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Huwa-San peroxide (hydrogen peroxide; HSP) is a NSF Standard 60 (maximum 8 mg/L(-1)) new generation peroxide stabilized with ionic silver suitable for continuous disinfection of potable water. Experiments were undertaken to examine the mechanism of HSP against planktonic and biofilm cultures of indicator bacterial strains. Contact/kill time (CT) relationships that achieve effective control were explored to determine the potential utility in primary disinfection. Inhibitory assays were conducted using both nutrient rich media and a medium based on synthetic wastewater. Assays were compared for exposures to three disinfectants (HSP, laboratory grade hydrogen peroxide (HP) and sodium hypochlorite) at concentrations of 20 ppm (therefore at 2.5 and 5 times the NSF limit for HP and sodium hypochlorite, respectively) and at pH 7.0 and 8.5 in dechlorinated tap water. HSP was found to be more or equally effective as hypochlorite or HP. Results from CT assays comparing HSP and HP at different bacterial concentrations with neutralization of residual peroxide with catalase suggested that at a high bacterial concentration HSP, but not HP, was protected from catalase degradation possibly through sequestration by bacterial cells. Consistent with this hypothesis, at a low bacterial cell density residual HSP was more effectively neutralized as less HSP was associated with bacteria and therefore accessible to catalase. Silver in HSP may facilitate this association through electrostatic interactions at the cell surface. This was supported by experiments where the addition of mono (K(+)) and divalent (Ca(+2)) cations (0.005-0.05M) reduced the killing efficacy of HSP but not HP. Experiments designed to distinguish any inhibitory effect of silver from that of peroxide in HSP were carried out by monitoring the metabolic activity of established P. aeruginosa PAO1 biofilms. Concentrations of 70-500 ppm HSP had a pronounced effect on metabolic activity while the equivalent concentrations of ionic silver (50- 375 ppb) had a negligible effect, demonstrating that the microbiocidal activity of HSP was due to peroxide rather than silver. Overall, it was found that the antimicrobial activity of HSP is enhanced over that of hydrogen peroxide; the presence of the ionic silver enhances interactions of HSP with the bacterial cell surface rather than acting directly as a biocide at the tested concentrations.

This article explores the life and influence of Indira Devi Niloy (1920–1997) who in 1949 began to encounter the sixteenth-century saint–poet Mirabai during her meditative trance states. She would recount songs, stories, and teachings that the saint gave to her as well as scenes from Mirabai’s life that she witnessed as an observer and at other times experienced directly as a participant. Their ongoing relationship would have a tremendous influence on Indira Devi as well as her guru Dilip Kumar Roy (1897–1980) and the increasingly international community that grew up around them. Their interactions and Indira Devi’s reports in turn would also significantly influence the reception and perceived continuing relevance of Mirabai as both inspiration and authorization for women’s self-realization. Additionally, Indira Devi’s own story reveals a mode of female guruhood, with a distinct absence of identification with shakti or divine incarnation, a more egalitarian model for the guru–disciple relationship, and an alternate bhakti mode of male–female collaborative leadership with Roy. Further their experiences with Mirabai offer insight into the ongoing engagement of women and men with such influential women of the past, the intersubjective nature of the traditions that surround them, and what Mirabai’s message might be for women (and men) today.

Arvind Sharma has made immensely significant contributions in the fields of both comparative religion and the study of Hinduism through his methodology of “reciprocal illumination” and his prominent role in international conversations on women and religion, religion and human rights, freedom of religion, and religious tolerance and conflict. Aware of the power of religion and its negative valuation, especially post-September 11, he displays a deep commitment to fostering interreligious understanding, arguing for religion as an essential and positive partner in envisioning and actualizing human flourishing, upholding human dignity, and engaging in global ethical cooperation, and equally he demonstrates Hinduism’s potential contribution both to these endeavors and to moving the field of comparative studies beyond its Western, Christian, and colonialist origins and assumptions. This essay details these contributions and Sharma’s place as an interpreter of Hinduism for those inside and outside the tradition in our time.

Rarely do members of diverse religions engaged in interreligious dialogue find agreement on metaphysics and doctrine, though such conversations may be very fruitful and lead to greater understanding and mutual illumination. In the area of religious experience, however, recognition of commonality may be much more readily apparent, and in such encounters, the life and spirituality of Jesus provide a meeting ground. This essay examines Jesus as a catalyst for spiritual inspiration and transformation from Islamic, Hindu, Buddhist and nontraditional perspectives. As an integral figure in Islam, Jesus appears in the writings of the likes of Ibn Arabi, Rumi and more contemporary Sufi teachers. Hindus and Buddhists, too, have embraced him, from Sri Ramakrishna and Gandhi to Thich Nhat Hanh. This essay will explore the integral role Jesus plays in such interreligious contexts, embodying self-sacrifice, wisdom and active love and interweaving personal transformation, contemplative practice and social engagement in the pursuit of liberating spiritual realization. In so doing, the essay will argue that such interreligious perspectives are an essential element in a full accounting of Jesus’ place in the spiritual lives of diverse human beings.

Venous Thrombo-embolism (VTE--Deep venous thrombosis (DVT) and/or pulmonary embolism (PE)--in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period--SP). The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP). All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs--diagnostic, therapeutic and surveillance--for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY) gained was calculated. 4234 patients were eligible (PSP--1422 and SP--2812). Rate of DVT in SP (2.8%) was significantly higher than in PSP (1.3%) - p<0.05, and rate of PE in SP (0.7%) was significantly lower than that in PSP (1.5%) - p<0.05. Logistic regression demonstrated that surveillance was an independent predictor of increased DVT detection (OR: 2.53 - CI: 1.462-4.378) and decreased PE incidence (OR: 0.487 - CI: 0.262-0.904). The incremental cost was $509,091/life saved in the base case, translating to $29,102/QALY gained. A sensitivity analysis over four of the parameters used in the model indicated that the incremental cost ranged from $18,661 to $48,821/QALY gained. Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society.

Purpose - Teacher attrition is a significant international concern facing administrators. Although a considerable amount of literature exists related to the causes of job dissatisfaction and teachers leaving the profession, relatively few theoretical models test the complex interrelationships between these variables. The goal of this paper is to partially fill this gap.Design methodology approach - Using a sample of 479 certified teachers who taught either at elementary (55.3 percent), middle (33.0 percent), or high (10.6 percent) school levels, three competing theoretical models with variables related to teacher stress or support were tested using structural equation modeling to predict job dissatisfaction and eventual intention to quit.Findings - The most parsimonious model revealed that student stressors completely mediated the relationship between teacher efficacy related to student engagement and job dissatisfaction, with social support superiors and student stressors being best predictors of job dissatisfaction. Although important within the school system, teacher workload stressors and social support from colleagues did not contribute significantly to the models.Originality value - Theoretical models are needed to assist school administrators and researchers in developing programs to improve teacher retention and to predict those teachers who will struggle within the profession. Moreover, developing and testing comprehensive models associated with variables related to teacher and student success is critical for a well functioning school system.

The purpose of this study was to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) equivalence of single 100 U/kg subcutaneous doses of Epoetin Hospira and Epogen in healthy male subjects as part of an overall program to demonstrate biosimilarity of Epoetin Hospira to the reference product Epogen. This single-center, open-label, randomized, 2-period, crossover study was conducted in 81 healthy male subjects. Subjects were randomized to Sequence 1, in which they received 100 U/kg of Epoetin Hospira or to sequence 2, in which they received 100 U/kg Epogen subcutaneously in the first study period and the alternative treatment in the second study period. Blood was collected for determination of baseline-adjusted epoetin concentrations (BAECs) for pharmacokinetics and for determination of reticulocyte percentage of total erythrocytes for pharmacodynamics throughout both study periods. The primary PK end points were the geometric mean ratios (GMRs) of the 2 treatments for AUC0–t and Cmax based on the BAEC, and the primary PD end points were the GMRs of the 2 treatments for AUC0–t and Cmax for reticulocyte percentage. The GMRs of Epoetin Hospira to Epogen for the BAEC-derived PK parameters were 1.05 for AUC0–t with a 90% CI of 1.01 to 1.11, and 1.09 for Cmax with a 90% CI of 1.01 to 1.18, with both 90% CIs contained within the prespecified equivalence margin of 0.80 to 1.25. The GMRs (Epoetin Hospira/Epogen) for the reticulocyte percentage–derived PD parameters were 1.01 for AUC0–t with a 95% CI of 0.98 to 1.05, and 1.02 for Cmax with a 95% CI of 0.98 to 1.06, with both 95% CIs contained within the prespecified equivalence margin of 0.80 to 1.25. Overall, the adverse events were of similar frequency (11.7% and 13.9% for Epoetin Hospira and Epogen, respectively) and severity between treatments. One subject had a positive anti– recombinant human erythropoietin antibody result by radioimmunoprecipitation assay before dosing and throughout the conduct of the study with negative neutralizing antibodies and with no evidence of clinical deterioration or impact on the pharmacokinetics, pharmacodynamics, or safety. The results of this study established the PK and PD equivalence of single 100 U/kg subcutaneous doses of the proposed biosimilar Epoetin Hospira to the reference product Epogen in healthy male subjects and support the overall demonstration of biosimilarity of Epoetin Hospira and Epogen.

Objectives To compare the results of two maternal death review processes conducted from 2002 to 2012 by Illinois regionalized perinatal centers with those conducted by the Illinois Department of Public Health’s (IDPH’s) statewide multidisciplinary external Maternal Mortality Review Committee (MMRC). Methods This is a retrospective record review linking MMRC case assessment forms to the IDPH’s Maternal Mortality Review Form database to compare causes of death and potential preventability as determined by both review processes. Results MMRC records for 76 maternal death reviews were linked to the IDPH maternal mortality review form database. Most deaths reviewed by the statewide MMRC were due to pregnancy-related causes. The statewide MMRC differed from the regional perinatal centers on cause of death in 55.3 % (n = 42) of cases and on the disposition of potential preventability in 48.7 % (n = 37) of cases. The statewide MMRC judged 69.7 % (n = 53) of cases potentially preventable, compared with 40.8 % (n = 31) for the regional perinatal centers. The MMRC identified more preventable provider and systems factors for potentially preventable deaths compared with regional perinatal centers which identified more preventable patient factors. Conclusions for practice The statewide MMRC found more potential preventability and determined that preventability was associated with provider and systems factors, not patient factors. Observed discrepancies between regional perinatal center and statewide MMRC reviews were likely due to the complexity of cases selected for review, the multidisciplinary external composition of the review team, and the de-identification of cases. Multidisciplinary statewide expert panels should be implemented in addition to local and regionalized reviews.

Background Antimuscarinic agents are currently the predominant treatment option for the clinical management of the symptoms of overactive bladder (OAB). However, low rates of persistence with these agents highlight the need for novel, effective and better-tolerated oral pharmacological agents. Mirabegron is a β 3 -adrenoceptor agonist developed for the treatment of OAB, with a mechanism of action distinct from that of antimuscarinics. In a randomized, double-blind, placebo- and active-controlled Phase 3 trial conducted in Europe and Australia (NCT00689104), mirabegron 50 mg and 100 mg resulted in statistically significant reductions from baseline to final visit, compared with placebo, in the co-primary end points – mean number of incontinence episodes/24 h and mean number of micturitions/24 h. We conducted a post hoc, subgroup analysis of this study in order to evaluate the efficacy of mirabegron in treatment-naïve patients and patients who had discontinued prior antimuscarinic therapy because of insufficient efficacy or poor tolerability. Methods Patients were randomized to placebo, mirabegron 50 or 100 mg, or tolterodine extended release (ER) 4 mg orally, once-daily, for 12 weeks. For the post hoc analysis, the primary patient population was divided into the following subgroups: (1) patients who had not received any prior antimuscarinic OAB medication (treatment-naïve) and (2) patients who had received prior antimuscarinic OAB medication. The latter subgroup was further subdivided into patients who discontinued due to: (3) insufficient efficacy or (4) poor tolerability. Analysis of the co-primary efficacy endpoints by subgroup was performed using analysis of covariance with treatment group, subgroup, sex, geographical region, and subgroup-by-treatment interaction as fixed factors; and baseline value as a covariate. Results Mirabegron, 50 mg and 100 mg once-daily, demonstrated similar improvements in the frequency of incontinence episodes and micturitions in OAB patients who were antimuscarinic-naïve and who had discontinued prior antimuscarinic therapy. While mirabegron demonstrated improvements in incontinence and micturition frequency in patients who had discontinued prior antimuscarinic therapy due to insufficient efficacy, the response to tolterodine was similar to that of placebo. Conclusion In this post hoc subgroup analysis, mirabegron provided treatment benefits in OAB patients who were antimuscarinic treatment-naïve and in patients who had received prior antimuscarinic treatment.