TRADITIONAL SRI LANKAN MEDICINE INTERVENTION IN THE MANAGEMENT OF KNEE OSTEOARTHRITIS (JANU SANDIGATAVATA): CASE SERIES

Background: Osteoarthritis (OA) of the knee is a degenerative disease, which significantly restricts the functions of the joint.  Janu Sandigatavata (JS) is considered to be the close equivalent in traditional medicine to OA in modern medicine. The aim of this case series was to report the effectiveness of Traditional Sri Lankan Medicine (TSM) on JS patients attend to National Ayurveda Teaching Hospital. Method: Reported cases (n=10) were at the age range of 45years to70 years and both female (n=8) and male (n=2) patients were diagnosed as having JS of the knee joints. Radiology (X-ray) reported by a radiologist confirmed that they were in Kellgren-Lawrence grade III or less. TSM treatments were given as regimens up to 86days. At the end point, external treatment of oleation and herbal immune enhancing drugs were further continued over 8 weeks. Visual analogue scale for pain, knee scores in Knee Society clinical Rating System (KSS) and Ayurveda clinical assessment criteria were used to evaluate the effects of treatment. Results: Reductions of visual analogue scale for pain was observed between baseline and the 86 days endpoint. Clinical assessment criteria and the KSS scores of pain, movement and stability were also improved up to good level and function score were improved up to excellent level. During the follow-up period, joint symptoms and signs and the knee scores were remaining unchanged. Conclusions: Study explored that substantial decrease in clinical parameters of OA in knee and improved patients’ quality of life by the intervention of the TSM

Vulnerability Assessment for Climate-Induced Disasters in Malaysia.

Climate induced disasters can be considered as an outcome of a triggering agents (often known as the hazard) and vulnerability factors. Within the context of climate-induced disasters, humans do not have the control over the triggering agents. Even though it is difficult to control the triggering agent, the level of its exposure to a vulnerable community or system would determine the severity of its impact. Within this context, by reducing the vulnerability the impact of climate-induced disasters can be minimized. Accordingly, this study evaluates the disaster vulnerability factors in Malaysia with particular reference to the climate-induced disaster- floods. A workshop has been carried out with the involvement of practitioners and professionals who are linked with the disaster management activities to identify the key vulnerable factors from the context of Malaysia. The findings identified Social Vulnerability as the main vulnerability factor that affect the Malaysian community followed by Operational/Managerial, Technological, Economic and Political. The findings of the study revealed the need of addressing vulnerability factors at different levels such as at the community, institutional and policy levels and how the vulnerability factors are interconnected with one another

Prestress evaluation in prestressed concrete plate-like structures

Condition assessment and capacity evaluation of existing structures using their vibration responses has been subjected to extensive research for many years. Prestressed concrete structures have been one of the main focuses of those studies. In the case of prestressed concrete structures, effective prestress force is the most important parameter for their best performance and yet currently there is no effective method in identifying the prestressing force in an existing prestressed concrete structure. Effect of prestress is different for different types of structural elements and has to be treated accordingly for its accurate quantification. This paper presents a new approach to evaluate the effective prestress force of plate-like structures with simply supported boundary conditions using their vibration responses. The proposed method quantifies the prestress effect with a reasonable good accuracy, even with noisy measurements using both periodic and impulsive excitations. Prestress estimation can be done using collected data from as less as two measurement locations

Group B streptococcal infective endocarditis in a young non-pregnant female with rheumatic heart disease - A Case Report

Group B Streptococcus (GBS) is a rare cause of infective endocarditis in adults associated with a high mortality rate due to the frequent occurrence of local and systemic complications. Here we report a case of infective endocarditis (IE) in a young non-pregnant female with a history of rheumatic heart disease (RHD) who presented with a short history of fever, shortness of breath and constitutional symptoms. GBS was isolated from a single blood culture along with echocardiographic findings of a cardiac vegetation and ophthalmologic findings of a Roth spot. Based on the Modified Duke Criteria, a definitive diagnosis of infective endocarditis was made. She was treated with a prolonged course of intravenous (IV) ceftriaxone, with gentamicin being added to the regimen, following which she made a complete recovery.</p

Establishing Campylobacter culture methods in a clinical diagnostic laboratory and the first report of Campylobacter species isolation in northern Sri Lanka

Introduction: The Enteric Reference Laboratory of the Medical Research Institute (ERL/MRI), Colombo is the only public sector laboratory in Sri Lanka that performs Campylobacter cultures. Due to logistic limitations involving specimen transport from distant sites, efforts were taken to establish Campylobacter culture facilities in our local clinical microbiology laboratory.Methods: A blood-free charcoal-based selective agar medium (Karmali medium) was chosen based on performance characteristics and quality control (QC)/verification performed at the ERL/MRI. A suitable incubating method was assessed and chosen, and QC was performed in our laboratory. A technical staff member of our local laboratory received capacity building training at the ERL/MRI.Results: The quality control/verification process of the Karmali medium was satisfactory. The variable atmospheric incubator was chosen as the incubating method as it was shown to be more economical in the long-term given the anticipated work load and the QC was satisfactory. Following a satisfactory verification process, Campylobacter culture method was introduced in our laboratory. Five C. jejuni and one hippurate-negative C. jejuni/C. coli was detected in faecal specimens of six paediatric patients between May-December 2018. The isolation rate was 2.25% (6/267). Ciprofloxacin resistance was detected in four out of five C. jejuni isolates.Conclusion: Establishing Campylobacter culture methods in a routine clinical diagnostic laboratory will be beneficial in regions with high prevalence of diarrhoeal disease and with logistic limitations for specimen transport to the central reference laboratory. This is the first report of isolation and antimicrobial susceptibility of Campylobacter species from patients in northern Sri Lanka.</p

Development and validation of a reference marker for identification of aerobic and anaerobic bacteria associated with diabetes chronic wound ulcers using PCR denaturing gradient gel electrophoresis

Introduction: Diabetes chronic wounds consist with a diverse microbial community and unculturablespecies may be highly prevalent.Objectives: This study aimed to establish a bacterial reference marker consisting of a group ofchronic wound related bacteria, using polymerase chain reaction-denaturing gradient gelelectrophoresis (PCR-DGGE) for profiling of bacteria in diabetes chronic wound infections.Methods: DNA was extracted from the known wound bacterial strains. PCR–DGGE was performedusing eubacterial specific primers targeting V2-V3 region of 16S rDNA. DGGE was performed usinga 30-55% denaturing gradient. Migration position of each organism was detected on DGGE gel andimportant organisms were selected. Equal volume from PCR products of each selected organism wasmixed, diluted with gel loading dye in 1:1.5 ratio and used for all DGGE gels. The ladder was thensubjected to species identification of fifteen tissue debridement specimens obtained from diabeteschronic wound ulcers. The identification efficacy was tested by sequencing.Results: DNA of bacterial pathogens which showed different migration distances on the gel werecombined and used as a reference panel. This bacterial ladder consisted of eleven different bacterialspecies including Bacteroides sp., S. aureus, Acineto bacter sp., P. aeruginosa, Streptococcus Group Aand Group B sp., E. faecalis, Providencia sp., Veillonella sp., E .coli and Enterobacter sp. Accordingto the reference panel, Pseudomonas species were abundant. Further the results were confirmed bysequencing.Conclusion: Reference marker allows comparative analysis of DGGE patterns and can be used as atool for presumptive identification of polymicrobial microbiota in chronic wound infections

Consumerisation in UK Higher Education Business Schools: Higher fees, greater stress and debatable outcomes

For many UK Higher Education Business Schools, the continued recruitment of UK, EU and International students is crucial for financial stability, viability and independence. Due to increasingly competitive funding models across the sector many institutional leaders and administrators are making decisions typical of highly marketised consumer environments. Thus, this paper explores, academics’ perceptions of the impact of consumerisation in UK Higher Education Business Schools. To achieve this 22 Business School academics were interviewed within three UK Higher Education institutions (HEIs) in the North of England. Participants had a minimum of three years teaching experience. Data was analysed using template analysis taking an interpretive approach. The findings indicate that academics perceived the introduction of tuition fees to have been the catalyst for students increasing demonstration of customer-like behaviour: viewing the education process as transactional, with the HEI providing a ‘paid for’ service. It is argued that these changes in UK Higher Education have created tensions between university leaders and academics, creating genuine dilemmas for those with decision-making responsibilities who must balance academic integrity and long term institutional financial viability

The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks

Background. Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. Methods and design. Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks. Discussion. Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective