Water Issues That Affect Affordability And Safety In A Community: The Camden Ohio Experience

This study describes the trials and tribulations of an Ohio township involved in maintaining utility rates at an affordable level while dealing with salt intrusion in drinking water wells that supply the Village. Emphasis is on the political, regulatory, and financial issues faced by management. This research deals exclusively with utility rate and water supply issues within the Village of Camden in Ohio when salt is discovered in the fresh water system. The analysis also discusses affordability as village officials decide whether to improve the existing well field, develop a new well field, or purchase water from an alternative supply

Adhiron: a stable and versatile peptide display scaffold for molecular recognition applications

We have designed a novel non-antibody scaffold protein, termed Adhiron, based on a phytocystatin consensus sequence. The Adhiron scaffold shows high thermal stability (Tm ca. 101°C), and is expressed well in Escherichia coli. We have determined the X-ray crystal structure of the Adhiron scaffold to 1.75 Å resolution revealing a compact cystatin-like fold. We have constructed a phage-display library in this scaffold by insertion of two variable peptide regions. The library is of high quality and complexity comprising 1.3 × 10(10) clones. To demonstrate library efficacy, we screened against the yeast Small Ubiquitin-like Modifier (SUMO). In selected clones, variable region 1 often contained sequences homologous to the known SUMO interactive motif (V/I-X-V/I-V/I). Four Adhirons were further characterised and displayed low nanomolar affinities and high specificity for yeast SUMO with essentially no cross-reactivity to human SUMO protein isoforms. We have identified binders against >100 target molecules to date including as examples, a fibroblast growth factor (FGF1), platelet endothelial cell adhesion molecule (PECAM-1; CD31), the SH2 domain Grb2 and a 12-aa peptide. Adhirons are highly stable and well expressed allowing highly specific binding reagents to be selected for use in molecular recognition applications

High altitudes and partial pressure of arterial oxygen in patients with chronic obstructive pulmonary disease - A systematic review and meta-analysis

Importance: Prior study in healthy subjects has shown a reduction of partial pressure of arterial oxygen (PaO$_{2}$) by -1.60 kPa/kilometre of altitude gain. However, the association of altitude-related change in PaO$_{2}$ and altitude-related adverse health effects (ARAHE) in patients with chronic obstructive pulmonary disease (COPD) remain unknown. Objective: To provide an effect size estimate for the decline in PaO$_{2}$ with each kilometre of altitude gain and to identify ARAHE in relation to altitude in patients with COPD. www.crd.york.ac.uk/prospero: CRD42020217938. Data sources: A systematic search of PubMed and Embase was performed from inception to May 30, 2023. Study selection: Peer-reviewed and prospective studies in patients with COPD staying at altitudes >1500 m providing arterial blood gases within the first 3 days at the target altitude. Data extraction and synthesis: Aggregate data (AD) on study characteristics were extracted, and individual patient data (IPD) were requested. Estimates were pooled using random-effects meta-analysis. Main outcome and measures: Relative risk estimates and 95 % confidence intervals for the association between PaO$_{2}$ and altitude in patients with COPD. Results: Thirteen studies were included in the AD analysis, of which 6 studies (222 patients, 45.2 % female) provided IPD, thus were included in the quantitative analysis. The estimated effect size of PaO$_{2}$ was -0.84 kPa [95 %CI, -0.92 to -0.76] per 1000 m of altitude gain (I$^{2}$=65.0 %, P < 0.001). In multivariable regression analysis, COPD severity, baseline PaO$_{2}$, age and time spent at altitude were predictors for PaO$_{2}$ at altitude. Overall, 37.8 % of COPD patients experienced an ARAHE, whereas older age, female sex, COPD severity, baseline PaO$_{2}$, and target altitude were predictors for the occurrence of ARAHE (area under ROC curve: 0.9275, P < 0.001). Conclusions and relevance: This meta-analysis, providing altitude-related decrease in PaO$_{2}$ and risk of ARAHE in patients with COPD ascending to altitudes >1500 m, revealed a lower altitude-related decrease in PaO$_{2}$ in COPD patients compared with healthy. However, these findings might improve patient care and facilitate decisions about initiating preventive measures against hypoxaemia and ARAHE in patients with COPD planning an altitude sojourn or intercontinental flight, i.e. supplemental oxygen or acetazolamide

4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty

Objective: The purpose was to evaluate the intra- and inter-observer reliability of combined quantitative 3D-volumetric single-photon emission computed tomography (SPECT)/CT analysis including size, intensity and localisation of tracer uptake regions and total knee arthroplasty (TKA) position. Materials and methods: Tc-99m-HDP-SPECT/CT of 100 knees after TKA were prospectively analysed. The anatomical areas represented by a previously validated localisation scheme were 3D-volumetrically analysed. The maximum intensity was recorded for each anatomical area. Ratios between the respective value and the mid-shaft of the femur as the reference were calculated. Femoral and tibial TKA position (varus-valgus, flexion-extension, internal rotation- external rotation) were determined on 3D-CT. Two consultant radiologists/nuclear medicine physicians interpreted the SPECT/CTs twice with a 2-week interval. The inter- and intra-observer reliability was determined (ICCs). Kappa values were calculated for the area with the highest tracer uptake between the observers. Results: The measurements of tracer uptake intensity showed excellent inter- and intra-observer reliabilities for all regions (tibia, femur and patella). Only the tibial shaft area showed ICCs 0.84). Conclusion: This combined 3D-volumetric standardised method of analysing the location, size and the intensity of SPECT/CT tracer uptake regions ("hotspots”) and the determination of the TKA position was highly reliable and represents a novel promising approach to biomechanic

Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes: A Systematic Review and Meta-Analysis

Importance: With increasing altitude, the partial pressure of inspired oxygen decreases and, consequently, the Pao$_{2}$ decreases. Even though this phenomenon is well known, the extent of the reduction as a function of altitude remains unknown. Objective: To calculate an effect size estimate for the decrease in Pao$_{2}$ with each kilometer of vertical gain among healthy unacclimatized adults and to identify factors associated with Pao$_{2}$ at high altitude (HA). Data Sources: A systematic search of PubMed and Embase was performed from database inception to April 11, 2023. Search terms included arterial blood gases and altitude. Study Selection: A total of 53 peer-reviewed prospective studies in healthy adults providing results of arterial blood gas analysis at low altitude (&amp;lt;1500 m) and within the first 3 days at the target altitude (≥1500 m) were analyzed. Data Extraction and Synthesis: Primary and secondary outcomes as well as study characteristics were extracted from the included studies, and individual participant data (IPD) were requested. Estimates were pooled using a random-effects DerSimonian-Laird model for the meta-analysis. Main Outcomes and Measures: Mean effect size estimates and 95% CIs for reduction in Pao$_{2}$ at HA and factors associated with Pao$_{2}$ at HA in healthy adults. Results: All of the 53 studies involving 777 adults (mean [SD] age, 36.2 [10.5] years; 510 men [65.6%]) reporting 115 group ascents to altitudes between 1524 m and 8730 m were included in the aggregated data analysis; 13 of those studies involving 305 individuals (mean [SD] age, 39.8 [13.6] years; 185 men [60.7%]) reporting 29 ascents were included in the IPD analysis. The estimated effect size of Pao$_{2}$ was −1.60 kPa (95% CI, −1.73 to −1.47 kPa) for each 1000 m of altitude gain (τ$^{2}$ = 0.14; I$^{2}$ = 86%). The Pao$_{2}$ estimation model based on IPD data revealed that target altitude (−1.53 kPa per 1000 m; 95% CI, −1.63 to −1.42 kPa per 1000 m), age (−0.01 kPa per year; 95% CI, −0.02 to −0.003 kPa per year), and time spent at an altitude of 1500 m or higher (0.16 kPa per day; 95% CI, 0.11-0.21 kPa per day) were significantly associated with Pao$_{2}$. Conclusions and Relevance: In this systematic review and meta-analysis, the mean decrease in Pao$_{2}$ was 1.60 kPa per 1000 m of vertical ascent. This effect size estimate may improve the understanding of physiological mechanisms, assist in the clinical interpretation of acute altitude illness in healthy individuals, and serve as a reference for physicians counseling patients with cardiorespiratory disease who are traveling to HA regions

A case series of eight amateur athletes: exercise-induced pre-/syncope during the Zurich Marathon 2023

BACKGROUND Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during the Zurich Marathon 2023, accompanied by elevated cardiac biomarkers. CASE SUMMARY Eight athletes (2 females, 6 males) aged 21-35 years, with pre-/syncope and various additional diverse symptoms such as dizziness and palpitations during the (half-)marathon, were admitted to two emergency departments in Zurich, Switzerland. Clinical evaluations included electrocardiogram, echocardiography, telemetry, coronary computed tomography (CT) scans, and cardiac biomarker assessments. High-sensitive troponin T (hs-cTnT) was elevated in all cases at initial assessment and returned to normal at follow-up. All athletes who received CT scans had normal coronary and brain CT results. None of the eight athletes had underlying cardiovascular disease. Renal function normalized post-admission, and neurological symptoms resolved within hours. Creatinine levels indicated transient acute kidney injury. A common feature was inexperience in running, inadequate race preparation, particularly regarding fluid, electrolyte, and carbohydrate intake, along with pacing issues and lack of coping strategies with heat. DISCUSSION From a clinician perspective, the case series highlights the challenge in the management of patients with a pre-/syncopal event during strenuous exercise and elevated cardiac biomarkers. Diverse initial symptoms prompted tailored investigations. Adequate training, medical assessments, and awareness of syncope triggers are essential for marathon participants. Caution and pacing strategies are crucial, especially among novices in competitive running. This information is pertinent given the growing popularity of marathon events and prompts a standardized diagnostic approach after these events

The effect of high altitude (2500 m) on incremental cycling exercise in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a randomised controlled cross-over trial

Objective: To investigate the effect of a daylong exposure to high altitude on peak exercise capacity and safety in stable patients with pulmonary arterial and chronic thromboembolic pulmonary hypertension (PAH/CTEPH). Methods: In a randomised controlled cross-over trial, stable patients with PAH or distal CTEPH without resting hypoxemia at low altitude performed two incremental exercise tests to exhaustion, one after 3–5 h at high (2500 m) and one at low altitude (470 m). Results: In 27 patients with PAH/CTEPH (44% women, 61±14 y), maximal work-rate was 110±64 watts at 2500 m and 123±64 watts at 470 m (−11%, 95%CI: −16 to −11, p<0.001). SpO$_{2}$and PaO$_{2}$at end-exercise were 83±6% versus 91±6% and 6.1±1.9 kPa versus 8.6±1.9 kPa (−8%; −29%; both p<0.001) at 2500 m versus 470 m, respectively. Maximal oxygen uptake at high altitude was 17.8±7.5 L·min$^{−1}$·kg$^{−1}$ versus 20±7.4 L·min$^{−1}$·kg$^{−1}$at low altitude (−11%, p<0.001). At end-exercise, the ventilatory equivalent for CO$_{2}$was 43±9 at 2500 m versus 39±9 at 470 m (+9%, 95%CI: 2 to 6; p=0.002). No adverse events occurred during or after exercise. Conclusion: Among predominantly low-risk patients with stable PAH/CTEPH, cycling exercise during the first day at 2500 m was well tolerated, but peak exercise capacity, blood oxygenation and ventilatory efficiency were lower compared to 470 m

Marketing as a means to transformative social conflict resolution: lessons from transitioning war economies and the Colombian coffee marketing system

Social conflicts are ubiquitous to the human condition and occur throughout markets, marketing processes, and marketing systems.When unchecked or unmitigated, social conflict can have devastating consequences for consumers, marketers, and societies, especially when conflict escalates to war. In this article, the authors offer a systemic analysis of the Colombian war economy, with its conflicted shadow and coping markets, to show how a growing network of fair-trade coffee actors has played a key role in transitioning the country’s war economy into a peace economy. They particularly draw attention to the sources of conflict in this market and highlight four transition mechanisms — i.e., empowerment, communication, community building and regulation — through which marketers can contribute to peacemaking and thus produce mutually beneficial outcomes for consumers and society. The article concludes with a discussion of implications for marketing theory, practice, and public policy

Individual particle handling in a microfluidic system based on parallel laser trapping

We present an optical trapping system combining individually addressable multiple laser traps with fluorescence spectroscopy. An in-line set of 64 near-IR laser diodes is used to create a line of individually addressable traps inside a microfluidic chip. This system is completed by an excitation/detection line for spectrally resolved fluorescence imaging of trapped particles. Highly parallel trapping in a constant flow (up to a few millimeters per second), fast particle handling rates (up to a few particles per second), and the possibility of recording fluorescence spectra of trapped objects lead to a performing bioanalytical platform, e. g., for highly parallel analysis and sorting. (C) 2011 Optical Society of Americ