Sodium hypochlorite dosage for household and emergency water treatment: updated recommendations.

Household water treatment with chlorine can improve the microbiological quality of household water and reduce diarrheal disease. We conducted laboratory and field studies to inform chlorine dosage recommendations. In the laboratory, reactors of varying turbidity (10-300 NTU) and total organic carbon (0-25 mg/L addition) were created, spiked with Escherichia coli, and dosed with 3.75 mg/L sodium hypochlorite. All reactors had >4 log reduction of E. coli 24 hours after chlorine addition. In the field, we tested 158 sources in 22 countries for chlorine demand. A 1.88 mg/L dosage for water from improved sources of <5 or <10 NTU turbidity met free chlorine residual criteria (≤2.0 mg/L at 1 hour, ≥0.2 mg/L at 24 hours) 91-94% and 82-87% of the time at 8 and 24 hours, respectively. In unimproved water source samples, a 3.75 mg/L dosage met relaxed criteria (≤4.0 mg/L at 1 hour, ≥0.2 mg/L after 24 hours) 83% and 65% of the time after 8 and 24 hours, respectively. We recommend water from improved/low turbidity sources be dosed at 1.88 mg/L and used within 24 hours, and from unimproved/higher turbidity sources be dosed at 3.75 mg/L and consumed within 8 hours. Further research on field effectiveness of chlorination is recommended.

A rapid assessment of drinking water quality in informal settlements after a cholera outbreak in Nairobi, Kenya.

Populations living in informal settlements with inadequate water and sanitation infrastructure are at risk of epidemic disease. In 2010, we conducted 398 household surveys in two informal settlements in Nairobi, Kenya with isolated cholera cases. We tested source and household water for free chlorine residual (FCR) and Escherichia coli in approximately 200 households. International guidelines are ≥0.5 mg/L FCR at source, ≥0.2 mg/L at household, and <1 E. coli/100 mL. In these two settlements, 82% and 38% of water sources met FCR guidelines; and 7% and 8% were contaminated with E. coli, respectively. In household stored water, 82% and 35% met FCR guidelines and 11% and 32% were contaminated with E. coli, respectively. Source water FCR≥0.5 mg/L (p=0.003) and reported purchase of a household water treatment product (p=0.002) were associated with increases in likelihood that household stored water had ≥0.2 mg/L FCR, which was associated with a lower likelihood of E. coli contamination (p<0.001). These results challenge the assumption that water quality in informal settlements is universally poor and the route of disease transmission, and highlight that providing centralized water with ≥0.5 mg/L FCR or (if not feasible) household water treatment technologies reduces the risk of waterborne cholera transmission in informal settlements.

Does use of a powered ankle-foot prosthesis restore whole-body angular momentum during walking at different speeds?

BACKGROUND: Whole-body angular momentum (H) influences fall risk, is tightly regulated during walking, and is primarily controlled by muscle force generation. People with transtibial amputations using passive-elastic prostheses typically have greater H compared with nonamputees. QUESTIONS/PURPOSES: (1) Do people with unilateral transtibial amputations using passive-elastic prostheses have greater sagittal and frontal plane H ranges of motion during walking compared with nonamputees and compared with using powered prostheses? (2) Does use of powered ankle-foot prostheses result in equivalent H ranges in all planes of motion compared with nonamputees during walking as a result of normative prosthetic ankle power generation? METHODS: Eight patients with a unilateral transtibial amputation and eight nonamputees walked 0.75, 1.00, 1.25, 1.50, and 1.75 m/s while we measured kinematics and ground reaction forces. We calculated H for participants using their passive-elastic prosthesis and a powered ankle-foot prosthesis and for nonamputees at each speed. RESULTS: Patients using passive-elastic prostheses had 32% to 59% greater sagittal H ranges during the affected leg stance phase compared with nonamputees at 1.00 to 1.75 m/s (p < 0.05). Patients using passive-elastic prostheses had 5% and 9% greater sagittal H ranges compared with using powered prostheses at 1.25 and 1.50 m/s, respectively (p < 0.05). Participants using passive-elastic prostheses had 29% and 17% greater frontal H ranges at 0.75 and 1.50 m/s, respectively, compared with nonamputees (p < 0.05). Surprisingly, patients using powered prostheses had 26% to 50% greater sagittal H ranges during the affected leg stance phase compared with nonamputees at 1.00 to 1.75 m/s (p < 0.05). Patients using powered prostheses also had 26% greater frontal H range compared with nonamputees at 0.75 m/s (p < 0.05). CONCLUSIONS: People with a transtibial amputation may more effectively regulate H at two specific walking speeds when using powered compared with passive-elastic prostheses. CLINICAL RELEVANCE: Our results support the hypothesis that an ankle-foot prosthesis capable of providing net positive work during the stance phase of walking reduces sagittal plane H; future studies are needed to validate our biomechanical findings with larger numbers of patients and should determine whether powered prostheses can decrease the risk of falls in patients with a transtibial amputation.

Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions.

The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (eg, higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments.

Clinical efficacy of melittin in the treatment of cats infected with the feline immunodeficiency virus. / Wirksamkeit von Melittin bei der Behandlung von Katzen mit feliner Immunschwächevirusinfektion.

OBJECTIVE: The bee venom melittin shows an antiviral efficacy against the human immunodeficiency virus in cell culture. It was shown to be non-toxic for cats. Aim of this pilot study was to investigate the clinical efficacy and side-effects of melittin in cats naturally infected with feline immunodeficiency virus (FIV). MATERIAL AND METHODS: The study was performed as a prospective, placebo-controlled double-blinded trial. Twenty cats were included, of which 10 cats each were treated with either melittin (500 µg/kg body weight) or phosphate-buffered saline (placebo) subcutaneously twice per week. During the treatment period of 6 weeks, the cats' general health status, determined by the Karnofsky's score, and the severity of clinical signs (conjunctivitis and stomatitis) using a clinical scoring system were evaluated. Haematology, biochemistry profiles, lymphocyte subpopulations, CD4/CD8 ratio, and pterines (biopterine, 7-xanthopterine) as surrogate parameters were also compared. RESULTS: The general health status and the clinical scores for conjunctivitis and stomatitis improved in cats treated with melittin. A statistically significant improvement however could only be detected for conjunctivitis in cats treated with melittin compared to cats treated with placebo which was likely due to different scores between both groups at the beginning. No influence on the lymphocyte subpopulations, CD4/CD8 ratio, and pterine concentrations was observed. No side effects occurred in this study. CONCLUSION AND CLINICAL RELEVANCE: In the protocol used in the present study, no significant efficacy of melittin could be detected. However, efficacy of melittin, especially if applied in a higher dosage as in the present study or for a longer period, could be evaluated in further studies. Synergistic effects if used in combination with classic antiretroviral drugs could be an interesting future approach.

Clinical efficacy of the acyclic nucleoside phosphonate 9-(2-phosphonylmethoxypropyl)-2,6-diaminopurine (PMPDAP) in the treatment of feline immunodeficiency virus-infected cats.

In in vitro studies, the acyclic nucleoside phosphonate 9-(2-phosphonylmethoxypropyl)-2,6-diaminopurine (PMPDAP) inhibited the replication of feline immunodeficiency virus (FIV). No information about its clinical efficacy is available so far. The aim of this prospective placebo-controlled, double-blinded study was to evaluate the antiviral efficacy of PMPDAP in cats naturally infected with FIV. Twenty cats were randomly assigned to two treatment groups receiving either PMPDAP (25 mg/kg) or placebo twice per week subcutaneously for 6 weeks. The general health status (Karnofsky's score), clinical signs, laboratory, immunological, and surrogate parameters were evaluated. No significant differences were found between PMPDAP- and placebo-treated cats, although cats treated with PMPDAP showed a tendency for improvement in their Karnofsky's score and clinical signs. Haematological side effects were noted in the PMPDAP-treated cats. Thus, PMPDAP may be an option in treating cats if it becomes available for veterinarians, but side effects have been monitored.