An Assessment of Indoor Air Quality (IAQ) in Metal industries of Delhi

With growing realization and concern for our health, the focus on Indoor Air Quality has increased. Exposure to indoor air pollution is responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Today it is critical that the industry be familiar with the environmental hazards that employees are subjected to in the workplace. Iron & steel and other manufacturing industries, foundries and forges produce a lot of pollutants in the indoor environment. Exposures to mineral dusts, metal fumes, products of combustion, resin bonding systems, physical noise and heat and vibration hazards may seriously impact the health of workers in foundries. The study aimed at assessing Indoor Air Quality in Metal industries of Delhi in Mayapuri industrial area. The study was carried out in 3 phases. In the first phase, the study collated awareness about Indoor Air Quality and related health effects amongst the owners and employees working in the enterprises. In the second phase, the study involved monitoring of the randomly selected enterprises in terms of CO2, PM2.5, PM10 and presence of dampness and molds in the enterprises. The third phase involved spreading awareness regarding Indoor Air Quality amongst the sample. Highlights of the study are: Majority of the owners were aware about the concept of Indoor Air Quality and its relationship with productivity and health of a person. They could also cite some of the health impacts caused due to poor Indoor Air Quality. In spite of their wisdom on Indoor Air Quality, there were no monitoring and maintenance provisions in their enterprises. Also, none of the owners provided their employees personal protective equipment (PPE) and any information or training regarding Indoor Air Quality and its health hazards. Majority of the employees were unaware of the concept of Indoor Air Quality. The employees could neither relate health with Indoor Air Quality nor showed any interest in improving the same. It was seen that there was a moderately high level of CO2 concentrations in the enterprises, mainly due to insufficient ventilation in the enterprises. PM2.5 concentrations were found to be poor and were almost double than its acceptable limits. While it was seen that PM10 concentrations were within their acceptable limits. It was observed that in majority enterprises presence of molds and dampness was observed. It was observed on walls and ceilings. The areas near the walls and places with molds were surrounded by a bad odor. This study has been helpful in providing clear direction towards the Indoor Air Quality in Metal industries operating in Mayapuri. It also highlights the awareness regarding Indoor Air Quality amongst the sample. The study concludes that there is a sense of knowledge regarding Indoor Air Quality amongst the owners/managers of the enterprises but a huge scope in monitoring and maintenance provisions. The need for spreading awareness about IAQ and its related health effects were highlighted which would improve Indoor Air Quality in industries. The study showcased a clear scope for awareness generation and training amongst the owners and employees of the enterprises regarding Indoor Air Quality. The study suggests surveying of health status in metal industries and similar research in other industries. The findings were also shared with competent authorities to sensitize them towards poor Indoor Air Quality in the metal industries

Onset of action of the beta 3-adrenoceptor agonist, mirabegron, in Phase II and III clinical trials in patients with overactive bladder

Purpose Long-term persistence with pharmacotherapy for overactive bladder (OAB) requires a drug with an early onset of action and good efficacy and tolerability profile. Although antimuscarinics improve OAB symptoms within 1–2 weeks of initiating treatment, adherence after 3 months is relatively poor due to bothersome side effects (e.g., dry mouth and constipation). Mirabegron, a b3-adrenoceptor agonist, has demonstrated significant improvements in key symptoms of OAB and good tolerability after 12 weeks in Phase III studies. Methods This was a prespecified pooled analysis of three randomized, double-blind, placebo-controlled, 12-week studies, and a Phase II study, to evaluate efficacy and tolerability of mirabegron 25 and 50 mg versus placebo. The main efficacy endpoints were change from baseline to week 1 (Phase II only), week 4, and final visit in mean number of incontinence episodes/24 h, micturitions/24 h, and mean volume voided/micturition (MVV). Results A significant benefit for mirabegron 25 and 50 mg versus placebo was evident at the first assessment point, 4 weeks after initiation of therapy, in Phase III studies for incontinence, micturitions, and MVV. The earliest measured benefit was after 1 week, in the Phase II study. Quality-of-life parameters also significantly improved with mirabegron 25 and 50 mg as early as week 4. Significant benefits continued throughout the studies. Mirabegron was well tolerated. Conclusions The early onset of action and good overall efficacy and tolerability balance that mirabegron offers may lead to high rates of persistence with mirabegron in the long-term treatment of OAB

Modeling dose-response relationships of the effects of fesoterodine in patients with overactive bladder

<p>Abstract</p> <p>Background</p> <p>Fesoterodine is an antimuscarinic for the treatment of overactive bladder, a syndrome of urgency, with or without urgency urinary incontinence (UUI), usually with increased daytime frequency and nocturia. Our objective was to develop predictive models to describe the dose response of fesoterodine.</p> <p>Methods</p> <p>Data from subjects enrolled in double-blind, placebo-controlled phase II and III trials were used for developing longitudinal dose-response models.</p> <p>Results</p> <p>The models predicted that clinically significant and near-maximum treatment effects would be seen within 3 to 4 weeks after treatment initiation. For a typical patient with 11 micturitions per 24 hours at baseline, predicted change was -1.2, -1.7, and -2.2 micturitions for placebo and fesoterodine 4 mg and 8 mg, respectively. For a typical patient with 2 UUI episodes per 24 hours at baseline, predicted change was -1.05, -1.26, and -1.43 UUI episodes for placebo and fesoterodine 4 mg and 8 mg, respectively. Increase in mean voided volume was estimated at 9.7 mL for placebo, with an additional 14.2 mL and 28.4 mL for fesoterodine 4 mg and 8 mg, respectively.</p> <p>Conclusions</p> <p>A consistent dose response for fesoterodine was demonstrated for bladder diary endpoints in subjects with overactive bladder, a result that supports the greater efficacy seen with fesoterodine 8 mg in post hoc analyses of clinical trial data. The dose-response models can be used to predict outcomes for doses not studied or for patient subgroups underrepresented in clinical trials.</p> <p>Trial Registration</p> <p>The phase III trials used in this analysis have been registered at ClinicalTrials.gov (NCT00220363 and NCT00138723).</p

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)) : Part B

In 2014 the International Endohernia Society (IEHS) published the first international "Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias". Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based-Medicine. For the present update all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne) the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques-minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite still insufficient evidence with respect to these new techniques it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initially guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before

COOL-LAMPS III: Discovery of a 25".9 Separation Quasar Lensed by a Merging Galaxy Cluster

In the third paper from the COOL-LAMPS Collaboration, we report the discovery of COOL J0542-2125, a gravitationally lensed quasar at $z=1.84$, observed as three images due to an intervening massive galaxy cluster at $z=0.61$. The lensed quasar images were identified in a search for lens systems in recent public optical imaging data and have separations on the sky up to 25".9, wider than any previously known lensed quasar. The galaxy cluster acting as a strong lens appears to be in the process of merging, with two sub-clusters separated by $\sim 1$ Mpc in the plane of the sky, and their central galaxies showing a radial velocity difference of $\sim 1000$ km/s. Both cluster cores show strongly lensed images of an assortment of background sources, as does the region between them. A preliminary strong lens model implies masses of $M(<250\ \rm{kpc}) = 1.79^{+0.16} _{-0.01} \times 10^{14} M_{\odot}$and$M(<250\ \rm{kpc}) = 1.48^{+0.04}_{-0.10} \times 10^{14} M_{\odot}$ for the East and West sub-clusters, respectively. This line of sight is also coincident with a ROSAT ALL-sky Survey source, centered between the two confirmed cluster halos reminiscent of other major cluster-scale mergers.Comment: 13 pages, 6 figures. Submitted to Ap

Basic mechanisms of urgency: roles and benefits of pharmacotherapy

Introduction Since urgency is key to the overactive bladder syndrome, we have reviewed the mechanisms underlying how bladder filling and urgency are sensed, what causes urgency and how this relates to medical therapy. Materials and methods Review of published literature. Results As urgency can only be assessed in cognitively intact humans, mechanistic studies of urgency often rely on proxy or surrogate parameters, such as detrusor overactivity, but these may not necessarily be reliable. There is an increasing evidence base to suggest that the sensation of ‘urgency’ differs from the normal physiological urge to void upon bladder filling. While the relative roles of alterations in afferent processes, central nervous processing, efferent mechanisms and in intrinsic bladder smooth muscle function remain unclear, and not necessarily mutually exclusive, several lines of evidence support an important role for the latter. Conclusions A better understanding of urgency and its causes may help to develop more effective treatments for voiding dysfunction

The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population

Contains fulltext : 81191.pdf (publisher's version ) (Closed access)INTRODUCTION AND HYPOTHESIS: In selected populations, pelvic organ prolapse (POP) was associated with bladder/bowel symptoms, but data on the general female population are lacking. Our aim was to obtain normative data on the prevalence of POP and pelvic floor dysfunction (PFD) symptoms and signs and to identify associations. METHODS: Validated questionnaires on POP and PFD (urogenital distress inventory, (UDI) and defaecation distress inventory (DDI)) were sent to a general population of 2,979 women (aged 45-85 years). Data were analysed using the Kruskal-Wallis test, chi square test and Spearman's rank correlation coefficient. RESULTS: Response rate was 62.7%. Associations between POP stage and parity (0.002) and vaginal bulging (<0.001) are significant. Anatomical locations of POP and PFD symptoms correlated significantly with incontinence of flatus, feeling anal prolapse, manual evacuation of stool, vaginal bulging, constipation and pain during faecal urge (p < or = 0.005). CONCLUSIONS: Strategies should be developed to alleviate obstructive bowel disorders associated with POP