Monday, November 30, 2020

Iris Publishers- Open access Journal of Otolaryngology and Rhinology | Pick up an oar - or swab - and row

 


Authored by Miriam I Redleaf1*

Opinion

On the morning of Thursday March 26, 2020 one of us, a facial plastics surgeon at the University of Illinois Department of Otolaryngology/Head and Neck Surgery, noted that COVID-19 nasopharyngeal swabs in the US were showing a very high false negative rate. She suggested this may be due to obtaining specimens from the septum and anterior portions of the turbinates, rather than the nasopharynx. In the afternoon, our department formed a swab education team, and another of us, our head neurotologist at the University of Illinois, was assigned as lead. As the two doctors were gathering information, we were approached on Friday, March 27th to also plan how we might help University Health Services accommodate the increase of COVID-19 related employee visits.

Therefore, during the week of March 30th through April 3rd, 2020 the two otolaryngology subspecialists demonstrated nasopharyngeal swabbing to 12 sessions of healthcare workersspeaking and answering questions to 10-20 people at a time. At the end of the week we made an educational video [1] which we posted on our health systems’ internet. The educational efforts were greatly appreciated by the hospital staff-in each of the 12 sessions, several nurses or doctors spoke up and stated that they were surprised how deep the nasopharynx was.

Meanwhile, two experienced administrators worked through the logistics of creating a high-turnover COVID testing site for our employees. By April 1st, they had found open clinical space and cleaned it and converted it. By April 2nd they had arranged an orientation session in the morning-complete with phone registration, patient lists, fit testing, one receptionist, two medical assistants, two medical student volunteers, one manager, and two security officers to safely route the patient traffic. Our first employee testing began in the afternoon with a limited schedule. On Friday, April 3rd, we had our first full schedule morning clinic with 2 ENT doctors performing the swabs. The second week of swabbing processed 43, 44, 62, 84, and 53 patients in 2-3 hours each morning. The University Health Services and the University employees have repeatedly expressed their thanks for the services and their satisfaction with how efficient and painless the entire process was.

We have thought about what features of this experience have made it so successful. One was that all the organizers were willing to perform tasks which they knew well how to do, but were “beneath them.” Otolaryngology subspecialists were immediately willing to demonstrate the lowly nasal swab over and over to groups of other healthcare professionals. Otolaryngologists who normally interpret specialized tests and perform complex operations pitched in-two at a time-every morning to swab dozens of fellow employees in a few hours. Administrators who no longer work “in the trenches” put aside their business analyses and revenue investigations and assembled a functioning clinic in two days. Everybody just picked up an oar-or nasopharyngeal swab-and rowed.

Another feature we uncovered is that, the joy of a light work day, and avoiding work altogether is a myth. Everyone working in the testing clinic-stated that they greatly enjoyed working full tilt without any down time. They never had to wait and they were never bored. Finally, despite the lowly task, everyone felt extreme satisfaction that they were doing something helpful-a task that was really needed.

The major early lessons from this experience are rather inspiring. First is that healthcare workers truly want to help others. Second is that many of the administrative procedures which hobble healthcare delivery in fact turn out to be dispensable. And third is that otolaryngologists love to work, and want to work hard and efficiently. In this age of increasing paperwork and computer clicks, COVID has shown that it is possible to get back to basics-healthcare.

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Iris Publishers- Open access Journal of Otolaryngology and Rhinology | We & CORONA, where to?!

 


Authored by Majid Mohammed Mahmood*

Opinion

As a novel virus, Coronavirus or SARS-Covid-19 as agreed to be called yet is expected to keep freely replicates comparing to other, known viruses for the fact that there were and still no previous exposure by the immune system to its antigens. The matter would be attributed to immune response gene that controls cellular& humoral specific immune responses.

As well known, historically many morbidity causatives agents had destroyed communities when they were not recognized (immunologically) yet, but they had gotten less & less chances to replicate and transmit once they’re gradually identified by the immune system in term of successive generations. This was for the host (the human, here) and his natural capabilities and diverse interventions. But for the virus, on other hand, it’s going to be less exhausting as time gone and this would be the ultimate trend of parasites of successful parasitism, since their host’s depletion or even further exhaustion would be against their favorites for reasons behind their persistence & continuation.

In respect to viruses, this matter of course is partially correlating to natural selection (postulate). Besides the fact that the graded recognition of the immune system to Coronavirus antigens throughout repeated exposure to a limit of copies of the virus (less than minimum infective dose) is undoubtedly considered as a typical, natural way to gain acquired immunity though that weak it would firstly be but it’d take accumulative& co-strengthen attitude on time ahead. Forgetting not what the lessen replicating chances and less availability of ready hosts due to candidate usable vaccines & successful vaccination.

All that is happening, steps wisely, & the virus might remain (eventually) included in human accompanied viruses’ list & revealed as mutations, tracked by the immune system, manifested through the resultant memory cells & serum level of protective antibodies that could providing us escape opportunities from infections were potentially been caused by. Likewise, more copies of the virus do not cause diseases, such as that caused by the day the immune system was of recent dealing with the virus, but rather its morbidity is transient that we do not feel or with slight symptoms that we don’t pay attention to.

Same virus’ vaccines could be transferred someday to describable vaccines’ list, which scheduled to be administered to certain community categories might include elderly, immune compromised & others (the vulnerable, who were feared about, from infection’s consequences &complications for their noncompetent immune systems, after a definite or indefinite reason). Bearing in mind that there is a fearsome of acquiring the virus (which stay dormant) during summer season in countries of hot climate, which reactivates during winter.

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Wednesday, November 25, 2020

Iris Publishers- Open access Journal of Complementary & Alternative Medicine | Sonodynamic and Photodynamic Therapy in Advanced Pancreas Carcinoma - A Case Report

 

Authored by Lucy Qing Li*

Abstract

Photodynamic Therapy (PDT) is a therapeutic treatment for certain kinds of tumors, approved by the FDA in 1998. Recent research data shows that a related procedure, Sonodynamic Therapy (SDT), is another new promising complementary method for cancer treatment. Here we report clinical results in an advanced pancreas cancer patient who was treated using a combination of Sonodynamic and Photodynamic Therapy (SPDT), along with conventional therapies. The patient was pathologically diagnosed with metastatic pancreas carcinoma (non-respectable advanced pancreas cancer) by the patient’s local oncology team. The advanced pancreas carcinoma had responded unsatisfactorily to conventional therapies. SPDT treatment involved using a new sensitizing agent Sonoflora a TM (SFa), which was administered sublingually; 12-hour latter, the patient was treated with a combination of light and ultrasound devices, and a low dosage of chemotherapy simultaneously as a whole body treatment (SPDT follows the chemotherapy cycle periodically). Patient had good partial responses. The results indicate that SPDT could be a promising new complementary therapeutic combination for the treatment of pancreas cancer.

Keywords: Sonodynimic therapy; Photodynamic therapy; Pancreas cancer; Chemotherapy; HIFU sensitizer; Sonosensitizer

Introduction

Photodynamic Therapy (PDT) was first approved as established therapeutic method by the FDA for certain kinds of cancer in 1998. However, In view of the limitation of the penetration of light energy into tumor tissues [1,2], the successful application from LED or coherent laser emission source of PDT has been mostly limited to superficial pathology or through invasive method which could approach to the pathology with unwanted side- effects. Ultrasound is a mechanical wave which could penetrate tissue excellently and safely without major attenuation of its energy [3,4]. Therefore, the potential medical application of ultrasound has been evaluated extensively and has led to the routine use of ultrasound for diagnostic imaging. Sonodynamic Therapy (SDT) has been widely researched to develop as a complementary or alternative therapy to PDT [5-10]. In SDT treatment, patients first ingest a sonosensitizer, an agent that can be activated by ultrasound. This agent is tailored to be activated through the use of low-intensity ultrasound energy producing a cascade of endogenous cytotoxic radicals. The therapy is thus similar to PDT, which is an attractive modality for cancer treatment with potential to focus the energy on tumor sites buried deep in tissues and to locally activate a preloaded sonosensitizer. The body transmits ultrasound energy much more efficiently than light energy, and this is a critical advantage when treating inside tumors and with minimal damage to peripheral healthy tissue. So far, many compounds were found to have sonodynamic activity [5- 13]. In recent years, a novel sonosensitizer was developed by the late Donald Burke, MD, of Advanced Technologies, Boston, USA. He named this Sonoflora 1™ (SF1). This agent is a chlorophyll derivative with very high sonodynamic as well as photodynamic activity. Embryonic zebra fish assay had showed SF1 has no evidence of toxicity [3]. Our animal studies demonstrate that SDT with SF1 inhibits the growth of mouse S-180 sarcoma, even when the tumor is covered by a bone [4]. We had successfully used Sonodynamic and Photodynamic Therapy (SPDT) with SF1 and a portable ultrasound device in terminally ill breast cancer patients [14].

Here, we report initial clinical data using two new chlorophyllderived sono-photo-sensitizing agents (SFa and UF) along with a new equipment, supplied by EEC Biotech (Guangzhou) Co. for systemic SDT. The sensitizers SFa and UF were given to patients through lingual absorption on day one and day three. On Day two today four ozone treatment was given twice a day. The tumor area and the whole body were irradiated by ultrasound on day two and day four twice a day for 40mins each time, then by red LED light at 45mV/cm2 and 554 nm of wavelength for 30 minutes once a day. We used multiple ultrasound transducers within systemic SDT device, the tumor area and whole body was irradiated for 40 minutes at 75% pulse, 1 MHz and 2.0 W/cm2. The second week the same treatment was repeated. One cycle of SPDT included two round treatments and a week free.

Case Presentation

The patient is female, at the age of 61. She went to the local hospital for medical examination for abdominal pain with jaundice for a month in November 2017. Examination indicated space occupying lesion in pancreatic head. CA19-9 was high. Local Doctor diagnosed pancreatic cancer. A stand was implanted in patient’s bile duct. Patient underwent chemotherapy of Gemcitabine for three months after her jaundice was gone. Patient then had severe digestive tract symptoms, bone marrow suppression grade IV, Rechecked CA199 dropped significantly. However, no tumor shrinkage was seen in original lesion in CT images. Patient had been on Abraxane+Gemcitabine for three months Since February 2018, during which she was showed digestive tract symptoms and had bone marrow suppression as well. Rechecked CT scan showed progression and patient started to build up a large amount of ascites.

Surgery and radiation were not suitable for the patients as metastasis and location of the tumor in pancreatic head. Two types of chemo failed after three months treatment and no conventional therapy was available for option.

July 2018 after all the necessary tests, the patient came to our hospital for treatment, she started the first cycle of SPDT on July 25, 2018, cooperating chemotherapy with targeted medicine Erlotinib 150mg Po Qd +Xeloda 1.5g Po Bid D1-14+Oxaliplatin 80mg D3, 50mg D10, assisting with 5 days of HIFU treatments. During the course, patient had Grade II of digestive symptoms, nausea and vomiting, which were attenuated after symptomatic treatment. Ascites reduced obviously after the first cycle treatment. Tumor marker dropped from 4289U/ml to 3038U/ml.

Second cycle of SPDT cooperating chemotherapy (same regimen as the first one). During this course, patient had mild nausea, no myelosuppression. Tumor marker CA199 after second cycle of SPDT dropped to 1873/ml and ascites reduced rapidly. Doctor’s assessment indicated “stable”.

Third and fourth cycles of SPDT started on September 05, 2018, continuing chemotherapy with Erlotinib 150mg Po Qd +Xeloda 1.0g in the morning and 1.5g in the afternoon D1-14+Oxaliplatin 80mg D3. Reduced the dosage of chemo’s for her Grade III nausea, with Grade I myelosuppression.

A review of PET/CT (Oct 15, 2018) compared with July 23, 2018 before treatment.

A. Metabolism in the head of pancreas slightly rises, size of focal obviously narrows and the metabolism obviously reduced. Considered suppressed in most tumor activity after treatment (Figure 1).

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Iris Publishers- Open access Journal of Complementary & Alternative Medicine | Overview of Buddhism and the Concept of Suffering

 


Authored by Michele Riley Kramer*

Abstract

Buddhism is a way of thinking and living that is used as a philosophy, a psychology, a religion, and a spiritual tradition. It began with the teachings from Lord Siddhartha about his experiences and journey toward enlightenment. His teachings were written down approximately three hundred years after his earthly existence. His teachings have since been followed literally or interpreted more broadly. Buddhism has influenced, and in return has been influenced by, other cultures. These cultures took what they felt to be important and integrated them with their own wisdom traditions. Hence, Buddhism and its expression vary throughout the countries that embraced it. The purpose of this paper is to broadly outline Buddhist teachings and their variations. The rest of the paper will focus on the Buddhist concept of suffering, which is the basis and main premise of Buddha’s teachings.

Overview of Buddhism

Buddhism began with the revelations received by a man named Siddhartha, or Gautama His revelations were not new but were realizations of ancient ageless wisdom brought through to him in answer to his question and quest to find the cause of, and a way to relieve it, suffering in the world [1,2]. Buddha is said to have lived about 650 B.C.E. or 450 B.C.E., but the former date is the most used. He lived in Northern India in a time where asceticism was the popular form of spiritual pursuit. He is said to have received enlightenment after sitting under a Bodhi tree for a great length of time. Afterward, he passed on what he learned to a group of loyal fellow ascetics who then began teaching as well. Monasteries were built so that those individuals in pursuit of enlightenment would have a place to pursue their path.

Buddhism branched into different sects within India before spreading outside to other countries. The splits and divisions resulted from conflicts over interpretation and practice. Fewer arhats (those who had achieved enlightenment), doctrinal strife and dissension, and “the demand of the laity for more equal rights with monks” contributed to the splits [1]. Although the origins are obscure, the Mahayana movement arose between 100 B.C.E. and 100 C.E. in opposition to those who followed the true and original Buddhist teachings (of which the Theravadin sect is the major school remaining). They were less exclusive than the Theravadins, opening their teachings to lay people. Those who believed in following the essence of the teachings and interpreting them (eventually designated as Mahayana) split from the main body that maintained and followed the teachings of Buddha in its original form (of which the Theravadin sect is the largest remaining) [1]. Asserts that development of Mahayana Buddhism, the main severance from the original practice and teachings, was necessary in order to appeal to the other cultures in which Buddhism spread its influence. Followers of what eventually became the Mahayana sect believed the doctrines and teachings of Buddha were stale and that the creation of new literature would keep Buddhism alive. Five new ideas evolved that distinguished Mahayana from the original (Theravadin) beliefs [1].

A. “shift from the Arhat-ideal to the Bodhisattva-ideal”.

B. “a new way of salvation is worked out, in which compassion ranks equal with wisdom, and which is marked by the gradual advance through six ‘perfections’ (paramita)”.

C. a new set of deities evolved, “or rather persons more than divine”.

D. “’Skill in means’ (upayakausalya), an entirely new virtue, becomes essential to the saint, and is placed even above wisdom, the highest virtue so far”.

E. “A coherent ontological doctrine is worked out, dealing with such items as ‘Emptiness’, ‘Suchness’, etc.”

Theravadin Buddhists see the culmination of wisdom and achievement of nirvana in human form as the arhat (or arahat). Mahayana Buddhists argue that arhats achieve this state for their own personal satisfaction while the bodhisattvas, the highest human pinnacle of the same achievement, do so in order to be able to help others. It is a significant difference between the sects [3]. According to Robinson R & Johnson W [4], “The Mahayana innovation was to proclaim that the bodhisattva course is open to all, to lay out a path for aspiring bodhisattvas to follow, and to create a new pantheon and cult of superhuman bodhisattvas and cosmic Buddhas who respond to the pleas of devotees”. It is important to mention another sect, Buddhist Tantra, in relation to the Buddhism characteristic of Tibet and Northern India. According to Robinson R & Johnson W [4], “Buddhist Tantra is a mysticism mixed with magic”, an amalgamation of both Buddhist and non-Buddhist concepts that do not rest with any one Indian religion. It came about around the sixth century C.E., in the areas in Northern India, about the same time that Buddhism was introduced into Tibet. Tibetan Buddhism is unique in its mixture of Mahayana and Tantric Buddhist influences, as well as aspects of its indigenous Bon religion.

About written literature, the earliest written Buddhist teachings were written approximately 80 B.C.E. According to Harvey P [3], there are six (non-Theravadin early canons preserved in Chinese and Tibetan translations, fragments of a Sanskrit Canon still existing in Nepal, and odd texts in various languages of India and Central Asia found in Tibet, Central Asia, and Japan”. The Mahayana’s generated a body of literature, called Sutras that were written in Sanskrit rather than the original Pali language. Harvey also notes “The main sources for our understanding of Mahayana teachings are the very extensive Chinese and Tibetan Buddhist Canons. While most of the Pali Canon has been translated into English, only selected texts from these have been translated into Western languages, though much progress is being made” [3]. Although each country whose people adopted Buddhism integrated it with aspects of their own belief systems, and created new literature as well, the main structure and teachings of either Theravadin or Mahayana are their foundations. The countries that practice primarily Theravadin Buddhism are Ceylon, Laos, Thailand, Myanmar, and Cambodia. Those countries whose Buddhism is primarily Mahayana are China, Vietnam (influenced by Chinese Buddhism and Indian practices), Northern India, Nepal, Korea (Chinese Buddhist influence), Tibet, and Japan, in the form of the Chinese Chan but called Zen [1,4].

Buddha’s Teachings

His Holiness the Dalai Lama states that there are “Three Jewels of Buddhism” that signify whether individuals are practicing Buddhists or not. He identifies practicing Buddhists as those who believe and accept “the Buddha; the Dharma, his teaching; and the Sangha or community of practitioners” [5]. What follows is an overview of the main teachings of Buddha. A plethora of texts have been written explaining various aspects of Buddha’s teachings in detail. However, due to the limitations of this paper, my intent is to provide some idea of Buddha’s teachings in order to concentrate in greater depth on Buddha’s concept of dukkha (Pali) and my understanding of the concept. Dukkha is the seed, the central point, and the reason for Buddha’s spiritual quest. It is the center point from which his discourses originate and the original premise of his teachings.

Simplistically, the main teachings (dharma in Sanskrit, dhamma in Pali) of Buddha consist first of the Four Noble Truths, which explain the main problem of human existence (suffering), its cause, and its remedy. The remedy is the Noble Eightfold Path called the Middle Way or the Middle Path. The Eightfold Path consists of eight “right” forms of living, thinking, and being. The rest of Buddha’s teachings are more detailed explanations and commentaries of the concepts associated both with the Four Noble Truths and the Noble Eightfold Path. The Four Noble Truths define the reason, cause and cure for freeing human existence from dukkha, frequently translated as suffering. Dukkha is an internal creation of the individual and is not externally created. Therefore, only the individual is responsible for creating and alleviating suffering, or dukkha. Humans can free themselves from suffering by following the Noble Eightfold Path of Enlightenment. The goal is to reach enlightenment, or nirvana (Sanskrit; in Pali, nibbana), through escaping and freeing oneself from dukkha, and from recognizing that all life, all existence is impermanent, samsara (Sanskrit) an illusion [3-6].

Five qualities, factors, or aggregates are the basis for the self, the personality, of the individual. They are matter, sensations, perceptions, mental formations, and consciousness [7]. These five aggregates contribute to dukkha. Therefore, eliminating the personality, the self, will free the individual from dukkha. One realizes the “No-Self”, which is a primary tenet of Buddhism, on the path to nirvana. The Noble Eightfold Path consists of eight “correct” behaviors that, if followed and developed, lead to enlightenment, or nirvana. They are grouped or correspond to the three Buddhist principles of wisdom, ethical conduct (love and compassion), and mental discipline. They are the right:

I. Understanding (wisdom)

II. Thought (wisdom)

III. Speech (ethical conduct)

IV. Action (ethical conduct)

V. Livelihood (ethical conduct)

VI. Effort (mental discipline)

VII. Mindfulness (mental discipline)

VIII. Concentration (mental discipline) [7].

The Eightfold Path is also called the Middle Way, or Middle Path, because it avoids the extreme of asceticism, which was the popular lifestyle in India for attaining higher spiritual development during Buddha’s life. It also avoids the other extreme on the continuum, the opposite of asceticism, of sloth and debauchery. It is a path of moderation and respect for one’s mind and body. Meditation is the vehicle used on to reach enlightenment. The two main types used in Buddhism are concentration/focus/mindfulness and insight meditations, with variations in the various sects [3,8,9] both have comprehensive explanations of various meditative practices. According to Buddha, in The Dhammapada 282. Through meditation, wisdom is won, through lack of meditation, wisdom is lost; let a man who knows this double path of gain and loss so conduct himself that wisdom may grow [10].

The Concept of Suffering

Like so many words I am finding in my readings that are difficult to translate in English in a way that truly explains their concepts, the term dukkha is difficult to translate in order to convey its true meaning. Dukkha lies at the heart of Buddha’s teachings and, to me, it is one of the most difficult to grasp or understand by its popular translation of “suffering.” His Holiness the Dalai Lama says that, “the first step we must take as practicing Buddhists is to recognize our present state [of being, living] as dukkha or suffering, frustration and unsatisfactoriness” [5,6]. Buddhist teachings describe three main “levels or types of suffering. The first is called ‘the suffering of suffering’, the second, ‘the suffering of change’, and the third is ‘the suffering of conditioning’” [5,6]. The first type consists of those painful experiences related to being physically human birth, sickness, aging, and death. The second type is happy or pleasurable. These experiences occur in our present unenlightened state and are therefore transient. We suffer when we perceive them, when the intensity of the experience ebbs, as temporal and short-term yet we desire to have them be permanent. I have found an explanation that helps to understand the paradox of happiness as suffering. The suffering of change is perceived as suffering because happiness and joy are on the opposite end of a continuum where pain and painful experiences represent the opposing end. From a dualistic perspective, they are the relief, or opposite of pain. And because change is a part of life, joy inevitably and eventually changes to something else, resulting in the experience of dukkha.

The third type of suffering is the existential realization that suffering will always be present as long as we continue to live in an unenlightened existence. There will always be something that causes suffering. This realization can lead to an existential crisis. And, according to the Dalai Lama, it is called the suffering of condition “because this state serves as the basis not only for painful experiences in this life, but also for the causes and conditions of suffering in the future” [6]. As Gunaratne metaphorically sums it up, “The axe of impermanence is always there to fell the tree of joy” [2]. Perhaps happiness, one end of the continuum, with unhappiness or dukkha at the other end, causes suffering if one attaches to keeping the feeling. Personally, though, I could recognize the feeling of happiness as an illusion and attachment and either choose to remain detached from the feeling or experience the physicalmental- spiritual sense in the moment and let it go neutrally until the next moment. I wonder how Buddhists who live happily really experience it. To [2], the closest approximation of dukkha in English is “disharmony”. He sees it as “inherent in the very formation of the human being”. It “is an experience of the internal world of the self”. He further expounds on the concept by breaking down the word. The word ‘Dukkha’ is made up of two words ‘Du’ and ‘Kha’, ‘Du’ is a prefix meaning bad, low, mean, base or vulgar. ‘Kha’ means empty or hollow. The two words taken together therefore refer to that which is bad because it is empty, unsubstantial, unsatisfactory or illusory. It refers to a state of unsatisfactoriness if one may use the expression. The popular rendering of Dukkha as ‘suffering’ is not quite satisfactory since the word ‘suffering’ is likely to convey the idea of pain only and does not introduce the idea of unsubstantiality or illusorines. Dukkha consists of a state of unbalance, that continued agitation and disturbance to which all beiigs sic, beings are subject by reason of the absence of stability and permanence in this world by reason of the never ending rise and fall of things leading to a universal ‘unsatisfactoriness’ or disharmony [2].

So, it seems that human beings, by the act of reincarnation and being born, are contractually bound to dukkha by the initiatory experience of birth. One can feel despair at just being born. Dukkha is inherent in living in this third-dimensional existence. It is like the metaphor of “hitting the ground running” (birth) and not stopping until one has reached the end of the road (physical death). It is as if an animal sense of survival is necessary, which is dukkha. It is a package deal the vehicle of the physical body and existence come standard with dukkha. However, esoterically, if we choose to be reincarnated in order to hasten our spiritual development, then wouldn’t’ coming into an existence of disharmony provide the impetus and drive to spiritually develop and stop reincarnating? I find this viewpoint both helpful and hopeful. Translator Moore JH [11] explains suffering as craving. Any craving creates an attachment to something. The something exists in our world, which is transient and illusory. Therefore, whatever we crave will not last. Put another way, this world is an illusion (samsara in Sanskrit), so whatever object we crave is also an illusion. The loss of the object creates feelings of grief and loss, which generates more attachment by the intensity of these feelings. It becomes an endless cycle. Naradamaha Thera’s translation of dukkha is that of “painful feeling”, “basis of pain”, “object of pain”, “cause of pain”, or “conditioning state of pain” [12]. Buddha is said to have identified eight causes of dukkha: birth, death, decay, disease, “association with the unpleasant”, “separation form the beloved”, when one does not obtain what one desires”, and the Five Aggregates matter, sensations, perceptions, mental formations, and consciousness [12].

The Bhikkhu Silacara translates Buddha’s first sense of dukkha, when he was sitting under the Bodhi tree as thus: “‘Idan pi Dukkka Here verily is Ill [13]. The Bhikkhu Silacara dispels the assertion that Buddhism, because of the concept of dukkha, is pessimistic. Pessimism is an attitude of mind toward a fact, and what the Buddha does in the first Four Noble Truths is only to call attention to a fact, not a word being said to prevent one from adopting whatever attitude he chooses toward the fact [13]. It is the subsequent revelation that there is hoped to be found in Buddha’s knowledge of a solution that is enough to dispel such a contention. In the Dhammapada, Buddha states:

A. 277. All existing things are transient.’ He who knows and sees this cease to be [in] the thrall of grief.

B. 278. All existing things are involved in suffering.’ He who know and perceives this cease to be [in] the thrall of grief.

C. 279. All existing things are unreal.’ He who knows and perceives this is no longer [in] the thrall of grief [10].

So far, we have discussed dukkha from the perspective of its meaning and its place in human existence which, according to Buddhist teachings, is the First Nobel Truth. According to Gunaratne VF [2], once one understands the First Noble Truth, that all life is dukkha, the Second Noble Truth naturally arises. And once the Second Noble Truth is understood, the cause of dukkha, the Third Noble Truth naturally presents itself, that there is a way to rid ourselves of dukkha, and so on. The Four Noble Truths are logically progressive. All four-address dukkha but answer a different question. The First Noble Truth makes the statement that life is dukkha. The Second Noble Truth therefore addresses the cause of dukkha, which is craving (Tanha in Pali; Trushna in Sanskrit), or selfish craving [2,11,13]. The Dalai Lama explains it as “those emotional experiences that lead to confusion, and which affect the mind [5].

The Third Noble Truth is that there is a way to end dukkha, to free us of its cycle and experience. Dukkha is eliminated by ridding ourselves of the cause, craving and desire, by renouncing it and our ignorance of its presence and cause [2]. As the Bhikkhu Silacara puts it: To cease from Craving, then, while it involves the removal of the motives that usually impel men to activity by no means imports the cessation of all activity. There is a greater call than ever for the display of energy, but it is energy directed in an altogether new channel [13]. Liberation from dukkha, according to the Dalai Lama, has four characteristics: “cessation of the continuum of afflictions”, “true peace”, “ultimate satisfaction”, and “definite emergence from the process of unenlightened existence” [6].

The Fourth Noble Truth explains Buddha’s method of achieving cessation of dukkha, which is called the Noble Eightfold Path, and uses the vehicle of meditation to achieve cessation and attain enlightenment. In Buddha’s words, in the Iti Vuttaka, a summary of the Four Noble Truths is thus:

i. The self-composed, mindful

ii. And thoughtful disciple of Buddha,

iii. Comprehendeth the Cravings,

iv. And the Cause of the Cravings,

v. And Comprehendeth where they cease,

vi. And the Path that leadeth to their destruction.

vii. By the destruction of (his) Cravings,

viii. This monk hath extinguished Hunger, and hath attained Nirvana [11].

And in the Dhammapada, Buddha says:

A. 190. He who takes refuge with Buddha, the Law and the Order; he who with clear understanding sees the four noble truths.

B. 191. Suffering, the origin of suffering, the destruction of suffering, and the eightfold noble path that leads to the release from suffering.

C. 192. That is the safe refuge, that is the best refuge; having gone to that refuge, a man is delivered from all suffering [10].

Personal Understanding of Dukkha

The importance of understanding the nature of dukkha, or suffering, cannot be overemphasized. According to His Holiness the Dalai Lama, “it is so crucial to realize the nature of suffering, because the stronger and deeper your insight into suffering is, the stronger your aspiration to gain freedom from it becomes” [6]. The premise is that insight leads to understanding, which leads to release. The term “suffering” has a very negative connotation to me. And the concept that all life is suffering rubs me the wrong way. I bristle at the notion. After the extensive reading I did for this paper, I feel less antagonism and I have a much better understanding of dukkha. I do not believe that term “suffering” is an appropriate translation of dukkha I think it is misleading. I propose the following definition instead: Dukkha is the state of being that begins at birth, lasts through life, ends in death, and returns in rebirth. It is a state of being involving internally generated attachments, emotions, and thoughts which, in our unenlightened state, we perceive as permanent when in fact they are not. Our desire for attachment, our cravings for transient situations and objects, results in our experience of dissatisfaction, grief, despair, and disharmony with life. This is dukkha.

To read more about this article....Open access Journal of Complementary & Alternative Medicine 

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Monday, November 23, 2020

Iris Publishers- Open access Journal of Current Trends in Civil & Structural Engineering | Decision Support Framework for Inspection and Maintenance; A Focus on Bridges using Post- Tensioning Tendons

 


Authored by Armin B Mehrabi2*

Abstract

Aging and decay of transportation facilities, and the higher long-term cost of passive maintenance has led to the need for development of proactive management systems for bridge maintenance, repair and rehabilitation. This paper proposes a framework for Bridge Decision Support Framework (BDSF) as a form of proactive asset management system. A BDSF allows the asset manager to perform economic analyses on a bridge in order to establish priorities and make preliminary selection of preservation, repair or rehabilitation options. Among various bridge systems, segmental bridges using internal and external post-tensioning have faced great challenges due to issues related to the durability of the posttensioning tendons. Although some reserve capacity has been designed into these bridges, failure of tendons can have profound effect in the safety and structural integrity. These experiences have stressed the need for a proactive and predictive BDSF. A major component of such system is the ability to accurately plan inspection and condition assessment of the bridge, and to provide appropriate mitigation strategies preventing major damages to progress beyond manageable levels. Employing BDSF allows consideration of a variety of rehabilitation scenarios and strategies under different criteria when different decision makers are involved. The BDSF proposed in this paper considers a bridge as a system comprising of subsystems, each with distinct structural role and performance. Special emphasis is placed on post-tensioning tendons as critical subsystem. This paper attempts to identify subsystems for a post-tensioned bridge, their position in the structural integrity of system, respective properties and deterioration potentials.

Keywords: Bridges; Post-tensioned bridges; Post-tensioning tendons; Reliability; Risk-based maintenance; Condition assessment; Maintenance; Decision Making; Rehabilitation; Corrosion; Deterioration.

Introduction

As important links within the overall transportation infrastructure, all bridges experience deterioration during their service life, and bridges using post-tensioning tendons, hereafter referenced as PT bridges, are not an exception. In fact, PT bridges have experienced alarmingly fast deterioration causing major concerns among bridges owners. Figure 1 shows a dissected tendon with incomplete grouting and severe corrosion of steel strands, a finding that applies to many contemporary bridges. Addressing bridge deterioration requires regular inspections, maintenance and repair actions targeted at improving the condition of the bridge and bridge elements and reducing the risk of failure. Because damage in PT tendons is in most cases not readily evident (FDOT) and the high costs associated with maintenance operations, the proper decision support framework for maintenance activities is needed to avoid (a) unexpected structural failures, and (b) unnecessary spending on maintenance and repair activities. Aging and decay of transportation facilities, and the higher long-term cost of passive maintenance has led to the need for development of proactive management systems for bridge maintenance, repair and rehabilitation. A framework for Bridge Decision Support Framework (BDSF) is proposed here as a form of proactive asset management system.

Innovation in bridge maintenance and rehabilitation is the key to the health and wellness of bridges as a valuable national asset. A major component of maintenance and rehabilitation is the ability to accurately plan inspection and condition assessment of the bridge, and to provide appropriate mitigation strategies [1]. Employing a decision support framework is common in maintenance management since it can satisfy the needs of planning and assessment while at the same time has the ability to carry a variety of rehabilitation scenarios and strategies under different criteria when different decision makers are involved [2]. This paper attempts to investigate the application of a reliability-based maintenance decision making for PT bridges. A framework for decision support is devised for a general PT bridge in basic design phase and includes several modules under multiple tasks. This framework can be customized for each bridge with respect to bridge characteristics. This framework is applicable to all types of bridges, however, some of the modules in this framework are developed further using practical approaches for specific PT-type bridges. The proposed methodology attempts to take advantage of timedependent variation of bridge reliability based on deterioration models to represent an effective and practical framework. Through implementation of adaptive modules structural simulation can be updated and made more accurate. The framework takes advantage of life-cycle-cost analysis and risk assessment process for effective and meaningful decision making for maintenance.

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Iris Publishers- Open access Journal of Current Trends in Civil & Structural Engineering | Development of the Trenchless Installations for Underground Structures in Highway Systems

 


Authored by Carl M. Duan*

Characteristics of HSLA Steel

There are many underground structures, such as culverts, tunnels and vehicle undercrossing in transportation systems throughout the world. These structures are used to convey water, wildlife, fish, pedestrians and vehicles. Their roles are just as important as surface structures, such as bridges. Cut-and-cover, immersing and trenchless installations are the three major methods to construct underground structures. For an installation of buried structure, the specific method should be chosen based on the factors such as geotechnical properties in subgrade, environment impact, cost and the degree of disturbance to the highway traffic above it. Currently, it is becoming more popular to use trenchless installations including tunneling methods for new structures and trenchless replacement method for existing structures. Comparing to cut-and-cover method, trenchless installations provide much less impact to the roadway traffic and the environment.

The trenchless installation method can be used to install a utility line with a small cross-sectional size of 4 inches in diameter for hundreds of feet long as well as a large facility with a width of 51 feet for 5.6 miles, as in the case of Chongming Tunnel across Yangtze River in Shanghai. Trenchless technology (TT) consists of a wide range of methods, materials, and equipment for installing new or rehabilitating existing underground structures. Frequently used tunneling methods include Pipe Jacking for pipes or concrete boxes, Horizontal Direct Drilling (HDD) for pipes, Auger Boring using steel casing (SC), Pipe Ramming using SC, Micro-tunneling, Tunneling by Tunneling Boring Machin (TBM) and so on. On the other hand, Cured-In-Place-Pipe (CIPP) is an effective method to replace existing pipes in place, and Slipling is used to rehabilitate existing pipes. Major trenchless installation methods, size limits and approximate maximum lengths are summarized in Table 1.

Installation

Proper geotechnical investigation of site, planning, design, and selection of compatible construction methods, materials, and equipment are very important for the successful installations of the underground structures in highway systems. One concern in trenchless installations is the road surface settlement when a hole underneath is created and a gap between the pipe and the adjacent soil exists. This is typical when a tunneling structure has a relatively shallow earth cover above it. An assessment to the roadway surface settlement during planning is needed to see if the amount of roadway subsidence is acceptable. Some tunneling methods can make this subsidence decreased during installation. For example, tunneling by TBM can reduce this concern by using a self-adjustable tunnel liner system such as rib and lagging liner system. The significant benefit of the rib and lag liner is the ability of the jacked casing to expand the tunnel liner after it exits the jacking shield against the adjacent soil to reduce potential for roadway subsidence. Structural analysis needs to be performed to check the integrity of the tunneling structures during construction under loadings such as horizontal jacking force, earth pressure, distributed live load from trucks and so on. Currently, there is a lack of unified methods to conduct this analysis. In addition, standard specifications for tunneling installations are another important document for the owners to adopt a specific method of installation.

Design for Service Life

If a tunneling structure is used as a permanent structure, it shall be designed for its service life. Currently, the structures in the U.S. highway system are designed using LRFD methodology. There is a large discrepancy in determining the appropriate soil or rock pressures applied to the tunneling structures. Improved methods in soil-structure interaction analysis should be developed for the safety, durability and the cost of the project. In the past, most of the buried structures in highway systems are not designed for seismic loading. But underground structures without seismic design in many countries suffered damages in the past earthquakes. For important utility lines and for large size tunneling structures, i.e., when the span is over 20 feet, seismic design is needed. AASHTO Technical Manual for Design and Construction of Road Tunnels has covered seismic design only for the tunnels used for traffic. Most of the methods used in seismic design are based on structural analysis using software. Experimental model tests and corresponding structural analysis are needed to validate those methods. Practical seismic design criteria using performance-based design methodology need to be established [1-3].

Development in the Future

With future forecast of traffic density higher and higher, trenchless installations, with least impact to traffic, will be used more frequently. The innovated trenchless installations have been developed in recent years to meet the project needs. The trenchless technology, design and installation specifications should be improved to keep up with the trend.

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Iris Publishers-Open access Journal of Hydrology & Meteorology | Influence of Community Resilience to Flood Risk and Coping Strategies in Bayelsa State, Southern Nigeria

  Authored by  Nwankwoala HO *, Abstract This study is aimed at assessing the influence of community resilience to flood risk and coping str...