Protective effect of cholecalciferol against cobalt-induced neurotoxicity in rats: ZO-1/iFABP, ChAT/AchE and antioxidant pathways as potential therapeutic targets.

Cobalt (Co) toxicity has been reported to produce central nervous system and gastrointestinal abnormalities. This study assessed the therapeutic effect of cholecalciferol (Cho) supplementation against damages caused by sub-acute (14-day) cobalt chloride (CoCl2) exposure in the brain and intestines. Thirty-five male Wistar rats were divided equally into five groups: Group I (control) received no treatment; Group II received oral CoCl2 (100 mg/kg) only; Groups III, IV, and V received 1000, 3000 and 6000 IU/kg of cholecalciferol, respectively by oral gavage, and concurrently with CoCl2. Cobalt-treated rats showed neuronal vacuolation and presence of pyknotic nuclei in the cerebral cortex and hippocampus, depletion of Purkinje cells in the cerebellum, as well as inflammation and congestion in the intestinal mucosa. Cobalt also increased brain and intestinal hydrogen peroxide (H2O2) and malondialdehyde (MDA) concentrations, while simultaneously reducing glutathione (GSH) content, superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione S-transferase (GST) activities. Further, CoCl2 induced increases in brain acetylcholinesterase (AchE) activity and serum zonulin (ZO-1) levels. Conversely, Cho administration suppressed CoCl2-induced damages in the brain and intestines by reducing lipid peroxidation and increasing the activities of antioxidant enzymes. Remarkably, Cho produced stimulation of brain choline acetyltransferase (ChAT) and suppression of AchE activity, along with dose-dependent reduction in serum levels of ZO-1, intestinal fatty acid-binding protein (iFABP) and nitric oxide. In conclusion, the protective role of cholecalciferol against cobalt-induced toxicity occurred via modulation of cholinergic, intestinal permeability and antioxidant pathways. The results may prove significant in the context of the role of gut-brain connections in neuroprotection.

Photocatalytic Degradation of Dyes in Wastewater Using Solar Enhanced Nickel Oxide (NiO) Nanocatalysts Prepared by Chemical Methods.

This study examined the surface morphology and photocatalytic activity of nickel oxide (NiO) nanoparticles prepared through a chemical method. The synthesized nanoparticle was characterized by using spectroscopic and microscopic techniques. Photocatalytic degradation of hazardous Eriochrome Black T (EBT) was carried out using the synthesized nanoparticle and the efficiency of the NiO used was determined. Highest degradation efficiency of 70% at 25 mg loading was observed at 40 min exposure time. The study concluded that the synthesized nanoparticles could be used in industrial wastewater treatment containing organic dyes.

Prospective, multi-site study of patient outcomes after implementation of the TREWS machine learning-based early warning system for sepsis.

Early recognition and treatment of sepsis are linked to improved patient outcomes. Machine learning-based early warning systems may reduce the time to recognition, but few systems have undergone clinical evaluation. In this prospective, multi-site cohort study, we examined the association between patient outcomes and provider interaction with a deployed sepsis alert system called the Targeted Real-time Early Warning System (TREWS). During the study, 590,736 patients were monitored by TREWS across five hospitals. We focused our analysis on 6,877 patients with sepsis who were identified by the alert before initiation of antibiotic therapy. Adjusting for patient presentation and severity, patients in this group whose alert was confirmed by a provider within 3 h of the alert had a reduced in-hospital mortality rate (3.3%, confidence interval (CI) 1.7, 5.1%, adjusted absolute reduction, and 18.7%, CI 9.4, 27.0%, adjusted relative reduction), organ failure and length of stay compared with patients whose alert was not confirmed by a provider within 3 h. Improvements in mortality rate (4.5%, CI 0.8, 8.3%, adjusted absolute reduction) and organ failure were larger among those patients who were additionally flagged as high risk. Our findings indicate that early warning systems have the potential to identify sepsis patients early and improve patient outcomes and that sepsis patients who would benefit the most from early treatment can be identified and prioritized at the time of the alert.

Factors driving provider adoption of the TREWS machine learning-based early warning system and its effects on sepsis treatment timing.

Machine learning-based clinical decision support tools for sepsis create opportunities to identify at-risk patients and initiate treatments at early time points, which is critical for improving sepsis outcomes. In view of the increasing use of such systems, better understanding of how they are adopted and used by healthcare providers is needed. Here, we analyzed provider interactions with a sepsis early detection tool (Targeted Real-time Early Warning System), which was deployed at five hospitals over a 2-year period. Among 9,805 retrospectively identified sepsis cases, the early detection tool achieved high sensitivity (82% of sepsis cases were identified) and a high rate of adoption: 89% of all alerts by the system were evaluated by a physician or advanced practice provider and 38% of evaluated alerts were confirmed by a provider. Adjusting for patient presentation and severity, patients with sepsis whose alert was confirmed by a provider within 3 h had a 1.85-h (95% CI 1.66-2.00) reduction in median time to first antibiotic order compared to patients with sepsis whose alert was either dismissed, confirmed more than 3 h after the alert or never addressed in the system. Finally, we found that emergency department providers and providers who had previous interactions with an alert were more likely to interact with alerts, as well as to confirm alerts on retrospectively identified patients with sepsis. Beyond efforts to improve the performance of early warning systems, efforts to improve adoption are essential to their clinical impact and should focus on understanding providers' knowledge of, experience with and attitudes toward such systems.

Development, Characterization, and Evaluation of SLN-Loaded Thermoresponsive Hydrogel System of Topotecan as Biological Macromolecule for Colorectal Delivery.

BACKGROUND: Chemotherapeutic drugs cause severe toxicities if administered unprotected, without proper targeting, and controlled release. In this study, we developed topotecan- (TPT-) loaded solid lipid nanoparticles (SLNs) for their chemotherapeutic effect against colorectal cancer. The TPT-SLNs were further incorporated into a thermoresponsive hydrogel system (TRHS) (TPT-SLNs-TRHS) to ensure control release and reduce toxicity of the drug. Microemulsion technique and cold method were, respectively, used to develop TPT-SLNs and TPT-SLNs-TRHS. Particle size, polydispersive index (PDI), and incorporation efficiency (IE) of the TPT-SLNs were determined. Similarly, gelation time, gel strength, and bioadhesive force studies of the TPT-SLNs-TRHS were performed. Additionally, in vitro release and pharmacokinetic and antitumour evaluations of the formulation were done. RESULTS: TPT-SLNs have uniformly distributed particles with mean size in nanorange (174 nm) and IE of ~90%. TPT-SLNs-TRHS demonstrated suitable gelation properties upon administration into the rat's rectum. Moreover, drug release was exhibited in a control manner over an extended period of time for the incorporated TPT. Pharmacokinetic studies showed enhanced bioavailability of the TPT with improved plasma concentration and AUC. Further, it showed significantly enhanced antitumour effect in tumour-bearing mice as compared to the test formulations. CONCLUSION: It can be concluded that SLNs incorporated in TRHS could be a potential source of the antitumour drug delivery with better control of the drug release and no toxicity.

A randomized controlled trial of online symptom searching to inform patient generated differential diagnoses.

Patient online health searching is now commonplace, however, the accuracy of patient generated differentials for new symptoms and potential for patient anxiety are concerns. We aimed primarily to determine the accuracy of patient generated differentials for new symptoms with and without online searching, and secondarily, to evaluate the impact of searching on anxiety levels. In the waiting room prior to seeing a clinician, 300 patients with new symptoms were randomly assigned 1:1:1 to Google searching with health related features including a symptom search tool vs Google searching with health related features disabled vs no searching. Participants were 18 years or older and presenting to the emergency department of an urban academic medical center with new low-acuity symptoms that were not due to exacerbation of a chronic condition. Search groups received access on a tablet/smartphone to Google searching with or without health related features. Both search groups could access any websites; health related features led the patient to common diagnoses and physician-validated information. The primary outcome was accuracy of the patient generated differential assessed by matching at least two of the top three diagnoses on the clinician's differential. A secondary outcome was anxiety by a visual analogue scale. Patients were a median of 33.1 (IQI 26.2-45.9) years old, 60% women, 63% black, 82% had a high school education or less, and 45.7% reported having performed an online search prior to presentation. Search group patients spent a median of 3.82 (2.53-5.72) minutes searching online. Similar proportions of patients in each group matched at least two of three clinician diagnoses: 27.0% and 28.3% for Google searching with and without health related features vs 23.8% in the no search group. Patients in the search groups had a similar odds of matching ≥2/3 diagnoses as the no search group [OR (95% CI): 1.23 (0.70-2.13), p = 0.47]. Anxiety was unchanged with online searching. In conclusion, brief online searching in the waiting room did not improve accuracy of patient generated differential diagnoses for new symptoms. The absence of an increase in patient anxiety provides reassurance for subsequent work to refine and investigate online symptom search tools.

Dataset of daily variation of rain rate distribution at Ota in Southwest Nigeria.

This article presents the data analysis of daily rainfall rate events experienced in Ota, Southwest Nigeria, a tropical station. The meteorological data were measured using a tipping bucket rain gauge mounted at the roof top of the College of Science and Technology, Covenant University, Ota. The data analysed is from April to December 2012. Descriptive statistics were used to show the daily variations in rainfall rate. Hence, the daily variation for rain rate shows variation in the minimum and maximum value within each of the months considered which varies from 0.8 mm/h to 230.4 mm/h. The results from this data will help microwave communication experts have a proper understanding of rainfall rate in this locality. This will assist to ensure a proper and efficient design and planning of radiowave propagation and satellite communication systems in Southwest Nigeria.

The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices.

We report that removing the clinically insensitive West Nile virus CSF nucleic acid amplification test (NAAT) from the electronic health record (EHR) test. This diagnostic stewardship intervention decreased costs and may have improved diagnostic yield.

Correction to: Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record.

In the HTML version of this paper, Ms. Goddu was incorrectly listed. The correct citation should be AP Goddu. Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.3 stigmatizing vs. 25.1 neutral, p < 0.001). Reading the stigmatizing language note was associated with less aggressive management of the patient's pain (4.7 stigmatizing vs. 5.3 neutral, p < 0.001).

Comparison between experimental and satellite temperature datasets in Covenant University.

This article contains the ground and satellite meteorological data sets of clear-sky temperature events for five years (2012-2016) in Covenant University, Ota, Ogun State, Nigeria. The satellite data were obtained from Atmospheric Infrared Sounder (AIRS) while the ground data information were acquired from Davis weather station data logger-vantage pro2. These data were acquired from propagation study that used same location (Lat: 6.67°N and Long: 3.23°E) for both satellite data and radiometer directed along the same path by providing information about the temperature. The data sets were assessed and evaluated by means of a descriptive statistics. There was perfect agreement between the two data. The peak temperature events occurs between the months of November and April for the five years of observation for both Ota and AIRS Satellite. The data from this article can be used for further studies on non-rainy attenuation effect in the study area.

Dataset of surface water vapour density in southeast, Nigeria.

In this data article, analysis of surface water vapour density in Southeast, Nigeria were reported. The meteorological data were obtained for the period of 39 years between 1973 and 2012 from National Oceanic and Atmospheric Administration (NOAA) Climatology Centre. Five stations considered in the research area includes: Enugu, Onitsha, Abakaliki, Aba and Ihiala. Descriptive statistics were used to show an increase in monthly variation of surface water vapour density (SWVD) minimum value of about 7.15 g/m3 at Enugu in January to maximum value of about 21.96 g/m3 at Onitsha in April. Hence, the seasonal variation for South East indicate peak value within the months of March to May in the rainy season and a lower value around December to February which is the dry season. The results from this data will help engineers in proper design and planning of radiowave propagation and satellite communication systems in southeastern, Nigeria.

Oligodendrocyte morphology in the developing brain of the African giant rat (Cricetomys gambianus, Waterhouse): Histology, immunohistochemistry and electron microscopy.

Oligodendrocyte and myelin-related studies have been pivotal in understanding disruption of central nervous system (CNS) myelin through injury, toxicological, pathological degeneration or genetic intervention. The African giant rat (AGR) has been postulated as an indigenous wild-type model within the African context. This work thus describes oligodendrocyte morphologies and myelin components of the developing African giant rat brain using histological, immunohistochemical and ultrastructural techniques. Five types, precursor-progenitor oligodendrocytes, pre-oligodendrocytes, immature oligodendrocytes, mature non-myelinating oligodendrocytes and mature myelinating oligodendrocytes, were identified. The first four types were observed in neonates while juvenile and adult AGR had predominantly mature myelinating oligodendrocytes with evidence of myelin sheath deposition. All cell types identified showed positive CNPase-positive immunosignalling across all age groups. This suggests CNPase as a suitable, sensitive and reliable biomarker for studying CNS neurodegenerative/demyelinating disorders in the AGR. This baseline study has given detailed insight into the morphology of oligodendrocytes and myelin in the AGR. It may be useful for anatomical studies and detection of alterations in neurocellular profile of oligodendrocytes and myelin in the AGR in real-life or in experimental models.

Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record.

BACKGROUND: Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another. OBJECTIVE: To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training's attitudes towards the patient and clinical decision-making. DESIGN: Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease. PARTICIPANTS: A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate). MAIN MEASURES: Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7-35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2-7 representing intensity of pain treatment). KEY RESULTS: Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral, p < 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient's pain (5.56 stigmatizing vs. 6.22 neutral, p = 0.003). CONCLUSIONS: Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.

Morphological Characterization of the African Giant Rat (Cricetomys gambianus, Waterhouse) Brain Across Age Groups: Gross Features of Cortices.

This experiment was designed to investigate the morphological characterization of the brain cortices of African giant rats, AGR (Cricetomys gambianus, Waterhouse) across age groups as related to function. A total of 15 male AGR were used for this study comprising of 5 neonates, 5 juveniles and 5 adults. Brains were described as having typical rodent features; the falx cerebri, the dura modification of interest, was partly inserted between the lobes of the olfactory bulb and extended towards the corpus callosum. Gross parameters extrapolated include cerebral and cerebellar cortical dimensions using a oneway ANOVA (p≤0.05). Most values showed highest significant value bias for juveniles over adults and neonates.  The average brain weight was 5.60±0.06g, 4.64±0.17g and 0.62±0.08g; cortex volume: 2.84±0.04cm3, 3.16±0.10cm3 and 0.23±0.02cm3 and antero-posterior dimensions: 11.93±0.26mm, 14.54±0.22mm and 6.00±0.16mm for adult, juvenile and neonates respectively. There was however adult bias in the cerebellum weight (0.83±0.02g, 0.76±0.02g and 0.04±0.02g); vermis length (13.23±0.32mm, 11.27±0.014mm and 0.24±0.02mm) and the antero-posterior length values (8.79±0.19mm, 6.97±0.03mm and 0.29±0.01mm) for adults, juveniles and neonates AGR respectively. Cortical parameters were related as a function of the brain development and plasticity, while age was described to play functional roles in intelligence determination of the AGR. The result of this study will be useful as baseline information for post mortem studies, medical imaging and useful as diagnostic tool for future research work on the AGR brain.

Low high-sensitivity troponin I and zero coronary artery calcium score identifies coronary CT angiography candidates in whom further testing could be avoided.

RATIONALE AND OBJECTIVES: Pilot study to determine whether among subjects receiving coronary computed tomography angiography (CTA), the combination of high-sensitivity troponin I (hsTnI) and coronary artery calcium score (CACS) identifies a low-risk population in whom CTA might be avoided. MATERIALS AND METHODS: A cross-sectional study of 314 symptomatic patients receiving CTA as part of their acute coronary syndrome evaluation was conducted. hsTnI was measured with Abbott Laboratories' hsTnI assay. CACSs were calculated via the Agatston method. Patients were followed for at least 30 days after discharge for the occurrence of major adverse cardiac events (MACEs; all-cause mortality, acute coronary syndrome, and revascularization). RESULTS: Of 314 subjects studied, 213 (67.8%) had no coronary artery stenosis, and 67 (21.3%), 28 (8.9%), and 6 (1.9%) had maximal coronary artery stenosis of 1%-49%, 50%-69%, and 70% or greater, respectively. All MACEs occurred during index hospitalization and include one myocardial infarction and four revascularizations. Sixty-two percent (189/307) of subjects had zero CACS, and 24% (76/314) of subjects had undetected hsTnI. No subjects with undetectable hsTnI or zero CACS had an MACE. A strategy of avoiding further testing in subjects with undetectable initial hsTnI, performing CACS on subjects with detectable initial hsTnI but nonincreased hsTnI (less than 99th percentile), and obtaining CTA in subjects with Agatston greater than 0 will have a negative predictive value of 100.0% (95% confidence interval, 98.2%-100.0%). This strategy will avoid CTA in 63% (198/314) of subjects. CONCLUSIONS: In this pilot study, the addition of CACS to hsTnI improves the identification of low-risk subjects in whom CTA might be avoided.

Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus, Waterhouse).

The African giant rat, AGR, is known for advantageous behavioural patterns among which are cognition and dexterous locomotion. This study investigated the morphological, morphometric and possible functional aspects of the AGR spinal cord (SC) anatomy. Ten adult (5 males and 5 females) AGR were used to determine the gross and histological features of the SC which were typically of rodent features. The mean SC weight and length given as 2.50±0.24g and 15.87±0.24cm respectively for the male and 2.32±0.16g and 15.40±0.61cm for the female showed no sexual dimorphism. A positive linear relationship between the tail length and SC weight were found in both sexes (r =0.81 males; r =0.95 females) suggesting significant contribution of the filum terminale to SC weight. Forty-three internal structures including nuclear aggregations and tracts were traced. Eight nuclear aggregations of neurons involved in nociception and limb coordination were observed to be prominent and larger than in laboratory rats. Same was noted for the dorsal, ventral and lateral funicular tracts which control the limbic system. This study provides morphometric baseline research information and delineates the functional aspects of the AGR SC anatomy. The information provided further strengthens the drive proposing the AGR as an indigenous research model for regional anaesthesia and locomotor disease.

Troponin elevations only detected with a high-sensitivity assay: clinical correlations and prognostic significance.

OBJECTIVES: With clinical use of high-sensitivity troponin I (hsTnI), more frequent troponin elevations will occur. However, the burden and implications of these elevations are not well understood. The authors quantified the prevalence of elevated hsTnI in patients presenting with possible acute coronary syndrome (ACS) who do not have elevated troponin with a current generation assay (cardiac troponin I [cTnI]) and determined the association of these newly detected elevations with a composite of all-cause mortality and subsequent cardiac hospitalization. METHODS: This was a prospective observational study of 808 subjects evaluated for possible ACS and followed for up to 1 year. Troponin values were measured with hsTnI (Abbott Laboratories) and cTnI (Abbott and Beckman Coulter). Cardiac hospitalization was defined as hospitalization for ACS, revascularization, acute heart failure (AHF), or tachy/brady arrhythmia that occurred after the index emergency department (ED) visit or hospital discharge. RESULTS: Forty subjects (5%) were diagnosed with ACS (26 myocardial infarction and 14 unstable angina). On the initial sample, the prevalence of elevated hsTnI among subjects with nonelevated cTnI was 9.2% using a gender-neutral cutoff (95% confidence interval [CI] = 7.1% to 11.4%) and 11.1% using a gender-specific cutoff (95% CI = 8.8% to 13.4%). Adjudicated diagnoses for subjects whose initial samples had elevated hsTnI but nonelevated cTnI (gender-neutral cutoff) were as follows: three (4.6%) ACS, 15 (23.1%) AHF, three (4.6%) volume overload etiology unclear/noncardiac, three (4.6%) cardiac (non-ACS), and 41 (63.1%) other. Of the 65 patients whose initial samples had hsTnI but nonelevated cTnI, eight developed cTnI elevation on subsequent serial sampling. After traditional cardiovascular risk factors and renal function were adjusted for, subjects with elevated initial hsTnI but nonelevated cTnI (initial and serial sampling) had a higher risk of all-cause mortality and subsequent cardiac hospitalization than subjects with both nonelevated hsTnI and nonelevated cTnI (hazard ratio [HR] = 1.91, 95% CI = 1.14 to 3.19). CONCLUSIONS: On the initial sample, 9% to 11% of subjects without cTnI elevation had hsTnI elevation. Although the majority of the patients with these newly detected hsTnI elevations did not have ACS, they had a higher risk for all-cause mortality and subsequent cardiac hospitalization.

Meeting new challenges in radon measurements service with solid state alpha track analysis.

The national and international radioprotection legislation now covers exposures to the naturally occurring radioactive materials (NORM) with particular emphasis on radon in workplaces. Consequently, a number of working environments have now been brought into the realm of radiation protection monitoring with a corresponding increase in the demand for radon monitoring services. The new challenges occasioned by the increase in demands are illustrated in this paper together with the radon measurement system developed at the ENEA IRP radon Service. In particular, this paper emphasises how to control using hardware and software analysis, the distributions (diameters and areas) of the track shape, which directly affect the quality of the radon service.