Modeling of seawater intrusion in a coastal aquifer of Karaburun Peninsula, western Turkey

Seawater intrusion is a major problem to freshwater resources especially in coastal areas where fresh groundwater is surrounded and could be easily influenced by seawater. This study presents the development of a conceptual and numerical model for the coastal aquifer of Karareis region (Karaburun Peninsula) in the western part of Turkey. The study also presents the interpretation and the analysis of the time series data of groundwater levels recorded by data loggers. The SEAWAT model is used in this study to solve the density-dependent flow field and seawater intrusion in the coastal aquifer that is under excessive pumping particularly during summer months. The model was calibrated using the average values of a 1-year dataset and further verified by the average values of another year. Five potential scenarios were analyzed to understand the effects of pumping and climate change on groundwater levels and the extent of seawater intrusion in the next 10 years. The result of the analysis demonstrated high levels of electrical conductivity and chloride along the coastal part of the study area. As a result of the numerical model, seawater intrusion is simulated to move about 420 m toward the land in the next 10 years under “increased pumping” scenario, while a slight change in water level and TDS concentrations was observed in “climate change” scenario. Results also revealed that a reduction in the pumping rate from Karareis wells will be necessary to protect fresh groundwater from contamination by seawater.Scientific and Technological Research Council of Turkey (TUBITAK 113Y042

Clinical audit of neonatal care in Assiut Women's Health Hospital, Egypt

Background: The current study aims to auditing the current care of healthy full term newborns in the delivery room and identify the gap between the current practice and ideal practice in Assiut Women's Health Hospital, Egypt.Methods: The current study was a clinical audit carried out in Assiut Woman Health Hospital, in the period from 1 September 2016 to 28 February 2017.The study included all newborns delivered in the delivery word of gestational age after 37 week. We excluded all Preterm babies, those with congenital anomalies, pregnant women with medical disorders and multiple pregnancies. In the present work all data was collected prospectively through direct personal patient contact, direct observation of care givers, patient interactions and attitudes, from the clinical records and then recording the data in special check sheet. All basic criteria of the study participants as age, parity, gestational age at delivery and type of delivery were obtained. The neonatal gender, weight, heart rate and respiratory rate were checked. Audit criteria were selected according to the WHO 2015 and AAP 2010-2015 guidelines.Results: The study included 800 women; the mean age of the women was 26.52±5.70 years. The mean parity was 1.78±1.85. The mean gestational age at delivery was 38.81±0.96 weeks. As regard the type of delivery, 54.1% of women were delivered by cesarean section. Calling neonatologists occurred in 67.9% of deliveries. The mean birth weight was 3.17±0.39 kilograms. Nearly half of them (52%) were males.Conclusions: Application of the guidelines of the neonatal handling is important for optimum care to the neonates. Re-audit the steps of the handling is important to discuss whether practice has improved or not in our tertiary hospital

New analysis of VSC-based modular multilevel DC-DC converter with low interfacing inductor for hybrid LCC/VSC HVDC network interconnections

The integration of multiterminal hybrid HVDC grids connecting LCC- and VSC-based networks faces several technical challenges such as DC fault isolation, ensuring multi-vendor interoperability, managing high DC voltage levels, and facilitating high-speed power reversal without interruptions. The two-stage DC-DC converter emerges as a key solution to address these challenges. By implementing the modular multilevel converter (MMC) structure, the converter's basic topology includes half-bridge sub-modules on the VSC side and full-bridge sub-modules on the LCC side. However, while this topology has been discussed in the literature, its connection to an LCC-based network with controlled current magnitude lacks detailed analysis regarding operational challenges, control strategies under various scenarios, and design considerations. This paper fills this gap by providing comprehensive mathematical analysis, design insights, and control strategies for the modular DC-DC converter to regulate DC voltage on the LCC-HVDC side. Additionally, the proposed control scheme minimizes the interfacing inductor between the two bridges, ensuring uninterrupted power flow during reversal and effective handling of DC faults. Validation through Control-Hardware-in-the-Loop testing across diverse operational and fault scenarios, along with a comparative analysis of different converters, further strengthens the findings

PCR array and protein array studies demonstrate that IL-1β (interleukin-1β) stimulates the expression and secretion of multiple cytokines and chemokines in human adipocytes

The role of IL-1β in regulating the expression and secretion of cytokines and chemokines by human adipocytes was examined. Adipocytes were incubated with human IL-1β for 4 or 24 h. The expression of a panel of 84 cytokine/chemokine genes was probed using PCR arrays. IL-1β stimulated the expression of >30 cytokine/chemokine genes on the arrays; 15 showed >100-fold increases in mRNA at 4 or 24 h including CSF3, CXCL1, CXCL2, CXCL12 and IL8. CSF3 exhibited a 10,000-fold increase in mRNA at 4 h. ADIPOQ was among the genes whose expression was inhibited. Protein arrays were used to examine the secretion of cytokines/chemokines from adipocytes. IL-1β stimulated the secretion of multiple cytokines/chemokines including MCP-1, IL-8, IP-10, MIP-1α and MCP-4. The most responsive was IP-10, which exhibited a 5,000-fold increase in secretion with IL-1β. IL-1β is likely to play a substantial role in stimulating the inflammatory response in human adipocytes in obesity

THE POWER OF INTEGRATION TOWARDS SUSTAINABLE PERFORMANCE: A MODEL TO MINIMIZE TECHNOSTRESS AMONG FRONTLINE RESTAURANT EMPLOYEES BY COMBINING JOB AND EMPLOYEE RESOURCES

To develop a model that integrates restaurant and employee resources to overcome technostress and achieve sustainable performance. This qualitative study is based on twenty-two semi-structured interviews with restaurant managers and frontline employees (FLEs) to comprehensively understand how restaurant resources and personnel can be employed to combat technostress and achieve sustainable performance. Restaurant FLEs experience technostress from multiple sources, including unclear work-life boundaries, complex new systems, job insecurity, and the frequent use of new technologies. In addition, restaurant managers and FLEs concur that integrating restaurant and FLE resources is an effective model for reducing technostress and achieving FLEs' sustainable performance. The study expands the JD-R model to address the challenges faced by FLEs in managing technology-induced job demands, offering a comprehensive solution that benefits restaurants and employees. This approach considers the role of both employers and employees in managing technostress, leading to a supportive work environment and improved sustainable performance

Variable expressivity of FGF3 mutations associated with deafness and LAMM syndrome

<p>Abstract</p> <p>Background</p> <p>Recessive mutations of fibroblast growth factor 3 (FGF3) can cause LAMM syndrome (OMIM 610706), characterized by fully penetrant complete labyrinthine aplasia, microtia and microdontia.</p> <p>Methods</p> <p>We performed a prospective molecular genetic and clinical study of families segregating hearing loss linked to <it>FGF3 </it>mutations. Ten affected individuals from three large Pakistani families segregating <it>FGF3 </it>mutations were imaged with CT, MRI, or both to detect inner ear abnormalities. We also modeled the three dimensional structure of FGF3 to better understand the structural consequences of the three missense mutations.</p> <p>Results</p> <p>Two families segregated reported mutations (p.R104X and p.R95W) and one family segregated a novel mutation (p.R132GfsX26) of <it>FGF3</it>. All individuals homozygous for p.R104X or p.R132GfsX26 had fully penetrant features of LAMM syndrome. However, recessive p.R95W mutations were associated with nearly normal looking auricles and variable inner ear structural phenotypes, similar to that reported for a Somali family also segregating p.R95W. This suggests that the mild phenotype is not entirely due to genetic background. Molecular modeling result suggests a less drastic effect of p.R95W on FGF3 function compared with known missense mutations detected in fully penetrant LAMM syndrome. Since we detected significant intrafamilial variability of the inner ear structural phenotype in the family segregating p.R95W, we also sequenced <it>FGF10 </it>as a likely candidate for a modifier. However, we did not find any sequence variation, pointing out that a larger sample size will be needed to map and identify a modifier. We also observed a mild to moderate bilateral conductive hearing loss in three carriers of p.R95W, suggesting either a semi-dominant effect of this mutant allele of <it>FGF3</it>, otitis media, or a consequence of genetic background in these three family members.</p> <p>Conclusions</p> <p>We noted a less prominent dental and external ear phenotype in association with the homozygous p.R95W. Therefore, we conclude that the manifestations of recessive <it>FGF3 </it>mutations range from fully penetrant LAMM syndrome to deafness with residual inner ear structures and, by extension, with minimal syndromic features, an observation with implications for cochlear implantation candidacy.</p

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

A Randomized Open-Label Trial of Artesunate- Sulfadoxine-Pyrimethamine with or without Primaquine for Elimination of Sub-Microscopic P. falciparum Parasitaemia and Gametocyte Carriage in Eastern Sudan

In areas of seasonal malaria transmission, treatment of asymptomatic carriers of malaria parasites, whose parasitaemia persists at low densities throughout the dry season, could be a useful strategy for malaria control. We carried out a randomized trial to compare two drug regimens for clearance of parasitaemia in order to identify the optimum regimen for use in mass drug administration in the dry season.A two-arm open-label randomized controlled trial was conducted during the dry season in an area of distinct seasonal malaria in two villages in Gedarif State in eastern Sudan. Participants were asymptomatic adults and children aged over 6 months, with low-density P. falciparum infection detected by PCR. Participants were randomized to receive artesunate/sulfadoxine-pyrimethamine (AS+SP) combination for three days with or without a dose of primaquine (PQ) on the fourth day. Parasitaemia detected by PCR on days 3, 7 and 14 after the start of treatment and gametocytes detected by RT-PCR on days 7 and 14 were then recorded. 104 individuals who had low density parasitaemia at screening were randomized and treated during the dry season. On day 7, 8.3% were positive by PCR in the AS+SP+PQ group and 6.5% in the AS+SP group (risk difference 1.8%, 95%CI -10.3% to +13.8%). At enrolment, 12% (12/100) were carrying gametocytes. This was reduced to 6.4% and 4.4% by day 14 (Risk difference 1.9% (95%CI -9.3% to +13.2%) in AS+SP+PQ and AS+SP groups, respectively.Addition of primaquine to artemisinin combination treatment did not improve elimination of parasitaemia and prevention of gametocyte carriage in carriers with low-density parasitaemia in the dry season.ClinicalTrials.gov NCT00330902

Gender and Educational Differences in Perception of Domestic Violence Against Women Among Libyan Migrants in Manchester.

Domestic violence against women (DVAW) is a worldwide phenomenon and refers to any act committed against women that results in physical and psychological harm, and coercion, loss of liberty, and deprivation. There is a dearth of research and information about the extent and prevalence of domestic violence among Libyan communities. The aim of the study was to explore community knowledge of, and attitudes toward, DVAW and to improve our understanding of the factors that influence knowledge, attitudes, and responses, particularly educational and gender differences. Using snowball sampling, we analyzed 20 semistructured interviews with Libyans living in Manchester, United Kingdom. We found gender and education-influenced participants' perception of DVAW. Men in general did not recognize DVAW as a serious social problem; noticeably, they saw it as a personal and family issue. Knowing attitudes toward DVAW is necessary for government and communities' prevention policies as attitudes influence perpetration of DVAW