Cutaneous leishmaniasis (CL) is a chronic skin infection caused by Leishmania parasites, causing single or multiple skin nodules and ulcers on the exposed body locations. Healing of lesions is ...followed by scar formation. Active and healed CL lesions may affect patient's health related quality of life (HRQL). The aim of this study was to determine whether the body location of the leishmaniasis lesions affects the HRQL of localized CL patients in Suriname. The HRQL of 163 patients with CL was assessed by Skindex-29 and EQ-5D/VAS questionnaires. Forty-six patients out of the total study population also participated in a qualitative anthropological study involving in depth interviews. All patients were allocated in 4 groups in the following hierarchy: head and face, upper limbs, lower limbs and trunk. Patients with lesions on the lower limbs had significantly higher Skindex-29 scores, indicating worse HRQL, in the symptom scale compared to lesions on head/face and trunk. The lower limb group was more likely to report problems in the dimensions self-care, mobility, daily activities and pain/discomfort of the EQ-5D. Little to no social stigma was reported in the in-depth interviews. The findings of this study indicate that Surinamese patients with CL lesions located on the lower limbs had more impairment in HRQL than on other body locations. Stigma related to CL seems to be virtually absent in Suriname.
Video‐based flipped class instruction can strengthen the learning motivation of students. The effectiveness of flipped class instruction on teaching effectiveness and subject satisfaction has been ...evaluated previously. The present study aims to examine the impact of two aspects of subject reading motivation. A total of 100 secondary school students were recruited from 4 classes of 25 students (ie, video‐based flipped Mathematics class, traditional Mathematics class, video‐based flipped Liberal Studies (LS) class and traditional LS class) in two local secondary schools. The same teachers taught both the traditional and video‐based flipped classes in their subject. The students filled in questionnaires which measured: motivation for general reading; motivation for subject reading; academic subject satisfaction and perceived teaching effectiveness of the teachers. Analysis of covariance controlling for motivation for general reading revealed that students in the flipped classes reported significantly lower motivation for subject reading including reading curiosity, reading importance and reading compliance (t (1,98) = 10.52, p < 0.001; t (1,98) = 7.68, p < 0.001; t (1,98) = 20.39, p < 0.001, respectively). However, students in the flipped classes reported significantly higher satisfaction and teaching effectiveness than those in the traditional classes (t (1,98) = −15.61. p < 0.001; t (1,98) = −11.98, p <0.001, respectively). A partial correlation controlling for motivation for general reading indicated that motivation for subject reading was negatively associated with academic subject satisfaction and perceived teaching effectiveness of teachers (rs ranged from −0.51 to −0.62, p < 0.001). Video‐based flipped class instruction was not only related to increased academic subject satisfaction and teaching effectiveness but also associated with lower motivation for subject reading. These findings suggest that video‐based flipped class instruction had limited capability to strengthen the learning motivation of students.
Air ionizers and 222-nm krypton-chlorine (KrCl) excilamp have proven to be effective disinfection apparatus for bacteria and viruses with limited health risks. We determined inactivation efficiencies ...by operating them individually and in combined modules. Gram-positive and gram-negative bacteria, non-enveloped dsDNA virus, and enveloped dsRNA virus were examined in a designed air disinfection system. Our results showed that the bioaerosols were inactivated efficiently by negative ionizers and far-UVC (222-nm), either used individually or in combination. Among which the combined modules of negative ionizers and KrCl excilamp had the best disinfection performance for the bacteria. The aerosolized virus P22 and Phi 6 were more susceptible to 222-nm emitted by KrCl excilamp than negative air ions. Significant greater inactivation of bacterial bioaerosols were identified after treated by combined treatment of negative air ion and far-UVC for 2 minutes (Escherichia coli, 6.25 natural log (ln) reduction; Staphylococcus epidermidis, 3.66 ln reduction), as compared to the mean sum value of inactivation results by respective individual treatment of negative ionizers and KrCl excilamp (Escherichia coli, 4.34 ln; Staphylococcus epidermidis, 1.75 ln), indicating a synergistic inactivation effect. The findings provide important baseline data to support the design and development of safe and high-efficient disinfection systems.
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•The bacteria and bacteriophage were effectively inactivated by far-UVC (222-nm) and negative air ions.•Synergistic effect on bacterial inactivation was observed when combining far-UVC and negative air ions.•The combined treatment of far-UVC and negative air ions could enhance efficiency by 37–116 %.•This air disinfection system produced a very low ozone concentration.
Skeletal muscle thickness is a valuable indicator of several aspects of a muscle's functional capabilities. We used computational analysis of ultrasound images, recorded from 10 humans walking and ...running at a range of speeds (0.7-5.0 m s
), to quantify interactions in thickness change between three ankle plantar flexor muscles (soleus, medial and lateral gastrocnemius) and quantify thickness changes at multiple muscle sites within each image. Statistical analysis of thickness change as a function of stride cycle (1d statistical parametric mapping) revealed significant differences between soleus and both gastrocnemii across the whole stride cycle as they bulged within the shared anatomical space. Within each muscle, changes in thickness differed between measurement sites but not locomotor condition. For some of the stride, thickness measures taken from the distal-mid image region represented the mean muscle thickness, which may therefore be a reliable region for these measures. Assumptions that muscle thickness is constant during a task, often made in musculoskeletal models, do not hold for the muscles and locomotor conditions studied here and researchers should not assume that a single thickness measure, from one point of the stride cycle or a static image, represents muscle thickness during dynamic movements.
Bioaerosols play a significant role in the transmission of many infectious diseases, especially in enclosed indoor environments. Ultraviolet (UV) disinfection has demonstrated a high efficacy in ...inactivating microorganisms suspended in the air. To develop more effective and efficient UV disinfection protocols, it is necessary to evaluate and optimize the effectiveness of UV disinfection against aerosolized bacteria and viruses across the entire UV spectrum. In this study, we evaluated the performance of UV disinfection across the UV spectrum, ranging from 222 to 365 nm, against aerosolized bacteria and viruses, including Escherichia coli, Staphylococcus epidermidis, Salmonella enterica, MS2, P22, and Phi6. Six commonly available UV sources, including gas discharge tubes and light-emitting diodes with different emission spectra, were utilized, and their performance in terms of inactivation efficacy, action spectrum, and energy efficiency was determined. Among these UV sources, the krypton chloride excilamp emitting at a peak wavelength of 222 nm was the most efficient in inactivating viral bioaerosols. A low-pressure mercury lamp emitting at 254 nm performed well on both inactivation efficacy and energy efficiency. A UV light-emitting diode emitting at 268 nm demonstrated the highest bacterial inactivation efficacy, but required approximately 10 times more energy to achieve an equivalent inactivation level compared with that of the krypton chloride excilamp and low-pressure mercury lamp. This study provides insights into UV inactivation on bioaerosols, which can guide the development of effective wavelength-targeted UV air disinfection technologies and may significantly help reduce bioaerosol transmission in public areas.
Abstract
BACKGROUND
The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy ...is important but challenging. In cases of ICAS, we often observe a phenomenon we call the microcatheter “first-pass effect,” which is temporary blood flow through the occluded intracranial artery when the angiographic microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally.
OBJECTIVE
To evaluate whether this microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism.
METHODS
A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the microcatheter first-pass effect for prediction of ICAS were assessed.
RESULTS
The microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P < .001). For identifying ICAS, sensitivity, specificity, PPV, and accuracy of the microcatheter first-pass effect were 90.9%, 87.2%, 80.0%, 88.5%, respectively.
CONCLUSION
The sensitivity and PPV of the microcatheter first-pass effect are high for prediction of ICAS in patients with acute symptoms.
Metal-assisted chemical etching (MACE) is a versatile anisotropic etch for silicon although its mechanism is not well understood. Here we propose that the Schottky junction formed between metal and ...silicon plays an essential role on the distribution of holes in silicon injected from hydrogen peroxide. The proposed mechanism can be used to explain the dependence of the etching kinetics on the doping level, doping type, crystallographic surface direction, and etchant solution composition. We used the doping dependence of the reaction to fabricate a novel etch stop for the reaction.
Background
New oral anticoagulants (NOACs) offer an alternative to warfarin for preventing stroke in patients with atrial fibrillation. NOACs are expected to replace warfarin and other vitamin K ...antagonists for most of their indications in the future. Knowledge of the use of NOACs in the perioperative period is important for optimal care.
Methods
Studies that reported on the use of NOACs were identified, focusing on evidence‐based guidance relating to the perioperative period. PubMed was searched for relevant articles published between January 2000 and January 2014.
Results
The anticipated expanded clinical use of NOACs such as rivaroxaban (Xarelto™), apixaban (Eliquis™) and dabigatran (Pradaxa™) has the potential to simplify perioperative anticoagulant management because of fewer drug–drug interactions, rapid onset of action, predictable pharmacokinetics and relatively short half‐lives. However, coagulation status cannot be monitored by international normalized ratio and no antidotes are currently available. In elective surgery, it is important to discontinue the use of NOACs, with special consideration of renal function as route of elimination. Guidelines for the management of bleeding complications in patients on NOACs are provided, and may be considered for trauma and emergency surgery. Haemodialysis could be considered for bleeding with use of dabigatran. Better options for reversal of the effects of NOACs when bleeding occurs may follow with novel drugs.
Conclusion
Management of NOACs in elective and emergency conditions requires knowledge of time of last intake of drug, current renal function and the planned procedure in order to assess the overall risk of bleeding. Currently no antidote exists to reverse the effects of these drugs.
Increasing use, no antidote available
The novel coronavirus disease 2019 (COVID-19) epidemic that emerged in December 2019 has rapidly evolved in recent months to become a worldwide and ongoing pandemic. Shortage of medical masks remains ...an unresolved problem. This study aims to investigate the filtration efficiency (FE) of home-made masks that could be used as alternatives for community mitigation of COVID-19.
Experimental observational analytic study.
The FE of home-made masks and medical masks (as the control) were tested under laminar flow within a scaled air duct system using nebulised NaCl aerosols sized 6–220 nm. The size-resolved NaCl aerosol count was measured using a scanning mobility particle-sizer spectrometer. Home-made masks with an external plastic face shield also underwent a splash test. In addition, the fibre structures of medical masks were studied under an electron microscope after treatment with either 75% alcohol or soap and water at 60 °C.
The FE of the home-made masks at 6–200 nm were non-inferior to that of medical masks (84.54% vs 86.94%, P = 0.102). Both types of masks achieved an FE of 90% at 6–89 nm. A significantly higher FE was achieved when one piece of tissue paper was added adjacent to the inner surface of the medical mask than medical mask alone (6–200 nm: 91.64% vs 86.94%, P < 0.0001; 6–89 nm: 94.27% vs 90.54%, P < 0.0001; 90–200 nm: 82.69% vs 73.81%, P < 0.0001). The plastic face shield prevented the home-made mask from fluid splash. The fibre structures of the external surface of medical masks were damaged after treatment with either 75% alcohol or soap and water at 60 °C.
The home-made masks in this study, which were made of one piece of tissue paper and two pieces of kitchen towels, layered from face to external, had an FE at 6–200 nm non-inferior to that of medical mask materials, which had a certified FE of ≥95% at 3 μm. In the current COVID-19 pandemic with the shortage of medical masks, these home-made masks combined with an external plastic shield could be used as an alternative to medical masks for community mitigation. In addition, one piece of tissue paper could be placed adjacent to the inner surface of a medical mask to prolong effective lifespan of the medical mask. These demand reduction strategies could be used to reserve medical masks for use in healthcare and certain high-risk community settings, such as symptomatic persons, caregivers and attendees to healthcare institutions.
•Our home-made masks have filtration efficiency comparable to medical masks.•They may be used as alternatives in low-risk community settings.•Plastic face shields may be used in situations when social distancing and/or face masks are not feasible.•Decontamination of medical masks with 75% alcohol or soap and water damages the fibres and is not recommended.•Community mitigation measures are an important part of the global efforts in combating COVID-19.
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