The PERMIT Project: Personalised Renal Function Monitoring via Information Technology

Patients with heart failure are typically elderly and are among those most at risk of renal failure due to both their condition and their medication. Regular monitoring of renal function may allow early detection of renal decline and appropriate intervention to prevent renal failure. However, clinical guidance on renal function monitoring in heart failure is sparse and based on anecdotal evidence. To reduce unnecessary admissions caused by renal impairment in heart failure due to inadequate monitoring, standardised practice for renal monitoring would be of benefit. Given that each patient has individual co-morbidities and rates of renal decline, general guidelines may have minimal impact and there may be a need for renal monitoring that is personalised case-by-case. The aim of the PERMIT project (Personalised Renal Function Monitoring via Information Technology) was to develop the framework for creating such personalised guidance by using machine-learning on large clinical datasets. The goal was to create a prediction model that could highlight which patients with heart failure were most at risk of renal decline, in order to intervene before they required hospital admission. In light of developing a future predictive algorithm for use in clinical care, patient and clinician engagement with heart failure-related remote healthcare technologies was investigated. The aim of this was to improve the knowledge base so that future technologies, such as remote renal monitoring, can improve upon their accessibility and acceptability in this patient cohort. Studies examining remote care in heart failure were thematically synthesised in a qualitative systematic review. This generated 5 core themes of engagement: Clinical Care, Convenience, Communication, Ease of use, and Education, with different perspectives from patients and healthcare staff. The themes which were generated were assessed prospectively via a discrete-choice questionnaire survey given to heart failure patients (n=93). Binary logit analysis showed that ‘Clinical care’ was most valued by patients with heart failure and was almost twice as important as ‘Communication’, the lowest ranked theme. The study provided important insights into the lived experiences of patients with heart failure that will allow the development of future interventions with greater acceptability and engagement rates. To create the predictive model for renal decline, retrospective primary care data was obtained from SIR (Salford Integrated Records). This data was processed into a longitudinal dataset which included 3800 adult patients with newly diagnosed heart failure, over an 8.5 year study window. The clinical parameters of each patient were mapped longitudinally with creatinine over time. A model-based clustering algorithm known as ‘flexmix’ was applied to the data. In order to select appropriate clinical variables to input into the clustering predictive model, pairwise mixed-model linear regression was used to determine correlation between each clinical parameter and log(creatinine). The most correlative covariates were serum urea and serum potassium, with urea showing the highest R-squared value for explaining variance in creatinine over time. The final clustering model therefore used the inputs of: age at heart failure diagnosis; time since heart failure diagnosis; gender; IMD decile; and serum urea. This process produced seven discrete clusters of renal change over time which were ranked by severity. Evaluation of the algorithm was made using the assigned cluster models to predict creatinine over time in patients with heart failure. The MAPE (mean absolute percentage error) of the creatinine prediction was between 17-33% depending on the cluster assigned. The work outlined in this thesis represents an important step towards developing personalised renal monitoring guidance. Important clinical correlates of renal function decline, identified in the process, can be used for prognostic research in future studies. The error of the prediction values was variable and will thus require further optimisation using additional datasets and clinical studies in the future

Clinical and Histopathological Study on Dermatophytes Infections Caused by Trichophyton mentagrophytes Using Animal Model

Background: dermatophytes are parasitic fungi that infect skin, hair and nails of both humans and animals, they are the primary causative agent of dermatophytosis, a major public health concern in some geographic regions. Objective : To study the pathogenesis of dermatophytes infections and the antifungal activity of essential oil extract of  Lavandula  intermedia. Methods: Zoophilic strain of Ttichophyton mentagrophytes isolated from  dermatophytic patients infected with tinea corporis inoculated in the back of the rabbits using the abrasion (non-occlusion) method. Results: Twenty animals were categorized into two groups as follows: control groups involved 10 animals, 5 animals were subjected to  abrasion only, and other 5 animals were subjected to infection (after abrasion).While the other ten animals represented by study groups which involved 5 animals were exposed to infection and treated in 10th day of infection with 1% terbinafine and the other 5 animals  were treated with 10% lavender essential oil extract(it gave 5%and 10% MIC and MFC respectively). The treated animals showed healing in 12-14 day, while not treated animals showed spontaneous healing in 35-40 day. Conclusion: Rabbit model was found to be useful in the primary screening and evaluation of the anti-dermatophytic efficacy of topical formulations of antifungal agents. T. mentagrophytes produced infection in rabbit's skin in 2X106 cells /ml. Lavender essential oil could be used as alternative antifungal agents in treatment of dermatophytosis in chronic diseases ,immunocompromised and immunosuppressed drugs therapy patients. Key words : Dermatophytosis, T. mentagrophytes animal mode

Prevalence of Dermatophytes Skin Infections in Babylon Province

Background: Dermatophytosis is an infection produced by dermatophytic fungi in the keratinized tissues. Dermatophytes are fungi that infect skin, hair and nails of both humans and animals, they are the primary causative agent of dermatophytosis. Objective :   Detecting the types and the frequencies of the dermatophytes infections in Babylon Province. Methods:   In this study, 254 specimens  of dermatophytic patients are collected in Babylon province. Collection of Specimens include: skin Scrapings, hair fragments and nail clippings  . The specimens were diagnosed by direct microscopic examination and culture. Results : 213 (83.86%) specimens of dermatophytes infection were positive in direct microscopic examination and culture , and used in phenotypic diagnosis .Tinea  corporis was the predominant infection in 106 (41.73%)   patients, Ttichophyton  rubrum showed the highest frequency of dermatophytes isolates 36 (16.90%) , Ttichophyton mentagrophytes 31 (14.55%)  and Microsporum canis 30 (14.08%). The invasion of  hair was ectothrix type, forming masses of arthroconidia on the outside of the hair shaft  in 57 (78.08%) specimens, while the invasion of hair was endothrix type, and abundant sporulation inside the hair shaft causes breakage of the hair near the surface of the scalp in 16 (21.92%) specimens. Conclusion: Tinea corporis was the predominant infection. T. rubrum , T. mentagrophytes and M.  canis showed the highest frequency of dermatophytes isolates. Positive direct microscopic  examination and culture isolates could be  used in phenotypic diagnosis. Key words : Dermatophytosis, T. rubrum , T. mentagrophytes and M.  cani

Effect of Urea Fertilizer Deep Placement Days after Transplanting Using BRRI Prilled Urea Applicator on Transplanted Boro Rice Yield

Rice is the most important crop in the developing countries of Asia. In the south and south-east Asia, rain-fed and irrigated transplanted rice occupies nearly two-thirds of the rice-growing area and produces more than 80% of the rough rice. In these areas, prilled urea conventionally applied by farmers is very insufficient in the transplanted rice field, where severe losses occur (up to 60% of applied N) via NH3volatilization, denitrification, leaching, and runoff. Considering loss minimization, an experiment was conducted during the Boro season at Bangladesh Agricultural Development Corporation (BADC) in Sylhet to evaluate the performance of BRRI Prilled Urea Applicator (BPUA) at the different periods after transplanting BRRI dhan28. The results reveal that the field performance of the BPUA was suitable on first day after seedling transplanting under sandy clay loam soil compared to the third day after transplanting (DAT). At the 105 DAT, the height of the crop was found to be 104.3, 104.3, and 95.7 cm for urea deep placement by BPUA on first, second, and third day after seedling transplanting respectively. The maximum grain and straw yield was found at 6.8 t ha-1 and 5.2 t ha-1, respectively which varied with the date of applicator operation after seedling transplanting. The benefit-cost ratio was found 1.63 at first DAT, whereas it was lower on the third days after seedling transplanting. Farmer can apply urea fertilizer in the non-oxidized zone by the BPUA after the first and second day of seedling transplanting in the sandy clay loam soil for maximum yield

Factors Affecting Patient and Physician Engagement in Remote Health Care for Heart Failure: Systematic Review.

BackgroundAdult chronic heart failure mainly affects an elderly population with multiple comorbidities that often require frequent medical visits to prevent poor health outcomes. However, the heart failure disease process reduces their independence by reducing mobility, exercise tolerance, and cognitive decline. Remote care technologies can bridge the gap in care for these patients by allowing them to be followed up within the comfort of their home and encourage their self-care. However, patients, carers, and health care professionals need to engage with the technology for it to be useful.ObjectiveThis systematic review explores qualitative primary studies of remote care technologies used in heart failure, to determine the factors that affect user engagement with the technology. This is explored from the perspective of patients, carers, and health care professionals.MethodsRelevant studies published between January 1, 1990, and September 19, 2020, were identified from EMBASE, Ovid MEDLINE, PubMed, Cochrane Library, and Scopus. These studies were then synthesized using thematic analysis. Relevant user experiences with remote care were extracted using line-by-line coding. These codes were summarized into secondary codes and core concepts, which were further merged into overarching themes that encapsulate user experience with remote care.ResultsThe review included 47 studies, which led to the generation of 5 overarching themes that affect engagement: (1) "Convenience" relates to time saved by the intervention; (2) "Clinical Care" relates to perceived quality of care and health outcomes; (3) "Communication" involves feedback and interaction between patients, staff, and carers; (4) "Education" concerns the tailored information provided; and (5) "Ease of Use" relates to accessibility and technical barriers to engagement. Each theme was applied to each user base of patient, carer, and health care professional in a different manner.ConclusionsThe 5 themes identified highlight aspects of remote care that facilitate engagement, and should be considered in both future design and trials evaluating these technologies

Anti-Pseudomonal Effect of Argan Oil on Pseudomonas aeruginosa Recovered from Burn Patients in Hilla City, Iraq

The burn and wound infection is considered one of the major health problems in the world, and one of the most frequent and severe complications in patients who have sustained burn. P. aeruginosa is a common cause of wound infections, especially of thermal burns, this is because burns have large exposed areas of dead tissue free of any defenses and, therefore, are ideal sites for infection by bacteria from the environment or normal microbiota. To assess Antibacterial effect Different concentrations of both Argan Oil (which was fetched from Maraco Kingdom) and Hydrogen Peroxide (H2O2). Bacterial isolates obtained from the Central Laboratory in Hilla City, Iraq. was preliminary diagnosed in this Lab. as Pseudomonas aeruginosa, the causative agents of skin and burns infections and the more resistant bacteria to antibiotics. Those isolates were reidentified in our Lab. for confirmation. The test bacterial isolates were treated with; H2O2 (1.5%) alone, Argan oil alone and with physiological saline as a control (by using the wells in agar method). No effect on bacterial activities and vitality were observed in this experiment. Argan oil and H2O2(1.5%) were combined together to form compounds in a rate of 1:1, 2:1 and 1:2 respectively. The results of this experiment revealed considerable effects on test organisms since the diameter of inhibition zones recorded as high as 23.82mm., 24.57mm. and 23.05mm. These effective of Argan oil Mixing with 1.5% H2O2 on P. aeruginosa burn isolates show remarkable results when compared to highly active antibiotics like Amikacin, Tobramycin, Ceftazidime, Aztreonam, Norfloxacin and Gentamycin

Tacrolimus Pharmacokinetics in Hispanic Children After Kidney Transplantation

Ethnic differences in drug pharmacokinetics are well recognized including that for tacrolimus (TAC) in adult subjects. However, similar knowledge among pediatric populations is missing. Our limited retrospective study compares steady-state pharmacokinetics of TAC in Hispanic versus non-Hispanic children. Serial blood samples were collected and whole blood concentrations of TAC were measured using radioimmunoassay. Compared with non-Hispanic children, Hispanic children had lower measures of drug exposure (maximum drug concentration [C(subscript max)] and area under the drug concentration-time curve [AUC(subscript 0-∞)]), higher volume of distribution, and faster clearance. Interestingly, only in Hispanic children, significant correlations were found between body weight and clearance, age and volume of distribution, and Schwartz estimated glomerular filtration rate and half-life. In conclusion, our study suggests that ethnic differences exist between Hispanic and non-Hispanic children in TAC PK, and based on our preliminary findings, either a higher or more frequent TAC dosing may be required for effective immunosuppression therapy in Hispanic children

Tolerance and biosorption capacity of Zn²⁺, Pb²⁺, Ni³⁺ and Cu²⁺ by filamentous fungi (Trichoderma harzianum, T. aureoviride and T. virens)

Heavy metal pollution has become a serious environmental issue in the last few decades. There is a need to develop potential technology that can remove toxic heavy metals ions found in polluted environments. This study was undertaken to determine the resistance levels of different concentrations of heavy metals using filamentous fungi of Trichoderma aureoviride, T. harzianum, and T. virens. Based on the results, the T. virens strain T128 gave the highest tolerance ability for Ni³⁺ and Pb²⁺ in a 1200 mg/L concentration. The accumulation and uptake capacity was determined by the maximum removal of Pb²⁺, Cu²⁺, and Ni³⁺ by a T. harzianum in liquid medium when compared to other fungi. The metal removal occurred at a concentration of 500 mg/L and was 13.48 g/g for Pb²⁺, 3.1254 g/g for Cu²⁺ and 0.8351 g/g for Ni³⁺. For Zn²⁺, the highest tolerance and uptake capacity of metal was recorded at 3.1789 g/g by T. virens

The Impact of Human Resource Development (HRD) Practices on Organizational Effectiveness: A Review

This paper attempted to review theoretically the HRD and its matrix and revealed to show the positive relationship between HRD and organizational effectiveness. In HRD shows the different variables (outcomes) such as HRD instruments, HRD processes & climate variables and organizational dimensions. HRD affects the organizational goals which may result from higher productivity, cost reduction, more profits, better image and more satisfied customers and stake holders considered as organization dimensions HRD activities, as such, do not reduce costs, improve quality or quantity, or benefit the enterprise in any way. It is the on-the- job applications of learning that ultimately can reduce costs, improve quality, and so forth. In the organizational context, therefore, HRD means a process which helps employees of an organization to improve their functional capabilities for their present and future roles, to develop their general capabilities, to harness their inner potentialities both for their self and organizational development and, to develop organizational culture to sustain harmonious superior-subordinate relationships, teamwork, motivation, quality and a sense of belongingness. The study also analyses the Kliman Model of HRM to show the path of mechanisms which could lead to competitive advantage. Today’s fast changing environment modern organizations are more careful to sustain in the competitive advantage relating to HRD our study has been developed to help the management students, academicians, and professionals to understand the subject properly and enhance their knowledge about HRD network within the organization for its effectiveness