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Qatar Foundation Annual Research Conference Proceedings Volume 2016 Issue 1
- Conference date: 22-23 Mar 2016
- Location: Qatar National Convention Center (QNCC), Doha, Qatar
- Volume number: 2016
- Published: 21 March 2016
201 - 250 of 656 results
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Application of TiO2–WO3 Composite for Continuous Reduction of Chromium(VI) in Light-limited Condition
Authors: Rand Elshorafa, Dong Suk Han, Hyunwoong Park and Ahmed Abdel-WahabHexavalent chromium (Cr(VI)) is toxic and hazard chemical to human health and it is categorized as a carcinogen chemical. Cr(VI) is released from many industrial processes such as electroplating, metal finishing, and textile/leather dyeing. Although there are many treatment technologies for removal of Cr(VI), the photocatalytic treatment using metal oxide semiconductor (SC) materials has been shown to be a promising technology because of the fact that toxic Cr(VI) can be effectively reduced to less toxic Cr(III) by cheap, nontoxic, and stable photocatalyst such as titanium dioxide (TiO2). In this study, two different types of TiO2 particles (nano-sized particle, nanotube particle) were used as photocatalysts for Cr(VI) reduction. These two types have different kinetics of transferring the charge carriers. Based on results of this research, each TiO2 particle type was used for fabrication of multijuntion SC with WO3 particles for continuous reduction of Cr(VI) in water.
For the continuous reduction of Cr(VI), two different methods were applied: Photoelectrochemical(PEC) system and Nanofiltration system. Regardless of the method, WO3 was in junction with TiO2 in order to reduce Cr(VI) even in the dark because WO3 has an ability to storing solar energy through charging/discharging route. Upon light-on, the electrons that was photogenerated from TiO2 transfer to WO3, forming HxW(6-x)O3 of the photocharged surface specie. Upon light-off, the trapped electrons in WO3 are released gradually to the environment that requires electrons for certain chemical reactions to take place thermodynamically. The fabricated heterojunction TiO2/WO3 will have a good example of the photoelectrode to perform the multi-functionalities: solar light conversion and simultaneous solar energy storage, and electron transfer for application of environmental remediation.
In case of the PEC system, TiO2 was doped with WO3 on the fluorine doped tin oxide (FTO) glass by a layer-by-layer deposition technique. The TiO2/WO3 composites that was charged at AM 1.5 G irradiation (100 mW/cm2) shows a gradual reduction of Cr(VI) in the dark until 12 hours. Also, the Cr(VI) results were dependent on TiO2 type, doping ratio of TiO2 and WO3, and charging time.
For the nanofiltration system, the suspended TiO2/WO3 particles were filtered by anodic membrane filtration (20 nm of pore size) and subsequently the deposited TiO2/WO3 particles were charged by illumination of sunlight with light intensity higher than 200 mW/cm2. The charged TiO2/WO3 retained on the membrane was inserted to dead-end filtration apparatus and the membrane system was used for continuous reduction of Cr(VI) over filtration time. For this, various experimental conditions were applied, including loading amount of TiO2/WO3 with different ratio of TiO2/WO3, initial concentration of Cr(VI), charging time, reduction capacity over number of recycle of charging/discharging, etc. This system will have a benefit of no application of UV or light source in the filtration system, which is a major challenge when photocatalysis and filtration are combined for a specific treatment process. Therefore, we believe that two approaches will provide scientific and technical information for continuous removal of Cr(VI) in the light-limited condition.
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Role of Biodiesel in the Enhancement of GTL Diesel Fuel Properties
Authors: Nimir Elbashir, Wajdi Jamal Ahmed, Ahmad Alrachid, Nasr Mohammed and Marwan ElwahshThe Conversion of natural gas into synthetic liquid fuel carried out through a catalytic conversion process, known as the gas-to-liquid (GTL) technology, had a great impact since its discovery. The process utilizes the Fischer-Tropsch synthesis (FTS) chemistry that was first developed in 1925. Gas-to-liquid (GTL) fuels are synthetic fuels that are intrinsically cleaner than conventional fuels.[1] They are environmentally benign due to the absence of sulfur content and the extremely low aromatic content. Gas-to-liquid (GTL) diesel fuel, being one of the most important GTL products, is therefore classified as ultra-clean fuel with lower emissions of carbon monoxide and particulates upon combustion. Nevertheless, the lack of sulfur and aromatic in the diesel fuels negatively impacts certain important physical characteristics such as lubricity and density. This fact makes these fuels improper for use in existing diesel engines. The lubricity issue is significant for GTL diesel fuels, as it not match the standards required by regulations in the United States, Europe and elsewhere. Lubricity is defined as “a qualitative term describing the ability of a fluid to affect friction between, and wear to, surfaces in relative motion under load.” [2]
The aim of this research project is to design new generation ultra clean diesel fuels, from the GTL process, that are environmentally friendly, have less emissions upon combustion but also practicable and compliant with global standards. The focus of this study is to develop a comprehensive knowledge and data to observe the possibility of stretching and tailoring the GTL diesel properties such that they meet the standards needed to be used in existing engines. The enhancement of lubricity, which serves as the major disadvantage, is to be carried out while maintaining all other physical properties within the range needed for existing engines and ASTM D975 and D7467 standards.
Fatty acid methyl and ethyl esters are biodiesels that can provide significant improvements in the lubricity of diesel fuel. Previous studies on the effects of fatty acid methyl esters on diesel fuel lubricity have shown an increase in lubricity associated with the addition of these esters [3]. Addition of these esters in GTL diesel was found to be the best fit for lubricity enhancement. Our campaign, unlike other studies on diesel lubricity, does not only focus on certain physical properties of diesel but provide a comprehensive study showing all changes in other properties that accompany the change of the targeted property, being diesel in this case.
For this study, four lubricity enhancement additives were selected. The selection covers a wide range of biodiesel characteristics and would thus allow deeper understanding of other factors such as saturation and chain length of esters on diesel lubricity and properties enhancement. The four esters that proved to have significant impact are Methyl Oleate (C19H36O2), Methyl Stearate (C19H38O2), Ethyl Oleate (C20H38O2) and Ethyl Stearate (C20H40O2). Both methyl and ethyl esters were found to affect the lubricity. However, other studies showed variation on which serves as a better lubricity enhancement additive. Our research will validate these findings and widen the study to experiment the effect of mixing different additives on all other diesel fuel properties. The concentrations of additives were selected to be in the range of 5%–20% by volume. For this purpose 28 blends were prepared for conducting the research.
Subsequently blends were tested for fuel characteristics and physical properties. The tests nclude vapor pressure, viscosity, flash point, pour point, cloud point, distillation performance, heat content and lubricity. Current results show an increase in density, viscosity, flash point and vapor pressure with increasing additive concentrations of biodiesel. In contrast, the increase in additive concentration decreased the pour point, cloud point, recovery by distillation and calculated cetane number. All the changes lie well within American Society of Testing and Materials (ASTM) standards.
The work will be further continued to validate experimental results with industry partners, testing of lubricity characteristics using advanced microscopy and conducting a thorough result analysis and representation statistical methods and visualization techniques.
This work will suggest ideal mixtures of GTL diesel and biodiesel additives that will best enhance the GTL diesel fuel. Such findings can be used in blending commercial GTL diesel fuel with suggested biodiesel to produce practicable, engine compliant and ASTM standard compliant GTL diesel. Since Qatar has the largest GTL plant in the world, this research is essentially significant and relevant. It also enriches Qatar's scientific research culture and serves the world by creating cleaner fuels for a cleaner environment.
References
[1] Elmalik, E.E., Raza, B., Warrag, S., Ramadhan, H., Alborzi, E., Elbashir, N.O. (2014). Role of Hydrocarbon Building Blocks on Gas-to-Liquid Derived Synthetic Jet Fuel Characteristics. Industrial & Engineering Chemistry Research, 53, 1856–1865.
[2] Crown, L., Warfield, L., Hockert, C. (2013). Handbook 130 (2013)- Uniform Laws and Regulations in the areas of legal metrology and engine fuel quality.
[3] Geller, D. P., & Goodrum, J. W. (2004). Effects of specific fatty acid methyl esters on diesel fuel lubricity. Fuel, 83(17-18), 2351–2356.
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Flooding Limitations in a Three-Phase Direct Contact Condenser for the Utilisation of Low-Grade Energy Sources for Desalination and Power Generation Application
More LessThe continuing enhancement of energy recovery cycles that exploit low grade energy resources requires an efficient heat absorption and rejection system. Implementation of a conventional surface type heat exchanger, evaporator or condenser has many disadvantages. The low efficiency, fouling, corrosion problems, high cost and high heat transfer resistance are the most important shortcomings that emerge as a result of the metallic barriers involved. On the other hand, a direct contact heat transfer device offers a high heat transfer area and reduces or eliminates fouling and corrosion problems. They can also work with very low temperature differences and subsequently can enhance the cycle efficiency. Direct contact heat exchangers clearly have many advantages over surface type heat exchangers and can also be efficiently used in places where the surface heat exchanger cannot be.
Accordingly, direct contact heat exchanger can be found in different applications, such as water desalination and power generation from geothermal brine. Water desalination utilising direct contact heat exchangers can be achieved by two general methods: direct contact freezing-melting and direct contact evaporation- condensation. The former is based on the ability to remove water from a solution by freezing it out as crystalline ice. The ice or crystal should contain only pure water; therefore the partial freezing separates the fresh water from brine. The ice melts at another stage to produce distilled water. Direct contact freezing exploits the concept of direct contact evaporation of a low boiling point working fluid by absorbing heat from surrounding continuous fluid (water). The heat absorbed by the working fluid; which causes the water to freeze, is equivalent to the energy required to melt the ice. The working fluid used must have a low boiling point and a high freezing point along with other properties mentioned above. Refrigerants such as carbon dioxide and butane are widely used as a working fluid. For second application, the most common application of direct contact heat exchangers is in the generation of electricity from hot geothermal brine, utilising low boiling point fluids and the conventional Rankine cycle. The first plant utilising a spray column, which produces 500 k. We was designed by Barber-Nichols Engineering and installed at the East Mesa Geothermal Field in the U.S. in 1980. The spray column was 12 m in length and 1 m diameter. Hot brine is flashed to remove the non-condensable gases before entering the spray column from the top, while the isopentane liquid is injected in to the bottom of the column through a suitable distributer. Direct contact counter-current heat transfer between the two fluids takes place throughout the column height. According to the density difference, isopentane drops/bubbles rise upward with brine falling down and exiting the column at the bottom after being cooled down. On the other hand, isopentane heats up as a result of absorbing heat from the brine, and leaves the column as a superheated vapour from the top of the column. Isopentane vapour expands through a turbine to produce electricity, is liquefied in a condenser, and sent back to the direct contact heat exchanger again.
For a bubble type three-phase direct contact condenser, it is widely reported that its performance is characterised by a volumetric heat transfer coefficient, which is directly proportional to the holdup ratio in the column. It is both economical and practical for the bubble type direct contact condenser to operate at the maximum possible holdup ratio. This, of course, increases the possibility of flooding, which considerably impairs the performance of the column. Flooding can be either defined as the case when the continuous phase is completely held up by the dispersed phase or the dispersed phase is swept backward by the continuous phase.
Two mechanisms could lead to the inception of flooding in the three direct contact columns, depending on the critical velocity of each individual phase. The critical velocity can be defined as a maximum velocity that can be achieved by a given direct contact system and it is a function of the bubble size, the flow rate and the physical properties of the phases. The first mechanism depends on the reduction in the dispersed phase (bubbles) upward velocity due to the interactions within a swarm of two-phase bubbles. The two-phase bubbles move closer together when the dispersed phase flow rate increases, which results in a further dispersed phase slowing. Bubbles are swept down and drain out with the continuous phase from the bottom of the column. Therefore, the danger from this form of flooding form is the increased loss of the working fluid. The second scenario assumes that the continuous phase is swept upwards because of a high dispersed phase flow rate. This occurs when the dispersed phase velocity passes the critical velocity. The result of this flooding type lies in a change of geometry and makes the heat transfer relationships available invalid. Accordingly, flooding can be defined as the case when the continuous phase is completely held up by the dispersed phase or the dispersed phase is swept backward by the continuous phase.
As the first time, experiments to study the limitation of flooding inception of three-phase direct contact condenser have been carried out in a counter-current small diameter vertical condenser. The total column height was 70 cm and 4 cm diameter. Only 48 cm has been used as an active three-phase direct contact condenser height. Vapour pentane with three different initial temperatures (40°, 43.5° and 47.5°) and water with a constant temperature (19°) have been used as a dispersed phase and a continuous phase respectively. Five different continuous phase mass flow rate and four different dispersed phase mass flow rate have been tested throughout the experiments.
The experimental results showed that the effect of dispersed phase initial temperature on flooding inception to be insignificant at low continuous phase velocity (v_L^(*1/2).
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Genome Mining of Secreted Effectors of Fusarium Oxysporum, Fusarium Solani and Rhizectonia Solani
Authors: Resna Nishad and Talaat AhmedAbstract Introduction: Of the various devastating diseases triggered by necrotrophic fungi, the diseases caused by following fungi Fusarium oxysporum, Fusarium solani and Rhizectonia solani are of particular economic significance in date palm (Phoenix dactylifera L.) growing countries. Undoubtedly date palm is the most important fruit tree cultivated in Arabian Peninsula. Unfortunately date palm cultivation encounter many challenges, such as fungal diseases. It has been reported that Fusarium oxysporum, Fusarium solani and Rhizectonia solani are the major causative of various diseases in Date palm.
For successful colonization of host, necrotrophic pathogens secrete an arsenal of effector proteins that facilitates infection by manipulating host cell structure and function. Thus secretory proteins (SPs) are critical for both short and long range intercellular signaling during infection and colonization.
The present study is conducted on three date palm pathogens, which causing diseases like bayoud disease and other necrotrophic diseases including root rot. This study focused on molecular genetics of necrotrophic pathogenicity in date palm by following an in silico approach to mine putative secreted elicitors from publically available Fusarium oxysporum, Fusarium solani and Rhizectonia solani ESTs. Methodology: Methodology involved mining of 25213 Fusarium oxysporum ESTs, 12433, Fusarium solani ESTs and 22324 Rhizectonia solani ESTs for protein sequence based features characteristic of SPs (signal peptides). All the ESTs were collected from NCBI. With using ORF predictor (http://proteomics.ysu.edu/tools/OrfPredictor.html) algorithm, found out all the six frame ORF. Predisi (http://www.predisi.de/) and SignalP (http://www.cbs.dtu.dk/services/SignalP/) algorithms was exploited to infer signal peptide within the ORF. Followed by scanning of transmembrane domain performed with TMHMM (http://www.cbs.dtu.dk/services/TMHMM/) to discard the transmembrane sequences. 0 TM/1TM proteins were selected for further CD (conserved domain) search.
Before going to the mining experiment, the pathogenicity of soil isolated (from northern part of Qatar) fungal pathogen on Date palm was confirmed with detached leaf inoculation method. All the three fungi, Fusarium oxysporum, Fusarium solani and Rhizectonia solani showed necrosis in date palm leaf after three days of infection. Result and conclusion: Out of 25213 Fusarium oxysporum ESTs 24890 have ORF. 12176 ORF found in Fusarium solani ESTs. Above 60% of all the three fungal ESTs had signal peptide. Number of sequences narrowed down by transmembrane topology search and the sequence doesn't containing transmembrane domain were selected for conserved domain identification.
Subsequent to our searches with sequences lacking transmembrane domains, we could catalog candidate effector sequences based on conserved features common to characterized fungal effectors. In Fusarium oxysporum following protein found to be extracellular secretory protein, this include cellulose binding protein, which possibly involved in in host cell adhesion, qaq like polyprotein: a virulent associated protein, lysin motif: an effector protein, extracellular peptidase, cell wall hydrolase, 150 amino acid cerato platanin sequence (elicitor), alpha amylase, beta 1,3 glucanase and 165 amino acid necrosis inducing protein. These effector proteins have the ability to degrade plant derived compound, this suggest the role of the effectors in pathogenicity.
In addition to these high amount of lipid targeting enzymes and glycoside hydrolase found in all the three phyto pathogenic ESTs. Presents of secretory protease detected in Fusarium solani. Peptidase like superfamily domain found in Rhizectonia solani.
To date, none of these effectors have been cloned and thus we propose that the catalogued effectors will in future be useful for isolation and characterization of these identified proteins. Expression studies are already underway and we expect that the results will provide insights into mechanisms underlying host-Pythium interactions and thereby help in generating new strategies for effective date palm disease control.
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33-Level Single-Phase SubMultilevel Inverter for Grid-Connected Photo-Voltaic Systems Using Model Predictive Control
Authors: Morcos Morad Saad Metry, Sertac Bayhan and Robert BalogGreen House Gases (GHG) that are currently being emitted from conventional energy production methods are of global concern; especially with the climate change that is occurring. The United Nations has taken the initiative by holding a global conference that aims combating climate change “United Nations Framework Convention on Climate Change (UNFCCC)”, which sets a common ground of regulations and agreements that aim at reducing polluting production methods. Qatar, as part of the UNFCCC, has signed and agreed to the Kyoto protocol. The first component of the protocol determines that countries should enhance energy efficiency in different sectors of their national economy.
In addition, “Qatar National Vision 2030”, states: “The rights of future generations would be threatened if the depletion of non-renewable resources were not compensated by the creation of new sources of renewable wealth”. With the increase in numbers of large-scale educational, industrial, commercial and residential buildings, Qatar needs to look into means of making them more energy efficient. Adopting solar energy is a priority for Qatar because of high abundance.
Photovoltaic (PV) systems transform sunlight into useful electricity with efficiencies that range from 12 to 20% without concentrators. PVs are designed with two layers, the n-layer (negative) and the p-layer (positive), which get charged when exposed to sunlight causing potential difference across the cell. PVs are static devices, eco-friendly, noise-less and require minimal maintenance. According to a study that compares unit generation costs of gas turbines and PVs, PVs are becoming a more viable alternative despite of the fact that they are still more expensive due to their initial installation costs. Another major disadvantage is the lower conversion efficiency. Power conditioning is also required in a solar PV system to convert DC power to AC power, regulate the load flow, offer different types of protection and keep the total harmonic distortion (THD) within the specified limit. Different types of inverters (DC to AC converter) have been employed for solar PV systems.
Dynamic behavior of solar energy resource entails the need of robust controllers that can converge to the maximum power point (MPP) to maximize energy harvest. The low conversion efficiency of PV systems is a significant hindrance to their growth, therefore Maximum Power Point Tracking (MPPT) is required to ensure the maximum available solar energy is harnessed from the solar panel. It is common in the industry that power conditioning is done at the array level. Less common but proven more efficient is to do conditioning at the module level. This guarantees maximum power is harnessed from one module regardless of the irradiance condition of the other neighboring modules. It would even be more efficient to do power conditioning at the cell level. In which case, each array of cells within a single module, has its own MPPT controller.
This project explores an improved Perturb and Observe (P&O) technique that combines a fixed step model predictive controller (MPC), to speed up the control loop, applied to a boost converter. The proposed MPC Maximum Power Point Tracking (MPPT) technique had proven higher efficacy and robustness over conventional MPPT. The main characteristic of MPC is predicting the future behavior of the desired control variables until a predefined step ahead in horizon of time. The predicted variables will be used to obtain the optimal switching state by minimizing a cost function.
A boost converter is used as a DC/DC converter prior to the sub multi-level inverter. P&O determines the reference current for the MPC, which determines the next switching state. This technique predicts the error of the next sampling time and based on optimization of the cost function g, the switching state will be determined. The inputs to the predictive controller are the PV system current and voltage, and the reference current. By deriving the discrete time set of equations, the behavior of control variables can be predicted at next sampling time k+1. The proposed methodology is based on the fact that the slope of the PV array power curve is zero at the predicted MPP, positive on the left and negative on the right of the predicted MPP.
The improved MPC-MPPT is tested for the first time on an MPC strategy of 33-level SubMultilevel Inverter (SMI) using 16 power arms cascaded with the H-bridge inverter. SMIs use less switches than conventional MIs and this is noticeable at larger number of levels. Such topology uses a switching frequency for the H-bridge that is equal to the grid frequency, which allows for lower switching losses when compared to conventional MIs. Such topology brings about many sizable benefits such as reduced number of power switches and their grate drivers when compared to the traditional multilevel inverter. MPC is also used as the control strategy for the SMI to eliminate complexities in the space vector pulse width modulation (SVPWM) and overcome the weaknesses of the inner control loop performance. This topology allows for each module to be divided into 16 parts each comprised of an array of cells. Each array of cells is connected to the MPC-MPPT boost converter. Then the 16 levels are fed to the input stage of the SMI. Finally, each module will have its own H-Bridge inverter that directly feeds the grid. Such topology provides the advantage of localized MPPT tracking, increased reliability of the whole power system as the failure of one cell won't fail the whole system, and lower components withstand ratings.
To verify the dynamic and steady-state performances of the proposed MPC scheme under various load and reference currents, simulation studies are performed with Matlab & Simulink software.
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Simulation Studies of Charged Particle Detectors for Collider Experiments
Authors: Taif Mohamed and Neeraja RenganathanThe Compact Muon Solenoid (CMS) experiment in the Large Hadron Collider (LHC) at CERN has been the tool to performing ground-breaking research in high energy physics. The CMS detector has been built over the last two decades by an international collaboration of scientists from all over the world. Two years after its operation, the two experiments ATLAS and CMS have announced in 2012 the discovery of the Higgs boson, a long awaited particle responsible to give elementary particles their respective masses.
After the first 3 years of operation at moderate luminosity, the LHC is entering a new phase of high luminosity and energy regimes, which will put stringent requirements on the detectors.
The CMS experiment has planned a rigorous plan of upgrade of its different components to cope with the harsh conditions imposed by the new regime. One of the subsystem of CMS detector that will require upgrade is the muon system. This latter detects muon particles, which are the signature of most of the interesting physics channels we are looking for at the LHC.
The Qatar team, together with an international team of scientists, has proposed the Gas Electron Multiplier (GEM) as the future detecting element of the upgrade of the muon system.
We have conducted an extensive simulation program to assess the GEM detector and optimize it for the future upgrade.
During this project, various simulations have been conducted to predict the efficiency and time resolution of the GEM. The simulations, which have been conducted using ANSYS, computational fluid dynamics software, focus on producing the electric field maps inside the detector. In addition, the resulting electron avalanche was simulated based on the solution of the Boltzmann equation. A signal was then generated to study the gain, resolution, and other parameters. During this work, several conditions were simulated in order to reach the optimum conditions under which the GEM would be most effective. These simulations had to be conducted using a supercomputing facility since their range surpasses the regular computing powers of personal computers. Using Raad, the cluster at Texas A&M University at Qatar, helped widen the scope of the simulations to approach a realistic situation that would occur within the CMS.
Furthermore, as part of its next upgrade, a novel detector, the Fast Timing Micropattern (FTM) detector is being considered as a possible beneficial addition to the CMS. Initial investigations of the FTM detector have shown a considerable improvement in the time resolution that is proportional to the number of layers. In addition, the use of resistive WELL techniques solves the problem of spark occurrences and discharges that such detectors experience with high electric fields. It also differs from the GEM in the sense that the gain is extracted at every multiplication stage rather than at the very last level of the detector where the readout plane exists. The FTM detector could be cost-efficient in its assembly process. Simulations are being further extended in order to evaluate the FTM's performance and optimize its gain and other resulting parameters.
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Green Mobility Application (GMAP)
Authors: Nurettin Sezer, Irfan Batur and Ibrahim ArıBroadly speaking, one of the most important aspects of Sustainable Development Goals (SDGs) of United Nations is to increase awareness of people for sustainability related issues namely economic, environmental and social problems. In this direction, it can be concluded that there is a lack of awareness for individuals regarding their habits and their related impacts on sustainability. Especially in developed countries, it is well-known that people are linked to over consumption, overweight, over waste, over pollution and so on. However, most of them are not aware of the results which are caused from their daily activities in terms of pollution, waste, energy footprints and their related effects on global sustainability. Mobility is one such area resulting in that kind of problems especially in urban areas. Our current road-based transportation system which is mainly dependent on automobile use causes a wide range of formidable problems. These include traffic congestion, air pollution, noise, accidents and related fatalities, depletion of non-renewable resources and inaccessibility of amenities and services. To illustrate this, more than one-quarter of total U.S. greenhouse gas emissions come from the transportation sector and light vehicles are responsible for 59% of transportation energy use (see Fig. 1). Due to the accidents on roads, approximately one million people dies except the millions of injuries (WHO, 2010). In addition to that, there are many cities suffering from traffic congestion which slows down daily businesses, causes unreliability in terms of time, results in unpleasant life in urban life and costs billions of dollars to the economies (Everyday Money, 2014; TomTom, 2013). These are just few figures to illustrate detrimental effects of transportation especially due to automobile use in urban areas. Transport demand, however, increases as economic growth increases (EU Energy, 2012) which will make the situation even worse in the upcoming years. Therefore, there are various dimensions of transport system which can be group into three categories: economic, environmental, and social (see Table 1). Given these problems, and their associated economic, environmental, and social impacts, the current transportation system especially in urban areas may be considered as unsustainable from various respects. To counter this challenge of moving towards sustainable transportation, much more effort is needed.
According to World Business Council on Sustainable Development (2004), sustainable mobility is defined as ‘the ability to meet the needs of society to move freely, gain access, communicate, trade, and establish relationships without sacrificing other essential human or ecological values today or in the future’. To this end, there are certain areas to focus on to mitigate transport related problems and make a transition towards sustainable transport (C2ES, 2012). Firstly, on the fuels side, transitioning to low-carbon energy sources such as biofuels or electricity from renewable resources to directly reduce emissions from fuel consumption is required. Secondly, more efficient transportation equipment is needed to run on these low-carbon fuel sources. Thirdly, increasing the efficiency of existing transportation system is needed such as applying advanced traffic monitoring and signaling. Lastly, switching from unsustainable modes (mostly personal car usage) to alternative (or sustainable) travel modes such as public transportation, walking and cycling is needed to reduce the demand for the use of more energy intensive by changing land use patterns, increasing and promoting sustainable travel options while dis-incentivizing the use of unsustainable modes. After all, it can be said that a “new mobility” is needed which is a vision of the cities in which resident no longer excessively rely on their cars but on public transportation, shared cars, bikes or walking. Therefore, there will be less pollution, less noise, less stress at the end; cities will be more livable environments.
In this direction, we are working on a mobile application project which will be capable of tracking individuals’ daily mobility activities; walking, bicycling, and driving. According to these mobility activities, the application will present the sustainability level of each individual in a sustainability scale and its related impacts on his\her health and the environment. By doing that, we aim to increase awareness of individuals for their current actions and encourage them to change their related behaviors into more sustainable ways by using different incentive and awareness tools. The application will prepare individualized packages to show people their mobility footprint with its effects on their life and on the environment and suggest other sustainable mobility ways.
Our main target group will be mostly educated people from younger and middle age groups, rich-enough to having a smart-phone, and most importantly having unsustainable mobility activities. After successfully completion of the application, as a pilot area, Education City would be a perfect place to conduct pilot experiments where members of the community are suitable to our potential customer portfolio then it can spread all over the world through Qatar and Gulf Cooperation Council (GCC) countries. By doing that, we need to tailor incentive and awareness tools towards culture and expectations of the community. In this sense, we are going to present our findings from initial phases we have conducted so far in this developing process which includes; (1) literature review, (2) market assessments via various interviews with different stakeholders and survey questionnaire with people from potential target groups to figure out their perceptions and needs regarding this behavioral change for mobility, (3) analysis of requirements based on the results from previous phase and (4) concept design which includes flow diagrams, database schema and sketching user interfaces etc. In addition to these, we will utilize Quality Function Deployment (QFD) in our concept design to transform business requirements and specs of GMAP into it. Comparison of the competitive mobile applications will be able to seen in QFD as well. GMAP intends to raise public awareness on the impacts of their behaviors, to make them healthier, to reduce carbon emissions a little by walking much more and to build a green social network who shares the same thoughts on sustainability. In short, we believe our application (when being turned into reality) will contribute orienting people into the new sustainable lifestyles or it will pave the way at least.
References
C2ES. (2012). Transportation Overview | Center for Climate and Energy Solutions. Retrieved November 9, 2015, from http://www.c2es.org/energy/use/transportation
EU Energy. (2012). Transport in Figures, Statistical Pocketbook 2012, European Commission.
Everyday Money. (2014). No Title. Retrieved November 10, 2015, from http://time.com/money/3511481/traffic-jams-cost-americans-124-billion-time-money/
Rahman, A., & Grol, R. van. (2005). SUMMA final publishable report v. 2.0; July 2005. Available Online on Http://www. Summa-Eu.Org/control/
TomTom. (2013). TomTom Congestion Index -. Retrieved from http://www.tomtom.com/en_gb/congestionindex/
WHO. (2010). Number of road traffic deaths. Retrieved November 9, 2015, from http://www.who.int/gho/road_safety/mortality/traffic_deaths_number/en/
World Business Council on Sustainable Development. (2004). Mobility 2030: Meeting the Challenges to Sustainability.
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Use of Formation Water and Associated Gases and their Simultaneous Utilization for Obtaining Microelement Concentrates Fresh Water and Drinking Water
Authors: Makhkam Mamatkulov, Mashal Mamatkulov and Ikrom GulamovAbstract Purpose: The invention relates to the oil industry, inorganic chemistry, in particular, to the methods of complex processing of formation water, using flare gas of oil and gas field as fuel for producing enriched concentrates of iodine, bromine, magnesium and valuable trace elements, as well as desalinated water (technical and drinking water). The technology includes pre-cleaning of formation water from mechanical impurities and oil using adsorbents, followed by evaporation of water under vacuum, condensing water vapor in the barometric condenser, using of condensed water vapor as the coolant, using of saline water as a coolant of hot water coming out of the barometric condenser to 15–20 °C. The novelty of the design?: The novelty of the design is to get a comprehensive treatment of formation water, using flare gas of oil and gas field as fuel for obtaining enriched concentrates of iodine, bromine, magnesium and valuable trace elements, as well as desalinated water (technical and drinking water). Recycling of formation water with this method considers new directions. Worldwide the patents were received for constructing chemical plants for producing cheap food salt, killing fluid for oil wells, iodine, bromine, hydrochloric acid, caustic soda, sodium sulfate, sodium chloride, potassium bromide, sodium bromide, borax, boric acid, phosphoric acid, lithium carbonate, lithium phosphate, borax, boric acid, ammonia and carbonate products, potassium chloride, bromide and products LiCl, alkali rare elements, uranium, etc.
Hundreds of plants are engaged in the processing of brines in the world, but due to the large content variety of raw materials for each company developed its own individual process steps, depending on the climate or nearby sources of cheap heat. This is due to the fact that for concentrating and isolating the salts removal of a large mass of water required. Therefore, all businesses usually do not produce a particular product, but try to all the useful chemical elements alongside with secondary products - metals, chlorine, bromine, etc. All plants use successive allocation scheme of used salts may vary greatly from each other depending on the primary composition of the brine.
An important advantage of groundwater as a raw material source of rare elements are: the low cost of the product, because groundwater is a grade raw material, some of its geochemical types have relatively high adaptability, besides exploitation of rare elements water deposits does not require expensive mining. So in most countries (United States, Italy, Israel, Japan, New Zealand, Iceland, Australia, etc.) technological research to develop methods for extracting these elements from specific geochemical types of natural waters are constantly and systematically conducted. Cleaning the reservoir water: The technology includes pre-cleaning of formation water from mechanical impurities and oil using adsorbents. Cleaning is carried out in order to separate the unnecessary substances (organic substances) for a concentrate. Organic substances with high concentration cause by negative effects under using a concentrate and are considered to be hazardous substances in fresh water. Getting technical and drinking water and concentrate?: This technology helps to solve issues on providing facilities and public by technical water and are urgently needed, especially in those areas where there are sufficient amounts of formation waters and flare gases resources. The authors of the project developed a way for using flare gas and reservoir water for drinking water treatment and concentrates for medicine. The advantages of this technology?: Thanks to Tashkent State Technical University scientists an improved vacuum evaporation plant, was developed to split reservoir water 2 fractions - for distillate and concentrate. The advantage of this plant is that it works at lower boiling temperatures. This fact has a positive effect on the process of evaporation. Process takes place with low fuel consumption and lack of scale on the inner surfaces of the plant, since it is operated at temperatures not exceeding the limit scaling. Moreover, a significant part of the energy consumed in this process, is formed during combustion of existing flare gas, which leads to cheaper cost of the products. Using the results of this project, the production of a concentrate rich in iodine, bromine, magnesium and other minerals, as well as technical and drinking water will be ensured.
Recycling formation water and separating necessary useful from its structure we can get low cost products, as well as improve the environmental situation. In addition, solving problems with providing with of water is urgently, especially in those areas where there is sufficient amounts of formation water and flare gases resources. Water scarcity is felt in more than 40 countries (estimated at the beginning of the 21st century will reach 120–150 √ 109 m3 per year). Nearly a billion people in the world suffer from a lack of clean drinking water. This deficit can be covered by desalination of saline (salt content of more than 10 g/l) and saline (2–10 g/l) of ocean, sea and groundwater reserves totaling 98% of all water on earth.
Currently, one of the areas of energy is an efficient search of alternative methods to the traditional technologies of desalination of saline and brackish water that is the development of desalination methods of electro- spray nozzles and with subsequent evaporation and condensation. The authors of the project developed a way to use flare gas and reservoir water for drinking water treatment and concentrates.
Another advantage of the technology is solving environmental issues. These environmental problems exist in the areas where flare gases is burnt more million tons per day. Flare gas contains sulfur compounds. Sulfur compounds influences negatively on man and nature. Before the use, flare gas is purify led from compounds of sulfur, moreover, a boiler used in the technology helps complete combustion of flare gases. As a result, of flare gas, full burning decreases a rate of waste gases in the atmosphere. Technical and economic advantages of technology: The developed technology has several technical and economic advantages extraction formation water does not require much cost to obtaining it, produced water gets oil and condensates, and separated from them as by water, oil and gas fields also present flare gases of low pressure. Flare gases can be used as a source of thermal energy concentration - the result of the evaporation process of saline salty water. In addition, the next to the field “South Kemachi” there is a pond of salt water (lake “Devhona”). In the technology it is used as a coolant. In this region, there is the scarcity of fresh water. It should be noted that obtaining a concentrate rich in trace elements, from mineral water from underground using this technology is considered to be cheap raw materials and of low cost.
Lack of technologies that allow effectively utilize APG (gases rich in heavy hydrocarbons, that complicates their pumping through pipelines). Remoteness of potential markets from oil locations. Construction of pipelines to transport the petroleum to plants requires much capital investments, 1 km of the pipeline will cost more than $ 1.0 million to transport APG gas to processing enterprises from remote fields increase the cost of associated gas.
Associated petroleum gas can be used by the subsoil user as fuel in order to heat and electricity in the manner prescribed by the legislation in the field of gas and electricity and in compliance with applicable statutory rules of industrial and environmental safety.
The feature of the field “South Kemachi” is the high content of hydrogen sulfide in oil and associated petroleum gas (APG). As part of APG volume fraction of hydrogen sulfide it is about 2%. Without prior purification of hydrogen sulfide is not possible to use APG for production needs of the field and in this case the only acceptable way of dealing with it is APG flaring. Consumption of crude APG production on the deposit site is not possible. Gas contaminated with hydrogen sulfide when it is used as fuel for the boiler with prolonged exposure can lead to hydrogen embrittlement, cracking sulfide stress and/or cracking under stress corrosion in iron alloys, in other words, to a rapid deterioration of equipment.
In this project the authors consider purification associated gas from hydrogen sulfide in order to use APG purified for use as fuel for a iodine-bromine-magnesium concentrate and desalinated water and gas condensate of the field of formation water, significantly reducing the pollutants and greenhouse gases (GHG) into the atmosphere.
Reduction GHG emission achieved by the volume of natural gas, as well as in a much more complete oxidation of methane using APG as fuel compared to flaring. Flares of the deposits provide a so-called smoke spot flaring characterized by a high coefficient of unburnt gas, which leads to the release of a significant amount of methane in to the atmosphere.
Purification of hydrogen sulfide chemicals is costly.
Boiler for of desulfurization. It makes sense to include this boiler in the project due to the fact that APG is burned with total oxidation. Therefore, due to the work of the boiler methane emissions are reduced compared to flaring.
In the technology barometric condenser is used to create the vacuum that receives the amount of vapor generated by concentrating the solution and evaporation of cooling water. Certain part of the barometric condenser condensate is brought refrigerator X -1 which is the bottom of the lake “Devhona.” cooling fresh water from the cooler X-1 is brought to the barometric condenser. These regions, are short of fresh water for cooling. It is required to develop new methods for cooling.
Reservoir coolers were designed and constructed at Smolensk, Kursk, Chernobyl, South Ukrainian, Khmelnitsky, Kostroma NPP, and Surgut GRES Berezovsky; a cooling reservoir on the basis of natural lakes and depressions is in: Kalinin NPP.
A the construction of such facilities in areas where there is a lack of cooling water is very important. Recently, the amount of industrial cooling water has been increased significantly, so penetrate existing and develop new cooling methods.
Lake water have different temperatures at different depths (10 to 25 °C on the surface of 30 to 40 °C at a depth of 1 m and from 40 to 60 °C at a depth of 1.5 m). In deeper layers, the temperature is lowered at a depth of 10 m up to 18–20 °C.
In the salt lakes several types of vertical thermal structure are observed. Salt lake is a reservoir with a capacity of warm water layer between two layers of colder. In some lakes may be two “hot” zone. Often “hot” area is located in the bottom layer and in this case the vertical thermal structure of the lake consists of an upper “cold” zone and the lower “hot” as it was observed in the lake. Vanda (Antarctica), Solarium Lake Elat (Israel), in some lakes Kulunda steppe, on the Crimean peninsula, the Karakum (Dzens-Litovsk, 1957) and on the lake. Sassykkul the Eastern Pamirs (Egorov, 1991).
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The Elimination of Selenium from Contaminated Water using Sulfide or Dithionite Activated by UV Light
Authors: Bahngmi Angela Jung, Aya Safan and Ahmed Abdel-WahabSelenium (Se) is an essential trace element for animals and humans because it functions as an antioxidant and catalyst for the production of active thyroid hormone. However, higher intake of Se can cause disease and death to humans. This study investigates the removal of inorganic Se (selenite, Se (IV)) from contaminated water which is known as less bioavailable and more toxic than organic forms. Several technologies exist for Se removal such as lime neutralization, bacterial reduction, ion exchange membranes, electrocoagulation, sorption, and hybrid processes such as coagulation/filtration. However, these techniques were demonstrated to be effective only at low Se concentrations levels (below 5 mg/L). This study employs an advanced reduction process (ARP) that combines a reducing agent and an activation method and investigates its applicability for Se removal at high concentrations (∼10 mg/L).
The goal of this research is to investigate the effectiveness of ARP for reducing Se (IV) to elemental Se or stable solids composing of Se and S (e.g. SeS or SeS2) in water using a combination of dithionite or sulfide as reducing agents and UV light as an activating method. Three different UV light sources including monochromatic 254 nm UV-L, UV-M with primary energy peak at 365 nm, and 312 nm UV-B were evaluated. This work studied the effects of operating conditions such as concentrations of reducing agents, solution pH, and initial selenium concentration for the optimum combination that achieves the efficient reduction of Se (IV).
In industrial applications, sulfur dioxide has been used as the reactant to reduce Se (IV) to elemental Se, but it was reported that SO2 was ineffective for Se (IV) reduction for waters with low Se concentration at room temperature. In this study, sodium dithionite and sodium sulfide were used as a strong reducing agent of interest. Sodium dithionite was proven to be an effective reductant and produce active reducing radicals when activated by UV light. It has been shown to be very effective in reducing chlorate, trichloroethylene or 1,2-dichloroethane in our earlier studies. It is known that dithionite undergoes decomposition reactions which is strongly dependent on the pH and is rapid in the acidic environment and its major decomposition products are thiosulfate (S2O3 2–) and bisulfite (HSO3–). Decomposition reaction is very complicated because its reaction products can decompose and interact with each other and can be activated by UV irradiation at various rates, which will result in the production of elemental sulfur or selenium, or precipitates of Se-S at different stages. In Se-S solution, the compounds having a general formula, SeSn (n:1–7) can be produced and it can form crystalline or amorphous composition. Therefore, we investigated the chemistry of dithionite and sulfide in Se-S water system and the behavior Se removal under UV irradiation.
Screening tests of various combinations of reducing agents and UV light types showed that the greatest Se removal (86.4%) was found with dithionite irradiated by UV-L lamp (254 nm) at around pH 5. Sulfide as a reducing reagent at neutral pH resulted in selenium removal percentages of 83.5% and 92.5% without and with UV-L irradiation, respectively. Maximum removal efficiency of Se was observed when sulfide or dithionite molar concentration was 40 times the initial Se molar concentration under UV light at given conditions. A typical color of the Se-dithionite mixture solution was milky yellow during UV-L irradiation.
Yellow-colored solids were precipitated. The combination of dithionite and UV-B (major peak at 312 nm) showed orange-colored solid in 3 hours of irradiation. It is expected that dithionite or dithionite decomposition products will produce active radicals dependent on UV light types, which may change Se-S solid chemistry. To investigate surface chemistry of solids and sulfur-containing species, X-ray powder diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy/energy dispersive spectrometry (SEM/EDS) were utilized. Also, incremental reducing agent solution injection or electrocoagulation method was utilized to reduce final Se concentration to below the maximum contaminant level.
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3D Geological Modeling with Multi-Source Data Integration for Asl Member in Rudies Formation Gulf of Suez
More LessBy stepwise refinement on multiple data, the method increases the accuracy of 3D models gradually and effectively. In addition, the mechanisms used in the method for organizing and manipulating information can have an equally important impact upon geologists’ thought, the interpretation of geological data, and 3D modeling methodology. A concrete example of using the method to Huai Bei fault and fold belt shows that the method can be applied to broad and complex geological areas. The technology of 3D geological modeling will bring about great changes in the methods of acquiring, storing, processing and displaying geological data. The 3D modeling methods frequently used are mainly based on plenty of 2D/3D seismic data or borehole data with cross sections between boreholes. Outlined a prospective 3D model construction method that depends on a 2.5D geological mapping anddata extraction technique. An open CORBA-based system architecture was presented that connects two existing geoscientific software tools—the geological 3D modeling and visualization tool (GOCAD) and a geophysical 3D modeling tool (IGMAS)––via a 3D Geo-database kernel. We propose a stepwise refinement method with multi-source data integration and present a comprehensive yet convenient 3D modeling system. The method can naturally simulate geological structures no matter whether the available geological data is sufficient or not. By stepwise refinement on multiple data, the method increases the accuracy of 3D modeling gradually and effectively. In addition, the mechanisms used in the method for organizing and manipulating information. 3D subsurface visualization system (SVS) has been developed. The SVS implemented in Visual C++ 6.0 and OpenGL graphics library and being able to run on the PC platform, provides a comprehensive yet convenient environment, which makes it possible for the user to build 3D models in oil exploration where there is enough available data, as well as in geological survey and mineral extraction where the geological data is insufficient. The method/SVS can be applied to broad and complex geological areas. The proposed method builds 3D models from multisource data in a stepwise manner and involves six steps: (1) integration of 2D/2.5D data, (2) supplement of cross sections, (3) Simulation of faults, (4) definition of a template, (5) construction of horizons, and (6) representation of solids. Data of different types and qualities are first merged into a 3D geologic model by data conversion interfaces. The diverse data are classified into three types: direct data, indirect data, or assistant data, depending on the type and the purpose of the information and application.
• 1-Direct data, such as borehole data and property data, is original sampling data obtained by direct observation and survey, and is highly accurate.
• 2-Indirect data, being original too, has different precision with different resolutions of graphs, such as boundaries, faults, folds and DEM derived from geological maps, topographic maps and structural geology maps, as well as 2D/3D seismic-reflection data, exploring data, etc. This type of data should be stored as files after being digitized. However, this kind of data cannot be used as direct input data for the 3D modeling system.
• 3-Assistant data will be used in the process of 3D modeling as icons like 2D/3D primitives, and texture maps including satellite or aerial imagery, scanned maps, etc. The research in the past has focused on generating 3D models from borehole and cross-section data. This has limitations, however, since these data are lacking in many areas. In this section, we emphasize on how to use data of different types and qualities, as well as various mathematical methods to gradually refine 3D models to a desired accuracy.
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Life Time Stability Study of PCDTBT:PC71BM Solar Cells with the Organic-inorganic Hybrid Hole Transport Layer Fabricated in Various Atmospheric Conditions
Authors: Saqib Rafique, Khaulah Sulaiman and Shahino Mah AbdullahBulk heterojuntion organic solar cells (BHJ OSCs) have gained much attraction in recent years. These solar cells have layered geometric structure and optimization of each layer is essential to achieve the overall performance of the device. Active layer consisting of donor and acceptor material is sandwiched between two electrodes. In order to improve the device stability and efficiency, often interfacial layers, namely electron and hole transport layers, between the active layer and electrodes are introduced. Poly (3.4-ethylenedioxythiophene): Poly (styrenesulfonate) (PEDOT:PSS) is most commonly applied hole transport layer (HTL) in OSCs. However, it limits the device performance due to its highly hygroscopic and acidic nature which arise reliability issues while reducing the cell life drastically. Metal oxides have been proved to be a good alternative to it. These metal oxides improve the device efficiency comparable with standard HTL and at the same time they substantially enhance cell stability. The aim of this work is to optimize the hole transport layer by using different metal oxides such as vanadium pentaoxide (V2O5) by improving its structural, optical, and electrical properties. V2O5 has been extensively studied as a promising candidate for charge extraction and transportation because of its exceptional electronic properties. It proved to be more stable due to its good transparency, low resistance and better adhesions to the active layer. The novelty of our study is to develop a highly controllable, reproducible and cost effective fabrication technique to build our device with poly [N-9’-heptadecanyl-2,7-carbazole-alt-5,5-(4’,7’-di-2-thienyl-2’,1’,3’-benzothiadiazole)] (PCDTBT), and (6,6)-Phenyl C71 butyric acid methyl ester (PC71BM) based active layer yielding high stability and efficiency. This work is focused on improving the device stability along with the efficiency which has not been explored much to date.
In this work, we demonstrate the fabrication of PCDTBT:PC71BM based bulk heterojunction solar cells with two variants of hole transport layer (HTL) in different fabrication atmospheres. Device with standard PEDOT:PSS hole transport layer has been compared with its organic-inorganic (V2O5 in PEDOT:PSS) hybrid variant in terms of efficiency and life time stability when they are fabricated in controlled mode in the nitrogen filled atmosphere and an ambient mode in the presence of oxygen and 65% relative humidity (RH). Vanadium pentaoxide (V2O5) nanoparticles, synthesized by co precipitation method, are mixed in PEDOT:PSS layer to form an organic-inorganic hybrid HTL. Both variant of hole transport layer are further characterised for their structural and optical properties to optimise these fundamental properties to ensure highly stable and efficient solar cell. Normalized efficiencies are calculated as a function of time for life time stability tests of both types of devices fabricated in both atmospheric modes. The best performance is achieved for a device with hybrid HTL fabricated in controlled mode where the life time stability has improved from 70% to 94% over one week period and from 65% to 90% over four week time when they are compared with their standard PEDOT:PSS HTL counterpart. Our results confirm that fabrication environment play a key role in device performance in terms of stability and efficiency along with the improvement brought by addition of V2O5 nanoparticles in the pristine PEDOT:PSS hole transport layer.
Keywords: Hole transport layer; Organic solar cells; PEDOT:PSS; Stability; V2O5
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Experimental and Numerical Analysis of Heat Transfer in Grooved Tubes for Solar Collector Applications
Authors: Ben Alex Baby and Y. Raja SekharSolar thermal energy research and utilization is progressing rapidly since it is clean energy and can achieve carbon credits in developed and developing countries. The energy conversion efficiency of most of the solar collectors is low, as much of the energy absorbed by collectors is lost due to transient atmospheric conditions. Reduction of losses and improving the performance of collectors by providing economical solutions has been the greatest challenge that scientists are facing even today. Material technology has achieved highest boundaries in all the applied fields ranging from medical to space. According to literature, the use of nanofluids in thermal devices improves the performance thereby further increasing the thermal conversion efficiency of solar collectors. The work here aims at numerically and experimentally studying the heat transfer enhancement obtained as a result of introducing grooved tube collector and using ZnO nanofluid as the working media in a solar flat plate collector. Helical grooves of different pitch are made in collector tubes that generate a spin flow which would increases the heat transfer rate at the expense of increased pressure drop. The convection heat transfer is enhanced as a result of flow through these grooved tubes which is the reason for the absorption efficiency increase. Heat transfer augmentation increase in grooved and plain tubes is compared here. Heat transfer augmentation is expected to increase when compared to a plain tube and a comparative analysis is carried out on the basis of the heat transfer coefficient, wall shear stress at constant Reynolds number and constant mass flow rate condition. The improvement in absorption efficiency at two different groove depth (e/d = .023, .0175) and varying flow velocity is also studied. The use of nanofluid has been a recent technological advancement as the metal/metal oxides dispersed in a base medium improved the absorptive solar energy by up to 95% which further increasing the thermal conversion efficiency. ZnO nanofluids are prepared by economical methods at different volume concentrations. The particle concentration is one determining parameter and on increasing the concentration the heat transfer properties show a rise up to a maximum value and beyond which it decreases. The numerical analysis here is done for ZnO nanofluid with particle concentration varying from .5%–2%. The synergic effect of the two improvements in the heat transfer and fluid flow characteristic is studied experimentally and numerically in the transition and turbulent flow regimes.
Keywords: Flat plate collector, grooved tube, Heat transfer coefficient, Reynolds number, ZnO nanofluid
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Stem Cell-Based Selective Delivery of Alpha Keto Reductases for Therapeutic Targeting of Residual Androgens in Metastatic Prostate Cancer
More LessIntroduction: The de novo synthesis and “intracrine” production of androgens by prostate tumors provides a significant survival advantage leading to the outgrowth of castration resistant tumors. Currently, targeting residual androgens in metastatic prostate cancer (PC) microenvironment is the toughest challenge in the clinical management of advanced PC patients treated with androgen ablation therapy (AAT), as they are implicated for development of castration-resistant PC (CRPC). Our previous studies (Stem Cells, 2014) demonstrate that PC-derived adipose derived stem cells (pASCs) promote tumor growth and undergo PC mimicry through neoplastic reprogramming. The present study examines the role of pASCs in synthesizing and producing and rogens and its potential in supporting growth of hormone-dependent PC cells under castrate conditions in vitro and in vivo. Further more, the study attempts to identify key players among the and rogen-metabolizing enzymes (AMEs) in the backdoor pathway for targeting and degradation of androgen synthesis in the prostate tumor microenvironment, by both in vitro and in vivo assays. Methods: Based on an IRB approved protocol, the pASCs were isolated from fatt issues procured from PC patients undergoing radical prostatectomies. The purity of the pASC isolates was validated by FACS analysis and differentiation assays. The ability of pASCs exposed to PC-derived conditioned media (CM) to produce androgens was monitored by expression of AMEs (PCR) and androgen release (EIAkit). The ability of pASC CM to support growth of androgen-dependent LNCaP cells was assessed by MTT assay and growth of LNCaP tumors co-transplanted with pASCs in castrated mice in vivo. Normal donor-derived adipose derived stem cells (nASCs) were enriched for tumor tropicity by a transwell system. Next, we subcloned in a GFP bicistronic IRES lentivirus construct (pLVX-IRES-ZsGreen1) the rat androgen hydrolyzing enzyme 3α-hydroxysteroid dehydrogenase (Type I, 3α-HSD), as known as AKRIC14, in-frame with IL-2SS sequence at the N-terminus. R1C14. The ILL2SS sequencec enables the AKR1C14 by the transduced cells. Upon transduction, the enriched nASC population was monitored for the transgene expression and release by qRT-PCR, immunoblotting and EIA kit. The efficacy and functional activity of the recombinant enzyme and the nASC-released ANR1C14 enzyme were monitored by MTT, LDH and luciferase reporterassays in the androgen-dependent LNCaP cells in vitro. The tumor-homing potential of the GFP-AKRC14 expressing nASCs infused by IV route was validated by their engraftment in LNCaP tumor-bearing mice. To examine the efficacy of secreted enzyme to hydrolyze androgens andinduce tumor regression in vivo, the GFP-AKR1C14 transduced nASCs were injected in mice bearing LNCaP tumors and tumor volumes were measured weekly. Results: We demonstrate here in that unlike normal adipose-tissue derived stem cells (nASCs), the PC cell microenvironment subverts tumor-tropic PC patients' derived ASCs (pASCs) to synthesize and produce androgens in the tumor microenvironment. The pASC-mediated hormone production was sufficient to support the growth of androgen-dependent LNCaP PC cells in vitro under hormone-deprivation conditions as well as in castrated nude mice. Comparative analysis of gene expression of AMEs in microdissected cells versus the adjacent normal tissue revealed AKR1C4, an alpha keto reductase, to be the most promising candidate for targeting the backdoor pathway in dihydrotestesterone (DHT) synthesis. Type 1 3α-HSD enzyme has been shown to readily oxidize testosterone to Δ4-androstene-3, 17-dione in a substrate dependent reaction. The recombinant AKR1C4 induced cytotoxicity and apoptosis in androgen-dependent PC cells in vitro. Next, using a GFP bicistronic IRES lentivirus construct, we demonstrate that the genetically engineered tumor-tropic nASCs enable expression and secretion of AKR1C14. The results showed that the engineered nASCs are capable of expressing the enzyme, which in turn catabolizes androgens in vitro and induce apoptosis in androgen-dependent LNCaP cells. The AKR1C14 transduced nASCs successfully engrafted in and reduced growth of LNCaP tumors in nude mice. Conclusions: Together, our data demonstrates that selective delivery of alpha keto reductases by nASCs could eliminate residual androgens and further paves the way for their potential use in combination with AAT for treatment of CRPC.
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The Impact of Bariatric Surgery on Neuropathic Pain and on Objective Markers of Neuropathy
Background: Obesity (BMI ≥ 30 kg/m2) is associated with T2 diabetes (40-fold relative risk) and cardiovascular complications. Bariatric surgery is becoming a treatment of choice in obese individuals because of the multiple benefits associated with significant weight loss leading to an improved quality of life and decreased morbidity and mortality, which far out weighs the cost of surgery. A major metabolic benefit is the remission from T2 diabetes as a consequence of alterations in gut hormone signaling and weight loss. Indeed cost-effectiveness analyses have led NICE to recommend that all patients with a BMI ≥ 35 kg/m2 with T2 diabetes should be considered for bariatric surgery. In relation to the impact on macro vascular complications there is a significant reduction in MI and stroke in long term follow up studies, which translates to reduced mortality. For the microvascular complications of diabetes, studies are limited but have primarily focused on retinopathy and nephropathy after bariatric surgery. Despite the fact that neuropathy (nerve damage) can lead to pain and foot ulceration with amputation together with increased mortality from autonomic neuropathy, few studies have objectively assessed the impact of bariatric surgery on neuropathy. However, there are concerns that neuropathy could worsen following bariatric surgery due to nutritional deficiencies [1] and indeed there are case-reports of acute Guillain-Barre like demyelinating [2] and motor axonal [3, 4] neuropathy following bariatric surgery. The term post bariatric surgery neuropathic pain has also been coined with a reported prevalence of 33% following bariatric surgery [5]. However, a more recent study has shown complete resolution of neuropathic symptoms with an improvement in the neuropathy disability score [6]. Whereas a recent case-control study has showed no improvement in nerve conduction velocity [7]. Given the potential benefits and indeed harm following bariatric surgery there is a need for a systematic quantitative assessment of neuropathy to define true rates of remission or worsening. Aims: Systematically define the baseline prevalence of neuropathic pain and neuropathy and the outcomes following bariatric surgery on neuropathic pain and objective markers of somatic and autonomic neuropathy in obese subjects with and without T2 diabetes, 6 and 12 months after surgery. Methods: This is a prospective, randomized, single center trial assessing the effect of gastric bypass surgery. The subjects in the study were recruited from Salford Royal NHS Foundation Trust, UK and the study was performed at the Wellcome Trust Clinical Research Facility/NIHR, Manchester, UK from 3 September 2013 until 30 July 2015. We estimated that the minimum sample required to detect a significant difference in peripheral autonomic (Neuropad response) and sensory nerve morphology using the novel imaging technique of corneal confocal microscopy (CCM) to quantify corneal nerve fibre length (CNFL) over 12 months was 52 and 46 subjects, respectively with a power of 80%. Exclusion criteria included history of neuropathy due to non-diabetic cause and corneal trauma or surgery. Painful neuropathy was defined using a composite score of the McGill questionnaire with either a positive neuropathic symptom profile (NSP) or diabetic neuropathy symptom (DNS). The objective end-points for remission from neuropathy were: 1) >15 nerve branches/mm2 in corneal nerve branch density (CNBD) and >15 mm/mm2 in corneal nerve fibre length (CNFL), 2) for autonomic neuropathy >90% on the Neuropad response, and 3) for sensory neuropathy, < 2 on the neuropathic disability score (NDS) and < 15 Volts for vibration perception threshold (VPT). The Local Research Ethics committee approved this study and all subjects gave informed consent to take part in the study. The research adhered to the tenets of the declaration of Helsinki. Results: Of 106 subjects recruited, 40 refused and 23 are awaiting follow-up assessments. We have analysed 43 subjects with an average age of 52.2 ± 2.1 years. Baseline BMI was 50.6 ± 2.8 kg/m2 and was significantly reduced to 38.2 ± 1.4 kg/m2 (P < 0.0001) and 35.8 ± 1.7 kg/m2 (P < 0.0001) at 6 and 12 months, respectively. 26/43 (60%) of subjects had T2 diabetes before surgery. Based on normalization of HbA1c the remission rate from diabetes was 81% 12 months after surgery. Baseline HbA1c in 26 subjects with T2 diabetes was 7.4 ± 0.3% and was significantly reduced to 5.9 ± 0.2% (P = 0.0007) and 5.6 ± 0.1% (P < 0.0001) at 6 and 12 months, respectively. Hypertension (Systolic BP >120 mmHg) was identified in 37/43 (86%) of subjects pre-surgery. The remission rate from hypertension was 57%, 12 months after bariatric surgery. The average starting systolic blood pressure in these subjects was 130.3 ± 2.7 mmHg and was significantly reduced to 120.8 ± 3.13 (P = 0.03) and 114.4 ± 5.49 (P = 0.008) at 6 and 12 months, respectively. The prevalence of sensory neuropathy assessed using the Neuropathy Disability Score (NDS) in 41 subjects was 34% pre-surgery and the remission rate was 50%, 12 months after surgery. Baseline NDS was 2.0 ± 0.4, indicative of minimal neuropathy but was significantly improved to 0.89 ± 0.4 (P = 0.05) at 12 months. Vibration perception threshold was 13.6 ± 1.25 V and showed no improvement (12.6 ± 1.46 V, P = 0.58) 12 months after surgery. The prevalence of neuropathic pain in 36 subjects was 39% pre-surgery and a complete recovery was observed in 71% and 93% of patients at 6 and 12 months, respectively. Likewise, 45% of the 22 subjects with T2 diabetes had neuropathic pain at baseline and 70% and 90% had no painful neuropathy at 6 and 12 months, respectively. The prevalence of peripheral autonomic dysfunction assessed using Neuropad in 24 subjects was 57% pre-surgery and the remission rate was 69% 12 months after surgery. The Neuropad response at baseline was 77.95 ± 5.1% and improved significantly (91.3 ± 3.86%, P = 0.04) 12 months after surgery. Corneal confocal microscopy showed a significant increase in corneal nerve fibre length in the 26 subjects with diabetes from a mean of 14.2 ± 0.7 mm/mm2 to 16.7 ± 1.04 mm/mm2 (P = 0.049) and an increase in corneal nerve branch density (32.8 ± 3.35 no./mm2 to 43.2 ± 4.49 no./mm2 (P = 0.068). However, there was no change in corneal nerve fibre length or branch density in 17 subjects without T2 diabetes 12 months after surgery. Conclusion: Our study shows a high prevalence of diabetes; hypertension, neuropathic pain and neuropathy assessed using objective measures of somatic and autonomic neuropathy in obese people. Bariatric surgery results in significant weight loss, and improved glycemic control and blood pressure, with a reduction in the prevalence of painful neuropathy and improvement in autonomic and in particular small fibre neuropathy assessed using corneal confocal microscopy. Morbid obesity is common (-30%) in the Qatari population and bariatric surgery is an increasingly performed procedure. Contrary to previous data showing a worsening of both neuropathic symptoms and deficits, our data show significant weight loss with an improvement in glycaemic control and blood pressure which improves neuropathy and therefore provide a strong rationale for undertaking bariatric surgery and reducing disabilities to reach the goals of VISION 2020-Qatar.
References
1. Thaisetthawatkul, P., et al., A controlled study of peripheral neuropathy after bariatric surgery. Neurology, 2004. 63(8): p. 1462-70.
2. Ishaque, N., et al., Guillain-Barre syndrome (demyelinating) six weeks after bariatric surgery: A case report and literature review. Obes Res Clin Pract, 2015. 9(4): p. 416-9.
3. Landais, A., Neurological complications of bariatric surgery. Obes Surg, 2014. 24(10): p. 1800-7.
4. Landais, A.F., Rare neurologic complication of bariatric surgery: acute motor axonal neuropathy (AMAN), a severe motor axonal form of the Guillain Barre syndrome. Surg Obes Relat Dis, 2014. 10(6): p. e85-7.
5. Kattalai Kailasam, V., et al., Postbariatric surgery neuropathic pain (PBSNP): case report, literature review, and treatment options. Pain Med, 2015. 16(2): p. 374-82.
6. Muller-Stich, B.P., et al., Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization-results of a prospective cohort study (DiaSurg 1 study). Ann Surg, 2013. 258(5): p. 760-5; discussion 765-6.
7. Miras, A.D., et al., Type 2 diabetes mellitus and microvascular complications 1 year after Roux-en-Y gastric bypass: a case-control study. Diabetologia, 2015. 58(7): p. 1443-7.
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The Role of 4-hydroxynonenal in Human Preadipocyte Proliferation and Differentiation
Accumulation of lipid peroxidation products in response to oxidative stress can cause dysfunction and pathology in a variety of tissues. In this study, we investigated the presence of 4-hydroxynonenal (4-HNE), the most abundant lipid peroxidation end product, in paired subcutaneous (SC) and omental (OM) tissues obtained from morbidly obese individuals undergoing weight reduction surgery. We further assessed 4-HNE effect on proliferation and differentiation of preadipocytes derived from these tissues in two metabolically distinct groups. Levels of 4-HNE accumulation were positively correlated between the paired SC and OM tissues (R2 = 0.9, p = 0.01) and exhibited a higher accumulation in OM-adipocytes and connective tissues compared to SC-derived counterparts. Exposure of tissues-derived preadipocytes to physiological levels of 4-HNE caused inhibition of proliferation and differentiation of SC, but not OM-derived preadipocytes. When samples were dichotomized into insulin sensitive (IS) and insulin resistant (IR) groups based on their HOMA-IR index, 4-HNE treatment caused a greater reduction of both proliferation by 76% with a mean difference of 11.4% (3–45.3) and differentiation capacity by 56% with a mean difference of 25.9% (3.9–55.7) in IS compared to IR. This data suggest that 4-HNE induced oxidative stress plays a role in the regulation of adipocyte proliferation and differentiation in a depot and insulin sensitivity-specific manners and may therefore contribute to metabolic dysfunction associated with insulin resistance. This research was sponsored by Qatar National Research Fund (QNRF), Grant number NPRP6-235-1-048.
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Alpha-Synuclein Oligomers as a Biomarker Candidate for Parkinson's Disease and Disorders
More LessDeveloping effective treatments for neurodegenerative diseases is one of the greatest medical challenges of the 21st century. Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are very common neurological disorders of the elderly (Jankovic et al., 2008). Although many of these clinical entities have been recognized for more than a hundred years, it is only during the past fifteen years that the molecular events that precipitate the diseases have begun to be understood. Mutations in the α-synuclein gene cause early-onset PD, often associated with dementia, and one an α-synuclein mutation segregated with pure DLB (with no Alzheimer's pathology). Neuropathologically these diseases are characterized by the presence of Lewy bodies, intraneuronal inclusions mostly composed of α-synuclein protein fibrils, cementing the notion that this protein has a central role in Lewy body diseases (LBD). Despite the progress that has been made in understanding the underlying disease mechanisms of LBD, there remains an urgent need to develop methods for use in diagnosis. The development of reliable surrogate markers for the presence and abundance of α-synuclein lesions (Lewy bodies) in the brain would naturally facilitate a more streamlined work-up during the early care of PD and DLB patients, and importantly, allow for the biologically guided evaluation of future drug trials aimed at neuroprotection in the synucleinopathies. Recently, we generated new antibodies specific for different forms of α-synuclein such as oligomeric-α-synuclein (o-α-synuclein), phosphorylated-α-synuclein at serine 129 (p-S129-α-synuclein) or total-α-synuclein (t-α-synuclein), to develop highly specific and sensitive ELISA systems to assess the levels of these species in biological fluids. Next, we utilized our assays to explore the potential use of α-synuclein species as biomarkers for PD in cerebrospinal fluid (CSF) samples from a cross-sectional cohort of 46 PD patients and 48 age-matched healthy controls. Thereafter, we validated our results in large longitudinal DATATOP cohort (n = 242) over two-year follow-up period). In our study we also investigated the potential predictive role of CSF Alzheimer's disease (AD) core biomarkers (Aβ42, total tau, p-tau). In our study we also investigated the added predictive value of CSF AD core biomarkers (Aβ42, total tau, p-tau) to CSF α-synuclein species. Interestingly, a strong positive correlation between the changes in CSF t- and o-α-synuclein levels was noted. Such a strong correlation clearly suggests that the increase of CSF t-α-synuclein levels at the early stages of the disease lead to the formation and accumulation of the pathogenic species of o-α-synuclein in the brain that cause neuronal cell death. It has been shown that soluble o-α-synuclein are elevated in brain homogenates from PD and DLB compared to normal brains (Sharon, et al., 2003; Paleologou, et al., 2009). Together with the results from our previous studies, we provide strong evidence for the important role of o-α-synuclein in the pathogenesis of PD and other synucleinopathies (El-Agnaf et al., 2003). Consistent with our recent study (Parnetti, et al., 2014), we also found that the change in CSF Aβ42 levels correlated with the change in UPDRS-mental scores, suggesting that CSF Aβ42 may aid in predicting cognitive decline in PD patients. It's worth mentioning that one of the many important features that distinguished the DATATOP study from other studies is that the untreated PD subjects enrolled in the DATATOP study were at a very early stage of the disease; a stage estimated to be earlier than most of the other clinical trials. At baseline, PD patients presented with minimal disability and were followed until just prior to the initiation of the dopamine replacement therapy, and this is reflected in the low H&Y scores registered for these patients. This limited motor disability may explain the lack of an association between the baseline or follow-up CSF biomarkers and disease severity. However, the significant changes of CSF α-synuclein levels we observed in the DATATOP cohort over approximately two years of disease progression, suggest that a correlation between CSF α-synuclein levels and clinical parameters will become apparent with longer follow-up. However, our findings still need to be further validated in large-scale, prospective and well-controlled studies, especially those that include subjects with neuroimaging-supported definite PD and healthy controls such as the on-going Parkinson's Progression Markers Initiative. Synucleinopathies and tauopathies show significant clinical and pathological overlap, making the early diagnosis of PD more challenging. This overlap necessitates a combination of measurements of CSF α-synuclein species with AD key biomarkers to improve diagnostic accuracy. Our cross-sectional analyses revealed a positive correlation between CSF t-α-synuclein and t-tau and p-tau in the PD group. Our findings confirm and extend the observations by Toledo and his colleagues who reported a positive correlation between CSF t-α-synuclein and tau levels in PD, AD and controls (Toledo et al., 2013). These data suggest that the elevation of CSF tau and t-α-synuclein reflect synaptic degeneration and axonal loss. To our knowledge, this is the first study that combines measurements of different species of α-synuclein, along with AD biomarkers, and showed significant changes of CSF α-synuclein species in large longitudinal study at the early stages of PD. Taken together, these data suggest that the levels of t-, o- and p-S129-α-synuclein species change over the natural course of the disease, and thus might aid in monitoring disease progression and severity. This supports our hypothesis that changes in CSF α-synuclein species are a more direct measure of the formation of LBs and Lewy neurites, which are the hallmarks of PD pathology. Our findings study demonstrated that quantification of α-synuclein species in CSF has strong potential value as a tool not only for PD diagnosis but also for presymptomatic screening of high-risk individuals who are good candidates for neuroprotective treatment.
References
El-Agnaf OM, Walsh DM, Allsop D. Soluble oligomers for the diagnosis of neurodegenerative diseases. Lancet Neurol 2003;2:461–462.
Jankovic, J. Parkinson's disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008;79:368–376, doi:10.1136/jnnp.2007.131045.
Kordower, J. H. et al. Disease duration and the integrity of the nigrostriatal system in Parkinson's disease. Brain 2013;136:2419–2431, doi:10.1093/brain/awt192.
Paleologou, K. E. et al. Detection of elevated levels of soluble alpha-synuclein oligomers in post-mortem brain extracts from patients with dementia with Lewy bodies. Brain 2009;132, doi:10.1093/brain/awn349.
Parnetti, L. et al. Differential role of CSF alpha-synuclein species, tau, and Aβ42 in Parkinson's Disease. Front Aging Neurosci 2014;6:53, doi:10.3389/fnagi.2014.00053.
Sharon, R. et al. The formation of highly soluble oligomers of alpha-synuclein is regulated by fatty acids and enhanced in Parkinson's disease. Neuron 2003;37:583–595.
Toledo, J. B., Korff, A., Shaw, L. M., Trojanowski, J. Q. & Zhang, J. CSF α-synuclein improves diagnostic and prognostic performance of CSF tau and Aβ in Alzheimer's disease. Acta Neuropathol 2013;126:683–697, doi:10.1007/s00401-013-1148-z.
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Exploring Depression Amongst Cardiovascular Patients Living in the State of Qatar – Findings from a Cross-Sectional Study
More LessIntroduction
Cardiovascular diseases are the leading cause of death. Studies show that depression is associated with an increased morbidity and mortality among cardiovascular (CV) patients. Depression contributed to patients’ unfavorable prognosis after a cardiac event, hamper cardiac rehabilitation, and increase hospital re-admission rate among CV patients. Studies show that 15 – 30% of CV patients experience depression. Early detection and intervention for depression among cardiovascular patients can reduce morbidity and mortality rates. Understanding factors contribute to the risk of depression and its management among cardiovascular patients is necessary to adequately address the complex nature of depression as co-morbidity among Arab CV patients in the Middle East region. Objectives: (1) To evaluate the prevalence and severity of depression among patients who have confirmed diagnosis of cardiovascular diseases; and (2) To find ways to manage depression among male and female Arab CV patients. Methods: Using non-probability, convenient sampling method, a cross-sectional survey was conducted with 1000 Arab CV patients of which 688 (69%) male and 312 (31%) females between January, 2013 and September, 2014 at the Heart Hospital in Qatar. Inclusion criteria were ≥ 20 years of age, agreeing to participate in the study (98% response rate), and having final confirmation of acute cardiac conditions. Face-to-face interviews were conducted using structured survey questionnaires which included an Arabic demographic questionnaire and the Arabic version of the Beck Depression Inventory 2nd Edition (BDI-II) - a self-report instrument, which had been translated into Arabic and validated for its validity and reliability. Descriptive and inferential statistics were performed using SPSS version 20. Results: Almost half of the male and female participants were Qatari nationals (46%). Citizens of the Levant countries (Syria, Lebanon, Palestine, Jordan) constituted 20% and North African countries (Egypt, Libya, Tunisia, Algeria, Morocco) constituted 17% of the participants. 80% of the patients had no depressive symptoms, 15% of the patients had Mild Mood Disturbance and 5% had symptoms of clinical depression. Almost twice as many females (29%) than males (16%) were found to suffer from Mild Mood Disturbance and Clinical Depression. Approximately half of both male and female patients who scored ≥ 17 on the BDI-II (suggesting symptoms of clinical depression) refused psychiatric assistance. Chi Square tests indicated that age and socioeconomic factors, nationality, marital status, monthly income, employment, occupation, financial stress and support were significantly related to gender and depression (all p < 0.001).
Conclusion: (1) In-depth systematic assessment of mental health status and screening for depression should be performed routinely for all patients who had diagnosed with cardiovascular diseases, particularly females.
(2) Public awareness and education about mental health are critical in order to reduce the stigma associated with accessing treatment for it.
(3) Practices, treatments and diagnostic tools for depression should be thoroughly investigated and adapted to the Arab Middle Eastern context in order to facilitate the development of culturally appropriate mental health care and uptake of cardiac interventions and rehabilitation.
(4) Health policy makers should encourage and support psychiatric training and primary health care providers should be trained to provide psychiatric assistance to CV patients.
(5) Socioeconomic related factors influence the mental health of male and female CV patients differently and accordingly their CV conditions and outcomes.
(6) To effectively manage and treat depression among Arab CV patients, health care providers should be encourage to integrate gender differences approach into clinical practice.
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Derivation of Hepatocyte Like Cells from Human Pluripotent Stem Cells in GMP Compliant Conditions
More LessThe liver is the largest internal organ in the human body and performs a broad range of functions. Hepatocytes are the primary cells of liver. They perform many functions, an endocrine function, secretion of most proteins found in the blood plasma including albumin, exocrine functions and secretion of bile into the digestive tract. They are also involved in carbohydrate and lipid metabolism, drug detoxification and storage of glycogen. In addition, the liver has a unique capability of regeneration as the liver can fully regenerate itself following severe damage which leaves one-third of the cells uninjured (Michalopoulos, 1997; Taub, 2004). Liver disease and progressive loss of liver function is a major clinical challenge. Liver disease is the fifth highest cause of early mortality in the UK and the only cause of death that is increasing every year (Office for National Statics., 2008). With changes in lifestyle, new diseases such-as non-alcoholic fatty liver disease and steatohepatitis, a lack of hepatitis C vaccination and risk of hepatocellular carcinoma in hepatitis patients with increasing age are further compounding the problem of liver disease in the UK (Bosch et al., 2004; Kim et al., 2002) Currently liver transplantation is the only treatment available for end stage liver disease and a few liver based metabolic defects (Sze et al., 2009). Split liver transplantations is available and makes more transplants possible but ultimately is not sufficient to fulfill the growing need. Cell-based therapy involving the transplantation of primary hepatocytes could greatly expand the number of patients provided with effective treatment. However, primary hepatocytes are difficult to obtain in sufficient number. Indeed, they can only be obtained from organs suitable for transplantation as they cannot be expanded in vitro. These limitations can be overcome by using human Embryonic stem cells (hESCs) or induced pluripotent stem cells to differentiate into hepatocytes. Stem cells have great potential because of their self-renewable capacity differentiation potential including differentiation into hepatocytes (Hannan et al., 2013; Si-Tayeb et al., 2010; Sullivan et al., 2010). In our lab Hannan et al. have previously published an efficient and robust protocol to differentiate human stem cells to hepatocyte-like cells in a stepwise manner using defined factors. Human pluripotent stem cells (hPSCs) hold several clinical promises including the potential to produce large quantity of cells necessary for cell based therapy approaches. Hence, hPSCs provide an advantageous alternative since they can be differentiated into hepatocyte-like cells which display functional characteristics of their in vivo counterparts. However, there are two major limitations that must be overcome before this approach can go to clinical trials. Firstly current protocols are not GMP (Good Manufacturing Practice) grade. Secondly, hepatocytes-like cells derived in-vitro lack a several characteristics of adult hepatocytes and express fetal markers indicating that they are not fully functional. Here, I aim to develop a method to generate hepatocyte-like cells from hPSCs in conditions compatible with clinical applications. For that, I have developed a culture system to generate hepatocyte-like cells using culture conditions compatible with GMP. The resulting cells display characteristics of their in vivo counterpart and represent a first step toward the development of cell based therapy for liver diseases. In my study, as far as we know I am the first to have translated differentiation of hepatocytes-like cells into GMP-compliant conditions. Here, I report a method to translate our previously published efficient and promising step-wise hPSCs directed research grade differentiation protocol for the generation of hepatocytes-like cells under GMP-compliance conditions, demonstrating that this can be attained and hepatocytes-like cells can be produced at a standard suitable for clinical trail purposes. In general, the employment of cell-based products in clinical studies needs formal approval from the respective regulatory body (British Standards Institution, London, UK). According to the current national regulations this approval requires manufacturing, processing and testing of cellular products (Bailey et al, 2014). The manufacturing of cell product requires use of safe and pure components and materials in order to fulfil the regulatory standards. It is essential to use stable and clinical grade hESCs cell lines that first generated and preserved in GMP banks which provided effective, safe cell source as starting material. If possible, licensed and GMP-grade materials must be used, in case of no alternatives, highly purified xeno-free or animal-free research grade reagent should be used, with additional in-house testing to ensure safety and quality. The translated protocol fulfills all the above criteria. Depending on the availability in the market the translated protocol has GMP compliant materials wherever possible. When no GMP grade material was available I used preclinical, xeno-free reagents from reputed suppliers. I tested 9 cell lines: two control cell lines derived in research grade (H9 and BBHX8) and 8 fully GMP grade (mShef3, mShef4, mShef7, mShef8, mShef10, mShef11, Val9). The matrixes used for maintenance and differentiation and hESC lines are fully GMP grade. The growth factors and supplements used are GMP grade apart from OncostatinM and HGF, which are soon-to-be GMP grade as promised by the manufacturer and are currently under preclinical version. The media used are GMP grade apart from hepatozyme, which is a serum free medium. Small molecules used are all GMP grade apart from LY294002, which is highly purified HPLC grade. In Addition, freezing medium, reconstitution reagents, splitting reagents, PBS, water etc. are all GMP grade. Both GMP grade and RG HPSCs cell lines maintained their pluripotency in GMP maintenance conditions and were karyotypically normal when karyotyped every 10 passages for 40 passages. Expression of all pluripotent markers was observed. These finding showed that the GMP maintenance conditions are robust, effective and good enough that cell grown in RG condition can also be transferred and maintained. I was able to generate hepatocytes-like cells expressing hepatic markers from mshef3, mShef7, mShef11, H9 and BBHX8. When compared to H9 GMP compliant derived hepatocytes-like cells these differentiated cell lines showed similar protein and gene expression, mShef3 being an exceptionally good cell line having 10 fold increase in Cyp3A4 and tyrosine aminotransferase (TAT). When analysed for the functionality mSef7, BBHX8 showed similar level of Cyp3A4 activity while mShef3 was 7 folds higher expressed. Here, I report successful translation of HPSCs differentiation protocol in hepatocytes-like cells into GMP-compliant conditions by using HPSCs derived in a fully GMP manner and changing into defined feeder and serum free differentiation media and supplements to GMP- compliant conditions.
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Job Stress and Job Satisfaction Among Health Care Professionals
By Abdul SalamBackground: Workplace stress can lead to poor health and work-related injuries. Health care professionals comprise an important group of individuals who are affected by emotional states and stress because of their unique work environment. The employee's stress level and satisfaction with his/her job are primary factors that influence the quality of work and individual productivity. In health care, employee job stress can have a negative impact on the quality of patient care. Among this group, studies have found various causes of stress, including varied working hours, heavy work load, night shifts resulting in sleep deprivation, imbalance between work and life, isolated feelings, and minimal control over the workplace accompanied by minimal autonomy. Results of various researchers show that stress, fatigue, burnout, depression, and general psychological distress negatively affect health care systems and patient care. While there are a few published studies examining the prevalence of stress and job satisfaction among health care professionals in the Middle East, no such studies are available from Kingdom of Saudi Arabia (KSA). Objective: To measure the prevalence of job stress and job satisfaction among healthcare professionals and to identify potential factors that could affect job stress or satisfaction among health care workers were also explored. Research Design: The design of this study was a quantitative, multi-center, cross-sectional, correlational study where job stress and job satisfaction validated questionnaires were administered to randomly selected health care professionals working at National Guard Health Affairs, Eastern Region, Kingdom of Saudi Arabia. A total sample size of 620 subjects was needed to produce a two-sided 99% confidence interval (44.8%–55.2%), with an effect size of 5.2%. Subjects: Physicians, residents, nurses, and radiologists working at National Guard Health Affairs, Eastern Region, Kingdom of Saudi Arabia. Measures: Job stress and satisfaction were measured using 25 specific questions about sources of work-related stress and 17 questions about sources of work related satisfaction. Demographic and job characteristics variable data were also collected.
Statistical Methods Descriptive results for all demographic variables, job characteristics, and socioeconomic factors were reported using mean ± standard deviation (SD) and number (percentage) as appropriate. Logistic regression analysis was performed to identify predictors among the demographic variables, job characteristics, and socioeconomic factors between those who were stressed and not stressed using Wald test-statistics. Results were expressed as odds ratios using a 95% confidence interval. Multiple logistic regression models were used to identify significant independent predictors of job stress after adjusting for potentially confounding factors. Results were expressed as adjusted odds ratios with 95% confidence intervals. The final model was assessed using the Pearson chi-square goodness-of-fit test to see how well the model fit the data. Statistical significance was established when p < .05 (two-tailed). All statistical analyses were performed using SPSS (Statistical Package for Social Sciences version 20.0). Results: A total of 626 of the 1168 health care professionals completed the job stress and job satisfaction surveys, resulting in a response rate of 54%. Twenty-nine percent of the respondents were male, and 71.0% were female. The mean age among all participants was 39.3 years. Job Stress Results indicated that the majority of the health care professionals who participated reported moderate to high stress levels, and the overall prevalence of job stress was 66.2%. Results indicated that, on average, younger staff had higher stress levels than older staff (OR = 0.968; 95% CI: 0.95–0.987; p = .001). Residents reported a higher level of stress (p = .003). Being of Saudi nationality resulted in 4.4 times more stress than being non-Saudi (OR: 4.36; 95% CI: 2.46–7.73; p < .001) while education level did not result in a statistically significant relationship. Those who work more than 50 hours per week were more stressed (79.4%; p = .001). Of those who always worked night shifts, 84.0% were more stressed (p < .001), and of those who always worked weekends were also more stressed (81.8%’ p = .001) compared to those who never or sometimes worked weekends or nights shifts. Those who received free time compensation all the time were less stressed (56.8%) than those who received it sometimes (62.2%) or not at all (70.9%; p = .044).
Additionally, 93.9% of those who felt under pressure all the time, 95.2% of those who had conflicts of demand all the time, and 73.1% of those who believed there was inadequate staff to do the job were more stressed (p < .001 for all three groups). Health care professionals who don't know whom to approach if they have stress affecting their work and life were more stressed (76.3%; p < .001), and those who were exposed to a stressful event outside of work within a year were more stressed (73.8% p < .001). Those variables that were significantly associated with job stress using univariate analysis were considered for step-by step multiple logistic regression models to identify the statistically significant independent factors associated with job stress. These factors were: working on weekends, not getting free time compensation, feeling under pressure to meet deadlines, conflicts in the demand on time, being Saudi, believing there is inadequate staff to do the job, not knowing whom to approach if they are under stress, and being exposed to a stressful event outside of work within a year. Conclusion: This study shows that the current workplace environment could increase the risk of stress among health care professionals. However, the satisfaction rate was high and not negatively associated with low stress levels. The high satisfaction rate among the highly stressed could be a result of the benefits and incentive system applied in this organization. Our study identifies some potential factors, which if eliminated or changed, could lead to a decrease the stress level among health care workers. Future research is recommended to assess the impact of high stress on medical errors. This should be accompanied by studying the introduction of new policies and programs that could reduce the stress level among our health care staff.
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Attitudes, Barriers and Motivators of Clinical Research Recruitment in State of Qatar: Findings from PERCEPTIONS Study
Authors: Hiba Tohid, Sahar Agouba, Lina Ahmed, Hoda Gad, Abdi Aden, Sopna Choudhury, Omar M. Omar, Odette Chagoury and Shahrad TaheriObjective: To explore the perceptions and attitudes about clinical research participation prevalent amongst the general public in State of Qatar. Background: Recruitment into research trials is a major challenge and an ongoing problem for biomedical researchers.1 A recent report indicates that only 6% of eligible subjects actually participate in a clinical trial.2 Costs of low recruitment rates are high. This includes not just loss of investment made in conducting the research but a more detrimental damage of investigator and institutional reputation as a result of a failed study.3 Surveys of attitudes to research participation have rarely been done.4 There is an urgent need to study and address recruitment shortfalls to ensure that trials meet their recruitment target.1
PERCEPTIONS Study (Perceptions about Enrollment and Recruitment in Clinical Research Prevalent In State of Qatar)
PERCEPTIONS Study is an elaborate, three phased, mixed design research project. Phase 1 was conducted to explore the existing attitudes and behaviours prevalent in the population in Qatar. With the dynamic National Vision 2030, Qatar is set to become world leader in health care research. Diabetes, hypertension, cancer and personalized medicine are some of the projected research goals therefore it is essential to gain an insight about the thoughts, beliefs and concerns of people that this research is meant to thrive with and eventually benefit. Methods: A survey was conducted at two large-scale public events held within the State of Qatar. Residents of Qatar who were 18 years of age or older were surveyed following a verbal consent. Those visiting/touring Qatar or under 18 years were excluded from the survey. Filled surveys were entered in Microsoft Excel and analyzed on SPSS version 23. Results: Total of 2517 surveys were conducted of which 2379 valid forms were analyzed. According to the data 5.6% respondents (n = 137) had previously been approached to participate in a clinical study. Of these 74.6% (n = 86) agreed to participate while 37.3% (n = 51) declined. Remaining 88.7% (n = 2114) of the surveyed population had never been approached to participate in a clinical study. Data was missing for 5.5% (n = 131) respondents. Main reasons for declined consent included: time constraint (50%, n = 11), ‘fear’ (13.6%, n = 3), lack of awareness about clinical research (9.1%, n = 2) and lack of interest in research (9.1%, n = 2). Maximum participation was reported in studies related to diabetes (n = 19) followed by heart diseases (n = 4). ‘To help others’ (n = 24) and ‘thought it might improve my access to health care’ (n = 21) were the prime motivators for participation. Maximum respondents (up to 50%) agreed that their research experience was associated with positive outcomes for self and others, research conduct was ethical and opportunities for participation were and will be welcomed. There was also significant disagreement that research had strong emotional repercussions or that the procedures were ‘too long’, ‘boring’ or ‘inconvenient’. Conclusion: Rate of clinical research participation in Qatar needs improvement. Out- reach to potentially eligible subjects is poor where an overwhelming majority is not approached for consent. Time constraints, lack of trust in and poor state of awareness about clinical research are main barriers to participation. Altruism, monetary benefits, improved health access are prime motivators. Length of stay in Qatar is a statistically significant determinant of recruitment in research (p < 0.002). Deeper insight into the factors affecting clinical research participation is needed to devise evidence based policies for improvement in recruitment strategies and the future of evidence based medical care.
Keywords: Attitudes, Barriers, Motivators, Clinical Research, State of Qatar
References: 1. Trauth JM, Musa D, Siminoff L, Jewell IK, Ricci E. Public attitudes regarding willingness to participate in medical research studies. J Health Soc Policy 2000;12(2):23–43.
2. Nair SC, Ibrahim H, Celentano DD. Clinical trials in the Middle East and North Africa (MENA) Region: grandstanding or grandeur? Contemp Clin Trials 2013 Nov;36(2):704–710.
3. McCullagh MC, Sanon MA, Cohen MA. Strategies to enhance participant recruitment and retention in research involving a community-based population. Appl Nurs Res 2014 Nov;27(4):249–253.
4. Teschke K, Marino S, Chu R, Tsui JK, Harris MA, Marion SA. Public opinions about participating in health research. Can J Public Health 2010 Mar-Apr;101(2):159–164.
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Towards a National Electronic Health Record in Qatar: Building on International Experiences
Authors: Rawan Alsaad, Rashid Al-Ali and Radja BadjiBackground: During the past decade, the IT industry has introduced several new concepts within the health domain including e-health, electronic health record, digital hospital, and many more. Although each of these terms has brought its own unique definition and perspectives, they were all based on the foundation that healthcare and wellness management are dependent on effectively using technology to access accurate data in a timely fashion; ensuring enhanced patient care and medical error reduction. The Electronic Health Record (EHR) is an integrated system that collects data from different healthcare providers to create a unified electronic record for each patient among the population. Today, the patient's health information is scattered across different healthcare facilities causing significant inefficiencies within the healthcare system. A national EHR system will tackle these challenges by producing a personal health record for each patient, integrating information from all healthcare providers, and additionally giving access to patients themselves allowing their contribution. Motivation: There are many health IT implementations for EHR programs around the world that serve as great learning experiences for Qatar, offering it a great opportunity to leverage the best national EHR implementation strategies and practices. National EHR initiatives in Qatar emphasize the need to have secure electronic management of health data in structured and standardized formats, which can be communicated across its hospitals, primary healthcare centres, and other healthcare facilities. Personalized medicine initiatives share and extend these goals, with additional precision provided by genetic/genomic-based improved diagnostic, prognostic, and preventive information; thereby demanding a coordinated extension for the adoption and implementation requirements of an integrated national EHR system. It is for this purpose and understanding that the State of Qatar has taken the first concrete steps towards a promising EHR journey that will promote significant changes on how healthcare services are delivered, and more importantly, how each individual in Qatar can be empowered to become an active contributor to the management of their own health. In moving towards the widespread adoption and implementation of a national EHR system in Qatar, it is important to study the different challenges and trends used for the adoption of EHR systems, under national strategies, in other countries. This is essential for health informatics researchers, clinicians, and policy makers, to gain greater insight into the issues concerning the transformation of healthcare using a national EHR system. The results of this review study shall complement, explain, and extend the conclusions of earlier studies commissioned to explore the health information technology ecosystem in the State of Qatar. Objectives: The purpose of this study is to review EHR programs from various countries with regard to the issues documented in the studies commissioned in these countries. Our analysis will derive the most common critical aspects and lessons learned from international experiences during the implementation of national EHR programs. Additionally, it will explore opportunities, constraints, and characteristics present in Qatar, necessary for tailoring the strategies and approaches to fully realize a national EHR system in the country. This review study presents two important contributions: 1) it will significantly support promoting health IT solutions that are right for Qatar's need, recognizing the size and capabilities of the country, leveraging existing healthcare organizations and solutions, and respecting the unique cultural characteristics of its population. 2) it will serve as a baseline from which comparisons, performance against target measures, and forward thinking can be scoped; allowing significant contribution towards productive future development of health information technology and personalized medicine initiatives in Qatar. Methods: The data collection techniques included: (a) literature review for articles about EHR adoption under national strategies in several countries, (b) review of reports regarding national e-health strategy and government policies in Qatar, and (c) interviews of people participating in the policy making for national EHR system in Qatar (health and academic professionals involved in health IT research in Qatar). The reviewed EHR programs were selected according to the following criteria: (a) program for the implementation of national EHR system has been initiated since at least 5 years, (b) pilot projects have already been conducted, and (c) the planned EHR systems encompass various approaches of implementation. In line with these criteria, the EHR programs that have been studied were those of the following five countries: United States, England, Estonia, Japan, and Australia. Results: The analysis performed on the selected international EHR programs revealed many lessons learned, including: 1) To achieve a successful EHR implementation, it is critical to increase the awareness of the Qatari population about the upcoming changes in their healthcare experiences, paving the way to a smoother transition while having people's trust and confidence in the new system. 2) It is essential to legally define the legislation of privacy protection of personal medical data to support new e-health concepts and eliminate the risk of violating the privacy of patient data. 3) It is important to allow appropriate time for procurement, utilization, benefit realization and the complete project, otherwise you may risk having stakeholders and the public lose confidence in the EHR project. 4) Financial incentives for healthcare providers proved to be an effective method towards raising the EHR adoption rate. 5) To expedite EHR program acceptance, it is imperative to recruit knowledgeable and experienced technical staff and healthcare leaders, who encourage others to play a critical role during the transition process, and view this change as a dominantly positive one. 6) In order to make EHR an everyday tool for doctors, nurses, patients and public authorities, it is necessary to implement services based on the interests of the healthcare providers and society. 7) Continuous adjustment and enhancement is needed in order to sustain a successful and efficient system. Conclusion: Experiences from other countries suggest that a clear focus needs to be carefully placed on technical, clinical, organizational, financial, social, and patient perspectives to ensure that the full benefits of a national EHR system in Qatar can be realized. In addition, it demonstrates that strategic and human challenges are more difficult to master than technical aspects. The results of this review study can be used as a baseline to provide recommendations on how to tackle potential barriers towards successful adoption of a national EHR system in Qatar.
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The Use of CT and Rapid Prototyping to Produce an Exact Replica of the Normal Human Aortic Root for Tissue Engineering
Introduction: Tissue engineered heart valves offer a promising alternative for the replacement of diseased heart valves avoiding the limitations faced with currently available bioprosthetic and mechanical heart valves. The aim of the tissue engineering is producing living heart valves that can be used to replace those affected by congenital and acquired disease, especially in younger patients. The central challenge of any tissue engineering project is to replicate the three dimensional architecture, physical and cellular function of the tissue to be replaced. Aortic valve function critically depends on the geometry and interaction between its component parts. The three dimensional design contributes several important functions to the valves; these include optimal hemodynamic performance, smooth opening and closing characteristics, passive dynamism, influence in ventricular function and coronary flow. Current prosthetic stented valves have the disadvantage of presenting high transvalvular gradients, incomplete regression of left ventricular hypertrophy and the rigid stent produces a residual obstruction in transaortic flow and reduces effective orifice area. This leads to a negative effect on ventricular function after aortic valve replacement and long-term survival. Recent advances in computed tomography scan, image processing and rapid prototyping offer the unique opportunity to recreate the phenotypic geometric relationship of the aortic root. Therefore it offers the possibility to produce a tissue engineered stentless valve with better hemodynamic performance with improved left ventricular function. Methods: Computed tomography scans were obtained via a Siemens Definition Flash with a slice thickness of 0.6 mm and a slice increment of 0.3 mm. DICOM were imported into Mimics (Materialise, Leuven, Belgium) for three dimensional reconstructions of the blood volumes. The processed files were exported as STL files into 3-matic (Materialise, Leuven, Belgium) to create various images showing the cross sections and models of interest. These STL files were used as the basis for the molds with suitable modification for 3D printing and the spraying process. The molds were three dimensionally printed (Objet 260 Connex, Stratasys, US) in three longitudinal segments each including the sinus, the adjoining aortic wall and the cusp. These were used to produce a scaffold which has the same physiological shape as a normal aortic root. The stentless valve scaffold was fabricated by using a custom made jet spraying device (Design RT, UK) to form anisotropic nanofibrillar poly ϵ-Caprolactone scaffold. The custom made device was developed with a computer controlled spray head with x, y, z, and angular movement to follow any complex shape. Results: Computed tomography scanned images were processed to form various models for three dimensional printing. The printed models were adjusted to produce various sleeves and molds for jet spraying. The resulting three dimensional nanofibrillar scaffold was an exact replica of the aortic root as defined by the computed tomography scan images and is being developed as a stentless tissue engineered heart valve. Conclusion: It is concluded that the use of computed tomography scan based model of the normal aortic root can reproduce a 3D scaffold with the same geometry. This is an important step towards personalized tissue engineered heart valves. Further studies are required to characterise the functional implications of this method.
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Characterization of Circulating miRNAs in Insulin Sensitive and Insulin Resistant Arab Individuals in Qatar
Authors: Mohamed Chikri, Hasan Khatib, Abdul-Badi Abou-Samra and Muhammad AbdulghaniSummary
Insulin resistance manifest in skeletal muscle, liver and adipocytes. Insulin stimulates muscle glucose uptake, suppresses the rate of hepatic glucose production (HGP) and restrains lipolysis. In insulin resistant individuals, insulin-stimulated glucose uptake is markedly reduced in skeletal muscle, impaired insulin-mediated suppression of hepatic glucose production (HGP) and inhibition of lipolysis. It is evident from human and animal studies that diabetes alters miRNAs expression in metabolically important organs (adipose, liver and skeletal muscle).micRNA are small non coding RNA molecules. However, they play critical role in the regulation of gene expression via post-transcriptional mechanisms. They are small in size (21?23 nucleotides) and recent studies have demonstrated that they play important role in many human complex diseases including diabetes. The ability of miRNA that simultaneously regulate many target genes makes them attractive candidates for regulating insulin production/secretion and action. mRNA are secreted to the circulation and are taken up from the circulation by several tissues, making them an attractive mechanism for inter-tissue signaling molecules. Thus, if micro RNA play role in the pathogenesis of insulin resistance or in communicating between insulin resistant tissues and the beta cell to regulate the level of beta cell function in concert with the prevailing level of insulin resistance, we anticipate a change in the circulatory profile of micro RNA in insulin resistant individuals compared to insulin sensitive individuals. Such a distinct circulatory profile of micro RNA in insulin sensitive versus insulin resistant individuals could provide a signature for the identification of insulin resistant individuals. Moreover, differentially expressed micro RNA molecules in insulin resistant individuals could serve signaling molecules which convey messages between insulin resistant tissues, i.e. liver, skeletal muscle and adipocytes and the beta cell. Insulin sensitivity is commonly assessed to predict the risk and evaluate the management of type 2 diabetes in clinical and research settings. Insulin sensitivity can be measured using a variety of techniques that are commonly employed in diabetes research and care. Among them, euglycemic hyperinsulemic clamp is the gold-standard method to quantify the sensitivity to insulin.
The aim of the present study is to determine the profile of miRNA in the plasma in insulin sensitive Arab individuals and compare the result to that in insulin resistant Arab individuals.
specific aims are;
1. To discover the circulatory profile of microRNA in insulin sensitive and insulin resistant Arab individuals by using next generation sequencing technology.
2. To identify novel microRNA/targets which are differentially expressed in insulin resistant individuals by real time Taq-Man PCR.
3. To explore the effects changes of these miRNAs in insulin resistance diabetes β-Cell Biology. The experiments range from relevant tissue and cell cultures systems to human physiology. Design and methods: The circulating miRNA profile was assessed in a pilot study of 20 healthy volunteers whom glucose tolerance status was determined by the OGTT, and their insulin sensitivity was quantitated by the gold standard method the euglycemic hyperinsulemic clamp. Based on Glucose Infusion rate (GIR: mg/kg/min), before and after a 6-h hyperinsulinemeic euglycemic clamp, we selected two groups: 10 with high levels of GIR (insulin-sensitive group) and 10 with Very low levels of GIR (insulin resistant group).The serum samples was collected from the two groups for miRNA extraction and subsequent sequencing using the True-seq Illumina protocol. A small RNA library was generated from samples using the Illumina Truseq™ Small. The purified cDNA library was used for cluster generation on Illumina's Cluster Station and then sequenced on Illumina GAIIx following vendor's instruction for running the instrument. Raw sequencing reads (40 nts) were obtained using Illumina's Sequencing Control Studio software version 2.8 (SCS v2.8) following real-time sequencing image analysis and base-calling by Illumina's Real-Time Analysis version 1.8.70 (RTA v1.8.70). Result: Sequencing of the small circulating RNA isolated from insulin-resistant and insulin-sensitive healthy samples produced 69,559,764 raw reads. A total of 41,697,300 mappable reads was obtained after sequence filtering. Using a 2-fold expression difference as a cutoff, 33 miRNAs showed significally differential expression between insulin sensitive and insulin-resistant group. Among which, 10 were up-regulated and 22 were down-regulated. This RNA-seq discovery study shows that the most changes in miRNAs expression is in accordance with previous studies performed to explore circulating miRNAs in human insulin resistance or T2DM. Indeed, among the 54 selected miRNAs, we have identified the same changes in mir-126 expression that has described by Zampetaki and colleagues. This group reported that mir-126 is a unique plasma miRNA signature in 800 patients with T2D and observed that the reduced levels of mir-126 showed the strongest association with T2D. From the 33 miRNAs, a relative number of them are much documented to be associated with insulin resistance and type 2 diabetes. Nevertheless, some identified miRNAs are potential novel candidates and need to be deeply exploring during the event of the pathogenesis of T2D. Conclusion: This study provides a comparative profiling of circulating miRNAs in insulin-resistant versus insulin–sensitive subjects and the identification of specific miRNAs in circulation that changes are associated with insulin action. To our knowledge, this is the first study to investigate insulin resistance in Arab population using euglycemic hyperinsulemic clamp the gold-standard method to assess insulin sensitivity and aim to identify changes in circulating miRNAs expression associated to insulin action and signaling. The study also provides evidence that Insulin Resistance in human is related to changes in multiples microRNAs. Functional Validation studies of the differentially expressed miRNAs and relevant target and signaling pathways are ongoing.
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Epigenetic Programming in Psychobiological Development: Evidence for the Dual-Activation Theory and a Mediating Role of Early Life Stress
By Vanessa LuxThe term epigenetics describes the study of relatively stable changes in gene expression which occur without changes of the DNA sequence. The three best described mechanisms are: 1, cytosine methylation at cytosine-guanine dinucleotides of the DNA; 2, histone modifications (such as acetylation, methylation, and phosphorylation); and 3, micro RNA interference. The interplay between DNA methylation, histone modifications and micro RNA interference functions as regulatory complex which allows to fine tune cell specific gene expression in cell differentiation and organ development, and which is sensible to environmental signals. More precisely, the sequence of histone deacetylation, histone methylation and DNA methylation has been discussed as ‘molecular switch’ which modifies long-term gene expression patterns and chromatin activity states. In neurons, this epigenetic switch is involved in the transformation of short-term into long-term memory and is propagated across brain areas via neural activity (‘systems heritability of epigenetic marks’, Sultan Day/David Sweatt). Other evidence indicates sensibility of epigenetic marks towards behavioral (maternal care), chemical (nutrients) and hormonal (stress hormones) influences.
In regard to psychobiological development, epidemiological and clinical data shows that early life stress affects later stress responsivity, emotion regulation and cognitive functions, as well as life-time vulnerability to psychopathology. Evidence indicates a multi-level relationship between early life stress, neural structure and function and mental and general health connected via the HPA axis and its feedback mechanisms over time. Associations between early life stress and changes in brain regions involved in stress regulation have been repeatedly reported, including a small hippocampus, reduced medial prefrontal cortical volume, reduced orbitofrontal cortical volume, and increased amygdala volume. Further alterations related to early life stress in humans include glucocorticoid resistance, increased levels of inflammation, increased central corticotropin-releasing hormone activity and decreased levels of oxytocin. These general observations in humans are supported by a more detailed picture derived from animal studies of early life stress. Research in rodents using a maternal stress and/or maternal separation paradigm showed consistently that pre- or postnatal stress results in elevated HPA axis activity as well as structural and functional changes of neural networks in brain regions involved in neuroendocrine control, vigilance and emotion regulation, and that these changes correspond with distinct and persistent physiological response types and behavioral patterns in the adult individual. In addition, the differences between stress responsivity and behavior following early life stress are associated with epigenetic differences. In the context of early life stress, epigenetic modifications represent a plausible pathway by which early experiences are integrated into the molecular regulation of adult hormonal responses and behavior. Life-time stability of epigenetic changes, stress response types and behavioral patterns together with the time-dependence of the induced changes – early in life – indicate an evolutionary and developmental function of the underlying mechanisms: It seems that during a critical period (developmental window) early in life the stress response undergoes adaptive changes regulated via epigenetic programming. Furthermore, the mechanisms involved in epigenetic programming of the HPA axis also seem to impact neural and mental development in general. Preliminary results from animal models indicate, that early life stress affects cognitive abilities such as spatio-visual learning and memory, and that these cognitive differences are associated with epigenetic differences such as different methylation patterns. This would indicate a broad and unspecific developmental impact of pre- and postnatal stress and corresponding epigenetic programming during critical periods of brain development.
Thus, epigenetic mechanisms seem to function as ‘developmental switch’, explaining the stability of long-term effects of early life stress by programming central feedback mechanisms of the HPA axis and other neural networks. The pathway very likely involves a ‘dual activation’ of the epigenetic machinery: First, acute HPA axis activity during critical periods of neurogenesis generally primes the epigenetic machinery in brain tissue for reprogramming effects via the release of glucocorticoids. Second, sensory induced activation of neural networks transforms the epigenetic regulatory system in target brain areas, so that stressor specific adaptive to maladaptive functional modifications are maintained.
The paper outlines the possible underlying molecular mechanisms of epigenetic programming in psychobiological development according to the dual-activitation theory and summarizes the accumulated evidence. The dual-activation theory specifies epigenetic programming in psychobiological development as the result of an interplay between HPA axis activity and neural activity following sensory stimulation in critical periods early in life. Implications for the treatment of stress dependent psychopathologies are discussed.
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Human Olfactory Bulb Neural Stem Cell Based Therapy for CNS Traumatic and Neurodegenerative Diseases
Authors: Hany Marei and Asmaa AlthaniNeural stem cells (NSC) have self-renewal and multipotent properties and may serve as an ideal cell source for transplantation to treat neurodegenerative insults such as Parkinson's, Alzheimer's, and spinal cord injury (SCI). Obtaining NSCs from adult human olfactory bulb (OB) would avoid ethical issues associated with the use of embryonic tissue, and provide an easily accessible cell source that would preclude the need for invasive brain surgery.
We used Agilent and Illumina Whole Human Genome Oligonucleotide Microarray to compare the genomic profiles of human embryonic NSC at a single time point in culture; and a multicellular tissue from postmortem adult substantia nigra (SN), an area rich in dopaminergic (DA) neurons. We identified 13525 up-regulated genes in both cell types of which 3737 (27.6%) genes were up-regulated in the hENSC, 4116 (30.4%) genes were up-regulated in the human substantia nigra dopaminergic cells, and 5672 (41.93%) were significantly up-regulated in both cell populations. Careful analysis of the data using DAVID has permitted us to distinguish several genes and pathways involved in dopaminergic (DA) differentiation, and to identify the crucial signaling pathways that direct this process. The set of genes expressed more highly at hENSC is enriched in molecules known or predicted to be involved in the M phase of the mitotic cell cycle. On the other hand, the genes expressed in SN cells include a different set of functional categories, namely synaptic transmission, central nervous system development, structural constituents of the myelin sheath, the internode region of axons, myelination, cell projection, cell somata, ion transport, and the voltage-gated ion channel complex. These data were compared with data from various databases, and between different types of arrays, Agilent versus Illumina. This approach has allowed us to confirm the consistency of our results for a large number of genes that delineate the phenotypical differences of embryonic NSCs, and SN cells.
Next we studied global gene expression profiling using RNA from human embryonic neural stem cells (hENSC), and adult human olfactory bulb-derived neural stem cells (OBNSCs), to define the gene expression pattern and signaling pathways specific for each cell lineage. We demonstrated large differences in the gene expression profile of human embryonic NSC, and adult human OBNSCs, but less variability between parallel cultures. Transcripts of genes involved in neural tube development and patterning (ALDH1A2, FOXA2), progenitor marker genes (LMX1a, ALDH1A1, SOX10), proliferation of neural progenitors (WNT1 and WNT3a), neuroplastin (NPTN), POU3F1 (OCT6), neuroligin (NLGN4X), MEIS2, and NPAS1 were up-regulated in both cell populations. Using Gene Ontology, 325 out of 3875 investigated gene sets were different. 41 out of the 307 investigated Cellular Component (CC) categories, 45 out of the 620 investigated Molecular Function (MF) categories, and 239 out of the 2948 investigated Biological Process (BP) categories were significant. KEGG Pathway Class Comparison revealed that 75 out of 171 investigated gene sets passed the 0.005 significance threshold. Levels of gene expression were explored in three signaling pathways, Notch, Wnt, and mTOR, all known to be involved in NS cell fate determination. The transcriptional signature also clarifies the role of genes involved in epigenetic modifications. The SWI/SNF DNA chromatin remodeling complex family, including SMARCC1 and SMARCE1, was specifically up-regulated in OBNSC but not in hENSC. Differences in the gene expression profile of transcripts controlling epigenetic modifications and signaling pathways might indicate differences in the therapeutic potential of the two cell populations with respect to potential cell survival, proliferation, migration, and differentiation following engraftments in different CNS insults.
Next, the transcriptional factors (TF) and genomic markers associated with neurogenesis, proliferation, differentiation, and epigenetic control in human embryonic neural stem cells (hENSC), and adult human olfactory bulb neural stem cells (OBNSC) were studied using immunohistochemistry (IHC) and DNA microarrays. The biological impact of TF gene changes in the examined cell types was estimated using DAVID to specify a different GO class and signaling pathway based on KEGG database. Eleven, and twenty eight TF genes were up-regulated (fold change ≤ 2–39) in OBNSC, and hENSC respectively. KEGG pathway analysis for the up-regulated TF genes revealed significant enrichments for the basal transcription factor pathway, and Notch signaling pathway in OBNSCs, and hENSCs, respectively. Immunofluorescence analysis revealed a significantly greater expression of β-tubulin III (TUBB3),MAP, glial fibrillary acidic protein (GFAP), and O4 in hENSC compared to OBNSC. Furthermore, the expression of epigenetic-related TF-genes SMARCC1, TAF12, and UHRF1 increased significantly in OBNSC when compared with hENSC.
This suggests that exogenous application of NGF may be a promising therapeutic strategy for traumatic and neurodegenerative diseases. However, effective delivery of NGF into the CNS parenchyma is still challenging due to its limited ability to cross the blood–brain barrier, and the intolerable side effects if administered into the brain ventricular system. An effective method to ensure delivery of NGF into the parenchyma of CNS might be genetic modification of NSC to overexpress the NGF gene. Overexpression of NGF in adult human OBNSC is expected to alter their proliferation and differentiation, possibly enhancing their therapeutic potential. We genetically modified adult human OBNS/PC to overexpress human NGF (hNGF) and green fluorescent protein (GFP) genes, hoping to provide insight about the effects of hNGF and GFP gene overexpression in adult human OBNS/PC and on their in vitro multipotentiality using DNA microarray, immunophenotyping, and Western blot (WB) protocols. Our analysis revealed that OBNS/PC-GFP and OBNS/PCGFP- hNGF differentiation is a multifaceted process involving changes in major biological processes as reflected in alteration of the gene expression levels of crucial markers such as cell cycle and survival markers, stemness markers, and differentiation markers. The differentiation of both cell classes was also associated with modulations of key signaling pathways such MAPK signaling pathway, ErbB signaling pathway, and neuroactive ligand-receptor interaction pathway for OBNS/PC-GFP, and axon guidance, calcium channel, voltage-dependent, gamma subunit 7 for OBNS/PC-GFP-hNGF, as revealed by GO and KEGG. Differentiated OBNS/PC-GFP-hNGF displayed extensively branched cytoplasmic processes, a significantly faster growth rate and up modulated the expression of oligodendroglia precursor cells markers (PDGFRα, NG2 and CNPase) respect to OBNS/PC-GFP counterparts. These findings suggest an enhanced proliferation and oligodendrocytic differentiation potential for OBNS/PC-GFP-hNGF as compared to OBNS/PC-GFP.
To assess the therapeutic potential of OBNSCs, we studied the fate of allogenic adult human olfactory bulb neural stem/progenitor cells (OBNSC/NPCs) transplanted into the rat hippocampus treated with ibotenic acid (IBO), a neurotoxicant specific to hippocampal cholinergic neurons that are lost in Alzheimer's disease. We assessed their possible ability to survive, integrate, proliferate, and differentiate into different neuronal and glial elements: we also evaluated their possible therapeutic potential, and the mechanism(s) relevant to neuroprotection following their engraftment into the CNS milieu. The isolated OBNSC/NPCs-hNGF were stereotaxically transplanted into the hippocampus of IBO-treated animals and controls. Stereological analysis of engrafted OBNSCs eight weeks post transplantation revealed a 1.89 fold increase with respect to the initial cell population, indicating a marked ability for survival and proliferation. In addition, 54.71_11.38%, 30.18_6.00%, and 15.09_5.38% of engrafted OBNSCs were identified by morphological criteria suggestive of mature neurons, oligodendrocytes and astrocytes respectively. Taken together, this work demonstrated that human OBNSCs expressing NGF ameliorate the cognitive deficiencies associated with IBO-induced lesions in AD model rats, and the improvement can probably be attributed primarily to neuronal and glial cell replacement as well as the trophic influence exerted by the secreted NGF.
Next, the hNFG-GFP-OBNSCs were transplanted into the striatum of 6-OHDA Parkinsonian rats. The grafted cells survived in the lesion environment for more than eight weeks after implantation with no tumor formation. The grafted cells differentiated in vivo into oligodendrocyte-like (25 ± 2.88%), neuron-like (52.63 ± 4.16%), and astrocytic-like (22.36 ± 1.56%) lineages based on morphological criteria. Transplanted rats exhibited a significant partial correction in stepping and placing non-pharmacological behavioral tests, using a pole and rotarod. Taken together, our data encourage further investigations for the possible use of OBNSCs as a promising cell-based therapeutic strategy for Parkinson's disease.
Finally, hNGF-GFP-OBNSCs were engrafted in a rat model of SCI at day 7 post injury. All transplanted animals exhibited successful engraftment. The survival rate was about 30% relevant to initially transplanted cells. 27% of the engrafted cells differentiated along the oligodendrocyte, nearly as many (16%) differentiated into neurons, and about 56% of the cells displayed astrocyte morphology. The study revealed that hNGF-GFP-OBNSCs were able to survive in the lesion environment for more than eight weeks after implantation; this was supported by transgenic overexpression of hNGF on engrafted cells. We didn't observe locomotor recovery by BBB test, footprint analysis and grid walk tests three months post-treatment. No sign of immunorejections were recorded during the 8 week time window of the study. Engrafted cells were distributed throughout gray and white matter of the cord with no evidence of abnormal morphology or any mass formation indicative of tumorigenesis.
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Prevalence of Co-Trimoxazole Induced Hyperkalemia in Chronic and Acute Users in a Tertiary Teaching Hospital
Authors: Rana Moustafa Al-Adawi and Zainab Malik JassimSeptrin
Objective
The primary purpose of this research is to evaluate the risk of hyperkalemia in patients receiving co-trimoxazole. The secondary purpose is to detect the changes of potassium levels from baseline to 7, 14, 21, and 30 days, determine the association between co-trimoxazole dose and potassium level and examine the relationship between renal function and hyperkalemia.
Methods
The approach was through retrospective observation of all patients treated with co-trimoxazole during Jan 2012 till Jan 2013.
Key finding
There was no significant correlation between co-trimoxazole doses and hyperkalemia (29% in 480 mg, 31.6% in 960 and 19.4% in 1920 mg; p = 0.129) within each dose group, however, around 62% of hyperkalemia cases were associated with significant increase in serum creatinine (p = 0.00). The highest mean change of potassium level in once daily dosing was at “baseline–7 days” interval, while it was highest at “baseline-30 days” interval in every other day dosing. However; none of the changes from baseline to 7, 14, 21 and 30 days was found to be significant. 40.9% of the studied patients were female and 59.1% were male and the mean age 54 ± 15 was significant higher in hyperkalemia group compare to 42.6 ± 20 in non hyperkalemia group (p = 0.001).
Conclusion
Although many patients taking co-trimoxazoledeveloped Hyperkalemia, the effect of age, dose, renal function and the use of other concomitant medications can't be ignored.
Keywords
co-trimoxazole, hyperkalemia, side effect
Objective
The primary purpose of this research is to evaluate the risk of hyperkalemia in patients receiving co-trimoxazole. The secondary purpose is to detect the changes of potassium levels from baseline to 7, 14, 21, and 30 days, determine the association between co-trimoxazole dose and potassium level and examine the relationship between renal function and hyperkalemia.
Methods
The approach was through retrospective observation of all patients treated with co-trimoxazole during Jan 2012 till Jan 2013.
Key finding
There was no significant correlation between co-trimoxazole doses and hyperkalemia (29% in 480 mg, 31.6% in 960 and 19.4% in 1920 mg; p = 0.129) within each dose group, however, around 62% of hyperkalemia cases were associated with significant increase in serum creatinine (p = 0.00). The highest mean change of potassium level in once daily dosing was at “baseline-7 days” interval, while it was highest at “baseline-30 days” interval in every other day dosing. However; none of the changes from baseline to 7, 14, 21 and 30 days was found to be significant. 40.9% of the studied patients were female and 59.1% were male and the mean age 54 ± 15 was significant higher in hyperkalemia group compare to 42.6 ± 20 in non hyperkalemia group (p = 0.001).
Conclusion
Although many patients taking co-trimoxazoledeveloped Hyperkalemia, the effect of age, dose, renal function and the use of other concomitant medications can't be ignored.
Keywords
co-trimoxazole, hyperkalemia, side effect Co-trimoxazole is an antibacterial drug that consists of two active ingredients, sulphamethoxazole and trimethoprime.
Sulphamethoxazole acts by inhibition of synthesis of dihydrofolateby bacterial cell through inhibition of Bara- amino-benzoic acid result in inhibition of bacterial growth, while the trimethoprimeact by blocking of tetrahydrofolate production by reversible inhibition the bacterial dihydrofolate reductase (DHR), resulting in inhibition of bacterial folic acid production which is necessary for biosynthesis of purine which is essential component of many bacterial nucleic acid production, [1][2].
Co-trimoxazole used with wide range of infections like: Chronic bronchitis, Cyclosporiasis (unlabeled use), Granuloma inguinale(donovanosis) (unlabeled use), Isosporiasis (Isospora belliinfection) in HIV-positive patients (unlabeled use; CDC, 2009), Meningitis (bacterial), Nocardia, Osteomyelitis due to MRSA (unlabeled use), Pneumocystis jirovecii pneumonia (PCP), Pneumocystis jirovecii pneumonia (PCP) prophylaxis and treatment in HIV-positive patients (CDC, 2009), Prosthetic joint infection (unlabeled use), Q fever (unlabeled use), Septic arthritis due to MRSA (unlabeled use), Shigellosis, Skin/soft tissue infection due to community-acquired MRSA (unlabeled use), Stenotrophomonas maltophilia (ventilator-associated pneumonia), Toxoplasma gondii encephalitis (unlabeled use; CDC, 2009), Travelers’ diarrhea AND Urinary tract infection [1]. Co-trimoxazole has many adverse drug reactions including Nausea, vomiting, anorexia, skin rash, urticaria, photosensitivity, SJS and hypokalemia. Each ADR has different mechanism some are due to allergic reaction while others are due to toxic metabolite, where the expected mechanism of hyperkalemia is the capability of trimethoprime to block the renal tubule secretion of potassium, due it's structural similarity to the potassium sparing diuretics, resulting in increase in serum potassium level, (ref: AnIm 124:316, 1996). Co-administration of ACE-I or ARBs was found to be associated with 7 fold increment of hyperkalemiainduced hospitalization. The same ADR has reported with potassium sparing diuretics, however the mechanism of hyperkalemia is due to decreasing the serum concentration of Aldosterone which reabsorb potassium at distal renal tubule [7].
Hyperkalemia is defined as serum potassium level above the normal range which 3.5–5.5 mEq/L, The symptoms usually is asymptomatic or associated with non-specific symptoms, like nausea, vomiting, weakness, fatigue or palpitation, unless the potassium level reaches 7 mEq/L, where some neurological and hemodynamic disturbance may occur, while increasing the potassium level to 8 mEq/L can be fatal as it may cause respiratory paralysis and cardiac arrest [3][4]. Hyperkalemia is a serious side effect of co-trimoxazole and some times evidence it is fatal. Therefore, we are going to retrospectively investigate potassium level in patients receiving co-trimoxazole for acute and chronic periods for all indications either as a treatment or prophylaxis, giving the focus on the rate of this under estimated side effect, in order to clearly identify the high risk patients and recommend the proper monitoring.
Conclusion
Around quarter of patients taking co-trimoxazole developed hyperkalemia; the effect of renal function, advanced age and the use of other concomitant medications that affect the potassium level put patients at higher risk of developing hyperkalemia. Incidence of hyperkalemia was more in daily rather than every other day dosing as well more in 960 mg daily dose comparing with other doses (480 mg and 1920 mg). We identified patients with high risk factor like renal impaired patients, advance aged, or patients who are receiving ACE-I, ABRs during the co-trimoxazole course are essential to minimize the incidence of such a severe adverse drug reaction of one of the broad spectrum antibiotic with various indications.
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Using ICTs and Internet-Based Technologies to Total Health Coverage in Remote Areas in Algeria: Towards the Development of a Telemedicine Project
Authors: Boutkhil Guemide, Maouche Salima, Chellali Benachaiba and Ibtissam BedriIn Algeria, there is about seventy percent of the population that lives in remote areas and the desert. These areas are cut from health services, and the people do not have access to modern health services existing in Northern Algeria. The limited health care budget-delivered to these desert areas, and the shortage of doctors (health care specialists) jeopardize the improvement of health care system in the desert areas in Southern Algeria. Recently, although the Centre du Development des Technologies Avancées (CDTA) was granted the right to develop the feasibility of telemedicine in the country, the project centered in the city of Ouarlga, 600 km South of Algiers, giving only medical consultation and diagnostic to pediatrics. However, this initial project does not cover all the Southern remote and desert areas in the country. Also, it does not provide universal health care coverage to all the people living there. The paper discusses the challenges faced by the local authorities to develop health care system coverage in the South of Algeria. Also, it introduces how ICTs and internet-based technologies can integrated into health care system to help people with delivering most of the modern health services while living the desert areas. It proposes a telemedicine project which is based on WINDOWS NET, Adruino, and other ICT applications to develop an eHealth strategy in the country.
Keywords
ICT applications, internet-based technologies, Health care system, Arduino, desert areas.
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Diabetic Foot in Qatar: A Primary Care Perspective
More LessDiabetic Foot in Qatar
A primary care Perspective Introduction Diabetes represents a major public health burden in developing countries, especially the Arabian Gulf region, which is going through a rapid socioeconomic transition. Diabetic foot is becoming an escalating problem in Qatar due to the high prevalence of diabetes which is around 16%. Currently, diabetic footcare is disintegrated within the health system resulting in increased medical costs, reduced quality of life, decreased productivity, increased hospitalization and unnecessary amputations. Primary care intervention in this regard is paramount in order to tilt the balance in favoring patient-centered integrated diabetic foot care strategies. As a result we have conducted a retrospective cohort study assessing the feasibility and efficacy of such an intervention. The morbidity and mortality associated with diabetic foot lesions remain extremely high, and management needs to be optimized to ensure the best outcome. Although it is accepted that the institution of rapid access to expert multidisciplinary service is an essential component of care, there are remarkably few data to justify particular approaches to the treatment of different types of foot ulcers. Evidence of the efficacy of specific interventions depends on the completion of robust clinical trials, whereas evidence of the overall effectiveness of a management strategy requires some form of systematic audit, using methods that allow comparison between different units. If such a comparative audit is controlled for case mix, it would provide an invaluable benchmark against which other units may compare their performance. For this to be done, it is necessary to establish clinically meaningful outcome measures. Outcome measures are of two broad types: those that relate primarily to the ulcer and those that relate more to the patient. Ulcer-related outcome measures are commonly used in clinical trials and are appropriate for studies designed to assess either the efficacy or the effectiveness of interventions directed to improving wound healing. Such ulcer-related outcome measures include healing, a change in ulcer area, and resolution of the ulcer by amputation. However, ulcer-related measures are not necessarily appropriate markers of the overall quality of clinical care and may not be the best measures of the effectiveness of practice in different specialist units. Thus, an index ulcer may heal, whereas the patient remains incapacitated by the presence of another (persistent or newly occurring) ulcer, by the effects of the treatment (e.g., amputation) of the original problem, or by comorbidity. It is for these reasons that patient-centered measures must also be considered, and these include survival, all amputations, ulcer-free status, duration of ulcer-free survival, well-being, and disability. Implicit in the choice of any outcome measure of the effectiveness of care, however, is the need for the process to be simple enough to be undertaken on a routine basis in all presenting patients and atone or more fixed intervals after presentation. We have therefore sought to determine the outcome of management in a consecutive series of patients presenting to a single primary health care center over a 5-year period.
Background
Chronic Diabetic foot ulcers (CDFU) is associated with increased morbidity, mortality and represents a huge burden especially in developing countries where diabetes has reached epidemic proportions.
Objective
To assess the efficacy, safety and acceptability of natural honey in the management of (CDFU) at primary care level & identify criteria predictive of failure.
Methods
We conducted a 5-year retrospective cohort study with prospective long-term follow-up of all diabetic patients with (CDFU) presented to Umgwalinah Primary Health Care Centre diabetic foot clinic, Doha, Qatar. The average follow-up after discharge was 1 year. Failure of Natural honey based treatment was the main outcome measure. Independent predictor variables were selected by logistic regression analysis.
Results
A total of 126 patients with diabetes were assessed and treated for various foot lesions; including neuropathic, neuro ischemic ulcers, charcot foot, second degree burns and trauma. Five patients (4%) of a total of 126 underwent immediate amputation. Natural honey treatment was successful for 91 (92.86%) of the 98 neuropathic ulcers, 3 (30%) of 10 neuro ischemic ulcer, 2 (66%) of 3 Charcot foot ulceration, 4 (100%) of 4 patients with second degree burns & 6 (100%) of 6 traumatic foot ulceration or (P < .001, chi2 for trend). Independent factors predictive of failure to heal were presence of osteomyelitis (odds ratio [OR] = 1.6, 95% confidence interval [CI], 1.0–1.3), increased Hemoglobin A1C level (OR = 1.002; 95% CI, 1.2–1.3), severe peripheral vascular disease (OR = 1.0, 95% CI, 1.0–1.03), prior hospitalization for (CDFU) (OR = 1.4; 95% CI, 1.2–1.6) & gangrenous lesion (OR = 1.7; 95% CI, 1.3–2.1). During the study period no side effects were reported and there was a high level of satisfaction by both patients and healthcare workers alike.
Conclusions
Primary care based management of (CDFU) using natural honey is efficacious, safe and acceptable. We propose a multi-disciplinary approach utilizing primary care diabetic foot coordinator (PCDFC). The (PC DFC) will work with patients and their caretakers in order to: Coordinate the care pathways, reduce waiting time, increase patient satisfaction, stratify the patients appropriately into: Low, Intermediate and High risk and finally, reduce cost and improve outcome. The (PCDFC) will propose and disseminate clinical guidelines for managing diabetic foot, offer continuous medical and nursing programs, including conferences and symposiums, propose hand on clinical courses for healthcare professionals interested in diabetic foot care and carry out prospective studies regarding the efficacy, process and outcomes of integrated diabetic foot care in Qatar. The objectives of the (PCDFC) are: Propose a multi-disciplinary integrated diabetic foot care program Introduce the concept of patient-centered diabetic foot care model Reduce the rate of diabetes related amputations in Qatar Reduce the cost and suffering of patients Empower primary care physicians in taking an active role in preventing diabetic foot complications.
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BAALC and ERG Expression in Egyptian Patients with Acute Myeloid Leukemia, Relation to Survival and Response to Treatment
Authors: Reham A. Aleem Afify, Aml S Nasr, Asmaa A Ahmed and Noha Y IbrahimBackground
Acute myeloid leukemia (AML) is a heterogeneous disease with respect to clinical picture and therapeutic outcome, partly reflected by differences in molecular and cyto-genetics. Clonal cytogenetic abnormalities are one of the most important factors predicting clinical outcome in acute myeloid leukemia and are used to guide risk-adapted treatment strategies.
Deregulated expression of genes coding transcription factors involved in cell proliferation, survival or differentiation is known to be implicated in the process of leukomogenesis. Brain and acute leukemia, cytoplasmic gene (BAALC) and ETS-related gene (ERG) are examples of these transcription factors BAALC gene, located on chromosome band 8q22.3, is considered as a marker of early hematopoietic progenitor cells. High levels of BAALC expression were found in AML patients with trisomy 8, as well as in a subset of cytogenetically normal–AML(CN-AML) patients in which it was considered as poor prognostic factor The role of BAALC in leukemogenesis is not fully understood, but it was proposed that BAALC blocks myeloid differentiation ERG gene, located on chromosome band 21q22, belongs to the ETS family of transcription factors required for normal hematopoiesis. It is a transforming proto-oncogene that is expressed in stem cells and endothelial cells. It is frequently overexpressed in AML patients with complex karyotypes and amplification of chromosome 21. The ERG gene has been found to be involved in atypical chromosomal rearrangements with alterations of the transcription factor in several cancers. Aberrant expression of full-length ERG protein has been found in acute myeloid leukemia and acute T-lymphoblastic Leukemia. Chromosomal rearrangements driving the formation of EWS/ERG and FUS/ERG fusion proteins have been described in a subset of Ewing sarcoma and in acute myeloid leukemia.
Most of the previous researches were concerned about levels and prognostic effect of BAALC and ERG in CN-AML patients, while data about their incidence in AML and relation to cases with abnormal karyotype were lacking. The objective of this study was to detect the incidence of BAALC and ERG in a group of AML patients with abnormal karyotype in comparison to normal individuals, their levels and distribution among AML FAB subtypes as well as to study their impact on the disease outcome and reliability in detection of minimal residual disease in relation to the cytogenetic markers.
Methods
The current study was carried out on 44 patients with acute myeloid leukemia (AML), in the period between, July 2011 and July 2012 among cases referred to nuclear medicine and oncology unit of Kasr Alainy School of medicine, Cairo University with follow up period of 18 months, as well as 44 age and sex matched controls. They were patients suspected to have hyperspleenism or idiopathic thrombocytopenia coming for BM aspirate. Cases were diagnosed according to WHO criteria. The diagnosis of AML was based on morphological and phenotypic data. Subtypes according to the French–American–British classification were available for all the patients. Patients were 21 males and 23 females. Age ranged from 21 to 65 years. The control group included 17 male and 27 females with no medical history of any type of cancer. Their ages ranged between 22 and 50 years. All patients and controls were analyzed for clinical and laboratory findings, including full history taking, clinical examination, routine laboratory investigations, LDH, abdominal ultrasound for detection of organomegaly and lymphadenopathy. The patients were subjected as well to cytochemical, immunophenotypic and cytogenetic analysis to confirm diagnosis and to divide the patients into their subtypes. Local institutional research board approval as well as written informed consent was obtained from all the participants before including them in the study. All patients included in the study were treated according to the protocol of the nuclear medicine and oncology department, Cairo University, using ongoing induction and consolidation regimens for treatment of adult AML cases.
Induction of remission
Patients were subjected to 7–3 protocol for induction of remission: Novantrone: 12 mg/m2, IV on day 1 and 3. ARA – C: 100 mg/m2, continuous IV infusion, from day l–7. If remission is not achieved, this protocol was repeated again. If no or minimal response, patients were shifted to high dose chemotherapy. Induction therapy for acute promyelocytic leukemia (PML) included oral administration of all-trans-retinoic acid (ATRA) 45 mg/m2/day until induces remission.
Consolidation
High dose ARA-C for 4 cycles. ARA-C: 2 g/m2, over 2 hours infusions, every 12 hours on days 1–4. Significant association to relapse free survival and overall survival were estimated for studied genes at a median follow-up of 18 months. Complete remission (CR) was defined as recovery of morphologically normal BM and peripheral blood cells with white cell counts ≥ 1,500/L, and platelets ≥ 100,000/L, less than 5% BM blasts and no evidence of extramedullary leukemia. Relapse was defined by ≥ 5% BM or peripheral blood blasts, or development of extramedullary leukemia in patients with previously documented CR. Relapse free survival (RFS) was measured from the date of CR until date of relapse or death. Quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) assay was performed for estimation of BAALC and ERG expression.
Results
BAALC was expressed in 36(81.82%) of AML cases versus 10(22.72%) of the control group which was highly statistically significant (P < 0.001). While ERG was positive in 39(88.64%) of cases and 8(18.18 %) of controls and that was also highly statistically significant (P < 0.001). The distribution of the positive cases among FAB subtypes did not show any significant differences. The lower values of BAALC and ERG in the cases compared to controls means higher levels in the cases as the numerical value of the CT is inversely related to the amount of amplicon in the reaction. Follow up of the patients revealed 12 cases of CR and 32 with unfavorable outcome; 17 showed partial recovery (PR), 8 cases relapsed and 7 patients died. Highly significant correlation was detected between positive genes expression and presence of bulky tumor and organomegaly. The levels of each gene were expressed as 2-ΔΔ CT i.e. number of fold increased above the mean level of the control group. Patients were divided into two groups according to these levels (high and low) as described previously in statistic paragraph. BAALC levels median and range were 1479.8(220.8–7550.2) for high levels group and 10.1(0.13–54.9) for low levels group. While levels of ERG were 425.5(27–1985) and 2.44(0.021–8.17) for high and low levels groups respectively. There were statistically no significant differences between the 2 studied groups regarding the BAALC gene expression before and after treatment (P value = 0.86) or the ERG gene expression before and after treatment (P value = 0.75). Multivariate regression test had revealed that BAALC and ERG are independent risk factors of acute leukemia, because (table7). Although we abolished the effect of bad prognostic factors (age>60 years, high serum LDH and WBC levels, high bone marrow blast percentage, presence of bulky tumor), still high levels of these genes are associated with lower CR, RFS, and shorter OS.
Conclusion
As regard ERG, the levels in AML cases did not differ significantly from theirs in normal BM. So determination of cut off value to detect MRD will not be applicable. Further researches still needed to clarify the role of BAALC and ERG in the pathogenesis of leukemia and their importance as targets for treatment of AML that could be promising due to their high incidence of expression in AML.
Keywords
BAALC, ERG, gene expression, Quantitative real-time RT-PCR, AML.
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Assessment of Medication Adherence and Factors Contributing to Non-Adherence to Calcium and Vitamin D as Mainstay in Treatment and Prophylaxis of Osteoporosis
Authors: Rana Moustafa Al-Adawi and Zainab Malik JassimObjective
This study aimed to assess the adherence and persistence to Calcium and vitamin D, and address the reasons of non-adherence.
Methods
All patients attending a secondary care rheumatology clinic in a teaching hospital serving a multiethnic population, in the period between April and June fulfill the inclusion criteria. Patients were asked verbally before distributing the question air about the duration and reason of prescribed Calcium and vitamin D, only patients who are receiving Calcium and Vitamin D for duration of one year or more for purpose of osteoporosis management (treatment and prophylaxis) and are welling to participate in the question are were given the consent formand included in the study.
Key finding
There was no statistically significant difference between calcium and vitamin D group in terms of adherence score (p = 0.175). About third of patients in both groups showed low adherence score; 31% (53/171), 38.2% (128/335) in calcium and vitamin D groups, respectively. Overall, there was significant difference in adherence score between age groups (p = 0.001). Low adherence score was mostly reported in young age group (18–39 years) for both medications but not related to level of education. Forget to take medication was the most reported reason of non adherence in both groups (29.5%, 89/302). Quarter of patients stated that multi-reasons contributed to their non adherence (24.8%, 75/302).
Conclusion
Low adherence was high among both Calcium and Vitamin D groups (around third of both groups), however; there were no significant differences in medications adherence between the two groups
Keywords
Adherence, osteoporosis, treatment and prophylaxis
Introduction
Osteoporosis has been defined by national and international organizations by either describing the outcomes or on the bases of Bone Mineral Density (BMD) or bone turnover markers (BTMs). The World Health Organization (WHO) 1994 defined Osteoporosis as “a disease characterized by low bone mass and micro-architectural deterioration of bone tissue, enhanced bone fragility and a consequent increase in fracture risk” (Kanis JA, et al., 1994, pp; 1137–41). On the bases of Bone Mineral Density (BMD), WHO 1994 defined Osteoporosis as BMD at hip or spine, that is less than or equal to 2.5 standard deviation below the young normal adult. While National Osteoporosis Foundation (NOF, 2010) defined the Osteoporosis as “a silent disease until it is complicated by fractures—fractures that can occur following minimal trauma. Usually causes no signs or symptoms except height loss and kyphosis until fracture occurs”. Osteoporosis became a major worldwide concern, due its high prevalence that will increase in the coming years due to the significant increase in life expectancy. The prevalence of Osteoporosis will continue to rise with the predicted demographic expulsion. According to IOF fast fact sheet (2011), about 1 in 2 Asian and Caucasian women and 1 in 4 Asian and Caucasian men over age 50 will have an Osteoporosis-related fracture in their life that will decrease their quality of life. Osteoporosis causes more than 8.9 million fractures annually worldwide (WHO, 2004 a). In the UK Osteoporosis affects 2 million people and is responsible for more than 300,000 fragility fractures per year. About 70,000 people suffer from hip fractures annually with about 1,150 of them dying every year. UK has one of the highest rates of Osteoporosis related fractures in Europe (Paul Mitchell, 2010). In Canada, Osteoporosis is estimated to affect women with rate of 12.1% at lumbar spine, 7.9% at the femoral neck, with a combined prevalence of 15.8%, while affecting men in rate of 2.9 % at lumbar spine and 4.8% at the femoral neck with a combined prevalence of 6.6%. (A. Tenenhouse, et al, 2000). While in China, Osteoporosis prevalence was 16.1% (LI Ninghua, et al, 2002). 31 Concerning Qatar and Osteoporosis, Hammoudeh M, et al. (2005:319–327) state “Osteoporosis is common among menopausal Qatari women and should be considered as a matter of public concern.” This was concluded through his cross-sectional study that examined 574 Qatari women between ages 20–69. The study aimed to determine the reference value for Qatari women and compare them with values from Western and other Arab countries. Finally, this study showed that BMD values of Qatari women are lower than Caucasians and Kuwaitis at the spine and the total femur in age group 60–69 years, but higher in values of total femur in the age group 40–59. Medical care and pharmacological treatment of Osteoporosis are currently available, including calcium (1200 mg daily intake) and vitamin D (800–1000 IU daily intake) as a mainstay of osteoporotic treatment along with an ant-osteoporotic medication such as Bisphosphonates, parathyroid hormone, the selective estrogen receptor modulator (raloxifene), calcitonin, denosumab and one anabolic agent (teriparatide) (Cranney A, et al., 2002). The importance of calcium and vitamin D supplementation in reduction of osteoporosis risk and osteoporosis related fracture risk is usually overlooked by patients and health care provider, so the standard care of osteoporosis should emphasis on optimal Calcium and Vitamin D supplementation. Many studies evaluate the relation between dietary or supplemental calcium intake in addition to vitamin D supplementation on the risk of osteoporosis and increased osteoporosis fracture, where in 2008–2009, heok hong, et al., evaluate in his study the BMD of adult Korean population after dividing them in to 4 quarters, to show that the q4 is high BMD than the other groups Q1 & Q2. (Q4 which had highest calcium intake). Additionally Wlodarek, 2012 and Higahuchi M, 2010 stated in their studies that, the higher the calcium intake the higher the BMD will increase. As well as Reid IR et al., 1995 & 1998 mentioned in his studies that calcium intake is linked with a00202–10% increment in BMD and 35–50% reduction in fracture risk The effectiveness of the medication not only depends on the efficacy of the medication but also on the compliance and persistence to prescribed medication. Adherence is essential to achieve the maximal benefit. Therefore in this study we are going to assess the adherence to Cal/Vit D and address the reasons of the non-adherence, in order to find ways to overcome these problems improve compliance and enhance the efficacy and improve the patient's quality of life
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Knowledge, Awareness and Practices of Workers Exposed to Pesticides in Qatar
Background
Pesticide poisoning is a global public health problem. Annually, 3 million people are hospitalized due to pesticide poisoning with over 250,000 deaths all over the world 1. With the growing population and rapid industrialization in Qatar, there has been a natural increase in pesticide usage and hence, exposure amongst the workers handling them. It is therefore vital to not only understand the existing knowledge, attitudes and practices about handling pesticides, but also to explore the effectiveness of measures like education and personal protective equipment on the general well being of the workers. We hypothesize that training the workers to handle pesticides is vital in maintaining high safety standards, thereby preventing associated toxicity while handling them that the use of personal protective equipment (PPE) improves the general health of pesticide handlers in the long run.
Methods
100 municipality employees in Qatar who work with pesticides, were interviewed in person by trained bilingual staff using a structured questionnaire model (Table 4). The questionnaire included basic demographic data, questions related to methods of pesticide storage, retrieval, application and disposition, usage of PPEs, adherence to safety practices and views of the worker on the company safety protocols and their implementation. The data was then entered into excel format and analyzed using descriptive statistics and associations inferred by odds ratios.
Results
The mean age of the workers was 37.4(SD-9.9)(Table1). Amongst workers nearly 2.9 % of them who did not use personal protective equipment visited hospital annually when compared to 1.4% of workers who used personal protective equipment (Table 2). Of the interviewed workers 81.1% did not know the contents or the name of the pesticides they were handling at work (Table 3). Unsafe behaviors such as preparation of pesticides at the site of its usage rather than in a specified preparation room (29.6%), noncompliance with wearing protective clothing (38.8%), handling of drinking water (22%) and food (10%) on site where pesticides are used and not washing clothes every day after work (45.9%) were observed. Around a quarter of the interviewees did not receive any training on preparation and handling of pesticides (Table 3). Workers who received training in pesticides usage were more likely to be aware of its effects on the environment (61.6%)(OR–3.9), less likely to eat or drink while handling pesticides(83.6%) (OR–4.3) and more likely to give household members appropriate instructions prior to application of pesticides (90.4%)(OR–5.0)(Table3).Workers who did not wear special protective clothes at work were found to be, more than twice as likely to visit hospitals per year, than those who wore(RR-2.2)(Table3). A third of the workers were not aware if their company had safety protocols in place, whereas a similar proportion felt no such protocols exist.
Conclusion
Unsafe practices were found to be significantly common amongst the personnel using pesticides in Qatar. Workers who received prior training, handled pesticides with better safety standards, highlighting the importance of training in pesticide handling. Wearing protective clothing most likely has a positive impact on the general well being of the workers.
Keywords
Improved safety standards, municipality workers, pesticide exposure, protective clothing.
Resources 1-World Health Organization
The Impacts of Pesticides on Health: Preventing Intentional and Unintentional Deaths from Pesticide Poisoning (fact sheet) 2- Gunnell, David and Eddleston, Michael. “Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries.” International Journal of Epidemiology 32 (2003): 902–909.
Table 1 (DEMOGRAPHIC DATA) Demographic variables (n = 100) Percentage* Age Less than 20 1 21 to 35 48.9 36 to 50 36.7 More than 50 13.3 Mean 37.4 years Education Primary 33.7 Secondary 44.9 Not educated 11.2 Other 8.2 Number of years working with pesticides < 1 11.2 1 to 5 30.6 6 to 10 24.5 >10 32.7 Living with Family 14.3 Friends 30.6 Colleagues 54.1 Children 0.00 Other 2.0 *Total may not be 100% if there were missing values
Table 2 (Comparison of variables for those wore special protective clothes to those who didn't) Variable Wore Special protective clothes (n,%) Did not wear(n,%) Number 59(59) 38(38) Age(mean) 37.4 37.5 Education Primary 27(45.8) 5(13.2) Secondary 20(33.9) 24(63.2) Not educated 8(13.6) 3(7.9) Years Working with pesticides < 1 5(8.5) 6(15.8) 1–5 20(33.9) 10(26.3) 6–10 14(23.7) 10(26.3) >10 20(33.9) 11(28.9) Co morbid conditions 16(27.1) 9(23.7) Knowledge on content of pesticides Yes 7(11.9) 11(28.9) No 52(88.1) 27(71.1) Any training received? Yes 46(77.9) 27(71.1) No 13(22.0) 11(28.9) Average hospital visit/year 1.4(0.8–1.9) 2.9(1.9–4.1)
Table 3 (ODDS RATIO) Variable Trained in pesticides (n = 73) Not trained in pesticides (n = 24) Odds Ratio with 95%CI Workers view on effect on environment YES 45 7 3.9(1.4 to 10.6) NO 28 17 Do not handle food/water at site 61 13 4.3(1.6–11.9) Wear special clothes 46 13 1.4(0.6–3.7) Knowledge of contents in pesticides present 16 2 3.1(0.7 – 14.5) Instruction to Household members 66 15 5.7(1.8–17.6) Washing clothes after work 40 13 1.02(0.41–2.59) Average visits to hospital/year 2.05(1.35–2.77) 2.04(0.68–3.41)
Table 4 (RESPONSE TO QUESTIONNAIRE IN PERCENTAGE) Affirmative response Do you know the contents of the pesticide you are using? 18.4 When spraying inside do you give any instructions to the household members? 82.7 If yes what are they? Stay away from home 56.3 Don't prepare food at home 7.5 Don't get into the room for a specified period of time 35 Pesticides are poisonous 1.3 Where do you prepare the pesticides? On site 29.6 Comes prepared 3.1 Preparation room 58.2 Other 0.00 Did you receive any education on how to prepare/apply the pesticides? 74.5 If yes, who educated you? Foreman 19.7 Supervisor 40.9 Senior co worker 27.3 Other staff 12.1 When were you educated? At the start of job 55.3 Periodically 28.7 Where do you store the pesticides? Home 0.00 At the site 15.3 Buy and use immediately 1.0 Specific store 83.7 How do you dispose the containers? Yourself 15.3 By the company 73.5 Other 6.1 Do you wear special protective clothes, while using the pesticides? 60.2 Do you wash your clothes daily after work? 64 Do you wash them separately? 59 Powder 75.5 Solid tablets 41.8 Spray 74.5 Liquid 26.5 Smoke 33.7 Other 3.1 Which form of pesticide do you use out door? Powder 52.6 Solid tablets 38.1 Spray 82.5 Liquid 32.9 Smoke 60.8 Other 1.0 What personal protective equipment are you using? Masks 95.9 Gloves 93.9 Clothes 67.4 Shoes 83.7 Goggles 51.0 Other 2.0 Do you know the effects of pesticides? On Humans 81 On the environment 53 Pesticides can be absorbed through? Skin 46.3 Mouth 75.8 Inhalation 93.7 Other 6.3 Pesticides have? Only acute effects 42.3 Only chronic effects 14.4 Both 29.9 Neither 13.4 In case of accident exposure, what do you do? Wash with water and soap 78.5 Drink milk 13.3 Call ambulance 8.1 Go to hospital 11.2 Inform supervisor 7.1 How do you dispose this equipment? General waste 28.9 Specific site for disposal 25.3 Company does it 30.1 Plastic bags 6 Reuse/keep it to oneself 3.6 During application, do you? Eat 10.3 Drink 22.7 Both 1.0 None 76.3 After application, do you wash hands? 98.9 Do you have any co morbid conditions? 25.5 Are you taking any medications? 20.4 How many visits to the Health care/E.D/Admissions per year? 1.9(1.4–2.5) Are there any safety protocols at your company/work place? Yes 29.6 No 39.8 Don't know 30.6 Is your Company/Employer strict about compliance of safety protocols? Yes 48.5 No 23.7 Don't Know 27.8 If any untoward incident occurs, are they documented/informed to respective officials? Yes 43.9 No 43.9 Don't Know 13.3 Did you ever witness any case of sever morbidity or death in your company workers due to pesticide poisoning? Yes 17.4 No 82.7 Does your company provide compensation for pesticide poisoned workers? Yes 1.0 No 40.8 Don't Know 58.2.
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A Qualitative Study to Develop a New Tool for Handover in the Emergency Department
More Lessالأهداف: تحدد هذه الدراسة أفضل ممارسة لتسليم المناوبة طبية وتقدم أداة جديدة تستخدم لتسليم المسائل السريرية والتشغيلية في نهاية جميع التحولات والمناوبات في أقسام الطوارئ. الأساليب: تم ومراجعة استعراض التراث الطبي لهذا الموضوع. وبعد المقابلات شبه المنظمة والملاحظات لتسليم المناوبات. مع المشاركين من المقيمين والأخصائيين والاستشاريين و كبار الممرضات. تم التوصل الى عملية موحدة لتسليم المناوبة الطبية في قسم الطوارئ للتعرف على أفضل الممارسات المتفق عليها ، واشتقاق أداة لتصنيف المعلومات في الأقسام ذات الصلة. النتائج:المقابلات والاستطلاع حددت مجموعة متنوعة من العجز الحالي المتصورة في التسليم بما في ذلك الافتقار إلى الممارسة الموحدّة والهيكلية وقدم المشاركون أمثلة سلبية للتسليم التي أدت إلى أحداث ضارة على المرضى والعناية الطبية السريرية وشملت هذه التأخير في التحقيقات والعلاج للمرضى الذين تم تسليمهم مع معلومات موجزة أو غير دقيقة واستخدمت ردود الخبراء للتوصل إلى توحيد ‘أفضل ممارسات للمحتوى لتسليم المناوبة. الاستنتاجات وضعت أداة بسيطة لتوفير الأساس لتسليم المناوبة الطبية لأقسام ألطوارئ الذي يتضمن المعلومات السريرية والتشغيلية اللازمة لكفاءة ومنظمة للتحول المقبل.
Objectives
This study identifies best practice for shift handover and introduces a new tool used to handover clinical and operational issues at the end of all shifts in the emergency department (ED).
Methods
Literature review, semi-structured interviews and observations of handover were used to develop a standardized process for handover. Participants were ED residents, specialists, consultants and senior nurses. Interviews were used to identify agreed best practice and derive a tool to classify the information into relevant sections.
Results
Interviews identified a variety of perceived current deficits in handover including a lack of standardized practice and structure. Participants provided examples of poor handover that were thought to have led to adverse events; these included delay in investigations and treatment for patients who were handed over with brief or inaccurate information. There was wide variation in the understanding of the meaning and purpose of shift handover, and differences were apparent according to the level of experience the individuals interviewed. The experts’ responses were used to reach a unifying ‘best practice’ for the content of handover.
Conclusions
A simple tool was developed to provide the basis for medical shift handover, which includes clinical and operational information necessary for efficiency and organization of the next shift.
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Examining Climatic Influence on the Respiratory Health of Qatar Residents: A Comparative Analysis between Winter and Summer Months
Authors: Kim Arlene Critchley, Kevin L Teather, Asma Alamgir, Nicola Dsouza and Lea JaboneteA variety of climatic factors are known to influence respiratory health, usually through their impact on air quality. High temperatures, for example, are often associated with an increase in ground levels of ozone, which in turn negatively impact respiratory function (Thurston and Ito 1999; WHO 2000). In New York City, high temperatures were correlated with increased hospital admissions for both chronic airway obstruction and asthma (as well as some cardiovascular problems) (Lin et al. 2009). Humidity levels are often positively correlated with allergenic spores (e.g., Hasnain et al. 2012) and other particulates (e.g., Kulshrestha et al. 2012) and thus can trigger asthmatic attacks or other forms of respiratory distress. More recently, investigators have begun to examine the relationship between dust-sand storms and respiratory health. For example, Waness et al. (2011) cited evidence suggesting that exposure to dust-sand storms in the Middle East may contribute to pulmonary alveolar proteinosis and silicosis. In this study, we conducted a detailed correlational analysis between various climatic variables, the density of airborne particulate matter, and the incidence of hospital admissions related to respiratory problems.Inhalation of air particulates may result in serious health problems, most notably with the respiratory system. Due to a variety of factors (traffic, construction, weather patterns), the air in Doha is of poor quality and is significantly over targets for PM2.5 and PM10 (WHO, 2014 rankings). We examined the levels of particulate matter to determine if there was a daily or weekly pattern. We then compared the number of air particulates in the summer and winter and attempted to determine if small (0.5–2.5 mg/l) or large (>2.5 mg) particulate matter was related to weather patterns and resulted in increased use of the nebulizer at a local clinic. We found that particle number (both small and large) was highest around 6 am and lowest around 12 pm, a pattern that didn't change between months. The number of large and small particles was generally lower on Friday when human activity was lowest. The temperature decreased in winter while humidity increased; wind speed remained relatively constant. Data suggest that nebulizer use was higher in the winter and lower in the summer although the reasons for this are speculative. There was no relationship found between the number of people using the nebulizer and the number of air particles.
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Characterization and Antibacterial Efficacy of Mycosynthesized Silver Nanoparticles from the Desert Truffle Tirmania nivea
Authors: Tawfik Muhammed Muhsin and Ahmad K. HachimDesert truffles are an obligate hypogenous ectomycorrhizal fungi in association with host plant roots Helianthemum sp. and are of socioeconomically important and naturally grown in the Middle East, North Africa, Southern Europe, Mediterranean countries including Arab Gulf countries. Truffles are edible and a rich source of protein and various chemical compounds and traditionally have been used as folk medicine in the Arabian countries. The last decade has witnessed an increase research interest focused on the biosynthesis of metal nanoparticles using fungi as natural sources and as a good tool in nanobiotechnology. Nevertheless, recently metal nanoparticles have been widely applied in multidisciplinary fields including medical and pharmaceutical applications. Among nanometals, silver nanoparticles are of great significance to be used in pharmaceutical aspect as antimicrobial agent. According to our knowledge little information so far is available regarding biosynthesis of silver nanoparticles by the truffles and to search for new antimicrobial alternatives, therefore, the objective of this study was to explore the desert truffle (Tirmania nivea) for its potentiality to biosynthesize silver nanoparticles (AgNPs) and to examine their efficacy against five strains of human pathogenic bacteria namely; Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Salmonella typhi and Staphylococcus aureus. Fruiting bodies (Ascocarps) of the truffle T. nivea were collected from the sandy desert of Iraq and brought to the laboratory, washed thoroughly with distilled water and dried at room temperature. Twenty gram of dried fruit bodies of truffle were grounded and dissolved in boiled water and filtered using Whatman filter paper No 1. For synthesis process of silver nanoparticles, 100 mL of truffle extract filtrate was treated with 1 mM of AgNO3 solution and kept for 24 hr at dark condition and synthesis of silver nanoparticles (AgNPs) was checked by visual observation of color changes from pale yellow to dark brown and was further confirmed by UV – Vis spectrum. Fungal filtrate without AgNO3 was maintained as control. The potentiality of silver nanoparticles was examined for their antibacterial efficiency using agar well diffusion method against the selected strains of pathogenic bacteria. Wells (5 mm diam) were made in Muller-Hinton agar (MHA) plates streaked with swabs of each bacterial strain. The wells were loaded with two concentrations (50 and 100 ul) of synthesized silver nanoparticles solutions. Incubated at 37°C for 24 hr and examined for the appearance of inhibition zones around the wells and their diameters were measured. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) assay was carried out using the micro dilution method with serial dilutions (100, 50, 25, 12, 6.5, 3.13, 1.56, 0.78, 0.39, 0.2, 0.1, 0.05, 0.025 μg/L) of the truffle extract filtrate against two strains of bacteria E. coli (ATCC 25922) and S. aureus (NCTC 6571). Disc diffusion method was used to assay the synergistic effect of synthesized AgNPs with commonly used antibiotic Gentamycin. Cytotoxicity of the truffle extract was examined against human blood. Characterization of the biosynthesized silver nanoparticles from truffle extract was carried out by using UV-Vis spectrophotometer analysis, Fourier transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM). The results showed that the biosynthesized silver nanoparticles exhibited a high growth inhibition activity at 50 ul/ml concentration (12–25.5 mm inhibition zones dim) and at 100 ul/ml (14.5–28 mm inhibition zones diam) against the tested pathogenic bacterial strains. Among the tested bacteria, highest growth inhibition was noticed against P. aeruginosa (25.5 and 228 mm diam) at the two concentrations of AgNPs, respectively. However, a remarkable increase of bacterial growth inhibition zones (23–37 mm diam) was observed for a combination of silver nanoparticles and Gentamycin compared with Gentamycin alone (20–30 mm diam). MIC values were very low (0.312 and 0.0097 ug/ml) against the two tested bacterial strains E. coli and S. aureus, respectively. The truffle extract did not show any toxicity against human blood. UV-Vis spectrophotometer analysis revealed a peak at 420 nm indicating the biosynthesis of silver nanoparticles, FTIR analysis verified the detection of protein capping of biosynthesized AgNPs while SEM images showed that the synthesized silver nanoparticles are dispersed or aggregated and mostly spherical shape and their size ranging between 3–41 nm. It can be concluded that the biosynthesized silver nanoparticles by the desert truffle T. nivea are a promising for future medical and pharmaceutical applications as antibacterial agent and a further investigation to examine their efficacy in vivo is recommended.
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Association between Insulin and Nitric Oxide in Human Retinal Microvascular Endothelial Cells in vitro
Authors: Nasser Moustafa Rizk, Sumbul Bushra and Isha SharmaObesity and type 2 diabetes is characterized by insulin resistance which has been reported as the major risk factors associated with the development of the endothelial dysfunction and vascular complications such as atherosclerosis. Induction of the vascular dysfunction is obviously a proved metabolic consequence of insulin resistance. Diabetes leads to altered retinal microvascular function and ultimately diabetic retinopathy. Insulin signaling may play a role in this process, and animal studies indicated a role of the insulin in the pathogenesis of retinal neovascularization through its effect on endothelial cells. Endothelial dysfunction impairs ocular hemodynamics by reducing the bioavailability of NO and increasing the production of reactive oxygen species (ROS) and may be responsible for the pathogenesis of vascular dysfunction in retinopathy. Diabetic retinopathy (DR) a major consequence of diabetes is considered the leading cause of vision loss and blindness worldwide among working adults. Endothelial dysfunction expediting imbalance in vascular homeostasis, is one of the primary manifestation leading to the pathogenesis of DR. NO a major vasodilator involved in the regulation of vascular homeostasis is reported to be released by insulin dependent PI3K/Akt signaling pathway. Endothelial dysfunction impairs ocular hemodynamics by reducing the bioavailability of NO and increasing the production of reactive oxygen species (ROS) and may be responsible for the pathogenesis of vascular dysfunction in retinopathy. Insulin stimulated NO productions are reported to be well established in cardiovascular and macrovascular endothelium and its association with PI3K/Akt pathway. Contrary to this insulin signaling in retinal endothelium have minimal reports with some studies suggesting it to be an important physiology player in hyperglycemia or insulin resistance induced DR. This prompted us to investigate the association between hyperglycemia and insulin mediated PI3K/Akt pathway eNOS directed NO production and associated multivariate effect on HRMECs survival, proliferation, angiogenesis, adhesion, apoptotic and inflammatory markers. The aim of this study is to examine the examine the effect of insulin on NO production in human retinal microvascular endothelial cells cultured in hyperglcemic conditions. In the current study in order to examine the effect of insulin on NO production, HRECs cells were cultured and grown in high glucose (30 mM) and normal (5 mM) glucose for 24 hours. Subsequently, the cells were treated with 100 nM insulin for 10 minutes, 1, 2, and 4 hours. The various parameters of PI3K/Akt signaling pathway were analyzed. IRS-1, IRS-2, PI3K, Akt, eNOS, VEFGA, NFkB were analyzed for gene expression. Adhesion molecules such as P-selectin and ICAM-1 were assessed by flow cytometry. ROS and NO production were measured by immunofluorescence and fluorometry respectively. The cell viability, cell cycle, apoptosis and total oxidative stress were evaluated by imaging flowcytometery. This study demonstrated that hyperglycemia causes an increase in ROS/oxidative stress and apoptosis, while insulin promotes a significant decrease in ROS and apoptosis. eNOS mediated NO production increases with hyperglycemia but remarkably decreases with insulin treatment after 1 hour, 2 hours and 4 hours. This dissimilarity of the results to previously reported studies could be due to different endothelial cell types used or varied duration of experimental hyperglycemia. The most significant reason for the variation may be due to different method of NO measurement where, most previous studies measured NO production by isolated NO meters. However, in the current study fluorometry a more sensititve method to measure oxidized product of NO, nitrite an indicator direct NO production was utilized and confirmed by the immunoflouresence technique using the dye DAF-FM Diacetate. The assessment of PI3K/Akt pathway gene expression revealed that this study demonstrates a slight increase but insignificant elevation of IRS-1 and IRS-2 genes expression in hyperglycemic condition compared to the basal control condition, while gene expression of PI3K, Akt and eNOS were significantly upregulated in the presence of high glucose. Insulin treatment caused an up regulation of IRS-1 and IRS-2 genes after 1 hour however, PI3K, Akt and eNOS were significantly reduced. The analysis of angiogenic and proapoptotic markers VEGFA and NFkB by RT-PCR showed no significant change in the expression of NFkB in hyperglycemic alone, hyperglycemic and normoglycemic cells with insulin treatment at all-time points. However, hyperglycemia significantly increased the expression of VEGF. Though compared to basal control group insulin treatment significantly increased the expression of VEGFA in both hyperglycemic and normoglycemic cells yet the expression was low compared to HG state. Consistent with the VEGFA gene expression HG significantly increased the increase the cell migration and angiogenesis while insulin treatment significantly improves barrier function. Hyperglycemia significantly increased adhesion protein P-selectin with significant reduction at 4hrs insulin treatment in the current study. This study demonstrated a significant reduction in P-selectin after insulin suggesting that insulin could participate in preventing leukocyte adhesion thereby attenuating the progression of DR. This study could not demonstrate significance change in the ICAM-1 protein. This could be due to difference in the endothelial cells used, the duration and the type of insulin treatment used. This study reported that short acting insulin commonly used in the treatment of DR could control the metabolic fluxes thereby leading to improvement in oxidative stress and apoptosis. This could prevent early changes in vasodilator, adhesion and angiogenic markers such as NO, VEGFA, P-selectin involved in the angiogenesis, inflammation and neovascularization involved in retinal vascular functioning. The study shows the potent effect of short-acting insulin treatment to counteract these biomarkers and factors involved in the pathogenesis of DR and conserving microvascular function in HRMECs exposed to hyperglycemia (30 mM) and were reported to be improved. Thus, the diabetic interventions using insulin as a key therapy with others may have the potential to be utilized as a readily available, safe and inexpensive medicine to protect against microvascular complications of DR and delay its onset. In conclusion, this study demonstrated that Hyperglycemia causes an increase in ROS/oxidative stress and apoptosis, while insulin promotes a significant decrease in ROS and apoptosis, eNOS mediated NO production increases with hyperglycemia but remarkably decreases with insulin treatment after 1 hour, 2 hours and 4 hours, insulin could counteract the hyperglycemic effect on AKT/pI3 kinase which mediates NO production and VEGF-A, decreased adhesion molecules p-selectin involved in barrier disorder of retinal endothelial cells. Thus it could be proposed that insulin could be considered as regulators of angiogenesis.
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Vitamin D Deficiency and the Risk of Metabolic Syndrome within the Qatar Biobank: A Cross-Sectional Study
Authors: Kawthar Al-Dabhani, Marc Gunter and Neil MurphyBackground
Despite the long hours of sunlight in Qatar and other regions of the Middle East, vitamin D deficiency ( < 20 ng/mL) has been rising. There are many factors that affect the synthesis of vitamin D including age, ethnicity, skin pigmentation, anthropometric measures, diet, smoking, physical activity, cholesterol levels, and sunscreen usage. In parallel, the prevalence of obesity and metabolic syndrome has also been increasing in Qatar. Vitamin D deficiency has been associated with adiposity and metabolic syndrome but data are inconsistent. Individual factors of metabolic syndrome including abdominal obesity, lipid profiles, blood glucose, and blood pressure have also shown inconsistent associations with low vitamin D levels. To date, none of these relationships have been explored in a Middle Eastern population characterised by high prevalence of obesity and metabolic syndrome. Objectives The aim of this study is to investigate the interrelationship of anthropometric measures (height, waist circumference, waist-to-hip ratio, body mass index (BMI), and weight), metabolic syndrome, metabolic factors, and vitamin D in the Qatar Biobank. Methods A cross-sectional study of 1,205 participants (702 women and 503 men) from the Qatar Biobank comprising Qataris and non-Qataris (residents of greater than 15 years), was used to perform multivariate logistic regression analyses for anthropometric measures and vitamin D deficiency. The relationship between vitamin D and the risk of metabolic syndrome, metabolic factors and diabetes were also investigated. Odds ratios (OR), 95% confidence intervals (CI) and p-values were calculated for all analyses. Results Approximately 56% of the participants in this dataset were vitamin D deficient ( < 20 ng/mL) with more men (63%) being vitamin D deficient compared to women (51%). Severe vitamin D deficiency ( < 10 ng/mL) was found in 6% of men and 11% of women. Approximately 10% of the participants were sufficient in vitamin D (>30 ng/mL). Weight, BMI and waist circumference were positively associated with vitamin D deficiency. For example, compared to individuals in the lowest category of waist circumference, those in the highest category were at greater than 2-fold higher risk of being vitamin D deficient (OR = 2.29; 95%CI: 1.73 – 3.36; P-trend = 0.001). However, there was no significant association between 25(OH)D levels and metabolic syndrome (OR = 0.75, 95%CI: 0.49 – 1.15; P-trend 0.18) or diabetes (self-reported diabetes: OR = 0.99, 95%CI: 0.59 – 1.68; P-trend 0.85 and diabetes defined by HbA1c levels: OR = 1.09, 95%CI: 0.61 – 1.95; P-trend 0.82) in this study. However, 25(OH)D was associated with higher levels of circulating triglycerides after multivariate adjustments (OR = 0.49, 95%CI: 0.32 – 0.76; P-trend 0.002).
Conclusion
Obesity was associated with vitamin D deficiency in this Qatari dataset. However, 25(OH)D was not associated with diabetes, metabolic syndrome or metabolic factors. Greater adiposity may lead to low vitamin D levels but lower vitamin D levels do not seem to predispose to poor metabolic health. Further causal investigations need to be conducted on the associations between serum vitamin D and obesity, metabolic syndrome and diabetes.
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Understanding Diabetes and Cardiovascular Risk Biomarkers in Clinical Samples - The FIELD Trial and the DAMAGE Study
More LessPeople in developing countries of the world are facing a changing environment due to urbanization – changes that include lifestyle changes as well as changes in the dietary habits (and content). These lifestyle changes are now known to contribute to an epidemic of metabolic disease. The underlying mechanisms are unclear. The burden of type 2 diabetes mellitus (T2D) is increasing worldwide, particularly in developing countries, where it is predicted that over 70% of the global burden of T2D will exist by 2030 (Echouffo-Tcheugui and Dagogo-Jack, 2012). Although reasons for the increasing rates of T2D in developing countries are not fully elucidated, important factors include lifestyle changes involving rural-to-urban migration (“urbanization”), intra-uterine undernutrition and foetal programming (epigenetic changes progressively introduced over multiple generations and associated with maternal undernutrition). During the past two decades, increasing evidence arising from multiple clinical studies conducted by the research teams of Yajnik and Barker support an important role of early life undernutrition, and specifically disturbances of one-carbon metabolism, in the heightened susceptibility of Indians to diabetes at a younger age, and in the absence of generalized obesity (Kulkarni et al., 2007; Yajnik et al., 2014; Yajnik and Deshmukh, 2012; Yajnik et al., 2003; Yajnik et al., 1995). The Pune Maternal Nutrition Studies have highlighted the body composition and nutritional-metabolic peculiarities of multigenerationally undernourished Indians: a thin-fat (low lean mass, high fat mass) phenotype compared to Europeans, with predominant visceral deposition of fat. This body composition is strongly associated with insulin resistance and related metabolic-endocrine abnormalities. Importantly, this ‘thin-fat’ phenotype was present at birth and therefore, programmed during intrauterine life, possibly through epigenetic mechanisms over multiple generations. Maternal intergenerational undernutrition, evident in stunting, low BMI, and a disturbance of dietary methyl donors (low protein and vitamin B12 and high folate status related to vegetarian food habits) appear contributory to the increased risk of diabetes and CVD in Indians (Yajnik, 2004; Yajnik and Deshmukh, 2012; Yajnik et al., 2008; Yajnik et al., 2003). It is now well-appreciated that the intra-uterine environment can induce heritable alterations that may be retained over generations (Aiken and Ozanne, 2014; Good speed et al., 2014; Ng et al., 2010). A primate maternal high-fat diet supplemented with calorically dense treats leading to obesity has been shown to epigenetically alter chromatin structure in their progeny via SIRT1 mediated covalent modifications of histones (Aagaard-Tillery et al., 2008; Cox et al., 2009; Suter et al., 2012). Increased adiposity and insulin resistance have also been reported in high fat diet fed rodent models. Intra-uterine programming may involve epigenetic changes, which are passed over generations, and may promote the development of adiposity and T2D. Recently, we demonstrated (cover story; August 2015 issue of Cell Metabolism) that the metabolic effects introduced over multiple (50) generations of undernutrition cannot be reversed after two generations of unrestricted access to nutrients. Undernourished rats demonstrated low birth-weight, high visceral adiposity (DXA/MRI), and insulin resistance (hyperinsulinemic-euglycemic clamps), compared to age/gender-matched Control rats. Relative to Controls, Undernourished rats had higher circulating insulin, homocysteine, endotoxin and leptin levels, lower adiponectin, vitamin B12 and folate levels, and an eight-fold increased susceptibility to diabetes, after Streptozotocin (STZ) exposure. These metabolic abnormalities were not reversed after two generations of recuperation. Adverse epigenetic (histone modification) profiles in insulin gene promoter region of Undernourished rats are not reversed following two generations of macro-nutrient availability and might explain the persistent detrimental metabolic profiles in similar multigenerational undernourished human populations. One of the major strengths of this study is that the current animal model of diabetes was not generated by genetic manipulations but rather by feeding Control rats with an undernourished died for 50 generations (over 12 years) and then a normal diet for two generations. The Undernourished rats showed visceral adiposity and were less sensitivity to insulin. They also demonstrated several markers of metabolic disease. In order to correct this state, we allowed Undernourished rats to have unrestricted access to Control chow and water (now called as “Recuperation” rats). Recuperation rats, surprisingly, show increased visceral adiposity, continue to be less sensitive to insulin, and have the same level of diabetes susceptibility as Undernourished rats. Analysis of epigenetic signatures at insulin gene promoter region in the pancreatic islet cells confirms that although a slight improvement is seen in histone modifications as well as the recruitment of histone methyl transferases at the insulin gene promoter region, two generations of normal nutrient availability is in itself not sufficient to reverse the epigenetic changes to Control levels. These studies underscore the importance of epigenetic regulation of gene expression and indicate that micronutrient or other appropriate supplementation should be considered in dietary intervention studies on populations that have faced undernutrition over multiple generations. I will present our recent data from animal models as well as our data from two independent clinical cohorts; first, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial of around 10,000 Type 2 diabetic individuals followed over 12 years and secondly, the Pune Maternal Nutrition Study comprising of around 700 women and their babies over a period of 18 years of follow-up. Our studies (Discovery Analysis of MicroRNAs in Gene-Environment Interactions: DAMAGE-I study) involve analysis of DNA methylation changes (using the Illumina 450 K methylation arrays), GWAS analysis (using the Affymetrix platform), Telomere length assay (using quantitative real-time PCR) and microRNA analysis (using high throughput high sensitivity real-time TaqMan-PCR panels/chips, in addition to several (over 100) clinical biomarkers. Studies are also in progress to understand the role of gut microbiota – our inner environment that significantly influences human physiology. These studies demonstrate that the change in diet and lifestyle (urbanization) leads to significant changes in the short-chain fatty acid-producing gut bacteria and influence our lifestyle through epigenetic programming of gut cells. Overall, the studies discussed above, demonstrate the potential for integrative research technologies that we have used in understanding newer molecular biomarkers of diabetes and cardiovascular health and will allow future application of these molecular biomarkers to understanding the progression of diabetes and its complications in other (non-Australian) cohorts of at-risk of diabetes individuals worldwide. Hopefully, these technologies will help in better understanding the progression of Diabetes in individuals at risk of diabetes, provide newer tools to clinicians for predicting treatment efficacies and patient stratification and enable the development of newer and effective strategies to manage and cure diabetes.
Declarations
The current research discussed here is funded via three different grants to Professor Hardikar from the Australian Research Council (ARC), the National Health and Medical Research Council (NHMRC) and the Juvenile Diabetes Research Foundation (JDRF). Professor Hardikar is also on the advisory committee for Abbott Pharmaceuticals in relation to a probiotic formulation that has the potential for improving metabolic health in diabetes.
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Helminth Infections Among Long-Term-Residents and Settled Immigrants in Qatar in the Decade from 2005 to 2014: Temporal Trends and Varying Prevalence Among Subjects from Different Regional Origins
Authors: Marawan Abu-Madi, Jerzy Behnke, Sanjay Doiphode and Sonia BoughattasWe analysed the prevalence of helminth infection in a dataset of 31,008 records of subjects referred for stool examination at the Hamad Medical Corporation over the course of a decade (2005 to 2014, inclusive). Overall prevalence of combined helminthe infections was low (1.78%) but there were significant temporal trends, age and sex effects and those arising from region of origin of the subjects. The most common helminth was hookworm (overall prevalence 1.2%) which accounted for 70.3% of cases, and therefore patterns for combined helminth infections were largely driven by hookworms. In both cases, and also in Trichuris trichiura and Ascaris lumbricoides prevalence peaked in 2008, since when prevalence has been steadily falling. Helminth infections were largely concentrated among subjects from W. Asian countries, and there was a highly biased prevalence in favour of male subjects in all cases. Prevalence of all three nematodes peaked in age class 7 (mean age 25.5 years, range = 20–29) and there were significant interactions between region of origin and sex of subjects and prevalence of combined helinths, and hookworms. These results offer optimism that prevalence will continue to decline in the years ahead, especially if control is targeted at those most at risk of carrying infections.
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Prevalence of Virulence/Stress Genes in Campylobacter Jejuni from Chicken Meat Sold in Qatari Retail Outlets
Authors: Marawan Abu-Madi, Jerzy Behnek, Aarti Sharma, Rebecca Bearden and Nadia Al-BannaChicken meat from the shelves of supermarkets in Qatar was tested for the presence of Camplobacter spp., and the presence of five virulence genes (htrB, cdtB, clpB, cadF and ciaB) was assessed in isolates. Forty eight percent of the chickens provided for supermarkets by Saudi (53%) and Qatari (45.9%) producers were found to be contaminated and the most important factor affecting the overall prevalence of contaminated chickens was the store from which chicken samples originated. Variation in prevalence of Camplylobacter in chicken meat from different stores was evident even when the same producer supplied the three stores in our survey. Differences in the prevalence and in the combinations of virulence genes in isolates that can and cannot grow in a classic maintenance medium (karmali) were identified, providing a starting point for linking presence/absence of particular virulence genes with actual in vivo virulence and pathogenicity. Because of the relatively low infective doses of Canpylobacter that are required to initiate infection in humans, it will be important to explore further the relationships we identified between certain Campylobacter virulence genes and their capacity for survival in poultry meat, and hence their contribution to the incidence of campylobacteriosis.
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Self-Rated Health Disparities Among Disadvantaged Older Adults in Ethnically-Diverse Urban Neighborhoods in a Middle Eastern Country
More LessObjectives and Rationale
This paper examines differentials in self-rated health among older adults aged 60 years and more across three impoverished and ethnically diverse neighborhoods in post conflict Lebanon and assesses whether variations are explained by social and economic factors. This study comes to fill a gap in the aging literature for Arab countries and aims to contribute to a better understanding of the social and economic determinants of health inequality in later life. The study is in tandem with the growing literature on ‘Aging in Place’ and the associated policy direction that stresses the importance of reinforcing the social and physical environment to ensure healthy aging in one's home and community, and prevention of isolation, marginalization, and the costly option of unwanted institutional care.
Design
Data were drawn for 740 older adults using a population based cross sectional survey conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom) and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. Social capital, a multidimensional construct was operationalized using 21 indicators assessing locational capital, social anchorage, social participation, civic trust, reciprocity, hypothetical social support, and social networks. Economic security was assessed using seven indicators that include current employment, a monthly income value exceeding the minimum wage, having other sources of income from self or spouse, not receiving monetary assistance from children, or from charity, or from relatives, and having no dependents. Analyses testing whether the social capital and economic security constructs qualify as mediators for the association between community type and self-rated health based on Baron and Kenny's criteria were also performed. These include contrasting the social capital and economic security indicators and their summative scores across communities using χ2 and ANOVA tests and examining their association with SRH using bivariate ordinal logistic regression models. The role of the social capital and economic security constructs in offsetting poorer self-rated health was assessed using multivariate ordinal logistic regression analyses after controlling for confounders which include age, sex, educational attainment, history of displacement, years living in the house, smoking, chronic conditions, and disability.
Results
Older adults in Nabaa fared better in self-rated health compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor self-rated health being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9% and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, 43.5% in Buj El-Barajneh. Nabaa also showed the highest level of social capital, scoring on a 21-points scale, a mean of 13.5 while Burj El-Barajneh camp and Hey El-Sellom followed with mean scores of 12.1 and 10.6, respectively (p–value < 0.001). This was mainly attributed to consistently higher scores on locational capital, social participation, reciprocity, hypothetical social support, and social networks beyond the immediate family in Nabaa. Meanwhile, the economic security assessment suggested significant differentials across the three communities with Burj El-Barajneh camp found to be the most disadvantaged, while Nabaa and Hey El-Sellom exhibited comparable characteristics. On a 7-points scale, we estimated a mean economic security of 2.9 in Burj El-Barajneh (p-value < 0.001) compared to 4.0 in Nabaa and 4.1 in Hey El-Sellom. In addition to their significant association with community, the social capital and economic security constructs were also found to be significantly associated with self-rated health with Odds ratios respectively assessed at 0.84 (95% confidence interval: 0.81–0.89) and 0.70 (95% confidence interval: 0.63–0.78), thus fulfilling the criteria for Baron and Kenny's mediation factors. The economic security construct attenuated the odds of poorer self-rated health in Burj El-Barajneh as compared to Nabaa from 2.6 (95% confidence interval: 1.9–3.8) to 1.42 (95% confidence interval: 0.9–2.1) after adjusting for confounders, but had no impact on this association in Hey El-Sellom (Odds ratio: 2.1, 95% confidence interval: 1.4–3.2). The incorporation of social capital in the fully adjusted model rendered this association insignificant in Hey El-Sellom (Odds ratio: 1.5, 95% confidence interval: 0.9–2.3), and led to further reductions in the magnitude of this association in Burj El-Barajneh camp (Odds ratio: 1.18, 95% confidence interval: 0.8–1.8).
Discussion and Conclusions
The three communities examined in this study share a low socio-economic profile characterized by dense urban livings, economic hardships, displacement, and lack of public services and infrastructure. Despite these similarities, striking differences in self-rated health were revealed and these were explained by differentials in the availability of social and economic resources, largely a reflection of the structural differences across these communities. Older adults in Nabaa, a formal neighborhood, fared better in self-rated health than the older cohort in Hey El-Sellom, an informal settlement, and the Palestinian refugees in Burj El-Barajneh camp. Although older adults in Nabaa and Hey El-Sellom were similar with regard to economic security, Nabaa exhibited higher levels of social capital. The poorer self-rated health among older adults in Hey El-Sellom was shown to be largely determined by social deficiencies in this neighborhood. Meanwhile, the study highlighted the scarcity of social and economic resources in Burj El-Barajneh camp, the result of dispossession of Palestinian refugees. In sum, the social context in which older adults live and their financial security are key determinants of well being that are often overlooked by interventions targeting older adults in deprived post conflict settings. Social capital and economic security should be the focus of public health interventions and policy aiming at promoting the quality of life of older adults in the Arab region.
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Exploring the SIRT1/P53 Pathway in Adipocytes Hyperplasia
More LessThe expansion of fat mass in the obese state is due to increased adipocyte hypertrophy and hyperplasia. Knowledge on what drives adipocyte hyperplasia in obesity remains limited. SIRT1, a key regulator of mammalian metabolism, maintains proper metabolic functions in many tissues counteracting obesity. By stably knocking down SIRT1 in mouse 3T3-L1 preadipocytes, we demonstrate that SIRT1 is a key regulator of proliferation in preadipocytes and mitotic clonal expansion (MCE) in differentiating adipocytes. Quantitative proteomics reveals that the p53 pathways is altered to drive enhanced proliferation in SIRT1 knockdown preadipocytes. Moreover, p53 is hyperacetylated, p27 is reduced and CDK2 is activated in SIRT1-silenced preadipocytes. Remarkably, differentiating SIRT1-silenced preadipocytes exhibit enhanced MCE accompanied with reduced p27, increased C/EBPβ, and also have hyperacetylated p53, leading to hyperplastic and dysfunctional adipocytes. Better understanding of the molecular mechanisms of adipocyte hyperplasia will open new venues towards understanding obesity.
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Effectiveness of Self Myofascial Release Technique in the Management of Non-Specific Low Back Pain in Nursing Professionals
By Ms AjimshaNonspecific low back pain (NSLBP) is defined as low back pain not attributed to recognizable, known specific pathology (van Tulder 2006). The global prevalence of activity-limiting LBP was recently estimated to be approximately 39% for lifetime prevalence and 18% for point-prevalence (Hoy et al. 2012). In spite of an enormous increase in the health resources spent on LBP disorders, the disability relating to them continues to increase. (Deyo et al. 2009) NSLBP remains a common and exorbitant problem among the nursing profession with a lifetime prevalence extending between 73% and 90% (Maul et al., 2003), a major cause of suffering, disability, and days of work lost. The frequency of reported disability from back injuries in nurses is among the highest of all worker groups (Jensen 1987). It accounts for 16·2% of all sick leave for nurses (Stubbs et al. 1983) and impairs performance. Myofascial release (MFR) is a form of manual therapy which involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function (Barnes, 1990). It has been hypothesized that fascial restrictions in one part of the body cause undue tension in other parts of the body due to fascial continuity. This may result in stress on any structures that are enveloped, divided, or supported by fascia (Schleip, 2003). Self MFR involves the application of MFR by themselves with the help of fingers, hands or hand held devices. A recent study by Ajimsha et al (2015) found that MFR was more effective than a control intervention in the back pain management of nursing professionals. The main objective of this study was to investigate whether Self Myofascial Release (SMFR) technique can reduces pain and disability in non-specific low back pain (NSLBP) in comparison with a control group receiving a sham Myofascial release (Sham-MFR) in nursing professionals.
Methods
This study was designed as a Randomized, controlled, single blinded trial and carried out in the clinical wing of Myofascial Therapy and Research Foundation, Kerala, India. Inclusion criteria for this study was nursing professionals aged 30–50 years with a diagnosis of NSLBP of 3 or more month's duration. Patients were excluded if they displayed: 1) osteoporosis of the spine; 2) primary joint disease such as active rheumatoid arthritis; 3) metabolic bone disease; 4) malignant bone disease; 5) fracture; 6) hyper mobility of the lumbar/sacral spine; 7) cardiovascular or other medical disorder preventing the person from engaging in strenuous exercise; 8) evidence of radiculopathy, or primary complaint of radiating pain; 9) pregnancy; or 10) severe psychiatric disturbance. Use of oral/systemic steroids, use of analgesics on more than 10 days a month and any other treatment for LBP during the previous 6 months were also excluded from the study. The Research Ethics Committee of the Myofascial Therapy and Research Foundation and Medical Research wing of Mahatma Gandhi University, Kerala, India, reviewed the study and raised no objections from an ethical point of view. Between May 2013 and October 2014, 73 nursing professionals were referred to the Myofascial Therapy and Research Foundation with a diagnosis of NSLBP. Of these, 57 individuals who met the inclusion criteria and provided written informed consent were randomized to the Self MFR (SMFR) or to the control arm of the study. Participants were asked to maintain a pain and medication diary in which any medication or change in pain pattern during the treatment period was to be recorded with date and time. The SMFR were administered by the nurses themselves whereas the sham-MFR was applied by physical therapists in a predetermined dosage (12 sessions in 4 weeks).
Main outcome measure
The McGill Pain Questionnaire (MPQ) for subjective pain experience and Quebec Back Pain Disability Scale (QBPDS) to assess the disability associated with NSLBP. The primary outcome measure was the difference in MPQ and QBPDS scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. Two evaluators blinded to the group to which the participants belonged analyzed scores from the MPQ and QBPDS. Procedure Subjects in each group received either SMFR, or a sham MFR program. The 2 interventions were provided for 3 times per week for 4 weeks (weeks 1–4), with a minimum of a 1 day gap between the 2 sessions; the duration of each treatment session was set as 45 min. A recorded audio which gives step wise instruction for the SMFR was given to the SMFR group with fixed daily timing for the release. A research assistant calls and confirms the SMFR adherence in a daily basis. MFR procedure We used the following treatment protocol for all the patients in the SMFR group derived from the protocol used by Ajimsha et al (2015) in his study. A normal tennis ball and a Rumble Roller® (RR 316, blue, original density) were the items given to the clients in the SMFR group. The clients in the SMFR group were given one hour training for the SMFR and were asked to demonstrate it on the very next day to a therapist who was not the instructor of the SMFR. Control intervention Patients in the control group received sham MFR over the same areas as the application of SMFR (in the other group) for same time and duration. Sham MFR were applied by gently placing the hand over the areas treated in the SMFR group just enough to maintain contact for the desired time. All study participants were advised to take medications only when there were any exacerbations, but were required to record them in their patient diaries, which were analyzed at weeks 4 and 12 after randomization SMFR protocol. a) MFR of the Gluteus Maximus and piriformis Client's Position: Supine with hips and knees bend Technique: By using a tennis ball at the area of release (between the posterior superior iliac spine and the greater trochanter, the client will be asked to slowly press the body against the ball in a way that it elicits an aching pain the region. The body has to be adjusted by using the weight transferred through the feet to roll the ball between the above positions. The client has to stop the rolling for 30 seconds at any point where he/she feels more pain. (Duration: 5 min × 2 sides = 10 min) b) Back work lower Client's Position: Supine with hips and knees flexed The client places themselves over a Rumble Roller so that the foam roller will be positioned at the lower back in the lumbosacral region. The client is trained in moving the lower back over the roller and releasing the muscles and fascia of the lower back by using the feet. (Duration: 4 minutes release, 2 minutes rest, 4 minutes release = 10 min). b) Back work upper Client's Position: Supine with hips and knees flexed. The Rumble Roller was positioned at the upper back in the thoracic region. The client is trained in moving the upper back over the roller and releasing the muscles and fascia of the lower back by using the feet. (Duration: 4 minutes release, 2 minutes rest, 4 minutes release = 10 min). c) The Trunk sides Client's Position: Side lying, head supported by a pillow. Hips in 450 of flexion, knees in 350 of flexion. The client places themselves over a Rumble Roller in a side line position so that the area between greater trochanter and lower ribs can be released. The client stabilizes himself over the form roller with the help of the upper and lower extremities opposite to the lying side. The feet will be used to move the lateral trunk over the roller. (Duration: 5 minutes × 2 sides = 10 minutes) d) Seated focused release Client's Position: Seated in a rolling stool with hips higher than the knees feet slightly forward of the knees and well connected to the ground. The client supports their back via their feet and legs. The client will use a tennis ball between the lower back and a wall and by moving the back against the ball by means of counter pressure, releases the deeper muscles of the back. The clients were encouraged to isolate the specific segments on which the pressure was applied. (Duration 5 minutes) Statistics Participants in both groups were comparable at baseline. The primary outcome measure was the difference in MPQ and QBPDS scores between baseline (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. Statistical analysis of the data was done by using a 2 × 3 (group × time) analysis of variance (ANOVA) and 2 × 2 (group × time) and 2 × 3 (group × time) repeated-measures ANOVA. The between groups (group), within-groups (time), and mixed-groups (group × time) interactions were examined; then, in accordance with the primary objective of the study, we compared the MPQ and QBPDS scores of the SMFR and control groups at different time intervals. A P < 0.05 was accepted as statistically significant.
Results
The mean differences between groups vary by time. This indicates the possible existence of their interaction effect. The simple main effects analysis showed that the SMFR group performed better than the control group in weeks 4 and 12 (P < 0.005). The patients in the SMFR group reported a 62.6% reduction in their pain and 36.3% reduction in functional disability as shown in the MPQ and QBPDS scores in week 4, which persisted as a 43.8% reduction of pain and 29.2% reduction of functional disability in the follow-up at week 12 in the SMFR group compared to the baseline. The patients in the control group reported a 9.5% and 3.6% reduction in their MPQ and QBPDS scores in week 4. The proportion of responders, defined as participants who had at least a 50% reduction in pain between weeks 1 and 4, was 63% in the SMFR group and 0 in the control group. The test's between subject effects showed a significant interaction between the effects of group and time on value (F2,189 Z 522.418, P < 0.001). The simple main effects analysis (Table 3) showed that the SMFR group significantly performed better than the control group in weeks 4 and 12 (P < 0.001), but there were no differences between the groups at baseline (P > 0.001). We observed that the interactions between time and group were significant based on univariate and multivariate methods for all 3 repeated-measures ANOVAs. Significant pairs of SMFR and control groups vary at weeks 4 and 12 due to the interaction effect between group type and time. Study limitations One limitation of this trial was that practitioners could not be blinded. Second, long-term outcomes were not assessed, and it is not known whether the differences observed at post-treatment can be maintained over a long time. We also did not examine other important treatment outcomes such as pain beliefs, mood, and quality of life.
Conclusions
This study provides evidence that SMFR can be a useful tool in the management of NSLBP in nursing professionals than a control. A cost and time benefit analysis can be undertaken in the future studies. A major section of nursing professionals with NSLBP might benefit from the use of SMFR and can be taught as a LBP prevention strategy for nursing professionals.
Keywords
Myofascial release; Non specific low back pain, Nursing professionals
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Secondhand Smoke Emission levels in Waterpipe Cafes in Doha, Qatar
By Nadia FanousBackground
Morbidity and premature mortality associated with exposure to secondhand tobacco smoke (SHS) represent a major global public health burden, and SHS exposure arising from all sources is responsible for an estimated 600 000 premature deaths. 1 The adverse health effects associated with waterpipe (WP) SHS exposure have been less well investigated compared with cigarette SHS. 2 Nonetheless, evidence shows that WP SHS contains similar tobacco-related toxicants as cigarette SHS, including more than 60 carcinogens, and fine respirable suspended particles, which can be deposited deep into the lung. Article 8 of the WHO's Framework Convention on Tobacco Control (FCTC) requires party nations, in part, to adopt, implement and actively promote effective legislative or other measures to protect the public from exposure to secondhand smoke in indoor workplaces and public places. In 2002, Qatar adopted smoke-free legislation that prohibits cigarette smoking inside public venues. 12 Although fines ranging between QAR200 and QAR500 (approximately US$55–US$137) may be imposed, the clean indoor air law is seldom enforced in Qatar. Tobacco WP use has recently experienced a marked increase in popularity in Middle Eastern and South Asian countries, where it has been a traditional form of tobacco use since at least the mid-17th century. 15 The tobacco WP, also often referred to as ‘shisha’ in Qatar and many Middle Eastern countries and ‘hookah’ in western countries, heats highly flavoured, moist mo'assel tobacco. One factor that may contribute to the popularity of WP use is the perception of lowered risk of WP smoking, compared with cigarette smoking. Objective data on indoor air quality in public venues in Qatar have not previously been reported. Air quality measurements in public venues have now been conducted among a substantial number of jurisdictions internationally to help promote smoke-free policy development and assess legislative compliance. 28 The purpose of this investigation was to measure respirable suspended particulate matter of 2.5 μ or less (PM2.5), a marker for SHS, in WP cafes in Qatar's largest city, Doha. The small size of PM2.5 emissions, which arise from combusted tobacco, allow them to be easily inhaled and deposited deep within the lungs, contributing to serious respiratory and cardiovascular diseases. Methods Particulate matter (PM2.5) levels were measured inside and outside of a sample of 40 waterpipe cafes and 16 smoke-free venues in Doha, Qatar between July and October 2012. In addition, the number of waterpipes being smoked and the number of cigarette smokers were counted within each venue. Non-paired and paired sample t tests were used to assess differences in mean PM2.5 measurements between venue type (waterpipe vs smoke-free) and environment (indoor vs outdoor).
Results
The air quality in 40 WP cafes (smoking venues) was measured for a mean duration of 35.6 min (SD = 3.7). The mean internal volume of smoking venues (365.8 m3, range = 85–1449) tended to be smaller than that of non-smoking venues (682.1 m3, range = 34–3120), although the difference was not statistically significant (t(52) ≤ 1.0, p = 0.90). The smoke-free venues were monitored for a mean duration of 35.4 min (SD = 8.5). Active smoking of WPs and cigarettes was observed in all 40 smoking venues with more WP smoking being observed. The mean number of WPs observed in active use was 9.4 (range = 0.7–27.3), while the mean number of cigarette smokers observed was 1.5 (range = 0.3–4.6). The mean WP ASD (mean = 0.035 smokers/m3; SD = 0.027) was significantly greater than the cigarette ASD (mean = 0.006 smokers/m3; D = 0.005: t(39) = 16.0, p < 0.001). No active smoking (WP or cigarette) was observed inside the smoke-free venues. The mean PM2.5 level inside the 40 WP cafes (mean = 476.1 μg/m3; SD = 309.6) was significantly higher than the mean PM2.5 level found immediately outside these venues (mean = 34.5 μg/m3, SD = 11.6; t(39) = 25.7, p < 0.001). PM2.5 levels inside the smoking venues also were significantly higher than inside the smoke-free venues (mean = 16.8 μg/m3, SD = 12.1; t(54) = 16.9, p < 0.001). Mean PM2.5 levels outside the smoke-free venues (mean = 30.3 μg/m3, SD = 33.4) were significantly higher than the levels observed inside those venues (t(15) = 3.4, p = 0.003). The proportion of active WP smokers, as a per cent of total smokers WP + cigarette), ranged from 58? to 97?. There was a significant positive correlation between PM2.5 levels and WP ASD (r = 0.38, p = 0.015), but not with cigarette ASD (r = 0.20, p = 0.223). ASD for the non-smoking venues was 0.
Conclusions
The mean levels of fine particulate pollution observed among a sample of WP cafes in Doha, Qatar were found to be significantly higher compared with smoke-free venues. Particulate levels were also more than 13-fold greater inside WP cafes, compared with outside these venues. To contextualise the observed PM2.5 levels, the WHO has set an air quality guideline for 24 h exposure of 25 μg/m3. 32 While patrons and staff are not likely to experience 24 h exposure, exposure to the levels observed here for just a few hours a day is likely to comprise a serious health risk in the longer term. These data reveal that the exemption for WP cafes in Qatar's smoke-free legislation has resulted in environments that are unsafe for workers and the public. As such, further actions and amendments for the law are needed. In 2013, after the completion of data collection for the present study, the Qatari Supreme Council of Health started working on introducing amendments to the smoke-free law of 2002. The amended smoke-free law is intended to provide more comprehensive protections and will prohibit all types of indoor smoking in public places, including WPs, and increase fines for non-compliance. Further, Qatar has succeeded in banning tobacco advertisements and promotions. These actions provide an excellent opportunity to ensure that implementation and enforcement of the new law is performed optimally. Future research should investigate the short-term impact of banning WP smoking on air quality and SHS exposure, and, in the longer term, the potential for changes in social norms and the relationship to the prevalence of use and health outcomes. The current investigation adds to the growing literature on the contributions of WP SHS on indoor air quality. Qatar has demonstrated its intent to protect the public from the dangers of SHS by enacting its smoke-free legislation, and by ratifying the FCTC. However, SHS remains a major contributor to elevated levels of PM2.5 in WP cafes. Comprehensive smoke-free legislation, which applies to all venues and for all combusted tobacco products, is a welcome development in the tobacco control policy of Qatar. If implemented and enforced appropriately, the experience of Qatar may serve as an example to the wider EMR. These data provide further evidence for policymakers that indoor WP use threatens to undermine the potential benefits of tobacco control policies in the Middle Eastern region and other countries in which WP use is a popular practice. Comprehensive indoor smoking bans, which do not exclude WP use, are needed to address a significant flaw in the smoke-free laws of some jurisdictions.
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Improving Documentation of Cardio-Vascular Disease Risk in Medical Records of Diabetic Patients attending Non Communicable Disease Clinics at West Bay Health Center in Qatar
Authors: Mohamed Salem, Amal Alali and Zelikha BashwarBackground
Patients with type 2 diabetes have an increased prevalence of lipid abnormalities, contributing to their high risk of CVD. Multiple clinical trials have demonstrated significant effects of pharmacological (primarily statin) therapy on CVD outcomes in individual subjects with CHD and for primary CVD prevention. Our aim is to improve documentation of cardiovascular disease risk in medical records of diabetic patients attending non communicable disease clinics at west bay health center from 13% to 70% using world health organization cardiovascular disease risk Prediction Charts from September 2014 to January 2015.
Methods
Baseline audit to determine the percentage of cardiovascular disease risk documentation, Brain storming session was done to identify the causes of such problem including fish bone analysis, Survey questionnaire was designated to assess the main causes of the problem and distributed to all nurses working in non communicable disease clinics, The results demonstrated in paretto chart, We discover the main causes of the problem lies on two main causes (nurses were not oriented to new non communicable disease format and some of them were not trained to calculate risk).Intervention in form of: Education session for nurses working in these clinics were done particularly on: Orientation about new format and cardiovascular disease riskdocumentation, Orientation sessions for clinic running physicians, Putting reminder posters in clinics and staff nurse stations. Several audits done retrospectively for two weeks (3 days each week) to show average percentage of documentation in pre-intervention stage from 15th September to 13th November 2014, Several audits done for three weeks (3 days each week) and then weekly for 5 weeks to show average percentage in post-intervention stage ending at 15th January 2015, All data was demonstrated using run chart.
Results
The intervention began in November 2014 to January 2015 reveals that: Percentage of complete cardiovascular risk documentation for diabetic patients average was 7% in pre-intervention stage and increased to average of 59% after the intervention
Conclusions
Intervention in the form of nurse education and physician orientation improved Documentation of cardiovascular disease risk by 52%. Raising the average of documentation from 7% to 59%. Sustainability is very important for success in such improvement processes.
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Relationship of Violence Exposure and Mental Health of Youth in Iraq
More LessIntroduction
Violence is an important public health problem that may be seen in every part of the life and has been increasing in the world. World Health Organization (WHO) defines violence as: “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation”. Violence exposure can lead to: Mental disorders such as anxiety, depression and posttraumatic stress disorder (PTSD).Behavior, Cognitive and social problems such as social withdrawal, alienation, poor academic functioning. ∅ Physical effects such as cardiovascular strain, fatigue, reduced immune response. Age limit of Youth “Time in a person's life between childhood and adulthood. The term “youth” in general refers to those who are between the ages of 15 to 25.” - World Bank Youth… those persons between the ages of 15 and 24 years.” - United Nations General Assembly. Objective of the research paper: ∅ To estimate the prevalence of symptoms of psycho-social disorders and problems among youths due to exposure to violence in Iraq. Iraqi youth and violence For more than three decades, the Iraqi nation as a whole has been suffering from wars, sanctions and violence. The Iraqi children and youth have been so greatly affected by these dire conditions especially after 2003 and mostly deteriorated since 2006. Research documented that the violence is the main cause of death in men between the age of 15 and 59 years during three years after 2003 invasion. Pre-invasion mortality rates were 5.5 per 1000 people per year compared with 13.3 per 1000 people in the 40 months post-invasion (after 2003 war). A household survey of Iraq that conducted in 2006 has found that approximately 600,000 people have been killed in the violence of the war that began with the U.S. invasion in March 2003 and gunfire remains the most common reason for death, though deaths from car bombing. The 2006 bombing of the Askirya shrine in Samarra, and the widespread sectarian violence that followed, displaced 1.6 million persons within Iraq. In a survey which was conducted by the International Organization for Migration and the Iraqi Ministry of Displacement and Migration (2008) found that there are more than 177000 internally displaced families and the reasons most commonly given by internally displaced persons (IDPs) for displacement were direct threats to life (61%), presence of generalized violence (47%), and fear (40%). An estimated 1 million of Iraq's displaced persons were without adequate access to shelter and food, and an estimated 300000 are without access to clean water. The UNHCR estimated that Iraq has 1.13 million internally displaced persons in 2013, and a total population of concern of 2.2 million. Refugees International put the number at 2.8 million. The condition is much deteriorated after 10 June 2014, Mental disorders among Iraqi youth - Posttraumatic stress disorder (PTSD): Posttraumatic stress disorder (PTSD) is a syndrome that develops after a person sees, involved in, or hears of an extreme traumatic stressor. The person acts to this experience with fear and helplessness, persistently relives the event, and tries to avoid being reminded of it. To make diagnosis, the symptoms must last for more than a month after the event and must significantly affect important areas of life such as family and work. The life time prevalence of PTSD is estimated to be about 8 percent of the general population. The more vulnerable categories for post-traumatic stress disorder (PTSD) attacks are children and young people, females (widows and divorcees). Prevalence of PTSD among Iraqi youth: According to certain academic studies which were conducted in different regions of Iraq (that have experienced high levels of violence and military operations), about 25% of youth have symptoms of PTSD. The table (1) shows prevalence of PTSD among Iraqi youth Region PTSD % Year of study Baghdad 26.43% (males: 17–19 years) 2012 Baghdad 22.9% (18–24 years) 2010 Erbil* 26.5% *(Among youth of displaced families) 2008 Mosul 22.13% 2007 Diyala 27.4% (12–18 years) 2006 - Depression which is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. The percentage of depressive symptoms among university student in Baghdad (2010) was more than 35%; the violence was the leading cause for symptoms of depression. A recent study which was conducted during 2013–2014, showing that percentage of youth (18–25 years) in Baghdad with depression feeling was 41%, among of them 16% had thoughts that would be better off dead, or of hurting in some way. Social problems: Exposure of violence and academic performance. Through a study which was conducted in 2010 on a sample of students from the University of Baghdad (for ages between 18–24 years) found that 30% of them had history of academic failure during their studies earlier, and there was a strong association between violence exposure and history of academic failure – among of these trauma exposure: threat of assault, kidnapping and displacement. Substance abuse Research documented that alcohol and drug abuse may have increased in Iraq since 2006–2007. This apparent increase may be due to increased availability of substances and more traumas experienced by the population. A study was conducted in 2009, showing that the prevalence of alcohol and drug abuse among youth (18–23 years) in Baghdad was 10.7% and 4.9 % respectively.
Conclusion
Iraqi youth are facing very real dangers of diseases, starvation, psychosocial - physical disorders and death due to military operations and terrorism. The real problem What has been mentioned of the figures is an alarm (snapshot) attempting to shed light on the current psychological and social problems which faced by the people especially the youth in Iraq. The important fact is the psychological effects may continue to next generations. The real problem is lack of wide national studies and statistics to document the effects of direct and indirect exposure to wars, military operations and violence against civilians, and thus lack of scientific programs for community development and therapeutic strategies at the official, local or international organizations levels. With ongoing violence, the health system is heavily focused on curative and trauma care, leaving public health programs less supported. Iraqis have witnessed a depletion of social capital, which led to social deprivation in most sectors of the society. Recommendation Urgent need for further wide scale national researches to explore the long term effect of violence exposure on Iraqi population. Establish programs for building resilience among most vulnerable groups (children, youth, and women) via cooperation of national and international organizations that concerned with such subject…Establish mental and social health support centers, especially in the governorates that exposed to high level of violence and military operations…Need the efforts of activists in the field of human rights -individuals and organizations - to claim for compensation about physical and psychological disorders that resulting from the US occupation of Iraq.
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Disinfection by-products of Chlorine
Authors: Fatima Al-Otoum and Mohammad Al-GhoutiThe occurrence of disinfection by-products (DBPs) of chlorine dioxide (ClO2) in drinking water, namely: chlorite, chlorate, and THMs as well as the concentration of ClO2 were investigated. Two hundred ninety four drinking water samples were collected during the time period from March to August 2014. The water samples were collected from seven desalination plants (DPs), four reservoirs and eight mosques distributed in South and North Qatar. The ClO2 level was ranged from 0.38 to less than 0.02 mg/L, with mean value of 0.17, 0.12, and 0.04 mg/L in the desalination plants (DPs), the reservoirs (R), and the mosques (M), respectively. The chlorite level was varied from 12.78 – 436.36 ppb with median values varied from 12.78 to 230.76, from 77.43 to 325.25, and from 84.73 to 436.36 ppb in the DPs, the reservoirs, and the mosques, respectively. While chlorate was varied from 10.66 ppb to 282.71 ppb with mean values varied from 35.58 to 282.72 ppb, from 11.02 to 200.69, and from 10.66 to 150.38 ppb in the DPs, R, and M respectively. However, the average value of THMs was 4.90 ppb, while maximum value reached 76.97. Lower disinfectant residual was observed in few samples, however this could be attributed to the normal decomposition reaction of ClO2 with organic and inorganic compounds, including biofilms, pipe materials, corrosion products, formation of slime or may due to the fact the water in distribution system experience water aging problem. Significant differences were observed in the concentration level of chlorite, chlorate and THMs between DPs, reservoirs and the mosques. However, the concentrations of all DBPs fell within the range of the regulatory limit set by GSO 149/2009, WHO and KAHRAMAA (KM). It is recommended to slightly increase the average ClO2 dosage at the DPs. Such slight increase would provide safer margin at the customer point of use in case of any microbial activities. Consideration must be given to the overall demand and should account for seasonal variations, temperature, and application points. As well as a monitoring approach is recommended for the drinking water safety assessment. Re-conducting the study to include other DPs of ClO2 is recommended.
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“The use of Arabic version of Social Communication Questionnaires (SCQ) in School Screening for Autism Spectrum Disorder (ASD) in Qatar”
Authors: Fouad Alshaban, Eric Fombonne, Mohammad Aldosari, Saba El-Haj, Hawraa Alshammari and Iman GhazalIntroduction
The prevalence rate of Autism Spectrum Disorder (ASD) in Qatar is uncertain, obtaining a reliable estimate is important in shedding the light on the magnitude of the problem, and help in better planning for providing the health care facilities needed for early detection and management of this disorder, since early intensive rehabilitation can improve the outcome of those affected tremendously.
Aims of the study
To estimate the prevalence rate of ASD among children age 5–12 years residing in Qatar.
Methodology
The research plan is to identify children with possible ASD among children attending ordinary primary schools as a “Low Probability Group”, through using the Social Communication Questionnaires (SCQ), and those who score above the cut-off point will be further diagnosed using the Autism Diagnostic Interview-Revised (ADI-R) and/or the Autism Diagnostic Observation Schedule-2 (ADOS–2).
Results
We worked on translating the English version of SCQ to Arabic, and we worked to validate this version through a pilot screening study that involved 35 cases of ASD and 778 controls from the schools. The pilot sample includes 813 (35 cases of ASD and 778 control children). The control children were selected in 8 schools, 3 for girls, 3 for boys and 2 mixed, between 14/6/2015 and 28/6/2015. The ASD children surveyed with the SCQ were selected from the Shafalla Center (N = 35). The boy: girl ratio was 4.0:1 (61/41; 80% male) in the ASD group. In the control group, the corresponding values were 0.59:1 (287/488; 35.9% male). The mean SCQ total score was significantly higher in cases as compared to controls (18.06 (SD = 7.2) vs 7.31 (SD = 5.2); p < .0001); as expected, the variability was larger in cases than in controls as illustrated by the standard deviations. Figure 1 shows the distribution of the SCQ scores in the total sample, and the distribution separately for cases and controls. A total of 93 children (22 cases, 71 controls) had scores equal or above the cut-off of 15; the remaining 13 cases (37.1% of the cases) had scores below the cut-off.
Conclusions
The analysis to examine the overall performance of the SCQ showed excellent discrimination between cases and controls. An examination of the performance for each possible cut point on the SCQ showed that the sensitivity and specificity were optimal for the cut-offs of 10, compared to the published cut-off of the SCQ (15).
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Design and Development of Textile Based Strain Sensor for Medical Textiles Applications
More LessIntegrating strain sensors into textiles opens new applications. For example when attaching the sensors in the knee or elbow region, the bending angle of the joints can be measured. Such a measurement can be used in sports (e.g. to measure the number of steps and the speed while jogging) or in rehabilitation to give the patient an online feedback whether he practices the injured joint in the appropriate range. Measurement of fabric strain flexion of human joints caused an elongation of the affixed skin up to 45% in the region of the knee and 30% in the region of the lower back. Consequently, strain sensitive materials that react to elongation were integrated into tight fitting garments for a reconstruction of the joint angle. One could even think of a whole body posture measurement which enables a quality and quantity measurement of exercise conduction in fitness training and rehabilitation.
Keywords
Medical textiles; Conductive yarns; Flexible strain sensors; knitted structures; Rehabilitation
Introduction
The fabrication of electronic systems onto substrates represents a breakthrough in many areas of application, such as virtual reality, tele-operation, tele-presence, ergonomics and rehabilitation engineering. The need of the hour is to develop such an integrated effective system for medical textile applications which is not only flexible but also conformable to the human body, for such type of flexible strain sensors, one should focus on some crucial parameters like development of optimized composite conductive yarns used for the substrate and flexible strain gauges based on composite conductive yarns. Measuring strain in textile is a problem addressed by different research groups. One of the first groups who mentioned this problem was Tognetti et al. They built a knitted strain sensor which was integrated into a jacket and was used to measure upper body movements [1]. Gibbs et al. designed a textile potential divider to measure joint movements. In a thin layer of poly-pyrrole (using chemical vapor deposition) was applied on the fabric substrate at low temperature. With this configuration, a measurement range of up to 50% strain and a strain sensitivity of 80 was achieved [2]. Mattmann et al. investigated ethylene-vinyl acetate (EVA) and ethylene-propylenediene rubber (EPDM) composites for sensor applications. Such carbon composite materials show high relaxation behavior and creep which means that the change in resistivity is influenced by the strain rate [3]. An elastomer/carbon black-composite (CE) was used by Tognetti et al. to measure arm and finger movements. This sensor showed high relaxation behavior too. Carbon black/elastomer- and rubber-composites need to be cured after compounding and shaping [4]. In contrast, when using thermoplastic elastomer (TPE) based composites, curing is not necessary and simple thermoplastic processing technology can be used for shaping. Therefore, such polymers are interesting when developing strain sensors with large strain. Yamada et al. presented a sensor of a thermoplastic elastomer and filled with carbon black (27.6 by %vol.). They focused on noncyclic strain sensing and looked at influences of temperature and humidity on the resistance. The sensor showed a dependence of the resistance on the humidity but not on the temperature [5]. In this paper we use a similar composition (50wt–%/32vol–% carbon black) but focus on the characterization of the sensor's dynamic behavior, as sensors integrated into textiles are exposed to repeated strain cycles. The conductive fibers can be incorporated into the yarn (Figure1) and then subsequently incorporated into fabric. Integrating strain sensors into textiles opens new applications in medical textiles, for example, when attaching the sensors in the knee or elbow region, the bending angle of the joints can be measured. Such a measurement can be used in rehabilitation to give the patients an online feedback whether they practiced the injured joint in the appropriate range or not. One could even think of a whole body posture measurement which enables a quality and quantity measurement of exercise conduction in fitness training and rehabilitation. Measuring the posture using strain sensors enables an unobtrusive integration into textile currently not possible with other sensors (e.g. accelerometer, gyroscope, and magnetometer). This calls for a combined effort on one hand from the materials side in terms of developing functionalized fabrics and tackling integration issues, and also from the computer applications side to provide user-friendly interfaces. Through characterization of their response and assess functionality for specific applications. These are not only valuable to the athlete who wish get the most from their training regime and assess their progress but also for different patient who need rehabilitation. This project will focus on the development of optimized composite conductive yarns and strain sensors which measures strain in textiles. Furthermore, these strain sensors will be integrated in to braces which could be used for many applications such as patient rehabilitation and monitoring and controlling of athlete movements. The scope of this work is to develop a device capable of measuring strain, based on conductive textile yarns and using them as strain sensors. Furthermore, these sensors can also be incorporated into intelligent braces which can be used for endless medical textile applications.
Material
The conductive yarns will be prepared by TPE (thermoplastic elastomer) based composites and for shaping simple thermoplastic processing technology will be used. The TPE material such as SEBS-Block copolymer (THERMOLAST Kr (FD-Series)), Compound No. TF7- ATL produced by KRAIBURG TPE GmbH, Germany may be used. Thermoplastic elastomers (TPE), sometimes referred to as thermoplastic rubbers, are a class of copolymers or a physical mix of polymers (usually a plastic and a rubber) which consist of materials with both thermoplastic and elastomeric properties. While most elastomers are thermosets, thermoplastics are in contrast relatively easy to use in manufacturing. The carbon black powder (ENSACO 250 produced by TIMCAL, Belgium) may be used and will be added in TPE during fiber manufacturing.
Method for producing filament
For the fibre manufacturing we will use extrusion and drawing method. The TPE pellets will be filled in an electrically heated torque rheometer with roller blade configuration. After melting the thermoplastic part of the TPE, carbon black powder will be added and subsequently homogenized and dispersed into the polymer. The rotation speed may be constant (10 rpm) during the whole procedure. After compounding, the fibre will be produced by using a capillary rheometer, and an extrusion die. The composite material will be preheated and compacted in the cylinder of the rheometer. By using the furnace (proposed) furnace we can produce activated carbon through stabilization and carbonization of different materials like polyamide and PAN (Polyacrylonitrile) in the presence of inert atmosphere. Then through ball milling machine (proposed) we can create nano particles of this activated carbon. The coating of these nano particles will give us good results regarding electrical and thermal conductivity. Strain sensor Preparation: Textile Stretch Sensor will be manufactured by Flat Hand Knitting through incorporate conductive yarns into fabric. With the help of weft knitted machine this sensor will be prepared. For the effectiveness of sensors, we may change different parameters such as Loose knitted with and without lycra yarn Tight knitted with and without lycra yarn Single Plied knitting Double plied knitting Testing: The Strain sensors will be characterized in terms of quasi-static and dynamic electromechanical transduction properties. Thermal and aging properties of the sensing fabrics will also be determined through cyclic loading on UTM machine. Conductive properties of the Textile Stretch Sensor (TSS) will be tested on ohm meter in BUITEMS Textile lab. All measurements will be performed on Electronic Extensometer (proposed). The resistance will be measured in parallel with a multi meter. These strain measurements will be done at a speed of 200 mm/min which corresponds to a strain rate of 16% = sec (sensor length 2 cm) which is achieved in typical body movements. Brace Performance Testing Following is the picture of the preliminary developed sensor. The target will be the improvement of reproducibility for the accurate results. We may also miniature the circuits involved to make it easy to wear.
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X-linked Genes with Novel Rare Variants Identified by WGS in ASD Patients are Involved in Neurodevelopment
Two boys with Autism Spectrum Disorder (ASD) from two unrelated consanguineous families of Arabic origin were studied by Whole Genome Sequencing (WGS) together with their parents. Thugs data of the X chromosome were analyzed to identify possible predisposing, recessive and/or de novo, X-linked variants. Comparative analysis of the WGS data for X-linked de novo inheritance identified no variants, while the recessive inheritance analysis identified the following three strong candidate gene variations, in order of priority; Family 1: IL1RAPL2c.206G>C/p.S69T; Family 2: SHROOM4 c.3370C>G/p.Q1124E, and SYTL5c.1370G>A/p.R457Q. All variations found to be damaging and conserved, validated by Sanger Sequencing, co-segregate with the disease phenotype within each family and are absent in known polymorphism databases, as well as in 1800 ethnically matched control chromosomes, genotyped by TaqMan assays and Real-Time PCR. For the Comparative Analysis, the CLC Genomic Workbench Software package was used, as well as the in-house pipeline, setting the MAF cutoff at 1% and including data for pathogen city, conservation, protein effect, variants databases and so on. In Family 1: IL1RAPL2 is associated with non-syndromic X-linked ID and/or ASD and the proteinis detected at low levels in fetal and adult brain (particularly in the frontal lobe, temporal lobe and cerebellum). In Family 2: SHROOM4 plays a role in cytoskeletal architecture and it is considered an XLMR gene, as mutations have been linked to Stocco dos Santos Syndrome. Deleterious mutations might affect the morphology of the neural cells and eventually the neural development. The SYTL5 encoded protein belongs to the synaptogamin-like protein family and seems to play a role in protein transportation in specific tissues, as it is expression is restricted to placenta and liver. Maybe during embryonic development its expression is required for downstream gene control that plays a role in neural development. Genes function and suggested mechanisms, as well as the absence of the mutations from the ethnically matched control population and publically available databases, indicate that these novel rare variants identified are strong candidates for predisposition to the development of ASD. Future studies on transcriptome analysis and gene expression will enable to confirm the indications and the mechanisms might justify their involvement to ASD.
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The Miniaturization of Reverse Addition-fragmentation atom Transfer Living Polymerizations — the Democratization of RAFT
More LessReverse addition-fragmentation atom transfer (RAFT) living polymerization, a popular means of preparing coplymers of methacrylate and methyl methacrylate with narrowly defined size distributions and architectures, can readily be performed in sub-mililiter quantities in the absence of stirring, yielding biocompatible materials with excellent yields and low PDI values, and a linear molecular weight response curve extending to above 180,000 g·mol–1. When multiple studies were done involving the variation on the RAFT/monomer ratio under a variety of concentrations, the corresponding molecular weights of the materials exhibited a linear response. Furthermore, in comparing the resulting material to polymers prepared using more classical free-radical polymerization techniques, the miniaturized RAFT-mediated batches showed similar biocompatibility. These facile reaction conditions offer the prospect of preparing well defined polymeric systems in parallel with minimal equipment investment, without compromising the quality of the final product. The resulting polymers were then inkjet printed onto an agarose-coated glass slide, and then tested for bioactivity.
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