Isolated cotton-wool spots of unknown etiology: management and sequential spectral domain optical coherence tomography documentation

Cotton-wool spots (CWSs) are common retinal manifestations of many diseases including diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome. Clinically they appear as whitish, fluffy patches on the retina and eventually fade with time. In this study, spectral domain optical coherence tomography (SD-OCT) with mapping was used to demonstrate in vivo the characteristics of an isolated CWS in a 59-year-old patient as well as its appearance immediately after ophthalmoscopic resolution. Presented here is the work-up and management of this clinical problem for the ophthalmologist. The authors propose that SD-OCT could be a valuable research tool in characterizing and following the dynamic CWS changes at individual retinal layer level, with potential clinical applications as a screening or diagnostic tool in CWS-related diseases

Epibenthic communities associated with unintentional artificial reefs (modern shipwrecks) under contrasting regimes of nutrients in the Levantine Sea (Cyprus and Lebanon)

Artificial reefs, in the Eastern Mediterranean (Cyprus,) became a popular and frequently used tool, in fisheries and biodiversity conservation management. Even though evaluation studies about the efficacy of artificial reefs are plentiful in the rest of the Mediterranean (Central and Western), in the Eastern Basin they are largely absent. As the Eastern part of the Mediterranean Sea is characterised by unique physical parameters, the necessity to study artificial reefs under these contrasting regimes increases. The epibenthic communities of two unintentional artificial reefs (modern shipwrecks) in Cyprus (Zenobia) and Lebanon (Alice-B) were evaluated in 2010. Both shipwrecks are at similar depth, type of sea bottom, made of the same material (steel) and were sunk approximately the same period of time. However, Alice-B shipwreck off the coast of Lebanon is constantly exposed to higher levels of nutrients than Zenobia in Cyprus. Significant dissimilarities were observed in the composition, percentage of benthic cover of predominant taxonomic groups and development of the epibenthic communities. Differences in physical and chemical parameters between sides lay mainly in the nutrient and thermal regimes affecting the shipwrecks and most likely bring about the differences in the observed community structure. The results of this study suggest that epibenthic communities could be highly impacted by eutrophication caused by anthropogenic activities, leading to less biodivers

Epidemiology of ATTRV30M neuropathy in Cyprus and the modifier effect of complement C1q on the age of disease onset.

BACKGROUND: ATTRV30M amyloidosis is a lethal autosomal dominant sensorimotor and autonomic neuropathy caused by amyloid deposition composed of aggregated misfolded TTR monomers with the V30M mutation. The age of onset in patients with ATTRV30M varies in different foci and the mechanism behind it is still unknown. METHODS: The tertiary neurology center following all ATTRV30M patients in Cyprus was used to collect demographic data to estimate; prevalence, incidence, penetrance, anticipation, time from disease onset to diagnosis and transplantation. Ocular, cardiac and leptomeningeal involvement in transplanted patients was explored. Correlation of C1q tagging SNPs with age of disease onset was carried out. RESULTS: Prevalence and incidence for ATTRV30M neuropathy in Cyprus are 5.4/100,000 and 0.3/100,000 respectively. Mean age of onset is 40.6 years and anticipation is 8.3 years. Penetrance reaches 51% and 75% by the ages of 50 and 80 years respectively. In liver transplanted patients rates of ocular, cardiac and leptomeningeal involvement were estimated to be 60%, 20% and 16%, respectively. C1q polymorphisms correlated with age of disease onset. CONCLUSIONS: ATTRV30M neuropathy has a rising prevalence in Cyprus due to improved survival of patients. Late onset complications are becoming a major problem. Complement C1q appears to be a modifier in this disease

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Development of e-learning platform on Solas Chapter II-2: Construction-Fire protection, fire detection and fire extinction

173 σ.Στην παρούσα διπλωματική εργασία αναπτύχθηκε η ηλεκτρονική διαδικτυακή πλατφόρμα ©Solearn. Η εφαρμογή ©Solearn αποσκοπεί στην φιλικότερη και αποδοτικότερη εκμάθηση και εκπαίδευση στους διεθνείς κανονισμούς πυρασφάλειας των πλοίων βάσει του (Safety of Life at Sea) Solas Chapter II-2, μέσω τεστ ερωτήσεων πολλαπλής επιλογής(quiz), και σεναρίων(scenarios) που έχουν δημιουργηθεί από δείγμα πραγματικών ατυχημάτων. Αρχικά γίνεται ιστορική αναφορά της διαμόρφωσης του κανονισμού πυρασφάλειας όπως έχει εξελιχθεί ως τη σημερινή του μορφή, καθώς και μια σύντομη περιγραφή των επιμέρους ρυθμίσεών του. Στη συνέχεια γίνεται στατιστική ανάλυση του δείγματος των ατυχημάτων για τη παραγωγή της βάσης δεδομένων των σεναρίων, αποδίδοντας ,τελικά, κατάλληλη κατανομή σε κάθε ορισμένη παράμετρο. Ακολουθεί η ανάλυση της δημιουργίας του quiz και το τελικό στάδιο τη δημιουργίας των σεναρίων, με χρήση της κατάλληλης δειγματολειπτικής μεθόδου. Ως απόρροια της παρούσας μελέτης, δημιουργήθηκε η ηλεκτρονική πλατφόρμα © Solearn, της οποίας η δομή, τα βασικά στοιχεία και οι λειτουργίες της παρουσιάζονται στο τελευταίο στάδιο της εργασίας.Τhe creation of an e-learning web platform regarding the regulations of Solas Chapter II-2 is the subject of the present thesis. The application, created under the name ©Solearn, aims at learning and training everyone interested in the regulations and requirements of fire protection in international shipping as mentioned in Solas Chapter II-2, by playing a game of quizzes, and scenarios based on real-life accidents. After the historical reference of Solas fire protection requirements, and a brief description of the parts and regulations that are included in the Solas Ch.II-2, the initial process for the building of the scenarios data base is presented. Statistical analysis of the extracted ship accident data sample is carried out, ending with the distribution fitting of the data parameters. In order to build the quiz questions base, data analysis and separation of the regulations of Solas Chapter II-2 in sub categories, depending on ship type, follows the statistical analysis. The final step for the creation of scenarios by using a proper sampling method, is then displayed. Finally, the web application ©Solearn is presented with screenshots, examples and explanations of its functions and elements, in order to visualize the result of the previous mentioned work.Αντώνης Γ. Ανδρέο

Symbolic execution for dynamic, evolutionary test data generation

This paper combines the advantages of symbolic execution with search based testing to produce automatically test data for JAVA programs. A framework is proposed comprising two systems which collaborate to generate test data. The first system is a program analyser capable of performing dynamic and static program analysis. The program analyser creates the control flow graph of the source code under testing and uses a symbolic transformation to simplify the graph and generate paths as independent control flow graphs. The second system is a test data generator that aims to create a set of test cases for covering each path. The implementation details of the framework, as well as the relevant experiments carried out on a number of JAVA programs are presented. The experimental results demonstrate the efficiency and efficacy of the framework and show that it can outperform the performance of related approaches

Assessing Health Care Providers’ Knowledge and Practices of Nutrition during Pregnancy in Lebanon: A Cross-Sectional Study

Background and objectives: Health care professionals (HCPs) are well-positioned to discuss healthy behaviors during pregnancy, but the published research of prenatal healthcare providers’ knowledge about the significance of nutrition during pregnancy in Lebanon is scarce. The purpose of this study was to explore the knowledge, attitudes, and practices of Lebanese prenatal healthcare providers towards nutrition during pregnancy. Materials and Methods: A cross-sectional study using an online questionnaire was conducted. Health care providers were contacted by phone and email to participate in the online survey. A list of all clinics providing antenatal health services was obtained from the Order of Physicians and the Order of Midwives. A multistage random sample was selected. In the first stage, it was stratified per region (Beirut center or suburbs, and the southern region). In the second phase, it was stratified per clinic type (private, primary healthcare center, or hospital). Gynecologists and midwives who are members of the Order of Physicians and the Order of Midwives (n = 1333), were included. Results: Two-hundred and six responses (55% males) were obtained. Approximately 44% of the HCP were aged 50 and older, and 68.4% had more than 10 years of work experience. HCPs from Beirut represented 41.3% of the respondents. Eighty-eight percent of the HCPs were physicians, and 11% were midwives. The majority of the participants considered nutrition during pregnancy to be very important. Furthermore, half of these participants considered their position in delivering nutrition information as very significant. Most of the respondents reported that they provide nutrition advice to pregnant women, and they also received nutrition education during their profession. However, they perceived their nutrition knowledge as inadequate. Conclusion: Health care providers’ attitude towards the importance of maternal nutrition and their confidence in talking about nutrition-related topics with pregnant women were positive despite the lack of knowledge in several areas related to nutrition during pregnancy. Therefore, there is a need for continuing nutrition education for health care providers and the implementation of nutrition education programs to achieve better health outcomes

Fouling Communities of Two Accidental Artificial Reefs (Modern Shipwrecks) in Cyprus (Levantine Sea)

Artificial reefs are considered one of the alternative methods in fisheries management, used in order to enhance stocks and marine biodiversity in general. A number of biotic and abiotic parameters influence the fouling communities’ formation on artificial reefs through complex interactions. In order to understand how epibiotic or fouling communities progress through time, it is important to study these communities in mature artificial reefs, especially those that have been around for many decades, or in some cases, millennia. This study was conducted on the coral and other fouling organisms of two accidental artificial reefs (40 to 70 year-old shipwrecks) in Cyprus (Levantine Sea). The thermal and nutrient annual regime of the study sites were characterized by processing satellite data. The results indicate that the wrecks are normally under warm and oligotrophic conditions. Percentage coverage of corals and other organisms on the wrecks was calculated (image-analysis software) on photos taken in 2010 (two wrecks) and again in 2016 (one wreck) of the fouling communities. Sponges were the organisms with the highest percent cover (~27%) at the two wrecks. Four scleractinian coral species were found (7%–19% total coral cover). The oldest wreck, which has well-developed coral communities, was revisited during fieldwork in a near-by area in 2016. Only two major benthic categories (dead coral and macro algae) changed significantly between sampling periods. Given the actual policies to sink wrecks to create artificial reefs and the diverse environmental conditions in different areas that will inevitably influence fouling, it is important to carry out studies relating to mature artificial reefs/wrecks in order to be able to assess the ecological effectiveness of longstanding artificial reefs