Advancing the framework for considering the effects of climate change on worker safety and health

In 2009, a preliminary framework for how climate change could affect worker safety and health was described. That framework was based on a literature search from 1988-2008 that supported seven categories of climate-related occupational hazards: (1) increased ambient temperature; (2) air pollution; (3) ultraviolet radiation exposure; (4) extreme weather; (5) vector-borne diseases and expanded habitats; (6) industrial transitions and emerging industries; and (7) changes in the built environment. This article reviews the published literature from 2008-2014 in each of the seven categories. Additionally, three new topics related to occupational safety and health are considered: mental health effects, economic burden, and potential worker safety and health impacts associated with the nascent field of climate intervention (geoengineering). Beyond updating the literature, this article also identifies key priorities for action to better characterize and understand how occupational safety and health may be associated with climate change events and ensure that worker health and safety issues are anticipated, recognized, evaluated, and mitigated. These key priorities include research, surveillance, risk assessment, risk management, and policy development. Strong evidence indicates that climate change will continue to present occupational safety and health hazards, and this framework may be a useful tool for preventing adverse effects to workers.

Socio-demographic study on extent of knowledge, awareness, attitude, and risks of zoonotic diseases among livestock owners in Puducherry region

AIM

This study was conducted to assess the extent of knowledge, awareness, attitude, and risks of zoonotic diseases among livestock owners in Puducherry region.

MATERIALS AND METHODS

A total of 250 livestock farmers were selected randomly from eight revenue villages. And each farmer was interviewed with a questionnaire containing both open- and close-ended questions on various aspects of zoonotic diseases, a total of 49 questionnaires were framed to assess the source and transmission of infection to the farmers and to test their knowledge and awareness about zoonotic diseases. The data collected were analyzed by chi-square test using software Graph pad prism, and results were used to assess the relationship between education level and zoonotic disease awareness; risk of zoonotic diseases and its relation with independent variables.

RESULTS

The present survey analysis represents that most of the respondents are belonging to the age group of 41-60 years. About 42.8% of respondents' household having a graduate. The most of the respondent are small-scale farmers and their monthly income was less than Rs. 10,000. About 61.2% of farmers were keeping their animal shed clean. About 29.6% of the respondents were ignorant about cleaning the dog bitten wound. Only 16.4% of respondents knew that diseases in animals can be transmitted to humans. Only 4.8%, 3.6%, 6.8%, and 22.4% of respondents knew about the zoonotic potential of diseases such as brucellosis, tuberculosis (TB), anthrax, and avian flu, respectively. Only 18% of the respondents were aware about zoonotic diseases from cattle. Regarding the list of zoonotic diseases contracted, 37.7% reported respiratory infection, 31.1% digestive disturbances, 15.5% had dermatological problem, and 15.5% reported indiscrete disease such as fever, body pain, and headache joint pain. From the respondent got the zoonotic disease (n=45), 51.2% of the respondent reported chronic infection and 48.8% of the respondent reported acute form of zoonotic infection. About 30% of the respondents' farm had an incidence of abortion. Our analyses showed that there was significant in educational level of respondents and treatment of dog bitten animals. Furthermore, there was statistical significance in occurrence of hand and foot lesions in the respondent and occurrence of foot-and-mouth disease outbreak in their animals.

CONCLUSION

From this study, it is concluded that involvement of educated family members in farming practices can create awareness and improve knowledge toward zoonotic disease. Further creation of awareness toward zoonotic diseases is of utmost important.

The frequency of snowline-region planets from four-years of OGLE-MOA-Wise second-generation microlensing

We present a statistical analysis of the first four seasons from a "second-generation" microlensing survey for extrasolar planets, consisting of near-continuous time coverage of 8 deg² of the Galactic bulge by the OGLE, MOA, and Wise microlensing surveys. During this period, 224 microlensing events were observed by all three groups. Over 12% of the events showed a deviation from single-lens microlensing, and for ~1/3 of those the anomaly is likely caused by a planetary companion. For each of the 224 events we have performed numerical ray-tracing simulations to calculate the detection efficiency of possible companions as a function of companion-to-host mass ratio and separation. Accounting for the detection efficiency, we find that 55 - 22 + 34 % of microlensed stars host a snowline planet. Moreover, we find that Neptunes-mass planets are ~ 10 times more common than Jupiter-mass planets. The companion-to-host mass ratio distribution shows a deficit at q ~ 10^-2, separating the distribution into two companion populations, analogous to the stellar-companion and planet populations, seen in radial-velocity surveys around solar-like stars. Our survey, however, which probes mainly lower-mass stars, suggests a minimum in the distribution in the super-Jupiter mass range, and a relatively high occurrence of brown-dwarf companions.

Superoxide Dismutase 1 Protects Hepatocytes from Type I Interferon-Driven Oxidative Damage

Tissue damage caused by viral hepatitis is a major cause of morbidity and mortality worldwide. Using a mouse model of viral hepatitis, we identified virus-induced early transcriptional changes in the redox pathways in the liver, including downregulation of superoxide dismutase 1 (Sod1). Sod1(-/-) mice exhibited increased inflammation and aggravated liver damage upon viral infection, which was independent of T and NK cells and could be ameliorated by antioxidant treatment. Type I interferon (IFN-I) led to a downregulation of Sod1 and caused oxidative liver damage in Sod1(-/-) and wild-type mice. Genetic and pharmacological ablation of the IFN-I signaling pathway protected against virus-induced liver damage. These results delineate IFN-I mediated oxidative stress as a key mediator of virus-induced liver damage and describe a mechanism of innate-immunity-driven pathology, linking IFN-I signaling with antioxidant host defense and infection-associated tissue damage. VIDEO ABSTRACT.

Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus

OBJECTIVES

To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS.

METHODS

Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively.

RESULTS

The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade.

CONCLUSIONS

The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.

Localized Castleman’s Disease in Retroperitoneum Mimicking Broad Ligament Leiomyoma – a Diagnostic Challenge

Primary retroperitoneal tumours pose a diagnostic dilemma and therapeutic challenges because of their location and late detection. Localized Castleman Disease (CD) in retroperitoneal location is a rare occurrence, with incidence of only 4% cases occurring in diverse locations like retroperitoneum. A rare case of unicentric localized Castleman Disease localized in broad ligament is hereby reported which was clinically & radiologically suspected as broad ligament leiomyoma but finally diagnosed as Castleman’s Disease, hyaline vascular type in a young female posing a diagnostic challenge both for the pathologist and clinician. Definite diagnosis is essential as complete surgical excision in case of unicentric Castleman’s Disease has good prognosis after resection.   

In situ surface/interface x-ray diffractometer for oxide molecular beam epitaxy

In situ studies of oxide molecular beam epitaxy by synchrotron x-ray scattering has been made possible by upgrading an existing UHV/molecular beam epitaxy (MBE) six-circle diffractometer system. For oxide MBE growth, pure ozone delivery to the chamber has been made available, and several new deposition sources have been made available on a new 12 in. CF (ConFlat, a registered trademark of Varian, Inc.) flange. X-ray diffraction has been used as a major probe for film growth and structures for the system. In the original design, electron diffraction was intended for the secondary diagnostics available without the necessity of the x-ray and located at separate positions. Deposition of films was made possible at the two diagnostic positions. And, the aiming of the evaporation sources is fixed to the point between two locations. Ozone can be supplied through two separate nozzles for each location. Also two separate thickness monitors are installed. Additional features of the equipment are also presented together with the data taken during typical oxide film growth to illustrate the depth of information available via in situ x-ray techniques.

Validation of Leiden Score in Predicting Progression of Rheumatoid Arthritis in Undifferentiated Arthritis in Indian Population

Background:

Leiden Score, is a very useful tool for predicting future development of rheumatoid arthritis (RA), among undifferentiated arthritis (UA) patients. This score has been validated in various western studies but rarely among south east Asian patients.

Aims:

To validate the Leiden early arthritis prediction rule in an Indian cohort of patients for predicting rheumatoid arthritis (RA) in undifferentiated arthritis (UA) patients and to formulate any simpler version of prediction score taking only clinical variables of original Leiden prediction rule.

Subjects and Methods:

In a group comparative longitudinal study model, 58 patients with early symmetrical polyarthritis were enrolled and baseline evaluation was done according to Leiden prediction rule and then 3 monthly. After 1 year, Leiden prediction score and chance of evolving into RA were calculated. Patients were divided into two groups: Those who developed RA and who did not. They were selected on random sampling process. Tender joint count (TJC), duration of morning stiffness, and duration of arthritis were selected as clinical variables for linear discriminant analysis with disease outcome being the dependent variable. Discriminant scores (D) for each patient was calculated. A receiver operating characteristic (ROC) curve was constructed with the discriminant score and compared with Leiden prediction score.

Results:

About 54% (27/50) of patients were diagnosed with RA and 46% (23/50) developed other rheumatologic condition or viral inflammatory arthritis or remained undifferentiated or attained complete remission. None of the patients with UA, who scored the regression coefficients 4 or less progressed to RA, and those who scored 7 or more, almost certainly progressed to RA. Unstandardized canonical discriminant coefficients for TJC (T), duration of morning stiffness (M), and duration of arthritis (A) were calculated. ROC curve was plotted with the formula: D = 0.164 × T + 0.066 × M + 0.012 × A − 2.838. Area under curve (AUC) at 95% confidence interval for our discriminant function was 0.845 (standard error [SE] 0.054). In comparison, AUC of Leiden prediction score was 0.897 (SE 0.043).

Conclusions:

Leiden prediction rule is highly applicable to UA patients to predict progression of RA in Indian patients and larger multi-center study with larger cohorts is needed to validate the formulation we derived to predict RA.

Use of Iron Chelating Agents in Transfusion Dependent Thalassaemia Major Patients

This cross-sectional study was done to find and investigate the utilization pattern of iron chelating agents among 73 transfusion-dependent thalassaemia major patients with continuous enrolment for at least 1 year in a day care treatment centre run by The Thalassaemia Society of India, Kolkata from November 2014 to January 2015. Transfusion dependent thalassaemia major patients above the age of 2 years managed by various haematologists and Thalassaemia specialists were studied. The administration of iron chelators namely Desferrioxamine (DFO), Deferiprone (DFP) and Deferasirox (DFX) were evaluated. Forty seven (64%) of the thalassaemics had serum ferritin level below 2500 ng/dl, of whom 20(27%) patients have ferritin level below 1000ng/dl. A number of 55(75%) of 73 patients who were treated with a single chelating agent consisted 50 patients only on DFX. Exact 8(67%) patients were on DFO+DFP and 4(33%) are treated with DFX+DFP. The mean age was 19 and mean serum ferritin level was 2280 ng/dl among the thalassaemia major patients. DFX was used 68% of patients as monotherapy and 5% patients in combination therapy with DFP. DFX in the dose of 30-40 mg/kg/day was prescribed in 52% of patients. Mean dose of 15 mg/kg/day of DFX was been administered in combination with DFP (75 mg/kg/day) in 5% patients. DFO+DFP were preferred by 8 patients, out of which 6 were aged above 25. Cost of monotherapy is twice that of combination therapy. These data demonstrates the ferritin status and present scenario of utilization of chelating agents among thalassaemia major patients on repeated transfusions. The dosing of new drug, Deferasirox and the cost analysis of various chelating regimen has also been dealt. Individualization rather than rationalization of chelation therapy should be focussed upon in managing iron overload in thalassaemia.

Spectral Weight Redistribution in (LaNiO3)n/(LaMnO3)2 Superlattices from Optical Spectroscopy

We have studied the optical properties of four (LaNiO3)n/(LaMnO3)2 superlattices (SL) (n=2,3,4,5) on SrTiO3 substrates. We have measured the reflectivity at temperatures from 20 to 400 K, and extracted the optical conductivity through a fitting procedure based on a Kramers-Kronig consistent Lorentz-Drude model. With increasing LaNiO3 thickness, the SLs undergo an insulator-to-metal transition (IMT) that is accompanied by the transfer of spectral weight from high to low frequency. The presence of a broad midinfrared band, however, shows that the optical conductivity of the (LaNiO3)n/(LaMnO3)2 SLs is not a linear combination of the LaMnO_{3} and LaNiO3 conductivities. Our observations suggest that interfacial charge transfer leads to an IMT due to a change in valence at the Mn and Ni sites.

Hydronephrosis: Comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure

INTRODUCTION

Pediatric ureteropelvic junction obstruction (UPJO) due to an extrinsic crossing vessel (CV) is rare and often remains undiagnosed preoperatively. Vascular hitch procedures are often performed as associated intrinsic obstruction is not expected. We compared data and intravenous urography (IVU) findings of patients with aberrant CV versus those with intrinsic UPJO, all undergoing open dismembered pyeloplasty.

PRIMARY OBJECTIVE

Is accurate pre-operative diagnosis of aberrant CV causing extrinsic UPJO possible?

SECONDARY OBJECTIVE

To assess differences in the demographic, clinical, radiological, intra-operative features and postoperative improvement after pyeloplasty between patients with a CV and those with only intrinsic UPJO.

PATIENTS AND METHODS

Prospective study of all children below 12 years with UPJO presenting to a tertiary referral centre and who underwent open Anderson - Hynes dismembered pyeloplasty between 2003 and 2013 was conducted. Pre-operative investigations included serial ultrasonography, renal dynamic [ethylene di-cysteine (EC)] scan and IVU. These were repeated 3 months after pyeloplasty. Pre-operative IVUs of children with CV were compared with the IVUs of an equal number of similar aged children, randomly selected from the intrinsic obstruction group.

RESULTS

Pyeloplasty was performed in 643 children during the study period. Data of 33 children with aberrant CVs (mean age 6.99 years) were compared with the remaining 610 children (mean age 3.27 years) with only intrinsic obstruction. Highly significant associations of those with CV included age above 2 years, female gender, associated anomalies, abdominal pain in those above 2 years and poor preoperative function on IVU. Specific IVU features which were statistically highly significant in favor of presence of CV were small, intrarenal and globular flat bottomed pelvis. (Figure) Calyceal dilatation was also more prominent in the CV group. A funnel shaped, extrarenal pelvis was highly significant in favor of intrinsic obstruction. There was associated intrinsic obstruction in addition to CV obstruction in 8 children. All children symptomatically improved after pyeloplasty and did well on long term follow up. The majority showed improvement or stabilization of function on EC scan.

DISCUSSION

With the advent of antenatal ultrasonography, most children with UPJO are detected early. Children with CV tend to present later. This is often detected during surgery. Color Doppler is useful but is operator dependant and not performed routinely. In this study, IVU showed the presence of obstruction and loss of function unlike color Doppler, but also revealed specific diagnostic features not previously reported in literature. This can help in accurate preoperative prediction and avoid endopyelotomy, or a dorsal lumbotomy/retroperitoneal approach. Renal function in CVs is expected to be good as the obstruction is thought to be intermittent. However, we noted delayed contrast uptake on IVU in 60.6% and differential renal function on EC scan below 40% in 17 patients (56.6%). These indicate the effect of the obstruction on the renal parenchyma and the importance of early detection. Higher association with other anomalies and higher incidence in females has also not been emphasized in the literature so far. We noted associated intrinsic obstruction in 24.24% patients which is highly significant. This category of patients is likely to be missed and inappropriately treated if a "vascular hitch procedure" is performed. None of our patients had postoperative complications.

CONCLUSIONS

Characteristic features were seen on IVU helping in preoperative diagnosis which can be extrapolated to magnetic resonance urography. There is a higher association of CV in age above 2 years, females, associated congenital anomalies, delayed uptake on IVU and differential renal function below 40% compared to intrinsic obstruction. Associated intrinsic obstruction in 24% with no postoperative complications indicates the superiority of dismembered pyeloplasty over vasculopexy procedures.

The methyltransferase Setdb2 mediates virus-induced susceptibility to bacterial superinfection

Immune responses are tightly regulated to ensure efficient pathogen clearance while avoiding tissue damage. Here we report that Setdb2 was the only protein lysine methyltransferase induced during infection with influenza virus. Setdb2 expression depended on signaling via type I interferons, and Setdb2 repressed expression of the gene encoding the neutrophil attractant CXCL1 and other genes that are targets of the transcription factor NF-κB. This coincided with occupancy by Setdb2 at the Cxcl1 promoter, which in the absence of Setdb2 displayed diminished trimethylation of histone H3 Lys9 (H3K9me3). Mice with a hypomorphic gene-trap construct of Setdb2 exhibited increased infiltration of neutrophils during sterile lung inflammation and were less sensitive to bacterial superinfection after infection with influenza virus. This suggested that a Setdb2-mediated regulatory crosstalk between the type I interferons and NF-κB pathways represents an important mechanism for virus-induced susceptibility to bacterial superinfection.