Diabetes Type 2 Management

Diabetes is a complex and chronic disease. Patients with diabetes may suffer complications such as microvascular and macrovascular diseases [1]. In 2018, the prevalence of diabetes was estimated to affect 34.2 million people, or 10.5% of the US population [2]. About 1 in 10 adults in Georgia has diabetes, a health condition that can be prevented with weight loss and lifestyle changes [3]. In 2018, diabetes-related emergencies accounted for 17 million emergency room visits, with 248,000 for hyperglycemia and 242,000 for hypoglycemia [4]. The purpose of this study was to implement a personalized, clinic-based diabetes management program with healthy lifestyles, reduce hemoglobin A1c, and prevent diabetic complications.https://jagworks.southalabama.edu/scholarsday2023_spring-posters/1005/thumbnail.jp

Differential response of esophageal cancer cells to particle irradiation

Background: Radiation therapy is a mainstay in the treatment of esophageal cancer (EC) patients, and photon radiotherapy has proved beneficial both in the neoadjuvant and the definitive setting. However, regarding the still poor prognosis of many EC patients, particle radiation employing a higher biological effectiveness may help to further improve patient outcomes. However, the influence of clinically available particle radiation on EC cells remains largely unknown. Methods: Patient-derived esophageal adenocarcinoma and squamous cell cancer lines were treated with photon and particle irradiation using clinically available proton (1H), carbon (12C) or oxygen (16O) beams at the Heidelberg Ion Therapy Center. Histology-dependent clonogenic survival was calculated for increasing physical radiation doses, and resulting relative biological effectiveness (RBE) was calculated for each radiation modality. Cell cycle effects caused by photon and particle radiation were assessed, and radiation-induced apoptosis was measured in adenocarcinoma and squamous cell EC samples by activated caspase-3 and sub-G1 populations. Repair kinetics of DNA double strand breaks induced by photon and particle radiation were investigated. Results: While both adenocarcinoma EC cell lines demonstrated increasing sensitivities for 1H, 12C and 16O radiation, the two squamous cell carcinoma lines exhibited a more heterogeneous response to photon and particle treatment; average RBE values were calculated as 1.15 for 1H, 2.3 for 12C and 2.5 for 16O irradiation. After particle irradiation, squamous cell EC samples reacted with an increased and prolonged block in G2 phase of the cell cycle compared to adenocarcinoma cells. Particle radiation resulted in an incomplete repair of radiation-induced DNA double strand breaks in both adenocarcinoma and squamous cell carcinoma samples, with the levels of initial strand break induction correlating well with the individual cellular survival after photon and particle radiation. Similarly, EC samples demonstrated heterogeneous levels of radiation-induced apoptosis that also corresponded to the observed cellular survival of individual cell lines. Conclusions: Esophageal cancer cells exhibit differential responses to irradiation with photons and 1H, 12C and 16O particles that were independent of tumor histology. Therefore, yet unknown molecular markers beyond histology may help to establish which esophageal cancer patients benefit from the biological effects of particle treatment

Implementation of point-of-care testing of C-reactive protein concentrations to improve antibiotic targeting in respiratory illness in Vietnamese primary care: a pragmatic cluster-randomised controlled trial

Background In previous trials, point-of-care testing of C-reactive protein (CRP) concentrations safely reduced antibiotic use in non-severe acute respiratory infections in primary care. However, these trials were done in a research-oriented context with close support from research staff, which could have influenced prescribing practices. To better inform the potential for scaling up point-of-care testing of CRP in respiratory infections, we aimed to do a pragmatic trial of the intervention in a routine care setting. Methods We did a pragmatic, cluster-randomised controlled trial at 48 commune health centres in Viet Nam between June 1, 2020, and May 12, 2021. Eligible centres served populations of more than 3000 people, handled 10–40 respiratory infections per week, had licensed prescribers on site, and maintained electronic patient databases. Centres were randomly allocated (1:1) to provide point-of-care CRP testing plus routine care or routine care only. Randomisation was stratified by district and by baseline prescription level (ie, the proportion of patients with suspected acute respiratory infections to whom antibiotics were prescribed in 2019). Eligible patients were aged 1–65 years and visiting the commune health centre for a suspected acute respiratory infection with at least one focal sign or symptom and symptoms lasting less than 7 days. The primary endpoint was the proportion of patients prescribed an antibiotic at first attendance in the intention-to-treat population. The per-protocol analysis included only people who underwent CRP testing. Secondary safety outcomes included time to resolution of symptoms and frequency of hospitalisation. This trial is registered with ClinicalTrials.gov, NCT03855215. Findings 48 commune health centres were enrolled and randomly assigned, 24 to the intervention group (n=18 621 patients) and 24 to the control group (n=21 235). 17 345 (93·1%) patients in the intervention group were prescribed antibiotics, compared with 20 860 (98·2%) in the control group (adjusted relative risk 0·83 [95% CI 0·66–0·93]). Only 2606 (14%) of 18 621 patients in the intervention group underwent CRP testing and were included in the per-protocol analysis. When analyses were restricted to this population, larger reductions in prescribing were noted in the intervention group compared with the control group (adjusted relative risk 0·64 [95% CI 0·60–0·70]). Time to resolution of symptoms (hazard ratio 0·70 [95% CI 0·39–1·27]) and frequency of hospitalisation (nine in the intervention group vs 17 in the control group; adjusted relative risk 0·52 [95% CI 0·23–1·17]) did not differ between groups. Interpretation Use of point-of-care CRP testing efficaciously reduced prescription of antibiotics in patients with non-severe acute respiratory infections in primary health care in Viet Nam without compromising patient recovery. The low uptake of CRP testing suggests that barriers to implementation and compliance need to be addressed before scale-up of the intervention. Funding Australian Government, UK Government, and the Foundation for Innovative New Diagnostics

Computer-aided prognosis of tuberculous meningitis combining imaging and non-imaging data

Tuberculous meningitis (TBM) is the most lethal form of tuberculosis. Clinical features, such as coma, can predict death, but they are insufficient for the accurate prognosis of other outcomes, especially when impacted by co-morbidities such as HIV infection. Brain magnetic resonance imaging (MRI) characterises the extent and severity of disease and may enable more accurate prediction of complications and poor outcomes. We analysed clinical and brain MRI data from a prospective longitudinal study of 216 adults with TBM; 73 (34%) were HIV-positive, a factor highly correlated with mortality. We implemented an end-to-end framework to model clinical and imaging features to predict disease progression. Our model used state-of-the-art machine learning models for automatic imaging feature encoding, and time-series models for forecasting, to predict TBM progression. The proposed approach is designed to be robust to missing data via a novel tailored model optimisation framework. Our model achieved a 60% balanced accuracy in predicting the prognosis of TBM patients over the six different classes. HIV status did not alter the performance of the models. Furthermore, our approach identified brain morphological lesions caused by TBM in both HIV and non-HIV-infected, associating lesions to the disease staging with an overall accuracy of 96%. These results suggest that the lesions caused by TBM are analogous in both populations, regardless of the severity of the disease. Lastly, our models correctly identified changes in disease symptomatology and severity in 80% of the cases. Our approach is the first attempt at predicting the prognosis of TBM by combining imaging and clinical data, via a machine learning model. The approach has the potential to accurately predict disease progression and enable timely clinical intervention

Outpatient antibiotic prescribing for acute respiratory infections in Vietnamese primary care settings by the WHO AWaRe (Access, Watch and Reserve) classification: An analysis using routinely collected electronic prescription data

Background: This study aims to investigate patterns of antibiotic prescribing and to determine patient-specific factors associated with the choice of antibiotics by the World Health Organization's Access-Watch-Reserve (WHO AWaRe) class for acute respiratory infections (ARIs) in rural primary care settings in northern Vietnam. Methods: We retrospectively reviewed health records for outpatients who were registered with the Vietnamese Health Insurance Scheme, visited one of 112 commune health centres in 6 rural districts of Nam Dinh province, Vietnam during 2019, and were diagnosed with ARIs. Patient-level prescription data were collected from the electronic patient databases. We used descriptive statistics to investigate patterns of antibiotic prescribing, with the primary outcomes including total antibiotic prescriptions and prescriptions by WHO AWaRe group. We identified patient-specific factors associated with watch-group antibiotic prescribing through multivariable logistic regression analysis. Findings: Among 193,010 outpatient visits for ARIs observed in this study, 187,144 (97.0%) resulted in an antibiotic prescription, of which 172,976 (92.5%) were access-antibiotics, 10,765 (5.6%) were watch-antibiotics, 3366 (1.8%) were not-recommended antibiotics. No patients were treated with reserve-antibiotics. The proportion of watch-antibiotic prescription was highest amongst children under 5-years old (18.1%, compared to 9.5% for 5–17-years, 4.9% for 18–49-years, 4.3% for 50–64-years, and 3.7% for 65-and-above-years). In multivariable logistic regression, children, district, ARI-type, comobid chronic respiratory illness, and follow-up visit were associated with higher likelihood of prescribing watch-group antibiotics. Interpretation: The alarmingly high proportion of antibiotic prescriptions for ARIs in primary care, and the frequent use of watch-antibiotics for children, heighten concerns around antibiotic overuse at the community level. Antimicrobial stewardship interventions and policy attention are needed in primary care settings to tackle the growing threat of antibiotic resistance

Spin-Dependent Electronic Transport in IrMn–Co/Pd Multilayered Systems

Relation between magnetoresistance and magnetization reversal in thin multilayered IrMn-Co/Pd films deposited both on planar and nanoporous substrates is in focus of the present work. Magnetic anisotropy, exchange coupling and mechanisms of magnetic resistivity are discussed

Efficient methane dry reforming process with low nickel loading for greenhouse gas mitigation

In this study, a series of nickels supported on gamma alumina with a metal dosage ranging from 0.5 to 3 wt.% were prepared and employed as the catalysts. The effect of nickel dosage on material properties, reaction performance, and catalyst deactivation was investigated. At a low dosage, the nickel-free having low metal-support interaction contributed significantly to the total active site. The basicity of the material was enhanced along with the increase in nickel loading. The presence of active metal showed a great impact at the beginning leading to big improvements in feedstock conversion. However, beyond a nickel dosage of 2 wt.%, further additions did not noticeably influence the reaction performance. Regarding catalyst deactivation, different carbon species were observed on catalyst surface, depending on the nickel dosage. Catalysts with less than 2 wt.% nickel exhibited amorphous carbon as the dominant morphology on the spent catalyst. In contrast, catalysts with 2Ni/Al2O3 and 3Ni/Al2O3 compositions showed graphitic carbon as the main side product. These findings provide insights into the relationship between nickel dosage, catalyst properties, and catalytic performance in methane dry reforming. By understanding the effects of nickel loading on material properties and reaction behavior, researchers can optimize catalyst design and develop more efficient and stable catalysts for sustainable syngas production

Enhanced Perpendicular Exchange Bias in Co/Pd Antidot Arrays

Magnetic nanostructures revealing the exchange bias (EB) effect have attracted much interest in recent years due to their promising applications in spintronics, magnetic sensing and recording devices with various functionalities. In this paper, we report on the perpendicular exchange bias effect in a multilayered thin film composed of [Co/Pd] ferromagnetic multilayers exchange-coupled to an antiferromagnetic IrMn. The film was deposited on a porous anodized titania template. Influences of the films’ surface morphology as well as the order of layers deposited on the EB effect were studied. The enhancements of the EB field HEB (up to 30%) and the coercive field HC (two times) were achieved in the nanoporous films relative to their continuous film counterparts, which could be attributed to the specific morphology of the porous surfaces

Carbon dioxide reforming of methane over modified iron-cobalt alumina catalyst : Role of promoter

Cobalt-based catalysts are widely employed in methane dry reforming but tend to deactivate quickly due to coke deposits and metal sintering. To enhance the performance, iron, a cost-effective promoter, is added, improving cobalt's metal dispersibility, reducibility, and basicity on the support. This addition accelerates carbon gasification, effectively inhibiting coke deposition. Methods: A series of iron-doped cobalt alumina MFe-5Co/Al2O3 (M= 0, 0.4, 0.8, 1, 2 wt.%) were prepared via simple incipient-wetness impregnation. The catalysts were thoroughly characterized via modern techniques including BET, XRD, H2-TPR, CO2-TPD. Significant findings: The addition of iron had a minimal impact on the properties of γ-Al2O3, but it significantly affected the dispersibility of cobalt. At an optimal dosage of 0.8 wt.%, there was a notable decrease of 29.44% in Co3O4 particle size. However, excessive iron loading induced agglomeration of Co3O4, which was reversible. The presence of iron also resulted in a decrease in the reduction temperature of Co3O4. The material's basicity was primarily influenced by the loading of iron, reaching its highest value of 705.7 μmol CO2 g−1 in the 2Fe-5Co/Al2O3. The correlation between catalytic activity and the physicochemical properties of the material was established. The 0.8Fe-5Co/Al2O3 sample exhibited excellent performance due to the favorable dispersibility of cobalt, its reducibility, and its affordable basicity

Establishing and validating noninvasive prenatal testing procedure for fetal aneuploidies in Vietnam

Noninvasive prenatal testing (NIPT) for fetal aneuploidies has been widely adopted in developed countries. Despite the sharp decrease in the cost of massively parallel sequencing, the technical know-how and skilled personnel are still one of the major limiting factors for applying this technology to NIPT in low-income settings. Here, we present the establishment and validation of our NIPT procedure called triSure for detection of fetal aneuploidies.We established the triSure algorithm based on the difference in proportion of fetal and maternal fragments from the target chromosome to all chromosomes. Our algorithm was validated using a published data set and an in-house data set obtained from high-risk pregnant women in Vietnam who have undergone amniotic testing. Several other aneuploidy calling methods were also applied to the same data set to benchmark triSure performance.The triSure algorithm showed similar accuracy to size-based method when comparing them using published data set. Using our in-house data set from 130 consecutive samples, we showed that triSure correctly identified the most samples (overall sensitivity and specificity of 0.983 and 0.986, respectively) compared to other methods tested including count-based, sized-based, RAPIDR and NIPTeR.We have demonstrated that our triSure NIPT procedure can be applied to pregnant women in low-income settings such as Vietnam, providing low-risk screening option to reduce the need for invasive diagnostic tests