ISSN 1694-0423

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(Peer Reviewed Ejournal - Published Biannually)


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Editorial Office

American University of Antigua College of Medicine
University Park
Jabberwock Beach Road
P.O. Box 1451
Coolidge, Antigua


Editor in Chief and Publisher

Arun Kumar Agnihotri, MBBS MD
Professor of Basic Sciences
American University of Antigua College of Medicine, Antigua and Barbuda, WI

Dr Arun Agnihotri was born in 1970 in Etawah (UP), India, and graduated in Medicine from MLB Medical College, Bundelkhand University, India in 1994. He received his MD in Forensic Medicine and Toxicology in 1999 from MLN Medical College, Allahabad University, India. He received a postgraduate certificate in Teaching and Learning in Higher Education at the University of Mauritius in 2014. He has been teaching both graduate and postgraduate medical students since 1999. He has been a Professor of Basic Sciences at the American University of Antigua College of Medicine in Antigua and Barbuda, West Indies in 2017. Dr Agnihotri is an Editor in Chief and Publisher of the ‘Internet Journal of Medical Update’ since the year 2005. Moreover, Dr. Agnihotri has a passion for research and has authored an impressive body of scientific literature on forensic pathology, forensic anthropology, clinical forensic medicine as well as medical education. He has had more than 75 papers published in the leading peer-reviewed journals serving the international scientific community. Dr Agnihotri’s expertise is mainly focused on forensic anthropology with a key element in identifying unknown individuals and compiled a comprehensive database of anthropometric data about the Mauritian population. Dr. Agnihotri’s passion for research combined with his managerial skills has resulted in one international research association, two scientific journals and five International Scientific conferences. Dr. Agnihotri has been nominated as a member of Disaster Victim Identification (DVI) Team Africa by ICRC forensic unit during ASFM Conference at Nairobi in Kenya in March 2015.


Executive / Managing Editor

Trevor Ngorosha, PhD
Department of Education
American University of Antigua College of Medicine, Antigua and Barbuda, WI

Dr Trevor Ngorosha was born in 1967 in Harare, Zimbabwe. He was educated in Zimbabwe and the USA. In 1991, he graduated with a Bachelor of Arts degree from the University of Zimbabwe where he studied English, Linguistics and Shona. After graduating he taught English, Literature in English, and English and Communication Skills at Murewa High School in Murewa, Zimbabwe. While teaching at Murewa High School, Dr. Ngorosha held several positions of responsibility. One, he was chair of the English Department from 1996-2009 when he left for the USA for graduate studies. Two, he was a provincial chief examiner, trainer of examiners, and national syllabus developer for one Advanced Level General Certificate of Education course. Three, he was high school debate and public speaking coach, a role that enabled him to participate in the International Youth Debate Forum held in 2004 in Roosta, Estonia, and sponsored by the International Debate Education Association (IDEA). In 2004 Dr. Ngorosha earned his Master’s degree in Education (psychology). In 2009 he enrolled for his second Master’s degree in Curriculum and Teacher Leadership at Miami University, Oxford, Ohio where he also obtained his Ph.D. degree in Educational Leadership with a concentration in experiential and adult learning. He taught at the same university as an adjunct instructor in the 2015-2016 academic year before joining the American University of Antigua, College of Medicine where he is an Assistant Professor. At this college, he designed and facilitated a faculty professional learning program in addition to facilitating small group learning in medical education. Dr. Ngorosha has published a book chapter on curriculum and instruction, a book review, and has a second book chapter in press. In 2006 he reviewed and recommended a high school English Language textbook series used in Zimbabwe, and in 2015 he edited a peer-reviewed article entitled Culture-based leadership.

Quality Control Editor

Sushil Dawka, MB MS EMBA ELS
Professor of Surgery
SSR Medical College, Belle Rive, Mauritius

Dr Sushil Dawka qualified as a surgeon in 1992 under Gauhati University, India, and worked at Gauhati Medical College till 2003. He then moved to Pokhara, Nepal, where he worked till 2009 as Surgical Consultant at Manipal Teaching Hospital, and as Professor in the Departments of Surgery and Anatomy, Manipal College of Medical Sciences. At present, he is Professor of Surgery at Sir Seewoosagur Ramgoolam Medical College, Mauritius, where he is also Academic Program Director and Quality Assurance Officer. Dr Dawka is a qualified Primary Trauma Care instructor and has trained in Disaster Management and Hospital Preparedness under the USAID program in Nepal. He was among the first batch of civilian doctors trained by the Indian Army and the Indian Mountaineering Foundation in High Altitude and Mountain Medicine. He holds a Postgraduate Certificate in Teaching and Learning in Higher Education from the University of Mauritius and an executive MBA from NIBM, India. He is also board-certified as an Editor in the Life Sciences. He has a special interest in teaching methodology as well as in travel medicine and the physiology of extreme environments. He is a member of the Association of Surgeons of India, World Association of Medical Editors (WAME) and WHO GIEESC (Global Initiative on Emergency and Essential Surgical Care). He is also editor-in-chief (Asia) for the Archives of Medical and Biomedical Research.


Co-Editor-in-Chief (Deputy Editor - Medical Sciences)

Vipul D Yagnik, MBBS MS FMAS
Director and Consultant Surgical Gastroenterologist
Nishtha Surgical Hospital and Research, Patan, Gugarat, India

Dr Vipul D Yagnik is a renowned Endoscopic and Laparoscopic surgeon in Patan, Gujarat, India. He was awarded MS General Surgery from M P Shah Medical College, Jamnagar, Gujarat, India in 2005. He obtained a Fellowship in minimal access surgery (FMAS) in 2008. He is also a Fellow of Indian Association for the gastrointestinal and endoscopic surgeon (FIAGES), Association of Surgeons of India (FAIS) and international society of Coloproctology (FISCP). He has been received a certificate of honor from district collector, Jamnagar for his tremendous work in natural calamities such as earth quake. He has worked as an assistant professor in Pramukhswami Medical College, Karamsad, Gujarat for four and half year. During this period, he served many responsibilities such as teaching postgraduates, member of board of study, executive member in the blood transfusion committee and revising the blood transfusion protocol. Dr Yagnik has more than 106 scientific publications in the various international peer reviewed journals including 70 indexed in Pubmed to his credit. He is an editor of international peer-reviewed biomedical scientific journals - 'Clinics and Practice' and 'Clinical and Experimental Gastroenterology', and a member of various professional organizations like WAME, AMASI, ASI, IAGES and ISCP. Dr Yagnik has published a book titled 'Fundamentals of operative surgery for undergraduate and post graduates medical students from Wolters Kluwer publication.


Deputy Editor - Biomedical Sciences

Theeshan Bahorun, GOSK PhD
Professor of Applied Biochemistry
ANDI Centre of Excellence for Biomedical and Biomaterials Reseach, University of Mauritius, Mauritius

Dr Theeshan Bahorun, National Research and Innovation Chair in Applied Biochemistry heads the ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius. His responsibilities center on providing leadership in developing research themes linked to biomedical, pharmaceutical and functional food sciences, in mentoring students in research, exploring connections with the biochemical, biomedical and pharmaceutical research community and exploring funding opportunities to support research and development. His research endeavors are focused on promoting public health nutrition and disease prevention. He has more than 22 years of experience in biomedical research on bioactive components of dietary/plant based factors (phytoceuticals), oxidative stress mechanisms, molecular nutrition, antioxidant pharmacology, pharmaceutical indications of antioxidant functional foods as prophylactic agents, cardio protective, neuroprotective and chemo preventive strategies, clinical research, pathophysiological mechanisms in diabetes, cancer and cardiovascular dysfunctions. He is the author/co-author of more than 200 publications and communications. In 2010 he was awarded the CV Raman Senior Fellowship for African researchers by the Government of India. In 2013 he has been conferred the title of Fellow of the Mauritius Academy of Science and Technology and received the Best Mauritian Scientist Award. He has been elevated to the rank of Grand Officer of the Star and Key of the Indian Ocean (G.O.S.K) on 12 March 2015 by the President of the Republic upon recommendation by the Prime Minister of Republic of Mauritius for his contribution to Scientific Research and Education. In 2016 he received the Project Leadership Certificate Hall of Fame Award for exemplary leadership in guiding the University of Technology, Mauritius Talent development programme.


Associate Editors

Vineet Bhandari MBBS, MD, DNB, DM, FAAP
Professor of Pediatrics
Drexel University College of Medicine, Philadelphia, USA

Dr Vineet Bhandari completed his medical school from the Armed Forces Medical College, Pune, India, followed by Pediatric residencies and Neonatology fellowships from the Post Graduate Institute of Medical Education and Research, Chandigarh, India and the University of Connecticut, USA. He is currently a Professor of Pediatrics, Obstetrics and Gynecology at Drexel University College of Medicine and Chief, Department of Neonatal-Perinatal Medicine at St. Christopher’s Hospital for Children / Hahnemann University Hospital / Temple University Hospital, Philadelphia, PA. He has edited 2 books (Manual of Neonatology and Bronchopulmonary Dysplasia) and authored over 240 book chapters and original research articles. He has been continuously funded by the NIH since 2003. He has presented his research in many national and international conferences.

Alessandro Leite Cavalcanti, PhD
Professor of Public Health
State University of Paraiba, Campina Grande, PB, Brazil

Dr Alessandro Leite Cavalcanti was born in 1968 in Paraiba - Brazil, and graduated from dentistry in 1991. He received his M.S. in Paediatric Dentistry in 1997 at the University of Sao Paulo (USP) Brazil. He received his PhD in Stomatology at the Federal University of Paraiba in 2002. He has been a postdoctoral scientist at the School of Dentistry of the Federal University of Minas Gerais in Belo Horizonte, Brazil in 2014. In 2016 he was promoted to Associate Professor. Moreover, Dr. Cavalcanti holds a research productivity scholarship (Level 2) from CNPq, a Brazilian funding agency. Dr Cavalcanti has been Professor of the Public Health Dentistry Discipline at the State University of Paraiba since 2002, where he teaches both undergraduate and graduate dental students. In the postgraduate course, he also teaches about dental research and manuscript writing. He is Editor in Chief of a Brazilian Research in Pediatric Dentistry and Integrated Clinic Journal. At the moment Dr Cavalcanti is member of the board of the IADR - International Association for Dental Research. His areas of research are Epidemiology, Forensic Dentistry and Public Health. He has published over 300 articles in peer-reviewed Brazilian and international journals.

Nandini Rao, PhD
Professor of Biochemistry
American University of Antigua College of Medicine, Antigua and Barbuda, WI

Dr Nandini Rao was born in 1964 in Karnataka - India, and did her Masters in Biochemistry in 1988 at the Kasturba Medical College, Mangalore University, India. She received her PhD in Biochemistry at the Manipal Academy of Higher Education (MAHE), India in 2000. She was a post-doctoral fellow from 2001-2003 at Indiana University School of Medicine, Indianapolis, Indiana, USA, and then a Visiting Research scientist from 2005-2007 at Indiana University School of Medicine, Terre Haute, Indiana, USA and from 2007-2010 at Center for Regenerative Biology and Medicine, Purdue University, Indianapolis, Indiana, USA. She was a lecturer teaching Medical biochemistry to medical, dental, Pharmacy, Physiotherapy and Nursing at Kasturba Medical College, India from 1990-2000 and then promoted to Assistant Professor in 2000 and then to She became Associate Professor in 2003 at the Melaka Manipal Medical College, Manipal, India. She joined American University of Antigua College of Medicine, Antigua, West Indies in 2010 as an Associate Professor where she has been teaching Biochemistry, Cell Biology and Genetics to the Medical students. She was promoted to Professor in 2015. She is currently an Associate Dean of Faculty Affairs in the same university. Her areas of research are Biochemistry, Cell Biology and Molecular Biology. The research work done during her post-doctoral studies has been published in a few journals such as BMC Biology, BMC Bioinformatics, and Developmental Dynamics which have high impact factor. She has authored a chapter in a textbook (Principles of Regenerative Medicine) published by Academic Press. She is also a PhD examiner for the two universities of India and a member in the editorial board for International Journal of Health and Rehabilitation Sciences.

Vicky Mody, PhD
Department of Pharmaceutical Sciences
PCOM School of Pharmacy, Suwanee, GA

Dr. Vicky Mody completed his M.Sc. degree in Analytical Chemistry at the University of Mumbai in 2001. After completing his M.Sc he was teaching Chemistry to the undergraduate students in Mumbai, India. Later, he obtained his Ph.D. from the University of Houston, Houston, TX. Being Ph.D student he was involved in the synthesis of high valent oxo and nitrido metalloporphyrins and characterizing it with the unique technique of resonance Raman spectroscopy. Shortly, he worked at small scale chemical industry, Polyorganix Inc. as a Research Chemist. As a Research chemist, he acted as the project lead for the development of novel drug delivering polymers based on polyphosphazenes and several monomers. As the matter of fact, one of the polymers developed by Professor Mody has been successfully characterized in vitro and in vivo and currently is being evaluated for its efficacy. To further expand his horizons, he served as a postdoctoral research fellow for 2 years in the Department of Pharmaceutical and Pharmacological sciences at the University of Houston, Houston, Texas. During his term as the post doctoral fellow he successfully developed MRI contrast agents based on superparamagnetic iron oxide nanoparticles for the early detection of breast and ovarian cancer. He also mentored several undergraduate students for their research projects in the development of MRI contrast agents based on superparamagnetic iron oxide nanoparticles. Currently Dr. Mody serves PCOM School of Pharmacy as an associate professor in the Department of Pharmaceutical Sciences. He is primarily involved in teaching biochemistry and medicinal chemistry of infectious disease and therapeutic courses. The research projects carried out in his lab includes the development of Synthesis of EP2 Antagonist and development of nanoparticles for the early diagnosis and therapy of tumors. Prior to joining PCOM School of Pharmacy, he served South University School of Pharmacy (September 2012 - October 2015) and Appalachian College of Pharmacy (August 2009 - August 2012).

Sanju George, MBBS MRCPsych FRCPsych
Department of Psychiatry
Government Medical College, Ernakulam, Kerala, India

Dr Sanju George was born in 1973 in Cochin, India and graduated in medicine from St John’s Medical College, Bangalore in 1996. He then moved to the UK where he completed his membership (MRCPsych) and fellowship (FRCPsych) of the Royal College of Psychiatrists, UK. He specialized in addiction psychiatry at the Birmingham and Solihull Mental Health NHS Trust. His primary research focus is gambling addiction and he has been working in the field since 2006, both in UK and now in India. He has also been actively involved in structured teaching activities since 2003, initially as an honorary clinical lecturer in psychiatry at the University of Birmingham and subsequently as an honorary senior lecturer in psychiatry from 2007 to 2014. His academic interests have seen him author over 130 scientific papers in international, peer-reviewed journals. He is on the editorial board of 7 journals and he is also a peer reviewer for over 25 scientific journals. In 2015, he moved back to India where he is currently pursuing clinical and academic work.

Smriti Agnihotri, MBBS MD
Department of Pathology
American University of Antigua College of Medicine, Antigua and Barbuda, WI

Dr. Smriti Agnihotri received her MD from Moti Lal Nehru Medical Colleege, Allahabad, India in 2001 and her MBBS in 1995 from Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India. She has also completed a training in Teaching and Learning in Higher Education at the University of Mauritius in 2012. Dr. Smriti has been teaching pathology to medical graduates since 2002 including teaching at Manipal College of Medical Sciences in Nepal, and Sir Seewoosagur Ramgoolam Medical College Medical College, in Mauritius. Dr. Smriti is a member of the Indian Medical Association (IMA), Indian Association of Pathologists and Microbiologists (IAPM) and the United States and Canadian Academy of Pathology (USCAP). Dr Smriti Agnihotri’s research interest is focused on gastrointestinal pathology and oncopathology including cervical and breast cancer, the prevalence of Helicobacter pylori associated histopathological changes in gastric biopsies of patients with portal hypertension and histopathological study of malignant soft tissue tumors. Dr Smriti Agnihotri administrative duties have included serving as secretary of the International Association of Medical and Biomedical Researchers from January 2015 to December 2016 and as Associate Editor of Internet Journal of Medical Update since 2006. She has authored more than 25 papers in peer-reviewed scientific journals over the course of her academic career.

Godfred A Menezes, PhD
Associate Professor of Medical Microbiology and Immunology
RAK College of Medical Sciences, RAKMHSU, Ras al Khaimah, UAE

Dr. Godfred A Menezes was born in 1977 in Sasthan, Karnataka, India, and graduated in Science from St. Aloysius College (Mangalore) in 1998. He received his Master’s in Medical Microbiology in 2003 at Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India. He received his PhD in Medical Microbiology at Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India in 2011. He has been a scientist at Erasmus MC, Rotterdam, The Netherlands. He was promoted to Associate Professor in the Department of Medical Microbiology and Immunology at RAK College of Medical Sciences (RAKCOMS) in 2018. He has also worked in Ha’il University in Saudi Arabia, and Central Research Laboratory and Sree Balaji Medical College & Hospital in India. Dr Menezes has been working extensively on molecular characterization of Enterobacteriaceae members, particularly extended and expanded spectrum beta-lactamase producing bacteria and fluoroquinolone resistant bacteria. He has more than 50 research publications in reputed journals to his credit with more than 800 citations. He serves as an editorial member of many scientific journals. He has research grants from Department of Biotechnology (DBT) - Government of India and King Abdulaziz City for Science and Technology (KACST) - Government of Saudi Arabia. For Recognition for his medical teaching and research activities, Marquis Who's Who has printed my biography in 2011 to 2018 Edition of Who's Who in the World (Marquis Who's Who VIP Number is: 35535126). He is a life member of Indian Association of Medical Microbiologists (IAMM), Emirates Medical Association (Emirates Society of Clinical Microbiology- ESCM) and the International Association of Medical and Biomedical Researchers (IAMBR).

Vidushi Neergheen-Bhujun, PhD
Department of Health Sciences
University of Mauritius, Mauritius

Dr Vidushi Neergheen-Bhujun is a senior lecturer since 2014 in the Department of Health Sciences and ANDI Centre for Biomedical and Biomaterials Research at the Faculty of Science of the University of Mauritius. She graduated with a PhD in Biosciences in 2008. Vidushi has research interest centered on the cancer chemopreventive effects of bioactive extracts derived from food and medicinal plants indigenous to Mauritius. Vidushi is determined at finding locally optimised solutions for the prevention and management of cancer, an intensifying problem on the African continent, including Mauritius. Her research interfaces with medicine, molecular biology and biochemistry and has culminated in more than 50 impactful communications. Moreover, to uphold her belief and engagement in scientific networking and knowledge sharing, she has been an active member of the Global Young Academy from 2012 to 2017, is a Next Einstein Forum Ambassador and is a fellow of the African Science Leadership Program. In 2014, she was honoured by the World Economic Forum as one of the Global Young Scientists 2014/2015, a group of scientists with a proven track record of advancing the frontiers of science in areas of high societal impact. In 2017, she received the Best African Woman Researcher Award from Merck Africa for her outstanding contribution to cancer research.

Hossam M Ashour, MS PhD
Associate Professor of Premedical Sciences
University of South Florida, Tampa, Florida, USA

Dr. Hossam M Ashour was born in Cairo, Egypt. He earned his MS degree in 2004 and PhD Biomedical Sciences (Immunology) in 2006 at the University of Texas Southwestern after completing his Pharmacy training at Cairo University. After spending a year of research and teaching at Cairo University, he was offered a research fellow position at the prestigious National Institutes of Health (NIH) in Bethesda, Maryland. Before joining the University of South Florida as an associate professor, Dr. Ashour worked at a number of institutions including the National Institutes of Health and Wayne State University. Dr Ashour has remarkable high-impact publications and is a distinguished editorial board member and reviewer for many scientific journals. He is also a member of the European Academy of Allergy and Clinical Immunology, Society for Clinical and Translational Science (SCTS), Belgian Immunological Society, the World Association of Medical Editors, and other prominent organizations. He has received numerous awards, and has been invited to participate in various scientific conferences and workshops in the US, Europe, and Australia. Dr. Ashour’s research interests are in the areas of Microbiology and Immunology with emphasis on subjects that have broader impacts on human health and a particular focus on immune tolerance networks, Anterior Chamber Associated Immune Deviation (ACAID), and autoimmune Diseases.

K Rao Poduri, MD, FAAPMR
Professor of Physical Medicine and Rehabilitation, and Neurology
University of Rochester Medical Center, Rochester, NY, USA

Dr K Rao Poduri is Past Chair and Professor (Emeritus) of Physical Medicine and Rehabilitation and Professor of Neurology at the University of Rochester Medical center, Rochester, NY. Dr Poduri graduated from Karnatak Medical College in Hubli, India. She has completed her residency training in Physical Medicine and Rehabilitation, and a fellowship in Geriatric Rehabilitation at the University of Rochester Medical Center/Strong Memorial Hospital. She is a Board-certified in Physical Medicine and Rehabilitation, Pain Medicine and in the subspecialty of Spinal Cord Injury Medicine. In addition to her clinical responsibilities and resident education, she has been teaching medical students and fellows at the University of Rochester School of Medicine and Dentistry in Rochester New York. She served as the Physical Medicine and Rehabilitation residency program director for 19 years from 1998 until 2017 and the chair of the Division of Physical Medicine and Rehabilitation for 14 years, and established the Academic department of Physical Medicine and Rehabilitation at the University of Rochester in 2008. Dr. Poduri was nominated for the Distinguished Academician Award for Association of Academic Physiatrists in 2010 and the 2016 Paralyzed Veterans Association Physician Excellence award. She is active with research grants and has published book chapters and peer reviewed articles in Physical Medicine and Rehabilitation journals. She serves on several editorial Boards and a peer reviewer for Physical Medicine and Rehabilitation journals and Journal of Neurology. Dr. Poduri has edited a book on Geriatric Rehabilitation from Bedside to curbside that was published in March 2017 by Taylor and Francis.

M Abdul Kareem, DMRD FCIP FAGE
Professor of Medical Radiology and Imaging
Taylor's University, Subang Jaya, Selangor, Malaysia

Dr. Hj. Abdul Kareem Meera Mohaideen, with a passion for academic and research works and invited speeches on Medical and social themes, is currently working in Taylor’s University at Malaysia. He is a senate member of the university, coordinator for integrated teaching for MBBS, Phase II stream coordinator and coordinator of Radiology in Taylor’s University. He has worked with teaching hospitals and medical Institutions since 44 years, after completing MBBS in 1973, Post-graduation in Radiology in 1978 and special training at japan in 1986 for cross sectional imaging. He received his fellowships in 1980. He received about twenty academic awards including community service award. He had been credited of being a Role model in teaching and got excellent teaching awards three times. He has more than 300 scientific and social science papers on his credit including conference presentations and publications. He has 118 invited/Keynote speeches at National and International level. His academic work and leadership have been widely recognized upon 72 areas such as chairman/facilitator in universities, editor and reviewer in many journals, scholar/leader in professional societies and associations.

Maryam Hammad, M.Phil Psychology
Lecturer of Psychology
International Islamic University Islamabad Pakistan

Maryam Hammad, Clinical and Forensic psychologist, completed her M.Phil Psychology from National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan, in 2003. She got 1st position (Gold Medalist) in M.Sc. Psychology from Bahauddin Zakariya University, Multan. Currently she is working as a lecturer in the department of psychology in International Islamic University, Islamabad. She has supervised many MPhil, Diploma and MSc students at different universities. Maryam has research interest centered on clinical and forensic psychology, and authored many papered in peer-reviewed scientific journals over the course of her academic career. She wrote research reports on DSM-IV (Diagnostic and Statistical Manual on Mental Disorder) and Drug Addition among Students. She has also presented her research in many national and international conferences. She is interested in different fields of psychology like, Forensic psychology, Clinical psychology, Social Psychology, School Psychology and Community Psychology.

Editorial Board Members

Professor Okezie I Aruoma, USA

Professor RK Marya, Malaysia

Professor Bharat B Aggarwal, USA

Professor Braj Bhushan, India

Professor Vatsala Misra, India

Dr. Sandipt Hindocha, UK

Dr. Asif Ansari, USA

Dr. Venkat Rajasurya, USA

Dr. Arun Gulani, USA

Note: Some rights reserved. The materials of this electronic journal are copyrighted © by Dr. Arun Kumar Agnihotri “A K S Publication”. No part of this publication may be reproduced by any means without the written permission of the copyright holder. The readers of this journal are free to download, copy, print, distribute and display the work provided; they must give the original author credit, not use this work for commercial purpose, and not alter, transform, or build upon this work.