ASSESSMENT OF THE OCCLUSAL CHARACTERISTICS OF THE PRIMARY DENTITION AMONG LEBANESE PRE-SCHOOL CHILDREN: A BASE LINE STUDY CROSS-SECTIONAL STUDY

One of the most important goals in pediatric dentistry is to achieve and maintain a normal occlusion throughout the development of the child. Any deviation from the normal dentofacial growth pattern might lead to esthetic and functional problems in the future. These changes can be noticed during regular dental checkups, and actions can be taken to reduce their effect on the developing dentition. The aim of this study is to assess the occlusal characteristics of primary dentition in children under 6 years of age, attending the BAU output dental clinics and a number of private schools. This cross-sectional study was conducted among 377 Lebanese children with their ages ranging between 3 to 6 years. Each child possessing a complete set of primary teeth, with no severe caries, and without the eruption of any of his permanent teeth, had his occlusal parameters evaluated separately such as: primary molar relationship (flushed terminal plane, mesial step, distal step), canine relationship (class I, class II, class III), overjet, overbite, presence or absence of spaces, crowding, crossbite (anterior and posterior) in each jaw. Then the percentage of each characteristic was calculated. The results showed the following percentages; flushed terminal plane molar relationship (62%), class 1 canine relationship (84%), spaced upper and lower arches (98%), over jet 2mm (49.1%), and overbite 50% (53%).. It was found that the flushed terminal plane molar relationship, Class I canine relationship, spacing in both arches, increased overbite and overbite predominated

Cost and life cycle assessment of upstream monoclonal antibody production

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Proinov type contractions on dislocated b-metric spaces

The authors thank their universities. The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through research group no. RG-1437-037. A.F. Roldán López de Hierro is grateful to Project TIN2017-89517-P of Ministerio de Economía, Industria y Competitividad and also to Junta de Andalucía by project FQM-365 of the Andalusian CICYE.In this paper, we improve the Proinov theorem by adding certain rational expressions to the definition of the corresponding contractions. After that, we prove fixed point theorems for these modified Proinov contractions in the framework of dislocated b-metric spaces. We show some illustrative examples to indicate the validity of the main results.King Saud University RG-1437-037Ministerio de Economia, Industria y Competitividad TIN2017-89517-PJunta de Andalucia FQM-36

Environmental assessment of a biorefinery concept for production of bulk and fine chemicals

Moving from a fossil-based to a bio-based economy requires the development of new technologies and process concepts for the production of bio-based energy, chemicals and materials. Biorefinery concepts can be designed by integrating such technologies in order to provide environmentally and economically attractive alternatives to produce bulk and fine chemicals. This paper presents life cycle and techno-economic assessments of a novel biorefinery concept, in its early stages of development, for the combined production of adipic acid from forest residues and of lutein from micro-algae. Adipic acid is a bulk chemical with a yearly production of approximately 2.3 million tonnes, and is primarily used for the production of nylon-6,6. Conventional adipic acid production from fossil resources causes significant emissions of N2O due to the use of nitric acid as an oxidizing agent. This conventional production can thus lead to a significant climate impact if these emissions are not sufficiently mitigated. Lutein is a high added-value chemical used in the food and pharmaceutical industries, and is conventionally produced from marigold flowers. The biorefinery concept in this work consists of the pretreatment of forest residues, the separation of lignin (which is an important by-product), and the hydrolysis and fermentation of the pretreated forest residues to adipic acid which is then separated and purified. Water, nutrients and CO2 flows from the adipic acid production can be connected to the algae production. The lutein is extracted from the micro-algae using methanol. Anaerobic digestion is used in this concept to produce biogas (another important by-product) from waste streams. The biorefinery concept thus comprises technologies that are at different technology readiness levels (TRLs), from as low as a TRL of 2 for the fermentation process, to a TRL of 9 for the anaerobic digestion process.Twelve design variants of the biorefinery concept were modelled and simulated based on experimental and literature data. These variants aimed at narrowing down uncertainties about, for instance, the performance of the fermentation process. The data and information resulting from the simulations of the design variants were used 1) to compile the life cycle inventories for the LCA of each of these variants, and to do the subsequent life cycle impact assessment, and 2) to determine the capital and operating costs in order to calculate the economic feasibility of the biorefinery design variants. The assessment of all variants provides a range for the environmental and economic performance of the biorefinery concept based on design choices and process conditions. Furthermore, scenarios for future energy systems were considered in order to assess the influence of the background system on the performance of the biorefinery concept.The results show that there is a large variation in the performance among the different design variants, where some designs can significantly improve the prospects for the bio-based adipic acid production. However, the results are strongly dependent on the foreground and background energy systems. The results provide valuable insights to industry and policy decision makers in order to guarantee an environmentally benign and economically feasible production of bulk and fine chemicals in a biorefinery

Prospective LCA of a biorefinery concept for production of bulk and fine chemicals

The move from a fossil-based to a bio-based economy requires the development of new technologies and process concepts for the production of bio-based energy, chemicals and materials. A biorefinery concept can be designed by integrating such technologies, and can thus provide a viable alternative to produce bulk and fine chemicals. This paper presents a prospective life cycle assessment (LCA) of a novel biorefinery concept, in its early stages of development, for the combined production of adipic acid from forest residues (GROT) and of lutein from micro-algae. Adipic acid is a high-volume chemical (yearly production of approx. 2.3 million tonnes) and is primarily used for the production of nylon-6,6. Conventional adipic acid production from fossil resources is characterized by significant emissions of N2O. Lutein is a high added-value chemical used in the food and pharmaceutical industries, and is conventionally produced from marigold flowers. Furthermore, lignin is an important by-product. The biorefinery concept in this work consists of the pretreatment of GROT, the separation of lignin, and the hydrolysis and fermentation of the pretreated GROT to adipic acid which is then separated and purified. Water, nutrients and CO2 flows from the adipic acid production can be connected to the algae production. Anaerobic digestion is used in this concept to produce biogas from waste streams. Multiple design variants of the biorefinery concept, which is the foreground system, were modelled and simulated based on both experimental and literature data. These variants aimed at narrowing down uncertainties about, for instance, the most suitable GROT pretreatment options, available technologies for anaerobic digestion, and possible routes for further processing of lignin. The data and information resulting from the simulations of the design variants were used to compile the life cycle inventories of each of these variants. The assessment of these variants provides a range for the future environmental performance of the biorefinery concept based on design choices and process conditions. Furthermore, scenarios for future energy systems were considered in order to assess the influence of the background system on the environmental performance of the biorefinery concept. The results provide more relevant information and valuable insight to industry and policy decision makers in order to guarantee an environmentally benign future production of bulk and fine chemicals

Various production and service models on small-scale of natural products as a new job opportunity for pharmacists.

Introduction: pharmacists' job opportunities in Iran are limited to the presence in the industry, pharmacy, hospital, research-centers and faculty of universities. The need of our community to the pharmacist is quantitatively 32 pharmacists per 100,000 people. Every year, 1000 pharmacists graduate in Iran; but there are not enough adequate employment opportunities for them. Given the huge costs of establishing and purchasing a pharmacy and a factory. Job opportunity for pharmacists should be created based on entrepreneurship principles. These opportunities can be defined in the format of designing knowledge-based models that are managed by the pharmacist. There are remarkable amounts of natural products required by healthcare providers on a small scale every day. Manufacturing these products is not cost-effective for a large industrial complex. Small-median enterprises model is one of the reasons for the success of the BRICK countries based on the small-scale chain production ultimately make a huge economic network structure­­ with high profitability.Methods and Results: Regulations of Health Ministry, the GMP principles for herbal productions, regulations of nutrition supplements registration, the process of issuing the production license, the process of issuing the establishment permit, the minimum requirements for establishing the units of medicinal plants packaging and production of plant extracts, the regulation for getting packaging and production license for plant products,supportive-policy package, industry relations with the university in the area of food and drug, regulations and guidelines for registration and establishment of knowledge-based companies, all were investigated.According to the existing criteria, the following proposed models can be presented:1) Small production with maximum 10 employees; including solids, semisolid and liquids production departments.2)Production workshop model outside the city with maximum 50 employees. 3) Providing consultation and training services in the field of medicine. Conclusions: As the pharmaceutical community need to the job that by applying a not-so-great capital to have a proper efficiency, and the pharmacist to use his knowledge, a set of products as a network can besides providing these needed items, provide the country with natural products. Therefore, the facilities to create new pharmaceutical job opportunity as well as holding empowerment courses for pharmaceutical students in this field are required

Effect of Different Implant Materials on Stresses Transmitted to Peri-Implant Areas of Implant-Retained Mandibular Overdenture

Aim this in vitro study was conducted to evaluate the effect of mechanical loading on different implant materials on supporting structures materials and methods: a total of three implant retained overdentures were used in this study, retained by two implants each (Titanium, polyetheretherketon and zirconia) were placed in epoxy resin casts at the canine area using a surgical guide. Soft liner material was used at the distal extension area to mimic the soft tissues. Two linear strain gauges were bonded buccal and lingual to each implant to measure the peri-implant strains during unilateral and bilateral loading. Results: during bilateral loading the highest strain values were recorded with the PEEK implants, while the lowest strain values were recorded with the zirconia implants. During unilateral loading, the highest strain values in the loading side were also demonstrated with the PEEK implants, and the lowest strain values were observed with the zirconia implants.Conclusion: within the limitations of this in vitro study, PEEK implants were found to transmit more occlusal stresses at the marginal bone area than titanium and zirconia implants, thus PEEK implants avoid stress shielding phenomenon and its subsequent disuse atrophy of bon

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio