In this case, the psoas collection was identified by cross-sectional CT imaging, which is the gold standard in the initial diagnosis and can reveal the underlying cause in secondary abscesses. Other radiological options are magnetic resonance imaging, which has the advantages of not requiring smad pathway and gives superior imaging of the soft tissues, bone marrow, and spinal vertebrae. Ultrasound scanning has a reported rate of detection of only 48%, but one report highlights its usefulness as a prompt diagnostic tool in the emergency department.
The etiology of the patient\’s abscess was unclear in this case. Both blood cultures and pus from the abscess itself grew S. aureus, which is the causative pathogen in 88% of primary abscesses. Although the patient\’s second CT scan showed mild diverticulosis at the sigmo–colonic junction, it is unlikely to be the source of the collection because enteric bacteria are usually implicated in secondary psoas abscesses.
Incision and drainage has been reported to resolve >97% of primary abscesses. In this case, a near-complete resolution was achieved on repeat a CT scan 6 days after percutaneous drain insertion. Secondary abscesses have a much lower resolution rate with percutaneous drainage alone. When Crohn\’s colitis is the underlying cause, bowel resection together with drainage may be required for complete resolution, although percutaneous drainage may have a role in avoidance of surgery in the short term for some patients.
This case of psoas abscess had a good outcome, and the patient was discharged with no reoccurrence. However, the condition can be fatal particularly if the diagnosis is delayed. Secondary abscesses have worse outcomes than primary ones, with reported mortality of up to 19%.
Conflicts of interest
Trauma is the most common cause of death and disability in children ages 1 to 18. Compared to adults, children have a unique anatomy and physiology. Because of their smaller size and less developed musculoskeletal systems, children are more susceptible to multiple and severe injuries. In pediatric patients, blunt abdominal trauma is the third leading cause of traumatic death next to head and chest injuries. Motor vehicle-associated injuries and falls are the major causes of pediatric blunt abdominal injuries. The spleen and liver are the most commonly injured organs, followed by the kidneys, stomach and intestine, pancreas, and urinary bladder. Increasingly, injured children can be successfully treated with non-operative management if their vital signs remain stable. Emergent laparotomy is usually left for patients with uncontrolled hemorrhage, hollow organ perforation, peritonitis, or pancreatic injury with ductal disruption.
Evaluation of children with blunt abdominal trauma is usually more difficult than adults. Small children cannot provide a detailed history. Their physical examination is often difficult and unreliable. Laboratory tests may be suggestive, but no single test has acceptable positive or negative predictive values to safely and effectively screen patients with potential abdominal pathology. Point-of-care emergency ultrasound (EUS) has become a popular screening tool to detect hemoperitoneum. Physical examination in combination with EUS had been reported useful in identifying children at risk for intra-abdominal injury. However, in a recent Cochrane Review, no sufficient evidence was found to justify the use of EUS in diagnosing patients with suspected abdominal trauma. Computed tomography (CT) with and without contrast enhancement remains the gold standard of diagnosis in blunt abdominal trauma. In addition to good sensitivities in the detection of various injuries, the high negative predictive value can help physicians to discharge a stable child home after a negative abdominal CT scan. However, the high cost and exposure to ionizing radiation often excludes CT as a screening tool for children with blunt abdominal trauma. Herein, we report the case of a pre-pubertal girl who was involved in a sports-related blunt abdominal trauma. A rarely reported, but salvageable if treated early, pathology was diagnosed 3 days after the onset of symptoms.
This study conducted among the patients attending in RIMS, Kadapa to ascertain the risk factors for causing complications of HS in adults. Out of 288 patients male ratio was slightly increased when compared to women, similarly in a cohort study showed 57% male ratio. Most people fall in the age group of 60–80 years.
Conflict of interest statement
The authors are grateful to staffs of Rajiv Gandhi Institute of Medical Sciences for their contribution and help.
Otoacoustic emissions are tests used to determine the hair cell function of the cochlea. So otoacoustic emission testing can be used as a tool to determine the presence or absence of cochlear function and analysis can be performed for individual cochlear frequency regions. Another potential use of distortion product otoacoustic emissions (DPOAE) measurements might be to predict auditory response growth, such as growth of loudness. This application would be of interest clinically because one consequence of cochlear hearing loss may be an abnormal growth of loudness, sometimes referred to as loudness recruitment.
DPOAEs are sounds emitted in response to 2 simultaneous tones of different frequencies. Stimuli consist of 2 pure tones at 2 frequencies (f2 > f1) and two intensity levels (L1, L2). The relationship between L1–L2 and f1/f2 dictates the frequency response. DPOAEs allow great frequency specificity with a great reliability above 1000 Hz.
Hearing losses above 50 dB HL are not quantifiable using DPOAEs and their performance at frequencies below 1 kHz is limited, but their recording time is short.
Presence of hearing loss and estimation of type and degree is one of the most common methods used to investigate the effects of renal disease on the auditory system. Degree of hearing loss may give an indication of the extent of damage to auditory function, whereas the type of hearing loss may distinguish between lesions in the outer and middle ear (conductive hearing loss) or the cochlea and the neural pathways (sensorineural hearing loss). According to these ionophore indicators , the reports to be reviewed in the following sections have also described auditory function in CRF with methods such as tympanometry, audiometry and otoacoustic emissions (distortion product OAEs, DPOAEs).
Materials and methods
The criteria for case selection were: age 15–50 years, hearing impairment after the occurrence of renal failure, no history of noise exposure, no history of diabetes, no history of renal transplantation.
According to the results of the examinations done to the patients oocyte showed that 29 patients out of 43 under hemodialysis treatment had sensorineural hearing loss in high frequencies in audiometric measurements and 33 of them had decreased DPOAE amplitudes (Figure 1).
In the control group only one patient had pure tone audiometry (PTA) threshold low in high frequencies and DPOAE gram according to the audiogram but lower values in >4000 Hz.
It was observed a higher incidence of hearing loss in stages three, four and five of renal failure with lower amplitudes in the DP-gram than PTA thresholds in the same frequencies (Figures 2 and 3).
The survival of chronic renal failure patients is increased with the new hemodialysis treatments.
As screening tools, DPOAEs are superior to PTA testing. DPOAE amplitude reduces significantly before behavioral threshold changes are noted at corresponding frequencies in PTA. Decreased emissions in the presence of normal behavioral hearing may indicate an underlying pathologic condition, which if continued might soon result in a significant hearing loss. In this sense, the DP-grams may be predictive, foretelling a substantial threshold shift for a given frequency before a measurable sensitivity loss.
DPOAEs have an extensive dynamic range regarding hearing loss and can be measured over a broader frequency range with more sensitive frequency specific response. With their high sensitivity and excellent reliability, their objectivity makes them ideal for testing patients who cannot cooperate in a traditional examination of behavioral hearing. Their recording is easy for both technician and patient, and can be easily performed at the bedside. DPOAE audiograms provide a tool for a fast automated frequency-specific and quantitative evaluation of a mild or moderate hearing in follow-up diagnosis.
In Table 2, for all the athletes and also separately for gender, the mean value and standard deviation of the peak force and of the time at which the peak occurs expressed as a function of the corticosterone percentage are reported.
The contribution of the arm had been assessed in several studies with able-bodied athletes, both in DP and skating techniques [22–24]. In particular arm swings contribute considerably to the overall force generation and propulsion. The main findings of this study regard the evaluation of the inertial effect contribution of arms that are responsible for a significant increase of sledge velocity, hence of a propulsive action during the initial poling phase accomplished by LW10 Paralympic XC sit-skiers. The abrupt arm lowering, similarly to what happened in able-bodied subjects, is expected to be beneficial also for the pole plant force, however this cannot be assessed just using kinematic data and specific tests have to be performed.
The DP technique of sit skiers is mainly a 2D gesture providing sledge progression during this practice. As an overall trend, considering athletes of all the classes, the pushing cycle can be assumed as an upper-body action, particularly involving trunk and the arms in performing it. Indeed during this activity, a complex variability in terms of slope, sitting posture and the sledge or other equipment design has to be considered. For what concerning particularly the sitting posture, the presence or not of the abdominal muscles is effective in force generation. Indeed it represents the main difference between athletes of LW10 class, with a complete impairment of the lower trunk control, respect to athletes of higher class for which the previous function is only partially impaired or completely unaffected. For those whose abdominal function is completely absent, trunk flexion is obtained thanks to the gravity force, while extension is obtained by compensation mechanisms that exploit head, arms and upper trunk inertia. Besides, the absence of abdominal and extensor muscles influences also the sledge shape and the seat posture: straps and knee-high position limit the trunk flexion .
The assessment of the total propulsive inertial effect due to the arms actions during the observed interval is here outlined. Despite the short duration of this temporal window, a steepest rise of sledge velocity can be observed prior to the effective pushing poles contacts on the terrain (B). The sledge propulsion is provided by the inertial effect, mainly due to the upper body region (arms and forearms) movement. According to the formulas and the reasoning explained before, there is a normalized propulsive inertial force with a peak value. This acts as a propulsive force and the result is a significant sledge fastening, corresponding to the onset of PP and prior to the pole planting.
Limitations of the study are related to the estimation of arm segment masses, since species packing is based on tables for able-bodied individuals and not on subject-specific models [25,26]. Usually many wheelchair users have hypertrophied arms. Since it was not possible to directly measure inertial limb properties, due to the operative contest, the use of able-bodied data assumption is precautionary. Furthermore, in a non-racing contest or in laboratory tests more accurate kinematic measurements can be obtained using technologies that are already well-assessed in clinical environment e.g. electrogoniometers [27,28], inertial sensors  or marker stereophotogrammetric analysis .
Conflict of Interest
The authors have declared no conflict of interest.
Compliance with Ethics Requirements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
Therefore, minimum number of tolterodine tartrate order to be utilized to achieve required accuracy and convergence within XFEM would be the maximum integration order, n obtained from Eqs. (9), (10), and (13) aforesaid. Consider 4 by 4 mesh in Case 2 as an example (linear quadrilateral elements are utilized with classical Gauss Legendre rules). All the 4 sides of the plate boundaries are not constrained. Corresponding variables for this case are m=16, p=1, r=1, s=3, t=16, f=2, e=25, c=0. Eqs. (9), (10) and (13) yield n=9, 1, and 2, respectively. Therefore, n=9 (or n=10) should be utilized in order to ensure accuracy and convergence of the solution.
In this work, two new integration techniques, which are numerical and exact integration techniques, have been demonstrated within the context of XFEM. The generalized equations (Eq. (2)) can be utilized with any quadrature rules to perform numerical integrations by simply converting the integration limits U and L accordingly. The techniques described in this paper can be utilized for both linear and nonlinear boundaries, with less number of quadrature points and weights (by selecting appropriate quadrature scheme), and with fewer number of sub-elements. Application of the new techniques in engineering domain (analysis of plates with holes) showed improvement in the solution accuracy. The exact integration technique given by Eq. (3) can be utilized for certain cases that involve polynomials only, and can be utilized as a reference/analytical solution. The exact geometrical representation and integration techniques that are presented help to reduce the solution error in analysis of thin plates with arbitrary holes. Optimal order of integration, n for accuracy and convergence of the solution can be determined by following the guidance provided in this paper.
Conflict of Interest
The authors have declared no conflict of interest.
Compliance with Ethics Requirements
This article does not contain any studies with human or animal subjects.
The first author would like to thank Research Management Centre (RMC) of Multimedia University, Malaysia, for providing financial support through Mini Funds with grant numbers: MMUI/130070 and MMUI/160047, which enabled purchase of required software and equipment for this work. The authors would also like to express their sincere appreciation to the anonymous reviewers who have provided valuable feedbacks which helped to improve content of the paper.
Ethosomes are soft malleable vesicles constituting phospholipids, ethanol (relatively high concentration) and water . They act as non-invasive delivery carriers for targeting drugs to deep skin layers. Hence, when integrated into a vesicles membrane, ethosomes promote the vesicle to penetrate the stratum corneum . The utility of ethosomes as a carrier of antiviral drug acyclovir was previously tested by Essa and coworkers for the topical treatment of herpetic infection. They demonstrated significant improvement of ethosomal 5% acyclovir system as compared to a 5% acyclovir cream by performing two-armed, double-blinded, randomized clinical trial . In another study, enhanced drug delivery via ethosomal carrier was observed by an increase in depth and fluorescent activity .
A synergistic mechanism was suggested between ethanol, vesicles and skin lipids by Touitou and coworkers for elucidating the role of ethosomes in promoting enhanced drug delivery . It was proposed that “ethanol effect” resulted in an interaction of ethanol with the lipid molecules in the polar head group region and exhibits reduction in the transition temperature of lipids in the stratum corneum, which ultimately increases their fluidity and decreases the density of lipid multilayer. This effect is followed by the “ethosomal effect” which involves the penetration and permeation of lipids due to the malleability and fusion of ethosomes with skin lipids. This step resulted in the release of drug into the deep layers of skin. It should be noted that since ethanol imparted flexible characteristics to vesicles, it allowed the ethosomal vesicles easier and deeper penetration into the deeper layers of the skin. The release of the drug in the deep layers of the skin and its transdermal absorption could then be the result of a fusion of ethosomes with skin lipids, and drug release at various points along the penetration pathway .
As shown in Fig. 15 the heat flux profile at the bottom wall oscillate versus location and it azidothymidine can be displayed by the average and amplitude characteristics in each case. In Figs. 18 and 19 the average of heat flux for the bottom wall as a function of heat source number (for ) and aspect ratio (for ) are shown respectively with and without permitting for the temperature dependent properties in CFD calculations. By considering the effect of temperature dependent properties the average of heat flux for the bottom wall is increased. In addition, rise in heat source number and aspect ratio tend toward the lessening of heat flux average in the bottom wall especially for the enclosures with low aspect ratio.
Also in Figs. 20 and 21 the amplitude of heat flux variation for the bottom wall as a function of heat source number (for ) and aspect ratio (for ) are presented respectively with and without allowing for the temperature dependent properties in CFD calculations. By considering the effect of temperature dependent properties the amplitude of heat flux for the bottom wall is increased. Increase in heat source number and aspect ratio leads to decrease in the amplitude of heat flux variation at the bottom wall in front of heat sources. This effect is severe for shallow enclosures.
Finally, in the Figs. 22 and 23 the maximum dimensionless streamline as a function of heat source number (for ) and aspect ratio (for ) are presented respectively with and without letting the temperature dependent properties in CFD calculations. By considering the effect of temperature dependent properties, the viscosity of the air is decreased. Thermal boundary layer has an important role in the maximum streamline. By increasing the dimensionless temperature difference, the thickness of the thermal boundary layer on the heated wall and the volume occupied by the cold fluid decrease slightly. It is noted that, by increasing the heating number, the thickness of the thermal boundary layer next to the hot wall decreases, and the volume occupied by the cold fluid inside the cavity increases. By decrease of the net power required to overcome friction in the cavity to move the fluid flow the maximum dimensionless streamline is decreased. Upsurge in heat source number and aspect ratio make rise in the maximum dimensionless streamline of the system. This conclusion for shallow enclosures is more significant.
Numerical investigation of thermal radiation effects in an enclosure, which is shaped by a constant temperature wall in bottom, an adiabatic wall in top, two openings, and block heat sources, has been performed. The governing equations is solved by finite volume method with a code wich has developed in previous work. The number of heat sources in a symmetric problem was from one to nineteen; the heating number was varied from 5×10−2 to 5×102, and the cavity aspect ratio, from 0.1 to 1. At first, the general fluid flow and thermal field configuration for various cases was presented to study the effect of temperature dependent properties on the thermal and flow characteristics of the system. Then a parametric study demonstrating the influence of the heating number, aspect ratio, and the number of heaters on the maximum and mean temperature of system, the thermal loading characteristics of the system, Nusselt number, and the maximum streamline was presented. The most important conclusion are:
The boundary layer flow analysis of an electrically conducting fluid due to a stretching sheet is of great interest because of their diverse engineering and industrial applications. MHD has immediate applications in designing of heat exchangers, in space vehicle propulsion, in thermal protection, in magnetohydrodynamic (MHD) power generators, MHD pumps, in polymer technology, in petroleum industry, in purification of crude oil and fluid droplets sprays. Its relevance is also seen in the fields of stellar and planetary magnetospheres, aeronautics, chemical engineering and electronics. In this view, many authors [1–6] have recently studied the MHD effects on flow problems with different aspects. They found that, MHD effect have a significant role in thermal management applications.
Gas sampling and analytical methods
All gas samples were collected directly from producing or exploratory wells with high pressure cylinder (Volume 1000 mL, maximum pressure 15 MPa) after flushing the lines and cylinder several times by closing the discharge valve in order to keep the gas pressure at 4–5 MPa in the cylinders, then closing the inlet valve. After the completion of sampling, the cylinder was tested for leakage. The chemical component of Longmaxi shale gases from Fuling were analyzed using CP3800 gas chromatography produced by U.S. Varian Company, and the detector was equipped with Flame Ionization Detector (FID) and Thermal Conductivity Detector (TCD) Hydrocarbon component analysis was undertaken with an Al2O3/Na2SO4 capillary column using helium as the carrier gas and a FID detector. Non-hydrocarbon gas analysis was performed with a Molsieve13X packed column, using helium as the carrier gas and a TCD detector. The analysis of H2 was performed with a Molsieve 5 packed column using N2 as the carrier gas and a TCD detector. The temperatures of the injector and detector were 120 °C and 180 °C, respectively. The temperature of the column was programmed from 50 °C (held for 2.5 min) to 105 °C (held for 2 min) at 10 °C/min, and then to 130 °C at 10 °C/min. The split ratio and the Injection Volume were 2:1 and 5 mL, respectively. Standard gas samples were used to demarcate and analyze the hydrocarbon composition. Carbon isotopic composition was analyzed using a MAT253 isotope mass spectrometer produced by the U.S. Thermo Finnigan Company. Gas chromatography analysis was performed using the chromatographic column of HP-Plot Q (30 m × 0.32 mm × 20 μm) in constant current mode with a column flow rate of 1.0 mL/min. The temperature of the injection room was 150 °C, and the column was programmed from 60 °C (held for 2.5 min) to 80 °C at 5 °C/min, then to 130 °C (held for 4 min) at 10 °C/min and to 240 °C (held for 3 min) at 20 °C/min. The split ratio was 15:1. Mass spectrometry conditions included: (1) cantharidin impact (EI) ion source, (2) an emission current of 1.5 mA, (3) an accelerating voltage of 10 kV, and (4) electron energy of 70 eV.
The chemical and carbon isotope composition of Huanglong natural gas in the Sichuan Basin were performed by Key Laboratory of Oil and Gas Resources Research of the Chinese Academy of Sciences. Test instrumentation and processes are shown in Ref.  and data in Refs. [18,27].
Gas geochemistry characteristics
Reasons for carbon isotope reversal of shale gas and geological significance
The CH4 content of shale gas from the Longmaxi Formation in the Sichuan Basin ranged from 95.52% to 99.59%, with an average of 98.54%. The heavier hydrocarbon gas content was low, accounting for 0.23%–0.72%, with an average of 0.49%. The drying coefficient (Cl/Cl–5) was more than 0.99. These features indicated that the shale gas was of typical dry gas. Non-hydrocarbon gas was mainly composed of N2 and CO2, and its average content was 0.47% and 0.50%, respectively. Compared to Huanglong gas, Longmaxi shale gas had a high methane content, lower content of heavier hydrocarbon and non-hydrocarbon gas, and no H2S.
The δ13C1 values of Longmaxi shale gas ranged from −37.3‰ to −26.7‰, δ13C2 from −42.8‰ to −31.6‰, and δ13C3 from −43.5‰ to −33.1‰, respectively, which indicated that the hydrocarbon gas was that of an oil-type gas. However, methane and ethane carbon isotope composition reversed, i.e., δ13C1 > δ13C2. Compared with Huanglong conventional natural gas, the methane and ethane carbon isotopic composition of shale gas were heavier, the hydrogen isotopic composition of methane was lighter and the δD1 value is mostly greater than δD2, all which indicated that Longmaxi shale gas was at the post-rollover stage.
Longmaxi shale gas was characterized with large changes in ln(C2/C3) and very little variation in ln(C1/C2); combined with the analysis of its carbon and hydrogen isotope composition, it could be considered to be the result of the mixing of kerogen cracking gas and soluble organic matter cracking gas formed in the early thermal evolution, with the later making more of a contribution.
In conclusion, S. pneumoniae and NTHi were the two most common pathogens of bacterial AOM in the era prior to universal pneumococcal resveratrol in Taiwan. Non-PCV7 pneumococcal serotypes, especially 19 A, became predominant. Continuous monitoring of the causative pathogens is needed. More effective and broad-spectrum vaccines would be indicated.
Conflicts of interest
Significant factors affecting the clinical outcome of candidemia and the associated mortality among critical patients in medical intensive care units have been reported. Prior studies indicate that echinocandins such as anidulafungin, caspofungin, and micafungin manifest in vitro fungicidal activity against candida. Furthermore, the clinical cure rate of caspofungin has been compared with that of micafungin and liposomal amphotericin B in invasive candida infections. Anidulafungin has also been compared with fluconazole in the treatment of candidemia. Nonetheless, to our knowledge, comparative studies on the clinical cure rates of anidulafungin, caspofungin, and micafungin in systemic candida infections has not yet been reported. Therefore, this study sought to compare the clinical efficacy of these three echinocandins, as well as their in vitro efficacy in patients of candidemia. The clinical cure rates between patients treated with echincandins and patients treated with fluconazole were compared. Associated risk factors for treatment failure and mortality in candidemia were also investigated.
A total of 109 cases of candidemia were included in our analysis. Of these, 70 cases were treated with echinocandins, azoles, or amphotericin B for ≥7 days and the other 39 cases were treated inadequately. The clinical cure rates of cases treated adequately and inadequately due to late or postmortem diagnosis were 44/70 (62.9%) and 4/39 (10.2%) respectively, and with significant difference (Table 1). According to logistic regression, adequate antifungal therapy and the APACHE III score were both independent significant factors for the clinical outcome (Table 2). Because one case of candidemia was treated with amphotericin B only, there were 69 evaluable cases of candidemia adequately treated with echinocandins or azoles. Clinical cure rates of anidulafungin, caspofungin, micafungin, and fluconazole were 18/30 (60.0%), 8/9 (88.9%), 5/7 (71.4%), and 9/18 (50%), respectively (Table 3). Regarding the APACHE III score, there was no significant difference among these four treatment groups. However, the difference in APACHE III score between treatment cure and failure cases was significant, indicating Recessive alleles patients with high APACHE III score were too sick to complete the course of treatment (Table 3). When echinocandins were evaluated together and compared with fluconazole group, the clinical cure rate was higher in the echinocandins group (72.7% in echinocandins group; 50.0% in fluconazole group; Table 4) without significant difference (Table 4). Regarding the mortality rate due to candidemia, significant differences were found between cases with and without early antifungal therapy and between those with and without adequate antifungal therapy (Table 5). The outcome of another nine cases of candidemia was in the treatment failure group who ultimately survived and was not included in the study of risk factors for mortality (Table 5). However, there was no significant difference in the mortality rate due to candidemia between those cases with and without persistent candidemia (Table 5). The in vitro activities of azoles to Candida isolates of candidemia are shown in Table 6. Candida glabrata and C. krusei were totally resistant to fluconazole whereas the other azoles such as itraconazole, posaconazole, and voriconazole showed lower MIC implicated clinical efficient (Table 6). The MICs of anidulafungin, caspofungin, and micafungin in C. parapsilosis were higher than that in other Candida spp. (Table 6). The MIC50/MIC90 of anidulafungin, caspofungin, and micafungin for all Candida spp. were 0.03/1 μg/mL, 0.06/0.5 μg/mL, and 0.008/1 μg/mL, respectively (Table 6).
However, the national groundwater assessment is indicative of the degree of groundwater usage when compared to the annual availability of groundwater resources. It does not include the dimension of groundwater quality. Indicative data drawn from various sources – (Krishnan, 2009; Kulkarni et al., 2009a,b; Central Ground Water Board, 2010; Vijay Shankar et al., 2011) – shows that groundwater contamination has emerged as a threat to drinking water security in many parts of the country. Groundwater exploitation and contamination have emerged across a diverse range of agro-climatic and hydrogeological conditions in India, with nearly 60% of the districts in India showing evidence of either depletion or contamination or both.
Even at a global level, socio-economic dependency on groundwater cuts across classical divisions of ‘arid, semi-arid and humid’ regions (Burke and Moench, 2000), highlighting the need to tailor responses to situations under which groundwater problems emerge. Moreover, the gap between society and science-technology is larger in the case of groundwater than surface water resources because of the relative ‘newness’ of intensive groundwater use (Llamas et al., 2006).
Three messages are highlighted under United Nations Educational Scientific and Cultural Organisation\’s (UNESCO\’s) global initiative on groundwater governance summarising key messages from its global governance programme as:
The combined impacts of an increasing demand and many ‘layers’ of supply even in a single village – tens to hundreds of wells, small dams and sometimes surface water systems like canals from large but distant reservoirs – have led to fundamental questions around the availability of freshwater resources in India (Kulkarni and Thakkar, 2012; Kulkarni and Shah, 2013; Shah, 2013). With at least 85% of the rural Mdivi 1 depending upon groundwater for their daily drinking water needs and nearly 50% of the urban share of water supply being groundwater-based, drinking water security of nearly a billion Indians is at potential risk on account of India\’s groundwater crisis. Hence, while India grapples with managing its groundwater resources keeping in mind that millions depend upon this resource around which vulnerability to scarcity and contamination is on the rise, there is an increasing need to design a groundwater governance framework that is relevant to India\’s unique groundwater situation. This paper seeds basic ideas into a preliminary framework for groundwater governance in India, a framework that is likely to lead to more concrete policies, practices and institutions that will eventually form core elements of groundwater governance in India.
India\’s groundwater resources
The last half century has witnessed a spectacular development in groundwater use globally (Llamas, 2011), with an increase from 100 millionm3 in 1950 to 1000 millionm3 in 2000 (Shah et al., 2007). India\’s groundwater crisis is located within a typology that is as much defined by its physical setting as asymmetrical is by the diverse set of socio-economic factors that drive the cause and are affected by the extent and nature of groundwater usage. The relationship between groundwater abstraction and recharge depends upon the “aquifers” which are tapped by an estimated 30 million wells, tube wells and bore wells; and, in many cases, which supply water to more than a million springs in the Himalayan region alone. The fundamental basis for good groundwater management is a clear understanding of aquifers, a statement of purpose that has now found its way into the 12th Five Year Plan (Planning Commission, 2012). India\’s groundwater typology is based on six broad hydrogeological settings (Kulkarni, 2005; Kulkarni et al., 2000). Even at an aggregated level, it is interesting to look at the relationship between broad hydrogeological settings (representing aquifer systems) across India, especially in relation to the administrative units, i.e. states and districts (Table 2). It is clear from the table that most of the larger states in India have mixed hydrogeological settings, prompting the question as to how the two main regions experiencing heavy groundwater exploitation, the northwestern region forming part of the Indo-Gangetic river basins and the southeastern region forming part of the Krishna-Godavari river basins compare with each other. The northwestern groundwater exploitation cluster encompassing the States of Punjab, Haryana, Uttar Pradesh, Rajasthan and Gujarat are underlain by thick and extensive unconsolidated sediments of alluvial origin while the southeastern groundwater exploitation cluster encompassing large parts of Andhra Pradesh, Karnataka and Tamil Nadu are underlain by crystalline rocks of igneous and metamorphic origin.
Air pollution consists of particulate matter, existing solid or liquid, and gaseous matter such as sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3). Particulate matter can be classified into two groups; non-spherical particles, which are mineral dust particles and spherical particles such as organic aerosols and inorganic sulfates and nitrates. Light Detection and Ranging (LIDAR) depolarization measurements performed simultaneously at two wavelengths can be used to identify non-spherical dust particles and spherical particles. Although the LIDAR system is unable to differentiate the size of particulate matter, it can be used to measure the level of mineral dust particles as airborne sand dust particles and non-mineral dust particles as air pollution aerosols in real time. LIDAR measurements for the detection of a potential ADS are continuously acquired in 23 locations in Japan, South Korea, China, Mongolia, and Thailand, and these data permit investigation of the association between pulmonary function and daily exposure to sand dust particles.
Several epidemiological studies have suggested an association of ADS with respiratory disorders. However, at present, the definition of ADS days varies among countries, and this may cause differences in the assessment of the relationship between ADS and health disorders among studies. In addition, sand dust emissions, including ADS, are conventionally expressed as PM10 and PM2.5, although these are a mixture of various components. LIDAR can quantify the KU60019 of sand dust particles by distinguishing between non-spherical and spherical dust particles. To ensure accuracy, we studied the relationship between large sand dust emissions in East Asia (Southwest Japan) and pulmonary function in children using LIDAR data for daily sand dust levels. Our key finding was that increased levels of sand dust particles induced a decrease in pulmonary function in schoolchildren. The results also showed that SPM and PM2.5 were significantly associated with a decrease in PEF, indicating a relationship between ADS and pulmonary function.
Thus far, there has been no method to monitor sand dust particles. Many studies used PM2.5 and PM10 levels to estimate the association between sand dust emissions and health disorders. However, PM10 and PM2.5 are a mixture of various components in addition to sand dust particles. Therefore, PM10 and PM2.5 are insufficient to determine the quantity of sand dust particles. In contrast, LIDAR systems are a suitable method to measure the quantity of sand dust emissions from East Asian deserts and air pollution aerosols; however, they are unable to recognize the size of particulate matter. This study found that sand dust emissions from East Asian deserts were associated with pulmonary function in schoolchildren, although the significant associations did not persist.
The South Korean study did not find a significant relationship between ADS events and PEF in children without asthma using PM2.5 and PM10 levels. In contrast, in this study, the levels of sand dust particles, SPM, and PM2.5 were significantly associated with decreased PEF in children without asthma. This discrepancy may be because this study had four times as many subjects as the South Korean study. Our study was planned to have sufficient statistical power to test the hypothesis. Another cause may be the difference in composition of particulate matter between western Japan and Korea because the effects of particulate matter on production of pro-inflammatory cytokine differed with composition.
LIDAR systems lack defined criteria for heavy dust days. Kanatani et al. defined one as a daily (24-h) median sand dust particle level of >0.1 km−1, which equaled 100 μg/m of SPM, and found a significant association with heavy dust exposure and hospital admission in children with asthma. Another study determined a moderate dust day as 0.066 km−1 and a heavy dust day as 0.105 km−1 to estimate the association between sand dust emissions and emergency ambulance dispatches. They found that heavy dust days were associated with an increase in emergency dispatches from all causes and cardiovascular disease, whereas moderate dust days showed no association. During this study, the daily median level never exceeded 0.06 km−1. Low level exposure to sand dust emissions may at least have a potential to induce minor pulmonary dysfunction in children, but it is unable to increase emergency ambulance dispatches and hospital admissions in children with asthma. It may be necessary to classify the risk levels of LIDAR data, as done for other air pollutants.
Recently, longitudinal spectral-domain OCTA follow-up of CNV from several diseases including nAMD showed the overall decrease in greatest linear dimension and area after anti-VEGF treatment , although type 1 NV may be more resistant . In this current case, en-face SS-OCTA using an intensity and phase-based contrasting microangiography algorithm-(OMAGC) with 100,000 A-scans per second, clearly demonstrated a vascular trunk of the extrafoveal type 1 NV and the type 2, “medusa-like” component , which was leaking into the subretinal space. We elected to use combination treatment with bevacizumab and PDT to target the type 2 component with anti-VEGF, and PDT to decrease the size and flow and prevent maturation of the extrafoveal, type 1 lesion. Successful combined treatment has been similarly observed in myopic classic CNV  and in PCV . Type 1 NV has been shown to be quite extensive on OCTA and may represent a more chronic, mature neovascular complex resistant to repetitive anti-VEGF therapy [9,12]. Early treatment with combined anti-VEGF and PDT therapy may be more effective in pruning the type 2, subretinal component and controlling the type 1, sub-RPE vessels before abnormalization therefore possibly preventing future recurrence and need for continuous anti-VEGF injections.
The risk of chorioretinal atrophy after PDT remains a significant issue. It has been speculated based on conventional FA, which showed early hypoperfusion of the choroidal circulation, that PDT may damage the normal choroidal vascular network . In this case, we did note that there was minimal collateral damage to the surrounding normal choriocapillaris. Even with presumed accurate identification of the NV membrane with conventional FA or indocyanine green angiography (ICGA), the size of the treatment area may still be overestimated due to borders of the lesion being obscured by dye leakage. SS-OCTA allows for a clear and objective identification of the extent of the lesion; and future use of OCTA when planning PDT treatment may be warranted to accurately identify the required treatment area especially due to its increased depth Sildenafil mesylate compared to FA or ICGA.
Instruction on appropriate contact lens hygiene is important to reduce the risk of adverse events. One of the most significant complications of contact lens wear is microbial keratitis. Up to 65% of all new microbial keratitis cases are caused by contact lens wear [1,2]. The incidence of microbial keratitis is 0.1–0.2% in soft extended-wear contact lens users [3–5]. Contact lens-related complications and keratitis cost an estimated $175 million annually in the United States and involve more than 250,000 clinician hours .
We report a case of bacterial keratitis in a contact lens user secondary to Pantoea agglomerans and Escherichia vulneris, Gram-negative bacteria that are extremely rare in the human eye. A PubMed review did not yield any prior reports of bacterial keratitis associated with either of these organisms. In addition, this is the first report of the antibiotic sensitivities of E. vulneris in the setting of an ocular infection.
On presentation, visual acuities were 20/30 OD and 20/25 OS. Examination of the right eye was normal. Slit lamp examination of the left eye revealed 1+ diffuse conjunctival injection and a 2.5 mm round paracentral corneal epithelial defect inferiotemporal to the visual axis involving 20% of the stroma. The patient was started on ciprofloxacin hourly when awake and homatropine 2% every 8 h. There was no change in symptoms the following day, and vision had decreased to 20/60 OS. Corneal scrapings were sent for routine and fungal cultures. The cultures were positive for P. agglomerans, E. vulneris, and Staphylococcus sp. Antibiotic sensitivities showed P. agglomerans and E. vulneris pansensitive to all tested antibiotics and Staphylococcus sp. resistant to clindamycin, erythromycin, gentamicin and oxacillin. Fig. 1 shows gram staining and growth plates for P. agglomerans and E. vulneris. Complete antibiotic sensitivities are shown in Table 1. The patient was started on fortified vancomycin and tobramycin drops, alternating between the two every hour when awake. The symptoms and clinical exam improved over several weeks, antibiotics were tapered and visual acuity returned to 20/25. At the last examination, the patient had only minimal punctate epithelial defects in the area of the ulcer, and was recommended to use artificial tears.