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Background:A comprehensive assessment of patients' problems and needs is essential for all patients with chronic diseases, including cancer.Aim:This study assesses the problems, unmet needs and requirement for palliative care (PC) among patients with cancer.Method:A descriptive cross-sectional design was employed using a valid self-reported questionnaire.Results:On average, 62% of patients had problems that were unresolved. The need for patients to have more information about their health was identified (75.1%), followed by financial problems because of the illness and ability to afford healthcare (72.9%), and psychological issues, such as depression, anxiety and stress (67.1%). Patients stated that their spiritual needs were not being met (78.8%), and that they were experiencing psychological distress and problems with daily living that needed to be addressed through PC (78%, 75.1%, respectively). A chi-square test revealed that all problems are significantly associated with the need for PC (P<.001).Conclusion:Patients needed more assistance in psychological, spiritual, financial and physical domains, and this can be provided by palliative care. Palliative care in low-income countries is a human right for patients with cancer.

AbstractRapid shallow landslides are a significant hillslope erosion mechanism and limited understanding of their initiation and development results in persistent risk to infrastructure. Here, we analyse the slope above the strategic A83 Rest and be Thankful road in the west of Scotland. An inventory of 70 landslides (2003–2020) shows three types of shallow landslide, debris flows, creep deformation, and debris falls. Debris flows dominate and account for 5,350 m3(98%) of shallow-landslide source volume across the site. We use novel time-lapse vector tracking to detect and quantify slope instabilities, whilst seismometers demonstrate the potential for live detection and location of debris flows. Using on-slope rainfall data, we show that shallow-landslides are typically triggered by abrupt changes in the rainfall trend, characterised by high-intensity, long duration rainstorms, sometimes part of larger seasonal rainfall changes. We derive empirical antecedent precipitation (>62 mm) and intensity-duration (>10 h) thresholds over which shallow-landslides occur. Analysis shows the new thresholds are more effective at raising hazard alerts than the current management plan. The low-cost sensors provide vital notification of increasing hazard, the initiation of movement, and final failure. This approach offers considerable advances to support operational decision-making for infrastructure threatened by complex slope hazards.

In this study, we give the numerical scheme to the stochastic nonlinear advection diffusion equation. This models is considered with white noise (or random process) having same intensity by changing frequencies. Furthermore, the stability and consistency of proposed scheme are also discussed. Moreover, it is concerned about the analytical solutions, the Riccati equation mapping method is adopted. The different families of single (shock and singular) and mixed (complex solitary-shock, shock-singular, and double-singular) form solutions are obtained with the different choices of free parameters. The graphical behavior of solutions is also depicted in 3D and corresponding contours.

Background: Ligustrazine and chalcones have been reported previously for various biological activities including anticancer effects. Objectives: Based on the multitargeted biological activities approach of ligustrazine-based chalcones, in the current study 18 synthetic ligustrazine-containing α, β-unsaturated carbonyl-based 1, 3- Diphenyl-2-propen-1-one derivatives were evaluated for their inhibitory effects on the growth of five different types of cancer cells. Methods: All the compounds were evaluated for anticancer effects on various cancer cell lines by propidium iodide fluorescence assay and various other assays were performed for mechanistic studies. Results: A majority of compounds exhibited strong inhibition of cancer cells, especially synthetic compounds 4a and 4b, bearing 1-Pyridin-3-yl-ethanone as a ketone moiety in the main structural backbone were found to be most powerful inhibitors of cancer cell growth. Nine most active compounds among the whole series were selected for further studies related to different cancer targets, including EGFR TK kinases, tubulin polymerization, KAF and BRAFV600E. Conclusion: Synthetic derivatives, including 4a-b and 5a-b showed a multitarget approach and strong inhibitory effects on EGFR, FAK and BRAF while three compounds, including 3e bearing methoxy substitution, 4a and 4b with 1-pyridin-3-yl-ethanone moiety showed the inhibition of tubulin polymerization.

Background: Environmental pollution has become a worldwide problem. In this regard, decontamination of wastewater and removal of organic pollutants from environment by photocatalysis has emerged as one of the most promising techniques from the last few decades. Objective: In order to degrade the harmful pollutants from wastewater, highly efficient non-toxic Fe2(WO4)3 photocatalyst was synthesized via co precipitation method. The photocatalytic activity of the as-synthesized material was examined by degrading methylene blue (MB) under various conditions. Methods: For this purpose, different experimental parameters such as catalyst load, model compound concentration, H2O2 percentage and pH value were adjusted for excellent degradation of MB, and response surface methodology (RSM) along with central composite design (CCD) as adequate model was employed for optimization process. Results: The experimental results revealed that 1.2 g/L of catalyst load, 10 g/L for dye concentration, 0.5% of H2O2 and pH 7 were found to be the optimized values for the aforesaid parameters. The optimized values led to 93% degradation of MB under UV light exposure. In addition, toxicological studies were analysed using various bioassays for both, untreated and treated samples and a conspicuous reduction (69.12%) in the toxicity level was observed. Conclusion: The study signifies that this method is useful for reclamation of water, making it useful for industry and irrigation.

Glioblastoma is one of the fatal and aggressive types of brain tumors. The current standard treatment for glioblastoma multiform (GBM) is surgical resection coupled with radiotherapy and chemotherapy. Although ample research has been performed, and multiple novel pharmacological approaches have been investigated for developing effective therapeutic drugs for treating GBM, the success of extending the survival of the patient is notably low. The unique barrier limiting GBM treatment is the presence of the blood-brain barrier (BBB), and most of the chemotherapeutic drugs fail to cross it due to their high molecular weight and large size. The currently used chemo drugs for GBM have poor penetration ability to the brain and cause off-target toxicity due to a high dose for maintaining drug concentration at the tumor site. The use of nanomaterial composites for co-delivery of multiple therapeutic drugs offers several advantages by encompassing the aforementioned obstacles. In this review, the first part sheds light on the characteristics of GBM and the major challenges faced by the current pharmacological treatments. The second part emphasizes the application of nanomaterials- based nanotherapeutics to overcome the challenges associated with current GBM therapy. A closer look is given to the use of FDA approved traditional Chinese medicine arsenic trioxide (ATO) and its application as co-delivery nanoparticles (i.e., ATO-NPs) against solid tumors, especially gliomas. In short, a breakthrough in nanotechnology offers a promising platform to treat GBM; however, rigorous efforts need to be devoted in order to develop novel therapeutic drugs with higher therapeutic efficiency and limited side effects.

COVID-19 pandemic has resulted in a strong impact on students’ wellbeing, with associated uncertainty about the future. We conducted a cross-sectional survey to assess the psychological effects of COVID-19 on the medical education of final year students in Pakistan.

Background: Insulin-dependent Diabetes Mellitus Type 1 (T1D) also referred to as autoimmune diabetes. T1D is a chronic disease which is characterized by way of insulin deficiency. The deficiency is due to the loss of pancreatic β cells and leads to hyperglycemia. There are many factors which play a significant role in T1D disease pathogenicity including genetic predisposition, the immune system, and environmental factors. The environmental factors may include Coxsackie B4 virus, a small RNA virus. Objective: The objective of current in silico study is to identify active lead compounds against Coxsackie B4 virus, a small RNA virus which has been reported in diabetic patients after PCR. There is a need to predict inhibitors against TID caused by Coxsackie B4 viral protein that may be used as a drug against TID in the future. Methods: For this purpose, different bioinformatics databases and tools were used. The protein structure generation and validation, retrieval of ligands and their properties analysis were performed by different databases, web servers, and software tools. Moreover, the docking tools were used to identify the target site of the protein and interaction of different inhibitors with the target protein molecule. Results: Based on the analysis, two lead compounds ZINC00034488 and ZINC00034585 were selected as potential drugs. These compounds are non-toxic and have best interaction energy and fulfill Lipinski rule, Veber rule, Ghose Rule, Weighted QED, Unweighted QED and BBB likeness parameters. Conclusion: Our work will help researchers to get an idea about the understanding of chemicals against Coxsackie B4 Viruses and helpful to design a drug and test these chemicals to overcome Diabetes Mellitus Type 1 caused by Coxsackie B4 virus.

Medication administration using bar-code medication administration technology enhances the verification of medication administration rights. Nurses' compliance with bar-code medication administration procedure is essential to maximize the benefits. This study evaluated the current rate of nurses' compliance with bar-code medication administration use through direct observation. A descriptive design was used and 134 RNs were recruited from two public hospitals located in the middle region of Jordan. Compliance with bar-code medication administration was evaluated using an evidence-based checklist of 17 items. Participants' compliance with the bar-code medication administration was 55%, which had a significant positive correlation with their level of comfort using bar-code medication administration, usefulness, and ease of use, perceived job productivity, and overall rating of bar-code medication administration. Stakeholders can benefit from assessing end-user acceptance and perceptions regarding the bar-code medication administration technology to promote acceptance and compliance.

Background:Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan.Aims:To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios.Methods:A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016.Findings:Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice.Conclusion:The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.

Ti–6Al–4V plates were subjected to warm rolling at 600°C up to 85% reduction in thickness followed by annealing at 850°C for different soak periods. It was observed that the ‘ß’ grains were prevalent along the grain boundaries and at the triple junctions of ‘a’ grains. The samples were found to be fully recrystallised after 30?min of annealing time. Further, globularizarion of ‘a’ grains was observed during the progress of annealing. The recrystallisation mechanism was identified to be through sub-grain formation and its growth. A dominant near basal texture, i.e. , was observed in the samples after annealing.

Iraq has proved reserves of 120 bil bbl of crude oil and estimated discovered oil reserves of 33.8 bil bbl of Tertiary and 107.1 bil bbl of Cretaceous oil. Iraq has significant exploration and production potential, since the country is producing only 600,000 b/d in 1996, well below its capacity of 2.5 mil b/d. The history of oil exploration in Iraq is discussed., Iraq has a volatile exploration and production history, but unlike more stable OAPEC countries it was National Oil Co. (INOC) rather than foreign oil companies that discovered most of the [...]

Abrupt urbanization and industrialization around the world resulted in elevated environmental pollution and depletion of natural energy resources. An eco-friendly and economical alternative for energy production is the need of an hour. This can be achieved by converting the waste material into energy. One such waste is lignocellulosic agricultural residues, produced in billions of tons every year all around the world, which can be converted into bioethanol. The main challenge in this bioconversion is the recalcitrant nature of lignocellulosic material. The removal of cementing material is lignin and to overcome the potential inhibitors produced during the disintegration of lignin is the challenging task for biotechnologist. This task can be achieved by a number of different methods but laccase is the most effective and eco-friendly method that can be used for effective removal of lignin along with the increase the accessibility of cellulose and bioethanol yield.

Capecitabine, an oral prodrug of 5-fluorouracil (5-FU) is extensively used to treat many solid tumors, particularly breast and colorectal cancers. Neurotoxicity of capecitabine has been rarely reported as peripheral neuropathy, cerebellar syndrome, and multifocal leukoencephalopathy. Although very little is known about the pathogenetic mechanisms responsible for this toxicity, dihydropyrimidine dehydrogenase (DPD) deficiency has been found in few of these patients. TYMSgene encodes for the human thymidylate synthase, and is considered a candid factor for toxicity and efficacy of 5-FU and capecitabine. However, TYMSpolymorphism has been associated previously with capecitabine-induced neurotoxicity. We report here a 31-year-old patient with metastatic colorectal cancer undergoing chemotherapy consisting of oxaliplatin and capecitabine who developed acute cerebellar syndrome during cycle 5. MRI did not show any abnormalities. We performed pharmacogenetic studies related to capecitabine including DPDdeficiency and TYMSpolymorphism. DPDgene mutation analysis was negative for the IVS14+1G>A mutation in the DPDgene, which accounts for 50% of the DPDdeficiency alleles. However, the patient was found to have 3RG/3RC genotype and Del/Del genotype of TYMS3′-untranslated region. Withdrawal of capecitabine improved his neurotoxicity in 9 days. No re-challenge was given to this patient but he was able to tolerate irinotecan, oxaliplatin, and bevacizumab without any toxicities. To the best of our knowledge, this is the first patient in the literature who developed acute cerebellar syndrome following capecitabine and was found to have mutations of TYMS. Patients on fluoropyrimidines, including capecitabine with new neurological symptoms must be investigated for a rare but real central neurotoxicity. Though the treatment of 5-FU neurotoxicity is supportive care but use of uridine triacetate may be indicated in few patients, especially with overdose.

The current set of themes related to the analysis of heat transfer by convection and heat transfer in a tube or channel is commonly referred to as the Graetz problem, which is to investigate the evolution of the temperature profile for a fluid flow in hydrodynamic developed laminar flow. The current research, in this regard, reports the Graetz problem for the constant wall(s) temperature case using the Rabinowitsch fluid model. The associated energy equation is solved via a classical separation of variable approach. The special case of the Rabinowitsch fluid model is also highlighted. The resultant boundary value problem is addressed computationally using the Matlab bvp4c function and the Runge–Kutta method. The real and positive eigenvalues along with the numerical solutions are obtained for the calculation of the temperature field. This study also explains that the Rabinowitsch model has both shear-thinning and shear-thickening effects. The impact of model parameters on mean temperature and Nusselt numbers are thoroughly examined with various graphs.

The present study evaluated the effects of 4 typical subtropical forages on ruminal microbial community composition to formulate a better diet for buffalo. Corn straw silage, elephant grass, cassava residues and sugarcane tail silage were used as substrates for in vitrofermentation. Eight replicates were set up for every substrate, and fermentation was carried out in a 100-mL glass syringe, using buffalo rumen inoculum. Every replicate was anaerobically dispensed with 10 mL of rumen inoculum, 20 mL of McDougall's buffer and 200 mg of dried substrate, and placed in a water bath at 39 °C. Gas production was recorded at 0, 2, 6, 12, 24, 36, 48 and 72 h of incubation. After 24 h, fermentation was ceased for 4 replicates and samples were collected. Volatile fatty acids (VFA) concentrations were measured using gas chromatography. Microbial populations were quantified using quantitative real-time PCR (qRT-PCR), and microbial community was analyzed using high throughput sequencing technology. The results showed, cassava residues as substrate had the highest gas production, acetate, propionate and total VFA concentrations (P < 0.05), and corn straw silage had the lowest acetate:propionate ratio (P < 0.05). The lowest numbers of fungi, Ruminococcus albusand Fibrobacter succinogenes, and the highest number of protozoa were observed with cassava residues (P < 0.05). The least abundances of bacterial phyla Firmicutes, Bacteroidetes and genus Prevotella, and substantially higher abundance of phylum proteobacteria (56%) and genus Succinivibrio(52%) were observed with cassava residues. The most abundances of Methanobrevibacter gottschalkiiand Entodiniumwere observed with cassava residues. Spearman's correlations analysis showed, Succinivibriohad strong positive correlations with propionate, butyrate, Metadiniumand M. gottschalkii, indicating fermentation products were related to microbial community. In conclusion, incubation with cassava residues resulted in lower number of fiber degrading microbes but higher protozoal population because of its low fiber contents. The microbial community was highly altered by in vitroincubation with cassava residues, whereas remained similar for the other 3 high fiber containing substrates.

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Clinical data for older patients with advanced liver disease are limited. This post hoc analysis evaluated the efficacy and safety of terlipressin in patients aged ≥65 years with hepatorenal syndrome using data from 3 Phase III, randomized, placebo-controlled studies

The current study evaluated the psychometric properties of the Arabic version of the Diabetes Distress Scale (DDS-A) among Arab patients with diabetes mellitus (DM) using a descriptive cross-sectional design. Participants' DDS-A total scores significantly correlated with depressive symptoms (The current study evaluated the psychometric properties of the Arabic version of the Diabetes Distress Scale (DDS-A) among Arab patients with diabetes mellitus (DM) using a descriptive cross-sectional design. Participants' DDS-A total scores significantly correlated with depressive symptoms (r= 0.288, p= 0.000) as well as two subscales, emotional burden (r= 0.276, p= 0.000) and regimen distress (r= 0.265, p= 0.000). Participants' DDS-A scores had significant negative correlations with income, DM self-management, and knowledge (r= −0.184, p= 0.008; r= −0.310, p= 0.000; r= −0.174, p= 0.003, respectively) and a positive correlation with HbA1c level (r= 0.153, p= 0.018). Factor analysis revealed a four-factor solution that retained all items and explained a variance of 65.59%. Cronbach's alpha was 0.822 for the total scale and 0.778 to 0.881 for the subscales, indicating a high internal consistency. The DDS-A was found to be a psychometrically sound measure to evaluate DM-related distress among Arab patients. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 43–51.]

In Gulf Cooperation Council (GCC) countries, cogeneration‐based desalination processes consume almost 25 % of the total annual energy, and this number increases annually by 2.2 %. The high demand for fresh water can be attributed to the high gross domestic product growth rate, 24 %, and high water languishes, which are more than 10 %. Over the past two decades, GCC countries have spent tens of billions of dollars to expand their present and planned desalination capacities. It is foreseeable that with a business‐as‐usual scenario, the domestic oil consumption of Saudi Arabia may exceed its production capacity by 2040. Innovative and sustainable water production solutions are urgently needed for future water supplies without an environment impact. In this paper, a hybrid desalination cycle is proposed by integrating a cascade evaporator (CE) system with an adsorption (AD) cycle. In this new innovative cycle, desorbed vapors from the AD are supplied to the CE to exploit the latent condensation energy within the evaporators arranged in both pressure and temperature cascades to improve the performance ratio of the cycle. Water production is improved more than tenfold with the hybrid cycle relative to that observed for the conventional AD cycle owing to a synergetic effect. This concept is demonstrated in a laboratory pilot plant with a cascade of three evaporators and simulation of eight evaporators. Salt away: The cascaded evaporator adsorption desalination cycle is one of the most‐efficient desalination processes operating with industrial waste heat or solar energy. The overall recovery can reach up to 80–85 % because of its low‐temperature operation. To date, this desalination process has one of the highest recoveries and lowest specific energy consumptions reported in the literature.

Neuroendocrine tumors (NETs) are a diverse set of tumors, being genetically varied. NETs can be presented with a distinct clinical picture, due to the production of various hormones, or being silent. Based on community health clinical statistics, the frequency numbers and reported occurrence of NETs are increasing. Although the therapeutic options for NETs have expanded in recent years, clinical diagnosis is possible only when metastases are present, requiring chronic complicated medical management. A positive development is that the recent evolution of molecularly-targeted therapy in oncology promotes the evolution of innovative tools for the management of these tumors. A diverse assortment of medical specialists is needed to improve outcomes and orchestrate the therapeutic care plan for NET patients.

AbstractObjective:During the coronavirus disease 2019 (COVID-19), individuals’ compliance with protective behaviors was the most effective strategy to break the infection chain and prevent disease spread, even with vaccine availability and use. Understanding protective behaviors within the Jordanian context will shape health promotion campaigns and guide decision-makers to facilitate required resources and support Jordanian citizens. The objective of this study was to identify personal protective (preventive and avoidant) measures used by the Jordanian population during the COVID-19 pandemic to protect themselves from infection.Methods:A cross-sectional study with an exploratory, descriptive design was used to collect data using an online self-reported questionnaire from Jordanian people. The survey included the Protection from Infection Scale and the Infection Avoidance Scale.Results:A total sample of 1053 Jordanian citizens was included in the study. The participants exhibited a moderate level of self-care behaviors and high levels of protective and infection avoidance behaviors. Their most common behaviors were getting enough sleep, wearing masks, washing hands, and avoiding travel to infected areas. Contrariwise, the least adopted behaviors were exercising, wearing gloves, and leaving their jobs or schools.Conclusions:During pandemics, policy-makers must understand public concerns and protective behaviors, then provide them with tailored education through health promotion campaigns to enhance healthy behaviors.

To explore Jordanian chronic illnesses patients' perceived exercise self‐efficacy, benefits and barriers, and commitment to exercise planning, and to assess the relationship between those variables. Descriptive cross‐sectional design. Data were collected from a convenience sample of 402 outpatient Jordanians with chronic illnesses, using Exercise Self‐Efficacy Scale, Exercise Benefits and Barriers Scale, and Commitment to a Plan for Exercise Scale. The average BMIwas 28.3, and exercise period 3.2 hours/ week. Participants reported moderate perceived self‐efficacy (M= 47.5%, SD= 11.7), commitment to exercise planning (M=2.0/3, SD=0.3), exercise barriers (M=2.4/4, SD=0.3), and benefits (M=2.3/4, SD=0.3). Commitment to exercise planning had a significant correlation with barriers (r=0.11) and benefits (r=0.10). Self‐efficacy was not found to correlate with other variables. Even though participants reported higher perceived self‐efficacy and commitment to exercise plan than that reported in literature, they were found to be overweight and inactive, which indicates the importance of such study. Exercise education programs are needed taking into considerations patients' individual differences. However, the broad grouping of diseases may not produce a homogenous sample, for which disease categories are recommended in future studies. Patients with chronic illness need more encouragement to engage themselves in exercise practices. Exercise educational program for patients with chronic illnesses should consider patients' reported exercise benefits and barriers.

Assessment of global longitudinal systolic strain (GLS) and longitudinal systolic strain of the basal segments (BLS) has shown prognostic value in cardiac disorders. However, strain is reduced with increased afterload. We assessed the prognostic value of GLS and BLS adjusted for afterload. GLS and BLS were determined in 272 subjects with normal ejection fraction and no known coronary disease, or significant valve disease. Systolic blood pressure (SP) and diastolic blood pressure (DP) obtained at the time of echocardiography were used to adjust GLS and BLS as follows: strain×SP (mmHg)/120 mmHg and strain×DP (mmHg)/80 mmHg. Patients were followed for cardiac events and mortality. The mean age was 53±15 years and 53% had hypertension. There were 19 cardiac events and 70 deaths over a mean follow-up of 26±14 months. Cox analysis showed that left ventricular mass index (P=0.001), BLS (P<0.001), and DP-adjusted BLS (P<0.001) were independent predictors of cardiac events. DP-adjusted BLS added incremental value (P<0.001) to the other two predictors and had an area under the curve of 0.838 for events. DP (P=0.001), age (P=0.001), ACE inhibitor use (P=0.017), and SP-adjusted BLS (P=0.012) were independent predictors of mortality. SP-adjusted BLS added incremental value (P=0.014) to the other independent predictors. In conclusion, DP-adjusted BLS and SP-adjusted BLS were independent predictors of cardiac events and mortality, respectively. Blood pressure-adjusted strain added incremental prognostic value to other predictors of outcome.

(1) To assess Jordanian ICU patients’ pain characteristics (intensity and interference) and levels of pain management satisfaction; and (2) to determine potential predictors of pain management satisfaction among ICU patients.

Medical imaging is one of the important and challenging areas of research in the field of image processing. Medical images play an important role in the field of medical science by giving support to the diagnostic process of a disease and in suggesting the treatment. Medical images produced by different acquisition devices are not of very high resolution and they require a very deep and critical analysis to diagnose a disease. In our work we have addressed the problem of very low resolution by improving the spatial quality of the images by applying super resolution (SR). Process of SR is further composed of two steps, namely image registration and image reconstruction. We have targeted Medical Resonance (MR) images and improved their spatial resolution, because MR is more capable of capturing the details of soft tissues. Our proposed algorithm consists of phases which deal with the image both in the spatial domain as well as the frequency domain. We have used the demons deformable image registration algorithm in the image registration phase and wavelet based method for image reconstruction. After reconstruction various qualitative and quantitative measures have been applied on the images. These measures clearly support the claim that the proposed technique has improved the visibility of 58% of the images, such that, reconstructed high resolution images have more resolving power as compared to the low resolution input images.

Background:Nurses from various settings lack sufficient knowledge about diabetes and diabetes management. Better understanding of evidence-based practices by nurses who are involved in caring for hospitalized individuals with diabetes can positively influence care outcomes.Method:A pretest–posttest design was used to evaluate the effectiveness of a diabetes education program for RNs working in Jordanian hospitals. One hundred twenty-nine RNs voluntarily participated. A 1-day education program was developed and delivered to the participating nurses. Knowledge regarding diabetes was tested before and after the education program.Results:A significant difference was noted in the modified diabetes basic knowledge mean test scores before and after implementation of the education program (A significant difference was noted in the modified diabetes basic knowledge mean test scores before and after implementation of the education program (t[128] = 17.95, p< 0.001).Conclusions:The diabetes education program had a positive effect on nurses’ knowledge. This finding has implications for developing diabetes education content within nursing curricula, as well as continuing education courses for practicing nurses.2015;46(3):129–133.J Contin Educ Nurs.2015;46(3):129–133.

ABSTRACTThe molecular epidemiology of 66 NDM-producing isolates from 2 Pakistani hospitals was investigated, with their genetic relatedness determined using repetitive sequence-based PCR (Rep-PCR). PCR-based replicon typing and screening for antibiotic resistance genes encoding carbapenemases, other β-lactamases, and 16S methylases were also performed. Rep-PCR suggested a clonal spread of Enterobacter cloacaeand Escherichia coli. A number of plasmid replicon types were identified, with the incompatibility A/C group (IncA/C) being the most common (78%). 16S methylase-encoding genes were coharbored in 81% of NDM-producing Enterobacteriaceae.

Probe-based confocal laser endomicroscopy may allow a strategy of “diagnose, resect, and discard” for small nonadvanced adenomas, but there are concerns about discarding polyps with advanced histology.

ABSTRACTThe aim of this study was to determine the ability of a disc susceptibility test using faropenem (10 µg) to predict carbapenemase activity in Enterobacteriaceae. A collection of 166 isolates of carbapenemase-producing Enterobacteriaceae(CPE) and 82 isolates of Enterobacteriaceaethat produced other ß-lactamases was compiled from diverse sources. Disc susceptibility testing was performed using the CLSI/EUCAST methodology with discs of faropenem (10 µg), temocillin (30 µg), and four carbapenems (each 10 µg). A further prospective evaluation of the faropenem disc susceptibility test was performed using 205 consecutive isolates referred to a United Kingdom reference laboratory in parallel with molecular methods for carbapenemase detection. Of 166 isolates of CPE, 99% showed growth up to the edge of a 10-µg faropenem disc compared with only 6% of other ß-lactamase producers (sensitivity, 99%; specificity, 94%). A “double zone” around 10-µg faropenem discs was frequently associated with OXA-48 producers. Of the carbapenems, the most useful agent was imipenem, where a zone diameter of =23 mm as a predictor of carbapenemase activity had a sensitivity of 99% and a specificity of 85%. The presence of no zone of inhibition around a 30-µg temocillin disc was a consistent feature of strains producing OXA-48 carbapenemase. For 205 isolates of Enterobacteriaceaereferred to a United Kingdom reference laboratory, growth up to a 10-µg faropenem disc correctly identified 84 of 86 carbapenemase producers (98% sensitivity), with a specificity of 87%. Disc susceptibility testing using faropenem (10 µg) is a simple, convenient, and highly predictive screening test for carbapenemase-producing Enterobacteriaceae.

To estimate the accuracy of probe-based confocal laser endomicroscopy (pCLE) and narrow band imaging (NBI), individually and in combination, for classification of duodenal polyps.

Aluminum alloys generally contain constituent particles. The population density and size these particles are important while considering fatigue performance. In present study, the crack growth process in stage II in the rolled plate of a high strength aluminum alloy AA 2219 was studied on samples prepared along the rolling direction. A three fold approach was adopted to understand the fatigue crack growth process: i) microstructural analysis ii) fatigue testing iii) post-fracture analysis. Microstructural analysis revealed a high density of constituent particles in the material. EDS analysis showed that the particles were mainly of CuAl2 type. However, particles with high concentration of Fe and Mn were also present in the material. Fatigue crack propagation tests were performed by using middle tension (MT) specimens prepared in rolling direction under constant amplitude loads. The da/dN vs ΔK plot on log-log scale showed a sigmoidal shape with a sharp increase of crack growth rate in the steady state regime. Topographical features were studied to understand the interaction of fatigue crack with the microstructural features. Post fracture analysis revealed that the macro fracture appearance changed with the change of stress level. However, the general mechanism of crack growth, in all the stress levels studied, was by formation of striations. At lower stress levels almost flat region with striations is present upto the final fracture. The crack growth surface showed crystallographic features with crack propagation almost perpendicular to the loading direction. However, a comparatively tortuous fatigue region was evident in the sample tested at high level of stress. The observation of crack path surface at high magnification did not reveal any influence of particles on the crack growth process. However, in sections taken from the fractured samples cracking and debonding of the constituent particles was observed near the fatigue crack path.

Background:GemOx (gemcitabine 1000 mg/m2> 100 min on day 1 and oxaliplatin 100 mg/m2on day 2 every 2 weeks) achieved a response rate of 26.8%, improved progression-free survival (PFS) but failed to demonstrate a benefit in overall survival (OS) compared with gemcitabine in pancreatic cancer. This regimen has regained attention after recent pooled- and meta-analysis suggested a survival benefit of gemcitabine–platinum doublets over gemcitabine. However, GemOx is associated with inconvenience to patients, early cumulative dose developing neuropathy and thrombocytopenia. In addition, fixed dose rate of gemcitabine showed no benefit > 30 min infusion schedule in the ECOG6201 study. Pharmacokinetic profiles of both drugs did not show statistically significant difference regardless of the order of administration.Patients and methods:In order to create a more convenient and equally effective regimen, we conducted a retrospective study to evaluate the efficacy and safety of single-day modified GemOx (S-GemOx, gemcitabine 1000 mg/m2> 30 min and oxaliplatin 85 mg/m2> 2 h on day 1 every 2 weeks) in patients with pancreatic and biliary cancers.Results:In all, 34 patients (median age 60 years, male/female: 17/17) received S-GemOx including locally advanced or metastatic pancreatic cancer (26) and biliary duct carcinoma (8). Median treatment was six cycles with duration of 12 weeks (range (r): 2 – 56). Median cumulative dose of oxaliplatin was 517.5 mg/m2(r: 85 – 2380). A total of 27 of 34 patients were evaluated for efficacy after initial staging: 1 (3.7%) complete response (CR), 4 (14.8%) partial response (PR), 18 (66.7%) stable disease and 4 (14.8%) progression of disease. Overall response rate (CR PR) was 18.5%. Median PFS and OS were 7 and 11.6 months, respectively. All patients were assessed for toxicities. Grade 3/4 hematological toxicities include anemia (8%), neutropenia (11%), thrombocytopenia (5%), nausea/vomiting (3%), diarrhea (3%), hypersensitivity reaction (14%) and neuropathy (3%). No deaths occurred due to therapy.Conclusions:S-GemOx regimen provides convenient schedule, toxicities appear to be comparable with GemOx. The incidence of neuropathy (3 vs 19.1%) and thrombocytopenia (5 vs 14%) are substantially lower compared with GemOx. Prospective studies of S-GemOx in a large patient population are warranted.

Importance of the field:The overexpression of EGFR has been documented in 30 – 90% of cases of advanced colorectal cancer (CRC). An increased understanding of the EGFR pathway in CRC has paved the way for the development of other targeted agents to augment therapeutic efficacy as well as for efforts to circumvent tumor resistance to therapy.Areas covered in this review:Our aim is to discuss the recent progress in the role of the EGFR pathway, the status of anti-EGFR therapeutic agents currently in use and the rationale for the development of novel agents that work along the pathway for the treatment of CRC.What the reader will gain:The readers will learn about the development and evolution of mAbs directed against EGFR as well as tyrosine kinase inhibitors in the management of CRC patients. In the same vein, determination of optimal dosing and better methods of defining those subsets of patients most likely to benefit will be discussed.Take home message:All these data must encourage clinicians and basic researches to continue in their efforts to untangle the network behind EGFR and try to focus all that effort towards improving patient's quality of life as well as survival.

Each year, approximately 37,000 new patients are diagnosed with pancreatic cancer (PC) in the USA. The incidence has been increasing since the 1930s. Prognosis of PC is extremely poor. In the USA, approximately 34,000 patients die from PC each year, making it the fourth leading cause of cancer-related death in the USA. The 5-year overall survival rate for advanced pancreatic cancer is less than 5%. Poor prognosis has been attributed to the inability to diagnose, while the tumor is resectable and its propensity toward early vascular dissemination and spread to regional lymph nodes. One of the greatest challenges in the treatment of pancreatic cancer remains its inherent lack of beneficial response to cytotoxic chemotherapy. For inoperable PC, gemcitabine is the only cytotoxic agent approved by the US FDA since 1997. Several trials have evaluated whether there is any benefit for gemcitabine-based combinations, including molecular targeted agents, over gemcitabine alone. Although several of these have shown a higher response rate favoring the combined regimens, a clear benefit in overall survival has yet to be shown. Despite the benefit of gemcitabine, most patients with advanced disease still do poorly, with a median time-to-tumor progression between 2 and 3 months and median overall survival of 4–6 months. The authors review slow progress and the recent developments with newer chemotherapeutic and molecular-targeted agents in the management of pancreatic cancer.

Abstract: In present study, as a basic step for modeling the fatigue behavior of an extruded Al alloy cylinder, the fatigue crack growth data of the alloy was collected in two orientations. Microstructural analysis revealed that the material had recrystallized grains and clusters of constituent particles aligned in the direction of extrusion. Fatigue life of the samples revealed a shorter fatigue life representing a higher fatigue crack growth rate in transverse direction. The Paris constants C and m were found to be 4 × 10−11 and 3.4 for the transverse orientation. The same constants were found to be 2 × 10−10 and 2.6 for the longitudinal direction. Post fracture analysis revealed that the topographical appearance of the fractured surfaces in two orientations was different. The mechanism of crack growth was the formation of striations. The present study revealed that the texture of the constituent particles created during extrusion process has a pronounced effect on the crack growth rate in two orientations.

The current study was aimed to design a thiolated chitosan (TC) based mucoadhesive nanoparticle (NP) formulation for enhancing the oral bioavailability of an anti-coagulant, Ticagrelor (TG). Nanoparticles (NPs) containing naturally occurring biodegradable polymers have been revealed as promising carriers for the controlled delivery of various therapeutic agents through the oral route. Ionic gelation technique was adopted to prepare thiolated chitosan nanoparticles of TG (TCNPs/TG) and chitosan (CH) nanoparticles of TG (CHNPs/TG) by varying the concentration of polymers with respect to TG and cross-linker i.e. tripolyphosphate (TPP). The prepared CHNPs/TG and TCNPs/TG were subjected to assessment for their particle size, the zeta potential, shape and morphology along with loading capacity (LC) and entrapment efficiency (EE). Formed TCNPs/TG showed a particle size of 190.3 nm, zeta potential of 16 mv along with the polydispersity index (PDI) of 0.375 as compared to CHNPs/TG, displaying particle size of 147.3 nm, zeta potential of 22.6 mv and PDI of 0.364. Likewise, during Fourier transform infrared spectroscopy (FTIR) analysis, the emergence of a characteristic peak at 2495 cm−1in TC, has confirmed the successful modification of CH. Moreover, in-vitrodrug release studies have disclosed a good sustained release behavior of the drug, both from CHNPs/TG and TCNPs/TG. However, the in-vivopharmacokinetics have illustrated the superiority (p< .05) of the TCNPs/TG (494.96 ng/mL) over the CHNPs/TG (438.73 ng/mL) in terms of bioavailability. Ultimately, the findings have indicated that TCNPs/TG might help to improve the oral bioavailability of TG and hence, its therapeutic effects.

We recorded the epidemiologic and clinical features of hypersensitivity reactions (HSRs) to oxaliplatin in colorectal cancer (CRC) patients in order to provide information on the management of these patients. We also developed a desensitization protocol and evaluated its clinical application. For these reasons, we analyzed retrospectively the records of 215 CRC patients treated with oxaliplatin-containing regimens either as an adjuvant, first-line, second-line, or more.

Monoclonal antibodies (mAbs) against growth factors, receptors and tumor-specific/tumor-selective antigens represent a rapidly growing class of pharmaceutical agents which are poised to make a major impact on the treatment of colorectal cancer. mAbs targeting the epidermal growth factor receptor and the vascular endothelial growth factor have already been approved for the treatment of metastatic colorectal cancer. Other antibodies to the same and other molecular targets implicated in tumor growth and metastasis are undergoing intense preclinical and clinical evaluation. In both the neoadjuvant and adjuvant clinical settings, although mAbs are typically administered in combination with established cytotoxic chemotherapy regimens given their synergistic effect, several agents have demonstrated efficacy when given as monotherapy. At the same time, combination therapies with multiple targeted biological agents are actively being investigated. Existing clinical data and recent progress in preclinical and clinical studies of mAbs are reviewed.

Attention-deficit/hyperactivity disorder (ADHD), a common disorder in adolescents, is associated with extensive comorbid Axis I psychopathology. However, few studies have addressed Axis I comorbidity in girls with ADHD, and even fewer have examined comorbid personality disorders in this population. This pilot study explored personality patterns in psychiatrically hospitalized adolescent females with ADHD.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality world-wide. The precise sequence of events in COPD is not completely understood. Inflammation in the airways has been unanimously seen by researchers as a pivotal factor, and cigarette smoking is, without doubt, the main cause. A large proportion of heavy smokers, however, does not suffer with COPD, suggesting a role of additional risk factors in pathogenesis. The inflammatory response to cigarette smoke and infectious agents is determined by the host's genetic composition. Cigarette smoking, by altering the surface milieu of respiratory mucosa and by causing immunosuppression, increases the susceptibility of individuals to infection with respiratory viral and bacterial pathogens. Virus infection has also been recognised as a susceptibility factor for secondary bacterial infection. An investigation into the role of individual genetic variations in inflammatory cell and cytokine production and non-host factors involved in COPD forms the basis of the development of more effective strategies to intervene in pathogenesis, progression and exacerbation of COPD. The aims of this article are to review the evidence for predisposing factors for COPD, with a particular emphasis on respiratory tract infections, and to examine those findings in relation to individual genetic variations and their interactions for induction of pro-inflammatory cytokine production in the respiratory tract.