De risico's van geneesmiddelen in het aquatisch milieu

In een literatuurstudie zijn de effecten en risico’s van een vijftal humane geneesmiddelen op het aquatisch milieu onderzocht. Het gaat om geneesmiddelen die frequent in Nederlandse oppervlaktewateren zijn gedetecteerd: carbamazepine, diclofenac, erytromycine, metoprolol en sulfamethoxazol. Vier van deze vijf geneesmiddelen vormen een risico voor het aquatisch milieu. Het Europese Parlement probeert risicovolle geneesmiddelen op de prioritaire stoffenlijst van de Kaderrichtlijn Water te krijgen. Hierdoor zal de farmaceutische industrie gestimuleerd worden om geneesmiddelen milieuvriendelijker te maken. Tevens zullen overheden en andere partijen aangespoord worden om maatregelen voor afvalwaterzuivering en verantwoord geneesmiddelgebruik te ontwikkele

High-resolution imaging of basin-bounding normal faults in the Southern Apennines seismic belt (Italy) by traveltime and frequency-domain full-waveform tomography

We apply a two-step seismic imaging flow by combined first-arrival traveltime and frequency-domain waveform tomographies to dense wide aperture data collected in the Val d’Agri basin (southern Italy). A large wavelength Vp model determined by first-arrival traveltime tomography is used as a starting model for waveform tomography. The multiscale waveform tomography consisting of successive inversion of increasing frequencies allows to progressively reconstruct the short wavelengths of the velocity model, providing valuable information on the Quaternary basin and on range-bounding normal-faulting systems

Design of a Prostate Cancer Patient Navigation Intervention for a Veterans Affairs Hospital

Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago

Digital dermoscopy to determine skin melanin index as an objective indicator of skin pigmentation

Clinical assessment of skin photosensitivity is subjectively determined by erythema and tanning responses to sunlight recalled by the subject, alternatively known as Fitzpatrick Skin Phototype (SPT). Responses may be unreliable due to recall bias, subjective bias by clinicians and subjects, and lack of cultural sensitivity of the questions. Analysis of red-green-blue (RGB) color spacing of digital images may provide an objective determination of SPT. This paper presents the studies to assess the melanin index (MI), as determined by RGB images obtained by both standard digital camera as well as by videodermoscope, and to correlate the MI with SPT based upon subjects' verbal responses to standardized questions administered by a dermatologist. A sample of subjects representing all SPTs I–VI was selected. Both the digital camera and videodermoscope were calibrated at standard illumination, light source and white balance. Images of constitutive skin of the upper ventral arm were taken of each subject using both instruments. The studies showed that 58 subjects (20 M, 38 F) were enrolled in the study (mean age: 47 years; range: 20–89), stratified to skin phototype I–VI. MI obtained by using both digital camera and videodermoscope increased significantly as the SPT increased (p = 0.004 and p &lt; 0.0001, respectively) and positively correlated with dermatologist-assessed SPT (Spearman correlation, r = 0.48 and r = 0.84, respectively). Digital imaging can quantify melanin content in order to quantitatively approximate skin pigmentation in all skin phototypes including Type VI skin. This methodology holds promise as a simple, non-invasive, rapid and objective approach to reliably determine skin phototype and, with further investigation, may prove to be both practical and useful in the prediction of skin cancer risk.</p

Oropharyngeal Swallow Efficiency as a Representative Measure of Swallowing Function

The purpose of this investigation was to correlate oropharyngeal swallow efficiency (OPSE), a summary measure of swallowing function, with its component variables. Videofluorographic assessment of oropharyngeal swallow resulted in the measurement of multiple measures of swallow function in five patient populations and a group of normal volunteers. In total, 759 swallows were studied in 149 persons. Specific dimensions of impairment were identified in the patient groups. Multiple regression analyses were used to relate multiple component variables to OPSE. In patient groups with distinct swallow impairments, OPSE was shown to be representative of the dimensions of impairment. In patient groups with limited impairment and in normal volunteers, the strongest correlates of OPSE were bolus transit times. In all groups, at least four variables were significantly related to OPSE and the squared multiple correlation coefficients ranged from 76% to 89%. We conclude that oropharyngeal swallow efficiency is a representative summary measure of swallowing function across populations characterized by a wide range of swallowing impairment

Monitoring of heart failure: comparison of left atrial pressure with intrathoracic impedance and natriuretic peptide measurements in an experimental model of ovine heart failure

Monitoring of HF (heart failure) with intracardiac pressure, intrathoracic impedance and/or natriuretic peptide levels has been advocated. We aimed to investigate possible differences in the response patterns of each of these monitoring modalities during HF decompensation that may have an impact on the potential for early therapeutic intervention. Six sheep were implanted with a LAP (left atrial pressure) sensor and a CRT-D (cardiac resynchronization therapy defibrillator) capable of monitoring impedance along six lead configuration vectors. An estimate of ALAP (LAP from admittance) was determined by linear regression. HF was induced by rapid ventricular pacing at 180 and 220 bpm (beats/min) for a week each, followed by a third week with daily pacing suspensions for increasing durations (1–5 h). Incremental pacing induced progressively severe HF reflected in increases in LAP (5.9 ± 0.4 to 24.5 ± 1.6 mmHg) and plasma atrial (20 ± 3 to 197 ± 36 pmol/l) and B-type natriuretic peptide (3.7 ± 0.7 to 32.7 ± 5.4 pmol/l) (all P<0.001) levels. All impedance vectors decreased in proportion to HF severity (all P<0.001), with the LVring (left ventricular)-case vector correlating best with LAP (r2=0.63, P<0.001). Natriuretic peptides closely paralleled rapid acute changes in LAP during alterations in pacing (P<0.001), whereas impedance changes were delayed relative to LAP. ALAP exhibited good agreement with LAP. In summary, impedance measured with an LV lead correlates significantly with changes in LAP, but exhibits a delayed response to acute alterations. Natriuretic peptides respond rapidly to acute LAP changes. Direct LAP, impedance and natriuretic peptide measurements all show promise as early indicators of worsening HF. ALAP provides an estimate of LAP that may be clinically useful

Аліментні обов'язки інших членів сім'ї та родичів

Виявлено проблеми у врегулюванні аліментних обов’язків інших членів сім’ї та родичів, вироблено рекомендації щодо їх вирішення. Проаналізовано специфіку правового регулювання аліментних зобов’язань зазначених суб’єктів, сімейне законодавство та міжнародний досвід. Ключові слова: аліментні обов’язки, правове регулювання, сімейне законодавство.Выявлены проблемы в урегулировании алиментных обязанностей других членов семьи и родственников, выработаны рекомендации по их решению. Проанализирована специфика правового регулирования алиментных обязательств указанных субъектов, семейное законодательство и международный опыт. Ключевые слова: алиментные обязанности, правовое регулирование, семейное законодавствоThis article is dedicated to identifying problems in the regulation of the alimentary obligations of other family members and relatives, and to making recommendations and proposing solutions. Studing the specificity of the legal regulation of alimentary obligations of these entities, analysing the current family law and international experience are very important. Key words: alimentary obligations, legal regulation, family law

Case Report: A Truck Driver with Pelvic Pain

Extraskeletal myxoid chondrosarcoma (EMC) is a relatively rare soft tissue malignancy, originally described in the 1950s and characterized as a distinct entity from chondrosarcoma of the bone in the 1970s. These tumors most commonly originate in the proximal extremities, and their occurrence in the genitourinary tract is exceedingly rare, with few case reports citing origination in its component organs. We present a clinical case report of an EMC originating from the base of the penis with significant local involvement of the bony pelvis

Visualization of HIV-1 interactions with penile and foreskin epithelia: clues for female-to-male HIV transmission

To gain insight into female-to-male HIV sexual transmission and how male circumcision protects against this mode of transmission, we visualized HIV-1 interactions with foreskin and penile tissues in ex vivo tissue culture and in vivo rhesus macaque models utilizing epifluorescent microscopy. 12 foreskin and 14 cadaveric penile specimens were cultured with R5-tropic photoactivatable (PA)-GFP HIV-1 for 4 or 24 hours. Tissue cryosections were immunofluorescently imaged for epithelial and immune cell markers. Images were analyzed for total virions, proportion of penetrators, depth of virion penetration, as well as immune cell counts and depths in the tissue. We visualized individual PA virions breaching penile epithelial surfaces in the explant and macaque model. Using kernel density estimated probabilities of localizing a virion or immune cell at certain tissue depths revealed that interactions between virions and cells were more likely to occur in the inner foreskin or glans penis (from local or cadaveric donors, respectively). Using statistical models to account for repeated measures and zero-inflated datasets, we found no difference in total virions visualized at 4 hours between inner and outer foreskins from local donors. At 24 hours, there were more virions in inner as compared to outer foreskin (0.0495 +/- 0.0154 and 0.0171 +/- 0.0038 virions/image, p = 0.001). In the cadaveric specimens, we observed more virions in inner foreskin (0.0507 +/- 0.0079 virions/image) than glans tissue (0.0167 +/- 0.0033 virions/image, p&lt;0.001), but a greater proportion was seen penetrating uncircumcised glans tissue (0.0458 +/- 0.0188 vs. 0.0151 +/- 0.0100 virions/image, p = 0.099) and to significantly greater mean depths (29.162 +/- 3.908 vs. 12.466 +/- 2.985 &mu;m). Our in vivo macaque model confirmed that virions can breach penile squamous epithelia in a living model. In summary, these results suggest that the inner foreskin and glans epithelia may be important sites for HIV transmission in uncircumcised men