Sample records for manage anti-hiv treatment

  1. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton


    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...... and knowledge of HIV led to short-term trials using surrogate outcomes such as viral load and CD4 count. This established a faster drug approval process that complimented the rapid need to evaluate and provide access to drugs based on short-term trials. However, no treatment has yet been found that eradicates...... the infection, so when treatment is started it is currently a lifelong commitment. Is it reasonable then that guidelines are based almost completely on short-term randomized trials and observational studies of surrogate markers, or is there still a need for trials with clinical outcomes?...

  2. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton


    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...... the infection, so when treatment is started it is currently a lifelong commitment. Is it reasonable then that guidelines are based almost completely on short-term randomized trials and observational studies of surrogate markers, or is there still a need for trials with clinical outcomes?...

  3. Lectins with Anti-HIV Activity: A Review

    Directory of Open Access Journals (Sweden)

    Ouafae Akkouh


    Full Text Available Lectins including flowering plant lectins, algal lectins, cyanobacterial lectins, actinomycete lectin, worm lectins, and the nonpeptidic lectin mimics pradimicins and benanomicins, exhibit anti-HIV activity. The anti-HIV plant lectins include Artocarpus heterophyllus (jacalin lectin, concanavalin A, Galanthus nivalis (snowdrop agglutinin-related lectins, Musa acuminata (banana lectin, Myrianthus holstii lectin, Narcissus pseudonarcissus lectin, and Urtica diocia agglutinin. The anti-HIV algal lectins comprise Boodlea coacta lectin, Griffithsin, Oscillatoria agardhii agglutinin. The anti-HIV cyanobacterial lectins are cyanovirin-N, scytovirin, Microcystis viridis lectin, and microvirin. Actinohivin is an anti-HIV actinomycete lectin. The anti-HIV worm lectins include Chaetopterus variopedatus polychaete marine worm lectin, Serpula vermicularis sea worm lectin, and C-type lectin Mermaid from nematode (Laxus oneistus. The anti-HIV nonpeptidic lectin mimics comprise pradimicins and benanomicins. Their anti-HIV mechanisms are discussed.

  4. A Survey of Plants with Anti-HIV Active Compounds and their Modes ...

    African Journals Online (AJOL)

    Background: Several limitations of current antiretroviral therapy (ART) programmes will continue to push patients towards the use of plants to manage HIV/AIDS. However, evidence about the use of anti-HIV plants is anecdotal. Objectives: Search the literature for research articles that document plants with anti-HIV ...

  5. Quarter Century of Anti-HIV CAR T Cells. (United States)

    Wagner, Thor A


    A therapy that might cure HIV is a very important goal for the 30-40 million people living with HIV. Chimeric antigen receptor T cells have recently had remarkable success against certain leukemias, and there are reasons to believe they could be successful for HIV. This manuscript summarizes the published research on HIV CAR T cells and reviews the current anti-HIV chimeric antigen receptor strategies. Research on anti-HIV chimeric antigen receptor T cells has been going on for at least the last 25 years. First- and second-generation anti-HIV chimeric antigen receptors have been developed. First-generation anti-HIV chimeric antigen receptors were studied in clinical trials more than 15 years ago, but did not have meaningful clinical efficacy. There are some reasons to be optimistic about second-generation anti-HIV chimeric antigen receptor T cells, but they have not yet been tested in vivo.

  6. Therapeutic genes for anti-HIV/AIDS gene therapy. (United States)

    Bovolenta, Chiara; Porcellini, Simona; Alberici, Luca


    The multiple therapeutic approaches developed so far to cope HIV-1 infection, such as anti-retroviral drugs, germicides and several attempts of therapeutic vaccination have provided significant amelioration in terms of life-quality and survival rate of AIDS patients. Nevertheless, no approach has demonstrated efficacy in eradicating this lethal, if untreated, infection. The curative power of gene therapy has been proven for the treatment of monogenic immunodeficiensies, where permanent gene modification of host cells is sufficient to correct the defect for life-time. No doubt, a similar concept is not applicable for gene therapy of infectious immunodeficiensies as AIDS, where there is not a single gene to be corrected; rather engineered cells must gain immunotherapeutic or antiviral features to grant either short- or long-term efficacy mostly by acquisition of antiviral genes or payloads. Anti-HIV/AIDS gene therapy is one of the most promising strategy, although challenging, to eradicate HIV-1 infection. In fact, genetic modification of hematopoietic stem cells with one or multiple therapeutic genes is expected to originate blood cell progenies resistant to viral infection and thereby able to prevail on infected unprotected cells. Ultimately, protected cells will re-establish a functional immune system able to control HIV-1 replication. More than hundred gene therapy clinical trials against AIDS employing different viral vectors and transgenes have been approved or are currently ongoing worldwide. This review will overview anti-HIV-1 infection gene therapy field evaluating strength and weakness of the transgenes and payloads used in the past and of those potentially exploitable in the future.

  7. Prospects for Foamy Viral Vector Anti-HIV Gene Therapy

    Directory of Open Access Journals (Sweden)

    Arun K. Nalla


    Full Text Available Stem cell gene therapy approaches for Human Immunodeficiency Virus (HIV infection have been explored in clinical trials and several anti-HIV genes delivered by retroviral vectors were shown to block HIV replication. However, gammaretroviral and lentiviral based retroviral vectors have limitations for delivery of anti-HIV genes into hematopoietic stem cells (HSC. Foamy virus vectors have several advantages including efficient delivery of transgenes into HSC in large animal models, and a potentially safer integration profile. This review focuses on novel anti-HIV transgenes and the potential of foamy virus vectors for HSC gene therapy of HIV.

  8. Contribution of the anti HIV/AIDS community conversation programs ...

    African Journals Online (AJOL)

    Background: HIV/AIDS has now been around for about three and half decades since first diagnosed in 1981. If we wish to curb the spread of HIV/AIDS effectively and sustainably, we need to design strategies that help mobilizing communities at large. Anti-HIV/AIDS Community Conversation (CC) Programs are part of ...

  9. Anti-HIV-1 activity of flavonoid myricetin on HIV-1 infection in a dual-chamber in vitro model.

    Directory of Open Access Journals (Sweden)

    Silvana Pasetto

    Full Text Available HIV infection by sexual transmission remains an enormous global health concern. More than 1 million new infections among women occur annually. Microbicides represent a promising prevention strategy that women can easily control. Among emerging therapies, natural small molecules such as flavonoids are an important source of new active substances. In this study we report the in vitro cytotoxicity and anti-HIV-1 and microbicide activity of the following flavonoids: Myricetin, Quercetin and Pinocembrin. Cytotoxicity tests were conducted on TZM-bl, HeLa, PBMC, and H9 cell cultures using 0.01-100 µM concentrations. Myricetin presented the lowest toxic effect, with Quercetin and Pinocembrin relatively more toxic. The anti-HIV-1 activity was tested with TZM-bl cell plus HIV-1 BaL (R5 tropic, H9 and PBMC cells plus HIV-1 MN (X4 tropic, and the dual tropic (X4R5 HIV-1 89.6. All flavonoids showed anti-HIV activity, although Myricetin was more effective than Quercetin or Pinocembrin. In TZM-bl cells, Myricetin inhibited ≥90% of HIV-1 BaL infection. The results were confirmed by quantification of HIV-1 p24 antigen in supernatant from H9 and PBMC cells following flavonoid treatment. In H9 and PBMC cells infected by HIV-1 MN and HIV-1 89.6, Myricetin showed more than 80% anti-HIV activity. Quercetin and Pinocembrin presented modest anti-HIV activity in all experiments. Myricetin activity was tested against HIV-RT and inhibited the enzyme by 49%. Microbicide activities were evaluated using a dual-chamber female genital tract model. In the in vitro microbicide activity model, Myricetin showed promising results against different strains of HIV-1 while also showing insignificant cytotoxic effects. Further studies of Myricetin should be performed to identify its molecular targets in order to provide a solid biological foundation for translational research.

  10. Testing of viscous anti-HIV microbicides using Lactobacillus


    Moncla, B.J.; Pryke, K.; Rohan, L. C.; Yang, H.


    The development of topical microbicides for intravaginal use to prevent HIV infection requires that the drugs and formulated products be nontoxic to the endogenous vaginal Lactobacillus. In 30 min exposure tests we found dapivirine, tenofovir and UC781 (reverse transcriptase inhibitor anti-HIV drugs) as pure drugs or formulated as film or gel products were not deleterious to Lactobacillus species; however, PSC-RANTES (a synthetic CCR5 antagonist) killed 2 strains of Lactobacillus jensenii. To...

  11. Fragment-based approaches to anti-HIV drug discovery: state of the art and future opportunities. (United States)

    Huang, Boshi; Kang, Dongwei; Zhan, Peng; Liu, Xinyong


    The search for additional drugs to treat HIV infection is a continuing effort due to the emergence and spread of HIV strains resistant to nearly all current drugs. The recent literature reveals that fragment-based drug design/discovery (FBDD) has become an effective alternative to conventional high-throughput screening strategies for drug discovery. In this critical review, the authors describe the state of the art in FBDD strategies for the discovery of anti-HIV drug-like compounds. The article focuses on fragment screening techniques, direct fragment-based design and early hit-to-lead progress. Rapid progress in biophysical detection and in silico techniques has greatly aided the application of FBDD to discover candidate agents directed at a variety of anti-HIV targets. Growing evidence suggests that structural insights on key proteins in the HIV life cycle can be applied in the early phase of drug discovery campaigns, providing valuable information on the binding modes and efficiently prompting fragment hit-to-lead progression. The combination of structural insights with improved methodologies for FBDD, including the privileged fragment-based reconstruction approach, fragment hybridization based on crystallographic overlays, fragment growth exploiting dynamic combinatorial chemistry, and high-speed fragment assembly via diversity-oriented synthesis followed by in situ screening, offers the possibility of more efficient and rapid discovery of novel drugs for HIV-1 prevention or treatment. Though the use of FBDD in anti-HIV drug discovery is still in its infancy, it is anticipated that anti-HIV agents developed via fragment-based strategies will be introduced into the clinic in the future.

  12. Nanomedicine in the development of anti-HIV microbicides. (United States)

    das Neves, José; Nunes, Rute; Rodrigues, Francisca; Sarmento, Bruno


    Prevention plays an invaluable role in the fight against HIV/AIDS. The use of microbicides is considered an interesting potential approach for topical pre-exposure prophylaxis of HIV sexual transmission. The prospects of having an effective product available are expected to be fulfilled in the near future as driven by recent and forthcoming results of clinical trials. Different dosage forms and delivery strategies have been proposed and tested for multiple microbicide drug candidates presently at different stages of the development pipeline. One particularly interesting approach comprises the application of nanomedicine principles to the development of novel anti-HIV microbicides, but its implications to efficacy and safety are not yet fully understood. Nanotechnology-based systems, either presenting inherent anti-HIV activity or acting as drug nanocarriers, may significantly influence features such as drug solubility, stability of active payloads, drug release, interactions between active moieties and virus/cells, intracellular drug delivery, drug targeting, safety, antiviral activity, mucoadhesive behavior, drug distribution and tissue penetration, and pharmacokinetics. The present manuscript provides a comprehensive and holistic overview of these topics as relevant to the development of vaginal and rectal microbicides. In particular, recent advances pertaining inherently active microbicide nanosystems and microbicide drug nanocarriers are discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Anti-HIV Antibody Responses and the HIV Reservoir Size during Antiretroviral Therapy.

    Directory of Open Access Journals (Sweden)

    Sulggi A Lee

    Full Text Available A major challenge to HIV eradication strategies is the lack of an accurate measurement of the total burden of replication-competent HIV (the "reservoir". We assessed the association of anti-HIV antibody responses and the estimated size of the reservoir during antiretroviral therapy (ART.We evaluated anti-HIV antibody profiles using luciferase immunoprecipitation systems (LIPS assay in relation to several blood-based HIV reservoir measures: total and 2-LTR DNA (rtPCR or droplet digital PCR; integrated DNA (Alu PCR; unspliced RNA (rtPCR, multiply-spliced RNA (TILDA, residual plasma HIV RNA (single copy PCR, and replication-competent virus (outgrowth assay. We also assessed total HIV DNA and RNA in gut-associated lymphoid tissue (rtPCR. Spearman correlations and linear regressions were performed using log-transformed blood- or tissue-based reservoir measurements as predictors and log-transformed antibody levels as outcome variables.Among 51 chronically HIV-infected ART-suppressed participants (median age = 57, nadir CD4+ count = 196 cells/mm3, ART duration = 9 years, the most statistically significant associations were between antibody responses to integrase and HIV RNA in gut-associated lymphoid tissue (1.17 fold-increase per two-fold RNA increase, P = 0.004 and between antibody responses to matrix and integrated HIV DNA in resting CD4+ T cells (0.35 fold-decrease per two-fold DNA increase, P = 0.003. However, these associations were not statistically significant after a stringent Bonferroni-adjustment of P<0.00045. Multivariate models including age and duration of ART did not markedly alter results.Our findings suggest that anti-HIV antibody responses may reflect the size of the HIV reservoir during chronic treated HIV disease, possibly via antigen recognition in reservoir sites. Larger, prospective studies are needed to validate the utility of antibody levels as a measure of the total body burden of HIV during treatment.

  14. A Novel Method for Determining the Inhibitory Potential of Anti-HIV Drugs (United States)

    Shen, Lin; Rabi, S. Alireza; Siliciano, Robert F.


    In the absence of a cure, most HIV-1-infected individuals will require life-long treatment. It is therefore essential to optimize highly active antiretroviral therapy. Recent research has shown that the slope parameter or Hill coefficient, which describes the steepness of a dose-response curve, is a critical missing dimension in the evaluation of antiviral drug activity. Based on this finding, the instantaneous inhibitory potential (IIP) has been derived as a new measure of antiviral drug activity. IIP incorporates the slope parameter and thus is a more accurate pharmacodynamic measure of antiviral activity than current measures such as IC50 and inhibitory quotient. However, it remains important to determine how to use IIP to predict the in vivo efficacy of anti-HIV-1 drugs. This article discusses recent advances in in vitro measures of antiviral activity and the therapeutic implications of the dose-response curve slope and IIP. PMID:19837466

  15. A Survey of Plants with Anti-HIV Active Compounds and their Modes ...

    African Journals Online (AJOL)


    proteins, alkaloids, and biflavonoids inhibit various ... several plant families and species contain anti-HIV .... articles reviewed, only about a third were included .... membranes against free .... Pedersen, B.K. Low plasma level of adiponectin.

  16. New findings on the d(TGGGAG) sequence: Surprising anti-HIV-1 activity. (United States)

    Romanucci, Valeria; Zarrelli, Armando; Liekens, Sandra; Noppen, Sam; Pannecouque, Christophe; Di Fabio, Giovanni


    The biological relevance of tetramolecular G-quadruplexes especially as anti-HIV agents has been extensively reported in the literature over the last years. In the light of our recent results regarding the slow G-quadruplex folding kinetics of ODNs based on d(TGGGAG) sequence, here we report a systematic anti-HIV screening to investigate the impact of the G-quadruplex folding on their anti-HIV activity. In particular, varying the single stranded concentrations of ODNs, it has been tested a pool of ODN sample solutions with different G-quadruplex concentrations. The anti-HIV assays have been designed favouring the limited kinetics involved in the tetramolecular G4-association based on the d(TGGGAG) sequence. Aiming to determine the stoichiometry of G-quadruplex structures in the same experimental conditions of the anti-HIV assays, a native gel electrophoresis was performed. The gel confirmed the G-quadruplex formation for almost all sample solutions while showing the formation of high order G4 structures for the more concentrated ODNs solutions. The most significant result is the discovery of a potent anti-HIV activity of the G-quadruplex formed by the natural d(TGGGAG) sequence (IC 50  = 14 nM) that, until now, has been reported to be completely inactive against HIV infection. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  17. G-Quadruplex Forming Oligonucleotides as Anti-HIV Agents. (United States)

    Musumeci, Domenica; Riccardi, Claudia; Montesarchio, Daniela


    Though a variety of different non-canonical nucleic acids conformations have been recognized, G-quadruplex structures are probably the structural motifs most commonly found within known oligonucleotide-based aptamers. This could be ascribed to several factors, as their large conformational diversity, marked responsiveness of their folding/unfolding processes to external stimuli, high structural compactness and chemo-enzymatic and thermodynamic stability. A number of G-quadruplex-forming oligonucleotides having relevant in vitro anti-HIV activity have been discovered in the last two decades through either SELEX or rational design approaches. Improved aptamers have been obtained by chemical modifications of natural oligonucleotides, as terminal conjugations with large hydrophobic groups, replacement of phosphodiester linkages with phosphorothioate bonds or other surrogates, insertion of base-modified monomers, etc. In turn, detailed structural studies have elucidated the peculiar architectures adopted by many G-quadruplex-based aptamers and provided insight into their mechanism of action. An overview of the state-of-the-art knowledge of the relevance of putative G-quadruplex forming sequences within the viral genome and of the most studied G-quadruplex-forming aptamers, selectively targeting HIV proteins, is here presented.

  18. Testing of viscous anti-HIV microbicides using Lactobacillus. (United States)

    Moncla, B J; Pryke, K; Rohan, L C; Yang, H


    The development of topical microbicides for intravaginal use to prevent HIV infection requires that the drugs and formulated products be nontoxic to the endogenous vaginal Lactobacillus. In 30min exposure tests we found dapivirine, tenofovir and UC781 (reverse transcriptase inhibitor anti-HIV drugs) as pure drugs or formulated as film or gel products were not deleterious to Lactobacillus species; however, PSC-RANTES (a synthetic CCR5 antagonist) killed 2 strains of Lactobacillus jensenii. To demonstrate the toxicity of formulated products a new assay was developed for use with viscous and non-viscous samples that we have termed the Lactobacillus toxicity test. We found that the vortex mixing of vaginal Lactobacillus species can lead to reductions in bacterial viability. Lactobacillus can survive briefly, about 2s, but viability declines with increased vortex mixing. The addition of heat inactivated serum or bovine serum albumin, but not glycerol, prevented the decrease in bacterial viability. Bacillus atrophaeus spores also demonstrated loss of viability upon extended mixing. We observed that many of the excipients used in film formulation and the films themselves also afford protection from the killing during vortex mixing. This method is of relevance for toxicity for cidal activities of viscous products. Copyright © 2011 Elsevier B.V. All rights reserved.

  19. Anti-HIV therapy with AZT prodrugs: AZT phosphonate derivatives, current state and prospects. (United States)

    Khandazhinskaya, Anastasiya; Matyugina, Elena; Shirokova, Elena


    AIDS, a disease caused by human immunodeficiency virus, was called 'plague of the twentieth century'. 3'-Azido-3'-deoxythymidine (AZT), the first compound approved for the treatment of HIV, is still a mandatory component of treatment schemes. However, its toxicity stimulated a search for new agents. This review presents the history and current state of the design of AZT prodrugs based on its phosphonate derivatives. Although every effort was made to include as many AZT structures bearing phosphonate residues and demonstrate the variety they offer, we also concentrated on the studies performed in our laboratory. Special attention was also paid to AZT 5'-H-phosphonate (phosphazide, Nikavir) approved in the Russian Federation as a drug for the prevention and treatment of HIV infection. The prodrug strategy applied to AZT phosphonate derivatives enriched chemistry, biology and medicine not only with new knowledge, methods and structures, but also with a new anti-HIV drug Nikavir. Currently, study of another phosphonate, AZT 5'-aminocarbonylphosphonate, is underway. Slow release of AZT following oral administration and penetration into cells, decreased toxicity and the lack of cumulative properties make the compounds of this group promising as extended-release forms of AZT.

  20. Plant-based anti-HIV-1 strategies: vaccine molecules and antiviral approaches. (United States)

    Scotti, Nunzia; Buonaguro, Luigi; Tornesello, Maria Lina; Cardi, Teodoro; Buonaguro, Franco Maria


    The introduction of highly active antiretroviral therapy has drastically changed HIV infection from an acute, very deadly, to a chronic, long-lasting, mild disease. However, this requires continuous care management, which is difficult to implement worldwide, especially in developing countries. Sky-rocketing costs of HIV-positive subjects and the limited success of preventive recommendations mean that a vaccine is urgently needed, which could be the only effective strategy for the real control of the AIDS pandemic. To be effective, vaccination will need to be accessible, affordable and directed against multiple antigens. Plant-based vaccines, which are easy to produce and administer, and require no cold chain for their heat stability are, in principle, suited to such a strategy. More recently, it has been shown that even highly immunogenic, enveloped plant-based vaccines can be produced at a competitive and more efficient rate than conventional strategies. The high variability of HIV epitopes and the need to stimulate both humoral neutralizing antibodies and cellular immunity suggest the importance of using the plant system: it offers a wide range of possible strategies, from single-epitope to multicomponent vaccines, modulators of the immune response (adjuvants) and preventive molecules (microbicides), either alone or in association with plant-derived monoclonal antibodies, besides the potential use of the latter as therapeutic agents. Furthermore, plant-based anti-HIV strategies can be administered not only parenterally but also by the more convenient and safer oral route, which is a more suitable approach for possible mass vaccination.

  1. Novel anti-HIV peptides containing multiple copies of artificially designed heptad repeat motifs

    International Nuclear Information System (INIS)

    Shi Weiguo; Qi Zhi; Pan Chungen; Xue Na; Debnath, Asim K.; Qie Jiankun; Jiang Shibo; Liu Keliang


    The peptidic anti-HIV drug T20 (Fuzeon) and its analog C34 share a common heptad repeat (HR) sequence, but they have different functional domains, i.e., pocket- and lipid-binding domains (PBD and LBD, respectively). We hypothesize that novel anti-HIV peptides may be designed by using artificial sequences containing multiple copies of HR motifs plus zero, one or two functional domains. Surprisingly, we found that the peptides containing only the non-natural HR sequences could significantly inhibit HIV-1 infection, while addition of PBD and/or LBD to the peptides resulted in significant improvement of anti-HIV-1 activity. These results suggest that these artificial HR sequences, which may serve as structural domains, could be used as templates for the design of novel antiviral peptides against HIV and other viruses with class I fusion proteins

  2. Accuracy of different thresholds for the anti-HIV avidity index

    Directory of Open Access Journals (Sweden)

    Claudio Galli


    Full Text Available Surveillance programs for human immunodeficiency virus (HIV infection are based on the reporting of newly diagnosed cases. In order to guarantee a more accurate estimate of the trends and behaviours of infected people, simple and reliable methods aimed at identifying recent (< 6 months HIV infections are needed. We evaluated the accuracy of the avidity index (AI of anti-HIV antibodies on 357 serum samples obtained from 127 subjects for whom an estimated date of seroconversion was calculated on the basis of the interval between the last negative and first positive anti-HIV test result.The ROC curve analysis performed at different thresholds of the AI showed that a cutoff of 0.80 (93.0% sensitivity and 98.5% specificity yields the best overall accuracy (95.8% and should be employed for surveillance purposes, whereas the application of the anti-HIV AI on individual cases is not recommended.

  3. Thiazoline peptides and a tris-phenethyl urea from Didemnum molle with anti-HIV activity. (United States)

    Lu, Zhenyu; Harper, Mary Kay; Pond, Christopher D; Barrows, Louis R; Ireland, Chris M; Van Wagoner, Ryan M


    As part of our screening for anti-HIV agents from marine invertebrates, the MeOH extract of Didemnum molle was tested and showed moderate in vitro anti-HIV activity. Bioassay-guided fractionation of a large-scale extract allowed the identification of two new cyclopeptides, mollamides E and F (1 and 2), and one new tris-phenethyl urea, molleurea A (3). The absolute configurations were established using the advanced Marfey's method. The three compounds were evaluated for anti-HIV activity in both an HIV integrase inhibition assay and a cytoprotective cell-based assay. Compound 2 was active in both assays with IC(50) values of 39 and 78 μM, respectively. Compound 3 was active only in the cytoprotective cell-based assay, with an IC(50) value of 60 μM.

  4. Stimuli-sensitive nanoparticles for multiple anti-HIV microbicides

    Energy Technology Data Exchange (ETDEWEB)

    Giri, Namita; Oh, Byeongtaek; Lee, Chi H., E-mail: [University of Missouri at Kansas City, Division of Pharmaceutical Sciences (United States)


    This study is aimed to develop and evaluate an advanced intravaginal formulation for the delivery of multiple anti-HIV microbicides. Novel stimuli-sensitive nanoparticles (NPs) which protected the encapsulated drugs from being degraded in acidic pH conditions were made of Eudragit S-100{sup ®} (ES100{sup ®}), a pH-sensitive polymer. ES100{sup ®} NPs were prepared using the quasi-emulsion solvent diffusion technique and loaded with two microbicides namely Tenofovir (TNF) and Etravirine (ETV). The effects of various fabrication parameters on the formulation properties were evaluated for the optimization of ES100{sup ®} NPs. The morphology of the ES100{sup ®} NPs was examined by scanning electron microscopy. The cytotoxicity of NPs containing microbicides individually or in a combination was assessed using cell viability and trans-epithelial electrical resistance (TEER) measurements. The cellular uptake rates of the model microbicides by human vaginal epithelial cells, VK2 E6/E7 cells, were evaluated using confocal microscopy and florescence-assisted cell sorting technique. ES100{sup ®} NPs had a spherical shape, smooth surface, and uniform texture with a little aggregation. The average particle size for NPs loaded with TNF ranged from 125 to 230 nm, whereas those for ETV-loaded NPs ranged from 160 to 280 nm. ES100{sup ®} NPs had zeta potential in the range of −5 to −10 mV. In-vitro release studies displayed the potential benefits of ES100{sup ®} NPs in retaining and protecting the loaded microbicides at vaginal pH (acidic), but immediately releasing them as the pH changes to neutral or 7.4 (physiological pH). Cell viability studies demonstrated that ES100{sup ®} NPs did not exert any cytotoxicity individually or in a combination of both microbicides. TEER measurements confirmed that ES100{sup ®} NPs loaded with TNF and ETV did not cause any changes in the barrier integrity of VK2 E6/E7 cell monolayer. The cellular uptake study revealed that ES100{sup

  5. Stimuli-sensitive nanoparticles for multiple anti-HIV microbicides

    International Nuclear Information System (INIS)

    Giri, Namita; Oh, Byeongtaek; Lee, Chi H.


    This study is aimed to develop and evaluate an advanced intravaginal formulation for the delivery of multiple anti-HIV microbicides. Novel stimuli-sensitive nanoparticles (NPs) which protected the encapsulated drugs from being degraded in acidic pH conditions were made of Eudragit S-100"® (ES100"®), a pH-sensitive polymer. ES100"® NPs were prepared using the quasi-emulsion solvent diffusion technique and loaded with two microbicides namely Tenofovir (TNF) and Etravirine (ETV). The effects of various fabrication parameters on the formulation properties were evaluated for the optimization of ES100"® NPs. The morphology of the ES100"® NPs was examined by scanning electron microscopy. The cytotoxicity of NPs containing microbicides individually or in a combination was assessed using cell viability and trans-epithelial electrical resistance (TEER) measurements. The cellular uptake rates of the model microbicides by human vaginal epithelial cells, VK2 E6/E7 cells, were evaluated using confocal microscopy and florescence-assisted cell sorting technique. ES100"® NPs had a spherical shape, smooth surface, and uniform texture with a little aggregation. The average particle size for NPs loaded with TNF ranged from 125 to 230 nm, whereas those for ETV-loaded NPs ranged from 160 to 280 nm. ES100"® NPs had zeta potential in the range of −5 to −10 mV. In-vitro release studies displayed the potential benefits of ES100"® NPs in retaining and protecting the loaded microbicides at vaginal pH (acidic), but immediately releasing them as the pH changes to neutral or 7.4 (physiological pH). Cell viability studies demonstrated that ES100"® NPs did not exert any cytotoxicity individually or in a combination of both microbicides. TEER measurements confirmed that ES100"® NPs loaded with TNF and ETV did not cause any changes in the barrier integrity of VK2 E6/E7 cell monolayer. The cellular uptake study revealed that ES100"® NPs were taken by vaginal epithelial cells through

  6. Safety and anti-HIV assessments of natural vaginal cleansing products in an established topical microbicides in vitro testing algorithm

    Directory of Open Access Journals (Sweden)

    Jones Maureen


    Full Text Available Abstract Background At present, there is no effective vaccine or other approved product for the prevention of sexually transmitted human immunodeficiency virus type 1 (HIV-1 infection. It has been reported that women in resource-poor communities use vaginally applied citrus juices as topical microbicides. These easily accessible food products have historically been applied to prevent pregnancy and sexually transmitted diseases. The aim of this study was to evaluate the efficacy and cytotoxicity of these substances using an established topical microbicide testing algorithm. Freshly squeezed lemon and lime juice and household vinegar were tested in their original state or in pH neutralized form for efficacy and cytotoxicity in the CCR5-tropic cell-free entry and cell-associated transmission assays, CXCR4-tropic entry and fusion assays, and in a human PBMC-based anti-HIV-1 assay. These products were also tested for their effect on viability of cervico-vaginal cell lines, human cervical explant tissues, and beneficial Lactobacillus species. Results Natural lime and lemon juice and household vinegar demonstrated anti-HIV-1 activity and cytotoxicity in transformed cell lines. Neutralization of the products reduced both anti-HIV-1 activity and cytotoxicity, resulting in a low therapeutic window for both acidic and neutralized formulations. For the natural juices and vinegar, the IC50 was ≤ 3.5 (0.8-3.5% and the TC50 ≤ 6.3 (1.0-6.3%. All three liquid products inhibited viability of beneficial Lactobacillus species associated with vaginal health. Comparison of three different toxicity endpoints in the cervical HeLa cell line revealed that all three products affected membrane integrity, cytosolic enzyme release, and dehydrogenase enzyme activity in living cells. The juices and vinegar also exerted strong cytotoxicity in cervico-vaginal cell lines, mainly due to their acidic pH. In human cervical explant tissues, treatment with 5% lemon or lime juice

  7. Photo-translocation of anti-HIV-1 drugs into TZM-bl cells

    CSIR Research Space (South Africa)

    Khanyile, T


    Full Text Available Targeted drug delivery into HIV-1 infected cells offers a reduction in toxicity and side effect. Using a femtosecond (fs) laser of different beam shapes anti-HIV-1 drugs are efficiently delivered into TZM-bl cells....

  8. Mechanism of anti-HIV activity of succinylated human serum albumin

    NARCIS (Netherlands)

    Kuipers, ME; Berg, HVD; Swart, PJ; Laman, Jon; Meijer, DKF; Kopelman, MHGM; Huisman, H


    In the present study, we described the interaction of succinylated human serum albumin (Suc-HSA), a negatively charged anti-HIV-1 active protein, with HIV-1 gp120 and in detail with the third variable domain of gp120 (V3 loop). To this end, different assay formats were tested in which gp120- and

  9. New anti-HIV-1, antimalarial, and antifungal compounds from Terminalia bellerica

    DEFF Research Database (Denmark)

    Valsaraj, R; Pushpangadan, P; Smitt, U W


    A bioactivity-guided fractionation of an extract of Terminalia bellerica fruit rind led to the isolation of two new lignans named termilignan (1) and thannilignan (2), together with 7-hydroxy-3',4'-(methylenedioxy)flavan (3) and anolignan B (4). All four compounds possessed demonstrable anti-HIV-......, antimalarial, and antifungal activity in vitro....

  10. Estimation of Anti-HIV Activity of HEPT Analogues Using MLR, ANN, and SVM Techniques

    Directory of Open Access Journals (Sweden)

    Basheerulla Shaik


    value than those of MLR and SVM techniques. Rm2= metrics and ridge regression analysis indicated that the proposed four-variable model MATS5e, RDF080u, T(O⋯O, and MATS5m as correlating descriptors is the best for estimating the anti-HIV activity (log 1/C present set of compounds.

  11. Preparation and characterization of anti-HIV nanodrug targeted to microfold cell of gut-associated lymphoid tissue. (United States)

    Roy, Upal; Ding, Hong; Pilakka-Kanthikeel, Sudheesh; Raymond, Andrea D; Atluri, Venkata; Yndart, Adriana; Kaftanovskaya, Elena M; Batrakova, Elena; Agudelo, Marisela; Nair, Madhavan


    The human immunodeficiency virus 1 (HIV-1) still remains one of the leading life-threatening diseases in the world. The introduction of highly active antiretroviral therapy has significantly reduced disease morbidity and mortality. However, most of the drugs have variable penetrance into viral reservoir sites, including gut-associated lymphoid tissue (GALT). Being the largest lymphoid organ, GALT plays a key role in early HIV infection and host-pathogen interaction. Many different treatment options have been proposed to eradicate the virus from GALT. However, it becomes difficult to deliver traditional drugs to the GALT because of its complex physiology. In this regard, we developed a polymer-based Pluronic nanocarrier containing anti-HIV drug called efavirenz (EFV) targeting Microfold cells (M-cells) in the GALT. M-cells are specialized epithelial cells that are predominantly present in the GALT. In this work, we have exploited this paracellular transport property of M-cells for targeted delivery of Pluronic nanocarrier tagged EFV, bioconjugated with anti-M-cell-specific antibodies to the GALT (nanodrug). Preliminary characterization showed that the nanodrug (EFV-F12-COOH) is of 140 nm size with 0.3 polydispersion index, and the zeta potential of the particles was -19.38±2.2 mV. Further, drug dissolution study has shown a significantly improved sustained release over free drugs. Binding potential of nanodrug with M-cell was also confirmed with fluorescence microscopy and in vitro uptake and release studies. The anti-HIV activity of the nanodrug was also significantly higher compared to that of free drug. This novel formulation was able to show sustained release of EFV and inhibit the HIV-1 infection in the GALT compared to the free drug. The present study has potential for our in vivo targeted nanodrug delivery system by combining traditional enteric-coated capsule technique via oral administration.

  12. 3D printed, controlled release, tritherapeutic tablet matrix for advanced anti-HIV-1 drug delivery. (United States)

    Siyawamwaya, Margaret; du Toit, Lisa C; Kumar, Pradeep; Choonara, Yahya E; Kondiah, Pierre P P D; Pillay, Viness


    A 3D-Bioplotter® was employed to 3D print (3DP) a humic acid-polyquaternium 10 (HA-PQ10) controlled release fixed dose combination (FDC) tablet comprising of the anti-HIV-1 drugs, efavirenz (EFV), tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC). Chemical interactions, surface morphology and mechanical strength of the FDC were ascertained. In vitro drug release studies were conducted in biorelevant media followed by in vivo study in the large white pigs, in comparison with a market formulation, Atripla®. In vitro-in vivo correlation of results was undertaken. EFV, TDF and FTC were successfully entrapped in the 24-layered rectangular prism-shaped 3DP FDC with a loading of ∼12.5 mg/6.3 mg/4 mg of EFV/TDF/FTC respectively per printed layer. Hydrogen bonding between the EFV/TDF/FTC and HA-PQ10 was detected which was indicative of possible drug solubility enhancement. The overall surface of the tablet exhibited a fibrilla structure and the 90° inner pattern was determined to be optimal for 3DP of the FDC. In vitro and in vivo drug release profiles from the 3DP FDC demonstrated that intestinal-targeted and controlled drug release was achieved. A 3DP FDC was successfully manufactured with the aid of a 3D-Bioplotter in a single step process. The versatile HA-PQ10 entrapped all drugs and achieved an enhanced relative bioavailability of EFV, TDF, and FTC compared to the market formulation for potentially enhanced HIV treatment. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. Development of an anti-HIV vaccine eliciting broadly neutralizing antibodies. (United States)

    Ahmed, Yousuf; Tian, Meijuan; Gao, Yong


    The extreme HIV diversity posts a great challenge on development of an effective anti-HIV vaccine. To solve this problem, it is crucial to discover an appropriate immunogens and strategies that are able to prevent the transmission of the diverse viruses that are circulating in the world. Even though there have been a number of broadly neutralizing anti-HIV antibodies (bNAbs) been discovered in recent years, induction of such antibodies to date has only been observed in HIV-1 infection. Here, in this mini review, we review the progress in development of HIV vaccine in eliciting broad immune response, especially production of bNAbs, discuss possible strategies, such as polyvalent sequential vaccination, that facilitates B cell maturation leading to bNAb response.

  14. 7,8-secolignans from Schisandra neglecta and their anti-HIV-1 activities

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Xuemei; Mu, Huaixue; Hu, Qiufen, E-mail: [Key Laboratory of Chemistry in Ethnic Medicinal Resources, State Ethnic Affairs Commission and Ministry of Education, Yunnan University of Nationalities (China); Wang, Ruirui; Yang, Liumeng; Zheng, Yongtang [Kunming Institute of Zoology, Chinese Academy of Sciences (China); Sun, Handong; Xiao, Weilie, E-mail: [State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming (China)


    Four new 7,8-secolignans (neglectahenols A-D), together with two known 7,8-secolignans, were isolated from leaves and stems of Schisandra neglecta. The structures were elucidated by spectroscopic methods, including extensive one and two dimension NMR (nuclear magnetic resonance) techniques. 7,8-Secolignans and neglectahenols A-D were also tested for their anti-HIV-1 (human immunodeficiency virus type 1) activities, and all of them showed modest activities. (author)

  15. One-by-one imprinting in two eccentric layers of hollow core-shells: Sequential electroanalysis of anti-HIV drugs. (United States)

    Singh, Kislay; Jaiswal, Swadha; Singh, Richa; Fatma, Sana; Prasad, Bhim Bali


    Double layered one-by-one imprinted hollow core-shells@ pencil graphite electrode was fabricated for sequential sensing of anti-HIV drugs. For this, two eccentric layers were developed on the surface of vinylated silica nanospheres to obtain double layered one-by-one imprinted solid core-shells. This yielded hollow core-shells on treatment with hydrofluoric acid. The modified hollow core-shells (single layered dual imprinted) evolved competitive diffusion of probe/analyte molecules. However, the corresponding double layered one-by-one imprinted hollow core-shells (outer layer imprinted with Zidovudine, and inner layer with Lamivudine) were found relatively better owing to their bilateral diffusions into molecular cavities, without any competition. The entire work is based on differential pulse anodic stripping voltammetry at double layered one-by-one imprinted hollow core-shells. This resulted in indirect detection of electro inactive targets with limits of detection as low as 0.91 and 0.12 (aqueous sample), 0.94 and 0.13 (blood serum), and 0.99 and 0.20 ng mL -1 (pharmaceutics) for lamivudine and zidovudine, respectively in anti-HIV drug combination. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Innate immunity in the vagina (Part II): Anti-HIV activity and antiviral content of human vaginal secretions. (United States)

    Patel, Mickey V; Ghosh, Mimi; Fahey, John V; Ochsenbauer, Christina; Rossoll, Richard M; Wira, Charles R


    Whether the concentrations of antiviral proteins, and anti-HIV activity, within human vaginal secretions change across the menstrual cycle is unknown. Using a menstrual cup, vaginal secretions from pre-menopausal women were recovered at the proliferative (d6-8), mid-cycle (d13-15), and secretory (d21-23) stages of the menstrual cycle. Antiviral protein concentration was determined by ELISA, and anti-HIV activity assessed using the TZM-bl reporter cell line. CCL20, RANTES, elafin, HBD2, SDF-1α, and IL-8 levels were detectable in the secretions. Vaginal secretions had anti-HIV activity against specific clade B strains of HIV, with significant inhibition of IIIB and increased infectivity of transmitted/founder CH077.t. No significant differences in either antiviral protein concentration or anti-HIV activity with respect to menstrual cycle stage were measured, but marked differences were observed in both parameters over the course of the cycle between different women and in consecutive cycles from the same woman. The vagina contains a complement of antiviral proteins. The variation in anti-HIV activity demonstrates that immune protection in the vagina is not constant. Intra- and interindividual variations suggest that factors in addition to sex hormones influence antiviral protection. Lastly, the menstrual cup is a new model for recovering undiluted vaginal secretions from women throughout their reproductive life. © 2014 John Wiley & Sons Ltd.

  17. Immunity in the Vagina (Part II): Anti-HIV Activity and Antiviral Content of Human Vaginal Secretions (United States)

    Patel, Mickey V.; Ghosh, Mimi; Fahey, John V.; Ochsenbauer, Christina; Rossoll, Richard M.; Wira, Charles R.


    Problem Whether the concentrations of antiviral proteins, and anti-HIV activity, within human vaginal secretions changes across the menstrual cycle is unknown. Method of Study Using a menstrual cup, vaginal secretions from premenopausal women were recovered at the proliferative (d6–8), mid-cycle (d13–15) and secretory (d21–23) stages of the menstrual cycle. Antiviral protein concentration was determined by ELISA, and anti-HIV activity assessed using the TZM-bl reporter cell line. Results CCL20, RANTES, elafin, HBD2, SDF-1α and IL-8 levels were detectable in the secretions. Vaginal secretions had anti-HIV activity against specific clade B strains of HIV, with significant inhibition of IIIB and increased infectivity of transmitted/founder CH077.t. No significant differences in either antiviral protein concentration or anti-HIV activity with respect to menstrual cycle stage were measured, but marked differences were observed in both parameters over the course of the cycle between different women, and in consecutive cycles from the same woman. Conclusion The vagina contains a complement of antiviral proteins. The variation in anti-HIV activity demonstrates that immune protection in the vagina is not constant. Intra- and inter-individual variations suggest that factors in addition to sex hormones influence antiviral protection. Lastly, the menstrual cup is a new model for recovering undiluted vaginal secretions from women throughout their reproductive life. PMID:24806967

  18. Seropositivity of HBsAg, anti-HCV and anti-HIV in preoperative patients

    Directory of Open Access Journals (Sweden)

    Berrin Karaayak Uzun


    Full Text Available Objective: The infections caused by human immunodeficiency virus (HIV, hepatitis B (HBV and C (HCV viruses pose a serious occupational risk for the healthcare workers especially those in emergency services, laboratories and surgery wards. Vaccination and establishment of the strict biosafety procedures are the main principles to prevent blood-borne infections in healthcare workers. Additionally, serological screening of the preoperative patients could decrease the risk for exposure. In this study, we aimed to determine the seroprevalence of HBsAg, anti-HCV, anti-HIV 1/2 in preoperative patients. Methods: Hospital automation records were evaluated retrospectively for 4.367 patients who were scheduled for surgery and scanned for anti-HIV 1/2, HBsAg and anti-HCV as preoperative procedures in the preparation period of operation between January 2012 and December 2012. Results: HBsAg positivity rate was found in 7.7% (n=336, anti-HCV positivity rate was found in 2.3% (n=101. A two (0.05% of five patients were positive for anti-HIV 1/2 was found positive verification test and the other three samples were accepted as false positive test results. Conclusion: All healthcare workers must be trained about occupational diseases and vaccinated against Hepatitis B. Universal precautions must be strictly followed particularly in the operating room. In addition, all patients should be considered as potential carriers regarded as a carrier of the potential for infection. J Clin Exp Invest 2013; 4 (4: 449-452

  19. Amperometric sensing of anti-HIV drug zidovudine on Ag nanofilm-multiwalled carbon nanotubes modified glassy carbon electrode

    Energy Technology Data Exchange (ETDEWEB)

    Rafati, Amir Abbas, E-mail:; Afraz, Ahmadreza


    The zidovudine (ZDV) is the first drug approved for the treatment of HIV virus infection. The detection and determination of this drug are very importance in human serum because of its undesirable effects. A new ZDV sensor was fabricated on the basis of nanocomposite of silver nanofilm (Ag-NF) and multiwalled carbon nanotubes (MWCNTs) immobilized on glassy carbon electrode (GCE). The modified electrodes were characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), cyclic voltammetry (CV), and linear sweep voltammetry (LSV) techniques. Results showed that the electrodeposited silver has a nanofilm structure and further electrochemical studies showed that the prepared nanocomposite has high electrocatalytic activity and is appropriate for using in sensors. The amperometric technique under optimal conditions is used for the determination of ZDV ranging from 0.1 to 400 ppm (0.37 μM–1.5 mM) with a low detection limit of 0.04 ppm (0.15 μM) (S/N = 3) and good sensitivity. The prepared sensor possessed accurate and rapid response to ZDV and shows an average recovery of 98.6% in real samples. - Highlights: • New anti-HIV drug sensor was fabricated on the basis of nanomaterials composite. • The GCE modified by prepared hydrophilic MWCNT silver nanoparticles. • Silver nanofilm electrodeposited on MWCNT/GCE and characterized by SEM, EDX, CV and LSV • Response of electrode to ZDV was thoroughly investigated by electrochemical techniques.

  20. Enhanced anti-HIV-1 activity of G-quadruplexes comprising locked nucleic acids and intercalating nucleic acids

    DEFF Research Database (Denmark)

    Pedersen, Erik Bjerregaard; Nielsen, Jakob Toudahl; Nielsen, Claus


    Two G-quadruplex forming sequences, 50-TGGGAG and the 17-mer sequence T30177, which exhibit anti-HIV-1 activity on cell lines, were modified using either locked nucleic acids (LNA) or via insertions of (R)-1-O-(pyren-1-ylmethyl)glycerol (intercalating nucleic acid, INA) or (R)-1-O-[4-(1......-pyrenylethynyl)phenylmethyl]glycerol (twisted intercalating nucleic acid, TINA). Incorporation of LNA or INA/TINA monomers provide as much as 8-fold improvement of anti-HIV-1 activity. We demonstrate for the first time a detailed analysis of the effect the incorporation of INA/TINA monomers in quadruplex forming...

  1. Sulfated Polysaccharides in Marine Sponges: Extraction Methods and Anti-HIV Activity

    Directory of Open Access Journals (Sweden)

    Ana I. S. Esteves


    Full Text Available The extraction, fractionation and HIV-1 inhibition potential of polysaccharides extracted from three species of marine sponges, Erylus discophorus, Cliona celata and Stelletta sp., collected in the Northeastern Atlantic, is presented in this work. The anti-HIV activity of 23 polysaccharide pellets and three crude extracts was tested. Crude extracts prepared from Erylus discophorus specimens were all highly active against HIV-1 (90 to 95% inhibition. Cliona celata pellets showed low polysaccharide content (bellow 38.5% and almost no anti-HIV activity (<10% inhibition. Stelletta sp. pellets, although quite rich in polysaccharide (up to 97.3%, showed only modest bioactivity (<36% HIV-1 inhibition. Erylus discophorus pellets were among the richest in terms of polysaccharide content (up to 98% and the most active against HIV-1 (up to 95% inhibition. Chromatographic fractionation of the polysaccharide pellet obtained from a specimen of Erylus discophorus (B161 yielded only modestly active fractions. However, we could infer that the active molecule is most probably a high molecular weight sulfated polysaccharide (>2000 kDa, whose mechanism is possibly preventing viral attachment and entry (fusion inhibitor.

  2. Characterization of Nanodiamond-based anti-HIV drug Delivery to the Brain. (United States)

    Roy, Upal; Drozd, Vadym; Durygin, Andriy; Rodriguez, Jesse; Barber, Paul; Atluri, Venkata; Liu, Xiaohua; Voss, Thomas G; Saxena, Surendra; Nair, Madhavan


    Human Immunodeficiency Virus Type 1 (HIV-1) remains one of the leading causes of death worldwide. Present combination antiretroviral therapy has substantially improved HIV-1 related pathology. However, delivery of therapeutic agents to the HIV reservoir organ like Central nervous system (CNS) remains a major challenge primarily due to the ineffective transmigration of drugs through Blood Brain Barrier (BBB). The recent advent of nanomedicine-based drug delivery has stimulated the development of innovative systems for drug delivery. In this regard, particular focus has been given to nanodiamond due to its natural biocompatibility and non-toxic nature-making it a more efficient drug carrier than other carbon-based materials. Considering its potential and importance, we have characterized unmodified and surface-modified (-COOH and -NH 2 ) nanodiamond for its capacity to load the anti-HIV-1 drug efavirenz and cytotoxicity, in vitro. Overall, our study has established that unmodified nanodiamond conjugated drug formulation has significantly higher drug loading capacity than surface-modified nanodiamond with minimum toxicity. Further, this nanodrug formulation was characterized by its drug dissolution profile, transmigration through the BBB, and its therapeutic efficacy. The present biological characterizations provide a foundation for further study of in-vivo pharmacokinetics and pharmacodynamics of nanodiamond-based anti-HIV drugs.

  3. Comparative pharmacokinetic, immunologic and hematologic studies on the anti-HIV-1/2 compounds aconitylated and succinylated HSA

    NARCIS (Netherlands)

    Swart, P J; Beljaars, E; Smit, C; Pasma, A; Schuitemaker, H; Meijer, D K


    Charge modification by succinylation or cis-aconitylation of the terminal epsilon NH2 functions of the amino acid lysine in human serum albumin, resulted in polyanionic compounds with an anti-HIV-1 activity in the low nanomolar concentration range. After iv injections in rats of the negatively

  4. Characterization of the anti-HIV effects of native lactoferrin and other milk proteins and protein-derived peptides

    NARCIS (Netherlands)

    Berkhout, Ben; van Wamel, Jeroen L. B.; Beljaars, Leonie; Meijer, Dirk K. F.; Visser, Servaas; Floris, René


    In a search for natural proteins with anti-HIV activity, we screened a large set of purified proteins from bovine milk and peptide fragments thereof. Because several charged proteins and peptides are known to inhibit the process of virus entry, we selected proteins with an unusual charge composition

  5. Characterization of the anti-HIV effects of native lactoferrin and other milk proteins and protein-derived peptides

    NARCIS (Netherlands)

    Berkhout, B; van Wamel, JLB; Beljaars, L; Meijer, DKF; Visser, Servaas; Floris, R

    In a search for natural proteins with anti-HIV activity, we screened a large set of purified proteins from bovine milk and peptide fragments thereof. Because several charged proteins and peptides are known to inhibit the process of virus entry, we selected proteins with an unusual charge composition

  6. Impetigo: treatment and management. (United States)

    Sandra, Lawton

    Impetigo is the third most common skin disease in children. It is highly infectious and can be transmitted through direct and indirect contact. This article discusses the types of impetigo, its cause, diagnosis and management, and highlights additional guidance and resources that can support practice.

  7. Syphilis management and treatment

    NARCIS (Netherlands)

    van Voorst Vader, PC


    Syphilis poses a serious health problem in many developing countries and in some areas of North America and Europe, especially Eastern Europe. This article initially addresses the state of the art regarding the interaction between syphilis and HIV infection and its consequences for management and

  8. Identification of anti-HIV active dicaffeoylquinic- and tricaffeoylquinic acids in Helichrysum populifolium by NMR-based metabolomic guided fractionation. (United States)

    Heyman, Heino Martin; Senejoux, François; Seibert, Isabell; Klimkait, Thomas; Maharaj, Vinesh Jaichand; Meyer, Jacobus Johannes Marion


    South Africa being home to more than 35% of the world's Helichrysum species (c.a. 244) of which many are used in traditional medicine, is seen potentially as a significant resource in the search of new anti-HIV chemical entities. It was established that five of the 30 Helichrysum species selected for this study had significant anti-HIV activity ranging between 12 and 21 μg/mL (IC50) by using an in-house developed DeCIPhR method on a full virus model. Subsequent toxicity tests also revealed little or no toxicity for these active extracts. With the use of NMR-based metabolomics, the search for common chemical characteristics within the plant extract was conducted, which resulted in specific chemical shift areas identified that could be linked to the anti-HIV activity of the extracts. The NMR chemical shifts associated with the activity were identified to be 2.56-3.08 ppm, 5.24-6.28 ppm, 6.44-7.04 ppm and 7.24-8.04 ppm. This activity profile was then used to guide the fractionation process by narrowing down and focusing the fractionation and purification processes to speed up the putative identification of five compounds with anti-HIV activity in the most active species, Helichrysum populifolium. The anti-HIV compounds identified for the first time from H. populifolium were three dicaffeoylquinic acid derivatives, i.e. 3,4-dicaffeoylquinic acid, 3,5-dicaffeoylquinic acid and 4,5-dicaffeoylquinic acid as well as two tricaffeoylquinic acid derivatives i.e. 1,3,5-tricaffeoylquinic acid and either 5-malonyl-1,3,4-tricaffeoylquinic or 3-malonyl-1,4,5-tricaffeoylquinic acid, with the latter being identified for the first time in the genus. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. [Asymmetry in international relations, industrial property rights and anti-HIV medication]. (United States)

    Costa-Couto, Maria Helena; Nascimento, Alvaro César


    This paper analyzes the asymmetry in the international relations as refers to the recognition of industrial property rights in the pharmaceutical industry. It focuses on the impact of such relations upon the access to ARV medication, an issue of worldwide interest due to its connection with the development of the nations. Clashing interests and the position taken by some countries in their patent laws point to a scenario less favorable for the access of peripheral countries to anti-HIV/AIDS medication. On the other hand, it seems that the success of the Brazilian STD/AIDS program in negotiating ARV prices will open new possibilities. The solution may be the internal strengthening of the National States and the active role played by the Agencies of the United Nations System in defense of the collective human interests.

  10. Flazinamide, a novel β-carboline compound with anti-HIV actions

    International Nuclear Information System (INIS)

    Wang Yunhua; Tang Jianguo; Wang Ruirui; Yang Liumeng; Dong Zejun; Du Li; Shen Xu; Liu Jikai; Zheng Yongtang


    A β-carboline compound, flazin isolated from Suillus granulatus has been shown weak anti-HIV-1 activity. Based on the structure of flazin, flazinamide [1-(5'- hydromethyl-2'-furyl)-β-carboline-3-carboxamide] was synthesized and its anti-HIV activities were evaluated in the present study. The cytotoxicity of flazinamide was about 4.1-fold lower than that of flazin. Flazinamide potently reduced syncytium formation induced by HIV-1IIIB with EC50 value of 0.38 μM, the EC50 of flazinamide was about 6.2-fold lower than that of flazin. Flazinamide also inhibited HIV-2ROD and HIV-2CBL-20 infection with EC50 values of 0.57 and 0.89 μM, respectively. Flazinamide reduced p24 antigen expression in HIV-1IIIB acute infected C8166 and in clinical isolated strain HIV-1KM018 infected PBMC, with EC50 values of 1.45 and 0.77 μM, respectively. Flazinamide did not suppress HIV-1 replication in chronically infected H9 cells. Flazinamide blocked the fusion between normal cells and HIV-1 or HIV-2 chronically infected cells. It weakly inhibited activities of recombinant HIV-1 reverse transcriptase, protease or integrase at higher concentrations. In conclusion, the conversion of the carboxyl group in 3 position of flazin markedly enhanced the anti-viral activity (TI value increased from 12.1 to 312.2) and flazinamide might interfere in the early stage of HIV life cycle

  11. Role of seminal plasma in the anti-HIV-1 activity of candidate microbicides

    Directory of Open Access Journals (Sweden)

    Li Yun-Yao


    Full Text Available Abstract Background Evaluation of microbicides for prevention of HIV-1 infection in macaque models for vaginal infection has indicated that the concentrations of active compounds needed for protection by far exceed levels sufficient for complete inhibition of infection in vitro. These experiments were done in the absence of seminal plasma (SP, a vehicle for sexual transmission of the virus. To gain insight into the possible effect of SP on the performance of selected microbicides, their anti-HIV-1 activity in the presence, and absence of SP, was determined. Methods The inhibitory activity of compounds against the X4 virus, HIV-1 IIIB, and the R5 virus, HIV-1 BaL was determined using TZM-bl indicator cells and quantitated by measuring β-galactosidase induced by infection. The virucidal properties of cellulose acetate 1,2-benzene-dicarboxylate (CAP, the only microbicide provided in water insoluble, micronized form, in the presence of SP was measured. Results The HIV-1 inhibitory activity of the polymeric microbicides, poly(naphthalene sulfonate, cellulose sulfate, carrageenan, CAP (in soluble form and polystyrene sulfonate, respectively, was considerably (range ≈ 4 to ≈ 73-fold diminished in the presence of SP (33.3%. Formulations of micronized CAP, providing an acidic buffering system even in the presence of an SP volume excess, effectively inactivated HIV-1 infectivity. Conclusion The data presented here suggest that the in vivo efficacy of polymeric microbicides, acting as HIV-1 entry inhibitors, might become at least partly compromised by the inevitable presence of SP. These possible disadvantages could be overcome by combining the respective polymers with acidic pH buffering systems (built-in for formulations of micronized CAP or with other anti-HIV-1 compounds, the activity of which is not affected by SP, e.g. reverse transcriptase and zinc finger inhibitors.

  12. Anti-HIV drugs nevirapine and efavirenz affect anxiety-related behavior and cognitive performance in mice. (United States)

    Romão, Pedro R T; Lemos, Joelson C; Moreira, Jeverson; de Chaves, Gisele; Moretti, Morgana; Castro, Adalberto A; Andrade, Vanessa M; Boeck, Carina R; Quevedo, João; Gavioli, Elaine C


    Nevirapine (NVP) and efavirenz (EFV) belong to the class of anti-HIV drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs), commonly used as part of highly active antiretroviral therapy (HAART). Although the HAART is able to bring down viral load to undetectable levels and restore immune function, their prolonged use causes several adverse effects. It has been demonstrated that both NVP and EFV are able to cross the blood-brain barrier, causing important central nervous system-related side effects. Thus, this study investigated the effects of chronic administration of EFV (10 mg/kg) and NVP (3.3 mg/kg) in mice submitted to two distinct series of experiments, which aimed to evaluate: (1) the emotional behavior (elevated plus-maze, forced swimming, and open-field test) and (2) the cognitive performance (object recognition and inhibitory avoidance test) of mice. Our results demonstrated that EFV, but not NVP, reduced the exploration to open arms in the elevated plus-maze test. Neither NVP nor EFV altered mouse behavior in the forced swimming and open-field tests. Both drugs reduced the recognition index in the object recognition test, but only EFV significantly impaired the aversive memory assessed in the inhibitory avoidance test 24 h after training. In conclusion, our findings point to a genuine anxiogenic-like effect to EFV, since it reduced exploration to open arms of elevated plus-maze test without affecting spontaneous locomotion. Additionally, both drugs impaired recognition memory, while only the treatment with EFV impaired significantly aversive memory.

  13. Aaptamine Derivatives with Antifungal and Anti-HIV-1 Activities from the South China Sea Sponge Aaptos aaptos

    Directory of Open Access Journals (Sweden)

    Hao-Bing Yu


    Full Text Available Five new alkaloids of aaptamine family, compounds (1–5 and three known derivatives (6–8, have been isolated from the South China Sea sponge Aaptos aaptos. The structures of all compounds were unambiguously elucidated by spectroscopic analyses, as well as by comparison with the literature data. Compounds 1–2 are characterized with triazapyrene lactam skeleton, whereas compounds 4–5 share an imidazole-fused aaptamine moiety. These compounds were evaluated in antifungal and anti-HIV-1 assays. Compounds 3, 7, and 8 showed antifungal activity against six fungi, with MIC values in the range of 4 to 64 μg/mL. Compounds 7–8 exhibited anti-HIV-1 activity, with inhibitory rates of 88.0% and 72.3%, respectively, at a concentration of 10 μM.

  14. Homeostatic properties of Lactobacillus jensenii engineered as a live vaginal anti-HIV microbicide. (United States)

    Yamamoto, Hidemi S; Xu, Qiang; Fichorova, Raina N


    moderately increased (SLPI). Similarly to MALP-2, colonization by L. jensenii WT activated NF-κB; however, unlike the synthetic TLR2/6 ligand, the live microorganisms did not induce significant changes in the secreted levels across all inflammation-associated proteins. The mCV-N production and function were confirmed by western blot and a HIV-1 gp120 binding assay, respectively. The bioengineered lactobacilli expressed mCV-N with anti-HIV activity preserved in the epithelial cell context and caused no significant immunoinflammatory changes as compared to the WT L. jensenii. These results highlight the translational value of the colonization model and justify further clinical investigation of the homeostatic and anti-HIV effectiveness of the L. jensenii derivates.

  15. A novel simple QSAR model for the prediction of anti-HIV activity using multiple linear regression analysis. (United States)

    Afantitis, Antreas; Melagraki, Georgia; Sarimveis, Haralambos; Koutentis, Panayiotis A; Markopoulos, John; Igglessi-Markopoulou, Olga


    A quantitative-structure activity relationship was obtained by applying Multiple Linear Regression Analysis to a series of 80 1-[2-hydroxyethoxy-methyl]-6-(phenylthio) thymine (HEPT) derivatives with significant anti-HIV activity. For the selection of the best among 37 different descriptors, the Elimination Selection Stepwise Regression Method (ES-SWR) was utilized. The resulting QSAR model (R (2) (CV) = 0.8160; S (PRESS) = 0.5680) proved to be very accurate both in training and predictive stages.

  16. Fluorine Substituted 1,2,4-Triazinones as Potential Anti-HIV-1 and CDK2 Inhibitors

    Directory of Open Access Journals (Sweden)

    Mohammed S. I. Makki


    Full Text Available Fluorine substituted 1,2,4-triazinones have been synthesized via alkylation, amination, and/or oxidation of 6-(2-amino-5-fluorophenyl-3-thioxo-3,4-dihydro-1,2,4-triazin-5(2H-one 1 and 4-fluoro-N-(4-fluoro-2-(5-oxo-3-thioxo-2,3,4,5-tetrahydro-1,2,4-triazin-6-ylphenylbenzamide 5 as possible anti-HIV-1 and CDK2 inhibitors. Alkylation on positions 2 and 4 in 1,2,4-triazinone gave compounds 6–8. Further modification was performed by selective alkylation and amination on position 3 to form compounds 9–15. However oxidation of 5 yielded compounds 16–18. Structures of the target compounds have been established by spectral analysis data. Five compounds (5, 11, 14, 16, and 17 have shown very good anti-HIV activity in MT-4 cells. Similarly, five compounds (1, 3, and 14–16 have exhibited very significant CDK2 inhibition activity. Compounds 14 and 16 were found to have dual anti-HIV and anticancer activities.

  17. Exploiting the anti-HIV 6-desfluoroquinolones to design multiple ligands. (United States)

    Sancineto, Luca; Iraci, Nunzio; Barreca, Maria Letizia; Massari, Serena; Manfroni, Giuseppe; Corazza, Gianmarco; Cecchetti, Violetta; Marcello, Alessandro; Daelemans, Dirk; Pannecouque, Christophe; Tabarrini, Oriana


    It is getting clearer that many drugs effective in different therapeutic areas act on multiple rather than single targets. The application of polypharmacology concepts might have numerous advantages especially for disease such as HIV/AIDS, where the rapid emergence of resistance requires a complex combination of more than one drug. In this paper, we have designed three hybrid molecules combining WM5, a quinolone derivative we previously identified as HIV Tat-mediated transcription (TMT) inhibitor, with the tricyclic core of nevirapine and BILR 355BS (BILR) non-nucleoside reverse transcriptase inhibitors (NNRTIs) to investigate whether it could be possible to obtain molecules acting on both transcription steps of the HIV replicative cycle. One among the three designed multiple ligands, reached this goal. Indeed, compound 1 inhibited both TMT and reverse transcriptase (RT) activity. Unexpectedly, while the anti-TMT activity exerted by compound 1 resulted into a selective inhibition of HIV-1 reactivation from latently infected OM10.1 cells, the anti-RT properties shown by all of the synthesized compounds did not translate into an anti-HIV activity in acutely infected cells. Thus, we have herein produced the proof of concept that the design of dual TMT-RT inhibitors is indeed possible, but optimization efforts are needed to obtain more potent derivatives. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Structural insights into the anti-HIV activity of the Oscillatoria agardhii agglutinin homolog lectin family. (United States)

    Koharudin, Leonardus M I; Kollipara, Sireesha; Aiken, Christopher; Gronenborn, Angela M


    Oscillatoria agardhii agglutinin homolog (OAAH) proteins belong to a recently discovered lectin family. All members contain a sequence repeat of ~66 amino acids, with the number of repeats varying among different family members. Apart from data for the founding member OAA, neither three-dimensional structures, information about carbohydrate binding specificities, nor antiviral activity data have been available up to now for any other members of the OAAH family. To elucidate the structural basis for the antiviral mechanism of OAAHs, we determined the crystal structures of Pseudomonas fluorescens and Myxococcus xanthus lectins. Both proteins exhibit the same fold, resembling the founding family member, OAA, with minor differences in loop conformations. Carbohydrate binding studies by NMR and x-ray structures of glycan-lectin complexes reveal that the number of sugar binding sites corresponds to the number of sequence repeats in each protein. As for OAA, tight and specific binding to α3,α6-mannopentaose was observed. All the OAAH proteins described here exhibit potent anti-HIV activity at comparable levels. Altogether, our results provide structural details of the protein-carbohydrate interaction for this novel lectin family and insights into the molecular basis of their HIV inactivation properties.

  19. A realização do teste anti-hiv no pré-natal: os significados para a gestante El establecimiento de la lucha contra la prueba del vih en pre-navidad: significados para el embarazo The establishment of anti-hiv test in pre-natal: meanings for pregnancy

    Directory of Open Access Journals (Sweden)

    Roberta Maria de Oliveira Silva


    parte de la construcción del papel maternal de un cuidado bien-tomado del concreto con la salud del bebé.The study had as objective, the knowledge and the analyzis of the meaning of the accomplishment for the test anti-HIV in the prenatal one for the pregnant women. One is about a research with qualitative approach and was carried through in a Hospital School and a Maternity at the city of Rio de Janeiro. As a resource of technician-methodological, the speech of the collective citizen was used (DSC. After the analysis of the speeches we verified that, for the pregnant women the accomplishment of the test means the possibility to prevent the vertical transmission of the HIV and as part of the prenatal assistance. The prenatal one was considered by the pregnant women an excellent chance for the accomplishment of the test anti HIV, for the knowledge of the serological condition and precocious beginning of the treatment. It is concluded that the test, for the majority of the pregnant women, represents the possibility to protect the son of the HIV, beyond being part of the construction of the maternal paper from a well-taken care of concrete with the health of the baby.

  20. HIV testing among pregnant women in Brazil: rates and predictors Prueba anti-HIV en mujeres embarazadas en Brasil: tasas y predictivos Testagem anti-HIV em mulheres grávidas no Brasil: taxas e preditores

    Directory of Open Access Journals (Sweden)

    Valdiléa G Veloso


    Full Text Available OBJECTIVE: To assess rates of offering and uptake of HIV testing and their predictors among women who attended prenatal care. METHODS: A population-based cross-sectional study was conducted among postpartum women (N=2,234 who attended at least one prenatal care visit in 12 cities. Independent and probabilistic samples were selected in the cities studied. Sociodemographic data, information about prenatal care and access to HIV prevention interventions during the current pregnancy were collected. Bivariate and multivariate analyses were carried out to assess independent effects of the covariates on offering and uptake of HIV testing. Data collection took place between November 1999 and April 2000. RESULTS: Overall, 77.5% of the women reported undergoing HIV testing during the current pregnancy. Offering of HIV testing was positively associated with: previous knowledge about prevention of mother-to-child transmission of HIV; higher number of prenatal care visits; higher level of education and being white. HIV testing acceptance rate was 92.5%. CONCLUSIONS: The study results indicate that dissemination of information about prevention of mother-to-child transmission among women may contribute to increasing HIV testing coverage during pregnancy. Non-white women with lower level of education should be prioritized. Strategies to increase attendance of vulnerable women to prenatal care and to raise awareness among health care workers are of utmost importance.OBJETIVO: Estimar las tasas de oferta y realización de la prueba anti-HIV y sus predictivos entre mujeres que recibieron atención prenatal. MÉTODOS: Se realizó un estudio transversal, de base poblacional, con 2.234 puérperas en 12 ciudades de Brasil. Las muestras probabilísticas fueron seleccionadas independientemente por ciudad, entre puérperas que asistieron a por lo menos una visita prenatal. Se colectaron datos sociodemográficos, informaciones sobre cuidado prenatal y acceso a

  1. A randomized trial to assess anti-HIV activity in female genital tract secretions and soluble mucosal immunity following application of 1% tenofovir gel.

    Directory of Open Access Journals (Sweden)

    Marla J Keller


    Full Text Available Preclinical and early phase clinical microbicide studies have not consistently predicted the outcome of efficacy trials. To address this gap, candidate biomarkers of microbicide pharmacodynamics and safety were evaluated in a double-blind, placebo-controlled trial of tenofovir gel, the first microbicide to demonstrate significant protection against HIV acquisition.30 women were randomized to apply a single daily dose of tenofovir or placebo gel for 14 consecutive days. Anti-HIV activity was measured in cervicovaginal lavage (CVL on Days 0, 3, 7, 14 and 21 by luciferase assay as a surrogate marker of pharmacodynamics. Endogenous activity against E. coli and HSV-2 and concentrations of immune mediators were quantified in CVL as candidate biomarkers of safety. Tenofovir levels were measured in CVL and blood.A significant increase in anti-HIV activity was detected in CVL from women who applied tenofovir gel compared to their endogenous anti-HIV activity in genital tract secretions on Day 0 and compared to activity in CVL from women in the placebo group. The activity correlated significantly with CVL concentration of tenofovir (r = 0.6, p<0.001 and fit a sigmoid E(max pharmacodynamic model. Anti-HIV activity in CVL from women who applied tenofovir persisted when virus was introduced in semen, whereas endogenous anti-HIV activity decreased. Tenofovir did not trigger an inflammatory response or induce sustained loss in endogenous antimicrobial activity or immune mediators.Tenofovir gel had no deleterious impact on soluble mucosal immunity. The increased anti-HIV activity in CVL, which persisted in the presence of semen and correlated with tenofovir concentration, is consistent with the efficacy observed in a recent clinical trial. These results promote quantified CVL anti-HIV activity as a surrogate of tissue pharmacodynamics and as a potential biomarker of adherence to product. This simple, feasible and inexpensive bioassay may promote the development

  2. Anti-HIV and immunomodulation activities of cacao mass lignin-carbohydrate complex. (United States)

    Sakagami, Hiroshi; Kawano, Michiyo; Thet, May Maw; Hashimoto, Ken; Satoh, Kazue; Kanamoto, Taisei; Terakubo, Shigemi; Nakashima, Hideki; Haishima, Yuji; Maeda, Yuuichi; Sakurai, Koji


    Recently, a prominent antiviral and macrophage stimulatory activity of cacao lignin-carbohydrate complex (LCC) has been reported. However, the solubility and sterility of LCC have not been considered yet. In the present study, complete solubilisation and sterilisation was achieved by autoclaving under mild alkaline conditions and the previously reported biological activities were re-examined. LCCs were obtained by 1% NaOH extraction and acid precipitation, and a repeated extraction-precipitation cycle. Nitric oxide (NO) and cytokine productions were assayed by the Griess method and ELISA, respectively. Inducible NO synthase (iNOS) expression was determined by Western blot analysis. Superoxide anion, hydroxyl radical and nitric oxide radical-scavenging activity was determined by ESR spectroscopy. Cacao mass LCC showed reproducibly higher anti-HIV activity than cacao husk LCC. Cacao mass LCC, up to 62.5 μg/ml, did not stimulate mouse macrophage-like cells (RAW264.7 and J774.1) to produce NO, nor did it induce iNOS protein, in contrast to lipopolysaccharide (LPS). Cacao mass LCC and LPS synergistically stimulated iNOS protein expression, suggesting a different point of action. Cacao mass LCC induced tumour necrosis factor-α production markedly less than LPS, and did not induce interleukin-1β, interferon-α or interferon-γ. ESR spectroscopy showed that cacao mass LCC, but not LPS, scavenged NO produced from NOC-7. This study demonstrated several new biological activities of LCCs distinct from LPS and further confirmed the promising antiviral and immunomodulating activities of LCCs.

  3. Precise engineering of dapivirine-loaded nanoparticles for the development of anti-HIV vaginal microbicides. (United States)

    das Neves, José; Sarmento, Bruno


    Polymeric nanoparticles (NPs) have the potential to provide effective and safe delivery of antiretroviral drugs in the context of prophylactic anti-HIV vaginal microbicides. Dapivirine-loaded poly(d,l-lactic-co-glycolic acid) (PLGA) NPs were produced by an emulsion-solvent evaporation method, optimized for colloidal properties using a 3-factor, 3-level Box-Behnken experimental design, and characterized for drug loading, production yield, morphology, thermal behavior, drug release, in vitro cellular uptake, cytotoxicity and pro-inflammatory potential. Also, drug permeability/membrane retention in well-established HEC-1-A and CaSki cell monolayer models as mediated by NPs was assessed in the absence or presence of mucin. Box-Behnken design allowed optimizing monodisperse 170nm drug-loaded NPs. Drug release experiments showed an initial burst effect up to 4h, followed by sustained 24h release at pH 4.2 and 7.4. NPs were readily taken up by different genital and macrophage cell lines as assessed by fluorescence microscopy. Drug-loaded NPs presented lower or at least similar cytotoxicity as compared to the free drug, with up to around one-log increase in half-maximal cytotoxic concentration values. In all cases, no relevant changes in cell pro-inflammatory cytokine/chemokine production were observed. Dapivirine transport across cell monolayers was significantly decreased when mucin was present at the donor side with either NPs or the free drug, thus evidencing the influence of this natural glycoprotein in membrane permeability. Moreover, drug retention in cell monolayers was significantly higher for NPs in comparison with the free drug. Overall, obtained dapivirine-loaded PLGA NPs possess interesting technological and biological features that may contribute to their use as novel safe and effective vaginal microbicides. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  4. Anti-staphylococcal, anti-HIV and cytotoxicity studies of four South African medicinal plants and isolation of bioactive compounds from Cassine transvaalensis (Burtt. Davy) codd. (United States)

    Mthethwa, Ningy S; Oyedeji, Bola A O; Obi, Larry C; Aiyegoro, Olayinka A


    Medicinal plants represent an important opportunity to rural communities in Africa, as a source of affordable medicine and as a source of income. Increased patient awareness about safe usage is important as well as more training with regards to traditional medicine. The aim of this study was to evaluate the ethnomedicinal prowess of some indigenous South African plants commonly used in Eastern Cape Province of South Africa for the treatment of skin and respiratory tract infections, HIV and their toxicity potential. Cassine transvaalensis, Vangueria infausta, Croton gratissimus and Vitex ferruginea were tested for antibacterial activities against Staphylococcus aureus and Staphylococcus epidermidis using Kirby-Bauer disk diffusion and minimum inhibition concentration (MIC). Cytotoxic and anti-HIV-1 activities of plants were tested using MTT Assay (3- (Dimethylthiozole-2-yl-2,5-diphenyltetrazolium bromide)) and anti- HIV-1iib assay. In search of bioactive lead compounds, Cassine transvaalensis which was found to be the most active plant extract against the two Staphylocoous bacteria was subjected to various chromatographic. Thin layer chromatography, Column chromatography and Nuclear Magnetic Resonance (NMR), (1H-1H, 13C-13C, in DMSO_d6, Bruker 600 MHz) were used to isolate and characterize 3-Oxo-28-hydroxylbetuli-20(29)-ene and 3,28-dihydroxylbetuli-20(29)-ene bioactive compounds from C. transvaalensis. The four plants studied exhibited bioactive properties against the test isolates. The zones of inhibition ranged between 16 mm to 31 mm for multi-drug resistant staphylococci species. MIC values varied between 0.6 and 0.02 μg/ml. C. gratissimus and C. transvaalensis exhibited the abilities to inhibit HIV-1iib. Two bioactive compounds were isolated from C. transvaalensis. Data from this study reveals the use of these plant by traditional healers in the Eastern Cape. Furthermore, C. transvaalensis and C. gratissimus were found to be more active as against HIV-1iib

  5. Synthesis of single- and double-chain fluorocarbon and hydrocarbon galactosyl amphiphiles and their anti-HIV-1 activity. (United States)

    Faroux-Corlay, B; Clary, L; Gadras, C; Hammache, D; Greiner, J; Santaella, C; Aubertin, A M; Vierling, P; Fantini, J


    Galactosylceramide (GalCer) is an alternative receptor allowing HIV-1 entry into CD4(-)/GalCer(+) cells. This glycosphingolipid recognizes the V3 loop of HIV gp120, which plays a key role in the fusion of the HIV envelope and cellular membrane. To inhibit HIV uptake and infection, we designed and synthesized analogs of GalCer. These amphiphiles and bolaamphiphiles consist of single and double hydrocarbon and/or fluorocarbon chain beta-linked to galactose and galactosamine. They derive from serine (GalSer), cysteine (GalCys), and ethanolamine (GalAE). The anti-HIV activity and cytotoxicity of these galactolipids were evaluated in vitro on CEM-SS (a CD4(+) cell line), HT-29, a CD4(-) cell line expressing high levels of GalCer receptor, and/or HT29 genetically modified to express CD4. GalSer and GalAE derivatives, tested in aqueous medium or as part of liposome preparation, showed moderate anti-HIV-1 activities (IC50 in the 20-220 microM range), whereas none of the GalCys derivatives was found to be active. Moreover, only some of these anti-HIV active analogs inhibited the binding of [3H]suramin (a polysulfonyl compound which displays a high affinity for the V3 loop) to SPC3, a synthetic peptide which contains the conserved GPGRAF region of the V3 loop. Our results most likely indicate that the neutralization of the virion through masking of this conserved V3 loop region is not the only mechanism involved in the HIV-1 antiviral activity of our GalCer analogs.

  6. Diarylpyrimidine-dihydrobenzyloxopyrimidine hybrids: new, wide-spectrum anti-HIV-1 agents active at (sub)-nanomolar level. (United States)

    Rotili, Dante; Tarantino, Domenico; Artico, Marino; Nawrozkij, Maxim B; Gonzalez-Ortega, Emmanuel; Clotet, Bonaventura; Samuele, Alberta; Esté, José A; Maga, Giovanni; Mai, Antonello


    Here, we describe a novel small series of non-nucleoside reverse transcriptase inhibitors (NNRTIs) that combine peculiar structural features of diarylpyrimidines (DAPYs) and dihydro-alkoxy-benzyl-oxopyrimidines (DABOs). These DAPY-DABO hybrids (1-4) showed a characteristic SAR profile and a nanomolar anti-HIV-1 activity at both enzymatic and cellular level. In particular, the two compounds 4d and 2d, with a (sub)nanomolar activity against wild-type and clinically relevant HIV-1 mutant strains, were selected as lead compounds for next optimization studies.

  7. Altertoxins with potent anti-HIV activity from Alternaria tenuissima QUE1Se, a fungal endophyte of Quercus emoryi


    Bashyal, Bharat P.; Wellensiek, Brian P.; Ramakrishnan, Rajesh; Faeth, Stanley H.; Ahmad, Nafees; Leslie Gunatilaka, A. A.


    Screening of a small library of natural product extracts derived from endophytic fungi of the Sonoran desert plants in a cell-based anti-HIV assay involving T-cells infected with the HIV-1 virus identified the EtOAc extract of a fermentation broth of Alternaria tenuissima QUE1Se inhabiting the stem tissue of Quercus emoryi as a promising candidate for further investigation. Bioactivity-guided fractionation of this extract led to the isolation and identification of two new metabolites, alterto...

  8. Broad anti-HIV activity of the Oscillatoria agardhii agglutinin homologue lectin family. (United States)

    Férir, Geoffrey; Huskens, Dana; Noppen, Sam; Koharudin, Leonardus M I; Gronenborn, Angela M; Schols, Dominique


    Oscillatoria agardhii agglutinin homologue (OAAH) proteins belong to a recently discovered lectin family. The founding member OAA and a designed hybrid OAAH (OPA) recognize similar but unique carbohydrate structures of Man-9, compared with other antiviral carbohydrate-binding agents (CBAs). These two newly described CBAs were evaluated for their inactivating properties on HIV replication and transmission and for their potential as microbicides. Various cellular assays were used to determine antiviral activity against wild-type and certain CBA-resistant HIV-1 strains: (i) free HIV virion infection in human T lymphoma cell lines and PBMCs; (ii) syncytium formation assay using persistently HIV-infected T cells and non-infected CD4+ T cells; (iii) DC-SIGN-mediated viral capture; and (iv) transmission to uninfected CD4+ T cells. OAA and OPA were also evaluated for their mitogenic properties and potential synergistic effects using other CBAs. OAA and OPA inhibit HIV replication, syncytium formation between HIV-1-infected and uninfected T cells, DC-SIGN-mediated HIV-1 capture and transmission to CD4+ target T cells, thereby rendering a variety of HIV-1 and HIV-2 clinical isolates non-infectious, independent of their coreceptor use. Both CBAs competitively inhibit the binding of the Manα(1-2)Man-specific 2G12 monoclonal antibody (mAb) as shown by flow cytometry and surface plasmon resonance analysis. The HIV-1 NL4.3(2G12res), NL4.3(MVNres) and IIIB(GRFTres) strains were equally inhibited as the wild-type HIV-1 strains by these CBAs. Combination studies indicate that OAA and OPA act synergistically with Hippeastrum hybrid agglutinin, 2G12 mAb and griffithsin (GRFT), with the exception of OPA/GRFT. OAA and OPA are unique CBAs with broad-spectrum anti-HIV activity; however, further optimization will be necessary for microbicidal application. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights

  9. Molecular cloning and anti-HIV-1 activities of APOBEC3s from northern pig-tailed macaques (Macaca leonina

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    Xiao-Liang ZHANG


    Full Text Available Northern pig-tailed macaques (NPMs, Macaca leonina are susceptible to HIV-1 infection largely due to the loss of HIV-1-restricting factor TRIM5α. However, great impediments still exist in the persistent replication of HIV-1 in vivo, suggesting some viral restriction factors are reserved in this host. The APOBEC3 proteins have demonstrated a capacity to restrict HIV-1 replication, but their inhibitory effects in NPMs remain elusive. In this study, we cloned the NPM A3A-A3H genes, and determined by BLAST searching that their coding sequences (CDSs showed 99% identity to the corresponding counterparts from rhesus and southern pig-tailed macaques. We further analyzed the anti-HIV-1 activities of the A3A-A3H genes, and found that A3G and A3F had the greatest anti-HIV-1 activity compared with that of other members. The results of this study indicate that A3G and A3F might play critical roles in limiting HIV-1 replication in NPMs in vivo. Furthermore, this research provides valuable information for the optimization of monkey models of HIV-1 infection.

  10. Altertoxins with potent anti-HIV activity from Alternaria tenuissima QUE1Se, a fungal endophyte of Quercus emoryi. (United States)

    Bashyal, Bharat P; Wellensiek, Brian P; Ramakrishnan, Rajesh; Faeth, Stanley H; Ahmad, Nafees; Gunatilaka, A A Leslie


    Screening of a small library of natural product extracts derived from endophytic fungi of the Sonoran desert plants in a cell-based anti-HIV assay involving T-cells infected with the HIV-1 virus identified the EtOAc extract of a fermentation broth of Alternaria tenuissima QUE1Se inhabiting the stem tissue of Quercus emoryi as a promising candidate for further investigation. Bioactivity-guided fractionation of this extract led to the isolation and identification of two new metabolites, altertoxins V (1) and VI (2) together with the known compounds, altertoxins I (3), II (4), and III (5). The structures of 1 and 2 were determined by detailed spectroscopic analysis and those of 3-5 were established by comparison with reported data. When tested in our cell-based assay at concentrations insignificantly toxic to T-cells, altertoxins V (1), I (3), II (4), and III (5) completely inhibited replication of the HIV-1 virus at concentrations of 0.50, 2.20, 0.30, and 1.50 μM, respectively. Our findings suggest that the epoxyperylene structural scaffold in altertoxins may be manipulated to produce potent anti-HIV therapeutics. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. [Isolation, idetification and anti-HIV-1 integrase activity of culturable endophytic fungi from Tibetan medicinal plant Phlomis younghusbandii Mukerjee]. (United States)

    Zhang, Da-Wei; Zhao, Ming-Ming; Chen, Juan; Li, Chao; Guo, Shun-Xing


    A total of 52 endophytic fungi were isolated from roots and stems of Tibetan medicinal plant Phlomis younghusbandii Mukerjee. These fungal isolates were molecularly identified based on ITS sequnces and 28S sequences distributed to 12 genera, including Phoma, Chaetosphaeronema, Fusarium and Leptosphaeria, etc. Among them, the dominant genus was Phoma. Extracts of all strains were evaluated for anti-HIV-1 integrase activity by using soluable integrase expressed in E. coli BL21 (DE3). The results showed that seven samples from five fungal endophytes PHY-24, PHY-38, PHY-40, PHY-51, PHY-53, which belonged to genus Chaetosphaeronema, inhibited strand transfer reaction catalyzed by HIV-1 integrase with IC50 values, of 6.60, 5.20, 2.86, 7.86, 4.47, 4.56 and 3.23 microg x mL(-1) respectively. In conclusion, the endophytic fungi of Phlomis younghusbandii Mukerjee are valuable for further screening anti-HIV-1 integrase agents.

  12. Management practices in substance abuse treatment programs. (United States)

    McConnell, K John; Hoffman, Kim A; Quanbeck, Andrew; McCarty, Dennis


    Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the "business of addiction treatment." This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of "good" management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.

  13. Novel Synthesis and Anti-HIV-1 Activity of 2-Arylthio-6-benzyl-2,3-dihydro-1H-pyrimidin-4-ones (Aryl S-DABOs)

    DEFF Research Database (Denmark)

    Aly, Youssef L.; Pedersen, Erik Bjerreg.; La Colla, Paolo


    The synthesis and the anti-HIV-1 activity of a series of 2-arylthio-6-benzyl-2,3-dihydro-1H-pyrimidin-4-ones (aryl S-DABOs) are reported. These compounds were synthesized via a coupling reaction of the corresponding 6-benzyl-2-thiouracils with aryl iodides in the presence of neocuproine hydrate...

  14. Anti-HIV activity in cervical-vaginal secretions from HIV-positive and -negative women correlate with innate antimicrobial levels and IgG antibodies.

    Directory of Open Access Journals (Sweden)

    Mimi Ghosh


    Full Text Available We investigated the impact of antimicrobials in cervicovaginal lavage (CVL from HIV(+ and HIV(- women on target cell infection with HIV. Since female reproductive tract (FRT secretions contain a spectrum of antimicrobials, we hypothesized that CVL from healthy HIV(+ and (- women inhibit HIV infection.CVL from 32 HIV(+ healthy women with high CD4 counts and 15 healthy HIV(- women were collected by gently washing the cervicovaginal area with 10 ml of sterile normal saline. Following centrifugation, anti-HIV activity in CVL was determined by incubating CVL with HIV prior to addition to TZM-bl cells. Antimicrobials and anti-gp160 HIV IgG antibodies were measured by ELISA. When CXCR4 and CCR5 tropic HIV-1 were incubated with CVL from HIV(+ women prior to addition to TZM-bl cells, anti-HIV activity in CVL ranged from none to 100% inhibition depending on the viral strains used. CVL from HIV(- controls showed comparable anti-HIV activity. Analysis of CH077.c (clone of an R5-tropic, mucosally-transmitted founder virus viral inhibition by CVL was comparable to laboratory strains. Measurement of CVL for antimicrobials HBD2, trappin-2/elafin, SLPI and MIP3alpha indicated that each was present in CVL from HIV(+ and HIV(- women. HBD2 and MIP3alpha correlated with anti-HIV activity as did anti-gp160 HIV IgG antibodies in CVL from HIV(+ women.These findings indicate that CVL from healthy HIV(+ and HIV(- women contain innate and adaptive defense mechanisms that inhibit HIV infection. Our data suggest that innate endogenous antimicrobials and HIV-specific IgG in the FRT can act in concert to contribute toward the anti-HIV activity of the CVL and may play a role in inhibition of HIV transmission to women.

  15. Detection of anti-HIV-1 IgG antibodies in whole saliva by GACELISA and Western blot assays. (United States)

    Matee, M I; Lyamuya, E F; Simon, E; Mbena, E C; Kagoma, C; Samaranayake, L P; Scheutz, F


    The present study, based on 158 HIV seropositives and 167 HIV seronegatives, demonstrates that saliva collected with the Omni-SAL device and tested with GACELISA (an IgG antibody capture ELISA) is an effective non-invasive alternative to serum for anti-HIV IgG antibody screening. The study also shows that a conventional serum Western blot kit can be used, with slight modifications, for confirmatory testing of saliva specimens. Collecting saliva with the Omni-SAL device had a very good acceptance rate among Tanzanian subjects, and although this diagnostic method is not yet known by the general public, 65% of the study participants preferred to give saliva instead of blood for HIV testing.

  16. Screening of anti-HIV-1 inophyllums by HPLC-DAD of Calophyllum inophyllum leaf extracts from French Polynesia Islands. (United States)

    Laure, Frédéric; Raharivelomanana, Phila; Butaud, Jean-François; Bianchini, Jean-Pierre; Gaydou, Emile M


    Various pyranocoumarins, calophyllolide, inophyllums B, C, G(1), G(2) and P, from Calophyllum inophyllum (Clusiaceae) leaves of French Polynesia (Austral, Marquesas, Society and Tuamotu archipelagos) have been determined in 136 leaf extracts using a high pressure liquid chromatography-UV-diode array detection (HPLC-UV-DAD) technique. Results show a wide range in chemical composition within trees growing on eighteen islands. The use of multivariate statistical analyses (PCA) shows geographical distribution of inophyllums and indicate those rich in HIV-1 active (+)-inophyllums. Inophyllum B and P contents (0.0-39.0 and 0.0-21.8 mg kg(-1), respectively) confirm the chemodiversity of this species within the large area of French Polynesia. The study suggests the presence of interesting chemotypes which could be used as plant source for anti-HIV-1 drugs.

  17. Methamphetamine inhibits HIV-1 replication in CD4+ T cells by modulating anti-HIV-1 miRNA expression. (United States)

    Mantri, Chinmay K; Mantri, Jyoti V; Pandhare, Jui; Dash, Chandravanu


    Methamphetamine is the second most frequently used illicit drug in the United States. Methamphetamine abuse is associated with increased risk of HIV-1 acquisition, higher viral loads, and enhanced HIV-1 pathogenesis. Although a direct link between methamphetamine abuse and HIV-1 pathogenesis remains to be established in patients, methamphetamine has been shown to increase HIV-1 replication in macrophages, dendritic cells, and cells of HIV transgenic mice. Intriguingly, the effects of methamphetamine on HIV-1 replication in human CD4(+) T cells that serve as the primary targets of infection in vivo are not clearly understood. Therefore, we examined HIV-1 replication in primary CD4(+) T cells in the presence of methamphetamine in a dose-dependent manner. Our results demonstrate that methamphetamine had a minimal effect on HIV-1 replication at concentrations of 1 to 50 μmol/L. However, at concentrations >100 μmol/L, it inhibited HIV-1 replication in a dose-dependent manner. We also discovered that methamphetamine up-regulated the cellular anti-HIV-1 microRNAs (miR-125b, miR-150, and miR-28-5p) in CD4(+) T cells. Knockdown experiments illustrated that up-regulation of the anti-HIV miRNAs inhibited HIV-1 replication. These results are contrary to the paradigm that methamphetamine accentuates HIV-1 pathogenesis by increasing HIV-1 replication. Therefore, our findings underline the complex interaction between drug use and HIV-1 and necessitate comprehensive understanding of the effects of methamphetamine on HIV-1 pathogenesis. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  18. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model. (United States)

    Frye, Victoria; Paige, Mark Q; Gordon, Steven; Matthews, David; Musgrave, Geneva; Kornegay, Mark; Greene, Emily; Phelan, Jo C; Koblin, Beryl A; Taylor-Akutagawa, Vaughn


    HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and "pop-up" street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team's experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related "space" as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming. Copyright © 2017. Published by Elsevier Ltd.

  19. Employee benefits managers' opinions about addiction treatment. (United States)

    McFarland, Bentson H; Lierman, Walter K; Penner, Norman R; McCamant, Lynn E; Zani, Brigid G


    Employee benefits managers arrange addictive disease treatment insurance coverage for the majority of people in the United States but little is known about these decision-makers. Managers were surveyed to learn their opinions about addiction treatment. Subjects were 131 people (61 percent female, 94 percent white, average age 46, average of 14 years in the human resources field). Managers were asked to rank health benefits (physical health, dental, alcohol-drug, vision, mental health, employee assistance program, and pharmaceuticals) on 15 dimensions. Managers ranked alcohol-drug abuse treatment worst on fiveitems and second to the worst on another four of the 15 dimensions. On the item considered most important by the managers, respondents noted that employees often (2.8) ask for improved physical health benefits but rarely do so for alcohol and drug (4.1) benefits (p < .001). Education of workers and payers will be needed to change opinions about treatment of addictive disorders.

  20. Management of treatment resistant schizophrenia

    African Journals Online (AJOL)


    Whilst gains have been made in recent years in the pharmacological treatment of schizophrenia, a number of ... pharmacotherapy to include psychological and occupational ... outcome studies suggesting that only 20-30% of people with.

  1. Case management of malaria: Treatment and chemoprophylaxis

    African Journals Online (AJOL)

    management, addressing treatment, monitoring for parasite drug resistance, and the impact of drug resistance on ... at all levels of healthcare delivery and ... System (DHS) based on primary healthcare .... intramuscular artesunate, artemether,.

  2. Municipal waste - management and treatment

    International Nuclear Information System (INIS)

    Paudel, E.S.R.


    Though per capita waste generation in Nepalese urban cities is not so high, the lack of proper waste management is considered one of the severe problems to be faced by urban people in future. With rapid urbanization, life style of people is changing their habits and consuming more materials and producing a large volume of waste in urban areas in Nepal. The nature and amount of waste generated in municipality is dependent of demography and geography. But most common aspect of municipal waste in Nepal is more than 60% of the waste biodegradable. Whatever the nature and amount of waste generated, the most common practice of managing municipal waste is to dispose in the riverside nearby or dumped elsewhere. The involvement of private sector in waste management is a new concept adopted by many municipalities in Nepal. One of the most progress approaches, 4R (reduces, reuse, recycle and refuse) principle is being practiced. The need of awareness progressive like segregation of wastes at collection point also being practiced in Nepal. Finally, Proper formulation of program and legislation and its application is one of the major challenges for local authorities in Nepal. (author)

  3. Treatment system operation, management, and finance

    Energy Technology Data Exchange (ETDEWEB)

    Truax, D.D. (Mississippi State Univ., Mississippi State (United States))


    This article deals with literature on operation, management, and financing of wastewater treatment plants. Some topics discussed are system hydraulics and flow monitoring, odor, reliability, equipment age, management philosophy, performance, reducing operating cost, planning and response to emergencies, preventative maintenance, inspection systems, mechanical vibrations, safety, privatization, municipal leasing, user and impact fees.

  4. Attitudes to malaria, prevention, treatment and management ...

    African Journals Online (AJOL)



    Nov 5, 2007 ... consequences of malaria treatment pattern and management strategies in an urban center. Questionnaires were issued ... anopheles mosquitoes as malaria vector are some of the factors militating against prevention and proper management of the .... bush clearing, drainage and gutter control in preventing.

  5. Hypertension management in Zimbabwe - awareness, treatment ...

    African Journals Online (AJOL)

    Hypertension management in Zimbabwe - awareness, treatment and blood pressure control. A community-based study. J A Matenga, T J Allain, A 0 Wilson, D J Adamchak,. B 5enzanje, E Mushangi, Z Gomo. Objective. To evaluate the level of awareness of hypertension, treatment and blood pressure control in rural and ...

  6. Waste management and treatment or disguised disposal?

    International Nuclear Information System (INIS)

    Drum, D.A.; Lauber, J.


    A number of political action groups, environmental groups, and waste management industries have purposely used medical waste data and municipal solid waste test results to mislead public officials and communities. Waste management schemes and waste treatment technologies must be measured and compared by the same test criteria. For example, anti-incineration groups often use the toxic dioxin/furan data and/or toxic metal arguments to oppose waste-to-energy incineration technologies. Comparable test data on waste management techniques such as waste composting, autoclaving, and landfilling are either nonexistent or often inappropriately applied. Integrated waste management systems require technologically accurate and complete data, environmentally-appropriate designed systems, and fiscal responsibility. The primary emphasis of waste management and treatment practices must be directed toward minimization, reuse, destruction, and detoxification of municipal solid wastes and medical wastes. The issues and alternatives will be examined

  7. ANN multiscale model of anti-HIV drugs activity vs AIDS prevalence in the US at county level based on information indices of molecular graphs and social networks. (United States)

    González-Díaz, Humberto; Herrera-Ibatá, Diana María; Duardo-Sánchez, Aliuska; Munteanu, Cristian R; Orbegozo-Medina, Ricardo Alfredo; Pazos, Alejandro


    This work is aimed at describing the workflow for a methodology that combines chemoinformatics and pharmacoepidemiology methods and at reporting the first predictive model developed with this methodology. The new model is able to predict complex networks of AIDS prevalence in the US counties, taking into consideration the social determinants and activity/structure of anti-HIV drugs in preclinical assays. We trained different Artificial Neural Networks (ANNs) using as input information indices of social networks and molecular graphs. We used a Shannon information index based on the Gini coefficient to quantify the effect of income inequality in the social network. We obtained the data on AIDS prevalence and the Gini coefficient from the AIDSVu database of Emory University. We also used the Balaban information indices to quantify changes in the chemical structure of anti-HIV drugs. We obtained the data on anti-HIV drug activity and structure (SMILE codes) from the ChEMBL database. Last, we used Box-Jenkins moving average operators to quantify information about the deviations of drugs with respect to data subsets of reference (targets, organisms, experimental parameters, protocols). The best model found was a Linear Neural Network (LNN) with values of Accuracy, Specificity, and Sensitivity above 0.76 and AUROC > 0.80 in training and external validation series. This model generates a complex network of AIDS prevalence in the US at county level with respect to the preclinical activity of anti-HIV drugs in preclinical assays. To train/validate the model and predict the complex network we needed to analyze 43,249 data points including values of AIDS prevalence in 2,310 counties in the US vs ChEMBL results for 21,582 unique drugs, 9 viral or human protein targets, 4,856 protocols, and 10 possible experimental measures.

  8. Two-dimensional IR spectroscopy of the anti-HIV agent KP1212 reveals protonated and neutral tautomers that influence pH-dependent mutagenicity


    Peng, Chunte Sam; Fedeles, Bogdan I.; Singh, Vipender; Li, Deyu; Amariuta, Tiffany; Essigmann, John M.; Tokmakoff, Andrei


    The anti-HIV drug KP1212 was designed to intentionally increase the mutation rate of HIV, thereby causing viral population collapse. Its mutagenicity and thus antiviral activity was proposed to be the result of tautomerization. We used 2D IR spectroscopy to identify rapidly interconverting tautomers under physiological conditions. The traditionally rare enol–imino tautomer for nucleobases was found to be the major species for KP1212, providing a structural support for the tautomer hypothesis....

  9. Challenges in integrating component level technology and system level information from Ayurveda: Insights from NMR phytometabolomics and anti-HIV potential of select Ayurvedic medicinal plants. (United States)

    Jayasundar, Rama; Ghatak, Somenath; Makhdoomi, Muzamil Ashraf; Luthra, Kalpana; Singh, Aruna; Velpandian, Thirumurthy


    Information from Ayurveda meeting the analytical challenges of modern technology is an area of immense relevance. Apart from the cerebral task of bringing together two different viewpoints, the question at the pragmatic level remains 'who benefits whom'. The aim is to highlight the challenges in integration of information (Ayurvedic) and technology using test examples of Nuclear Magnetic Resonance (NMR) metabolomics and anti-HIV-1 potential of select Ayurvedic medicinal plants. The other value added objective is implications and relevance of such work for Ayurveda. Six medicinal plants (Azadirachta indica, Tinospora cordifolia, Swertia chirata, Terminalia bellerica, Zingiber officinale and Symplocos racemosa) were studied using high resolution proton NMR spectroscopy based metabolomics and also evaluated for anti-HIV-1 activity on three pseudoviruses (ZM53 M.PB12, ZM109F.PB4, RHPA 4259.7). Of the six plants, T.bellerica and Z.officinale showed minimum cell cytotoxicity and maximum anti-HIV-1 potential. T.bellerica was effective against all the three HIV-1 pseudoviruses. Untargeted NMR profiling and multivariate analyses demonstrated that the six plants, all of which had different Ayurvedic pharmacological properties, showed maximum differences in the aromatic region of the spectra. The work adds onto the list of potential plants for anti-HIV-1 drug molecules. At the same time, it has drawn attention to the different perspectives of Ayurveda and Western medicine underscoring the inherent limitations of conceptual bilinguism between the two systems, especially in the context of medicinal plants. The study has also highlighted the potential of NMR metabolomics in study of plant extracts as used in Ayurveda. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

  10. Attitudes toward Shock Advertising of Western-European and Serbian University Students With Regard To Public Health Context (Anti-Smoking and Anti-HIV/AIDS Campaigns)


    Krstic, Tamara


    The main objective of this dissertation is to examine attitudes toward shock advertising of western-European and Serbian university students with regard to public health context (anti-smoking and anti-HIV/AIDS campaigns). Although the use of shock advertising is widely adopted in practice, there has not been extensive research with regard to this topic. Public health context is of special interest in this dissertation as there is an urge for social marketing on Serbian market. The results of ...

  11. Synergistic activity profile of carbosilane dendrimer G2-STE16 in combination with other dendrimers and antiretrovirals as topical anti-HIV-1 microbicide. (United States)

    Sepúlveda-Crespo, Daniel; Lorente, Raquel; Leal, Manuel; Gómez, Rafael; De la Mata, Francisco J; Jiménez, José Luis; Muñoz-Fernández, M Ángeles


    Polyanionic carbosilane dendrimers represent opportunities to develop new anti-HIV microbicides. Dendrimers and antiretrovirals (ARVs) acting at different stages of HIV replication have been proposed as compounds to decrease new HIV infections. Thus, we determined the potential use of our G2-STE16 carbosilane dendrimer in combination with other carbosilane dendrimers and ARVs for the use as topical microbicide against HIV-1. We showed that these combinations obtained 100% inhibition and displayed a synergistic profile against different HIV-1 isolates in our model of cells. Our results also showed their potent activity in the presence of an acidic vaginal or seminal fluid environment and did not activate an inflammatory response. This study is the first step toward exploring the use of different anionic carbosilane dendrimers in combination and toward making a safe microbicide. Therefore, our results support further studies on dendrimer/dendrimer or dendrimer/ARV combinations as topical anti-HIV-1 microbicide. This paper describes the first steps toward the use of anionic carbosilane dendrimers in combination with antivirals to address HIV-1, paving the way to further studies on dendrimer/dendrimer or dendrimer/ARV combinations as topical anti-HIV-1 microbicides. © 2014.

  12. Stimuli-sensitive thiolated hyaluronic acid based nanofibers: synthesis, preclinical safety and in vitro anti-HIV activity. (United States)

    Agrahari, Vivek; Meng, Jianing; Ezoulin, Miezan Jm; Youm, Ibrahima; Dim, Daniel C; Molteni, Agostino; Hung, Wei-Ting; Christenson, Lane K; Youan, Bi-Botti C


    To develop a seminal enzyme bioresponsive, mucoadhesive nanofibers (NFs) as safe and effective nanocarriers for the prevention of HIV vaginal transmission. A novel thiolated hyaluronic acid (HA-SH) polymer was synthesized to fabricate tenofovir (TFV)-loaded electrospun NFs (HA-SH-NFs) and characterized in vitro/in vivo. A triggered drug release (87% w/w) from the engineered HA-SH-NFs (mean diameter ∼75 nm) occured within 1 h under the influence of seminal hyaluronidase enzyme. HA-SH-NFs were noncytotoxic, induced no damage on the C57BL/6 mice genital-tract and other organs. No significant CD45 cell-infiltration and changes in cytokines level in cervicovaginal tissues were observed. HA-SH-NFs significantly enhanced both TFV retention and bioavailability in vaginal tissue compared with the 1% TFV-gel. The anti-HIV activity of TFV (on pseudotyped virus followed by luciferase assay) was not adversely affected by the electrospinning process. HA-SH-NFs developed in this study could potentially serve as a safe nanotemplate for topical intravaginal delivery of HIV/AIDS microbicides.

  13. Electrochemical studies of nevirapine, an anti-HIV drug, and its assay in tablets and biological samples

    Directory of Open Access Journals (Sweden)



    Full Text Available The electrochemical oxidation of nevirapine, an anti-HIV drug, at a glassy carbon electrode has been studied by voltammetric techniques. Nevirapine showed one well defined irreversible oxidation peak with a potential of 0.749 V in phosphate buffer at pH 10. The effects of different electrolytes, pH and scan rate on the electrochemical behaviour of nevira¬pine were examined to determine the optimum reaction conditions. The oxidation peak current was found to vary linearly with the concentration of nevirapine in the range of 5.0 – 350 µM. The limit of detection and limit of quantification values were calculated and found to be 1.026 µM and 3.420 µM, respectively. The low relative standard deviation values of inter-day and intra-day assays highlighted the good reproducibility of the proposed m¬ethod for assay of nevirapine. Further, a sensitive and accurate differential pulse voltammetric method was developed for the determination of nevirapine concentrations in pharma¬ceutical formulations.

  14. Short communication: Anti-HIV-1 envelope immunoglobulin Gs in blood and cervicovaginal samples of Beninese commercial sex workers. (United States)

    Batraville, Laurie-Anne; Richard, Jonathan; Veillette, Maxime; Labbé, Annie-Claude; Alary, Michel; Guédou, Fernand; Kaufmann, Daniel E; Poudrier, Johanne; Finzi, Andrés; Roger, Michel


    Characterization of the immune correlates of protection against HIV infection is crucial for the development of preventive strategies. This study examined HIV-1 envelope (Env) glycoproteins, specifically immunoglobulin G (IgG), in systemic and mucosal compartments of female Beninese commercial sex workers (CSWs). Samples of 23 HIV-1-positive and 20 highly exposed HIV-1-seronegative (HESN) CSWs were studied. HIV-1 Env-specific IgG detection in sera and cervicovaginal lavages (CVLs) from the study population was done by cell-based ELISA. The HIV neutralizing activity was evaluated with a neutralization assay. The HIV-1-specific antibody-dependent cellular cytotoxicity (ADCC) response of the cohort was measured with a FACS-based assay evaluating the ADCC-mediated elimination of gp120-coated target cells. No anti-HIV-1 Env-specific IgG neutralizing or ADCC activities were detected in samples from HESN CSWs. Samples from HIV-1-infected CSWs presented ADCC activity in both sera and CVLs. Anti-Env IgG from sera and CVLs from HIV-1-infected CSWs preferentially recognized Env in its CD4-bound conformation. HIV-1-infected CSWs have ADCC-mediating IgG that preferentially recognizes Env in its CD4-bound conformation at the mucosal site.

  15. In vitro profiling of the vaginal permeation potential of anti-HIV microbicides and the influence of formulation excipients. (United States)

    Grammen, Carolien; Augustijns, Patrick; Brouwers, Joachim


    In the search for an effective anti-HIV microbicidal gel, limited drug penetration into the vaginal submucosa is a possible reason for failed protection against HIV transmission. To address this issue in early development, we here describe a simple in vitro strategy to predict the tissue permeation potential of vaginally applied drugs, based on solubility, permeability and flux assessment. We demonstrated this approach for four model microbicides (tenofovir, darunavir, saquinavir mesylate and dapivirine) and additionally examined the influence of formulation excipients on the permeation potential. When formulated in an aqueous-based HEC gel, high flux values across an HEC-1A cell layer were reached by tenofovir, as a result of its high aqueous solubility. In contrast, saquinavir and dapivirine fluxes remained low due to poor permeability and solubility, respectively. These low fluxes suggest limited in vivo tissue penetration, possibly leading to lack of efficacy. Dapivirine fluxes, however, could be enhanced up to 30-fold, by including formulation excipients such as polyethylene glycol 1000 (20%) or cyclodextrins (5%) in the HEC gels. Alternative formulations, i.e. emulsions or silicone elastomer gels, were less effective in flux enhancement compared to cyclodextrin-HEC gels. In conclusion, implementing the proposed solubility and permeability profiling in early microbicide development may contribute to the successful selection of promising microbicide candidates and appropriate formulations. Copyright © 2012 Elsevier B.V. All rights reserved.

  16. Nullbasic, a potent anti-HIV tat mutant, induces CRM1-dependent disruption of HIV rev trafficking.

    Directory of Open Access Journals (Sweden)

    Min-Hsuan Lin

    Full Text Available Nullbasic, a mutant of the HIV-1 Tat protein, has anti-HIV-1 activity through mechanisms that include inhibition of Rev function and redistribution of the HIV-1 Rev protein from the nucleolus to the nucleoplasm and cytoplasm. Here we investigate the mechanism of this effect for the first time, establishing that redistribution of Rev by Nullbasic is not due to direct interaction between the two proteins. Rather, Nullbasic affects subcellular localization of cellular proteins that regulate Rev trafficking. In particular, Nullbasic induced redistribution of exportin 1 (CRM1, nucleophosmin (B23 and nucleolin (C23 from the nucleolus to the nucleus when Rev was coexpressed, but never in its absence. Inhibition of the Rev:CRM1 interaction by leptomycin B or a non-interacting RevM10 mutant completely blocked redistribution of Rev by Nullbasic. Finally, Nullbasic did not inhibit importin β- or transportin 1-mediated nuclear import, suggesting that cytoplasmic accumulation of Rev was due to increased export by CRM1. Overall, our data support the conclusion that CRM1-dependent subcellular redistribution of Rev from the nucleolus by Nullbasic is not through general perturbation of either nuclear import or export. Rather, Nullbasic appears to interact with and disrupt specific components of a Rev trafficking complex required for its nucleocytoplasmic shuttling and, in particular, its nucleolar accumulation.

  17. Qualitative and quantitative intravaginal targeting: key to anti-HIV-1 microbicide delivery from test tube to in vivo success. (United States)

    Pillay, Viness; Mashingaidze, Felix; Choonara, Yahya E; Du Toit, Lisa C; Buchmann, Eckhart; Maharaj, Vinesh; Ndesendo, Valence M K; Kumar, Pradeep


    The past decade has seen several effective anti-HIV-1 agent discoveries, yet microbicides continue to disappoint clinically. Our review expounds the view that unsatisfactory microbicide failures may be a result of inefficient delivery systems employed. We hereby propose a thorough scientific qualitative and quantitative investigation of important aspects involved in HIV-1 transmission as a prerequisite for microbicide delivery. Intravaginal targeting of HIV-1 increases the chances of microbicide success, wherein vaginal microenvironmental factors including pH should be maintained at HIV-1 prohibitive acidic levels simultaneously to ward off other sexually transmitted diseases, which compromise vaginal epithelial barrier properties. Furthermore, choice of receptors to target both on HIV-1 and on target cells is vital in deterring transmission. Appropriate modeling of virus-target cell interactions as well as targeting early stages of the HIV-1 infection accompanied by computation and delivery of appropriate microbicide quantities could revolutionize microbicide research, ultimately delivering a female-controlled HIV-1 prevention modality appropriately. Copyright © 2012 Wiley Periodicals, Inc.

  18. Wolfram Syndrome: Diagnosis, Management, and Treatment. (United States)

    Urano, Fumihiko


    Wolfram syndrome is a rare genetic disorder characterized by juvenile-onset diabetes mellitus, diabetes insipidus, optic nerve atrophy, hearing loss, and neurodegeneration. Although there are currently no effective treatments that can delay or reverse the progression of Wolfram syndrome, the use of careful clinical monitoring and supportive care can help relieve the suffering of patients and improve their quality of life. The prognosis of this syndrome is currently poor, and many patients die prematurely with severe neurological disabilities, raising the urgency for developing novel treatments for Wolfram syndrome. In this article, we describe natural history and etiology, provide recommendations for diagnosis and clinical management, and introduce new treatments for Wolfram syndrome.

  19. Management of Antiepileptic Treatment After Epilepsy Surgery

    DEFF Research Database (Denmark)

    Rubboli, Guido; Sabers, Anne; Uldall, Peter


    BACKGROUND: Although epilepsy surgery is a recognized treatment option for drug-resistant epilepsies since several decades, the management of antiepileptic drugs (AEDs) after successful surgery still remains one of the most difficult and unsolved therapeutic challenges. Indeed, no systematic cont...

  20. Urinary Incontinence: Management and Treatment Options (United States)

    Griebling, Tomas L.


    Urinary incontinence, defined as the involuntary leakage of urine, is a common health problem in both women and men. Children may also suffer from this condition. Management and treatment of urinary incontinence depends primarily on the specific type of incontinence and the underlying problem causing the leakage for a given patient. Because…

  1. [Options for stress management in obesity treatment]. (United States)

    Czeglédi, Edit


    Overeating and physical inactivity are of great importance in the etiology of obesity. Psychological factors are often found in the background of life style. Chronic stress can contribute to physical inactivity and behaviors that hinder the keeping of a diet (e.g., irregular eating pattern, emotional eating). Results of randomized controlled trials show that relaxation can reduce emotional eating, improve cognitive restraint, and thereby reduce weight. However, stress management is more than relaxation. It consists of adaptive emotion-focused and problem-focused coping strategies and skills to improve relationships. Deflection skills may help in replacing emotional eating with other behaviors. Cognitive restructuring, saying no, and problem solving help to prevent or manage conflicts and difficulties otherwise would result in overeating due to distress. Developing stress management skills may result in greater compliance with the treatment. The techniques presented in the study can be easily applied by general practitioners or specialists, and provide tools for optimizing obesity treatment.

  2. Discovery and Assesment of New Target Sites for Anti-HIV Therapies

    DEFF Research Database (Denmark)

    The HIV viruses infect cells by endocytosis and takes over parts of the cells reaction pathways in order to reproduce itself and spread the infection. One such pathway is the mammalian inflammatory signaling, which invoke NF-κB as the principal transcription factor. A treatment against HIV could ...

  3. Use of Anti-HIV Immunotoxins as Probes of the Biology of HIV-Infected Cells

    Directory of Open Access Journals (Sweden)

    SETH H Pincus


    Full Text Available OBJECTIVE: Anti-human immunodeficiency virus (HIV immunotoxins are potential treatments for HIV infection. but they may also be used as probes to study the relationship between HIV and the cell it infects. Data from the present study indicate the complexity of this relationship.

  4. Regulated production and anti-HIV type 1 activities of cytidine deaminases APOBEC3B, 3F, and 3G. (United States)

    Rose, Kristine M; Marin, Mariana; Kozak, Susan L; Kabat, David


    APOBEC3G and 3F (A3G and A3F) cytidine deaminases incorporate into retroviral cores where they lethally hypermutate nascent DNA reverse transcripts. As substantiated here, the viral infectivity factor (Vif) encoded by human immunodeficiency virus type-1 (HIV-1) binds A3G and A3F and induces their degradation, thereby precluding their incorporation into viral progeny. Previous evidence suggested that A3G is expressed in H9 and other nonpermissive cells that contain this antiviral defense but not in several permissive cells, and that overexpression of A3G or A3F makes permissive cells nonpermissive. Using a broader panel of cell lines, we confirmed a correlation between A3G and cellular abilities to inactivate HIV-1(Deltavif). However, there was a quantitative discrepancy because several cells with weak antiviral activities had similar amounts of wild-type A3G mRNA and protein compared to H9 cells. Antiviral activity of H9 cells was also attenuated in some conditions. These quantitative discrepancies could not be explained by the presence of A3F or other A3G paralogs in some of the cell lines. Thus, A3A, A3B, and A3C had weak but significant anti-HIV-1 activities and did not dominantly interfere with A3G or A3F antiviral functions. Control of A3G synthesis by the protein kinase C/mitogen-activated protein kinase kinase/extracellular signal-regulated kinase pathway was also similar in permissive and nonpermissive cells. A3G in highly permissive cells is degraded by Vif, suggesting that it is not in a sequestered site, and is specifically incorporated in low amounts into HIV-1(Deltavif). Although A3G and/or A3F inactivate HIV-1(Deltavif) and are neutralized by Vif, the antiviral properties of cell lines are also influenced by other cellular and viral factors.

  5. Dynamic features of apo and bound HIV-Nef protein reveal the anti-HIV dimerization inhibition mechanism. (United States)

    Moonsamy, Suri; Bhakat, Soumendranath; Soliman, Mahmoud E S


    The first account on the dynamic features of Nef or negative factor, a small myristoylated protein located in the cytoplasm believes to increase HIV-1 viral titer level, is reported herein. Due to its major role in HIV-1 pathogenicity, Nef protein is considered an emerging target in anti-HIV drug design and discovery process. In this study, comparative long-range all-atom molecular dynamics simulations were employed for apo and bound protein to unveil molecular mechanism of HIV-Nef dimerization and inhibition. Results clearly revealed that B9, a newly discovered Nef inhibitor, binds at the dimeric interface of Nef protein and caused significant separation between orthogonally opposed residues, namely Asp108, Leu112 and Gln104. Large differences in magnitudes were observed in the radius of gyration (∼1.5 Å), per-residue fluctuation (∼2 Å), C-alpha deviations (∼2 Å) which confirm a comparatively more flexible nature of apo conformation due to rapid dimeric association. Compared to the bound conformer, a more globally correlated motion in case of apo structure of HIV-Nef confirms the process of dimeric association. This clearly highlights the process of inhibition as a result of ligand binding. The difference in principal component analysis (PCA) scatter plot and per-residue mobility plot across first two normal modes further justifies the same findings. The in-depth dynamic analyses of Nef protein presented in this report would serve crucial in understanding its function and inhibition mechanisms. Information on inhibitor binding mode would also assist in designing of potential inhibitors against this important HIV target.

  6. Rapid transient production in plants by replicating and non-replicating vectors yields high quality functional anti-HIV antibody.

    Directory of Open Access Journals (Sweden)

    Frank Sainsbury


    Full Text Available The capacity of plants and plant cells to produce large amounts of recombinant protein has been well established. Due to advantages in terms of speed and yield, attention has recently turned towards the use of transient expression systems, including viral vectors, to produce proteins of pharmaceutical interest in plants. However, the effects of such high level expression from viral vectors and concomitant effects on host cells may affect the quality of the recombinant product.To assess the quality of antibodies transiently expressed to high levels in plants, we have expressed and characterised the human anti-HIV monoclonal antibody, 2G12, using both replicating and non-replicating systems based on deleted versions of Cowpea mosaic virus (CPMV RNA-2. The highest yield (approximately 100 mg/kg wet weight leaf tissue of affinity purified 2G12 was obtained when the non-replicating CPMV-HT system was used and the antibody was retained in the endoplasmic reticulum (ER. Glycan analysis by mass-spectrometry showed that the glycosylation pattern was determined exclusively by whether the antibody was retained in the ER and did not depend on whether a replicating or non-replicating system was used. Characterisation of the binding and neutralisation properties of all the purified 2G12 variants from plants showed that these were generally similar to those of the Chinese hamster ovary (CHO cell-produced 2G12.Overall, the results demonstrate that replicating and non-replicating CPMV-based vectors are able to direct the production of a recombinant IgG similar in activity to the CHO-produced control. Thus, a complex recombinant protein was produced with no apparent effect on its biochemical properties using either high-level expression or viral replication. The speed with which a recombinant pharmaceutical with excellent biochemical characteristics can be produced transiently in plants makes CPMV-based expression vectors an attractive option for

  7. Selection and Neutral Mutations Drive Pervasive Mutability Losses in Long-Lived Anti-HIV B-Cell Lineages (United States)

    Vieira, Marcos C; Zinder, Daniel; Cobey, Sarah


    Abstract High-affinity antibodies arise within weeks of infection from the evolution of B-cell receptors under selection to improve antigen recognition. This rapid adaptation is enabled by the distribution of highly mutable “hotspot” motifs in B-cell receptor genes. High mutability in antigen-binding regions (complementarity determining regions [CDRs]) creates variation in binding affinity, whereas low mutability in structurally important regions (framework regions [FRs]) may reduce the frequency of destabilizing mutations. During the response, loss of mutational hotspots and changes in their distribution across CDRs and FRs are predicted to compromise the adaptability of B-cell receptors, yet the contributions of different mechanisms to gains and losses of hotspots remain unclear. We reconstructed changes in anti-HIV B-cell receptor sequences and show that mutability losses were ∼56% more frequent than gains in both CDRs and FRs, with the higher relative mutability of CDRs maintained throughout the response. At least 21% of the total mutability loss was caused by synonymous mutations. However, nonsynonymous substitutions caused most (79%) of the mutability loss in CDRs. Because CDRs also show strong positive selection, this result suggests that selection for mutations that increase binding affinity contributed to loss of mutability in antigen-binding regions. Although recurrent adaptation to evolving viruses could indirectly select for high mutation rates, we found no evidence of indirect selection to increase or retain hotspots. Our results suggest mutability losses are intrinsic to both the neutral and adaptive evolution of B-cell populations and might constrain their adaptation to rapidly evolving pathogens such as HIV and influenza. PMID:29688540

  8. Anti-HIV-1 B cell responses are dependent on B cell precursor frequency and antigen-binding affinity. (United States)

    Dosenovic, Pia; Kara, Ervin E; Pettersson, Anna-Klara; McGuire, Andrew T; Gray, Matthew; Hartweger, Harald; Thientosapol, Eddy S; Stamatatos, Leonidas; Nussenzweig, Michel C


    The discovery that humans can produce potent broadly neutralizing antibodies (bNAbs) to several different epitopes on the HIV-1 spike has reinvigorated efforts to develop an antibody-based HIV-1 vaccine. Antibody cloning from single cells revealed that nearly all bNAbs show unusual features that could help explain why it has not been possible to elicit them by traditional vaccination and instead would require a sequence of different immunogens. This idea is supported by experiments with genetically modified immunoglobulin (Ig) knock-in mice. Sequential immunization with a series of specifically designed immunogens was required to shepherd the development of bNAbs. However, knock-in mice contain superphysiologic numbers of bNAb precursor-expressing B cells, and therefore how these results can be translated to a more physiologic setting remains to be determined. Here we make use of adoptive transfer experiments using knock-in B cells that carry a synthetic intermediate in the pathway to anti-HIV-1 bNAb development to examine how the relationship between B cell receptor affinity and precursor frequency affects germinal center (GC) B cell recruitment and clonal expansion. Immunization with soluble HIV-1 antigens can recruit bNAb precursor B cells to the GC when there are as few as 10 such cells per mouse. However, at low precursor frequencies, the extent of clonal expansion is directly proportional to the affinity of the antigen for the B cell receptor, and recruitment to GCs is variable and dependent on recirculation.

  9. [Contingency management in opioid substitution treatment]. (United States)

    Specka, M; Böning, A; Scherbaum, N


    The majority of opiate-dependent patients in substitution treatment show additional substance-related disorders. Concomitant use of heroin, alcohol, benzodiazepines or cocaine compromises treatment success. Concomitant drug use may be treated by using contingency management (CM) which is based on learning theory. In CM, abstinence from drugs, as verified by drug screenings, is reinforced directly and contingently. Reinforcers used in CM studies with substituted patients were, amongst others, vouchers and take-home privileges. Studies in the USA show a medium average effect of CM on drug consumption rates and abstinence. The effects decrease markedly after the end of the intervention. We discuss whether CM is applicable within the German substitution treatment system and how it can be combined with other interventions such as selective detoxification treatments or cognitive-behavioural programmes. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Management pain and anxiety in endodontic treatment

    Directory of Open Access Journals (Sweden)

    Andi Sumidarti


    Full Text Available Dental pain is a common symptom that most often causes patient to seek dentist. A survey conducted by the American Association of Endodontics revealed that more than half patients who come to dentist have experienced pain, which originate from the teeth or of the surrounding tissue, can causes difficulties in handling, also the anxiety of the patient. Understanding the pain experienced by patient will help dentist to determine when to make an action. Most patient being fear with pain, so they delay to getting treatment from dentist, and led to the development of further infection and inflammation. Aim of this paper is to improve the understanding of pharmacology and procedures for pain and anxiety management in endodontic treatment. So, it was importance of determining accurate diagnosis, management and drug administration.

  11. Synthesis of highly anti-HIV active sulfated poly- and oligo-saccharides and analysis of their action mechanisms by NMR [nuclear magnetic resonance] spectroscopy

    International Nuclear Information System (INIS)

    Uryu, Toshiyuki


    We have been synthesizing sulfated polysaccharides and oligosaccharides with highly anti-HIV (human immunodeficiency virus) activities. It has been known that sulfated polysaccharides such as dextran sulfate and pentosan polysulfate have biological activities such as anticoagulant activity and recently anti-HIV activity. Curdlan sulfate having 1,3-β-linked glucan backbone had high anti-HIV activity but low anticoagulant activity. Phase I/II test for the curdlan sulfate as an AIDS (acquired immunodeficiency syndrome) drug was carried out in the United States. In this study, regioselectivity sulfatec curdlan sulfates were prepared in order to study effects of sulfate groups and conformation of curdlan sulfates. In addition, action mechanisms of curdlan sulfate as anti-AIDS drug and of heparin as an anticoagulant were examined by means of NMR spectroscopy. 1. Structure dependence of anti-HIV and anticoagulant activities of sulfated polysaccharides. Curdlan with M n 9000 was regioselectively sulfated on its hydroxyl groups at 6, 4, and 2 positions. Those were a curdlan sulfate 62S in which 100% of 6-OH, and about 50% of 2-OH was sulfated, a curdlan sulfate 42S in which 4- and 2-OH's were sulfated, and a curdlan sulfate in which 6, 4, and 2-OH's were partially sulfated. All curdlan sulfates had very high anti-HIV activities exhibited by the drug concentration of 50% inhibition of infection, i.e., EC 50 of 0.04 - 0.25 μg/mL. However, there was almost no difference in the activity among the samples. Therefore, it was revealed that the degree of sulfation and putative conformation of the curdlan sulfates but not the position of sulfate groups have large effects on the anti-HIV activity. On the other hand, the anticoagulant activity increased with increasing molecular weight of the curdlan sulfates. As a result, it is assumed that the size of reaction sites of the virus protein reacting with curdlan sulfate is different from that of the proteins related to anticoagulant

  12. Prolonged expression of an anti-HIV-1 gp120 minibody to the female rhesus macaque lower genital tract by AAV gene transfer. (United States)

    Abdel-Motal, U M; Harbison, C; Han, T; Pudney, J; Anderson, D J; Zhu, Q; Westmoreland, S; Marasco, W A


    Topical microbicides are a leading strategy for prevention of HIV mucosal infection to women; however, numerous pharmacokinetic limitations associated with coitally related dosing strategy have contributed to their limited success. Here we test the hypothesis that adeno-associated virus (AAV) mediated delivery of the b12 human anti-HIV-1 gp120 minibody gene to the lower genital tract of female rhesus macaques (Rh) can provide prolonged expression of b12 minibodies in the cervical-vaginal secretions. Gene transfer studies demonstrated that, of various green fluorescent protein (GFP)-expressing AAV serotypes, AAV-6 most efficiently transduced freshly immortalized and primary genital epithelial cells (PGECs) of female Rh in vitro. In addition, AAV-6-b12 minibody transduction of Rh PGECs led to inhibition of SHIV162p4 transmigration and virus infectivity in vitro. AAV-6-GFP could also successfully transduce vaginal epithelial cells of Rh when applied intravaginally, including p63+ epithelial stem cells. Moreover, intravaginal application of AAV-6-b12 to female Rh resulted in prolonged minibody detection in their vaginal secretions throughout the 79-day study period. These data provide proof of principle that AAV-6-mediated delivery of anti-HIV broadly neutralizing antibody (BnAb) genes to the lower genital tract of female Rh results in persistent minibody detection for several months. This strategy offers promise that an anti-HIV-1 genetic microbicide strategy may be possible in which topical application of AAV vector, with periodic reapplication as needed, may provide sustained local BnAb expression and protection.

  13. Fatores associados à submissão ao teste rápido anti-HIV na assistência ao parto

    Directory of Open Access Journals (Sweden)

    Maria Inês Couto de Oliveira

    Full Text Available Resumo Os testes rápidos anti-HIV vêm sendo empregados nas maternidades com vistas à prevenção da transmissão vertical. O objetivo do estudo foi analisar os fatores associados à submissão ao teste rápido anti-HIV (desfecho. Estudo transversal, conduzido em 2009, em 15 hospitais do SUS do Rio de Janeiro/RJ, mediante entrevista a amostra representativa de 835 parturientes internadas e consulta a prontuários. Razões de prevalência ajustadas foram obtidas por regressão de Poisson, segundo modelo hierarquizado, permanecendo no modelo final as variáveis associadas ao desfecho (p ≤ 0,05. Segundo os prontuários (SP, 79,6% das mães foram submetidas ao teste rápido anti-HIV e, segundo as entrevistas (SE, 55,7%. No nível distal, a ausência de companheiro (SP, ter ≥ 6 moradores na residência (SP e a cor da pele não branca (SE se associaram a uma maior prevalência do desfecho. No nível intermediário, não dispor de sorologia negativa para o HIV do pré-natal (SP e SE se associou a uma maior prevalência do desfecho, bem como a realização de pré-natal na rede básica (SP e a não realização de pré-natal (SE. No nível proximal, o parto em hospital não certificado como amigo da criança se associou a uma maior prevalência do desfecho (SP e SE.

  14. HIV testing and treatment in the antenatal care setting.

    LENUS (Irish Health Repository)

    Coulter-Smith, S


    Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.

  15. HIV testing and treatment in the antenatal care setting.

    LENUS (Irish Health Repository)

    Coulter-Smith, S


    Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.

  16. [Management of opioid maintenance treatments when analgesic treatments are required]. (United States)

    Laprevote, Vincent; Geoffroy, Pierre A; Rolland, Benjamin; Leheup, Benoît F; Di Patrizio, Paolo; Cottencin, Olivier; Schwan, Raymund


    Opioid maintenance treatments (OMT) reduce illicit opiate use and its associated risks. They are often prescribed on a long-term basis. Physiological changes induced by long-term OMT may cause hyperalgesia and cross-tolerance to opioid agonists, which suggests that the dosage of analgesic treatment should be modified in cases of acute pain, especially when an opioid-based analgesia is required. When treatment with analgesics is necessary, OMT must be maintained, except in exceptional cases. If a split-dosing schedule is temporarily employed during OMT, the daily dosage should not be increased for analgesic purposes. Analgesic treatment must be managed differently in case of treatment with buprenorphine or methadone. With buprenorphine, non-opioid analgesics should be introduced first, if possible. If this strategy is inefficient or contraindicated, a temporary or definitive switch to methadone should be considered. In the case of methadone-based OMT, opioid analgesics should be added directly and the dosage should be adapted according to the level of pain reported by the patient. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Managing peatland vegetation for drinking water treatment. (United States)

    Ritson, Jonathan P; Bell, Michael; Brazier, Richard E; Grand-Clement, Emilie; Graham, Nigel J D; Freeman, Chris; Smith, David; Templeton, Michael R; Clark, Joanna M


    Peatland ecosystem services include drinking water provision, flood mitigation, habitat provision and carbon sequestration. Dissolved organic carbon (DOC) removal is a key treatment process for the supply of potable water downstream from peat-dominated catchments. A transition from peat-forming Sphagnum moss to vascular plants has been observed in peatlands degraded by (a) land management, (b) atmospheric deposition and (c) climate change. Here within we show that the presence of vascular plants with higher annual above-ground biomass production leads to a seasonal addition of labile plant material into the peatland ecosystem as litter recalcitrance is lower. The net effect will be a smaller litter carbon pool due to higher rates of decomposition, and a greater seasonal pattern of DOC flux. Conventional water treatment involving coagulation-flocculation-sedimentation may be impeded by vascular plant-derived DOC. It has been shown that vascular plant-derived DOC is more difficult to remove via these methods than DOC derived from Sphagnum, whilst also being less susceptible to microbial mineralisation before reaching the treatment works. These results provide evidence that practices aimed at re-establishing Sphagnum moss on degraded peatlands could reduce costs and improve efficacy at water treatment works, offering an alternative to 'end-of-pipe' solutions through management of ecosystem service provision.

  18. A realização do teste anti-hiv no pré-natal: os significados para a gestante


    Silva, Roberta Maria de Oliveira; Araújo, Carla Luzia França; Paz, Fatima Maria Trigo da


    O estudo teve por objetivo conhecer e analisar o significado da realização do teste anti-HIV no pré-natal para as gestantes. Trata-se de uma pesquisa com abordagem qualitativa e foi realizada em um Hospital Escola e em uma Maternidade do município do Rio de Janeiro. Como recurso técnico-metodológico utilizou-se o discurso do sujeito coletivo (DSC). Após a análise dos discursos verificamos que para as gestantes a realização do teste significa a possibilidade de prevenir a transmissão vertical ...

  19. Ciguatera Fish Poisoning: Treatment, Prevention and Management

    Directory of Open Access Journals (Sweden)

    Andrew Reich


    Full Text Available Ciguatera Fish Poisoning (CFP is the most frequently reported seafood-toxin illness in the world, and it causes substantial physical and functional impact. It produces a myriad of gastrointestinal, neurologic and/or cardiovascular symptoms which last days to weeks, or even months. Although there are reports of symptom amelioration with some interventions (e.g. IV mannitol, the appropriate treatment for CFP remains unclear to many physicians. We review the literature on the treatments for CFP, including randomized controlled studies and anecdotal reports. The article is intended to clarify treatment options, and provide information about management and prevention of CFP, for emergency room physicians, poison control information providers, other health care providers, and patients.

  20. Ciguatera fish poisoning: treatment, prevention and management. (United States)

    Friedman, Melissa A; Fleming, Lora E; Fernandez, Mercedes; Bienfang, Paul; Schrank, Kathleen; Dickey, Robert; Bottein, Marie-Yasmine; Backer, Lorraine; Ayyar, Ram; Weisman, Richard; Watkins, Sharon; Granade, Ray; Reich, Andrew


    Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world, and it causes substantial physical and functional impact. It produces a myriad of gastrointestinal, neurologic and/or cardiovascular symptoms which last days to weeks, or even months. Although there are reports of symptom amelioration with some interventions (e.g. IV mannitol), the appropriate treatment for CFP remains unclear to many physicians. We review the literature on the treatments for CFP, including randomized controlled studies and anecdotal reports. The article is intended to clarify treatment options, and provide information about management and prevention of CFP, for emergency room physicians, poison control information providers, other health care providers, and patients.

  1. Ciguatera Fish Poisoning: Treatment, Prevention and Management (United States)

    Friedman, Melissa A.; Fleming, Lora E.; Fernandez, Mercedes; Bienfang, Paul; Schrank, Kathleen; Dickey, Robert; Bottein, Marie-Yasmine; Backer, Lorraine; Ayyar, Ram; Weisman, Richard; Watkins, Sharon; Granade, Ray; Reich, Andrew


    Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world, and it causes substantial physical and functional impact. It produces a myriad of gastrointestinal, neurologic and/or cardiovascular symptoms which last days to weeks, or even months. Although there are reports of symptom amelioration with some interventions (e.g. IV mannitol), the appropriate treatment for CFP remains unclear to many physicians. We review the literature on the treatments for CFP, including randomized controlled studies and anecdotal reports. The article is intended to clarify treatment options, and provide information about management and prevention of CFP, for emergency room physicians, poison control information providers, other health care providers, and patients. PMID:19005579

  2. Interferon-Inducible CD169/Siglec1 Attenuates Anti-HIV-1 Effects of Alpha Interferon (United States)

    Akiyama, Hisashi; Ramirez, Nora-Guadalupe Pina; Gibson, Gregory; Kline, Christopher; Watkins, Simon; Ambrose, Zandrea


    ). Although type I IFN induces an antiviral state in many cell types in vitro, HIV-1 can replicate in vivo via mechanisms that have remained unclear. In this study, we tested the hypothesis that CD169, a type I IFN-inducible HIV-1 attachment factor, offsets antiviral effects of type I IFN. Infection of HIV-1 was rescued in IFN-α-treated myeloid cells via upregulation of CD169 and a subsequent increase in CD169-dependent virus entry. Furthermore, extensive colocalization of viral Gag and CD169 was observed in lymph nodes of infected pigtailed macaques, suggesting productive infection of CD169+ cells in vivo. Treatment of dendritic cell (DC)-T cell cocultures with IFN-α upregulated CD169 expression on DCs and rescued HIV-1 infection of CD4+ T cells in trans, suggesting that HIV-1 exploits CD169 to attenuate type I IFN-induced restrictions. PMID:28794041

  3. Anti-HIV double variable domain immunoglobulins binding both gp41 and gp120 for targeted delivery of immunoconjugates.

    Directory of Open Access Journals (Sweden)

    Ryan B Craig

    Full Text Available BACKGROUND: Anti-HIV immunoconjugates targeted to the HIV envelope protein may be used to eradicate the latent reservoir of HIV infection using activate-and-purge protocols. Previous studies have identified the two target epitopes most effective for the delivery of cytotoxic immunoconjugates the CD4-binding site of gp120, and the hairpin loop of gp41. Here we construct and test tetravalent double variable domain immunoglobulin molecules (DVD-Igs that bind to both epitopes. METHODS: Synthetic genes that encode DVD-Igs utilizing V-domains derived from human anti-gp120 and anti-gp41 Abs were designed and expressed in 293F cells. A series of constructs tested different inter-V-linker domains and orientations of the two V domains. Antibodies were tested for binding to recombinant Ag and native Env expressed on infected cells, for neutralization of infectious HIV, and for their ability to deliver cytotoxic immunoconjugates to infected cells. FINDINGS: The outer V-domain was the major determinant of binding and functional activity of the DVD-Ig. Function of the inner V-domain and bifunctional binding required at least 15 AA in the inter-V-domain linker. A molecular model showing the spatial orientation of the two epitopes is consistent with this observation. Linkers that incorporated helical domains (A[EAAAK](nA resulted in more effective DVD-Igs than those based solely on flexible domains ([GGGGS](n. In general, the DVD-Igs outperformed the less effective parental antibody and equaled the activity of the more effective. The ability of the DVD-Igs to deliver cytotoxic immunoconjugates in the absence of soluble CD4 was improved over that of either parent. CONCLUSIONS: DVD-Igs can be designed that bind to both gp120 and gp41 on the HIV envelope. DVD-Igs are effective in delivering cytotoxic immunoconjugates. The optimal design of these DVD-Igs, in which both domains are fully functional, has not yet been achieved.

  4. Synthesis and anti-HIV activity of novel 3-substituted phenyl-6,7-dimethoxy-3a,4-dihydro-3H-indeno[1,2-c]isoxazole analogues. (United States)

    Ali, Mohamed A; Ismail, Rusli; Choon, Tan S; Yoon, Yeong K; Wei, Ang C; Pandian, Suresh; Samy, Jeyabalan G; De Clercq, Eric; Pannecouque, Christophe


    A series of novel 3-(substituted phenyl)-6,7-dimethoxy-3a,4-dihydro-3H-indeno[1,2-c]isoxazole analogues were synthesized by the reaction of 5,6-dimethoxy-2-[(E)-1-phenylmethylidene]-1-indanone with hydroxylamine hydrochloride. The title compounds were tested for their in vitro anti-HIV activity. Among the compounds, (4g) showed a promising anti-HIV activity in the in vitro testing against IIIB and ROD strains. The IC50 of both IIIB and ROD were found to be 9.05 microM and > 125 microM, respectively.

  5. The offer of the anti-HIV test to the users of the health basic net units: different aproaches of professionals

    Directory of Open Access Journals (Sweden)

    Sergio Corrêa Marques


    Full Text Available Objetivos: identificar e descrever as condutas dos profissionais de saúde na oferta do teste anti-HIV; analisar as práticas dos profissionais a partir dos relatos das usuárias dos serviços da rede básica de saúde. Método: é um estudo descritivo, qualitativo, com 40 mulheres assistidas em 08 Centros Municipais de Saúde. Resultados: a produção discursiva das entrevistas foi submetida ao programa Alceste, constituindo duas categorias de análise. A primeira contempla as abordagens no atendimento individual na rede de CMS do Rio de Janeiro descrevendo os três modos de conduta dos profissionais de saúde durante a oferta de teste anti-HIV. A segunda categoria refere-se às abordagens no atendimento coletivo, onde se observa que as atividades de aconselhamento não ocorrem de maneira uniforme. Conclusão: que os resultados apontam para uma prática que se desvirtua do que vem sendo preconizado pelos Programas oficiais em relação ao Aconselhamento.

  6. FT-IR spectra of the anti-HIV nucleoside analogue d4T (Stavudine). Solid state simulation by DFT methods and scaling by different procedures (United States)

    Alcolea Palafox, M.; Kattan, D.; Afseth, N. K.


    A theoretical and experimental vibrational study of the anti-HIV d4T (stavudine or Zerit) nucleoside analogue was carried out. The predicted spectra in the three most stable conformers in the biological active anti-form of the isolated state were compared. Comparison of the conformers with those of the natural nucleoside thymidine was carried out. The calculated spectra were scaled by using different scaling procedures and three DFT methods. The TLSE procedure leads to the lowest error and is thus recommended for scaling. With the population of these conformers the IR gas-phase spectra were predicted. The crystal unit cell of the different polymorphism forms of d4T were simulated through dimer forms by using DFT methods. The scaled spectra of these dimer forms were compared. The FT-IR spectrum was recorded in the solid state in the 400-4000 cm-1 range. The respective vibrational bands were analyzed and assigned to different normal modes of vibration by comparison with the scaled vibrational values of the different dimer forms. Through this comparison, the polymorphous form of the solid state sample was identified. The study indicates that d4T exist only in the ketonic form in the solid state. The results obtained were in agreement with those determined in related anti-HIV nucleoside analogues.

  7. Zirconium phosphatidylcholine-based nanocapsules as an in vivo degradable drug delivery system of MAP30, a momordica anti-HIV protein. (United States)

    Caizhen, Guo; Yan, Gao; Ronron, Chang; Lirong, Yang; Panpan, Chu; Xuemei, Hu; Yuanbiao, Qiao; Qingshan, Li


    An essential in vivo drug delivery system of a momordica anti-HIV protein, MAP30, was developed through encapsulating in chemically synthesized matrices of zirconium egg- and soy-phosphatidylcholines, abbreviated to Zr/EPC and Zr/SPC, respectively. Matrices were characterized by transmission electron microscopy and powder X-ray diffractometry studies. Zr/EPC granule at an approximate diameter of 69.43±7.78 nm was a less efficient encapsulator than the granule of Zr/SPC. Interlayer spacing of the matrices encapsulating MAP30 increased from 8.8 and 9.7 Å to 7.4 and 7.9 nm, respectively. In vivo kinetics on degradation and protein release was performed by analyzing the serum sampling of intravenously injected SPF chickens. The first order and biphasic variations were obtained for in vivo kinetics using equilibrium dialysis. Antimicrobial and anti-HIV assays yielded greatly decreased MIC50 and EC50 values of nanoformulated MAP30. An acute toxicity of MAP30 encapsulated in Zr/EPC occurred at a single intravenous dose above 14.24 mg/kg bw in NIH/KM/ICR mice. The folding of MAP30 from Zr/EPC sustained in vivo chickens for more than 8 days in high performance liquid chromatography assays. These matrices could protect MAP30 efficiently with strong structure retention, lowered toxicity and prolonged in vivo life. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. D77, one benzoic acid derivative, functions as a novel anti-HIV-1 inhibitor targeting the interaction between integrase and cellular LEDGF/p75

    International Nuclear Information System (INIS)

    Du Li; Zhao Yaxue; Chen, Jing; Yang Liumeng; Zheng Yongtang; Tang Yun; Shen Xu; Jiang Hualiang


    Integration of viral-DNA into host chromosome mediated by the viral protein HIV-1 integrase (IN) is an essential step in the HIV-1 life cycle. In this process, Lens epithelium-derived growth factor (LEDGF/p75) is discovered to function as a cellular co-factor for integration. Since LEDGF/p75 plays an important role in HIV integration, disruption of the LEDGF/p75 interaction with IN has provided a special interest for anti-HIV agent discovery. In this work, we reported that a benzoic acid derivative, 4-[(5-bromo-4-{[2,4-dioxo-3-(2-oxo-2-phenylethyl) -1,3-thiazolidin-5-ylidene]methyl}-2-ethoxyphenoxy)methyl]benzoic acid (D77) could potently inhibit the IN-LEDGF/p75 interaction and affect the HIV-1 IN nuclear distribution thus exhibiting antiretroviral activity. Molecular docking with site-directed mutagenesis analysis and surface plasmon resonance (SPR) binding assays has clarified possible binding mode of D77 against HIV-1 integrase. As the firstly discovered small molecular compound targeting HIV-1 integrase interaction with LEDGF/p75, D77 might supply useful structural information for further anti-HIV agent discovery

  9. Management and Treatment of Human Lice

    Directory of Open Access Journals (Sweden)

    Abdoul Karim Sangaré


    Full Text Available Of the three lice (head, body, and pubic louse that infest humans, the body louse is the species involved in epidemics of louse-borne typhus, trench fever, and relapsing fever, but all the three cause pediculosis. Their infestations occur today in many countries despite great efforts to maintain high standards of public health. In this review, literature searches were performed through PubMed, Medline, Google Scholar, and EBSCOhost, with key search words of “Pediculus humanus”, “lice infestation”, “pediculosis”, and “treatment”; and controlled clinical trials were viewed with great interest. Removing lice by hand or with a lice comb, heating infested clothing, and shaving the scalp were some of the oldest methods of controlling human lice. Despite the introduction of other resources including cresol, naphthalene, sulfur, mercury, vinegar, petroleum, and insecticides, the numbers of lice infestation cases and resistance have increased. To date, viable alternative treatments to replace insecticides have been developed experimentally in vitro. Today, the development of new treatment strategies such as symbiotic treatment and synergistic treatment (antibiotics + ivermectin in vitro has proved effective and is promising. Here, we present an overview on managing and treating human lice and highlight new strategies to more effectively fight pediculosis and prevent resistance.

  10. Management of treatment-resistant depression. (United States)

    Keitner, Gabor I; Mansfield, Abigail K


    Given the limitations of evidence for treatment options that are consistently effective for TRD and the possibility that TRD is in fact a form of depression that has a low probability of resolving, how can clinicians help patients with TRD? Perhaps the most important conceptual shift that needs to take place before treatment can be helpful is to accept TRD as a chronic illness, an illness similar to many others, one that can be effectively managed but that is not, at our present level of knowledge, likely to be cured. An undue focus on remission or even a 50% diminution of symptoms sets unrealistic goals for both patients and therapists and may lead to overtreatment and demoralization. The focus should be less on eliminating depressive symptoms and more on making sense of and learning to function better in spite of them. It is important to acknowledge the difficult nature of the depressive illness, to remove blame from the patient and clinician for not achieving remission, to set realistic expectations, and to help promote better psychosocial functioning even in the face of persisting symptoms. The critical element when implementing such an approach is a judicious balance between maintaining hope for improvement without setting unrealistic expectations. It is important to reemphasize that following a disease management model with acceptance of the reality of a chronic illness is not nihilistic and does not mean the abandonment of hope for improvement. The first step in treating a patient with TRD is to perform a comprehensive assessment of the patient’s past and current treatment history to ensure that evidence-based treatment trials have in fact been undertaken, and if not, such treatment trials should be implemented. If the patient continues to have significant residual symptoms, it is important to determine the impact is of these symptoms on the patient’s quality of life and ability to function. It is also important to evaluate the factors that may be

  11. Neutralizing Activity of Broadly Neutralizing Anti-HIV-1 Antibodies against Clade B Clinical Isolates Produced in Peripheral Blood Mononuclear Cells. (United States)

    Cohen, Yehuda Z; Lorenzi, Julio C C; Seaman, Michael S; Nogueira, Lilian; Schoofs, Till; Krassnig, Lisa; Butler, Allison; Millard, Katrina; Fitzsimons, Tomas; Daniell, Xiaoju; Dizon, Juan P; Shimeliovich, Irina; Montefiori, David C; Caskey, Marina; Nussenzweig, Michel C


    HIV-1 epidemic. Antibodies with exceptional neutralizing activity against HIV-1 may provide several advantages to traditional HIV drugs, including an improved side-effect profile, a reduced dosing frequency, and immune enhancement. The activity of these antibodies has been established in vitro by utilizing HIV-1 Env-pseudotyped viruses derived from circulating viruses but produced in 293T cells by pairing Env proteins with a backbone vector. We tested PBMC-produced circulating viruses against five anti-HIV-1 antibodies currently in clinical development. We found that the activity of these antibodies against PBMC isolates is significantly less than that against 293T Env-pseudotyped viruses. This decline varied among the antibodies tested, with some demonstrating moderate reductions in activity and others showing an almost 100-fold reduction. As the development of these antibodies progresses, it will be critical to determine how the results of different in vitro tests correspond to performance in the clinic. Copyright © 2018 Cohen et al.

  12. A new activity of anti-HIV and anti-tumor protein GAP31: DNA adenosine glycosidase - Structural and modeling insight into its functions

    Energy Technology Data Exchange (ETDEWEB)

    Li, Hui-Guang [Department of Biochemistry, New York University School of Medicine, New York, NY 10016 (United States); Huang, Philip L. [American Biosciences, Boston, MA 02114 (United States); Zhang, Dawei; Sun, Yongtao [Department of Biochemistry, New York University School of Medicine, New York, NY 10016 (United States); Chen, Hao-Chia [Endocrinology and Reproduction Research Branch, National Institute of Child Health and Human Development, NIH, Bethesda, MD 20892 (United States); Zhang, John [Department of Chemistry, New York University, New York, NY 10003 (United States); Huang, Paul L. [Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02114 (United States); Kong, Xiang-Peng, E-mail: [Department of Biochemistry, New York University School of Medicine, New York, NY 10016 (United States); Lee-Huang, Sylvia, E-mail: [Department of Biochemistry, New York University School of Medicine, New York, NY 10016 (United States)


    We report here the high-resolution atomic structures of GAP31 crystallized in the presence of HIV-LTR DNA oligonucleotides systematically designed to examine the adenosine glycosidase activity of this anti-HIV and anti-tumor plant protein. Structural analysis and molecular modeling lead to several novel findings. First, adenine is bound at the active site in the crystal structures of GAP31 to HIV-LTR duplex DNA with 5' overhanging adenosine ends, such as the 3'-processed HIV-LTR DNA but not to DNA duplex with blunt ends. Second, the active site pocket of GAP31 is ideally suited to accommodate the 5' overhanging adenosine of the 3'-processed HIV-LTR DNA and the active site residues are positioned to perform the adenosine glycosidase activity. Third, GAP31 also removes the 5'-end adenine from single-stranded HIV-LTR DNA oligonucleotide as well as any exposed adenosine, including that of single nucleotide dAMP but not from AMP. Fourth, GAP31 does not de-purinate guanosine from di-nucleotide GT. These results suggest that GAP31 has DNA adenosine glycosidase activity against accessible adenosine. This activity is distinct from the generally known RNA N-glycosidase activity toward the 28S rRNA. It may be an alternative function that contributes to the antiviral and anti-tumor activities of GAP31. These results provide molecular insights consistent with the anti-HIV mechanisms of GAP31 in its inhibition on the integration of viral DNA into the host genome by HIV-integrase as well as irreversible topological relaxation of the supercoiled viral DNA.

  13. Design and cellular kinetics of dansyl-labeled CADA derivatives with anti-HIV and CD4 receptor down-modulating activity. (United States)

    Vermeire, Kurt; Lisco, Andrea; Grivel, Jean-Charles; Scarbrough, Emily; Dey, Kaka; Duffy, Noah; Margolis, Leonid; Bell, Thomas W; Schols, Dominique


    A new class of anti-retrovirals, cyclotriazadisulfonamide (CADA) and its derivatives, specifically down-regulate CD4, the main receptor of HIV, and prevent HIV infection in vitro. In this work, several CADA derivatives, chemically labeled with a fluorescent dansyl group, were evaluated for their biological features and cellular uptake kinetics. We identified a derivative KKD-016 with antiviral and CD4 down-modulating capabilities similar to those of the parental compound CADA. By using flow cytometry, we demonstrated that the dose-dependent cellular uptake of this derivative correlated with CD4 down-modulation. The uptake and activity of the dansyl-labeled compounds were not dependent on the level of expression of CD4 at the cell surface. Removal of the CADA compounds from the cell culture medium resulted in their release from the cells followed by a complete restoration of CD4 expression. The inability of several fluorescent CADA derivatives to down-modulate CD4 was not associated with their lower cellular uptake and was not reversed by facilitating their cell penetration by a surfactant. These results prove the successful integration of the dansyl fluorophore into the chemical structure of a CD4 down-modulating anti-HIV compound, and show the feasibility of tracking a receptor and its down-modulator simultaneously. These fluorescent CADA analogs with reversible CD4 down-regulating potency can now be applied in further studies on receptor modulation, and in the exploration of their potentials as preventive and therapeutic anti-HIV drugs.

  14. In vivo evaluation of a mucoadhesive polymeric caplet for intravaginal anti-HIV-1 delivery and development of a molecular mechanistic model for thermochemical characterization. (United States)

    Ndesendo, Valence M K; Choonara, Yahya E; Meyer, Leith C R; Kumar, Pradeep; Tomar, Lomas K; Tyagi, Charu; du Toit, Lisa C; Pillay, Viness


    The aim of this study was to develop, characterize and evaluate a mucoadhesive caplet resulting from a polymeric blend (polymeric caplet) for intravaginal anti-HIV-1 delivery. Poly(lactic-co-glycolic) acid, ethylcellulose, poly(vinylalcohol), polyacrylic acid and modified polyamide 6, 10 polymers were blended and compressed to a caplet-shaped device, with and without two model drugs 3'-azido-3'-deoxythymidine (AZT) and polystyrene sulfonate (PSS). Thermal analysis, infrared spectroscopy and microscopic analysis were carried out on the caplets employing temperature-modulated DSC (TMDSC), Fourier transform infra-red (FTIR) spectrometer and scanning electron microscope, respectively. In vitro and in vivo drug release analyses as well as the histopathological toxicity studies were carried out on the drug-loaded caplets. Furthermore, molecular mechanics (MM) simulations were carried out on the drug-loaded caplets to corroborate the experimental findings. There was a big deviation between the Tg of the polymeric caplet from the Tg's of the constituent polymers indicating a strong interaction between constituent polymers. FTIR spectroscopy confirmed the presence of specific ionic and non-ionic interactions within the caplet. A controlled near zero-order drug release was obtained for AZT (20 d) and PSS (28 d). In vivo results, i.e. the drug concentration in plasma ranged between 0.012-0.332 mg/mL and 0.009-0.256 mg/mL for AZT and PSS over 1-28 d. The obtained results, which were corroborated by MM simulations, attested that the developed system has the potential for effective delivery of anti-HIV-agents.

  15. Genome-wide expression profiling analysis to identify key genes in the anti-HIV mechanism of CD4+ and CD8+ T cells. (United States)

    Gao, Lijie; Wang, Yunqi; Li, Yi; Dong, Ya; Yang, Aimin; Zhang, Jie; Li, Fengying; Zhang, Rongqiang


    Comprehensive bioinformatics analyses were performed to explore the key biomarkers in response to HIV infection of CD4 + and CD8 + T cells. The numbers of CD4 + and CD8 + T cells of HIV infected individuals were analyzed and the GEO database (GSE6740) was screened for differentially expressed genes (DEGs) in HIV infected CD4 + and CD8 + T cells. Gene Ontology enrichment, KEGG pathway analyses, and protein-protein interaction (PPI) network were performed to identify the key pathway and core proteins in anti-HIV virus process of CD4 + and CD8 + T cells. Finally, we analyzed the expressions of key proteins in HIV-infected T cells (GSE6740 dataset) and peripheral blood mononuclear cells(PBMCs) (GSE511 dataset). 1) CD4 + T cells counts and ratio of CD4 + /CD8 + T cells decreased while CD8 + T cells counts increased in HIV positive individuals; 2) 517 DEGs were found in HIV infected CD4 + and CD8 + T cells at acute and chronic stage with the criterial of P-value T cells. The main biological processes of the DEGs were response to virus and defense response to virus. At chronic stage, ISG15 protein, in conjunction with IFN-1 pathway might play key roles in anti-HIV responses of CD4 + T cells; and 4) The expression of ISG15 increased in both T cells and PBMCs after HIV infection. Gene expression profile of CD4 + and CD8 + T cells changed significantly in HIV infection, in which ISG15 gene may play a central role in activating the natural antiviral process of immune cells. © 2018 Wiley Periodicals, Inc.

  16. Treatment and management of child pornography use. (United States)

    Seto, Michael C; Ahmed, A G


    Advances in Internet and other digital technologies have created ready and affordable access to pornography involving real children or computer-generated images of children. To better understand and manage child pornography users, clinicians must acquaint themselves with the characteristics and behaviors of these offenders. This article distinguishes motivations to use child pornography and different types of child pornography offenders and provides a brief overview of the assessment, diagnosis, and management options available. The authors conclude with recommendations on future directions in the assessment, diagnosis, and management of child pornography offenders. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Management of treatment resistant schizophrenia | Jones | African ...

    African Journals Online (AJOL)

    Whilst gains have been made in recent years in the pharmacological treatment of schizophrenia, a number of patients still have residual symptoms and disabilities, or simply do not show response to antipsychotic medications. For such 'treatment resistant' patients, there is little by way of randomised controlled data to ...

  18. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study

    DEFF Research Database (Denmark)

    Worm, Signe Westring; Sabin, Caroline; Weber, Rainer


    BACKGROUND. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. METHODS. Poisson regression models were adjusted for cardiovascular risk...... factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. RESULTS. Over 178,835 person-years, 580 patients......% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. CONCLUSIONS. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI...

  19. Research on monitoring and management information integration technique in waste treatment and management

    International Nuclear Information System (INIS)

    Kong Jinsong; Yu Ren; Mao Wei


    The integration of the waste treatment process and the device status monitoring information and management information is a key problem required to be solved in the information integration of the waste treatment and management. The main content of the monitoring and management information integration is discussed in the paper. The data exchange techniques, which are based on the OPC, FTP and data push technology, are applied to the different monitoring system respectively, according to their development platform, to realize the integration of the waste treatment process and device status monitoring information and management information in a waste treatment center. (authors)

  20. Priming B cell-mediated anti-HIV envelope responses by vaccination allows for the long-term control of infection in macaques exposed to a R5-tropic SHIV

    International Nuclear Information System (INIS)

    Buckner, Clarisa; Gines, Leoned G.; Saunders, Cheryl J.; Vojtech, Lucia; Srivastava, Indresh; Gettie, Agegnehu; Bohm, Rudolph; Blanchard, James; Barnett, Susan W.; Safrit, Jeffrey T.; Stamatatos, Leonidas


    The potential of vaccine-elicited anti-HIV envelope antibodies to control HIV-infection was evaluated by immunizing macaques with the HIV envelope protein and transiently depleting them of their CD8+ cells before intravenous challenge with the pathogenic CCR5-tropic SIV/HIV chimeric virus, SHIV SF162P4 . Although sterilizing immunity was not achieved, all vaccinated animals effectively controlled infection and remained free of disease for the duration of observation (over 3 years). In contrast, during the same period, the control animals progressed to disease. Both the vaccinees and the controls developed robust cell-mediated antiviral and neutralizing antibody responses following infection. A comparative analysis of these responses suggests that the more effective long-term control of infection by the vaccinated animals is due to the more rapid development of anti-HIV envelope antibodies. These studies suggest that priming by vaccination of B cell anti-HIV envelope responses maybe crucial for the long-term control of HIV infection

  1. Cervical cancer and pregnancy: treatment management

    International Nuclear Information System (INIS)

    Lazar, I.; Toth, R.


    Pregnancy and cervical carcinoma occurring concomitantly causes therapeutic and ethical dilemmas. The management for this situation will depend on the gestational age at the time of diagnosis, disease staging, size of the lesion and the patient’s wish to maintain pregnancy and fertility. Review of the literature suggest that pregnancy does not seem to influence the prognosis of cervical cancer. (author)

  2. Management and treatment of distal ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Andrea Calafiore


    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.


    Energy Technology Data Exchange (ETDEWEB)



    This study evaluates parameters relevant to River Protection Project secondary waste streams generated during Early Low Activity Waste operations and recommends a strategy for secondary waste management that considers groundwater impact, cost, and programmatic risk. The recommended strategy for managing River Protection Project secondary waste is focused on improvements in the Effiuent Treatment Facility. Baseline plans to build a Solidification Treatment Unit adjacent to Effluent Treatment Facility should be enhanced to improve solid waste performance and mitigate corrosion of tanks and piping supporting the Effiuent Treatment Facility evaporator. This approach provides a life-cycle benefit to solid waste performance and reduction of groundwater contaminants.

  4. Expression of a Recombinant Anti-HIV and Anti-Tumor Protein, MAP30, in Nicotiana tobacum Hairy Roots: A pH-Stable and Thermophilic Antimicrobial Protein.

    Directory of Open Access Journals (Sweden)

    Ali Moghadam

    Full Text Available In contrast to conventional antibiotics, which microorganisms can readily evade, it is nearly impossible for a microbial strain that is sensitive to antimicrobial proteins to convert to a resistant strain. Therefore, antimicrobial proteins and peptides that are promising alternative candidates for the control of bacterial infections are under investigation. The MAP30 protein of Momordica charantia is a valuable type I ribosome-inactivating protein (RIP with anti-HIV and anti-tumor activities. Whereas the antimicrobial activity of some type I RIPs has been confirmed, less attention has been paid to the antimicrobial activity of MAP30 produced in a stable, easily handled, and extremely cost-effective protein-expression system. rMAP30-KDEL was expressed in Nicotiana tobacum hairy roots, and its effect on different microorganisms was investigated. Analysis of the extracted total proteins of transgenic hairy roots showed that rMAP30-KDEL was expressed effectively and that this protein exhibited significant antibacterial activity in a dose-dependent manner. rMAP30-KDEL also possessed thermal and pH stability. Bioinformatic analysis of MAP30 and other RIPs regarding their conserved motifs, amino-acid contents, charge, aliphatic index, GRAVY value, and secondary structures demonstrated that these factors accounted for their thermophilicity. Therefore, RIPs such as MAP30 and its derived peptides might have promising applications as food preservatives, and their analysis might provide useful insights into designing clinically applicable antibiotic agents.

  5. An anti-HIV-1 compound that increases steady-state expression of apoplipoprotein B mRNA-editing enzyme-catalytic polypeptide-like 3G. (United States)

    Ejima, Tomohiko; Hirota, Mayuko; Mizukami, Tamio; Otsuka, Masami; Fujita, Mikako


    Human apoplipoprotein B mRNA-editing enzyme-catalytic polypeptide-like (APOBEC) 3G (A3G) is an antiviral protein that blocks HIV-1 replication. However, the antiviral activity of A3G is overcome by the HIV-1 protein Vif. This inhibitory function of Vif is related to its ability to degrade A3G in the proteasome. This finding prompted us to examine the activities of 4-(dimethylamino)-2,6-bis[(N-(2-[(2-nitrophenyl)dithio]ethyl)amino)methyl]pyridine (SN-2) and SN-3. We found that 5 µM SN-2 increases the expression of A3G to a level much higher than that observed in the absence of Vif, without affecting the level of Vif expression. The proteasome inhibitor MG-132 increased the level of both A3G and Vif expression. These results demonstrate that A3G is ubiquitinated and degraded in the proteasome by a factor other than Vif, and that SN-2 selectively inhibits these processes. Furthermore, 5 µM SN-2 significantly inhibited the MAGI cell infectivity of wild-type HIV-1. These findings may contribute to the development of a novel anti-HIV-1 drug.

  6. Synthesis and anti-HIV activity of novel N-1 side chain-modified analogs of 1-[(2-hydroxyethoxy)methyl]-6-(phenylthio)thymine (HEPT). (United States)

    Pontikis, R; Benhida, R; Aubertin, A M; Grierson, D S; Monneret, C


    A series of 33 N-1 side chain-modified analogs of 1-[(2-hydroxyethoxy)methyl]-6-(phenylthio)thymine (1, HEPT) were synthesized and evaluated for their anti-HIV-1 activity. In particular, the influence of substitution of the terminal hydroxy group of the acyclic structure of HEPT and the structural rigidity of this side chain were investigated. Halo (7, 8), azido (9), and amino (10-15) derivatives were synthesized from HEPT via the p-tosylate derivative 6. Acylation of the primary amine 15 afforded the amido analogs 16-20. The diaryl derivatives 26-29 were prepared by reaction of HEPT, or of the 6-(2-pyridylthio) analog 23, with diaryl disulfides in the presence of tri-n-butylphosphine. Compounds 39-41, in which the N-1 side chain is rigidified by incorporation of an E-configured double bond, were obtained by palladium(0)-catalyzed coupling of several different 6-(arylthio)uracil derivatives (37, 38) with allyl acetates 33. Compounds 13, 40a,c,d,f, and 41, incorporating an aromatic ring at the end of the acyclic side chain, were found to be more potent than the known diphenyl-substituted HEPT analog BPT (2), two of them, 40c,d, being 10-fold more active.

  7. Formação, práticas e trajetórias de aconselhadores de centros de testagem anti-HIV do Rio de Janeiro, Brasil

    Directory of Open Access Journals (Sweden)

    Claudia Mora


    Full Text Available Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.

  8. High throughput virtual screening and in silico ADMET analysis for rapid and efficient identification of potential PAP248-286 aggregation inhibitors as anti-HIV agents (United States)

    Malik, Ruchi; Bunkar, Devendra; Choudhary, Bhanwar Singh; Srivastava, Shubham; Mehta, Pakhuri; Sharma, Manish


    Human semen is principal vehicle for transmission of HIV-1 and other enveloped viruses. Several endogenous peptides present in semen, including a 39-amino acid fragments of prostatic acid phosphatase (PAP248-286) assemble into amyloid fibrils named as semen-derived enhancer of viral infection (SEVI) that promote virion attachment to target cells which dramatically enhance HIV virus infection by up to 105-fold. Epigallocatechin-3-gallate (EGCG), a polyphenolic compound, is the major catechin found in green tea which disaggregates existing SEVI fibers, and inhibits the formation of SEVI fibers. The aim of this study was to screen a number of relevant polyphenols to develop a rational approach for designing PAP248-286 aggregation inhibitors as potential anti-HIV agents. The molecular docking based virtual screening results showed that polyphenolic compounds 2-6 possessed good docking score and interacted well with the active site residues of PAP248-286. Amino acid residues of binding site namely; Lys255, Ser256, Leu258 and Asn265 are involved in binding of these compounds. In silico ADMET prediction studies on these hits were also found to be promising. Polyphenolic compounds 2-6 identified as hits may act as novel leads for inhibiting aggregation of PAP248-286 into SEVI.

  9. Prevalence, Modes of Management and Treatment outcomes ...

    African Journals Online (AJOL)



    Jan 31, 2003 ... Treatment for Tuberculosis and AIDS depends on the CD4 levels and that TB was treated first before HAART in the ... No side effects from the drug therapy were observed in all patients involved in this .... ARV when CD4 fall below 200. ... Tuberculosis research-Balancing ... Manual of the NTLP in Tanzania.

  10. Effects of ecosystem-based management treatments (United States)

    Michael G. Harrington; Carl E. Fiedler; Stephen F. Arno; Ward W. McCaughey; Leon J. Theroux; Clinton E. Carlson; Kristin L. Zouhar; Thomas H. DeLuca; Donald J. Bedunah; Dayna M. Ayers; Elizabeth A. Beringer; Sallie J. Hejl; Lynn Bacon; Robert E. Benson; Jane Kapler Smith; Rick Floch


    The prescribed burn treatments were applied to reduce pre-existing and new slash fuel loadings, reduce understory tree density to lower crown fire potential, stimulate vigor of decadent understory vegetation, produce mineral seedbeds for seral species establishment, and increase availability of mineral nutrients. To test the feasibility of prescribed burning under a...

  11. Common Variable Immunodeficiency: Diagnosis, Management, and Treatment. (United States)

    Abbott, Jordan K; Gelfand, Erwin W


    Common variable immunodeficiency (CVID) refers to a grouping of antibody deficiencies that lack a more specific genetic or phenotypic classification. It is the immunodeficiency classification with the greatest number of constituents, likely because of the numerous ways in which antibody production can be impaired and the frequency in which antibody production becomes impaired in human beings. CVID comprises a heterogeneous group of rare diseases. Consequently, CVID presents a significant challenge for researchers and clinicians. Despite these difficulties, both our understanding of and ability to manage this grouping of complex immune diseases has advanced significantly over the past 60 years. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Management of HBV Infection During Immunosuppressive Treatment


    Marzano, Alfredo


    The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and refers mainly to the pre-antivirals era. Currently, a rational approach to the problem of hepatitis B in these patients provides for: a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), b) the treatment with antivirals (therapy) of active carriers, c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if...

  13. Assessment, management and treatment of acute fingertip injuries. (United States)

    Kearney, Anthony; Canty, Louise


    Fingertip injuries with nail bed trauma can require specialist hand surgery, depending on severity. However, most of these injuries can be managed in well-equipped emergency departments by emergency nurses with an in-depth knowledge and understanding of the anatomy and physiology of the fingernail and surrounding structures, assessment and examination, pain management and treatment. This article describes the surface and underlying anatomy and physiology of the nail, the most common mechanisms of injury, relevant diagnostic investigations, and initial assessment and management. It also discusses treatment options, referral pathways, and patient discharge advice.

  14. Pleural effusion: diagnosis, treatment, and management (United States)

    Karkhanis, Vinaya S; Joshi, Jyotsna M


    A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula. PMID:27147861

  15. Options for Healthcare Waste Management and Treatment in China

    Institute of Scientific and Technical Information of China (English)


    Healthcare waste management and treatment is one of the national priority tasks of China's Tenth Five-Year Plan.Numerous installations disposing medical waste have already operated the project or under construction to the operation in 2006. This paper focuses on the assessment of existing and fu~re options to handle medical waste (MW). Internationally available and so far in China applied technologies and management practice are analysed, including the problems how to materials. Non-hazardous MW can be managed and treated in analogue to municipal solid waste (MSW). In most of the European countries decentralised hospital incinerators have been, because of high operation costs and pollution problems,widely banned and replaced by pre-treatment technologies at the source and centralised incineration plants for hazardous MW.Information for adapting and further developing MW management solutions and treatment technologies in China and applying the most appropriate MWM practice is provided.

  16. Hilar cholangiocarcinoma: diagnosis, treatment options, and management (United States)

    Soares, Kevin C.; Kamel, Ihab; Cosgrove, David P.; Herman, Joseph M.


    Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6th decade of life. Of the 3,000 cases seen annually in the United States, less than one half of these tumors are resectable. A variety of risk factors have been associated with HC, most notably primary sclerosing cholangitis (PSC), biliary stone disease and parasitic liver disease. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Computed topography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are used to characterize biliary lesions. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) assess local ductal extent of the tumor while allowing for therapeutic biliary drainage. MRCP has demonstrated similar efficacies to PTC and ERCP in identifying anatomic extension of tumors with less complications. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. Local resection should not be undertaken. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Five-year survival after surgical resection of HC ranges from 10% to 40% however, recurrence can be as high as 50-70% even after R0 resection. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease. PMID:24696835

  17. Contingency management for the treatment of methamphetamine use disorders. (United States)

    Roll, John M; Petry, Nancy M; Stitzer, Maxine L; Brecht, Mary L; Peirce, Jessica M; McCann, Michael J; Blaine, Jack; MacDonald, Marilyn; DiMaria, Joan; Lucero, Leroy; Kellogg, Scott


    Theory and some preliminary evidence suggest that contingency management may be an effective treatment strategy or adjunct to psychosocial treatment for methamphetamine use disorders. An experimentally rigorous investigation on the topic was provided by a large multisite trial conducted under the auspices of the Clinical Trials Network of the National Institute on Drug Abuse. The authors report data on 113 participants who were diagnosed with methamphetamine abuse or dependence. They were randomly assigned to receive 12 weeks of either treatment as usual or treatment as usual plus contingency management. Urine samples were tested for illicit drugs, and breath samples were tested for alcohol. The reinforcers for drug-negative samples were plastic chips, some of which could be exchanged for prizes. The number of plastic chips drawn increased with each week of negative samples but was reset to one after a missed or positive sample. The participants in both groups remained in treatment for equivalent times, but those receiving contingency management in addition to usual treatment submitted significantly more negative samples, and they were abstinent for a longer period of time (5 versus 3 weeks). These results suggest that contingency management has promise as a component in treatment strategies for methamphetamine use disorder.

  18. Sports Hernia: Diagnosis, Management and Operative Treatment (United States)

    Emblom, Benton A.


    Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.

  19. Aconselhamento pós-teste anti-HIV: análise à luz de uma teoria humanística de Enfermagem Consejería pós test Anti-HIV: análisis a luz de una teoría humanistica de enfermería Anti-HIV after-test counselling: analysis at a light of a Nursing humanistic theory

    Directory of Open Access Journals (Sweden)

    Maria Alix Leite Araújo


    Full Text Available Este trabalho analisa o aconselhamento pós-teste anti-HIV em Unidades Básicas de Saúde. Trata-se de um estudo qualitativo desenvolvido em Unidades Básicas de Saúde da Família de Fortaleza (UBASF. O trabalho de campo ocorreu pela observação do atendimento de 12 enfermeiros em consultas de pré-natal. O referencial teórico de análise foi a Teoria Humanística de Enfermagem de Paterson e Zderad visto que a Enfermagem, segundo a teoria, implica um tipo especial de encontro entre seres humanos. A análise baseou-se no conceito de diálogo, tendo como variáveis seus elementos estruturais: o encontro, o relacionamento, a presença e o chamado, e a resposta. Observou-se que a assistência às gestantes não atingiu o relacionamento EU-TU, ou seja, o relacionamento sujeito-sujeito, com a presença do diálogo genuíno. Prevaleceu o relacionamento EU-ISSO, sujeito-objeto. As consultas eram rápidas e puramente mecânicas, levando esses profissionais, em certos momentos, a fugirem de uma assistência humanizada.Este trabajo analiza el pos test de consejería anti-HIV en las Unidades Básicas de Salud. Es un estudio cualitativo desarrollado en las Unidades Básicas de Salud de la Familia en la ciudad de Fortaleza (UBASF. El trabajo de campo sucedió por la observación de la asistencia de 12 enfermeros en las consultas de pré-natal. El referencial teórico de análisis fué la Teoría Humanistica de Paterson y Zderad de Enfermería, visto en la enfermería, según la teoría, implica en un tipo especial de encuentro entre los seres humanos. El análisis era basado en el concepto de diálogo, teniendo como las variables sus elementos estructurales: el encuentro, la relación, la presencia y el llamamiento y la respuesta. Fue observado que la ayuda a la embarazada no alcanzó la relación YO-USTED, en otros términos, el sujeto-sujeto de la relación, con la presencia del diálogo auténtico. La relación que prevaleció era el YO-AQUEL, sujeto


    Directory of Open Access Journals (Sweden)

    Alfredo Marzano


    Full Text Available

    The literature on hepatitis B virus (HBV in immunocompromised patients is heterogeneous and refers mainly to the pre-antivirals era. Currently, a rational approach to the problem of hepatitis B in these patients provides for: a the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline, b the treatment with antivirals (therapy of active carriers, c the pre-emptive use of antivirals (prophylaxis in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, d the biochemical and HBsAg monitoring (or universal prophylaxis in case of high risk immunosuppression, as in onco-haematologic patients and bone marrow transplantation in subjects with markers of previous contact with HBV (HBsAg-negative and antiHBc-positive, in order to prevent reverse seroconversion.

    Moreover in solid organ transplants it is suggested a strict adherence to the criteria of allocation based on the virological characteristics of both recipients and donors  and the universal prophylaxis or therapy with nucleos(tides analogs

  1. Drug delivery strategies and systems for HIV/AIDS pre-exposure prophylaxis and treatment. (United States)

    Nelson, Antoinette G; Zhang, Xiaoping; Ganapathi, Usha; Szekely, Zoltan; Flexner, Charles W; Owen, Andrew; Sinko, Patrick J


    The year 2016 will mark an important milestone - the 35th anniversary of the first reported cases of HIV/AIDS. Antiretroviral Therapy (ART) including Highly Active Antiretroviral Therapy (HAART) drug regimens is widely considered to be one of the greatest achievements in therapeutic drug research having transformed HIV infection into a chronically managed disease. Unfortunately, the lack of widespread preventive measures and the inability to eradicate HIV from infected cells highlight the significant challenges remaining today. Moving forward there are at least three high priority goals for anti-HIV drug delivery (DD) research: (1) to prevent new HIV infections from occurring, (2) to facilitate a functional cure, i.e., when HIV is present but the body controls it without drugs and (3) to eradicate established infection. Pre-exposure Prophylaxis (PrEP) represents a significant step forward in preventing the establishment of chronic HIV infection. However, the ultimate success of PrEP will depend on achieving sustained antiretroviral (ARV) tissue concentrations and will require strict patient adherence to the regimen. While first generation long acting/extended release (LA/ER) DD Systems (DDS) currently in development show considerable promise, significant DD treatment and prevention challenges persist. First, there is a critical need to improve cell specificity through targeting in order to selectively achieve efficacious drug concentrations in HIV reservoir sites to control/eradicate HIV as well as mitigate systemic side effects. In addition, approaches for reducing cellular efflux and metabolism of ARV drugs to prolong effective concentrations in target cells need to be developed. Finally, given the current understanding of HIV pathogenesis, next generation anti-HIV DDS need to address selective DD to the gut mucosa and lymph nodes. The current review focuses on the DDS technologies, critical challenges, opportunities, strategies, and approaches by which novel

  2. An improved protocol for efficient engraftment in NOD/LTSZ-SCIDIL-2Rγnull mice allows HIV replication and development of anti-HIV immune responses.

    Directory of Open Access Journals (Sweden)

    Maneesh Singh

    Full Text Available Cord blood hematopoietic progenitor cells (CB-HPCs transplanted immunodeficient NOD/LtsZ-scidIL2Rγ(null (NSG and NOD/SCID/IL2Rγ(null (NOG mice need efficient human cell engraftment for long-term HIV-1 replication studies. Total body irradiation (TBI is a classical myeloablation regimen used to improve engraftment levels of human cells in these humanized mice. Some recent reports suggest the use of busulfan as a myeloablation regimen to transplant HPCs in neonatal and adult NSG mice. In the present study, we further ameliorated the busulfan myeloablation regimen with fresh CB-CD34+cell transplantation in 3-4 week old NSG mice. In this CB-CD34+transplanted NSG mice engraftment efficiency of human CD45+cell is over 90% in peripheral blood. Optimal engraftment promoted early and increased CD3+T cell levels, with better lymphoid tissue development and prolonged human cell chimerism over 300 days. These humanized NSG mice have shown long-lasting viremia after HIV-1JRCSF and HIV-1Bal inoculation through intravenous and rectal routes. We also saw a gradual decline of the CD4+T cell count, widespread immune activation, up-regulation of inflammation marker and microbial translocation after HIV-1 infection. Humanized NSG mice reconstituted according to our new protocol produced, moderate cellular and humoral immune responses to HIV-1 postinfection. We believe that NSG mice reconstituted according to our easy to use protocol will provide a better in vivo model for HIV-1 replication and anti-HIV-1 therapy trials.

  3. Present and New Treatment Strategies in the Management of Glaucoma

    DEFF Research Database (Denmark)

    Kolko, Miriam


    risk factor for progression of the disease. However, it is clear that a significant number of glaucoma patients show disease progression despite of pressure lowering treatments. Much attention has been given to the development of neuroprotective treatment strategies, but the identification of such has...... of RGCs. In this matter, recent approaches aim to rescue RGCs and regenerate axons in order to restore visual function in glaucoma. The present review seeks to provide an overview of the present and new treatment strategies in the management of glaucoma. The treatment strategies are divided into current...

  4. Desenvolvimento de formulações e tecnologia de obtenção de comprimidos revestidos de efavirenz: terapia anti-HIV Development of formulations and technology of efavirenz coated tablets obtention: anti-HIV therapy

    Directory of Open Access Journals (Sweden)

    Osnir de Sá Viana


    Full Text Available O efavirenz é uma das mais recentes classes de agentes anti-retrovirais aplicados no tratamento de infecções por HIV. Está entre os medicamentos de primeira escolha no tratamento da AIDS. Como o efavirenz possui característica hidrofóbica, baixa densidade e oferece grande resistência ao escoamento, a escolha de uma formulação adequada deste fármaco é essencial no desenvolvimento dos comprimidos e para garantir melhor disponibilização no trato gastrointestinal, de forma a alcançar a biodisponibilidade e o efeito terapêutico desejados. Neste trabalho, apresentamos, de forma lógica, o desenvolvimento tecnológico de comprimidos revestidos de efavirenz, levando em consideração suas características físicas e físico-químicas. Os núcleos (comprimidos de efavirenz foram obtidos utilizando-se a técnica de granulação por via úmida. No revestimento por película utilizou-se Opadry® Y-1-7000 em sistema aquoso. Os parâmetros adotados para avaliação física dos comprimidos seguiram as especificações farmacopéicas oficiais e a determinação quantitativa foi realizada mediante método analítico desenvolvido e validado.Efavirenz is one of the most recent classes of anti-retroviral drugs used in the treatment of HIV infections. It is the first choice therapy for AIDS treatment. As efavirenz detains hydrofobic characteristic, low density and offers great resistance to draining, it has been essential to choose an adequated formulation for it, in order to guarantee drug's availability in gastro-intestinal tract, achieving bioavailability and expected therapeutical effects. This work presents efavirez coated tablets thecnological development, considering the physics and physico-chemical characteristics of this drug. The efavirez nucleus (tablets has been obtained employing granulation technics by humid via. In the coating by film, Opadry Y-1-7000 in aquous system was used. The adopted parameters to tablet phisics evaluation

  5. Orthodontic management by functional activator treatment: a case report. (United States)

    Aprile, Giuseppe; Ortu, Eleonora; Cattaneo, Ruggero; Pietropaoli, Davide; Giannoni, Mario; Monaco, Annalisa


    Managing orthodontic treatment is often very difficult for the orthodontist. Many devices are used during the orthopedic phase of orthodontic treatment, always with different functions. We describe a case of orthodontic management treated with the Equilibrator O.S.A. device (equilibrator designed by Ovidi, Santi, and Aprile for Eptamed SRL; Cesena, Italy; ). A healthy 10-year-old white boy presented with a skeletal class II, division 1 malocclusion, molar class II, exhibiting an overjet of 7 mm prior to treatment. For treatment, we only used the Equilibrator O.S.A. device. We successfully treated an orthopedic/orthodontic case with a particular device that we describe here.

  6. Treatment principles for the management of mold infections. (United States)

    Kontoyiannis, Dimitrios P; Lewis, Russell E


    Survival rates among immunocompromised patients with invasive mold infections have markedly improved over the last decade with earlier diagnosis and new antifungal treatment options. Yet, increasing antifungal resistance, breakthrough infections with intrinsically resistant fungi, and potentially life-threatening adverse effects and drug interactions are becoming more problematic, especially with prolonged therapy. Evidence-based recommendations for treating invasive aspergillosis and mucormycosis provide excellent guidance on the initial workup and treatment of these molds, but they cannot address all of the key management issues. Herein, we discuss 10 general treatment principles in the management of invasive mold disease in immunocompromised patients and discuss how these principles can be integrated to develop an effective, individualized treatment plan. Copyright © 2015 Cold Spring Harbor Laboratory Press; all rights reserved.



    Abida*, Md. Tauqir Alam, Mohd. Imran, Said A.H. El-Feky, Mohamed A.M. Hagga


    Fibromyalgia is a disorder, which is characterized by widespread musculoskeletal pain accompanied by fatigue, memory, mood, and sleep issues. Scientists believe that this condition may be due to injury, emotional distress, or viruses that change the way the brain perceives pain, but the exact cause is unclear. Generally, fibromyalgia is treated with antidepressants, pain relievers, and Anti-seizure drugs. There is not much specific treatment available for the treatment and management of fibro...

  8. Treatment interruptions: Statistics, causes and management in service radiotherapy

    International Nuclear Information System (INIS)

    Ferrando Sanchez, A.; Milanes Gaillet, A. I.; Eugui Martinez, R.; Crespo Diaz, M. P.


    Despite the clinical maximum administer the prescribed dose at a given time, treatment interruptions are unavoidable in practice. In tumors quickly reproduce no evidence that the prolongation thereof entails loss of tumor control. It has tracked two of these conditions: squamous cell cancer of the head and neck (SCCHN) and lung cancer (NSCLC) over 2011 and 2012 to evaluate both the number of stops treatment as the reason for them and its management. (Author)

  9. Weight Management Preferences in a Non-Treatment Seeking Sample

    Directory of Open Access Journals (Sweden)

    Victoria B. Barry


    Full Text Available Background: Obesity is a serious public health issue in the United States, with the CDC reporting that most adult Americans are now either overweight or obese. Little is known about the comparative acceptability of available weight management approaches in non-treatment seeking samples. Method: This report presents preliminary survey data collected from an online sample on weight management preferences for 8 different weight management strategies including a proposed incentive-based program. Participants were 72 individuals (15 men, 55 women and 2 transgendered individuals who self-re-ported being overweight or obese, or who currently self-reported a normal weight but had attempted to lose weight in the past. Results: ANOVA and Pair-wise comparison indicated clear preferences for certain treatments over others in the full sample; most notably, the most popular option in our sample for managing weight was to diet and exercise without professional assistance. Several differences in preference between the three weight groups were also observed. Conclusions: Dieting and exercising without any professional assistance is the most highly endorsed weight management option among all groups. Overweight and obese individuals may find self-management strategies for weight loss less attractive than normal weight individuals, but still prefer it to other alternatives. This has implications for the development and dissemination of empirically based self-management strategies for weight.

  10. Recombinant protein of heptad-repeat HR212, a stable fusion inhibitor with potent anti-HIV action in vitro

    International Nuclear Information System (INIS)

    Pang, Wei; Wang Ruirui; Yang Liumeng; Liu Changmei; Tien Po; Zheng Yongtang


    HR212, a recombinant protein expressed in Escherichia coli, has been previously reported to inhibit HIV-1 membrane fusion at low nanomolar level. Here we report that HR212 is effective in blocking laboratory strain HIV-1 IIIB entry and replication with EC 50 values of 3.92 ± 0.62 and 6.59 ± 1.74 nM, respectively, and inhibiting infection by clinic isolate HIV-1 KM018 with EC 50 values of 44.44 ± 10.20 nM, as well as suppressing HIV-1-induced cytopathic effect with an EC 50 value of 3.04 ± 1.20 nM. It also inhibited HIV-2 ROD and HIV-2 CBL-20 entry and replication in the μM range. Notably, HR212 was highly effective against T20-resistant strains with EC 50 values ranging from 5.09 to 7.75 nM. Unlike T20, HR212 showed stability sufficient to inhibit syncytia formation in a time-of-addition assay, and was insensitive to proteinase K digestion. These results suggest that HR212 has great potential to be further developed as novel HIV-1 fusion inhibitor for treatment of HIV/AIDS patients, particularly for those infected by T20-resistant variants

  11. Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study

    DEFF Research Database (Denmark)

    De Wit, Stephane; Sabin, Caroline A; Weber, Rainer


    OBJECTIVE: The aims of this study were to determine the incidence of diabetes among HIV-infected patients in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort, to identify demographic, HIV-related, and combination antiretroviral therapy (cART)-related factors associated...... with the onset of diabetes, and to identify possible mechanisms for any relationships found. RESEARCH DESIGN AND METHODS: D:A:D is a prospective observational study of 33,389 HIV-infected patients; diabetes is a study end point. Poisson regression models were used to assess the relation between diabetes...

  12. Compliance with standard treatment guidelines in the management ...

    African Journals Online (AJOL)

    Introduction: Hypertension is a leading lifestyle disease and major cause of morbidity and mortality in South Africa, and globally. Standard Treatment Guidelines are issued in this country to assist healthcare workers in the diagnosis and management there of. Considering the debilitating effects caused by hypertension, the ...

  13. Public and Private Management of Wastewater Treatment: A Comparative Study. (United States)

    O'Toole, Laurence J., Jr.


    The costs and performance of contract management of municipal wastewater treatment facilities are considered, using information from a nationwide empirical examination of evidence from individual plants, municipalities, and regulatory agencies. The broad issues arising in the evaluation are outlined as the specifics are discussed. (SLD)

  14. Self-management program in treatment of asthma

    Directory of Open Access Journals (Sweden)

    Milenković Branislava


    Full Text Available Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30 or to conventional treatment (Group B, n=30, with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist, courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p<0.05, unscheduled visits to ambulatory care facilities (p<0.005, days off work (p<0.0001, courses of oral prednisolone (p<0.001 and antibiotics (p<0.05. At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work, but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. Conclusion. These results suggest that peak-flow based self management is more effective than traditonal treatment in mild and moderate persistent asthma. .

  15. HIV-1 tat promotes integrin-mediated HIV transmission to dendritic cells by binding Env spikes and competes neutralization by anti-HIV antibodies.

    Directory of Open Access Journals (Sweden)

    Paolo Monini

    Full Text Available Use of Env in HIV vaccine development has been disappointing. Here we show that, in the presence of a biologically active Tat subunit vaccine, a trimeric Env protein prevents in monkeys virus spread from the portal of entry to regional lymph nodes. This appears to be due to specific interactions between Tat and Env spikes that form a novel virus entry complex favoring R5 or X4 virus entry and productive infection of dendritic cells (DCs via an integrin-mediated pathway. These Tat effects do not require Tat-transactivation activity and are blocked by anti-integrin antibodies (Abs. Productive DC infection promoted by Tat is associated with a highly efficient virus transmission to T cells. In the Tat/Env complex the cysteine-rich region of Tat engages the Env V3 loop, whereas the Tat RGD sequence remains free and directs the virus to integrins present on DCs. V2 loop deletion, which unshields the CCR5 binding region of Env, increases Tat/Env complex stability. Of note, binding of Tat to Env abolishes neutralization of Env entry or infection of DCs by anti-HIV sera lacking anti-Tat Abs, which are seldom present in natural infection. This is reversed, and neutralization further enhanced, by HIV sera containing anti-Tat Abs such as those from asymptomatic or Tat-vaccinated patients, or by sera from the Tat/Env vaccinated monkeys. Thus, both anti-Tat and anti-Env Abs are required for efficient HIV neutralization. These data suggest that the Tat/Env interaction increases HIV acquisition and spreading, as a mechanism evolved by the virus to escape anti-Env neutralizing Abs. This may explain the low effectiveness of Env-based vaccines, which are also unlikely to elicit Abs against new Env epitopes exposed by the Tat/Env interaction. As Tat also binds Envs from different clades, new vaccine strategies should exploit the Tat/Env interaction for both preventative and therapeutic interventions.

  16. Integrated Waste Treatment Unit GFSI Risk Management Plan

    International Nuclear Information System (INIS)

    W. A. Owca


    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP)

  17. A treatment model for craving identification and management. (United States)

    Stalcup, S Alex; Christian, Darrell; Stalcup, Janice; Brown, Michelle; Galloway, Gantt P


    This article presents an addiction treatment model based on craving identification and management (CIM). Craving is broadly defined as the desire to use alcohol or other drugs; it increases the likelihood of use of these substances. In the CIM Model treatment interventions are referenced to craving, i.e., helping clients to identify their craving level and equipping them with strategies to avoid use. Four causes of craving are identified: (1) environmental cues (triggers): exposure to people, places, and things associated with prior drug-using experiences may cause immediate and overwhelming craving; (2) stress: addicted persons experience stress as craving; (3) mental illness; and (4) drug withdrawal: symptoms of both mental illness and withdrawal lead to craving if clients associate use with relief of these symptoms. The CIM Model incorporates four service delivery elements: Relapse Prevention Workshop, individual counseling, medical/psychiatric services, and screening for ongoing drug use. At its core, the CIM Model asks clients to be aware of craving, analyze its causes, and, based on those causes, implement specific strategies to prevent and manage craving. The CIM Model combines several treatment components, including control of exposure to environmental cues, establishment of a daily schedule, the use of behaviors that dissipate craving (tools), and treatment (with medications when appropriate) of mental health and withdrawal symptoms. The CIM Model is a client-derived approach to achieving and maintaining sobriety based on a process of analyzing craving and managing it with an individualized program of recovery activities.

  18. Treatment, Therapy and Management of Metabolic Epilepsy: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Vanessa Lin Lin Lee


    Full Text Available Metabolic epilepsy is a metabolic abnormality which is associated with an increased risk of epilepsy development in affected individuals. Commonly used antiepileptic drugs are typically ineffective against metabolic epilepsy as they do not address its root cause. Presently, there is no review available which summarizes all the treatment options for metabolic epilepsy. Thus, we systematically reviewed literature which reported on the treatment, therapy and management of metabolic epilepsy from four databases, namely PubMed, Springer, Scopus and ScienceDirect. After applying our inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines, we reviewed a total of 43 articles. Based on the reviewed articles, we summarized the methods used for the treatment, therapy and management of metabolic epilepsy. These methods were tailored to address the root causes of the metabolic disturbances rather than targeting the epilepsy phenotype alone. Diet modification and dietary supplementation, alone or in combination with antiepileptic drugs, are used in tackling the different types of metabolic epilepsy. Identification, treatment, therapy and management of the underlying metabolic derangements can improve behavior, cognitive function and reduce seizure frequency and/or severity in patients.

  19. Energy Data Management Manual for the Wastewater Treatment Sector

    Energy Technology Data Exchange (ETDEWEB)

    Lemar, Paul [Resource Dynamics Corporation, McLean, VA (United States); De Fontaine, Andre [Dept. of Energy (DOE), Washington DC (United States)


    Energy efficiency has become a higher priority within the wastewater treatment sector, with facility operators and state and local governments ramping up efforts to reduce energy costs and improve environmental performance. Across the country, municipal wastewater treatment plants are estimated to consume more than 30 terawatt hours per year of electricity, which equates to about $2 billion in annual electric costs. Electricity alone can constitute 25% to 40% of a wastewater treatment plant’s annual operating budget and make up a significant portion of a given municipality’s total energy bill. These energy needs are expected to grow over time, driven by population growth and increasingly stringent water quality requirements. The purpose of this document is to describe the benefits of energy data management, explain how it can help drive savings when linked to a strong energy management program, and provide clear, step-by-step guidance to wastewater treatment plants on how to appropriately track energy performance. It covers the basics of energy data management and related concepts and describes different options for key steps, recognizing that a single approach may not work for all agencies. Wherever possible, the document calls out simpler, less time-intensive approaches to help smaller plants with more limited resources measure and track energy performance. Reviews of key, publicly available energy-tracking tools are provided to help organizations select a tool that makes the most sense for them. Finally, this document describes additional steps wastewater treatment plant operators can take to build on their energy data management systems and further accelerate energy savings.

  20. The management of esophageal achalasia: from diagnosis to surgical treatment. (United States)

    Dobrowolsky, Adrian; Fisichella, P Marco


    The goal of this review is to illustrate our approach to patients with achalasia in terms of preoperative evaluation and surgical technique. Indications, patient selection and management are herein discussed. Specifically, we illustrate the pathogenetic theories and diagnostic algorithm with current up-to-date techniques to diagnose achalasia and its manometric variants. Finally, we focus on the therapeutic approaches available today: medical and surgical. A special emphasis is given on the surgical treatment of achalasia and we provide the reader with a detailed description of our pre and postoperative management.

  1. Aconselhamento em DST/Aids às gestantes que realizaram o teste anti-HIV na admissão para o parto: os sentidos de uma prática

    Directory of Open Access Journals (Sweden)

    Patrícia de Lima Fonseca

    Full Text Available Foram analisadas as práticas e os sentidos do aconselhamento para gestantes submetidas ao teste anti-HIV na admissão para o parto, e para profissionais de saúde que atuam na assistência à maternidade em Salvador, Brasil. Foi realizado um estudo qualitativo em uma maternidade, com observação participante e entrevistas semiestruturadas com 13 puérperas sem diagnóstico prévio para o HIV e sete profissionais de saúde. Observou-se que o exame anti-HIV é realizado de forma compulsória, sem considerar a autonomia da gestante, e que o aconselhamento se limita a informar o diagnóstico e dar orientações no pós-teste somente àquelas cujos resultados foram positivos. Os sentidos que permeiam o exame, assim como o entendimento da experiência e os significados construídos pelas puérperas, sobretudo quando se descobrem positivas para o HIV, não são abordados pelos profissionais, que não se sentem capacitados para acolherem a subjetividade das pacientes.

  2. Aconselhamento em DST/Aids às gestantes que realizaram o teste anti-HIV na admissão para o parto: os sentidos de uma prática

    Directory of Open Access Journals (Sweden)

    Patrícia de Lima Fonseca


    Full Text Available Foram analisadas as práticas e os sentidos do aconselhamento para gestantes submetidas ao teste anti-HIV na admissão para o parto, e para profissionais de saúde que atuam na assistência à maternidade em Salvador, Brasil. Foi realizado um estudo qualitativo em uma maternidade, com observação participante e entrevistas semiestruturadas com 13 puérperas sem diagnóstico prévio para o HIV e sete profissionais de saúde. Observou-se que o exame anti-HIV é realizado de forma compulsória, sem considerar a autonomia da gestante, e que o aconselhamento se limita a informar o diagnóstico e dar orientações no pós-teste somente àquelas cujos resultados foram positivos. Os sentidos que permeiam o exame, assim como o entendimento da experiência e os significados construídos pelas puérperas, sobretudo quando se descobrem positivas para o HIV, não são abordados pelos profissionais, que não se sentem capacitados para acolherem a subjetividade das pacientes.

  3. 1,4-Bis(5-(naphthalen-1-yl)thiophen-2-yl)naphthalene, a small molecule, functions as a novel anti-HIV-1 inhibitor targeting the interaction between integrase and cellular Lens epithelium-derived growth factor. (United States)

    Gu, Wan-gang; Ip, Denis Tsz-Ming; Liu, Si-jie; Chan, Joseph H; Wang, Yan; Zhang, Xuan; Zheng, Yong-tang; Wan, David Chi-Cheong


    Translocation of viral integrase (IN) into the nucleus is a critical precondition of integration during the life cycle of HIV, a causative agent of Acquired Immunodeficiency Syndromes (AIDS). As the first discovered cellular factor to interact with IN, Lens epithelium-derived growth factor (LEDGF/p75) plays an important role in the process of integration. Disruption of the LEDGF/p75-IN interaction has provided a great interest for anti-HIV agent discovery. In this work, we reported that one small molecular compound, 1,4-bis(5-(naphthalen-1-yl)thiophen-2-yl)naphthalene(Compound 15), potently inhibit the IN-LEDGF/p75 interaction and affect the HIV-1 IN nuclear distribution at 1 μM. The putative binding mode of Compound 15 was constructed by a molecular docking simulation to provide structural insights into the ligand-binding mechanism. Compound 15 suppressed viral replication by measuring p24 antigen production in HIV-1IIIB acute infected C8166 cells with EC50 value of 11.19 μM. Compound 15 might supply useful structural information for further anti-HIV agent discovery. Copyright © 2014. Published by Elsevier Ireland Ltd.

  4. Sludge quantification at water treatment plant and its management scenario. (United States)

    Ahmad, Tarique; Ahmad, Kafeel; Alam, Mehtab


    Large volume of sludge is generated at the water treatment plants during the purification of surface water for potable supplies. Handling and disposal of sludge require careful attention from civic bodies, plant operators, and environmentalists. Quantification of the sludge produced at the treatment plants is important to develop suitable management strategies for its economical and environment friendly disposal. Present study deals with the quantification of sludge using empirical relation between turbidity, suspended solids, and coagulant dosing. Seasonal variation has significant effect on the raw water quality received at the water treatment plants so forth sludge generation also varies. Yearly production of the sludge in a water treatment plant at Ghaziabad, India, is estimated to be 29,700 ton. Sustainable disposal of such a quantity of sludge is a challenging task under stringent environmental legislation. Several beneficial reuses of sludge in civil engineering and constructional work have been identified globally such as raw material in manufacturing cement, bricks, and artificial aggregates, as cementitious material, and sand substitute in preparing concrete and mortar. About 54 to 60% sand, 24 to 28% silt, and 16% clay constitute the sludge generated at the water treatment plant under investigation. Characteristics of the sludge are found suitable for its potential utilization as locally available construction material for safe disposal. An overview of the sustainable management scenario involving beneficial reuses of the sludge has also been presented.

  5. Management of Spinal Deformities and Evidence of Treatment Effectiveness (United States)

    Bettany-Saltikov, Josette; Turnbull, Deborah; Ng, Shu Yan; Webb, Richard


    Introduction: The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults. Material and Methods: The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann’s disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included. Results: The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn. For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis

  6. Popular treatment modalities in the management of sacroiliac joint dysfunction

    Directory of Open Access Journals (Sweden)

    E.D. Watson


    Full Text Available The treatment of sacroiliac joint (SIJ dysfunction presents aclinical challenge for physiotherapists. The aim of this study was to investigatecurrent physiotherapy practise in the management of acute and chronic SIJdysfunction. A chart audit of 677 SIJ patient reports (N=677 from 75 differentprivate physiotherapy practises were analysed to determine the following:(1 the prevalence of the use of exercise therapy, and the types of exercise used inthe management of SIJ dysfunction, and (2 the prevalence of other therapeuticmodalities utilised alongside exercise therapy. The results of the study indicated thatuse of exercise therapy, specifically stretches and mobility exercises, is a popular treatment choice by physiotherapists.Joint mobilisations and soft tissue massage often accompanied exercise. Despite research outcomes suggesting both astrengthening and stabilisation program for the lumbo-pelvic complex, these approaches were less favoured.

  7. Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam. (United States)

    Phuong, N T M; Nhung, N V; Hoa, N B; Thuy, H T; Takarinda, K C; Tayler-Smith, K; Harries, A D


    The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009. To document the annual numbers of patients enrolled for multidrug-resistant tuberculosis (MDR-TB) treatment during 2010-2014 and to determine characteristics and treatment outcomes of patients initiating treatment during 2010-2012. A retrospective cohort study using national reports and data from the national electronic data system for drug-resistant TB. The number of patients enrolled annually for MDR-TB treatment increased from 97 in 2010 to 1522 in 2014. The majority of patients were middle-aged men who had pulmonary disease and had failed a retreatment regimen; 77% had received ⩾2 courses of TB treatment. Favourable outcomes (cured and treatment completed) were attained in 73% of patients. Unfavourable outcomes included loss to follow-up (12.5%), death (8%) and failure (6.3%). Having had ⩾2 previous treatment courses and being human immunodeficiency virus-positive were associated with unfavourable outcomes. Increasing numbers of patients are being treated for MDR-TB each year with good treatment outcomes under national programme management in Viet Nam. However, there is a need to increase case detection-currently at 30% of the estimated 5100 MDR-TB cases per year, reduce adverse outcomes and improve monitoring and evaluation.

  8. Development of Nuclear Control and Management Information Treatment System

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, J. G.; Lee, B. D.; So, D. S. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)


    To implement obligations under the Non-Proliferation Treaty (NPT) and the bilateral agreements more effectively, we proposed a computerized system named the Nuclear Control and Management Information Treatment System (NCAMITS) as a part of the Nuclear Transparency Enhancement Project at the Korea Atomic Energy Research Institute (KAERI). The database system is designed not only to undertake the facility-level accounting for and control of nuclear material at KAERI, but also to meet the requirements of the State (National) System of Accounting and Control (SSAC). Since the NCAMITS will provide services for the facility operators as well as the safeguard information managers at KAERI, the development of the system is supposed to accommodate the end-user's convenience and the manager's sophisticated specifications as well.

  9. Current and emerging treatments for the management of osteogenesis imperfecta (United States)

    Monti, Elena; Mottes, Monica; Fraschini, Paolo; Brunelli, PierCarlo; Forlino, Antonella; Venturi, Giacomo; Doro, Francesco; Perlini, Silvia; Cavarzere, Paolo; Antoniazzi, Franco


    Osteogenesis imperfecta (OI) is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II), in which the problem is survival at birth; the severe and moderate forms (types III–IX), in which the objective is ‘autonomy’; and the mild form (type I), in which the aim is to reach ‘normal life’. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting), surgical management (intramedullary rod positioning, spinal and basilar impression surgery) and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI). Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment. PMID:20856683

  10. Managing AVN following internal fixation: treatment options and clinical results. (United States)

    Hoskinson, Simon; Morison, Zachary; Shahrokhi, Shahram; Schemitsch, Emil H


    Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Managed care and the quality of substance abuse treatment. (United States)

    Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H


    In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that

  12. Current and emerging treatment options in the management of lupus (United States)

    Jordan, Natasha; D’Cruz, David


    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. PMID:27529058

  13. The management of shoreline protection and treatment operations

    International Nuclear Information System (INIS)

    Owens, E.H.


    The management of shoreline cleaning operations in the event of an oil spill, was discussed. An eight-step approach was introduced which was based on the definition of objectives and strategies. The discussion included evaluation of the feasibility of each of these strategies, as well as the effects of the proposed actions. It was emphasized that apart from natural recovery, any response action will have an effect either directly, by the protection or treatment actions, or indirectly, by the support actions, on the shore zone or the adjacent backshore. The main purpose of a response is to accelerate natural recovery. This new response approach can be an effective management tool, since the use of standard terms and strategy statements give operations personnel a well defined set of instruction which reduce the potential for misinterpretation. 4 refs., 9 figs

  14. Biological control and management of the detoxication wastewater treatment technologies

    Directory of Open Access Journals (Sweden)

    Topalova Yana


    Full Text Available Detoxication technologies require the combination of theoretical and practical knowledge of xenobiotic biodegradation, wastewater treatment technologies, and management rules. The purpose of this complicated combination is to propose specialized strategies for detoxication, based on lab- and pilot-scale modeling. These strategies include preliminary created algorithms for preventing the risk of water pollution and sediments. The technologies and algorithms are essentially important outcome, applied in the textile, pharmaceutical, cosmetic, woodtreating, and oiltreating industries. In this paper four rehabilitation technologies for pretreatment of water contaminated by pentachlorophenol (PCP have been developed in the frame of the European and Bulgarian National projects. Emphasize is put on the biological systems and their potential of detoxication management. The light and transmission electron microscopy of the reconstructed activated sludges the microbial, kinetic and enzymological indicators are presented and approved as critical points in the biocontrol.

  15. Medical treatment and management of patients with dementia. (United States)

    Dening, Tom; Babu Sandilyan, Malarvizhi


    This article, the fifth in a series on dementia, discusses the principles of management and treatment of people with dementia. It describes how to proceed after a diagnosis of dementia has been made in the early stages of the condition, and general measures to maintain physical and mental health. Drug therapy for cognitive dysfunction is explained in the context of the National Institute for Health and Care Excellence guidance, and strategies for managing depression and psychotic symptoms are outlined. Non-pharmacological approaches are often effective. For behavioural problems such as agitation and aggression, it is important to try to understand any underlying factors. In general, the most important strategy is to avoid excessive prescribing.

  16. Management of Hyposalivation and Xerostomia: Criteria for Treatment Strategies. (United States)

    Epstein, Joel B; Beier Jensen, Siri


    Saliva management in patients with hyposalivation is potentially complex. Future development of oral care products and treatment strategies requires attention to the biology of saliva and the best means of providing a continuum of relief for people with xerostomia--the sensation of dry mouth--and hyposalivation--documented reduction in saliva flow. Improvement in patient care requires that clinicians be aware of approaches to management, desirable qualities of methods and products, and that they seek the development of products that support the functions of saliva and promote comfort and health. In this brief review of the epidemiology of hyposalivation, the biology and functions of saliva are presented in order to guide clinical decision-making to address the needs of patients with dry mouth.

  17. Ectopic expression of anti-HIV-1 shRNAs protects CD8{sup +} T cells modified with CD4ζ CAR from HIV-1 infection and alleviates impairment of cell proliferation

    Energy Technology Data Exchange (ETDEWEB)

    Kamata, Masakazu, E-mail: [Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Kim, Patrick Y. [Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Ng, Hwee L. [Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Ringpis, Gene-Errol E.; Kranz, Emiko; Chan, Joshua; O' Connor, Sean [Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Yang, Otto O. [Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); UCLA AIDS Institute, Los Angeles, CA (United States); AIDS Healthcare Foundation, Los Angeles, CA (United States); Chen, Irvin S.Y. [Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); UCLA AIDS Institute, Los Angeles, CA (United States)


    Chimeric antigen receptors (CARs) are artificially engineered receptors that confer a desired specificity to immune effector T cells. As an HIV-1-specific CAR, CD4ζ CAR has been extensively tested in vitro as well as in clinical trials. T cells modified with this CAR mediated highly potent anti-HIV-1 activities in vitro and were well-tolerated in vivo, but exerted limited effects on viral load and reservoir size due to poor survival and/or functionality of the transduced cells in patients. We hypothesize that ectopic expression of CD4ζ on CD8{sup +} T cells renders them susceptible to HIV-1 infection, resulting in poor survival of those cells. To test this possibility, highly purified CD8{sup +} T cells were genetically modified with a CD4ζ-encoding lentiviral vector and infected with HIV-1. CD8{sup +} T cells were vulnerable to HIV-1 infection upon expression of CD4ζ as evidenced by elevated levels of p24{sup Gag} in cells and culture supernatants. Concurrently, the number of CD4ζ-modified CD8{sup +} T cells was reduced relative to control cells upon HIV-1 infection. To protect these cells from HIV-1 infection, we co-expressed two anti-HIV-1 shRNAs previously developed by our group together with CD4ζ. This combination vector was able to suppress HIV-1 infection without impairing HIV-1-dependent effector activities of CD4ζ. In addition, the number of CD4ζ-modified CD8{sup +} T cells maintained similar levels to that of the control even under HIV-1 infection. These results suggest that protecting CD4ζ-modified CD8{sup +} T cells from HIV-1 infection is required for prolonged HIV-1-specific immune surveillance. - Highlights: • Ectopic expression of CD4ζ CAR in CD8{sup +} T cells renders them susceptible to HIV-1 infection. • Co-expression of two anti-HIV-1 shRNAs protects CD4ζ CAR-modified CD8{sup +} T cells from HIV-1 infection. • Protecting CD4ζ CAR-modified CD8{sup +} T cells from HIV-1 infection suppresses its cytopathic effect.

  18. Ectopic expression of anti-HIV-1 shRNAs protects CD8+ T cells modified with CD4ζ CAR from HIV-1 infection and alleviates impairment of cell proliferation

    International Nuclear Information System (INIS)

    Kamata, Masakazu; Kim, Patrick Y.; Ng, Hwee L.; Ringpis, Gene-Errol E.; Kranz, Emiko; Chan, Joshua; O'Connor, Sean; Yang, Otto O.; Chen, Irvin S.Y.


    Chimeric antigen receptors (CARs) are artificially engineered receptors that confer a desired specificity to immune effector T cells. As an HIV-1-specific CAR, CD4ζ CAR has been extensively tested in vitro as well as in clinical trials. T cells modified with this CAR mediated highly potent anti-HIV-1 activities in vitro and were well-tolerated in vivo, but exerted limited effects on viral load and reservoir size due to poor survival and/or functionality of the transduced cells in patients. We hypothesize that ectopic expression of CD4ζ on CD8 + T cells renders them susceptible to HIV-1 infection, resulting in poor survival of those cells. To test this possibility, highly purified CD8 + T cells were genetically modified with a CD4ζ-encoding lentiviral vector and infected with HIV-1. CD8 + T cells were vulnerable to HIV-1 infection upon expression of CD4ζ as evidenced by elevated levels of p24 Gag in cells and culture supernatants. Concurrently, the number of CD4ζ-modified CD8 + T cells was reduced relative to control cells upon HIV-1 infection. To protect these cells from HIV-1 infection, we co-expressed two anti-HIV-1 shRNAs previously developed by our group together with CD4ζ. This combination vector was able to suppress HIV-1 infection without impairing HIV-1-dependent effector activities of CD4ζ. In addition, the number of CD4ζ-modified CD8 + T cells maintained similar levels to that of the control even under HIV-1 infection. These results suggest that protecting CD4ζ-modified CD8 + T cells from HIV-1 infection is required for prolonged HIV-1-specific immune surveillance. - Highlights: • Ectopic expression of CD4ζ CAR in CD8 + T cells renders them susceptible to HIV-1 infection. • Co-expression of two anti-HIV-1 shRNAs protects CD4ζ CAR-modified CD8 + T cells from HIV-1 infection. • Protecting CD4ζ CAR-modified CD8 + T cells from HIV-1 infection suppresses its cytopathic effect

  19. Current and emerging treatments for the management of osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Elena Monti


    Full Text Available Elena Monti1, Monica Mottes1, Paolo Fraschini2, PierCarlo Brunelli3, Antonella Forlino4, Giacomo Venturi1, Francesco Doro1, Silvia Perlini1, Paolo Cavarzere1, Franco Antoniazzi11Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy; 2Istituto Di Ricovero e Cura a Carattere Scientifico, ‘E. Medea’, Associazione La Nostra Famiglia, Bosisio Parini (LC, Italy; 3Divisione di Ortopedia Pediatrica, Spedali Civili, Brescia, Italy; 4Department of Biochemistry “A. Castellani”, University of Pavia, ItalyAbstract: Osteogenesis imperfecta (OI is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II, in which the problem is survival at birth; the severe and moderate forms (types III–IX, in which the objective is ‘autonomy’; and the mild form (type I, in which the aim is to reach ‘normal life’. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting, surgical management (intramedullary rod positioning, spinal and basilar impression surgery and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI. Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment.Keywords: osteogenesis imperfecta, bone genetic disorder, bone brittleness, “brittle bone disease”, connective tissue malfunction, short


    Directory of Open Access Journals (Sweden)

    Floramis Pérez Martín


    Full Text Available The aim of this paper is to assess the current operating and safety conditions of biological treatment systems for wastewater in the centers of swinish and poultry breeding at Villa Clara Water Management Company, with the purpose of setting a group of organizational, technical and human measures that contributes to prevent contamination and minimize biological risks. In this way it can be guaranteed the protection to the workers, the facilities, community and the environment, to have a sure occupational atmosphere in the organization. As a result of the evaluation the factors that affect the operation of the biodigestion system and the security of the process are defined.

  1. Motivation and Contingency Management Treatments for Substance Use Disorders. (United States)

    Walter, Kimberly N; Petry, Nancy M


    Contingency management (CM) is a highly efficacious psychosocial treatment for substance use disorders based on the principles of behavioral analysis. CM involves delivering a tangible positive reinforcer following objective evidence of submission of a drug-negative urine sample. Although CM interventions primarily involve applying extrinsic rewards, a patient's intrinsic motivation to change substance use behavior may also be impacted by CM. This chapter provides an introduction to CM interventions for substance use disorders and examines the impact of CM on intrinsic motivation . It also addresses applications of this intervention to other conditions and patient populations.

  2. Management of growth failure in the treatment of malignant disease

    International Nuclear Information System (INIS)

    Leiper, A.D.


    Growth failure due to endocrine dysfunction as a result of treatment for malignant disease is becoming increasingly common. It may occur after cranial or craniospinal irradiation given in the treatment of acute lymphoblastic leukemia and brain tumors, and is often coupled with early or precocious puberty. It also occurs after neck and gonadal radiation and is particularly severe after total body irradiation where multiple endocrine deficiencies frequently occur. Failure to appreciate its occurrence or failure to institute therapy early enough may lead to short stature in adult life. Accurate and regular monitoring of standing and sitting height, bone age, and endocrine data should be undertaken by the oncologist in close collaboration with an endocrinologist, to ensure appropriate management of the patient. 17 references

  3. [Data supporting quality circle management of inpatient depression treatment]. (United States)

    Brand, S; Härter, M; Sitta, P; van Calker, D; Menke, R; Heindl, A; Herold, K; Kudling, R; Luckhaus, C; Rupprecht, U; Sanner, Dirk; Schmitz, D; Schramm, E; Berger, M; Gaebel, W; Schneider, F


    Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management. In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment. According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious. Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.

  4. Treatment strategies in the management of jejunoileal and colonic atresia

    Directory of Open Access Journals (Sweden)

    Chadha Rajiv


    Full Text Available BACKGROUND/PURPOSE: The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. MATERIALS AND METHODS: There were 42 patients with jejunoileal atresia (JIA and 4 with colonic atresia (CA. The 4 group types were: type I-membranous (n=20, type II- blind ends separated by a fibrous cord (n=6, type IIIa- blind ends with a V-shaped mesenteric defect (n=10, type IIIb- apple-peel atresia (n=4 and type IV- multiple atresias (n=6. Primary surgery for JIA consisted of resection with a single anastomosis (n=37, anastomosis after tapering jejunoplasty (n=3, multiple anastomosis (n=1 and a Bishop-Koop ileostomy (n=1. For CA, resection with primary anastomosis was performed. A single end-to-oblique anastomosis after adequate resection of dilated proximal bowel, was the preferred surgical procedure. In the absence of facilities for administering TPN, early oral/nasogastric (NG tube feeding was encouraged. In patients with anastomotic dysfunction, conservative treatment of the obstruction followed after its resolution by gradually increased NG feeds, was the preferred treatment protocol. RESULTS: Late presentation or diagnosis with hypovolemia, electrolyte imbalance, unconjugated hyperbilirubinemia (n=25 and sepsis (n=6, were significant preoperative findings. After resection and anastomosis, significant shortening of bowel length was seen in 16 patients (34.7%. Postoperative complications included an anastomotic leak (n=3, a perforation proximal to the anastomosis in 1 and anastomotic dysfunction in 5 patients. Full oral or NG tube feeding was possible only by the 13th to 31st postoperative day (POD, after the primary surgery in patients with anastomotic dysfunction and those undergoing reoperation. Overall, 38 patients survived (82.6%. Mortality was highest in patients with type IIIb or type IV

  5. Diabetes mellitus, preexisting coronary heart disease, and the risk of subsequent coronary heart disease events in patients infected with human immunodeficiency virus: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study)

    DEFF Research Database (Denmark)

    Worm, Signe W; De Wit, Stephane; Weber, Rainer


    of DM and preexisting CHD on the development of a new CHD episode among 33,347 HIV-infected individuals in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study). METHODS AND RESULTS: Over 159,971 person-years, 698 CHD events occurred. After adjustment for gender, age, cohort, HIV...... transmission, ethnicity, family history of CHD, smoking, and calendar year, the rate of a CHD episode was 7.52 times higher (Poisson regression, 95% CI 6.02 to 9.39, P=0.0001) in those with preexisting CHD than in those without preexisting CHD, but it was only 2.41 times higher (95% CI 1.91 to 3.05, P=0...

  6. Hyperglycemia Associated With Targeted Oncologic Treatment: Mechanisms and Management. (United States)

    Goldman, Jonathan W; Mendenhall, Melody A; Rettinger, Sarah R


    : Molecularly targeted cancer therapy has rapidly changed the landscape of oncologic care, often improving patients' prognosis without causing as substantial a quality-of-life decrement as cytotoxic chemotherapy does. Nevertheless, targeted agents can cause side effects that may be less familiar to medical oncologists and that require the attention and expertise of subspecialists. In this review, we focus on hyperglycemia, which can occur with use of new anticancer agents that interact with cell proliferation pathways. Key mediators of these pathways include the tyrosine kinase receptors insulin growth factor receptor 1 (IGF-1R) and epidermal growth factor receptor (EGFR), as well as intracellular signaling molecules phosphatidylinositol 3-kinase (PI3K), AKT, and mammalian target of rapamycin (mTOR). We summarize available information on hyperglycemia associated with agents that inhibit these molecules within the larger context of adverse event profiles. The highest incidence of hyperglycemia is observed with inhibition of IGF-1R or mTOR, and although the incidence is lower with PI3K, AKT, and EGFR inhibitors, hyperglycemia is still a common adverse event. Given the interrelationships between the IGF-1R and cell proliferation pathways, it is important for oncologists to understand the etiology of hyperglycemia caused by anticancer agents that target those pathways. We also discuss monitoring and management approaches for treatment-related hyperglycemia for some of these agents, with a focus on our experience during the clinical development of the EGFR inhibitor rociletinib. Treatment-related hyperglycemia is associated with several anticancer agents. Many cancer patients may also have preexisting or undiagnosed diabetes or glucose intolerance. Screening can identify patients at risk for hyperglycemia before treatment with these agents. Proper monitoring and management of symptoms, including lifestyle changes and pharmacologic intervention, may allow patients to

  7. The management of radiation treatment error through incident learning

    International Nuclear Information System (INIS)

    Clark, Brenda G.; Brown, Robert J.; Ploquin, Jodi L.; Kind, Anneke L.; Grimard, Laval


    Purpose: To assess efficacy of an incident learning system in the management of error in radiation treatment. Materials and methods: We report an incident learning system implementation customized for radiation therapy where any 'unwanted or unexpected change from normal system behaviour that causes or has the potential to cause an adverse effect to persons or equipment' is reported, investigated and learned from. This system thus captures near-miss (potential) and actual events. Incidents are categorized according to severity, type and origin. Results: Our analysis spans a period of 3 years with an average accrual of 11.6 incidents per week. We found a significant reduction in actual incidents of 28% and 47% in the second and third year when compared to the first year (p < 0.001), which we attribute to the many interventions prompted by the analysis of incidents reported. We also saw a similar significant reduction in incidents generated at the treatment unit correlating with the introduction of direct treatment parameter transfer and electronic imaging (p < 0.001). Conclusions: Implementation of an incident learning system has helped us to establish a just environment where all staff members report deviations from normal system behaviour and thus generate evidence to initiate safety improvements.

  8. Endovascular Treatment of Epistaxis: Indications, Management, and Outcome

    International Nuclear Information System (INIS)

    Strach, Katharina; Schröck, Andreas; Wilhelm, Kai; Greschus, Susanne; Tschampa, Henriette; Möhlenbruch, Markus; Naehle, Claas P.; Jakob, Mark; Gerstner, Andreas O. H.; Bootz, Friedrich; Schild, Hans H.; Urbach, Horst


    Objective: Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis. Methods: All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed. Results: A total of 48 patients required 53 embolizations. Depending on the etiology of bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization. Conclusions: Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk–benefit profile.

  9. Waste Management Effluent Treatment Facility: Phase I. CAC basic data

    International Nuclear Information System (INIS)

    Gemar, D.W.; O'Leary, C.D.


    In order to expedite design and construction of the Waste Management Effluent Treatment Facility (WMETF), the project has been divided into two phases. Phase I consists of four storage basins and the associated transfer lines, diversion boxes, and control rooms. The design data pertaining to Phase I of the WMETF project are presented together with general background information and objectives for both phases. The project will provide means to store and decontaminate wastewater streams that are currently discharged to the seepage basins in F Area and H Area. This currently includes both routine process flows sent directly to the seepage basins and diversions of contaminated cooling water or storm water runoff that are stored in the retention basins before being pumped to the seepage basins

  10. Risk management program for the 283-W water treatment facility

    International Nuclear Information System (INIS)

    Green, W.E.


    This Risk Management (RM) Program covers the 283-W Water Treatment Facility (283W Facility), located in the 200 West Area of the Hanford Site. A RM Program is necessary for this facility because it stores chlorine, a listed substance, in excess of or has the potential to exceed the threshold quantities defined in Title 40 of the Code of Federal Regulations (CFR) Part 68 (EPA, 1998). The RM Program contains data that will be used to prepare a RM Plan, which is required by 40 CFR 68. The RM Plan is a summary of the RM Program information, contained within this document, and will be submitted to the U.S. Environmental Protection Agency (EPA) ultimately for distribution to the public. The RM Plan will be prepared and submitted separately from this document

  11. Diagnosis, Treatment and Management of Haemonchus contortus in Small Ruminants. (United States)

    Besier, R B; Kahn, L P; Sargison, N D; Van Wyk, J A


    Haemonchus contortus is a highly pathogenic, blood-feeding nematode of small ruminants, and a significant cause of mortalities worldwide. Haemonchosis is a particularly significant threat in tropical, subtropical and warm temperate regions, where warm and moist conditions favour the free-living stages, but periodic outbreaks occur more widely during periods of transient environmental favourability. The clinical diagnosis of haemonchosis is based mostly on the detection of anaemia in association with a characteristic epidemiological picture, and confirmed at postmortem by the finding of large numbers of H. contortus in the abomasum. The detection of impending haemonchosis relies chiefly on periodic monitoring for anaemia, including through the 'FAMACHA' conjunctival-colour index, or through faecal worm egg counts and other laboratory procedures. A range of anthelmintics for use against H. contortus is available, but in most endemic situations anthelmintic resistance significantly limits the available treatment options. Effective preventative programmes vary depending on environments and enterprise types, and according to the scale of the haemonchosis risk and the local epidemiology of infections, but should aim to prevent disease outbreaks while maintaining anthelmintic efficacy. Appropriate strategies include animal management programmes to avoid excessive H. contortus challenge, genetic and nutritional approaches to enhance resistance and resilience to infection, and the monitoring of H. contortus infection on an individual animal or flock basis. Specific strategies to manage anthelmintic resistance centre on the appropriate use of effective anthelmintics, and refugia-based treatment schedules. Alternative approaches, such as biological control, may also prove useful, and vaccination against H. contortus appears to have significant potential in control programmes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Surgical management of failed endoscopic treatment of pancreatic disease. (United States)

    Evans, Kimberly A; Clark, Colby W; Vogel, Stephen B; Behrns, Kevin E


    Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.

  13. Management strategies in the treatment of neonatal and pediatric gastroenteritis

    Directory of Open Access Journals (Sweden)

    Ciccarelli S


    Full Text Available Simona Ciccarelli,1 Ilaria Stolfi,1 Giuseppe Caramia2 1Neonatal Intensive Care Unit, Sapienza University of Rome, Rome, Italy; 2Division of Neonatology and Pediatrics, Maternal and Child Hospital "G. Salesi", Ancona, Italy Abstract: Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron, some antidiarrheal agents (racecadotril, and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the

  14. How can laparoscopic management assist radiation treatment in cervix carcinoma?

    International Nuclear Information System (INIS)

    Gerbaulet, A.; Lartigau, E.; Haie-Meder, C.; Castaigne, D.; Morice, P.; Breton, C.; Pautier, P.; Duvillard, P.


    Purpose: To determine the role of laparoscopic lymphadenectomy (pelvis ± para-aortic nodes) and laparoscopic hysterectomy in cervical cancer compared to 'classic radical surgery' in patients undergoing surgery in comparison with modern imaging in patients treated with radiotherapy alone.Materials and methods: The limitations of modern imaging are presented as well as how complication rates can be increased when classic laparotomy is followed by radiation therapy.Laparoscopic procedures are described with particular emphasis on how to provide information on lymph node metastases with the risk of overlooking microscopic involvement. A number of clinical experiences are cited to illustrate this problem and show how treatment approaches can be adapted.Results: The role of laparoscopy is evaluated according to different clinical situations and treatment protocols emphasizing the possibilities offered by this method to the radiotherapist. Conclusion: When developing laparoscopic techniques for the management of cervical carcinoma, caution must be exercised to ensure that these techniques are not detrimental to the prognosis. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

  15. Access database application in medical treatment management platform

    International Nuclear Information System (INIS)

    Wu Qingming


    For timely, accurate and flexible access to medical expenses data, we applied Microsoft Access 2003 database management software, and we finished the establishment of a management platform for medical expenses. By developing management platform for medical expenses, overall hospital costs for medical expenses can be controlled to achieve a real-time monitoring of medical expenses. Using the Access database management platform for medical expenses not only changes the management model, but also promotes a sound management system for medical expenses. (authors)

  16. Permanence of Two Self-Managed Treatments of Overweight in University and Community Populations (United States)

    And Others; Hall, Robert G.


    Males and females from community and university samples were assigned to two self-management treatments, nonspecific, or no-treatment controls. At six month follow-up, differences were not significant. Results are discussed in terms of conceptualizations of self-management and the utility of treatments employed. (Author)

  17. Changing treatment paradigms for the management of inflammatory bowel disease. (United States)

    Im, Jong Pil; Ye, Byong Duk; Kim, You Sun; Kim, Joo Sung


    Inflammatory bowel disease (IBD) is a chronic and progressive inf lammatory condition of the gastrointestinal tract causing bowel damage, hospitalizations, surgeries, and disability. Although there has been much progress in the management of IBD with established and evolving therapies, most current approaches have failed to change the natural course. Therefore, the treatment approach and follow-up of patients with IBD have undergone a significant change. Usage of immunosuppressants and/or biologics early during the course of the disease, known as top-down or accelerated step-up approach, was shown to be superior to conventional management in patients who had been recently diagnosed with IBD. This approach can be applied to selected groups based on prognostic factors to control disease activity and prevent progressive disease. Therapeutic targets have been shifted from clinical remission mainly based on symptoms to objective parameters such as endoscopic healing due to the discrepancies observed between symptoms, objectively evaluated inf lammatory activity, and intestinal damage. The concept of treat-to-target in IBD has been supported by population-based cohort studies, post hoc analysis of clinical trials, and meta-analysis, but more evidence is needed to support this concept to be applied to the clinical practice. In addition, individualized approach with tight monitoring of non-invasive biomarker such as C-reactive protein and fecal calprotectin and drug concentration has shown to improve clinical and endoscopic outcomes. An appropriate de-escalation strategy is considered based on patient demographics, disease features, current disease status, and patients' preferences.

  18. Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report


    Slaven, Emily J; Mathers, Jessie


    Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management ...

  19. Urine management after treatment with ''153 Sm-EDTMP (QUADRAMET)

    International Nuclear Information System (INIS)

    Delgado, A.; Diaz, J. P.; Carrasco, J. L.; Jimenez-Hoyuela, J. M.; Rebollo, A. C.; Martinez del Valle, M. D.; Ortega, S. J.


    The main purpose was to establish and to evaluate a new protocol of individualized treatment of patient urine after ''153 Sm-EDTMP injection, with a more efficient management of the wastes. Excreted urine was collected in an appropriate container form which, previous to sealing it, an aliquot of 10 ml was obtained. Experimental half-life (t1/2) of the isotope was then determined by measuring the activity at different times, besides the minimum time necessary for disposing of the radioactive wastes as regular trash. The measured half-life adjusted well to the theoretical value of the isotope. The time of considered storage oscillated between 19 and 26 days, based on the activity excreted by each patient. The main idea is the consideration of the set container-urine as solid waste: the evaluation of the minimum storage time necessary to its elimination is made in terms of legal limitation of specific activity by mass unit. The immediate advantages ares: the elimination of disagreeable scents by the storage of urine, it is not necessary a liquid waste disposal to eliminate it, and a more accurate knowledge of the specific activity at the moment of the elimination (dilution factor is not used). (Author) 10 refs

  20. Diagnostic and treatment challenges in management of allergic fungal rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Abhishek Bahadur Singh


    Full Text Available Among infections pertaining to head and neck rhinosinusitis holds a significant position both with regard to the prevalence and morbidity. Allergic fungal rhinosinusitis (AFRS was initially considered a counterpart of allergic bronchopulmonary aspergillosis when first diagnosed by Sa firstein in 1976 due to its clinical presentations and seemingly similar pathogenesis. Initially only Aspergillus was known as the causative, but now various other fungal species are known to cause chronic rhinosinusitis; hence, the terminology allergic fungal sinusitis was preferred. Exposure to fungi results in similar as asthma in atopic individuals, but then, some nonatopic individuals may also present with similar symptoms. It has also been studied that the presence of serum immunoglobulin E does not ensure the presence of allergy. Till date, there are several controversies regarding pathogenesis, whether humoral or immune mediated, population at risk, variations in presentations, diagnostic parameters, and treatment protocols. In this review, we try to revisit and learn from past documented experiences to further our attempt toward better understanding of the disease process, its diagnosis, and management.

  1. Parent knowledge of disease management in cystic fibrosis: Assessing behavioral treatment management. (United States)

    Nicolais, Christina J; Bernstein, Ruth; Riekert, Kristin A; Quittner, Alexandra L


    Cystic fibrosis (CF) is a life-shortening, burdensome disease requiring complex knowledge to manage the disease. Significant gaps in knowledge have been documented for parents, which may lead to unintentionally poor adherence and insufficient transfer of treatment responsibility from parents to adolescents. There are no current, validated measures of parent knowledge for this population and there are no measures that assess the knowledge required for day-to-day behavioral management of CF. We assessed the psychometric properties of the parent version of the Knowledge of Disease Management-Cystic Fibrosis measure (KDM-CF-P) using data from iCARE (I Change Adherence and Raise Expectations), a randomized control adherence intervention trial. A total of 196 parents in the iCARE standard care/control arm completed 35 items assessing their knowledge of disease management at their 12-month study visit, prior to beginning the intervention. Items were eliminated from the measure if they met the threshold for ceiling effects, were deemed clinically irrelevant, or did not correlate well with their intended scale. Item-to-total correlations, confirmatory factor analysis, discriminant function, reliability, and convergent validity were calculated. The KDM-CF-P (19 items) demonstrated internal consistency of KR20 = 0.60 on each scale and a two-scale structure. Convergent validity for knowledge scores was found with maternal education, family income, and type of medical insurance. Parents correctly answered approximately 85% of items on the KDM-CF-P. The KDM-CF-P psychometrics support a two-scale measure with clinical utility. It is useful for assessing gaps in knowledge that can be remediated through individualized, tailored interventions. © 2017 Wiley Periodicals, Inc.

  2. Diversity management: the treatment of HIV-positive employees. (United States)

    Yap, Matthew H T; Ineson, Elizabeth M


    Socio-demographic dimensions such as age, gender, sexual orientation, race and ethnicity are commonly included in diversity studies. With a view to helping Asian hospitality managers to manage HIV-positive employees in their workplaces through diversity management (DM) theory, this research extends the boundaries of previous diversity studies by considering Human Immunodeficiency Virus (HIV) infection as a diverse characteristic. Both quantitative and qualitative primary data were collected from purposively selected Asian hospitality managers through postal questionnaire and follow-up telephone interviews. Transformed raw data were analysed using summary statistics and template analysis. Asian hospitality managers agreed that DM would be appropriate in the management of HIV-positive employees and that it could generate substantial benefits for employees and employers. However, they believe that the successful adoption and implementation of DM is not easy; it requires training and, ideally, the recruitment of experienced directors. Nevertheless, Asian hospitality managers are confident that implementing DM to manage HIV-positive employees can enhance tolerance, improve understanding and promote equality. The purposive sampling technique and the small number of respondents have impacted the external validity of the study. However, this exploratory study initiates an equality discussion to include HIV-positive employees in DM discourse beyond antidiscrimination legislation. It also supplements the sparse literature addressing HIV-positive employees in the Asian hospitality workplace. Asian hospitality managers are advised to understand and employ DM to treat HIV-positive employees fairly to overcome hospitality workplace marginalisation, discrimination and stigmatisation.

  3. Current and emerging treatments for the management of myasthenia gravis (United States)

    Sathasivam, Sivakumar


    Myasthenia gravis is an autoimmune neuromuscular disorder. There are several treatment options, including symptomatic treatment (acetylcholinesterase inhibitors), short-term immunosuppression (corticosteroids), long-term immunosuppression (azathioprine, cyclosporine, cyclophosphamide, methotrexate, mycophenolate mofetil, rituximab, tacrolimus), rapid acting short-term immunomodulation (intravenous immunoglobulin, plasma exchange), and long-term immunomodulation (thymectomy). This review explores in detail these different treatment options. Potential future treatments are also discussed. PMID:21845054

  4. The role of self-treatment guidelines in self-management education for adult asthmatics

    NARCIS (Netherlands)

    van der Palen, Jacobus Adrianus Maria; Klein, J.J.; Zielhuis, G.A.; van Herwaarden, C.L.A.


    Guidelines on asthma management have changed considerably in the last two decades. Patient education has gained in popularity and especially asthma self-management training is thought to be essential in the treatment of adult asthma. Since 1989 many researchers have added self-treatment guidelines

  5. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. (United States)

    Dorri, Mojtaba; Martinez-Zapata, Maria José; Walsh, Tanya; Marinho, Valeria Cc; Sheiham Deceased, Aubrey; Zaror, Carlos


    Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (Clinical

  6. Planning for management information systems in drug treatment organizations. (United States)

    Zalkind, D; Zelon, H; Moore, M; Kaluzny, A


    An attempt to set up a management information system for individual drug abuse programs throughout a state is described. The principles upon which the system is based are discussed along with the problems encountered in its implementation. A series of guidelines for establishing management information systems in operating human services agencies is included.

  7. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposl of radioactive and hazardous waste. Volume II

    International Nuclear Information System (INIS)


    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type.Volume II is an integral part of the Office of Environmental Management''s (EM''s) Waste Management Programmatic Environmental Impact Statement (WM PEIS), which portrays the impacts of EM''s waste management activities at each of the 17 major DOE sites evaluated in the WM PEIS

  8. Contingency management for patients with dual disorders in intensive outpatient treatment for addiction. (United States)

    Kelly, Thomas M; Daley, Dennis C; Douaihy, Antoine B


    This quality improvement program evaluation investigated the effectiveness of contingency management for improving retention in treatment and positive outcomes among patients with dual disorders in intensive outpatient treatment for addiction. The effect of contingency management was explored among a group of 160 patients exposed to contingency management (n = 88) and not exposed to contingency management (no contingency management, n = 72) in a six-week partial hospitalization program. Patients referred to the partial hospitalization program for treatment of substance use and comorbid psychiatric disorders received diagnoses from psychiatrists and specialist clinicians according to the Diagnostic and Statistical Manual of the American Psychiatric Association. A unique application of the contingency management "fishbowl" method was used to improve the consistency of attendance at treatment sessions, which patients attended 5 days a week. Days attending treatment and drug-free days were the main outcome variables. Other outcomes of interest were depression, anxiety and psychological stress, coping ability, and intensity of drug cravings. Patients in the contingency management group attended more treatment days compared to patients in the no contingency management group; M = 16.2 days (SD = 10.0) versus M = 9.9 days (SD = 8.5), respectively; t = 4.2, df = 158, p contingency management and self-reported drug-free days. Contingency management is a valuable adjunct for increasing retention in treatment among patients with dual disorders in partial hospitalization treatment. Exposure to contingency management increases retention in treatment, which in turn contributes to increased drug-free days. Interventions for coping with psychological stress and drug cravings should be emphasized in intensive dual diagnosis group therapy.


    Directory of Open Access Journals (Sweden)

    Turan Aktas


    In total, whose age change between 27 and 90, who got mPTE diagnosis and received thrombolytic treatment were included in the study. Male vs. female rate was 2/3. Mortality developed in 2 patients, who were included in the study. Intracranial hemorrhage which is one of the major complications occurred in only one patient . Recurrence thromboembolism was not followed in none of the patients after the thrombolytic treatment. In mPTE, early diagnosis and rapid treatment are life saving. With the help of the diagnostic methods developing and becoming widespread lately, diagnosis of the mPTE can be made more rapidly and the treatment can be started without losing time. Moreover, it can be said that thrombolytic treatment is definitely a life saving treatment way in mPTE when it is made with close follow-up. [J Contemp Med 2013; 3(3.000: 166-172

  10. ["Flare-up" during endodontic treatment--etiology and management]. (United States)

    Zuckerman, O; Metzger, Z; Sela, G; Lin, S


    "Flare-ups" during or following endodontic treatment are not uncommon. A "Flare-up" refers to post-operative pain and/or swelling resulting from bacterial, mechanical or chemical irritation. Prompt diagnosis and treatment are essential for reducing patients' pain and discomfort. Prevention of bacterial, chemical or mechanical invasion to the periapical tissues is the best approach. Other treatment modalities which reduce the probability of periradicular tissue irritation should also be adopted. Etiology, prevention, diagnosis and treatment options of "flare-up" cases are discussed as well as indications for analgesics, in accordance with the severity of the pain.

  11. Grout Treatment Facility Land Disposal Restriction Management Plan

    International Nuclear Information System (INIS)

    Hendrickson, D.W.


    This document establishes management plans directed to result in the land disposal of grouted wastes at the Hanford Grout Facilities in compliance with Federal, State of Washington, and Department of Energy land disposal restrictions. 9 refs., 1 fig

  12. Operation, Maintenance and Management of Wastewater Treatment Facilities: A Bibliography of Technical Documents. (United States)

    Himes, Dottie

    This is an annotated bibliography of wastewater treatment manuals. Fourteen manuals are abstracted including: (1) A Planned Maintenance Management System for Municipal Wastewater Treatment Plants; (2) Anaerobic Sludge Digestion, Operations Manual; (3) Emergency Planning for Municipal Wastewater Treatment Facilities; (4) Estimating Laboratory Needs…

  13. Post-surgical management of pontine hemorrhage with Ayurvedic treatment

    Directory of Open Access Journals (Sweden)

    Areekkat Manojkumar


    Full Text Available A female aged 30 years, consulted the Govt. Ayurveda Hospital, Perinthalmanna with complaints of left side of the body totally paralysed along with severe shivering of the right hand and head and the patient was bedridden for 1½ years. She was diagnosed earlier with spontaneous pontine hematoma (on 10 th Nov 2007 and had undergone midline sub occipital craniectomy (on 13 th Nov 2007 as an emergency treatment. She developed neurotrophic ulcer in the right eye with lagophthalmos post-surgery. The patient showed no improvement to treatment but further developed stromal abscess and hence paramedian tarsorraphy (4 th Jan 2008 was done. The deficits in the right eye led to diminution of vision of that eye after Allopathy treatment. The patient sought Ayurvedic treatment for a better prognosis. The patient was under Ayurvedic treatment from 5 th Mar 2009 to 24 th Nov 2009. During that period Ayurvedic treatment such as abhyaṅga (oil massage, patra poṭṭalī sveda (use of poultices and mṛdu virecana (purgation was also done. After a period of 8 months of internal medication and treatment, the shivering of the right hand and head resolved. She could move the left leg and left hand and started walking without support. There was gradual loss of vision during the course of Ayurvedic treatment. At present, the patient is able to move around and do household works on her own.

  14. Characterising aquifer treatment for pathogens in managed aquifer recharge. (United States)

    Page, D; Dillon, P; Toze, S; Sidhu, J P S


    In this study the value of subsurface treatment of urban stormwater during Aquifer Storage Transfer Recovery (ASTR) is characterised using quantitative microbial risk assessment (QMRA) methodology. The ASTR project utilizes a multi-barrier treatment train to treat urban stormwater but to date the role of the aquifer has not been quantified. In this study it was estimated that the aquifer barrier provided 1.4, 2.6, >6.0 log(10) removals for rotavirus, Cryptosporidium and Campylobacter respectively based on pathogen diffusion chamber results. The aquifer treatment barrier was found to vary in importance vis-à-vis the pre-treatment via a constructed wetland and potential post-treatment options of UV-disinfection and chlorination for the reference pathogens. The risk assessment demonstrated that the human health risk associated with potable reuse of stormwater can be mitigated (disability adjusted life years, DALYs aquifer is integrated with suitable post treatment options into a treatment train to attenuate pathogens and protect human health.

  15. Current treatment options for the management of patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Takeuchi K


    Full Text Available Koh Takeuchi,1 Atsushi Hirota,2 Sachito Minegishi,1 Jotaro Kobayashi,1 Keiji Tsuchiya3 1Division of Cardiovascular Surgery, 2Department of Neonatology, 3Department of Pediatrics, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan Abstract: Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA in the very premature infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, three ways of approaching the closure of PDA including pharmacological treatment, catheter intervention, and surgical intervention, are reviewed in detail. In addition, the different treatment strategies applied in clinical care are evaluated with a focus on the discussion of the available evidence of PDA treatment in the literature. Keywords: patent ductus arteriosus, premature infant, treatment option

  16. [OISO, automatic treatment of patients management in oncogenetics]. (United States)

    Guien, Céline; Fabre, Aurélie; Lagarde, Arnaud; Salgado, David; Gensollen-Thiriez, Catherine; Zattara, Hélène; Beroud, Christophe; Olschwang, Sylviane

    Oncogenetics is a long-term process, which requires a close relation between patients and medical teams, good familial links allowing lifetime follow-up. Numerous documents are exchanged in between the medical team, which has to frequently interact. We present here a new tool that has been conceived specifically for this management. The tool has been developed according to a model-view-controler approach with the relational system PostgreSQL 9.3. The web site used PHP 5.3, HTML5 and CSS3 languages, completed with JavaScript and jQuery-AJAX functions and two additional modules, FPDF and PHPMailer. The tool allows multiple interactions, clinical data management, mailing and emailing, follow-up plannings. Requests are able to follow all patients and planning automatically, to send information to a large number of patients or physicians, and to report activity. The tool has been designed for oncogenetics and adapted to its different aspects. The CNIL delivered an authorization for use. Secured web access allows the management at a regional level. Its simple concept makes it evolutive according to the constant updates of genetic and clinical management of patients. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  17. Community case management improves use of treatment for ...

    African Journals Online (AJOL)

    Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea, fever and pneumonia – in a pre-HEW setting in Liben Woreda, Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from ...

  18. Management systems, patient quality improvement, resource availability, and substance abuse treatment quality. (United States)

    Fields, Dail; Roman, Paul M; Blum, Terry C


    To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. © Health Research and Educational Trust.

  19. Forearm diaphyseal fractures in the adolescent population: treatment and management. (United States)

    Truntzer, Jeremy; Vopat, Matthew L; Kane, Patrick M; Christino, Melissa A; Katarincic, Julia; Vopat, Bryan G


    Pediatric both-bone diaphyseal forearm fractures are commonly treated in a variety of clinical settings. Most often, closed reduction followed by immobilization leads to satisfactory results. However, in the adolescent population (10-16 years of age), forearm fractures are more challenging due to less remodeling potential. The purpose of this review was to provide an overview of the anatomy, biomechanics, and treatment options relevant to adolescent patients. A systematic review of peer-reviewed publications and abstracts related to the treatment for pediatric both-bone diaphyseal forearm fractures in adolescents was carried out. Forearm fractures in the pediatric population are most common following indirect blows to the forearm. When treating these fractures using closed reduction, it is important to recognize the muscular attachments of the forearm. In roughly 70-90% of cases, closed reduction leads to adequate alignment. In all cases, return to function is the primary goal; however, exact alignment parameters remain controversial. In the adolescent population, surgical treatment has risen substantially in the last few decades. Intramedullary nailing and open reduction using plate fixation are the two most common operative techniques. Unfortunately, recent results have shown that nonunion, malunion, and overall complication rates are higher in older pediatric patients. Moreover, no consensus exists regarding one technique over another. Both-bone diaphyseal fractures in the adolescent population present unique challenges regarding optimal treatment, especially when considering surgical intervention. Further research is necessary to better understand indications for specific surgical treatment.

  20. Understanding lupus nephritis: diagnosis, management, and treatment options

    Directory of Open Access Journals (Sweden)

    Mok CC


    Full Text Available Chi Chiu MokDepartment of Medicine, Tuen Mun Hospital and Center for Assessment and Treatment of Rheumatic Diseases, Pok Oi Hospital, Hong Kong, ChinaAbstract: Systemic lupus erythematosus (SLE predominantly affects women in their reproductive years. Renal disease (glomerulonephritis is one of the most frequent and serious manifestations of SLE. Of the various histological types of lupus glomerulonephritis, diffuse proliferative nephritis carries the worst prognosis. Combined with high-dose prednisone, mycophenolate mofetil (MMF has emerged as a first-line immunosuppressive treatment, although data regarding the efficacy of MMF on the long-term preservation of renal function are forthcoming. Cyclophosphamide is reserved for more severe forms of lupus nephritis, such as crescentic glomerulonephritis with rapidly deteriorating renal function, patients with significant renal function impairment at presentation, and refractory renal disease. Evidence for the calcineurin inhibitors in the treatment of lupus nephritis is weaker, and it concerns patients who are intolerant or recalcitrant to other agents. While further controlled trials are mandatory, B cell modulation therapies, such as rituximab, belimumab and epratuzumab are confined to refractory disease. Non-immunosuppressive measures, such as angiotensin-converting enzyme inhibitors, vigorous blood pressure control, prevention and treatment of hyperlipidemia and osteoporosis, are equally important.Keywords: lupus, nephritis, nephropathy, glomerulonephritis, treatment, therapy, women

  1. A Cinnamon-Derived Procyanidin Compound Displays Anti-HIV-1 Activity by Blocking Heparan Sulfate- and Co-Receptor- Binding Sites on gp120 and Reverses T Cell Exhaustion via Impeding Tim-3 and PD-1 Upregulation.

    Directory of Open Access Journals (Sweden)

    Bridgette Janine Connell

    Full Text Available Amongst the many strategies aiming at inhibiting HIV-1 infection, blocking viral entry has been recently recognized as a very promising approach. Using diverse in vitro models and a broad range of HIV-1 primary patient isolates, we report here that IND02, a type A procyanidin polyphenol extracted from cinnamon, that features trimeric and pentameric forms displays an anti-HIV-1 activity against CXCR4 and CCR5 viruses with 1-7 μM ED50 for the trimer. Competition experiments, using a surface plasmon resonance-based binding assay, revealed that IND02 inhibited envelope binding to CD4 and heparan sulphate (HS as well as to an antibody (mAb 17b directed against the gp120 co-receptor binding site with an IC50 in the low μM range. IND02 has thus the remarkable property of simultaneously blocking gp120 binding to its major host cell surface counterparts. Additionally, the IND02-trimer impeded up-regulation of the inhibitory receptors Tim-3 and PD-1 on CD4+ and CD8+ cells, thereby demonstrating its beneficial effect by limiting T cell exhaustion. Among naturally derived products significantly inhibiting HIV-1, the IND02-trimer is the first component demonstrating an entry inhibition property through binding to the viral envelope glycoprotein. These data suggest that cinnamon, a widely consumed spice, could represent a novel and promising candidate for a cost-effective, natural entry inhibitor for HIV-1 which can also down-modulate T cell exhaustion markers Tim-3 and PD-1.

  2. The distribution of the anti-HIV drug, 2'3'-dideoxycytidine (ddC), across the blood-brain and blood-cerebrospinal fluid barriers and the influence of organic anion transport inhibitors. (United States)

    Gibbs, J E; Thomas, S A


    The brain and CSF distribution of the HIV reverse transcriptase inhibitor, 2'3'-dideoxycytidine (ddC), was investigated by the in situ brain perfusion and isolated incubated choroid plexus methods in the guinea pig. Multiple-time brain perfusions indicated that the distribution of [3H]ddC to the brain and CSF was low and the unidirectional rate constant (K(in)) for the brain uptake of this nucleoside analogue (0.52 +/- 0.10 microL/min/g) was not significantly different to that for the vascular marker, [14C]mannitol (0.44 +/- 0.09 microL/min/g). The influence of unlabelled ddC, six organic anion transport inhibitors and 3'-azido 3'-deoxythymidine (AZT) on the CNS uptake of [3H]ddC was examined in situ and in vitro. ddC, probenecid and 2,4-dichlorophenoxyacetic acid altered the distribution of [3H]ddC into the brain and choroid plexuses, indicating that the limited distribution of [3H]ddC was a result of an organic anion efflux transporter, in addition to the low lipophilicity of this drug (octanol-saline partition coefficient, 0.047 +/- 0.001). The CNS distribution was also sensitive to p-aminohippurate and deltorphin II, but not digoxin, suggesting the involvement of organic anion transporters (OAT1/OAT3-like) and organic anion transporting polypeptides (OATP1/OATPA-like). AZT did not effect the accumulation of [3H]ddC, indicating that when these nucleoside analogues are used in anti-HIV combination therapy, the CNS distribution of ddC is unchanged.

  3. Unicystic Ameloblastoma with Mural Proliferation Managed by Conservative Treatment

    Directory of Open Access Journals (Sweden)

    Natália Galvão Garcia


    Full Text Available Unicystic ameloblastoma is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally aggressive. Three histological types are recognized according to the degree of ameloblastomatous epithelial extension, namely, luminal, intraluminal, and mural types. This classification has a direct bearing on their biological behavior, treatment, and prognosis. However, there is difficulty in determining the most appropriate form of treatment for unicystic ameloblastoma. We present a case of unicystic ameloblastoma that occurred in the right posterior mandible of 19-year-old girl, which was enucleated and did not recur after 12-month follow-up.

  4. Off Grid Photovoltaic Wastewater Treatment and Management Lagoons (United States)

    LaPlace, Lucas A.; Moody, Bridget D.


    The SSC wastewater treatment system is comprised of key components that require a constant source of electrical power or diesel fuel to effectively treat the wastewater. In alignment with the President's new Executive Order 13653, Planning for Federal Sustainability in the Next Decade, this project aims to transform the wastewater treatment system into a zero emissions operation by incorporating the advantages of an off grid, photovoltaic system. Feasibility of implementation will be based on an analytical evaluation of electrical data, fuel consumption, and site observations.

  5. Evaluation and management of side effects of breast cancer treatment

    NARCIS (Netherlands)

    Boekhout, A.H.


    Breast cancer is one of the most common malignant diseases. Adjuvant systemic therapies such as chemotherapy, immunotherapy and endocrine therapy play an important role in the treatment of breast cancer. These therapies reduce the risk of relapse of breast cancer and increase cure rates. However,

  6. Emerging treatments and combinations in the management of NSCLC

    DEFF Research Database (Denmark)

    Reck, Martin; Mellemgaard, Anders


    There remains an unmet need for effective, well-tolerated treatment options in advanced non-small cell lung cancer (NSCLC) to alleviate the disease burden for a broad selection of patients. Nintedanib is a potent, oral, triple angiokinase inhibitor of vascular endothelial growth factor, fibroblast...

  7. Cancer Survivors: Managing Your Emotions After Cancer Treatment (United States)

    ... Devise your own plan for coping with your emotions. Have an open mind and try different strategies to find out what works best for you. Coping with fear of recurrence. Cancer.Net. ... side effects of cancer treatment. Cancer.Net. http://www.cancer. ...

  8. Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans (United States)


    only one site – Cleveland Clinic Foundation. No cost extension of a 12-months of period has been submitted. Study Advertisements The online ads...other documentation. Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans REPORT DOCUMENTATION PAGE...2016 4. TITLE AND SUBTITLE Effectiveness of Acupressure Treatment for Pain Management and Fatigue Relief in Gulf War Veterans 5a. CONTRACT NUMBER 5b

  9. Decentralized approaches to wastewater treatment and management: applicability in developing countries. (United States)

    Massoud, May A; Tarhini, Akram; Nasr, Joumana A


    Providing reliable and affordable wastewater treatment in rural areas is a challenge in many parts of the world, particularly in developing countries. The problems and limitations of the centralized approaches for wastewater treatment are progressively surfacing. Centralized wastewater collection and treatment systems are costly to build and operate, especially in areas with low population densities and dispersed households. Developing countries lack both the funding to construct centralized facilities and the technical expertise to manage and operate them. Alternatively, the decentralized approach for wastewater treatment which employs a combination of onsite and/or cluster systems is gaining more attention. Such an approach allows for flexibility in management, and simple as well as complex technologies are available. The decentralized system is not only a long-term solution for small communities but is more reliable and cost effective. This paper presents a review of the various decentralized approaches to wastewater treatment and management. A discussion as to their applicability in developing countries, primarily in rural areas, and challenges faced is emphasized all through the paper. While there are many impediments and challenges towards wastewater management in developing countries, these can be overcome by suitable planning and policy implementation. Understanding the receiving environment is crucial for technology selection and should be accomplished by conducting a comprehensive site evaluation process. Centralized management of the decentralized wastewater treatment systems is essential to ensure they are inspected and maintained regularly. Management strategies should be site specific accounting for social, cultural, environmental and economic conditions in the target area.

  10. Lipid raft-like liposomes used for targeted delivery of a chimeric entry-inhibitor peptide with anti-HIV-1 activity. (United States)

    Gómara, María José; Pérez-Pomeda, Ignacio; Gatell, José María; Sánchez-Merino, Victor; Yuste, Eloisa; Haro, Isabel


    The work reports the design and synthesis of a chimeric peptide that is composed of the peptide sequences of two entry inhibitors which target different sites of HIV-1 gp41. The chimeric peptide offers the advantage of targeting two gp41 regions simultaneously: the fusion peptide and the loop both of which are membrane active and participate in the membrane fusion process. We therefore use lipid raft-like liposomes as a tool to specifically direct the chimeric inhibitor peptide to the membrane domains where the HIV-1 envelope protein is located. Moreover, the liposomes that mimic the viral membrane composition protect the chimeric peptide against proteolytic digestion thereby increasing the stability of the peptide. The described liposome preparations are suitable nanosystems for managing hydrophobic entry-inhibitor peptides as putative therapeutics. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Management strategy for treatment of vasospasm following transsphenoidal excision of craniopharyngioma. (United States)

    Nash, Robert; Elwell, V; Brew, S; Powell, M; Grieve, J P


    We describe two cases of clinical and radiographic vasospasm after transsphenoidal resection of a craniopharyngioma. We review the literature on the association of vasospasm and craniopharyngioma and examine management options. Given the lack of evidence for the optimal management of these patients, treatment in concordance with protocols for vasospasm due to subarachnoid haemorrhage is recommended.

  12. Burns at KCMC: epidemiology, presentation, management and treatment outcome. (United States)

    Ringo, Y; Chilonga, K


    About 90% of the global burden of burns occurs in the low and middle income countries. In Africa it is estimated that between 17,000 and 30,000 children under five die each year due to burns. In Tanzania there are no specialized burn centers. Burn patients are often managed in the general surgical wards in most hospitals. Kilimanjaro Christian Medical Centre is one of the four tertiary referral hospitals in Tanzania. This study aimed to review the epidemiology presentation management and outcome of burn patients in this challenging environment. A cross-sectional prospective study involving 41 patients was undertaken from October 2011 to April 2012. 65.9% were males. The largest age group was below 5 years (36.6%). 19.5% were epileptic. More than half of the burns were due to open flame. 80.5% had second degree burns. 56.1% had a BSA of 15% or less and 56.1% had an APACHE score of 10 or less. It was found that 73.2% of burns occurred at home. The commonest prehospital first aid applied was honey. Only 41.5% arrived in hospital within the first 24h after burn. Among the 14.6% who had skin grafting, none had early excision of burn wound. 53.7% developed wound sepsis while 24.4% developed contractures. The mortality rate was 26.8%. Children under five are the worst affected by burns. Most patients had second degree burn wounds. Inappropriate management of the burn wound started just after injury and continued even in hospital. Mortality and complication rates are high. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  13. Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

    Directory of Open Access Journals (Sweden)

    Nikolaos Mouchtouris


    Full Text Available Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics.

  14. Complications of Open Tibial Fracture Management: Risk Factors and Treatment


    Lua, JYC; Tan, VH; Sivasubramanian, H; Kwek, EBK


    Open tibial fractures result in high rates of complications. This study aims to elucidate the risk factors causing these complications, and suggest antimicrobial regimens based on the organisms grown in post-operative infections. Over a period of five years, 173 patients had sustained open tibial fractures and undergone operative treatment at a single institution. All surgical data was gathered retrospectively through online medical records. Thirty-one patients (17.9%) had sustained post-oper...

  15. Upper Extremity Injuries in Tennis Players: Diagnosis, Treatment, and Management. (United States)

    Chung, Kevin C; Lark, Meghan E


    Upper extremity tennis injuries are most commonly characterized as overuse injuries to the wrist, elbow, and shoulder. The complex anatomy of these structures and their interaction with biomechanical properties of tennis strokes contributes to the diagnostic challenges. A thorough understanding of tennis kinetics, in combination with the current literature surrounding diagnostic and treatment methods, will improve clinical decision-making. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Managing trichomonal vaginitis refractory to conventional treatment with metronidazole.


    Ahmed-Jushuf, I H; Murray, A E; McKeown, J


    Three patients with vulvovaginitis caused by Trichomonas vaginalis, which was refractory to conventional treatment with metronidazole are described. The T vaginalis strain isolated from one patient was resistant to metronidazole (minimum inhibitory concentration (MIC) more than 100 mg/l) under aerobic conditions, although under anaerobic conditions it was as susceptible as a normal reference strain. The effect of the concomitant use of other medication and the influence of other vaginal patho...

  17. Does compliance with amblyopia management improve following supervised occlusion treatment? (United States)

    El-Ghrably, I A; Longville, D; Gnanaraj, L


    To demonstrate improvement in compliance following supervised occlusion therapy for amblyopia in children who had failed to respond to outpatient treatment. Retrospective review of the visual outcome of 30 children who were admitted to an ophthalmology ward for 1-day intensive supervised occlusion. These children had documented poor compliance and previously failed to respond to the outpatient occlusion treatment. During their stay a trained ophthalmology nurse educated parents regarding amblyopia and the benefits of occlusion therapy. Visual acuity (VA) of the amblyopic and fellow eyes was recorded on admission, discharge, and at each subsequent visit. The compliance was recorded from parent's history and also indirectly by noticing improvement in vision. The mean supervised occlusion was 7.4 hours (range 4-12 hours). The compliance with occlusion therapy improved in 23 children (77%) after discharge. The mean duration of occlusion after discharge improved to 4 hours (range 1-12 hours). The mean follow-up was 18 months (range 4-24 months). Though there was no dramatic improvement in VA at discharge there was a statistically significant improvement in VA between admission and last recorded VA (pocclusion following discharge, 21 (91%) gained at least one line of acuity in their amblyopic eye on the last assessment of their VA and five of them achieved 6/12. Of the seven children who did not comply with occlusion following discharge, only one patient gained one line improvement in his amblyopic eye. This study shows that supervised occlusion treatment and parental education was effective in children who had initially failed traditional outpatient treatment.

  18. Management of genetic epilepsies: From empirical treatment to precision medicine. (United States)

    Striano, Pasquale; Vari, Maria Stella; Mazzocchetti, Chiara; Verrotti, Alberto; Zara, Federico


    Despite the over 20 antiepileptic drugs (AEDs) now licensed for epilepsy treatment, seizures can be effectively controlled in about ∼70% of patients. Thus, epilepsy treatment is still challenging in about one third of patients and this may lead to a severe medically, physically, and socially disabling condition. However, there is clear evidence of heterogeneity of response to existing AEDs and a significant unmet need for effective intervention. A number of studies have shown that polymorphisms may influence the poor or inadequate therapeutic response as well as the occurrence of adverse effects. In addition, the new frontier of genomic technologies, including chromosome microarrays and next-generation sequencing, improved our understanding of the genetic architecture of epilepsies. Recent findings in some genetic epilepsy syndromes provide insights into mechanisms of epileptogenesis, unrevealing the role of a number of genes with different functions, such as ion channels, proteins associated to the vesical synaptic cycle or involved in energy metabolism. The rapid progress of high-throughput genomic sequencing and corresponding analysis tools in molecular diagnosis are revolutionizing the practice and it is a fact that for some monogenic epilepsies the molecular confirmation may influence the choice of the treatment. Moreover, the novel genetic methods, that are able to analyze all known genes at a reasonable price, are of paramount importance to discover novel therapeutic avenues and individualized (or precision) medicine. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Management Information System (MIS: Tool for Monitoring the Waste Management Health Service (RSS and Cost of Treatment

    Directory of Open Access Journals (Sweden)

    Vania Elisabete Schneider


    Full Text Available One of the major challenges of solid waste management has been improve and deploy systems that perform monitoring and control of management processes of health service’s waste (HSW. This study aims to evaluate the total cost per category of HSW/day and active bed/day with the handling of HSW in a teaching hospital in northeastern area of Brazil`s Rio Grande do Sul state and identify contributions of a management information system (MIS in the management process, especially considering the generation and segregation of waste. Utilized methodology was developed in two stages: data collection about the management of the HSW and proposition, implementation and feed of a MIS for recording and processing of data related to waste characterization. Results show that whether the management system of the hospital in this study were 100% right, the monthly savings for the treatment of infectious waste would be 18.4% of the costs and 5.83% of costs of chemical waste. The implementation of MIS becomes an essential tool in the evaluation of the management process of HSW since it makes possible to raise issues of fundamental importance to the implementation and evaluation of strategies contained in the HSW management plan. The MIS also represents a tool of easy reference and of great importance to evaluate generation of HSW as it helps to promote the surveillance, identification of sectors that have the biggest problems with segregation, as well as ways to minimize costs and impacts.

  20. Management and treatment of splenic trauma in children. (United States)

    Arslan, Serkan; Guzel, Mahmut; Turan, Cuneyt; Doğanay, Selim; Kopru, Mehmet


    To assess types of splenic traumas, accompanying injuries, their management and results. We studied the reports of 90 patients (64 boys, 26 girls) who were treated for splenic injuries as a result of blunt abdominal trauma between 2005-2012. Age, sex, hospitalization time, mechanisms of traumas, accompanying injuries and management methods were recorded. Causes of trauma were falls from height (46 patients, 51%), pedestrian traffic accidents (17 patients, 19%), passenger traffic accidents (11 patients, 12%), bicycle accidents (10 patients, 11%) and falling objects from height (6 patients, 6.6%). Splenic injury alone was observed in 57 patients (63.3%) and other organ injuries together with splenic injury in 33 patients (36.7%). Splenectomy was performed in six patients (6.6%) due to hemodynamic instability and small intestine repair due to small intestine injury in one patient (1.1%). None of these patients died from their injuries. A large proportion of splenic injuries recover with conservative therapy. Some of the advantages of conservative therapy include short hospitalization time, less need for blood transfusion, and less morbidity and mortality. Falls from height and traffic accidents are important factors in etiology. The possibility of other organ injuries together with splenic injuries should be considered.

  1. Patient compliance and disease management in the treatment of psoriasis in the Netherlands

    NARCIS (Netherlands)

    van de Kerkhof, P. C.; de Hoop, D.; de Korte, J.; Cobelens, S. A.; Kuipers, M. V.


    Compliance behaviour and disease management are important issues in chronic skin diseases. Psoriasis patients are 'experts by experience' because of many years of treatment. Therefore, it is relevant to gather data from patients on the actual use of antipsoriatic treatments. The following questions

  2. An Integrated Model for Identifying Linkages Between the Management of Fuel Treatments, Fire and Ecosystem Services (United States)

    Bart, R. R.; Anderson, S.; Moritz, M.; Plantinga, A.; Tague, C.


    Vegetation fuel treatments (e.g. thinning, prescribed burning) are a frequent tool for managing fire-prone landscapes. However, predicting how fuel treatments may affect future wildfire risk and associated ecosystem services, such as forest water availability and streamflow, remains a challenge. This challenge is in part due to the large range of conditions under which fuel treatments may be implemented, as response is likely to vary with species type, rates of vegetation regrowth, meteorological conditions and physiographic properties of the treated site. It is also due to insufficient understanding of how social factors such as political pressure, public demands and economic constraints affect fuel management decisions. To examine the feedbacks between ecological and social dimensions of fuel treatments, we present an integrated model that links a biophysical model that simulates vegetation and hydrology (RHESSys), a fire spread model (WMFire) and an empirical fuel treatment model that accounts for agency decision-making. We use this model to investigate how management decisions affect landscape fuel loads, which in turn affect fire severity and ecosystem services, which feedback to management decisions on fuel treatments. We hypothesize that this latter effect will be driven by salience theory, which predicts that fuel treatments are more likely to occur following major wildfire events. The integrated model provides a flexible framework for answering novel questions about fuel treatments that span social and ecological domains, areas that have previously been treated separately.

  3. Managing orthopedics and neurosciences costs through standard treatment protocols. (United States)

    McGinnity, E S; Pluth, T E


    High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines

  4. Management of patients with resistant hypertension: current treatment options

    Directory of Open Access Journals (Sweden)

    Kumar N


    Full Text Available Nilay Kumar,1 David A Calhoun,2 Tanja Dudenbostel21Department of Medicine, 2Division of Cardiovascular Disease, Hypertension and Vascular Biology Program, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Resistant hypertension (RHTN is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new

  5. [Thyroid and treatment with amiodarone diagnosis, therapy and clinical management]. (United States)

    Mikosch, Peter


    Amiodarone is a frequently used antiarrhythmic drug with a high antiarrhythmic potency. However, beside its antiarrhythmic effects Amiodarone also reveals a variety of adverse effects and drug-related complications. The affected organs include the eyes, skin, lungs, nervous system, liver, gastrointestinal tract and the thyroid. The thyroid is one of the most frequently affected organs by Amiodarone. An altered hormone equilibrium always occurs and has to be distinguished from Amiodarone induced hyperthyroidism and hypothyroidism. The differentiation of these states frequently causes problems and may even be a diagnostic and therapeutic challenge in certain cases. The article gives an overview on the interactions between Amiodarone and the thyroid, the diagnostic and therapeutic options and management strategies of patient on Amiodarone therapy in the view of thyroid function.

  6. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. (United States)

    Giannini, Edoardo G; Zentilin, Patrizia; Dulbecco, Pietro; Vigneri, Sergio; Scarlata, Pamela; Savarino, Vincenzo


    Whether patients with typical gastroesophageal reflux disease (GERD) symptoms and without alarm features should be treated empirically or undergo endoscopy first is a debated issue. In this study, our aim was to assess the efficacy, and to compare the direct costs and impact on health-related quality of life (HRQL), of two treatment strategies (empirical vs endoscopy-oriented treatment) in a large population of patients with GERD. In total, 612 patients were randomized to either empirical treatment with esomeprazole 40 mg once daily (od) (group 1, N = 309) or endoscopy and treatment according to endoscopic findings (group 2, N = 303, esomeprazole 40 mg od in patients with reflux esophagitis and esomeprazole 20 mg od in patients without esophagitis) for 4 wk, followed by esomeprazole 20 mg od maintenance treatment in both groups. Direct costs and HRQL were analyzed in both treatment arms. At the end of the acute treatment phase (week 4), 267 patients in group 1 (86.4%) and 265 patients in group 2 (87.5%) were considered responders to treatment (intention-to-treat analysis, P= 0.878). Empirical treatment proved to be cost-effective by saving 38.72 euros per treated patient. At the end of the maintenance phase (week 24), a similar proportion of patients responded to treatment in the two groups (71.8%vs 68.3%, P= 0.389). HRQL improved from baseline to week 24 in both groups (difference between study groups not significant). In patients with GERD, empirical treatment with esomeprazole proved to be cost-effective compared with endoscopy-oriented treatment, and did not negatively affect patient HRQL. These results should be taken into account in the management of GERD patients in clinical practice.

  7. Optimization of Inpatient Management of Radioiodine Treatment in Korea

    International Nuclear Information System (INIS)

    Park, Min Jae; Kim, Jung Hyun; Jeong, Jae Min; Lee, Dong Soo; Jang, Jung Chan; Kim, Chang Ho


    We established a model to calculate radioactive waste from sewage disposal tank of hospitals to optimize the number of patients receiving inpatient radioiodine therapy within the safety guideline in our country. According to this model and calculation of radioactivity concentration using the number of patients per week, the treatment dose of radioiodine, the capacity and the number of sewage tanks and the daily amount of water waste per patient, estimated concentration of radioactivity in sewage waste upon disposal from disposal tanks after long term retention were within the safety guideline (30 Bq/L) in all the hospitals examined. In addition to the fact that we could increase the number of patients in two thirds of hospitals, we found that the daily amount of waste water was the most important variable to allow the increase of the number of patients within the safety margin of disposed radioactivity. We propose that saving the water amount be led to increase the number of patients and they allow two patients in an already furnished hospital inpatient room to meet the increasing need of inpatient radioiodine treatment for thyroid cancer

  8. Diagnosis and treatment of anterior uveitis: optometric management

    Directory of Open Access Journals (Sweden)

    Harthan JS


    Full Text Available Jennifer S Harthan,1 Dominick L Opitz,2 Stephanie R Fromstein,1 Christina E Morettin3 1Cornea Center for Clinical Experience, 2Ophthalmology Services and Practice Development, 3Urgent Eye Care Service, Illinois College of Optometry, Chicago, IL, USA Abstract: Anterior uveitis encompasses inflammation of the iris and/or ciliary body and is one of the most common types of ocular inflammation that primary eye care practitioners will encounter. Anterior uveitis may be caused by a variety of etiologies, including infectious, noninfectious, and masquerade diseases. The short-term and long-term treatment of uveitis should include the evaluation of location, duration, pathology, and laterality, in addition to presenting signs and symptoms of the disease. A complete review of systems, thorough examination, and laboratory testing, may assist the practitioner in narrowing the list of possible causes for the uveitis. This is imperative as once a list of diagnoses has been made, a targeted approach to treatment can be pursued. Keywords: anterior uveitis, iritis, inflammation

  9. Marfan syndrome. Part 2: treatment and management of patients. (United States)

    Cañadas, Victoria; Vilacosta, Isidre; Bruna, Isidoro; Fuster, Valentin


    Aortic disease is the main cause of death among patients with Marfan syndrome. Before the development of open surgery, most patients died in the fourth decade of life. Improvements in surgical techniques have facilitated prophylactic surgery and have dramatically changed the life expectancy of patients with Marfan syndrome. Valve-sparing techniques are becoming the standard surgical treatment for these patients, since the operative and long-term results are comparable with those obtained with the Bentall and De Bono procedure and their theoretical advantages over the Bentall and De Bono procedure are attractive for young patients. Distal aortic complications still cause substantial morbidity in patients who have undergone surgery. On the other hand, several medical approaches have appeared as alternatives or adjuncts to the standard treatment with beta-blockers. Mouse models of the disease have shown that the angiotensin II receptor blocker losartan can rescue the phenotype. Among female patients, pregnancy deserves special consideration. Aortic dissection occurs mainly in the third trimester of gestation and in patients with dilated aortas. As aortic dissection carries a high risk of maternal mortality and fetal demise, prophylactic aortic surgery is recommended before attempting pregnancy for those women with an aortic diameter exceeding 40 mm.

  10. Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

    International Nuclear Information System (INIS)

    Bristol, Ian J.; Woodward, Wendy A.; Strom, Eric A.; Cristofanilli, Massimo; Domain, Delora; Singletary, S. Eva; Perkins, George H.; Oh, Julia L.; Yu, T.-K.; Terrefe, Welela; Sahin, Aysegul A.; Hunt, Kelly K.; Hortobagyi, Gabriel N.; Buchholz, Thomas A.


    Purpose: The aims of this study were to determine outcomes for patients with inflammatory breast cancer (IBC) treated with multimodality therapy, to identify factors associated with locoregional recurrence, and to determine which patients may benefit from radiation dose escalation. Methods and Materials: We retrospectively reviewed 256 consecutive patients with nonmetastatic IBC treated at our institution between 1977 and 2004. Results: The 192 patients who were able to complete the planned course of chemotherapy, mastectomy, and postmastectomy radiation had significantly better outcomes than the 64 patients who did not. The respective 5-year outcome rates were: locoregional control (84% vs. 51%), distant metastasis-free survival (47% vs. 20%), and overall survival (51% vs. 24%) (p < 0.0001 for all comparisons). Univariate factors significantly associated with locoregional control in the patients who completed plan treatment were response to neoadjuvant chemotherapy, surgical margin status, number of involved lymph nodes, and use of taxanes. Increasing the total chest-wall dose of postmastectomy radiation from 60 Gy to 66 Gy significantly improved locoregional control for patients who experienced less than a partial response to chemotherapy, patients with positive, close, or unknown margins, and patients <45 years of age. Conclusions: Patients with IBC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control. Escalation of postmastectomy radiation dose to 66 Gy appears to benefit patients with disease that responds poorly to chemotherapy, those with positive, close, or unknown margin status, and those <45 years of age

  11. Canine separation anxiety: strategies for treatment and management

    Directory of Open Access Journals (Sweden)

    Sargisson RJ


    Full Text Available Rebecca J Sargisson School of Psychology, University of Waikato, Tauranga, New ZealandAbstract: Dogs with separation-related behavior problems engage in unwanted behavior such as destruction of property and excessive vocalization when left alone, causing distress for both the dog and the owner, and often leading to the dog being relinquished or euthanized. I review research on factors likely to predispose dogs to developing separation anxiety and on the treatments available. Although research is equivocal, dogs seem to develop separation-related behavior problems if they are male, sourced from shelters or found, and separated from the litter before they are 60 days old. Protective factors include ensuring a wide range of experiences outside the home and with other people between the ages of 5–10 months, stable household routines and absences from the dog, and the avoidance of punishment. The most successful treatment for canine separation-related problems may be behavior modification that focuses on systematic desensitization and counterconditioning, which can be supplemented with medication in the initial stages. Where individual therapy from an animal behavior expert is not possible, advice to dog owners should be clear, simple, and contain five or fewer instructions to improve adherence. Advice is given for people seeking to adopt a dog, for new dog owners, and for existing dog owners who wish to treat their dog’s separation anxiety.Keywords: systematic desensitization, counterconditioning, medication, separation anxiety

  12. Surgical versus Non-surgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation


    Kweon, Christopher Y.; Gagnier, Joel Joseph; Robbins, Christopher; Bedi, Asheesh; Carpenter, James E.; Miller, Bruce S.


    Objectives: Rotator cuff tears are a common shoulder disorder resulting in significant disability to patients and strain on the health care system. While both surgical and non-surgical management are accepted treatment options, little data exist to guide the surgeon in treatment allocation. Defining variables to guide treatment allocation may be important for patient education and counseling, as well as to deliver the most efficient care plan at the time of presentation. The objective of this...

  13. Implementation of a management applied program for liquid radioactive waste treatment

    International Nuclear Information System (INIS)

    Lee, Y. H.; Ann, S. J.; Jo, H. S.; Son, J. S.


    A data collection of a liquid radioactive waste treatment process of a research organization became necessary while developing the RAWMIS(Radioactive Waste Management Integration System) which it can generate personal history management for efficient management of a waste, documents, all kinds of statistics. This paper introduces an input and output application program design to do to database with data in the results and a stream process of a treatment that analyzed the waste occurrence present situation and data by treatment process. Data on the actual treatment process that is not limited experiment improve by a document, human traces, saving of material resources and improve with efficiency of tracking about a radioactive waste and a process and give help to radioactive waste material valance and inventory study

  14. Glycosylphosphatidylinositol-Anchored Anti-HIV scFv Efficiently Protects CD4 T Cells from HIV-1 Infection and Deletion in hu-PBL Mice (United States)

    Ye, Chaobaihui; Wang, Weiming; Cheng, Liang; Li, Guangming; Wen, Michael; Wang, Qi; Zhang, Qing; Li, Dan


    ABSTRACT Despite success in viral inhibition and CD4 T cell recovery by highly active antiretroviral treatment (HAART), HIV-1 is still not curable due to the persistence of the HIV-1 reservoir during treatment. One patient with acute myeloid leukemia who received allogeneic hematopoietic stem cell transplantation from a homozygous CCR5 Δ32 donor has had no detectable viremia for 9 years after HAART cessation. This case has inspired a field of HIV-1 cure research focusing on engineering HIV-1 resistance in permissive cells. Here, we employed a glycosylphosphatidylinositol (GPI)-scFv X5 approach to confer resistance of human primary CD4 T cells to HIV-1. We showed that primary CD4 T cells expressing GPI-scFv X5 were resistant to CCR5 (R5)-, CXCR4 (X4)-, and dual-tropic HIV-1 and had a survival advantage compared to control cells ex vivo. In a hu-PBL mouse study, GPI-scFv X5-transduced CD4 T cells were selected in peripheral blood and lymphoid tissues upon HIV-1 infection. Finally, GPI-scFv X5-transduced CD4 T cells, after being cotransfused with HIV-infected cells, showed significantly reduced viral loads and viral RNA copy numbers relative to CD4 cells in hu-PBL mice compared to mice with GPI-scFv AB65-transduced CD4 T cells. We conclude that GPI-scFv X5-modified CD4 T cells could potentially be used as a genetic intervention against both R5- and X4-tropic HIV-1 infections. IMPORTANCE Blocking of HIV-1 entry is one of most promising approaches for therapy. Genetic disruption of the HIV-1 coreceptor CCR5 by nucleases in T cells is under 2 clinical trials and leads to reduced viremia in patients. However, the emergence of viruses using the CXCR4 coreceptor is a concern for therapies applying single-coreceptor disruption. Here, we report that HIV-1-permissive CD4 T cells engineered with GPI-scFv X5 are resistant to R5-, X4-, or dual-tropic virus infection ex vivo. In a preclinical study using hu-PBL mice, we show that CD4 T cells were protected and that GPI-scFv X5

  15. Diagnosis and management of neuropathic pain: a balanced approach to treatment. (United States)

    Nicholson, Bruce D


    To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided. A comprehensive literature review was conducted. Clinical articles, meta-analyses, and reviews were selected for their relevance to the diagnosis and management of chronic neuropathic pain and PHN. Managing patients with chronic neuropathic pain is a common clinical challenge due to variability in individual symptoms, mechanisms, and treatment responses. In patients with PHN, a balanced treatment approach focusing on efficacy, safety, and tolerability is recommended. With appropriate treatment, most patients are able to achieve clinically significant relief from neuropathic pain. Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care.

  16. Treatment management between orthodontists and general practitioners performing clear aligner therapy. (United States)

    Best, Alexandra D; Shroff, Bhavna; Carrico, Caroline K; Lindauer, Steven J


    To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners. A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment. Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction. There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.

  17. Management of Barrett's esophagus: Screening to newer treatments

    Directory of Open Access Journals (Sweden)

    V. Thoguluva Chandrasekar


    Full Text Available Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.

  18. Financial treatment of demand management expenditures at Ontario Hydro

    International Nuclear Information System (INIS)

    Ariss, D.G.


    Ontario Hydro's demand side management (DSM) plan comprises reduction of load, load shifting, and peak shaving. It includes an accounting policy applied only to measures which reduce demand by the increase in the efficiency of electricity of utilization or by the shifting of load from peak periods to off-peak periods. In order to choose the pertinent periods for which the DSM expenditures should be recovered, the utility has considered three accounting options: expensing all DSM expenditures as incurred; deferring all DSM expenditures; or deferring only those DSM expenditures that meet specified criteria. Ontario Hydro has chosen the last option, since it is in conformity with generally accepted accounting principles. This option is based on the matching principle, under which costs and revenues that are linked to each other in a cause-and-effect relationship should be recognized in the same accounting period. It has also been judged advantageous to amortize the deferred expenses corresponding to each measure over appropriate periods. It has also been established that the amortization period should begin immediately after each measure has been put into operation. This accounting policy ensures that expenses relating to DSM are accounted in a pertinent and uniform manner. 6 refs

  19. Management, treatment and final disposal of solid hazardous hospital wastes

    International Nuclear Information System (INIS)

    Sebiani Serrano, T.


    Medical Waste is characterized by its high risk to human health and the environment. The main risk is biological, due to the large amount of biologically contaminated materials present in such waste. However, this does not mean that the chemical and radioactive wastes are less harmful just because they represent a smaller part of the total waste. Hazardous wastes from hospitals can be divided in 3 main categories: Solid Hazardous Hospital Wastes (S.H.H.W.), Liquid Hazardous Hospital Wastes (L.H.H.W.) and Gaseous Hazardous Hospital Wastes (G.H.H.W.) Most gaseous and liquid hazardous wastes are discharged to the environment without treatment. Since this inappropriate disposal practice, however, is not visible to society, there is no societal reaction to such problem. On the contrary, hazardous solid wastes (S.H.H.W.) are visible to society and create worries in the population. As a result, social and political pressures arise, asking for solutions to the disposal problems of such wastes. In response to such pressures and legislation approved by Costa Rica on waste handling and disposal, the Caja Costarricense de Seguro Social developed a plan for the handling, treatment, and disposal of hazardous solid wastes at the hospitals and clinics of its system. The objective of the program is to reduce the risk to society of such wastes. In this thesis a cost-effectiveness analysis was conducted to determine the minimum cost at which it is possible to reach a maximum level of reduction in hazardous wastes, transferring to the environment the least possible volume of solid hazardous wastes, and therefore, reducing risk to a minimum. It was found that at the National Children's Hospital the internal handling of hazard solid wastes is conducted with a high level of effectiveness. However, once out of the hospital area, the handling is not effective, because hazardous and common wastes are all mixed together creating a larger amount of S.H.H.W. and reducing the final efficiency

  20. Failure of operative treatment for glenohumeral instability: etiology and management. (United States)

    Shah, Apurva S; Karadsheh, Mark S; Sekiya, Jon K


    Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology. Orthopaedic surgeons must recognize excessive capsular laxity or large glenohumeral bone defects preoperatively to avoid recurrence of instability. When history, physical examination, and radiographic evaluation are used in conjunction, patients at risk for failure can be identified. The instability severity index score permits precise identification of patients at risk. When treating patients in whom prior surgical intervention has failed, the success of revision procedures correlates to the surgeon's ability to identify the essential pathology and use lesion-specific treatment strategies. Revision procedures remain technically demanding. Keen preoperative and intraoperative judgment is required to avoid additional recurrence of instability after revision procedures, particularly because results deteriorate with each successive operation. Glenoid or humeral defects with greater than 25% bone loss compromise stability provided through the mechanism of concavity compression. These defects must be specifically addressed to avoid recurrence of instability. We prefer anatomic reconstruction techniques combined with capsulolabral repair and, if bone defects are present, anatomic reconstruction with osteochondral allograft. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  1. [Development of performance evaluation and management system on advanced schistosomiasis medical treatment]. (United States)

    Zhou, Xiao-Rong; Huang, Shui-Sheng; Gong, Xin-Guo; Cen, Li-Ping; Zhang, Cong; Zhu, Hong; Yang, Jun-Jing; Chen, Li


    To construct a performance evaluation and management system on advanced schistosomiasis medical treatment, and analyze and evaluate the work of the advanced schistosomiasis medical treatment over the years. By applying the database management technique and C++ programming technique, we inputted the information of the advanced schistosomiasis cases into the system, and comprehensively evaluated the work of the advanced schistosomiasis medical treatment through the cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. We made a set of software formula about cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. This system had many features such as clear building, easy to operate, friendly surface, convenient information input and information search. It could benefit the performance evaluation of the province's advanced schistosomiasis medical treatment work. This system can satisfy the current needs of advanced schistosomiasis medical treatment work and can be easy to be widely used.

  2. Safety and quality management for radiotherapy treatments - ASN guide nr 5 - Index 1 - Release of the 10/04/2009

    International Nuclear Information System (INIS)


    This guide aims at proposing a framework for the safety and quality management for radiotherapy treatments. It addresses the general requirements for the quality management system (general requirements and requirements related to documentation), the management responsibility, the resource management (human and hardware resources), the preparation and performance of activities allowing the taking into care of a patient from his first consultation to the post-treatment follow-up, the assessment, analysis and improvement of the quality management system

  3. Direct costs of managing adverse drug reactions during rifampicin-resistant tuberculosis treatment in South Africa. (United States)

    Schnippel, K; Firnhaber, C; Berhanu, R; Page-Shipp, L; Sinanovic, E


    To estimate the provider costs of managing adverse drug reactions (ADRs) to standard long-course treatment for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) according to South African guidelines. We parameterised a published Markov health state model for MDR/RR-TB with guidelines-based, bottom-up public-sector provider costing of ADR management. Frequency of ADR occurrence was extracted from the literature. Costs were estimated over 10 years, discounted 3% annually and tested using probabilistic sensitivity analysis. On average, guidelines-based costing of moderate ADRs weighted by the frequency of occurrence was US$135.76 (standard deviation [SD] US$17.18) and the cost of serious ADRs was US$521.29 (SD US$55.99). We estimated that the incremental costs of ADR management were US$380.17 annually per patient initiating MDR/RR-TB treatment. The incremental costs of ADR management for the public health sector in South Africa was US$4.76 million, 8.3% of the estimated cohort costs of MDR/RR-TB treatment ($57.55 million) for the 2015 cohort of 12 527 patients. Management of multiple ADRs and serious ADRs, which are common during the first 6 months of standard, long-course MDR/RR-TB treatment, substantially increases provider treatment costs. These results need to be taken into account when comparing regimen costs, and highlight the urgent need to identify drug regimens with improved safety profiles.

  4. Tibia Shaft Fractures in Adolescents: How and When Can They be Managed Successfully With Cast Treatment? (United States)

    Ho, Christine A


    Despite the increasing popularity of operative treatment in adolescent tibia fractures, casting remains a viable first-line treatment. Because the selection bias in published reports does not allow direct comparison between casting and flexible nail treatment of closed pediatric tibia fractures, it is unclear whether flexible nailing offers any advantages over casting. This overview discusses parameters of acceptable alignment, indications, techniques for successful reduction and casting, subsequent inpatient and outpatient management including wedging of casted tibia fractures, expected outcomes, and comparison of casting with flexible nailing. As with any orthopaedic procedure, careful attention to patient selection, indications, and detail facilitates successful cast treatment in this older pediatric population.

  5. The Effectiveness of Stress Management Program on Quality of Life among Methadone Maintenance Treatment Members

    Directory of Open Access Journals (Sweden)

    s Zarei


    Full Text Available Objective: The aim of present study was to investigate the effectiveness of stress management program on quality of life among methadone maintenance treatment members. Method: In this pre-test, post-test experimental study, 30 individual who referred to Saba MMT center in Pakdasht were randomly divided into experimental group (n=15 participants and control group (n=15 participants. The experimental group was undergone ten 90 minutes sessions of stress management program and the control group didn’t receive any treatment program. Quality of life questionnaire (SF-36 was administered. Result: The results showed that the mean sf-36 score in the experimental group had significant higher increased in comparison of control group. Conclusion: It can be concluded stress management program is effective on increasing of quality of life among methadone maintenance treatment members.

  6. Septage unit treatment by sludge treatment reed beds for easy management and reuse: performance and design considerations. (United States)

    Kim, Boram; Bel, Thomas; Bourdoncle, Pascal; Dimare, Jocelyne; Troesch, Stéphane; Molle, Pascal


    Sustainable treatment and management of fecal sludge in rural areas require adapted solutions. Rustic and simple operating processes such as sludge treatment reed beds (STRB) have been increasingly considered for this purpose. The biggest full scale (2,600 m 2 of STRB) septage treatment unit in France had been built in Nègrepelisse with the final objectives of reusing treated sludge and leachates for agriculture spreading and tree irrigation, respectively. The aim of this investigation was to validate the treatment chain of this installation. The obtained field data showed firstly that the overall removal efficiencies of STRB were satisfactory and stable. Removal rates higher than 98% for chemical oxygen demand and suspended solids and a 95% for Kjeldahl nitrogen represented so far a beneficial septage treatment by STRB. The highlighted necessity of a suitable complementary leachate treatment (before tree irrigation) justified the presence of the second stage of vertical flow constructed wetland. The sludge deposit drying and mineralization efficiencies were on the right track. According to hydrotextural diagram analysis, surface deposit was however found to have high deformability probably due to the youth of the installation. An in-depth understanding of STRB system needs continuous long-term studies.

  7. Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review

    Directory of Open Access Journals (Sweden)

    Mothanna K. AlRahabi, PhD


    Full Text Available Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.

  8. Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management


    Prendergast, Michael; Cartier, Jerome J.


    In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post...

  9. Moral Decision-Making among Assertive Community Treatment (ACT) Case Managers

    DEFF Research Database (Denmark)

    Lerbæk, Birgitte; Aagaard, Jørgen; Andersen, Mette Braendstrup


    The context of care in assertive community treatment (ACT) can be precarious and generate ethical issues involving the principles of autonomy and paternalism. This focus group study examined case managers' situated accounts of moral reasoning. Our findings show how they expressed strong moral...... obligation towards helping the clients. Their moral reasoning reflected a paternalistic position where, on different occasions, the potential benefits of their interventions would be prioritised at the expense of protecting the clients' personal autonomy. The case managers' reasoning emphasised situational...

  10. Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment program


    Hartzler, Bryan; Jackson, T. Ron; Jones, Brinn E.; Beadnell, Blair; Calsyn, Donald A.


    Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (interventio...

  11. Re-treatment tuberculosis cases categorised as "other": are they properly managed?

    Directory of Open Access Journals (Sweden)

    Hannock Tweya

    Full Text Available BACKGROUND: Although the World Health Organization (WHO provides information on the number of TB patients categorised as "other", there is limited information on treatment regimens or treatment outcomes for "other". Such information is important, as inappropriate treatment can lead to patients remaining infectious and becoming a potential source of drug resistance. Therefore, using a cohort of TB patients from a large registration centre in Lilongwe, Malawi, our study determined the proportion of all TB re-treatment patients who were registered as "other", and described their characteristics and treatment outcomes. METHODS: This retrospective observational study used routine program data to determine the proportion of all TB re-treatment patients who were registered as "other" and describe their characteristics and treatment outcomes between January 2006 and December 2008. RESULTS: 1,384 (12% of 11,663 TB cases were registered as re-treatment cases. Of these, 898 (65% were categorised as "other": 707 (79% had sputum smear-negative pulmonary TB and 191 (21% had extra pulmonary TB. Compared to the smear-positive relapse, re-treatment after default (RAD and failure cases, smear-negative "other" cases were older than 34 years and less likely to have their HIV status ascertained. Among those with known HIV status, "other" TB cases were more likely to be HIV positive. Of TB patients categorised as "other", 462 (51% were managed on the first-line regimen with a treatment success rate of 63%. CONCLUSION: A large proportion of re-treatment patients were categorised as "other". Many of these patients were HIV-infected and over half were treated with a first-line regimen, contrary to national guidelines. Treatment success was low. More attention to recording, diagnosis and management of these patients is warranted as incorrect treatment regimen and poor outcomes could lead to the development of drug resistant forms of TB.

  12. Municipal solid waste options : integrating organics management and residual disposal treatment : executive summary

    Energy Technology Data Exchange (ETDEWEB)

    Cant, M. (comp.) [Totten Sims Hubicki Associates Ltd., Calgary, AB (Canada); Van der Werf, P. [2cg Inc., Edmonton, AB (Canada); Kelleher, M. [Kelleher Environmental, Toronto, ON (Canada); Merriman, D. [MacViro Consultants, Markham, ON (Canada); Fitcher, K. [Gartner Lee Ltd., Toronto, ON (Canada); MacDonald, N. [CH2M Hill Engineering Ltd., Calgary, AB (Canada)


    The Municipal Solid Waste (MSW) Options Report explored different MSW management options for 3 community sizes: 20,000, 80,000 and 200,0000 people. It was released at a time when many communities were developing waste management plans to cost-effectively reduce environmental impacts and conserve landfill capacity. The purpose of this report was to provide a greater understanding on the environmental, social, economic, energy recovery/utilization and greenhouse gas (GHG) considerations of MSW management. The report also demonstrated the interrelationships between the management of organics and residuals. It was based on information from existing waste diversion and organics management options and emerging residual treatment technology options. The following organics management and residual treatment disposal options were evaluated: composting; anaerobic digestion; sanitary landfills; bioreactor landfills; and thermal treatment. Composting was examined with reference to both source separated organics (SSO) and mixed waste composting. SSO refers to the separation of materials suitable for composting solid waste from households, while mixed waste composting refers to the manual or mechanical removal of recyclable material from the waste, including compost. The composting process was reviewed along with available technologies such as non-reactor windrow; aerated static pile; reactor enclosed channel; and, container tunnel. An evaluation of SSO and mixed waste composting was then presented in terms of environmental, social, financial and GHG impacts. refs., tabs., figs.

  13. Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer. (United States)

    Nicholson, Helen L; Al-Hakeem, Yasser; Maldonado, Javier J; Tse, Vincent


    The aim of this review is to examine all urethral strictures and stenoses subsequent to treatment for prostate cancer, including radical prostatectomy (RP), radiotherapy, high intensity focused ultrasound (HIFU) and cryotherapy. The overall majority respond to endoscopic treatment, including dilatation, direct visual internal urethrotomy (DVIU) or bladder neck incision (BNI). There are adjunct treatments to endoscopic management, including injections of corticosteroids and mitomycin C (MMC) and urethral stents, which remain controversial and are not currently mainstay of treatment. Recalcitrant strictures are most commonly managed with urethroplasty, while recalcitrant stenosis is relatively rare yet almost always associated with bothersome urinary incontinence, requiring bladder neck reconstruction and subsequent artificial urinary sphincter (AUS) implantation, or urinary diversion for the devastated outlet.

  14. Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation. (United States)

    Ness, M G


    To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. A retrospective review of 10 cases. Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.

  15. Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis. (United States)

    Dalar, Levent; Karasulu, Levent; Abul, Yasin; Özdemir, Cengiz; Sökücü, Sinem Nedime; Tarhan, Merve; Altin, Sedat


    Bronchoscopic treatment is 1 of the treatment choices for both palliative and definitive treatment of benign tracheal stenosis. There is no consensus on the management of these patients, however, especially patients having complex stenoses. The aim of the present study was to assess, in the largest group of patients with complex stenoses yet reported, which types of tracheal stenosis are amenable to optimal management by bronchoscopic treatment. The present study was a retrospective cohort study including 132 consecutive patients with benign tracheal stenoses diagnosed between August 2005 and January 2013. The mean age of the study population was 52 ± 18 years; 62 (47%) were women and 70 (53%) were men. Their lesions were classified as simple and complex stenoses. Simple stenoses (n = 6) were treated with 12 rigid and flexible bronchoscopic procedures (mean of 2 per patient); 5 stents were placed. The total success rate was 100%. Among the 124 complex stenoses, 4 were treated directly with surgical intervention. In total, 481 rigid and 487 flexible bronchoscopic procedures were performed in these patients. In this group, the success rate was 69.8%. From the present study, we propose that after accurate classification, interventional bronchoscopic management may have an important role in the treatment of benign tracheal stenosis. Bronchoscopic treatment should be considered as first-line therapy for simple stenoses, whereas complex stenoses need a multidisciplinary approach and often require surgical intervention. However, bronchoscopic treatment may be a valid conservative approach in the management of patients with complex tracheal stenosis who are not eligible for operative treatment. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Research and practice of informatization construction in waste treatment and management

    International Nuclear Information System (INIS)

    Kong Jinsong; Guo Weiqun; Yu Ren; Xiang Xinmin


    The goal, content and requirement of the informatization construction in waste treatment and management in nuclear power system are discussed in the paper, as well as some key problems in this process. Taking the engineering practice of informatization construction in a waste treatment center as an example, the composition and architecture of the information system, the consideration and the solution methods of some key problems in system design and development are introduced in the paper. (authors)

  17. A Summary of the Academic Symposium on the Treatment and Management of City Wastes

    Institute of Scientific and Technical Information of China (English)


    <正> With the continuous worsening of theproblems of urban wastes about 60 urbanscientific workers gathered in Guiyang to dis-cuss the present state of the treatment andmanagement of urban wastes and find rela-tive solutions to the problems.The“Guiyang Symposium on the Treat-ment and Management of City Wastes”jointly sponsored by the Chinese Urban Sci-entific Research Institute,the Urban Con-struction Department of the Ministry of Ur-

  18. Abatement vs. treatment for efficient diffuse source water pollution management in terrestrial-marine systems. (United States)

    Roebeling, P C; Cunha, M C; Arroja, L; van Grieken, M E


    Marine ecosystems are affected by water pollution originating from coastal catchments. The delivery of water pollutants can be reduced through water pollution abatement as well as water pollution treatment. Hence, sustainable economic development of coastal regions requires balancing of the marginal costs from water pollution abatement and/or treatment and the associated marginal benefits from marine resource appreciation. Water pollution delivery reduction costs are, however, not equal across abatement and treatment options. In this paper, an optimal control approach is developed and applied to explore welfare maximizing rates of water pollution abatement and/or treatment for efficient diffuse source water pollution management in terrestrial-marine systems. For the case of diffuse source dissolved inorganic nitrogen water pollution in the Tully-Murray region, Queensland, Australia, (agricultural) water pollution abatement cost, (wetland) water pollution treatment cost and marine benefit functions are determined to explore welfare maximizing rates of water pollution abatement and/or treatment. Considering partial (wetland) treatment costs and positive water quality improvement benefits, results show that welfare gains can be obtained, primarily, through diffuse source water pollution abatement (improved agricultural management practices) and, to a minor extent, through diffuse source water pollution treatment (wetland restoration).

  19. [Consensus on clinical diagnosis, treatment and pedigree management of hereditary colorectal cancer in China]. (United States)


    Hereditary colorectal cancer can be divded into two categories based on the presence or absence of polyps. The first category is characterized by the development of polyposis, which includes familial adenomatous polyposis (FAP); The second category is nonpolyposis colorectal cancer, which is represented by Lynch syndrome. "Consensus on clinical diagnosis, treatment and pedigree management of hereditary colorectal cancer in China" developed by the Genetics Group of the Committee of Colorectal Cancer, Chinese Anti-cancer Association, is composed of three sections, including hereditary nonpolyposis syndrome, polyposis syndrome as well as genetic evaluation of hereditary colorectal cancer. The consensus aims to provide recommendations on management of the respective hereditary syndromes in terms of definition, clinical and pathological features, diagnostic standards, treatment, and follow-ups. In addition to describing diagnostic and treatment strategies, prophylactic treatment as well as genetic screening and pedigree monitoring is highly recommended. Through the establishment of this expert consensus, we hope to promote better understanding of hereditary colorectal cancer for clinicians and encourage standardized treatment through multidisciplinery approaches, eventually improving clinical treatment and pedigree management of hereditary colorectal cancer in China.

  20. In-Hospital Management and Follow-Up Treatment of Venous Thromboembolism: Focus on New and Emerging Treatments. (United States)

    Lenchus, Joshua D; Biehl, Michelle; Cabrera, Jorge; Moraes, Alice Gallo de; Dezfulian, Cameron


    Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep venous thrombosis (DVT), is a major cause of morbidity and mortality of particular relevance for intensivists and hospitalists. Acute VTE is usually managed with parenteral unfractionated heparin or low-molecular-weight heparin, followed by an oral vitamin K antagonist. Data are lacking for optimal treatment of less common occurrences, such as upper extremity DVT, and for approaches such as thrombolysis for PE associated with early signs of hemodynamic compromise or inferior vena cava filters when anticoagulation is contraindicated. Direct oral anticoagulants (DOACs) including apixaban, dabigatran, edoxaban, and rivaroxaban are now added to the armamentarium of agents available for acute management of VTE and/or reducing the risk of recurrence. This review outlines an algorithmic approach to acute VTE treatment: from aggressive therapies when anticoagulation may be inadequate, to alternative choices when anticoagulation is contraindicated, to anticoagulant options in the majority of patients in whom anticoagulation is appropriate. Evidence-based guidelines and the most recent DOAC clinical trial data are discussed in the context of the standard of care. Situations and treatment approaches for which data are unavailable or insufficient are identified. VTE therapy in care transitions is discussed, as are choices for secondary prevention.


    Directory of Open Access Journals (Sweden)

    O.V. Zaitseva


    Full Text Available A problem of etiology and pathogenesis of acute respiratory infections in children are observed in this article. Modern approach to management of its treatment in pediatric patients, including often ailing children, is described. Authors give characteristics to main directions of treatment of obstructive syndrome. An experience of anti-inflammatory therapy with fenspiride (eurespal in children of different age is summa ized in this article.Key words: often ailing children, acute respiratory infections, bronchoobstructive syndrome, anti-inflammatory treatment, fenspiride.

  2. An effective tool to manage the distribution of medicines and monitor the treatment in hospital pharmacies. (United States)

    Franzoso, Gianpaolo


    Introduction The purpose of the article is to share a modus operandi and a tool that allows the recruitment and management of thousands of patients and their treatment by using a simple software created by the author and made freely available to all colleague-pharmacists. The author, a pharmacist, created this database because there were no tools on the market with all the features needed to manage the treatment of patients and the orders of drugs to ensure continuity of care without waste of public money. Methods The data collection is facilitated by the software and allows the monitoring of treatment of the patients and their re-evaluation. This tool can create a table containing all the information needed to predict the demand for drugs, the timing of therapies and of the treatment plans. It is an effective instrument to calculate the optimal purchase of drugs and the delivery of therapies to patients. Conclusions A simple tool that allows the management of many patients, reduces research time and facilitates the control of therapies. It allows us to optimize inventory and minimize the stock of drugs. It allows the pharmacist to focus attention on the clinical management of the patient by helping him to follow therapy and respond to his needs.

  3. Waste Management, Treatment, and Disposal for the Food Processing Industry. Special Circular 113. (United States)

    Wooding, N. Henry

    This publication contains information relating to waste prevention, treatment and disposal, and waste product utilization. Its primary purpose is to provide information that will help the food industry executive recognize waste problems and make wise management decisions. The discussion of the methods, techniques, and the state-of-the-art is…

  4. The Treatment of Six Sigma in Introductory Operations Management Textbooks: Clearing Up the Confusion (United States)

    Ravinder, Handanhal; Misra, Ram B.


    This paper critically examines the treatment of the statistical basis for Six Sigma and process capability in popular operations management textbooks. It discusses areas of confusion and suggest ways of treating the topic that make sense to instructors as well as students. Even though Six Sigma was introduced almost 30 years ago, misconceptions…

  5. Enhanced Case Management versus Substance Abuse Treatment Alone among Substance Abusers with Depression (United States)

    Striley, Catherine W.; Nattala, Prasanthi; Ben Abdallah, Arbi; Dennis, Michael L.; Cottler, Linda B.


    This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to…

  6. The Advancing Role of Neuromodulation for the Management of Chronic Treatment-Refractory Pain 

    NARCIS (Netherlands)

    Shamji, Mohammed; de Vos, Cecile; Sharan, Ashwini

    Neuropathic pain is a common cause of disability and health care utilization. While judicious pharmacotherapy and management of comorbid psychological distress can provide for improved quality of life, some patients with treatment-refractory disease require more invasive therapies. Spinal cord

  7. Ixabepilone: a new treatment option for the management of taxane-resistant metastatic breast cancer

    International Nuclear Information System (INIS)

    Cobham, Marta Vallee; Donovan, Diana


    Ixabepilone (Ixempra ® ; Bristol-Myers Squibb) is a novel microtubule stabilizing agent recently approved for the treatment of metastatic breast cancer (MBC). This article focuses on considerations for ixabepilone administration and adverse event (AE) management, drawing from the biomedical literature indexed in PubMed, published abstracts from the American Society of Clinical Oncology annual meetings, and the manufacturer’s prescribing information for ixabepilone. Administered as monotherapy or in combination with capecitabine in clinical studies, ixabepilone demonstrated positive clinical response rates, prolonged progression-free survival, and a favorable safety profile in patients with MBC. Treatment-related AEs were predictable and manageable with dose modification, treatment interruption, and active management. As ixabepilone undergoes development in earlier lines of breast cancer therapy and in other solid tumors, oncology nurses will encounter more and more patients receiving ixabepilone therapy. If nurses are acquainted with the unique management strategies associated with ixabepilone treatment, as detailed herein, patients are more likely to receive the full benefit of therapy

  8. Non-drug Non-invasive Treatment in the Management of Low Back ...

    African Journals Online (AJOL)

    ... of functional independence and quality of life. Aim: The main purpose of this study was to assess the results of non-drug non-invasive treatment in the management of LBP. Subjects and Methods: This was prospective study conducted in the Department of Orthopedics in M. M. Medical College, Mullana, Ambala, Haryana, ...


    This Engineering Issue document on treatment of mining waters is a practical guide to understanding and selecting technologies for the environmental management of waste materials and effluents at hard-rock mines. For the purposes of this discussion, hard-rock mining primarily ref...

  10. Effect of nurse case management on the treatment of older women with breast cancer. (United States)

    Goodwin, James S; Satish, Shiva; Anderson, Elizabeth T; Nattinger, Ann B; Freeman, Jean L


    To evaluate the effect of nurse case management on the treatment of older women with breast cancer. Randomized prospective trial. Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas. Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer. Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer. The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis. More women in the intervention group received breast-conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast-conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management. Nurse case management results in more appropriate management of older women with breast cancer.

  11. Treatment phases in management of a comprehensive restorative case. A case report

    International Nuclear Information System (INIS)

    AlSamh, Duaa Abo; Endo, Cert End


    The aim of this case report was to emphasize the value of preforming patient's treatment plan into phases of treatment and encouraging colleagues to apply such phases in the clinical practice for the management of complex restorative cases. Traditional approach to treatment planning has certain merits. However, new treatment approach should improve oral health rather than react to presenting problems and therefore, dentists should aim to convert their irregular attendee to a regular attendee with treatment plan directed to enhance oral health, prevent disease, improve esthetic and free the patient from pain and discomfort. In this report, a complex restorative case of a 16-year-old female patient was managed for comprehensive dental therapy in the form of treatment plan which was divided into phases by way of a ''staircase'' approach with one clinical step being dependent on the previous step. The whole treatment was completed in three months and the results were satisfactory and patient became a highly motivated person with more self-confidence. (author)

  12. Substance abuse treatment management information systems: balancing federal, state, and service provider needs. (United States)

    Camp, J M; Krakow, M; McCarty, D; Argeriou, M


    There is increased interest in documenting the characteristics and treatment outcomes of clients served with Alcohol, Drug Abuse, and Mental Health Block Grant funds. The evolution of federal client-based management systems for substance abuse treatment services demonstrates that data collection systems are important but require continued support. A review of the Massachusetts substance abuse management information system illustrates the utility of a client-based data set. The development and implementation of a comprehensive information system require overcoming organizational barriers and project delays, fostering collaborative efforts among staff from diverse agencies, and employing considerable resources. In addition, the need to develop mechanisms for increasing the reliability of the data and ongoing training for the users is presented. Finally, three applications of the management information system's role in shaping policy are reviewed: developing services for special populations (communities of color, women, and pregnant substance abusers, and injection drug users), utilizing MIS data for evaluation purposes, and determining funding allocations.

  13. Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management. (United States)

    Prendergast, Michael; Cartier, Jerome J


    In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.

  14. Consumer factors predicting level of treatment response to illness management and recovery. (United States)

    White, Dominique A; McGuire, Alan B; Luther, Lauren; Anderson, Adrienne I; Phalen, Peter; McGrew, John H


    This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations. Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR. Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Variable effects of dipteran parasitoids and management treatment on grasshopper fecundity in a tallgrass prairie. (United States)

    Laws, A N; Joern, A


    Grasshoppers host a number of parasitoids, but little is known about their impact on grasshopper life history attributes or how those impacts may vary with land use. Here, we report on a three-year survey of nine grasshopper species in a tallgrass prairie managed with fire and bison grazing treatments. We measured parasitoid prevalence and the impact of parasitoid infection on grasshopper fecundity to determine if grasshopper-parasitoid interactions varied with management treatment. Adult female grasshoppers were collected every three weeks from eight watersheds managed with different prescribed burning and grazing treatments. Grasshopper fecundity with and without parasitoids was estimated through dissections of reproductive tracts. Dipteran parasitoids from two families (Nemestrinidae and Tachinidae) were observed infecting grasshoppers. We found significant effects of grazing treatment, but not burn interval, on grasshopper-parasitoid interactions. Parasitoids were three times more abundant in watersheds with bison grazing than in ungrazed watersheds, and the relative abundance of nemestrinid and tachinid flies varied with grazing treatment. Parasitoid prevalence varied among grasshopper species from grasshopper fecundity, with stronger effects on current reproduction than on past reproduction. Furthermore, current fecundity in parasitized grasshoppers was lower in grazed watersheds compared to ungrazed watersheds. Nemestrinid parasitoids generally had stronger impacts on grasshopper fecundity than tachinid parasitoids, the effects of which were more variable.

  16. Depoliticising the political: Market solutions and the retreat of Swedish institutional drug treatment from state management. (United States)

    Edman, Johan


    This article examines developments in the Swedish drug treatment services in 1982-2000 and explores the ways in which political initiatives and the state administration's management have contributed to the major privatisations of institutional drug treatment during this period. The empirical basis for the textual analysis lies in official reports, parliamentary material and archived records from the Stockholm County Administrative Board's management of treatment facilities. The major privatisations of drug treatment services in the 1980s were both unintentional and unwanted and mainly arose from a lack of bureaucratic control and ideological anchorage. The privatisations were, however, reinforced by ideologically driven NPM-oriented political initiatives in the 1990s. The market-oriented treatment services have failed to fulfil the needs for diversity and availability within a publicly financed sector, which deals with unevenly informed and often socio-economically weak citizens. New management models in this field must ensure that ideological considerations are taken into account to meet politically decided goals and means. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Waste management system alternatives for treatment of wastes from spent fuel reprocessing

    International Nuclear Information System (INIS)

    McKee, R.W.; Swanson, J.L.; Daling, P.M.


    This study was performed to help identify a preferred TRU waste treatment alternative for reprocessing wastes with respect to waste form performance in a geologic repository, near-term waste management system risks, and minimum waste management system costs. The results were intended for use in developing TRU waste acceptance requirements that may be needed to meet regulatory requirements for disposal of TRU wastes in a geologic repository. The waste management system components included in this analysis are waste treatment and packaging, transportation, and disposal. The major features of the TRU waste treatment alternatives examined here include: (1) packaging (as-produced) without treatment (PWOT); (2) compaction of hulls and other compactable wastes; (3) incineration of combustibles with cementation of the ash plus compaction of hulls and filters; (4) melting of hulls and failed equipment plus incineration of combustibles with vitrification of the ash along with the HLW; (5a) decontamination of hulls and failed equipment to produce LLW plus incineration and incorporation of ash and other inert wastes into HLW glass; and (5b) variation of this fifth treatment alternative in which the incineration ash is incorporated into a separate TRU waste glass. The six alternative processing system concepts provide progressively increasing levels of TRU waste consolidation and TRU waste form integrity. Vitrification of HLW and intermediate-level liquid wastes (ILLW) was assumed in all cases

  18. An interprofessional approach to managing children with treatment-resistant enuresis: an educational review. (United States)

    Caldwell, Patrina H Y; Lim, Melissa; Nankivell, Gail


    Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered.

  19. Fecal sludge management in developing urban centers: a review on the collection, treatment, and composting. (United States)

    Odey, Emmanuel Alepu; Li, Zifu; Zhou, Xiaoqin; Kalakodio, Loissi


    The problems posed by fecal sludge (FS) are multidimensional because most cities rapidly urbanize, which results in the increase in population, urban settlement, and waste generation. Issues concerning health and waste treatment have continued to create alarming situations. These issues had indeed interfered with the proper steps in managing FS, which contaminates the environment. FS can be used in agriculture as fertilizer because it is an excellent source of nutrients. The recent decline in crop production due to loss of soil organic component, erosion, and nutrient runoff has generated interest in the recycling of FS into soil nutrients through stabilization and composting. However, human feces are considerably liable to spread microorganisms to other persons. Thus, sanitation, stabilization, and composting should be the main objectives of FS treatment to minimize the risk to public and environmental health. This review presents an improved FS management (FSM) and technology option for soil amendment that is grouped into three headings, namely, (1) collection, (2) treatment, and (3) composting. On the basis of the literature review, the main problems associated with the collection and treatment of FS, such as inadequate tools and improper treatment processes, are summarized, and the trends and challenges that concern the applicability of each of the technologies in developing urban centers are critically reviewed. Stabilization during pretreatment before composting is suggested as the best method to reduce pathogens in FS. Results are precisely intended to be used as a support for decisions on policies and strategies for FSM and investments for improved treatment facilities.

  20. SU-F-P-03: Management of Time to Treatment Inititation: Case for An Electronic Whiteboard

    Energy Technology Data Exchange (ETDEWEB)

    Adnani, N [The Global Medical Physics Institute, Irvine, CA (United States)


    Purpose: To determine if data mining of an electronic whiteboard improves the management of the Time to Treatment Initiation (TTI) in radiation oncology. Methods: An electronic whiteboard designed to help in managing the planning workflow and improves communication regarding patient planning progress was used to record the dates at which each phase of the planning process began or completed. These are CT Sim date, Plan Start, Physician Review, Physicist Review, Approval for Treatment Delivery, Setup or Verification of Simulation. Results: During clinical implementation, the electronic whiteboard was able to fulfill its primary objective of providing a transparent account of the planning progress of each patient. Peer pressure also meant that individual tasks, such as contouring, were easily brought to the attention of the responsible party and prioritized accordingly. Data mining to analyze the electronic whiteboard per patient (figure 1), per diagnosis (figure 2), per treatment modality (figure 3), per physician (figure 4), per planner (figure 5), etc., added another sophisticated tool in the management of Time to Treatment Initiation without compromising quality of the plans being generated. A longer than necessary time between CT Sim and Plan Start can be discussed among the members of the treatment team as an indication of inadequate/outdated CT Simulator, Contouring Tools, Image Fusion Tools, Other Imaging Studies (MRI, PET/CT) performed, etc. The same for the Plan Start to Physician Review where an extended time than expected may be due unrealistic planning goals, limited planning system features, etc. Conclusion: An Electronic Whiteboard in radiation oncology is not only helping with organizing planning workflow, it is also a potent tool that can be used to reduce the Time to Treatment Initiation by providing the clinic with hard data about the duration of each phase treatment planning as a function of different variable affecting the planning process. The

  1. SU-F-P-03: Management of Time to Treatment Inititation: Case for An Electronic Whiteboard

    International Nuclear Information System (INIS)

    Adnani, N


    Purpose: To determine if data mining of an electronic whiteboard improves the management of the Time to Treatment Initiation (TTI) in radiation oncology. Methods: An electronic whiteboard designed to help in managing the planning workflow and improves communication regarding patient planning progress was used to record the dates at which each phase of the planning process began or completed. These are CT Sim date, Plan Start, Physician Review, Physicist Review, Approval for Treatment Delivery, Setup or Verification of Simulation. Results: During clinical implementation, the electronic whiteboard was able to fulfill its primary objective of providing a transparent account of the planning progress of each patient. Peer pressure also meant that individual tasks, such as contouring, were easily brought to the attention of the responsible party and prioritized accordingly. Data mining to analyze the electronic whiteboard per patient (figure 1), per diagnosis (figure 2), per treatment modality (figure 3), per physician (figure 4), per planner (figure 5), etc., added another sophisticated tool in the management of Time to Treatment Initiation without compromising quality of the plans being generated. A longer than necessary time between CT Sim and Plan Start can be discussed among the members of the treatment team as an indication of inadequate/outdated CT Simulator, Contouring Tools, Image Fusion Tools, Other Imaging Studies (MRI, PET/CT) performed, etc. The same for the Plan Start to Physician Review where an extended time than expected may be due unrealistic planning goals, limited planning system features, etc. Conclusion: An Electronic Whiteboard in radiation oncology is not only helping with organizing planning workflow, it is also a potent tool that can be used to reduce the Time to Treatment Initiation by providing the clinic with hard data about the duration of each phase treatment planning as a function of different variable affecting the planning process. The

  2. Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. (United States)

    van Rijn, Dafne; van den Akker-Scheek, Inge; Steunebrink, Mirjam; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk


    Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments. A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials. In total, 138 patients with PT were included in the analysis. Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31). Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment. Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance). Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.

  3. CO₂-neutral wastewater treatment plants or robust, climate-friendly wastewater management? A systems perspective. (United States)

    Larsen, Tove A


    CO2-neutral wastewater treatment plants can be obtained by improving the recovery of internal wastewater energy resources (COD, nutrients, energy) and reducing energy demand as well as direct emissions of the greenhouse gases N2O and CH4. Climate-friendly wastewater management also includes the management of the heat resource, which is most efficiently recovered at the household level, and robust wastewater management must be able to cope with a possible resulting temperature decrease. At the treatment plant there is a substantial energy optimization potential, both from improving electromechanical devices and sludge treatment as well as through the implementation of more energy-efficient processes like the mainstream anammox process or nutrient recovery from urine. Whether CO2 neutrality can be achieved depends not only on the actual net electricity production, but also on the type of electricity replaced: the cleaner the marginal electricity the more difficult to compensate for the direct emissions, which can be substantial, depending on the stability of the biological processes. It is possible to combine heat recovery at the household scale and nutrient recovery from urine, which both have a large potential to improve the climate friendliness of wastewater management. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Recent Improvements In Interface Management For Hanfords Waste Treatment And Immobilization Plant - 13263

    International Nuclear Information System (INIS)

    Arm, Stuart T.; Pell, Michael J.; Van Meighem, Jeffery S.; Duncan, Garth M.; Harrington, Christopher C.


    The U.S. Department of Energy (DOE), Office of River Protection (ORP) is responsible for management and completion of the River Protection Project (RPP) mission, which comprises both the Hanford Site tank farms operations and the Waste Treatment and Immobilization Plant (WTP). The RPP mission is to store, retrieve and treat Hanford's tank waste; store and dispose of treated wastes; and close the tank farm waste management areas and treatment facilities by 2047. The WTP is currently being designed and constructed by Bechtel National Inc. (BNI) for DOE-ORP. BNI relies on a number of technical services from other Hanford contractors for WTP's construction and commissioning. These same services will be required of the future WTP operations contractor. The WTP interface management process has recently been improved through changes in organization and technical issue management documented in an Interface Management Plan. Ten of the thirteen active WTP Interface Control Documents (ICDs) have been revised in 2012 using the improved process with the remaining three in progress. The value of the process improvements is reflected by the ability to issue these documents on schedule

  5. Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report. (United States)

    Slaven, Emily J; Mathers, Jessie


    Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.

  6. Contemporary Management of Mandibular Fracture Nonunion-A Retrospective Review and Treatment Algorithm. (United States)

    Ostrander, Benjamin T; Wang, Howard D; Cusano, Alessandro; Manson, Paul N; Nam, Arthur J; Dorafshar, Amir H


    Nonunion is an uncommon complication after mandibular fractures. The purpose of this investigation was to compare outcomes of patients with mandibular fracture nonunion who were treated with a 1- versus 2-stage approach and propose a pragmatic treatment algorithm for surgical management based on preoperative characteristics. The authors conducted a retrospective study consisting of patients who presented to 2 level 1 trauma centers for the management of mandibular fracture nonunion over a 10-year period. The primary predictor variable was 1- versus 2-stage treatment. Outcomes were examined to propose a treatment algorithm. Eighteen patients were included in the study. The sample's mean age was 44.0 ± 19.3 years and most were men (88.9%). Mandibular angle and body accounted for 77.8% of cases. A single-stage approach was used in 13 patients (72.2%). Bone grafts or vascularized bone flaps were required in 13 patients (72.2%). Patients who required 2-stage treatments had intraoral soft tissue defects. Mean length of follow-up was 13.3 ± 20.4 months. All patients achieved bony union, with complications occurring in 5 patients (27.8%). The authors' 10-year experience was used to formulate a treatment algorithm based on bony defect size and soft tissue status, which can be used to inform optimal surgical management. Nonunion of mandibular fractures is an infrequent and complex condition requiring careful and deliberate surgical management. A single-stage approach is appropriate in most cases and does not negatively affect outcomes. Bony defect size and soft tissue status are essential parameters for determining the approach and timing of reconstruction. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Post-Polio Syndrome and the Late Effects of Poliomyelitis: Part 2. Treatment, Management and Prognosis. (United States)

    Lo, Julian K; Robinson, Lawrence R


    Post-Polio Syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years following the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

  8. Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals

    Directory of Open Access Journals (Sweden)

    Lydeka Zigmas


    Full Text Available Abstract Background The regulations of the Quality Management System (QMS implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. Methods A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence. Results Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it. The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale. The most critical issues related to the QMS implementation include procedure development (5.5, lack of financial resources (5.4 and information (5.1, and development of work guidelines (4.6, while improved responsibility and power sharing (5.2, better service quality (5.1 and higher patient satisfaction (5.1 were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6. However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. Conclusion

  9. Cancer-Related Fatigue in Adolescents and Young Adults After Cancer Treatment: Persistent and Poorly Managed. (United States)

    Spathis, Anna; Hatcher, Helen; Booth, Sara; Gibson, Faith; Stone, Paddy; Abbas, Laura; Barclay, Matt; Brimicombe, James; Thiemann, Pia; McCabe, Martin G; Campsey, Rachel; Hooker, Louise; Moss, Wendy; Robson, Jane; Barclay, Stephen


    Cancer-related fatigue is the most prevalent and distressing symptom experienced by adolescents and young adults (AYAs). An electronic survey was undertaken to ascertain current fatigue management and perceptions of its effectiveness. Eighty-five percent of responders (68/80) experienced fatigue, and it was worse more than 1 year after cancer treatment ended, compared to fatigue management. Although advice to exercise was the most frequent intervention, the greatest impact of fatigue was on the ability to exercise and most did not find exercise advice helpful. Early intervention is warranted, supporting AYAs to persevere with increasing activity.

  10. Young Adults' Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development. (United States)

    Lanoye, Autumn; Gorin, Amy A; LaRose, Jessica Gokee


    Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight-related constructs. The aim of this review is to explore young adults' attitudes toward obesity and weight management, with particular attention to those factors that may play a role in the development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults' perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group.

  11. Young Adults’ Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development (United States)

    Lanoye, Autumn; Gorin, Amy A.; LaRose, Jessica Gokee


    Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight related constructs. The aim of this review is to explore young adults’ attitudes toward obesity and weight management, with particular attention to those factors that may play a role in development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults’ perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group. PMID:26923688

  12. State-of-the-Art Management of Complications of Myeloma and Its Treatment

    Directory of Open Access Journals (Sweden)

    Monique A. Hartley-Brown


    Full Text Available Multiple myeloma is an incurable disease, although patient survival has increased with the availability of novel agents. Both multiple myeloma and its therapies often affect the renal, immune, skeletal, hematologic, and nervous systems. The resulting organ dysfunctions often impair the quality of life of affected patients, complicate and limit subsequent therapies, and may result in significant mortality. Research on the treatment of complications of multiple myeloma has been limited; hence, preventative and management strategies for patients with these complications are heterogeneous and often based on anecdotal experience. In this paper, we review the effects of myeloma and the novel therapies on organ systems and suggest management strategies.

  13. The practice and effect of combined duty of administrative management, medical treatment and nursing

    Directory of Open Access Journals (Sweden)

    Min HU


    Full Text Available Objective: To explore the effect of combined duty mode on discovery and control of medical nursing hidden trouble. Method: In order to make sure that patients are in the first place, we should take the mode of combined duty of administrative management, medical treatment and nursing. Results:The incidence of nursing errors and defects reduced, and patients’ satisfaction improved. the differences were statistically significant (P<0.01 or P<0.05.Results: Combined duty can the reduce medical nursing defects, improve the efficiency of quality health care services and the management efficiency.

  14. The Outcome of Surgery versus Medical Management in the Treatment of Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Caleb P. Nelson


    Full Text Available Evaluation of the relative merits of medical versus surgical management of vesicoureteral reflux (VUR has been limited by the few prospective studies comparing these strategies. Among those trials that have been reported, the only consistent positive finding has been that incidence of febrile UTI is lower among children undergoing surgical treatment in comparison with medical treatment. Studies have not found significant differences in overall incidence of UTI, or in rates of new renal scarring or progression of existing scarring. It is likely that there is a subset of children with VUR who do benefit from aggressive treatment of their VUR, but we are not yet able to fully determine which children these are. It is hoped that future research will further clarify which treatments are useful in which children.

  15. Recent Improvements in Interface Management for Hanford's Waste Treatment and Immobilization Plant - 13263

    Energy Technology Data Exchange (ETDEWEB)

    Arm, Stuart T.; Van Meighem, Jeffery S. [Washington River Protection Solutions, P.O. Box 850, Richland, Washington, 99352 (United States); Duncan, Garth M.; Pell, Michael J. [Bechtel National Inc., 2435 Stevens Center Place, Richland, Washington, 99352 (United States); Harrington, Christopher C. [Department of Energy - Office of River Protection, 2440 Stevens Center Place, Richland, Washington, 99352 (United States)


    The U.S. Department of Energy (DOE), Office of River Protection (ORP) is responsible for management and completion of the River Protection Project (RPP) mission, which includes the Hanford Site tank farms operations and the Waste Treatment and Immobilization Plant (WTP). The RPP mission is to store, retrieve and treat Hanford's tank waste; store and dispose of treated wastes; and close the tank farm waste management areas and treatment facilities by 2047. The WTP is currently being designed and constructed by Bechtel National Inc. (BNI) for DOE-ORP. BNI relies on a number of technical services from other Hanford contractors for WTP's construction and commissioning. These same services will be required of the future WTP operations contractor. Partly in response to a DNFSB recommendation, the WTP interface management process managing these technical services has recently been improved through changes in organization and issue management. The changes are documented in an Interface Management Plan. The organizational improvement is embodied in the One System Integrated Project Team that was formed by integrating WTP and tank farms staff representing interfacing functional areas into a single organization. A number of improvements were made to the issue management process but most notable was the formal appointment of technical, regulatory and safety subject matter experts to ensure accurate identification of issues and open items. Ten of the thirteen active WTP Interface Control Documents have been revised in 2012 using the improved process with the remaining three in progress. The value of the process improvements is reflected by the ability to issue these documents on schedule and accurately identify technical, regulatory and safety issues and open items. (authors)

  16. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management. (United States)

    Babu, Ranjith; Sharma, Richa; Bagley, Jacob H; Hatef, Jeffrey; Friedman, Allan H; Adamson, Cory


    There are a variety of treatment options for the management of vestibular schwannomas (VSs), including microsurgical resection, radiotherapy, and observation. Although the choice of treatment is dependent on various patient factors, physician bias has been shown to significantly affect treatment choice for VS. In this study the authors describe the current epidemiology of VS and treatment trends in the US in the modern era. They also illustrate patient and tumor characteristics and elucidate their effect on tumor management. Patients diagnosed with VS were identified through the Surveillance, Epidemiology, and End Results database, spanning the years 2004-2009. Age-adjusted incidence rates were calculated and adjusted using the 2000 US standard population. The chi-square and Student t-tests were used to evaluate differences between patient and tumor characteristics. Multivariate logistic regression was performed to determine the effects of various patient and tumor characteristics on the choice of tumor treatment. A total of 6225 patients with VSs treated between 2004 and 2009 were identified. The overall incidence rate was 1.2 per 100,000 population per year. The median age of patients with VS was 55 years, with the majority of patients being Caucasian (83.16%). Of all patients, 3053 (49.04%) received surgery only, with 1466 (23.55%) receiving radiotherapy alone. Both surgery and radiation were only used in 123 patients (1.98%), with 1504 patients not undergoing any treatment (24.16%). Increasing age correlated with decreased use of surgery (OR 0.95, 95% CI 0.95-0.96; pmanagement (OR 1.04, 95% CI 1.04-1.05; pmanaged conservatively despite presenting with larger tumors. Further studies are needed to elucidate the reasons for treatment disparities and investigate the nationwide trend of resection for the treatment of small VSs.

  17. Pericardial tamponade complicated by interventional management for Budd-Chiari syndrome: clinical analysis and treatment

    International Nuclear Information System (INIS)

    Zhang Luxi; Zu Maoheng; Wu Jinping; Xu Hao; Jiao Xudong; Chen Zhengkan


    Objective: To discuss the cases and treatment of pericardial tamponade (PT) occurred in the interventional management for Budd-Chiari syndrome (BCS). Methods: During the period from 1990 to 2006, interventional treatment was performed in 812 patients with BCS. Pericardial tamponade occurred in nine patients during the period of interventional treatment. The clinical data, including angiographic findings, clinical symptoms, management and outcomes, of the nine patients were retrospectively analyzed. The possible causes of pericardial tamponade were discussed. Results: Of the nine patients occurring pericardial tamponade, successful treatment was obtained in eight and death occurred in one. The lesions of BCS in the nine cases included inferior vena cava obstruction type (n=7), hepatic venous obstruction type (n=1) and mixed type (n=1). Pericardial tamponade was caused by mistakenly puncturing into pericardium (n=5), mistakenly puncturing together with laceration of pericardium by balloon (n=3), and breaking of pericardium by displaced stent (n=1). Conventional pericardicentesis was employed in one case, surgery was carried out in three cases, and infra-xiphoid catheterization and drainage using Seldinger technique was performed in two cases. Conservative treatment was adopted in one case and aspiration through the wrongly inserted catheter was tried in one case. In the remaining one case, aspiration through the wrongly inserted catheter together with infra-xiphoid catheterization and drainage by using Seldinger technique was carried out. Conclusion: The pericardial tamponade is an severe complication occurred in the interventional management for Budd-Chiari syndrome, although it is rarely seen. Preoperative prevention, prompt detection and rational treatment are the keys avoid serious consequences. (authors)

  18. Treatment and disease management of multiple sclerosis patients: A review for nurse practitioners. (United States)

    Roman, Cortnee; Menning, Kara


    This review discusses the role of the nurse practitioner (NP) in evaluating the clinical effects, potential side effects, and monitoring requirements for treatment options in multiple sclerosis (MS) and provides guidance on how to help patients understand these issues. A literature search was conducted on PubMed to identify publications on monitoring and disease management of MS patients. Additional resources included drug information web sites and package inserts. NPs play an active role in the management of MS patients via effective monitoring and communication throughout the patient's treatment regimen and disease course. In the shared decision-making model of MS treatment, NPs ensure that patients understand the implications of their disease-modifying therapies (DMTs). As patients move through treatments during the course of their disease, the importance of this role increases, and it is critical that NPs follow the guidelines in each medication's product label and take into account any potential lingering effects of prior medications. It is critical for NPs to promote patient adherence, to ensure that patients understand treatment side effects and monitoring requirements, and to take sequencing and reversibility implications of DMTs into account when making clinical decisions. ©2017 American Association of Nurse Practitioners.

  19. Surgical Management of Severe Spontaneous Hemorrhage of the Abdominal Wall Complicating Acenocoumarol Treatment

    Directory of Open Access Journals (Sweden)

    Orestis Ioannidis


    Full Text Available Acenocoumarol is a vitamin K antagonist that is used for the treatment of acquired and congenital, both arterial and venous, thrombotic diseases. Its use is complicated by the narrow therapeutic range. Bleeding following oral anticoagulation, despite rare, remains the major complication. Most cases of hemorrhagic episodes usually require short hospitalization and transfusion, while surgical drainage of the hematoma is not recommended. However, in cases that conservative treatment isn’t successful, surgical intervention remains an option. We present a case of severe spontaneous bleeding of the rectus abdominis muscle which was successfully managed surgically.

  20. The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm. (United States)

    Tuchman, Alexander; Pham, Martin; Hsieh, Patrick C


    Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery. A PubMed database search was performed using a combination of search terms and Medical Subject Headings, to identify clinical studies reporting on the treatment and outcome of SEA. The literature review revealed 28 original case series containing at least 30 patients and reporting on treatment and outcome. All cohorts were deemed Class III evidence, and in all but two the data were obtained retrospectively. Based on the conclusions of these studies along with selected smaller studies and review articles, the authors present an evidence-based algorithm for selecting patients who may be safe candidates for nonoperative management. Patients who are unable to undergo an operation, have a complete spinal cord injury more than 48 hours with low clinical or radiographic concern for an ascending lesion, or who are neurologically stable and lack risk factors for failure of medical management may be initially treated with antibiotics alone and close clinical monitoring. If initial medical management is to be undertaken the patient should be made aware that delayed neurological deterioration may not fully resolve even after prompt surgical treatment. Patients deemed good surgical

  1. The optimization of treatment and management of schizophrenia in Europe (OPTiMiSE) trial

    DEFF Research Database (Denmark)

    Leucht, Stefan; Winter-van Rossum, Inge; Heres, Stephan


    Commission sponsored "Optimization of Treatment and Management of Schizophrenia in Europe" (OPTiMiSE) trial which aims to provide a treatment algorithm for patients with a first episode of schizophrenia. METHODS: We searched Pubmed (October 29, 2014) for randomized controlled trials (RCTs) that examined...... switching the drug in nonresponders to another antipsychotic. We described important methodological choices of the OPTiMiSE trial. RESULTS: We found 10 RCTs on switching antipsychotic drugs. No trial was conclusive and none was concerned with first-episode schizophrenia. In OPTiMiSE, 500 first episode...

  2. Synergy between research activity and management procedures in an industrial waste treatment

    International Nuclear Information System (INIS)

    Bertanza, G.; Collivignarelli, M.C.; Zanaboni, S.


    The optimization of operation criteria for centralized industrial waste treatment plants is a difficult task. Experimental research can be a useful tool for understanding how to carry out this optimization process; however, in order to obtain proper solution, a very close connection must been observed activity and the field (e.g. practical application at the full scale). In this paper a three years successful experience is described: the research was carried out in an industrial waste treatment facility located in Northern Italy. Thanks to a close interaction between management and research activities, a significant synergy was achieved: in fact, interesting and original suggestions for the research arose from plant monitoring, and the first findings of the research have already led to important improvements in the full scale plant management [it

  3. Intended process water management concept for the mechanical biological treatment of municipal solid waste

    Institute of Scientific and Technical Information of China (English)

    D. Weichgrebe; S. Maerker; T. Boning; H. Stegemann


    Accumulating operational experience in both aerobic and anaerobic mechanical biological waste treatment (MBT) makes it increasingly obvious that controlled water management would substantially reduce the cost of MBT and also enhance resource recovery of the organic and inorganic fraction. The MBT plant at Gescher, Germany, is used as an example in order to determine the quantity and composition of process water and leachates from intensive and subsequent rotting, pressing water from anaerobic digestion and scrubber water from acid exhaust air treatment, and hence prepare an MBT water balance. The potential of, requirements for and limits to internal process water reuse as well as the possibilities of resource recovery from scrubber water are also examined. Finally, an assimilated process water management concept with the purpose of an extensive reduction of wastewater quantity and freshwater demand is presented.

  4. Investigation of development and management of treatment planning systems for BNCT at foreign facilities

    International Nuclear Information System (INIS)


    A new computational dosimetry system for BNCT: JCDS is developed by JAERI in order to carry out BNCT with epithermal neutron beam at present. The development and management situation of computational dosimetry system, which are developed and are used in BNCT facilities in foreign countries, were investigated in order to accurately grasp functions necessary for preparation of the treatment planning and its future subjects. In present state, 'SERA', which are developed by Idaho National Engineering and Environmental Laboratory (INEEL), is used in many BNCT facilities. Followings are necessary for development and management of the treatment planning system. (1) Reliability confirmation of system performance by verification as comparison examination of calculated value with actual experimental measured value. (2) Confirmation systems such as periodic maintenance for retention of the system quality. (3) The improvement system, which always considered relative merits and demerits with other computational dosimetry system. (4) The development of integrated system with patient setting. (author)

  5. Spanish Consensus Statement: Clinical Management and Treatment of Tendinopathies in Sport. (United States)

    Fernandez-Jaén, Tomas; Rey, Guillermo Álvarez; Angulo, Francisco; Cuesta, Jordi Ardevol; Loureda, Rafael Arriaza; España, Fernando Ávila; Ayala, Juan; Matas, Ramón Balius; Pazos, Fernando Baró; de Dios Beas Jiménez, Juan; Rosell, Jorge Candel; Fernandez, César Cobián; Del Pilar Doñoro Cuevas, M; Ros, Francisco Esparza; Colmenero, Josefina Espejo; de Prado, Jorge Fernández; García Cota, Juan José; Garrido González, Jose Ignacio; de Vega, Carlos Gonzalez; Santander, Manuela González; Herrador Munilla, Miguel Ángel; Ruiz, Francisco Ivorra; Díaz, Fernando Jiménez; Fernandez, Antonio Maestro; Marqueta, Pedro Manonelles; Muñoz Benito, Juan José; Vilás, Ramón Olivé; Pedret, Carles; Teres, Xavier Peirau; Amaro, José Peña; Grifell, Jordi Puigdellivoll; San Roque, Juan Pérez; Parenteu, Christophe Ramírez; Serna, Juan Ribas; Rodas, Gil; Álvarez, Mikel Sánchez; Marchori, Carlos Sanchez; Perez, Lluis Til; Durán, Rosario Ureña; Del Valle Soto, Miguel; Villalón Alonso, José María; García, Pedro Guillen


    On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert's experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.

  6. Development of an Integrated Leachate Treatment Solution for the Port Granby Waste Management Facility - 12429

    Energy Technology Data Exchange (ETDEWEB)

    Conroy, Kevin W. [Golder Associates Inc., Lakewood, Colorado (United States); Vandergaast, Gerald [Atomic Energy of Canada Limited, Port Hope, Ontario (Canada)


    The Port Granby Project (the Project) is located near the north shore of Lake Ontario in the Municipality of Clarington, Ontario, Canada. The Project consists of relocating approximately 450,000 m{sup 3} of historic Low-Level Radioactive Waste (LLRW) and contaminated soil from the existing Port Granby Waste Management Facility (WMF) to a proposed Long-Term Waste Management Facility (LTWMF) located adjacent to the WMF. The LTWMF will include an engineered waste containment facility, a Wastewater Treatment Plant (WTP), and other ancillary facilities. A series of bench- and pilot-scale test programs have been conducted to identify preferred treatment processes to be incorporated into the WTP to treat wastewater generated during the construction, closure and post-closure periods at the WMF/LTWMF. (authors)

  7. Management of gingival recession associated with orthodontic treatment: a case report. (United States)

    Rana, Tarun Kumar; Phogat, Megha; Sharma, Tarun; Prasad, Narayana; Singh, Shailendra


    Many patients undergo orthodontic treatment for aesthetic improvement. It is well established that the patients who undergo orthodontic treatment have a high susceptibility to present plaque accumulation on their teeth because of the presence of brackets, wires and/or other orthodontic elements on the teeth surfaces with which the oral hygiene procedures might be more difficult. The orthodontic treatment is a double-action procedure regarding the periodontal tissues which may be very meaningful in increasing the periodontal health status and may be a harmful procedure which can be followed by several types of periodontal complications. There is a strong correlation between the severity and extent of gingival recessions and the orthodontic treatment suggesting that orthodontic tooth movement may lead to gingival recession. The principal objective in the treatment of gingival recession is to cover the exposed root surfaces to improve aesthetics and to reduce hypersensitivity. Different soft tissue grafting procedures have been proposed in the treatment of gingival recessions. Subepithelial connective tissue graft is a reliable method for treatment of gingival recession. The purpose of this case report was to illustrate the relationship between orthodontic therapy and gingival recession and to describe the management of this case.

  8. Prevalence and Treatment Management of Oropharyngeal Candidiasis in Cancer Patients: Results of the French Candidoscope Study

    International Nuclear Information System (INIS)

    Gligorov, Joseph; Bastit, Laurent; Gervais, Honorine; Henni, Mehdi; Kahila, Widad; Lepille, Daniel; Luporsi, Elisabeth; Sasso, Giuseppe; Varette, Charles; Azria, David


    Purpose: The aim of this pharmaco-epidemiological study was to evaluate the prevalence of oropharyngeal candidiasis (OPC) in cancer patients treated with chemotherapy and/or radiotherapy. Methods and Materials: Signs and symptoms of OPC were noted for all patients. Antifungal therapeutic management was recorded in OPC patients. Patients receiving local antifungal treatments were monitored until the end of treatment. Results: Enrolled in the study were 2,042 patients with solid tumor and/or lymphoma treated with chemotherapy and/or another systemic cancer treatment and/or radiotherapy. The overall prevalence of OPC was 9.6% (95% confidence interval, 8.4%-11.0%] in this population. It was most frequent in patients treated with combined chemoradiotherapy (22.0%) or with more than two cytotoxic agents (16.9%). Local antifungal treatments were prescribed in 75.0% of OPC patients as recommended by guidelines. The compliance to treatment was higher in patients receiving once-daily miconazole mucoadhesive buccal tablet (MBT; 88.2%) than in those treated with several daily mouthwashes of amphotericin B (40%) or nystatin (18.8%). Conclusion: OPC prevalence in treated cancer patients was high. Local treatments were usually prescribed as per guidelines. Compliance to local treatments was better with once-daily drugs.

  9. Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management

    Directory of Open Access Journals (Sweden)

    Michelle M. Lamb


    Full Text Available The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief.   Type: Original Research

  10. Spasticity: its physiology and management. Part IV. Current and projected treatment procedures for spasticity. (United States)

    Bishop, B


    Today's prescriptions for treating spasticity may include pharmacological, surgical, or physical procedures. All derive their rationale from the classical concepts of decerebrate rigidity and of brain organization as discussed in Part I. This paper describes the advantages and disadvantages of these current treatment procedures and proposes that recent discoveries about the "recovery" capabilities of the central nervous system may influence the means for managing spasticity in the future.

  11. Innovations in management of cardiac disease: drugs, treatment strategies and technology. (United States)

    Foëx, P


    Within the last generation, the management of patients with heart disease has been transformed by advances in drug treatments, interventions and diagnostic technologies. The management of arterial hypertension saw beta-blockers demoted from first- to third-line treatment. Recent studies suggest that the goal of treatment may have to change to lower systolic blood pressures to prevent long-term organ damage. Today less than 15% of coronary revascularizations are surgical and more than 85% are done by interventional cardiologists inserting coronary stents. Thus, managing patients on dual antiplatelet therapy has become an important issue. With new generations of coronary stents, recommendations are changing fast. In the past, decisions concerning non-cardiac surgery after acute myocardial infarction were based on the delay between infarction and non-cardiac surgery. Today, the main concern is the patient's status in respect of dual antiplatelet therapy after primary percutaneous intervention. There have been advances in the management of heart failure but new drugs (ivabradine, sacubitril/valsartan) and cardiac resynchronization are recommended only in patients with an ejection fraction below 35% on optimal medication. Heart failure remains a major perioperative risk factor. Prospective studies have shown that troponin elevations represent myocardial injury (not necessarily myocardial infarction), are mostly silent and are associated with increased 30-day mortality. Monitoring (troponin assays) for myocardial injury in non-cardiac surgery (MINS) seems increasingly justified. The treatment of MINS needs further research. Technological advances, such as intelligent, portable monitors benefit not only patients with cardiac disease but all patients who have undergone major surgery and are on the wards postoperatively. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please

  12. Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management

    Directory of Open Access Journals (Sweden)

    Ann Lloyd, Pharm.D., BCPS


    Full Text Available The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief.

  13. Management of treatment failure in restless legs syndrome (Willis-Ekbom disease). (United States)

    Garcia-Borreguero, Diego; Cano-Pumarega, Irene; Marulanda, Rafael


    Dopaminergic drugs have been widely used over the last decades for the treatment of restless legs syndrome (RLS)/Willis-Ekbom disease (WED). While the majority of studies show an initial improvement in symptoms, longer studies and clinical experience show that either treatment efficacy decreases with time, and/or augmentation develops: dopaminergic augmentation has been reported to be the main reason for treatment discontinuation and treatment failure in RLS/WED. The current review discusses the main reasons for treatment failure in RLS/WED and outlines the most recent expert-based strategies to prevent and manage it. The main strategy for preventing augmentation is to consider non-dopaminergic medications such as α2δ ligands for initial RLS/WED treatment; these effective drugs have been shown to have little risk of augmentation. Alternatively, should dopaminergic drugs be elected as initial treatment, then the daily dose should be kept low and not exceed maximum recommended doses, however, it should be kept in mind that even low dose dopaminergics can cause augmentation. Patients with low iron stores should be given appropriate iron supplementation. Daily treatment should start only when symptoms significantly impact quality of life in terms of frequency and severity; while intermittent treatment might be considered in intermediate cases. Treatment of existing augmentation should be initiated, where possible, with the elimination/correction of extrinsic exacerbating factors (iron levels, antidepressants, antihistamines, etc.). In cases of mild augmentation, dopamine agonist therapy can continue by dividing or advancing the dose, or increasing the dose if there are breakthrough nighttime symptoms. Alternatively, the patient can be switched to an α2δ ligand or rotigotine. For severe augmentation, the patient can be switched to an α2δ ligand or rotigotine, noting that rotigotine may produce augmentation at higher doses with long-term use. In more severe cases

  14. Surgical Versus Nonsurgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation. (United States)

    Kweon, Christopher; Gagnier, Joel J; Robbins, Christopher B; Bedi, Asheesh; Carpenter, James E; Miller, Bruce S


    Rotator cuff tears are a common shoulder disorder resulting in significant disability to patients and financial burden on the health care system. While both surgical and nonsurgical management are accepted treatment options, there is a paucity of data to support a treatment algorithm for care providers. Defining variables to guide treatment allocation may be important for patient education and counseling, as well as to deliver the most efficient care plan at the time of presentation. To identify independent variables at the time of initial clinical presentation that are associated with preferred allocation to surgical versus nonsurgical management for patients with known full-thickness rotator cuff tears. Case control study; Level of evidence, 3. A total of 196 consecutive adult patients with known full-thickness rotator cuff tears were enrolled into a prospective cohort study. Robust data were collected for each subject at baseline, including age, sex, body mass index (BMI), shoulder activity score, smoking status, size of cuff tear, duration of symptoms, functional comorbidity index, the American Shoulder and Elbow Surgeons (ASES) score, the Western Ontario Rotator Cuff index (WORC), and the Veterans Rand 12-Item Health Survey (VR-12). Logistic regression was performed to identify variables associated with treatment allocation, and the corresponding odds ratios were calculated. Of the 196 patients enrolled, 112 underwent surgical intervention and 84 nonoperative management. With covariates controlled for, significant baseline patient characteristics predictive of eventual allocation to surgical treatment included younger age, lower BMI, and durations of symptoms less than 1 year. Increasing age, higher BMI, and duration of symptoms longer than 1 year were predictive of nonsurgical treatment. Factors that were not associated with treatment allocation included sex, tear size, functional comorbidity score, or any of the patient-derived outcome scores at presentation

  15. Prize-based contingency management for the treatment of substance abusers: a meta-analysis. (United States)

    Benishek, Lois A; Dugosh, Karen L; Kirby, Kim C; Matejkowski, Jason; Clements, Nicolle T; Seymour, Brittany L; Festinger, David S


    To review randomized controlled trials to assess efficacy of a prize-based contingency management procedure in reducing substance use (where a drug-free breath or urine sample provides a chance of winning a prize). A meta-analysis was conducted on papers published from January 2000 to February 2013 to determine the effect size of studies comparing prize-based contingency management to a treatment-as-usual control condition (k = 19 studies). Parallel analyses evaluated the efficacy of both short- (k = nine studies) and long-term outcomes (k = six studies) of prize-based contingency management. The average end-of-treatment effect size (Cohen's d) was 0.46 [95% confidence interval (CI) = 0.37, 0.54]. This effect size decreased at the short-term (≤3-month) post-intervention follow-up to 0.33 (95% CI = 0.12, 0.54) and at the 6-month follow-up time-point there was no detectable effect [d = -0.09 (95% CI = -0.28, 0.10)]. Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence, but the effect does not appear to persist to 6 months. © 2014 Society for the Study of Addiction.

  16. Pathology, treatment and management of posterior fossa brain tumors in childhood

    International Nuclear Information System (INIS)

    Bonner, K.; Siegel, K.R.


    Brain tumors are the second most common childhood malignancy. Between 1975 and 1985, 462 newly diagnosed patients were treated at the Children's Hospital of Philadelphia; 207 (45%) tumors arose in the posterior fossa and 255 (55%) appeared supratentorially. A wide variety of histological subtypes were seen, each requiring tumor-specific treatment approaches. These included primitive neuroectodermal tumor (n = 86, 19%), astrocytoma (n = 135, 30%), brainstem glioma (n = 47, 10%), anaplastic astrocytoma (n = 32, 7%), and ependymoma (n = 30, 6%). Because of advances in diagnostic abilities, surgery, radiotherapy, and chemotherapy, between 60% and 70% of these patients are alive today. Diagnostic tools such as computed tomography and magnetic resonance imaging allow for better perioperative management and follow-up, while the operating microscope, CO 2 laser, cavitron ultrasonic aspirator and neurosurgical microinstrumentation allow for more extensive and safer surgery. Disease specific treatment protocols, utilizing radiotherapy and adjuvant chemotherapy, have made survival common in tumors such as medulloblastoma. As survival rates increase, cognitive, endocrinologic and psychologic sequelae become increasingly important. The optimal management of children with brain tumors demands a multidisciplinary approach, best facilitated by a neuro-oncology team composed of multiple subspecialists. This article addresses incidence, classification and histology, clinical presentation, diagnosis, pre-, intra- and postoperative management, long-term effects and the team approach in posterior fossa tumors in childhood. Management of specific tumor types is included as well. 57 references

  17. Dental case manager encounters: the association with retention in dental care and treatment plan completion. (United States)

    Lemay, Celeste A; Tobias, Carol; Umez-Eronini, Amarachi A; Brown, Carolyn; McCluskey, Amanda; Fox, Jane E; Bednarsh, Helene; Cabral, Howard J


    Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3-4 and; 23% had 5-29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard-to-engage populations should consider these findings when planning interventions. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

  18. Fate of cyanobacteria and their metabolites during water treatment sludge management processes. (United States)

    Ho, Lionel; Dreyfus, Jennifer; Boyer, Justine; Lowe, Todd; Bustamante, Heriberto; Duker, Phil; Meli, Tass; Newcombe, Gayle


    Cyanobacteria and their metabolites are an issue for water authorities; however, little is known as to the fate of coagulated cyanobacterial-laden sludge during waste management processes in water treatment plants (WTPs). This paper provides information on the cell integrity of Anabaena circinalis and Cylindrospermopsis raciborskii during: laboratory-scale coagulation/sedimentation processes; direct filtration and backwashing procedures; and cyanobacterial-laden sludge management practices. In addition, the metabolites produced by A. circinalis (geosmin and saxitoxins) and C. raciborskii (cylindrospermopsin) were investigated with respect to their release (and possible degradation) during each of the studied processes. Where sedimentation was used, coagulation effectively removed cyanobacteria (and intracellular metabolites) without any considerable exertion on coagulant demand. During direct filtration experiments, cyanobacteria released intracellular metabolites through a stagnation period, suggesting that more frequent backwashing of filters may be required to prevent floc build-up and metabolite release. Cyanobacteria appeared to be protected within the flocs, with minimal damage during backwashing of the filters. Within coagulant sludge, cyanobacteria released intracellular metabolites into the supernatant after 3d, even though cells remained viable up to 7d. This work has improved the understanding of cyanobacterial metabolite risks associated with management of backwash water and sludge and is likely to facilitate improvements at WTPs, including increased monitoring and the application of treatment strategies and operational practices, with respect to cyanobacterial-laden sludge and/or supernatant recycle management. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. The prevention, detection and management of cancer treatment-induced cardiotoxicity: a meta-review

    International Nuclear Information System (INIS)

    Conway, Aaron; McCarthy, Alexandra L; Lawrence, Petra; Clark, Robyn A


    The benefits associated with some cancer treatments do not come without risk. A serious side effect of some common cancer treatments is cardiotoxicity. Increased recognition of the public health implications of cancer treatment-induced cardiotoxicity has resulted in a proliferation of systematic reviews in this field to guide practice. Quality appraisal of these reviews is likely to limit the influence of biased conclusions from systematic reviews that have used poor methodology related to clinical decision-making. The aim of this meta-review is to appraise and synthesise evidence from only high quality systematic reviews focused on the prevention, detection or management of cancer treatment-induced cardiotoxicity. Using Cochrane methodology, we searched databases, citations and hand-searched bibliographies. Two reviewers independently appraised reviews and extracted findings. A total of 18 high quality systematic reviews were subsequently analysed, 67 % (n = 12) of these comprised meta-analyses. One systematic review concluded that there is insufficient evidence regarding the utility of cardiac biomarkers for the detection of cardiotoxicity. The following strategies might reduce the risk of cardiotoxicity: 1) The concomitant administration of dexrazoxane with anthracylines; 2) The avoidance of anthracyclines where possible; 3) The continuous administration of anthracyclines (>6 h) rather than bolus dosing; and 4) The administration of anthracycline derivatives such as epirubicin or liposomal-encapsulated doxorubicin instead of doxorubicin. In terms of management, one review focused on medical interventions for treating anthracycline-induced cardiotoxicity during or after treatment of childhood cancer. Neither intervention (enalapril and phosphocreatine) was associated with statistically significant improvement in ejection fraction or mortality. This review highlights the lack of high level evidence to guide clinical decision-making with respect to the detection

  20. Greater Occipital Nerve Treatment in the Management of Spontaneous Intracranial Hypotension Headache: A Case Report. (United States)

    Niraj, G; Critchley, Peter; Kodivalasa, Mahesh; Dorgham, Mohammed


    Clinical presentation of spontaneous intracranial hypotension headache (SIHH) has similarities with postdural puncture headache (PDPH). Recommended treatment for both conditions is an epidural blood patch. Successful outcomes following greater occipital nerve blocks have been reported in the management of PDPH. We present the first report of greater occipital nerve treatment in SIHH. A 40-year-old male presented with a 2-year history of daily postural headaches having a significant impact on quality of life. Magnetic resonance imaging revealed bilateral convexity subdural collections. Post gadolinium scan revealed pachymeningeal enhancement with reduced pontomesencephalic angle below 50 degrees. The patient was offered an epidural blood patch and greater occipital nerve block with corticosteroids. The patient chose occipital nerve block. The patient reported significant short-term benefit lasting 4 months. Thereafter, the patient underwent pulsed radiofrequency treatment to bilateral greater occipital nerves. He reported significant benefit lasting 10 months. Greater occipital nerve treatment may have a role in management of SIHH. © 2017 American Headache Society.

  1. The evolution of prostacyclins in pulmonary arterial hypertension: from classical treatment to modern management. (United States)

    Burger, Charles D; D'Albini, Lesley; Raspa, Susan; Pruett, Janis A


    Prostacyclins for the treatment of pulmonary arterial hypertension (PAH) have historically been covered under the insurance medical benefit because they require durable medical equipment and are administered by an intravenous, subcutaneous, or inhalation route. However, more treatment options that target the prostacyclin pathway have become available. As the number and type of options expand, an improved understanding of these drugs will aid managed care decision makers in evaluating new treatment options and making clinically sound and cost-effective treatment decisions. PAH is a progressive disease of pulmonary vascular remodeling that increases pulmonary vascular resistance and often results in right-side heart failure and death if left untreated. Adverse event profiles, the complexity of administration modalities, and potential complications must be considered when administering prostacyclin therapy. Traditional modes of administration, with their potential challenges and complications, may have contributed to the unmet need for an oral agent. Another consideration for managed care decision makers is that oral agents are generally covered under the insurance pharmacy benefit. Access to oral medications with long-term outcomes data, as well as the improved convenience of oral therapy, may help patients with PAH maximize function by maintaining a more convenient and consistent therapeutic regimen.

  2. Final Environmental Impact Statement for the Treatment and Management of Sodium-Bonded Spent Nuclear Fuel

    International Nuclear Information System (INIS)


    DOE is responsible for the safe and efficient management of its sodium-bonded spent nuclear fuel. This fuel contains metallic sodium, a highly reactive material; metallic uranium, which is also reactive; and in some cases, highly enriched uranium. The presence of reactive materials could complicate the process of qualifying and licensing DOE's sodium-bonded spent nuclear fuel inventory for disposal in a geologic repository. Currently, more than 98 percent of this inventory is located at the Idaho National Engineering and Environmental Laboratory (INEEL), near Idaho Falls, Idaho. In addition, in a 1995 agreement with the State of Idaho, DOE committed to remove all spent nuclear fuel from Idaho by 2035. This EIS evaluates the potential environmental impacts associated with the treatment and management of sodium-bonded spent nuclear fuel in one or more facilities located at Argonne National Laboratory-West (ANL-W) at INEEL and either the F-Canyon or Building 105-L at the Savannah River Site (SRS) near Aiken, South Carolina. DOE has identified and assessed six proposed action alternatives in this EIS. These are: (1) electrometallurgical treatment of all fuel at ANL-W, (2) direct disposal of blanket fuel in high-integrity cans with the sodium removed at ANL-W, (3) plutonium-uranium extraction (PUREX) processing of blanket fuel at SRS, (4) melt and dilute processing of blanket fuel at ANL-W, (5) melt and dilute processing of blanket fuel at SRS, and (6) melt and dilute processing of all fuel at ANL-W. In addition, Alternatives 2 through 5 include the electrometallurgical treatment of driver fuel at ANL-W. Under the No Action Alternative, the EIS evaluates both the continued storage of sodium-bonded spent nuclear fuel until the development of a new treatment technology or direct disposal without treatment. Under all of the alternatives, the affected environment is primarily within 80 kilometers (50 miles) of spent nuclear fuel treatment facilities. Analyses indicate

  3. Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

    International Nuclear Information System (INIS)

    Nazir, Sarfraz Ahmed; Ganeshan, Arul; Nazir, Sheraz; Uberoi, Raman


    Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

  4. Postoperative Pain Management after Carpal Tunnel Syndrome Surgical Treatment: Comparing Practice with Guidelines. (United States)

    Utrobičić, Ivan; Utrobičić, Frane; Prološčić, Ivona; Utrobičić, Toni; Jerić, Milka; Jeličić Kadić, Antonia; Puljak, Livia


    The management of postoperative pain after carpal tunnel syndrome surgical treatment at a tertiary hospital was analyzed and compared with the guidelines for perioperative pain management. This retrospective study included 579 patients operated on for carpal tunnel syndrome at the Split University Hospital Center in Split, Croatia. The following key data were collected from patient medical records: age, gender, type and dosage of premedication, type and dosage of anesthesia, type and dosage of postoperative analgesia per each postoperative day. The procedures related to perioperative pain were analyzed and compared with the current guidelines for perioperative acute pain management. Study results showed that 99.6% of patients with carpal tunnel syndrome were operated under local anesthesia, of which 2.9% also received sedation. Analgesics were prescribed to 45% of patients after surgery, and according to patient charts, 39% of patients actually received postoperative analgesic(s). Generally, postoperative pain was treated on the fi rst postoperative day, mostly with nonsteroidal anti-inflammatory drugs. Only two patients received weak opioids for postoperative pain. Many recommendations from the guidelines for perioperative acute pain management were not followed. In conclusion, the guidelines should be followed and appropriate interventions used to improve postoperative pain management.

  5. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu


    Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  6. Managing fatigue after cancer treatment: development of RESTORE, a web-based resource to support self-management. (United States)

    Foster, C; Calman, L; Grimmett, C; Breckons, M; Cotterell, P; Yardley, L; Joseph, J; Hughes, S; Jones, R; Leonidou, C; Armes, J; Batehup, L; Corner, J; Fenlon, D; Lennan, E; Morris, C; Neylon, A; Ream, E; Turner, L; Richardson, A


    The aim of this study is to co-create an evidence-based and theoretically informed web-based intervention (RESTORE) designed to enhance self-efficacy to live with cancer-related fatigue (CRF) following primary cancer treatment. A nine-step process informed the development of the intervention: (1) review of empirical literature; (2) review of existing patient resources; (3) establish theoretical framework; (4) establish design team with expertise in web-based interventions, CRF and people affected by cancer; (5) develop prototype intervention; (6) user testing phase 1; (7) refinement of prototype; (8) user testing phase 2; and (9) develop final intervention. Key stakeholders made a critical contribution at every step of intervention development, and user testing, which involved an iterative process and resulted in the final intervention. The RESTORE intervention has five sessions; sessions 1 and 2 include an introduction to CRF and goal setting. Sessions 3-5 can be tailored to user preference and are designed to cover areas of life where CRF may have an impact: home and work life, personal relationships and emotional adjustment. It is feasible to systematically 'co-create' an evidence-based and theory-driven web-based self-management intervention to support cancer survivors living with the consequences of cancer and its treatment. This is the first account of the development of a web-based intervention to support self-efficacy to manage CRF. An exploratory trial to test the feasibility and acceptability of RESTORE is now warranted. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study. (United States)

    Penney, Lauren S; Ritenbaugh, Cheryl; DeBar, Lynn L; Elder, Charles; Deyo, Richard A


    Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1. We identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants' perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment. These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more

  8. Valorisation of fish by-products against waste management treatments--Comparison of environmental impacts. (United States)

    Lopes, Carla; Antelo, Luis T; Franco-Uría, Amaya; Alonso, Antonio A; Pérez-Martín, Ricardo


    Reuse and valorisation of fish by-products is a key process for marine resources conservation. Usually, fishmeal and oil processing factories collect the by-products generated by fishing port and industry processing activities, producing an economical benefit to both parts. In the same way, different added-value products can be recovered by the valorisation industries whereas fishing companies save the costs associated with the management of those wastes. However, it is important to estimate the advantages of valorisation processes not only in terms of economic income, but also considering the environmental impacts. This would help to know if the valorisation of a residue provokes higher impact than other waste management options, which means that its advantages are probably not enough for guarantying a sustainable waste reuse. To that purpose, there are several methodologies to evaluate the environmental impacts of processes, including those of waste management, providing different indicators which give information on relevant environmental aspects. In the current study, a comparative environmental assessment between a valorisation process (fishmeal and oil production) and different waste management scenarios (composting, incineration and landfilling) was developed. This comparison is a necessary step for the development and industrial implementation of these processes as the best alternative treatment for fish by-products. The obtained results showed that both valorisation process and waste management treatments presented similar impacts. However, a significant benefit can be achieved through valorisation of fish by-products. Additionally, the implications of the possible presence of pollutants were discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Expert Opinion on the Management of Lennox–Gastaut Syndrome: Treatment Algorithms and Practical Considerations

    Directory of Open Access Journals (Sweden)

    J. Helen Cross


    Full Text Available Lennox–Gastaut syndrome (LGS is a severe epileptic and developmental encephalopathy that is associated with a high rate of morbidity and mortality. It is characterized by multiple seizure types, abnormal electroencephalographic features, and intellectual disability. Although intellectual disability and associated behavioral problems are characteristic of LGS, they are not necessarily present at its outset and are therefore not part of its diagnostic criteria. LGS is typically treated with a variety of pharmacological and non-pharmacological therapies, often in combination. Management and treatment decisions can be challenging, due to the multiple seizure types and comorbidities associated with the condition. A panel of five epileptologists met to discuss consensus recommendations for LGS management, based on the latest available evidence from literature review and clinical experience. Treatment algorithms were formulated. Current evidence favors the continued use of sodium valproate (VPA as the first-line treatment for patients with newly diagnosed de novo LGS. If VPA is ineffective alone, evidence supports lamotrigine, or subsequently rufinamide, as adjunctive therapy. If seizure control remains inadequate, the choice of next adjunctive antiepileptic drug (AED should be discussed with the patient/parent/caregiver/clinical team, as current evidence is limited. Non-pharmacological therapies, including resective surgery, the ketogenic diet, vagus nerve stimulation, and callosotomy, should be considered for use alongside AED therapy from the outset of treatment. For patients with LGS that has evolved from another type of epilepsy who are already being treated with an AED other than VPA, VPA therapy should be considered if not trialed previously. Thereafter, the approach for a de novo patient should be followed. Where possible, no more than two AEDs should be used concomitantly. Patients with established LGS should undergo review by a neurologist

  10. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches. (United States)

    Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi


    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  11. Percutaneous vertebroplasty and conservative management for the treatment of osteoporotic vertebral fractures: a comparative study

    International Nuclear Information System (INIS)

    Liu Wengui; Lu Jinyu; Sun Jianhua; Liang Ding; Li Zhiwei; Wang Hesheng; Guo Shanfeng


    Objective: To investigate the better therapeutic measures for painful osteoporotic vertebral compression fractures (OVCF) through comparing the efficacy of percutaneous vertebroplasty (PVP) with that of conservative management. Methods: Forty-three consecutive patients, encountered from December 2009 to December 2010 in authors' hospital, were enrolled in this study. The patients were divided into PVP group (n=22) and conservative group (n=21). Visual analog score (VAS) for pain and Oswestry disability index (ODI) questionnaire scores were assessed before and 1 week, 1, 3, 6, 12 months after the treatment. Patients' activity levels and other information, including complications and new fractures after treatment, were also evaluated. Results: Before the treatment both the VAS and ODI scores showed no statistically significant difference between the two groups. Significant reduction of both VAS and ODI was observed in PVP group at 1 week and at 1 and 3 months after treatment when compared with those in conservative group (P<0.05). Patients' activity levels in PVP group were significantly improved than that in conservative group (P<0.01). One new fracture was observed in the conservative group, while no new fracture was seen in the PVP group. Conclusion: Immediate pain relief and improvement of daily activities after PVP can be achieved in all patients. PVP should be considered as the treatment of first choice for symptomatic osteoporotic vertebral fractures. (authors)

  12. Management of Depression in Patients with Dementia: Is Pharmacological Treatment Justified? (United States)

    Ford, Andrew H; Almeida, Osvaldo P


    Depression in the context of dementia is common and contributes to poorer outcomes in individuals and those who care for them. Non-pharmacological treatments are the preferred initial approach to managing these symptoms but data in support of these are scarce. There are a number of pharmacological treatment options available to clinicians but efficacy is uncertain and concern about potential side effects in an aging and vulnerable population needs to be taken into consideration. This review aims to provide a concise overview of pharmacological treatments for depression in dementia. Antidepressants are the mainstay of pharmacological treatment for clinically significant depression in the general population but evidence to support their use in dementia is mixed. Trials of antidepressants should generally be reserved for individuals with depression where the symptoms are distressing and surpass the threshold for major depression. Acetylcholinesterase inhibitors and memantine are effective in the symptomatic treatment of Alzheimer's disease but current evidence does not support their use to treat depressive symptoms in dementia. Similarly, antipsychotics and mood stabilizers have no proven efficacy for depression and the risk of adverse effects seems to outweigh any potential benefit. Pain can be a frequent problem in dementia and may have significant effects on behavior and mood. Preliminary evidence supports a role of adequate analgesia in improving mood in people with dementia.

  13. A worldwide comparison of the management of surgical treatment of advanced oral cancer. (United States)

    Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Haers, Piet; Ghali, G E; Hoffmann, Jürgen


    Microvascular surgery following tumor resection has become an important field of oral and maxillofacial surgery (OMFS). Following the results from management of T1/T2 floor-of-mouth and tongue squamous cell carcinoma (SCC) in German-speaking countries, Europe, and worldwide, this paper presents specific concepts for the management of resection and reconstruction of T3/T4 SCC of the maxillary and mandibular alveolar process and tongue. The DÖSAK questionnaire was distributed in three different phases to a growing number of maxillofacial units worldwide. Within this survey, clinical patient settings were presented to participants and center-specific treatment strategies were evaluated. A total of 188 OMFS units from 36 different countries documented their treatment strategies for T3/T4 maxillary and mandibular alveolar process and tongue SCC. The extent of surgical resections and subsequent reconstructions is more consistent than with T1/T2 tumors, although the controversy surrounding continuity resections and mandible-sparing procedures remains. For continuity resection of the mandible the fibula free flap is the most frequently used bone replacement, whereas maxilla reconstruction concepts are less consistent, ranging from locoregional coverage concepts and different microvascular reconstruction options to treatment via obturator prosthesis. Results from treatment strategies for T3/T4 tumors underline the limited evidence for the appropriate amount of resection and subsequent reconstruction process, especially in cases involving the mandible. Prospective randomized trials will be necessary in the long term to establish valid treatment guidelines. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  14. Resilience and resistance of sagebrush ecosystems: implications for state and transition models and management treatments (United States)

    Chambers, Jeanne C.; Miller, Richard F.; Board, David I.; Pyke, David A.; Roundy, Bruce A.; Grace, James B.; Schupp, Eugene W.; Tausch, Robin J.


    In sagebrush ecosystems invasion of annual exotics and expansion of piñon (Pinus monophylla Torr. and Frem.) and juniper (Juniperus occidentalis Hook., J. osteosperma [Torr.] Little) are altering fire regimes and resulting in large-scale ecosystem transformations. Management treatments aim to increase resilience to disturbance and enhance resistance to invasive species by reducing woody fuels and increasing native perennial herbaceous species. We used Sagebrush Steppe Treatment Evaluation Project data to test predictions on effects of fire vs. mechanical treatments on resilience and resistance for three site types exhibiting cheatgrass (Bromus tectorum L.) invasion and/or piñon and juniper expansion: 1) warm and dry Wyoming big sagebrush (WY shrub); 2) warm and moist Wyoming big sagebrush (WY PJ); and 3) cool and moist mountain big sagebrush (Mtn PJ). Warm and dry (mesic/aridic) WY shrub sites had lower resilience to fire (less shrub recruitment and native perennial herbaceous response) than cooler and moister (frigid/xeric) WY PJ and Mtn PJ sites. Warm (mesic) WY Shrub and WY PJ sites had lower resistance to annual exotics than cool (frigid to cool frigid) Mtn PJ sites. In WY shrub, fire and sagebrush mowing had similar effects on shrub cover and, thus, on perennial native herbaceous and exotic cover. In WY PJ and Mtn PJ, effects were greater for fire than cut-and-leave treatments and with high tree cover in general because most woody vegetation was removed increasing resources for other functional groups. In WY shrub, about 20% pretreatment perennial native herb cover was necessary to prevent increases in exotics after treatment. Cooler and moister WY PJ and especially Mtn PJ were more resistant to annual exotics, but perennial native herb cover was still required for site recovery. We use our results to develop state and transition models that illustrate how resilience and resistance influence vegetation dynamics and management options.

  15. Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden

    Directory of Open Access Journals (Sweden)

    Nilsson Gunnar H


    Full Text Available Abstract Background Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. Methods Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. Results In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. Conclusion Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.

  16. Management of side effects during and post-treatment in breast cancer survivors. (United States)

    Palesh, Oxana; Scheiber, Caroline; Kesler, Shelli; Mustian, Karen; Koopman, Cheryl; Schapira, Lidia


    Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors. © 2017 Wiley Periodicals, Inc.

  17. Effectiveness of Stress Management Training on Hope and Interpersonal Compatibility of Addicts under Treatment

    Directory of Open Access Journals (Sweden)

    Z Sepehrinasab


    Full Text Available Objective: The current study was aimed to examine the effectiveness of stress management with behavioral–cognitive mode in the promotion of hope and socio-affective adjustment of drug abusers under methadone maintenance treatment. Method: A quasi – experimental research design, along with pretest-posttest and control group was employed for the conduct of this study. In this regard, the number of 20 drug abusers under methadone maintenance treatment was selected by convenience sampling method and these participants were assigned into experimental group (10 individuals and control group (10 individuals. The participants received ten training sessions and, then, completed Snyder's Trait Hope Scale and Bell’s social adjustment scale (BAS. Results: The results of the study showed that there is a significant difference between the two groups in terms of hope and affective and social adjustment. In fact, the experimental group experienced a considerable promotion. Conclusion: It can be concluded that stress management with behavioral–cognitive training can be an effective interventionist method for the addicts under methadone maintenance treatment.

  18. Natural treatment system models for wastewater management: a study from Hyderabad, India. (United States)

    Sonkamble, Sahebrao; Wajihuddin, Md; Jampani, Mahesh; Sarah, S; Somvanshi, V K; Ahmed, Shakeel; Amerasinghe, Priyanie; Boisson, Alexandre


    Wastewater generated on a global scale has become a significant source of water resources which necessitates appropriate management strategies. However, the complexities associated with wastewater are lack of economically viable treatment systems, especially in low- and middle-income countries. While many types of treatment systems are needed to serve the various local issues, we propose natural treatment systems (NTS) such as natural wetlands that are eco-friendly, cost-effective, and can be jointly driven by public bodies and communities. In order for it to be part of wastewater management, this study explores the NTS potential for removal of pollutants, cost-effectiveness, and reuse options for the 1.20 million m 3 /day of wastewater generated in Hyderabad, India. The pilot study includes hydro-geophysical characterization of natural wetland to determine pollutant removal efficiency and its effective utilization for treated wastewater in the peri-urban habitat. The results show the removal of organic content (76-78%), nutrients (77-97%), and microbes (99.5-99.9%) from the wetland-treated wastewater and its suitability for agriculture applications. Furthermore, the wetland efficiency integrated with engineered interventions led to the development of NTS models with different application scenarios: (i) constructed wetlands, (ii) minimized community wetlands, and (iii) single outlet system, suitable for urban, peri-urban and rural areas, respectively.

  19. Mapping clinical outcomes expectations to treatment decisions: an application to vestibular schwannoma management. (United States)

    Cheung, Steven W; Aranda, Derick; Driscoll, Colin L W; Parsa, Andrew T


    Complex medical decision making obligates tradeoff assessments among treatment outcomes expectations, but an accessible tool to perform the necessary analysis is conspicuously absent. We aimed to demonstrate methodology and feasibility of adapting conjoint analysis for mapping clinical outcomes expectations to treatment decisions in vestibular schwannoma (VS) management. Prospective. Tertiary medical center and US-based otologists/neurotologists. Treatment preference profiles among VS stakeholders-61 younger and 74 older prospective patients, 61 observation patients, and 60 surgeons-were assessed for the synthetic VS case scenario of a 10-mm tumor in association with useful hearing and normal facial function. Treatment attribute utility. Conjoint analysis attribute levels were set in accordance to the results of a meta-analysis. Forty-five case series were disaggregated to formulate microsurgery facial nerve and hearing preservation outcomes expectations models. Attribute utilities were computed and mapped to the realistic treatment choices of translabyrinthine craniotomy, middle fossa craniotomy, and gamma knife radiosurgery. Among the treatment attributes of likelihoods of causing deafness, temporary facial weakness for 2 months, and incurable cancer within 20 years, and recovery time, permanent deafness was less important to tumor surgeons, and temporary facial weakness was more important to tumor surgeons and observation patients (Wilcoxon rank-sum, p knife radiosurgery. Mapping clinical outcomes expectations to treatment decisions for a synthetic clinical scenario revealed inhomogeneous drivers of choice selection among study cohorts. Medical decision engines that analyze personal preferences of outcomes expectations for VS and many other diseases may be developed to promote shared decision making among health care stakeholders and transparency in the informed consent process.

  20. Contingency management for tobacco smoking during opioid addiction treatment: a randomised pilot study. (United States)

    Ainscough, Tom Stephen; Brose, Leonie S; Strang, John; McNeill, Ann


    Smoking rates among individuals in treatment for opioid addiction are close to five times that of the general public. Moreover, drug-addicted smokers have a premature mortality rate four times greater than drug-addicted non-smokers. The aim of this pilot study was to investigate whether contingency management (CM) can be successfully added to evidence-based stop smoking treatment in individuals undergoing treatment for opioid addiction and assess preliminary evidence for its impact. Forty tobacco smokers currently undergoing treatment for opioid addiction. Escalating with reset CM as an adjunct to standard smoking cessation treatment. Financial incentives will be administered over a 5-week period for either biochemically verified abstinence from smoking or attendance at the clinic. Participants will be randomised to conditions stratified on current levels of smoking (high or low). To assess whether a CM intervention can be successfully added to standard stop smoking services treatment, in patients undergoing outpatient treatment for opioid addiction. This will be measured as the number of people completing the 5 weeks of the intervention. Ethics approval for the study was granted on the 16 June 2016 by the London-city and east (reference 16/LO/0990) ethics committee. The pilot study was retrospectively registered on in January 2017 (ID: NCT03015597). A SPIRIT checklist and figure are available for this protocol. It is planned that the results of this study will be published in an academic journal. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Management Recommendations for Improving Decentralized Wastewater Treatment by the Food and Beverage Industries in Nigeria

    Directory of Open Access Journals (Sweden)

    Olajumoke F. Kayode


    Full Text Available The main aim of this study was to identify the enabling conditions that can lead to better wastewater management by industries (non-oil and gas sector in Nigeria. The relevant data and information’s required for this study were obtained through semi-structured interviews with different stakeholders in the Nigerian environmental sector. The lack of financial capability, technical expertise, and environmental awareness was envisaged as the main reason for non-compliance. According to the results, the enabling conditions that can lead to better decentralized wastewater management are government support, improved legal and regulatory framework, increased capacity, and skills of the regulators and financial arrangements for implementing environmental policies and treatment technologies in polluting facilities.

  2. LANDSAT supports data needs for EPA 208 planning. [water quality control and waste treatment management (United States)


    Excerpts from federal legislation and regulations mandating areawide waster treatment management as a means of restoring and maintaining the integrity of the nation's water are presented along with requirements for grants to the states for water quality planning, management, and implementation. Experiences using LANDSAT to identify nonpoint sources of water pollution as well as land/use/land cover features in South Dakota, Kentucky, Georgia, New Jersey, and Texas are described. Present activities suggest that this type of remote sensing is an efficient, effective tool for areawide water quality planning. Interaction with cognizant federal, state, and local government personnel involved in EPA section 208 planning activities can guide the development of new capabilities and enhance their utility and prospect for use.

  3. The cardiometabolic effect of current management of polycystic ovary syndrome: strategies of prevention and treatment. (United States)

    Baldani, Dinka Pavicic; Skrgatic, Lana; Ougouag, Roya; Kasum, Miro


    Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder amongst women of reproductive age, which is characterized by reproductive and cardiometabolic disturbances with long-term health repercussions. Insulin resistance (IR), impaired glucose tolerance, type 2 diabetes mellitus (DM2), obesity and dyslipidemia occur more in women with PCOS than in age-comparable women without PCOS. Long term data regarding risks or benefits of medical intervention for metabolic dysfunction of PCOS are lacking. Therapies, such as oral contraceptives (OCPs) and anti-androgenic medications used to manage the reproductive manifestations of PCOS, may themselves be the cause of cardiometabolic perturbations. Hence, strategies regarding the management of reproductive issues in PCOS encompass a patient-specific tailored approach. Factors that influence the cardiometabolic side effects arising during treatment of the reproductive manifestations of PCOS (hirsutism/anovulation) are also discussed in this paper in order to build future strategies to minimize the overall cardiometabolic risk.

  4. Conservative management of vestibular schwannoma--a prospective cohort study: treatment, symptoms, and quality of life. (United States)

    Breivik, Cathrine Nansdal; Varughese, Jobin K; Wentzel-Larsen, Tore; Vassbotn, Flemming; Lund-Johansen, Morten


    One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study. To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms. The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified. The median follow-up time was 43 months (range, 9-115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment. There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

  5. Fate of cyanobacteria and their metabolites during water treatment sludge management processes

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Lionel, E-mail: [Australian Water Quality Centre, SA Water Corporation, 250 Victoria Square, Adelaide, SA 5000 (Australia); Centre for Water Management and Reuse, University of South Australia, Mawson Lakes, SA 5095 (Australia); Dreyfus, Jennifer; Boyer, Justine; Lowe, Todd [Australian Water Quality Centre, SA Water Corporation, 250 Victoria Square, Adelaide, SA 5000 (Australia); Bustamante, Heriberto; Duker, Phil [Sydney Water, PO Box 399, Parramatta, NSW 2124 (Australia); Meli, Tass [TRILITY Pty Ltd, PO Box 86, Appin, NSW 2560 (Australia); Newcombe, Gayle [Australian Water Quality Centre, SA Water Corporation, 250 Victoria Square, Adelaide, SA 5000 (Australia); Centre for Water Management and Reuse, University of South Australia, Mawson Lakes, SA 5095 (Australia)


    Cyanobacteria and their metabolites are an issue for water authorities; however, little is known as to the fate of coagulated cyanobacterial-laden sludge during waste management processes in water treatment plants (WTPs). This paper provides information on the cell integrity of Anabaena circinalis and Cylindrospermopsis raciborskii during: laboratory-scale coagulation/sedimentation processes; direct filtration and backwashing procedures; and cyanobacterial-laden sludge management practices. In addition, the metabolites produced by A. circinalis (geosmin and saxitoxins) and C. raciborskii (cylindrospermopsin) were investigated with respect to their release (and possible degradation) during each of the studied processes. Where sedimentation was used, coagulation effectively removed cyanobacteria (and intracellular metabolites) without any considerable exertion on coagulant demand. During direct filtration experiments, cyanobacteria released intracellular metabolites through a stagnation period, suggesting that more frequent backwashing of filters may be required to prevent floc build-up and metabolite release. Cyanobacteria appeared to be protected within the flocs, with minimal damage during backwashing of the filters. Within coagulant sludge, cyanobacteria released intracellular metabolites into the supernatant after 3 d, even though cells remained viable up to 7 d. This work has improved the understanding of cyanobacterial metabolite risks associated with management of backwash water and sludge and is likely to facilitate improvements at WTPs, including increased monitoring and the application of treatment strategies and operational practices, with respect to cyanobacterial-laden sludge and/or supernatant recycle management. - Highlights: Black-Right-Pointing-Pointer Coagulation removed cyanobacteria without an additional exertion on coagulant demand. Black-Right-Pointing-Pointer During a stagnation period in direct filtration intracellular metabolites were

  6. Fate of cyanobacteria and their metabolites during water treatment sludge management processes

    International Nuclear Information System (INIS)

    Ho, Lionel; Dreyfus, Jennifer; Boyer, Justine; Lowe, Todd; Bustamante, Heriberto; Duker, Phil; Meli, Tass; Newcombe, Gayle


    Cyanobacteria and their metabolites are an issue for water authorities; however, little is known as to the fate of coagulated cyanobacterial-laden sludge during waste management processes in water treatment plants (WTPs). This paper provides information on the cell integrity of Anabaena circinalis and Cylindrospermopsis raciborskii during: laboratory-scale coagulation/sedimentation processes; direct filtration and backwashing procedures; and cyanobacterial-laden sludge management practices. In addition, the metabolites produced by A. circinalis (geosmin and saxitoxins) and C. raciborskii (cylindrospermopsin) were investigated with respect to their release (and possible degradation) during each of the studied processes. Where sedimentation was used, coagulation effectively removed cyanobacteria (and intracellular metabolites) without any considerable exertion on coagulant demand. During direct filtration experiments, cyanobacteria released intracellular metabolites through a stagnation period, suggesting that more frequent backwashing of filters may be required to prevent floc build-up and metabolite release. Cyanobacteria appeared to be protected within the flocs, with minimal damage during backwashing of the filters. Within coagulant sludge, cyanobacteria released intracellular metabolites into the supernatant after 3 d, even though cells remained viable up to 7 d. This work has improved the understanding of cyanobacterial metabolite risks associated with management of backwash water and sludge and is likely to facilitate improvements at WTPs, including increased monitoring and the application of treatment strategies and operational practices, with respect to cyanobacterial-laden sludge and/or supernatant recycle management. - Highlights: ► Coagulation removed cyanobacteria without an additional exertion on coagulant demand. ► During a stagnation period in direct filtration intracellular metabolites were released. ► Cyanobacterial cells were not damaged

  7. Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices

    DEFF Research Database (Denmark)

    Deharo, Jean-Claude; Sciaraffia, Elena; Leclercq, Christophe


    .7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor...... pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while...

  8. Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia. (United States)

    El-Mallakh, Peggy; Howard, Patricia B; Rayens, Mary Kay; Roque, Autumn P; Adkins, Sarah


    Organizational support is essential for successful implementation of evidence-based practice (EBP) in clinical settings. This 3-year study used a mixed qualitative and quantitative design to implement a medication management EBP in the treatment of schizophrenia in six community mental health clinics in a south-central state of the United States. Findings from organizational fidelity assessments indicate that support for EBP implementation was moderate. Organizational support was highest for prescriber access to relevant patient information at each medication visit, scheduling flexibility for patients' urgent problems, and availability of medication guidelines. Organizational support was lowest for medication availability and identification of treatment refractory patients. Findings suggest that leadership is essential to support successful implementation. Nurse educators can incorporate implementation research and leadership training into graduate nursing programs to facilitate successful EBP implementation in practice settings. Copyright 2013, SLACK Incorporated.

  9. Medicaid care management: description of high-cost addictions treatment clients. (United States)

    Neighbors, Charles J; Sun, Yi; Yerneni, Rajeev; Tesiny, Ed; Burke, Constance; Bardsley, Leland; McDonald, Rebecca; Morgenstern, Jon


    High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Radioactive waste management of the radiological accident in Goianaia, Brazil - Cooperation of Waste Treatment Division

    International Nuclear Information System (INIS)

    Guzella, M.F.R.; Miaw, S.T.W.; Reis, L.C.S.; Santos, P.O.; Silva, E.M.P.; Tello, C.C.O.


    Radioactive waste were generated in Goiania by an accidental breakage of Cesium 137 radiotherapie source (A=5,0 x 10 13 Bq) in September 1987. The Waste Treatment Division (DITRR.CN) CDTN/NUCLEBRAS has worked in all critical areas to remove the contamination and carried out the tasks at the interim storage. Experience on the waste management and the results from the R and D works conducted by the Division were applied. The R and D works conducted by the Division were applied. The R and D works conducted by the Division were applied. The R and D works comprise package for storage and transport of radioactive material, the use of selected bentonite for Cesium 137 retention, installation of waste treatment facilities and elaboration of several specific procedures. (author) [pt

  11. Management of treatment-related toxicities in advanced medullary thyroid cancer. (United States)

    Brose, Marcia S; Bible, Keith C; Chow, Laura Q M; Gilbert, Jill; Grande, Carolyn; Worden, Francis; Haddad, Robert


    Progress in the treatment of advanced medullary thyroid cancer (MTC) has resulted from the approval of 2 drugs within the past 5 years, vandetanib and cabozantinib. These multikinase inhibitors (MKIs) possess overlapping specificities for multiple kinase targets implicated in the progression of MTC. Both drugs are associated with toxicities, including hypertension, hemorrhage/perforation, diarrhea and other gastrointestinal events, several dermatologic events, and hypothyroidism. In addition, vandetanib is uniquely associated with QTc prolongation through interaction with myocardial potassium channels, and cabozantinib is uniquely associated with hand-foot skin reaction. Treatment-related toxicities occur frequently and can be severe or life-threatening, and patients undergoing long-term treatment will likely experience adverse events (AEs). Here we offer specific practical recommendations for managing AEs commonly occurring with vandetanib and cabozantinib. The recommended approach relies on early recognition and palliation of symptoms, dose interruption, and dose reduction as necessary in order for the patient to maintain the highest tolerable dose for as long as possible and optimal quality of life. Treatment guidelines do not specify a recommended sequence for treating with vandetanib and cabozantinib; however, most patients will receive both drugs during their lifetime. The choice for first-line therapy is individualized after a risk-benefit assessment and depends on physician preference and patient-related factors, such as comorbid conditions. Because most generalist practices may not be familiar with the intricacies of agents such as vandetanib and cabozantinib, we commend that patients with advanced MTC be managed and treated by a thyroid cancer specialist with coordination of care within a multidisciplinary team. Copyright © 2018. Published by Elsevier Ltd.

  12. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke. (United States)

    Romero Kräuchi, O; Valencia, L; Iturri, F; Mariscal Ortega, A; López Gómez, A; Valero, R


    To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Managing fertile women under lithium treatment: the challenge of a Teratology Information Service. (United States)

    Neri, Caterina; De Luca, Carmen; D'oria, Luisa; Licameli, Angelo; Nucci, Marta; Pellegrino, Marcella; Caruso, Alessandro; De Santis, Marco


    The objective of the present study is to review the literature regarding the management of fertile patients under lithium treatment for bipolar disorder and to report the experience of our Teratology Information Service over the past thirteen years in managing women treated with lithium during preconception, pregnancy and breastfeeding. This research focuses on a selective review of the literature and a retrospective survey has been carried out on fertile women under lithium treatment who called our service at A. Gemelli University Hospital in Rome from May 2002 to December 2015. A total of 140 women under lithium treatment called our TIS. A complete follow-up has been performed on 34 patients: 29 called during pregnancy and 5 called during preconception. None of the patients called during breastfeeding, while half of the patients were taking concomitant drugs during pregnancy. One major cardiac malformation (hypoplastic left heart syndrome) has been reported. No minor malformations have been detected. Twenty-one patients delivered a living child, with one premature neonate. Two patients underwent voluntary interruption of pregnancy and six patients had early spontaneous abortion. In one patient, intrauterine growth retardation occurred, but with no adverse neonatal outcomes. Four neonates experienced transient respiratory distress at birth. Two children developed mild to severe language delay, but normal motor development. Lithium treatment in fertile women is a very delicate topic, where risks and benefits of discontinuing therapy when women plan to become pregnant should be accurately evaluated. Thorough peri-conceptional counselling is crucial for the outcome of pregnancy and for maternal health status during preconception, gestation and breastfeeding.

  14. Yield Responses of Black Spruce to Forest Vegetation Management Treatments: Initial Responses and Rotational Projections

    Directory of Open Access Journals (Sweden)

    Peter F. Newton


    Full Text Available The objectives of this study were to (1 quantitatively summarize the early yield responses of black spruce (Picea mariana (Mill. B.S.P. to forest vegetation management (FVM treatments through a meta-analytical review of the scientific literature, and (2 given (1, estimate the rotational consequences of these responses through model simulation. Based on a fixed-effects meta-analytic approach using 44 treated-control yield pairs derived from 12 experiments situated throughout the Great Lakes—St. Lawrence and Canadian Boreal Forest Regions, the resultant mean effect size (response ratio and associated 95% confidence interval for basal diameter, total height, stem volume, and survival responses, were respectively: 54.7% (95% confidence limits (lower/upper: 34.8/77.6, 27.3% (15.7/40.0, 198.7% (70.3/423.5, and 2.9% (−5.5/11.8. The results also indicated that early and repeated treatments will yield the largest gains in terms of mean tree size and survival. Rotational simulations indicated that FVM treatments resulted in gains in stand-level operability (e.g., reductions of 9 and 5 yr for plantations established on poor-medium and good-excellent site qualities, resp.. The challenge of maintaining coniferous forest cover on recently disturbed sites, attaining statutory-defined free-to-grow status, and ensuring long-term productivity, suggest that FVM will continue to be an essential silvicultural treatment option when managing black spruce plantations.

  15. Current classification, treatment options, and new perspectives in the management of adipocytic sarcomas

    Directory of Open Access Journals (Sweden)

    De Vita A


    Full Text Available Alessandro De Vita,1 Laura Mercatali,1 Federica Recine,1 Federica Pieri,2 Nada Riva,1 Alberto Bongiovanni,1 Chiara Liverani,1 Chiara Spadazzi,1 Giacomo Miserocchi,1 Dino Amadori,1 Toni Ibrahim1 1Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST IRCCS, Meldola, FC, 2Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy Abstract: Sarcomas are a heterogeneous group of mesenchymal tumors arising from soft tissue or bone, with an uncertain etiology and difficult classification. Soft tissue sarcomas (STSs account for around 1% of all adult cancers. Till date, more than 50 histologic subtypes have been identified. Adipocyte sarcoma or liposarcoma (LPS is one of the most common STS subtypes, accounting for 15% of all sarcomas, with an incidence of 24% of all extremity STSs and 45% of all retroperitoneal STSs. The new World Health Organization classification system has divided LPS into four different subgroups: atypical lipomatous tumor/well-differentiated LPS, dedifferentiated LPS, myxoid LPS, and pleomorphic LPS. These lesions can develop at any location and exhibit different aggressive potentials reflecting their morphologic diversity and clinical behavior. Patients affected by LPS should be managed in specialized multidisciplinary cancer centers. Whereas surgical resection is the mainstay of treatment for localized disease, the benefits of adjuvant and neoadjuvant chemotherapy are still unclear. Systemic treatment, particularly chemotherapy, is still limited in metastatic disease. Despite the efforts toward a better understanding of the biology of LPS, the outcome of advanced and metastatic patients remains poor. The advent of targeted therapies may lead to an improvement of treatment options and clinical outcomes. A larger patient enrollment into translational and clinical studies will help increase the knowledge of the biological behavior of LPSs, test new drugs, and introduce new

  16. Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians. (United States)

    Miller, Ross M; Happe, Laura E; Meyer, Kellie L; Spear, Rachel J


    Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

  17. Integration of treatment wetlands as sustainable wastewater management systems for small communities

    Energy Technology Data Exchange (ETDEWEB)

    Dahab, M.F.; Surampalli, R.Y. [Univ. of Nebraski-Lincoln, Dept. of Civil Engineering, Lincoln, NE (United States)


    This paper discuses the applicability as well as the integration of the constructed wetlands technology within the environmental infrastructure in small communities. To that end, a case study involving the use of Constructed wetlands (CW) for waste management in the Nebraska plains is presented. CW systems have been shown to be effective treatment alternatives in resource-limited small communities; and hence, can contribute to improving the economic well-being and the sustainability of many small communities. The paper specifically discusses the performance of subsurface-flow constructed wetlands systems used as the wastewater treatment process for a small community in eastern Nebraska and outlines operational experience gained through five years of plant operation. The results show that effective and sufficient CW seasonal removals of TSS, VSS, CBOD{sub 5}, COD, and fecal coliform were achieved. Wastewater temperatures seemed to affect CBOD{sub 5} and COD removal rates. Nitrogen and phosphorus reductions were not as effective and varied seasonally, as well as with wastewater temperature. The addition of a sand filter, to aid in further nitrification and disinfection following CW treatment, markedly improved the performance of the wetlands system. After a few years of operation, the performance of the system was dampened by apparent clogging and subsequent eruption of wastewater at the head-end of the treatment cells. While clogging was partially caused by biomass build-up in the wetlands substrate, visual observations suggest that excessive vegetation and relaxed maintenance may also be responsible. (author)

  18. Integration of treatment wetlands as sustainable wastewater management systems for small communities

    International Nuclear Information System (INIS)

    Dahab, M.F.; Surampalli, R.Y.


    This paper discuses the applicability as well as the integration of the constructed wetlands technology within the environmental infrastructure in small communities. To that end, a case study involving the use of Constructed wetlands (CW) for waste management in the Nebraska plains is presented. CW systems have been shown to be effective treatment alternatives in resource-limited small communities; and hence, can contribute to improving the economic well-being and the sustainability of many small communities. The paper specifically discusses the performance of subsurface-flow constructed wetlands systems used as the wastewater treatment process for a small community in eastern Nebraska and outlines operational experience gained through five years of plant operation. The results show that effective and sufficient CW seasonal removals of TSS, VSS, CBOD 5 , COD, and fecal coliform were achieved. Wastewater temperatures seemed to affect CBOD 5 and COD removal rates. Nitrogen and phosphorus reductions were not as effective and varied seasonally, as well as with wastewater temperature. The addition of a sand filter, to aid in further nitrification and disinfection following CW treatment, markedly improved the performance of the wetlands system. After a few years of operation, the performance of the system was dampened by apparent clogging and subsequent eruption of wastewater at the head-end of the treatment cells. While clogging was partially caused by biomass build-up in the wetlands substrate, visual observations suggest that excessive vegetation and relaxed maintenance may also be responsible. (author)


    Dodić, Biljana; Miljković, Tatjana; Bjelobrk, Marija; Cemerlic Ađić, Nada; Ađić, Filip; Dodić, Slobodan


    The term "management" is best characterized as "managing" economic or social processes to achieve objectives through a rational use of material and immaterial resources by applying the principles, functions, and management methods. This study has been aimed at evaluating the value of an integrated quality management system implemented at the Institute of Cardiovascular Diseases of Vojvodina to improve the quality of treatment. In the period from 2008 to 2010 about 40 employees from the Institute of Cardiovascular Diseases of Vojvodina attended various courses given by the lecturers of the Faculty of Technical Sciences, where the function and significance of the "International Standards Organization" were explained, after which standards of interest were implemented at the Institute of Cardiovascular Diseases of Vojvodina. The Department of Cardiology has introduced 11 cardiac procedures with 5 special instructions, 14 general procedures, and 7 specific procedures with 2 instructions. The Department of Cardiac Surgery has introduced 7 procedures to be implemented. The "Vojvodina score" model was put into practice for the perioperative evaluation of cardiac surgery risk. During 2014, the Institute of Cardiovascular Diseases ofVojvodina obtained accreditation for the period of 7 years. The integrated quality management system must be applied in order to achieve a high level of health care in the shortest possible time and with the least possible consumption of material and human resources. The application of this system in practice gives a realistic insight into the working processes and facilitates their functioning. It demands and requires constant monitoring of the system efficiency along with continuous changes and improvements of all elements of the working processes and functional units.

  20. Management of horizontal crown fracture caused by traumatic injury with endorestoration treatment

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    Nanik Zubaidah


    Full Text Available Background: Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. The horizontal crown fracture more frequently observed usually occurs in maxillary anterior region and young male patients. The most common type of coronal fracture is in the middle third, followed by root and apical part. Purpose: The aim of this case report is to present the management of crown fracture of teeth with pulp exposure caused by dental trauma with endorestoration treatment in order to reconstruct the shape and the function of the teeth. Case: A 22 years old male with horizontal crown fracture of anterior teeth. The patient asked for aesthetic dental treatment both for its form and function. Case management: This horizontal crown fracture of anterior teeth with pulp exposure caused by dental trauma still could be reconstructed, mainly by endorestoration treatment. The endodontic treatment with post and core insertion in the root canal then would increase its retention. Later, the porcelain crown would aesthetically recover its original form and function, therefore, it would improve the patient’s confidence and teeth function. Conclusion:  Endorestoration treatment on anterior teeth with harizontal crown fractures and pulp exposure is able to recover the normal function, aesthetic, and self-confidence.Latar belakang: Trauma pada gigi merupakan penyebab utama perawatan darurat dalam praktek dokter gigi. Fraktur mahkota horisontal pada umunya terjadi pada gigi anterior rahang atas dan terjadi pada penderita pria muda. Jenis yang paling sering dari fraktur mahkota adalah pada sepertiga tengah, daerah akar dan apical. Tujuan: Laporan kasus ini menjelaskan penatalaksanaan fraktur mahkota gigi dengan pulpa terbuka akibat trauma dengan perawatan endorestorasi untuk mengembalikan bentuk dan fungsi gigi. Kasus: Penderita pria umur 22 tahun dengan fraktur mahkota horizontal pada gigi anterior. Penderita tersebut menginginkan perawatan

  1. Management of severe idiopathic oligohydramnios: is antepartum transabdominal amnioinfusion really a treatment option? (United States)

    Kozinszky, Zoltan; Pásztor, Norbert; Vanya, Melinda; Sikovanyecz, János; Pál, Attila


    The aim of this study was an evaluation of the role of antepartum transabdominal amnioinfusion (APTA) in the management of severe idiopathic oligohydramnios with a view to improving the pregnancy outcome. The study comprised an analysis of 20 pregnant women with severe oligohydramnios who were treated with APTA in 2009 and 2012. The pregnancy outcomes and the complications of the procedure were analysed. The mean gestational age at first treatment was 22 weeks 3 days. The preprocedure amniotic fluid index of <5 cm was restored by the treatment to 8 cm. More than a half of the pregnancies (66.7%, 8/12) treated with APTA finished with spontaneous abortion in the second trimester, mostly due to rupture of the membranes (as a consequence of retroamniotic filling with saline in four cases). The later the oligohydramnios developed, the higher the probability of a significant prolongation of the gestation. Although APTA is a useful procedure in the management of severe oligohydramnios, it may be followed by a relatively high rate of rupture of the membranes, particularly in the second trimester. Paradoxically, a higher volume of infused saline into the amniotic cavity is associated with a significantly lower risk of rupture.

  2. New treatment options in the management of fibromyalgia: role of pregabalin

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    Grazyna Zareba


    Full Text Available Grazyna ZarebaDepartment of Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USAAbstract: Fibromyalgia (FM is a common, chronic pain disorder with unknown etiology, characterized by widespread musculoskeletal pain and tenderness, and accompanied by several other symptoms such as sleep disturbance, fatigue, and mood disorders. Pregabalin is the first drug approved for the treatment of FM. Pregabalin has analgesic, anticonvulsant, and anxiolytic activity and has earlier demonstrated efficacy in the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, and as adjuvant therapy for adult patients with partial onset seizures. Pregabalin, a lipophilic gamma-aminobutyric acid (GABA analog, is α2δ-1 ligand that binds to, and modulates, voltage-gated calcium channels. This modulation is characterized by a reduction of the excessive neurotransmitter release that is observed in certain neurological and psychotic disorders. Several randomized, double-blind, placebo-controlled studies have demonstrated that pregabalin has been effective in pain management, improving sleep quality and fatigue, as well as in several domains of health related quality of life. Because of mild to moderate adverse effects it can be considered a well-tolerated therapy for FM.Keywords: fibromyalgia, pregabalin, GABA analog, fibromyalgia treatment

  3. The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review. (United States)

    Ziser, Katrin; Resmark, Gaby; Giel, Katrin Elisabeth; Becker, Sandra; Stuber, Felicitas; Zipfel, Stephan; Junne, Florian


    Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

  4. Management of acute diarrhoeal disease at Edendale Hospital: Are standard treatment guidelines followed?

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    Kershinee Reddy


    Full Text Available Background. Diarrhoeal disease (DD is a major cause of childhood mortality in developing countries. In South Africa (SA, it ranks as one of the top five causes of under-5 mortality. Local and global guidelines on the management of acute DD are readily available. The Standard Treatment Guidelines (STGs and Essential Drugs List for Hospital Level Paediatrics are a recognised standard of care for children in SA hospitals. However, children still die from this preventable disease. Objective. To determine whether doctors adhered to standard treatment guidelines when treating children under 5 years of age presenting to Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province, with acute DD. Methods. The study was a retrospective clinical audit of individual patient records. Results. One hundred and thirty-five patient records were reviewed. Forty-seven percent had a correct nutritional assessment, 41% were correctly assessed for shock and 27% for dehydration. Appropriate investigations were undertaken in 12%. Ninety-seven percent of patients had appropriate fluid plans prescribed. Zinc was prescribed in only 39% of patients, whereas 84% were appropriately not prescribed antibiotics and no patients received anti-diarrhoeal medication. In 90% of patients, the correct post-care patient referral was made, and 47% of caregivers were adequately advised about ongoing care of their children. Conclusion. This study identifies substantial non-adherence to the SA STGs for the management of young children with acute DD.

  5. Current status of achalasia management: a review on diagnosis and treatment. (United States)

    Tuason, Joshua; Inoue, Haruhiro


    Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

  6. Guide to managing persistent upper gastrointestinal symptoms during and after treatment for cancer. (United States)

    Andreyev, H Jervoise N; Muls, Ann C; Shaw, Clare; Jackson, Richard R; Gee, Caroline; Vyoral, Susan; Davies, Andrew R


    Guidance : the practical management of the gastrointestinal symptoms of pelvic radiation disease was published in 2014 for a multidisciplinary audience. Following this, a companion guide to managing upper gastrointestinal (GI) consequences was developed. The development and peer review of an algorithm which could be accessible to all types of clinicians working with patients experiencing upper GI symptoms following cancer treatment. Experts who manage patients with upper GI symptoms were asked to review the guide, rating each section for agreement with the recommended measures and suggesting amendments if necessary. Specific comments were discussed and incorporated as appropriate, and this process was repeated for a second round of review. 21 gastroenterologists, 11 upper GI surgeons, 9 specialist dietitians, 8 clinical nurse specialists, 5 clinical oncologists, 3 medical oncologists and 4 others participated in the review. Consensus (defined prospectively as 60% or more panellists selecting 'strongly agree' or 'agree') was reached for all of the original 31 sections in the guide, with a median of 90%. 85% of panellists agreed that the guide was acceptable for publication or acceptable with minor revisions. 56 of the original 61 panellists participated in round 2. 93% agreed it was acceptable for publication after the first revision. Further minor amendments were made in response to round 2. Feedback from the panel of experts developed the guide with improvement of occasional algorithmic steps, a more user-friendly layout, clearer time frames for referral to other teams and addition of procedures to the appendix.

  7. Disseminating contingency management: impacts of staff training and implementation at an opiate treatment program. (United States)

    Hartzler, Bryan; Jackson, T Ron; Jones, Brinn E; Beadnell, Blair; Calsyn, Donald A


    Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study's collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed. Published by Elsevier Inc.

  8. Viral bronchiolitis in young infants: new perspectives for management and treatment

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    Mauricio T. Caballero

    Full Text Available Abstract Objective: The aim of this review was to address advances in management and treatment of acute viral bronchiolitis in infants. Sources: A systematic review search was made including all articles published in English between 2010 and 2017, and available in the electronic databases PubMed and Cochrane Central Register of Controlled Trials (CENTRAL and specialized register of the Acute Respiratory Infections Group (Cochrane review group. The following MESH terms in English were included, using different Boolean operators for the search strategy: “bronchiolitis, viral,” “diagnosis,” “epidemiology,” “etiology,” “therapy,” “virology,” “prevention and control,” “respiratory syncytial virus, human.” Additional filters were used. Summary of findings: Few effective interventions are recommended for the management of RSV bronchiolitis in young infants. The main goal is to ensure an adequate oxygen supplementation and fluid balance whenever deemed necessary. Hypertonic saline nebulization is helpful only for hospitalized infants. Numerous antiviral drugs and specific vaccines for RSV are under evaluation and foretell advances in disease management in the near future. Conclusion: A number of promising new technologies are advancing in the field. Until new interventions became feasible, early detection and modification of preventable risk factors is essential to improve outcomes.

  9. Management and analysis of data from petroleum refinery wastewater treatment plants

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, D T [Wastewater, Technology Centre, Burlington, ON (Canada); Grammas, J [SOHO, Lima, OH (USA)


    Current efforts to monitor trace contaminants in treated oil refinery wastewaters increase the need to implement systematic, clear, and consistent procedures for reporting and presenting all monitoring data. The ability to interpret trace contaminant data which is to be collected by the governments of the U.S. and Canada for regulations development will rely on information about operating procedures and the efficiency of removal of conventional pollutants. An overview is provided of the main issues which must be addressed in managing and analyzing data from wastewater treatment facilities. The objectives of enviromental data management and analysis are discussed from the point of view of both the plant operator or owner and the regulatory authority. Based on the examination of the 1985 records of flow and phenol concentrations from seven Canadian petroleum refineries, recommendations are made for improving existing databases. In analyzing environmental data to transform raw data into information, exploratory data analysis techniques should be used by engineers or operators who do not have formal statistical training. These methods employ simple statistical summaries and graphical data displays. The paper concludes with a brief discussion about future trends in environmental data management and analysis. 15 refs., 5 figs., 2 tabs.

  10. Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. (United States)

    Herrmann, Nathan; Gauthier, Serge


    The management of severe Alzheimer disease often presents difficult choices for clinicians and families. The disease is characterized by a need for full-time care and assistance with basic activities of daily living. We outline an evidence-based approach for these choices based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of severe Alzheimer disease. Subsequent to the conference, we searched for additional articles published from January 2006 to March 2008 using the same search terms. We graded the strength of the evidence using the criteria of the Canadian Task Force on Preventive Health Care. We identified 940 articles, of which 838 were selected for further study. Thirty-four articles were judged to be of at least good or fair quality and were used to generate 17 recommendations. Assessment of severe Alzheimer disease should include the measurement of cognitive function and the assessment of behaviour, function, medical status, nutrition, safety and caregiver status. Management could include treatment with a cholinesterase inhibitor or memantine, or both. Treatment of neuropsychiatric symptoms begins with nonpharmacologic approaches to addressing behavioural problems. Severe agitation, aggression and psychosis, which are potentially dangerous to the patient, the caregiver and others in the environment, can be treated with atypical antipsychotics, with consideration of their increased risk of cerebrovascular events and death. All pharmacologic approaches require careful monitoring and periodic reassessment to determine whether continued treatment is necessary. Caregiver support and use of community

  11. An evaluation of the sustainability of onsite wastewater treatment systems for nutrient management. (United States)

    Diaz-Elsayed, Nancy; Xu, Xiaofan; Balaguer-Barbosa, Maraida; Zhang, Qiong


    The impairment of water bodies from nutrient pollution is a challenging environmental problem that could lead to high eutrophic conditions, fish kills, and human illness, while negatively impacting industries that rely on thriving water bodies. Onsite wastewater treatment systems (OWTSs) are a major source of nutrients, however no prior studies have conducted a holistic sustainability assessment of OWTSs that considers their ability to manage nutrients at the household-level in the United States. The aim of this study is therefore to evaluate the environmental and economic impacts of conventional and advanced OWTSs with respect to their ability to remove total nitrogen (TN). Septic tank and drainfield materials were varied for conventional systems, and the advanced systems evaluated consisted of aerobic treatment units (ATUs) and passive nitrogen reduction systems (PNRSs) with nitrification and denitrification stages. Life cycle assessment and life cycle cost analysis were performed to evaluate OWTSs operating in different soil and temperature conditions. Nutrient management of the advanced OWTSs outperformed the conventional systems (96.7-100% vs. 61-65% TN removal), and resulted in less than 40% of the freshwater (0.06-0.14 vs. 0.37-0.40 kg P-eq/kg TN) and marine eutrophication (0.04-0.06 vs. 0.54-0.65 kg N-eq/kg TN). However, the tradeoff for nutrient management was higher life cycle costs ($101-$121 vs. $45-$58 USD 2015/kg TN) and environmental impacts for the remaining impact categories. Lastly, when the TN removed by the drainfield was <20%, the advanced system had lower impacts than conventional OWTSs across all impact categories except ecotoxicity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Saline sewage treatment and source separation of urine for more sustainable urban water management. (United States)

    Ekama, G A; Wilsenach, J A; Chen, G H


    While energy consumption and its associated carbon emission should be minimized in wastewater treatment, it has a much lower priority than human and environmental health, which are both closely related to efficient water quality management. So conservation of surface water quality and quantity are more important for sustainable development than green house gas (GHG) emissions per se. In this paper, two urban water management strategies to conserve fresh water quality and quantity are considered: (1) source separation of urine for improved water quality and (2) saline (e.g. sea) water toilet flushing for reduced fresh water consumption in coastal and mining cities. The former holds promise for simpler and shorter sludge age activated sludge wastewater treatment plants (no nitrification and denitrification), nutrient (Mg, K, P) recovery and improved effluent quality (reduced endocrine disruptor and environmental oestrogen concentrations) and the latter for significantly reduced fresh water consumption, sludge production and oxygen demand (through using anaerobic bioprocesses) and hence energy consumption. Combining source separation of urine and saline water toilet flushing can reduce sewer crown corrosion and reduce effluent P concentrations. To realize the advantages of these two approaches will require significant urban water management changes in that both need dual (fresh and saline) water distribution and (yellow and grey/brown) wastewater collection systems. While considerable work is still required to evaluate these new approaches and quantify their advantages and disadvantages, it would appear that the investment for dual water distribution and wastewater collection systems may be worth making to unlock their benefits for more sustainable urban development.

  13. An information system to manage the rollout of the antiretroviral treatment programme in the Free State

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    J.E. Kotzé


    Full Text Available The Acquired Immune Deficiency Syndrome epidemic, caused by the Human Immunodeficiency Virus, is a global crisis which threatens development gains, economies, and societies. Within sub-Saharan Africa, where the epidemic began the earliest and the HIV prevalence is the highest, African countries have death rates not seen before. In South Africa the epidemic has a devastating impact which creates profound suffering on individuals and their families, and the impact on the socio-economic level is of great concern. The eradication of HIV/AIDS represents one of humanity’s greatest challenges, which requires co-operation and comprehensive collaboration between many different role players. In this endeavour clinical information plays a major role. To combat the effect of the disease, the Free State Department of Health started with the provisioning of antiretroviral therapy in the public health sector. The objective of this paper was to address the challenges they faced in order to develop and implement an information system to manage the rollout of antiretroviral treatment effectively. They started with a paper-based system to collect vital information. It was followed by a palm computer project that was initiated to electronically capture the data collected by the paper-based system. This system was then replaced by a comprehensive Hospital and Clinic Information System which was acquired and customised for the antiretroviral data collection process. Research partners developed a standalone antiretroviral data warehouse for collecting information associated with the monitoring and evaluation of the Free State antiretroviral and HIV/ AIDS treatment programme. The data warehouse successfully produced several management information reports to the antiretroviral management team. A need was identified to design a comprehensive antiretroviral data warehouse that will integrate data from several operational sources which are all associated with HIV/AIDS.

  14. Performance indicators and indices of sludge management in urban wastewater treatment plants. (United States)

    Silva, C; Saldanha Matos, J; Rosa, M J


    Sludge (or biosolids) management is highly complex and has a significant cost associated with the biosolids disposal, as well as with the energy and flocculant consumption in the sludge processing units. The sludge management performance indicators (PIs) and indices (PXs) are thus core measures of the performance assessment system developed for urban wastewater treatment plants (WWTPs). The key PIs proposed cover the sludge unit production and dry solids concentration (DS), disposal/beneficial use, quality compliance for agricultural use and costs, whereas the complementary PIs assess the plant reliability and the chemical reagents' use. A key PI was also developed for assessing the phosphorus reclamation, namely through the beneficial use of the biosolids and the reclaimed water in agriculture. The results of a field study with 17 Portuguese urban WWTPs in a 5-year period were used to derive the PI reference values which are neither inherent to the PI formulation nor literature-based. Clusters by sludge type (primary, activated, trickling filter and mixed sludge) and by digestion and dewatering processes were analysed and the reference values for sludge production and dry solids were proposed for two clusters: activated sludge or biofilter WWTPs with primary sedimentation, sludge anaerobic digestion and centrifuge dewatering; activated sludge WWTPs without primary sedimentation and anaerobic digestion and with centrifuge dewatering. The key PXs are computed for the DS after each processing unit and the complementary PXs for the energy consumption and the operating conditions DS-determining. The PX reference values are treatment specific and literature based. The PI and PX system was applied to a WWTP and the results demonstrate that it diagnosis the situation and indicates opportunities and measures for improving the WWTP performance in sludge management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Non-Hodgkin's lymphoma - Part II: Management of primary extranodal lymphomas, generalized disease and salvage treatment

    International Nuclear Information System (INIS)

    Gospodarowicz, Mary K.; Sutcliffe, Simon B.


    Objective: To review the approach to the diagnosis, classification, assessment, treatment and continuing management of patients with primary extranodal non-Hodgkin's lymphoma, and the management of generalized disease with the emphasis on the current role of salvage treatment with high dose chemotherapy and stem cell/bone marrow support strategies. Non-Hodgkin's lymphoma may involve any part of the body. Many lymphomas, such as MALT, angiocentric T-cell, etc., commonly present in extranodal sites. Lymphomas presenting in the GI tract, and head and neck, are most common with the single most common site being the stomach. Gastric lymphoma is associated with Helicobacter pylorii and is most common in areas endemic for Helicobacter pylorii infection. Recent advances in the understanding of the etiology of gastric MALT, thyroid, and intestinal lymphomas present new opportunities for the application of novel therapeutic approaches e.g. antibiotic therapy for Helicobacter pylori and early stage IPSID. Lymphomas presenting in the orbit, thyroid, breast, bone, extradural and skin are of interest because of the importance of expert RT in securing local control. Primary brain lymphomas present a particular challenge to the radiation oncologist. Although localized, primary brain lymphomas are extremely difficult to control. Rare sites of extranodal lymphoma include testis, female genital tract, and lung. Extranodal lymphomas are often localized and cure with RT or CMT is possible. They represent a assorted group of diseases with diverse presentations, prognosis, sensitivity to RT and expected outcome. They are of particular importance to radiation oncologists as they require special attention to patterns of spread and treatment planning. The principles of management of primary extranodal lymphoma, however, follow those applicable to localized nodal presentations. Although primary extranodal lymphomas are highly curable, a proportion of patients will fail with disseminated

  16. A botulinum toxin A treatment algorithm for de novo management of torticollis and laterocollis (United States)

    Kupsch, Andreas; Müngersdorf, Martina; Paus, Sebastian; Stenner, Andrea; Jost, Wolfgang


    Objectives Few studies have investigated the injection patterns for botulinum toxin type A for the treatment of heterogeneous forms of cervical dystonia (CD). This large, prospective, open-label, multicentre study aimed to evaluate the effectiveness and safety of 500 U botulinum toxin A for the initial treatment according to a standardised algorithm of the two most frequent forms of CD, predominantly torticollis and laterocollis. Design Patients (aged ≥18 years) with CD not previously treated with botulinum neurotoxin therapy were given one treatment with 500 U Dysport, according to a defined intramuscular injection algorithm based on clinical assessment of direction of head deviation, occurrence of shoulder elevation, occurrence of tremor (all evaluated using the Tsui rating scale) and hypertrophy of the sternocleidomastoid muscle. Results In this study, 516 patients were enrolled, the majority of whom (95.0%) completed treatment. Most patients had torticollis (78.1%). At week 4, mean Tsui scores had significantly decreased by −4.01, −3.76 and −4.09 points in the total, torticollis and laterocollis populations, respectively. Symptom improvement was equally effective between groups. Tsui scores remained significantly below baseline at week 12 in both groups. Treatment was well tolerated; the most frequent adverse events were muscular weakness (13.8%), dysphagia (9.9%) and neck pain (6.6%). Conclusions Dysport 500 U is effective and well tolerated for the de novo management of a range of heterogeneous forms of CD, when using a standardised regimen that allows tailored dosing based on individual symptom assessment. Clinical trials information (NCT00447772; PMID:22021883

  17. Therapeutic outcome of various treatment modalities for the management of 34 cases of mandibular unicystic ameloblastoma

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    Rajib Khadka


    Full Text Available Background & Objectives: Unicystic ameloblastoma is a challenge, as conservative modalities have high recurrence chances whereas radical modalities have high morbidity for defects and deformity. Enucleation with peripheral ostectomy and Carnoy’s solution is an intermediate treatment with less risk of recurrence and good outcome. The objectives of the study was to determine the therapeutic outcome for various treatment modalities for the management of mandibular unicystic ameloblastoma.Materials & Methods:Retrospective analysis of 34 cases from 2005 to 2014 was done and were analysed in terms of demographic profiles, treatment modalities and its efficacy (recurrence in 6 years’ follow up time.Results: The total number of patients was 34. The age ranged from 12 years to 28 years with a mean age of 18.82 years. Gender distribution was 21 males (61.8% and 13 females (38.2%. The location found was 26 (76.5% cases in posterior mandibular region and 8 (23.5% cases in the anterior mandibular region. Size of the lesions was small in 10 (29.4% cases, medium in 18 (52.9% cases and large in 6 (17.6% cases. Perforation of buccal or lingual cortex was present in 6 (17.6% and no preforation in 28 (82.4%. Treatment modalities done was marsupilisation in 6 (17.6% cases, enucleation with peripheral ostectomy with caroney solution in 22 (64.7% cases and resection with safe margin in 6 (17.6% cases. Recurrence occurred in 8 (23.5% cases and no recurrence in 26 (76.5% cases.Conclusion:Enucleation with peripheral ostectomy and Carnoy’s solution is one of the good treatment modality for unicystic ameloblastoma of the mandible whereas complete resection of the mandible with safe margin has low risk of recurrence in long term follow up.

  18. The Effects of Combined Treadmill Training and Pharmacological Treatment on Management of Multiple Sclerosis Female Patients

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    Ali Asghar Arastoo


    Full Text Available Objectives: To compare the effectiveness of two treatment methods of ‘combination pharmacological treatment and treadmill training’ and ‘pharmacological treatment’ on management of multiple sclerosis (MS female patients. Methods: In this quasi experimental and interventional study a sample of 20 MS patients (mean age: 36.75 years with Expanded Disability Status Scale scores (EDSS 1.0 to 4.0 were randomly assigned to a ‘pharmacologic treatment’ (Ph group and a combination group of ‘pharmacologic treatment& treadmill training’ (PhTT. All these individuals used the drugs of choice ‘Rebif’ and ‘Avonex’. The intervention consisted of 8-weeks (24 sessions of treadmill training (30 minutes each, at 40-75% of age-predicted maximum heart rate for the PhTT group. The Ph group followed their own routine treatment program. Balance, speed and endurance of walking, quality of life and fatigue were measured by Berg Balance Score, 10 meter timed walk test, 2 minute walk test, and Fatigue Severity Scale (FFS. Data were analyzed by paired t test and one way ANOVA. Results: Comparison of results indicated that pre and post intervention led to significant improvements in the balance score (P=0.001, 10m walk time (P=0.001, walking endurance (P=0.007, and FFS (P=0.04 in the PhTT group. In contrast, no significant changes were observed in the Ph group’s balance score, 10m timed walk and fatigue, while there was a significant decrease in the 2min walking distance (P=0.015 in this group. Discussion: These results suggest that treadmill training in combination with pharmacological treatment improve balance and walking capacity and level of fatigue in women with mild to moderate MS.

  19. Head and neck cancer treatment in the elderly. Evaluation and management of complications

    International Nuclear Information System (INIS)

    Monden, Nobuya; Nishikawa, Kunio; Morishita, Tokiwa; Nagata, Motoki; Tominaga, Susumu


    With the population over age 70 growing, treatment for head and neck cancer in the elderly has increased. We retrospectively evaluated their management and outcome. Subjects numbered 121, 83 men and 38 women from 70 to 94 years old, initially treated at our hospital. We classified them into 2 groups by age, the aged at 70-79 years (55 men and 26 women) and the very old at 80 years and older (28 men and 12 women). We also evaluated a younger control group aged 50-59 years (37 men and 19 women). Primary tumor sites were the oral cavity (28.1%), larynx (28.1%), paranasal sinus (15.8%), and hypopharynx (9.9%). Preoperative geriatric disease was seen in 54% of controls, 74% of the aged, and 93% of the very old. Cardiovascular and respiratory diseases were most common. Surgical treatment and irradiation were essential for cancer treatment. Postoperative complications, including pneumonia, delirium, renal and cardiovascular hypofunction occurred in 56.5% of controls, 48.2% of the aged, and 47.8% of the very old. The frequency of postoperative complications correlated significantly with the American Society of Anesthesiologist classification of physical status (ASA) and preoperative performance status (PS). The complications of irradiation including pneumonia, dehydration, and feeding disturbance occurred in 53% of the very old. Cures were achieved in 83.9% of controls, 81.5% of the aged, and 65.0% of the very old. Cause specific 5-year survival in those cured was 85.2% of controls, 84.5% of the aged, and 80.0% of the very old. Median survival in those not cured was 4 months in controls, 9.6 months in the aged, and 5 months in the very old. We concluded that curative treatment is important in the elderly, and the success of curative treatment and the prevention of complications depend on careful assessment of systemic disease, PS, ASA, and mental activity. (author)

  20. Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perceptions. (United States)

    Palacios, S; Cancelo, M J; Castelo Branco, C; Llaneza, P; Molero, F; Borrego, R Sanchez


    To gain a deeper comprehension of current vulvovaginal atrophy (VVA) knowledge among Spanish postmenopausal women. An online survey (REVIVE) was conducted in four European countries with an overall sample of 768 participants included in Spain. Perceptions, experiences and needs of Spanish postmenopausal women in terms of sexual and vaginal health were reported. Vaginal dryness was the most common VVA symptom in Spain (81%). The severity of symptoms reported by postmenopausal women tended to be similar or worse than at onset, especially in the most troublesome symptom, dyspareunia (80%). VVA symptoms significantly impact on Spanish participants' ability to achieve sexual enjoyment (75%), relationship with partner (67%) and sexual spontaneity (66%). Although 71% of participants with partners (83%) were sexually active, their sex drive was reduced by one-third as a consequence of VVA. Despite the fact that women expected doctors to start asking them about menopausal symptoms, this rarely occurred. Treatments were administered mainly vaginally without prescription (62% were using over-the-counter products at the time). Postmenopausal women who had discussed their symptoms with physicians were twice as likely to be treated (66% vs. 33%) than those who had not. Low compliance with treatment was justified by Spanish participants with not bothersome enough symptoms (22%), relief (21%), inability to reverse vaginal changes (15%) and treatment price (13%). Almost half of the participants with a current local estrogen prescription showed satisfaction. The acknowledged main limitation for all treatments was the inability to restore the natural conditions of the vagina. The price of over-the-counter products was also reported as an important concern in Spanish postmenopausal women. VVA remains underdiagnosed and undertreated in Spain, despite its high frequency and significant impact on quality of life. Since patient satisfaction with available treatments remains compromised

  1. Management of the obstructive sleep apnoea syndrome: More knowledge required for an optimal choice of treatment modality

    NARCIS (Netherlands)

    Hoekema, A


    In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to

  2. Mineralizing urban net-zero water treatment: Field experience for energy-positive water management. (United States)

    Wu, Tingting; Englehardt, James D


    An urban net-zero water treatment system, designed for energy-positive water management, 100% recycle of comingled black/grey water to drinking water standards, and mineralization of hormones and other organics, without production of concentrate, was constructed and operated for two years, serving an occupied four-bedroom, four-bath university residence hall apartment. The system comprised septic tank, denitrifying membrane bioreactor (MBR), iron-mediated aeration (IMA) reactor, vacuum ultrafilter, and peroxone or UV/H 2 O 2 advanced oxidation, with 14% rainwater make-up and concomitant discharge of 14% of treated water (ultimately for reuse in irrigation). Chemical oxygen demand was reduced to 12.9 ± 3.7 mg/L by MBR and further decreased to below the detection limit (treatment. The process produced a mineral water meeting 115 of 115 Florida drinking water standards that, after 10 months of recycle operation with ∼14% rainwater make-up, had a total dissolved solids of ∼500 mg/L, pH 7.8 ± 0.4, turbidity 0.12 ± 0.06 NTU, and NO 3 -N concentration 3.0 ± 1.0 mg/L. None of 97 hormones, personal care products, and pharmaceuticals analyzed were detected in the product water. For a typical single-home system with full occupancy, sludge pumping is projected on a 12-24 month cycle. Operational aspects, including disinfection requirements, pH evolution through the process, mineral control, advanced oxidation by-products, and applicability of point-of-use filters, are discussed. A distributed, peroxone-based NZW management system is projected to save more energy than is consumed in treatment, due largely to retention of wastewater thermal energy. Recommendations regarding design and operation are offered. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Management of subarachnoid hemorrhage classified grade V. Possibility of intravascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Uzura, Masahiko; Oshima, Kousuke; Morishima, Hiroyuki; Uchida, Kazuyoshi; Watanabe, Hiroyuki; Nakamura, Homare; Tanaka, Katsuyuki; Sekino, Hiroaki; Akashi, Katsuya [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine


    Management outcomes in poor-grade patients (World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale Grade V) with ruptured cerebral aneurysms have historically been unsatisfactory. In the present study, we examined the possibility of intravascular treatment for ruptured aneurysm detected by 3-Dimensional CT angiography (3D-CTA) in poor-grade SAH patients. From April 1997 to July 2000, 3D-CTA was performed on 54 of 73 patients admitted with Grade V subarachnoid hemorrhage (SAH). Excluding 3 patients who underwent emergency surgery for ruptured aneurysms and intracerebral hematomas, CT findings from the remaining 51 patients were analyzed. The study included 23 men and 28 women, ranging in age from 28 to 91 with an average age of 63.6. The patients' initial scores on the Glasgow Coma Scale upon admission were 3 in 36 patients (including 19 patients who had undergone cardio-pulmonary arrest), 4 in 11 patients, 5 in 2 patients, and 6 in 2 patients. Ruptured aneurysms responsible for SAH were clearly delineated in 41 aneurysms from 39 patients, with 32 aneurysms in the anterior circulation and 9 in the posterior circulation. Patients with Glasgow Coma Scale of 4 or higher whose score did not progressively decrease for 12 hours after symptom onset were considered for intravascular treatment. In our study, 4 of 39 patients (10.3%) met these criteria. Glasgow Outcome Scale results were good recovery in 1 case, moderate disability in 1 case, severe disability in 1 case, and death in the remaining 48 cases. These results suggest that the management course for poor-grade (WFNS Grade V) SAH patients who retain brain stem reflexes contain the following: identification of aneurysms by 3D-CTA, maintenance of adequate sedation and external drainage to treat acute hydrocephalus, continued minimum 12-hour observation, monitoring levels of consciousness where possible, and consideration of aggressive therapy including

  4. Comparison of management out comes of open and laparoscopic cholecystectomy in the treatment of symptomatic cholelithiasis

    International Nuclear Information System (INIS)

    Dian, A.; Azam, U.F.; Malik, N.A.; Khan, J.S.; Khan, M.


    Introduction: Open cholecystectomy (OC) has gradually been superseded by laparoscopic cholecystectomy (LC) for the treatment of cholelithiasis. Laparoscopic cholecystectomy is associated with fewer complications than open cholecystectomy when performed in experienced hands. The study was conducted to compare the two techniques for management of symptomatic gall stones. Objective: Our objective was to compare the management outcomes of laparoscopic cholecystectomy with those of open holecystectomy in the treatment of symptomatic cholelithiasis. Study Design: Quasi experimental study. Settings: It was carried out at Surgical Unit - I of Holy Family Hospital, Rawalpindi. Subjects and Methods: Eighty consecutive patients with symptomatic cholelithiasis confirmed on ultrasonography from September 2007 to March 2008 were included in the study. They were randomly allocated to LC or OC and were eventually operated. Results: Mean operating time of LC was 64 minutes (30-90) (SD=13.4) where as in OC it was 37.12 minutes (25-70) (SD-9.6). Return of bowel sounds postoperatively was within 12 hours (9-18) (SD=3.25) in LC while it was 16 hours (9-30) in OC group (SD=4.75). Postoperative hospital stay was 1.5 days mean (1-4 days) (SD=0.71). In LC while it was 2.9 days (2-5) in OC group (SD=0.84). The duration of injectable analgesia requirement was 1.3 days (1-3) (SD=0.51) and 1.8 days (1-3) (SD=0.7) in LC and OC patients respectively. The gall bladder perforation was 22.5% in OC and 15% in LC. The common bile duct injury occurred in 2% of patients with LC while none with OC. The conversion rate was 5%. Conclusion: Laparoscopic cholecystectomy is safe treatment of cholelithiasis with short duration of postoperative hospital stay, lesser post operative pain, early return of normal bowel activity as compared to the open cholecystectomy. (author)

  5. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume V of V

    International Nuclear Information System (INIS)


    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear energy research and the development, production, and testing of nuclear weapons at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives, which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type. This information includes the cumulative impacts of combining future siting configurations for the five waste types and the collective impacts of other past, present, and reasonably foreseeable future activities. The selected waste management facilities being considered for these different waste types are treatment and disposal facilities for low-level mixed waste; treatment and disposal facilities for low-level waste; treatment and storage facilities for transuranic waste in the event that treatment is required before disposal; storage facilities for created (vitrified) high-level waste canisters; and treatment of nonwastewater hazardous waste by DOE and commercial vendors. In addition to the No Action Alternative, which includes only existing of approved waste management facilities, the alternatives for each of the waste-type configurations include Decentralized, Regionalized, and Centralized Alternatives for using existing and operating new waste management facilities. However, the siting, construction, and operations of any new facility at a selected site will not be decided until completion of a sitewide or project-specific environmental impact review

  6. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume I of V

    International Nuclear Information System (INIS)


    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type. This information includes the cumulative impacts of combining future siting configurations for the five waste types and the collective impacts of other past, present, and reasonably foreseeable future activities. The selected waste management facilities being considered for these different waste types are treatment and disposal facilities for low-level mixed waste; treatment and disposal facilities for low-level waste; treatment and storage facilities for transuranic waste in the event that treatment is required before disposal; storage facilities for treated (vitrified) high-level waste canisters; and treatment of nonwastewater hazardous waste by DOE and commercial vendors. In addition to the no action alternative, which includes only existing or approved waste management facilities, the alternatives for each of the waste type configurations include decentralized, regionalized, and centralized alternatives for using existing and operating new waste management facilities. However, the siting, construction and operations of any new facility at a selected site will not be decided until completion of a sitewide or project-specific environmental impact review

  7. Contemporary Management of Struvite Stones Using Combined Endourologic and Medical Treatment: Predictors of Unfavorable Clinical Outcome. (United States)

    Iqbal, Muhammad Waqas; Youssef, Ramy F; Neisius, Andreas; Kuntz, Nicholas; Hanna, Jonathan; Ferrandino, Michael N; Preminger, Glenn M; Lipkin, Michael E


    Struvite stones have been associated with significant morbidity and mortality, yet there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series. A retrospective review of patients who were treated with percutaneous nephrolithotomy (PCNL) for struvite stones at Duke University Medical Center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow-up and were included in this analysis. Stone activity, defined as either stone recurrence or stone-related events, and predictors of activity were evaluated after combined surgical and medical treatment. The study included 43 patients with either pure (35%) or mixed (65%) struvite stones with a median age of 55±15 years (range 21-89 years). The stone-free rate after PCNL was 42%. Stone recurrence occurred in 23% of patients. Postoperatively, 30% of patients had a stone-related event, while 60% of residual stones remained stable with no growth after a median follow-up of 22 months (range 6-67 mos). Kidney function remained stable during follow-up. Independent predictors of stone activity included the presence of residual stones >0.4 cm(2), preoperative large stone burden (>10 cm(2)), and the presence of medical comorbidities (P<0.05). Struvite stones can be managed safely with PCNL followed by medical therapy. The majority of patients with residual fragments demonstrated no evidence of stone growth on medical therapy. With careful follow-up and medical management, kidney function can be maintained and stone morbidity can be minimized. Initial large stone burden, residual stones after surgery, and associated medical comorbidities may have deleterious effect on stone recurrence or residual stone-related events.

  8. Treatment and recycling of spent nuclear fuel. Actinide partitioning - Application to waste management

    International Nuclear Information System (INIS)

    Abonneau, E.; Baron, P.; Berthon, C.; Berthon, L.; Beziat, A.; Bisel, I.; Bonin, L.; Bosse, E.; Boullis, B.; Broudic, J.C.; Charbonnel, M.C.; Chauvin, N.; Den Auwer, C.; Dinh, B.; Duhamet, J.; Escleine, J.M.; Grandjean, S.; Guilbaud, P.; Guillaneux, D.; Guillaumont, D.; Hill, C.; Lacquement, J.; Masson, M.; Miguirditchian, M.; Moisy, P.; Pelletier, M.; Ravenet, A.; Rostaing, C.; Royet, V.; Ruas, A.; Simoni, E.; Sorel, C.; Vaudano, A.; Venault, L.; Warin, D.; Zaetta, A.; Pradel, P.; Bonin, B.; Bouquin, B.; Dozol, M.; Lecomte, M.; Forestier, A.; Beauvy, M.; Berthoud, G.; Defranceschi, M.; Ducros, G.; Guerin, Y.; Latge, C.; Limoge, Y.; Madic, C.; Santarini, G.; Seiler, J.M.; Sollogoob, P.; Vernaz, E.; Bazile, F.; Parisot, J.P.; Finot, P.; Roberts, J.F.


    subsequent to its in-reactor dwell time, spent fuel still contains large amounts of materials that are recoverable, for value-added energy purposes (uranium, plutonium), together with fission products, and minor actinides, making up the residues from nuclear reactions. The treatment and recycling of spent nuclear fuel, as implemented in France, entail that such materials be chemically partitioned. The development of the process involved, and its deployment on an industrial scale stand as a high achievement of French science, and technology. Treatment and recycling allow both a satisfactory management of nuclear waste to be implemented, and substantial savings, in terms of fissile material. Bolstered of late as it has been, due to spectacularly skyrocketing uranium prices, this strategy is bound to become indispensable, with the advent of the next generation of fast reactors. This Monograph surveys the chemical process used for spent fuel treatment, and its variants, both current, and future. It outlines currently ongoing investigations, setting out the challenges involved, and recent results obtained by CEA. (authors)

  9. Treatment and recycling of spent nuclear fuel. Actinide partitioning - Application to waste management

    Energy Technology Data Exchange (ETDEWEB)

    Abonneau, E.; Baron, P.; Berthon, C.; Berthon, L.; Beziat, A.; Bisel, I.; Bonin, L.; Bosse, E.; Boullis, B.; Broudic, J.C.; Charbonnel, M.C.; Chauvin, N.; Den Auwer, C.; Dinh, B.; Duhamet, J.; Escleine, J.M.; Grandjean, S.; Guilbaud, P.; Guillaneux, D.; Guillaumont, D.; Hill, C.; Lacquement, J.; Masson, M.; Miguirditchian, M.; Moisy, P.; Pelletier, M.; Ravenet, A.; Rostaing, C.; Royet, V.; Ruas, A.; Simoni, E.; Sorel, C.; Vaudano, A.; Venault, L.; Warin, D.; Zaetta, A.; Pradel, P.; Bonin, B.; Bouquin, B.; Dozol, M.; Lecomte, M.; Forestier, A.; Beauvy, M.; Berthoud, G.; Defranceschi, M.; Ducros, G.; Guerin, Y.; Latge, C.; Limoge, Y.; Madic, C.; Santarini, G.; Seiler, J.M.; Sollogoob, P.; Vernaz, E.; Bazile, F.; Parisot, J.P.; Finot, P.; Roberts, J.F


    subsequent to its in-reactor dwell time, spent fuel still contains large amounts of materials that are recoverable, for value-added energy purposes (uranium, plutonium), together with fission products, and minor actinides, making up the residues from nuclear reactions. The treatment and recycling of spent nuclear fuel, as implemented in France, entail that such materials be chemically partitioned. The development of the process involved, and its deployment on an industrial scale stand as a high achievement of French science, and technology. Treatment and recycling allow both a satisfactory management of nuclear waste to be implemented, and substantial savings, in terms of fissile material. Bolstered of late as it has been, due to spectacularly skyrocketing uranium prices, this strategy is bound to become indispensable, with the advent of the next generation of fast reactors. This Monograph surveys the chemical process used for spent fuel treatment, and its variants, both current, and future. It outlines currently ongoing investigations, setting out the challenges involved, and recent results obtained by CEA. (authors)

  10. Management of high-risk Myeloma: an evidence-based review of treatment strategies. (United States)

    Lehners, Nicola; Hayden, Patrick J; Goldschmidt, Hartmut; Raab, Marc-Steffen


    Despite the progress made in the treatment of patients with multiple myeloma over recent decades, a significant cohort with high-risk disease as defined by specific clinical and genetic criteria continue to respond poorly to standard treatment. These patients represent a particular challenge to the treating physician and require early identification as well as personalized treatment strategies. In this review, we discuss the prognostic impact of adverse clinical, radiological and genetic factors, evaluate available scoring systems and highlight key aspects of the therapeutic management of high-risk myeloma. MEDLINE and recent scientific meetings' databases were searched for the keywords 'high-risk' and 'multiple myeloma' and relevant studies relating to both diagnostic and therapeutic approaches were identified. Expert commentary: A case is made for intensive induction using combinations of novel agents, early high-dose therapy supported by autologous stem cell transplantation and the widespread use of maintenance therapies. Novel therapeutic options, especially in the field of immunotherapy, are currently explored in clinical trials and have the potential to further improve outcomes for patients with high-risk multiple myeloma.

  11. Managing many patients with a urethral stricture: a cost-benefit analysis of treatment options. (United States)

    Ogbonna, B C


    To report a management method in a community where there are many patients with urethral stricture and where the short-term goal of providing some treatment to most may override the sometimes conflicting long-term aim of minimizing recurrence rates. Over a 3-year period, using optical urethrotomy in 76 patients followed by intermittent self-dilatation (ISD) in 29, urethroplasty in 28 and dilatation in three, 92 of 134 patients with a urethral stricture were treated and the outcome compared. The overall recurrence rate was 22%; a combination of urethrotomy plus ISD had a recurrence rate of 17% and gave a mean duration of follow-up without recurrence similar to that after urethroplasty. ISD significantly increased both the time before recurrence and the duration of follow-up without recurrence after urethrotomy. In addition to providing lasting treatment to many patients, urethrotomy was also 10 times cheaper, 10 times faster to perform and offered the surgeon better protection from infection with human immunodeficiency virus than did urethroplasty. Because wrongly selecting urethrotomy (resulting in a failed procedure) wastes valuable operating time and resources, the pre-operative recognition of strictures unsuitable for urethrotomy and their treatment by urethroplasty is important for overall efficiency.

  12. Management of recurrent nasal vestibular furunculosis by jalaukāvacaraṇa and palliative treatment

    Directory of Open Access Journals (Sweden)

    Amol Sudhakar Kadu


    Full Text Available Nasal vestibular furunculosis is a common bacterial skin infection among the general population mostly affecting adults and children.It is characterized by acute localized infection of hair follicle in the skin lining of the nasal vestibule caused by Staphylococcus aureus. Immunodeficiency also plays an important role in recurrent skin and soft tissue infections (SSTI including Nasal furunculosis. Though, the lesion is small, it is extremely painful and tender. Treatment is mostly conservative which consists of warm compresses, analgesics to relieve pain, topical and systemic antibiotics directed against staphylococcus. With rapidly increasing resistance to antibacterial agents, management of these bacterial infections is becoming increasingly difficult. In Ayurveda, it can be correlated with Nāsāruṇaśikhā (Nasal furunculosis. Morphologically, it appears like pīḍikā (Furuncle which is characterized by Rāgayuktaśotha (inflammation with reddening. Jalaukāvacaraṇa (Leech therapy is one of the ancient and important parasurgical procedures described in Ayurveda for treatment of various diseases. In this case, a leech has been applied at the affected area. After leech treatment, throbbing pain was reduced in its intensity followed by gradual reduction in swelling and reddening in two days.This case suggests the utility of leech application in Nasal vestibular furunculosis.

  13. Treatment and management of myelofibrosis in the era of JAK inhibitors. (United States)

    Keohane, Clodagh; Radia, Deepti H; Harrison, Claire N


    Myelofibrosis (MF) can present as a primary disorder or evolve from polycythemia vera (PV) or essential thrombocythemia (ET) to post-PV MF or post-ET MF, respectively. MF is characterized by bone marrow fibrosis, splenomegaly, leukoerythroblastosis, extramedullary hematopoiesis, and a collection of debilitating symptoms. Until recently, the therapeutic options for patients with MF consisted of allogeneic hematopoietic stem cell transplant (alloHSCT), the use of cytoreductive agents (ie, hydroxyurea), splenectomy and splenic irradiation for treatment of splenomegaly, and management of anemia with transfusions, erythropoiesis-stimulating agents (ESAs), androgens, and immunomodulatory agents. However, with increased understanding of the pathogenesis of MF resulting from dysregulated Janus kinase (JAK) signaling, new targeted JAK inhibitor therapies, such as ruxolitinib, are now available. The purpose of this article is to review the clinical features of MF, discuss the use and future of JAK inhibitors, reassess when and how to use conventional MF treatments in the context of JAK inhibitors, and provide a perspective on the future of MF treatment.

  14. [Pulmonary hypertension of the newborn--recent advances in the management and treatment]. (United States)

    Vakrilova, L; Radulova, P; Hitrova, St; Slancheva, B


    Pulmonary hypertension of the newborn is a clinical syndrome with diverse etiology in which the transition from fetal circulation with high pulmonary vascular resistance to postnatal circulation with low pulmonary vascular resistance failed. The persistence of high pulmonary vascular pressure leads to right-left shunts and marked cyanosis. Despite of the advances in neonatology, the treatment of some forms of PPHN is often difficult and mortality rate remains high. In infants with PPHN appropriate interventions are critical to reverse hypoxemia, improve pulmonary and systemic perfusion and preserve end-organ function. Our understanding for management of PPHN has evaluated over decades. This review summarizes the current strategies for treatment of pulmonary hypertension of the newborn: general care, cardiovascular support, the advantages and limitations of different ventilatory strategies, oxygen therapy, extracorporal membrane oxygenation, and the evidence-based inhaled nitric oxide therapy. The balance between pulmonary vasoconstrictor and vasodilator mediators plays an important role for pulmonary vascular resistance. Recent studies are designed to develop evidence-based therapies for regulation of pulmonary vascular tone, safe medications for selective pulmonary vasodilatation effective for treatment of PPHN and other forms of pulmonary hypertension in the neonatal intensive care unit.

  15. Treatment and management of myelofibrosis in the era of JAK inhibitors

    Directory of Open Access Journals (Sweden)

    Keohane C


    Full Text Available Clodagh Keohane, Deepti H Radia, Claire N HarrisonDepartment of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UKAbstract: Myelofibrosis (MF can present as a primary disorder or evolve from polycythemia vera (PV or essential thrombocythemia (ET to post-PV MF or post-ET MF, respectively. MF is characterized by bone marrow fibrosis, splenomegaly, leukoerythroblastosis, extramedullary hematopoiesis, and a collection of debilitating symptoms. Until recently, the therapeutic options for patients with MF consisted of allogeneic hematopoietic stem cell transplant (alloHSCT, the use of cytoreductive agents (ie, hydroxyurea, splenectomy and splenic irradiation for treatment of splenomegaly, and management of anemia with transfusions, erythropoiesis-stimulating agents (ESAs, androgens, and immunomodulatory agents. However, with increased understanding of the pathogenesis of MF resulting from dysregulated Janus kinase (JAK signaling, new targeted JAK inhibitor therapies, such as ruxolitinib, are now available. The purpose of this article is to review the clinical features of MF, discuss the use and future of JAK inhibitors, reassess when and how to use conventional MF treatments in the context of JAK inhibitors, and provide a perspective on the future of MF treatment.Keywords: myelofibrosis, ruxolitinib, JAK inhibitor

  16. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions

    Directory of Open Access Journals (Sweden)

    Deirdre R Pachman


    Full Text Available Deirdre R Pachman1, Jason M Jones1, Charles L Loprinzi21Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Medical Oncology, Mayo Clinic, Rochester, MN, USAAbstract: Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block.Keywords: vasomotor symptoms, hot flashes, menopause, therapy

  17. Implication of ultrasound bladder parameters on treatment response in patients with benign prostatic hyperplasia under medical management

    Directory of Open Access Journals (Sweden)

    Rajeev Thekumpadam Puthenveetil


    Conclusion: Ultrasound bladder parameters are useful tools for measuring the treatment response in BPH patients. Our study shows that RI and DWT significantly correlate with the treatment response in BPH patients. More importantly, pretreatment values of increased IPP and PUA determines the non-improvement of symptoms in BPH patients. Our study suggests the importance of transabdominal ultrasonography (KUB–P with Doppler for evaluating treatment responses to medical management.

  18. A bio-behavioral model of addiction treatment: applying dual representation theory to craving management and relapse prevention. (United States)

    Matto, Holly


    A bio-behavioral approach to drug addiction treatment is outlined. The presented treatment model uses dual representation theory as a guiding framework for understanding the bio-behavioral processes activated during the application of expressive therapeutic methods. Specifically, the treatment model explains how visual processing techniques can supplement traditional relapse prevention therapy protocols, to help clients better manage cravings and control triggers in hard-to-treat populations such as chronic substance-dependent persons.

  19. Leading processes of patient care and treatment in hierarchical healthcare organizations in Sweden--process managers' experiences. (United States)

    Nilsson, Kerstin; Sandoff, Mette


    The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers' experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization. This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style. The process managers' experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager's responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager. Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings. This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers' experiences, a subject that has not been investigated earlier.

  20. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume III of V

    International Nuclear Information System (INIS)


    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type

  1. Improvement of the management of residual waste in areas without thermal treatment facilities: A life cycle analysis of an Italian management district

    Energy Technology Data Exchange (ETDEWEB)

    Di Maria, Francesco, E-mail: [LAR Laboratory, Dipartimento di Ingegneria, Via G. Duranti 93, Perugia (Italy); Micale, Caterina; Morettini, Emanuela [LAR Laboratory, Dipartimento di Ingegneria, Via G. Duranti 93, Perugia (Italy); Sisani, Luciano [TSA spa, Via Case Sparse 107, Magione (Italy); Damiano, Roberto [GESENU spa, Via della Molinella 7, Perugia (Italy)


    Highlights: • LCA analysis of two option for residual waste management. • Exploitation of mechanical physical sorting facility for extracting recyclable from RMSW. • Processing the mechanically sorted organic fraction in bioreactor landfill. • Sensitivity analysis demonstrate high influence for impact assessment of substitution ratio for recycle materials. - Abstract: Starting from an existing waste management district without thermal treatment facilities, two different management scenarios for residual waste were compared by life cycle assessment (LCA). The adoption of a bioreactor landfill for managing the mechanically sorted organic fraction instead of bio-stabilization led to reduction of global warming and fresh water eutrophication by 50% and 10%, respectively. Extraction of recyclables from residual waste led to avoided emissions for particulate matter, acidification and resource depletion impact categories. Marginal energy and the amount of energy recovered from landfill gas marginally affected the LCA results. On the contrary the quality of the recyclables extracted can significantly modify the eco profile of the management schemes.

  2. Slaughterhouse wastewater characteristics, treatment, and management in the meat processing industry: A review on trends and advances. (United States)

    Bustillo-Lecompte, Ciro Fernando; Mehrvar, Mehrab


    A thorough review of advancement in slaughterhouse wastewater (SWW) characteristics, treatment, and management in the meat processing industry is presented. This study also provides a general review of the environmental impacts, health effects, and regulatory frameworks relevant to the SWW management. A significant progress in high-rate anaerobic treatment, nutrient removal, advanced oxidation processes (AOPs), and the combination of biological treatment and AOPs for SWW treatment is highlighted. The treatment processes are described and few examples of their applications are given. Conversely, few advances are accounted in terms of waste minimization and water use reduction, reuse, and recycle in slaughterhouses, which may offer new alternatives for cost-effective waste management. An overview of the most frequently applied technologies and combined processes for organic and nutrient removal during the last decade is also summarized. Several types of individual and combined processes have been used for the SWW treatment. Nevertheless, the selection of a particular technology depends on the characteristics of the wastewater, the available technology, and the compliance with regulations. This review facilitates a better understanding of current difficulties that can be found during production and management of the SWW, including treatment and characteristics of the final effluent. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Ambulatory Blood Pressure Monitoring for the Effective Management of Antihypertensive Drug Treatment. (United States)

    O'Brien, Eoin; Dolan, Eamon


    This purpose of this article is to review the current recommendations for ambulatory blood pressure measurement (ABPM) and the use of ABPM in assessing treatment. We review current international guidelines and undertake a critical review of evidence supporting the clinical use of ABPM in effectively managing antihypertensive drug treatment. Current guidelines emphasize the diagnostic superiority of ABPM, mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of white-coat hypertension and by demonstrating the presence of masked hypertension. ABPM also offers diagnostic insights into nocturnal patterns of blood pressure, such as dipping and nondipping, reverse dipping, and excessive dipping, and the presence of nocturnal hypertension; although less attention is given to the nocturnal behavior of blood pressure in clinical practice, the nocturnal patterns of blood pressure have particular relevance in assessing the response to blood pressure-lowering medication. Surprisingly, although the current guidelines give detailed recommendations on the diagnostic potential and use of ABPM, there are scant recommendations on the benefits and application of the technique for the initiation of blood pressure-lowering therapy in clinical practice and virtually no recommendations on how it might be used to assess the efficacy of drug treatment. In view of a deficiency in the literature on the role of ABPM in assess the efficacy of drug treatment, we put forward proposals to correct this deficiency and guide the prescribing physician on the most appropriate drug administration and dosage over time. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

  4. Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy. (United States)

    Becker, Sara J; Kelly, Lourah M; Kang, Augustine W; Escobar, Katherine I; Squires, Daniel D


    Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, M age = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation

  5. Migration check tool: automatic plan verification following treatment management systems upgrade and database migration. (United States)

    Hadley, Scott W; White, Dale; Chen, Xiaoping; Moran, Jean M; Keranen, Wayne M


    Software upgrades of the treatment management system (TMS) sometimes require that all data be migrated from one version of the database to another. It is necessary to verify that the data are correctly migrated to assure patient safety. It is impossible to verify by hand the thousands of parameters that go into each patient's radiation therapy treatment plan. Repeating pretreatment QA is costly, time-consuming, and may be inadequate in detecting errors that are introduced during the migration. In this work we investigate the use of an automatic Plan Comparison Tool to verify that plan data have been correctly migrated to a new version of a TMS database from an older version. We developed software to query and compare treatment plans between different versions of the TMS. The same plan in the two TMS systems are translated into an XML schema. A plan comparison module takes the two XML schemas as input and reports any differences in parameters between the two versions of the same plan by applying a schema mapping. A console application is used to query the database to obtain a list of active or in-preparation plans to be tested. It then runs in batch mode to compare all the plans, and a report of success or failure of the comparison is saved for review. This software tool was used as part of software upgrade and database migration from Varian's Aria 8.9 to Aria 11 TMS. Parameters were compared for 358 treatment plans in 89 minutes. This direct comparison of all plan parameters in the migrated TMS against the previous TMS surpasses current QA methods that relied on repeating pretreatment QA measurements or labor-intensive and fallible hand comparisons.


    Directory of Open Access Journals (Sweden)

    V. N. Shtepa


    Full Text Available A critical analysis of the shortcomings of the existing water purification systems is conducted. In order to ensure environmental safety and energy savings it is proposed to use the combined units, including physical, chemical, physical-and-chemical and biological methods. The attention is driven to the fact that the most effective way to maintain current water purification is an adaptive control system. The shortcomings of the management of water treatment units were revealed and it was proposed to produce their synthesis based on the mathematical apparatus of artificial intelligence systems. Taking into account the requirements of the environmental safety and the need in the energy savings, the energy efficiency criteria of combined system functioning has been developed. At an industrial plant (slaughterhouse wastewater treatment the compliance of the production conditions of the criterion has been undertaken that confirmed the criterion relevance and usefulness as applied to the synthesis of energy-efficient control systems. A synthetic control system combined the water treatment plants. Having based on the preliminary research and analysis of the current work in the subject area the architecture of a control system of combined water treatment units that use intelligent technology was developed. The key functional of the unit – information-analytical subsystem of the formation control actions including: multilayer perceptrons self-organization Kohonen network, fuzzy cognitive map. The basic difference between the developed design and its analogues is the ability to adjust the settings of equipment adaptively on the basis of processing sensor data, information on the price of consumables, volley discharges of pollutants, a sudden change in the flow and other force majeure. Adjustment of the parameters of the control system is carried out with the use of experimental and analytical data stored in the knowledge base of technological

  7. Management of Work–Related Injuries Leading to Amputation and Its Relation with Treatment Outcome

    Directory of Open Access Journals (Sweden)

    Iravan Masoudi-Asl


    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal" mso-tstyle-rowband-size:0 mso-tstyle-colband-size:0 mso-style-noshow:yes mso-style-priority:99 mso-style-parent:"" mso-padding-alt:0mm 5.4pt 0mm 5.4pt mso-para-margin-top:0mm mso-para-margin-right:0mm mso-para-margin-bottom:10.0pt mso-para-margin-left:0mm line-height:115% mso-pagination:widow-orphan font-size:11.0pt font-family:"Calibri","sans-serif" mso-ascii-font-family:Calibri mso-ascii-theme-font:minor-latin mso-hansi-font-family:Calibri mso-hansi-theme-font:minor-latin mso-bidi-font-family:Arial mso-bidi-theme-font:minor-bidi}   Objective: Work related accidents are considered as a significant health problem of working population. The goal of this study was to determine relation of treatment management with treatment outcome of Work-Related injuries leading to amputation.   Materials & Methods: current study was based on correlation method which was evidence based and was based on actual data of medical records of occupational accidents leading to amputations. Study population included all injuries that suffered limb amputation due to work and were referred to Laleh hospital during 2005 to 2009 (N=135. The data were collected by check list and analyzed by descriptive and inferential Statistics.   Results: Taking care method had a considerable effect on success of replant operation of that limb (P<0.001 so that in 95.23% of injuries whom principles of primary care had been done for them during transportation of amputated limb to hospital, had a successful operation. Treatment results of injuries in large limbs have had a strong relation to interval of incident occurrence to start of operation (P=0.038 How to refer injuries to hospital has not had a meaningful impact on treatment outcome (P=0.469 although referring injuries from health centers of workplace directly to hospital had more successful result comparing to

  8. [Consequences of a Failed Project: Introduction and Management of a Hospitalization-Substituting Treatment Model]. (United States)

    Peters, Uwe


    This article is a report on a psychiatric project introducing services that substitute in-patient treatment and a new control and management system. The implementation of the project was a failure. Nevertheless, the project has made a contribution to further development of community-based psychiatry. Design, organization and course of the project are described and analyzed from the point of view of the communal actors involved. Effects going beyond the time course of the project have been taken into consideration. The results show that the contracting authority, project developer and local actors involved had differing ideas on the weight attached to different parts of the project as well as on the project goal and resources for carrying out the project. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Risk-adapted treatment and follow-up management in childhood-onset craniopharyngioma. (United States)

    Müller, Hermann L


    Craniopharyngiomas are rare embryonic malformations of the sellar/parasellar region with low histological grade. Here, we review findings on the diagnosis, treatment, clinical course, follow-up, and prognosis of craniopharyngioma patients. Clinical manifestations develop from increased intracranial pressure, anterior visual pathway damage, and hypothalamic/pituitary deficiencies. If the tumor is favorably localized (no anatomical involvement with the hypothalamic and optical structures) therapy of choice is complete resection, meticulously performed to preserve hypothalamic and optic functions. In patients with unfavorable tumor involvement, optimal therapy is limited hypothalamus-sparing surgical strategy, followed by judicious irradiation dosage to minimize recurrences and progression. Surgical lesions and/or anatomical involvement of posterior hypothalamic areas result in serious sequelae, mainly hypothalamic syndrome. Craniopharyngioma is a chronic disease and must be managed as such, providing ongoing care of pediatric and adult patients by experienced multidisciplinary teams in the context of multicenter trials.

  10. Pharmacological management of binge eating disorder: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    McElroy SL


    Full Text Available Susan L McElroy, Anna I Guerdjikova, Nicole Mori, Anne M O'MeliaLindner Center of HOPE, Mason, and Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USAAbstract: Growing evidence suggests that pharmacotherapy may be beneficial for some patients with binge eating disorder (BED, an eating disorder characterized by repetitive episodes of uncontrollable consumption of abnormally large amounts of food without inappropriate weight loss behaviors. In this paper, we provide a brief overview of BED and review the rationales and data supporting the effectiveness of specific medications or medication classes in treating patients with BED. We conclude by summarizing these data, discussing the role of pharmacotherapy in the BED treatment armamentarium, and suggesting future areas for research.Keywords: binge eating disorder, pharmacotherapy, medication management

  11. Immune Checkpoint Inhibitors: An Innovation in Immunotherapy for the Treatment and Management of Patients with Cancer. (United States)

    Dine, Jennifer; Gordon, RuthAnn; Shames, Yelena; Kasler, Mary Kate; Barton-Burke, Margaret


    Cancer survival rates are generally increasing in the United States. These trends have been partially attributed to improvement in therapeutic strategies. Cancer immunotherapy is an example of one of the newer strategies used to fight cancer, which primes or activates the immune system to produce antitumor effects. The first half of this review paper concisely describes the cell mechanisms that control antitumor immunity and the major immunotherapeutic strategies developed to target these mechanisms. The second half of the review discusses in greater depth immune checkpoint inhibitors that have recently demonstrated tremendous promise for the treatment of diverse solid tumor types, including melanoma, non-small cell lung cancer, and others. More specifically, the mechanisms of action, side effects, and patient and family management and education concerns are discussed to provide oncology nurses up-to-date information relevant to caring for cancer-affected patients treated with immune checkpoint inhibitors. Future directions for cancer immunotherapy are considered.

  12. An Integrated Water Treatment Technology Solution for Sustainable Water Resource Management in the Marcellus Shale

    Energy Technology Data Exchange (ETDEWEB)

    Matthew Bruff; Ned Godshall; Karen Evans


    This Final Scientific/ Technical Report submitted with respect to Project DE-FE0000833 titled 'An Integrated Water Treatment Technology Solution for Sustainable Water Resource Management in the Marcellus Shale' in support of final reporting requirements. This final report contains a compilation of previous reports with the most current data in order to produce one final complete document. The goal of this research was to provide an integrated approach aimed at addressing the increasing water resource challenges between natural gas production and other water stakeholders in shale gas basins. The objective was to demonstrate that the AltelaRain{reg_sign} technology could be successfully deployed in the Marcellus Shale Basin to treat frac flow-back water. That objective has been successfully met.

  13. Managing medical treatment waste and effluent: the point of view of a nuclear medicine practitioner

    International Nuclear Information System (INIS)

    Karcher, G.


    The nuclear medicine department of the Nancy CHU hospital is one of the largest in France: 16.000 patients are welcomed each year and 4.000 persons undergo a tomography there. 5 shielded and isolated rooms, dedicated to Iodine 131 treatment, allow the care of 150 to 200 patients each year. The head of the nuclear medicine department gives his meaning about the new regulation on the management of radioactive effluents. According to him, regulations are necessary but the values of the imposed thresholds have to be scientifically justified. Another point is that a lot of money is spent on radiation protection issues while the radioactive risks are almost null, which leads to wasting money. The elaboration of the radioprotection regulations must be made not as a whole but on a specific basis according to the domain: nuclear power plants, research reactors or nuclear medicine, it applies. (A.C.)

  14. Use of integrated dual disorder treatment via assertive community treatment versus clinical case management for persons with co-occurring disorders and antisocial personality disorder. (United States)

    Frisman, Linda K; Mueser, Kim T; Covell, Nancy H; Lin, Hsiu-Ju; Crocker, Anne; Drake, Robert E; Essock, Susan M


    We conducted secondary analyses of data from a randomized trial testing the effectiveness of Assertive Community Treatment (ACT) in delivery of integrated dual disorder treatment (IDDT) to explore the impact of IDDT delivered through ACT teams compared with standard clinical case management for dually-disordered persons with and without antisocial personality disorder (ASPD). This analysis included 36 individuals with ASPD and 88 individuals without ASPD. Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in standard clinical case management, whereas participants without ASPD did not differ between the 2 case management approaches. There were no significant differences for other substance use or criminal justice outcomes. This study provides preliminary evidence that persons with co-occurring serious mental illness, substance use disorders, and ASPD may benefit from delivery of IDDT through ACT teams.

  15. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. (United States)

    Wieckiewicz, Mieszko; Boening, Klaus; Wiland, Piotr; Shiau, Yuh-Yuan; Paradowska-Stolarz, Anna


    Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical management. A survey was performed using the PubMed, SCOPUS and CINAHL databases for documents published between 1994 and 2014. The following search keywords were selected using MeSH terms of the National Library of Medicine in combination: TMD pain, TMD, TMJ, TMJ disorders, occlusal splint, TMD physiotherapy, TMJ rheumatoid disorders and TMJ surgery. Original articles and review papers which presented the clinical relevance and practical validity regarding the possibility of application in TMD management have been included. Authors have excluded articles without outstanding practical aspect and evidence-based background. A first selection was carried out by reviewing titles and abstracts of all articles found according to the criteria. After that the full texts of potentially suitable articles were assessed. In line with these criteria, among 11467 results the writers have included 66 papers. The most commonly reported conservative treatments are massage therapy and individually fabricated occlusal splints. In addition to massage, other popular methods include manual therapy and taping, warming/cooling of aching joints, and light and laser therapy. Drugs are also commonly used. In the most severe cases of the temporomandibular joint degeneration, surgical restoration of the joint is sometimes applied. The authors concluded that conservative treatment including counselling, exercises, occlusal splint therapy, massage, manual therapy and others should be considered as a first choice therapy for TMD pain because of their low risk of side effects. In the case of severe acute pain or chronic pain resulting from serious disorders, inflammation and/or degeneration pharmacotherapy, minimally invasive and invasive procedures should be considered.

  16. Geographic information system-based healthcare waste management planning for treatment site location and optimal transportation routeing. (United States)

    Shanmugasundaram, Jothiganesh; Soulalay, Vongdeuane; Chettiyappan, Visvanathan


    In Lao People's Democratic Republic (Lao PDR), a growth of healthcare centres, and the environmental hazards and public health risks typically accompanying them, increased the need for healthcare waste (HCW) management planning. An effective planning of an HCW management system including components such as the treatment plant siting and an optimized routeing system for collection and transportation of waste is deemed important. National government offices at developing countries often lack the proper tools and methodologies because of the high costs usually associated with them. However, this study attempts to demonstrate the use of an inexpensive GIS modelling tool for healthcare waste management in the country. Two areas were designed for this study on HCW management, including: (a) locating centralized treatment plants and designing optimum travel routes for waste collection from nearby healthcare facilities; and (b) utilizing existing hospital incinerators and designing optimum routes for collecting waste from nearby healthcare facilities. Spatial analysis paved the way to understand the spatial distribution of healthcare wastes and to identify hotspots of higher waste generating locations. Optimal route models were designed for collecting and transporting HCW to treatment plants, which also highlights constraints in collecting and transporting waste for treatment and disposal. The proposed model can be used as a decision support tool for the efficient management of hospital wastes by government healthcare waste management authorities and hospitals.

  17. The practical management of bleedings during treatment with direct oral anticoagulants: the emergency reversal therapy

    Directory of Open Access Journals (Sweden)

    Luca Masotti


    Full Text Available Bleeding represents the most feared complication of the new oral anticoagulants, direct oral anticoagulants (DOACs, as well as all the antithrombotic therapies. During the acute phase of bleeding in patients taking anticoagulants, restoration of an effective hemostasis represents the cornerstone of practical management. While vitamin K antagonists are effectively and promptly reversed by specific antidotes such as prothrombin complex concentrates (PCCs, fresh frozen plasma or vitamin K, it is still not clear how to manage the urgent reversal of DOACs during life-threatening or major bleedings due to the lack of specific antidotes. However, in vitro and ex vivo studies have suggested some potential strategies to reverse DOACs in clinical practice, other than general support measures that are always recommended. Activated charcoal could be used in subjects with DOAC-related bleedings presenting to the emergency department within two hours of the last oral intake. Non-activated or activated PCCs (FEIBA and recombinant activated Factor VII (raFVII seem to be the optimal strategy for urgent reversal of dabigatran, while non-activated PCCs seem to have efficacy in reversing rivaroxaban. Due to its low plasma protein binding, dabigatran could be also dialyzed in urgent cases. Clinically relevant non-major bleedings and minor bleedings should be treated with general and local measures, respectively, and, when necessary, with dose delay or drug withdrawal. In this article, the Authors describe the practical approach to bleedings occurring during DOACs treatment.

  18. Are Improvements in Measured Performance Driven by Better Treatment or "Denominator Management"? (United States)

    Harris, Alex H S; Chen, Cheng; Rubinsky, Anna D; Hoggatt, Katherine J; Neuman, Matthew; Vanneman, Megan E


    Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it is reasonable to wonder if improvements in measured quality are driven by expanding numerators or contracting denominators. In 2003, the US Department of Veteran Affairs (VA) based executive compensation in part on performance on a substance use disorder (SUD) continuity-of-care quality measure. The first goal of this study was to evaluate if implementing the measure in this way resulted in expected improvements in measured performance. The second goal was to examine if the proportion of patients with SUD who qualified for the denominator contracted after the quality measure was implemented, and to describe the facility-level variation in and correlates of denominator contraction or expansion. Using 40 quarters of data straddling the implementation of the performance measure, an interrupted time series design was used to evaluate changes in two outcomes. All veterans with an SUD diagnosis in all VA facilities from fiscal year 2000 to 2009. The two outcomes were 1) measured performance-patients retained/patients qualified and 2) denominator prevalence-patients qualified/patients with SUD program contact. Measured performance improved over time (P management, and also the exploration of "shadow measures" to monitor and reduce undesirable denominator management.

  19. Treatments and other prognostic factors in the management of the open abdomen: A systematic review. (United States)

    Cristaudo, Adam T; Jennings, Scott B; Hitos, Kerry; Gunnarsson, Ronny; DeCosta, Alan


    The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Despite this, challenges remain with it associated with a high incidence of complications and poor outcomes. The objective of this article is to perform a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify prognostic factors in OA patients in regard to definitive fascial closure (DFC), mortality and intra-abdominal complications. An electronic database search was conducted involving Medline, Excerpta Medica, Central Register of Controlled Trials, Cumulative Index to Nursing, and Allied Health Literature and All studies that described prognostic factors in regard to the above outcomes in OA patients were eligible for inclusion. Data collected were synthesized by each outcome of interest and assessed for methodological quality. Thirty-one studies were included in the final synthesis. Enteral nutrition, organ dysfunction, local and systemic infection, number of reexplorations, worsening Injury Severity Score, and the development of a fistula appeared to significantly delay DFC. Age and Adult Physiology And Chronic Health Evaluation version II score were predictors for in-hospital mortality. Failed DFC, large bowel resection and >5 to 10 L of intravenous fluids in 5 to 10 and >10 L of intravenous fluids in management of OA patients will avoid prolonged treatment and facilitate early DFC. Future research should focus on the development of a prognostic model. Systematic review, level III.

  20. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility. (United States)

    Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G


    The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

  1. Firewater Storage, Treatment, Recycling and Management: New Perspectives Based on Experiences from the United Kingdom

    Directory of Open Access Journals (Sweden)

    Miklas Scholz


    Full Text Available Smart firewater management and recycling helps reduce water use and protect the environment from pollution. However, contamination of recycled water may pose a health risk to fire fighters. This review assesses international literature to identify best practices, and to recommend new technologies and methods on firewater management and recycling. The literature assessment indicates that this is a new research area where insufficient findings have been published in Web of Science-referenced journals. Therefore, informally published materials (a.k.a. grey literature were also assessed. Findings indicate the need for practical decision support tools to estimate consumption rates, predict “bottlenecks” and bund capacity, assess water quality and determine pump requirements. This article recommends that cost-efficient and rapid on-site treatment methods, such as compact and mobile filtration units for firewater recycling should be researched in the future. The filters should be based on compartments with different media. The empty pore space should decrease from inflow to outflow. A light plastic media should be positioned near the inflow to retain large particles, such as a grid. Activated carbon media could be placed near the outlet to remove fine suspended solids and dissolved contaminants. This should address concerns by fire fighters dealing with contaminated water, spray and foam.

  2. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility

    Energy Technology Data Exchange (ETDEWEB)

    LeBlance, R.J.; Allain, C.J.; Laughton, P.J.; Henry, J.G.


    The Greater Moncton Sewerage Commission's 115 000 m{sup 3}/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Universite de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and ''cumulative effects'' as part of the overall biosolids management strategy is also discussed. (author)

  3. The importance of self-management in the prevention and treatment of excessive weight and obesity. (United States)

    Tóthová, Valérie; Bártlová, Sylva; Šedová, Lenka; Olišarová, Věra; Prokešová, Radka; Adámkova, Věra; Mauritzová, Ilona; Trešlová, Marie; Chloubová, Ivana; Mikšová, Zdeňka


    The aim of this research into 'self-management' was to determine to what extent respondents were aware of their status as overweight or obese. For respondents who indicated that they were overweight or obese, the goal was to determine whether they tried to lose weight, what steps they took to control their, and what specific methods they used. Information was collected using semi-structured interviews from May 31, 2014, to January 30, 2015. Data processing was performed using statistical analysis of the social data SASDM 01/04/10 software. The total study group consisted of 600 respondents, including 302 from the Roma minority, and 298 from the non-Roma majority population (control group). Respondents were selected specifically from South Bohemia Region of the Czech Republic. The sample from the Roma minority was constructed using the snowball method (Snowball Sampling). The control sample of non-Roma was selected through quota sampling. The results indicate that the respondents from both the Roma minority and the non-Roma control group generally recognized when they were overweight or obese, or they were aware of it to a much lesser extent than objective indicators revealed. More than two thirds of the respondents who admitted they were overweight or obese (N = 143) reported that they had suffered from overweight or obesity since they were young adults. Significantly more members of the majority population had tried to lose weight using self-management, whereas the level of effort was significantly less among members of the Roma minority (P = 0). Nevertheless, Roma respondents significantly more often reported (P < 0.01) that they had agreed on a specific weight loss plan with a doctor. The results of our research show that in the context of prevention, it is important to promote self-managed skills, habits and other characteristics that can play an important role in the prevention and treatment of obesity and overweight.

  4. Assessing the value and pest management window provided by neonicotinoid seed treatments for management of soybean aphid (Aphis glycines Matsumura) in the Upper Midwestern United States. (United States)

    Krupke, Christian H; Alford, Adam M; Cullen, Eileen M; Hodgson, Erin W; Knodel, Janet J; McCornack, Brian; Potter, Bruce D; Spigler, Madeline I; Tilmon, Kelley; Welch, Kelton


    A 2-year, multi-state study was conducted to assess the benefits of using soybean seed treated with the neonicotinoid thiamethoxam to manage soybean aphid in the upper Midwestern USA and compare this approach with an integrated pest management (IPM) approach that included monitoring soybean aphids and treating with foliar-applied insecticide only when the economic threshold was reached. Concentrations of thiamethoxam in soybean foliage were also quantified throughout the growing season to estimate the pest management window afforded by insecticidal seed treatments. Both the IPM treatment and thiamethoxam-treated seed resulted in significant reductions in cumulative aphid days when soybean aphid populations reached threshold levels. However, only the IPM treatment resulted in significant yield increases. Analysis of soybean foliage from thiamethoxam-treated seeds indicated that tissue concentrations of thiamethoxam were statistically similar to plants grown from untreated seeds beginning at the V2 growth stage, indicating that the period of pest suppression for soybean aphid is likely to be relatively short. These data demonstrate that an IPM approach, combining scouting and foliar-applied insecticide where necessary, remains the best option for treatment of soybean aphids, both in terms of protecting the yield potential of the crop and of break-even probability for producers. Furthermore, we found that thiamethoxam concentrations in foliage are unlikely to effectively manage soybean aphids for most of the pests' activity period across the region. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  5. Sorption-reagent treatment of brines produced by reverse osmosis unit for liquid radioactive waste management

    International Nuclear Information System (INIS)

    Avramenko, V. A.; Zheleznov, V. V.; Sergienko, V. I.; Chizhevsky, I. Yu


    The results of the pilot plant tests (2002-2003) of the sorption-reagent decontamination of high salinity radioactive waste (brines) remaining after the low-salinity liquid radioactive waste (LRW) treatment in the reverse-osmosis unit from long-lived radionuclides are presented. The sorption-reagent materials used in this work were developed in the Institute of Chemistry FEDRAS. They enable one to decontaminate brines with total salt content up to 50 g/l from long-lived radionuclides of Cs, Sr and Co. At joint application of the reverse-osmosis and sorption-reagent technologies total volume of solid radioactive waste (SRW) decreases up to 100-fold as compared to the technology of cementation of reverse osmosis brines. In this case total cost of LRW treatment and SRW disposal decreases more than 10-fold. Brines decontaminated from radionuclides are then diluted down to the ecologically safe total salts content in water to be disposed of. Tests were performed to compare the efficiency of technologies including evaporation of brines remaining after reverse osmosis process and their decontamination by means of the sorption-reagent method. It was shown that, as compared to evaporation, the sorption-reagent technology provides substantial advantages as in regard to radioactive waste total volume reduction as in view of total cost of the waste management

  6. An overview of municipal solid waste management and landfill leachate treatment: Malaysia and Asian perspectives. (United States)

    Kamaruddin, Mohamad Anuar; Yusoff, Mohd Suffian; Rui, Lo Ming; Isa, Awatif Md; Zawawi, Mohd Hafiz; Alrozi, Rasyidah


    Currently, generation of solid waste per capita in Malaysia is about 1.1 kg/day. Over 26,500 t of solid waste is disposed almost solely through 166 operating landfills in the country every day. Despite the availability of other disposal methods, landfill is the most widely accepted and prevalent method for municipal solid waste (MSW) disposal in developing countries, including Malaysia. This is mainly ascribed to its inherent forte in terms cost saving and simpler operational mechanism. However, there is a downside. Environmental pollution caused by the landfill leachate has been one of the typical dilemmas of landfilling method. Leachate is the liquid produced when water percolates through solid waste and contains dissolved or suspended materials from various disposed materials and biodecomposition processes. It is often a high-strength wastewater with extreme pH, chemical oxygen demand (COD), biochemical oxygen demand (BOD), inorganic salts and toxicity. Its composition differs over the time and space within a particular landfill, influenced by a broad spectrum of factors, namely waste composition, landfilling practice (solid waste contouring and compacting), local climatic conditions, landfill's physico-chemical conditions, biogeochemistry and landfill age. This paper summarises an overview of landfill operation and leachate treatment availability reported in literature: a broad spectrum of landfill management opportunity, leachate parameter discussions and the way forward of landfill leachate treatment applicability.

  7. Topical patches as treatments for the management of patient musculoskeletal and neuropathic pain

    Directory of Open Access Journals (Sweden)

    Simona Mirel


    Full Text Available The variety and multiple dimensions of pain (acute/chronic, mild/moderate/severe, nociceptive/neuropathic requires different pharmacologic and non-pharmacologic treatments in certain patients. A lot of topical formulation, from various therapeutic classes have been proposed in order to decrease systemic exposure and to reduce the risks of adverse events. Topical as well as transdermal drug delivery systems are proposed as medicated plasters with: anesthetics (lidocaine, analgesic or nonsteroidal anti-inflamatory drugs (NSAIDs, alone or co-formulated. Capsaicin, salicylates, menthol and camphor represent the counterirritant class of topical analgesics used as patch active compounds. These compounds produce their analgesic effect by activating and desensitizing epidermal nociceptors. The most used topical treatment in order to decrease pain is the application of cold and heat patches - by acting directly on the affected tissue. In many cases there is a limited number of studies providing insufficient information to clinicians in order to evaluate the benefits of these products. This paper reviews the use and efficacy of available self-adhesing occlusive medicated plaster (pain patches that might represent an alternative option for the management of patient pain, specially in the case of musculoskeletal and neuropathic disorders.

  8. MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. (United States)

    Liamis, G; Filippatos, T D; Liontos, A; Elisaf, M S


    Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly. © 2017 European Society of Endocrinology.

  9. Assessment of impacts from different waste treatment and waste disposal technologies: Regional Management Plan

    International Nuclear Information System (INIS)

    Robertson, B.C.; Sutherland, A.A.


    This report presents assessments of treatment and disposal technologies that appear to be appropriate for use in regional facilities in the Midwest Compact Region. The treatment technologies assessed: compaction with a supercompactor; incineration; and incineration followed by solidfication of the incinerator ash. The disposal technologies assessed are: shallow land burial, considered a baseline for comparison of other technologies; below-ground vaults; abov-groudn vaults; the earth mounded concrete bunker, a technology developed in France; improved shallow land burial, essentially deeper burial; modular concrete canister disposal; mined cavities (both new and existing); and unlined augered holes; and lined augered holes. The teatment technologies are assessed primarily in terms of the their impact on the waste management system, and generally not comparatively. The dispoal technologies are assessed relative to the present standard practice shallow land burial; shallow land burial was slected as a frame of reference because it has an experience base spanning several decades, not because of any preferential characteristics. 20 refs., 5 tabs

  10. HPV-Based Screening, Triage, Treatment, and Followup Strategies in the Management of Cervical Intraepithelial Neoplasia

    Directory of Open Access Journals (Sweden)

    Oscar Peralta-Zaragoza


    Full Text Available Cervical cancer is the second most common cause of death from cancer in women worldwide, and the development of new diagnostic, prognostic, and treatment strategies merits special attention. Many efforts have been made to design new drugs and develop immunotherapy and gene therapy strategies to treat cervical cancer. HPV genotyping has potentially valuable applications in triage of low-grade abnormal cervical cytology, assessment of prognosis and followup of cervical intraepithelial neoplasia, and in treatment strategies for invasive cervical cancer. It is known that during the development of cervical cancer associated with HPV infection, a cascade of abnormal events is induced, including disruption of cellular cycle control, alteration of gene expression, and deregulation of microRNA expression. Thus, the identification and subsequent functional evaluation of host proteins associated with HPV E6 and E7 oncoproteins may provide useful information in understanding cervical carcinogenesis, identifying cervical cancer molecular markers, and developing specific targeting strategies against tumor cells. Therefore, in this paper, we discuss the main diagnostic methods, management strategies, and followup of HPV-associated cervical lesions and review clinical trials applying gene therapy strategies against the development of cervical cancer.

  11. Treatment options and patient perspectives in the management of fibromyalgia: future trends

    Directory of Open Access Journals (Sweden)

    Kim Lawson


    Full Text Available Kim LawsonBiomedical Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield, UKAbstract: Fibromyalgia (FM is a common, complex, and difficult to treat chronic widespread pain disorder, which usually requires a multidisciplinary approach using both pharmacological and non-pharmacological (education and exercise interventions. It is a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms including pain, sleep dysfunction, and fatigue, where the pathophysiology could include dysfunction of the central nervous system pain modulatory systems, dysfunction of the neuroendocrine system, and dysautonomia. A cyclic model of the pathophysiological processes is compatible with the interrelationship of primary symptoms and the array of postulated triggers associated with FM. Many of the molecular targets of current and emerging drugs used to treat FM have been focused to the management of discrete symptoms rather than the condition. Recently, drugs (eg, pregabalin, duloxetine, milnacipran, sodium oxybate have been identified that demonstrate a multidimensional efficacy in this condition. Although the complexity of FM suggests that monotherapy, non-pharmacological or pharmacological, will not adequately address the condition, the outcomes from recent clinical trials are providing important clues for treatment guidelines, improved diagnosis, and condition-focused therapies.Keywords: fibromyalgia, pain, sleep dysfunction, fatigue, exercise, pharmacological treatments

  12. Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management. (United States)

    Ikpeze, Tochukwu C; Mesfin, Addisu


    Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

  13. Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies. (United States)

    Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon


    An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level.

  14. Radiological assessment and management of radioactive spill in a liquid waste treatment facility - Case study

    International Nuclear Information System (INIS)

    Amer, H.A.; Shawky, S.; Ibrahiem, N.


    The radiological assessment and management of radioactive spill from liquid waste treatment facility is presented. The incident contaminated the area surrounding the treatment facility with various radionuclides, which were dispersed into the soil. A method based on the European basic safety standards was used to contain the risks associated with the contaminated site. The introduced case study proceeded up to the stage of simplified risk study, since the site is small and it was relatively easy to remove and store the contaminated soil. According to the obtained results, the removal of the upper 30-cm would be considered as appropriate remedying action to resume background level. One of the most important basic concepts of radiation protection in nuclear facilities is the continuity of monitoring radiological release to the environment. It is known that from nuclear facilities only very small amounts of radioactivity are discharged with the liquid effluents and the exhaust air into the environment. Recent studies screening the natural and artificial radionuclide in soil samples from the investigated area revealed normal background concentrations with no anomalies

  15. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols

    Directory of Open Access Journals (Sweden)

    Stacey Dawn


    Full Text Available Abstract Background Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©. Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. Methods A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a establishing an advisory knowledge user team in each of three targeted settings; (b assessing factors influencing nurses’ use of protocols using interviews/focus groups and a standardized survey instrument; (c adapting protocols for local use, ensuring fidelity of the content; (d selecting intervention strategies to overcome known barriers and implementing the protocols; (e conducting think-aloud usability testing; (f evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g assessing satisfaction with remote support using symptom protocols and change in nurses’ barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing

  16. Psoriasis treatment and management - a systematic review of full economic evaluations. (United States)

    Hamilton, M P; Ntais, D; Griffiths, C E M; Davies, L M


    Psoriasis frequently requires lifetime control and current therapies vary significantly in price. High-quality economic evaluations are necessary to determine if higher-cost treatments are value for money. This review aims to identify the cost-effectiveness of psoriasis care (whether more expensive interventions are associated with savings in health care and psoriasis management and/or improve patients' health); assess the level of uncertainty and transferability of this evidence to policy and practice; and, identify future research needs. Searches of electronic databases Embase, MEDLINE and NHS EED for full economic evaluations were conducted in January 2012 (updated April 2014). Included articles were screened, selected and critically appraised using predefined inclusion criteria and data extraction forms: 1355 articles were identified; 37 papers reporting 71 comparisons met the inclusion criteria. Treatments evaluated were systemic (n = 45), topical (n = 22), phototherapies (n = 14) and combination (n = 4). Despite a significant number of recent economic evaluations, the cost-effectiveness of all therapies remains unclear. This uncertainty arises from a diversity in settings, perspective and design. Economic evaluations were constrained by limited availability of high-quality short- and long-term head-to-head comparisons of the effectiveness, safety and adherence of different interventions. The economic evidence is dominated by comparisons of interventions to placebo, with implicit comparisons of different therapies. There is a lack of evaluations of service model innovations to deliver complex packages of care for psoriasis. Primary and secondary integrated clinical and economic research is needed to address the limitations and to identify patient preferences and barriers/facilitators to treatment. © 2014 British Association of Dermatologists.

  17. Recent advances in the treatment and management of excessive daytime sleepiness. (United States)

    Black, Jed; Duntley, Stephen P; Bogan, Richard K; O'Malley, Mary B


    Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric care. Patients with conditions of EDS have often been misdiagnosed with depression due to their complaints of lack of energy, poor concentration, memory disturbance, and a reduced interest in life. Impaired alertness associated with EDS can be detrimental to a person's quality of life by causing decreased work performance, self-consciousness, low self esteem, and social isolation. Excessive sleepiness is also associated with various health problems, comorbid medical and psychiatric conditions, and fatal accidents occurring after the driver has fallen asleep at the wheel. Contributing factors leading to EDS range from insufficient sleep hours to central nervous system-mediated debilitating hypersomnolence. Circadian rhythm disorders, sleep disorders such as obstructive sleep apnea and narcolepsy, and medications that cause sleepiness may also contribute to symptoms of EDS. Recognition of the symptoms of sleep deprivation is essential, as many such patients do not have a clear awareness of their own sleepiness. Treatment options, depending upon the condition, include light therapy or appropriate airway management techniques such as nasal continuous positive airway pressure (CPAP). Occasionally, wakefulness-promoting medications are necessary, particularly in patients with narcolepsy. In this expert roundtable supplement, Stephen P. Duntley, MD, reviews the definition and prevalence of EDS and discusses the contributing factors and consequences of daytime sleepiness. Next, Richard K. Bogan, MD, FCCP, gives an overview of the differential diagnosis of EDS and the assessment tools available for identifying sleepiness in symptomatic patients. Finally, Mary B. O'Malley, MD, PhD, reviews treatment of EDS, including counseling on sleep hygiene and duration of sleep, mechanical treatments, bright-light therapy, and wake-promoting medications.

  18. Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges

    Directory of Open Access Journals (Sweden)

    Brandie D Taylor


    Full Text Available Brandie D Taylor, Catherine L HaggertyUniversity of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USAAbstract: Chlamydia trachomatis is a prevalent sexually transmitted infection that can lead to serious reproductive morbidity. Management and control of C. trachomatis is a challenge, largely due to its asymptomatic nature and our incomplete understanding of its natural history. Although chlamydia screening programs have been implemented worldwide, several countries have observed increasing rates of reported chlamydia cases. We reviewed the literature relating to the long-term complications of C. trachomatis, as well as screening strategies, treatment, and prevention strategies for reducing chlamydia in the population. Articles from 1950–2010 were identified through a Medline search using the keyword “Chlamydia trachomatis” combined with “screening”, “pelvic inflammatory disease”, “endometritis”, “salpingitis”, “infertility”, "ectopic pregnancy”, “urethritis”, “epididymitis”, “proctitis”, “prostatitis”, “reinfection”, “cost-effectiveness”, “treatment”, “vaccines”, or “prevention”. Progression of C. trachomatis varies, and recurrent infections are common. Currently, there is limited evidence on the effectiveness of chlamydia screening. Higher quality studies are needed to determine the efficacy of more frequent screening, on a broader range of sequelae, including infertility and ectopic pregnancy, in addition to pelvic inflammatory disease. Studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures. Furthermore, alternatives to screening, such as vaccines, should continue to be explored.Keywords: Chlamydia trachomatis, sexually transmitted disease, chlamydia screening, chlamydia treatment

  19. Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy. (United States)

    Fanelli, Andrea; Ruggeri, Matteo; Basile, Michele; Cicchetti, Americo; Coluzzi, Flaminia; Della Rocca, Giorgio; Di Marco, Pierangelo; Esposito, Clelia; Fanelli, Guido; Grossi, Paolo; Leykin, Yigal; Lorini, Ferdinando Luca; Paolicchi, Adriana; Scardino, Marco; Corcione, Antonio


    The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re

  20. Illness perception, treatment beliefs, self-esteem, and self-efficacy as correlates of self-management in multiple sclerosis. (United States)

    Wilski, M; Tasiemski, T


    Self-management of a disease is considered one of the most important factors affecting the treatment outcome. The research on the correlates of self-management in multiple sclerosis (MS) is limited. The aim of this study was to determine if personal factors, such as illness perception, treatment beliefs, self-esteem and self-efficacy, are correlates of self-management in MS. This cross-sectional study included 210 patients with MS who completed Multiple Sclerosis Self-Management Scale - Revised, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Rosenberg Self-Esteem Scale, and Generalized Self-Efficacy Scale. The patients were recruited from a MS rehabilitation clinic. Demographic data and illness-related problems of the study participants were collected with a self-report survey. Correlation and regression analyses were performed to determine associations between variables. Four factors: age at the time of the study (β = 0.14, P = 0.032), timeline (β = 0.16, P = 0.018), treatment control (β = 0.17, P = 0.022), and general self-efficacy (β = 0.19, P = 0.014) turned out to be the significant correlates of self-management in MS. The model including these variables explained 25% of variance in self-management in MS. Personal factors, such as general self-efficacy, perception of treatment control and realistic MS timeline perspective, are more salient correlates of self-management in MS than the objective clinical variables, such as the severity, type, and duration of MS. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: a qualitative study


    Beune, E.J.A.J.; Haafkens, J.A.; Agyemang, C.; Schuster, J.S.; Willems, D.L.


    OBJECTIVES: To explore and compare how Ghanaian, African-Surinamese (Surinamese), and White-Dutch patients perceive and manage antihypertensive drug treatment in Amsterdam, the Netherlands. METHODS: Qualitative study was conducted using detailed interviews with a purposive sample of 46 hypertensive patients without comorbidity who were prescribed antihypertensives. RESULTS: Patients in all the ethnic groups actively decided how to manage their prescribed antihypertensive regimens. In all the ...

  2. Repeated application of fuel reduction treatments in the southern Appalachian Mountains, USA: implications for achieving management goals (United States)

    Thomas A. Waldrop; Donald L. Hagan; Dean M. Simon


    Fire and resource managers of the southern Appalachian Mountains, USA, have many questions about the use of prescribed fire and mechanical treatments to meet various land management objectives. Three common objectives include restoration to an open woodland, oak regeneration, and fuel reduction. This paper provides information about reaching each of these three...

  3. Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries. (United States)

    Lamb, S E; Williams, M A; Williamson, E M; Gates, S; Withers, E J; Mt-Isa, S; Ashby, D; Castelnuovo, E; Underwood, M; Cooke, M W


    To examine the clinical effectiveness of a stepped care approach over a 12-month period after an acute whiplash injury; to estimate the costs and cost-effectiveness of each strategy including treatments and subsequent health-care costs; and to gain participants' perspective on experiencing whiplash injury, NHS treatment, and recovery within the context of the Managing Injuries of the Neck Trial (MINT). Two linked, pragmatic, randomised controlled trials. In Step 1, emergency departments (EDs) were cluster randomised to usual care advice (UCA) or The Whiplash Book advice (WBA)/active management advice. In Step 2, participants were individually randomised to either a single session of advice from a physiotherapist or a physiotherapy package of up to six sessions. An economic evaluation and qualitative study were run in parallel with the trial. Twelve NHS trusts in England comprising 15 EDs. People who attended EDs with an acute whiplash injury of whiplash-associated disorder grades I-III were eligible for Step 1. People who had attended EDs with whiplash injuries and had persistent symptoms 3 weeks after ED attendance were eligible for Step 2. In Step 1, the control intervention was UCA and the experimental intervention was a psycho-educational intervention (WBA/active management advice). In Step 2 the control treatment was reinforcement of the advice provided in Step 1 and the experimental intervention was a package of up to six physiotherapy treatments. The primary outcome was the Neck Disability Index (NDI), which measures severity and frequency of pain and symptoms, and a range of activities including self-care, driving, reading, sleeping and recreation. Secondary outcomes included the mental and physical health-related quality-of-life (HRQoL) subscales of the Short Form questionnaire-12 items (SF-12) and the number of work days lost. A total of 3851 patients were recruited to Step 1 of the trial. 1598 patients attending EDs were randomised to UCA, and 2253 were

  4. Training opioid addiction treatment providers to adopt contingency management</