Guidelines for the treatment of bacterial vaginosis: focus on tinidazole

Bacterial vaginosis (BV) is a complex vaginal infection most commonly associated with women of child-bearing age. Risk factors for BV are numerous. There are currently multiple clinical and laboratory tests for diagnosis of BV, including the most commonly used diagnostic methods: Amsel’s criteria or Nugent’s Gram stain scale. The mainstay of BV therapy is metronidazole, but tinidazole as well as a few other agents have also been used successfully. Tinidazole is the second nitroimidazole antiprotozoal agent and a structural derivative of metronidazole. With a favorable pharmacokinetic profile and reduced side effects, tinidazole is an alternative agent for BV treatment. There are minimal head-to-head comparative data to establish tinidazole’s superiority to metronidazole or other therapeutic agents. Available data suggest tinidazole has a role in special populations particularly for refractory or relapsing BV

Vulvovaginal Trichosporonosis

Objective: Isolation of Trichosporon species from vaginal secretions is a rare event, and no data are available on its pathogenic role. A case series is presented to determine the pathogenic role of Trichosporon species in vulvovaginal infections. Methods: We performed a retrospective chart review of patients seen in the W.S.U. Vaginitis Clinic in order to identify patients from whom Trichosporon species were isolated. Results: Between 1986 and 2001, a total of 13 patients had a total of 18 positive vaginal cultures for Trichosporon species. All 18 vaginal isolates were T. inkin. In general, positive vaginal cultures were accompanied by low yeast colony counts. Four out of 18 positive T. inkin cultures were obtained from visits by asymptomatic patients. Of the remaining 14 positive T. inkin cultures from patients with symptoms, nine out of 14 cultures had other diagnoses (Candida albicans, six cases; bacterial vaginosis, two cases; Trichomonas, one case). Five positive T. inkin cultures were obtained from visits at which patients had symptoms and no associated diagnosis. In only one of the five episodes could we establish a clear pathogenic role for Trichosporon. In this case the patient was treated with boric acid and had resolution of symptoms and a negative culture at follow-up. In-vitro susceptibility tests revealed that T. inkin was resistant to flucytosine and susceptible to all topical and oral azoles. Conclusions: T. inkin is occasionally found in vulvovaginal cultures and is usually a non-pathogen. Transient colonization tended to occur in women, usually of African—American origin, with major perturbations in vaginal flora (bacterial vaginosis and trichomoniasis) and increased pH. Pathogenic consequences of Trichosporon colonization appear to be rare

Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes

BACKGROUND: Diabetes mellitus increases the rate of vaginal colonization and infection with Candida species METHODS: We surveyed women with diabetes receiving care at either an urban or suburban diabetes clinic to examine the relationship between vaginal Candida colonization, diabetes type and duration, and HbA(1c) level. 101 participants completed the self-administered questionnaire and self-collected a vaginal swab for Candida culture. Candida colonization was similar by age and race. RESULTS: Type 1 diabetics were three times as likely as type 2 diabetics to be colonized with any Candida species (OR = 3.4; 95% CI: 1.03, 11.41; p = 0.04); even after adjusting for abnormal HbA(1c), which had an independent effect (OR = 1.4; 95% CI: 1.04, 1.76; p = 0.02). Recent antibiotic use (OR = 4.5; 95% CI: 1.18, 16.79; p = 0.03), lifetime history of chlamydia (OR = 5.8; 95% CI: 1.09, 30.54; p = 0.04), and performing oral sex during the past 2 weeks (OR = 4.9; 95% CI:0.84, 28.27; p = 0.08) were also associated with Candida carriage after adjusting for diabetic type and abnormal HbA(1c). C. albicans was isolated from the majority of colonized type 1 participants (56%), while C. glabrata was the most common isolate among colonized type 2 participants (54%). CONCLUSIONS: Improving glucose control and possibly modifying sexual behavior may reduce risk of Candida colonization, and potentially symptomatic infection, among women with diabetes

Tropical Intraseasonal Variability in Version 3 of the GFDL Atmosphere Model

Tropical intraseasonal variability is examined in version 3 of the Geophysical Fluid Dynamics Laboratory Atmosphere Model (AM3). In contrast to its predecessor AM2, AM3 uses a new treatment of deep and shallow cumulus convection and mesoscale clouds. The AM3 cumulus parameterization is a mass-flux-based scheme but also, unlike that in AM2, incorporates subgrid-scale vertical velocities; these play a key role in cumulus microphysical processes. The AM3 convection scheme allows multiphase water substance produced in deep cumuli to be transported directly into mesoscale clouds, which strongly influence large-scale moisture and radiation fields. The authors examine four AM3 simulations using a control model and three versions with different modifications to the deep convection scheme. In the control AM3, using a convective closure based on CAPE relaxation, both MJO and Kelvin waves are weak relative to those in observations. By modifying the convective closure and trigger assumptions to inhibit deep cumuli, AM3 produces reasonable intraseasonal variability but a degraded mean state. MJO-like disturbances in the modified AM3 propagate eastward at roughly the observed speed in the Indian Ocean but up to 2 times the observed speed in the west Pacific Ocean. Distinct differences in intraseasonal convective organization and propagation exist among the modified AM3 versions. Differences in vertical diabatic heating profiles associated with the MJO are also found. The two AM3 versions with the strongest intraseasonal signals have a more prominent “bottom heavy” heating profile leading the disturbance center and “top heavy” heating profile following the disturbance. The more realistic heating structures are associated with an improved depiction of moisture convergence and intraseasonal convective organization in AM3

Legal coercion, respect & reason-responsive agency

Legal coercion seems morally problematic because it is susceptible to the Hegelian objection that it fails to respect individuals in a way that is ‘due to them as men’. But in what sense does legal coercion fail to do so? And what are the grounds for this requirement to respect? This paper is an attempt to answer these questions. It argues that (a) legal coercion fails to respect individuals as reason-responsive agents; and (b) individuals ought to be respected as such in virtue of the fact that they are human beings. Thus it is in this sense that legal coercion fails to treat individuals with the kind of respect ‘due to them as men’.The Leverhulme Trust (ECF-2012-032); AHRC (AH/H015655/1

Majorana Neutrinos and Gravitational Oscillation

We analyze the possibility of encountering resonant transitions of high energy Majorana neutrinos produced in Active Galactic Nuclei (AGN). We consider gravitational, electromagnetic and matter effects and show that the latter are ignorable. Resonant oscillations due to the gravitational interactions are shown to occur at energies in the PeV range for magnetic moments in the $10^{-17} \mu_B$ range. Coherent precession will dominate for larger magnetic moments. The alllowed regions for gravitational resonant transitions are obtained.Comment: 11 pages, 8 figures, Latex; requires revtex and epsf.tex submitted to Physical Review

Smoke gets in your eyes:what is sociological about cigarettes?

Contemporary public health approaches increasingly draw attention to the unequal social distribution of cigarette smoking. In contrast, critical accounts emphasize the importance of smokers’ situated agency, the relevance of embodiment and how public health measures against smoking potentially play upon and exacerbate social divisions and inequality. Nevertheless, if the social context of cigarettes is worthy of such attention, and sociology lays a distinct claim to understanding the social, we need to articulate a distinct, positive and systematic claim for smoking as an object of sociological enquiry. This article attempts to address this by situating smoking across three main dimensions of sociological thinking: history and social change; individual agency and experience; and social structures and power. It locates the emergence and development of cigarettes in everyday life within the project of modernity of the nineteenth and twentieth centuries. It goes on to assess the habituated, temporal and experiential aspects of individual smoking practices in everyday lifeworlds. Finally, it argues that smoking, while distributed in important ways by social class, also works relationally to render and inscribe it

Group testing with Random Pools: Phase Transitions and Optimal Strategy

The problem of Group Testing is to identify defective items out of a set of objects by means of pool queries of the form "Does the pool contain at least a defective?". The aim is of course to perform detection with the fewest possible queries, a problem which has relevant practical applications in different fields including molecular biology and computer science. Here we study GT in the probabilistic setting focusing on the regime of small defective probability and large number of objects, $p \to 0$ and $N \to \infty$. We construct and analyze one-stage algorithms for which we establish the occurrence of a non-detection/detection phase transition resulting in a sharp threshold, $\bar M$, for the number of tests. By optimizing the pool design we construct algorithms whose detection threshold follows the optimal scaling $\bar M\propto Np|\log p|$. Then we consider two-stages algorithms and analyze their performance for different choices of the first stage pools. In particular, via a proper random choice of the pools, we construct algorithms which attain the optimal value (previously determined in Ref. [16]) for the mean number of tests required for complete detection. We finally discuss the optimal pool design in the case of finite $p$

Thermally-driven morphing with high temperature composites

The thermal expansion mismatch between heat-resisting metals and high-temperature composite materials is explored as a method of achieving thermally-driven morphing in elevated-temperature environments, with an eye towards applications in variable-geometry hot structures in gas turbine engines. Three concepts are presented and demonstrated. The first thermal morphing system is a bimorph laminate which exploits the CTE mismatch between a titanium metal matrix composite and its parent titanium matrix material. The second concept is similar to the first, but uses a diffusion-bonded austenitic stainless steel alloy as the high expansion layer. The third concept utilizes a carbon fiber, silicon carbide matrix ceramic matrix composite joined to a stainless steel skin in a trailing-edge flap arrangement. Furnace-based experiments of cantilever-mounted specimens are performed to evaluate the displacement response of the metal-matrix and ceramic-matrix concepts at temperatures up to 606°C and 1035°C, respectively.</p