Recreational use assessment of water-based activities, using time-lapse construction cameras

Recreational exposure to surface waters during periods of increased pathogen concentration may lead to a significantly higher risk of illness. However, estimates of elementary exposure factors necessary to evaluate health risk (i.e., usage distributions and exposure durations) are not available for many non-swimming water-related activities. No prior studies have assessed non-swimming water exposure with respect to factors leading to impaired water quality from increased pathogen concentration, such as weather condition (rain events produce increased runoff and sewer overflows) and type of day (heavy recreational periods). We measured usage patterns and evaluated the effect of weather and type of day at eight water sites located within Philadelphia, by using a novel "time lapse photography" technology during three peak recreational seasons (May-September) 2008-2010. Camera observations validated with simultaneous in-person surveys exhibited a strong correlation (R(2)=0.81 to 0.96) between the two survey techniques, indicating that the application of remote photography in collecting human exposure data was appropriate. Recreational activities usage varied more on a temporal basis than due to inclement weather. Only 14% (6 out of 44) of the site-specific activity combinations showed dry weather preference, whereas 41.5% (17 out of 41) of the combinations indicated greater usage on weekends as compared with weekday. In general, the log normal distribution described the playing and wading duration distribution, while the gamma distribution was the best fit for fishing durations. Remote photography provided unbiased, real-time human exposure data and was less personnel intensive compared with traditional survey methods. However, there are potential limitations associated with remote surveillance data related to its limited view. This is the first study to report that time lapse cameras can be successfully applied to assess water-based human recreational patterns and can provide precise exposure statistics for non-swimming recreational exposures.     

Comparison of different regimes of misoprostol for the termination of early pregnancy failure

Background

Nearly 20% of all confirmed pregnancies end in spontaneous abortion. Misoprostol's use in early pregnancy failure is varied and dose and route are not well established. The aim of this study was to compare the efficacy and the side effects of different regimes of misoprostol in causing expulsion of products of conception in early pregnancy failure.

Method

Women patients with an ultrasound diagnosis of early pregnancy failure, less than 12 weeks gestation were divided into two, Group-A: tab. Misoprostol 800 mcg 6 hourly vaginally, upto 3 doses. Group-B tablet misoprostol 600 mcg 6 hourly, sublingually for 3 doses. All observations were noted and statistical analyzed.

Results

Mean gestational age was 7.93 weeks. Mean induction abortion interval 18.183 h. Women patients with less than six weeks gestational age had least mean induction-abortion interval time, 15.75 ± 2.82 h in vaginal group but was highest in sublingual group 22 ± 2 h and 18.43 h in overall (P = 0.02). Though after 8 weeks, both routes were equally effective. Mean dose required in group-A was 20044 mcg and in group-B was 1564 mcg (P < 0.001). Efficacy of protocol was 88.89% in group-A and 92.85% in group-B.

Conclusion

Both regimes had comparable efficacy, acceptability (90%) and side effects. In women patients less than six weeks period of gestation, the vaginal (800 mcg) route was distinctly superior, in women patients with 6–8 weeks the sublingual (600 mcg) route was more advantageous. The correct dose must be used for the route chosen. The route of administration should be decided in accordance with the preference of the patient and the clinical situation.     

Cost-effective smart microfluidic device with immobilized silver nanoparticles and embedded UV-light sources for synergistic water disinfection effects

A novel microfluidic-device for water disinfection via diverse physiochemical effects has been demonstrated. Firstly, a microfluidic device with embedded, multiple germicidal UV-LEDs was fabricated through the innovatively modified cost-effective soft-lithography process. Further, synthesised silver nanoparticles were immobilized within its inner microchannel surface. Disinfection results proved the synergistic bactericidal effect of coated AgNPs and coupled UV-light, while a suspension of bacterial strains, were passed through the micro-device.

A novel microfluidic-device for water disinfection via diverse physiochemical effects has been demonstrated.

The expansion of micro-devices, with different functionalities, is the need of the hour. In particular, cost-effective disinfection of water can profoundly affect the health of the developing world particularly children and is expected to have a huge market. Currently, a large number of water purification systems are commercially available, with effective performance; however, they are exceedingly costly and have heavy maintenance costs for their successful operation. In various distinct approaches a UV light source or silver metal has been used for water purification in large scale water purification systems.In one of the earlier studies, the antimicrobial activity of a doped hydroxyapatite/polydimethylsiloxane (Ag: HAp-PDMS) composite layer, obtained by the thermal evaporation technique, proved to be active against Candida albicans.¹ According to Shekhar Agnihotri et. al., the bacteriostatic/bactericidal effect of AgNPs were size and dose-dependent and for AgNPs.² However, in these studies, they did not immobilize the nanoparticles on any surface, rather they have directly used the nanoparticles in suspension-form to conduct the analysis.² Ping Y. Furlan et. al. designed a bifunctional activated carbon nanocomposite with incorporated nanoscale-sized magnetic magnetite and antimicrobial silver nanoparticles (MACAg) and tested its antimicrobial efficacy against Escherichia coli (E. coli). They concluded that only Ag nanoparticles and Ag⁺ ions showed antimicrobial activities.³ Joong Hyun Kim et. al., conducted in situ fabrication of AgNPs on the surface of PDMS and found the effective antibacterial activity of the nanocomposites against both E. coli and S. aureus. Also, the nanocomposites were observed to have no cellular toxicity and thus could be used as implants for medical devices.⁴ G. Ipek Yucelen and team presented a novel approach to synthesize silver nanoparticles on aluminosilicate nanotubes by decomposition of AgNO₃ solution to AgNPs at room temperature and found this hybrid to show strong antibacterial activity towards Staphylococcus epidermidis and Escherichia coli.⁵ The AgNP sheets (AgNPs deposited on the cellulose fibres of an absorbent blotting paper) exhibited antibacterial properties toward suspensions of Escherichia coli and Enterococcus faecalis, when these pathogenic bacteria were inactivated during percolation through the sheet.⁶ A water filter was coated with silver paint to form silver ions (Ag⁺) for killing the bacteria present in dirty water and make it drinkable. An overview of nanomaterials for water and wastewater treatment had been recently presented by Haijiao Lu et al.⁷ Alexandru Rus et. al. designed a filter using additive manufacturing techniques and coated it with different concentrations of silver solutions.⁸The performance of the world''s first commercial UV-C LED water disinfection reactor (the Pearl Aqua by Aquisense) was compared with an existing chlorination system and all the tests showed the reactor equivalent to the chlorination system in all aspects.⁹ Andrej Gross and team investigated light guidance capabilities of optical pure quartz glass with UV-C LEDs and found the system to show increased disinfection efficiency when tested against Escherichia coli and Bacillus subtilis.¹⁰ In this approach, they have used the phenomenon of total internal reflection of UV-C irradiation for disinfecting water, in which they have coupled UV-C LEDs to a quartz tube and a glass tube for conducting the analysis.¹⁰Further, none of the abovementioned approaches, in earlier reported study, has demonstrated the cumulative disinfection effect of UV-light source, as well as, silver nano-particle, at micro-scale. Unfortunately, none of the existing water disinfection methods provides a crucial combination of key requirements such as high antimicrobial efficiency, low cost, easy maintenance and scalability to both small and large scale. In our premiere approach, a novel cost-effective microfluidic device for water disinfection, with multiple physiochemical effects has been projected in the current study for effective and faster disinfection.The water disinfection system described here, resolves such problems by providing a simple, cost-effective and efficient water disinfection method with the utilization of silver nanoparticles and ultraviolet (UV) light in a microfluidic system via a synergistic effect. The bacteria-infested water was disinfected in the microscopic volumes per unit time. Further, similar multiple microchannels can be arranged in a parallel manner to obtain the required flow rate and quantity of water, needed to be disinfected. The system also ensures safety against silver leakage and excessive human exposure to ultraviolet (UV) light.     

Spontaneous cryptococcal peritonitis with fungemia in patients with decompensated cirrhosis: Report of two cases

Cryptococcus neoformans is encapsulated yeast that predominately infects immunocompromised individuals. Liver disease is an under-recognized predisposition for cryptococcal disease. We report two nonalcoholic, nondiabetic, and human immunodeficiency virus - negative cirrhotic patients, with spontaneous cryptococcal peritonitis. Cryptococcus infection was diagnosed by culture of ascitic fluid and peripheral blood in both. We treated the first patient with amphotericin-B, but he expired. The second patient with earlier diagnosis, survived to discharge with fluconazole treatment. We suggest a high clinical suspicion for Cryptococcus as a possible etiology of spontaneous peritonitis in cirrhotic patients.     

Randomised Comparative Study on Propofol and Diazepam as a Sedating Agent in Day Care Surgery

Objective

The study was conducted to assess the usefulness by qualitative comparison between the two intravenous sedative drugs, Diazepam and Propofol and to provide sedation in apprehensive and uncooperative patients undergoing day care oral surgical procedures.

Methods

The present study was conducted on 20 adult patients, 10 in each group (Propofol and Diazepam) irrespective of age and sex. Intravenous sedation of Propofol compared with Diazepam in terms of onset of action, recovery, and anterograde amnesia, patient co-operation, surgeon’s convenience and side effects and other parameters.

Results

Propofol was found to be the superior sedating agent compared to Diazepam, having rapid onset and predictability of action, profoundness of amnesia and a faster recovery period, offering advantages of early patient discharge and better patient compliance.

Conclusion

Propofol was found to be an ideal sedating agent in day care oral surgical procedures.     

Expectations for Phase-Appropriate Drug Substance and Drug Product Specifications for Early-Stage Protein Therapeutics

Early-phase specifications are established to ensure that materials used in clinical studies have appropriate product quality, reducing the risk of harm to patients. Currently, guidance is available for specification setting practices at commercial phase. With very limited data and manufacturing experience available, it is not possible to fully align to these expectations at the start of clinical trials. A survey was performed among 19 biopharmaceutical companies to gather information about the current practices for setting specifications in early-phase development. The results indicate that most companies develop platform approaches to support setting specifications at the first-in-human clinical trial stage of development. Based on shared learning across multiple companies, example specification approaches for monoclonal antibodies and antibody-drug conjugates are included. General principles of the example specifications can also be applied to other protein therapeutics and vaccines. Strategies for justification of acceptance criteria are described, along with discussion of considerations for some specific tests. Options for use of non-numerical acceptance criteria are also discussed. While specifications for each molecule must be set considering available molecule-specific information, the presented information leverages shared learning from multiple companies, to provide guidance for early phase specification setting strategies.     

The influence of aerobic fitness on cerebral white matter integrity and cognitive function in older adults: Results of a one‐year exercise intervention

Cerebral white matter (WM) degeneration occurs with increasing age and is associated with declining cognitive function. Research has shown that cardiorespiratory fitness and exercise are effective as protective, even restorative, agents against cognitive and neurobiological impairments in older adults. In this study, we investigated whether the beneficial impact of aerobic fitness would extend to WM integrity in the context of a one‐year exercise intervention. Further, we examined the pattern of diffusivity changes to better understand the underlying biological mechanisms. Finally, we assessed whether training‐induced changes in WM integrity would be associated with improvements in cognitive performance independent of aerobic fitness gains. Results showed that aerobic fitness training did not affect group‐level change in WM integrity, executive function, or short‐term memory, but that greater aerobic fitness derived from the walking program was associated with greater change in WM integrity in the frontal and temporal lobes, and greater improvement in short‐term memory. Increases in WM integrity, however, were not associated with short‐term memory improvement, independent of fitness improvements. Therefore, while not all findings are consistent with previous research, we provide novel evidence for correlated change in training‐induced aerobic fitness, WM integrity, and cognition among healthy older adults. Hum Brain Mapp 34:2972–2985, 2013. © 2012 Wiley Periodicals, Inc.     

Impact of genomic assays on treatment and outcomes in locally advanced breast cancer

Breast Cancer Research and Treatment - Genomic profiling in early-stage breast cancer provides prognostic and predictive information. Genomic profiling assays have not been validated in locally...     

Atypical presentation of ectopia lentis in Marfan’s syndrome

The purpose of this article is to report an unusual bilateral inferior subluxation of the lens in a patient with Marfan’s syndrome. A 14-year-old boy presented with gradual painless diminution of vision in both eyes. His family history showed that his maternal uncle also had similar complaints. Systemic examination of the patient revealed no neurological deficits. Cardiovascular system examination was unremarkable. Hands and fingers were long and slender with hyperflexible joints. The ratio of arm spam to height was 1.06. He was myopic with a best-corrected visual acuity of 6/24 with ?11 D spherical/? 2 D cylindrical in both eyes. Anterior chambers were deep with the presence of mild iridodonesis in both eyes. Pupillary reactions were sluggish. On pupillary dilatation, the lens was found to be subluxated inferiorly which is unlike the typical superotemporal subluxation of the lens in Marfan’s syndrome. The diagnosis of Marfan’s syndrome is usually made on clinical examination only, as there is no specific investigation for this condition; however, it may have atypical presentations. Therefore, it is important to recognize and report such atypical cases.