Extra Precautions Research Articles

Missing the 'window' might shut the light forever: Central retinal artery occlusion following spine surgery.

Missing the 'window' might shut the light forever: Central retinal artery occlusion following spine surgery.

Temporal stability evaluation of fluorescein-nanoparticles loaded on albumin-coated microbubbles

Purpose: This study aims to evaluate the temporal stability of newly designed FITC-nanoparticles (NPs) loaded on albumin-coated microbubbles (MBs) to be used for future drug delivery purposes. Materials and Methods: MBs (3.6 108 MB/mL) were obtained by sonicating 5% bovine serum albumin and 15% dextrose solution. NPs (5 mg/mL) were produced from fluorescein (FITC)-PLA polymers and functionalized using EDC/NHS. NP-loaded MBs resulted from the covalent linking between functionalized NPs and MBs via carbodiimide technique. Three parameters were quantitatively monitored over a 4-week duration at 8 time points: MB diameter was determined using a circle detection routine based on the Hough transform, MB number density was evaluated using a hemocytometer, and NP-loading yield was assessed based on the loaded-MB fluorescence uptake. Based on the hypotheses, analyses of variance or Kruskal Wallis test were run to evaluate the stability of these physical parameters over the time of the experiment. Results: Statistical analysis exhibited no significant differences in NP-loaded MB mean sizes, number densities, and loading yields over time (p > 0.05). Conclusion: Newly designed NP-loaded MBs are stable over at least a 4-week duration and can be used without extra precaution concerning their temporal stability. [This work was supported by NIH R37EB002641.]

Testing Methods for PUF-Based Secure Key Storage Circuits

Design for test is an integral part of any VLSI chip. However, for secure systems extra precautions have to be taken to prevent that the test circuitry could reveal secret information. This paper addresses secure test for Physical Unclonable Function based systems. It investigates two secure Built-In Self-Test (BIST) solutions for Fuzzy Extractor (FE) which is the main component of PUF-based systems. The schemes target high stuck-at-fault (SAF) coverage by performing scan-chain free functional testing, to prevent scan-chain abuse for attacks. The first scheme reuses existing FE blocks (for pattern generation and compression) to minimize the area overhead, while the second scheme tests all the FE blocks simultaneously to minimize the test time. The schemes are integrated in FE design and simulated; the results show that for the first test scheme, a SAF fault coverage of 95 % can be realized with no more than 47.1k clock cycles at the cost of a negligible area overhead of only 2.2 %; while for the second test scheme a SAF fault coverage of 95 % can be realized with 3.5k clock cycles at the cost of 18.6 % area overhead. Higher fault coverages are possible to realize at extra cost (i.e., either by extending the test time, or by adding extra hardware, or a combination of both).

Can obstetrical brachial plexus palsy be caused by a cervical rib?

The incidence of obstetric brachial plexus palsy (OBPP) is between 0.38 to 2.6 per 1000 live births. However, incidence of OBPP caused by cervical rib is unknown. Cervical ribs prevalence is 0.74–12 % and is higher in females. We describe such a case of OBPP successfully treated with early operative intervention. Patient with normal weight and uncomplicated vaginal birth suffered from brachial plexus injury (Narakas II) with no clinical improvement postpartum, after 3 months of observation. Preoperative imaging (X-ray/magnetic resonance imaging) showed no findings, but intraoperative exploration revealed that C7 root was riding on the cervical rib with a thick neuroma-incontinuity involving C5, C6, and C7 roots. After resecting the neuroma and cervical rib, nerve defects were reconstructed microsurgically with spinal-accessory nerve transfer and nerve grafts. Postoperatively, shoulder- and arm-function after 1 year were nearly fully restored (Gilbert 120 and Mallet V). Shoulder strength rated M4. Elbow and hand strength rated M4 and M5 with Gilbert and Raimondi functional scores of IV and V, respectively. While OBPP caused by cervical rib is rare, this etiology should be identified during the prenatal screening sonography. Thus, extra precautions can be taken during deliveries to decrease incidence of OBPP secondary to cervical rib. Early surgical intervention for OBPP is successful in achieving functional restoration of the arm.

Determination of free Bisphenol A (BPA) concentrations in breast milk of U.S. women using a sensitive LC/MS/MS method

Bisphenol A (BPA) is a synthetic, endocrine-disrupting compound. Free BPA has been detected in human samples indicating that humans are internally exposed to estrogenically active BPA. The purpose of this study was to develop a sensitive method to detect free BPA in human breast milk. BPA was isolated from the milk of 21 nursing mothers in the U.S. by solid-phase extraction. It was then derivatized to improve sensitivity and subsequently analyzed by ultra high performance liquid chromatography–tandem mass spectrometry. Free BPA was detected in 62% of the milk samples (⩽0.22–10.8ngmL−1, median 0.68ngmL−1, mean 3.13ngmL−1). No statistical difference in BPA concentrations was observed between women with a low or high Body Mass Index (BMI) (<30 (n=11) and>30 (n=10), respectively). However, there was a significant association between BPA concentration and race. Caucasian women had significantly higher levels of free BPA in their breast milk than non-Caucasian women (mean=4.44 (n=14) and 0.52 (n=7), respectively; p<0.05). The difference between races could be attributed to variations in exposure, lifestyle or metabolism and suggests that certain populations should take extra precautions to limit BPA exposure, particularly during pregnancy and lactation.

What is needed for allergic children?

What is needed for allergic children?

Effects of different types of forensic information on eyewitness’ memory and confidence accuracy

This study investigated eyewitnesses’ memory and confidence accuracy for action information (what happened at the crime scene), and detail information (descriptions of persons, objects, time and place). In Experiment 1, 89 participants watched a film and participated in one of four conditions: Laboratory discussion, Family discussion, Retell and Control, the first three with five meetings each. Three weeks later all participants open free recalled the events, and confidence judged their answers. The participants showed better free recall and confidence accuracy for action than for detail information. Participants in the two discussion conditions and in the Retell condition recalled more items and those in the Lab-discussion and Retell conditions more correct items for action information, than those in Control group. However, the four conditions did not differ for proportion correct of all action items recalled and confidence accuracy for action items. In brief, Experiment 1 showed that witness discussions and retellings of the experienced event with others improved recall for action information but had had no, or small, effects on confidence accuracy. Experiment 2 investigated recall and confidence accuracy performance for action and detail information using focused questions. Seventy-seven participants watched a film, answered and confidence judged 63 questions about action and detail information about the events. Again, participants showed better memory and confidence accuracy for action information. Overall, the results indicate that, for both free recall and focused questions, witnesses’ recall and confidence accuracy is better for action information than for detail information, thus extra precaution is needed in the forensic system when detail information from witnesses is considered.

STUDY OF VASCULAR SEGMENTS OF LIVER IN DISSECTED CADAVERIC LIVER SPECIMEN

Liver surgeries are common in western world. The details are available both by imaging techniques as well as liver surgeries. The transplantation and resection of liver are in their initial stages in India. So, such data is not available in Indian population. Individual variations in morphology of vessels exist. Knowledge of vessels will define the segments of liver. It helps to plan the plane of resection for surgeries helping in conservation of normal tissue. Palliative embolisation of portal vein feeding the affected segment may provide some relief to the patient. Study of pattern of hepatic vessels by dissection tells about different arrangements and range of dimensions of these vessels to define segments and their respectability prior to surgery. During surgery if cranial hepatic vein is small, it warn us of the larger caudal vein, which warrants extra precautions during surgery. The diameter of inferior vena cava, hepatic veins and their common trunk decide the course of surgery during transplantation 2 . The study was planned to study the vascular segments of the liver specimen without any liver pathology obtained by cadaveric dissection. Study includes morphologic and biometric study of its major vessels.

Antibiotic precautions in athletes.

Context:Antibiotics are the mainstay of treatment for bacterial infections in patients of all ages. Athletes who maximally train are at risk for illness and various infections. Routinely used antibiotics have been linked to tendon injuries, cardiac arrhythmias, diarrhea, photosensitivity, cartilage issues, and decreased performance.Evidence Acquisition:Relevant articles published from 1989 to 2012 obtained through searching MEDLINE and OVID. Also, the Food and Drug Administration website was utilized.Study Design:Clinical review.Level of Evidence:Level 3.Results:The team physician should consider alternative medications in place of the “drug of choice” when adverse drug effects are a concern for an athlete’s health or performance. If alternative medications cannot be selected, secondary preventative measures, including sunscreen or probiotics, may be needed.Conclusion:Physicians choose medications based on a variety of factors to help ensure infection resolution while limiting potential side effects. Extra precautions are indicated when treating athletes with certain antibiotics.

Remixing the Remix: Fannish Appropriation and the Limits of Unauthorised Use

Remixing the Remix: Fannish Appropriation and the Limits of Unauthorised Use

Mother's Knowledge of Efforts to Prevent Covid 19 Transmission in Children Age 3 - 5 Years Old

Background : The Covid-19 pandemic that has spread worldwide threatens all groups, including children. Health protocols were quickly implemented to break the chain of the spread of Covid-19. The mother's role is crucial in taking extra precautions for safety against COVID-19, especially for children aged 3-5 years. Objective : The purpose of the study was to analyze mothers' knowledge about efforts to prevent transmission of covid 19 in children aged 3 - 5 years. Method: This is descriptive research. The research variable is the mother's knowledge about efforts to prevent the transmission of covid 19 in children aged 3-5 years. The study was carried out in Asmorobangun Village, Puncu Health Center, Kediri Regency, on July 5 - August 5, 2021. The study population was 228 mothers. Using the Proportional Random Sampling technique, a sample of 213 mothers was obtained. They collected data using a questionnaire. Result : The knowledge of respondents who have children aged 3-5 years is good as many as 179 people (84%), 28 respondents (13.1%) respondents have sufficient knowledge and 6 respondents (2.8%) have less knowledge. Conclusion : Information that mothers receive through various public service advertisements in various media can encourage mothers to memorize the information provided, provide the benefit of increasing mothers' knowledge in terms of preventing transmission of the coronavirus, especially to children, so that mothers can use it in carrying out coronavirus prevention behaviours properly and avoiding members families, especially children from exposure to the coronavirus.

Diagnostic value of a heart-type fatty acid-binding protein (H-FABP) bedside test in suspected acute coronary syndrome in primary care

To determine the diagnostic accuracy of a rapid heart-type fatty acid-binding protein (H-FABP) test in patients suspected of acute coronary syndrome (ACS) in primary care. General practitioners included 298 patients suspected of ACS. In all patients, whether referred to hospital or not, ECG and cardiac biomarker testing was performed. ACS was determined in accordance with international guidelines. Multivariate analysis was used to determine the value of H-FABP in addition to clinical findings. Mean patient age was 66 years (SD 14), 52% was female and 66 patients (22%) were diagnosed with ACS. The H-FABP bedside test was performed within 24h (median 3.1, IQR 1.5 to 7.1) after symptom onset. The positive predictive value (PPV) of H-FABP was 65% (95% confidence interval (CI) 50-78). The negative predictive value (NPV) was 85% (95% CI 80-88). Sensitivity was 39% (29-51%) and specificity 94% (90-96%). Within 6h after symptom onset, the PPV was 72% (55-84) and the NPV was 83% (77-88), sensitivity 43% (31-57%) and specificity 94% (89-97%). Adding the H-FABP test to a diagnostic model for ACS led to an increase in the area under the receiver operating curve from 0.66 (95% CI 0.58-0.73) to 0.75 (95% CI 0.68-0.82). The H-FABP rapid test provides modest additional diagnostic certainty in primary care. It cannot be used to safely exclude rule out ACS. The test can only be used safely in patients otherwise NOT referred to hospital by the GP, as an extra precaution not to miss ACS ('rule in').

Angio-oedema: an overview of differential diagnosis and clinical management

Angio-oedema is painless swelling of subcutaneous or submucosal tissues in any part of the body due to increased vascular permeability. It can cause symptoms secondary to a pressure effect on neighbouring structures but can also lead to life-threatening complications when occurring in the airway. Despite angio-oedema being a relatively rare clinical condition, it is of great importance to the anaesthetist who may be asked to assist with emergency airway management in acute presentations or be presented with patients with a history of angio-oedema on a routine operating list. These require extra precautions before administration of anaesthesia. Angio-oedema can occur as a result of a number of clinical conditions and the aim of this article is to give an overview of differential diagnoses and clinical management.

E-Security Issues

With the rapid growth of e-commerce, governmental and corporate agencies are taking extra precautions when it comes to protecting information. The development of e-security as a discipline has enabled organisations to discover a wider array of similarities between attacks occurring across their security environment and develop appropriate countermeasures. To further improve the security of information, there is a need for conceptualising the interrelationships between e-security and the major elements involved in changing a company's infrastructure. Organisations should act in an ethical manner, especially when it comes to e-security and e-privacy policies, procedures, and practices. The consequential theory of utilitarianism is used and applied to a conceptual model to help explain how organisations may develop better secured information in an information-sharing and globally networked environment. E-security is a critical concern for both consumers and business. Establishing trust between all parties in an online transaction is vital for the success of e-commerce. The public wants full assurance that the information they supply is going to the company they think it is going to, will not be misused by that company, and that credit card information or other payment mechanisms are confidential and secure. On the other hand, companies also want that their systems must remain protected from intruders and they cannot tamper with the data. Some degree of risk is always associated with E-transactions, if security controls are not applied while engaging into such transactions. Users must be sure before engaging into transactions that they are safe and the information provided by them is not going to unauthorized people. Cyber crimes can involve criminal activities that are traditional in nature, such as theft, fraud, forgery, defamation and mischief, all of which are subject to the Indian Penal Code. The abuse of computers has also given birth to a gamut of new age crimes that are addressed by the Information Technology Act, 2000. In this paper, I have covered the e-security issues such as elements of e-security, security threats or cyber crimes, tools for e-security, precautions for secure e-commerce and various studies regarding e-security issues.

The hazards of DAPI photoconversion: effects of dye, mounting media and fixative, and how to minimize the problem

Immunocytochemistry is a powerful tool for detection and visualization of specific molecules in living or fixed cells, their localization and their relative abundance. One of the most commonly used fluorescent DNA dyes in immunocytochemistry applications is 4',6-diamidino-2-phenylindole dihydrochloride, known as DAPI. DAPI binds strongly to DNA and is used extensively for visualizing cell nuclei. It is excited by UV light and emits characteristic blue fluorescence. Here, we report a phenomenon based on an apparent photoconversion of DAPI that results in detection of a DAPI signal using a standard filter set for detection of green emission due to blue excitation. When a sample stained with DAPI only was first imaged with the green filter set (FITC/GFP), only a weak cytoplasmic autofluorescence was observed. Next, we imaged the sample with a DAPI filter set, obtaining a strong nuclear DAPI signal as expected. Upon reimaging the same samples with a FITC/GFP filter set, robust nuclear fluorescence was observed. We conclude that excitation with UV results in a photoconversion of DAPI that leads to detection of DAPI due to excitation and emission in the FITC/GFP channel. This phenomenon can affect data interpretation and lead to false-positive results when used together with fluorochrome-labeled nuclear proteins detected with blue excitation and green emission. In order to avoid misinterpretations, extra precaution should be taken to prepare staining solutions with low DAPI concentration and DAPI (UV excitation) images should be acquired after all other higher wavelength images. Of various DNA dyes tested, Hoechst 33342 exhibited the lowest photoconversion while that for DAPI and Hoechst 33258 was much stronger. Different fixation methods did not substantially affect the strength of photoconversion. We also suggest avoiding the use of mounting medium with high glycerol concentrations since glycerol showed the strongest impact on photoconversion. This photoconversion effect cannot be avoided even when using narrow bandpass filter sets.

Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia.

BackgroundStigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia.MethodsA cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson’s correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey.ResultsMean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors.ConclusionsHigher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS.

Short communication. Effects of some environmental factors and extended calving interval on milk yield of Red Holstein cows

The effects of extended calving interval (CI), calving month, calving year and parity on lactation length (LL), lactation milk yield (LMY), the first 305 days milk production of the lactation (305-dMY) and daily milk yield (DMY) of Red-Holstein cows were investigated. A total of 286 CI and lactation records were collected from 116 cows in a dairy farm located in Aegean Region of Turkey between 2001 and 2010. The CI data were divided into three classes: CI12 (12 months), CI15 (15 months) and CI18 (18 months). The CI class affected LL (p0.05) and by 15.9% in CI18 (p&lt;0.01). Because of the higher temperature and relative humidity in summer months, it is advised that some extra precautions need to be taken to compensate the adverse effects of heat stress in cows in the region. In addition, extending CI from 12 to 15 months did not cause any significant production losses; however extending CI to 18 months resulted in a significant decrease in DMY.

Keeping Dysphagic Residents Safe at Home

Keeping Dysphagic Residents Safe at Home

New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home

Although chronic use of diuretics has been implicated as a risk factor for falls, it is unknown whether changes in diuretic drugs are associated with an acutely elevated risk of falls. We evaluated the relationship between change in a diuretic prescription (new prescription or increased dose) and the occurrence of documented falls among nursing home residents. Participants of the cohort were 1785 long-term care residents of two large nursing homes (2005-2010; Boston, MA). A self-matched, case-crossover analysis was used to examine whether there is an acutely increased risk of falling in the day following a diuretic drug change compared with days without a diuretic drug change. Odds ratios with 95% confidence intervals were calculated using conditional logistic regression models. During a mean follow-up of 8.4 months, 1181 participants experienced an incident fall. Nine participants experienced a diuretic change on the day before the fall. The odds of falling one day following a change in a diuretic was elevated (OR = 2.08; 95% CI = 0.89, 4.86). The association was stronger and reached nominal statistical significance when loop diuretics were examined separately (OR = 2.46; 95% CI = 1.02, 5.92). We estimated that, for every 271 loop diuretic drug changes, one excess fall occurred. Nursing home residents are at an increased risk of falls in the day following a new prescription or increased dose of a loop diuretic drug. Extra precautions should be taken immediately following a loop diuretic drug change in an effort to prevent falls.

On the upper bound of the number of modes of a multivariate normal mixture

The main result of this article states that one can get as many as D+1 modes from just a two component normal mixture in D dimensions. Multivariate mixture models are widely used for modeling homogeneous populations and for cluster analysis. Either the components directly or modes arising from these components are often used to extract individual clusters. Although in lower dimensions these strategies work well, our results show that high dimensional mixtures are often very complex and researchers should take extra precautions when using mixture models for cluster analysis. Further our analysis shows that the number of modes depends on the component means and eigenvalues of the ratio of the two component covariance matrices, which in turn provides a clear guideline as to when one can use mixture analysis for clustering high dimensional data.