Evaluating alternative crosslinking agents in poly(vinyl alcohol) hydrogels membranes

Hydrogels are a network of polymer chains with properties that absorb, store and transport solutions. A hydrogel membrane has a permeability that allows influx and excretion. Therefore, it is the ideal material for medicated membranes. This study investigates the crosslinking of poly(vinyl alcohol) (PVA) hydrogel membranes using different agents and explores the usability of the candidate membranes as drug delivery systems. The model protein, bovine albumin serum (BSA), was used to test the stability and controlled drug release rate characteristics of the candidate hydrogel membranes. This investigation also evaluated the stability different crosslinkers for hydrogel membranes. Glutaraldehyde (GA) and an alternative crosslinking method of ultraviolet irradiation with the sensitizer, sodium benzoate (SB), were used to crosslink PVA containing BSA. In GA crosslinked membranes, BSA release diffusion experiments showed 48%, 45%, and 63% recovery of protein at pH 6.5, 7.4 and 8.0, respectively; this confirmed that this system is suited for physiological conditions and controlled release. Although SB has been used for membrane fabrication, our Fourier Transform Infrared Spectroscopy (FTIR) and Thermogravimetric Analysis (TGA) results indicate that UV(SB)-crosslinked films are not suited for drug delivery, despite the release of BSA

Assessment of Keratitis Damage in an Age Dependent Mouse Model Using Analytical Software

Background: Streptococcus pneumoniae (pneumococcus) is a grampositive bacterium that is responsible for diseases such as, otitis media, conjunctivitis, bacterial keratitis, pneumonia, and meningitis. Bacterial keratitis is one of the most common after-effects of trauma to the eye. Some reports have shown the S. pneumoniae spreads through enzymes that are produced to digest the cornea, which in turn can causes blindness. There is a need for more improved measures that can reverse the detrimental effects of the bacteria. The long-term goal of this research is to better understand the complete role of S. pneumoniae and its components in bacterial keratitis to develop next generation therapies to prevent blindness. The purpose of this study is to develop alternative measures to evaluate damage associated with keratitis infection by use of computer applications. Methods: This study analyzed images of the established Keratitis pneumococcal mouse model. The eye images of mice 7-8-week-old and 9-month-old were collected. Additional images were taken on post-infection days one, three, five, and nine, revealing the progression of the infection. Results: The ImageJ Application provided more in depth review to determine the detrimental effects of S. pneumoniae. Through the software, a “Color Threshold” was created on every image to emphasize the area of damage caused by the bacteria. A scatter plot of every image created a map of the particles, and the diameter created a scale demonstrating the impact of keratitis. Data revealed that the most significant increase in infection occurs between Day 1 and 3 post-infection. Conclusions: The study has created a computer model to establish a baseline for the infection process of S. pneumoniae in the traditional mouse model. ImageJ has proven to be a useful tool to analyze the impact of disease on the murine model. Results from this study also provide evidence of the importance of early intervention in ocular disease

A novel 1-bp deletion in PITX3 causing congenital posterior polar cataract

Purpose: Cataracts are the most common cause of blindness worldwide. Inherited cataract is a clinically and genetically heterogeneous disease. Here we report a novel mutation in the paired-like homeodomain 3 (PITX3) gene segregating in a four generation English family with an isolated autosomal dominant posterior polar cataract.Methods: A genome-wide linkage was performed by means of single nucleotide polymorphism (SNP) and microsatellite markers. Linkage analyses were performed with the GeneHunter and MLINK programs. Direct sequencing of PCR products was performed to detect mutation in the gene, using the BigDye version 3.1 and analyzed using Sequence analysis version 5.2.Results: Genome-wide linkage analysis with SNP markers, identified a disease-haplotype interval on chromosome 10q. Two point positive logarithm of odds (LOD) scores was obtained with markers D10S205 (Z=3.10 at theta=0.00), flanked by markers D10S1709 and D10S543, which harbors the homeobox gene PITX3. Sequence analysis of PITX3 revealed a 1-bp deletion that cosegregated with all the affected members of this family which resulted in a frameshift in codon 181 and likely to produce an aberrant protein consisting of 127 additional residues.Conclusions: The 542delC is a novel mutation in PITX3 causing an isolated posterior polar cataract

A comparison of pneumolysin activity and concentration in vitro and in vivo in a rabbit endophthalmitis model

The purpose of this study was to determine whether the in vitro activity and concentration of Streptococcus pneumoniae pneumolysin correlated to the pathogenesis of S. pneumoniae endophthalmitis. Five S. pneumoniae clinical endophthalmitis strains were grown in media to similar optical densities (OD), and extracellular milieu was tested for pneumolysin activity by hemolysis of rabbit red blood cells. Pneumolysin concentration was determined using a sandwich ELISA. Rabbit vitreous was injected with 102 colony-forming units (CFU) of 1 of 2 different strains with low hemolytic activity (n = 10 and 12 for strains 4 and 5, respectively) or 1 of 3 different strains with high hemolytic activity (n = 12 per strain). Pathogenesis of endophthalmitis infection was graded by slit lamp examination (SLE) at 24 hours post-infection. Bacteria were recovered from infected vitreous and quantitated. The SLE scores of eyes infected with strains having high hemolytic activity were significantly higher than the scores of those infected with strains having low hemolytic activity (P < 0.05). Pneumolysin concentration in vitro, however, did not correlate with hemolysis or severity of endophthalmitis. Bacterial concentrations from the vitreous infected with 4 of the strains were not significantly different (P > 0.05). These data suggest that pneumolysin hemolytic activity in vitro directly correlates to the pathogenesis of S. pneumoniae endophthalmitis. The protein concentration of pneumolysin, however, is not a reliable indicator of pneumolysin activity

Military elites and the study of war

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67081/2/10.1177_002200275700100103.pd

Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

This narrative review explores the pathophysiology, geographic variation, and historical developments underlying the selection of fixed ratio versus whole blood resuscitation for hemorrhaging trauma patients. We also detail a physiologically driven and goal-directed alternative to fixed ratio and whole blood, whereby viscoelastic testing guides the administration of blood components and factor concentrates to the severely bleeding trauma patient. The major studies of each resuscitation method are highlighted, and upcoming comparative trials are detailed

Common strategies in empirically supported psychological interventions for alcohol use disorders: A meta-review.

ISSUES: Despite the large number of effective psychological interventions for alcohol use disorders (AUD), there is still a lack of clarity concerning the strategies that make these interventions effective. APPROACH: The overall goal of this review was to identify, examine and synthesise the information about common strategies from evidence-based psychological interventions for AUDs by conducting a review of systematic reviews, that is, a meta-review. We isolated the relevant primary studies from eligible systematic reviews and extracted information about the interventions from these studies to understand the strategies used. Analysis was restricted to narrative summaries. KEY FINDINGS: Thirteen reviews were eligible for inclusion in our meta-review. Of these, eight demonstrated the effectiveness of a range of psychological interventions-behavioural couples therapy, cognitive behaviour therapy combined with motivational interviewing, brief interventions, contingency management, psychotherapy plus brief interventions, Alcoholics Anonymous and 12-step treatment programs, family-therapy or family-involved treatment, and community reinforcement approach. The most commonly used component strategies in effective interventions for AUDs included assessment, personalised feedback, motivational interviewing, goal setting, setting and review of homework, problem solving skills and relapse prevention/management. IMPLICATIONS: Evidence about commonly used strategies in evidence-based psychological interventions for AUDs offer the possibility of creating menu-driven interventions that can be tailored to respond to individual client needs and preferences in different contexts

A Complex Intervention for Alcohol Misuse Among Conflict-Affected Populations in Uganda and Ukraine: Study Protocol for the Qualitative Components in the CHANGE Trial

Qualitative research is increasingly being integrated within the development and evaluation phases of trials of complex health interventions. Qualitative research can complement effectiveness data and provide insights around how context and implementation impact the results of the trial and to what extent interventions fit implementation contexts after evaluation. Several qualitative studies have been conducted at different stages of trials of mental health and psychosocial support interventions for populations affected by adversity such as armed conflict and disasters. However, these qualitative components are usually implemented as disjointed components within the trial. The current protocol aims to provide a shared framework detailing the qualitative components of the CHANGE project trial: a program of work to address alcohol misuse and associated mental health comorbidities among conflict-affected populations in Uganda and Ukraine. In particular, the objectives of the current protocol are (i) to identify the specific qualitative questions and methods that will be undertaken in CHANGE; (ii) characterize the different methodological approaches to analyzing the data; and (iii) explain how each qualitative component within the different work-packages will cumulatively add value to each other over the duration of the CHANGE project. The current protocol will represent a useful template for the integration of serial qualitative research components within complex health interventions in humanitarian settings. Each qualitative components described will undergo formal ethics approval by ethics boards in the United Kingdom, Uganda, and Ukraine. Multiple mechanisms will be in place to ensure rigor and trustworthiness of the research by meeting the criteria of credibility, transferability, dependability, and confirmability. </jats:p

The Effects of Language Barriers on the treatment of HIV/AIDS in Namibia

Thesis (Master's)--University of Washington, 2013Background: HIV/AIDS continues to be a devastating disease of great global importance despite the fact that antiretroviral therapy (ART) is a proven effective treatment. In the last decade, there have been massive efforts to improve access to antiretroviral drugs (ARVs) around the world. Beyond the logistics of obtaining access to ART, many personal, social, cultural, and economic factors influence an HIV+ person's ability or willingness to initiate and adhere to ART. This study investigates one such factor, the effects that language barriers between the patient and provider potentially have on the treatment of HIV in Namibia. Methods: Patients analyzed (n=387) were a subset of a larger (n=590) prospective study at four ART clinics around Namibia. All patients were enrolling in ART for the first time between Jan 2012 and Jan 2013. Background demographic information was collected at enrollment and their consultation with their provider was audio recorded and later coded using Roter interaction analysis system (RIAS) methodology. Language barrier, the exposure of interest, was defined as the patient and provider speaking at least one language in common and was assessed for 387 subjects. Adherence to treatment was measured by timing of attendance to their first follow-up appointment after their initial treatment visit. Low patient positive affect and low provider positive affect were calculated from global affect scores, which are a part of the RIAS coding, and split into binary variables based on expected results. The number of questions asked by the patient was also calculated from the RIAS data and excluded questions checking patients own understanding or asking for repetition as they are likely caused by language barriers. The outcome measured was the length of the consultation as determined by the length of the audio file. Poisson regression was used to obtain relative risks (RRs) for the binary outcomes and linear regression was used to analyze the continuous outcomes. Multivariable analyses adjusted for clinic, patient gender, age, education, and marital status and included robust variance estimates that adjusted for within-provider correlation. A set of secondary analyses on the effects of translators on these same outcomes were also performed. Results: Language barrier was not significantly associated with adherence (RR 1.05, 95% CI 0.96, 1.15), low provider positive affect RR=1.74 (0.78, 3.89), or low patient positive affect RR= 1.41 (0.96, 2.07). The coefficients relating language barrier to consultation length and number of questions were not meaningful or significant. Amongst those with language barrier, having a translator was associated with an increase in the mean consultation length by 2.65 min (p= 0.047). Conclusion: We found that patient provider language barriers were not associated with a change in likelihood of patient adherence and were associated with low provider and patient positive affect score though they were not significant at the α=0.05 level. Furthermore, the presence of a translator increases the mean length of consultation but does not affect adherence or positive affect of the provider or patient. This was the first study to look into the effects of language barriers on HIV/AIDS treatment in a developing country, and further research is needed to verify and further explore this relationship