Measurement in Comparative Effectiveness Research

Comparative effectiveness research (CER) on preventive services can shape policy and help patients, their providers, and public health practitioners select regimens and programs for disease prevention. Patients and providers need information about the relative effectiveness of various regimens they may choose. Decision makers need information about the relative effectiveness of various programs to offer or recommend. The goal of this paper is to define and differentiate measures of relative effectiveness of regimens and programs for disease prevention. Cancer screening is used to demonstrate how these measures differ in an example of two hypothetical screening regimens and programs.     

Chronic Active Hepatitis and Pregnancy: A Report of Two Cases in Adolescence

The course and outcome of pregnancy in two adolescents with chronic active hepatitis is described. Pregnancy was uneventful in both patients apart from mild biochemical deterioration in one patient. Both infants are entirely normal. One mother died 4 1/2 months after delivery from primary pulmonary hypertension, an extrahepatic manifestation of her chronic active hepatitis. The second patient is asymptomatic but bas evidence of ongoing liver disease 26 months postdelivery.     

Viral protein U counteracts a human host cell restriction that inhibits HIV-1 particle production

Human cells resist viral infections by a variety of mechanisms. Viruses must overcome host cell restrictions to successfully reproduce their genetic material. Here, we identify a host restriction to viral replication that acts at the stage of particle assembly. Viral protein U (Vpu) is an HIV-1 accessory protein that enhances particle assembly and release in most human cells, but not in simian cells. By using human-simian cell heterokaryons, we show that the inhibition of assembly in human cells is dominant. Vpu overcomes the block to assembly in human cells and in human-simian heterokaryons. The HIV-1 vpu gene may have evolved to counteract an assembly restriction that is present in human cells.     

Structural and magnetic study of undoped and cobalt doped TiO2 nanoparticles

The present study investigates the influence of cobalt doping on the structural and magnetic properties of TiO₂ nanoparticles prepared by a simple wet chemical method. The single phase anatase structure of Co-doped TiO₂ nanoparticles was confirmed by X-ray powder diffraction. A morphological study using scanning electron microscopy and transmission electron microscopy indicates the formation of TiO₂ nanoparticles of sizes 6–10 nm. The high resolution TEM image shows clear lattice fringes indicating the highly crystalline nature of the nanoparticles which was further analysed by selected area electron diffraction pattern which indicates a polycrystalline nature of anatase TiO₂. The shifting and broadening of the most intense E_g (1) mode in micro-Raman study of Co-doped TiO₂ nanoparticles and XPS spectra indicate the incorporation of Co in TiO₂. Magnetic measurement shows ferromagnetic behavior at room temperature in undoped TiO₂ which has originated due to the presence of oxygen vacancies which are intrinsic in nature. But the M–H curve of Co-doped TiO₂ shows the coexistence of ferromagnetic and paramagnetic phases with enhanced magnetization. The enhancement in magnetization has arisen due to Co doping and the paramagnetism may be due to the presence of some undetected clusters of oxides of cobalt.

The present study investigates the influence of cobalt doping on the structural and magnetic properties of TiO₂ nanoparticles prepared by a simple wet chemical method.     

Smartphone-based kanamycin sensing with ratiometric FRET

Smartphone-based fluorescence detection is a promising avenue for biosensing that can aid on-site analysis. However, quantitative detection with fluorescence in the field has been limited due to challenges with robust excitation and calibration requirements. Here, we show that ratiometric analysis with Förster resonance energy transfer (FRET) between dye pairs on DNA aptamers can enable rapid and sensitive kanamycin detection. Since our detection scheme relies on ligand binding-induced changes in the aptamer tertiary structure, it is limited only by the kinetics of ligand binding to the aptamer. Our FRET-based kanamycin binding aptamer (KBA) sensor displays two linear ranges of 0.05–5 nM (detection limit of 0.18 nM) and 50–900 nM of kanamycin. The aptamer displays high specificity even in the presence of the ‘natural’ background from milk. By immobilizing the aptamer in the flow cell, our KBA sensor design is also suitable for repeated kanamycin detection. Finally, we show that the ratiometric FRET-based analysis can be implemented on a cheap custom-built smartphone setup. This smartphone-based FRET aptamer scheme detects kanamycin in a linear range of 50–500 nM with a limit of detection (LOD) of 28 nM.

FRET aptamer based kanamycin detection enables reusable and smartphone sensing.     

Short-term glucose dysregulation following acute poisoning with organophosphorus insecticides but not herbicides,carbamate or pyrethroid insecticides in South Asia

Background: Ingestion of organophosphorus (OP) insecticides is associated with acute hyperglycaemia. We conducted a prospective study to determine whether glucose dysregulation on admission associated with ingestion of OP insecticides or other pesticides is sustained to hospital discharge or to 3–12 months later.

Methods: We recruited participants to two similar studies performed in parallel in Anuradhapura, Sri Lanka, and Chittagong, Bangladesh, following hospitalisation for OP insecticide, herbicide or other pesticide self-poisoning. Two-hour 75?g oral glucose tolerance testing (OGTT) was performed after recovery from the acute poisoning, at around the time of discharge. In Sri Lanka, a four time-point OGTT for area-under-the-curve (AUC), C-peptide and homeostatic modelling of insulin resistance (HOMA-IR) was undertaken, repeated after 1 year. In Bangladesh, a 2-h OGTT for glucose was undertaken and repeated after 3 months in participants with initial elevated 2-h glucose. We compared glucose homeostasis by poison group and adjusted findings for age, BMI and sex.

Findings: Seventy-three Sri Lankan and 151 Bangladeshi participants were recruited. We observed higher mean [SD] fasting (4.91 [0.74] vs. 4.66 [0.46] mmol/L, p?=?.003) and 2-h glucose (7.94 [2.54] vs. 6.71 [1.90] mmol/L, p?p?=?.352; 2-h glucose 6.96 [2.31] mmol/L vs. 6.27 [1.86] mmol/L, p?=?.225).

Conclusion: We found in this small prospective study that acute OP insecticide poisoning caused acute glucose dysregulation that was sustained to hospital discharge but had recovered by 3–12 months. Acute glucose dysregulation was related to defects in insulin action and secretion. This study did not address long-term risk of diabetes following acute OP insecticide poisoning, but could provide the data for a power calculation for such a study     

Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai

Background:

Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program''s potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people.

Objectives:

To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV.

Materials and Methods:

A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire.

Results:

In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV).

Conclusion:

Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India.