Rajesh Varma
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Voluntary Selection; Bringing Evolution at the Service of Humanity
No full textHuman populations can be characterized by their corresponding phenotypic profiles which do not necessarily align. These differences are not our points of strength in building harmonious societies and establishing a sustainable world order; it is therefore desirable to seek a pathway to resolve them. This article reflects on genetics as the most profound source of our differences and introduces Voluntary Selection as a means of acquiring genetic qualities and resolving the imbalance in their possession by different populations. Voluntary Selection is a healthcare program allowing for voluntarily involving the reproductive cells of another individual than the parents to conceive a child at the discretion of a parent population. Genetic qualities in this context are desired phenotypes as perceived by each population. The article then presents a computational approach through which thoughtful decisions about the design of a program can be made. These methods are applied to a pedigree data set of adult heights and the results are used to demonstrate the influence of the program design and the significance of its outcomes.</p
Clinical features and outcome of prosthetic pulmonary valve infective endocarditis
No full textBackground: Infective endocarditis is a serious complication in patients with prostheses in the right ventricle outflow tract. The aim of our study is to assess clinical features in these patients.Methods: We have analyzed all cases of prosthetic pulmonary valve infective endocarditis (PPVIE) and compared them to the rest of the patients with IE. Since the year 2000, 375 cases of IE have been diagnosed in our center and nine patients had a PPVIE.: 3 patients with Melody percutaneous prostheses, 5 with a homograft (3 after a Rastelli procedure, 2 a Ross procedure), and 1 patient with a heterograft (Contegra conduit).Results: Mean age of PPVIE patients was 31±15 years old and 89% were male. A presumed portal of entry could only be identified in 4 of the 9 patients with PPVIE. The most common was a dental origin (3 patients). A causative microorganism was detected in all but one PPVIE patient: 3 S.viridans, 2 S.aureus, 2 coagulase-negative staphylococci, and 1 enterococcus. Most patients suffered complications during the in-hospital phase: 7 out of 9 PPVIE patients (78 vs.75% of the rest of IE patients), the most common congestive heart failure (5 patients), and persistent sepsis (4 patients). Six patients were operated on during hospitalization (67 vs. 55%) with a mean time from admission to surgery of 15 days. In-hospital mortality was similar (22 vs. 26%).Conclusions: Prevalence of PPVIE is low, with a clinical outcome, surgery rate, and survival similar to the rest of patients with IE.</p
Ambiguities of care in Alzheimer’s disease: To care/become a caregiver by obligation or by the charity
No full textObjective: To understand the meaning of the ambiguities of being a caregiver experienced by family caregivers of people with Alzheimer’s disease and health workers inserted in community Mutual Help Groups.Method: a study based on the ontology of Maurice Merleau-Ponty’s experience based on the notion of the body itself. It is revealed by the participation of 12 women, family caregivers, and health workers, members of community mutual aid groups, in the city of Jequié, Bahia, Brazil. The production of the experiential descriptions took place in three Focus Group meetings, during April and December 2019, whose resulting material was submitted to the Ambiguity Analysis. Results: The results reveal the ambiguities of taking care mobilized by the tradition of fulfilling social, cultural, and religious duties. Inserted in the groups, they experience openness to the other, reconfiguring “doing for doing” in “doing for pleasure” in care practices, becoming another. Conclusion: the experience of caring as an obligation, which was previously expressed by anguish, sadness, and illness, after insertion in the group, opens up to the experience of the other and makes care a manifestation of otherness, which privileges the care of the self to care from the other. The study points out the group strategy in health services as a possibility of transforming social actors in the community in the context of Alzheimer’s disease.</p
Survival benefits and safety of chemotherapy regimens for pancreatic cancer: An umbrella review of meta-analyses of randomized controlled trials
No full textIntroduction: Several meta-analyses have reported the survival benefits and safety issues of chemotherapy regimens for pancreatic cancer (PC). The aim was to perform an umbrella review to summarize the existing evidence from meta-analyses of randomized controlled trials (RCTs). Methods: EMBASE, PubMed, Cochrane database of systematic reviews, and Epistemonikos were searched from inception to October 31st, 2021.Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). The quality of evidence was evaluated using GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluations).Results: A total of 2,732 records were identified with 24 articles corresponding to 168 meta-analyses in resected/metastatic PC. Two (8.3%) studies were found to be of high methodological quality. Eighty (47.6%) meta-analyses reported survival benefits of using combination chemotherapy, while 88 (52.4%) meta-analyses reported safety outcomes. 78 (46.42%; 36-efficacy, 42-safety outcomes) of the 168 meta-analyses were statistically significant (P ≤0.05). No meta-analyses were found to be of high-quality evidence. Twelve meta-analyses reporting the survival benefits of gemcitabine combinations were graded as moderate quality of evidence. Combination regimen FOLFIRINOX, gemcitabine nab-paclitaxel (gem/nab), and gemcitabine capecitabine (gem/cap) compared to gemcitabine monotherapy were found to improve overall survival (OS) and progression free survival (PFS) for both resected (OS: HR = 0.78 (0.69-0.89); PFS: HR=0.79 (0.66-0.94)) and advanced PC (OS: HR = 0.76 (0.68-0.85); PFS: HR = 0.68 (0.60 -0.78)). One meta-analysis comparing the gemcitabine combination regimens (with Nab/Paclitaxel or Capecitabine) versus monotherapy among metastatic PC patients was upgraded to high quality after a sensitivity analysis excluding small-sized studies (PFS; HR = 0.78 (95% CI, 0.69-0.88)). The remaining meta-analyses were either low or very low quality of evidence. Conclusion: Our review showed that the use of combination chemotherapy regimens demonstrated survival benefits over gemcitabine monotherapy, which were supported by moderate to high-quality evidence. Gemcitabine combined with taxanes particularly showed high benefits for overall survival but only a modest benefit for progression free survival for metastatic PC. SWOG-1505 study compared perioperative FOLFIRINOX vs gem/nab in patients with resectable PC but no differences in survival was found. To date, FOLFIRINOX and gem/nab have been compared in the perioperative setting but no phase III trials have performed direct head-to-head comparisons for FOLFIRINOX against gemcitabine-based combination treatments in the metastatic setting. In future, head-to-head clinical trials comparing safety and efficacy for FOLFIRINOX vs gemcitabine-based combinations regimens (specifically gem/nab and gem/cap) in the metastatic setting are required.</p
Healthcare providers’ attitude towards abortion service provision in Gulu city, Northern Uganda
No full textBackground: Although induced abortion is legally allowed on various grounds in several sub-Saharan African countries, health care providers in these countries often persist in viewing induced abortion as immoral. Providers’ attitudes may conflict with the national abortion law or their personal and or religious values. Abortion services are severely restricted and highly contentious in Uganda. This study, therefore, is aimed at determining attitudes among healthcare providers on induced abortion service provision in Gulu City. Procedures: A cross-section survey was conducted among health workers about attitudes toward induced abortion between September and November 2019 using a modified abortion attitudinal score. The study was conducted in the Hospitals and Health centers in Gulu City, in Northern Uganda, the participants were drawn from Public, Private non-for-profit faith-based, Private for Profit and, Private non-for-profit Non-Government Organisation health centers.Findings: A total of 252 health care providers were surveyed. The mean attitudinal score for generally in support, generally not in support, conditional in support, personal attitude, and beliefs against and toward abortion provision were 2.80, 2.71, 2.86, 3.239, and 3.35 respectively. Factors that were positively associated with general support included age 40 years and above; and being employed in private non-for-profit non-governmental health facilities, with coefficients of 0.85 and 0.67 respectively. Factors that were positively associated with conditional support were; age 40years or above; being employed in a non for profit non-governmental health facility; private for-profit and private not-for-profit faith-based health facilities coefficients 0.55, 0.54, 0.40, and 0.37 respectively. However, being a born-again Christian was negatively associated with general support for induced abortion provision. Conclusion: Healthcare providers’ attitude is an important element in the provision of quality stigma-free post-abortion care services. A clear national effort to improve post-abortion and comprehensive abortion care training should include value clarification and attitude transformation among all healthcare providers.</p
The results of a clinical and neurophysiological study of the effectiveness of Parkon spray in the treatment of Parkinson’s Disease (PD)
No full textFor more than 25 years, we have begun an experimental study of the physiological effect of micromolar concentrations of reactive oxygen species on the regulatory functions of the central nervous system. We found that these effects extend to the CNS centers and hormonal regulation of the hypothalamus and pituitary gland [1-4], as well as in the control of BBB permeability [5].</p
Changchun SLR data analysis using different techniques
No full textThe aim of the present study is to investigate three different techniques for fitting the SLR data observed from the Changchun observatory in China which is characterized by its huge amount of data points and to examine which of the three techniques is more proper for fitting such kind of data. The first technique is the interpolation using the Chebyshev polynomial for fitting the total number of satellite laser ranging (SLR) data points. The second technique is the spline technique which is used for matching continuous intervals for fitting the SLR data. The third technique is the method, which is used at Changchun observatory, known as the Iterative 4th order polynomial fit. The three techniques are applied to 100 samples; 50 samples for the satellite LAGEOS I and the other 50 samples for the satellite Starlette that were observed during the first quarter of 2018. From the obtained results, it is found that the first two techniques, namely the Chebyshev polynomial and Spline techniques provide better standard deviation in comparison to the Iterative 4th order polynomial fit technique that is used at Changchun observatory, with merit to Spline technique over the Chebyshev polynomial. </p
Graphene oxide-based waveguides for enhanced self-phase modulation
No full textThe enhanced self-phase modulation (SPM) in silicon nitride (Si3N4) and silicon (Si) waveguides integrated with graphene oxide (GO) films is experimentally demonstrated. By using both picosecond and femtosecond optical pulses, we observe significant spectral broadening in the waveguides due to the high Kerr nonlinearity of GO films. The maximum broadening factors of up to ~3.4 and ~4.3 are achieved in GO-coated Si3N4 waveguides and GO-coated Si waveguides, respectively. The spectral broadening for femtosecond pulses is more significant than the picosecond pulses, which can be attributed to their relatively high peak power. These results show the strong potential of GO films for improving the Kerr nonlinearity of photonic devices. </p
Cooperative investment problem with an authoritative risk determined by Central Bank
No full textIn this paper, we are interested to provide an analytic solution for cooperative investment risk with an authoritative risk determined by the central Bank. This problem plays an important role in solving cooperative investment problems in an investment sector such as insurance companies or banks etc and keeping in our mind the effect of a risk determined by the central Bank which has not been done before. We reformulate cooperative investment risk by writing dual representation for each risk preference (Coherent risk measure) for each agent (investor). Finding an analytic solution for this problem for both cases individual and cooperative investment problem by using dual representation for each risk preference has a strong effect on the financial market. Moreover, we find the equilibrium allocation in terms of an equilibrium price by formulating the optimization problem in the case of equilibrium with an initial endowment for each agent’s ’investor’. In addition, formulate a problem that covers the risk minimization problem with an expected return constraint and expected return maximization problem with risk constraint, in both individual and cooperative investment cases, for the general case of an arbitrary joint distribution for the asset return under certain conditions and assuming that all coherent risk measure is continuous from below. Thus, the optimal portfolio is written as the optimal Lagrange multiplier associated with an equality-constrained dual problem. Furthermore, a unique equilibrium allocation as a fair optimal allocation solution in terms of equilibrium price density function for each agent (investor) is also shown.AMS Subject Classification: [2022].</p
Complex network reveals the spatiotemporal pattern of summer extreme precipitation in Eastern China
No full textIn this study, complex networks were constructed based on the synchronization of summer extreme precipitation events (SEPEs) in eastern China. Then, a detailed analysis of spatiotemporal patterns of SEPEs and the relationship between SEPEs in eastern China with the eastern Asian monsoon was presented. The results showed that (1) the event synchronization is low in the coastal region but high in the inland region; (2) the intensity of the monsoon varies at different phases of summer and the area and intensity of the monsoon's influence on the summer extreme rainfall events were different. In conclusion, this study provides valuable insights to reveal the influence of monsoon strength on SEPEs in different regions of China. </p