From nZVI to SNCs: development of a better material for pollutant removal in water

Abstract

Nanoscale zero-valent iron (nZVI), with its reductive potentials and wide availability, offers degradative remediation for environmental pollutants. However, weaknesses such as easy aggregation, easy oxidation, and nanoscale size have hindered its further applications in the environment to some extent. Therefore, various supported nZVI composites (SNCs) with higher dispersibility, enhanced water stability, and tunable size have been developed to overcome the weaknesses. SNCs family is a great alternative for water purification applications that require high removal efficiency and rapid kinetics, as a result of their multifunctional properties and magnetic separation capacity. In this review, we compare the advantages of SNCs to nZVI for pollutant removal in water, discuss for the first time the synthetic techniques of obtaining SNCs, and analyze the influencing factors and mechanisms associated with the removal of some typical hazardous pollutants (e.g., dyes, heavy metals, nitrogen, and phosphorus) using SNCs. Moreover, limitations and future research needs of such material are discussed. More attention should be paid to the evaluation of toxicity, development of green synthetic routes, and potential application areas of such materials in future research.

Exposure and risk analysis to particulate matter, metals, and polycyclic aromatic hydrocarbon at different workplaces in Argentina

Abstract

In order to estimate air quality at work environments from small and medium-sized enterprises (SMEs), we determined both the concentration of particulate matter (PM₁₀ and PM_2.5) and the presence of polycyclic aromatic hydrocarbons (PAHs), as the heavy metals in the composition of the particulate matter. Three SMEs located in the city of La Plata, Argentina, were selected: an electromechanical repair and car painting center (ERCP), a sewing work room (SWR), and a chemical analysis laboratory (CAL). The results evidenced high levels of PM exceeding the limits allowed by the USEPA and the presence of benzo(k)fluoranthene in all the analyzed sites and benzo(a)pyrene in the most contaminated site (ERCP). Regarding metals, the presence of Cd, Ni, Cu, Pb, and Mn, mainly in the fraction of PM_2.5, in the same workplace was found. As far as risk assessment at all the workplaces surveyed is concerned, risk values for contracting cancer throughout life for exposed workers (LCR) did not comply with the parameters either of USEPA or of WHO (World Health Organization).

Identifying Pseudoscience: A Social Process Criterion

Abstract

Many philosophers have come to believe there is no single criterion by which one can distinguish between a science and a pseudoscience. But it need not follow that no distinction can be made: a multifactorial account of what constitutes a pseudoscience remains possible. On this view, knowledge-seeking activities fall on a spectrum, with the clearly scientific at one end and the clearly non-scientific at the other. When proponents claim a clearly non-scientific activity to be scientific, it can be described as a pseudoscience. One feature of a scientific theory is that it forms part of a research tradition being actively pursued by a scientific community. If a theory lacks this form of epistemic warrant, this is a pro tanto reason to regard it as pseudoscientific.

Study of marine bacteria inactivation by photochemical processes: disinfection kinetics and growth modeling after treatment

Abstract

The importance of seawater treatment in order to avoid microbiological pollution related to aquaculture or ballast water management has increased during the last few years. Bacterial indicators used for the evaluation of different disinfection treatments are usually related with both waste and drinking water, these standards are not usual microorganisms found in seawater. Thus, it is thought necessary to study the behavior of different marine-specific organisms in regard to improve the disinfection processes in seawater. In this study, three different bacteria have been selected among major groups of bacterial community from marine waters: two water-associated, Roseobacter sp. and Pseudomonas litoralis, and one sediment-associated, Kocuria rhizophila. A kinetic inactivation model together with a post-treatment growth tendency has been obtained after the application of UV-C and UV/H₂O₂ processes. According to the first kinetic rate constant, different responses were obtained for the different bacterial groups. Once the treatment was applied, modeling of growth curves revealed high recover within the first 3 days after treatment, even when UV/H₂O₂ was applied. This study introduces a sensitivity index, in which results show different levels of resistance for both treatments, being Roseobacter sp. the most sensitive bacteria, followed by P. litoralis and K. rhizophila.

An assessment of the use of antihistamines in the management of atopic dermatitis

Antihistamines are often used to treat pruritus associated with atopic dermatitis (AD) despite lack of evidence for their efficacy. The American Academy of Dermatology does not recommend the general use of antihistamines in the management of AD, although the value of short-term sedating antihistamine use for insomnia secondary to itch is recognized.

Personal History of Keratinocyte Carcinoma is Associated with Reduced Risk of Death from Invasive Melanoma in Men

Previous studies have found an increased risk of invasive cutaneous melanoma (CM) among those with a history of keratinocyte carcinoma (KC).

Just A Quick Pic: Ethics of Medical Photography

In vitro assessment of the broad-spectrum ultraviolet protection of clothing

Post-diagnosis aspirin use and overall survival in patients with melanoma

Mouse studies show that tumor-derived prostaglandins and platelets promote melanoma progression and immune-evasion.

Malassezia species in students from universities of Sabzevar, Northeastern Iran

Publication date: Available online 5 January 2018
Source:Journal de Mycologie Médicale
Author(s): H. Moallaei, M.J. Namazi, J.P. Bouchara, S. Pourhammed
BackgroundMalassezia species, usually part of normal human skin microbiota, may also cause cutaneous infections, mainly pityriasis versicolor (PV) which may rapidly spread in crowded communities, particularly in students' dormitories and sport leisure centers.ObjectiveFew studies have been conducted on PV in students in the Middle East. The present study was designed to determine prevalence of Malassezia species and related diseases in students from city of Sabzevar, Northeast Iran.MethodsSpecimens were collected from 189 students and analyzed by direct microscopy and cultures. Following PCR amplification of the large subunit of ribosomal DNA, species were identified by restriction fragment length polymorphism analysis (RFL-PCR).ResultsPV was suspected for 28 students which was confirmed by direct examination and cultures. Cultures also revealed positive for 13 students with healthy skin. Four Malassezia species were identified, with M. restricta as the most prevalent. A higher rate of PV was observed compared to other regions in Iran. However, despite the lipophilic feature of Malassezia species, no significant association was observed between PV or Malassezia species and fatty skin or gender.ConclusionThis study determined the frequencies of Malassezia species in part of Northeast Iran, but further studies are needed to identify risk factors for PV.

Dermatomyositis: A Diagnostic Dilemma

Publication date: Available online 5 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Diego M. Da Silva, Basil Patel, Victoria P. Werth

Reply to “Serious infections among a large cohort of subjects with systemically treated psoriasis”

Publication date: Available online 5 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): David L. Arnold, Steven R. Feldman

Fluorescence microscopy for the evaluation of elastic tissue patterns within fibrous proliferations of the skin on hematoxylin-eosin-stained slides

Publication date: Available online 5 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Robert Borucki, David M. Perry, Dan R. Lopez-Garcia, Viktoryia Kazlouskaya, Dirk M. Elston
BackgroundDiagnosis of fibrous tumors can be challenging and expensive due to the use of special stains.ObjectiveDetermine the usefulness of fluorescence microscopy in the evaluation of elastic pattern on H&E stained slides.MethodsA total of 228 slides were evaluated by fluorescence microscopy for elastic tissue patterns and sensitivity and specificity determined for relevant comparisons.ResultsFluorescence microscopy was found to be useful especially in the case of distinguishing dermatofibroma (DF) vs dermatofibrosarcoma protuberans (DFSP) and also dermatomyofibroma (DMF) vs other fibrous tumors.LimitationsIn some cases, excessive background staining made it difficult to interpret.ConclusionEvaluation of elastic tissue patterns by fluorescence microscopy in fibrous tumors is a cheap and efficient means to further delineate these often challenging tumors.

Comment on “Association of bullous pemphigoid with malignancy: A systematic review and meta-analysis”

Publication date: Available online 5 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Maglie Roberto, Antiga Emiliano, Caproni Marzia

Life cycle assessment of opencast coal mine production: a case study in Yimin mining area in China

Abstract

China has the largest coal production in the world due to abundant resource requirements for economic development. In recent years, the proportion of opencast coal mine production has increased significantly in China. Opencast coal mining can lead to a large number of environmental problems, including air pollution, water pollution, and solid waste occupation. The previous studies on the environmental impacts of opencast coal mine production were focused on a single production process. Moreover, mined land reclamation was an important process in opencast coal mine production; however, it was rarely considered in previous research. Therefore, this study attempted to perform a whole environmental impact analysis including land reclamation stage using life cycle assessment (LCA) method. The Yimin opencast coal mine was selected to conduct a case study. The production of 100 tons of coal was used as the functional unit to evaluate the environmental risks in the stages of stripping, mining, transportation, processing, and reclamation. A total of six environmental impact categories, i.e., resource consumption, acidification, global warming, solid waste, eutrophication, and dust, were selected to conduct this assessment. The contribution rates of different categories of environmental impacts were significantly different, and different stages exhibited different consumption and emissions that gave rise to different environmental effects. Dust was the most serious environmental impact category, and its contribution rate was 36.81%, followed by global warming and acidification with contribution rates of 29.43% and 22.58%, respectively. Both dust and global warming were mainly affected in mining stage in Yimin opencast coal mine based on comprehensive analysis of environmental impact. Some economic and feasible measures should be used to mitigate the environmental impacts of opencast coal mine production, such as water spraying, clean transportation, increasing processing efficiency, and improving mining technologies. This study can be considered as a useful reference for a deeper understanding of key environmental impacts related to the whole coal production in opencast coal mine.

Dietary exposure to HCH and DDT congeners and their associated cancer risk based on Pakistani food consumption

Abstract

Dietary exposure to organochlorine pesticides such as hexachlorocyclohexane (HCH) and dichlorodiphenyltrichloroethane (DDT) congeners was assessed using diet study approach, and for this purpose, different food items were collected in August 2014. The levels of ∑(HCHs + DDTs) in different food groups were ranged from 2.57 to 206 ng g⁻¹, ww, with contamination order of fish > poultry > milk > vegetables > cereals > flour > fruits. In the present study, the ratios of β-HCH/∑HCH (0.19–0.40) were < 0.5, where the ratios of (DDE + DDD)/∑DDT (0.48–6.70 with mean value of 0.61) were > 0.5 demonstrated the recent and past inputs of HCH and DDT, respectively. The major contributing groups (6.3–70.3%) to total dietary intake of HCHs and DDTs were animal origin (fish, poultry, and milk), while the less contributing food groups (2–4.5%) were vegetarian origin (vegetables, cereals, flour, and fruits). Cancer risk was estimated for HCHs and DDTs ingested via local foodstuffs. On the basis of both average and high end (95th percentile) exposure levels, the HRs for HCHs and DDTs were found greater than one (safety limit), indicating a potential cancer risk for Pakistani people from life-time consumption of contaminated food items selected in this study. The congener-specific cancer risk was found in order of α-HCH > β-HCH > ∑DDT > γ-HCH > p,p'-DDE > p,p'-DDT.

Graphical abstract

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Polyaniline-based adsorbents for removal of hexavalent chromium from aqueous solution: a mini review

Abstract

Hexavalent chromium (Cr(VI)) is a common hazardous contaminant in the environment and carcinogenic or mutagenic to aquatic animals and human beings. Therefore, the removal and detoxification of Cr(VI) have been attracting increasing attention of researchers. Among various conducting polymers, polyaniline (PANI)-based adsorbents have shown an excellent performance on the removal of Cr(VI) because of their redox properties, eased synthesis, and favorable biocompatibility. In this review, the characteristics of various PANI-based adsorbents were described, including PANI-modified nanofiber mats and membranes, PANI/bio-adsorbents, PANI/magnetic adsorbents, PANI/carbon adsorbents, PANI-modified clay composites, and PANI-inorganic hybrid composites. The mechanisms for the detoxification and adsorption of Cr(VI) were also discussed. The results indicated the potential applications of PANI-based adsorbents for the removal of Cr(VI).

Graphical abstract

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Simultaneous decolorization and desalination of dye wastewater through electrochemical process

Abstract

Salt-containing dye wastewater discharged from textile industries causes serious environmental problems. Simultaneous decolorization and desalination of dye wastewater in a laboratory scale electrochemical cell are realized for the first time with boron-doped diamond anode. With initial methyl orange (MO) and NaCl of 50 and 3000 mg L⁻¹, decolorization and desalination efficiencies of 70.2 and 88.7% were achieved after 6-h treatment with applied voltage of 6 V. Increasing applied voltages resulted in the improvements of both color and salt removal, while higher MO concentrations suppressed decolorization and higher NaCl concentration accelerated desalination rate. MO dissociated into anions transferred through the anion exchange membrane into the anode compartment and reacted with the active species as ·OH, H₂O₂, and ClO⁻ generated in anode compartment, leading to color removal. Component analysis confirmed the destruction of MO, with generation of low molecular weight compounds such as phenol and indole. Ions balance analysis indicated that Cl⁻ and Na⁺ moved to the anode and the cathode compartments respectively through the employed membranes driven by external voltage, realizing salt removal. This study has collectively demonstrated an efficient alternative for satisfactory treatment of salt-containing dye wastewater based on electrochemical technology.

A Cunning Foe

(See pages 156—7 for the Answer to the Photo Quiz.)

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In the Literature

A Cunning Foe

(See pages 154–5 for the Photo Quiz.)

The Critical Importance of Sampling Fraction to Inferences of Mycobacterium tuberculosis Transmission

To the Editor—In the study by Manson et al [1], whole-genome sequencing was performed on 223 Mycobacterium tuberculosis isolates from the Tiruvallur and Madurai districts of India. They subsequently examined local strain diversity and mutations associated with phenotypic drug resistance in these regions. In this important study, the authors show that lists of published resistance mutations (including [2–4]) have lower positive predictive values for phenotypic resistance in this context; lineages 1 and 3 predominate in India [1], but these published mutations were largely identified using strains from different M. tuberculosis lineages. This highlights a key obstacle to the implementation of genomics for resistance prediction in India and potentially other endemic regions with diverse lineages of M. tuberculosis. By extension, this study emphasizes the critical need to collect strains and categorize the mutations circulating in these regions to better inform such predictions.

Reply to Lee and Howden

To the Editor—We thank Dr Lee and Prof Howden for their letter and for giving us an opportunity to better articulate our interpretation of findings, especially with respect to transmission of Mycobacterium tuberculosis among patients within 2 southern Indian districts. Based on analysis of single nucleotide polymorphism (SNP) differences between 223 M. tuberculosis strains from 196 patients within the Thiruvallur and Madurai districts of Tamil Nadu, we report recent intradistrict, but no recent interdistrict, transmission of strains among patients. In drawing these conclusions, we limited our interpretation to the data available to us, which showed that the closest SNP distance between M. tuberculosis isolated from patients in different districts was 85 SNPs, which is substantially higher than the very small numbers of SNPs (as few as 0) observed when comparing isolates from patients treated in the same district and treatment center.

In- and Out-of-hospital Mortality Associated with Seasonal and Pandemic Influenza and Respiratory Syncytial Virus in South Africa, 2009–2013

Abstract

Background

Estimates of influenza- and respiratory syncytial virus (RSV)-associated mortality burden are important to guide policy for control. Data are limited on the contribution of out-of-hospital deaths to this mortality.

Methods

We modeled excess mortality attributable to influenza and RSV infection by applying regression models to weekly deaths from national vital statistics from 2009 through 2013, using influenza and RSV laboratory surveillance data as covariates. We fitted separate models for in- and out-of-hospital deaths.

Results

There were 509791 average annual deaths in South Africa, of which 44% (95% confidence interval [CI] 43%–45%) occurred out-of-hospital. Seasonal influenza and RSV all-cause mortality rates were 23.0 (95% CI 11.0–30.6) and 13.2 (95% CI 6.4–33.8) per 100000 population annually (2.3% [95%CI 2.3%–2.4%] and 1.3% [95% CI 1.2%–1.4%] of all deaths respectively). The peak mortality rate was in individuals aged ≥75 years (386.0; 95% CI 176.5–466.3) for influenza and in infants (143.4; 95% CI 0–194.8) for RSV. Overall, 63% (95% CI 62%–-65%) of seasonal influenza and 48% (95% CI 47%–49%) of RSV-associated deaths occurred out-of-hospital. Among children aged <5 years, RSV-associated deaths were more likely to occur in-hospital, whereas influenza-associated deaths were more likely to occur out-of-hospital. The mortality rate was 6.7 (95% CI 6.4–33.8) in the first influenza A(H1N1)pdm09 wave in 2009 and 20.9 (95% CI 6.4–33.8) in the second wave in 2011, with 30% (95% CI 29%–32%) of A(H1N1)pdm09-associated deaths in 2009 occurring out-of-hospital.

Discussion

More than 45% of seasonal influenza- and RSV-associated deaths occur out-of-hospital in South Africa. These data suggest that hospital-based studies may substantially underestimate mortality burden.

Call for Action: Invasive Fungal Infections Associated With Ibrutinib and Other Small Molecule Kinase Inhibitors Targeting Immune Signaling Pathways

Abstract

Opportunistic infections caused by Pneumocystis jirovecii, Cryptococcus neoformans, and ubiquitous airborne filamentous fungi have been recently reported in patients with hematological cancers historically considered at low risk for invasive fungal infections (IFIs), after receipt of the Bruton tyrosine kinase inhibitor ibrutinib. The spectrum and severity of IFIs often observed in these patients implies the presence of a complex immunodeficiency that may not be solely attributed to mere inhibition of Bruton tyrosine kinase. In view of the surge in development of small molecule kinase inhibitors for treatment of malignant and autoimmune diseases, it is possible that there would be an emergence of IFIs associated with the effects of these molecules on the immune system. Preclinical assessment of the immunosuppressive effects of kinase inhibitors and human studies aimed at improving patient risk stratification for development of IFIs could lead to prevention, earlier diagnosis, and better outcomes in affected patients.

The Effect of Female Sex on Hepatitis C Incidence Among People Who Inject Drugs: Results From the International Multicohort InC3 Collaborative

Abstract

Background

The objective of this study was to assess differences in hepatitis C virus (HCV) incidence by sex in people who inject drugs (PWID), using a large international multicohort set of pooled biological and behavioral data from prospective observational studies of incident human immunodeficiency virus (HIV) and HCV infections in high-risk cohorts (the InC3 Collaborative).

Methods

HCV infection date was estimated based on a hierarchy of successive serological (anti-HCV), virological (HCV RNA), and clinical (symptoms and/or liver function tests) data. We used a Cox proportional hazards model to calculate the crude and adjusted female to male (F:M) hazard ratio (HR) for HCV incidence using biological sex as the main exposure.

Results

A total of 1868 PWID were observed over 3994 person-years of observation (PYO). Unadjusted F:M HR was 1.38 (95% confidence interval [CI], 1.15–1.65) and remained significant after adjusting for behavioral and demographic risk factors (1.39 [95% CI, 1.12–1.72]). Although syringe and equipment sharing were associated with the highest HCV incidence rate in women (41.62 and 36.83 PYO, respectively), we found no sex differences attributed to these risk factors.

Conclusions

Our findings indicate that women who inject drugs may be at greater risk of HCV acquisition than men, independent of demographic characteristics and risk behaviors. Multiple factors, including biological (hormonal), social network, and differential access to prevention services, may contribute to increased HCV susceptibility in women who inject drugs.

Machine Learning for Healthcare: On the Verge of a Major Shift in Healthcare Epidemiology

Abstract

The increasing availability of electronic health data presents a major opportunity in healthcare for both discovery and practical applications to improve healthcare. However, for healthcare epidemiologists to best use these data, computational techniques that can handle large complex datasets are required. Machine learning (ML), the study of tools and methods for identifying patterns in data, can help. The appropriate application of ML to these data promises to transform patient risk stratification broadly in the field of medicine and especially in infectious diseases. This, in turn, could lead to targeted interventions that reduce the spread of healthcare-associated pathogens. In this review, we begin with an introduction to the basics of ML. We then move on to discuss how ML can transform healthcare epidemiology, providing examples of successful applications. Finally, we present special considerations for those healthcare epidemiologists who want to use and apply ML.

Improvement in Diagnosis of Histoplasma Meningitis by Combined Testing for Histoplasma Antigen and Immunoglobulin G and Immunoglobulin M Anti-Histoplasma Antibody in Cerebrospinal Fluid

Abstract

Background

Central nervous system (CNS) histoplasmosis is a life-threatening condition and represents a diagnostic and therapeutic challenge. Isolation of Histoplasma capsulatum from cerebrospinal fluid (CSF) or brain tissue is diagnostic; however, culture is insensitive and slow growth may result in significant treatment delay. We performed a retrospective multicenter study to evaluate the sensitivity and specificity of a new anti-Histoplasma antibody enzyme immunoassay (EIA) for the detection of IgG and IgM antibody in the CSF for diagnosis of CNS histoplasmosis, the primary objective of the study. The secondary objective was to determine the effect of improvements in the Histoplasma galactomannan antigen detection EIA on the diagnosis of Histoplasma meningitis.

Methods

Residual CSF specimens from patients with Histoplasma meningitis and controls were tested for Histoplasma antigen and anti-Histoplasma immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody using assays developed at MiraVista Diagnostics.

Results

A total of 50 cases and 157 controls were evaluated. Fifty percent of patients with CNS histoplasmosis were immunocompromised, 14% had other medical conditions, and 36% were healthy. Histoplasma antigen was detected in CSF in 78% of cases and the specificity was 97%. Anti-Histoplasma IgG or IgM antibody was detected in 82% of cases and the specificity was 93%. The sensitivity of detection of antibody by currently available serologic testing including immunodiffusion and complement fixation was 51% and the specificity was 96%. Testing for both CSF antigen and antibody by EIA was the most sensitive approach, detecting 98% of cases.

Conclusions

Testing CSF for anti-Histoplasma IgG and IgM antibody complements antigen detection and improves the sensitivity for diagnosis of Histoplasma meningitis.

Relationship Between Viremia and Specific Organ Damage in Ebola Patients: A Cohort Study

Abstract

Background

Pathogenesis of Ebola virus disease remains poorly understood. We used concomitant determination of routine laboratory biomarkers and Ebola viremia to explore the potential role of viral replication in specific organ damage.

Methods

We recruited patients with detectable Ebola viremia admitted to the EMERGENCY Organizzazione Non Governativa Organizzazione Non Lucrativa di Utilità Sociale (ONG ONLUS) Ebola Treatment Center in Sierra Leone. Repeated measure of Ebola viremia, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), activated prothrombin time (aPTT), international normalized ratio (INR), creatinine, and blood urea nitrogen (BUN) were recorded. Patients were followed up from admission until death or discharge.

Results

One hundred patients (49 survivors and 51 nonsurvivors) were included in the analysis. Unadjusted analysis to compare survivors and nonsurvivors provided evidence that all biomarkers were significantly above the normal range and that the extent of these abnormalities was generally higher in nonsurvivors than in survivors. Multivariable mixed-effects models provided strong evidence for a biological gradient (suggestive of a direct role in organ damage) between the viremia levels and either ALT, AST, CPK LDH, aPTT, and INR. In contrast, no direct linear association was found between viremia and either creatinine, BUN, or bilirubin.

Conclusions

This study provides evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system. We did not find strong evidence suggestive of a direct role of Ebola virus in kidney damage. The role of the virus in liver damage remains unclear, but our evidence suggests that acute severe liver injury is not a typical feature of Ebola virus disease.

Disability Among Ebola Survivors and Their Close Contacts in Sierra Leone: A Retrospective Case-Controlled Cohort Study

Abstract

Ebola survivors (21/27 [77.8%]) suffered more disability than their close contacts (6/54 [11.1%]) (adjusted odds ratio, 23.5 [95% confidence interval, 6.5–85.7]; P < .001) when measured by the Washington Group Disability Extended Questionnaire. Major limitations in vision, mobility, cognition, and affect were observed in survivors 1 year following the 2014–2016 Ebola outbreak, highlighting the need for long-term rehabilitation.

A Novel Human Pegivirus, HPgV-2 (HHpgV-1), Is Tightly Associated With Hepatitis C Virus (HCV) Infection and HCV/Human Immunodeficiency Virus Type 1 Coinfection

Abstract

Background

Human pegivirus type 2 (HPgV-2) is a novel blood-borne human pegivirus that mainly infects hepatitis C virus (HCV)–infected subjects. We have investigated the prevalence of HPgV-2 in China, its association with HCV and human immunodeficiency virus type 1 (HIV-1), and the impact on HCV viral load and liver damage.

Methods

A cross-sectional study was conducted with both blood donors and HCV- and HIV-1–infected patients in Guangzhou, China. All subjects were screened for anti-HPgV-2 and HPgV-2 RNA. Demographic and clinical information were obtained from electronic medical records.

Results

We tested 8198 serum or plasma samples. Only 0.15% (6/4017) of healthy blood donors were positive for anti-HPgV-2 and negative for HPgV-2 RNA. No HPgV-2 viremia was detected in hepatitis B virus– or HIV-1–monoinfected individuals. The relatively high frequency of HPgV-2 infection was observed in 1.23% (30/2440) and 0.29% (7/2440) of HCV-infected persons by serological assay and reverse-transcription polymerase chain reaction, respectively. Furthermore, anti-HPgV-2 and HPgV-2 RNA were detected in 8.91% (18/202) and 3.47% (7/202), respectively, of HCV/HIV-1–coinfected subjects. HPgV-2 persistent infection was documented in about 30% of anti-HPgV-2–positive individuals. In addition, HPgV-2 infection may not affect HCV-related liver injury and HCV viral load.

Conclusions

Our results indicate the rarity of HPgV-2 infection in the general population and tight association with HCV, in particular with HCV/HIV-1 coinfection. HPgV-2 appears not to worsen HCV-related liver damage. Our study provides new findings about the association of HPgV-2 and HCV/HIV-1 and the impact of HPgV-2 infection on HCV replication and pathogenesis.

Higher Mortality Despite Early Antiretroviral Therapy in Human Immunodeficiency Virus and Hepatitis B Virus (HBV)–Coinfected Patients With High HBV Replication

Abstract

Background

In human immunodeficiency virus (HIV)–infected patients, hepatitis B virus (HBV) coinfection increases the risk of disease progression. Tenofovir plus emtricitabine/lamivudine (TDF/XTC)–based antiretroviral therapy (ART), which suppresses HIV and HBV replication, has the potential for decreasing this risk. Here, we analyze the association between HBV replication, early ART, and mortality in West African adults.

Methods

The Temprano randomized controlled trial assessed the benefits of immediately initiating vs deferring ART in HIV-infected adults with high CD4 counts. After trial completion, participants continued follow-up in a posttrial phase. We analyzed the association between HBV status, immediate ART, and mortality over the entire trial and posttrial follow-up using multivariable Cox proportional hazards regression.

Results

A total of 2052 HIV-infected adults (median baseline CD4 count, 464 cells/μL) were followed for 9394 person-years. At baseline, 1862 (91%) were HIV monoinfected and 190 (9%) HIV/HBV coinfected. Of the latter, 135 (71%) had plasma HBV DNA <2000 IU/mL and 55 (29%) HBV DNA ≥2000 IU/mL. The 60-month probability of death was 11.8% (95% confidence interval [CI], 5.4%–24.5%) in coinfected patients with HBV DNA ≥2000 IU/mL; 4.4% (95% CI, 1.9%–10.4%) in coinfected patients with HBV DNA <2000 IU/mL; and 4.2% (95% CI, 3.3%–5.4%) in HIV-monoinfected patients. Adjusting for ART strategy (immediate vs deferred), the hazard ratio of death was 2.74 (95% CI, 1.26–5.97) in coinfected patients with HBV DNA ≥2000 IU/mL and 0.90 (95% CI, .36–2.24) in coinfected patients with HBV DNA <2000 IU/mL compared to HIV-monoinfected patients. There was no interaction between ART strategy and HBV status for mortality.

Conclusions

African HIV/HBV-coinfected adults with high HBV replication remain at heightened risk of mortality in the early ART era. Further studies are needed to assess interventions combined with early ART to decrease mortality in this population.

Clinical Trials Registration

NCT00495651

Epidemiology, Clinical Features, and Outcome of Infective Endocarditis due to Abiotrophia Species and Granulicatella Species: Report of 76 Cases, 2000–2015

Abstract

Background

Infective endocarditis (IE) caused by Abiotrophia (ABI) and Granulicatella (GRA) species is poorly studied. This work aims to describe and compare the main features of ABI and GRA IE.

Methods

We performed a retrospective study of 12 IE institutional cases of GRA or ABI and of 64 cases published in the literature (overall, 38 ABI and 38 GRA IE cases).

Results

ABI/GRA IE represented 1.51% of IE cases in our institution between 2000 and 2015, compared to 0.88% of HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)–related IE and 16.62% of Viridans group streptococci (VGS) IE. Institutional ABI/GRA IE case characteristics were comparable to that of VGS, but periannular complications were more frequent (P = .008). Congenital heart disease was reported in 4 (10.5%) ABI and in 11 (28.9%) GRA cases (P = .04). Mitral valve was more frequently involved in ABI than in GRA (P < .001). Patient sex, prosthetic IE, aortic involvement, penicillin susceptibility, and surgical treatment were comparable between the genera. New-onset heart failure was the most frequent complication without genera differences (P = .21). Five (13.2%) ABI patients and 2 (5.3%) GRA patients died (P = .23). Factors associated with higher mortality were age (P = .02) and new-onset heart failure (P = .02). The genus (GRA vs ABI) was not associated with higher mortality (P = .23).

Conclusions

GRA/ABI IE was more prevalent than HACEK IE and approximately one-tenth as prevalent as VGS; periannular complications were more frequent. GRA and ABI genera IE presented similar clinical features and outcomes. Overall mortality was low, and related to age and development of heart failure.

Cost Drivers of a Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia Phase 3 Clinical Trial

Abstract

Background

Studies indicate that the prevalence of multidrug-resistant infections, including hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP), has been rising. There are many challenges associated with these disease conditions and the ability to develop new treatments. Additionally, HABP/VABP clinical trials are very costly to conduct given their complex protocol designs and the difficulty in recruiting and retaining patients.

Methods

With input from clinicians, representatives from industry, and the US Food and Drug Administration, we conducted a study to (1) evaluate the drivers of HABP/VABP phase 3 direct and indirect clinical trial costs; (2) to identify opportunities to lower these costs; and (3) to compare (1) and (2) to endocrine and oncology clinical trials. Benchmark data were gathered from proprietary and commercial databases and used to create a model that calculates the fully loaded (direct and indirect) cost of typical phase 3 HABP/VABP endocrine and oncology clinical trials.

Results

Results indicate that the cost per patient for a 200-site, 1000-patient phase 3 HABP/VABP study is $89600 per patient. The cost of screen failures and screen failure rates are the main cost drivers.

Conclusions

Results indicate that biopharmaceutical companies and regulatory agencies should consider strategies to improve screening and recruitment to decrease HABP/VABP clinical trial costs.

Reply to Gupta-Wright et al

We thank Gupta-Wright et al for their insightful comments on our article and enthusiastically echo many of their points [1, 2]. Indeed, we share their concern regarding the difficulty of ruling out tuberculosis coinfection among patients with confirmed disseminated nontuberculous mycobacterial (NTM) infection who have a positive Determine TB-LAM lateral flow assay (LF-LAM) result. For that reason, in our high-burden tuberculosis setting, it is our policy to always err on the side of initially treating such patients for both infections while continuing to search for definitive evidence of tuberculosis coinfection.

Urinary Lipoarabinomannan Detection and Disseminated Nontuberculous Mycobacterial Disease

To the Editor—We read with interest Nel and colleagues' article, "Does disseminated nontuberculous mycobacterial disease cause false-positive Determine TB-LAM lateral flow assay results? A retrospective review" [1]. The authors present an important finding relevant to clinicians who manage patients with advanced human immunodeficiency virus (HIV). Although we agree that disseminated nontuberculous mycobacterial (NTM) disease needs to be considered in patients with positive Determine TB-LAM lateral flow assay (LF-LAM) results, we urge that the implications for clinical practice be considered in the context of what is known about the relative incidence of tuberculosis and NTM disease in high HIV burden settings. Disseminated NTM disease is almost exclusively observed in patients with extreme immunosuppression (median CD4 count consistently <50 cells/μL, often <10 cells/μL) [2], has always been uncommon in HIV-infected patients in Africa, and has become more rare in the era of combination antiretroviral therapy (ART).

The Relational Conception of Practical Authority

Abstract

I argue for a new conception of practical authority based on an analysis of the relationship between authority and subject. Commands entail a demand for practical deference, which establishes a relationship of hierarchy, vulnerability, and responsibility that involves a variety of signals and commitments. In order for this relationship to be justified, the subject must be under a preexisting duty, the authority's commands must take precedence over the subject's judgment regarding fulfillment of that duty, the authority must accept the position and responsibilities of command, and the authority must be sufficiently trustworthy relative to how vulnerable the subject makes herself by deferring. This results in an instrumentalist conception of practical authority that can be favorably compared to Joseph Raz's influential service conception. The relational conception's main advantage is that it focuses on the authority as much as the subject, requiring that the authority accept responsibility for the relationship and be sufficiently trustworthy. This allows the relational conception to avoid problems that the service conception faces and illuminates institutional authority.

Response to Cherrie, ‘How to Quantitatively Assess Dermal Exposure to Volatile Organic Compounds’

Editorial Note. Letters to the Editor are peer reviewed to ensure that the arguments are reasonable and clearly expressed. However, letters may express a particular opinion rather than a balanced interpretation. Authors of papers commented on are invited to reply, but neither the journal nor peer reviewers should be assumed to support the arguments made.

On the Relation Between Visualized Space and Perceived Space

Abstract

In this paper, I will examine the question of the space of visual imagery. I will ask whether in visually imagining an object or a scene, we also thereby imagine that object or scene as being in a space unrelated to the space we're simultaneously perceiving or whether it is the case that the space of visual imagination is experienced as connected to the space of perceptual experience. I will argue that the there is no distinction between the spatial content of visualization and the spatial content of visual perception. I will base my conclusion on two uncontroversial, empirically confirmed aspects of imagery: (a) the perspectival character of imagery, and (b) the possibility of superimposing an imagined object upon the perceived scene.

Drug-induced aseptic meningitis: A possible T-cell–mediated hypersensitivity

Publication date: Available online 6 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Julie Castagna, Audrey Nosbaum, Thierry Vial, Aurore Rozieres, Florence Hacard, Marc Vocanson, Pauline Pralong, Christine Chuniaud-Louche, Jean-François Nicolas, Aurore Gouraud, Frédéric Bérard

Spatio-temporal assessment and seasonal variation of tropospheric ozone in Pakistan during the last decade

Abstract

This study uses the tropospheric ozone data derived from combined observations of Ozone Monitoring Instrument/Microwave Limb Sounder instruments by using the tropospheric ozone residual method. The main objective was to study the spatial distribution and temporal evolution in the troposphere ozone columns over Pakistan during the time period of 2004 to 2014. Results showed an overall increase of 3.2 ± 1.1 DU in tropospheric ozone columns over Pakistan. Spatial distribution showed enhanced ozone columns in the Punjab and southern Sindh consistent to high population, urbanization, and extensive anthropogenic activities, and exhibited statistically significant temporal increase. Seasonal variations in tropospheric ozone columns are driven by various factors such as seasonality in UV-B fluxes, seasonality in ozone precursor gases such as NO_x and volatile organic compounds (caused by temperature dependent biogenic emission) and agricultural fire activities in Pakistan. A strong correlation of 96% (r = 0.96) was found between fire events and tropospheric ozone columns in Pakistan.

Lifetime cost of chronic ulcers requiring hospitalization in Ontario, Canada: a population-based study

Publication date: Available online 6 January 2018
Source:Wound Medicine
Author(s): Brian C.F. Chan, Suzanne M. Cadarette, Walter P. Wodchis, Nicole Mittmann, Murray D. Krahn
ObjectiveTo determine the lifetime cost-of-illness of chronic ulcers from the perspective of the Ontario public health care payer.MethodsWe calculated health care costs for a cohort of individuals hospitalized for a diabetic foot ulcer, pressure ulcer or leg ulcer between 2005 and 2011 using Ontario administrative health care data. Lifetime costs for this cohort were estimated using phase-based costing methods. Net cost was determined by calculating the difference in lifetime costs between the chronic ulcer cohort and a matched non-chronic ulcer cohort. Matching was conducted using a combination of hard matching and propensity score methods. The chronic ulcer cohort represents all individuals residing in Ontario, Canada.ResultsA total of 7,316 individuals with chronic ulcers were identified and matched with a non-chronic ulcer cohort (5,583 diabetic foot ulcer, 1,470 pressure ulcer, 262 leg ulcer). Lifetime net modeled cost of diabetic foot ulcer was $619,300 (95% CI $593,900-$642,800), for pressure ulcer $98,500 (95% CI $88,300-$109,100) and for leg ulcer $548,100 (95% CI $524,400-$569,500).ConclusionsChronic ulcers present a substantial economic burden to the health care system. Health care decision makers are encouraged to consider additional resources to preventative interventions for chronic ulcers to reduce downstream costs.

Crayfish can distinguish between natural and chemical stimuli as assessed by cardiac and locomotor reactions

Abstract

In this study, cardiac and locomotor activities of signal crayfish Pacifastacus leniusculus were investigated under exposure to a range of natural (i.e., odors of conspecific crayfish, predatory fish, food, and injured conspecific) and one chemical (i.e., disinfectant chloramine-T) stimuli. Crayfish locomotion was simultaneously initiated with an increase in heart rate only when affected by chloramine-T, while locomotor response was delayed in all cases (or was not manifested at all by some specimens) when disturbed by the natural stressors. The heart rate differences measured before and during the stimulation were arranged as follows: odor of conspecific crayfish (9.2 ± 7.1%) < predator (18.4 ± 13%) < food (33.5 ± 15.7%) < chloramine-T (41.1 ± 14.7%) < injured conspecific (51.8 ± 28.4%). Analysis of the peculiarities of crayfish heartbeat under exposure to the tested stimuli revealed complex cardiac responses as was previously observed by an electrocardiography approach, that is, a slowed heart rate followed by a delayed increase. Evaluation of the intrinsic parameters of crayfish bioindicators remains essential due to the possibility of detection of the substantial ethological responses even in motionless animals. The role and appropriateness of signal crayfish as a bioindicator of water quality is discussed; they seem to be an applicable species for this task due to their sufficient sensitivity and broad availability. In addition to providing a better understanding of stereotypic crayfish behaviors induced by common and chemical stressors, the results of this study may serve as reference data for the evaluation of crayfish suitability for water quality tests.

Sawdust biochar application to rice paddy field: reduced nitrogen loss in floodwater accompanied with increased NH 3 volatilization

Abstract

Sawdust biochar (SDB) was for the first time applied to rice paddy field to evaluate its effects on potential nitrogen (N) runoff and ammonia (NH₃) volatilization losses in a soil column experimental system. Results showed that total N concentration of surface floodwater under SDB treatments was reduced by 7.29–35.16, 16.34–32.35, and 12.21–28.12% after three split N fertilizations, respectively. Particularly, NH₄⁺–N was decreased by 11.84–27.08, 14.29–36.50, and 2.97–19.64%, respectively. However, SDB addition has no significant influence on NO₃⁻–N concentration. Meanwhile, SDB application increased NH₄⁺–N and total N content of top (0–15 cm) soil. Furthermore, these SDB-induced influences were more pronounced for 3 wt% SDB treatments. SDB treatments recorded 3.56–5.78 kg ha⁻¹ higher NH₃ volatilization than urea control treatment, which was attributed to the elevated pH values of floodwater and top soil induced by SDB. Fortunately, the yield-scale NH₃ volatilization was not increased dramatically.

Metals in bones of the middle-aged inhabitants of Sardinia island (Italy) to assess nutrition and environmental exposure

Abstract

Metals in bones of 72 subjects lived between the twelfth and eighteenth century AC and collected in four Sardinian (Italian insular region) burial sites (Alghero, Bisarcio, Geridu, and Sassari) were determined and used as biomarkers to evaluate diet and potential social-environmental differences. Concentrations of Ba, Ca, Cd, Cu, Hg, Pb, Sr, and Zn were quantified in different types of compact bone (femur, fibula, humerus, radius, tibia, ulna) by sector field inductively coupled plasma mass spectrometry previous acidic digestion and differences among the various burial sites, centuries, types of bone, gender, and age were explored by univariate and multivariate analyses. Results indicated differences between sites in terms of diet: Bisarcio (inland village) had increased ratios of Ba/Ca and Zn/Ca due to higher incidence of vegetables, cereals, and animal foods in the diet; Geridu (coastal village) showed increased Sr/Ca ratio indicating foods of plant and marine origin that were predominant; Alghero (coastal site) and Sassari (inland site) displayed prevalently a mixed diet reflecting a higher economy and food imports. In addition, these latter sites showed increased levels of Hg/Ca (fish, drugs, cosmetics) and Pb/Ca (coins, utensils, pipeline for water). In conclusion, the elemental Ba/Ca, Sr/Ca, and Zn/Ca ratios were indicative of provenance and diet, while Hg/Ca and Pb/Ca ratios were associated to various forms of environmental exposure.

Benchmarking the efficiency of the Chilean water and sewerage companies: a double-bootstrap approach

Abstract

Benchmarking the efficiency of water companies is essential to set water tariffs and to promote their sustainability. In doing so, most of the previous studies have applied conventional data envelopment analysis (DEA) models. However, it is a deterministic method that does not allow to identify environmental factors influencing efficiency scores. To overcome this limitation, this paper evaluates the efficiency of a sample of Chilean water and sewerage companies applying a double-bootstrap DEA model. Results evidenced that the ranking of water and sewerage companies changes notably whether efficiency scores are computed applying conventional or double-bootstrap DEA models. Moreover, it was found that the percentage of non-revenue water and customer density are factors influencing the efficiency of Chilean water and sewerage companies. This paper illustrates the importance of using a robust and reliable method to increase the relevance of benchmarking tools.

Prevention of landfill pollution by multicriteria spatial decision support systems (MC-SDSS): development, implementation, and case study

Abstract

Landfilling of municipal solid waste (MSW) is one of the serious environmental concerns as improper location of MSW landfill site can release the pollutants into the surrounding environment. The process of selecting MSW landfill site is a complicated decision making problem since it is subjected to simultaneous assessment of several environmental criteria, rules, and restrictions besides sociocultural and economic ones. The current study suggests a framework based on Multicriteria spatial decision support systems (MC-SDSS) to select landfill site. The MC-SDSS is an advanced method to integrate multiple criteria decision analysis (MCDA) and geographical information systems (GIS) techniques. This approach enables the incorporation of several conflicting objectives and preferences into spatial decision models. In this study, 14 criteria were chosen and then divided into environmental, sociocultural, and economic categories. Finally, suitability maps were generated based on the MC-SDSS analysis. The developed method was implemented in a real case study in Arak city in northwestern region of Iran, which is environmentally sensitive area. The suitability maps of the case study in Arak showed that 10% (391 km²) is least suitable area, 23% (942 km²) is low suitable, 37% (1507 km²) is moderate suitable, 19% (783 km²) is suitable, and 11% (489 km²) is most suitable locations for landfill site, and finally, three best alternative sites were introduced for the final landfill site.

Vulvar intraepithelial neoplasia and vulvar squamous cell carcinoma: differential dermoscopic features in a case series, and a progression model

Laboratory-confirmed respiratory infections as predictors of hospital admission for myocardial infarction and stroke: time-series analysis of English data for 2004-2015

Abstract

Background

Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke, however, the role of different organisms is poorly characterised.

Methods

We undertook a time-series analysis of English hospital admissions for MI and stroke (age-stratified: 45-64, 65-74, 75+ years), laboratory-confirmed viral respiratory infections and environmental data for 2004-2015. Weekly counts of admissions were modelled using multivariable Poisson regression with weekly counts of respiratory viruses (influenza, parainfluenza, rhinovirus, respiratory syncytial virus (RSV), adenovirus or human meta-pneumovirus (HMPV)) investigated as predictors. We controlled for seasonality, long-term trends and environmental factors.

Results

Weekly hospital admissions in adults aged 45+ years averaged 1347 (IQR 1217-1541) for MI and 1175 (IQR 1023-1395) for stroke. Median numbers of respiratory infections ranged from 11 cases per week (IQR 5-53) for influenza to 55 (IQR 7-127) for rhinovirus. In the adjusted models, all viruses except parainfluenza were significantly associated with MI and ischaemic stroke admissions in those aged 75+. Among 65-74 year olds, adenovirus, rhinovirus and RSV were associated with MI but not ischaemic stroke admissions. Respiratory infections were not associated with MI or ischaemic stroke in people aged 45-64, nor with haemorrhagic stroke in any age group. An estimated 0.4-5.7% of MI and ischaemic stroke admissions may be attributable to respiratory infection, with greater excess burden during weeks with high circulating virus levels.

Conclusions

We identified small but strongly significant associations in the timing of respiratory infection (with HMPV, RSV, influenza, rhinovirus and adenovirus) and MI or ischaemic stroke hospitalisations in the elderly.

Registered at Clinicaltrials.gov

NCT02984280