Increased waterborne blaNDM-1 resistance gene abundances associated with seasonal human pilgrimages to the Upper Ganges River

Antibiotic resistance (AR) is often rooted in inappropriate antibiotic use, but poor water quality and inadequate sanitation exacerbate the problem, especially in emerging countries. An example is increasing multi-AR due to mobile carbapenemases, such as NDM-1 protein (coded by blaNDM-1 genes), which can produce extreme drug-resistant phenotypes. In 2010, NDM-1 positive isolates and blaNDM-1 genes were detected in surface waters across Delhi and have since been detected across the urban world. However, little is known about blaNDM-1 levels in more pristine locations, such as the headwaters of the Upper Ganges River. This area is of particular interest because it receives massive numbers of visitors during seasonal pilgrimages in May/June, including visitors from urban India. Here we quantified blaNDM-1 abundances, other AR genes (ARG) and coliform bacteria in sediments and water column samples from seven sites in the Rishikesh-Haridwar region of the Upper Ganges and five sites on the Yamuna River in Delhi to contrast blaNDM-1 levels and water quality conditions between season and region. Water quality in the Yamuna was very poor (e.g., anoxia at all sites), and blaNDM-1 abundances were high across sites in water (5.4 ± 0.4 log(blaNDM-1·mL-1); 95% confidence interval) and sediment (6.3 ± 0.7 log(blaNDM-1·mg-1)) samples from both seasons. In contrast, water column blaNDM-1 abundances were very low across all sites (2.1 ± 0.6 log(blaNDM-1·mL-1)) in February in the Upper Ganges and water quality was good (e.g., near saturation oxygen). However, per capita blaNDM-1 levels were 20 times greater in June in the Ganges water column relative to February and blaNDM-1 levels significantly correlated with fecal coliform levels (r=0.61; p=0.007). Given waste management infrastructure is limited in Rishikesh-Haridwar; data imply blaNDM-1 levels are higher in visitor's wastes than local residents, which results in seasonally higher blaNDM-1 levels in the river. Pilgrimage areas without adequate waste treatment are possible "hot spots" for AR transmission, and waste treatment must be improved to reduce broader AR dissemination via exposed returning visitors

The Australasian COVID-19 Trial (ASCOT) to assess clinical outcomes in hospitalised patients with SARS-CoV-2 infection (COVID-19) treated with lopinavir/ritonavir and/or hydroxychloroquine compared to standard of care: A structured summary of a study protocol for a randomised controlled trial

Objectives: To determine if lopinavir/ritonavir +/- hydroxychloroquine will reduce the proportion of participants who survive without requiring ventilatory support, 15 days after enrolment, in adult participants with non-critically ill SARS-CoV-2 infection. Trial design: ASCOT is an investigator-initiated, multi-centre, open-label, randomised controlled trial. Participants will have been hospitalised with confirmed COVID-19, and will be randomised 1:1:1:1 to receive lopinavir /ritonavir, hydroxychloroquine, both or neither drug in addition to standard of care management. Participants: Participants will be recruited from >80 hospitals across Australia and New Zealand, representing metropolitan and regional centres in both public and private sectors. Admitted patients will be eligible if aged ≥ 18 years, have confirmed SARS-CoV-2 by nucleic acid testing in the past 12 days and are expected to remain an inpatient for at least 48 hours from the time of randomisation. Potentially eligible participants will be excluded if admitted to intensive care or requiring high level respiratory support, are currently receiving study drugs or their use is contraindicated due to allergy, drug interaction or comorbidities (including baseline QTc prolongation of 470ms for women or 480ms for men), or death is anticipated imminently

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Robotic sensing for the partially sighted

Partial sightedness is a sensory disability which can to some extent be alleviated by artificial aids. Many of the sensory methods used in robotics can be applied in attempts to recapture some of the sensory information a partially sighted person has lost. This paper describes a device which uses sonar and stereo vision sensors for this task. The device is portable, and is worn by the user, giving them freedom of movement over kerbs, stairs and rough ground. Sensor motion during walking is measured using visual egomotion recovery and odometry, and has been modelled to allow compensation in the sensor readings. A ground position estimate is continually updated by scene ground-plane fitting, or from the walk-motion model, and is used to classify scene features as obstacles or parts of the ground. Methods for the robust reconstruction of image points and lines into scene features are developed. The recognition of world objects of exceptional significance to a mobile person - kerbs and stairs - is given particular attention. A user interface, which has undergone limited real world testing, is also described. Experimental results are presented for the various parts of the system. © 1999 Elsevier Science B.V. All rights reserved

A Stereo Vision-Based Aid for the Visually Impaired

This paper describes a portable vision-based obstacle detection system, intended for use by blind people. The system combines an obstacle detection system designed for AGVs with recalibration of ground position and a Kalman Filter based model of the person's walking movement. The system uses stereo vision. Obstacle detection is achieved through comparison of the disparity seen with that expected from the position of the ground. Recalibration of ground position is made by plane tting in the ground region. Motion estimation using two visual methods and the use of an inclinometer is described. The results show satisfactory success in all parts of the system. Keywords: Obstacle Avoidance, Mobility Aids, Visual Navigation 1 Introduction There are about two million visually impaired people living in Europe and about three million in the United States who could benet from some form of aid to help them in their daily lives. The most obvious problem faced by the blind person is mov..

PRZEDRUK POLSKIEGO TŁUMACZENIA ARTYKUŁU ZA ZGODĄ INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN (IASP) - PAIN 154 (2013) 2775-2781 Wartość rokownicza strategii radzenia sobie z bólem w wybranej z populacji próbie osób z przewlekłymi objawowymi zmianami zwyrodnieniowymi stawów kolanowych

Radiographic knee osteoarthritis (OA) is a highly prevalent condition that has been the focus of a number of studies identifying factors that are prognostic of continued or worsening pain and function. Although prior prognostic studies have identified a number of demographic, physical, and psychological factors that are predictive of outcome, minimal focus has been placed on pain coping skills as prognostic factors, despite crosssectional evidence suggesting that pain coping skills are associated with pain and function in knee OA. The present study reports on the use of pain coping skills as prognostic factors for changes in pain and/or function over a 1-year period. Participants were drawn from the Osteoarthritis Initiative, a prospective longitudinal cohort study of persons recruited from the community who either had knee OA or were at high risk for developing knee OA. Data from the Coping Strategies Questionnaire were compared against 1-year change in pain, function, or both, using established criteria for defining whether the patient got better, worse, or stayed the same over the 1-year period. Results revealed a significant effect for praying/hoping, increased behavioral activities, and pain catastrophizing as prognostic of pain outcomes; ignoring pain and praying/hoping were prognostic of function outcomes; and increased behavioral activities and pain catastrophizing were prognostic of a combined pain and function outcome. The findings provide important new evidence regarding the potential clinical relevance of a number of pain coping responses hypothesized to influence future pain and function in persons with arthritis.Stwierdzane radiograficznie zmiany zwyrodnieniowe stawów kolanowych to schorzenie bardzo częste i będące przedmiotem licznych badań, w których identyfikowano czynniki rokownicze utrzymującego się lub narastającego bólu i zaburzeń czynności. We wcześniejszych badaniach dotyczących rokowania zidentyfikowano liczne czynniki demograficzne, fizyczne i psychologiczne, które są predyktorami wyniku leczenia, ale niewiele uwagi poświęcono umiejętnościom radzenia sobie z bólem jako czynnikowi rokowniczemu, pomimo danych pochodzących z badań przekrojowych, które wskazują, że umiejętności te wiążą się z bólem i z funkcjonowaniem w chorobie zwyrodnieniowej stawów kolanowych. W bieżącym badaniu opisujemy zastosowanie umiejętności radzenia sobie z bólem jako jednym z czynników rokowniczych zmian w zakresie bólu i/lub funkcjonowania w ciągu rocznej obserwacji. Uczestnicy badania pochodzili z Osteorthritis Initiative, prospektywnego podłużnego badania kohortowego osób rekrutowanych ze społeczności, które miały chorobę zwyrodnieniową stawów kolanowych lub były obciążone dużym ryzykiem rozwoju tego schorzenia. Dane z Coping Strategies Questionnaire porównano z rocznymi zmianami w zakresie bólu, czynności lub obu tych zmiennych, za pomocą określonych kryteriów definiujących zmianę stanu klinicznego pacjenta na lepszy, gorszy lub bez zmian w ciągu roku. Wyniki wskazały na istotne efekty modlitwy/nadziei, zwiększonej aktywności behawioralnej i myślenia katastroficznego na temat bólu, jako czynników rokowniczych wyniku leczenia; ignorowanie bólu oraz modlitwa/nadzieja były czynnikami prognostycznymi wyniku leczenia w zakresie funkcjonowania; zwiększona aktywność behawioralna i myślenie katastroficzne na temat bólu były czynnikami rokowniczymi odnoszącymi się łącznie do wyników leczenia bólu oraz funkcjonowania. Wyniki dostarczają istotnych nowych danych naukowych odnośnie do potencjalnego klinicznego znaczenia wielu reakcji radzenia sobie z bólem, które przypuszczalnie mogą wpływać na przyszły ból i funkcjonowanie osób z chorobą zwyrodnieniową stawów