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Chia D.B.,LINK Development | Wong L.Y.,LINK Development | Liu D.Y.K.,LINK Development | Toh M.P.H.S.,LINK Development
Diabetes Research and Clinical Practice | Year: 2017

Aims This study describes the incidence and predictive factors for development of Type II Diabetes Mellitus (T2DM), Acute Myocardial Infarction (AMI) and stroke, among subjects with IFG over a five-year period. Methods This is a retrospective cohort study of subjects with newly diagnosed IFG from the Singapore National Healthcare Group hospitals and primary care clinics from 1 January 2008 to 31 December 2010. Clinical data were collected over a five-year period from the date of diagnosis. Outcomes of interest were T2DM, AMI and stroke based on first occurrence of the ICD-9 diagnoses from the chronic disease registry. Demographic characteristics, laboratory tests, anthropometric measurements and medical history were adjusted for in the multivariate logistic regression. Results Out of 2295 eligible subjects, 552(24.1%) developed at least one of the outcomes. 492(21.4%) developed T2DM, 20(0.9%) developed AMI and 62(2.7%) developed stroke. Predictive factors for development of any of the three outcomes included age 40–49 [Adjusted OR = 2.25; 95% CI 1.44–3.51], blood pressure of 140/90 mmHg and above [Adjusted OR = 1.62, 95% CI 1.26–2.10] and BMI of 27.5 kg/m2 or more [Adjusted OR = 2.35; 95% CI 1.61–3.41]. Females were more likely to develop T2DM [Adjusted OR = 1.43; 95% CI 1.10–1.85] but less likely to develop AMI and/or stroke compared to males [Adjusted OR = 0.43; 95% CI 0.24–0.76]. Conclusions Development of T2DM/AMI/stroke within the first five years of IFG is significantly high for subjects age 40–49 and those with high BMI. Frequency of cardiovascular risk screening, which is currently once every three years, could be increased. © 2017 Elsevier B.V.

Teng M.,LINK Development | Lin L.,LINK Development | Zhao Y.J.,LINK Development | Khoo A.L.,LINK Development | And 4 more authors.
Drugs and Aging | Year: 2015

Background: Statins have been shown to be beneficial in primary and secondary prevention settings; however, their role in the elderly remains a clinical conundrum, given that age-related factors could alter the risk–benefit ratio of statin treatment. This study aimed to critically evaluate the efficacy and safety of statins for primary prevention of cardiovascular disease (CVD) in the elderly. Methods: We systematically reviewed randomized controlled trials comparing any statins with placebo or usual care for primary prevention of CVD in subjects aged ≥65 years. Relative risks (RRs) using a random effects model were calculated and sensitivity analyses were performed to assess the robustness of findings. Results: Eight studies (n = 25,952) were included in the meta-analysis. Statins significantly reduced the risks of composite major adverse cardiovascular events (RR 0.82, 95 % CI 0.74–0.92), nonfatal myocardial infarction [MI] (0.75, 0.59–0.94) and total MI (0.74, 0.61–0.90). Treatment effects of statins were statistically insignificant in fatal MI (0.43, 0.09–2.01), stroke (fatal: 0.76, 0.24–2.45; nonfatal: 0.76, 0.53–1.11; total: 0.85, 0.68–1.06) and all-cause mortality (0.96, 0.88–1.04). Significant differences were not observed in myalgia (0.88, 0.69–1.13), elevation of hepatic transaminases (0.98, 0.71–1.34), new–onset diabetes (1.07, 0.77–1.48), serious adverse events (1.00, 0.97–1.04) and discontinuation due to adverse events (1.10, 0.85–1.42). The occurrence of myopathy, rhabdomyolysis and cognitive impairment was largely unreported in the included trials. Conclusions: From a risk–benefit perspective, there is a role of statins for the primary prevention of major adverse cardiovascular events in elderly patients. Further studies are needed to ascertain the benefits of statins on fatal MI, stroke and all-cause mortality. © 2015, Springer International Publishing Switzerland.

Hamdan H.A.,Power Unit Thermal Generation | Khoury R.,LINK Development
International Conference on the European Energy Market, EEM | Year: 2015

This paper investigates the viability of an LNG import infrastructure and a coastal pipeline interconnecting most of the countries' power plants. The analysis is performed in light of the pending offshore gas discoveries and the world's falling oil prices. The methodology used in this research is based on a probabilistic approach through the development of an integrated energy-economics appraisal-model that uses a probabilistic Fuel Demand Module (FDM) which is derived from a traditional production-costing approach. The developed energy model is interrelated to an investment feasibility model used to assess the financial feasibility of the terminal. This two-folded paper provides a proposal to concatenate an FDM to the traditional probabilistic production-costing model, which is an effective tool for the financial appraisal of a typical fuel infrastructure. The other fold is the technical and commercial aspects that are considered advantageous to the country's policy makers. © 2015 IEEE.

Swahn M.H.,Georgia State University | Braunstein S.,Georgia State University | Kasirye R.,LINK Development
Western Journal of Emergency Medicine | Year: 2014

Introduction: The use of mobile phones and other technology for improving health through research and practice is growing quickly, in particular in areas with difficult-to-reach population or where the research infrastructure is less developed. In Sub-Saharan Africa, there appears to be a dramatic increase in mobile phone ownership and new initiatives that capitalize on this technology to support health promotion campaigns to change behavior and to increase health literacy. However, the extent to which difficult-to-reach youth in the slums of Kampala may own and use mobile phones has not been reported despite the burden of injuries, substance use, and HIV that they face. The purpose of this study is to determine the prevalence of mobile phone ownership and use in this high-risk population and to identify psychosocial characteristics that may differentiate those owning and using a phone from those who do not. Methods: We conducted secondary analyses of the Kampala Youth Survey (N=457). Data collection took place in 2011, and the survey was designed to quantify high-risk behaviors in a convenience sample of urban youth living on the streets or in the slums, 14-24 years of age, who were participating in a Uganda Youth Development Link drop-in center for disadvantaged street youth. We computed chisquare analyses to determine any significant differences in psychosocial characteristics based on phone ownership and use. Results: Overall, 46.9% of youth reported owning a mobile phone and ownership did not vary by sex but was more common among youth older than 18 years of age. Mobile phone ownership was also more common among those who reported taking care of themselves at night, who reported current drug use and who reported trading sex for money, food or other things. Conclusion: Given that nearly half of the youth own and use phones daily, new research is needed to determine next steps for mobile health (mhealth),including the feasibility of using mobile phones for data collection and interventions with this hard-to-reach population. Moreover, this technology may also be suitable for injury-specific research given that there were few differences with respect to injury-related variables in mobile phone ownership and usage. Copyright 2014 by the article author(s).

Swahn M.H.,Georgia State University | Palmier J.B.,Georgia State University | Kasirye R.,LINK Development | Yao H.,Georgia State University
International Journal of Environmental Research and Public Health | Year: 2012

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14-24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23-4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16-3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09-3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20-4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12-6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53-4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11-3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30-7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25-3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed. © 2012 by the authors; licensee MDPI, Basel, Switzerland.

Takahashi E.,Keio University | Takahashi E.,Kumamoto University | Nagano O.,Keio University | Nagano O.,Japan Science and Technology Agency | And 11 more authors.
Journal of Biological Chemistry | Year: 2010

Aberrant epithelial-mesenchymal transition (EMT) is involved in development of fibrotic disorders and cancer invasion. Alterations of cell-extracellular matrix interaction also contribute to those pathological conditions. However, the functional interplay between EMT and cell-extracellular matrix interactions remains poorly understood.Wenow show that the inflammatory mediator tumor necrosis factor-α (TNF-α) induces the formation of fibrotic foci by cultured retinal pigment epithelial cells through activation of transforming growth factor-β (TGF-β) signaling in a manner dependent on hyaluronan-CD44-moesin interaction. TNF-α promoted CD44 expression and moesin phosphorylation by protein kinase C, leading to the pericellular interaction of hyaluronan and CD44. Formation of the hyaluronan-CD44-moesin complex resulted in both cell-cell dissociation and increased cellular motility through actin remodeling. Furthermore, this complex was found to be associated with TGF-β receptor II and clathrin at actin microdomains, leading to activation of TGF-β signaling. We established an in vivo model of TNF-α-induced fibrosis in the mouse eye, and such ocular fibrosis was attenuated in CD44-null mice. The production of hyaluronan and its interaction with CD44, thus, play an essential role in TNF-α-induced EMT and are potential therapeutic targets in fibrotic disorders. © 2010 by The American Society for Biochemistry and Molecular Biology, Inc.


LINK Development | Date: 2012-04-17

Carts; Electric cars; Fork lift trucks; Land vehicles; Railway cars; Tires for vehicles; Trailers; Trolleys; Trucks; Vehicle seats.

Anwar A.,Software Engineering Competence Center | Kamel A.A.,Cairo University | Ahmed E.,LINK Development
ACM International Conference Proceeding Series | Year: 2016

An organization with an established process, assessed at CMMI maturity Level 3 more than 10 years ago, realized process corrosion symptoms. Over the years, changes in business conditions resulted in more and more process tailoring rules to adhere to the new needs, while maintaining the process maturity level. The increase in tailoring rules has made the process definition hard to understand with inconclusive tailoring results in some cases. This lead to major changes in the organization's process improvement strategy. To build a sound process and avoid previous improvements pitfalls, the process improvement team decided to research the applicability of process agility before adopting it. The question we tried to answer was "Can agile processes improve the organization's performance indicators while maintaining the process maturity level?" We used action research, a practical and widely used research methodology, to answer our question. We selected action research to engage process actors in the improvement and/or refinement process. In this paper, we report on our improvement efforts during the first year of deployment. This paper focuses on issues, pains and challenges we faced during the first cycle of redefining and deploying the processes to achieve the agility goals. Results from the first deployment cycle, were promising. Among other improvements, process agility reduced the rate of rework from 29% to 13%. © 2016 ACM.

The time has come that Sub-Saharan Africa benefit from implementation of Evidence-Based Interventions (EBIs) that have been developed over time in the United States, Europe, and by the United Nations (UN) agencies. This paper has been written partly because less information is coming out of Africa regarding diffusion and implementation of EBIs. There is a need to highlight and reflect on the delivery of interventions of human immunodeficiency virus (HIV) and substance use(r) programs in Sub-Saharan Africa. Both the evidence and practices may help enrich discussions as a way to improve the quality of program outcome in the region and at the same time retire inappropriate old interventions "Prevention can work, but not everything called prevention works" Belinda E. Sims (2011). © 2015 Taylor and Francis Group, LLC.

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