170 research outputs found
Synthesis Paper on Strengthening Policy Reforms for Transport Infrastructure Development
This paper presents the results of a series of eight research papers commissioned by the Asian Development Bank and the Department of Economic Affairs, in the area of transport infrastructure development in India. The research was intended to provide primary insight in the relevant area, through a mix of field study, technology assessment, socio-economic analysis, primary data collection and analysis of managerial and policy implementation, as appropriate in each area. The research was steered by an advisory group. The eight papers cover a wide range of specific issues in different sectors within the overall transport sector. The paper also places these issues in the context of the overall transport scenario, and points to the consolidated policy implications of implementation of the recommendations of the authors. Secondary objectives were also to initiate networking in the academic and professional research community in the area, and to enable policy makers to tap such resources at a high level.
Viability of Inland Water Transport in India
Water based transport is effective as generally speaking, operating costs of fuel are low and environmental pollution is lower than for corresponding volumes of movement by road, rail or air. A major advantage is that the main infrastructure - the waterway - is often naturally available. This paper attempts to assess the viability of movement of passengers and freight by inland water transport in India. Inland waterways refer to rivers, canals, lakes etc. In inland water transport, the waterway, though naturally available, has to be "trained", maintained and upgraded. Transport over inland waterways is especially effective when the source and/or destination are waterfront locations. There is an overlap of this sector with coastal shipping where tidal rivers are involved. Legally, there are separate Acts covering inland waterways, the vessels that can ply on them and the setting up of the Inland Waterways Authority of India. Three waterways in the country have been designated as National Waterways (NW-1, NW-2 and NW-3).
Colocalization of intranuclear lamin foci with RNA splicing factors
The lamins form a fibrous network underlying the inner nuclear membrane termed the nuclear lamina. In order to gain insights into the role of lamins in nuclear organization, we have characterized a monoclonal antibody (LA-2H10) raised against recombinant rat lamin A that labels nuclei in a speckled pattern in all cells of unsynchronized populations of HeLa and rat F-111 fibroblast cells, unlike the typical nuclear periphery staining by another monoclonal antibody to lamin A, LA-2B3. In immunolocalization studies the lamin A speckles or foci were found to colocalize with the RNA splicing factors SC-35 and U5-116 kD, but not with p80 coilin found in coiled bodies. Lamin B1 was also associated with these foci. These foci dispersed when cells entered mitosis and reformed during anaphase. The differential reactivity of LA-2H10 and LA-2B3 was retained after nuclei were extracted with detergents, nucleases and salt to disrupt interactions of lamins with chromatin and other nuclear proteins. Using deletion fragments of recombinant lamin A, the epitope recognized by LA-2H10 was located between amino acids 171 and 246. Our findings are consistent with a structural role for lamins in supporting nuclear compartments containing proteins involved in RNA splicing
Antibiotic prophylaxis is associated with subsequent resistant infections in children with an initial extended-spectrum-cephalosporin-resistant Enterobacteriaceae infection
ABSTRACT
The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistant
Enterobacteriaceae
. We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant
Escherichia coli
and
Klebsiella
spp. isolated from normally sterile sites of patients aged <22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and
fumC-fimH
(
E. coli
) or
tonB
(
Klebsiella pneumoniae
) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with
E. coli
sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.
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Effect of nocturnal ventilation on the occurrence of Botrytis cinerea in Mediterranean unheated tomato greenhouses
Botrytis cinerea is the causal agent of grey mould disease which is one of the most important diseases affecting tomato crops in unheated greenhouses. Nocturnal ventilation is a technique that can be used to reduce relative humidity inside unheated greenhouses. The main objectives of this research were to investigate the effect of ventilation management on the environmental conditions and on the disease severity, to develop and validate a model which could predict disease severity and to present a warning system.
Experiments were conducted in two plastic greenhouses. Two natural ventilation treatments were randomly assigned to the greenhouses. One was nocturnal ventilation (NV), with the vents open during the day and night, while the other was classical ventilation (CV), in which the vents were open during the day and closed during the night.
A tomato crop was grown directly in the soil between the end of February and the end of July during two crop seasons. Climatic data were measured with three meteorological stations, averaged and recorded on an hourly basis. The number of diseased leaflets were counted and removed from the greenhouse.
In the NV greenhouse a significant reduction of air humidity and disease appearance was observed. A warning system was developed and can be a useful tool for helping to decide on appropriate actions and the correct timing to avoid conditions that favour disease development. For a more practical application, disease risk levels were defined as a function of the duration of periods with RH > 90%
Assesment of Water Contamination Due to Industry Effluents on Noyyal River Basin
The purpose of this study was to assess the water quality of Noyyal river and to understand the impact of anthropogenic activities on the water quality. Water samples were collected from different sites along the river and analyzed for various physical and chemical parameters. The results of the analysis showed that the water quality of Noyyal river was poor, with levels of certain parameters such as pH, electrical conductivity, and total dissolved solids above the limits set. The results of the analysis also showed that the river was polluted due to the discharge of untreated effluents from various industries located in and around the river. The study also showed that the water quality of Noyyal river was deteriorating due to the anthropogenic activities in the catchment area. The results of this study can be used to develop strategies to improve the water quality of Noyyal river and to protect the catchment area from further degradation
Phase IIa Global Study Evaluating Rituximab for the Treatment of Pediatric Patients With Granulomatosis With Polyangiitis or Microscopic Polyangiitis
OBJECTIVE: To assess the safety, tolerability, pharmacokinetics, and efficacy of rituximab (RTX) in pediatric patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). METHODS: The Pediatric Polyangiitis Rituximab Study was a phase IIa, international, open-label, single-arm study. During the initial 6-month remission-induction phase, patients received intravenous infusions of RTX (375 mg/m2 body surface area) and glucocorticoids once per week for 4 weeks. During the follow-up period, patients could receive further treatment, including RTX, for GPA or MPA. The safety, pharmacokinetics, pharmacodynamics, and exploratory efficacy outcomes with RTX were evaluated. RESULTS: Twenty-five pediatric patients with new-onset or relapsing disease were enrolled at 11 centers (19 with GPA [76%] and 6 with MPA [24%]). The median age was 14 years (range 6-17 years). All patients completed the remission-induction phase. During the overall study period (≤4.5 years), patients received between 4 and 28 infusions of RTX. All patients experienced ≥1 adverse event (AE), mostly grade 1 or grade 2 primarily infusion-related reactions. Seven patients experienced 10 serious AEs, and 17 patients experienced 31 infection-related AEs. No deaths were reported. RTX clearance correlated with body surface area. The body surface area-adjusted RTX dosing regimen resulted in similar exposure in both pediatric and adult patients with GPA or MPA. Remission, according to the Pediatric Vasculitis Activity Score, was achieved in 56%, 92%, and 100% of patients by months 6, 12, and 18, respectively. CONCLUSION: In pediatric patients with GPA or MPA, RTX is well tolerated and effective, with an overall safety profile comparable to that observed in adult patients with GPA or MPA who receive treatment with RTX. RTX is associated with a positive risk/benefit profile in pediatric patients with active GPA or MPA
Attainment of Low Disease Activity and Remission Targets reduces the risk of severe flare and new damage in Childhood Lupus
Objectives: To assess the achievability and effect of attaining low disease activity (LDA) or remission in childhood (cSLE). /
Methods: Attainment of three adult-SLE derived definitions of LDA (LLDAS, LA, Toronto-LDA), and four definitions of remission (clinical-SLEDAI-defined remission on/off treatment, pBILAG-defined remission on/off treatment) was assessed in UK JSLE Cohort Study patients longitudinally. Prentice-Williams-Petersen-GAP recurrent event models assessed the impact of LDA/remission attainment on severe flare/new damage. /
Results: LLDAS, LA and Toronto-LDA targets were reached in 67%, 73% and 32% of patients, after a median of 18, 15 or 17 months, respectively. Cumulatively, LLDAS, LA and Toronto-LDA was attained for a median of 23%, 31% and 19% of total follow-up-time, respectively. Remission on-treatment was more common (61% cSLEDAI-defined, 42% pBILAG-defined) than remission off-treatment (31% cSLEDAI-defined, 21% pBILAG-defined). Attainment of all target states, and disease duration (>1 year), significantly reduced the hazard of severe flare (p 0.05). Attainment of all targets reduced the hazards of new damage (p< 0.05). /
Conclusions: This is the first study demonstrating that adult-SLE-derived definitions of LDA/remission are achievable in cSLE, significantly reducing risk of severe flare/new damage. Of the LDA definitions, LLDAS performed best, leading to a statistically comparable reduction in the hazards of severe flare to attainment of clinical-remission
Clinical and laboratory characteristics in juvenile-onset systemic lupus erythematosus across age groups
BACKGROUND
Systemic lupus erythematous (SLE) is a systemic autoimmune/inflammatory condition. Approximately 15–20% of patients develop symptoms before their 18th birthday and are diagnosed with juvenile-onset SLE (JSLE). Gender distribution, clinical presentation, disease courses and outcomes vary significantly between JSLE patients and individuals with adult-onset SLE. This study aimed to identify age-specific clinical and/or serological patterns in JSLE patients enrolled to the UK JSLE Cohort Study.
METHODS
Patient records were accessed and grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years) and adolescent (14–18 years). The presence of American College of Rheumatology (ACR) classification criteria, laboratory results, disease activity [British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) scores] and damage [Systemic Lupus International Collaborating Clinics (SLICC) damage index] were evaluated at diagnosis and last follow up.
RESULTS
A total of 418 JSLE patients were included in this study: 43 (10.3%) with pre-pubertal disease onset; 240 (57.4%) with peri-pubertal onset and 135 (32.3%) were diagnosed during adolescence. At diagnosis, adolescent JSLE patients presented with a higher number of ACR criteria when compared with pre-pubertal and peri-pubertal patients [pBILAG2004 scores: 9(4–20] vs. 7(3–13] vs. 7(3–14], respectively, p = 0.015] with increased activity in the following BILAG domains: mucocutaneous (p = 0.025), musculoskeletal (p = 0.029), renal (p = 0.027) and cardiorespiratory (p = 0.001). Furthermore, adolescent JSLE patients were more frequently ANA-positive (p = 0.034) and exhibited higher anti-dsDNA titres (p = 0.001). Pre-pubertal individuals less frequently presented with leukopenia (p = 0.002), thrombocytopenia (p = 0.004) or low complement (p = 0.002) when compared with other age groups. No differences were identified in disease activity (pBILAG2004 score), damage (SLICC damage index) and the number of ACR criteria fulfilled at last follow up.
CONCLUSIONS
Disease presentations and laboratory findings vary significantly between age groups within a national cohort of JSLE patients. Patients diagnosed during adolescence exhibit greater disease activity and “classic” autoantibody, immune cell and complement patterns when compared with younger patients. This supports the hypothesis that pathomechanisms may vary between patient age groups
Enterovirus D68 outbreak detection through a syndromic disease epidemiology network
BACKGROUND: In 2014, enterovirus D68 (EV-D68) was responsible for an outbreak of severe respiratory illness in children, with 1,153 EV-D68 cases reported across 49 states. Despite this, there is no commercial assay for its detection in routine clinical care. BioFire® Syndromic Trends (Trend) is an epidemiological network that collects, in near real-time, deidentified. BioFire test results worldwide, including data from the BioFire® Respiratory Panel (RP). OBJECTIVES: Using the RP version 1.7 (which was not explicitly designed to differentiate EV-D68 from other picornaviruses), we formulate a model, Pathogen Extended Resolution (PER), to distinguish EV-D68 from other human rhinoviruses/enteroviruses (RV/EV) tested for in the panel. Using PER in conjunction with Trend, we survey for historical evidence of EVD68 positivity and demonstrate a method for prospective real-time outbreak monitoring within the network. STUDY DESIGN: PER incorporates real-time polymerase chain reaction metrics from the RPRV/EV assays. Six institutions in the United States and Europe contributed to the model creation, providing data from 1,619 samples spanning two years, confirmed by EV-D68 gold-standard molecular methods. We estimate outbreak periods by applying PER to over 600,000 historical Trend RP tests since 2014. Additionally, we used PER as a prospective monitoring tool during the 2018 outbreak. RESULTS: The final PER algorithm demonstrated an overall sensitivity and specificity of 87.1% and 86.1%, respectively, among the gold-standard dataset. During the 2018 outbreak monitoring period, PER alerted the research network of EV-D68 emergence in July. One of the first sites to experience a significant increase, Nationwide Children's Hospital, confirmed the outbreak and implemented EV-D68 testing at the institution in response. Applying PER to the historical Trend dataset to determine rates among RP tests, we find three potential outbreaks with predicted regional EV-D68 rates as high as 37% in 2014, 16% in 2016, and 29% in 2018. CONCLUSIONS: Using PER within the Trend network was shown to both accurately predict outbreaks of EV-D68 and to provide timely notifications of its circulation to participating clinical laboratories
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