The relationship between the hardness of potable water and cardiovascular and ischaemic heart disease mortality in South African urban areas

Studies carried out in a number of countries have revealed statistically significant negative correlations between death rates from cardiovascular disease (CVD) or ischaemic heart disease (IHD), and the hardness of local water supplies, a phenomenon which is known as the "water story". These findings have not, however, been universal and it was decided that a study carried out in South Africa with its high CVD and IHD death rates, might yield meaningful results to contradict or support existing findings. In 1983 a pilot study was thus initiated using a spatial model and a more detailed study began in 1984. This study ultimately involved the correlation of standardized mortality ratios (SMRs) for CVD and IHD with total water hardness and with a number of contributory and associated water quality factors. The study supported the hypothesised "water story", showing the existence of negative correlations between standardized mortality ratios (SMRs) for both CVD and IHD, and the hardness of potable water, whether measured as total hardness or as its two major contributory cations, calcium and magnesium. The level of statistical significance at which this correlation occurred, however, varied with differences in methodological approach. A "population-unweighted" methodology, which was applied to enable comparison with a number of previously published studies, pointed to potassium (a known hypertension normalisor) in permanently hard water as being an important factor. Problems inherent to each methodological approach have been discussed as has the need for improved data. In this regard, the need for a National water quality data bank has been emphasised

Expect analgesic failure; pursue analgesic success

Peer reviewe

NREM Sleep Parasomnias Commencing in Childhood:Trauma and Atopy as Perpetuating Factors

Objective/Background: Phenotyping of non-rapid-eye-movement (NREM) parasomnias is currently poorly undertaken. This study aimed to determine whether there are differences phenotypically among childhood-, adolescent-, and adult-onset NREM parasomnias continuing into and presenting in adulthood. Patients/Methods: A retrospective, cohort study of patients presenting with NREM parasomnia between 2008 and 2019 (n = 307) was conducted. Disorders included sleepwalking (n = 231), night terrors (n = 150), sexualised behaviour in sleep (n = 50), and sleep-related eating disorder (n = 28). Results: Compared to the adult-onset NREM behaviours group, the childhood- and adolescent-onset groups were more likely to have a family history of NREM behaviours (p < 0.001), experience a greater spectrum of NREM disorders (p = 0.001), and report a history of sleep-talking significantly more frequently (p = 0.014). Atopy was most prevalent in the childhood-onset group (p = 0.001). Those with childhood-onset NREM parasomnias were significantly more likely to arouse from N3 sleep on video polysomnography (p = 0.0003). Psychiatric disorders were more likely to be comorbid in the adult-onset group (p = 0.012). A history of trauma coinciding with onset of NREM behaviours was significantly more common in the childhood- and adolescent-onset groups (p < 0.001). Conclusions: Significant differences exist across childhood-, adolescent-, and adult-onset NREM parasomnia presenting in adulthood. This study suggests that adult-onset slow-wave sleep disorders may be confounded by psychiatric disorders resulting in nocturnal sleep disruption and that unresolved traumatic life experiences perpetuate NREM disorders arising in childhood and comprise one of the strongest external risk factors for triggering and perpetuating these disorders in adolescence

Rancang Bangun Sistem Latihan Tekanan Lidah

Terapi gerakan lidah secara rutin dengan stimulasi ujung syaraf bisa digunakan sebagai alat bantu terapi bagi pasien untuk penyakit stroke, dysphasia dan sleep apnea. Pada penelitian awal ini akan didesain rancang bangun Sistem Latihan Tekanan Lidah (LTL) dengan menggunakan alat LTL yang dirancang dengan menggunakan sensor tekanan Force Sensing Resistor (FSR) untuk memfasilitasi gerakan latihan lidah yang terdiri dari Tongue Force, Tongue Slide, dan Tongue Press. Pilihan jenis gerakan latihan lidah, panduan dan hasil latihan gerakan lidah yang dilakukan akan ditampilkan pada aplikasi smartphone. Simpulan yang didapat dari penelitian ini adalah Sistem LTL telah berhasil direalisasikan dengan sensor FSR, dari pembacaan nilai sensor tekanan pada Arduino dan smartphone terdapat delay rata-rata 1 detik. Besar tekanan lidah pada gerakan Tongue Force, Tongue Slide, dan Tongue Press sebesar 0-730 Gram-force. Pada Gerakan Tongue Slide ada perubaan besaran tekanan pada Sensor-1 dan Sensor-2, dikarenakan ada gerakan lidah kearah belakang. Berbeda dengan gerakan Tongue Press dan Tounge Force yang hanya mempengaruhi pada Sensor-1 saja.Routine tongue movement therapy with nerve tip stimulation can be used as a therapeutic aid for patients for stroke, dysphasia and sleep apnea. In this initial research, the design of the Tongue Pressure Training System (LTL) will be designed using an LTL tool designed using a Force Sensing Resistor (FSR) pressure sensor to facilitate tongue exercise movements consisting of Tongue Force, Tongue Slide, and Tongue Press. A selection of types of tongue exercise movements, guides and results of tongue movement exercises performed will be displayed on the smartphone application. The results obtained from this study are the LTL system which is realized from the reading of the pressure sensor value on the smartphone display, there is an average delay of 1 second so that there is a large difference in pressure readings on Arduino and smartphones. The amount of tongue pressure when performing Tongue Force, Tongue Slide, and Tongue Press movements has a pressure reading value of 0-700 Gram-force. In the Tongue Slide Movement, there is a change in the amount of pressure on sensor-1 and sensor-2, because the movement requires the tongue to move. In contrast to the Tongue Press and Tounge Force movements which focus more on pressure in sensor-1

Ares I-X Best Estimated Trajectory Analysis and Results

The Ares I-X trajectory reconstruction produced best estimated trajectories of the flight test vehicle ascent through stage separation, and of the first and upper stage entries after separation. The trajectory reconstruction process combines on-board, ground-based, and atmospheric measurements to produce the trajectory estimates. The Ares I-X vehicle had a number of on-board and ground based sensors that were available, including inertial measurement units, radar, air-data, and weather balloons. However, due to problems with calibrations and/or data, not all of the sensor data were used. The trajectory estimate was generated using an Iterative Extended Kalman Filter algorithm, which is an industry standard processing algorithm for filtering and estimation applications. This paper describes the methodology and results of the trajectory reconstruction process, including flight data preprocessing and input uncertainties, trajectory estimation algorithms, output transformations, and comparisons with preflight predictions

Ares I-X Best Estimated Trajectory and Comparison with Pre-Flight Predictions

The Ares I-X trajectory reconstruction produced best estimated trajectories of the flight test vehicle ascent through stage separation, and of the first and upper stage entries after separation. The trajectory reconstruction process combines on-board, ground-based, and atmospheric measurements to produce the trajectory estimates. The Ares I-X vehicle had a number of on-board and ground based sensors that were available, including inertial measurement units, radar, air- data, and weather balloons. However, due to problems with calibrations and/or data, not all of the sensor data were used. The trajectory estimate was generated using an Iterative Extended Kalman Filter algorithm, which is an industry standard processing algorithm for filtering and estimation applications. This paper describes the methodology and results of the trajectory reconstruction process, including flight data preprocessing and input uncertainties, trajectory estimation algorithms, output transformations, and comparisons with preflight predictions

Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence inspecifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission

Synthesis, Characterization, and Pickering Emulsifier Performance of Anisotropic Cross-Linked Block Copolymer Worms: Effect of Aspect Ratio on Emulsion Stability in the Presence of Surfactant

Reversible addition–fragmentation chain transfer (RAFT) aqueous dispersion polymerization is used to prepare epoxy-functional PGMA–P(HPMA-stat-GlyMA) diblock copolymer worms, where GMA, HPMA, and GlyMA denote glycerol monomethacrylate, 2-hydroxypropyl methacrylate, and glycidyl methacrylate, respectively. The epoxy groups on the GlyMA residues were ring-opened using 3-aminopropyltriethoxysilane (APTES) in order to cross-link the worm cores via a series of hydrolysis–condensation reactions. Importantly, the worm aspect ratio can be adjusted depending on the precise conditions selected for covalent stabilization. Relatively long cross-linked worms are obtained by reaction with APTES at 20 °C, whereas much shorter worms with essentially the same copolymer composition are formed by cooling the linear worms from 20 to 4 °C prior to APTES addition. Small-angle X-ray scattering (SAXS) studies confirmed that the mean aspect ratio for the long worms is approximately eight times greater than that for the short worms. Aqueous electrophoresis studies indicated that both types of cross-linked worms acquired weak cationic surface charge at low pH as a result of protonation of APTES-derived secondary amine groups within the nanoparticle cores. These cross-linked worms were evaluated as emulsifiers for the stabilization of n-dodecane-in-water emulsions via high-shear homogenization at 20 °C and pH 8. Increasing the copolymer concentration led to a reduction in mean droplet diameter, indicating that APTES cross-linking was sufficient to allow the nanoparticles to adsorb intact at the oil/water interface and hence produce genuine Pickering emulsions, rather than undergo in situ dissociation to form surface-active diblock copolymer chains. In surfactant challenge studies, the relatively long worms required a thirty-fold higher concentration of a nonionic surfactant (Tween 80) to be displaced from the n-dodecane–water interface compared to the short worms. This suggests that the former nanoparticles are much more strongly adsorbed than the latter, indicating that significantly greater Pickering emulsion stability can be achieved by using highly anisotropic worms. In contrast, colloidosomes prepared by reacting the hydroxyl-functional adsorbed worms with an oil-soluble polymeric diisocyanate remained intact when exposed to high concentrations of Tween 80

Epilepsia partialis continua complicated by disseminated tuberculosis and hemophagocytic lymphohistiocytosis: a case report.

BACKGROUND: We describe a patient copresenting with epilepsia partialis continua, tuberculosis, and hemophagocytic lymphohistiocytosis. To our knowledge, this is the first documented case of this triad. CASE PRESENTATION: A 54-year-old black South African woman presented to a hospital in Scotland with an acute history of right-sided facial twitching, breathlessness, and several months of episodic night sweats. Clinical examination revealed pyrexia and continuous, stereotyped, right-sided facial contractions. These worsened with speech and continued through sleep. A clinical diagnosis of epilepsia partialis continua was made, and we provide a video of her seizures. Computed tomographic imaging of the chest and serous fluid analyses were consistent with a diagnosis of disseminated Mycobacterium tuberculosis. An additional diagnosis of hemophagocytic lymphohistiocytosis was made following the identification of pancytopenia and hyperferritinemia in peripheral blood, with hemophagocytosis evident in bone marrow investigation. We provide images of her hematopathology. The patient was extremely unwell and was hospitalized for 6 months, including two admissions to the intensive care unit for ventilatory support. She was treated successfully with high doses of antiepileptic drugs (benzodiazepines, levetiracetam, and phenytoin) and 12 months of oral antituberculosis therapy, and she underwent chemotherapy with 8 weeks of etoposide and dexamethasone for hemophagocytic lymphohistiocytosis, followed by 12 months of cyclosporine and prednisolone. CONCLUSIONS: This combination of pathologies is unusual, and this case report helps educate clinicians on how such a patient may present and be managed. A lack of evidence surrounding the coexpression of this triad may represent absolute rarity, underdiagnosis, or incomplete case ascertainment due to early death caused by untreated tuberculosis or hemophagocytic lymphohistiocytosis. Further research is needed

A Midsummer Night's Dream

A simple, economic, highly sensitive and highly selective method for the detection of caffeine has been developed at bare and Nafion-modified glassy carbon electrodes (GCE). The electrochemical behaviour of caffeine was examined in electrolyte solutions of phosphate buffer saline, sodium perchlorate, and in choline chloride plus oxalic acid, using analytical determinations by fixed potential amperometry, phosphate buffer saline being the best. Modifications of the GCE surface with poly(3,4-ethylenedioxythiophene) (PEDOT), Nafion, and multi-walled carbon nanotubes were tested in order to evaluate possible sensor performance enhancements, Nafion giving the most satisfactory results. The effect of interfering compounds usually found in samples containing caffeine was examined at GCE without and with Nafion coating, to exclude interferences, and the sensors were successfully applied to determine the caffeine content in commercial beverages and drugs