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Mya MM, Saxena RK, Bhakat P, Roy A. Effect of serum dilution in diagnosis of malaria in community. THE JOURNAL OF COMMUNICABLE DISEASES 2000; 32:28-32. [PMID: 11129562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Recently, it has been shown that immunological methods can be used for the diagnosis of malaria other than sero-epidemiology. A study has been done to investigate optimum binding capacity of antigen-antibody (Ag-Ab) at different serum dilutions. For validating antigen-antibody (Ag-Ab) reaction at 1:100, 1:1000 and 1:1000 serum dilutions, have been tested in two different laboratories to establish validation of the ELISA method. Inter laboratory test on synthetic peptide (RI) ELISA was found comparable and meaningful for assessing malaria transmission in defined locality at 1:100 dilution. Results also showed that 1:1000 serum dilution can be useful for diagnostic purpose.
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78
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Kidwai M, Bhushan KR, Sapra P, Saxena RK, Gupta R. Alumina-supported synthesis of antibacterial quinolines using microwaves. Bioorg Med Chem 2000; 8:69-72. [PMID: 10968266 DOI: 10.1016/s0968-0896(99)00256-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
7-(5'-Alkyl-1',3',4'-thiadiazol/oxadiazol-2'-ylthio)-6 -fluoro-2,4-dimethylquinolines and 3-formyl-2-(2'-hydroxy- 1',4'-naphthoquinon-3'-yl)-4-methyl/6-methyl/7-quinolines have been synthesised by the reaction of 5-alkyl-1,3,4-thiadiazol/oxadiazol-2-thiols with 7-chloro-6-fluoro-2,4-dimethylquinoline and by the reaction of 2-hydroxy-1,4-naphthoquinone with 2-chloro-3-formyl-4-methyl/6-methyl/7-methyl/8-methylquinolines respectively on basic alumina using microwaves, the reaction time has been brought down from hours to seconds with improved yield as compared to conventional heating. The compounds were tested for their in vitro antibacterial activity. All compounds showed promising antibacterial activity. The best activity was observed by compounds 3a and 3f.
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79
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Dhillon S, Saxena RK. Upregulation of KIR expression on murine bone marrow cells by paraformaldehyde fixed tumor cells. Immunol Lett 1999; 70:157-63. [PMID: 10656668 DOI: 10.1016/s0165-2478(99)00153-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We have previously shown that the activation of mouse spleen NK cells by IL2 is markedly boosted if paraformaldehyde fixed tumor target cells are added during the activation phase. In the present study, we have shown that such a boosting effect is not seen if mouse bone marrow (BM) cells are used instead of spleen cells. Addition of fixed tumor cells (1:100 ratio of tumor cells to BM cells) however resulted in a marked increase in the expression of Ly49 molecules on BM cells. The enhancement of Ly49 expression was not seen if fixed allogeneic BM cells were added, suggesting that Ly49 upregulation was tumor specific. Expression of Ly49A as well as Ly49C isotypes were augmented by fixed tumor cells. Moreover, increased Ly49 expression was seen on cell populations expressing TCRbeta as well as NK1.1 markers. These results indicate that exposure to tumor cells may be an important factor regulating KIR expression on NK and T cells. Implications of these results are discussed.
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80
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Saxena RK, Adler WH. Cytolytic activity of mitogen activated old and young mouse spleen cells against tumor target cells expressing high or low levels of Fas antigen. Exp Mol Med 1999; 31:137-41. [PMID: 10551262 DOI: 10.1038/emm.1999.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Sensitivity of Fas expressing tumor cells (high levels in Hut78 & Jurkat; low levels in P815) toward the cytotoxic Con-A (5 microg/ml) activated spleen cells from young (12 to 16 week old males) and old (2 year old males) mice were studied. The spleen cells from young mice activated for a day showed high levels of cytotoxic activity against Hut78 and Jurkat cell lines but not against P815 cells. The cytotoxic activity against P815 cells were detected in the spleen cells from old but not young mice following a longer period of Con-A activation (three days). Comparable levels of cytotoxic activity against Hut78 and Jurkat cells were observed in the spleen cells from both young and old mice following three days of activation. Treatment of Hut78 cells with anti-Fas antibody affected the tumor cells become resistant against the cytotoxic activity of the spleen cells from young mice in a dose dependent manner however P815 cells were not affect by the anti-Fas antibody treatment. These results show that there are differences in the sensitivity of target tumor cells toward Con-A induced cytotoxic spleen cells from young and old mouse. Mitogen-induced cytotoxic lymphocytes from young mouse spleen appear to kill targets through mechanisms involving Fas antigen, specially, in early stage (1 day) of activation. Old mouse spleen cells generated high levels of cytotoxic cells in later phase (3 days), which appear to kill through Fas-unrelated mechanisms.
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81
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Ahuja P, Gupta R, Saxena RK. Sorption and desorption of cobalt by Oscillatoria anguistissima. Curr Microbiol 1999; 39:49-52. [PMID: 10387117 DOI: 10.1007/pl00006826] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Oscillatoria anguistissima rapidly adsorbs appreciable amounts of cobalt from the aqueous solutions within 15 min of initial contact with the metal solution. O. anguistissima showed a high sequestration of cobalt at low equilibrium concentrations, and it followed the Freundlich model of adsorption. The adsorption is a strongly pH-dependent and temperature-independent phenomenon. The presence of Mg2+ and Ca2+ (100-200 ppm) resulted in decline in Co2+ adsorption capacity of Oscillatoria biomass. Sulphate and nitrate (0. 75-10 mM) drastically reduced the extent of Co2+ biosorption. The biosorption of cobalt is an ion-exchange process as the Co2+ binding was accompanied by release of a large amounts of Mg2+ ions. Na2CO3 (1.0 mM) resulted in about 76% desorption of Co2+ from the loaded biomass.
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Sharma DR, Gupta AK, Saxena RK, Mohan C, Sharma ML. Audiovestibular changes in diabetes mellitus. Indian J Otolaryngol Head Neck Surg 1999; 51:40-4. [PMID: 23119514 PMCID: PMC3451529 DOI: 10.1007/bf02997988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Audiovestibular functions in 50 cases of diabetes mellitus have been evaluated to find out the type of hearing loss. Diabetes mellitus causes a significant bilateral symmetrical hearing loss at higher frequencies and with the progress of disease and added complications the hearing further deteriorates. On control of diabetes hearing changes are found to be irreversible. However vestibular functions remain uninvolved in cases of diabetes mellitus. A direct correlation was found between hearing loss and increasing blood sugar level.
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83
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Puri N, Saxena RK. Induction of proliferation in resting B-cells by a factor released by activated mouse spleen cells. Exp Mol Med 1998; 30:199-204. [PMID: 9894149 DOI: 10.1038/emm.1998.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Mouse spleen cells activated in a mixed lymphocyte reaction release a soluble factor, which induces a significant proliferative response in fresh mouse spleen cells. This proliferation inducing factor (PIF) was found to be heat stable (90 degrees C for 45 min) and also resistant to trypsin or chymotrypsin treatment. By using a sizing HPLC column, the molecular weight of PIF appears to be 25 kDa. Mouse spleen cells treated with anti-thy-1 + complement lost Con-A induced proliferative responses but responded well to PIF. B cell depleted spleen cells obtained by negative selection panning, did not respond to PIF. These results indicate that B cells proliferated in response to PIF. Polymixin-B, which blocks the B cell proliferative response to LPS, did not inhibit PIF induced proliferation.
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84
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Yadav RP, Saxena RK, Gupta R, Davidson WS. Purification and characterization of a regiospecific lipase from Aspergillus terreus. Biotechnol Appl Biochem 1998; 28 ( Pt 3):243-9. [PMID: 9799723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Aspergillus terreus lipase was purified to homogeneity with 18.0% yield. The specific activity of the enzyme increased from 20.80 to 250 U/mg of protein. Ion exchange on Q-Sepharose was highly effective in the purification process. The molecular mass of the purified enzyme was 41+/-1 kDa as determined by SDS/PAGE. The purified lipase showed excellent temperature tolerance (15-90 degreesC) and was highly thermostable, retaining 100% activity at 60 degreesC for 24 h. It showed good pH tolerance (3.0-12.0) and was stable over a pH range of 4.0-10.0 for 24 h. The activity of the enzyme was inhibited by ionic detergents, whereas non-ionic detergents stimulated enzyme activity. Mg2+ and Ca2+ ions stimulated lipase activity, whereas Co2+, Cu2+, Ni2+ and Fe3+ ions caused inhibition. The enzyme was unaffected by the metal chelator EDTA or by 2-mercaptoethanol and potassium ferrocyanide. At a concentration of 100 microM, 3,4-dichloroisocoumarin caused weak inhibition with 40% loss of activity, but diethyl p-nitrophenyl phosphate at the same concentration strongly inhibited enzyme activity (98.12% loss of activity), confirming that the A. terreus lipase is a serine hydrolase. The lipase was highly active on pig fat (151% relative activity) and groundnut oil (103% relative activity) and least active on kusum oil (18% relative activity). Extensive dialysis did not affect enzyme activity up to 168 h, suggesting the absence of any dialysable cofactor in the enzyme. The A. terreus lipase retained significant activity on freeze-drying and had a shelf-life of more than 6 months at room temperature. The A. terreus lipase exhibited 1,3-regiospecificity and was stable in various organic solvents.
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Yadav RP, Saxena RK, Gupta R, Davidson S. Lipase production by Aspergillus and Penicillium species. Folia Microbiol (Praha) 1998; 43:373-8. [PMID: 9821291 DOI: 10.1007/bf02818576] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Forty each of aspergilli and penicillia were screened for extracellular lipase production on agar plates and in liquid medium containing olive oil as substrate. Twenty-nine aspergilli and twenty-six penicillia produced lipase. Out of these, 19 aspergilli and 22 penicillia showed activity both on Nile blue sulfate and glycerol tributyrate agar plates while only 10 aspergilli and 4 penicillia showed a positive response to glycerol tributyrate agar alone. The screening revealed 11 Aspergillus spp. and 15 Penicillium spp. as new lipase producers. Pig fat as an economic substrate for lipase production was also investigated.
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Saxena RK. Continuing education in immunology. IMMUNOLOGY TODAY 1998; 19:437. [PMID: 9785664 DOI: 10.1016/s0167-5699(98)01356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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87
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Dhillon S, Saxena RK. Tumor specific boosting of IL-2 induced NK activation by paraformaldehyde fixed tumor cells. Immunol Lett 1998; 63:153-8. [PMID: 9840684 DOI: 10.1016/s0165-2478(98)00069-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
NK activation in C57B1/6 mouse spleen cells was carried out with IL-2 in the presence or absence of paraformaldehyde fixed YAC tumor cells. Generation of anti-YAC cytolytic activity was markedly higher when activation was carried out in the presence of fixed tumor cells. In addition the cytotoxic effector cells generated were resistant to anti-Thy-1 + C treatment, indicating that the effector cells were not T lymphocytes. IL-2 activation of NK cells was compared When fixed YAC or EL4 tumor cells were added during the IL-2 activation phase, it was found that the addition of either of these tumor cells significantly boosted the levels of cytotoxic activity generated against both targets. Significantly higher anti-YAC cytotoxic activity was however generated when fixed YAC cells instead of EL4 cells were present during the activation phase. Similarly, significantly greater cytolytic activity was generated against EL4 cells, when fixed EL4 rather than YAC cells were present during the activation phase. Addition of paraformaldehyde fixed syngeneic or allogenic spleen cells instead of tumor cells, did not boost NK activation in response to IL-2, indicating that the boosting of NK activation did not result from exposure to alloantigens during the activation phase. These results indicate that an exposure to tumor cells during IL-2 activation phase, may boost the activation of NK cells in a tumor specific manner.
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Parmar VS, Kumar A, Pati HN, Saxena RK, Davidson S, Gupta R. Potential use of a novel lipase from Aspergillus carneus in deacetylation reactions. BIOCHIMICA ET BIOPHYSICA ACTA 1998; 1387:325-30. [PMID: 9748644 DOI: 10.1016/s0167-4838(98)00148-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A novel lipase from Aspergillus carneus has been used in organic solvents for efficient regioselective and chemoselective deacetylation of the peracetates of polyphenolic aromatic ketones, esters and amides. A reversal of regioselectivity was observed as compared with the results obtained during deacetylation with porcine pancreatic lipase (PPL).
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Puri N, Saxena RK. Partial purification and characterization of a novel murine factor that augments the expression of class I MHC antigens on tumor cells. Exp Mol Med 1998; 30:93-9. [PMID: 9873829 DOI: 10.1038/emm.1998.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A soluble factor which augments the expression of major histocompatibility complex class I (MHC I) antigens on a number of murine tumor cell lines, has been isolated from the culture supernatants of mixed lymphocyte reaction of spleen cells derived from C57B1/6, Balb/c and Swiss mice. The factor, termed MHC-augmenting factor (MHC-AF) has been partially purified by Sephadex G-100 column chromatography and reverse phase HPLC. MHC-AF activity is associated with an 18 kDa molecule. MHC-AF activity was resistant to pH 2.0 treatment and partially purified MHC-AF preparations did not have any activity in L929 cell/vesicular stomatitis virus (VSV) interferon bioassay system. Antibodies to IFN-gamma did not block the activity of MHC-AF. These results indicate that a MHC-AF distinct from IFN-gamma, is produced by mouse spleen cells undergoing a mixed lymphocyte reaction.
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Raval A, Puri N, Rath PC, Saxena RK. Cytokine regulation of expression of class I MHC antigens. Exp Mol Med 1998; 30:1-13. [PMID: 9873816 DOI: 10.1038/emm.1998.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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92
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Saxena RK, Agarwal K, Sahay KB, Guha SK, Dave PK. Interplay of matrices in cartilage synovial fluid combine under moderate & high loadings. Indian J Med Res 1998; 107:123-7. [PMID: 9599951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Interplay of the constituents of the articular cartilage synovial fluid combine and its role was examined through the biochemical and rheological studies on bovine joints. The results showed an inverse relationship between the changes in the hyaluronic acid of synovial fluid and the proteoglycans content in articular cartilage together with alterations in the rheological properties of synovial fluid. The study indicated that the inter-movement of fluid solutes across the cartilage and synovial fluid may have an important role in the pathophysiology of osteoarthritis.
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Abstract
Oscillatoria anguistissima rapidly adsorbs Cu2+ from aqueous solution. The adsorption of Cu2+ followed Freundlich Isotherm, and the amount of Cu2+ removed from solution increased with increasing Cu2+ concentration. The adsorption is pH dependent, and maximum Cu2+ removal occurs at pH 5. Of the various pretreatments, HCl treatment of the biomass increased the capacity for Cu2+ removal. Presence of Mg2+ and Ca2+ resulted in decline in the Cu2+ adsorption capacity of Oscillatoria cells. This species could also effectively remove Cu2+ from mine water containing 68.4 microg/ml of Cu2+ at pH 3.45.
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Saxena RK. Biomedical research funding in India. THE NATIONAL MEDICAL JOURNAL OF INDIA 1997; 10:105-6. [PMID: 9230596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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95
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Haridas V, Saxena RK. Mechanism of interaction of pH 3.0 treated tumor cells expressing lower levels of class I MHC antigens, with IL-2 activated NK cells. Immunol Lett 1997; 55:167-71. [PMID: 9161883 DOI: 10.1016/s0165-2478(97)02703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Effect of lowering the levels of class I MHC antigens, on the ability of three murine (YAC, P815, SP2O) and three human (Molt4, Raji, HR7) tumor cell lines, to compete in cold target inhibition assays, was studied. Specific reduction in class I MHC levels (range 60-76%) was induced by brief exposure to citrate buffer (pH 3.0). Susceptibility of the acid pH treated tumor cells to lysis by IL-2 activated NK cells, was found to be significantly increased in all cases with the exception of YAC cells. Reduction in class I MHC antigen expression by acid pH treatment, had no significant effect on competing ability of the tumor cells. In contrast, tumor cells on which MHC class I antigens were upregulated by interferon treatment, had significantly lower ability to compete. These results suggest that the mechanisms of altered interactions between MHC I up or down regulated target cells may be different. A model compatible with increased NK susceptibility along with an unaltered ability to compete for acid pH treated tumor cells, has been proposed.
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Kuhad RC, Singh A, Tripathi KK, Saxena RK, Eriksson KE. Microorganisms as an alternative source of protein. Nutr Rev 1997; 55:65-75. [PMID: 9170892 DOI: 10.1111/j.1753-4887.1997.tb01599.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Demand for human food and animal feed proteins from nonconventional sources has increased, particularly in developing countries. Microbial protein is one such source. It is desirable because it is amenable to controlled intensive cultivation and is less dependent on variations in climate, weather, and soil. Microbial proteins must be evaluated for nutritive value, safety, and economic considerations before mass production is undertaken.
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97
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98
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Gulati R, Saxena RK, Gupta R. A rapid plate assay for screening L-asparaginase producing micro-organisms. Lett Appl Microbiol 1997; 24:23-6. [PMID: 9024001 DOI: 10.1046/j.1472-765x.1997.00331.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A pH and dye-based fast procedure for screening L-asparaginase producing micro-organisms is reported. The procedure is suitable for bacterial and fungal screening. The results are obtained within 24 and 48 h for bacteria and fungi, respectively. The results correlate with quantitative estimations in culture broths.
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Saxena RK, Collins GD, Chrest JF, Adler WH. Bcl-2 transfection protects Hut78 cell line from different types of cytotoxic effector cells. Immunol Lett 1996; 52:95-8. [PMID: 8905402 DOI: 10.1016/0165-2478(96)02590-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human T lymphoma cell line Hut78 was transfected with Bel-2 gene or with control G418 Neomycin resistance-conferring plasmid. Bcl-2 transfected and Neomycin selected Hut78 cells expressed about ten-fold greater Bcl-2 protein than the neo-transfected controls. Susceptibility of Bcl-2-transfected Hut78 cells to human NK cells, human mixed lymphocyte reaction-generated cytotoxic effector cells, and mouse cytotoxic spleen cells generated by immunization with Hut78 cells was examined. In all systems tested, Bcl-2-transfected Hut78 target cells were significantly less susceptible to lysis than the neo-transfected control target cells. These results suggest that in Hut78 cells, Bcl-2 gene product may confer partial resistance to different types of cytotoxic effector mechanisms.
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Sahay KB, Saxena RK. Biomedical equipment and medical services in India. JOURNAL (ACADEMY OF HOSPITAL ADMINISTRATION (INDIA)) 1996; 8-9:7-9. [PMID: 10166967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Varieties of Biomedical Equipment (BME) are now used for quick diagnosis, flawless surgery and therapeutics etc. Use of a malfunctioning BME could result in faulty diagnosis and wrong treatment and can lead to damaging or even devastating aftermath. Modern Biomedical Equipments inevitably employ highly sophisticated technology and use complex systems and instrumentation for best results. To the best of our knowledge the medical education in India does not impart any knowledge on the theory and design of BME and it is perhaps not possible also. Hence there is need for a permanent mechanism which can maintain and repair the biomedical equipments routinely before use and this can be done only with the help of qualified Clinical Engineers. Thus there is a genuine need for well organized cadre of Clinical Engineers who would be persons with engineering background with specialization in medical instrumentation. These Clinical engineers should be made responsible for the maintenance and proper functioning of BME. Every hospital or group of hospitals in the advanced countries has a clinical engineering unit that takes care of the biomedical equipments and systems in the hospital by undertaking routine and preventive maintenance, regular calibration of equipments and their timely repairs. Clinical engineers should be thus made an essential part of modern health care system and services. Unfortunately such facilities and mechanism do not exist in India. To make BME maintenance efficient and flawless in India, study suggests following measures and remedies: (i) design and development of comprehensive computerized database for BME (ii) cadre of Clinical engineers (iii) online maintenance facility and (iv) farsighted managerial skill to maximize accuracy, functioning and cost effectiveness.
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