Association of neighbourhood walkability and haemoglobin A1c levels among Latino and non-Hispanic White patients with diabetes

BACKGROUND

Neighbourhood walkability can benefit cardiovascular health. Latino patients are more likely than non-Hispanic White patients to have diabetes, and evidence has shown better diabetes-related outcomes for patients living in neighbourhoods conducive to physical activity. Our objective was to determine whether neighbourhood walkability was associated with haemoglobin A1c (HbA1c) levels among English- and Spanish-preferring Latino patients compared to non-Hispanic White patients.

METHODS

We used electronic health record data from patients in the OCHIN, Inc. network of community health centres (CHC) linked to public walkability data. Patients included those age ≥ 18 with ≥ 1 address recorded, with a study clinic visit from 2012 to 2020, and a type 2 diabetes diagnosis (N = 159,289). Generalized estimating equations logistic regression, adjusted for relevant covariates, was used to model the primary binary outcome of always having HbA1c < 7 by language/ethnicity and walkability score.

RESULTS

For all groups, the walkability score was not associated with higher odds and prevalence of always having HbA1c < 7. Non-Hispanic White patients were most likely to have HbA1c always < 7 (prevalence ranged from 32.8% [95%CI = 31.2-34.1] in the least walkable neighbourhoods to 33.4% [95% CI 34.4-34.7] in the most walkable), followed by English-preferring Latinos (28.6% [95%CI = 25.4-31.8]-30.7% [95% CI 29.0-32.3]) and Spanish-preferring Latinos (28.3% [95% CI 26.1-30.4]-29.3% [95% CI 28.2-30.3]).

CONCLUSIONS

While walkability score was not significantly associated with glycaemic control, control appeared to increase with walkability, suggesting other built environment factors, and their interaction with walkability and clinical care, may play key roles. Latino patients had a lower likelihood of HbA1c always < 7, demonstrating an opportunity for equity improvements in diabetes care.

Measurement of energy and directional distribution of neutron ambient dose equivalent for the 7Li(p,n)7Be reaction

Double differential neutron fluence distributions were measured in the 7Li(p,n)7Be reaction for proton beam energies 7, 9 and 12 MeV. Seven liquid scintillator based detectors were employed to measure neutron fluence distributions using the Time of Flight technique. Neutron ambient dose equivalents were determined from the measured fluence distribution using ICRP (International Commission on Radiological Protection) recommended fluence to dose equivalent conversion coefficients. Neutron dose equivalents were also measured using a conventional BF3 detector based REM counter. Ambient dose equivalent measured by the REM counter is found to be in agreement with that determined from the neutron fluence spectra within their uncertainties. Angular distributions of the ambient dose equivalents were also determined from the measured fluence distributions at different angles.

Association of Early Childhood Wheeze and Asthma Diagnosis Documentation by Race, Ethnicity, and Language in Children

OBJECTIVE

To determine whether electronic health record (EHR) documentation of certain early childhood risk factors for asthma, such as wheeze differ by race, ethnicity, and language group, and whether these children have different subsequent asthma prevalences.

METHODS

We used EHR data from the Accelerating Data Value Across a National Community Health Center (ADVANCE) Clinical Research Network from children receiving care in US community health centers (n = 71,259 children) across 21 states to examine the presence of ICD-coded documentation of early childhood wheeze and its association with subsequent asthma diagnosis documentation in the EHR by race/ethnicity/language.

RESULTS

ICD-coded wheeze was present in 2 to 3% of each race/ethnicity/language group. Among the total sample, 18.5% had asthma diagnosed after age 4. The adjusted prevalence of subsequent asthma diagnosis was greater in children with wheeze than those without. Odds of asthma diagnosis did not differ among children in all race/ethnicity/language groups with early childhood wheeze. Non-Latino Black children without wheeze had higher odds of asthma (OR = 1.19, 95% CI = 1.08-1.32) compared with non-Latino White children without wheeze.

DISCUSSION

In US community health centers which serve medically underserved populations, EHR documentation of early childhood wheeze was uncommon and did not differ significantly among race/ethnicity/language groups. Differences in asthma diagnosis in Latinos may not stem from differences in early-life wheeze documentation. However, our findings suggest that there may be opportunities for improvement in early asthma symptom recognition for non-Latino Black children, especially in those without early childhood wheeze.

Comparison of associations of household-level and neighbourhood-level poverty markers with paediatric asthma care utilisation by race/ethnicity in an open cohort of community health centre patients

OBJECTIVE

The objective of this research was to examine how different measurements of poverty (household-level and neighborhood-level) were associated with asthma care utilisation outcomes in a community health centre setting among Latino, non-Latino black and non-Latino white children.

DESIGN, SETTING AND PARTICIPANTS

We used 2012-2017 electronic health record data of an open cohort of children aged <18 years with asthma from the OCHIN, Inc. network. Independent variables included household-level and neighborhood-level poverty using income as a percent of federal poverty level (FPL). Covariate-adjusted generalised estimating equations logistic and negative binomial regression were used to model three outcomes: (1) ≥2 asthma visits/year, (2) albuterol prescription orders and (3) prescription of inhaled corticosteroids over the total study period.

RESULTS

The full sample (n=30 196) was 46% Latino, 26% non-Latino black, 31% aged 6-10 years at first clinic visit. Most patients had household FPL <100% (78%), yet more than half lived in a neighbourhood with >200% FPL (55%). Overall, neighbourhood poverty (<100% FPL) was associated with more asthma visits (covariate-adjusted OR 1.26, 95% CI 1.12 to 1.41), and living in a low-income neighbourhood (≥100% to <200% FPL) was associated with more albuterol prescriptions (covariate-adjusted rate ratio 1.07, 95% CI 1.02 to 1.13). When stratified by race/ethnicity, we saw differences in both directions in associations of household/neighbourhood income and care outcomes between groups.

CONCLUSIONS

This study enhances understanding of measurements of race/ethnicity differences in asthma care utilisation by income, revealing different associations of living in low-income neighbourhoods and households for Latino, non-Latino white and non-Latino black children with asthma. This implies that markers of family and community poverty may both need to be considered when evaluating the association between economic status and healthcare utilisation. Tools to measure both kinds of poverty (family and community) may already exist within clinics, and can both be used to better tailor asthma care and reduce disparities in primary care safety net settings.

Ethnicity, Language, and HIV Screening in Older Adult Safety-Net Patients

INTRODUCTION

HIV screening should occur for all adults at least once by age 65 years. Older adults have low screening rates. Latinos, with historically low screening rates, have worse HIV outcomes than non-Hispanic White patients. Electronic health record data from a multistate network of community health centers were used to examine whether there are differences in HIV screening for Latino (English and Spanish preferring) and non-Hispanic White older adults.

METHODS

Data were from the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network of PCORnet from 21 states in 2012-2021 among an open cohort of patients aged 50-65 years. Relative odds of ever having received HIV screening comparing Latinos with non-Hispanic Whites using generalized estimating equation logistic regression modeling were calculated, adjusting for relevant patient-level covariates. Analyses were conducted in 2022.

RESULTS

Among 251,645 patients, the covariate-adjusted odds of ever receiving HIV screening were 18% higher for English-preferring Latino patients (OR=1.18, 95% CI=1.11, 1.25) and 32% higher for Spanish-preferring Latinos than for non-Hispanic Whites (OR=1.32, 95% CI=1.24, 1.42).

CONCLUSIONS

Latinos seen in community health centers, regardless of language spoken, are more likely to be screened at least once for HIV than non-Hispanic Whites. This increased screening may be due at least in part to the community health center setting, a setting known to mitigate disparities, as well as due to participation efforts by community health centers in public health campaigns. Future research can prioritize understanding the cause of this relative advantage.

Compositional modelling of immune response and virus transmission dynamics

Transmission models for infectious diseases are typically formulated in terms of dynamics between individuals or groups with processes such as disease progression or recovery for each individual captured phenomenologically, without reference to underlying biological processes. Furthermore, the construction of these models is often monolithic: they do not allow one to readily modify the processes involved or include the new ones, or to combine models at different scales. We show how to construct a simple model of immune response to a respiratory virus and a model of transmission using an easily modifiable set of rules allowing further refining and merging the two models together. The immune response model reproduces the expected response curve of PCR testing for COVID-19 and implies a long-tailed distribution of infectiousness reflective of individual heterogeneity. This immune response model, when combined with a transmission model, reproduces the previously reported shift in the population distribution of viral loads along an epidemic trajectory. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Time-resolved velocity and ion sound speed measurements from simultaneous bow shock imaging and inductive probe measurements

We present a technique to measure the time-resolved velocity and ion sound speed in magnetized, supersonic high-energy-density plasmas. We place an inductive ("b-dot") probe in a supersonic pulsed-power-driven plasma flow and measure the magnetic field advected by the plasma. As the magnetic Reynolds number is large (R_M > 10), the plasma flow advects a magnetic field proportional to the current at the load. This enables us to estimate the flow velocity as a function of time from the delay between the current at the load and the signal at the probe. The supersonic flow also generates a hydrodynamic bow shock around the probe, the structure of which depends on the upstream sonic Mach number. By imaging the shock around the probe with a Mach-Zehnder interferometer, we determine the upstream Mach number from the shock Mach angle, which we then use to determine the ion sound speed from the known upstream velocity. We use the sound speed to infer the value of Z̄T_e, where Z̄ is the average ionization and T_e is the electron temperature. We use this diagnostic to measure the time-resolved velocity and sound speed of a supersonic (M_S ∼ 8), super-Alfvénic (M_A ∼ 2) aluminum plasma generated during the ablation stage of an exploding wire array on the Magpie generator (1.4 MA, 250 ns). The velocity and Z̄T_e measurements agree well with the optical Thompson scattering measurements reported in the literature and with 3D resistive magnetohydrodynamic simulations in GORGON.

Diabetes Screening and Monitoring Among Older Mexican-Origin Populations in the U.S

OBJECTIVE

The purpose of the study is to examine diabetes screening and monitoring among Latino individuals as compared with non-Latino White individuals and to better understand how we can use neighborhood data to address diabetes care inequities.

RESEARCH DESIGN AND METHODS

This is a retrospective observational study linked with neighborhood-level Latino subgroup data obtained from the American Community Survey. We used generalized estimating equation negative binomial and logistic regression models adjusted for patient-level covariates to compare annual rates of glycated hemoglobin (HbA1c) monitoring for those with diabetes and odds of HbA1c screening for those without diabetes by ethnicity and among Latinos living in neighborhoods with low (0.0-22.0%), medium (22.0-55.7%), and high (55.7-98.0%) population percent of Mexican origin.

RESULTS

Latino individuals with diabetes had 18% higher rates of HbA1c testing than non-Latino White individuals with diabetes (adjusted rate ratio [aRR] 1.18 [95% CI 1.07-1.29]), and Latinos without diabetes had 25% higher odds of screening (adjusted odds ratio 1.25 [95% CI 1.15-1.36]) than non-Latino White individuals without diabetes. In the analyses in which neighborhood-level percent Mexican population was the main independent variable, all Latinos without diabetes had higher odds of HbA1c screening compared with non-Latino White individuals, yet only those living in low percent Mexican-origin neighborhoods had increased monitoring rates (aRR 1.31 [95% CI 1.15-1.49]).

CONCLUSIONS

These findings reveal novel variation in health care utilization according to Latino subgroup neighborhood characteristics and could inform the delivery of diabetes care for a growing and increasingly diverse Latino patient population. Clinicians and researchers whose work focuses on diabetes care should take steps to improve equity in diabetes and prevent inequity in treatment.

Conductivity prediction model for ionic liquids using machine learning

Ionic liquids (ILs) are salts, composed of asymmetric cations and anions, typically existing as liquids at ambient temperatures. They have found widespread applications in energy storage devices, dye-sensitized solar cells, and sensors because of their high ionic conductivity and inherent thermal stability. However, measuring the conductivity of ILs by physical methods is time-consuming and expensive, whereas the use of computational screening and testing methods can be rapid and effective. In this study, we used experimentally measured and published data to construct a deep neural network capable of making rapid and accurate predictions of the conductivity of ILs. The neural network is trained on 406 unique and chemically diverse ILs. This model is one of the most chemically diverse conductivity prediction models to date and improves on previous studies that are constrained by the availability of data, the environmental conditions, or the IL base. Feature engineering techniques were employed to identify key chemo-structural characteristics that correlate positively or negatively with the ionic conductivity. These features are capable of being used as guidelines to design and synthesize new highly conductive ILs. This work shows the potential for machine-learning models to accelerate the rate of identification and testing of tailored, high-conductivity ILs.

Disparities in HbA1c testing between aging US Latino and non-Latino white primary care patients

US Latinos disproportionately face diabetes-related disparities compared to non-Latino Whites. A number of barriers, including linguistic and cultural discordance, have been consistently linked to these disparities. Glycated hemoglobin (HbA1c) testing is used to assess glycemic control among individuals living with diabetes. This study aimed to compare HbA1c levels and corresponding testing rates among non-Latino Whites and Latinos with both English and Spanish preference from a national cohort of primary care patients within community health centers. We analyzed electronic health records from patients who turned 50 years of age (n = 66,921) and were diagnosed with diabetes during or prior to the study period. They also must have been under observation for at least one year from January 1, 2013 to December 31, 2017. We calculated the rates of HbA1c tests each person received over the number of years observed and used covariate-adjusted negative binomial regression to estimate incidence rate ratios for Spanish preferring Latinos and English preferring Latinos compared to non-Latino Whites. Spanish preferring Latinos (rate ratio = 1.23, 95% CI = 1.16-1.30), regardless of HbA1c level, had higher testing rates than non-Latino Whites and English preferring Latinos. English preferring Latinos with controlled HbA1c levels had higher rates of HbA1c testing compared to non-Latino whites. Overall, the Latinos with Spanish preference maintained higher HbA1c testing rates and had disproportionately higher rates of uncontrolled HbA1c levels compared to non-Latino whites. Future efforts should focus on understanding effective approaches to increasing engagement among Spanish preferring Latinos and addressing organizational-level barriers, given HbA1c disparities.

Sub-Kelvin cooling for two kilopixel bolometer arrays in the PIPER receiver

The Primordial Inflation Polarization Explorer (PIPER) is a balloon-borne telescope mission to search for inflationary gravitational waves from the early universe. PIPER employs two 32 × 40 arrays of superconducting transition-edge sensors, which operate at 100 mK. An open bucket Dewar of liquid helium maintains the receiver and telescope optics at 1.7 K. We describe the thermal design of the receiver and sub-Kelvin cooling with a continuous adiabatic demagnetization refrigerator (CADR). The CADR operates between 70 and 130 mK and provides ≈10 μW cooling power at 100 mK, nearly five times the loading of the two detector assemblies. We describe electronics and software to robustly control the CADR, overall CADR performance in flightlike integrated receiver testing, and practical considerations for implementation in the balloon float environment.

Exploration of insecticidal potential of an alpha glucosidase enzyme inhibitor from an endophytic Exophiala spinifera

AIM

The present study aimed to isolate and screen endophytes from Trachyspermum ammi with the ability to inhibit alpha glucosidase enzyme and evaluate their insecticidal potential.

METHODS AND RESULTS

Endophytic fungi isolated from T. ammi were screened for alpha glucosidase inhibitory activity. Maximum inhibition (96%) was observed in an isolate AZ-9, identified to be Exophiala spinifera on morphological and molecular basis. Production of fungal metabolites was carried out in malt extract broth followed by extraction with ethyl acetate. Brown coloured gummy residue obtained after evaporation of ethyl acetate was partially soluble in water yielding white precipitates. The precipitate exhibiting α-glucosidase inhibitory activity was purified by repeated washing and centrifugation. The insecticidal activity of inhibitor was evaluated on Spodoptera litura (Fab.) by feeding this pest on diet amended with inhibitor. It resulted in significant larval mortality as well as deformities in emerging adults. A reduction in vivo digestive enzyme activity was also observed. Nutritional analysis revealed the toxic effect of AZ-9 inhibitor on various food utilization parameters of S. litura. A significant reduction was recorded in relative growth and consumption rate of S. litura.

CONCLUSIONS

This is the first report on production of an alpha glucosidase inhibitor from E. spinifera with insecticidal activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study highlights the importance of endophytes in providing protection against insect pests to the host. It also suggests the insecticidal potential of alpha glucosidase inhibitor from E. spinifera against polyphagous pest S. litura.

Removal of prometryn from hydroponic media using marsh pennywort (Hydrocotyle vulgaris L.)

The aquatic plant Hydrocotyle vulgaris was evaluated for its efficacy in removing prometryn from nutrient solution. Under optimized experimental conditions, up to 94.0% of the initial prometryn was removed from the hydroponic culture medium by H. vulgaris in 30 days. The concentration of prometryn decreased from the initial level of 0.55 ± 0.013 mg/L to 0.036 ± 0.001 mg/L at the end of the experimental period. The removal kinetics followed first-order kinetic equation (Ct = 0.4569e^-0.09t). Half-life (t_1/2) of prometryn was greatly shortened from 27.16 days (without plant) to 5.58 days (with H. vulgaris). Approximately 22% of the initial prometryn residue was found in H. vulgaris tissue, while 11.7% was degraded by the plant in 30 days. The metabolites of prometryn detected were 2,4-diamino-1,3,5-triazine (in the hydroponic culture medium) and 2,4,6-trihydroxy-1,3,5-triazine (in plant tissue) after 30 days. The results indicate that H. vulgaris can be used for phytoextraction of prometryn and could potentially be effective in removing other s-trazine pesticides from contaminated aquatic ecosystems.

Arctic cut-off high drives the poleward shift of a new Greenland melting record

Large-scale atmospheric circulation controls the mass and energy balance of the Greenland ice sheet through its impact on radiative budget, runoff and accumulation. Here, using reanalysis data and the outputs of a regional climate model, we show that the persistence of an exceptional atmospheric ridge, centred over the Arctic Ocean, was responsible for a poleward shift of runoff, albedo and surface temperature records over the Greenland during the summer of 2015. New records of monthly mean zonal winds at 500 hPa and of the maximum latitude of ridge peaks of the 5,700±50 m isohypse over the Arctic were associated with the formation and persistency of a cutoff high. The unprecedented (1948–2015) and sustained atmospheric conditions promoted enhanced runoff, increased the surface temperatures and decreased the albedo in northern Greenland, while inhibiting melting in the south, where new melting records were set over the past decade.

Atmospheric circulation controls the mass and energy balance of the Greenland ice sheet, yet the exact dynamics remain unknown. Here, the authors show that record conditions over Greenland during the summer of 2015 were associated with the formation and persistency of an Arctic cut-off high.

Uptake of 2,4-bis(Isopropylamino)-6-methylthio-s-triazine by Vetiver Grass (Chrysopogon zizanioides L.) from Hydroponic Media

2,4-bis(Isopropylamino)-6-methylthio-s-triazine (prometryn) poses a risk to aquatic environments in several countries, including China, where its use is widespread, particularly due to its chemical stability and biological toxicity. Vetiver grass (Chrysopogon zizanioides L.) was tested for its potential for phytoremediation of prometryn. Vetiver grass was grown in hydroponic media in a greenhouse, in the presence of prometryn, with appropriate controls. Plant uptake and removal of prometryn from the media were monitored for a period of 67 days. The results showed that the removal of the prometryn in the media was expedited by vetiver grass. The removal half-life (t1/2) was shortened by 11.5 days. Prometryn removal followed first-order kinetics (Ct = 1.8070e(-0.0601t)). This study demonstrated the potential of vetiver grass for the phytoremediation for prometryn.

Large-aperture wide-bandwidth antireflection-coated silicon lenses for millimeter wavelengths

The increasing scale of cryogenic detector arrays for submillimeter and millimeter wavelength astrophysics has led to the need for large aperture, high index of refraction, low loss, cryogenic refracting optics. Silicon with n=3.4, low loss, and high thermal conductivity is a nearly optimal material for these purposes but requires an antireflection (AR) coating with broad bandwidth, low loss, low reflectance, and a matched coefficient of thermal expansion. We present an AR coating for curved silicon optics comprised of subwavelength features cut into the lens surface with a custom three-axis silicon dicing saw. These features constitute a metamaterial that behaves as a simple dielectric coating. We have fabricated silicon lenses as large as 33.4 cm in diameter with micromachined layers optimized for use between 125 and 165 GHz. Our design reduces average reflections to a few tenths of a percent for angles of incidence up to 30° with low cross polarization. We describe the design, tolerance, manufacture, and measurements of these coatings and present measurements of the optical properties of silicon at millimeter wavelengths at cryogenic and room temperatures. This coating and lens fabrication approach is applicable from centimeter to submillimeter wavelengths and can be used to fabricate coatings with greater than octave bandwidth.

OVERCOMING INCOMPATIBILITY PROBLEMS IN ELASTOMER BLENDS BY TAILORED SURFACE PROPERTIES OF RUBBER ADDITIVES

Rubber is a challenging composite material, whose functionality strongly depends on the affinity of the different materials in the composite and its morphology. One way to tailor polarity and chemistry of the filler surface is plasma coating. When using acetylene, thiophene, or pyrrole as monomers, the coating results in a reduced polarity of the filler compared with untreated silica, and unsaturated C–C bonds are formed on the surface. This improves the compatibility of the filler–polymer blends. In a SBR/EPDM blend, the filler–polymer compatibility is improved for all plasma-coated fillers compared with untreated silica. The best dispersion is achieved by plasma–pyrrole coating, as measured by the Payne effect and reinforcement parameter. The rubber–filler interaction is also highest for this blend, as measured by the bound rubber content. As expected, this results in improved tensile properties. In NBR/EPDM, the filler–filler interaction is significantly reduced by the plasma–pyrrole coating, which indicates a balanced compatibility of the pyrrole-treated silica in both polymers. The properties of the vulcanizate show the combinatorial effect of dispersion, filler–polymer interaction, polymer entanglements, and cross-link density. All plasma-treated, silica-filled NBR/EPDM materials show a considerable increase in tensile strength compared with untreated silica, with polyacetylene-treated silica resulting in the best properties. When plasma-coated curatives are used in SBR/EPDM blends, the scorch safety of the compounds is increased and the rupture energy is enhanced. In NBR/EPDM blends, all packages of the modified curatives provide an increased maximum torque compared with the control. Mechanical properties of the NBR/EPDM blend are improved even more than they are with SBR/EPDM. This indicates a more-balanced distribution of cross-links, along with a more-homogeneous carbon black dispersion over the different rubber phases. A better polarity match between additives and polymers usually results in improved material properties. The wide variety of monomers for the plasma polymerization allows researchers to tailor the surface properties of the additives.

Retained oesophageal foreign bodies - report of three cases

Incarceration of foreign bodies in the oesophagus is a welknown clinical problem. Either children in the first decade of life or adults between 50 and 60 years of age are the commoner victims. Types of oesophageal foreign bodies differ according to age, being toys and coins in the childhood and dental prosthesis, fish bones or bone splinters in adulthood. Severe oesophageal injury due to incarceration of foreign bodies is exceptional in children but rule in adults. Foreign bodies can be retrieved from the oesophagus successfully in 99% cases with a mortality of less than 0.2%. Three cases have been discussed here, all having retained foreign bodies in their oesophagus for varying length of time with unique problems. Different management strategies were planned and successfully applied in these cases. All of them survived and doing well after reasonable period of follow up.

Conventional Versus Endoscopic Powered Adenoidectomy: A Comparative Study

BACKGROUND

Adenoidectomy is a commonly performed ENT surgery. It is conventionally performed using the curettage method. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative.

METHODS

Sixty consecutive cases requiring adenoidectomy were randomized into two groups of thirty each. Group A underwent conventional adenoidectomy using the curettage method and Group B underwent endoscopic assisted micro-debrider adenoidectomy. The parameters studied were intra-operative time, intra-operative bleeding and completeness of resection, collateral damage, post operative pain and recovery time.

RESULT

Sixty cases of adenoidectomy were done using conventional surgery and powered endoscopic adenoidectomy in the study period from Aug 04 to Dec 05. The time taken in Group A (conventional surgery) varied from 22-39 minutes (95% Confidence Interval (CI) -27.7 - 30.9)and in Group B (powered endoscopic surgery) from 27-55 minutes(95% CI 36.6 - 41.9) (p<0.05). The average blood loss in Group A was 21 ml (range 10-50) as compared to 31.67 ml (range 10-60) in Group B (p<0.05). The resection was invariably complete in Group B whereas seven(23%) cases had more than 50% residual adenoid tissue in Group A. Three cases in group A had collateral damage whereas in Group B, there were no added injuries. Post operative pain was studied only in cases undergoing adenoidectomy alone. Group A (n=8) demonstrated a pain score of 1.64-2.63-3.63 (95% CI) whereas Group B (n=11) demonstrated a pain score of 1.19-2.13-3.06 (95% CI). This difference was not statistically significant. In group A, the mean recovery period was 3.5 days and 2.93 days in Group B(p<0.05).

CONCLUSION

Endoscopic powered adenoidectomy was found to be a safe and effective tool for adenoidectomy. The study parameters where endoscopic powered adenoidectomy fared better were completeness of resection, accurate resection under vision, lesser collateral damage and faster recovery time. On the other hand, conventional adenoidectomy scored in matter of lesser operative time and intra-operative bleeding.

Laryngopharyngeal Reflux : Larynx on Fire

Laryngopharyngeal Reflux (LPR) is a commonly occurring and recently described clinical entity due to the retrograde flow of gastric contents into the pharynx. It accounts for many symptoms of upper airway including hoarseness, chronic throat irritation and globus sensation. The sensitive laryngeal mucosa is prone to damage by the combination of acid and pepsin. The inflammatory changes that follow are presumed to cause the symptoms and predispose the individual to laryngeal disorders. Diagnosis can usually be made clinically based on symptoms and laryngeal signs but a 24 hour pH metry is essential to establish diagnosis. Treatment centres on lifestyle modifications, vocal hygiene measures and long term use of proton pump inhibitors. Recent research in this field may lead to a better understanding of the pathophysiology of the disease and change the way LPR is managed.

Impact of Nasal Symptoms on the Quality of Life of Fresh Inductees in High Altitude

BACKGROUND

Troops deployed in high altitude areas of Ladakh face nasal problems in the form of obstructive nasal symptoms and recurrent epistaxis. This study analyses the changes in the nasal mucociliary transit times (NMTT) and deterioration in quality of life of troops on first high altitude induction.

METHODS

A prospective study on 100 healthy volunteers was done. Mucociliary transit time was measured and a standardized quality of life questionnaire (RQLQ) administered at onset and after a period of three months in high altitude. Thereafter the subjects were divided into two groups and the study group was administered normal saline nasal drops. The observations were taken and results were statistically analysed after a period of three months.

RESULT

The mucociliary transit time was prolonged after a three month stay in high altitude (p< 0.005). Normal saline nasal drops were successful in improving the nasal mucociliary transit times (p < 0.05). There was a statistically significant derangement in the quality of life which was improved by administering normal saline nasal drops (p<0.05).

CONCLUSION

An increased muco-cilliary transport time after exposure to high altitude denotes a deranged physiology of the nasal mucosa. This leads to a statistically significant adverse impact on the quality of life of the troops deployed. The use of normal saline nasal drops is a simple and effective method of reversing some of these changes.

Fluid Therapy in Trauma

Advances in shock resuscitation have occurred as a result of various military conflicts. Primary objective of trauma care is to minimize or reverse shock, avoiding the lethal triad of hypothermia, acidosis, and coagulopathy. The concept of Damage Control Resuscitation has evolved along with "damage control surgery" which includes hypotensive and haemostatic resuscitation, where small aliquots of fluid are infused, with hypovolaemia and hypotension tolerated as a necessary evil until definitive haemorrhage control can be achieved. In the initial stages of trauma resuscitation the precise fluid, crystalloid or colloid, used is probably not important as long as an appropriate volume is given. Haemostatic resuscitation includes early use of fresh frozen plasma in a 1:1 ratio with packed red cells with emphasis on whole blood, frequent cryo precipitates and platelets and the use of recombinant Factor VII for control of bleeding.

PARP-1 deficiency blocks IL-5 expression through calpain-dependent degradation of STAT-6 in a murine asthma model

BACKGROUND

We recently showed that poly(ADP-ribose)polymerase-1 (PARP-1) may play a role in allergen (ovalbumin)-induced airway eosinophilia, potentially through a specific effect on IL-5 production. We also reported that while IL-5 replenishment promotes reversal of eosinophilia in lungs of PARP-1(-/-) mice, IL-4 or Immunoglobulin E replenishment do not, suggesting a potentially significant regulatory relationship between PARP-1 and IL-5.

OBJECTIVE

To explore the mechanism by which PARP-1 regulates IL-5 production and to determine how PARP-1 inhibition blocks allergen-induced eosinophilia.

METHODS

This study was conducted using a murine model of allergic airway inflammation and primary splenocytes.

RESULTS

PARP-1 knockout-associated reduction in IL-5 upon allergen exposure occurs at the mRNA level. Such an effect appears to take place after IL-4 receptor activation as PARP-1 inhibition exerted no effect on JAK1/JAK3 activation. Signal transducer and activator of transcription-6 (STAT-6) protein was severely downregulated in spleens of PARP-1(-/-) mice without any effect on mRNA levels, suggesting an effect on protein integrity rather than gene transcription. Interestingly, the degradation of STAT-6 in PARP-1(-/-) mice required allergen stimulation. Additionally, PARP-1 enzymatic activity appears to be required for STAT-6 integrity. The downregulation of STAT-6 coincided with mRNA and protein reduction of GATA-binding protein-3 and occupancy of its binding site on the IL-5 gene promoter. IL-4 was sufficient to induce STAT-6 downregulation in both PARP-1(-/-) mice and isolated splenocytes. Such degradation may be mediated by calpain, but not by proteasomes.

CONCLUSION

These results demonstrate a novel function of PARP-1 in regulating IL-5 expression during allergen-induced inflammation and explain the underlying mechanism by which PARP-1 inhibition results in IL-5 reduction.

An attempt towards simultaneous biobased solvent based extraction of proteins and enzymatic saccharification of cellulosic materials from distiller's grains and solubles

Distiller's grains and solubles (DGS) is the major co-product of corn dry mill ethanol production, and is composed of 30% protein and 30-40% polysaccharides. We report a strategy for simultaneous extraction of protein with food-grade biobased solvents (ethyl lactate, d-limonene, and distilled methyl esters) and enzymatic saccharification of glucan in DGS. This approach would produce a high-value animal feed while simultaneously producing additional sugars for ethanol production. Preliminary experiments on protein extraction resulted in recovery of 15-45% of the protein, with hydrophobic biobased solvents obtaining the best results. The integrated hydrolysis and extraction experiments showed that biobased solvent addition did not inhibit hydrolysis of the cellulose. However, only 25-33% of the total protein was extracted from DGS, and the extracted protein largely resided in the aqueous phase, not the solvent phase. We hypothesize that the hydrophobic solvent could not access the proteins surrounded by the aqueous phase inside the fibrous structure of DGS due to poor mass transfer. Further process improvements are needed to overcome this obstacle.

Modulation of acetone-butanol-ethanol fermentation by carbon monoxide and organic acids

Metabolic modulation of acetone-butanol-ethanol fermentation by Clostridium acetobutylicum with carbon monoxide (CO) and organic acids is described. CO, which is a known inhibitor of hydrogenase, was found to be effective in the concentration range of dissolved CO corresponding to a CO partial pressure of 0.1 to 0.2 atm. Metabolic modulation by CO was particularly effective when organic acids such as acetic and butyric acids were added to the fermentation as electron sinks. The uptake of organic acids was enhanced, and increases in butyric acid uptake by 50 to 200% over control were observed. Hydrogen production could be reduced by 50% and the ratio of solvents could be controlled by CO modulation and organic acid addition. Acetone production could be eliminated if desired. Butanol yield could be increased by 10 to 15%. Total solvent yield could be increased 1 to 3% and the electron efficiency to acetone-butanol-ethanol solvents could be increased from 73 to 78% for controls to 80 to 85% for CO- and organic acid-modulated fermentations. Based on these results, the dynamic nature of electron flow in this fermentation has been elucidated and mechanisms for metabolic control have been hypothesized.

Control of Carbon and Electron Flow in Clostridium acetobutylicum Fermentations: Utilization of Carbon Monoxide to Inhibit Hydrogen Production and to Enhance Butanol Yields

Extracts prepared from non-solvent-producing cells of Clostridium acetobutylicum contained methyl viologen-linked hydrogenase activity (20 U/mg of protein at 37 degrees C) but did not display carbon monoxide dehydrogenase activity. CO addition readily inhibited the hydrogenase activity of cell extracts or of viable metabolizing cells. Increasing the partial pressure of CO (2 to 10%) in unshaken anaerobic culture tube headspaces significantly inhibited (90% inhibition at 10% CO) both growth and hydrogen production by C. acetobutylicum. Growth was not sensitive to low partial pressures of CO (i.e., up to 15%) in pH-controlled fermentors (pH 4.5) that were continuously gassed and mixed. CO addition dramatically altered the glucose fermentation balance of C. acetobutylicum by diverting carbon and electrons away from H(2), CO(2), acetate, and butyrate production and towards production of ethanol and butanol. The butanol concentration was increased from 65 to 106 mM and the butanol productivity (i.e., the ratio of butanol produced/total acids and solvents produced) was increased by 31% when glucose fermentations maintained at pH 4.5 were continuously gassed with 85% N(2)-15% CO versus N(2) alone. The results are discussed in terms of metabolic regulation of C. acetobutylicum saccharide fermentations to achieve maximal butanol or solvent yield.

Ghrelin in the regulation of body weight and metabolism

Ghrelin, a peptide hormone predominantly produced by the stomach, was isolated as the endogenous ligand for the growth hormone secretagogue receptor. Ghrelin is a potent stimulator of growth hormone (GH) secretion and is the only circulatory hormone known to potently enhance feeding and weight gain and to regulate energy homeostasis following central and systemic administration. Therapeutic intervention with ghrelin in catabolic situations may induce a combination of enhanced food intake, increased gastric emptying and nutrient storage, coupled with an increase in GH thereby linking nutrient partitioning with growth and repair processes. These qualities have fostered the idea that ghrelin-based compounds may have therapeutic utility in treating malnutrition and wasting induced by various sub-acute and chronic disorders. Conversely, compounds that inhibit ghrelin action may be useful for the prevention or treatment of metabolic syndrome components such as obesity, impaired lipid metabolism or insulin resistance. In recent years, the effects of ghrelin on glucose homeostasis, memory function and gastrointestinal motility have attracted considerable amount of attention and revealed novel therapeutic targets in treating a wide range of pathologic conditions. Furthermore, discovery of ghrelin O-acyltransferase has also opened new research opportunities that could lead to major understanding of ghrelin physiology. This review summarizes the current knowledge on ghrelin synthesis, secretion, mechanism of action and biological functions with an additional focus on potential for ghrelin-based pharmacotherapies.