Water quality risks of 'improved' water sources: evidence from Cambodia.

OBJECTIVES: The objective of this study was to investigate the quality of on-plot piped water and rainwater at the point of consumption in an area with rapidly expanding coverage of 'improved' water sources. METHODS: Cross-sectional study of 914 peri-urban households in Kandal Province, Cambodia, between July-August 2011. We collected data from all households on water management, drinking water quality and factors potentially related to post-collection water contamination. Drinking water samples were taken directly from a subsample of household taps (n = 143), stored tap water (n = 124), other stored water (n = 92) and treated stored water (n = 79) for basic water quality analysis for Escherichia coli and other parameters. RESULTS: Household drinking water management was complex, with different sources used at any given time and across seasons. Rainwater was the most commonly used drinking water source. Households mixed different water sources in storage containers, including 'improved' with 'unimproved' sources. Piped water from taps deteriorated during storage (P < 0.0005), from 520 cfu/100 ml (coefficient of variation, CV: 5.7) E. coli to 1100 cfu/100 ml (CV: 3.4). Stored non-piped water (primarily rainwater) had a mean E. coli count of 1500 cfu/100 ml (CV: 4.1), not significantly different from stored piped water (P = 0.20). Microbial contamination of stored water was significantly associated with observed storage and handling practices, including dipping hands or receptacles in water (P < 0.005), and having an uncovered storage container (P = 0.052). CONCLUSIONS: The microbial quality of 'improved' water sources in our study area was not maintained at the point of consumption, possibly due to a combination of mixing water sources at the household level, unsafe storage and handling practices, and inadequately treated piped-to-plot water. These results have implications for refining international targets for safe drinking water access as well as the assumptions underlying global burden of disease estimates, which posit that 'improved' sources pose minimal risks of diarrhoeal diseases.

Analysis of biofluids for gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) by headspace GC-FID and GC-MS.

The past few years have seen a dramatic increase in the abuse of gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) in the United States. The abuse stems primarily from their euphoric and sedative properties, but these substances are also misused by bodybuilders as steroid alternatives. Recently there has been an alarming increase in the use of GHB and GBL in crimes of drug-facilitated sexual assault. A rapid and sensitive procedure was developed for the analysis of biofluids containing GHB and GBL. Two separate aliquots of a biological specimen were spiked with an alpha-methylene-gamma-butyrolactone internal standard solution. One of the aliquots was treated with concentrated sulfuric acid for cyclization of GHB to GBL and the other remained untreated. Both aliquots were extracted with methylene chloride and concentrated. Extracts were screened using automated headspace gas chromatography-flame-ionization detection (GC-FID). Qualitative findings were quantitated and confirmed in a manner similar to the GC-FID procedure with some modifications. A calibrated solution of GHB-d6 (or GBL-d6, when warranted) was added to the aliquots at a concentration approximating the level determined by the GC-FID screen. The extraction was as described with conversion of GHB to GBL, but analysis was by full-scan gas chromatography-mass spectrometry (El). Quantitation was performed by comparison of the area of the molecular ion of the parent drug (m/z 86) to that of the calibrated deuterated analogue (m/z 92). This analytical procedure allows for the rapid detection of GHB and GBL in biofluids. Its sensitivity has proven useful for the toxicological investigation of cases of drug-facilitated sexual assault.

Analysis of biofluids for flunitrazepam and metabolites by electrospray liquid chromatography/mass spectrometry.

A rapid and sensitive liquid chromatography/electrospray ionization mass spectrometry (LC/MS) procedure has been developed for the analysis of biofluids containing flunitrazepam and its metabolites. Specimens were spiked with deuterated analogs of the analytes. Urine specimens were enzymatically hydrolyzed and blood specimens were untreated. Extractions were carried out using CleanScreen DAU SPE cartridges. The drugs were separated on a C18 column using a methanol-water-ammonium hydroxide (60:40: 0.03 v/v) mobile phase. After determination of base peaks using full scan mass spectrometry, the mass spectrometry method was optimized to operate in selected-ion monitoring (SIM) mode for the base peak of each analyte. Positive findings were confirmed by LC/MS/MS using the same mobile phase and column. This analytical procedure allows for the detection of low levels of flunitrazepam and metabolites in biofluids. It is useful for ascertaining the role of flunitrazepam in cases of drug-facilitated sexual assault.

Detection of coronary artery disease in asymptomatic aircrew members with thallium-201 scintigraphy.

Thallium-201 exercise myocardial perfusion scintigraphy was accomplished in 130 aircrew members prior to their undergoing coronary angiography. Most were undergoing cardiac catheterization for an abnormal exercise response to treadmill testing. Of these, 22 men had arteriographic evidence of obstructive coronary disease of at least 50% narrowing in a single vessel. All had abnormal myocardial scintigrams. There were 12 other aviators who had minimal degrees of coronary artery disease with lesions less than 50% as the maximum degree of obstruction. Of these, 8 had abnormal thallium scans showing a perfusion defect in the area of the myocardium, presumably supplied by the diseased coronary artery. Of the 96 men with normal angiograms, only 4 had abnormal myocardial scintigraphy. An abnormal myocardial scintigram was often associated with significant obstructive disease. A normal scan accurately ruled out the presence of high-grade obstructive lesions and missed only four cases of minimal coronary disease. The application of gated thallium myocardial perfusion scans in the practice of aerospace cardiology has important significant applications for followup of therapeutic modalities as well as screening for evidence of myocardial ischemia in apparently healthy aircrew members.

The Use of Benzodiazepines to Facilitate Sexual Assault.

Benzodiazepines are one of the classes of drugs most commonly associated with drug-facilitated sexual assault. As a widely prescribed class of medications and abused drugs, benzodiazepines are extensively available. Their sedating and amnesic effects make them effective candidates for use in drug-facilitated assaults. Detection methods for benzodiazepines and their metabolites in biological fluids are plentiful, but methods must be tailored to the low concentrations of drugs and metabolites expected to be encountered in these cases.

The Use of GHB to Facilitate Sexual Assault.

γ-Hydroxybutyric acid (GHB) and its metabolic precursors, γ-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), may be among the most favored drugs used to commit drug-facilitated sexual assault (DFSA). In fact, federal legislation was enacted in the form of the Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000 to control and penalize use and distribution of GHB, GBL, and 1,4-BD. Unfortunately, solid proof of their use in many cases is difficult to obtain because GHB, GBL, and 1,4-BD have strong sedative and memory-impairing effects and are rapidly eliminated after ingestion. To further complicate the matter, GHB is a metabolite of γ-aminobutyric acid (GABA), a naturally occurring neurotransmitter in humans. This review focuses on the chemistry and pharmacology of these drugs and their use in DFSA. An overview of analytical techniques used to identify their presence is provided, as well as guidance on the toxicological interpretation of findings of GHB in biological specimens.

Challenges of Drug-Facilitated Sexual Assault.

This article provides the reader with an understanding of the numerous challenges of drug-facilitated sexual assaults (DFSA). The challenges are categorized as follows: the drugs, reporting the crime, evidence collection, and laboratory analysis of specimens. The challenges associated with the drugs used to commit DFSA emphasizes the pharmacological effects of strong central nervous system depressants and how the pharmacokinetics and pharmacodynamics of these drugs create difficulties in an investigation. For example, while sexual assaults are generally considered to be a significantly underreported crime, the drug effects further complicate victims' reporting to law enforcement. Any delay in reporting decreases the ability of a laboratory to detect the presence of drugs or metabolites in useful evidentiary specimens such as blood and urine. Finally, differences in instrumentation and mission from one laboratory to the next will impact the ability to provide consistent identification of DFSA drugs or metabolites in these cases. Although the true prevalence of DFSAs will never be fully known, acknowledgment of the many challenges that come with these cases provides insight as to how to improve chances of successfully investigating DFSA allegations.

The Frequency of Drug-Facilitated Sexual Assault Investigations.

While there is a general belief throughout parts of the world that drug-facilitated sexual assault (DFSA) cases have dramatically increased in recent times, the true prevalence of DFSA will never be fully realized. This is due to the general underreporting of sexual assaults, the pharmacodynamics of the drugs used to commit these crimes, the challenges that delayed reporting can impose on the charges associated with these cases, and the lack of a uniform system of defining and statistically capturing data on sexual assaults that are facilitated by drugs. Over the years, a number of studies have attempted to quantitate the frequency of DFSA in various countries throughout the world. Unfortunately, no two studies have taken the same approach in their assessment of DFSA; therefore, it is difficult to combine their results to allow for a realistic evaluation of how prevalent DFSA really is. This manuscript reviews the studies that have attempted such an assessment of DFSA prevalence to compare and contrast their results.

Stabilisation of critically ill children at the district general hospital prior to intensive care retrieval: a snapshot of current practice.

OBJECTIVE: To describe current practice during stabilisation of children presenting with critical illness to the district general hospital (DGH), preceding retrieval to intensive care. DESIGN: Observational study using prospectively collected transport data. SETTING: A centralised intensive care retrieval service in England and referring DGHs. PATIENTS: Emergency transports to intensive care during 2-month epochs from 4 consecutive years (2005-2008). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Proportion of key airway, breathing, and circulatory and neurological stabilisation procedures, such as endotracheal intubation, mechanical ventilation, vascular access, and initiation of inotropic agents, performed by referring hospital staff prior to the arrival of the retrieval team. RESULTS: 706 emergency retrievals were examined over a 4-year period. The median age of transported children was 10 months (IQR, 18 days to 43 months). DGH staff performed the majority of endotracheal intubations (93.7%, CI 91.3% to 95.5%), initiated mechanical ventilation in 76.9% of cases (CI 73.0% to 80.4%), inserted central venous catheters frequently (67.4%, CI 61.7% to 72.6%), and initiated inotropic agents in 43.7% (CI 36.6% to 51.1%). The retrieval team was more likely to perform interventions such as reintubation for air leak, repositioning of misplaced tracheal tubes, and administration of osmotic agents for raised intracranial pressure. The performance of one or more interventions by the retrieval team was associated with severity of illness, rather than patient age, diagnostic group, or team response time (OR 3.62, 95% CI 1.47 to 8.92). CONCLUSIONS: DGH staff appropriately performs the majority of initial stabilisation procedures in critically ill children prior to retrieval. This practice has not changed significantly for the past 4 years, attesting to the crucial role played by district hospital staff in a centralised model of paediatric intensive care.

Resources of adaptation for daily living.

Occupational therapy addresses the chronically disabled person's adaptation to problems in daily living. Resources of adaptation are those inherent abilities and lifelong learnings which the individual uses to deal with daily living problems. Adaptation is described as flexible behavior to meet the changing needs of a changing environment. A review of the literature from a bio-social frame of reference identifies resources of adaptation. These resources are classified into a conceptual framework of three hierarchical levels corresponding to three time spans of adaptation: evolution, ontogenesis, and immediate learning. The classification of the resources of adaptation has implications for therapeutic evaluation and treatment, including the discovery and assessment of the resources of adaptation, a strategy for resource reorganization, and the environmental management of limited resources by the policy of "mini-max."

Commercial sunscreen lotions prevent ultraviolet radiation-induced depletion of epidermal Langerhans cells in Skh-1 and C3H mice.

There is much controversy regarding the ability of sunscreens to prevent ultraviolet (UV)-induced immune suppression. Epidermal Langerhans cells (LC) play a key antigen-presenting role in the afferent limb of the immune system's response to antigens introduced through the skin. It has been suggested that depletion of LC in UV-exposed skin is a critical step toward the induction of immunosuppression by UV radiation. There are a number of disparate reports with inconsistent results concerning the ability of sunscreens to prevent UV-induced depletion of LC. The purpose of this study was to systematically evaluate the ability of sunscreens to prevent UV-induced LC depletion in mice. Epidermal sheets obtained from skin biopsies taken from mice exposed to UV radiation from Kodacel-filtered FS20 sunlamps, which do not emit UV power at wavelengths < 290 nm, were immunoperoxidase stained for LC using a rat monoclonal antibody against mouse Ia (major histocompatibility complex class II antigen). Time course and dose-response curves for LC depletion were generated for Skh-1 and C3H mice. Dose-response curves for acute UV exposure induced depletion of LC in Skh-1 and C3H mice were similar, but not identical. LC density in the skin of Skh-1 mice that received chronic UV exposure (3 days/week for 8 weeks) was reduced by 62% after 2 weeks of exposure, but returned to normal levels by 6 weeks. Five commercial sunscreen lotions with labeled sun protection factors (SPF) of 4, 8, 15, 30 and 45 were tested for their capacity to block UV-induced depletion of LC. LC were depleted approximately 75% in the skin of unprotected or placebo lotion treated Skh-1 mice exposed to UV given on two consecutive days. Conversely, LC depletion was prevented in similarly UV exposed Skh-1 mice protected with a SPF 30 sunscreen. In C3H mice the levels of protection against LC depletion provided by the five sunscreens were proportional to the level of protection predicted by their labeled SPF. Comparisons of dose-response curves showed that significantly higher doses of UV were required for LC depletion and induction of skin edema than for the induction of local suppression of contact hypersensitivity. Thus, at UV doses where sunscreens provide complete protection against immunosuppression of contact hypersensitivity, prevention of LC depletion and skin edema would be expected.

Cloning and molecular characterization of the Chinese hamster ERCC2 nucleotide excision repair gene.

The Chinese hamster ERCC2 nucleotide excision repair gene, encoding a presumed ATP-dependent DNA helicase, was cloned from the V79 cell line, and its nucleotide sequence was determined. The approximately 15-kb gene comprises 23 exons with a 2283-base open reading frame. The predicted 760-amino-acid protein is 98% identical to the human ERCC2/XPD (760 amino acids), 51% identical to the Saccharomyces cerevisiae RAD3 (778 amino acids), and 54% identical to the Schizosaccharomyces pombe rad15 (772 amino acids) proteins. The promoter region of the hamster ERCC2 gene contains a pyrimidine-rich stretch (42 nucleotides, 88% C+T) similar to sequences found in the promoter regions of two other nucleotide excision repair genes, a GC box, a putative alpha-Pal transcription factor binding site, and two CAAT boxes. There is no apparent TAATA box. No consensus polyadenylation sequence (AATAAA or its variants) was found within 663 bases 3' of the translation termination codon.

Femoral artery catheterization complications: a study of 503 consecutive patients.

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.