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Elayna Kirsch,1 Sadiq Rahman,2 Katrina Kerolus,2 Rabale Hasan,1 Dorota B Kowalska,1 Amruta Desai,2 Sergio D Bergese2 1Department of Obstetrics and Gynecology, Stony Brook University Hospital, Stony Brook, NY, USA; 2Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY, USACorrespondence: Sergio D Bergese, School of Medicine, Stony Brook University, Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794, USA, Tel +631444-2979, Fax +631444-2907, Email sergio.bergese@stonybrookmedicine.eduAbstract: Dysmenorrhea is the most common pathology women of childbearing age face. It is defined as painful uterine cramping associated with menstruation. Primary dysmenorrhea occurs in the absence of an organic cause, whereas secondary dysmenorrhea is pelvic pain associated with an underlying pelvic pathology. The purpose of this review is to discuss the pathophysiology of dysmenorrhea and provide a discussion of pharmacologic and non-pharmacologic treatment options. Prostaglandins play a large role in the pathophysiology of dysmenorrhea by causing myometrial contraction and vasoconstriction. The first-line treatment for dysmenorrhea is with nonsteroidal anti-inflammatory drugs due to the inhibition of cyclooxygenase enzymes, thereby blocking prostaglandin formation, as well as hormonal contraception. Other pharmacologic treatment options include Paracetamol, as well as Gonadotrophic Release Hormone Analogs, which are typically used in the treatment for endometriosis. Non-pharmacologic treatments with strong evidence include heat therapy and physical exercise. There are less evidence-based data behind other modalities for treating dysmenorrhea, such as dietary supplements, acupuncture, and transcutaneous nerve stimulation, and these methods should be used in conjunction with first-line therapy after a discussion of risks and benefits. Lastly, for women who fail medical management, surgical options include endometrial ablation, presacral neurectomy, and laparoscopic uterosacral nerve ablation. Further research is needed to measure the socioeconomic burden of dysmenorrhea on the healthcare system and to evaluate the efficacy of treatment combinations, as a multi-modal approach likely provides the most benefit for women who suffer from this condition.Keywords: dysmenorrhea, prostaglandin, NSAIDs, hormonal contraception, pelvic pain, pharmacologic management, behavioral interventions, surgical intervention

Sarah A Elliott,1,2 Sholeh Rahman,1 Shannon D Scott,3 Wiliam R Craig,4 Lisa Knisley,5,6 Kathleen Shearer,7 Lisa Hartling1,2 1Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada; 2Cochrane Child Health, University of Alberta, Edmonton, Alberta, Canada; 3Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; 4Division of Pediatric Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; 5The Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; 6College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; 7Pediatric Parents’ Advisory Group, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Lisa Hartling, 4-472 Edmonton Clinic Health Academy, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada, Tel +1 780-492-6124, Email hartling@ualberta.caAbstract: The objective of this review was to explore parents’ experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents’ self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child’s IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child’s condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents’ desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents’ experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.Keywords: child, developmental disabilities, parents, emergency service, communication

Previously, many works dealt with the study of the order differential subordination and shortly after that other studies dealt with the order differential subordination in the unit disc. Recently the order differential subordination was presented by Antonino and Miller (2011). This paper looks at a considerably broader class of order differential inequalities and subordination. The authors define the criteria on an admissible class of operators, implying that order differentiale subordination exists. Meromorphic in is a function that is holomorphic in domain except for poles. If it simply states the function is meromorphic. Meromorphic functions in are those that may be represented as a quotient of two entire functions. Struve functions have applications in surface wave and water wave issues, unstable aerodynamics, optical direction and resistive MHD instability theory. Struve functions have lately appeared in a number of particle systems. The idea of differential subordination in is a generalization of differential inequality in , and it was initiated in 1981 by the works of Miller, Mocanu and Reade. In this artical, appropriate classes of admissible functions are examined and the properties of order differential subordination are established by using the operator of meromorphic multivalent functions connected with generalized Struve function. In this study, there is a need to present many concepts including subordination, superordination, the dominant, the best dominant, convolution (or Hadamard product), meromorphic multivalent function, the Struve function addition to the concept of shifted factorial (or Pochhammer symbol) and admissible functions.

The main goal of the present paper is to introduce a new class of harmonic multivalent functions defined by a new linear operator in the open unit disc . Thus, some geometric properties have examined, including coefficient inequality, extreme points, convolution conditions, convex linear combinations, and integral transforms for the class .

Aims: The escalating demands for traditional fossil fuels with unsecured deliverance and issues of climate change compel the researchers to develop alternative fuels like bioethanol. This study examines the prospect of biofuel production from high carbohydrate containing lignocellulosic material, e.g. sugarcane bagasse through biological means. Methodology and Results: Cellulolytic enzymes were collected from the culture filtrate of thermotolerant Trichodermaviride grown on variously pre-treated sugarcane bagasse. CMCase and FPase enzyme activities were determined as a measure of suitable substrate pre-treatment and optimum condition for cellulolytic enzyme production. The highest CMCase and FPase activity was found to be 1.217 U/ml and 0.109 U/ml respectively under the production conditions of 200 rpm, pH 4.0 and 50 °C using steamed NaOH treated bagasse as substrate. SEM was carried out to compare and confirm the activity of cellulolytic enzymes on sugarcane bagasse. Saccharification of pre-treated bagasse was carried out with crude enzymes together using a two-factor experimental design. Under optimized conditions the pre-treated bagasse was saccharified up to 42.7 % in 24 h. The hydrolysate was concentrated by heating to suitable concentration and then used for fermentation by an indigenous isolate of Saccharomyces cerevisiae. With 50 and 80 % brix containing liquor the concentration of alcohol was 0.579 % and 1.15 % respectively. Conclusion, significance and impact of study: This is the first report in Bangladesh for the production of cellulosicethanol using local isolates. Though the rate of alcohol production was very low, a great impetus in this field can maximize the production thereby meet the demand for fuel in future.

BackgroundEvidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application.MethodsThe study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work.DiscussionSuccessful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD.Trial registrationClinicalTrials.gov. (NCT05027789, posted 8/30/2021).