymerized Fe reagents, such as polyferric sulfate (PFS) and polyferric chloride (PFCl). The efficiency of coagulants was evaluated by the removal of natural organic matter (NOM) and suspended solids (SS), which were determined in terms of reducing the UV absorption at 254 nm and turbidity, respectively. The residual metal concentration (Fe and Al) was also measured. Coagulants were added at five concentrations (1, 2, 3, 4 and 5 mg/L) and three pH values (7.0, 7.3 and 7.6). Experiments were conducted in a jar-test device, with two types of synthetic surface water (i.e., of high and low organic strength) which consisted of humic acid (HA) and kaolin at different concentrations (5 mg/L and 50 mg/L). After the coagulation/flocculation process, clean water was separated with filters of pore size 0.45 μm. Filtration was also conducted before the addition of coagulants in order to compare the ‘net’ effect of the coagulation/flocculation process on the examined parameters (UV at 254 nm, turbidity, and residual metal concentration). Results showed that the use of PACl resulted in the highest removal of humics for both types of surface water. For the surface water of high organic strength (humic acid-kaolin, 50 mg/L-50 mg/L), the highest removal of humics was observed at the highest coagulant dosage of 5 mg/L and at pH=7. On the contrary, turbidity was not significantly affected by the coagulant dosage. However, the use of PACl decreased turbidity the most, especially when the surface water of high organic strength was employed. As expected, the application of coagulation/flocculation prior to filtration improved NOM removal but slightly affected turbidity. Finally, the residual Fe concentration (0.01-0.1 mg/L) was much lower than the residual Al concentration (0.1-0.25 mg/L).

Keywords: coagulation/flocculation, iron and aluminum coagulants, metal salts, pre-polymerized coagulants, surface water treatment

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Authors: Komal Vig

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Cardiovascular disease (CVD)-related deaths occur in 17.3 million people globally each year, accounting for 30% of all deaths worldwide, with a predicted annual incidence of deaths to reach 23.3 million globally by 2030. Autologous bypass grafts remain an important therapeutic option for the treatment of CVD, but the poor quality of the donor patient’s blood vessels, the invasiveness of the resection surgery, and postoperative movement restrictions create issues. The present study is aimed to improve the endothelialization of intimal surface of graft by using low temperature plasma (LTP) to increase the cell attachment and proliferation. Polytetrafluoroethylene (PTFE) was treated with LTP. Air was used as the feed-gas, and the pressure in the plasma chamber was kept at 800 mTorr. Scaffolds were also modified with gelatin and collagen by dipping method. Human umbilical vein endothelial cells (HUVEC) were plated on the developed scaffolds, and cell proliferation was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay and by microscopy. mRNA expressions levels of different cell markers were investigated using quantitative real-time PCR (qPCR). XPS confirmed the introduction of oxygenated functionalities from LTP. HUVEC cells showed 80% seeding efficiency on the scaffold. Microscopic and MTT assays indicated increase in cell viability in LTP treated scaffolds, especially when treated with gelatin or collagen, compared to untreated scaffolds. Gene expression studies shows enhanced expression of cell adhesion marker Integrin- α 5 gene after LTP treatment. LTP treated scaffolds exhibited better cell proliferation and viability compared to untreated scaffolds. Protein treatment of scaffold increased cell proliferation. Based on our initial results, more scaffolds alternatives will be developed and investigated for cell growth and vascularization studies. Acknowledgments: This work is supported by the NSF EPSCoR RII-Track-1 Cooperative Agreement OIA-2148653.

Keywords: LTP, HUVEC cells, vascular graft, endothelialization

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Authors: Izdihar Ismail, Alona C. Linatoc, Maryati Mohamed

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The tropical rainforest of Malaysia is known for its rich biological diversity and high endemicity. The potential for these forests to hold the cure for many diseases and illnesses is high and much is yet to be discovered. This study explores the richness of the tropical rainforest of Endau-Rompin National Park in Johor, Malaysia in search of plants traditionally used by the indigenous people in the treatment of malaria and malaria-like symptoms. Seven species of plants were evaluated and tested for antiplasmodial activities. Different plant parts were subjected to methanolic and aqueous extractions. A total of 24 extracts were evaluated by histidine-rich protein II (HRP2) assay against K1 strain of Plasmodium falciparum chloroquine-resistant. Ten extracts showed significant inhibition of the growth of P. falciparum. Phytochemical screening of the same extracts revealed the presence of alkaloids, flavonoids, terpenoids and anthraquinones. This study affirms that tropical rainforests may still hold undiscovered cures for many diseases and illnesses that have inflicted millions of people worldwide. The species studied herein have not known to have been studied elsewhere before.

Keywords: Endau-Rompin, malaria, Malaysia, tropical rainforest, traditional knowledge

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Authors: Rahaf Mandura

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Background: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure (ICP) more than 250 mm H₂O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. The aim of this research is to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. Methodology: This is a retrospective observational study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital (JEH), Saudi Arabia. A total of fifty-one patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. Results: Most of the patients were females (43, 91.5%) with a mean age of presentation of 30.83±11.40 years. The most common presenting symptom was headache (40 patients, 85.1%), followed by transient visual obscuration (20 patients, 42.6%), and reduced visual acuity (15 patients, 31.9%). All 47 patients were started on medical treatment with oral acetazolamide with four patients (8.5%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.5%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. Conclusion: The present study has shown that IIH-related papilledema is common in young female patients with headaches, transient visual obscurations and reduced visual acuity. Those are the commonest symptoms in our IIH population. Medical treatment of IIH is significantly efficacious and should be considered in order to enhance the prognosis of IIH-related complications. Therefore, the visual status should be frequently monitored for these patients.

Keywords: idiopathic intracranial hypertension, intracranial hypertension, papilledema, headache

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Authors: A. Kavandi, K. Goshtasbi, M. R. Hadei, H. Nejati

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In geothermal energy production, the method of liquid nitrogen (LN₂) fracturing in hot, dry rock is one of the most effective methods to increase the permeability of the reservoir. The geothermal reservoirs mainly consist of hard rocks such as granites and metamorphic rocks like gneiss with high temperatures. Gneiss, as a metamorphic rock, experiences a high level of inherent anisotropy. This type of anisotropy is considered as the nature of rocks, which affects the mechanical behavior of rocks. The aim of this study is to investigate the effects of heating-liquid nitrogen (LN₂) cooling treatment and rock anisotropy on the fracture toughness of gneiss. For this aim, a series of semi-circular bend (SCB) tests were carried out on specimens of gneiss with different anisotropy plane angles (0°, 30°, 60°, and 90°). In this study, gneiss specimens were exposed to heating–cooling treatment through gradual heating to 100°C followed by LN₂ cooling. Results indicate that the fracture toughness of treated samples is lower than that of untreated samples, and with increasing the anisotropy plane angle, the fracture toughness increases. The scanning electron microscope (SEM) technique is also implemented to evaluate the fracture process zone (FPZ) ahead of the crack tip.

Keywords: heating-cooling, anisotropic rock, fracture toughness, liquid nitrogen

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Authors: Ennus Tajuddin Tamboli, Madhukar Garg, Mohd. Mujeeb, Sayeed Ahmad

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An efficient protocol for simultaneous production of forskolin and rosmarinic acid in in vitro callus derived from the leaves of Coleus forskohlii Briq. has been developed. MS media was used for the establishment of cultures and NAA + 6-BA (1.0 ppm) was found best for callus growth. The callus was further subjected to treatment with various elicitor/precursors viz. chitosan, thidiazuron and methyl jasmonate to observe their effect on production of biomass and accumulation of secondary metabolites. The content of forskolin and rosmarinic acid were estimated by HPTLC, in comparison to natural explant which showed 2 fold and 10 fold rise in forskolin and rosmarinic acid content, respectively. Methy1 jasmonate 50 µM was found best for production of forskolin, whereas thidiazuron showed best results in the yield of rosmarinic acid, separately in static culture. However, combined treatment in suspension culture showed moderated effect for increase in secondary metabolites but the biomass increased significantly as compared to static culture.

Keywords: plant tissue culture, secondary metabolites, coleus, forskolin, rosmarinic acid, HPTLC

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Authors: Omaymah Al-Otoom, Rajesh Mehta

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Introduction: Migration is an established risk factor in the development of schizophrenia and other forms of psychosis. The exposure to different social adversities, including social isolation, discrimination, and economic stress, is thought to contribute to elevated rates of psychosis in immigrants and their children. We present a case of resistant schizophrenia in an immigrant adolescent. Case: The patient is a 15-year-old male immigrant. In October 2021, the patient was admitted for irritability, suicidal ideations, and hallucinations. He was treated with Fluoxetine 10 mg daily for irritability. In November 2021, he presented with similar manifestations. Fluoxetine was discontinued, and Risperidone 1 mg at bedtime was started for psychotic symptoms. In March 2022, he presented with commanding auditory hallucinations (voices telling him that people were going to kill his father). Risperidone was gradually increased to 2.5 mg twice daily for hallucinations. The outpatient provider discontinued Risperidone and started Olanzapine 7.5 mg and Lurasidone 40 mg daily. In August 2022, he presented with worsening paranoia due to medication non-adherence. The patient had limited improvement on medications. In October 2022, the patient presented to the ED for visual hallucinations and aggression towards the family. His medications were Olanzapine 10 mg daily, Lurasidone 60 mg daily, and Haloperidol 2.5 mg twice daily. In the ED, he received multiple as-needed medications and was placed in seclusion for his aggressive behavior. The patient showed a positive response to a higher dose of Olanzapine and decreased dose of Lurasidone. The patient was discharged home in stable condition. Two days after discharge, he was brought for bizarre behavior, visual hallucinations, and homicidal ideations at school. Due to concerns for potential antipsychotic side effects and poor response, Lurasidone and Olanzapine were discontinued, and he was discharged home on Haloperidol 5 mg in the morning and 15 mg in the evening. Clozapine treatment was recommended on an outpatient basis. He has no family history of psychotic disorders. He has no history of substance use. A medical workup was done, the electroencephalogram was normal, and the urine toxicology was negative. Discussion: Our patient was on three antipsychotics at some point with no improvement in his psychotic symptoms, which qualifies as treatment-resistant schizophrenia (TRP). It is well recognized that migrants are at higher risk of different psychiatric disorders, including posttraumatic stress disorder, affective disorders, schizophrenia, and psychosis. This is thought to be related to higher exposure to traumatic life events compared to the general population. In addition, migrants are more likely to experience poverty, separation from family members, and discrimination which could contribute to mental health issues. In one study, they found that people who migrated before the age of 18 had twice the risk of psychotic disorders compared to the native-born population. It is unclear whether migration increases the risk of treatment resistance. In a Canadian study, neither ethnicity nor migrant status was associated with treatment resistance; however, this study was limited by its small sample size. There is a need to implement psychiatric prevention strategies and outreach programs through research to mitigate the risk of mental health disorders among immigrants.

Keywords: psychosis, immigrant, adolescent, treatment resistant schizophrenia

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Authors: Alhaji Musa Abdullahi, Usman Abdullahi, Adamu Adamu, Aminu Maidala

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One hundred and fifty (150) day old chicks were randomly allocated into five dietary treatments birds and each treatment where replicated twice in groups of fifteen birds in each replicate. Camel rumen content (CRC) was included in the diets of broiler at 0, 5, 10, 15, and 20% to replace maize and groundnut cake to evaluate the effect on the performance and hematological parameters at the starter and finisher phase. A completely randomized design was used and 600g of feed was given daily and water was given ad libitum. At the starter phase, the daily weight gain and feed conversion ratio were significantly affected by the test ingredients, although T1(0% CRC) which serve as a control, were similar with T2(5% CRC), T3(10% CRC), and T4(15% CRC), while the lowest value was recorded in T5(20% CRC). The result indicates that up to 15% (CRC) level can be included in the starter diet to replace maize and groundnut cake without any effect on the performance. However, at the finisher phase, the daily feed intake, daily weight gain and feed conversion ratio show no significant (F>0.05) difference among the dietary treatments. Similarly, Packed cell volume (PCV), Red Blood Cell (RBC), White Blood Cell (WBC), Mean Corpuscular Volume (MCV), and Mean Corpuscular Haemoglobin (MCH) also did not differ significantly (F>0.05) among the dietary treatments while hemoglobin (Hb) and Mean Corpuscular Haemoglobin Concentration (MCHC) differs significantly. The differential counts of eosinophils, heterophils, and lymphocytes differ significantly among the treatment groups, while that of basophils and monocytes shows no significant difference among the treatment groups. This means up to 20% CRC inclusion level can be used to replaced maize and groundnut cake in the finisher diet without any adverse effect on the performance and hematological parameters of the chickens.

Keywords: camel, rumen content, growth, hematology

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Authors: Kaouka Alaeddine, K. Benarous

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This study aims to obtain a surface of pure titanium and titanium alloy Ti-64Al with high performance by the diffusion process. Two agents metal alloy have been used in this treatment, niobium (Nb) and molybdenum (Mo), spread on elemental titanium and Ti-64Al alloy. Nb and Mo are used as powder form to increase the contact surface and to improve the distribution. Both Mo and Nb are distributed on samples of Ti and Ti-64Al at 1100 °C and 1200 °C for 3 h. They were performed to effect different experiments objectives. This work was achieved to improve some properties and microstructure of Ti and Ti-64Al surface, using optical microscopy and SEM and study some mechanical properties. The effects of temperature and the powder contents on the microstructure of Ti and Ti-64Al alloy, different phases and hardness value of Ti and Ti-64Al alloy were determined. Experimental results indicate that increasing the powder contents and/or the temperature, the α + β phases change to the equiaxed β lamellar structure. In particular, experiments in 1200 °C were created by diffusion α + β phases both equiaxed β phase laminar and α + β phase, thus meeting the objectives were established in the work. In addition, simulation results are used for comparison with the experimental results by DICTRA software.

Keywords: diffusion, powder metallurgy, titanium alloy, molybdenum, niobium

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Authors: Nourhan G. Sahly, Ahmed Moustafa, Mohamed S. Zaghloul, Tamer Z. Salem

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The gut microbiome plays important roles in the human body that includes but not limited to digestion, immunity, homeostasis and response to some drugs such as chemotherapy and immunotherapy. Its role has also been linked to radiotherapy and associated gastrointestinal injuries, where the microbial dysbiosis could be the driving force for dose determination or the complete suspension of the treatment protocol. Linking the gut microbiota alterations to different cancer treatment protocols is not easy especially in humans. However, enormous effort was exerted to understand this complex relationship. In the current study, we described the gut microbiota dysbiosis in pediatric sarcoma patients, in the pelvic region, with regards to radiotherapy and antibiotics. Fecal samples were collected as a source of microbial DNA for which the gene encoding for V3-V5 regions of 16S rRNA was sequenced. Two of the three patients understudy had experienced an increase in alpha diversity post exposure to 50.4 Gy. Although phylum Firmicutes overall relative abundance has generally decreased, six of its taxa increased in all patients. Our results may indicate the possibility of radiosensitivity or enrichment of the antibiotic resistance of the elevated taxa. Further studies are needed to describe the extent of radiosensitivity with regards to antibiotic resistance.

Keywords: combined radiotherapy and chemotherapy, gut microbiome, pediatric cancer, radiosensitivity

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Authors: Amer Elgerwi, Abdelrazzag El-Magdoub, Abubakr El-Mahmoudy

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There are many bacterial infections affecting sheep that necessitates antibiotic intervention. Amoxicillin is among commonly used antibiotics in such case for its broad spectrum of activity. However, the side alterations in blood and organ function that may be associated during or after treatment are questionable. Therefore, the aim of the present study was to assess the possible alterations in blood parameters and organ function bio markers of sheep that may occur following intramuscular injection of amoxicillin. Amoxicillin has been administered intramuscularly to 10 sheep at a dosage regimen of 7 mg/kg of body weight for 5 successive days. Two types of blood samples (with and without anticoagulant) were collected from the jugular vein pre- and post-administration of the drug. Amoxicillin significantly (P < 0.001) increased total leukocyte count and (P < 0.05) absolute eosinophilic count when compared with those of the control samples. Aspartate aminotransferase, alkaline phosphatase and cholesterol were significantly (P < 0.05) higher than the corresponding control values. In addition, amoxicillin significantly (P < 0.05) increased blood urea nitrogen and creatinine but decreased phosphorus level when compared with those of prior-administration samples. These data may indicate that although the side changes caused by amoxicillin are minor in sheep, yet the liver and kidney functions should be monitored during its usage in therapy and it should be used with care for treatment of sheep with renal and/or hepatic impairments.

Keywords: amoxicillin, biogram, haemogram, sheep

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Authors: Raviporn Madarasmi, Anjalee Vacharaksa, Pravej Serichetaphongse

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The host response in peri-implant tissue may differ from that in periodontal tissue in a healthy individual. The purpose of this study is to investigate the expression of inflammatory cytokines in peri-implant crevicular fluid (PICF) from single implant with different abutment types in comparison to healthy periodontal tissue. 19 participants with healthy implants and teeth were recruited according to inclusion and exclusion criteria. PICF and gingival crevicular fluid (GCF) was collected using sterile paper points. The expression level of inflammatory cytokines including IL-1α, IL-1β, TNF-α, IFN-γ, IL-6, and IL-8 was assessed using enzyme-linked immunosorbent assay (ELISA). Paired t test was used to compare the expression levels of inflammatory cytokines around natural teeth and peri-implant in PICF and GCF of the same individual. The Independent t-test was used to compare the expression levels of inflammatory cytokines in PICF from titanium and UCLA abutment. Expression of IL-6, TNF-α, and IFN-γ in PICF was not statistically different from GCF among titanium and UCLA abutment group. However, the level of IL-1α in the PICF from the implants with UCLA abutment was significantly higher than GCF (P=0.030). In addition, the level of IL-1β in PICF from the implants with titanium abutment was significantly higher than GCF (P=0.032). When different abutment types was compared, IL-8 expression in PICF from implants with UCLA abutment was significantly higher than titanium abutment (P=0.003).

Keywords: abutment, dental implant, gingival crevicular fluid and peri-implant crevicular fluid

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Authors: Varsha Gupta, Priya Datta, Gursimran Mohi, Jagdish Chander

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Fluoroquinolones form the mainstay of therapy for the treatment of infections due to Salmonella enterica subsp. enterica. There is a complex interplay between several resistance mechanisms for quinolones and various fluoroquinolones discs, giving varying results, making detection and interpretation of fluoroquinolone resistance difficult. For detection of fluoroquinolone resistance in Salmonella ssp., we compared the use of pefloxacin and nalidixic acid discs as surrogate marker. Using MIC for ciprofloxacin as the gold standard, 43.5% of strains showed MIC as ≥1 μg/ml and were thus resistant to fluoroquinoloes. Based on the performance of nalidixic acid and pefloxacin discs as surrogate marker for ciprofloxacin resistance, both the discs could correctly detect all the resistant phenotypes; however, use of nalidixic acid disc showed false resistance in the majority of the sensitive phenotypes. We have also tested newer antimicrobial agents like cefixime, imipenem, tigecycline and azithromycin against Salmonella spp. Moreover, there was a comeback of susceptibility to older antimicrobials like ampicillin, chloramphenicol, and cotrimoxazole. We can also use cefixime, imipenem, tigecycline and azithromycin in the treatment of multidrug resistant S. typhi due to their high susceptibility.

Keywords: salmonella, pefloxacin, surrogate marker, chloramphenicol

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Authors: Azad Khalid, Ime Akanyeti

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About 68% of the urban solid waste generated in Turkish Republic of Northern Cyprus TRNC is household solid waste, at present, its disposal in landfills. In other hand more than 3000 ton per year of sewage sludge produces in Nicosia waste water treatment plant, the produced sludge piled up without any processing. Co-composting of organic fraction of municipal solid waste and sewage sludge is diverting of municipal solid waste from landfills and best disposal of wastewater sewage sludge. Three 10 L insulated bioreactor R1, R2 and R3 obtained with aeration rate 0.05 m3/h.kg for R2 and R3, R1 was without aeration. The mixture was destined with ratio of sewage sludge: food waste: sawdust; 1:5:0.8 (w/w). The effective of aeration monitored during 42 days of process through investigation in key parameter moisture, C/N ratio, temperature and pH. Results show that the high moisture content cause problem and around 60% recommend, C/N ratio decreased about 17% in aerated reactors and 10% in without aeration and mixture volume reduced in volume 40% in final compost with size of 1.00 to 20.0 mm. temperature in reactors with aeration reached thermophilic phase above 50 °C and <40 °C in without aeration. The final pH is 6.1 in R1, 8.23 in R2 and 8.1 in R3.

Keywords: aeration, sewage sludge, food waste, sawdust, composting

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Authors: Bei Shan Lin, Chun Mei Lu, Ya Ping Chen, Li Chen Lu

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This study explores the ethical issues concerning the use of physical restraint in geriatric care. Physical restraint use in a medical care setting is seen as a controversial form of treatment that has occurred over decades. There is no doubt that people nowadays are living longer than previous generations. The ageing process is inevitable. Common disease such as impaired comprehension, memory loss, and trouble expressing one’s self contribute to the difficulty that these older patients have in adapting to medical institution. For these reasons, physical restraint is often used in reducing the risk of falling, managing wandering behaviour, preventing agitation, and promoting patient compliance in geriatric care. It can mean that physical restraints are considered as a common practice that is used in the care of older patients. It is most commonly used for three specific purposes, including procedural restraint, restraint to prevent falls, and behavioural restraints. Although there have been well documented instances of morbidity and mortality recognised as being potential risks associated with physical restraint use, it continues to be permitted and used in healthcare, often in the name of safety. However, there is insufficient evidence supporting the effectiveness of physical restraint use reducing injuries from falls and controlling challenging behaviour in geriatric care settings. There is barely any empirical evidence of either a scientific basis or clinical trials have evaluated the improvement in patient safety following physical restraint. In difficult clinical situations, guidelines and practical suggestions for Healthcare professionals to comply requirements can help those making appropriate decisions and to facilitate better judgement regarding physical restraint use. The following recommendations are given for physical restraint use in long-term care settings: an interdisciplinary team approach to assess, evaluate, and treat underlying diseases to determine if treatment can ease issues precipitating physical restraint use; a clearly stated purpose of treatment plan should be made after weighing up the risk of physical restraint use against the risk of without physical restraint use; a care plan for physical restraint has to include individualised treatment planning, informed consent, identification and remedial action to avoid negative consequences, regular assessment and modification, reduction and removal of risks; patients and their families must have the opportunity to consider and give voluntary informed consent prior to physical restraint utilisation; patients, family members, and Healthcare professionals should be educated on use and adverse consequences of physical restraints in order to make raise awareness of potential risks and to take appropriate steps to prevent unnecessary harm; after physical restraint removal, Healthcare professionals should discuss with patients and family members about their experience, feelings, and any anxieties regarding the treatment. Physical restraint should always be considered a last resort as deprive patient’s freedom, control, and individuality. Healthcare professionals should emphasise on providing individualized care, interdisciplinary decision-making process, and creative and collaborative alternatives to promote older patient’s rights, dignity and overall well-being as much as possible.

Keywords: ethics healthcare, geriatric care, healthcare, physical restraint

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Authors: Wisit Wichitkosoom

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Objective:The majority of the hisk-risk patients (ST-elevation myocardial infarction (STEMI), Acute cerebrovascular accident, Sepsis, Acute Traumatic patient ) are admitted to district or lacal hospitals (average 1-1.30 hr. from Udonthani general hospital, Northeastern province, Thailand) without proper facilities. The referral system was support to early care and early management at pre-hospital stage and prepare for the patient data to higher hospital. This study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to Udonthani General Hospital. Methods and results: Four district or local hospitals without proper facilities for treatment the very high-risk patient were serving the study region. Pre-hospital diagnoses were established with the simple technology such as LINE, SMS, telephone and Fax for concept of LEAN process and then the telemedicine, by ambulance monitoring (ECG, SpO2, BT, BP) in both real time and snapshot mode was administrated during the period of transfer for safety transfer concept (inter-hospital stage). The standard treatment for patients with STEMI, Intracranial injury and acute cerebrovascular accident were done. From 1 October 2012 to 30 September 2013, the 892 high-risk patients transported by ambulance and transferred to Udonthani general hospital were registered. Patients with STEMI diagnosed pre-hospitally and referred directly to the Udonthani general hospital with telemedicine closed monitor (n=248). The mortality rate decreased from 11.69% in 2011 to 6.92 in 2012. The 34 patients were arrested on the way and successful to CPR during transfer with the telemedicine consultation were 79.41%. Conclusion: The proper innovation could apply for health care system. The very high-risk patients must had the closed monitoring with two-way communication for the “safety transfer period”. It could modified to another high-risk group too.

Keywords: safety transfer, telemedicine, critical patients, medical and health sciences

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Authors: Umar Rehman, Holly Roy, K. T. Tsang, D. S. Jeyaretna, W Singleton, B. Fisher, P. A. Glew, J. Greig, Peter C. Whitfield

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Introduction: A brain abscess is a life-threatening condition, carrying significant mortality. It requires rapid identification and treatment. Management involves a combination of antibiotics and surgery. The aim of the current study was to identify common bacteria responsible for cerebral abscesses as well as the long term functional and neurological outcomes of patients following treatment in a retrospective series at a single UK neurosurgical centre. Methodology: We analysed patients that had received a diagnosis of 'cerebral abscess' or 'subdural empyema' between June 2002 and June 2018. This was done in the form of a retrospective review. The search resulted in a total of 180 patients; with 37 patients being excluded (spinal abscess, below 18 or non-abscess related admissions). Data were collected from medical case notes including information about demographics, comorbidities, immunosuppression, presentation, size/location of lesions, pathogens, treatment, and outcomes. Results: In total, we analysed 143 patients between the ages of 18-90. Focal neurological deficit and headaches were seen in 84% and 68% of patients respectively. 108 positive brain cultures were seen; with the largest proportion, 59.2% being gram-positive cocci, with strep intermedius being the most common pathogen identified in 13.9% of patients. Of the patients with positive blood cultures (n=11), 72.7% showed the same organism both in the blood and on the brain cultures. Long term outcomes (n=72) revealed that 48% of patients seizure-free without requiring anti-epileptics, 51.3% of patients had full recovery of their neurological symptoms. There was a mortality rate of 13.9% in the series. Conclusion: In conclusion, the largest bacterial cause of abscess within our population was due to gram-positive cocci. The majority of the patient demonstrated full neurological recovery with close to half of patients not requiring anti-epileptics following discharge.

Keywords: bacteria, cerebral abscess, long term outcome, neurological deficit

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Authors: Carlos M. Goncalves, Luisa Duarte, Teresa Cartaxo

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The aim of this work was to understand the reasons behind the underutilization of electroconvulsive therapy (ECT) in the younger population and raise possible solutions. We conducted a non-systematic review of literature throughout a search on PubMed, using the terms ‘children’, ‘adolescents’ and ‘electroconvulsive’, ‘therapy’. Candidate articles written in languages other than English were excluded. Articles were selected according to title and/or abstract’s content relevance, resulting in a total of 5 articles. ECT is a recognized effective treatment in adults for several psychiatric conditions. As in adults, ECT in children and adolescents is proven most beneficial in the treatment of severe mood disorders, catatonia, and, to a lesser extent, schizophrenia. ECT in adults has also been used to treat autism’s self-injurious behaviours, Tourette’s syndrome and resistant first-episode schizophrenia disorder. Despite growing evidence on its safety and effectiveness in children and adolescents, like those found in adults, ECT remains a controversial and underused treatment in patients this age, even when it is clearly indicated. There are various possible reasons to this; limited awareness among professionals (lack of knowledge and experience among child psychiatrists), stigmatic public opinion (despite positive feedback from patients and families, there is an unfavourable and inaccurate representation in the media, contributing to a negative public opinion), legal restrictions and ethical controversies (restrictive regulations such as a minimum age for administration), lack of randomized trials (the currently available studies are retrospective, with small size samples, and most of the publications are either case reports or case series). This shows the need to raise awareness and knowledge, not only for mental health professionals, but also to the general population, through the media, regarding indications, methods and safety of ECT in order to provide reliable information to the patient and families. Large-scale longitudinal studies are also useful to further demonstrate the efficacy and safety of ECT and can aid in the formulation of algorithms and guidelines as without these changes, the availability of ECT to the younger population will remain restricted by regulations and social stigma. In conclusion, these results highlight that lack of adequate knowledge and accurate information are the most important factors behind the underutilization of ECT in younger population. Mental healthcare professionals occupy a cornerstone position; if data is given by a well-informed healthcare professional instead of the media, general population (including patients and their families) will probably regard the procedure in a more favourable way. So, the starting point should be to improve health care professional’s knowledge and experience on this choice of treatment.

Keywords: adolescents, children, electroconvulsive, therapy

Procedia PDF Downloads 124

Authors: Christopher R. Triggle, Hong Ding, Khaled Machaca, Gnanapragasam Arunachalam

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The antidiabetic drug, metformin, has been in clinical use for over 50 years and remains the first choice drug for the treatment of type two diabetes. In addition to its effectiveness as an oral anti-hyperglycaemic drug metformin also possesses vasculoprotective effects that are assumed to be secondary to its ability to reduce insulin resistance and control glycated hemoglobin levels; however, recent data from our laboratory indicate that metformin also has direct vasoprotective effects that are mediated, at least in part, via the anti-ageing gene, SIRT1. Diabetes is a major risk factor for the development of cardiovascular disease (CVD) and it is also well established that tobacco use further enhances the risk of CVD; however, it is not known whether treatment with metformin can offset the negative effects of diabetes and tobacco use on cardiac function. The current study was therefore designed to investigate 1: the effects of hyperglycaemia (HG) either alone or in the presence of elevated fatty acids (palmitate) and nicotine on the protein expression levels of the deacetylase sirtuin 1 (the protein product of SIRT1), anti-apoptotic Bcl-2, pro-apoptotic BIM and the pro-apoptotic, tumour suppressor protein, acetylated p53 in cardiomyocytes. 2: the ability of metformin to prevent the detrimental effects of HG, palmitate and nicotine on cardiomyocyte survival. Cell culture protocols were designed using a rat cardiomyocyte cell line, H9c2, either under normal glycaemic (NG) conditions of 5.5mM glucose, or hyperglycaemic conditions (HG) of 25mM glucose with, or without, added palmitate (250μM) or nicotine (1.0mM) for 24h. Immuno-blotting was used to detect the expression of sirtuin 1, Bcl-2, BIM, acetylated (Ac)-p53, p53 with β-actin used as the reference protein. Exposure to HG, palmitate, or nicotine alone significantly reduced expression of sirtuin1, Bcl-2 and raised the expression levels of acetylated p53 and BIM; however, the combination of HG, palmitate and nicotine had a synergistic effect to significantly suppress the expression levels of sirtuin 1 and Bcl-2, but further enhanced the expression of Ac-p53, and BIM. The inclusion of 1000μM, but not 50μM, metformin in the H9c2 cell culture protocol prevented the effects of HG, palmitate and nicotine on the pro-apoptotic pathways. Collectively these data indicate that metformin, in addition to its anti-hyperglycaemic and vasculoprotective properties, also has direct cardioprotective actions that offset the negative effects of hyerglycaemia, elevated free fatty acids and nicotine on cardiac cell survival. These data are of particular significance for the treatment of patients with diabetes who are also smokers as the inclusion of metformin in their therapeutic treatment plan should help reduce cardiac-related morbidity and mortality.

Keywords: apoptosis, cardiac muscle, diabetes, metformin, nicotine

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Authors: J. Hrabovský, M. Chabičovský, J. Horský

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Water spray cooling is a technique typically used in heat treatment and other metallurgical processes where controlled temperature regimes are required. Water spray cooling is used in static (without movement) or dynamic (with movement of the steel plate) regimes. The static regime is notable for the fixed position of the hot steel plate and fixed spray nozzle. This regime is typical for quenching systems focused on heat treatment of the steel plate. The second application of spray cooling is the dynamic regime. The dynamic regime is notable for its static section cooling system and moving steel plate. This regime is used in rolling and finishing mills. The fixed position of cooling sections with nozzles and the movement of the steel plate produce nonhomogeneous water distribution on the steel plate. The length of cooling sections and placement of water nozzles in combination with the nonhomogeneity of water distribution leads to discontinued or interrupted cooling conditions. The impact of static and dynamic regimes on cooling intensity and the heat transfer coefficient during the cooling process of steel plates is an important issue. Heat treatment of steel is accompanied by oxide scale growth. The oxide scale layers can significantly modify the cooling properties and intensity during the cooling. The combination of the static and dynamic (section) regimes with the variable thickness of the oxide scale layer on the steel surface impact the final cooling intensity. The study of the influence of the oxide scale layers with different cooling regimes was carried out using experimental measurements and numerical analysis. The experimental measurements compared both types of cooling regimes and the cooling of scale-free surfaces and oxidized surfaces. A numerical analysis was prepared to simulate the cooling process with different conditions of the section and samples with different oxide scale layers.

Keywords: heat transfer coefficient, numerical analysis, oxide layer, spray cooling

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Authors: U. Pangnakorn, S. Chuenchooklin

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Acute and chronic effects of biopesticide from entomopathogenic nematode (Steinernema thailandensis n. sp.), bacteria ISR (Pseudomonas fluorescens), wood vinegar and fermented organic substances from plants: (neem Azadirachta indica + citronella grass Cymbopogon nardus Rendle + bitter bush Chromolaena odorata L.) were tested on culantro (Eryngium foetidum L.). The biopesticide was investigated for infestation reduction of the major insect pest whitefly (Bemisia tabaci (Gennadius)). The experimental plots were located at a farm in Nakhon Sawan Province, Thailand. This study was undertaken during the drought season (late November to May). Effectiveness of the treatment was evaluated in terms of acute and chronic effect. The populations of whitefly were observed and recorded every hour up to 3 hours with insect nets and yellow sticky traps after the treatments were applied for the acute effect. The results showed that bacteria ISR had the highest effectiveness for controlling whitefly infestation on culantro; the whitefly numbers on insect nets were 12.5, 10.0 and 7.5 after 1 hr, 2 hr, and 3 hr, respectively while the whitefly on yellow sticky traps showed 15.0, 10.0 and 10.0 after 1 hr, 2 hr, and 3 hr, respectively. For chronic effect, the whitefly was continuously collected and recorded at weekly intervals; the result showed that treatment of bacteria ISR found the average whitefly numbers only 8.06 and 11.0 on insect nets and sticky traps respectively, followed by treatment of nematode where the average whitefly was 9.87 and 11.43 on the insect nets and sticky traps, respectively. In addition, the minor insect pests were also observed and collected. The biopesticide influenced the reduction number of minor insect pests (red spider mites, beet armyworm, short-horned grasshopper, pygmy locusts, etc.) with only a few found on the culantro cultivation.

Keywords: whitefly (Bemisia tabaci Gennadius), culantro (Eryngium foetidum L.), acute and chronic effect, entomopathogenic nematode (Steinernema thailandensis n. sp.), bacteria ISR (Pseudomonas fluorescens)

Procedia PDF Downloads 281

Authors: Ramachandra Pradhan, Sandeep Singh Rama, Sabyasachi Mishra

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Jackfruit (Artocarpus heterophyllus L.) in its tender form is consumed as a vegetable and popular for its flavour, colour and meat like texture. In South Asian countries like Bangladesh, India, Pakistan and Indonesia the market value for tender jackfruit is very high. However, due to lack of technology the marketing and transportation of the fruit is a challenge. The processing activities like washing, sorting, peeling and cutting enhances oxidative stress in fresh cut jackfruit. It is also having the ill effects on quality of fresh cut tender jackfruit by an increase in microbial contaminations, excessive tissue softening, and depletion of phytochemicals and browning. Hence, this study was conducted as a solution to the above problem. Fresh cut tender Jackfruit slices were processed by using the independent parameters such as concentration of CaCl2 (2-5%), concentration of citric acid (1-2.5%) and treatment time (4-10 min.) and the depended variables were Browning index (BI), colour change (ΔE), Firmness (F) and Overall all acceptability (OAA) after the treatment. From the response variables the best combination of independent variables was resulted as 3% concentration of CaCl2 and 2% concentration of citric acid for 6 minutes. At these optimised processing treatments, the browning can be prevented for fresh cut tender jackfruit. This technology can be used by the researcher, scientists, industries, etc. for further processing of tender jackfruit.

Keywords: tender jackfruit, browning index, firmness, texture

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Authors: Gimhani Madhushika Hewayalage, Thilini Ariyadasa, Sanja Gunawardena

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In Sri Lanka, the largest contribution for the industrial export earnings is governed by textile and apparel industry. However, this industry generates huge quantities of effluent consists of unfixed dyes which enhance the effluent colour and toxicity thereby leading towards environmental pollution. Therefore, the effluent should properly be treated prior to the release into the environment. The biological technique has now captured much attention as an environmental-friendly and cost-competitive effluent decolourization method due to the drawbacks of physical and chemical treatment techniques. The present study has focused on identifying dye decolourizing potential of several bacterial isolates obtained from the effluent of the local textile industry. Yellow EXF, Red EXF, Blue EXF, Nova Black WNN and Nylosan-Rhodamine-EB dyes have been selected for the study to represent different chromophore groups such as Azo and Xanthene. The rates of decolorization of each dye have been investigated by employing distinct bacterial isolates. Bacterial isolate which exhibited effective dye decolorizing potential was identified as Proteus mirabilis using 16S rRNA gene sequencing analysis. The high decolorizing rates of identified bacterial strain indicate its potential applicability in the treatment of dye-containing wastewaters.

Keywords: azo, bacterial, biological, decolourization, xanthene

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Authors: G. Chakhaia, S. Gogilava, L. Tsulukidze, Z. Laoshvili, I. Khubulava, S. Bosikashvili, T. Gugushvili

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The work reviewed and evaluated various genesis debris flow phenomena recently formatted in the Mletiskhevi, accordingly it revealed necessity of treatment modern debris flow against measures. Based on this, it is proposed the debris flow against truncated semi cone shape construction, which elements are contained in the car’s secondary tires. its constituent elements (sections), due to the possibilities of amortization and geometric shapes is effective and sustainable towards debris flow hitting force. The construction is economical, because after crossing the debris flows in the river bed, the riverbed is not cleanable, also the elements of the building are resource saving. For assessment of influence of cohesive debris flow at the construction and evaluation of the construction effectiveness have been implemented calculation in the specific assumptions with approved methodology. According to the calculation, it was established that after passing debris flow in the debris flow construction (in 3 row case) its hitting force reduces 3 times, that causes reduce of debris flow speed and kinetic energy, as well as sedimentation on a certain section of water drain in the lower part of the construction. Based on the analysis and report on the debris flow against construction, it can be said that construction is effective, inexpensive, technically relatively easy-to-reach measure, that’s why its implementation is prospective.

Keywords: construction, debris flow, sections, theoretical calculation

Procedia PDF Downloads 193

Authors: Sang-Myung Jung, Jeong Hyun Ju, Gwang Heum Yoon, Hwa Sung Shin

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Central nervous system (CNS) consists of neuronal cell and supporting cells. Astrocytes are the most common supporting cells and play roles in metabolism between neurons and blood vessel. For this function, engineered astrocytes have been studied as a therapeutic source for CNS injury. In neural tissue engineering, nanofiber has been suggested as an effective scaffold for providing structure and mechanical properties influencing physiology. Cellulose acetate (CA) has been investigated for material to fabricate scaffold because of its biocompatibility, biodegradability and fine thermal stability. In this research, CA nanofiber was modified via heat treatment and its effect on astrocyte activity was evaluated. Adhesion and viability of astrocyte were increased in proportion to stiffness. Additionally, expression of GFAP, a marker of astrocyte activation, was increased via stiffness of scaffold. This research suggests a simple modification method to change stiffness of CA nanofiber and shows cellular behavior affecting stiffness of three-dimensional scaffold independently. For the results, we highlight that the stiffness is a factor to regulate astrocyte activity.

Keywords: astrocyte, cellulose acetate, cell therapy, stiffness of scaffold

Procedia PDF Downloads 477

Authors: Nuhi Arslani, Stojan Potrc, Timotej Mikuljan

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Background: In Department of Abdominal and General Surgery of University Medical Centre Maribor, we treated 578 patients for rectal cancer between 2004 and 2014. During and after treatment we especially concentrated on monitoring local and systemic complications. Methods: For analysis, we used data gathered from preoperative diagnostic tests, reports gathered during operation, reports from the pathohistologic review, and reports on complications after surgery and follow up. Results: In the case of 573 (out of 578) patients (99.1%) we performed resection. R0 was achieved in 551 patients (96,1%). R1 was achieved in 8 patients (1,4%). R2 was achieved in 14 patients (2,4%). Local complications were reported in 78 (13.5%) patients and systemic complications were reported in 68 (11.7%). We would like to point out the low number of local and systemic complications. Conclusions: With advances in surgical techniques, with a multimodal-multidisciplinary approach and with the use of total mesorectal excision we experienced a significant improvement in reducing the number of local and systemic complications in patients with rectal cancer. However, there still remains the question for truly optimal care for each patient with rectal cancer and his quality of life after surgical treatment.

Keywords: local complications, rectal cancer, resection, systemic complications

Procedia PDF Downloads 167