Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.

OBJECTIVE: To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine. DESIGN: Cohort analysis. SETTING: The three main abortion providers. POPULATION OR SAMPLE: Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally. METHODS: Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. MAIN OUTCOME MEASURES: Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability. RESULTS: Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. CONCLUSIONS: A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care. TWEETABLE ABSTRACT: Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.

Congenital Eventration of Diaphragm Presenting As Diaphragmatic Hernia: A Case Report.

Eventration of diaphragm is an abnormal elevation of diaphragmatic musculature while retaining normal attachments to the sternum, ribs and dorsolumber spine. It is a rare anomaly where the continuity of diaphragm remains intact. Pathological process can affect either all or only a portion of hemidiaphragm. Symptoms vary according to size of the defect. Large defect may mimic diaphragmatic hernia. The present case represents a full term female newborn that developed respiratory distress, cyanosis and feeding difficulties since 1st day of life. Clinical features and chest imaging of this case was assumed to be left sided diaphragmatic hernia which was found wrong in the operation theater. She was found to have left sided eventration of diaphragm to create symptom. Successful plication of ipsilateral diaphragm was done on 13th day of life. Supervised post operative ventilatory support along with other postoperative care improved the condition of this neonate. A large defect with eventration of diaphragm may be life threatening but a timely good management can save neonate from such condition.

Development of indices for surface and ground water quality assessment and characterization for Indian conditions.

Water quality indices are mathematical equations that transform water quality data into a particular number which describe the status of water. A number of water quality indices have been developed by various researchers for categorizing the water quality for different uses. These indices are developed based on classification criteria, sub-indices, and aggregation function. In the present study, a generalized Composite Water Quality Index (CWQI) is developed to classify the water into five categories, viz excellent, good, fair, poor, and polluted. For this purpose, the concentration ranges have been categorized on the basis of the Indian Standards (IS) and Central Pollution Control Board (CPCB) standards and considering International standards of World Health Organization (WHO) and European Commission (EC). Twenty-five water quality parameters are selected based on the social and environmental impacts, and weights are computed using the Saaty's Analytic Hierarchy Process (AHP) Multiple Criteria Decision Analysis (MCDA) tool. These parameters are selected such that the same indices can be used to assess the quality of both surface and ground water. The computed weights minimize the subjectivity in assigning the parameter weights. The proposed index improves understanding of water quality issues by integrating complex data and generates a score which describes the status of water quality. The index will be very useful for the water management authorities to maintain good health of surface water resources.

Index-based assessment of suitability of water quality for irrigation purpose under Indian conditions.

Agriculture is a major sector in India which contributes around 14% of country's gross domestic product (GDP). Being an agriculture-based country, good quality of water for irrigation has been a prime requisite. Highly growing population and accelerated industrial development are causing anthropogenic pollution to both surface and groundwater on one side and geogenic contamination like arsenic, fluoride, high dissolved solids, sodicity, and iron in groundwater on other side. As a result, ensuring safe water quality for the irrigation has become a major challenge to both the central and state governments. The present irrigation water quality standards being followed in India have been set by the Central Pollution Control Board (CPCB) and Central Ground Water Board (CGWB) in the year 2000. These standards are solely based on four parameters, namely electrical conductivity, sodium percentage, sodium absorption ratio, and residual sodium carbonate, which are quite subjective and many times are not capable to exactly decide the quality of irrigation water particularly when there are large variations in the source water quality. Therefore, in the present paper, an indices-based approach is presented for categorization of irrigation water quality. These indices are mathematical equations that transform water quality data into a numeric value, which describes the quality of irrigation water. The proposed irrigation water quality index (IWQI), which is based on 12 parameters, classifies the water into five categories, viz. excellent, good, medium, bad, and very bad in the same manner as given by the CPCB and CGWB. In order to give proper rating to various parameters of the index, weights are computed using Saaty's analytic hierarchy process (AHP)-based multiple criteria decision analysis (MCDA) approach. This approach minimizes the subjectivity in assessment of weights and improves understanding of water quality issues by generating an overall index to describe the status of water quality. The proposed index will be beneficial for the water management authorities in ensuring safe water to the stakeholders.

Establishment of an AUC0-24 Threshold for Nephrotoxicity Is a Step towards Individualized Vancomycin Dosing for Methicillin-Resistant Staphylococcus aureus Bacteremia.

Unlike vancomycin trough concentrations, data on the utility of vancomycin pharmacokinetic (PK) parameters, namely, the area under the concentration-time curve from 0 to 24 h (AUC0-24), in predicting acute kidney injury (AKI) are limited. Our aim was to investigate this relationship in patients receiving vancomycin therapy for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B). A single-center retrospective observational cohort study involving 127 consecutive MRSA-B patients was conducted to examine the incidence of AKI (defined as serum creatinine of ≥0.5 mg/liter and a 50% increase from baseline) and vancomycin exposure parameters associated with nephrotoxicity. Bayesian estimation was used to predict individual vancomycin AUC0-24 All patients received vancomycin monotherapy for a minimum of 14 days following the diagnosis of MRSA-B. AKI was observed in 15.7% of patients (20/127). Clinical characteristics were similar between patients with and without AKI. At steady state, higher vancomycin trough concentrations were associated with AKI (17.2 mg/liter versus 13.1 mg/liter; P = 0.003). A vancomycin AUC0-24 threshold for AKI of >563 mg · h/liter was detected by classification and regression tree (CART) analysis; patients with exposures above this threshold were significantly more likely to experience AKI than patients with lower vancomycin exposures (40% [8/20] versus 11.2% [12/107]; P = 0.002). This parameter remained an independent predictor of AKI on multivariate logistic regression (odds ratio [OR], 5.07; 95% confidence interval [CI], 1.57 to 16.29; P = 0.006) and was a better predictor of nephrotoxicity than vancomycin trough concentrations. Overall, AKI is associated with higher vancomycin exposure as measured by AUC0-24 These results suggest that individualized patient dosing may be possible with dose modifications directed toward established pharmacodynamic targets while balancing AKI risks.

Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries.

BACKGROUND: Ultrasound has become an increasingly utilized tool for the imaging of the musculoskeletal system, especially for imaging the components of the knee. Even though MRI is touted as being the golden standard for identifying knee pathologies, the use of ultrasound has gained popularity in this field given its ability for rapid diagnosis. This study aims to investigate the efficacy of point-of-care ultrasound (POCUS) to diagnose injuries to the medial knee compartment when compared to magnetic resonance imaging (MRI). METHODS: This was a prospective, observational study conducted at an orthopedic outpatient clinic. Prospective patients with medial knee pain scheduled for an MRI of the knee were evaluated by POCUS prior to the MRI. Sonographic findings were then compared to MRI results to assess correlation. RESULTS: Nine patients were enrolled in the study. Median age was 53 years and eight were male (89%). POCUS demonstrated 100% sensitivity and 50% specificity for medial meniscus tear and 67% sensitivity and 83% specificity for medial collateral ligament (MCL) tear. CONCLUSION: Ultrasound may have a role as the initial rapid imaging modality in patients with suspected medial meniscus or MCL tears as it is highly sensitive, and it may serve as an effective screening tool for patients with both acute and chronic knee pain.

Optimized weak measurements of Goos-Hänchen and Imbert-Fedorov shifts in partial reflection.

The spatial and the angular variants of the Imbert-Federov (IF) beam shifts and the angular Goos-Hänchen (GH) shift contribute in a complex interrelated way to the resultant beam shift in partial reflection at planar dielectric interfaces. Here, we show that the two variants of the IF effects can be decoupled and separately observed by weak value amplification and subsequent conversion of spatial ↔angular nature of the beam shifts using appropriate pre and post selection of polarization states. Such optimized weak measurement schemes also enable one to nullify one effect (either the GH or the IF) and exclusively observe the other. We experimentally demonstrate this and illustrate various other intriguing manifestations of optimized weak measurements in elliptical and / or linear polarization basis. We also present a Poincare sphere based analysis on conversion / retention of the angular or spatial nature of the shifts with pre and post selection of states in weak measurement. The demonstrated ability to amplify, controllably decouple or combine the beam shifts via weak measurements may prove to be valuable for understanding the different physical contributions of the effects and for their applications in sensing and precision metrology.

Development & validation of a quantitative anti-protective antigen IgG enzyme linked immunosorbent assay for serodiagnosis of cutaneous anthrax.

BACKGROUND & OBJECTIVES: Anthrax caused by Bacillus anthracis is primarily a disease of herbivorous animals, although several mammals are vulnerable to it. ELISA is the most widely accepted serodiagnostic assay for large scale surveillance of cutaneous anthrax. The aims of this study were to develop and evaluate a quantitative ELISA for determination of IgG antibodies against B. anthracis protective antigen (PA) in human cutaneous anthrax cases. METHODS: Quantitative ELISA was developed using the recombinant PA for coating and standard reference serum AVR801 for quantification. A total of 116 human test and control serum samples were used in the study. The assay was evaluated for its precision, accuracy and linearity. RESULTS: The minimum detection limit and lower limit of quantification of the assay for anti-PA IgG were 3.2 and 4 µg/ml, respectively. The serum samples collected from the anthrax infected patients were found to have anti-PA IgG concentrations of 5.2 to 166.3 µg/ml. The intra-assay precision per cent CV within an assay and within an operator ranged from 0.99 to 7.4 per cent and 1.7 to 3.9 per cent, respectively. The accuracy of the assay was high with a per cent error of 6.5 - 24.1 per cent. The described assay was found to be linear between the range of 4 to 80 ng/ml (R [2] = 0.9982; slope = 0.9186; intercept = 0.1108). INTERPRETATION & CONCLUSIONS: The results suggested that the developed assay could be a useful tool for quantification of anti-PA IgG response in human after anthrax infection or vaccination.

A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma.

Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pretransplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995 and 2010. The probabilities of PFS at 1, 5 and 10 years were 66% (95% confidence interval (CI): 62-70), 52% (95% CI: 48-57) and 47% (95% CI: 42-51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ⩾90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low-, intermediate- and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64-80), 53% (95% CI: 47-59) and 23% (95% CI: 9-36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk of progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT.

Design of sampling locations for river water quality monitoring considering seasonal variation of point and diffuse pollution loads.

The design of a water quality monitoring network (WQMN) is a complicated decision-making process because each sampling involves high installation, operational, and maintenance costs. Therefore, data with the highest information content should be collected. The effect of seasonal variation in point and diffuse pollution loadings on river water quality may have a significant impact on the optimal selection of sampling locations, but this possible effect has never been addressed in the evaluation and design of monitoring networks. The present study proposes a systematic approach for siting an optimal number and location of river water quality sampling stations based on seasonal or monsoonal variations in both point and diffuse pollution loadings. The proposed approach conceptualizes water quality monitoring as a two-stage process; the first stage of which is to consider all potential water quality sampling sites, selected based on the existing guidelines or frameworks, and the locations of both point and diffuse pollution sources. The monitoring at all sampling sites thus identified should be continued for an adequate period of time to account for the effect of the monsoon season. In the second stage, the monitoring network is then designed separately for monsoon and non-monsoon periods by optimizing the number and locations of sampling sites, using a modified Sanders approach. The impacts of human interventions on the design of the sampling net are quantified geospatially by estimating diffuse pollution loads and verified with land use map. To demonstrate the proposed methodology, the Kali River basin in the western Uttar Pradesh state of India was selected as a study area. The final design suggests consequential pre- and post-monsoonal changes in the location and priority of water quality monitoring stations based on the seasonal variation of point and diffuse pollution loadings.

Simultaneous weak value amplification of angular Goos-Hänchen and Imbert-Fedorov shifts in partial reflection.

The optical analogue of quantum weak measurements has shown considerable promise for the amplification and observation of tiny optical beam shifts, namely Goos-Hänchen (GH) and Imbert-Fedorov (IF) shifts. Here, we demonstrate simultaneous weak value amplification of both the angular GH and the IF shifts in partial reflection of a fundamental Gaussian beam at planar dielectric interfaces. We employ pre and postselection schemes with appropriate linear polarization basis states for simultaneous weak measurements and amplification of both of these shifts. The experimentally observed enhancement of the beam shifts and their dependence on the angle of incidence are analyzed/interpreted via theoretical treatment of weak measurements.

The late phase of post-stroke neurorepair in aged rats is reflected by MRI-based measures.

Non-invasive criteria determining the progress of brain healing are especially important in aging, providing a case-specific therapeutic strategy in populations with dysregulated neurorepair mechanisms. We hypothesized that temporal evolution of magnetic resonance imaging (MRI) of T2 tissue relaxation values correlate with neurological severity scores (NS), and provide a robust indicator of healing in the aging brain after stroke. Pre-treatment of aged rats with brain-only proton irradiation was undertaken to pre-condition the inflammatory system. Irradiation was performed 10days prior to right middle cerebral artery occlusion (MCAO) for 50min (MCAO+Rad). Control rats included naïve (no ischemia, no radiation), irradiated-only (Rad), irradiated ischemic, or ischemic-only (MCAO). MRI and NS were obtained at 3, 14 and 28days post-stroke. At 28days post-stroke, immunofluorescence for visualizing blood vessels (Von Willebrand factor; vWF), neurons (neuronal nuclear antigen; NeuN), astrocytes (glial fibrillary acidic protein; GFAP), activated microglia/macrophages (ionized calcium-binding adapter molecule 1, Iba1), T-lymphocytes (CD3), phagocytes (ED1) and apoptotic cells (caspase-3) was assessed. We found a positive T2-NS correlation in irradiated, ischemic rats that corresponded to late-stage brain recovery. Late-stage brain recovery was characterized by improved neovascularization, formation of glio-vascular complexes (visualized by GFAP/vWF) and enhanced neuronal viability (by NeuN/caspase-3) in the peri-lesional zone. The immune response plateaued at the late stage of repair as evidenced by significantly decreased expression (41.7%) and distribution of phagocytes (phagocytic rim decreased 44.6%). We also found reduced infiltration of T-lymphocytes (CD3) in the brain and normalization of blood lymphocytes. The observed T2-NS correlations may provide a simple MRI-based criterion for recognition of regenerative brain transformation in aged patients following stroke. Selective activation of innate immunity and accelerated transition from pro-inflammatory to pro-healing macrophage phenotypes induced by localized brain irradiation is a potential mechanism for enhancing repair ability in the elderly.

Giant Goos-Hänchen shift in scattering: the role of interfering localized plasmon modes.

The longitudinal and transverse beam shifts, namely, the Goos-Hänchen (GH) and the Spin-Hall (SH) shifts are usually observed at planar interfaces. It has recently been shown that the transverse SH shift may also arise due to scattering of plane waves. Here, we show that analogous in-plane (longitudinal) shifts also exist in the scattering of plane waves from micro/nano systems. We study both the GH and the SH shifts in plasmonic metal nanoparticles/nanostructures and dielectric micro-particles employing a unified framework that utilizes the transverse components of the Poynting vector of the scattered wave. The results demonstrate that the interference of neighboring resonance modes in plasmonic nanostructures (e.g., electric dipolar and quadrupolar modes in metal spheres) leads to great enhancement of the GH shift in scattering from such systems. We also unravel interesting correlations between these shifts with the polarimetry parameters, diattenuation and retardance.

Impact of source of infection and vancomycin AUC0-24/MICBMD targets on treatment failure in patients with methicillin-resistant Staphylococcus aureus bacteraemia.

Despite recent controversies about toxicity and reduced efficacy, vancomycin remains the current treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. The parameter associated with treatment success is the vancomycin 24-h area under concentration-time curve to MIC ratio (AUC0-24/MIC). We aimed to determine the utility of calculated AUCs and explore the optimal AUC0-24/MIC targets associated with treatment success. In this single-centre retrospective observational cohort study of 127 patients with MRSA bacteraemia, forty-five (35.4%) did not respond to vancomycin treatment. Patient characteristics were essentially the same between those who did not respond to vancomycin treatment and those with treatment success, with independent predictors of treatment failure being source of bacteraemia (odds ratio (OR), 4.29; 95% confidence interval (CI), 1.50-12.26; p 0.007) and not achieving an AUC0-24/MICBMD (using broth microdilution) target of ≥398 (OR, 11.4; 95% CI, 4.57-28.46; p< 0.001). Bacteraemic source-specific thresholds were observed with a higher AUC0-24/MICBMD target of 440 required for high-risk sources (e.g. infective endocarditis) compared with 330 for low-risk sources (line related bacteraemia). Overall treatment success in patients with MRSA bacteraemia was associated with a vancomycin AUC0-24/MICBMD target of ≥398, with source-specific targets observed. Future vancomycin practice guidelines will need to take into account MIC methodology, source of bacteraemia and patient populations prior to setting targets and monitoring recommendations.

Preparation of nanoferrites and their applications.

Ferrites have a plethora of applications in the myriad fields of technology. Ferrites are widely used in conventional electronic, electrical, and magnetic devices. For the past two decades, since the discovery of the superparamagnetic nature of nanostructured ferrites, their applications in biotechnology and biomedical sciences as well as in advanced electronics and microwave devices have gained immense attention. In this review, the historical development of ferrite science and technology, and the synthesis methods for ferrite nanoparticle preparation and their applications have been discussed. Various synthetic methods with typical examples, their advantages as well as limitations have been discussed in details. Traditional industrial applications of various ferrites have also been discussed citing relevant patents. Recent developments on nanoferrite research in terms of synthetic methods as well as advanced applications have been discussed elaborately.

Quantitative Mueller matrix fluorescence spectroscopy for precancer detection.

Quantitative fluorescence spectroscopic Mueller matrix measurements from the connective tissue regions of human cervical tissue reveal intriguing fluorescence diattenuation and polarizance effects. Interestingly, the estimated fluorescence linear diattenuation and polarizance parameters were considerably reduced in the precancerous tissues as compared to the normal ones. These polarimetry effects of the autofluorescence were found to originate from anisotropically organized collagen molecular structures present in the connective tissues. Consequently, the reduction of the magnitude of these polarimetric parameters at higher grades of precancer was attributed to the loss of anisotropic organization of collagen, which was also confirmed by control experiments. These results indicate that fluorescence spectral diattenuation and polarizance parameters may serve as potentially useful diagnostic metrics.

Enhancing spin-orbit interaction of light by plasmonic nanostructures.

The spin orbit interactions (SOI) of light mediated by single scattering from plasmon resonant metal nanoparticles (nanorods and nanospheres) are investigated using Jones and Mueller matrix polarimetry formalism. The effect of neighboring resonances in plasmonic nanostructures (e.g., orthogonal electric dipolar modes in rods or electric dipolar and quadrupolar modes in spheres) on the individual SOI effects are analyzed and interpreted via the Mueller matrix-derived polarimetry characteristics, namely, diattenuation d and retardance δ. The results clearly reveal that each of these can be controllably tuned and enhanced by exploiting the interference of neighboring modes.

Cystic schwannoma of the pelvis.

Schwannomas are benign tumours that arise from the Schwann cells of nerve fibres. They commonly occur in the head and neck, mediastinum and extremities. They are extremely rare in the pelvis. These are usually slow-growing tumours and are often detected incidentally. Preoperative diagnosis is extremely difficult as there are no definitive signs on imaging. Aspiration biopsy is often inconclusive or misleading. Surgical excision is both diagnostic and therapeutic. As these tumours are often large in size, open excision is most commonly performed. We describe a case of a large, cystic schwannoma of the pelvis causing bladder outlet obstruction and bilateral hydroureteronephrosis. Complete surgical excision was performed laparoscopically.

Serodiagnosis of human cutaneous anthrax in India using an indirect anti-lethal factor IgG enzyme-linked immunosorbent assay.

Anthrax, caused by Bacillus anthracis, is primarily a zoonotic disease. Being a public health problem also in several developing countries, its early diagnosis is very important in human cases. In this study, we describe the use of an indirect enzyme-linked immunosorbent assay (ELISA) for detection of anti-lethal factor (anti-LF) IgG in human serum samples. A panel of 203 human serum samples consisting of 50 samples from patients with confirmed cutaneous anthrax, 93 samples from healthy controls from areas of India where anthrax is nonendemic, 44 samples from controls from an area of India where anthrax is endemic, and 16 patients with a disease confirmed not to be anthrax were evaluated with an anti-LF ELISA. The combined mean anti-LF ELISA titer for the three control groups was 0.136 ELISA unit (EU), with a 95% confidence interval (CI) of 0.120 to 0.151 EU. The observed sensitivity and specificity of the ELISA were 100% (95% CI, 92.89 to 100%) and 97.39% (95% CI, 93.44 to 99.28%), respectively, at a cutoff value of 0.375 EU, as decided by receiver operating characteristic (ROC) curve analysis. The likelihood ratio was found to be 49.98. The positive predictive value (PPV), negative predictive value (NPV), efficiency, and Youden's index (J) for reliability of the assay were 92.5%, 100%, 98.02%, and 0.97, respectively. The false-positive predictive rate and false-negative predictive rate of the assay were 2.61% and 0%. The assay could be a very useful tool for early diagnosis of cutaneous anthrax cases, as antibodies against LF appear much earlier than those against other anthrax toxins in human serum samples.