Search results for: electrochemical treatment
Commenced in January 2007
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Paper Count: 8548

Search results for: electrochemical treatment

238 A Mixed-Methods Design and Implementation Study of ‘the Attach Project’: An Attachment-Based Educational Intervention for Looked after Children in Northern Ireland

Authors: Hannah M. Russell

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‘The Attach Project’ (TAP), is an educational intervention aimed at improving educational and socio-emotional outcomes for children who are looked after. TAP is underpinned by Attachment Theory and is adapted from Dyadic Developmental Psychotherapy (DDP), which is a treatment for children and young people impacted by complex trauma and disorders of attachment. TAP has been implemented in primary schools in Northern Ireland throughout the 2018/19 academic year. During this time, a design and implementation study has been conducted to assess the promise of effectiveness for the future dissemination and ‘scaling-up’ of the programme for a larger, randomised control trial. TAP has been designed specifically for implementation in a school setting and is comprised of a whole school element and a more individualised Key Adult-Key Child pairing. This design and implementation study utilises a mixed-methods research design consisting of quantitative, qualitative, and observational measures with stakeholder input and involvement being considered an integral component. The use of quantitative measures, such as self-report questionnaires prior to and eight months following the implementation of TAP, enabled the analysis of the strengths and direction of relations between the various components of the programme, as well as the influence of implementation factors. The use of qualitative measures, incorporating semi-structured interviews and focus groups, enabled the assessment of implementation factors, identification of implementation barriers, and potential methods of addressing these issues. Observational measures facilitated the continual development and improvement of ‘TAP training’ for school staff. Preliminary findings have provided evidence of promise for the effectiveness of TAP and indicate the potential benefits of introducing this type of attachment-based intervention across other educational settings. This type of intervention could benefit not only children who are looked after but all children who may be impacted by complex trauma or disorders of attachment. Furthermore, findings from this study demonstrate that it is possible for children to form a secondary attachment relationship with a significant adult in school. However, various implementation factors which should be addressed were identified throughout the study, such as the necessity of protected time being introduced to facilitate the development of a positive Key Adult- Key Child relationship. Furthermore, additional ‘re-cap’ training is required in future dissemination of the programme, to maximise ‘attachment friendly practice’ in the whole staff team. Qualitative findings have also indicated that there is a general opinion across school staff that this type of Key Adult- Key Child pairing could be more effective if it was introduced as soon as children begin primary school. This research has provided ample evidence for the need to introduce relationally based interventions in schools, to help to ensure that children who are looked after, or who are impacted by complex trauma or disorders of attachment, can thrive in the school environment. In addition, this research has facilitated the identification of important implementation factors and barriers to implementation, which can be addressed prior to the ‘scaling-up’ of TAP for a robust, randomised controlled trial.

Keywords: attachment, complex trauma, educational interventions, implementation

Procedia PDF Downloads 146
237 Biological Monitoring: Vegetation Cover, Bird Assemblages, Rodents, Terrestrial and Aquatic Invertebrates from a Closed Landfill

Authors: A. Cittadino, P. Gantes, C. Coviella, M. Casset, A. Sanchez Caro

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Three currently active landfills receive the waste from Buenos Aires city and the Great Buenos Aires suburbs. One of the first landfills to receive solid waste from this area was located in Villa Dominico, some 7 km south from Buenos Aires City. With an area of some 750 ha, including riparian habitats, divided into 14 cells, it received solid wastes from June 1979 through February 2004. In December 2010, a biological monitoring program was set up by CEAMSE and Universidad Nacional de Lujan, still operational to date. The aim of the monitoring program is to assess the state of several biological groups within the landfill and to follow their dynamics overtime in order to identify if any, early signs of damage the landfill activities might have over the biota present. Bird and rodent populations, aquatic and terrestrial invertebrates’ populations, cells vegetation coverage, and surrounding areas vegetation coverage and main composition are followed by quarterly samplings. Bird species richness and abundance were estimated by observation over walk transects on each environment. A total of 74 different species of birds were identified. Species richness and diversity were high for both riparian surrounding areas and within the landfill. Several grassland -typical of the 'Pampa'- bird species were found within the landfill, as well as some migratory and endangered bird species. Sherman and Tomahawk traps are set overnight for small mammal sampling. Rodent populations are just above detection limits, and the few specimens captured belong mainly to species common to rural areas, instead of city-dwelling species. The two marsupial species present in the region were captured on occasions. Aquatic macroinvertebrates were sampled on a watercourse upstream and downstream the outlet of the landfill’s wastewater treatment plant and are used to follow water quality using biological indices. Water quality ranged between weak and severe pollution; benthic invertebrates sampled before and after the landfill, show no significant differences in water quality using the IBMWP index. Insect biota from yellow sticky cards and pitfall traps showed over 90 different morphospecies, with Shannon diversity index running from 1.9 to 3.9, strongly affected by the season. An easy-to-perform non-expert demandant method was used to assess vegetation coverage. Two scales of determination are utilized: field observation (1 m resolution), and Google Earth images (that allow for a better than 5 m resolution). Over the eight year period of the study, vegetation coverage over the landfill cells run from a low 83% to 100% on different cells, with an average between 95 to 99% for the entire landfill depending on seasonality. Surrounding area vegetation showed almost 100% coverage during the entire period, with an average density from 2 to 6 species per sq meter and no signs of leachate damaged vegetation.

Keywords: biological indicators, biota monitoring, landfill species diversity, waste management

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236 Measurement and Modelling of HIV Epidemic among High Risk Groups and Migrants in Two Districts of Maharashtra, India: An Application of Forecasting Software-Spectrum

Authors: Sukhvinder Kaur, Ashok Agarwal

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Background: For the first time in 2009, India was able to generate estimates of HIV incidence (the number of new HIV infections per year). Analysis of epidemic projections helped in revealing that the number of new annual HIV infections in India had declined by more than 50% during the last decade (GOI Ministry of Health and Family Welfare, 2010). Then, National AIDS Control Organisation (NACO) planned to scale up its efforts in generating projections through epidemiological analysis and modelling by taking recent available sources of evidence such as HIV Sentinel Surveillance (HSS), India Census data and other critical data sets. Recently, NACO generated current round of HIV estimates-2012 through globally recommended tool “Spectrum Software” and came out with the estimates for adult HIV prevalence, annual new infections, number of people living with HIV, AIDS-related deaths and treatment needs. State level prevalence and incidence projections produced were used to project consequences of the epidemic in spectrum. In presence of HIV estimates generated at state level in India by NACO, USIAD funded PIPPSE project under the leadership of NACO undertook the estimations and projections to district level using same Spectrum software. In 2011, adult HIV prevalence in one of the high prevalent States, Maharashtra was 0.42% ahead of the national average of 0.27%. Considering the heterogeneity of HIV epidemic between districts, two districts of Maharashtra – Thane and Mumbai were selected to estimate and project the number of People-Living-with-HIV/AIDS (PLHIV), HIV-prevalence among adults and annual new HIV infections till 2017. Methodology: Inputs in spectrum included demographic data from Census of India since 1980 and sample registration system, programmatic data on ‘Alive and on ART (adult and children)’,‘Mother-Baby pairs under PPTCT’ and ‘High Risk Group (HRG)-size mapping estimates’, surveillance data from various rounds of HSS, National Family Health Survey–III, Integrated Biological and Behavioural Assessment and Behavioural Sentinel Surveillance. Major Findings: Assuming current programmatic interventions in these districts, an estimated decrease of 12% points in Thane and 31% points in Mumbai among new infections in HRGs and migrants is observed from 2011 by 2017. Conclusions: Project also validated decrease in HIV new infection among one of the high risk groups-FSWs using program cohort data since 2012 to 2016. Though there is a decrease in HIV prevalence and new infections in Thane and Mumbai, further decrease is possible if appropriate programme response, strategies and interventions are envisaged for specific target groups based on this evidence. Moreover, evidence need to be validated by other estimation/modelling techniques; and evidence can be generated for other districts of the state, where HIV prevalence is high and reliable data sources are available, to understand the epidemic within the local context.

Keywords: HIV sentinel surveillance, high risk groups, projections, new infections

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235 Mixed Monolayer and PEG Linker Approaches to Creating Multifunctional Gold Nanoparticles

Authors: D. Dixon, J. Nicol, J. A. Coulter, E. Harrison

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The ease with which they can be functionalized, combined with their excellent biocompatibility, make gold nanoparticles (AuNPs) ideal candidates for various applications in nanomedicine. Indeed several promising treatments are currently undergoing human clinical trials (CYT-6091 and Auroshell). A successful nanoparticle treatment must first evade the immune system, then accumulate within the target tissue, before enter the diseased cells and delivering the payload. In order to create a clinically relevant drug delivery system, contrast agent or radiosensitizer, it is generally necessary to functionalize the AuNP surface with multiple groups; e.g. Polyethylene Glycol (PEG) for enhanced stability, targeting groups such as antibodies, peptides for enhanced internalization, and therapeutic agents. Creating and characterizing the biological response of such complex systems remains a challenge. The two commonly used methods to attach multiple groups to the surface of AuNPs are the creation of a mixed monolayer, or by binding groups to the AuNP surface using a bi-functional PEG linker. While some excellent in-vitro and animal results have been reported for both approaches further work is necessary to directly compare the two methods. In this study AuNPs capped with both PEG and a Receptor Mediated Endocytosis (RME) peptide were prepared using both mixed monolayer and PEG linker approaches. The PEG linker used was SH-PEG-SGA which has a thiol at one end for AuNP attachment, and an NHS ester at the other to bind to the peptide. The work builds upon previous studies carried out at the University of Ulster which have investigated AuNP synthesis, the influence of PEG on stability in a range of media and investigated intracellular payload release. 18-19nm citrate capped AuNPs were prepared using the Turkevich method via the sodium citrate reduction of boiling 0.01wt% Chloroauric acid. To produce PEG capped AuNPs, the required amount of PEG-SH (5000Mw) or SH-PEG-SGA (3000Mw Jenkem Technologies) was added, and the solution stirred overnight at room temperature. The RME (sequence: CKKKKKKSEDEYPYVPN, Biomatik) co-functionalised samples were prepared by adding the required amount of peptide to the PEG capped samples and stirring overnight. The appropriate amounts of PEG-SH and RME peptide were added to the AuNP to produce a mixed monolayer consisting of approximately 50% PEG and 50% RME. The PEG linker samples were first fully capped with bi-functional PEG before being capped with RME peptide. An increase in diameter from 18-19mm for the ‘as synthesized’ AuNPs to 40-42nm after PEG capping was observed via DLS. The presence of PEG and RME peptide on both the mixed monolayer and PEG linker co-functionalized samples was confirmed by both FTIR and TGA. Bi-functional PEG linkers allow the entire AuNP surface to be capped with PEG, enabling in-vitro stability to be achieved using a lower molecular weight PEG. The approach also allows the entire outer surface to be coated with peptide or other biologically active groups, whilst also offering the promise of enhanced biological availability. The effect of mixed monolayer versus PEG linker attachment on both stability and non-specific protein corona interactions was also studied.

Keywords: nanomedicine, gold nanoparticles, PEG, biocompatibility

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234 Effectiveness of Dry Needling with and without Ultrasound Guidance in Patients with Knee Osteoarthritis and Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis

Authors: Johnson C. Y. Pang, Amy S. N. Fu, Ryan K. L. Lee, Allan C. L. Fu

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Dry needling (DN) is one of the puncturing methods that involves the insertion of needles into the tender spots of the human body without the injection of any substance. DN has long been used to treat the patient with knee pain caused by knee osteoarthritis (KOA) and patellofemoral pain syndrome (PFPS), but the effectiveness is still inconsistent. This study aimed to conduct a systematic review and meta-analysis to assess the intervention methods and effects of DN with and without ultrasound guidance for treating pain and dysfunctions in people with KOA and PFPS. Design: This systematic review adhered to the PRISMA reporting guidelines. The registration number of the study protocol published in the PROSPERO database was CRD42021221419. Six electronic databases were searched manually through CINAHL Complete (1976-2020), Cochrane Library (1996-2020), EMBASE (1947-2020), Medline (1946-2020), PubMed (1966-2020), and Psychinfo (1806-2020) in November 2020. Randomized controlled trials (RCTs) and controlled clinical trials were included to examine the effects of DN on knee pain, including KOA and PFPS. The key concepts included were: DN, acupuncture, ultrasound guidance, KOA, and PFPS. Risk of bias assessment and qualitative analysis were conducted by two independent reviewers using the PEDro score. Results: Fourteen articles met the inclusion criteria, and eight of them were high-quality papers in accordance with the PEDro score. There were variations in the techniques of DN. These included the direction, depth of insertion, number of needles, duration of stay, needle manipulation, and the number of treatment sessions. Meta-analysis was conducted on eight articles. DN group showed positive short-term effects (from immediate after DN to less than 3 months) on pain reduction for both KOA and PFPS with the overall standardized mean difference (SMD) of -1.549 (95% CI=-0.588 to -2.511); with great heterogeneity (P=0.002, I²=96.3%). In subgroup analysis, DN demonstrated significant effects in pain reduction on PFPS (p < 0.001) that could not be found in subjects with KOA (P=0.302). At 3-month post-intervention, DN also induced significant pain reduction in both subjects with KOA and PFPS with an overall SMD of -0.916 (95% CI=-0.133 to -1.699, and great heterogeneity (P=0.022, I²=95.63%). Besides, DN induced significant short-term improvement in function with the overall SMD=6.069; 95% CI=8.595 to 3.544; with great heterogeneity (P<0.001, I²=98.56%) when analyzed was conducted on both KOA and PFPS groups. In subgroup analysis, only PFPS showed a positive result with SMD=6.089, P<0.001; while KOA showed statistically insignificant with P=0.198 in short-term effect. Similarly, at 3-month post-intervention, significant improvement in function after DN was found when the analysis was conducted in both groups with the overall SMD=5.840; 95% CI=9.252 to 2.428; with great heterogeneity (P<0.001, I²=99.1%), but only PFPS showed significant improvement in sub-group analysis (P=0.002, I²=99.1%). Conclusions: The application of DN in KOA and PFPS patients varies among practitioners. DN is effective in reducing pain and dysfunction at short-term and 3-month post-intervention in individuals with PFPS. To our best knowledge, no study has reported the effects of DN with ultrasound guidance on KOA and PFPS. The longer-term effects of DN on KOA and PFPS are waiting for further study.

Keywords: dry needling, knee osteoarthritis, patellofemoral pain syndrome, ultrasound guidance

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233 Developing and Standardizing Individual Care Plan for Children in Conflict with Law in the State of Kerala

Authors: Kavitha Puthanveedu, Kasi Sekar, Preeti Jacob, Kavita Jangam

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In India, The Juvenile Justice (Care and Protection of Children) Act, 2015, the law related to children alleged and found to be in conflict with law, proposes to address to the rehabilitation of children in conflict with law by catering to the basic rights by providing care and protection, development, treatment, and social re-integration. A major concern in addressing the issues of children in conflict with law in Kerala the southernmost state in India identified were: 1. Lack of psychological assessment for children in conflict with law, 2. Poor psychosocial intervention for children in conflict with law on bail, 3. Lack of psychosocial intervention or proper care and protection of CCL residing at observation and special home, 4. Lack convergence with systems related with mental health care. Aim: To develop individual care plan for children in conflict with law. Methodology: NIMHANS a premier Institute of Mental Health and Neurosciences, collaborated with Social Justice Department, Govt. of Kerala to address this issue by developing a participatory methodology to implement psychosocial care in the existing services by integrating the activities through multidisciplinary and multisectoral approach as per the Sec. 18 of JJAct 2015. Developing individual care plan: Key informant interviews, focus group discussion with multiple stakeholders consisting of legal officers, police, child protection officials, counselors, and home staff were conducted. Case studies were conducted among children in conflict with law. A checklist on 80 psychosocial problems among children in conflict with law was prepared with eight major issues identified through the quantitative process such as family and parental characteristic, family interactions and relationships, stressful life event, social and environmental factors, child’s individual characteristics, education, child labour and high-risk behavior. Standardised scales were used to identify the anxiety, caseness, suicidality and substance use among the children. This provided a background data understand the psychosocial problems experienced by children in conflict with law. In the second stage, a detailed plan of action was developed involving multiple stakeholders that include Special juvenile police unit, DCPO, JJB, and NGOs. The individual care plan was reviewed by a panel of 4 experts working in the area of children, followed by the review by multiple stakeholders in juvenile justice system such as Magistrates, JJB members, legal cum probation officers, district child protection officers, social workers and counselors. Necessary changes were made in the individual care plan in each stage which was pilot tested with 45 children for a period of one month and standardized for administering among children in conflict with law. Result: The individual care plan developed through scientific process was standardized and currently administered among children in conflict with law in the state of Kerala in the 3 districts that will be further implemented in other 14 districts. The program was successful in developing a systematic approach for the psychosocial intervention of children in conflict with law that can be a forerunner for other states in India.

Keywords: psychosocial care, individual care plan, multidisciplinary, multisectoral

Procedia PDF Downloads 253
232 Defense Priming from Egg to Larvae in Litopenaeus vannamei with Non-Pathogenic and Pathogenic Bacteria Strains

Authors: Angelica Alvarez-Lee, Sergio Martinez-Diaz, Jose Luis Garcia-Corona, Humberto Lanz-Mendoza

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World aquaculture is always looking for improvements to achieve productions with high yields avoiding the infection by pathogenic agents. The best way to achieve this is to know the biological model to create alternative treatments that could be applied in the hatcheries, which results in greater economic gains and improvements in human public health. In the last decade, immunomodulation in shrimp culture with probiotics, organic acids and different carbon sources has gained great interest, mainly in larval and juvenile stages. Immune priming is associated with a strong protective effect against a later pathogen challenge. This work provides another perspective about immunostimulation from spawning until hatching. The stimulation happens during development embryos and generates resistance to infection by pathogenic bacteria. Massive spawnings of white shrimp L. vannamei were obtained and placed in experimental units with 700 mL of sterile seawater at 30 °C, salinity of 28 ppm and continuous aeration at a density of 8 embryos.mL⁻¹. The immunostimulating effect of three death strains of non-pathogenic bacterial (Escherichia coli, Staphylococcus aureus and Bacillus subtilis) and a pathogenic strain for white shrimp (Vibrio parahaemolyticus) was evaluated. The strains killed by heat were adjusted to O.D. 0.5, at A 600 nm, and directly added to the seawater of each unit at a ratio of 1/100 (v/v). A control group of embryos without inoculum of dead bacteria was kept under the same physicochemical conditions as the rest of the treatments throughout the experiment and used as reference. The duration of the stimulus was 12 hours, then, the larvae that hatched were collected, counted and transferred to a new experimental unit (same physicochemical conditions but at a salinity of 28 ppm) to carry out a challenge of infection against the pathogen V. parahaemolyticus, adding directly to seawater an amount 1/100 (v/v) of the live strain adjusted to an OD 0.5; at A 600 nm. Subsequently, 24 hrs after infection, nauplii survival was evaluated. The results of this work shows that, after 24 hrs, the hatching rates of immunostimulated shrimp embryos with the dead strains of B. subtillis and V. parahaemolyticus are significantly higher compared to the rest of the treatments and the control. Furthermore, survival of L. vanammei after a challenge of infection of 24 hrs against the live strain of V. parahaemolyticus is greater (P < 0.05) in the larvae immunostimulated during the embryonic development with the dead strains B. subtillis and V. parahaemolyticus, followed by those that were treated with E. coli. In summary superficial antigens can stimulate the development cells to promote hatching and can have normal development in agreeing with the optical observations, plus exist a differential response effect between each treatment post-infection. This research provides evidence of the immunostimulant effect of death pathogenic and non-pathogenic bacterial strains in the rate of hatching and oversight of shrimp L. vannamei during embryonic and larval development. This research continues evaluating the effect of these death strains on the expression of genes related to the defense priming in larvae of L. vannamei that come from massive spawning in hatcheries before and after the infection challenge against V. parahaemolyticus.

Keywords: immunostimulation, L. vannamei, hatching, survival

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231 Biomaterials Solutions to Medical Problems: A Technical Review

Authors: Ashish Thakur

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This technical paper was written in view of focusing the biomaterials and its various applications in modern industries. Author tires to elaborate not only the medical, infect plenty of application in other industries. The scope of the research area covers the wide range of physical, biological and chemical sciences that underpin the design of biomaterials and the clinical disciplines in which they are used. A biomaterial is now defined as a substance that has been engineered to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic procedure. Biomaterials are invariably in contact with living tissues. Thus, interactions between the surface of a synthetic material and biological environment must be well understood. This paper reviews the benefits and challenges associated with surface modification of the metals in biomedical applications. The paper also elaborates how the surface characteristics of metallic biomaterials, such as surface chemistry, topography, surface charge, and wettability, influence the protein adsorption and subsequent cell behavior in terms of adhesion, proliferation, and differentiation at the biomaterial–tissue interface. The chapter also highlights various techniques required for surface modification and coating of metallic biomaterials, including physicochemical and biochemical surface treatments and calcium phosphate and oxide coatings. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials. In addition to this, chapter introduces nanomedicine and the use of both natural and synthetic polymeric biomaterials, focuses on specific current polymeric nanomedicine applications and research, and concludes with the challenges of nanomedicine research. Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. Polymeric nanomaterial-based therapeutics plays a key role in the field of medicine in treatment areas such as drug delivery, tissue engineering, cancer, diabetes, and neurodegenerative diseases. Advantages in the use of polymers over other materials for nanomedicine include increased functionality, design flexibility, improved processability, and, in some cases, biocompatibility.

Keywords: nanomedicine, tissue, infections, biomaterials

Procedia PDF Downloads 238
230 Determination of Gross Alpha and Gross Beta Activity in Water Samples by iSolo Alpha/Beta Counting System

Authors: Thiwanka Weerakkody, Lakmali Handagiripathira, Poshitha Dabare, Thisari Guruge

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The determination of gross alpha and beta activity in water is important in a wide array of environmental studies and these parameters are considered in international legislations on the quality of water. This technique is commonly applied as screening method in radioecology, environmental monitoring, industrial applications, etc. Measuring of Gross Alpha and Beta emitters by using iSolo alpha beta counting system is an adequate nuclear technique to assess radioactivity levels in natural and waste water samples due to its simplicity and low cost compared with the other methods. Twelve water samples (Six samples of commercially available bottled drinking water and six samples of industrial waste water) were measured by standard method EPA 900.0 consisting of the gas-less, firm wear based, single sample, manual iSolo alpha beta counter (Model: SOLO300G) with solid state silicon PIPS detector. Am-241 and Sr90/ Y90 calibration standards were used to calibrate the detector. The minimum detectable activities are 2.32mBq/L and 406mBq/L, for alpha and beta activity, respectively. Each of the 2L water samples was evaporated (at low heat) to a small volume and transferred into 50mm stainless steel counting planchet evenly (for homogenization) and heated by IR lamp and the constant weighted residue was obtained. Then the samples were counted for gross alpha and beta. Sample density on the planchet area was maintained below 5mg/cm. Large quantities of solid wastes sludges and waste water are generated every year due to various industries. This water can be reused for different applications. Therefore implementation of water treatment plants and measuring water quality parameters in industrial waste water discharge is very important before releasing them into the environment. This waste may contain different types of pollutants, including radioactive substances. All these measured waste water samples having gross alpha and beta activities, lower than the maximum tolerance limits for industrial waste water discharge of industrial waste in to inland surface water, that is 10-9µCi/mL and 10-8µCi/mL for gross alpha and beta respectively (National Environmental Act, No. 47 of 1980). This is according to extraordinary gazette of the democratic socialist republic of Sri Lanka in February 2008. The measured water samples were below the recommended radioactivity levels and do not pose any radiological hazard when releasing the environment. Drinking water is an essential requirement of life. All the drinking water samples were below the permissible levels of 0.5Bq/L for gross alpha activity and 1Bq/L for gross beta activity. The values have been proposed by World Health Organization in 2011; therefore the water is acceptable for consumption of humans without any further clarification with respect to their radioactivity. As these screening levels are very low, the individual dose criterion (IDC) would usually not be exceeded (0.1mSv y⁻¹). IDC is a criterion for evaluating health risks from long term exposure to radionuclides in drinking water. Recommended level of 0.1mSv/y expressed a very low level of health risk. This monitoring work will be continued further for environmental protection purposes.

Keywords: drinking water, gross alpha, gross beta, waste water

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229 Sublethal Effects of Industrial Effluents on Fish Fingerlings (Clarias gariepinus) from Ologe Lagoon Environs, Lagos, Nigeria

Authors: Akintade O. Adeboyejo, Edwin O. Clarke, Oluwatoyin Aderinola

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The present study is on the sub-lethal toxicity of industrial effluents (IE) from the environment of Ologe Lagoon, Lagos, Nigeria on the African catfish fingerlings Clarias gariepinus. The fish were cultured in varying concentrations of industrial effluents: 0% (control), 5%, 15%, 25%, and 35%. Trials were carried out in triplicates for twelve (12) weeks. The culture system was a static renewable bioassay and was carried out in the fisheries laboratory of the Lagos State University, Ojo-Lagos. Weekly physico-chemical parameters: Temperature (0C), pH, Conductivity (ppm) and Dissolved Oxygen (DO in mg/l) were measured in each treatment tank. Length (cm) and weight (g) data were obtained weekly and used to calculate various growth parameters: mean weight gain (MWG), percentage weight gain (PWG), daily weight gain (DWG), specific growth rate (SGR) and survival. Haematological (Packed Cell Volume (PCV), Red blood cells (RBC), White Blood Cell (WBC), Neutrophil and Lymphocytes etc) and histological alterations were measured after 12 weeks. The physico-chemical parameters showed that the pH ranged from 7.82±0.25–8.07±0.02. DO range from 1.92±0.66-4.43±1.24 mg/l. The conductivity values increased with increase in concentration of I.E. While the temperature remained stable with mean value range between 26.08±2.14–26.38±2.28. The DO showed significant differences at P<0.05. There was progressive increase in length and weight of fish during the culture period. The fish placed in the control had highest increase in both weight and length while fish in 35% had the least. MWG ranged from 16.59–35.96, DWG is from 0.3–0.48, SGR varied from 1.0–1.86 and survival was 100%. Haematological results showed that C. gariepinus had PCV ranging from 13.0±1.7-27.7±0.6, RBC ranged from 4.7±0.6–9.1±0.1, and Neutrophil ranged from 26.7±4.6–61.0±1.0 amongst others. The highest values of these parameters were obtained in the control and lowest at 35%. While the reverse effects were observed for WBC and lymphocytes. This study has shown that effluents may affect the health status of the test organism and impair vital processes if exposure continues for a long period of time. The histological examination revealed several lesions as expressed by the gills and livers. The histopathology of the gills in the control tanks had normal tissues with no visible lesion, but at higher concentrations, there were: lifting of epithelium, swollen lamellae and gill arch infiltration, necrosis and gill arch destruction. While in the liver: control (0%) show normal liver cells, at higher toxic level, there were: vacoulation, destruction of the hepatic parenchyma, tissue becoming eosinophilic (i.e. tending towards Carcinogenicity) and severe disruption of the hepatic cord architecture. The study has shown that industrial effluents from the study area may affect fish health status and impair vital processes if exposure continues for a long period of time even at lower concentrations (Sublethal).

Keywords: sublethal toxicity, industrial effluents, clarias gariepinus, ologe lagoon

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228 Dental Caries among Children in Bazartete, Timor-Leste and the impact of Maluk Timor School Outreach Program

Authors: A. Flaviana da Silva, B. Jenifer Apriani Ximenes, C. Efigenia dos Santos Pereira

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The World Health Organization's 2022 Global Oral Health Status Report reveals a staggering statistic: more than 3.5 billion people, or half of the world's population, currently suffer from untreated oral diseases, encompassing issues like tooth loss, gum disease, and oral cancers. Among these, dental caries, commonly known as tooth decay, affects over 2.5 billion people globally. Dental caries result from acid erosion of teeth due to plaque build-up and consumption of free sugars. Despite being preventable through basic measures such as regular tooth-brushing with fluoride toothpaste and reduced sugar intake, untreated dental caries poses a significant and growing public health crisis. In children, dental caries stands as the most prevalent non-communicable disease worldwide, affecting 60-90% of school children to some extent. This condition severely impacts their physical, emotional, and social well-being, hindering essential activities and overall quality of life. Timor-Leste, a small nation in South-east Asia, grapples with the escalating problem of childhood dental caries, exacerbated by its unique challenges including poor access to healthcare services and limited resources. Methods: This study analysed Secondary, cross-sectional data collected by Maluk Timor in 2022 during the School Outreach Program. A total of 1,008 children aged 4-16 from eight primary schools in the Bazartete administrative post were examined for dental caries in their primary and permanent teeth. All students were invited to participate, and consent was obtained from parents and children. A team comprising one dentist and two dental nurses conducted health promotion sessions, dental examinations, and SDF treatment. A screening form based on WHO guidelines collected demographic data and caries diagnosis, categorized as decayed or healthy. Data analysis involved entering the data into Google Sheets, verifying its accuracy, and importing it into Microsoft Excel for analysis. Variables were created to identify students with carious lesions, and prevalence tables were generated, stratified by age group, gender, and location. Results: Among the 1,008 children analysed, 58.3% had dental caries. Caries prevalence was higher in primary teeth (36.7%) compared to permanent teeth (29.5%). Conclusion: In summary, this report highlights the alarming prevalence of dental caries among children in Timor-Leste and the efforts of Maluk Timor's School Outreach Program in addressing this critical issue. The results emphasize the need for effective preventive measures and improved access to oral healthcare in this region.

Keywords: dental caries, timor-leste, oral health, children, public health, primary health care, teeth

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227 Hexahydropyrimidine-2,4-Diones: Synthesis and Cytotoxic Activity

Authors: M. Koksal, T. Ozyazici, E. Gurdal, M. Yarım, E. Demirpolat, M. B. Y. Aycan

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The discovery of new drugs in cancer chemotherapy is still a major topic because of severe side effects, selectivity problems and resistance development potential of existing drugs. In recent years, combined anticancer therapies or multi-acting drugs are clinically preferred over traditional cytotoxic treatment, with the aim of avoiding resistance and toxic side effects. Arrangement of multi-acting targets can be carried out either by combination of several drugs with different mechanisms or by usage of a single chemical compound capable of regulating several targets of a disease with multiple factors. In literature, several pyrimidine and piperazine derivatives have been involved in the structure of many compounds which have been used as chemotherapeutic agents along with wide clinical applications. The aim of this study is to combine pyrimidine and piperazine core structures to research and develop novel piperazinylpyrimidine derivatives with selective cytotoxicity over cancer cells. In this study, a group of novel 6-fluorophenyl-3-[2-(substitutedpiperazinyl)ethyl] hexahydropyrimidine-2,4-dione derivatives designed to observe the desired anticancer activity due to pyrimidine and piperazine based scaffolds. Target compounds were obtained by the reaction of appropriate piperazine derivatives and 6-(2/4-fluorophenyl)-3-(2-chloroethyl)hexahydropyrimidine-2,4-dione. The synthetic pathway of 6-(2/4-fluorophenyl)-3-(2-chloroethyl)hexahydropyrimidine-2,4-dione was started with Rodionov reaction using aldehyde, malonic acid and ammonium acetate in ethanol. Isolated β-fluorophenyl-β-amino acids were treated with 2-chloroethylisocyanate in the presence of an aqueous sodium hydroxide solution at room temperature to yield the sodium salts of the corresponding ureido acids. By addition of a mineral acid, ureido acids were precipitated. Later, these ureido acids were refluxed in thionyl chloride to give the 6-(2/4-fluorophenyl)-3-(2-chloroethyl)hexahydropyrimidine-2,4-di-one which were furthermore treated with secondary amines. Structures of purified compounds were characterized with IR, 1H-NMR, 13C-NMR, mass spectroscopies and elemental analysis. All of the compounds gave satisfactory analytical and spectroscopic data, which were in full accordance with their depicted structures. In IR spectra of the compounds, N-H group was seen at 3230-3213 cm⁻¹. C-H was seen at 3100-2820 cm⁻¹ and C=O vibrational peaks were observed approximately at 1725 and 1665 cm⁻¹ in accordance with literature. In the NMR spectra of target compounds, the methylene protons of piperazine give two separate multiplet peaks around 3.5 and 4.5 ppm representing the successful N-alkylation of the structure. The cytotoxic activity of the synthesized compounds was investigated on human bronchial epithelial (BEAS 2B), lung (A549), colon adenocarcinoma (COLO205) and breast (MCF7) cell lines, by means of sulphorhodamine B (SRB) assays in triplicate. IC₅₀ values of the screened derivatives were found in range of 11.8-78 µM. This project was supported by The Scientific and Technological Research Council of Turkey (TUBITAK, Project no: 215S157).

Keywords: cytotoxicity, hexahydropyrimidine, piperazine, sulphorhodamine B assay

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226 Supercritical Water Gasification of Organic Wastes for Hydrogen Production and Waste Valorization

Authors: Laura Alvarez-Alonso, Francisco Garcia-Carro, Jorge Loredo

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Population growth and industrial development imply an increase in the energy demands and the problems caused by emissions of greenhouse effect gases, which has inspired the search for clean sources of energy. Hydrogen (H₂) is expected to play a key role in the world’s energy future by replacing fossil fuels. The properties of H₂ make it a green fuel that does not generate pollutants and supplies sufficient energy for power generation, transportation, and other applications. Supercritical Water Gasification (SCWG) represents an attractive alternative for the recovery of energy from wastes. SCWG allows conversion of a wide range of raw materials into a fuel gas with a high content of hydrogen and light hydrocarbons through their treatment at conditions higher than those that define the critical point of water (temperature of 374°C and pressure of 221 bar). Methane used as a transport fuel is another important gasification product. The number of different uses of gas and energy forms that can be produced depending on the kind of material gasified and type of technology used to process it, shows the flexibility of SCWG. This feature allows it to be integrated with several industrial processes, as well as power generation systems or waste-to-energy production systems. The final aim of this work is to study which conditions and equipment are the most efficient and advantageous to explore the possibilities to obtain streams rich in H₂ from oily wastes, which represent a major problem both for the environment and human health throughout the world. In this paper, the relative complexity of technology needed for feasible gasification process cycles is discussed with particular reference to the different feedstocks that can be used as raw material, different reactors, and energy recovery systems. For this purpose, a review of the current status of SCWG technologies has been carried out, by means of different classifications based on key features as the feed treated or the type of reactor and other apparatus. This analysis allows to improve the technology efficiency through the study of model calculations and its comparison with experimental data, the establishment of kinetics for chemical reactions, the analysis of how the main reaction parameters affect the yield and composition of products, or the determination of the most common problems and risks that can occur. The results of this work show that SCWG is a promising method for the production of both hydrogen and methane. The most significant choices of design are the reactor type and process cycle, which can be conveniently adopted according to waste characteristics. Regarding the future of the technology, the design of SCWG plants is still to be optimized to include energy recovery systems in order to reduce costs of equipment and operation derived from the high temperature and pressure conditions that are necessary to convert water to the SC state, as well as to find solutions to remove corrosion and clogging of components of the reactor.

Keywords: hydrogen production, organic wastes, supercritical water gasification, system integration, waste-to-energy

Procedia PDF Downloads 118
225 The Role of Uterine Artery Embolization in the Management of Postpartum Hemorrhage

Authors: Chee Wai Ku, Pui See Chin

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As an emerging alternative to hysterectomy, uterine artery embolization (UAE) has been widely used in the management of fibroids and in controlling postpartum hemorrhage (PPH) unresponsive to other therapies. Research has shown UAE to be a safe, minimally invasive procedure with few complications and minimal effects on future fertility. We present two cases highlighting the use of UAE in preventing PPH in a patient with a large fibroid at the time of cesarean section and in the treatment of secondary PPH refractory to other therapies in another patient. We present a 36-year primiparous woman who booked at 18+6 weeks gestation with a 13.7 cm subserosal fibroid at the lower anterior wall of the uterus near the cervix and a 10.8 cm subserosal fibroid in the left wall. Prophylactic internal iliac artery occlusion balloons were placed prior to the planned classical midline cesarean section. The balloons were inflated once the baby was delivered. Bilateral uterine arteries were embolized subsequently. The estimated blood loss (EBL) was 400 mls and hemoglobin (Hb) remained stable at 10 g/DL. Ultrasound scan 2 years postnatally showed stable uterine fibroids 10.4 and 7.1 cm, which was significantly smaller than before. We present the second case of a 40-year-old G2P1 with a previous cesarean section for failure to progress. There were no antenatal problems, and the placenta was not previa. She presented with term labour and underwent an emergency cesarean section for failed vaginal birth after cesarean. Intraoperatively extensive adhesions were noted with bladder drawn high, and EBL was 300 mls. Postpartum recovery was uneventful. She presented with secondary PPH 3 weeks later complicated by hypovolemic shock. She underwent an emergency examination under anesthesia and evacuation of the uterus, with EBL 2500mls. Histology showed decidua with chronic inflammation. She was discharged well with no further PPH. She subsequently returned one week later for secondary PPH. Bedside ultrasound showed that the endometrium was thin with no evidence of retained products of conception. Uterotonics were administered, and examination under anesthesia was performed, with uterine Bakri balloon and vaginal pack insertion after. EBL was 1000 mls. There was no definite cause of PPH with no uterine atony or products of conception. To evaluate a potential cause, pelvic angiogram and super selective left uterine arteriogram was performed which showed profuse contrast extravasation and acute bleeding from the left uterine artery. Superselective embolization of the left uterine artery was performed. No gross contrast extravasation from the right uterine artery was seen. These two cases demonstrated the superior efficacy of UAE. Firstly, the prophylactic use of intra-arterial balloon catheters in pregnant patients with large fibroids, and secondly, in the diagnosis and management of secondary PPH refractory to uterotonics and uterine tamponade. In both cases, the need for laparotomy hysterectomy was avoided, resulting in the preservation of future fertility. UAE should be a consideration for hemodynamically stable patients in centres with access to interventional radiology.

Keywords: fertility preservation, secondary postpartum hemorrhage, uterine embolization, uterine fibroids

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224 Changes in Physicochemical Characteristics of a Serpentine Soil and in Root Architecture of a Hyperaccumulating Plant Cropped with a Legume

Authors: Ramez F. Saad, Ahmad Kobaissi, Bernard Amiaud, Julien Ruelle, Emile Benizri

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Agromining is a new technology that establishes agricultural systems on ultramafic soils in order to produce valuable metal compounds such as nickel (Ni), with the final aim of restoring a soil's agricultural functions. But ultramafic soils are characterized by low fertility levels and this can limit yields of hyperaccumulators and metal phytoextraction. The objectives of the present work were to test if the association of a hyperaccumulating plant (Alyssum murale) and a Fabaceae (Vicia sativa var. Prontivesa) could induce changes in physicochemical characteristics of a serpentine soil and in root architecture of a hyperaccumulating plant then lead to efficient agromining practices through soil quality improvement. Based on standard agricultural systems, consisting in the association of legumes and another crop such as wheat or rape, a three-month rhizobox experiment was carried out to study the effect of the co-cropping (Co) or rotation (Ro) of a hyperaccumulating plant (Alyssum murale) with a legume (Vicia sativa) and incorporating legume biomass to soil, in comparison with mineral fertilization (FMo), on the structure and physicochemical properties of an ultramafic soil and on root architecture. All parameters measured (biomass, C and N contents, and taken-up Ni) on Alyssum murale conducted in co-cropping system showed the highest values followed by the mineral fertilization and rotation (Co > FMo > Ro), except for root nickel yield for which rotation was better than the mineral fertilization (Ro > FMo). The rhizosphere soil of Alyssum murale in co-cropping had larger soil particles size and better aggregates stability than other treatments. Using geostatistics, co-cropped Alyssum murale showed a greater root surface area spatial distribution. Moreover, co-cropping and rotation-induced lower soil DTPA-extractable nickel concentrations than other treatments, but higher pH values. Alyssum murale co-cropped with a legume showed a higher biomass production, improved soil physical characteristics and enhanced nickel phytoextraction. This study showed that the introduction of a legume into Ni agromining systems could improve yields of dry biomass of the hyperaccumulating plant used and consequently, the yields of Ni. Our strategy can decrease the need to apply fertilizers and thus minimizes the risk of nitrogen leaching and underground water pollution. Co-cropping of Alyssum murale with the legume showed a clear tendency to increase nickel phytoextraction and plant biomass in comparison to rotation treatment and fertilized mono-culture. In addition, co-cropping improved soil physical characteristics and soil structure through larger and more stabilized aggregates. It is, therefore, reasonable to conclude that the use of legumes in Ni-agromining systems could be a good strategy to reduce chemical inputs and to restore soil agricultural functions. Improving the agromining system by the replacement of inorganic fertilizers could simultaneously be a safe way of rehabilitating degraded soils and a method to restore soil quality and functions leading to the recovery of ecosystem services.

Keywords: plant association, legumes, hyperaccumulating plants, ultramafic soil physicochemical properties

Procedia PDF Downloads 142
223 Isolation and Characterization of Chromium Tolerant Staphylococcus aureus from Industrial Wastewater and Their Potential Use to Bioremediate Environmental Chromium

Authors: Muhammad Tariq, Muhammad Waseem, Muhammad Hidayat Rasool

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Isolation and characterization of chromium tolerant Staphylococcus aureus from industrial wastewater and their potential use to bioremediate environmental chromium. Objectives: Chromium with its great economic importance in industrial use is major metal pollutant of the environment. Chromium are used in different industries for various applications such as textile, dyeing and pigmentation, wood preservation, manufacturing pulp and paper, chrome plating, steel and tanning. The release of untreated chromium in industrial effluents causes serious threat to environment and human health, therefore, the current study designed to isolate chromium tolerant Staphylococcus aureus for removal of chromium prior to their final discharge into the environment due to its cost effective and beneficial advantage over physical and chemical methods. Methods: Wastewater samples were collected from discharge point of different industries. Heavy metal analysis by atomic absorption spectrophotometer and microbiological analysis such as total viable count, total coliform, fecal coliform and Escherichia coli were conducted. Staphylococcus aureus was identified through gram’s staining, biomeriux vitek 2 microbial identification system and 16S rRNA gene amplification by polymerase chain reaction. Optimum growth conditions with respect to temperature, pH, salt concentrations and effect of chromium on the growth of bacteria, resistance to other heavy metal ions, minimum inhibitory concentration and chromium uptake ability of Staphylococcus aureus strain K1 was determined by spectrophotometer. Antibiotic sensitivity pattern was also determined by disc diffusion method. Furthermore, chromium uptake ability was confirmed by Fourier transform infrared spectroscopy (FTIR) and scanning electron microscope equipped with Oxford Energy Dipersive X-ray (EDX) micro analysis system. Results: The results presented that optimum temperature was 35ᵒC, pH was 8.0 and salt concentration was 0.5% for growth of Staphylococcus aureus K1. The maximum uptake ability of chromium by bacteria was 20mM than other heavy metal ions. The antibiotic sensitivity pattern revealed that Staphylococcus aureus was vancomycin and methicillin sensitive. Non hemolytic activity on blood agar and negative coagulase reaction showed that it was non-pathogenic. Furthermore, the growth of bacteria decreases in the presence of chromium and maximum chromium uptake by bacteria observed at optimum growth conditions. Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) and Energy dispersive X-ray (EDX) analysis confirmed the presence of chromium uptake by Staphylococcus aureus K1. Conclusion: The study revealed that Staphylococcus aureus K1 have the potential to bio-remediate chromium toxicity from wastewater. Gradually, this biological treatment becomes more important due to its advantage over physical and chemical methods to protect environment and human health.

Keywords: wastewater, staphylococcus, chromium, bioremediation

Procedia PDF Downloads 142
222 Transport of Reactive Carbo-Iron Composite Particles for in situ Groundwater Remediation Investigated at Laboratory and Field Scale

Authors: Sascha E. Oswald, Jan Busch

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The in-situ dechlorination of contamination by chlorinated solvents in groundwater via zero-valent iron (nZVI) is potentially an efficient and prompt remediation method. A key requirement is that nZVI has to be introduced in the subsurface in a way that substantial quantities of the contaminants are actually brought into direct contact with the nZVI in the aquifer. Thus it could be a more flexible and precise alternative to permeable reactive barrier techniques using granular iron. However, nZVI are often limited by fast agglomeration and sedimentation in colloidal suspensions, even more so in the aquifer sediments, which is a handicap for the application to treat source zones or contaminant plumes. Colloid-supported nZVI show promising characteristics to overcome these limitations and Carbo-Iron Colloids is a newly developed composite material aiming for that. The nZVI is built onto finely ground activated carbon of about a micrometer diameter acting as a carrier for it. The Carbo-Iron Colloids are often suspended with a polyanionic stabilizer, and carboxymethyl cellulose is one with good properties for that. We have investigated the transport behavior of Carbo-Iron Colloids (CIC) on different scales and for different conditions to assess its mobility in aquifer sediments as a key property for making its application feasible. The transport properties were tested in one-dimensional laboratory columns, a two-dimensional model aquifer and also an injection experiment in the field. Those experiments were accompanied by non-invasive tomographic investigations of the transport and filtration processes of CIC suspensions. The laboratory experiments showed that a larger part of the CIC can travel at least scales of meters for favorable but realistic conditions. Partly this is even similar to a dissolved tracer. For less favorable conditions this can be much smaller and in all cases a particular fraction of the CIC injected is retained mainly shortly after entering the porous medium. As field experiment a horizontal flow field was established, between two wells with a distance of 5 meters, in a confined, shallow aquifer at a contaminated site in North German lowlands. First a tracer test was performed and a basic model was set up to define the design of the CIC injection experiment. Then CIC suspension was introduced into the aquifer at the injection well while the second well was pumped and samples taken there to observe the breakthrough of CIC. This was based on direct visual inspection and total particle and iron concentrations of water samples analyzed in the laboratory later. It could be concluded that at least 12% of the CIC amount injected reached the extraction well in due course, some of it traveling distances larger than 10 meters in the non-uniform dipole flow field. This demonstrated that these CIC particles have a substantial mobility for reaching larger volumes of a contaminated aquifer and for interacting there by their reactivity with dissolved contaminants in the pore space. Therefore they seem suited well for groundwater remediation by in-situ formation of reactive barriers for chlorinated solvent plumes or even source removal.

Keywords: carbo-iron colloids, chlorinated solvents, in-situ remediation, particle transport, plume treatment

Procedia PDF Downloads 224
221 Associated Factors the Safety of the Patient in Hemodialysis Clinics of a Brazilian Municipality: Cross-Sectional Study

Authors: Magda Milleyde de Sousa Lima, Letícia Lima Aguiar, Marina Guerra Martins, Erika Veríssimo Dias Sousa, Lizandra Sampaio de Oliveira, Lívia Moreira Barros, Joselany Áfio Caetano

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Patients with chronic kidney disease are vulnerable to episodes which make the safety of their health vulnerable, mainly due to the treatment process that exposes them to high rates of interventions during hemodialysis sessions. Some factors associated with health care contribute to the risk of death and complications. However, there are a small number of scientific studies evaluating the level of safety of hemodialysis clinics, and the sociodemographic characteristics of patients and professionals associated with this safety. Therefore, the present study aims to examine the level of patient safety in hemodialysis clinics in the Brazilian capital, to identify the sociodemographic and clinical factors of patients and nursing staff associated with the level of safety. This is an observational, descriptive and quantitative research conducted in three hemodialysis clinics placed in the city of Fortaleza-CE, Brazil, from September to November 2019. The sample was formed after a sample calculation for finite inhabitants of correlation with 200 chronic renal patients, 30 nursing technicians and seven nurses. Conventional sampling was used based on the inclusion criteria: being present at the hemodialysis session on the day the researcher performed the data collection and being 18 years of age or older. Participants who presented communication difficulties to listen to and/or answer the sociodemographic and clinical questionnaire were excluded. Two instruments were applied: sociodemographic and clinical characterization form and Chronic Renal Patient Safety Assessment Scale on Hemodialysis (EASPRCH). The data were analyzed using the Kruskal Walls Test for categorical variables and Spearman correlation coefficient for non-categorical variables, using the Statistical Package SPSS version 20.0. The present study respected the ethical and legal principles determined by resolution 466/2012 of the National Health Council, under the approval of the Ethics and Research Committee with an opinion number: 3,255,635. The results showed that a hemodialysis clinic presented unsafe care practices of 32 points in the EASPRCH (p=0.001). A statistical association was identified between the level of safety and the variables of the patients: level of education (p=0.018), family income (p=0.049), type of employment (p=0.012), venous access site (p=0.009), use of medication during the session (p=0.008) and time of hemodialysis (p=0.002). When evaluating the profile of nurses, a statistical association was evidenced between the level of safety with the variables: marital status (p=0.000), race (p=0.017), schooling (p= 0.000), income (p=0.013), age (p=0.000), clinic workload (p=0.000), time working with hemodialysis (p=0.000), time working in the clinic (p= 0.007) and clinic sizing (p=0.000). In order, the sociodemographic factors of nursing technicians associated with the level of patient safety were: race (p= 0.001) and weekly workload at (p=0.010). Therefore, it is concluded that there is a non-conformity in the level of patient safety in one of the clinics studied and, that sociodemographic and clinical factors of patients and health professionals corroborate the level of safety of the health unit.

Keywords: hemodialysis, nursing, patient safety, quality improvement

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220 Studies on the Bioactivity of Different Solvents Extracts of Selected Marine Macroalgae against Fish Pathogens

Authors: Mary Ghobrial, Sahar Wefky

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Marine macroalgae have proven to be rich source of bioactive compounds with biomedical potential, not only for human but also for veterinary medicine. Emergence of microbial disease in aquaculture industries implies serious loses. Usage of commercial antibiotics for fish disease treatment produces undesirable side effects. Marine organisms are a rich source of structurally novel biologically active metabolites. Competition for space and nutrients led to the evolution of antimicrobial defense strategies in the aquatic environment. The interest in marine organisms as a potential and promising source of pharmaceutical agents has increased in the last years. Many bioactive and pharmacologically active substances have been isolated from microalgae. Compounds with antibacterial, antifungal and antiviral activities have been also detected in green, brown and red algae. Selected species of marine benthic algae belonging to the Phaeophyta and Rhodophyta, collected from different coastal areas of Alexandria (Egypt), were investigated for their antibacterial and antifungal, activities. Macroalgae samples were collected during low tide from the Alexandria Mediterranean coast. Samples were air dried under shade at room temperature. The dry algae were ground, using electric mixer grinder. They were soaked in 10 ml of each of the solvents acetone, ethanol, methanol and hexane. Antimicrobial activity was evaluated using well-cut diffusion technique In vitro screening of organic solvent extracts from the marine macroalgae Laurencia pinnatifida, Pterocladia capillaceae, Stepopodium zonale, Halopteris scoparia and Sargassum hystrix, showed specific activity in inhibiting the growth of five virulent strains of bacteria pathogenic to fish Pseudomonas fluorescens, Aeromonas hydrophila, Vibrio anguillarum, V. tandara, Escherichia coli and two fungi Aspergillus flavus and A. niger. Results showed that, acetone and ethanol extracts of all test macroalgae exhibited antibacterial activity, while acetone extract of the brown Sargassum hystrix displayed the highest antifungal activity. The extracts of seaweeds inhibited bacteria more strongly than fungi and species of the Rhodophyta showed the greatest activity against the bacteria rather than fungi tested. The gas liquid chromatography coupled with mass spectrometry detection technique allows good qualitative and quantitative analysis of the fractionated extracts with high sensitivity to the smaller amounts of components. Results indicated that, the main common component in the acetone extracts of L. pinnatifida and P. capillacea is 4-hydroxy-4-methyl2-pentanone representing 64.38 and 58.60%. Thus, the extracts derived from the red macroalgae were more efficient than those obtained from the brown macroalgae in combating bacterial pathogens rather than pathogenic fungi. The most preferred species over all was the red Laurencia pinnatifida. In conclusion, the present study provides the potential of red and brown macroalgae extracts for development of anti-pathogenic agents for use in fish aquaculture.

Keywords: bacteria, fungi, extracts, solvents

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219 ADAM10 as a Potential Blood Biomarker of Cognitive Frailty

Authors: Izabela P. Vatanabe, Rafaela Peron, Patricia Manzine, Marcia R. Cominetti

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Introduction: Considering the increase in life expectancy of world population, there is an emerging concern in health services to allocate better care and care to elderly, through promotion, prevention and treatment of health. It has been observed that frailty syndrome is prevalent in elderly people worldwide and this complex and heterogeneous clinical syndrome consist of the presence of physical frailty associated with cognitive dysfunction, though in absence of dementia. This can be characterized by exhaustion, unintentional weight loss, decreased walking speed, weakness and low level of physical activity, in addition, each of these symptoms may be a predictor of adverse outcomes such as hospitalization, falls, functional decline, institutionalization, and death. Cognitive frailty is a recent concept in literature, which is defined as the presence of physical frailty associated with mild cognitive impairment (MCI) however in absence of dementia. This new concept has been considered as a subtype of frailty, which along with aging process and its interaction with physical frailty, accelerates functional declines and can result in poor quality of life of the elderly. MCI represents a risk factor for Alzheimer's disease (AD) in view of high conversion rate for this disease. Comorbidities and physical frailty are frequently found in AD patients and are closely related to heterogeneity and clinical manifestations of the disease. The decreased platelets ADAM10 levels in AD patients, compared to cognitively healthy subjects, matched by sex, age and education. Objective: Based on these previous results, this study aims to evaluate whether ADAM10 platelet levels of could act as a biomarker of cognitive frailty. Methods: The study was approved by Ethics Committee of Federal University of São Carlos (UFSCar) and conducted in the municipality of São Carlos, headquarters of Federal University of São Carlos (UFSCar). Biological samples of subjects were collected, analyzed and then stored in a biorepository. ADAM10 platelet levels were analyzed by western blotting technique in subjects with MCI and compared to subjects without cognitive impairment, both with and without presence of frailty. Statistical tests of association, regression and diagnostic accuracy were performed. Results: The results have shown that ADAM10/β-actin ratio is decreased in elderly individuals with cognitive frailty compared to non-frail and cognitively healthy controls. Previous studies performed by this research group, already mentioned above, demonstrated that this reduction is still higher in AD patients. Therefore, the ADAM10/β-actin ratio appears to be a potential biomarker for cognitive frailty. The results bring important contributions to an accurate diagnosis of cognitive frailty from the perspective of ADAM10 as a biomarker for this condition, however, more experiments are being conducted, using a high number of subjects, and will help to understand the role of ADAM10 as biomarker of cognitive frailty and contribute to the implementation of tools that work in the diagnosis of cognitive frailty. Such tools can be used in public policies for the diagnosis of cognitive frailty in the elderly, resulting in a more adequate planning for health teams and better quality of life for the elderly.

Keywords: ADAM10, biomarkers, cognitive frailty, elderly

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218 Reducing Diagnostic Error in Australian Emergency Departments Using a Behavioural Approach

Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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217 Effects of Hydrogen Bonding and Vinylcarbazole Derivatives on 3-Cyanovinylcarbazole Mediated Photo-Cross-Linking Induced Cytosine Deamination

Authors: Siddhant Sethi, Yasuharu Takashima, Shigetaka Nakamura, Kenzo Fujimoto

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Site-directed mutagenesis is a renowned technique to introduce specific mutations in the genome. To achieve site-directed mutagenesis, many chemical and enzymatic approaches have been reported in the past like disulphite induced genome editing, CRISPR-Cas9, TALEN etc. The chemical methods are invasive whereas the enzymatic approaches are time-consuming and expensive. Most of these techniques are unusable in the cellular application due to their toxicity and other limitations. Photo-chemical cytosine deamination, introduced in 2010, is one of the major technique for enzyme-free single-point mutation of cytosine to uracil in DNA and RNA, wherein, 3-cyanovinylcarbazole nucleoside (CNVK) containing oligodeoxyribonucleotide (ODN) having CNVK at -1 position to that of target cytosine is reversibly crosslinked to target DNA strand using 366 nm and then incubated at 90ºC to accommodate deamination. This technique is superior to enzymatic methods of site-directed mutagenesis but has a disadvantage that it requires the use of high temperature for the deamination step which restricts its applicability in the in vivo applications. This study has been focused on improving the technique by reducing the temperature required for deamination. Firstly, the photo-cross-linker, CNVK has been modified by replacing cyano group attached to vinyl group with methyl ester (OMeVK), amide (NH2VK), and carboxylic acid (OHVK) to observe the acceleration in the deamination of target cytosine cross-linked to vinylcarbazole derivative. Among the derivatives, OHVK has shown 2 times acceleration in deamination reaction as compared to CNVK, while the other two derivatives have shown deceleration towards deamination reaction. The trend of rate of deamination reaction follows the same order as that of hydrophilicity of the vinylcarbazole derivatives. OHVK being most hydrophilic has shown highest acceleration while OMeVK is least hydrophilic has proven to be least active for deamination. Secondly, in the related study, the counter-base of the target cytosine, guanine has been replaced by inosine, 2-aminopurine, nebularine, and 5-nitroindole having distinct hydrogen bonding patterns with target cytosine. Among the ODNs with these counter bases, ODN with inosine has shown 12 fold acceleration towards deamination of cytosine cross-linked to CNVK at physiological conditions as compared to guanosine. Whereas, when 2-aminopurine, nebularine, and 5-nitroindole were used, no deamination reaction took place. It can be concluded that inosine has potential to be used as the counter base of target cytosine for the CNVK mediated photo-cross-linking induced deamination of cytosine. The increase in rate of deamination reaction has been attributed to pattern and number of hydrogen bonding between the cytosine and counter base. One of the important factor is presence of hydrogen bond between exo-cyclic amino group of cytosine and the counter base. These results will be useful for development of more efficient technique for site-directed mutagenesis for C → U transformations in the DNA/RNA which might be used in the living system for treatment of various genetic disorders and genome engineering for making designer and non-native proteins.

Keywords: C to U transformation, DNA editing, genome engineering, ultra-fast photo-cross-linking

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216 Edible Active Antimicrobial Coatings onto Plastic-Based Laminates and Its Performance Assessment on the Shelf Life of Vacuum Packaged Beef Steaks

Authors: Andrey A. Tyuftin, David Clarke, Malco C. Cruz-Romero, Declan Bolton, Seamus Fanning, Shashi K. Pankaj, Carmen Bueno-Ferrer, Patrick J. Cullen, Joe P. Kerry

Abstract:

Prolonging of shelf-life is essential in order to address issues such as; supplier demands across continents, economical profit, customer satisfaction, and reduction of food wastage. Smart packaging solutions presented in the form of naturally occurred antimicrobially-active packaging may be a solution to these and other issues. Gelatin film forming solution with adding of natural sourced antimicrobials is a promising tool for the active smart packaging. The objective of this study was to coat conventional plastic hydrophobic packaging material with hydrophilic antimicrobial active beef gelatin coating and conduct shelf life trials on beef sub-primal cuts. Minimal inhibition concentration (MIC) of Caprylic acid sodium salt (SO) and commercially available Auranta FV (AFV) (bitter oranges extract with mixture of nutritive organic acids) were found of 1 and 1.5 % respectively against bacterial strains Bacillus cereus, Pseudomonas fluorescens, Escherichia coli, Staphylococcus aureus and aerobic and anaerobic beef microflora. Therefore SO or AFV were incorporated in beef gelatin film forming solution in concentration of two times of MIC which was coated on a conventional plastic LDPE/PA film on the inner cold plasma treated polyethylene surface. Beef samples were vacuum packed in this material and stored under chilling conditions, sampled at weekly intervals during 42 days shelf life study. No significant differences (p < 0.05) in the cook loss was observed among the different treatments compared to control samples until the day 29. Only for AFV coated beef sample it was 3% higher (37.3%) than the control (34.4 %) on the day 36. It was found antimicrobial films did not protect beef against discoloration. SO containing packages significantly (p < 0.05) reduced Total viable bacterial counts (TVC) compared to the control and AFV samples until the day 35. No significant reduction in TVC was observed between SO and AFV films on the day 42 but a significant difference was observed compared to control samples with a 1.40 log of bacteria reduction on the day 42. AFV films significantly (p < 0.05) reduced TVC compared to control samples from the day 14 until the day 42. Control samples reached the set value of 7 log CFU/g on day 27 of testing, AFV films did not reach this set limit until day 35 and SO films until day 42 of testing. The antimicrobial AFV and SO coated films significantly prolonged the shelf-life of beef steaks by 33 or 55% (on 7 and 14 days respectively) compared to control film samples. It is concluded antimicrobial coated films were successfully developed by coating the inner polyethylene layer of conventional LDPE/PA laminated films after plasma surface treatment. The results indicated that the use of antimicrobial active packaging coated with SO or AFV increased significantly (p < 0.05) the shelf life of the beef sub-primal. Overall, AFV or SO containing gelatin coatings have the potential of being used as effective antimicrobials for active packaging applications for muscle-based food products.

Keywords: active packaging, antimicrobials, edible coatings, food packaging, gelatin films, meat science

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215 Separation of Urinary Proteins with Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis in Patients with Secondary Nephropathies

Authors: Irena Kostovska, Katerina Tosheska Trajkovska, Svetlana Cekovska, Julijana Brezovska Kavrakova, Hristina Ampova, Sonja Topuzovska, Ognen Kostovski, Goce Spasovski, Danica Labudovic

Abstract:

Background: Proteinuria is an important feature of secondary nephropathies. The quantitative and qualitative analysis of proteinuria plays an important role in determining the types of proteinuria (glomerular, tubular and mixed), in the diagnosis and prognosis of secondary nephropathies. The damage of the glomerular basement membrane is responsible for a proteinuria characterized by the presence of large amounts of protein with high molecular weights such as albumin (69 kilo Daltons-kD), transferrin (78 kD) and immunoglobulin G (150 kD). An insufficiency of proximal tubular function is the cause of a proteinuria characterized by the presence of proteins with low molecular weight (LMW), such as retinol binding protein (21 kD) and α1-microglobulin (31 kD). In some renal diseases, a mixed glomerular and tubular proteinuria is frequently seen. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) is the most widely used method of analyzing urine proteins for clinical purposes. The main aim of the study is to determine the type of proteinuria in the most common secondary nephropathies such as diabetic, hypertensive nephropathy and preeclampsia. Material and methods: In this study were included 90 subjects: subjects with diabetic nephropathy (n=30), subjects with hypertensive nephropahty (n=30) and pregnant women with preeclampsia (n=30). We divided all subjects according to UM/CR into three subgroups: macroalbuminuric (UM/CR >300 mg/g), microalbuminuric (UM/CR 30-300 mg/g) and normolabuminuric (UM/CR<30 mg/g). In all subjects, we measured microalbumin and creatinine in urine with standard biochemical methods. Separation of urinary proteins was performed by SDS-PAGE, in several stages: linear gel preparation (4-22%), treatment of urinary samples before their application on the gel, electrophoresis, gel fixation, coloring with Coomassie blue, and identification of the separated protein fractions based on standards with exactly known molecular weight. Results: According to urinary microalbumin/creatinin ratio in group of subject with diabetic nephropathy, nine patients were macroalbuminuric, while 21 subject were microalbuminuric. In group of subjects with hypertensive nephropathy, we found macroalbuminuria (n=4), microalbuminuria (n=20) and normoalbuminuria (n=6). All pregnant women with preeclampsia were macroalbuminuric. Electrophoretic separation of urinary proteins showed that in macroalbuminric patients with diabetic nephropathy 56% have mixed proteinuria, 22% have glomerular proteinuria and 22% have tubular proteinuria. In subgroup of subjects with diabetic nephropathy and microalbuminuria, 52% have glomerular proteinuria, 8% have tubular proteinuria, and 40% of subjects have normal electrophoretic findings. All patients with maroalbuminuria and hypertensive nephropathy have mixed proteinuria. In subgroup of patients with microalbuminuria and hypertensive nephropathy, we found: 32% with mixed proteinuria, 27% with normal findings, 23% with tubular, and 18% with glomerular proteinuria. In all normoalbuminruic patiens with hypertensive nephropathy, we detected normal electrophoretic findings. In group of subjects pregnant women with preeclampsia, we found: 81% with mixed proteinuria, 13% with glomerular, and 8% with tubular proteinuria. Conclusion: By SDS PAGE method, we detected that in patients with secondary nephropathies the most common type of proteinuria is mixed proteinuria, indicating both loss of glomerular permeability and tubular function. We can conclude that SDS PAGE is high sensitive method for detection of renal impairment in patients with secondary nephropathies.

Keywords: diabetic nephropathy, preeclampsia, hypertensive nephropathy, SDS PAGE

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214 Phycoremiadation of Heavy Metals by Marine Macroalgae Collected from Olaikuda, Rameswaram, Southeast Coast of India

Authors: Suparna Roy, Anatharaman Perumal

Abstract:

The industrial effluent with high amount of heavy metals is known to have adverse effects on the environment. For the removal of heavy metals from aqueous environment, different conventional treatment technologies had been applied gradually which are not economically beneficial and also produce huge quantity of toxic chemical sludge. So, bio-sorption of heavy metals by marine plant is an eco-friendly innovative and alternative technology for removal of these pollutants from aqueous environment. The aim of this study is to evaluate the capacity of heavy metals accumulation and removal by some selected marine macroalgae (seaweeds) from marine environment. Methods: Seaweeds Acanthophora spicifera (Vahl.) Boergesen, Codium tomentosum Stackhouse, Halimeda gracilis Harvey ex. J. Agardh, Gracilaria opuntia Durairatnam.nom. inval. Valoniopsis pachynema (Martens) Boergesen, Caulerpa racemosa var. macrophysa (Sonder ex Kutzing) W. R. Taylor and Hydroclathrus clathratus (C. Agardh) Howe were collected from Olaikuda (09°17.526'N-079°19.662'E), Rameshwaram, south east coast of India during post monsoon period (April’2016). Seaweeds were washed with sterilized and filtered in-situ seawater repeatedly to remove all the epiphytes and debris and clean seaweeds were kept for shade drying for one week. The dried seaweeds were grinded to powder, and one gm powder seaweeds were taken in a 250ml conical flask, and 8 ml of 10 % HNO3 (70 % pure) was added to each sample and kept in room temperature (28 ̊C) for 24 hours and then samples were heated in hotplate at 120 ̊C, boiled to evaporate up to dryness and 20 ml of Nitric acid: Percholoric acid in 4:1 were added to it and again heated to hotplate at 90 ̊C up to evaporate to dryness, then samples were kept in room temperature for few minutes to cool and 10ml 10 % HNO3 were added to it and kept for 24 hours in cool and dark place and filtered with Whatman (589/2) filter paper and the filtrates were collected in 250ml clean conical flask and diluted accurately to 25 ml volume with double deionised water and triplicate of each sample were analysed with Inductively-Coupled plasma analysis (ICP-OES) to analyse total eleven heavy metals (Ag, Cd, B, Cu, Mn, Co, Ni, Cr, Pb, Zn, and Al content of the specified species and data were statistically evaluated for standard deviation. Results: Acanthophora spicifera contains highest amount of Ag (0.1± 0.2 mg/mg) followed by Cu (0.16±0.01 mg/mg), Mn (1.86±0.02 mg/mg), B (3.59±0.2 mg/mg), Halimeda gracilis showed highest accumulation of Al (384.75±0.12mg/mg), Valoniopsis pachynema accumulates maximum amount of Co (0.12±0.01 mg/mg), Zn (0.64±0.02 mg/mg), Caulerpa racemosa var. macrophysa contains Zn (0.63±0.01), Cr (0.26±0.01 mg/mg ), Ni (0.21±0.05), Pb (0.16±0.03 ) and Cd ( 0.02±00 ). Hydroclathrus clathratus, Codium tomentosum and Gracilaria opuntia also contain adequate amount of heavy metals. Conclusions: The mentioned species of seaweeds are contributing important role for decreasing the heavy metals pollution in marine environment by bioaccumulation. So, we can utilise this species to remove excess amount of heavy metals from polluted area.

Keywords: heavy metals pollution, seaweeds, bioaccumulation, eco-friendly, phyco-remediation

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213 Endometrial Biopsy Curettage vs Endometrial Aspiration: Better Modality in Female Genital Tuberculosis

Authors: Rupali Bhatia, Deepthi Nair, Geetika Khanna, Seema Singhal

Abstract:

Introduction: Genital tract tuberculosis is a chronic disease (caused by reactivation of organisms from systemic distribution of Mycobacterium tuberculosis) that often presents with low grade symptoms and non-specific complaints. Patients with genital tuberculosis are usually young women seeking workup and treatment for infertility. Infertility is the commonest presentation due to involvement of the fallopian tubes, endometrium and ovarian damage with poor ovarian volume and reserve. The diagnosis of genital tuberculosis is difficult because of the fact that it is a silent invader of genital tract. Since tissue cannot be obtained from fallopian tubes, the diagnosis is made by isolation of bacilli from endometrial tissue obtained by endometrial biopsy curettage and/or aspiration. Problems are associated with sampling technique as well as diagnostic modality due to lack of adequate sample volumes and the segregation of the sample for various diagnostic tests resulting in non-uniform distribution of microorganisms. Moreover, lack of an efficient sampling technique universally applicable for all specific diagnostic tests contributes to the diagnostic challenges. Endometrial sampling plays a key role in accurate diagnosis of female genital tuberculosis. It may be done by 2 methods viz. endometrial curettage and endometrial aspiration. Both endometrial curettage and aspirate have their own limitations as curettage picks up strip of the endometrium from one of the walls of the uterine cavity including tubal osteal areas whereas aspirate obtains total tissue with exfoliated cells present in the secretory fluid of the endometrial cavity. Further, sparse and uneven distribution of the bacilli remains a major factor contributing to the limitations of the techniques. The sample that is obtained by either technique is subjected to histopathological examination, AFB staining, culture and PCR. Aim: Comparison of the sampling techniques viz. endometrial biopsy curettage and endometrial aspiration using different laboratory methods of histopathology, cytology, microbiology and molecular biology. Method: In a hospital based observational study, 75 Indian females suspected of genital tuberculosis were selected on the basis of inclusion criteria. The women underwent endometrial tissue sampling using Novaks biopsy curette and Karmans cannula. One part of the specimen obtained was sent in formalin solution for histopathological testing and another part was sent in normal saline for acid fast bacilli smear, culture and polymerase chain reaction. The results so obtained were correlated using coefficient of correlation and chi square test. Result: Concordance of results showed moderate agreement between both the sampling techniques. Among HPE, AFB and PCR, maximum sensitivity was observed for PCR, though the specificity was not as high as other techniques. Conclusion: Statistically no significant difference was observed between the results obtained by the two sampling techniques. Therefore, one may use either EA or EB to obtain endometrial samples and avoid multiple sampling as both the techniques are equally efficient in diagnosing genital tuberculosis by HPE, AFB, culture or PCR.

Keywords: acid fast bacilli (AFB), histopatholgy examination (HPE), polymerase chain reaction (PCR), endometrial biopsy curettage

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212 Management of Myofascial Temporomandibular Disorder in Secondary Care: A Quality Improvement Project

Authors: Rishana Bilimoria, Selina Tang, Sajni Shah, Marianne Henien, Christopher Sproat

Abstract:

Temporomandibular disorders (TMD) may affect up to a third of the general population, and there is evidence demonstrating the majority of Myofascial TMD cases improve after education and conservative measures. In 2015 our department implemented a modified care pathway for myofascial TMD patients in an attempt to improve the patient journey. This involved the use of an interactive group therapy approach to deliver education, reinforce conservative measures and promote self-management. Patient reported experience measures from the new group clinic revealed 71% patient satisfaction. This service is efficient in improving aspects of health status while reducing health-care costs and redistributing clinical time. Since its’ establishment, 52 hours of clinical time, resources and funding have been redirected effectively. This Quality Improvement Project was initiated because it was felt that this new service was being underutilised by our surgical teams. The ‘Plan-Do-Study-Act cycle’ (PDSA) framework was employed to analyse utilisation of the service: The ‘plan’ stage involved outlining our aims: to raise awareness amongst clinicians of the unified care pathway and to increase referral to this clinic. The ‘do’ stage involved collecting data from a sample of 96 patients over 4 month period to ascertain the proportion of Myofascial TMD patients who were correctly referred to the designated clinic. ‘Suitable’ patients who weren’t referred were identified. The ‘Study’ phase involved analysis of results, which revealed that 77% of suitable patients weren’t referred to the designated clinic. They were reviewed on other clinics, which are often overbooked, or managed by junior staff members. This correlated with our original prediction. Barriers to referral included: lack of awareness of the clinic, individual consultant treatment preferences and patient, reluctance to be referred to a ‘group’ clinic. The ‘Act’ stage involved presenting our findings to the team at a clinical governance meeting. This included demonstration of the clinical effectiveness of the care-pathway and explaining the referral route and criteria. In light of the evaluation results, it was decided to keep the group clinic and maximize utilisation. The second cycle of data collection following these changes revealed that of 66 Myofascial TMD patients over a 4 month period, only 9% of suitable patients were not seen via the designated pathway; therefore this QIP was successful in meeting the set objectives. Overall, employing the PDSA cycle in this QIP resulted in appropriate utilisation of the modified care pathway for patients with myofascial TMD in Guy’s Oral Surgery Department. In turn, this leads to high patient satisfaction with the service and effectively redirected 52 hours of clinical time. It permitted adoption of a collaborative working style with oral surgery colleagues to investigate problems, identify solutions, and collectively raise standards of clinical care to ensure we adopt a unified care pathway in secondary care management of Myofascial TMD patients.

Keywords: myofascial, quality Improvement, PDSA, TMD

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211 Developing a GIS-Based Tool for the Management of Fats, Oils, and Grease (FOG): A Case Study of Thames Water Wastewater Catchment

Authors: Thomas D. Collin, Rachel Cunningham, Bruce Jefferson, Raffaella Villa

Abstract:

Fats, oils and grease (FOG) are by-products of food preparation and cooking processes. FOG enters wastewater systems through a variety of sources such as households, food service establishments, and industrial food facilities. Over time, if no source control is in place, FOG builds up on pipe walls, leading to blockages, and potentially to sewer overflows which are a major risk to the Environment and Human Health. UK water utilities spend millions of pounds annually trying to control FOG. Despite UK legislation specifying that discharge of such material is against the law, it is often complicated for water companies to identify and prosecute offenders. Hence, it leads to uncertainties regarding the attitude to take in terms of FOG management. Research is needed to seize the full potential of implementing current practices. The aim of this research was to undertake a comprehensive study to document the extent of FOG problems in sewer lines and reinforce existing knowledge. Data were collected to develop a model estimating quantities of FOG available for recovery within Thames Water wastewater catchments. Geographical Information System (GIS) software was used in conjunction to integrate data with a geographical component. FOG was responsible for at least 1/3 of sewer blockages in Thames Water waste area. A waste-based approach was developed through an extensive review to estimate the potential for FOG collection and recovery. Three main sources were identified: residential, commercial and industrial. Commercial properties were identified as one of the major FOG producers. The total potential FOG generated was estimated for the 354 wastewater catchments. Additionally, raw and settled sewage were sampled and analysed for FOG (as hexane extractable material) monthly at 20 sewage treatment works (STW) for three years. A good correlation was found with the sampled FOG and population equivalent (PE). On average, a difference of 43.03% was found between the estimated FOG (waste-based approach) and sampled FOG (raw sewage sampling). It was suggested that the approach undertaken could overestimate the FOG available, the sampling could only capture a fraction of FOG arriving at STW, and/or the difference could account for FOG accumulating in sewer lines. Furthermore, it was estimated that on average FOG could contribute up to 12.99% of the primary sludge removed. The model was further used to investigate the relationship between estimated FOG and number of blockages. The higher the FOG potential, the higher the number of FOG-related blockages is. The GIS-based tool was used to identify critical areas (i.e. high FOG potential and high number of FOG blockages). As reported in the literature, FOG was one of the main causes of sewer blockages. By identifying critical areas (i.e. high FOG potential and high number of FOG blockages) the model further explored the potential for source-control in terms of ‘sewer relief’ and waste recovery. Hence, it helped targeting where benefits from implementation of management strategies could be the highest. However, FOG is still likely to persist throughout the networks, and further research is needed to assess downstream impacts (i.e. at STW).

Keywords: fat, FOG, GIS, grease, oil, sewer blockages, sewer networks

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210 Negative Environmental Impacts on Marine Seismic Survey Activities

Authors: Katherine Del Carmen Camacho Zorogastua, Victor Hugo Gallo Ramos, Jhon Walter Gomez Lora

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Marine hydrocarbon exploration (oil and natural gas) activities are developed using 2D, 3D and 4D seismic prospecting techniques where sound waves are directed from a seismic vessel emitted every few seconds depending on the variety of air compressors, which cross the layers of rock at the bottom of the sea and are reflected to the surface of the water. Hydrophones receive and record the reflected energy signals for cross-sectional mapping of the lithological profile in order to identify possible areas where hydrocarbon deposits can be formed. However, they produce several significant negative environmental impacts on the marine ecosystem and in the social and economic sectors. Therefore, the objective of the research is to publicize the negative impacts and environmental measures that must be carried out during the development of these activities to prevent and mitigate water quality, the population involved (fishermen) and the marine biota (e.g., Cetaceans, fish) that are the most vulnerable. The research contains technical environmental aspects based on bibliographic sources of environmental studies approved by the Peruvian authority, research articles, undergraduate and postgraduate theses, books, guides, and manuals from Spain, Australia, Canada, Brazil, and Mexico. It describes the negative impacts on the environment and population (fishing sector), environmental prevention, mitigation, recovery and compensation measures that must be properly implemented and the cases of global sea species stranding, for which international experiences from Spain, Madagascar, Mexico, Ecuador, Uruguay, and Peru were referenced. Negative impacts on marine fauna, seawater quality, and the socioeconomic sector (fishermen) were identified. Omission or inadequate biological monitoring in mammals could alter their ability to communicate, feed, and displacement resulting in their stranding and death. In fish, they cause deadly damage to physical-physiological type and in their behavior. Inadequate wastewater treatment and waste management could increase the organic load and oily waste on seawater quality in violation of marine flora and fauna. The possible estrangement of marine resources (fish) affects the economic sector as they carry out their fishing activity for consumption or sale. Finally, it is concluded from the experiences gathered from Spain, Madagascar, Mexico, Ecuador, Uruguay, and Peru that there is a cause and effect relationship between the inadequate development of seismic exploration activities (cause) and marine species strandings (effect) since over the years, stranded or dead marine mammals have been detected on the shores of the sea in areas of seismic acquisition of hydrocarbons. In this regard, it is recommended to establish technical procedures, guidelines, and protocols for the monitoring of marine species in order to contribute to the conservation of hydrobiological resources.

Keywords: 3D seismic prospecting, cetaceans, significant environmental impacts, prevention, mitigation, recovery, environmental compensation

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209 Pharmacokinetics and Safety of Pacritinib in Patients with Hepatic Impairment and Healthy Volunteers

Authors: Suliman Al-Fayoumi, Sherri Amberg, Huafeng Zhou, Jack W. Singer, James P. Dean

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Pacritinib is an oral kinase inhibitor with specificity for JAK2, FLT3, IRAK1, and CSF1R. In clinical studies, pacritinib was well tolerated with clinical activity in patients with myelofibrosis. The most frequent adverse events (AEs) observed with pacritinib are gastrointestinal (diarrhea, nausea, and vomiting; mostly grade 1-2 in severity) and typically resolve within 2 weeks. A human ADME mass balance study demonstrated that pacritinib is predominantly cleared via hepatic metabolism and biliary excretion (>85% of administered dose). The major hepatic metabolite identified, M1, is not thought to materially contribute to the pharmacological activity of pacritinib. Hepatic diseases are known to impair hepatic blood flow, drug-metabolizing enzymes, and biliary transport systems and may affect drug absorption, disposition, efficacy, and toxicity. This phase 1 study evaluated the pharmacokinetics (PK) and safety of pacritinib and the M1 metabolite in study subjects with mild, moderate, or severe hepatic impairment (HI) and matched healthy subjects with normal liver function to determine if pacritinib dosage adjustments are necessary for patients with varying degrees of hepatic insufficiency. Study participants (aged 18-85 y) were enrolled into 4 groups based on their degree of HI as defined by Child-Pugh Clinical Assessment Score: mild (n=8), moderate (n=8), severe (n=4), and healthy volunteers (n=8) matched for age, BMI, and sex. Individuals with concomitant renal dysfunction or progressive liver disease were excluded. A single 400 mg dose of pacritinib was administered to all participants. Blood samples were obtained for PK evaluation predose and at multiple time points postdose through 168 h. Key PK parameters evaluated included maximum plasma concentration (Cmax), time to Cmax (Tmax), area under the plasma concentration time curve (AUC) from hour zero to last measurable concentration (AUC0-t), AUC extrapolated to infinity (AUC0-∞), and apparent terminal elimination half-life (t1/2). Following treatment, pacritinib was quantifiable for all study participants at 1 h through 168 h postdose. Systemic pacritinib exposure was similar between healthy volunteers and individuals with mild HI. However, there was a significant difference between those with moderate and severe HI and healthy volunteers with respect to peak concentration (Cmax) and plasma exposure (AUC0-t, AUC0-∞). Mean Cmax decreased by 47% and 57% respectively in participants with moderate and severe HI vs matched healthy volunteers. Similarly, mean AUC0-t decreased by 36% and 45% and mean AUC0-∞ decreased by 46% and 48%, respectively in individuals with moderate and severe HI vs healthy volunteers. Mean t1/2 ranged from 51.5 to 74.9 h across all groups. The variability on exposure ranged from 17.8% to 51.8% across all groups. Systemic exposure of M1 was also significantly decreased in study participants with moderate or severe HI vs. healthy participants and individuals with mild HI. These changes were not significantly dissimilar from the inter-patient variability in these parameters observed in healthy volunteers. All AEs were grade 1-2 in severity. Diarrhea and headache were the only AEs reported in >1 participant (n=4 each). Based on these observations, it is unlikely that dosage adjustments would be warranted in patients with mild, moderate, or severe HI treated with pacritinib.

Keywords: pacritinib, myelofibrosis, hepatic impairment, pharmacokinetics

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