Search results for: energy balance method

Authors: Loyce Nahwera, Joy Wachira, Edwin Kiptolo, Constance Nsibambi, Mshilla Maghanga, Timothy Makubuya

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Introduction: Hypertension is one of the most prominent risk factors for cardiovascular diseases globally, and it can be modified through lifestyle interventions such as exercise. The objective of this study was to investigate the effects of a 12-week aerobic dance programme on systolic blood pressure (SBP) in stage 1 hypertensive individuals. Methods: This study employed an experimental research design. A total of 36 stage 1 hypertensive individuals who were randomly assigned into experimental and control groups completed the study. Systolic BP was measured using a mercury sphygmomanometer at baseline, mid-point and after the program. The experimental group participants trained 3 days a week, 45 minutes per session, at a moderate intensity of 40-60% of maximum oxygen consumption (VO2max) monitored by Garmin heart rate monitors. Data were analyzed using SPSS version 20. The significance level was set at p<0.05. A paired sample t-test was used to compare mean differences within the groups. Results: Data from the 36 participants (22 males and 14 females) (experimental; n=18, control; n=18) show that the experimental group had a mean SBP of 143.83±6.382 mmHg at baseline while the control had a mean of 137.61±6.400 mmHg. Following the end of a 6-week aerobic dance, the mean SBP of the experimental group reduced to 138.06±9.539 mmHg while that of the control marginally decreased to 137.00±8.073 mmHg. At the completion of a 12-week program, the mean SBP of the experimental group reduced to 136.33±9.191 mmHg, while that of the control marginally increased to 139.56±9.954 mmHg. This implies that both the 6-week and 12-week aerobic dance program reduced the SBP of the experimental group by 5.77±7.133 mmHg and 7.50±8.487 mmHg, respectively, while the control group fast reduced marginally by 0.61 before ultimately increasing by 1.95±7.974 mmHg at 12-weeks. The changes were statistically significant (p<0.05) at both 6 and 12 weeks of an aerobic dance program. Conclusion: The study concluded that aerobic dance is an effective non-pharmacological method for managing SBP of stage 1 hypertensive individuals both in the short-term (6 weeks) and long-term (12 weeks).

Keywords: aerobic dance, blood pressure, stage 1 hypertension, systolic blood pressure.

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Authors: Giovanna Grosso, Martien A. Hulsen, Arash Sarhangi Fard, Andrew Overend, Patrick. D. Anderson

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In many industrial applications and, in particular in polymer industry, the quality of mixing between different materials is fundamental to guarantee the desired properties of finished products. However, properly modelling and understanding polymer mixing often presents noticeable difficulties, because of the variety and complexity of the physical phenomena involved. This is the case of the Cavity Transfer Mixer (CTM), for which a clear understanding of mixing mechanisms is still missing, as well as clear guidelines for the system optimization. This device, invented and patented by Gale at Rapra Technology Limited, is an add-on to be mounted downstream of existing extruders, in order to improve distributive mixing. It consists of two concentric cylinders, the rotor and stator, both provided with staggered rows of hemispherical cavities. The inner cylinder (rotor) rotates, while the outer (stator) remains still. At the same time, the pressure load imposed upstream, pushes the fluid through the CTM. Mixing processes are driven by the flow field generated by the complex interaction between the moving geometry, the imposed pressure load and the rheology of the fluid. In such a context, the present work proposes a complete and accurate three dimensional modelling of the CTM and results of a broad range of simulations assessing the impact on mixing of several geometrical and functioning parameters. Among them, we find: the number of cavities per row, the number of rows, the size of the mixer, the rheology of the fluid and the ratio between the rotation speed and the fluid throughput. The model is composed of a flow part and a mixing part: a finite element solver computes the transient velocity field, which is used in the mapping method implementation in order to simulate the concentration field evolution. Results of simulations are summarized in guidelines for the device optimization.

Keywords: Mixing, non-Newtonian fluids, polymers, rheology.

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Authors: Chidiebere C. Agoha, Chukwuebuka N. Onwubuariri, Collins U.amasike, Tochukwu I. Mgbeojedo, Joy O. Njoku, Lawson J. Osaki, Ifeyinwa J. Ofoh, Francis B. Akiang, Dominic N. Anuforo

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In order to interpret the airborne magnetic data and evaluate the approximate location, depth, and geometry of the magnetic sources within Obudu area using the standard Euler deconvolution method, very high-resolution aeromagnetic data over the area was acquired, processed digitally and analyzed using Oasis Montaj 8.5 software. Data analysis and enhancement techniques, including reduction to the equator, horizontal derivative, first and second vertical derivatives, upward continuation and regional-residual separation, were carried out for the purpose of detailed data Interpretation. Standard Euler deconvolution for structural indices of 0, 1, 2, and 3 was also carried out and respective maps were obtained using the Euler deconvolution algorithm. Results show that the total magnetic intensity ranges from -122.9nT to 147.0nT, regional intensity varies between -106.9nT to 137.0nT, while residual intensity ranges between -51.5nT to 44.9nT clearly indicating the masking effect of deep-seated structures over surface and shallow subsurface magnetic materials. Results also indicated that the positive residual anomalies have an NE-SW orientation, which coincides with the trend of major geologic structures in the area. Euler deconvolution for all the considered structural indices has depth to magnetic sources ranging from the surface to more than 2000m. Interpretation of the various structural indices revealed the locations and depths of the source bodies and the existence of geologic models, including sills, dykes, pipes, and spherical structures. This area is characterized by intrusive and very shallow basement materials and represents an excellent prospect for solid mineral exploration and development.

Keywords: Euler deconvolution, horizontal derivative, Obudu, structural indices

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Authors: Tatjana Jurić, Bojana Blagojević, Denis Uka, Ružica Ždero Pavlović, Boris M. Popović

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Natural deep eutectic solvents (NADES) represent a class of modern systems that have been developed as a green alternative to toxic organic solvents, which are commonly used as extraction media. It has been considered that hydrogen bonding is the main interaction leading to the formation of NADES. The aim of this study was phytochemical characterization and determination of the antioxidant and antibacterial activity of Mentha piperita leaf extracts obtained by six choline chloride-based NADES. NADES were prepared by mixing choline chloride with different hydrogen bond donors in 1:1 molar ratio following the addition of 30% (w/w) water. The mixtures were then heated (60 °C) and stirred (650 rpm) until the clear homogenous liquids were obtained. The Mentha piperita extracts were prepared by mixing 75 mg of peppermint leaves with 1 mL of NADES following by the heating and stirring (60 °C, 650 rpm) within 30 min. The content of six phenolics in extracts was determined using HPLC-PDA. The dominant compounds presented in peppermint leaves - rosmarinic acid and luteolin 7-O-glucoside, were extracted by NADES at a similar level as 70% ethanol. The microdilution method was applied to test the antibacterial activity of extracts. Compared with 70% ethanol, all NADES systems showed higher antibacterial activity towards Pseudomonas aeruginosa (Gram -), Staphylococcus aureus (Gram +), Escherichia coli (Gram -), and Salmonella enterica (Gram -), especially NADES containing organic acids. The majority of NADES extracts showed a better ability to neutralize DPPH radical than conventional solvent and similar ability to reduce Fe3+ to Fe2+ ions in FRAP assay. The obtained results introduce NADES systems as the novel, sustainable, and low-cost solvents with a variety of applications.

Keywords: antibacterial activity, antioxidant activity, green extraction, natural deep eutectic solvents, polyphenols

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Authors: Muqarrab Akbar

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Pakistan is considered as a state confronting different internal and external challenges. Extremism is one of the most vital internal challenges faced by Pakistani society. The state’s contradictory policies, political instability, socio-economic injustice, absence of the rule of law are the major reasons behind the proliferation of violence and extremism in society. The fall of the Shah of Iran, the Iranian revolution, the 1979 Afghan war of 1979, the emergence of Al-Qaeda, Talibanisation, war against terrorism, and involvement of Saudia and Iran have further aggravated the culture of violence and extremism in Pakistan. The absence of a narrative of peaceful coexistence and harmony has created a vacuum for youth in Pakistani society. In the contemporary era, civil society and the government of Pakistan has initiated different steps to introduce a narrative to counter violent extremism. These narratives have helped a lot in creating community resilience to promote peace and harmony among Pakistani society in general and to bridge the gap between the Sunni Shia divide in particular. This paper will highlight those factors in detail that threw the society into extremism and violence, particularly with reference to Sunni Shia divide in Pakistan. This paper explores the impact of sectarian violence in Pakistan and highlights the different initiatives and their impacts on Pakistani society at large. A quantitative method has been adopted to explore the results. Empirical study used in the paper was based on the survey conducted by distributing questionnaires among 300 people from both community Sunni and Shia in Pakistan. Some interviews of the religious scholars of both communities are also conducted for this research. The recent developments on the government level and society levels have created community resilience. The results of the survey show that Pakistani society in the contemporary era is more peaceful and tolerant as compared to the past. The research concludes that the counter-narrative approach is positively affecting the peaceful environment in Pakistan.

Keywords: extremism, Pakistan, Shia, Sunni, violence

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Authors: Ademola Azeez

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Background: This study is a two year review of requests pattern for Prostate Specific Antigen (PSA), in a Nigerian tertiary health care institution. Prostate specific antigen was first described about 44 years ago but is still in use today for, diagnosis, monitoring, screening and prognosis of prostatic carcinoma though not-very specific as was widely believed. Prostate cancer is an increasingly important public health problem among adult men worldwide. Nigeria, which was formerly regarded as a low-incidence area by several authors is now witnessing a steep rise in the occurrence of this disease. This has been suggested to be due to increasing availability of screening tests and diagnostic facilities and not necessarily because of increased incidence of the diseases. Many notable Nigerians have died due to this dreaded disease. Methods: All plasma samples for PSA from January 2021-December 2022 were analyzed weekly by abbot autoanalyser, chemiluminescence assay method. Bio-data from request form were collated and analyzed. A total of 385 requests were received for the period under review. Result: There was an increase of request from inception to the last year of review. Smoked food, consumption of local herb and alcohol in order of importance, respectively, appears to be prominent factor in patient requested for PSA. The mean age was 67.years; the youngest was 29, while the oldest was 93years. Age 70 has the highest frequency of 8.5% .Mean PSA was 12.9ng/ml. There was a positive correlation between age and PSA (R=0.255, P < 0.05).Significant increase in PSA with age were reported. Men who retired from active jobs constitute the highest request for PSA test. Conclusion: There was an increasing trend in the proportion of requests with values outside the reference interval especially in patients diagnosed of benign prostatic hyperplasia, prostate cancer, while some routine test for PSA were elevated for the first time .This is in line with earlier report of increasing incidence of prostate cancer in Nigeria despite the increasing knowledge of healthy lifestyle.

Keywords: pattern, PSA, tertiary institution, Nigeria

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Authors: Luís Rocha, Adam Gąska, Enrico Savio, Michael Marxer, Christoph Battaglia

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The changes observed in the last years in the field of manufacturing and production engineering, popularly known as "Fourth Industry Revolution", utilizes the achievements in the different areas of computer sciences, introducing new solutions at almost every stage of the production process, just to mention such concepts as mass customization, cloud computing, knowledge-based engineering, virtual reality, rapid prototyping, or virtual models of measuring systems. To effectively speed up the production process and make it more flexible, it is necessary to tighten the bonds connecting individual stages of the production process and to raise the awareness and knowledge of employees of individual sectors about the nature and specificity of work in other stages. It is important to discover and develop a suitable education method adapted to the specificities of each stage of the production process, becoming an extremely crucial issue to exploit the potential of the fourth industrial revolution properly. Because of it, the project “Train4Dim” (T4D) intends to develop complex training material for digital manufacturing, including content for design, manufacturing, and quality control, with a focus on coordinate metrology and portable measuring systems. In this paper, the authors present an approach to using an active learning methodology for digital manufacturing. T4D main objective is to develop a multi-degree (apprenticeship up to master’s degree studies) and educational approach that can be adapted to different teaching levels. It’s also described the process of creating the underneath methodology. The paper will share the steps to achieve the aims of the project (training model for digital manufacturing): 1) surveying the stakeholders, 2) Defining the learning aims, 3) producing all contents and curriculum, 4) training for tutors, and 5) Pilot courses test and improvements.

Keywords: learning, Industry 4.0, active learning, digital manufacturing

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Authors: Ghadeer Mohammad Said El-Sheikh, Samer Mohamad Shalhoob

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Medical equipment operation state is a valid reflection of health care organizations' performance, where such equipment highly contributes to the quality of healthcare services on several levels in which quality improvement has become an intrinsic part of the discourse and activities of health care services. In healthcare organizations, clinical and biomedical engineering departments play an essential role in maintaining the safety and efficiency of such equipment. One of the most challenging topics when it comes to such sophisticated equipment is the lifespan of medical equipment, where many factors will impact such characteristics of medical equipment through its life cycle. So far, many attempts have been made in order to address this issue where most of the approaches are kind of arbitrary approaches and one of the criticisms of existing approaches trying to estimate and understand the lifetime of a medical equipment lies under the inquiry of what are the environmental factors that can play into such a critical characteristic of a medical equipment. In an attempt to address this shortcoming, the purpose of our study rises where in addition to the standard technical factors taken into consideration through the decision-making process by a clinical engineer in case of medical equipment failure, the dimension of environmental factors shall be added. The investigations, researches and studies applied for the purpose of supporting the decision making process by a clinical engineers and assessing the lifespan of healthcare equipment’s in the Lebanese society was highly dependent on the identification of technical criteria’s that impacts the lifespan of a medical equipment where the affecting environmental factors didn’t receive the proper attention. The objective of our study is based on the need for introducing a new well-designed plan for evaluating medical equipment depending on two dimensions. According to this approach, the equipment that should be replaced or repaired will be classified based on a systematic method taking into account two essential criteria; the standard identified technical criteria and the added environmental criteria.

Keywords: technical, environmental, healthcare, characteristic of medical equipment

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Authors: Zenaida M. De Guzman, Davison T. Baldos, Gilberto T. Diano, Jeff Darren G. Valdez, Levelyn Mitos Tolentino, Gina B. Abrera, Ma. Lucia Cobar, Cristina Gragasin

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One of the factors affecting the quality of brown rice is the free fatty acid produced from surface lipids. It is the purpose of the study to determine the effect of gamma radiation, packaging materials and age and variety of paddy on the surface free fatty acid content using two different brown rice variety, namely, RC-160 and SL-7, packed in two different packaging materials, namely, regular polyethylene bag and Super bag irradiated at 0.5 and 1.0 kGy. Brown rice was produced from 2-week old (Lot 1) and two months old paddy (Lot 2) and irradiated at the Co-60 Multipurpose Irradiation Facility, PNRI. The surface Free Fatty Acid (FFA) content was obtained following the AOCS Official Method (1982) with some modifications. The experiment was laid out using Split-Plot Randomized Control Block Design. Analysis of variance (ANOVA) showed that the effects of variety, age of paddy and interactions of both were both significant. The surface FFA of SL-7 variety was found to be significantly higher than the RC-160 variety for all radiation doses. Likewise, Lot 2 was observed to have higher surface FFA than Lot 1 regardless of packaging material and radiation dose. It was observed that the surface FFA of both varieties packed in both packaging materials increased significantly up to the 2nd or 3rd month of storage and remains the same until the 5th month. On the other hand, radiation dose did not significantly affect the surface free fatty acid content for all storage/sampling time while the packaging material significantly interacts with the type of variety and radiation dose. Gamma radiation was proven to have no significant effect on the surface free fatty acid at 0.5 and 1.0 kGy and further analyses are needed to determine the action of gamma radiation to the activity of enzyme (lipase-induced and microbial) responsible for the production of other lipolytic products and the effect of gamma radiation on the integrity of the packaging materials.

Keywords: brown rice, free fatty acid, gamma radiation, polyethylene bag

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Authors: Yuxi Liu, Boris Belousov, Mehrzad Esmaeili Charkhab, Oliver Tessmann

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This paper presents a computational solution for designing reconfigurable interlocking structures that are fully assembled with SL Blocks. Formed by S-shaped and L-shaped tetracubes, SL Block is a specific type of interlocking puzzle. Analogous to molecular self-assembly, the aggregation of SL blocks will build a reversible hierarchical and discrete system where a single module can be numerously replicated to compose semi-interlocking components that further align, wrap, and braid around each other to form complex high-order aggregations. These aggregations can be disassembled and reassembled, responding dynamically to design inputs and changes with a unique capacity for reconfiguration. To use these aggregations as architectural structures, we developed computational tools that automate the configuration of SL blocks based on architectural design objectives. There are three critical phases in our work. First, we revisit the hierarchy of the SL block system and devise a top-down-type design strategy. From this, we propose two key questions: 1) How to translate 3D polyominoes into SL block assembly? 2) How to decompose the desired voxelized shapes into a set of 3D polyominoes with interlocking joints? These two questions can be considered the Hamiltonian path problem and the 3D polyomino tiling problem. Then, we derive our solution to each of them based on two methods. The first method is to construct the optimal closed path from an undirected graph built from the voxelized shape and translate the node sequence of the resulting path into the assembly sequence of SL blocks. The second approach describes interlocking relationships of 3D polyominoes as a joint connection graph. Lastly, we formulate the desired shapes and leverage our methods to achieve their reconfiguration within different levels. We show that our computational strategy will facilitate the efficient design of hierarchical interlocking structures with a self-replicating geometric module.

Keywords: computational design, SL-blocks, 3D polyomino puzzle, combinatorial problem

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Authors: Suphap Sikkhaphan, Muwanga Zake, Johnnie Wycliffe Frank

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The purposes of the study included a) investigating the authentic and transformational leadership model of the directors of tambon health promoting hospitals b) evaluating the relation between the authentic and transformation leadership of the directors of tambon health promoting hospitals and the effectiveness of their hospitals and c) assessing the invariance test of the authentic and transformation leadership of the directors of tambon health promoting hospitals. All 400 southern tambon health promoting hospital directors were enrolled into the study. Half were males (200), and another half were females (200). They were sampled via a stratified method. A research tool was a questionnaire paper containing 4 different sections. The Alpha-Cronbach’s Coefficient was equally to .98. Descriptive analysis was used for demographic data, and inferential statistics was used for the relation and invariance tests of authentic and transformational leadership of the directors of tambon health promoting hospitals. The findings revealed overall the authentic and transformation leadership model of the directors of tambon health promoting hospitals has the relation to the effectiveness of the hospitals. Only the factor of “strong community support” was statistically significantly related to the authentic leadership (p < .05). However, there were four latent variables statistically related to the transformational leadership including, competency and work climate, management system, network cooperation, and strong community support (p = .01). Regarding the relation between the authentic and transformation leadership of the directors of tambon health promoting hospitals and the effectiveness of their hospitals, four casual variables of authentic leadership were not related to those latent variables. In contrast, all four latent variables of transformational leadership has statistically significantly related to the effectiveness of tambon health promoting hospitals (p = .001). Furthermore, only management system variable was significantly related to those casual variables of the authentic leadership (p < .05). Regarding the invariance test, the result found no statistical significance of the authentic and transformational leadership model of the directors of tambon health promoting hospitals, especially between male and female genders (p > .05).

Keywords: authentic leadership, transformational leadership, tambon health promoting hospital

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Authors: Boitumelo Setlhare, Mduduzi P. Mokoena, Ademola O. Olaniran

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Agricultural and industrial activities have led to increasing production of xenobiotics such as 2,4-dichlorophenol (2,4-DCP), a derivative of 2,4-dichlorophenoxyacetic acid (2,4-D), which is a widely used herbicide. Bioremediation offers an efficient, cost-effective and environmentally friendly method for degradation of the compound through the activities of the various microbial enzymes involved in the catabolic pathway. The aim of this study was to isolate and characterize bacterial isolate indigenous to contaminated sites in Durban, South Africa for 2,4-DCP degradation. One bacterium capable of utilizing 2,4-DCP as sole carbon source was isolated using culture enrichment technique and identified as Pseudomonas chlororaphis strain UFB2 via PCR amplification and analysis of 16S rRNA gene sequence. This isolate was able to degrade up to 75.11% of 2,4-DCP in batch cultures within 10 days, with the degradation rate constant of 0.14 mg/l/d. Phylogenetic analysis revealed the relatedness of this bacterial isolate to other Pseudomonas sp. previously characterized for chlorophenol degradation. PCR amplification of the catabolic genes involved in 2,4-DCP degradation revealed the presence of the correct amplicons for phenol hydroxylase (600 bp), catechol 1,2-dioxygenase (214 bp), muconate isomerase (851 bp), cis-dienelactone hydrolase (577 bp), and trans-dienelactone hydrolase (491 bp) genes. Enzyme assays revealed activity as high as 21840 mU/mg, 15630 mU/mg, 2340 mU/mg and 1490 mU/mg obtained for phenol hydroxylase, catechol 1,2-dioxygenase, cis-dienelactone hydroxylase and trans-dienelactone hydroxylase, respectively. The absence of catechol 2,3-dioxygenase gene and the corresponding enzyme in this isolate suggests that the organism followed ortho-pathway for 2,4-DCP degradation. Furthermore, the absence of malaycetate reductase genes showed that the bacterium may not be able to completely mineralize 2,4-DCP. Further studies are required to optimize 2,4-DCP degradation by this isolate as well as to elucidate the mechanism of 2,4-DCP degradation.

Keywords: biodegradation, catechol 1, 2-dioxygenase, 2, 4-dichlorophenol, phenol hydroxylase, Pseudomonas chlororaphis

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Authors: Dineshsingh Thakur, S. Nagesh, J. Basha

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A lightweight High Speed Flexible Coupling (HSFC) is used to connect the Engine Gear Box (EGB) with an Accessory Gear Box (AGB) of the combat aircraft. The HSFC transmits the power at high speeds ranging from 10000 to 18000 rpm from the EGB to AGB. The HSFC is also accommodates larger misalignments resulting from thermal expansion of the aircraft engine and mounting arrangement. The HSFC has the series of metallic contoured annular thin cross-sectioned flexible plates to accommodate the misalignments. The flexible plates are accommodating the misalignment by the elastic material flexure. As the HSFC operates at higher speed, the flexural and axial resonance frequencies are to be kept away from the operating speed and proper prediction is required to prevent failure in the transmission line of a single engine fighter aircraft. To study the influence of flexible plate’s contour on the lateral critical speed (LCS) of HSFC, a mathematical model of HSFC as a elven rotor system is developed. The flexible plate being the bending member of the system, its bending stiffness which results from the contoured governs the LCS. Using transfer matrix method, Influence of various flexible plate contours on critical speed is analyzed. In the above analysis, the support bearing flexibility on critical speed prediction is also considered. Based on the study, a model is built with the optimum contour of flexible plate, for validation by experimental modal analysis. A good correlation between the theoretical prediction and model behavior is observed. From the study, it is found that the flexible plate’s contour is playing vital role in modification of system’s dynamic behavior and the present model can be extended for the development of similar type of flexible couplings for its computational simplicity and reliability.

Keywords: flexible rotor, critical speed, experimental modal analysis, high speed flexible coupling (HSFC), misalignment

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Authors: Zhaojun Wang, Zongdi Sun, Yongjie Chen, Manman Chen, Linghui Wang

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This paper uses the analytic hierarchy process to study the execution effect of the minimum purchase price of grain in different regions and various grain crops. Firstly, for different regions, five indicators including grain yield, grain sown area, gross agricultural production, grain consumption price index, and disposable income of rural residents were selected to construct an evaluation index system. We collect data of six provinces including Hebei Province, Heilongjiang Province and Shandong Province from 2006 to 2017. Then, the judgment matrix is constructed, and the hierarchical single ordering and consistency test are carried out to determine the scoring standard for the minimum purchase price of grain. The ranking of the execution effect from high to low is: Heilongjiang Province, Shandong Province, Hebei Province, Guizhou Province, Shaanxi Province, and Guangdong Province. Secondly, taking Shandong Province as an example, we collect the relevant data of sown area and yield of cereals, beans, potatoes and other crops from 2006 to 2017. The weight of area and yield index is determined by expert scoring method. And the average sown area and yield of cereals, beans and potatoes in 2006-2017 were calculated, respectively. On this basis, according to the sum of products of weights and mean values, the execution effects of different grain crops are determined. It turns out that among the cereals, the minimum purchase price had the best execution effect on paddy, followed by wheat and finally maize. Moreover, among major categories of crops, cereals perform best, followed by beans and finally potatoes. Lastly, countermeasures are proposed for different regions, various categories of crops, and different crops of the same category.

Keywords: analytic hierarchy process, grain yield, grain sown area, minimum grain purchase price

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Authors: Naomi Huang Wenya, Xin Xiaohui, Vijaya Rao, Wong Ting Hway, Chow Kah Hoe Pierce, Tan Hiang Khoon

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Background: The majority of the cancelled elective surgeries caused by the COVID-19 pandemic globally were estimated to occur in low- and middle-income countries (LMICs), where surgical services had long been in short supply even before the pandemic. Therefore, minimising disruption to existing surgical care in LMICs is of crucial importance during a pandemic. This study aimed to explore contributory factors to the continuity of surgical care in LMICs, in the face of a pandemic. Methods: Semi-structured interviews were conducted over zoom, with surgical leaders of 25 tertiary hospitals from 11 LMICs in South and Southeast Asia, from September to October 2020. Key themes were subsequently identified from the interview transcripts, using Braun and Clarke's method of thematic analysis. Results: The COVID-19 pandemic affected all surgical services of participating institutions but to varying degrees. Overall, elective surgeries suffered the gravest disruption, followed by outpatient surgical care, and finally, emergency surgeries. Keeping healthcare workers safe and striving for continuity of essential surgical care emerged as notable response strategies observed across all participating institutions. Conclusion: This study suggested that four factors are important for the resilience of surgical care against COVID-19: adequate COVID-19 testing capacity and effective institutional infection control measures, designated COVID-19 treatment facilities, a whole-system approach to balancing pandemic response and meeting essential surgical needs, and active community engagement. These findings can inform healthcare institutions in other countries, especially LMICs, in their effort to tread a fine line between preserving healthcare capacity for pandemic response and protecting surgical services against pandemic disruption.

Keywords: COVID-19, pandemic, LMICs, continuity of surgical service

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Authors: Harley Stephens

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Although fiducial marker insertion is regarded as the ‘gold standard’ in terms of image guided radiotherapy (IGRT), its application must be considered carefully as the procedure can be invasive, time-consuming, and reliant on consultant expertise. Precision of the fiducials is dependent on these markers remaining in the same location and on the prostate not changing shape during the course treatment. To facilitate the acquirement of non-ionising IGRT and intra-fractional prostate tracking, Clarity TPUS was developed as an alternative imaging system. The main benefits of Clarity TPUS are that it is non-invasive, non-ionising and cost-effective. Other studies have compared fiducials to transabdominal ultrasound, which has since been proven to not be as accurate as trans-perineal imaging, as included in this study. CBCT fiducial translations and Clarity TPUS translations for 120 images as part of the PACE-C prostate SABR trial were retrospectively evaluated by three imaging specialists. Differences were analysed using correlation and Bland-Altman plots. Inter-observer matches agreed within 3mm 88.3 % of the time in left/right direction, 86.7 % of the time in in superior/inferior direction, and 91.7% of the time in ant/post direction. They agreed within 5mm more than 98.3 % of the time in all directions. The intra-class correlation co-efficient was calculated for each direction to show agreement between imaging specialist for inter-observer variability. Each was 0.95 or above, with 1 indicating perfect reliability. Agreement between observers was slightly higher for CBCT and fiducials at 98.7% agreement within 5 mm, compared to clarity TPUS where 96.7% agreement was seen within 5mm. Clarity TPUS has the benefit of no additional dose and intra-fractional monitoring, and results show a good correlation between the different modalities. Inter-observer variability is to be considered, and further research with a larger population would be of benefit.

Keywords: oncology, prostate radiotherapy, image guided radiotherapy, IGRT

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Authors: Avanika Gupta

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Education plays a significant and remedial role in balancing the socio-economic fabric of a country. Inclusive education is considered as the most appropriate mode of teaching students with hearing impairment (SwHI) by various national and international legislations. But inclusive education is still an evolving concept among the disability studies scholars and policy makers in India. The study aimed to examine accessibility of SwHI in mainstream schools if there are special provisions for SwHI. The study also intended to identify if the provisions are same for deaf and hard-of-hearing students. Using stratified random sampling technique, a school was selected from each of the six administrative zones of Nagpur city. All the selected schools had primary and secondary level education and were co-educational in nature. Interview with principals of these schools and focused-group- observation method showcased lack of accessibility for SwHI in attending schools. Not even a single school had a hearing impaired student, either deaf or hard-of-hearing depicting the double marginalization of SwHI. This is despite the fact that the right to education is a fundamental right in India, and national legislation on disability has special provisions for ensuring educational opportunities to SwHI. None of the schools even had an Indian Sign Language (ISL) instructor. Both observations seemed cause and effect of one another. One of the principals informed that they have seats for all students with disabilities but they usually lie vacant due to lack of awareness among the parents. One school had 2 students with locomotive impairment while another had a student with visual impairment. Principals of two special schools were also interviewed to understand the reason behind the low enrollment rate of SwHI in mainstream schools. Guardian preference, homogeneity, relatable faculty, familiar environment were some of the chief reasons mentioned. Few suggestions for the policymakers, teachers, guardians and the students are also recommended so that Indian education system could become inclusive in true sense.

Keywords: deaf, hard-of-hearing, inclusive education, India, Nagpur, students with hearing impairment

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Authors: Kalimah Ibrahiim, Israa Elmousa

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This study employed the world café method alongside semi-structured interviews within a 'conversation café' setting to engage stakeholders from the public health and primary care sectors. The objective was to collaboratively explore strategies to improve outcomes for young people not in education, employment, or training (NEET). The discussions were aimed at identifying the underlying causes of disparities faced by NEET individuals, exchanging experiences, and formulating community-driven solutions to bolster preventive efforts and shape policy initiatives. A thematic analysis of the qualitative data gathered emphasized the importance of community problem-solving through the exchange of ideas and reflective discussions. Healthcare professionals reflected on their potential roles, pinpointing a significant gap in understanding the specific needs of the NEET population and the unclear distribution of responsibilities among stakeholders. The results underscore the necessity for a unified approach in primary care and the fostering of multi-agency collaborations that focus on addressing social determinants of health. Such strategies are critical not only for the immediate improvement of health outcomes for NEET individuals but also for informing broader policy decisions that can have long-term benefits. Further research is ongoing, delving deeper into the unique challenges faced by this demographic and striving to develop more effective interventions. The study advocates for continued efforts to integrate insights from various sectors to create a more holistic and effective response to the needs of the NEET population, ensuring that future strategies are informed by a comprehensive understanding of their circumstances and challenges.

Keywords: multi-agency working, primary care, public health, social inequalities

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Authors: Diksha Sapkota, Kathleen Baird, Amornrat Saito, Debra Anderson

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Background: Violence during pregnancy is global public health problem incurring huge amount of social, economic and human costs. It is of particular concern as it affects health of mother, neonates and also disrupt family functioning. Mental illness is one of its commonest consequences affecting both mother and baby and likely to be chronic if left unattended. Past decade has seen advances in knowledge about different forms of violence, its health impacts and intervention/s helping to confront the violence. However, limited range and lack of consistency in measurable outcomes undermine overall effect of interventions, and available evidence are largely slanted towards high-income countries. Despite recognition of integrating screening and counselling for abused pregnant women in health settings, there is a dearth of evidence on its effectiveness from developing countries limiting its applicability and feasibility. This study intends to summarise the high-quality evidence on intimate partner violence interventions in reducing violence and improving mental health and implement the promising intervention in our context. Methods: Quantitative systematic review will be done using PRISMA statement and based on its finding; randomised controlled intervention will be carried out. The study will be conducted among women attending ANC clinic of Dhulikhel Hospital, Nepal. Being the pilot study, samples just adequate to draw the inferences i.e. not less than 30 in each arm will be taken. Phenomological approach will be used to explore the strengths and weaknesses of tested intervention and recommendations for better planning in future. Conclusion: This study intends to provide concrete evidence on what works best in our context and will assist policymakers, programme planners, donors in informed decision making.

Keywords: intimate partner violence/prevention and control, mental health, Nepal, pregnant

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Authors: Dwi Arisandi Wijaya, Ernawati Arifin Giri-Rachman, Neni Nurainy

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Typhoid fever disease can be prevented by using a polysaccharide-based vaccine Vi which is a virulence factor of S.typhi. To produce high yield Vi polysaccharide from bacteria, it is important to know the biosynthesis of Vi polysaccharide and the regulators involved. In the In vivo condition, S. typhi faces different osmolarity, and the bacterial two-component system OmpR-EnvZ, regulate by up and down Capsular Vi polysaccharide biosynthesis. A high yielded Vi Polysaccharide strain, S. typhi strain C6524 used to study the effect of media osmolarity on Vi polysaccharide biosynthesis and the osmoregulation pattern of S. typhi strain C6524. The methods were performed by grown S. typhi strain C6524 grown on medium with 50 mM, 100 mM, and 150 mM osmolarity with the batch system. Vi polysaccharide concentration was measured by ELISA method. For further investigation of the osmoregulation pattern of strain C6524, the osmoregulator gene, OmpR, has been isolated and sequenced using the specific primer of the OmpR gene. Nucleotide sequence analysis is done with BLAST and Lallign. Amino Acid sequence analysis is done with Prosite and Multiple Sequence Alignment. The results of cultivation showed the average content of polysaccharide Vi for 50 mM, 100 mM, and 150 mM osmolarities 11.49 μg/mL, 12.06 μg/mL, and 14.53 μg/mL respectively. Analysis using Anova stated that the osmolarity treatment of 150 mM significantly affects Vi content. Analysis of nucleotide sequences shows 100% identity between S. typhi strain C6524 and Ty2. Analysis of amino acid sequences shows that the OmpR response regulator protein of the C6524 strain also has a α4-β5-α5 motif which is important for the regulatory activation system when phosphorylation occurs by domain kinase. This indicates that the regulator osmolarity response of S. typhi strain C6524 has no difference with the response regulator owned by S. typhi strain Ty2. A high Vi response rate in the 150 mM osmolarity treatment requires further research for RcsB-RcsC, another two-component system involved in Vi Biosynthesis.

Keywords: osmoregulator, OmpR, Salmonella, Vi polysaccharide

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Authors: M. A. Barros, M. V. Barros

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The aim of this work is to analyze the discursive dynamics of preservice teachers during the implementation of a didactic sequence on topics of Quantum Mechanics for High School. Our research methodology was qualitative, case study type, in which we selected two prospective teachers on the Physics Teacher Training Course of the Sao Carlos Institute of Physics, at the University of Sao Paulo/Brazil. The set of modes of communication analyzed were the intentions and interventions of the teachers, the established communicative approach, the patterns and the contents of the interactions between teachers and students. Data were collected through video recording, interviews and questionnaires conducted before and after an 8 hour mini-course, which was offered to a group of 20 secondary students. As teaching strategy we used an active learning methodology, called: Peer Instruction. The episodes pointed out that both future teachers used interactive dialogic and authoritative communicative approaches to mediate the discussion between peers. In the interactive dialogic dimension the communication pattern was predominantly I-R-F (initiation-response-feedback), in which the future teachers assisted the students in the discussion by providing feedback to their initiations and contributing to the progress of the discussions between peers. Although the interactive dialogic dimension has been preferential during the use of the Peer Instruction method the authoritative communicative approach was also employed. In the authoritative dimension, future teachers used predominantly the type I-R-E (initiation-response-evaluation) communication pattern by asking the students several questions and leading them to the correct answer. Among the main implications the work contributes to the improvement of the practices of future teachers involved in applying active learning methodologies in classroom by identifying the types of communicative approaches and communication patterns used, as well as researches on curriculum innovation in physics in high school.

Keywords: curricular innovation, high school, physics teaching, discursive dynamics

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Authors: Ákos Wolf, Richard P. Ray

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Due to the introduction of Eurocode 8, the structural design for seismic and dynamic effects has become more significant in Hungary. This has emphasized the need for more effort to describe the behavior of structures under these conditions. Soil conditions have a significant effect on the response of structures by modifying the stiffness and damping of the soil-structural system and by modifying the seismic action as it reaches the ground surface. Shear modulus (G) and shear wave velocity (v_s), which are often measured in the field, are the fundamental dynamic soil properties for foundation vibration problems, liquefaction potential and earthquake site response analysis. There are several laboratory and in-situ measurement techniques to evaluate dynamic soil properties, but unfortunately, they are often too expensive for general design practice. However, a significant number of correlations have been proposed to determine shear wave velocity or shear modulus from Cone Penetration Tests (CPT), which are used more and more in geotechnical design practice in Hungary. This allows the designer to analyze and compare CPT and seismic test result in order to select the best correlation equations for Hungarian soils and to improve the recommendations for the Hungarian geologic conditions. Based on a literature review, as well as research experience in Hungary, the influence of various parameters on the accuracy of results will be shown. This study can serve as a basis for selecting and modifying correlation equations for Hungarian soils. Test data are taken from seven locations in Hungary with similar geologic conditions. The shear wave velocity values were measured by seismic CPT. Several factors are analyzed including soil type, behavior index, measurement depth, geologic age etc. for their effect on the accuracy of predictions. The final results show an improved prediction method for Hungarian soils

Keywords: CPT correlation, dynamic soil properties, seismic CPT, shear wave velocity

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Authors: Anuj Kumar, Kummara M. Rao, Sung S. Han

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Bone tissue engineering has emerged as a potentially alternative method for localized bone defects or diseases, congenital deformation, and surgical reconstruction. The designing and the fabrication of the ideal scaffold is a great challenge, in restoring of the damaged bone tissues via cell attachment, proliferation, and differentiation under three-dimensional (3D) biological micro-/nano-environment. In this case, hydrogel system composed of high hydrophilic 3D polymeric-network that is able to mimic some of the functional physical and chemical properties of the extracellular matrix (ECM) and possibly may provide a suitable 3D micro-/nano-environment (i.e., resemblance of native bone tissues). Thus, this proposed hydrogel system is highly permeable and facilitates the transport of the nutrients and metabolites. However, the use of hydrogels in bone tissue engineering is limited because of their low mechanical properties (toughness and stiffness) that continue to posing challenges in designing and fabrication of tough and stiff hydrogels along with improved bioactive properties. For this purpose, in our lab, polyacrylamide-based hybrid hydrogels were synthesized by involving sodium alginate, cellulose nanocrystals and silica-based glass using one-step free-radical polymerization. The results showed good in vitro apatite-forming ability (biomineralization) and improved mechanical properties (under compression in the form of strength and stiffness in both wet and dry conditions), and in vitro osteoblastic (MC3T3-E1 cells) cytocompatibility. For in vitro cytocompatibility assessment, both qualitative (attachment and spreading of cells using FESEM) and quantitative (cell viability and proliferation using MTT assay) analyses were performed. The obtained hybrid hydrogels may potentially be used in bone tissue engineering applications after establishment of in vivo characterization.

Keywords: bone tissue engineering, cellulose nanocrystals, hydrogels, polyacrylamide, sodium alginate

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Authors: Matej Buzgo, Erico Himawan, Ksenija JašIna, Aiva Simaite

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Electrospinning is a versatile and efficient technology for producing nanofibers for biomedical applications. One of the most common polymers used for the preparation of nanofibers for regenerative medicine and drug delivery applications is polycaprolactone (PCL). PCL is a biocompatible and bioabsorbable material that can be used to stimulate the regeneration of various tissues. It is also a common material used for the development of drug delivery systems by blending the polymer with small active molecules. However, for many drug delivery applications, e.g. cancer immunotherapy, PCL biodegradation rate that may exceed 9 months is too long, and faster nanofiber dissolution is needed. In this paper, we investigate the dissolution and small molecule release rates of PCL blends with two hydrophilic polymers: polyethylene oxide (PEO) or polyvinylpyrrolidone (PVP). We show that adding hydrophilic polymer to the PCL reduces the water contact angle, increases the dissolution rate, and strengthens the interactions between the hydrophilic drug and polymer matrix that further sustain its release. Finally using this method, we were also able to increase the nanofiber degradation rate when PCL-PEO and PCL-PVP were used as a shell in the electrospun core-shell nanofibers and spread up the release of active proteins from their core. Electrospinning can be used for the preparation of the core-shell nanofibers, where active ingredients are encapsulated in the core and their release rate is regulated by the shell. However, such fibers are usually prepared by coaxial electrospinning that is an extremely low-throughput technique. An alternative is emulsion electrospinning that could be upscaled using needleless blades. In this work, we investigate the possibility of using emulsion electrospinning for encapsulation and sustained release of the growth factors for the development of the organotypic skin models. The core-shell nanofibers were prepared using the optimized formulation and the release rate of proteins from the fibers was investigated for 2 weeks – typical cell culture conditions.

Keywords: electrospinning, polycaprolactone (PCL), polyethylene oxide (PEO), polyvinylpyrrolidone (PVP)

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Authors: Mohammad Moridzadeh, Aaron Gallant

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The paper will present the design and construction of the underground excavations of a pump station forebay and its related components including connector tunnels, access shaft, riser shaft and well shafts. The underground openings include an 8 m-diameter riser shaft, an 8-m-diameter access shaft, 34 2.4-m-diameter well shafts, a 107-m-long forebay with a cross section having a height of 11 m and width of 10 m, and a 6 m by 6 m stub connector tunnel between the access shaft and a future forebay extension. The riser shaft extends down from the existing forebay connector tunnel at elevation 247 m to the crown of the forebay at elevation 770.0 feet. The access shaft will extend from the platform at the surface down to El. 223.5 m. The pump station will have the capacity to deliver 600 million gallons per day. The project is located on an uplifted horst consisting of a mass of Precambrian metamorphic rock trending in a north-south direction. The eastern slope of the area is very steep and pronounced and is likely the result of high-angle normal faulting. Toward the west, the area is bordered by a high angle normal fault and recent alluvial, lacustrine, and colluvial deposits. An evaluation of rock mass properties, fault and discontinuities, foliation and joints, and in situ stresses was performed. The response of the rock mass was evaluated in 3DEC using Discrete Element Method (DEM) by explicitly accounting for both major and minor discontinuities within the rock mass (i.e. joints, shear zones, faults). Moreover, the stability of the entire subsurface structure including the forebay, access and riser shafts, future forebay, well shafts, and connecting tunnels and their interactions with each other were evaluated using a 3D coupled hydromechanical Finite Element Analysis (FEA).

Keywords: coupled hydromechanical analysis, discontinuities, discrete element, finite element, pump station

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Authors: Maryam Beiranvand, Sajad Yaghoubi

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Background: Some microbes can colonize plants’ inner tissues without causing obvious damage and can even produce useful bioactive substances. In the present study, the diversity of the endophytic bacteria associated with medicinal plants from Iran was investigated by culturing techniques, molecular gene identification, as well as measuring them for antibacterial activity. Results: In the spring season from 2013 to 2014, 35 herb pharmacology samples were collected, sterilized, meshed, and then cultured on selective media culture. A total of 199 endophytic bacteria were successfully isolated from 35 tissue cultures of medical plants, and sixty-seven out of 199 bacterial isolates were subjected to identification by the 16S rRNA gene sequence analysis method. Based on the sequence similarity gene and phylogenetic analyses, these isolates were grouped into five classes, fourteen orders, seventeen families, twenty-one genera, and forty strains. The most abundant group of endophytic bacteria was actinobacterial, consisting of thirty-two (47%) out of 67 bacterial isolates. Ten (22.3%) out of 67 bacterial isolates remained unidentified and classified at the genus level. The signature of the 16S rRNA gene formed a distinct line in a phylogenetic tree showing that they might be new species of bacteria. One (5.2%) out of 67 bacterial isolates was still not well categorized. Forty-two out of 67 strains were candidates for antimicrobial activity tests. Nineteen (45%) out of 42 strains showed antimicrobial activity multidrug-resistance (MDR); thirteen (68%) out of 19 strains were allocated to classes actinobacteria. Four (21%) out of 19 strains belonged to the Bacillaceae family, one (5.2%) out of 19 strains was the Paenibacillaceae family, and one (5.2%) out of 19 strains belonged to the Pseudomonadaceae family. The other twenty-three strains did not show inhibitory activities. Conclusions: Our research showed a high-level phylogenetic diversity and the intoxicating antibiotic activity of endophytic bacteria in the herb pharmacology of Iran.

Keywords: medical plant, endophytic bacteria, antimicrobial activity, whole genome sequencing analysis

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Authors: Farzam Fatolazadeh, Kalifa Goita, Mehdi Eshagh, Shusen Wang

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The Gravity Recovery and Climate Experiment (GRACE) is a satellite mission with twin satellites for the precise determination of spatial and temporal variations in the Earth’s gravity field. The products of this mission are monthly global gravity models containing the spherical harmonic coefficients and their errors. These GRACE models can be used for estimating terrestrial water storage (TWS) variations across the globe at large scales, thereby offering an opportunity for surface and groundwater storage (GWS) assessments. Yet, the ability of GRACE to monitor changes at smaller scales is too limited for local water management authorities. This is largely due to the low spatial and temporal resolutions of its models (~200,000 km2 and one month, respectively). High-resolution GRACE data products would substantially enrich the information that is needed by local-scale decision-makers while offering the data for the regions that lack adequate in situ monitoring networks, including northern parts of Canada. Such products could eventually be obtained through downscaling. In this study, we extended the spectral combination theory to simultaneously downscale spatiotemporally the 3o spatial coarse resolution of GRACE to 0.25o degrees resolution and monthly coarse resolution to daily resolution. This method combines the monthly gravity field solution of GRACE and daily hydrological model products in the form of both low and high-frequency signals to produce high spatiotemporal resolution TWSA and GWSA products. The main contribution and originality of this study are to comprehensively and simultaneously consider GRACE and hydrological variables and their uncertainties to form the estimator in the spectral domain. Therefore, it is predicted that we reach downscale products with an acceptable accuracy.

Keywords: GRACE satellite, groundwater storage, spectral combination, terrestrial water storage

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Authors: S. Curtin, A. Trace

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Introduction: As patients can often be ambivalent about or resistant to any change in their smoking behavior the traditional ‘5 A’ model may be limited as it assumes that patients are ready and motivated to change. However, there is a stage model that is helpful to give guidance for dental students: the Transtheoretical Model (TTM). This model allows students to understand the tasks and goals for the pre-contemplation stage. The TTM was introduced in early stages as a core component of a smoking cessation programme that was integrated into a Behavioral Science programme as applied to dentistry. The aim of the present study is to evaluate and illustrate the students’ current level of knowledge from the questions the students generated in order to engage patients in the tasks and goals of the pre-contemplation stage. Method: N=47 responses of fifth-year undergraduate dental students. These responses were the data set for this study and related to their knowledge base of appropriate questions for a dentist to ask at the pre-contemplation stage of change. A deductive -descriptive analysis was conducted on the data. The goals and tasks of the pre-contemplation stage of the TTM provided a template for this deductive analysis. Results: 51% of students generated relevant, open, exploratory questions for the pre-contemplation stage, whilst 100% of students generated closed questions. With regard to those questions appropriate for the pre-contemplation stage, 19% were open and exploratory, while 66% were closed questions. A deductive analysis of the open exploratory questions revealed that 53% of the questions addressed increased concern about the current pattern of behavior, 38% of the questions concerned increased awareness of a need for change and only 8% of the questions dealt with the envisioning of the possibility of change. Conclusion: All students formulated relevant questions for the pre-contemplation stage, and half of the students generated the open, exploratory questions that increased patients’ awareness of the need to change. More training is required to facilitate a shift in the formulation from closed to open questioning, especially given that, traditionally, smoking cessation was modeled on the ‘5 As’, and that the general training for dentists supports an advisory and directive approach.

Keywords: behaviour change, pre-contemplation stage, trans-theoretical model, undergraduate dentistry students

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Authors: Nduduzo Andrias Ngxongo, Nsizwazikhona Simon Chili

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This analytical exploration illustrates how the non-existence of a proper marketing strategy for a tourism destination may have resulted in a radical decline in both financial outputs and visitor arrivals. The marketing strategy is considered as the foundation for any tourism destination’s marketing tactics. Tourism destinations are ought to have dynamic and adaptive marketing strategies that will develop a promotional approach to help the destination to gain market share, identify its target markets, stay relevant to its existing clients, attract new visitors, and increase profits-earned. Accordingly, the Moses Mabhida Stadium (MMS), one of the prominent tourist attractions in KwaZulu-Natal; boasting a world-class architectural design, several international prestigious awards, and vibrant, adventurous activities, has in recent years suffered a gradual slump in both visitors and profits. Therefore, the basis of this paper was to thoroughly establish precisely how the existing MMS marketing strategy may be a basis for a decline in the number of visitors and profits-earned in recent years. The study adopted mixed method research strategy, with 380 participants. The outcome of the study suggests some costly disparities in the marketing strategy of MMS which has led to poor performance and a loss in tourism market share. In consequence, the outcome further suggests that the non-existence of market research analysis and destination marketing tools contributed vastly to the in-progress dilemma. This fact-finding exploration provides a birds-eye outlook of MMS marketing strategy, and based on the results, the study recommends for the introduction of a more far-reaching and revitalising marketing strategy through; constant and persistent market research initiatives, minimal political interference in the administration of state-funded organisations, reassessment of the feasibility study, vigorous, and sourcing of proficient personnel.

Keywords: tourism, destination, marketing , marketing strategy

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Authors: M. Zeitoun, K. Abdallah, M. Rashwan

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Introduction: A growing body of evidence indicates that apelin, a relatively recent member of the adipokines family, has a potential anti-atherogenic effect. An association between low serum apelin state and coronary artery disease (CAD) was previously reported; however, the relationship between apelin and the atherosclerotic burden was unclear. Objectives: Our aim was to explore the correlation of serum apelin level with coronary calcium score (CCS) as a quantitative marker of coronary atherosclerosis. Methods: This observational cross-sectional study enrolled 100 consecutive subjects referred for cardiac multi-detector computed tomography (MDCT) for assessment of CAD (mean age 54 ± 9.7 years, 51 male and 49 females). Clinical parameters, glycemic and lipid profile, high sensitivity CRP (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum creatinine and complete blood count were assessed. Serum apelin levels were determined using a commercially available Enzyme Immunoassay (EIA) Kit. High-resolution non-contrast CT images were acquired by a 64-raw MDCT and CCS was calculated using the Agatston scoring method. Results: Forty-three percent of the studied subjects had positive coronary artery calcification (CAC). The mean CCS was 79 ± 196.5 Agatston units. Subjects with detectable CAC had significantly higher fasting plasma glucose, HbA1c, and WBCs count than subjects without detectable CAC (p < 0.05). Most importantly, subjects with detectable CAC had significantly lower serum apelin level than subjects without CAC (1.3 ± 0.4 ng/ml vs. 2.8 ± 0.6 ng/ml, p < 0.001). In addition, there was a statistically significant inverse correlation between serum apelin levels and CCS (r = 0.591, p < 0.001); on multivariate analysis this correlation was found to be independent of traditional cardiovascular risk factors and hs-CRP. Conclusion:To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

Keywords: HbA1c, apelin, adipokines, coronary calcium score (CCS), coronary artery disease (CAD)

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