Investigating The Effect And Mechanism Of Antiphospholipid Antibodies On Human Endometrial Endothelial Cell Function And The Impact Of Current Standard Therapies

Women with pathologic levels of antiphospholipid antibodies (aPL) are at high risk for recurrent pregnancy loss and preeclampsia. Despite treatment with low molecular weight heparin (LMWH), either alone or with low dose aspirin (ASA), the incidence of late-term complications remains high for these patients. aPL recognizing β 2 glycoprotein I (β2GPI) are particularly harmful during pregnancy as they target the placenta causing insufficient spiral artery transformation and inflammation, giving rise to obstetric APS. There have been extensive studies into the mechanisms by which aPL affect the placental trophoblast which constitutively synthesizes and expresses β2GPI. However, aPL specific for β2GPI can also bind to maternal uterine endothelial cells, but much less is known about the impact aPL have on the maternal side of the maternal-fetal interface. This study sought to characterize the effects of anti-β2GPI aPL on human endometrial endothelial cells (HEECs); the role of toll-like receptor-4 (TLR4) in the mechanism of aPL-HEEC interactions; and the influence of LMWH and ASA on aPL-mediated HEEC responses using in vitro culture systems. aPL, but not control IgG, significantly increased HEEC secretion of pro-angiogenic vascular endothelial growth factor (VEGF) and placental growth factor (PlGF); increased anti-angiogenic soluble fms-like tyrosine kinase receptor-1 (sFlt-1); inhibited basal secretion of the chemokines monocyte chemoattractant protein-1 (MCP-1), granulocyte colony-stimulating factor (G-CSF) and growth related oncogene- α (GRO-α); and impaired angiogenesis. The aPL-triggered inhibition of HEEC MCP-1 was mediated by activation of TLR4. LMWH and ASA, alone and in combination, exacerbated the aPL-induced changes in the HEEC angiogenic factor and chemokine profile. There was no reversal of the aPL-inhibition of HEEC angiogenesis by either single or combination therapy. In conclusion, HEECs produce chemokines necessary for normal trophoblast invasion, immune cell recruitment, and spiral artery remodeling. By aPL inhibiting HEEC chemokine secretion and promoting sFlt-1 release, the uterine endothelium may contribute to impaired placentation and vascular transformation in obstetric APS. Combination LMWH and ASA may further contribute to this endothelium dysfunction in women with obstetric APS

Asset market approach to exchange rate determination

The paper provides an analysis of exchange rate determination using an asset market approach model. The analysis includes exchange rate response to changes in government policies which are unanticipated and to changes in government policies which are anticipated before they occur. It is shown that the announcement of an expansionary policy will cause the exchange rate to depreciate, which induces balance of trade surplus and hence, external assets accumulation, before the policy is implemented. Empirical results accord well with the model, in particular they establish the positive relationship between anticipated money and the spot exchange rate. The results also support the hypothesis that anticipated expansionary monetary policy has a smaller impact on the exchange rate than the effect of unanticipated expansionary monetary policy

Design and implementation of a speed detection system using radar and image processing

Capstone Project submitted to the Department of Engineering, Ashesi University in partial fulfillment of the requirements for the award of Bachelor of Science degree in Computer Engineering, May 2020The issue of vehicle accidents occurring on the roads on a daily basis, which only seems to be increased by the minute is what this paper researches and seeks to tackle. With the simple technology that has been made available globally, a cost-effective system can be developed to fight overspeeding, reduce road accidents and save lives. As a result, in this project, an Automatic Number Plate Recognition program and a web service for speed detection were implemented. This was done with the aim of monitoring frequently used roads, and those areaswhere the accidents normally take place in order to sanction drivers guilty of driving above set speeding limits. This made use of machine learning-based Optical Character Recognition program couples with a web application to issue speeding fines dynamically to offenders via email. In the course of this project a validation accuracy of 97% was achieved for the training done with Nigerian License plate characters. The mailing was fully functionally at the end of the project. Though, a few hitches were experienced on the license plate detection phase as some license plate shapes vary slightly. This proved the need to improve the license plate detection to detect modded license plates in addition to the regular ones.Ashesi Universit

Building PRM in sub-Saharan Africa

It is estimated that about 50% of people in low- and middle- income countries who require rehabilitation do not get it. Multidisciplinary rehabilitation services led by Physical and Rehabilitation Medicine (PRM) physicians have been shown to improve functioning, independence and the quality of life of persons with reduced functioning or disability. However, there is a dearth of PRM physicians in low to middle income countries (LMICs), particularly in sub-Saharan Africa. One potential solution to this lack of specialists is the establishment of PRM training programs, which are currently lacking. The International Rehabilitation Forum (IRF) developed and implemented a fellowship program to train physicians in rehabilitation medicine and has been successful in Ghana, Ethiopia and Cameroon, all LMICs in sub-Saharan Africa. However, ongoing challenges include inadequate PRM trainers, availability of logistics and services for hands on experience, and funding. The fellowship program has a promising future and an ultimate goal of having locally trained fellows leading the program and expanding it to other LMICs. There has however been no publication of the process followed to achieve this or of a similar process undertaken anywhere in Africa. The process followed in this publication highlights the journey from engaging stakeholders to the admission of new and current fellows in training

An investigation of the financial monitoring policies for microfinance institutions in Ghana

The need to regulate microfinance institutions (MFIs) was advocated and researched yet lacks purposeful in-depth exploring studies of the formulation process of financial monitoring policies, their implementation and accompanying challenges. Consequently, this study contributes by reviewing the specific financial policies for microfinance in Ghana and assesses factors mitigating effective implementation of such policies. It also introduces implementation theory into the MF research arena, thus shifting MF research focus. The study revealed that policies formulated for MFIs in Ghana and elsewhere are skewed and policy implementation, monitoring and supervision found to be less effective. The results further identified inadequate support structures and large unlicensed profit-oriented informal microfinance operations in Ghana as major obstacles to efficient implementation of microfinance policies. This paper therefore recommends the creation of a semi-autonomous institution, the National Microfinance Oversight Authority, to license, regulate and supervise the informal microfinance institutions in Ghana

Propuesta para el manejo de residuos sólidos en la plaza de mercado SAPRAMA LTDA del municipio de Chaparral Tolima

Anexo Nº 1. encuesta para vendedores de la plaza de mercado SAPRAMA LTDA de Chaparral Tolima, Anexo Nº2. Encuesta para visitantes y compradores en la plaza de mercado SAPRAMA LTDAEl presente proyecto aplicado fue realizado en la plaza de mercado SAPRAMA LTDA de chaparral Tolima, donde se evidencia una situación de contaminación ambiental, producto del inadecuado manejo de los desechos sólidos, generados por las diferentes actividades realizadas allí; entre la contaminación más visible en la plaza se encuentran la calidad del aire, pues se perciben olores ofensivos y contaminación al recurso agua y suelo. Los objetivos de la investigación se fundamentan a través del diagnóstico de la situación actual de la plaza de mercado SAPRAMA LTDA, diseñar una propuesta de manejo de los desechos sólidos bajo la metodología MGA y proponer estrategias para el manejo adecuado de los desechos sólidos, enfocadas a concientizar a ciudadanos sobre la importancia de darles un buen manejo. La metodología a utilizar es la metodología general ajustada MGA, donde se formula el proyecto aplicado a través de la herramienta informática conformada por cuatro módulos en sus diferentes etapas pre inversión, inversión, operación y evaluación. La investigación tendrá un enfoque mixto de tipo descriptivo, los instrumentos a utilizar son la encuesta y la matriz DOFA para la recolección de información con el fin de dar solución al objetivo general. Los resultados obtenidos en los instrumentos aplicados evidencian que no se realiza la debida separación y clasificación de los desechos, los vendedores no tienen un conocimiento claro sobre el correcto manejo de los desechos y se requiere de estrategias que permitan dar solución al problema como el aprovechamiento de residuos y capacitar al talento humano.Abstract This applied project was carried out in the SAPRAMA LTDA market place in Chaparral Tolima, where an environmental contamination situation is evident, due to the inadequate management of waste, as a result of the different activities carried out there; Among the most visible contamination in the plaza are air quality, as offensive odors are perceived as a result of the decomposition of solid waste and contamination of the water and soil resources. The objectives of the research are based on the diagnosis of the current situation regarding the management of solid waste by merchants and the community that visits the market place SAPRAMA LTDA, designing a proposal for waste management solids under the MGA methodology and propose strategies for the implementation of adequate solid waste management, focused on raising awareness among citizens on the importance of giving solid waste good management. The methodology to be used is the adjusted general MGA methodology, the research will have a qualitative approach of a descriptive type, the instruments to be used are the survey and the DOFA matrix for the collection of information in order to solve the general objective

The Inhibitory Effect of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on the Monophenolase and Diphenolase Activities of Mushroom Tyrosinase

In the present work, we investigated the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on the monophenolase and diphenolase activity of mushroom tyrosinase. The results showed that diflunisal and indomethacin inhibited both monophenolase and diphenolase activity. For monophenolase activity, the lag time was extended in the presence of diflunisal. In the presence of indomethacin, the lag time did not change. IC50 values of monophenolase activity were estimated to be 0.112 mM (diflunisal) and 1.78 mM (indomethacin). Kinetic studies of monophenolase activity revealed that both diflunisal and indomethacin were non-competitive inhibitors. For diphenolase activity, IC50 values were estimated to be 0.197 mM (diflunisal) and 0.509 mM (indomethacin). Diflunisal and indomethacin were also found to be non-competitive diphenolase inhibitors

Implementation approaches for leprosy prevention with single-dose rifampicin: a support tool for decision making

BACKGROUND: In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. METHODOLOGY: The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. PRINCIPAL FINDINGS: Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. CONCLUSION: An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP

Routine Surveillance Data as a Resource for Planning Integration of NTD Case Management

Background: There is a high burden of morbidity due to neglected tropical diseases. To help address this, the World Health Organization recommends integration of case management (CM). Here, we present a practical framework designed to identify areas that could benefit from an integrated CM strategy in Ghana. We also investigated the accessibility of primary health care (PHC) to CM cases, and the impact of this on morbidity at diagnosis. Methods: Routinely detected cases of Buruli ulcer (BU) and leprosy, and suspected lymphedema identified through morbidity surveys during mass drug administration campaigns in Ghana in 2014 were remotely georeferenced. We estimated distances from cases’ home communities to the nearest primary healthcare facility (PHC), and compared rates of reported disease, completeness of clinical information, and risk of more severe morbidity, relative to PHC accessibility. Results: We georeferenced communities of 295/350 reported leprosy cases, 240/333 BU cases, and 1,557/2383 instances of lymphedema. Overlap of these diseases was predominantly around Accra and in the Upper East Region. Rates of reported disease appeared higher in populations with higher accessibility to PHC, and leprosy cases living further from PHC had a higher risk of disability at diagnosis. Conclusions: This investigation demonstrates the feasibility and value of using routinely collected data to map CM-NTDs at low cost. The maps presented are intended to provide a resource for planning the implementation of integrated CM for NTDs in Ghana. This approach could be easily implemented by national health services in other endemic countries in the future