Particle Image Velocimetry in Cerebral Aneurysm Models to Evaluate Fluid Dynamic Performance of Flow Diverting Stents Across Parent Vessel Sizes

A cerebral aneurysm is a life-threatening abnormality that requires clinical intervention. Appropriate treatment is essential in order to avoid aneurysmal hemorrhage, which can result in irreparable damage or death. In particular, saccular wide-neck aneurysms (WNAs) are associated with reduced treatment success rates and require advanced surgical approaches. The current standard of treatment for WNAs is the flow diverter which minimizes aneurysmal inflow and provides an endovascular scaffold for the parent vessel, ultimately inducing aneurysm occlusion. As the use of flow diverters has expanded to include a wider range of clinical scenarios, aneurysm characteristics, such as the dome-to-neck ratio (DNR) and inflow angle, have become important for device optimization. However, another key characteristic of flow diverter mechanisms, the parent vessel, is rarely assessed in terms of fluid dynamics. In this Thesis, the impact of parent vessel size on aneurysmal fluid dynamics was investigated in order to provide insights for treatment planning. In-vitro flow measurements were obtained for stented and non-stented patient-specific aneurysm models using particle image velocimetry (PIV). The models examined included four distinct parent vessel variants of two separate WNA anatomies, under both steady and pulsatile flow conditions. PIV results displayed greater percentage reductions in smaller parent vessel diameters in comparison to larger parent vessel diameters, suggesting that parent vessel size can be a determining factor in aneurysmal hemodynamics. This finding may provide useful in prospective treatment planning in the clinical setting.M.S

The role of the United Nations in Promoting the Rights of Indigenous Peoples

The issues of indigenous peoples are one of the most prominent international issues that have attracted much international attention from international bodies and organizations. Their problems and challenges have been raised widely and in various areas - regional and global - have become the Effective of many international parties, its main organs or assistance and its specialized international agencies. The International Labor Organization (ILO) has been at the forefront of its efforts, for many centuries to be neglected and forgotten by the violation of its various rights. The United Nations has played a major role in the formulation, promotion and protection of the rights of indigenous peoples through many of the major organs that comprise it. The General Assembly, which has the mandate over most of the Organization\u27s activities, has exercised and continues to play a major and fundamental role in this area. The Economic and Social Council, In this regard, the activities of the two main organs of the Organization are carried out through many forms, including at the level of the adoption of the relevant legal rules, or provide the necessary financial assistance, and the allocation of the appropriate As well as the establishment of the bodies concerned, and finally the mechanisms of protection against violations

Cultural trauma and the politics of access to higher education in Syria

This paper examines the relationship between the politics of Higher Education access pertaining to longstanding practices of patrimonial authoritarian politics and the narration of collective trauma. Building on an empirical study of Syrian HE during war, we suggest that a narrative disjuncture within HEIs has a damaging impact not only upon the educational process, HE reconstruction and reform, but also upon the possibility of social reconciliation. This is especially true when access to education and post-graduation opportunities are directly linked to patrimonial favouritism; widespread social inequalities in access and retention; a violent turn in the purging of oppositional academics; a severely exacerbated brain drain linked to political views; and significantly sparser employment opportunities. Building on the study findings, we show how these challenges are linked to ethico-political positioning vis-à-vis the mass movement of 2011 and related cultural trauma narratives. In closing, we suggest that understanding the relationship between HE access and cultural trauma can inform decision-making on HE reconstruction and future reform. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group

Impact of Skills for Change Program on metabolic control, diet and physical activity levels in adults with type 2 diabetes: A cluster randomized trial

Background: Type 2 diabetes mellitus is highly prevalent in the Arab Gulf countries. Despite this, limited culturally-adapted lifestyle intervention studies have been conducted in this region. Methods: In this culturally adapted 12-month cluster randomized trial, 382 patients with type 2 diabetes, aged 20–70 years were recruited from 6 public healthcare centers (3 interventions and 3 controls) in Al Ain, United Arab Emirates. The primary outcome of this study was a change in hemoglobin A1c (HbA1c). The secondary outcomes were Body Mass Index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, dietary intake, and physical activity levels. A diet and physical activity intervention, guided by the social cognitive theory, was delivered individually and in group format to the intervention group. The control group continued receiving only their usual diabetes management care. The data were collected at baseline and 1 year after participation. Results: The mean baseline HbA1c levels of the control and the intervention groups were 7.45 ± 0.11% and 7.81 ± 0.11%, respectively. At the end of the 12-month intervention, there was no significant difference in the changes of mean HbA1c between the intervention and the control groups. On the other hand, BMI and daily caloric intake were significantly decreased in the intervention compared to the control group by 1.18 kg/m2 (95% CI: -1.78 − -0.60) and 246 kcal (95% CI: -419.52 − -77.21), respectively, after controlling for age, gender, education, marital status, duration since diabetes diagnosis, diabetes treatment, treatment clinic, and baseline values. Sitting time during the week-end was significantly lower, difference 52.53 minutes (95% CI: 93.93 − -11.14). Conclusions: This community-based lifestyle intervention for patients with baseline HbA1c <8% did not result in a significant decrease of HbA1c but reduced caloric intake, body weight, and weekend inactivity after controlling for the covariates. Trial registration: This trial was registered on February 11, 2020 with Clinicaltrials.gov (NCT04264793)

Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Creativity in the use of Grid system of the computer three-dimensional programs in the product design

In the field of product design, the design elements with its importance and characteristics is not able to show the aesthetics of design as a body before it is a product, each of these elements has its nature, characteristics and importance. In order for these elements to be effective, these elements must be put in their proper aesthetic proportions to show their value and influence in the design. It is necessary to organize the relation between these elements and their relation to the mass and space. Hence the role of the grid system arises, where the grid system is a way to organize the different elements in the space of the design. The problem of research has been established that despite the use of industrial design technology in two-dimensional design, however its use in three-dimensional product design is not widely used. Although for many decades three-dimensional design capabilities have been developed through digital design techniques, design programs, and computer manufacturing. A team of designers in general and product designers in particular still see that adherence to the web system in design is a kind of restriction of creativity freedom. The research aims to reach the stage of creativity in the grid system using the three-dimensional computer programs in products design, and to recognize the importance of using the grid system and what it can add to the designer and the design. The research found that relying on the grid system in the products design using three-dimensional computer programs does not interfere with the achievement of creativity in the design and it can help the designer to reach faster the creativity stage and to put a lot of values ​​of balance and uniqueness in the products design

A case of atrial fibrillation complicated by complete atrioventricular block

Atrial fibrillation and complete atrioventricular block are two well-established arrhythmias that can share common aetiologies and risk factors. Although the two arrhythmias can co-exist, only a limited number of cases of atrial fibrillation complicated by complete atrioventricular block have been reported. Correct recognition is essential due to the risk of sudden cardiac death. A 78-year-old female with known atrial fibrillation presented with a 1-week history of shortness of breath, chest tightness and dizziness. On assessment, she was bradycardic with a heart rate of 38 bpm, despite the absence of any rate-limiting medication. Electrocardiography revealed an absence of P waves with a regular ventricular rhythm, consistent with a diagnosis of atrial fibrillation complicated by complete atrioventricular block. This case highlights the diagnostic electrocardiography features of co-existing atrial fibrillation with complete atrioventricular block that are often misinterpreted, leading to a delay in correct diagnosis and initiation of definitive management. Upon diagnosis, it is essential to exclude the reversible causes of complete atrioventricular block before considering permanent pacing. In particular, this includes rate-limiting medications in patients with pre-existing arrhythmias such as atrial fibrillation and electrolyte disturbances

The role of iron in the pathogenesis of COVID-19 and possible treatment with lactoferrin and other iron chelators

Iron overload is increasingly implicated as a contributor to the pathogenesis of COVID-19. Indeed, several of the manifestations of COVID-19, such as inflammation, hypercoagulation, hyperferritinemia, and immune dysfunction are also reminiscent of iron overload. Although iron is essential for all living cells, free unbound iron, resulting from iron dysregulation and overload, is very reactive and potentially toxic due to its role in the generation of reactive oxygen species (ROS). ROS react with and damage cellular lipids, nucleic acids, and proteins, with consequent activation of either acute or chronic inflammatory processes implicated in multiple clinical conditions. Moreover, iron-catalyzed lipid damage exerts a direct causative effect on the newly discovered nonapoptotic cell death known as ferroptosis. Unlike apoptosis, ferroptosis is immunogenic and not only leads to amplified cell death but also promotes a series of reactions associated with inflammation. Iron chelators are generally safe and are proven to protect patients in clinical conditions characterized by iron overload. There is also an abundance of evidence that iron chelators possess antiviral activities. Furthermore, the naturally occurring iron chelator lactoferrin (Lf) exerts immunomodulatory as well as anti-inflammatory effects and can bind to several receptors used by coronaviruses thereby blocking their entry into host cells. Iron chelators may consequently be of high therapeutic value during the present COVID-19 pandemic