Asian guidelines for UTIs & STIs UTI section: Complicated UTIs with neurogenic bladder.

EPIDEMIOLOGY AND PATHOGENESIS: Urinary tract infection (UTI) in patients with neurogenic bladder causes significant morbidity and mortality. DIAGNOSIS: UTI in neurogenic bladder causes atypical symptomatology. Urine tests are pivotal in confirming or excluding UTI, and in guiding appropriate antibiotic treatment. TREATMENT: 1. Symptomatic UTI warrants appropriate antibiotic treatment with reference to culture results and local antibiotic resistance patterns. Asymptomatic bacteriuria should not be treated, and antibiotic prophylaxis is generally not recommended.2. Adequate bladder drainage is essential in reducing the occurrence of urinary tract infections.3. Recurrent UTI in neurogenic bladder may necessitate the treatment of neurogenic detrusor overactivity and the restoration of low bladder pressure during bladder storage and voiding by drugs or surgery.

Size Preferences Uptake of Glycosilica Nanoparticles to MDA-MB-231 Cell.

Recently, studies on the development and investigation of carbohydrate-functionalized silica nanoparticles (NPs) and their biomedicine applications such as cell-specific targeting and bioimaging has been carried out extensively. Since the number of breast cancer patients has been growing in recent years, potential NPs were being studied in this project for targeting breast cancer cells. Mannose receptors can be found on the surface of MDA-MB-231, which is a kind of human breast cancer cell line. Therefore, we decorated a cyanine 3 fluorescent dye (Cy3) and mannosides on the surface of silica NPs for the purpose of imaging and targeting. Galactoside was also introduced onto the surface of silica NPs acting as a control sample. Various sizes of silica NPs were synthesized by using different amounts of ammonium to investigate the effect of the size of NPs on the cellular uptake rate. The physical properties of these NPs were characterized by scanning electron microscope, dynamic light scattering, and their zeta potential. Cellular experiments demonstrated that mannoside-modified NPs can be uptaken by MDA-MB-231. From the experiment, we found out that the best cellular uptake rate of nanoparticle size is about 250 nm. The MTT assay showed that Man@Cy3SiO2NPs are not cytotoxic, indicating they may have the potential for biomedical applications.

Practical Use of Regularization in Individualizing a Mathematical Model of Cardiovascular Hemodynamics Using Scarce Data.

Individualizing physiological models to a patient can enable patient-specific monitoring and treatment in critical care environments. However, this task often presents a unique "practical identifiability" challenge due to the conflict between model complexity and data scarcity. Regularization provides an established framework to cope with this conflict by compensating for data scarcity with prior knowledge. However, regularization has not been widely pursued in individualizing physiological models to facilitate patient-specific critical care. Thus, the goal of this work is to garner potentially generalizable insight into the practical use of regularization in individualizing a complex physiological model using scarce data by investigating its effect in a clinically significant critical care case study of blood volume kinetics and cardiovascular hemodynamics in hemorrhage and circulatory resuscitation. We construct a population-average model as prior knowledge and individualize the physiological model via regularization to illustrate that regularization can be effective in individualizing a physiological model to learn salient individual-specific characteristics (resulting in the goodness of fit to individual-specific data) while restricting unnecessary deviations from the population-average model (achieving practical identifiability). We also illustrate that regularization yields parsimonious individualization of only sensitive parameters as well as adequate physiological plausibility and relevance in predicting internal physiological states.

Towards sustainable consumption: A socio-economic analysis of household waste recycling outcomes in Hong Kong.

Many high-density cities struggle to find space for disposing municipal solid waste. Hong Kong is one of these cities, seeking to scale up waste recovery efforts as an alternative to disposal. However, territory-wide recovery initiatives do not account for socio-economic variations across place, leading to mixed outcomes among diverse communities. This study aims to investigate socio-economic effects on recycling behavior in a sample of subsidized rental housing estates. It constitutes an improvement from previous studies by using the entire estate as a unit of analysis and analyzing actual recycling outcomes, which have received limited attention from researchers. The analysis focused on the volume of recyclables collected from 158 public housing estates in Hong Kong, with an average population of 12,285. Results suggest that recycling outcomes vary with a limited set of socio-economic factors. Housing estates managed by a private property management company and populated by better off households collected more recyclables from their residents. Measures of absolute and relative recycling intensity achieved similar results. The findings will be useful for identifying residential communities requiring additional support for promoting waste separation and recycling. Differentiated policies for economically disadvantaged communities are warranted.

National income and environmental concern: Observations from 35 countries.

National income produces mixed impacts on public environmental concern. In a cross-national survey, environmental concern was measured in terms of propensity to act and environmental risk perception. Results of a multilevel regression analysis show that these two measures respond to gross domestic product per capita in opposite ways. Citizens of advanced industrial countries are more likely than those of lower-income countries to contribute to environmental protection. However, they are less likely to see the harmful impacts on the environment as very dangerous. Using an indicator of national adaptive capacity, this article demonstrates that environmental risk perception is a function of a country's estimated capacity for coping with condition changes. The stronger sense of collective security among citizens of wealthier nations offers a possible explanation for the negative effects of national income. These results indicate the complex relationship between development and public environmental concern across countries.

A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA).

HIV facial lipoatrophy (FLA) is characterized by facial volume loss. HIV FLA affects the facial contours of the cheeks, temples, and orbits, and is associated with social stigma. Although new highly active antiretroviral therapy medications are associated with less severe FLA, the prevalence of HIV FLA among treated individuals exceeds 50%. The goal of our systematic review is to examine published clinical studies involving the use of filler agents for aesthetic treatment of HIV FLA and to provide evidence-based recommendations based on published efficacy and safety data. A systematic review of the published literature was performed on July 1, 2015, on filler agents for aesthetic treatment of HIV FLA. Based on published studies, poly-L-lactic acid is the only filler agent with grade of recommendation: B. Other reviewed filler agents received grade of recommendation: C or D. Poly-L-lactic acid may be best for treatment over temples and cheeks, whereas calcium hydroxylapatite, with a Food and Drug Administration indication of subdermal implantation, may be best used deeply over bone for focal enhancement. Additional long-term randomized controlled trials are necessary to elucidate the advantages and disadvantages of fillers that have different biophysical properties, in conjunction with cost-effectiveness analysis, for treatment of HIV FLA.

Let's Talk About Sex! - Improving sexual health for patients in stroke rehabilitation.

Sexual health contributes greatly to quality of life. Research shows that stroke survivors want to learn and talk about sexual health, but are not given information. In keeping with the Canadian Best Practice Recommendations for Stroke Care, this project aimed to provide all stroke rehabilitation inpatients with the opportunity to discuss sexual health concerns with healthcare providers at West Park Healthcare Centre, a rehabilitation and complex continuing care centre in Toronto. Gap analysis conducted via staff member interviews and retrospective chart reviews showed that close to no patients were given the opportunity to discuss sexual health concerns at baseline. Plan-Do-Study-Act (PDSA) methodology was used as the project framework. The changes implemented included a reminder system, standardization of care processes for sexual health, patient-centred time points for the delivery of sexual health discussions, and the development of a sexual health supported conversation tool for patients with aphasia. By the end of the ten month project period and after three PDSA cycles, the percentage of patients provided with the opportunity to discuss sexual health during inpatient rehabilitation increased to 80%. This quality improvement project successfully implemented the Canadian Best Practice Recommendations for Stroke Care with respect to sexual health. Lessons learned included the importance of early baseline data collection and advance planning for tools used in QI projects. Future projects may focus on improving the discussion of sexual health concerns during outpatient stroke rehabilitation.

Come rain or shine? Public expectation on local weather change and differential effects on climate change attitude.

Tailored messages are instrumental to climate change communication. Information about the global threat can be 'localised' by demonstrating its linkage with local events. This research ascertains the relationship between climate change attitude and perception of local weather, based on a survey involving 800 Hong Kong citizens. Results indicate that concerns about climate change increase with expectations about the likelihood and impacts of local weather change. Climate change believers attend to all three types of adverse weather events, namely, temperature rises, tropical cyclones and prolonged rains. Climate scepticism, however, is not associated with expectation about prolonged rains. Differential spatial orientations are a possible reason. Global climate change is an unprecedented and distant threat, whereas local rain is a more familiar and localised weather event. Global climate change should be articulated in terms that respect local concerns. Localised framing may be particularly effective for engaging individuals holding positive views about climate change science.

Significance of perceived social expectation and implications to conservation education: turtle conservation as a case study.

The likelihood of participating in wildlife conservation programs is dependent on social influences and circumstances. This view is validated by a case study of behavioral intention to support conservation of Asian turtles. A total of 776 college students in China completed a questionnaire survey designed to identify factors associated with their intention to support conservation. A regression model explained 48 % of variance in the level of intention. Perceived social expectation was the strongest predictor, followed by attitudes toward turtle protection and perceived behavioral control, altogether explaining 44 %. Strong ethics and socio-economic variables had some statistical significant impacts and accounted for 3 % of the variance. The effects of general environmental awareness, trust and responsibility ascription were modest. Knowledge about turtles was a weak predictor. We conclude that perceived social expectation is a limiting factor of conservation behavior. Sustained interest and commitment to conservation can be created by enhancing positive social influences. Conservation educators should explore the potential of professionally supported, group-based actions that can nurture a sense of collective achievement as part of an educational campaign.

Lack of association between pretreatment neurology consultation and subsequent protocol deviation in tissue plasminogen activator-treated patients with stroke.

BACKGROUND AND PURPOSE: We evaluated the hypothesis that consultation with neurology would be associated with fewer protocol deviations in tissue plasminogen activator-treated patients with stroke. METHODS: A retrospective analysis of consecutive tissue plasminogen activator-treated patients with acute patients was performed. Using chi(2) tests, the proportion of patients with a protocol deviation was calculated and compared between those with evidence of a neurology consultation and those without. Logistic regression was then used to determine the OR for protocol deviation at the same time as controlling for clinical presentation covariates. RESULTS: Two hundred seventy-three subjects were included. Protocol deviation rates did not significantly differ between those with (44%) and those without (41%) a consultation. The adjusted OR for deviation comparing any consultation versus nonconsultation was 1.25 (95% CI: 0.58 to 2.68). There was no statistically significant difference between symptomatic intracranial hemorrhage and in-hospital mortality rates between the groups. The proportion of patients with pretreatment deviations not related to timing was low in both the consultation (9.7%) and nonconsultation groups (8.1%). CONCLUSIONS: Neurological consultation was not found to be associated with decreased protocol deviations in this cohort, although the high proportion of deviations with and without consultation suggests that quality improvement is needed. Most observed pretreatment deviations were attributable to timing. As acute stroke care becomes more efficient and additional methods in reducing door-to-treatment times are sought, models in which emergency physicians direct the initial phase of treatment may merit further consideration.

Kinase-dead PKB gene therapy combined with hyperthermia for human breast cancer.

We have previously demonstrated that protein kinase B (PKB) is a mediator of heat-induced apoptosis for human breast cancer cells. To investigate the therapeutic potential of abrogating the function of this important survival protein, a novel replication-deficient adenovirus was constructed, wherein a mutant, kinase-inactive PKB gene (AAA) was inserted downstream of the CMV promoter. Two human breast cancer cell lines, MCF-7 and MDA-468, were treated, along with the MCF-10 serving as a "normal" mammary epithelial comparator. Apoptosis was increased with adv.AAA (25 PFU/cell) infection alone, but was significantly enhanced with the addition of heat exposure. Differential survival was observed with the MDA-468 cancer cells being more sensitive than the MCF-7 cells. The MCF-10 cells, in contrast, were most resistant to these treatments. Results from the clonogenic assay reflected the apoptosis data, with an apparent additive interaction between adv.AAA and hyperthermia treatments, again with greater differential sensitivity of the malignant, compared to the "normal" mammary epithelial cells. Heat or adv.beta-gal treatments led to phosphorylation of PKB and Forkhead, but this phosphorylation was reduced with adv.AAA therapy. In parallel, the combination of adv.AAA and heat treatment reduced PKB kinase activity more so than with either heat or adv.beta-gal alone. In conclusion, our results demonstrate that inhibition of the PKB-dependent survival pathway will promote apoptosis and thermosensitization in malignant breast cancer cells, with relative sparing of their normal counterpart, suggesting that a therapeutic gain could be achievable using this therapeutic strategy.