Drug-loaded Cellulose Acetate and Cellulose Acetate Butyrate Films as Ocular Inserts

The purpose of this research work was to evaluate the contribution of formulation variables on release properties of matrix type ocular films containing chloramphenicol as a model drug. This study investigated the use of cellulose acetate and cellulose acetate butyrate as film-forming agents in development of ocular films. Formulation variables were concentration of polymer and plasticizer. Prepared films were evaluated for thickness, tensile strength, water vapor transmission rate and in vitro dissolution study. All formulations showed extended drug release over aperiod of 12 hours. The levels of polymer and plasticizer had a significant influence on the drug release in initial periods. Diffusion exponents of all formulations were less than 0.5, which confirmed that drug release occurred without swelling of inserts. Water vapor transmission rate was influenced by concentration of plasticizer. The best formulation showed 81.26% drug release in vivo at the end of 12 h with cellulose acetate and 79.06% with cellulose acetate butyrate. The in vitroin vivo release correlation was evaluated and the regression coefficient was found tobe 0.9767 and 0.9007 for cellulose acetate and cellulose acetate butyrate formulation, respectively indicating good correlation between the in vitro and in vivo drug release

A blockchain based architecture for asset management in coalition operations

To support dynamic communities of interests in coalition operations, new architectures for efficient sharing of ISR assets are needed. The use of blockchain technology in wired business environments, such as digital currency systems, offers an interesting solution by creating a way to maintain a distributed shared ledger without requiring a single trusted authority. In this paper, we discuss how a blockchain-based system can be modified to provide a solution for dynamic asset sharing amongst coalition members, enabling the creation of a logically centralized asset management system by a seamless policy-compliant federation of different coalition systems. We discuss the use of blockchain for three different types of assets in a coalition context, showing how blockchain can offer a suitable solution for sharing assets in those environments. We also discuss the limitations in the current implementations of blockchain which need to be overcome for the technology to become more effective in a decentralized tactical edge environment

Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

Background: Acute appendicitis, the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances and is essentially clinical. However a decision to operate based on clinical suspicion alone can lead to removal of normal appendix in 15-30% cases. Several diagnostic scoring systems have been devised as an aid to early diagnosis of acute appendicitis and to reduce the incidence of negative appendicectomy. One such scoring system was described by Alvarado and later modified by Kalan et al. The present study is attempted to evaluate the efficiency of modified Alvarado score in pre-operative diagnosis of acute appendicitis.Methods: One hundred twenty consecutive patients suspected of acute appendicitis that were admitted, investigated and treated were taken for the study. After detailed examination and investigations a modified Alvarado score was applied to these patients. They were assigned in three groups and were treated accordingly.Results: The result of the study showed that high scores in men and children (7-9) had a sensitivity of 92.3% and 83.3% respectively, whereas in females it had a sensitivity of 72.7%. The score (5-6) in males and females had a sensitivity of 57% and 50% respectively.Conclusions: The high scores in modified Alvarado score is dependable aid in the early diagnosis of acute appendicitis in men and children but it’s not true as far as women are considered. Ultrasonography of abdomen is a useful tool in avoiding negative appendicectomy rates particularly in females.

Drug utilization study in the inpatients of pediatric department of a tertiary care hospital

Background: Infants and children constitute a large proportion of the population in developing countries. In Gujarat, studies on drug use patterns in the pediatric age group are lacking in the Saurashtra region hospitals. The objective was to study demographical information and the utilization pattern in the in patients of the pediatric ward.Methods: A cross-sectional, observational drug utilization study was carried out over a period of 6 months in 630 pediatric inpatients of the pediatric department of Guru Gobind Singh Hospital, Jamnagar, a tertiary care teaching hospital. Analyzed data included demographic details and drugs prescribed in respective patients.Results: Most commonly affected age group was 1-5 years, boys in 62.06% and girls in 37.94% and 40.16% were admitted in the pediatric ward. Acute gastroenteritis and pneumonia had the highest admission rate with 31.90% and 22.38%, respectively. The majority of children were prescribed 5-6 drugs. Ceftriaxone (64.92%) was the top most frequently prescribed antibiotic, followed by amoxicillin (49.21%). Prescribing drugs were mainly from essential drug list (64.44%) and by generic names (61.89%). Drugs prescribed orally in 66.10% and by injections in 33.90%.Conclusion: It is quite evident that significantly large number of children were from 1 to 5 year age group. The majority of the children were admitted in inpatients of the pediatric ward for acute gastroenteritis, followed by pneumonia and meningitis. Most frequently prescribed antibiotic group was cephalosporin, followed by penicillin group

Structured Collaboration Across a Transformative Knowledge Network-Learning Across Disciplines, Cultures and Contexts?

Realising the Sustainable Development Goals (SDGs) will require transformative changes at micro, meso and macro levels and across diverse geographies. Collaborative, transdisciplinary research has a role to play in documenting, understanding and contributing to such transformations. Previous work has investigated the role of this research in Europe and North America, however the dynamics of transdisciplinary research on ‘transformations to sustainability’ in other parts of the world are less well-understood. This paper reports on an international project that involved transdisciplinary research in six different hubs across the globe and was strategically designed to enable mutual learning and exchange. It draws on surveys, reports and research outputs to analyse the processes of transdisciplinary collaboration for sustainability that took place between 2015-2019. The paper illustrates how the project was structured in order to enable learning across disciplines, cultures and contexts, and describes how it also provided for the negotiation of epistemological frameworks and different normative commitments between members across the network. To this end, it discusses lessons regarding the use of theoretical and methodological anchors, multi-loop learning and evaluating emergent change (including the difficulties encountered). It offers insights for the design and implementation of future international transdisciplinary collaborations that address locally-specific sustainability challenges within the universal framework of the 2030 Agenda for Sustainable Development

Safety and immunogenicity of heterologous versus homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine (Com-COV): a single-blind, randomised, non-inferiority trial

BACKGROUND: Use of heterologous prime-boost COVID-19 vaccine schedules could facilitate mass COVID-19 immunisation. However, we have previously reported that heterologous schedules incorporating an adenoviral vectored vaccine (ChAdOx1 nCoV-19, AstraZeneca; hereafter referred to as ChAd) and an mRNA vaccine (BNT162b2, Pfizer–BioNTech; hereafter referred to as BNT) at a 4-week interval are more reactogenic than homologous schedules. Here, we report the safety and immunogenicity of heterologous schedules with the ChAd and BNT vaccines. METHODS: Com-COV is a participant-blinded, randomised, non-inferiority trial evaluating vaccine safety, reactogenicity, and immunogenicity. Adults aged 50 years and older with no or well controlled comorbidities and no previous SARS-CoV-2 infection by laboratory confirmation were eligible and were recruited at eight sites across the UK. The majority of eligible participants were enrolled into the general cohort (28-day or 84-day prime-boost intervals), who were randomly assigned (1:1:1:1:1:1:1:1) to receive ChAd/ChAd, ChAd/BNT, BNT/BNT, or BNT/ChAd, administered at either 28-day or 84-day prime-boost intervals. A small subset of eligible participants (n=100) were enrolled into an immunology cohort, who had additional blood tests to evaluate immune responses; these participants were randomly assigned (1:1:1:1) to the four schedules (28-day interval only). Participants were masked to the vaccine received but not to the prime-boost interval. The primary endpoint was the geometric mean ratio (GMR) of serum SARS-CoV-2 anti-spike IgG concentration (measured by ELISA) at 28 days after boost, when comparing ChAd/BNT with ChAd/ChAd, and BNT/ChAd with BNT/BNT. The heterologous schedules were considered non-inferior to the approved homologous schedules if the lower limit of the one-sided 97·5% CI of the GMR of these comparisons was greater than 0·63. The primary analysis was done in the per-protocol population, who were seronegative at baseline. Safety analyses were done among participants receiving at least one dose of a study vaccine. The trial is registered with ISRCTN, 69254139. FINDINGS: Between Feb 11 and Feb 26, 2021, 830 participants were enrolled and randomised, including 463 participants with a 28-day prime-boost interval, for whom results are reported here. The mean age of participants was 57·8 years (SD 4·7), with 212 (46%) female participants and 117 (25%) from ethnic minorities. At day 28 post boost, the geometric mean concentration of SARS-CoV-2 anti-spike IgG in ChAd/BNT recipients (12 906 ELU/mL) was non-inferior to that in ChAd/ChAd recipients (1392 ELU/mL), with a GMR of 9·2 (one-sided 97·5% CI 7·5 to ∞). In participants primed with BNT, we did not show non-inferiority of the heterologous schedule (BNT/ChAd, 7133 ELU/mL) against the homologous schedule (BNT/BNT, 14 080 ELU/mL), with a GMR of 0·51 (one-sided 97·5% CI 0·43 to ∞). Four serious adverse events occurred across all groups, none of which were considered to be related to immunisation. INTERPRETATION: Despite the BNT/ChAd regimen not meeting non-inferiority criteria, the SARS-CoV-2 anti-spike IgG concentrations of both heterologous schedules were higher than that of a licensed vaccine schedule (ChAd/ChAd) with proven efficacy against COVID-19 disease and hospitalisation. Along with the higher immunogenicity of ChAd/BNT compared with ChAD/ChAd, these data support flexibility in the use of heterologous prime-boost vaccination using ChAd and BNT COVID-19 vaccines. FUNDING: UK Vaccine Task Force and National Institute for Health Research

Second round statewide sentinel-based population survey for estimation of the burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population of Karnataka, India, during January-February 2021

Objective Demonstrate the feasibility of using the existing sentinel surveillance infrastructure to conduct the second round of the serial cross-sectional sentinel-based population survey. Assess active infection, seroprevalence, and their evolution in the general population across Karnataka. Identify local variations for locally appropriate actions. Additionally, assess the clinical sensitivity of the testing kit used on account of variability of antibody levels in the population. Methods The cross-sectional study of 41,228 participants across 290 healthcare facilities in all 30 districts of Karnataka was done among three groups of participants (low, moderate, and high-risk). The geographical spread was sufficient to capture local variations. Consenting participants were subjected to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, and antibody (IgG) testing. Clinical sensitivity was assessed by conducting a longitudinal study among participants identified as COVID-19 positive in the first survey round. Results Overall weighted adjusted seroprevalence of IgG was 15.6% (95% CI: 14.9–16.3), crude IgG prevalence was 15.0% and crude active infection was 0.5%. Statewide infection fatality rate (IFR) was estimated as 0.11%, and COVID-19 burden estimated between 26.1 to 37.7% (at 90% confidence). Further, Cases-to-infections ratio (CIR) varied 3-35 across units and IFR varied 0.04–0.50% across units. Clinical sensitivity of the IgG ELISA test kit was estimated as ≥38.9%. Conclusion We demonstrated the feasibility and simplicity of sentinel-based population survey in measuring variations in subnational and local data, useful for locally appropriate actions in different locations. The sentinel-based population survey thus helped identify districts that needed better testing, reporting, and clinical management. The state was far from attaining natural immunity during the survey and hence must step up vaccination coverage and enforce public health measures to prevent the spread of COVD-19.The Institutional Ethics Committee (IEC) of the Indian Institute of Public Health - Bengaluru campus reviewed and approved the study (vide. IIPHHB/TRCIEC/174/2020) and the subsequent change of protocol to perform the longitudinal study (vide PHFI/IIPH-BLR/076/2020-21). We informed the participants of the purpose of the surveys, how the samples would be taken and requested them to respond to the screening questions. After obtaining informed consent, we noted basic demographic details, exposure history, symptoms observed in the previous month, and clinical history. Participants' test results were shared with them by the concerned healthcare facility.Scopu