Significant Increase In Frequency Research Articles

Physicians report adopting safer opioid prescribing behaviors after academic detailing intervention

ABSTRACTBackgroundThis study evaluated an educational intervention intended to increase physicians’ use of patient prescription history information from the state prescription monitoring program (PMP) and their adoption of clinical behaviors consistent with opioid prescription guidelines to reduce patient risk.MethodsPhysician volunteers (n = 87) in community practices and Veterans Administration medical settings in South Carolina received an office-based, individualized, educational intervention (Academic Detailing) from a trained pharmacist who promoted three key messages about safer opioid prescribing. Physicians were registered for the state PMP, guided through retrieving patient information from the PMP, and given patient-centered materials. Physicians consented to completing web-surveys; 68 (78%) completed follow-up surveys on average 12.2 weeks post-intervention.ResultsOf 43 respondents who did not use the PMP before the intervention, 83% adopted PMP use. Self-reports also revealed a significant increase in frequency of the following behaviors: 1) using patient report information from the PMP, 2) using a standardized scale to monitor pain intensity and interference with daily functioning, and 3) issuing orders for urine toxicology screens for patients maintained long-term on opioids.ConclusionsThe intervention was effective in promoting physician adoption of prescribing behaviors intended to reduce risks associated with prescription opioids. The self-report findings of this study should be confirmed by analysis using data on the number of queries submitted to the state's PMP. The present study suggests that a single academic detailing visit may be an effective tool for increasing physician voluntary registration and utilization of data on patients’ prescription history contained in a state PMP.

HYPERTROPHIC CARDIOMYOPATHY IN THE OLDER AGE GROUP: THE EFFECT OF CARDIOMETABOLIC RISK FACTORS AND RS2290149 AND RS10838692 OF THE MADD GENE

Objective. To study the impact of cardiometabolic risk factors and polymorphic variants rs2290149 and rs10838692 of the MADD gene on myocardial remodeling in the elderly patients with hypertrophic cardiomyopathy (HCM). Design and methods . We enrolled 257 patients with left ventricular hypertrophy (LVH) of various origin (mean age 57,7 ± 11,2 years; men — 5 %, women — 48 %): HCM (n = 154) and LVH caused by cardiometabolic risk factors (n = 103). The control group included 288 healthy donors. A standard clinical (laboratory and instrumental) diagnostic methods were applied. Genotyping for SNPs rs2290149 and rs10838692 of the MADD gene was performed using real time polymerase chain reaction (PCR). Results . Pre-obesity and obesity in patients with HCM were associated with increased left ventricular (LV) posterior wall thickness (14,82 ± 3,6 versus 12,77 ± 3,69 mm, respectively, p = 0,01), but not with the LV mass index and the interventricular septum. Obese HCM patients had greater detection rate of the symmetrical LVH (64 versus 10 % in non-obese HCM patients, p = 0,001). We observed a significant increase in frequency of TT genotype of rs2290149 and rs10838692 of the MADD gene in patients with LVH of various origin compared to healthy group: 81,6 vs. 71,5 % (ТТ : ТС+СС, p = 0,007) and 54,1 vs. 43,1 % (ТТ : ТС+СС, р = 0,002), respectively. The allele frequency also differs for rs2290149 (T : C = 89,6 : 10,4 % vs. 82,3 : 17,7 %; odds ratio (OR) = 1,864, 95 % confidence interval (CI) 1,306 to 2,660; p = 0,01) and for rs10838692 (T : C = 72,6: 27,4 % vs. 62,2 : 37,8 %; OR = 1,611, 95 % CI 1,246 to 2,082; p = 0,01). We found a significant increase in frequency of TT genotype of rs10838692 of MADD gene in patients with HCM 55,2 % (ТТ : ТС+СС, р = 0,019) and LVH caused by cardiometabolic risk factors — 52,4 % (ТТ : ТС+СС, p = 0,014) compared to healthy group (43,1 %). We also detected a trend towards the predominance of the TT genotype in rs2290149 of the MADD gene in patients with LVH caused by cardiometabolic risk factors (80,4 %) (ТТ : ТС+СС, р = 0,097), reaching a statistical significance in the HCM group (82,5 %) (ТТ : ТС+СС, р = 0,025) compared to healthy group (71,5 %). The allele frequency also differs for rs2290149 (T : C = 89,9 : 10,1 %, p = 0,01 in HCM; 89,2:10,8 %, р = 0,04 in LVH caused by cardiometabolic risk factors) versus 82,3 : 17,7 % in control group and for rs10838692 (T : C = 72,4 : 27,6 %, p = 0,01; 72,8 : 27,2 %, р = 0,01, respectively) versus 62,2 : 37,8 % in control. Conclusions . Pre-obesity and obesity in patients with HCM led to a greater LV posterior wall thickness and symmetrical myocardial remodelling. The T allele and TT genotype of SNPs rs10838692 and rs2290149 of the MADD gene were associated with the presence of LVH of various origin in the older subjects, but do not affect the degree of myocardial hypertrophy. Patients with HCM showed greater frequency of simultaneous carriage of the TT genotype and сombined carriage of the T allele of the polymorphic variants rs10838692 and rs2290149 of the MADD gene compared to the control group. The presence of obesity/overweight in patients with combined carriage of the TT genotype and simultaneous carriage of the T allele is associated with a greater thickness of the LV posterior wall, an increase in the left atrium size and the LV end-diastolic dimension.

Genotoxicity and cytotoxicity analysis of curcumin and sunset yellow in human lymphocyte culture.

Genotoxic and cytotoxic effects of curcumin and sunset yellow were tested by the chromosome aberration analysis and cytokinesis-block micronucleus cytome assay in human lymphocyte culture. Water solutions of food dyes, in concentrations of 1, 2, 4 and 8 mM, were added to the cultures at the beginning of the cultivation period. Concentrations of 4 and 8 mM of sunset yellow induced significant increase in frequencies of cells with chromosome aberrations. Tested concentrations of sunset yellow significantly associated with frequencies of structural aberrations, chromatid-type aberrations, total aberrant cells and micronuclei showing considerable dose dependent clastogenic activity. In higher analyzed concentrations, curcumin significantly increased only nuclear buds frequency, suggesting its potential genotoxicity, while sunset yellow showed dose-dependent genotoxic potential. Obtained results point toward favorization of natural coloring agents in food consumption and emphasize the need of controlled use of food colorants.

Genotoxicity and histopathological assessment of silver nanoparticles in Swiss albino mice

Silver nanoparticles (AgNPs) are widely used in industrial and medical applications. However, there is a growing concern about the potentialities of AgNPs to induce genotoxicity and DNA damage in humans. In this study, genotoxic and histopathological effects of AgNPs were investigated in mice using two well-characterized genetic assays: mouse bone marrow micronuclei (MN) and mouse sperm morphology assays. Swiss albino mice (total N=18) were exposed to varying concentrations (3,000mg/Kg, 4,000mg/Kg, 5,000mg/Kg and 6,000mg/Kg) of AgNPs for 5 consecutive days and observed for 30 days afterwards. Distilled water and colchicine were used as negative and positive controls, respectively. The MN assay showed that the frequency of micronuclei induction increased with AgNP concentration. Statistically significant differences (p<0,05) were observed for the micronucleus frequency in the blood erythrocytes in all the test concentrations. Sperm head morphology assay also revealed various types of abnormal sperm head morphology and there was statistically significant increase in frequency of sperm abnormalities. Histopathological profiles of the liver also showed enlarge sinusoids, irregular portal tract, and dose-dependent vacuolation. These results suggest that AgNPs is genotoxic and represent a serious health risk to human heatlh.

Alterations in natural killer and dendritic cell subsets in individuals with HIV‐associated neurotuberculosis

One of the commonest HIV-associated opportunistic infections of the central nervous system is neurotuberculosis. Interaction between HIV, Mycobacterium tuberculosis and host immune system in co-infected individuals may result in altered frequencies of immune cells, thereby modulating dissemination and disease progression. We examined the frequencies of natural killer (NK) cell and dendritic cell (DC) subsets in HIV infected individuals with neurotuberculosis (HIVNTB) as compared to individuals with HIV associated systemic TB (HIVSTB), asymptomatic HIV, non-HIV NTB, non-HIV STB, and healthy controls. Peripheral blood mononuclear cells (PBMC) were stained with fluorochrome-conjugated monoclonal antibodies- Lineage cocktail (containing CD3, CD14, CD19, and CD20), HLA-DR, CD16, CD56, CD11c, and CD123, fixed with 2% paraformaldehyde and analyzed on the flow cytometer. The pDCs were significantly reduced in all HIV infected groups, with a marked reduction in HIVNTB cases as compared to healthy controls. While the CD56- CD16bt NK cell subset displayed a significant increase in frequency in all three HIV infected groups compared the three HIV negative groups, the CD56dim CD16bt subset was significantly lower in frequency in the HIVNTB compared to healthy controls. The decreased frequencies of plasmacytoid DCs and cytotoxic NK cells, which are crucial for innate immune defence against HIV, may result in ineffective virus control and lead to an exacerbated course of disease in HIVNTB individuals.

Association of polymorphic variants of IL-1β and IL-1RN genes in the development of Graves’ disease in Kashmiri population (North India)

PurposeGraves’ disease (GD) is a multigenic, organ specific autoimmune disorder with a strong genetic predisposition and IL-1β has been shown to be involved in its pathogenesis. The present study was aimed to determine the genetic associations between polymorphisms of IL-1β gene promoter region (−511 T>C) (rs16944), exon 5 (+3954 C>T) (rs1143634) and IL-1RN gene VNTR (rs2234663) polymorphism in patients with GD in ethnic Kashmiri population. MethodsA total of 135 Graves’ disease patients and 150 healthy individuals were included in the study. PCR and PCR-based restriction analysis methods were done for IL-1RNVNTR and IL-1β gene polymorphisms respectively. ResultsWe found statistically significant increased frequencies of the C/C + CT genotype (P = 0.001; odds ratio (OR) = 5.04, 95% confidence interval (CI) = 3.02–8.42) and the C allele (P = 0.001; OR = 3.10, 95% CI = 2.14–4.50) in IL-1β gene promoter polymorphism (rs16944) with GD patients compared to normal controls. Also in the exon 5 (rs1143634), a significant increase in frequency of the C/C homozygous genotype (P = 0.001; OR = 0.18, 95% CI = 0.11–0.30) and C allele (P = 0.001; OR = 0.31, 95% CI = 0.20–0.48) was observed in GD cases as against controls. For IL-1RNVNTR (rs2234663), we didn’t observe any significant difference in the allelic and genotypic frequencies between cases and controls. ConclusionOur findings suggest that both promoter and exon polymorphisms of IL-1β gene have a significant role in the risk of developing GD, whereas IL-1RNVNTR has no association with GD.

Influence of Anatomic Changes on the Outcomes of Carotid Siphon Aneurysms After Deployment of Flow-Diverter Stents.

Flow-diverter stent (FDS) deployment can cause morphological and hemodynamic changes in the carotid siphon (CS), influencing the occlusion rate of aneurysms in this location. To evaluate morphological changes to the CS after FDS deployment and their relationship with the rate of occlusion of intracranial aneurysms. A cohort of 183 patients with CS aneurysms were treated by deployment of Pipeline® FDS (Medtronic Inc, Dublin, Ireland). Their CSs were classified as type U, V, C, or S, depending on morphology. The posterior and anterior bend angles were measured on strict lateral cerebral angiogram with digital subtraction before FDS deployment, immediately after deployment, and at 6 mo. Differences between angles were analyzed to identify any correlations with rates of aneurysm occlusion, using the O'Kelly-Marotta classification. FDS deployment was associated with immediate changes in CS morphology. The mean anterior angle increased from 3.97 ± 25.06° to 22.05 ± 25.18° (P < .001) and the mean posterior angle increased from 71.98 ± 31.27° to 79.43 ± 31.80° (P < .001). Multivariate analysis revealed a progressive, statistically significant increase in frequency of complete (grade D) occlusion at 6-mo follow-up with increasing anterior bend angle (prevalence ratios (PR) = 1.42 for increases between 5.3° and 12°, P = .017; PR = 1.56 for increases between 12.1° and 27.6°, P = .002; PR = 1.83 for increases >27.6°, P < .001, all vs increases <5.3°). FDS deployment induces changes in CS morphology. Specifically, increases in mean anterior angle are associated with better radiological results on 6-mo follow-up digital subtraction angiography.

Epidemiological trends of cryptococcosis in Italy: Molecular typing and susceptibility pattern of Cryptococcus neoformans isolates collected during a 20-year period.

In the present study clinical data and isolates from cases of cryptococcosis recorded during clinical surveys carried out in Italy from 1997 to 2016, were investigated. Molecular typing and antifungal susceptibility testing were performed in order to delineate the epidemiological trend of cryptococcosis in Italy and to define wild-type population for four different antifungal compounds. During the studied period, a total of 302 cases collected from 32 centers of 11 Italian regions were recorded. Analysis of clinical data showed a significant increase of frequency (from 7% to 38%) of cryptococcosis in human immunodeficiency virus (HIV)-negative patients primarily with hematologic malignancies and solid organ transplantations. The prevalence of the molecular types has significantly changed during the study period, showing an increase of VNIII isolates from 11% to 41% in HIV-negative patients, and a decrease of VNIV isolates from 36% to 16%. Antifungal susceptibility testing allowed us to calculate the epidemiological cut-off for flucytosine (1 mg/l), fluconazole (8 mg/l), itraconazole (0.5 mg/l), and voriconazole (0.25 mg/l). Most of the isolates were wild-type strains. Comparison of the MIC distributions according to molecular types showed that VNIV isolates had lower MICs for fluconazole and itraconazole than the VNI and VIII isolates. The current study emphasizes that the epidemiology of cryptococcosis in Italy has significantly changed over the last decades.

Постконтрактный оппортунизм на рынке добровольного медицинского страхования

This paper contributes to the discussion on possibilities to reveal ex post moral hazard in the Russian market for private health insurance. By ‘ex post’ we mean the period when a health insurance contract is valid. Moral hazard implies risky behavior of a respondent that increases health care utilization and/or decreases their incentives to prevent an insured event. In our empirical estimates, we explore the uniqueness of the Russian data that consists in the fact that many medical organizations provide services to respondents insured by enterprises. Adverse selection is hardly possible among such respondents. It gives us the possibility to observe ex post moral hazard, simply controlling for ex ante moral hazard by the use of individual fixed effects in panel data models. We use the RLMS-HSE data (2000–2015) for empirical estimates. We consider doctor visits, tobacco and alcohol consumption, physical exercises, and self-assessed health (SAH) as moral hazard indicators, estimating ordered choice regression models for each of the dependent variables mentioned above. To avoid inconsistency in estimates of parameters caused by the incidental parameter problem, we use the Blow-Up and Cluster (BUC) estimator. The results show a statistically significant increase in frequency of visits to the doctor and in alcohol consumption, as well as a decrease in SAH during the period of insurance. These results could be useful for insurance companies and could be accounted for in contracts for private health insurance.

Negative Impact of Prolonged Antibiotics or Persistent Diarrhea on Vitamin K1 Levels in 2-24 Weeks aged Egyptian Infants.

BackgroundTo evaluate the hazard of prolonged antibiotic therapy and/or persistent diarrhea on vitamin K1 (VK1) level and bleeding profile in infants (2–24 weeks).MethodsA one-year case-control study, conducted at Ain Shams University, Egypt. 338 infants (2–24 weeks) were recruited and divided into 3 groups (1:1:3 ratios); group A (n=67) patients who received antibiotics for ≥10 days, group B (n=67) who had persistent diarrhea ≥ 14 days and group C (n=204) age- and gender- matched infants who had not either received antibiotics nor had diarrhea. All subjected to clinical assessment, bleeding history and had their complete blood count (CBC), PT and PTT, liver transaminases and VK1 level assayed.ResultsThere was a significant increase in frequency of VKDB (vitamin K deficiency bleeding) and abnormal bleeding profile in cases than control group. There was significant negative correlation between VK1 level and duration of diarrhea, length of antibiotics used and bleeding profile. Antibiotic usage has hazardous effect on VK1 level in those with diarrhea; more patients were receiving antibiotic in those with persistent diarrhea and VKDB (N=55) than those with persistent diarrhea and normal VK1 (N=12). The longer duration of antibiotic therapy the lower level of VK1. Combining cephalosporin/penicillin therapy and/or diarrhea, in particular, had an impact on VK1 level.ConclusionVKDB, a preventable cause of life-threatening hemorrhage, is still a major health problem in Egyptian infants, where persistent diarrhea and misuse of antibiotics are prevalent, necessitate a booster dose of VK in those high risk infants.

MICRONEEDLING AND GLYCOLIC ACID PEEL FOR TREATMENT OF ACNE SCAR; COMPARATIVE STUDY

ABSTRACT Background : Atrophic acne scars are common and undesirable outcome of acne vulgaris related to both its severity and delay in treatment. Such scars can be classified according to the depth and shape of the collagen loss: ice pick, boxcar, or rolling. Many options are available for treatment of acne scars such as: laser surgery, radiofrequency intervention, chemical peels, chemical reconstruction of skin scars (cross technique), dermabrasion, needling, subcision, punch techniques, fat transplantation, and other tissue augmenting agents. Objective : The aim of this study was to compare between GA peel monotherapy and microneedling with dermapen monotherapy in treatment of acne scars. Moreover, combined treatment of GA peel and microneedling with dermapen is compared to each of the above monotherapies in treatment of acne scars. Methods : Thirty patients of both sexes (10 men and 20 women) with age ranged from 19-45 years old with different types of atrophic acne scars were enrolled in the study. Patients were randomly divided into three groups: Group I : Included ten patients (4 males and 6 females) aged 27 - 45 years. They had microneedling with dermapen for treatment of the scars. Group II: Included ten patients (4 males and 6 females) aged 19- 42 years. They had glycolic acid 35% peel for treatment of the scars. Group III: Included ten patients (2 males and 8 females) aged 19-39 years. They were treated with skin microneedling with dermapen combined with glycolic acid 35% peel. Results : Results revealed that there was statistical significant decrease between acne scar grade in dermapen group before and after treatment with degree of improvement (80%). Also, in glycolic acid group before and after treatment with degree of improvement (70%). Statistical significant decrease between acne scar grade in combination group before and after treatment with degree of improvement (100%). Statistical significant increase in frequency of improvement in rolling compared to boxcar and icepick in all groups and also in boxcar compared to icepick. Conclusion : Dermapen and glycolic acid peel are effective and safe techniques in acne scars especially (superficial scars). Combination of dermapen and glycolic acid peel is more effective than monotherapy by either dermapen or glycolic acid peel and also helps in improvement of deep acne scars. Keyword : Microneedling, Glycolic acid, Acne scar.

FEATURES OF THE MICROBIAL SPECTRUM UROGENITAL SYSTEM OF WOMEN WITH RECURRENT PYELONEPHRITIS

The aim of our research was to identify the peculiarities of the microbial spectrum urogenital system of the women with recurrent pyelonephritis.&#x0D; Materials and methods. We have conducted a comprehensive micro-biological examination different biological material (urine, vaginal swabs, scraping of urethral and cervical canal’s) of 175 women with recurrent pyelonephritis. The patients were divided in accordance with frequency of recurrent. The microbial spectrum urogenital system of 98 women with recurrent pyelonephritis (group 1) was compared with 77 women with sporadic pyelonephritis (up to 2 times per year) (group 2). The research included the process of identification of bacterial agents, mollicutes, chlamydia as well as yeasts.&#x0D; Results. In the women with recurrent pyelonephritis had the significant increase of frequency of identification of E. faecalis in urine (p=0.03), in urethral canal (p=0.05), and vaginal scraping (p=0.02). 48 women from 1st group had bacterial mix-infection. At the same time, the women from comparative group had only in 25 (32.6%) cases (p=0.027). The direct associative relationship was found between existence of S. epidermidis in urethral canal, in cervical canal, in vagina and the frequency of recurrent pyelonephritis (ρ=0.2, р=0.009; ρ=0.23, р=0.004 and ρ=0.19, р=0.01 respectively); E. faecalis in the urethral canal (ρ=0.19, р=0.02); Candida albicans in the vagina (ρ=0.17, р=0.03). 79.6% examined patients were infected by mollicutes, viruses and chlamydia.&#x0D; Conclusions. Consistent high level of urethral’s and vaginal’s bacterial weight of the women with recurrent pyelonephritis leads to the migration of causative agents into bladder and to activates formation of recurrent of the disease. Identified peculiarities of microbial spectrum prove the necessity mandatory micro-biological research not only urine, but urethra, cervical canal, and vagina.

Epinephrine syringe exchange events in a paediatric cardiovascular ICU: analysing the storm.

In all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data. This novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.

Is there a relationship between spondyloarthritis and periodontitis? A case–control study

ObjectiveTo compare the frequency and severity of periodontitis in patients with spondyloarthritis (SpA) with healthy control individuals, through the evaluation of clinical, serological and microbiological periodontal condition.MethodsPatients with a diagnosis...

The transition from water to air in aeshnid dragonflies is associated with a change in ventilatory responses to hypoxia and hypercapnia

Dragonflies are amphibiotic, spending most of their lives as aquatic nymphs before metamorphosing into terrestrial, winged imagoes. Both the nymph and the adult use rhythmic abdominal pumping movements to ventilate their gas exchange systems: the nymph tidally ventilates its rectal gill with water, while the imago pumps air into its tracheal system through its abdominal spiracles. The transition from water to air is known to be associated with changes in both respiratory chemosensitivity and ventilatory control in vertebrates and crustaceans, but the changes experienced by amphibiotic insects have been poorly explored. In this study, dragonfly nymphs (Anax junius) and imagoes (Anax junius and Aeshna multicolor) were exposed to hypoxia and hypercapnia while their abdominal ventilation frequency and amplitude was recorded. Water-breathing nymphs showed a significant increase in abdominal pumping frequency when breathing hypoxic water (<10 kPa O2), but no strong response to CO2, even in severe hypercapnia (up to 10 kPa CO2). In contrast, both species of air-breathing imago increased their abdominal pumping amplitude when exposed to either hypoxia or hypercapnia, but did not show any significant increase in frequency. These results demonstrate that aquatic dragonfly nymphs possess a respiratory sensitivity that is more like other water breathing animals, being sensitive to hypoxia but not hypercapnia, while their air-breathing adult form responds to both respiratory challenges, like other terrestrial insects. Shifting from ventilating a rectal gill with water to ventilating a tracheal system with air is also associated with a change in how abdominal ventilation is controlled; nymphs regulate gas exchange by varying frequency while imagoes respond by varying amplitude.

Upper Respiratory Infections and Airway Adverse Events in Pediatric Procedural Sedation.

Upper respiratory infections (URIs) are associated with airway adverse events (AAEs) during general anesthesia. There have been no large studies examining the relationship between URIs and AAEs during pediatric procedural sedation. We hypothesized that there would be a relationship between URI status and AAEs in pediatric procedural sedation. We examined prospectively collected data from the Pediatric Sedation Research Consortium database. Specific questions regarding URI status were added to the database to facilitate our analysis. Characteristics of patients, procedure types, adjunctive medications, adverse events, and airway interventions (AIs) were reported. We performed bivariate analysis of adverse events and URI status, then used a multivariable logistic regression model to assess the relationship between URI status and adverse events. We examined the secondary outcome of AI similarly. Of the 105 728 sedations entered into the Pediatric Sedation Research Consortium database during the study period, we were able to use 83 491 for analysis. Controlling for multiple patient, drug, and procedure characteristics, recent and current URI were associated with increased frequency of AAEs. In general, the frequency of AAEs and AIs increased from recent URI, to current URI-clear secretions to current URI-thick secretions. We did not find a relationship between URI status and non-AAEs. URI status is associated with a statistically significant increase in frequency of AAEs and AI during pediatric procedural sedation for the population sedated by our consortium. Although URI status merits consideration in determining potential risk for sedation, rates of some AAEs and AIs remained low regardless of URI status.

Assessing changes in knowledge, attitude and practices on dengue diagnosis and management among primary care physicians after the largest dengue epidemic in Singapore

BackgroundDengue results in high morbidity and mortality globally. The knowledge, attitude and practices (KAP) of dengue management, including diagnosis, among primary care physicians (PCPs) are important to reduce dengue transmission and burden. However, there is a lack of understanding on the impact of dengue epidemic on dengue management. Hence, the aim of this study is to examine the changes in KAP on dengue management among PCPs before and after the largest dengue epidemic in 2013 in Singapore.MethodsSurveys were mailed to 2000 and 1514 PCPs registered under the Singapore Medical Council in March of year 2011 and 2014, respectively. Survey data were then collected between April and June of that year. Chi-square or Fisher’s exact test was used for comparing categorical variables. A multivariate logistic regression model was implemented to determine independent factors for frequent use of dengue diagnostic tests (DDTs). All tests were conducted at 5% level of significance. Adjusted odds ratio and corresponding 95% confidence intervals were reported, where applicable. Qualitative data were descriptively coded for themes and analysis.ResultsAmong PCPs surveyed in 2011 and 2014, 89.9% and 86% had good knowledge on dengue management respectively. The usage of DDTs had increased significantly in 2014 (N = 164;56%) as compared to 2011 (N = 107;29.5%) in both private and public clinics (p < 0.001). Dengue Duo point-of-care test (POCT) kits was independently associated with frequent use of DDTs (adjusted odds ratio = 2.15; 95% confidence interval = 1.25–3.69). There was a significant reduction in referral of dengue patients to hospital (31.4% in 2011; 13.3% in 2014; p < 0.001), and a significant increase in frequency of clinic follow-ups (18.4% in 2011; 28.5% in 2014; p = 0.003). One key theme highlighted was that dengue management can be improved with availability of POCT kit, better awareness of the disease and any revised clinical guidelines.ConclusionThe knowledge on dengue management remained high, while the attitude and practices, particularly on the usage of DDTs improved significantly after a large epidemic. Furthermore, PCPs had more confident in managing dengue patients in primary care settings and in educating patients on the importance of vector control and dengue warning signs to reduce dengue transmission and burden.

Current and future groundwater withdrawals: Effects, management and energy policy options for a semi-arid Indian watershed

Effects of future expansion/intensification of irrigated agriculture on groundwater and surface water levels and availability in a semi-arid watershed were evaluated using an integrated hydrologic model (MIKE SHE/MIKE 11) in conjunction with biophysical measurements. Improved water use efficiency, water storage, and energy policy options were evaluated for their ability to sustain the future (2035) increased groundwater withdrawals. Three future withdrawal scenarios (low = 20, medium = 30, high = 50 wells/100 km2/year) based on the historical rate of growth of irrigation wells were formulated. While well drying from falling groundwater levels was limited to drought and consecutive below average rainfall years, under the current (2015) withdrawals, significant increases in frequency and duration (17–97 days/year) of well drying along with 13–26% (19–37 mm) reductions in surface flows were predicted under the future withdrawals. Higher (27–108%) energy demands of existing irrigation pumps due to declining groundwater levels and reduced hydroelectric generation due to decreased surface flows would create a vicious water-food-energy nexus in the future. Crop failure, one of the main causes of farmers’ emotional distress and death in the region, is predicted to exacerbate under the future withdrawal scenarios. Shift to negative net recharge (−63 mm) and early and prolonged drying of wells under the high scenario will reduce the groundwater availability and negatively affect crop production in more than 60% and 90% of cropped areas in the Rabi (November–February) and summer (March–May) seasons, respectively during a drought year. Individual and combined demand (drip irrigation and reduced farm electricity subsidy) and supply (water storage) management options improved groundwater levels and reduced well drying by 55–97 days/year compared to business-as-usual management under the high scenario. The combined management (50% drip conversion, 50% reduction in subsidy, and enhanced water storage) mitigated well drying even during drought and consecutive below average rainfall years under the high scenario. A conservative economic evaluation for management options under the high scenario showed increases in crop production and per farmer annual profits by $987–$1397 during a drought year (average household income = $1520/year). A scale-up of results showed that diverting 50% state power subsidy ($6 billion for 3–6 years) can almost entirely fund the conversion to drip irrigation ($4.2 billion) and water storage structures ($2.9 billion) and help meet the water supply demand of a 50% increase in irrigated area under the high scenario. Converting flood to drip irrigation in 50% of irrigated area under the high scenario can reduce the electric energy consumption (7 × 106Mwh/year) and carbon footprint (6000 Mt/year) of groundwater irrigation by 24% in the state. Management options considered can potentially create a sustainable water-food-energy nexus in the larger semi-arid hard rock region. Reducing the power subsidy will require a strong political will since it has been used as a tool to win the elections in India. Considering future agricultural intensification, timely interventions are needed to ensure the livelihood and well-being of millions of small- and medium-scale farmers that rely on low storage, hard rock aquifers in the semi-arid regions of the world.

A method for the assessment of facial hedonic reactions in newborns

ObjectiveThis study describes a quantitative and qualitative methodology to assess hedonic responses to sweet stimulus in healthy newborns. MethodsA descriptive, cross‐sectional, observational study, with healthy newborns (up to 24h of life), between 37 and 42 gestational weeks, vaginally born and breastfed previously to all tests. The evaluation of the newborns reactions was performed by hedonic facial expression analysis, characterized by facial expressions with rhythmic serial tongue protrusion after neutral or sweet solution intake. Initially, 1mL of water solution was provided to the newborn, followed by a 1‐minute recording. Afterwards, the same amount of 25% sucrose solution was provided, performing a second recording. The concordance between researchers was analyzed by the Bland–Altman statistical method. ResultsA total of 100 newborns (n=49 males, n=51 females; mean lifetime=15h 12min±6h 29min) were recorded for neutral and sucrose solution intake, totaling 197 videos (n=3 missing in the water treatment). These videos were double‐blind analyzed and the test revealed a 90% concordance between the two trained researchers, in relation to both solutions. The intraclass correlation coefficient was 0.99 for both solutions, with a significant increase in frequency of hedonic expressions evoked by sucrose solution intake. ConclusionsThese results confirm that the proposed method has an efficient power to detect significant differences between neutral and sucrose stimuli. In conclusion, this evaluation method of hedonic facial reactions in newborns reflects the response to a specific taste.

An Inter-comparison of Three Heat Wave Types in China during 1961\u20132010: Observed Basic Features and Linear Trends

Using observed daily temperatures in China, three independent types of heat waves (HWs), including daytime HWs, nighttime HWs, and compound HWs (with both extreme daily maxima and minima), were defined. Different types of HWs showed distinctive preferences in occurrence locations and timing. However, spatial patterns of accompanying relative humidity were generally independent of categorization, except for closer association of nighttime events with high humidity level. Compound HWs and nighttime HWs experienced significant increases in frequency, participating days, mean duration, intensity and areal extent. Conversely, significant decreasing trends of above indicators prevailed in daytime HWs, especially in central-eastern China. Tendency of relative humidity changes didn’t vary with HW types. Instead it caused an interesting phenomenon that dry HWs in the west became more humid and humid events in the east got dryer, as manifested most obviously in compound type. Thorough comparisons highlight the evolutionary dominance of HW types. Specifically, previously-dominating independent daytime HWs have been increasingly replaced by independent nighttime events in central-eastern China, and by compound HWs in southern China. That’s the very reason for negative trends of independent daytime HWs in eastern China, even in a warming climate.