Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services

Biogenic silver nanoparticles mediated by Broussonetia papyrifera: anticancer and antimicrobial activity against pathogenic organisms

Objective: To evaluate the potential aspects of biologically synthesized silver nanoparticles mediated by Broussonetia papyrifera against the human pathogens. The same is acknowledged to have high efficiency in the field of Pharmaceutical industry.Methods: The 1Mm of AgNO3 is prepared and mixed with appropriate volume of plant extract and reaction volume was made up to 100 ml. the physical   characterization of AgNPs was done. The anti-microbial activity was done against dread pathogens. Cytotoxic activity of the AgNPs was investigated against breast and lung cancer cell lines.Results: The FESEM and EDAX of the microscopic level showed the particle surface measurements around 44 nm to 50 nm. The XRD investigations are being an evidence for the crystalline structure of the AgNPs with 30 nm. The bacterial pathogen Rhodococcus rhodochrous showed the maximum zone of inhibition (11.8±0.447). The A549 human lung cancer cell line and MCF-7 human breast cancer cell line were tested against the toxicity of AgNPs. The toxicity of AgNPs was valued and corresponding IC50 for Lung cancer (A549) is 12.95± 0.05 µg/mL and Breast cancer (MCF-7) is 10.75± 0.05 µg/mL respectively.Conclusion: The present research denotes that biomolecules derived AgNPs have larger impact as antimicrobials in the biomedical field. Since the aggressive chemicals are not involved AgNPs production, these bio-substances can of alternative medicine to resistant once. The in-vitro experiments exhibits the therapeutic effect of this AgNPs based on the ambient concentration on the process.Â

A Comparison of Wavelet, Curvelet and Contourlet based Texture Classification Algorithms for Characterization of Bone Quality in Dental CT

Abstract: The objective of this paper is to design and implement classifier framework to assist the surgeon for preoperative assessment of bone quality from Dental Computed Tomography images. This article focuses on comparing the discriminating power of several multiresolution texture analysis methods to evaluate the quality of the bone based on the texture variations of the images obtained from the implant site using wavelet, curvelet and contourlet.The approach consists of three steps: automatic extraction of the most discriminative texture features from regions of interest, creation of a classifier that automatically grades the bone depends on the quality. Since this is medical domain, the validation against the human experts is carried out. The results indicate that the combination of the statistical and multiscale representation of the bone image gives adequate information to classify the different bone groups compared to gray level features at single scale

Application of the rainbow trout derived intestinal cell line (RTgutGC) for ecotoxicological studies: molecular and cellular responses following exposure to copper.

There is an acknowledged need for in vitro fish intestinal model to help understand dietary exposure to chemicals in the aquatic environment. The presence and use of such models is however largely restrictive due to technical difficulties in the culturing of enterocytes in general and the availability of appropriate established cell lines in particular. In this study, the rainbow trout (Oncorhynchus mykiss) intestinal derived cell line (RTgutGC) was used as a surrogate for the "gut sac" method. To facilitate comparison, RTgutGC cells were grown as monolayers (double-seeded) on permeable Transwell supports leading to a two-compartment intestinal model consisting of polarised epithelium. This two-compartment model divides the system into an upper apical (lumen) and a lower basolateral (portal blood) compartment. In our studies, these cells stained weakly for mucosubstances, expressed the tight junction protein ZO-1 in addition to E-cadherin and revealed the presence of polarised epithelium in addition to microvilli protrusions. The cells also revealed a comparable transepithelial electrical resistance (TEER) to the in vivo situation. Importantly, the cell line tolerated apical saline (1:1 ratio) thus mimicking the intact organ to allow assessment of uptake of compounds across the intestine. Following an exposure over 72 h, our study demonstrated that the RTgutGC cell line under sub-lethal concentrations of copper sulphate (Cu) and modified saline solutions demonstrated uptake of the metal with saturation levels comparable to short term ex situ gut sac preparations. Gene expression analysis revealed no significant influence of pH or time on mRNA expression levels of key stress related genes (i.e. CYP3A, GST, mtA, Pgp and SOD) in the Transwell model. However, significant positive correlations were found between all genes investigated suggesting a co-operative relationship amongst the genes studied. When the outlined characteristics of the cell line are combined with the division of compartments, the RTgutGC double seeded model represents a potential animal replacement model for ecotoxicological studies. Overall, this model could be used to study the effects and predict aquatic gastrointestinal permeability of metals and other environmentally relevant contaminants in a cost effective and high throughput manner

‘Site of contact genotoxicity’ assessment for implants - Potential use of single cell gel electrophoresis in biocompatibility testing of medical devices

Toxicological risk assessment of medical devices requires genotoxicity assessment as per ISO 10993, Part 3, which is designed to address gene mutations, clastogenicity and/or aneugenicity endpoints. ‘Site of contact genotoxicity’ is a potential genotoxic risk especially for medical implants, that is currently not addressed in biocompatibility standards. We therefore performed initial validation study on the use of alkaline single cell gel electrophoresis (comet assay) for detecting ‘site of contact genotoxicity’ of medical devices, using test items made of acrylic implants impregnated with ethyl methanesulphonate (EMS). Comet assay detected increased DNA migration at the site of implantation, but not in the liver. The same implants also failed to show any genotoxicity potentials, when tested on the standard test battery using Salmonella/microsome and chromosome aberration assays. The study suggested that some medical implants can cause ‘site of contact genotoxicity’, without producing systemic genotoxicity. In conclusion, comet assay will add new dimension to safety assessment of medical devices, and this assay can be added to the battery of genetic toxicology tests for evaluating biocompatibility of medical implants

Manpower management in construction projects

Construction projects generally involve a long period of construction, huge financial investment and more problems that need to be faced in the development process. Several risk factors have to be encountered, among those one of the major risk factors is Manpower Management. Though the construction sector employs more people than other industries do, its human resource management is still poor and ineffective. This review paper concentrates on a workforce that directly contributes to the building process, labours, site engineers, and engineers or contractors. This study helps engineers or contractors to understand the value of labour resource management in the project to effectively manage them in construction projects. The primary issues in managing labour resources in construction projects have been identified with the help of a literature survey. The major problems identified will be considered for further investigation on manpower management

Genotoxicity evaluation of medical devices: A regulatory perspective

This review critically evaluates our current regulatory understanding of genotoxicity testing and risk assessment of medical devices. Genotoxicity risk assessment of these devices begins with the evaluation of materials of construction, manufacturing additives and all residual materials for potential to induce DNA damage. This is followed by extractable and/or leachable (E&L) studies to understand the worst case and/or clinical exposures, coupled with risk assessment of extractables or leachables. The TTC (Threshold of Toxicological Concern) approach is used to define acceptable levels of genotoxic chemicals, when identified. Where appropriate, in silico predictions may be used to evaluate the genotoxic potentials of identifiable chemicals with limited toxicological data and above the levels defined by TTC. Devices that could not be supported by E&L studies are evaluated by in vitro genotoxicity studies conducted in accordance with ISO10993-3 and 33. Certain endpoints such as ‘site of contact genotoxicity’ that are specific for certain classes of medical devices are currently not addressed in the current standards. The review also illustrates the potential uses of recent advances to achieve the goal of robust genotoxicity assessment of medical devices which are being increasingly used for health benefits. The review also highlights the gaps for genotoxicity risk assessment of medical devices and suggests possible approaches to address them taking into consideration the recent advances in genotoxicity testing including their potential uses in biocompatibility assessment

Removal of power-line interference from the ECG: a review of the subtraction procedure

BACKGROUND: Modern biomedical amplifiers have a very high common mode rejection ratio. Nevertheless, recordings are often contaminated by residual power-line interference. Traditional analogue and digital filters are known to suppress ECG components near to the power-line frequency. Different types of digital notch filters are widely used despite their inherent contradiction: tolerable signal distortion needs a narrow frequency band, which leads to ineffective filtering in cases of larger frequency deviation of the interference. Adaptive filtering introduces unacceptable transient response time, especially after steep and large QRS complexes. Other available techniques such as Fourier transform do not work in real time. The subtraction procedure is found to cope better with this problem. METHOD: The subtraction procedure was developed some two decades ago, and almost totally eliminates power-line interference from the ECG signal. This procedure does not affect the signal frequency components around the interfering frequency. Digital filtering is applied on linear segments of the signal to remove the interference components. These interference components are stored and further subtracted from the signal wherever non-linear segments are encountered. RESULTS: Modifications of the subtraction procedure have been used in thousands of ECG instruments and computer-aided systems. Other work has extended this procedure to almost all possible cases of sampling rate and interference frequency variation. Improved structure of the on-line procedure has worked successfully regardless of the multiplicity between the sampling rate and the interference frequency. Such flexibility is due to the use of specific filter modules. CONCLUSION: The subtraction procedure has largely proved advantageous over other methods for power-line interference cancellation in ECG signals

A dimensioning and tolerancing methodology for concurrent engineering applications I: problem representation

This paper is the first of two which present a methodology for determining the dimensional specifications of all the component parts and sub-assemblies of a product according to their dimensional requirements. To achieve this goal, two major steps are followed, each of which is described in a paper. In the first paper, all relationships necessary for finding the values of dimensions and tolerances are represented in a matrix form, known as a Dimensional Requirements/Dimensions (DR/D) matrix. In the second paper, the values of individual dimensions and tolerances are determined by applying a comprehensive solution strategy to satisfy all the relationships represented in the DR/D matrix. The methodology is interactive and suitable for use in a concurrent engineering (CE) environment. The graphical tool presented in this paper will assist a CE team in visualizing the overall D&T problem and foreseeing the ramifications of decisions regarding the selection of dimensions and tolerances. This will assist the CE team to systematically determine all the controllable variables, such as dimensions, tolerances, and manufacturing processes