HEPARIN INDUCED THROMBOCYTOPENIA AND HEMODIALYSIS

Unfractionated heparin is the most commonly used anticoagulant for hemodialysis (HD).  It is well-known that heparin can cause immune-mediated thrombocytopenia due to immunoglobulin antibody formation against the complex of platelet factor 4 (PF4) and heparin. Heparin may also contribute to HD-associated platelet activation, thrombocytopenia, and increased PF4 release from platelets during a heparin dialytic session. The present study was conducted to study the effect of unfraction heparin as anticoagulant in newly treatment hemodialysis patients. Material and method: A sample of 72 people were selected, 32 patients on dialysis for first time from unite of kidney dialysis. At the same time a group of 40 randomly selected healthy adults to participate in the study as control. By Automated cell counter (sysmex X 21) platelets from all patients on dialysis before starting heparin and after one month later were estimated. Result: The mean value of platelets in patients after treated with heparin was significant lower (192.3 ± 20.7 ) — 109/l as compare before treated with heparin 203 ± 20.7 — 109/l  ( P = 0.001). Conclusion: From this study, heparin as anti-coagulant has effect on decrease platelets count but still patients have no thrombocytopenia platelets level 150 — 109/l.

HEPARIN INDUCED THROMBOCYTOPENIA AND HEMODIALYSIS

Unfractionated heparin is the most commonly used anticoagulant for hemodialysis (HD).  It is well-known that heparin can cause immune-mediated thrombocytopenia due to immunoglobulin antibody formation against the complex of platelet factor 4 (PF4) and heparin. Heparin may also contribute to HD-associated platelet activation, thrombocytopenia, and increased PF4 release from platelets during a heparin dialytic session. The present study was conducted to study the effect of unfraction heparin as anticoagulant in newly treatment hemodialysis patients. Material and method: A sample of 72 people were selected, 32 patients on dialysis for first time from unite of kidney dialysis. At the same time a group of 40 randomly selected healthy adults to participate in the study as control. By Automated cell counter (sysmex X 21) platelets from all patients on dialysis before starting heparin and after one month later were estimated. Result: The mean value of platelets in patients after treated with heparin was significant lower (192.3 ± 20.7 ) — 109/l as compare before treated with heparin 203 ± 20.7 — 109/l  ( P = 0.001). Conclusion: From this study, heparin as anti-coagulant has effect on decrease platelets count but still patients have no thrombocytopenia platelets level 150 — 109/l.

Tensile behavior of multiple forged 6082 Al alloy

The present study focus on the influence of multiple forging (MF) on the tensile behavior of 6082 aluminium alloy, where the MF specimens were achieved using multi-step closed die forging. Cylindrical tensile specimens were machined from the MF specimens then subjected to tensile testing. Beside the main target of the study, the effect of MF on microstructure homogeneity and the fracture surface of the samples were studied using hardness testing, optical and scanning electron microscopy respectively. The results show the influence of MF on the tensile strength and the maximum elongation; with increasing passes of MF the strength increases while the maximum elongation decreases. The hardness measurement results demonstrate the structure homogeneity, the fractography pictures show ductile fracture of the specimen, and the micrographs describe the microstructure development during MF process.

Carcinomes nasopharynges localement avances

Les carcinomes nasopharyngés représentent une entité spécifique différente des cancers de la tête et du cou. L’incidence est plus élevée en Asie du Sud-Est et en Afrique du Nord. Le pronostic reste sombre pour les stades localement avancés (IIB—IVB), plus d’un tiers des cas présenteront une récidive locale et/ou métastatique, la survie globale à cinq ans tous stades confondus est estimée à 50—70 %. L’objectif de ce travail est de préciser les aspects cliniques, diagnostiques, thérapeutiques et pronostiques chez 100 malades porteur de carcinome nasopharyngé localement avancé traités à l’Institut Salah Azaiz (ISA) et de préciser l’impact de la chimiothérapie neoadjuvante (CNA) ainsi que les séquelles thérapeutiques à court et à long terme.Mots clés : carcinome nasopharyngé - chimiothérapie - radiothérapieNasopharyngeal carcinoma represents a specific entity different from cancers of head and neck. The incidence is highest in South- East Asia and North Africa. The prognosis remains poor for locally advanced stages (IIB -IVB), more than one third of cases presented locally recurrent and / or metastatic disease, the overall five-year survival for all stages is estimated at 50-70%. The objective of this study is to clarify the impact of neoadjuvant chemotherapy on long-term survival among 100 patients treated in Institut of Salah Azaiz by neo adjuvant chemotherapy followed by locoregional radiotherapy for locally advanced nasopharyngeal carcinoma, and identify prognostic factors and clinical long term effect.Key words: nasopharyngeal carcinoma – chemotherapy - radiotherap

An Architecture for Multi-User Software Development Environments

We present an architecture for multi-user software development environments, covering general, process-centered and rule-based MUSDEs. Our architecture is founded on componentization, with particular concern for the capability to replace the synchronization component - to allow experimentation with novel concurrency control mechanisms - with minimal effects on other components while still supporting integration. The architecture has been implemented in the MARVEL SD

Introductory programming: a systematic literature review

As computing becomes a mainstream discipline embedded in the school curriculum and acts as an enabler for an increasing range of academic disciplines in higher education, the literature on introductory programming is growing. Although there have been several reviews that focus on specific aspects of introductory programming, there has been no broad overview of the literature exploring recent trends across the breadth of introductory programming. This paper is the report of an ITiCSE working group that conducted a systematic review in order to gain an overview of the introductory programming literature. Partitioning the literature into papers addressing the student, teaching, the curriculum, and assessment, we explore trends, highlight advances in knowledge over the past 15 years, and indicate possible directions for future research

Marine climate change risks to biodiversity and society in the ROPME Sea Area

The subtropical ROPME Sea Area (RSA), comprising the Gulf, the Gulf of Oman and the northern Arabian Sea, is a heavily exploited sea region that experiences extreme environmental conditions, and for which climate change is expected to further impact marine ecosystems and coastal communities, sectors and industries. Climate change risk assessments provide a valuable tool to inform decision-making and adaptation planning through identifying and prioritising climate risks and/or opportunities. Using the first UK Climate Change Risk Assessment as an example, a marine climate change risk assessment was undertaken for the marine and coastal environment of the RSA for the first time. Through an extensive literature review and a workshop involving regional experts, marine and coastal climate change risks were identified, scored and prioritised. A total of 45 risks were identified, which spanned two key themes: ‘Risks to Biodiversity’ and ‘Risks to Economy and Society’. Of these, 13 were categorised as ‘severe’, including degradation of coral reefs and their associated ecological assemblages, shifts in the distribution of wild-capture fisheries resources, changes to phytoplankton primary productivity, impacts on coastal communities, threats to infrastructure and industries, and impacts on operations and safety in maritime transport. The diversity of risks identified and their transboundary nature highlight that climate change adaptation responses will require coordinated action and cooperation at multiple scales across the RSA. This risk assessment provides a crucial baseline for a largely overlooked geographic area, that can be used to underpin future decision-making and adaptation planning on climate change, and serve as a ‘blueprint’ for similar assessments for other regional shared seas

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations