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OBJECTIVES: To assess the effects of antibiotics delivered via the respiratory tract in preventing ventilator-associated pneumonia (VAP). DATA SOURCES: We searched PubMed, Scopus, the Cochrane Library, and ClinicalTrials.gov for studies published in English up to October 25, 2023. STUDY SELECTION: Adult patients with mechanical ventilation of over 48 h and receiving inhaled or instilled antibiotics (with control group) to prevent VAP were included. DATA EXTRACTION: Two independent groups screened studies, extracted the data, and assessed the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty/quality of the evidence. Results of a random-effects model were reported for overall and predefined subgroup meta-analyses. The analysis was primarily conducted on randomized controlled trials, and observational studies were used for sensitivity analyses. DATA SYNTHESIS: Seven RCTs with 1445 patients were included, of which six involving 1283 patients used nebulizers to deliver antibiotics. No obvious risk of bias was found among the included RCTs for the primary outcome. Compared with control group, prophylactic antibiotics delivery via the respiratory tract significantly reduced the risk of VAP (risk ratio [RR], 0.69 [95% CI, 0.53-0.89]), particularly in subgroups where aminoglycosides (RR, 0.67 [0.47-0.97]) or nebulization (RR, 0.64 [0.49-0.83]) were used as opposed to other antibiotics (ceftazidime and colistin) or intratracheal instillation. No significant differences were observed in mortality, mechanical ventilation duration, ICU and hospital length of stay, duration of systemic antibiotics, need for tracheostomy, and adverse events between the two groups. Results were confirmed in sensitivity analyses. CONCLUSIONS: In adult patients with mechanical ventilation for over 48 h, prophylactic antibiotics delivered via the respiratory tract reduced the risk of VAP, particularly for those treated with nebulized aminoglycosides. [ABSTRACT FROM AUTHOR]

Background: The postpartum period is associated with a high risk of illness episodes in women with bipolar disorder (BD) and is a critical developmental phase for both a new mother and her infant. This mixed-methods study aimed to investigate the occurrence of mood symptoms among infant mothers with BD in the first year postpartum, as well as their perceptions of the first year, their challenges and their strategies for wellbeing. Methods: Twenty-six women with BD participated. Mood symptoms were assessed at 3 and 12 months postpartum with the Inventory of Depressive Symptomatology and Young Mania Rating Scale. Occurrences of additional postpartum mood deviations were investigated through an interview at 12 months, which also covered the women's postpartum experiences. Thematic analysis was applied to the qualitative dataset (interviews and field notes). Results: 42% of the women were euthymic or had only mild mood symptoms at 3 and 12 months. 58% had moderate to severe symptoms at either or both time points. A positive (38%) vs. mixed (62%) perception of the first year was strongly associated with euthymia-mild vs. moderate-severe mood deviations, as was the experience of maternal developmental achievement vs. struggles. The women experienced postpartum mood deviations and illness episodes as being particularly poorly timed. Further challenges included balancing self-care and infant mothering, familial relations, and negative experiences with the health and care systems. Illness acceptance with mindfulness of one's own and the infant's needs was a primary strategy for wellbeing, which was complemented by the support of one's partner and family and postpartum treatment. Conclusions: Our findings propose that without impeding mood deviations and concomitant challenges, infant mothers with BD can enjoy their new motherhood and experience phase-specific growth equally to healthy mothers. On the other hand, moderate to severe mood deviations can adversely impact the experience of the postpartum year and one's own sense of mothering. Efforts to prevent postpartum mood deviations need to be complemented with interventions that target phase-specific BD challenges and support wellbeing strategies for both the mother and her infant. In summary, women's needs to function as infant mothers must be considered in the postpartum treatment of BD. [ABSTRACT FROM AUTHOR]

Simple Summary: Immune checkpoint inhibitors (ICIs) and chimeric antigen receptor (CAR) T-cell therapy have been successful in treating select solid and blood borne cancers. However, ICIs and CAR-T have failed to yield benefit in glioblastoma (GBM) across multiple randomized trials. The major obstacles in ICI and CAR-T stem from the complex, immunosuppressive microenvironment, brain barrier penetrance, and systemic leukopenia inherent to GBM. ICIs and CAR-T therapy bolster the immune response by mitigating tumor-cell induced exhaustion through blocking critical checkpoint pathways and equipping cytotoxic T-cells with targetable tumor-specific proteins, respectively. This review highlights the clinical trials done using ICI and CAR-T therapy and the significant challenges that GBM and the immunosuppressive tumor microenvironment (TIME) pose for future strategies. Overcoming GBM's profound immunosuppression may lie within the abundant myeloid-derived cell population in the microenvironment. Background: Glioblastoma (GBM) is the most common primary malignant brain tumor, with fewer than 5% of patients surviving five years after diagnosis. The introduction of immune checkpoint inhibitors (ICIs), followed by chimeric antigen receptor (CAR) T-cell therapy, marked major advancements in oncology. Despite demonstrating efficacy in other blood and solid cancers, these therapies have yielded limited success in clinical trials for both newly diagnosed and recurrent GBM. A deeper understanding of GBM's resistance to immunotherapy is essential for enhancing treatment responses and translating results seen in other cancer models. Objectives: In this review, we examine clinical trial outcomes involving ICIs and CAR-T for GBM patients and explore the evasive mechanisms of GBM and the tumor microenvironment. Findings and Discussion: Multiple clinical trials investigating ICIs in GBM have shown poor outcomes, with no significant improvement in progression-free survival (PFS) or overall survival (OS). Results from smaller case studies with CAR-T therapy have warranted further investigation. However, no large-scale trials or robust studies have yet established these immunotherapeutic approaches as definitive treatment strategies. Future research should shift focus from addressing the scarcity of functional T cells to exploiting the abundant myeloid-derived cells within the tumor microenvironment. Conclusions: Translating these therapies into effective treatments for glioblastoma in humans remains a significant challenge. The highly immunosuppressive nature of GBM and its tumor microenvironment continue to hinder the success of these innovative immunotherapeutic approaches. Targeting the myeloid-derived compartment may lead to more robust and sustained immune responses. [ABSTRACT FROM AUTHOR]

Despite significant advancements in multiple myeloma (MM) treatment, including novel therapies and combination strategies, the translation of findings from randomized controlled trials (RCTs) into real-world clinical practice has been associated with several challenges. Specifically, the principles and criterion that shape the current design of MM RCTs have left out a sizable portion of patients that would particularly benefit from trial inclusion. In addition, RCTs may use primary outcomes which only partially cover patient-relevant endpoints important for evaluating treatment efficacy and quality of life. In this review, we explore the current MM RCT landscape and suggest possible solutions to improve generalizability of trial results, mitigate logistical pitfalls, and integrate real-world evidence into trials. Together, these strategies are designed to refine MM treatment guidelines and improve outcomes for all patient populations. [ABSTRACT FROM AUTHOR]

The article discusses the use of ChatGPT-4, an advanced language model, in addressing multiple-choice questions (MCQs) in the primary examination of the Australian and New Zealand College of Anaesthetists. ChatGPT-4 demonstrated success in answering official MCQs, achieving a score of 73% overall, with strong performance in physiology and pharmacology. While the model showed promise, it is noted that it may generate factual errors and should not be solely relied upon for exam preparation. The study highlights the potential of AI models like ChatGPT-4 as study aids in anaesthesia education and assessment, with room for further improvement and research in the field. [Extracted from the article]

This article illustrates how practices of mapping existed prior to the British colonisation of India, but also how the colonial cartographers rejected these local practices as non-scientific. I argue that the cartography of the Indian subcontinent is largely the result of an entanglement between the European technology and native knowledge systems, aided by colonialism, and influenced by the diversities within the colonial subjects. The British East India Company made cartography an important tool of imperialism, as knowledge of territory was essential to enhancing trade and administration. These cartographers made extensive use of local human resources and knowledge in mapping colonial India, while natives employed by the British adapted new technologies without denouncing their existing knowledge systems. The intricate interplay between colonialism and the Indian caste structure also had a significant impact on the discourse of cartography. Over time, these encounters facilitated a new sense of visual affinity with the depiction of the Indian nation, thus making indigenous cartographic practices integral to Indian nationalist discourses. This article therefore illustrates the limitations of the colonial portrayal of a passive recipient and foregrounds the active participation of natives in the process of mapping. [ABSTRACT FROM AUTHOR]

ABSTRACT: Context: Novelty in today's dental practice aims at superiority in aesthetics. Dental practitioners address patient anxiety about retaining teeth while maintaining aesthetic appeal. The debate revolves around the best approach to meet their aesthetic and functional needs, leading to the development of various inlay techniques. Choosing between laboratory-processed composite resins and metal-free ceramic restorations has become increasingly complex. Laboratory-processed composites offer similar aesthetics and physical properties to dental ceramics, but ceramic restorations tend to adapt better to cavity preparation. Aims: This study aimed to compare clinical performance, post-operative sensitivity, marginal discrepancy, interfacial staining, and secondary caries between direct composite inlays, indirect composite inlays, and ceramic inlays, with the null hypothesis being no significant difference. Methods and Material: The study involved 30 patients aged 18-45 from Bapuji Dental College and Hospital in Karnataka who underwent composite inlays for their posterior teeth. The patients were selected based on inclusion and exclusion criteria, and the study was approved by the Ethical Committee. Post-operative pain was assessed using the Visual Analog Scale. Statistical Analysis Used: Statistical analysis was performed using the Chi-square test. Results: Satisfactory results were observed throughout the evaluation, with statistically no significant differences between them but with a more assured performance of the ceramic inlay group and acceptable presentation of the indirect composite inlay group. Conclusions: Posterior tooth-coloured inlays provide acceptable outcomes, making them reliable candidates for clinical use, and ceramic inlays exhibit better performance rates. [ABSTRACT FROM AUTHOR]

This study presents a hybrid (Bayesian‐frequentist) approach to sample size re‐estimation (SSRE) for cluster randomised trials with continuous outcome data, allowing for uncertainty in the intra‐cluster correlation (ICC). In the hybrid framework, pre‐trial knowledge about the ICC is captured by placing a Truncated Normal prior on it, which is then updated at an interim analysis using the study data, and used in expected power control. On average, both the hybrid and frequentist approaches mitigate against the implications of misspecifying the ICC at the trial's design stage. In addition, both frameworks lead to SSRE designs with approximate control of the type I error‐rate at the desired level. It is clearly demonstrated how the hybrid approach is able to reduce the high variability in the re‐estimated sample size observed within the frequentist framework, based on the informativeness of the prior. However, misspecification of a highly informative prior can cause significant power loss. In conclusion, a hybrid approach could offer advantages to cluster randomised trials using SSRE. Specifically, when there is available data or expert opinion to help guide the choice of prior for the ICC, the hybrid approach can reduce the variance of the re‐estimated required sample size compared to a frequentist approach. As SSRE is unlikely to be employed when there is substantial amounts of such data available (ie, when a constructed prior is highly informative), the greatest utility of a hybrid approach to SSRE likely lies when there is low‐quality evidence available to guide the choice of prior. [ABSTRACT FROM AUTHOR]

The article deals with the challenges in implementing an Antimicrobial Stewardship Program (ASP) in developing countries. These include the disproportionate burden of high infectious disease, poor sanitation, over-crowding, poor infection-control practices, under-resourced healthcare systems, lack of policies and guidelines, and weak data management systems.

This study analyzes the variations within LaCrO3 induced by diamagnetic gallium (Ga) substitution at the chromium (Cr) sites, exploring the consequential changes in both structural configuration and magnetic attributes. Through structural characterization employing X-ray diffraction (XRD) and scanning electron microscopy (SEM), the modified lattice parameters and crystalline structure resulting from Ga incorporation are revealed, shedding light on the structural and phase modifications within the material. The magnetic property investigations unveil the impact on the weak ferromagnetism intrinsic to LaCrO3 and in Ga substituted samples. Additionally, this research scrutinizes the consequential shifts in entropy resulting from Ga substitution, offering insights into the material's thermodynamic properties. The findings elucidate the intricate relationship between structural modifications and magnetic properties within perovskite oxides, providing valuable insights into the multifunctional effects of Ga substitution on LaCrO3. [ABSTRACT FROM AUTHOR]

The introduction of white light-emitting diodes (LEDs) is one of the key innovations that has revolutionized the lighting industry due to its multiple benefits. Despite their advantages, there is a gap in the environmental impact information of the recently developed high-power LED products within the whole lifecycle, which is a key step to achieve sustainable and green development. This life cycle assessment (LCA) is conducted by considering the cradle-to-grave system boundary. The functional units considered are a LED and compact fluorescent lamp (CFL) of 40 million lumen-hours (lm-h) used for indoor applications over an operating time of 20 000 h. In this study, the LCA was carried out using the SimaPro software and built-in ecoinvent database V2.2 with appropriate life cycle inventory data. The analysis results indicate that: (1) the LED-package has a dominant environmental impact followed by the LED driver while the housing and corrugated-board packaging materials showed the least negative effect to the ecosystem during the manufacturing phase. On the contrary, the CFL drivers are dominant followed by the light sources in the case of CFLs. From the lifecycle stages, the usage-phase showed a predominant environmental effect, mainly due to the energy consumption and sources of energy production. (2) A scenario analysis on the sources of electricity production revealed that prospective sources (70% natural gas, 25% nuclear and 5% pumped storage) of energy production lowered the environmental impact compared to the current electricity mix. These proposed electricity generation production sources provide a 61% reduction in the global warming potential in light sources for Hong Kong. [ABSTRACT FROM AUTHOR]

Background: Long-term morbidity of breast radiotherapy, particularly due to the dose received by the heart and lungs is a cause for concern. Prone positioning for treatment has reported benefits with regard to acute and late toxicities with no detrimental effect on efficacy, especially for patients with large and pendulous breasts. This dosimetric study was aimed at assessing the dose conformity and homogeneity to a defined breast PTV and doses received by structures such as the heart, lungs, and contralateral breast using 3DCRT plans generated in supine and prone positions. The study was approved by the Institutional Review Board. Methods: The computed tomography (CT) image data sets of 41 consecutive women with large breasts who had undergone breast conservation surgery for pT1/T2, N0 cancer, and underwent dual CT imaging (in supine and prone positions) for planning whole breast radiotherapy were used for this comparative analysis. The various dosimetric parameters were calculated for the target volumes and organs-at-risk (OARs) and compared for both positions. Results: Among the 41 patients, 32 had left-sided cancer. The mean of breast PTV dose and homogeneity index were better for the prone position. The mean conformity index was comparable for both positions. The PTV V95%, V98%, and V100% of the prescribed dose were significantly better in the supine position; however, the V107% was comparable for both positions. The mean dose, V20, V12, and V5 of the ipsilateral lung were better in the prone position. The mean heart dose was comparable for both supine and prone positions. The V5 (%) of the heart was significantly lower for the prone position. The mean contralateral breast dose and low-dose radiation to normal tissue were significantly worse for the prone position. Based on individual dosimetric parameters, 26 patients had superior plans in the prone position. Conclusion: Prone breast radiotherapy is capable of producing improved normal tissue sparing with no detriment to target volume coverage in appropriately selected patients with large/pendulous breasts. Strict standard operating procedures with regard to simulation, planning, and treatment execution should be in place to ensure accuracy and daily reproducibility to achieve maximum benefit from this labor-intensive process. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To quantify the frequency and patterns of clinicians' use of choice frames when discussing preference-sensitive care with surrogate decision-makers in the ICU. DESIGN: Secondary sequential content analysis. SETTING: One hundred one audio-recorded and transcribed conferences between surrogates and clinicians of incapacitated, critically ill adults from a prospective, multicenter cohort study. SUBJECTS: Surrogate decision-makers and clinicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four coders identified preference-sensitive decision episodes addressed in the meetings, including topics such as mechanical ventilation, renal replacement, and overall goals of care. Prior critical care literature provided specific topics identified as preference-sensitive specific to the critical care context. Coders then examined each decision episode for the types of choice frames used by clinicians. The choice frames were selected a priori based on decision science literature. In total, there were 202 decision episodes across the 101 transcripts, with 20.3% of the decision episodes discussing mechanical ventilation, 19.3% overall goals of care, 14.4% renal replacement therapy, 14.4% post-discharge care (i.e. discharge location such as a skilled nursing facility), and the remaining 32.1% other topics. Clinicians used default framing, in which an option is presented that will be carried out if another option is not actively chosen, more frequently than any other choice frame (127 or 62.9% of decision episodes). Clinicians presented a polar interrogative, or a "yes or no question" to accept or reject a specific care choice, in 43 (21.3%) decision episodes. Clinicians more frequently presented options emphasizing both potential losses and gains rather than either in isolation. CONCLUSIONS: Clinicians frequently use default framing and polar questions when discussing preference-sensitive choices with surrogate decision-makers, which are known to be powerful nudges. Future work should focus on designing interventions promoting the informed use of these and the other most common choice frames used by practicing clinicians. [ABSTRACT FROM AUTHOR]

The letter published in the Annals of Cardiac Anaesthesia discusses the impact of closing an atrial septal defect (ASD) on the severity of mitral regurgitation (MR) in a pediatric patient. The study highlights changes in the pulmonary venous doppler (PVD) flow pattern before and after surgical correction, indicating a downgrade in MR severity post-surgery. The closure of the ASD may have influenced the PVD profile of severe MR, leading to a reversal of systolic flow in the PVD waveform. Further research is needed to explore this phenomenon in more detail. [Extracted from the article]

Until recently space travel was considered a privilege of governmental astronauts, with the exception perhaps of a few billionaire space tourists, who had been accommodated on the International Space Station on some rare occasions. Nonetheless, with major space pioneers announcing plans for space tourism activities and after the successful launch in orbit of space tourism vehicles from the Virgin Galactic and Blue Origin companies, academic interest about human spaceflight for purposes of leisure and recreation has ignited. Taking into account that space tourism is in fact an unregulated activity, this paper will firstly examine whether space tourism activities fall under the scope of space law or under the scope of international air law, depending on the planned trajectory of the space tourism vehicle. Furthermore, the authors will attempt to draw conclusions concerning the legal implications of space tourism activities through a comparative analysis with the 1974 Athens Convention on the Carriage of Passengers and the Carriage of their Luggage by Sea. This international convention provides a great example on the regulation of touristic ventures, as it refers to commercial touristic activities realized within a res communis omnium , i. e., the high seas, similarly with touristic activities in space. Moreover, said Convention provides for a specialized regime for touristic activities and is of particular interest, since it has achieved stability and a desirable balance of interests between private tourism operators and passengers. In this connection, the authors will evaluate the provisions of the 1974 Athens Convention in comparison with the space treaties applicable to space tourism activities. Furthermore, suggestions will be made as to whether it would be appropriate and feasible to introduce in the space law realm certain rules of law similar to those of the 1974 Athens Convention, in order to facilitate growth in the space tourism sector, without compromising the safety of human spaceflight for space passengers. • The 1974 Athens Convention in comparison with the space treaties applicable to space tourism activities. • Legal analogy between space law and maritime law. • Legal regime governing space tourism activities. [ABSTRACT FROM AUTHOR]

In the current study, the electronic, optical, thermoelectric, and Structural properties of Mg 1−x Zn x O composition have been investigated. The density of states of MgO showed the predominant contribution of Mg- s and O- p orbitals, while for Zn-doped MgO, density of states spectra exhibited strong hybridization among O- p , Mg- s , and Zn- d orbitals. The reduction in band gap with the increase of Zn doping in the MgO host matrix was observed. The thermoelectric properties of pure and Zn-doped MgO samples were measured by utilizing the Boltztrap package. Structural studies showed that the thin films possess the single phase crystalline cubic structure, which retained its stability after Zn incorporation. The results demonstrated that Zn doping into MgO reduced the optical band gap and enhanced the optical properties. The current research focus indicates that Zn-doped MgO thin films with enhanced optical and thermoelectric properties could be potential choices for optoelectronic and thermoelectric applications. [ABSTRACT FROM AUTHOR]

To assess the Knowledge, Attitude, and Practice on Noise Induced Hearing Loss(NIHL) caused by using Personal Listening Devices (PLD). To assess the usage pattern of PLD among undergraduate medical students studying at a tertiary health center in South India. A descriptive study was conducted by the Department of ENT over a three-month duration on undergraduate medical students who volunteered to fill in an electronic questionnaire form that they received via WhatsApp. A convenient sampling technique was used. NIHL questionnaire consisted of three sets of electronic questionnaires: Q1, Q2, and Q3. In Q1 total score of more than 75% was taken as good knowledge, 50–75% as fair knowledge, and less than 50% as poor knowledge. Q2 score of more than 50% was taken as a good attitude and less than 50% as a need to improve upon attitude. A total of 224(94.5%) participants had consented, out of the 224 students, 132(58.9%) were males and 92(41.1%) were females. 195(87.1%) of the 224 participants are regular users of PLD and the most common PLD used was earbuds (76.8%). The mean total knowledge on NIHL is less than 75%. Medical students have fair knowledge (54.5%). The weaker areas of knowledge were about the nature of the disease believing that NIHL is a reversible condition. Their overall attitude score is good (61.8%). Students more than 18 years of age had a positive attitude score (3.42 +/- 0.856) as compared with students less than 18 years of age (2.69 +/- 0.800). Most participants preferred a volume level of 6.26 +/- 1.517 on a scale of 1 to 10 for PLD, indicating that students prefer to set the volume at higher level. The participants showed fair knowledge and a good attitude concerning NIHL. The present study highlights a concerning lack of practice about NIHL and the prevalence of unsafe PLD among medical students. This underscores the importance of educational interventions to increase awareness among this population. [ABSTRACT FROM AUTHOR]

We offered and suggested some classes N Ω,Β,α,γ (ψ, τ, φ) and Ch,b,α,γ (τ, α, ψ, φ) of bi-univalent functions in the unit disk u, to apply the effects to the classes through convolution of the operators Rof(z) and Isa,uf(z). Which satisfies the condition quasi-subordination. We got estimates the first two Taylor-Maclaurin coefficients |a2| and |a3| by convolution of the operators Rof(z) and Iauf (2). [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: Stresses tend to vary depending on the kind of implant material (titanium or zirconium) because of differences in their mechanical and physical characteristics. Objectives: The current research was done to assess the peri-implant stresses around zirconium and titanium dental implants using finite element analysis. Materials and Method: Three distinct implant configurations were used to create three-dimensional finite element models (M1, M2, and M3) using ANSYS (11.0 Version) software, a P4 CPU running at 3 GHz, and hardware with three gigabytes of RAM. These configurations are typical for zirconium and titanium implants. Under 250 N of axial force and 50 N of nonaxial load, the stress surrounding the implants was examined. Result: When compared to titanium implants, zirconium implants displayed higher strains in cancellous bone and lower stresses in cortical bone. Overall, titanium implants caused larger stresses in the bone than zirconium implants. Conclusion: Compared to titanium implants, zirconium implants resulted in reduced peri-implant stresses. [ABSTRACT FROM AUTHOR]

The article discusses the ongoing debate between using colloid or crystalloid solutions for resuscitation in sepsis patients. Colloids, such as albumin, have been used for their ability to improve oncotic pressure and treat hypoalbuminemia. However, recent randomized control trials have shown that albumin does not improve survival in critically ill septic patients, although it also does not cause harm. The optimal approach to fluid management in septic patients remains uncertain, and the most recent guidelines recommend initial resuscitation with crystalloids. A recent feasibility study comparing albumin and balanced crystalloid in early sepsis found no difference in mortality, but further research is needed to determine the best fluid choices in early sepsis. [Extracted from the article]

We devised a palladium‐catalyzed α‐stereoselective glycosylation that incorporates oxygen via in‐situ generation of gem‐disubstituted methanols from p‐quinone methides to access 2,3‐unsaturated gem‐diarylmethyl O‐glycosides under open‐air atmosphere at room temperature. Advantages of this environmentally friendly strategy include the absence of additives and ligands, using water as the green source of oxygen, mildest, operationally simple, exhibiting a wide functional group tolerance, and compatibility with a variety of glycal progenitors in appreciable yields. A mechanistic study has been verified via H218O labeling, which validates that water (moisture) is a sole source of oxygen. [ABSTRACT FROM AUTHOR]

The effect of hydrogen sulphide concentration on the corrosion behaviour of 07Cr16Ni6 austenitic-martensitic stainless steel in a 5% NaCl + 0.5% CH3COOH solution was studied to determine the role of H2S in the corrosion product formation and corrosion mechanism. Unstable passivation of steel is detected in a solution containing <100 mg/dm3 H2S. Steel corrodes in an electrochemically active state at >100 mg/dm3 H2S. When the pitting potential is reached, pitting damage occurs at the grain boundaries. The corrosion rate decreases by ∼five times after exposition for 720 h due to the formation of nickel and iron sulphides on the surface. Corrosion is accompanied by the absorption of 4.2–17.5 ppm hydrogen, 62...70% of which is diffusible and can cause hydrogen embrittlement. The scheme of steel corrosion under the influence of different concentrations of hydrogen sulphide is proposed. [ABSTRACT FROM AUTHOR]

This study provides a thorough analysis of magnesium oxynitride (MgON), employing first-principles calculations to investigate its potential for electronic, thermoelectric, and optical applications. The main objective was to comprehend the fundamental electronic, thermoelectric, and optical parameters of MgON using density functional theory (DFT) calculations. In electronic properties, the density of states (DOS) spectra revealed the significant contribution of Mg-s and O-p states for pristine MgO, while N-p states provide the maximum contributions with overlapping at the Fermi level in nitrogen-containing compositions. The band structure depicted a direct nature for undoped and doped MgO, and the bandgap of compositions was observed to decrease with the increment in nitrogen concentration. The thermoelectric properties of pure and N-doped MgO compositions were evaluated, which showed significant variations with an increase in temperature and doping. Furthermore, the optical properties of MgON were inspected and found to enhance optical conductivity, and absorption coefficient, whereas the refractive index and dielectric constant decrease at specific energy regions for elevated dopant content, which suggests its suitability for optoelectronic applications. Overall, this study reveals the versatility of MgON, making it a potential candidate for advanced electronic, thermoelectric, and optical applications. [ABSTRACT FROM AUTHOR]

The daily timings of our behavioural activities and physiological functions are regulated by the master biological clock in the brain. Disruption of these circadian rhythms can lead to poor performance and poor health. Consistent exposure to bright days and dim nights is necessary for circadian entrainment and, thus, for good sleep and good health. Since we spend most of our lives indoors, we often must rely on electric lighting for circadian entrainment. Surprisingly perhaps, current lighting practice does not purposely support circadian entrainment. A perceived barrier to promoting circadian entrainment with electric lighting is the absence of a standard test method for assessing the efficiency of luminaires for providing circadian-effective light to building occupants. Proposed is a measure for quantifying luminaire efficiency based on the electric power (watts) needed to reach the circadian stimulus criterion (CS = 0.3) at the eyes of a standard observer, termed Standard Observer Watts (SOWatt). The present paper describes how SOWatt can be applied to ceiling mounted, accent and table-top luminaires. [ABSTRACT FROM AUTHOR]

• Macropropagation is a low cost farmer friendly technique for large scale production of quality planting material in banana. • Macropropagation technique is likely to bridge the gap in supply of healthy planting material at a reasonable cost to the small and marginal farmers. • Musa cvs. Rasthali and Neypoovan, are the two most important choice varieties in the southern parts of India. • Sucker pre-treatment and age had a significant influence on the propagation rate. • Macropropagated plants of both cultivars performed at par with conventional suckers under field conditions and the survival rate was 100 %. Macropropagation is a low cost farmer friendly alternative to tissue culture propagation to cater to the farmers' need for quality planting material at an affordable cost. Attempts were made to study the effect of age and hot water treatment on macropropagation of cvs. Rasthali (AAB, Silk) and Neypoovan (AB, Neypoovan) in pot and bed methods. Age of the sucker, hot water treatment and propagation method played a vital role on shoot bud production in both the test cultivars. In cv. Rasthali, bed method produced maximum number of plants (50.5) in five months old suckers subjected to hot water treatment in 42.2 days but the same treatment produced only 24.7 plants under pot method. In cv. Neypoovan, five months old suckers subjected to hot water treatment resulted in 23.3 and 16.7 plants in bed and pot methods respectively. Therefore, five months old suckers with hot water treatment under bed method are more appropriate for macropropagation purpose in banana. Results of field evaluation indicated that macropropagated bananas were at par with control in respect of all plant parameters like plant height, bunch weight and fruit parameters like total soluble sugar (TSS) and acidity. [ABSTRACT FROM AUTHOR]

Spontaneous vaginal delivery in a tracheostomised woman is rare and literature concerning the same is also very limited, hence this might help in considering vaginal delivery at term as an option in such patients when there are no medical or obstetrical contraindications for the same. We present a case of a 24 years female patient hailing from Tamil Nadu in South India, who was tracheostomised secondary to subglottic stenosis, presented to Otorhinolaryngology department at thirty-eight weeks of gestation to know the possibility of a vaginal delivery at term. Since the patient had an uneventful obstetrical history and no medical or obstetrical contraindications for a vaginal delivery, patient was advised breathing exercises including Valsalva manoeuvre and kept under close follow up. Patient went to labor at term at thirty-nine weeks and five days of gestation, and with the help of a panel of senior doctors underwent spontaneous vaginal delivery with no complications. Vaginal delivery can be attempted in tracheostomised women, in the absence of any medical or obstetrical contra indications, if the patient is motivated and we have a panel of expert doctors from all concerned departments. [ABSTRACT FROM AUTHOR]

ObjectiveThis study examined the liking of fruits and vegetables among college students and the relationship between skin carotenoid levels and liking of fruits and vegetables. Participants: Sixty-six undergraduate students enrolled at a university in the southeastern United States participated in this study beginning August 2019. Methods: Skin carotenoid levels were measured using the Veggie Meter® reflection spectroscopy device. Liking of individual fruits and vegetables was measured using a hedonic general Labeled Magnitude Scale. Results: There were significant differences in mean skin carotenoid levels by year of study and age group. Students had a very strong liking for potatoes and pineapple. Veggie Meter scores and overall liking for fruits and vegetables were positively correlated. Conclusions: In order to encourage the consumption of fruits and vegetables, preferences for specific fruits and vegetables as well as accessibility should be considered to better serve and accommodate college students. [ABSTRACT FROM AUTHOR]

Carbon dioxide electroreduction reaction (CO2RR) can take full advantage of sustainable power to reduce the continuously increasing carbon emissions. Recycling CO2 to produce formic acid or formate is a technologically and economically viable route to accomplish CO2 cyclic utilization. Developing efficient and cost‐effective electrocatalysts with high selectivity towards formate is prioritized for the industrialized applications of CO2RR electrolysis. From the previous explored CO2RR catalysts, Sn, Bi and In based materials have drawn increasing attentions due to the high selectivity towards formate. However, there are still confronted with several challenges for the practical applications of these materials. Therefore, a rational design of the catalysts for formate is urgently needed for the target of industrialized applications. Herein, we comprehensively summarized the recent development in the advanced electrocatalysts for the CO2RR to formate. Firstly, the reaction mechanism of CO2RR is introduced. Then the preparation and design strategies of the highly active electrocatalysts are presented. Especially the innovative design mechanism in engineering materials for promoting catalytic performance, and the efforts on mechanistic exploration using in situ (ex situ) characterization techniques are reviewed. Subsequently, some perspectives and expectations are proposed about current challenges and future potentials in CO2RR research. [ABSTRACT FROM AUTHOR]

• Whether blood pressure elevation is temporary and in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. • Many patients presented in the ED with acute pain or stress, may have an acute BP increased due to pain, stress or "white coat" effect. • Hypertensive emergency is often a life-threatening clinical condition and is defined as the presence of abnormal BP values associated with acute hypertension-related organ damage. • It's important to distinguish hypertensive emergency from hypertensive urgency, usually considered a more benign condition that requires more likely an outpatient visit and treatment. Hypertension urgency and emergency represents a challenging condition in which clinicians should determine the assessment and/or treatment of these patients. Whether the elevation of blood pressure (BP) levels is temporary, in need of treatment, or reflects a chronic hypertensive state is not always easy to unravel. Unfortunately, current guidelines provide few recommendations concerning the diagnostic approach and treatment of emergency department patients presenting with severe hypertension. Target organ damage determines: the timeframe in which BP should be lowered, target BP levels as well as the drug of choice to use. It's important to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment. [ABSTRACT FROM AUTHOR]

Hearing aids and implants are used to treat hearing loss, with cochlear implants being the most successful option for severe sensorineural hearing loss. Patients frequently use the internet as a trusted source of clinical information before committing to any therapeutic procedure, including receiving a cochlear implant. A health resource's readability and dependability influence its value to patients. Readability refers to how easily language can be understood, whereas reliability refers to the correctness and consistency of the information presented. JAMA standards and the DISCERN tool were used to assess the reliability of the websites listed. For readability analysis, the FRE, FKG and GFI were chosen. The acceptable readability level was set to < 7 for the FKG, GF score over 17 as the equivalent of college-level education and ≥ 80.0 for the FRE. The readability scores vary across the sources, suggesting a range of comprehension levels required for understanding the cochlear implant patient information found on Google. There was a statistical difference detected in Discern score between the groups (p = 0.008). The mean discern score was significantly higher in hospital generated sources when compared to industry (3.13 ± 0.69 vs. 2.11 ± 0.78, p = 0.03). [ABSTRACT FROM AUTHOR]

Otoacariasis is a rare condition characterized by ticks and mites in the ear canal. Human otoacariasis remains underrepresented in literature as otoacariasis is more common in animals. Systemic diseases being transmitted by these arachnids pave the way for potential complications. This case series sheds light on this uncommon condition by highlighting the diverse symptomatology and difficulties in diagnosis and treatment. Three different presentations highlight the diversity of this condition. A 40-year-old male exhibited itching and tinnitus, revealing a mite on the tympanic membrane on otoscopy. A 35-year-old female with persistent itching and tinnitus showed multiple whitish mites on examination. A 50-year-old female complained of ear pain and was found to have a tick attached to the external auditory canal. The relevance and rarity of human otoacariasis are highlighted in this study, thereby encouraging caution in situations of earache. We aim to increase clinician awareness about this condition and the necessary interventions required by conducting a thorough literature review. [ABSTRACT FROM AUTHOR]

Background: Foreign Body Aspiration (FBA) is one of the paediatric emergencies which require timely diagnosis and management. The inherent tendency of children to explore small objects with their mouths often prove to be fatal as they are difficult to remove once aspirated. Case Report: We present the case of a 5-year-old boy who presented with dyspnea and vomiting following the aspiration of a pen cap. Chest radiograph and Rigid Bronchoscopy helped to identify the foreign body but it couldn't be removed by Rigid Bronchoscopy alone due it's wedge-shaped nature. Hence, an unconventional method of foreign body removal was performed by making a tracheostoma, pushing the foreign body to the level of tracheostoma and thereby taking it out from the tracheostoma under strict monitoring of anesthesia team. Conclusion: Alternative approaches like this are required for prompt intervention in a difficult case as it helps to reduce complications produced by repeated failed attempts. [ABSTRACT FROM AUTHOR]

AbstractIntroduction: The Transgender Awareness Webinar was designed to educate the general public about transgender individuals and reduce stigmatizing attitudes toward transgender and gender diverse people.Methods: The present study involved the development of an update of the webinar to be more inclusive of non-binary gender identities and to evaluate the revised webinar using a pilot randomized control trial (RCT) design. The study included 203 participants (n = 102 treatment group; n = 101 control group). Each participant completed a pre-test and post-test of the Transphobia Scale before and after participation in the webinar.Results: Results indicated that transphobia scores went down from pre-to-posttest among participants in the high baseline transphobia category. In addition, several demographic groups had significantly higher levels of mean transphobia scores (higher income, male gender, traditional religious groups).Conclusions: The results of this study suggest that the updated Transgender Awareness Webinar holds promise for reducing transphobia among members of the general public who have high levels of baseline transphobia. Other findings and implications are presented with regard to the development of an anti-stigma webinar. [ABSTRACT FROM AUTHOR]

This article reviews the long-term results and complications of bronchial artery embolization (BAE) in patients with hemoptysis at a quaternary hospital in India over a period of 7 years. The study included 70 patients, with a higher incidence in males aged 60-70 years. The most common underlying disease was tuberculosis, followed by fungal infections and bacterial infections. Lung parenchymal changes and bronchial/nonbronchial systemic artery anatomy were assessed using CT scan imaging. The procedure was generally successful, with only a few minor complications reported. [Extracted from the article]

This article, titled "Case Report of Endovascular Embolization of Dorsal Penile Artery in a High-Flow Priapism," discusses a case of priapism, which is a persistent erection of the penis unrelated to sexual stimulation. The case involves a 34-year-old man who experienced sustained penile erection for two days after sexual intercourse. The patient underwent a CECT angiogram, which revealed active contrast extravasation into the left side of the corpora cavernosa. The article describes the use of a microcatheter-guidewire system to catheterize the right internal pudendal artery and embolize the active contrast extravasation using microcoils. The patient experienced a reduction in swelling and pain, but a repeat CT scan showed contrast leak into both corpora cavernosa. A second embolization procedure was performed using a gel foam slurry to achieve complete detumescence without compromising the patient's erectile function. [Extracted from the article]

The increasing prevalence of neurodegenerative diseases has spurred researchers to develop advanced 3D models that accurately mimic neural tissues. Hydrogels stand out as ideal candidates as their properties closely resemble those of the extracellular matrix. A critical challenge in this regard is to comprehend the influence of the scaffold's mechanical properties on cell growth and differentiation, thus enabling targeted modifications. In light of this, a synthesis and comprehensive analysis of acrylamide‐based hydrogels incorporating a peptide has been conducted. Adequate cell adhesion and development is achieved due to their bioactive nature and specific interactions with cellular receptors. The integration of a precisely controlled physicochemical hydrogel matrix and inclusion of the arginine‐glycine‐aspartic acid peptide sequence has endowed this system with an optimal structure, thus providing a unique ability to interact effectively with biomolecules. The analysis fully examined essential properties governing cell behavior, including pore size, mechanical characteristics, and swelling ability. Cell‐viability experiments were performed to assess the hydrogel's biocompatibility, while the incorporation of grow factors aimed to promote the differentiation of neuroblastoma cells. The results underscore the hydrogel's ability to stimulate cell viability and differentiation in the presence of the peptide within the matrix. [ABSTRACT FROM AUTHOR]

This letter published in the Annals of Cardiac Anaesthesia discusses the challenge of diagnosing severe tricuspid regurgitation (TR) in children with congenital heart disease using intraoperative transesophageal echocardiography (TEE). The authors present a case study of a 2-year-old boy with severe TR and highlight the presence of systolic flow reversal in the superior vena cava (SVC) Doppler waveform as an indicator of TR severity. The study suggests that systolic flow reversal in the SVC could be a valuable echocardiographic indicator for assessing TR severity in pediatric patients, although further research is needed to validate this method. [Extracted from the article]

We report an unusual case of a 29-year-old female with a short duration of right lower eyelid swelling, painful eye movement and paraesthesia of right cheek. She was subsequently worked up with mucormycosis in mind, but intra-operative findings were suggestive of an infected Haller cell and post-operatively she was symptom free. [ABSTRACT FROM AUTHOR]

The human urobiome, comprising diverse microbial members, plays a crucial role in maintaining urinary tract health. One urobiome member identified in many studies to date – including our group - is Actinotignum schaalii. A. schaalii is a Gram-positive facultative anaerobe that has also been implicated in urinary tract infections in certain patient populations. There is a scarcity of data on the prevalence of Actinotignum in the urobiome given its fastidious growth requirements. This study focuses on the identifying the prevalence of Actinotignum species and identifying conditions necessary for its growth. In collaboration with Vanderbilt University Medical Center's clinical microbiology laboratory, we collected 350 de-identified random urine specimens. To identify and characterize the presence of Actinotignum in the urobiome we used a combination of Expanded Urine Culture (EUC), 16S rRNA amplicon sequencing, and targeted PCR that allows the propagation and identification of low abundance bacteria. Bacterial identification following EUC was performed using MALDI-TOF and standard laboratory techniques. To characterize features of A. schaalii, we used a reference strain of A. schaalii CCUG 27420 to test growth conditions and performed scanning and transmission electron microscopy. From randomly collected urine samples, we detected Actinotignum species in 20% of specimens by 16S rRNA sequencing. No patient factors readily associated with the presence of Actinotignum. We were able to identify corresponding bacterial colonies by EUC. Growth of the reference strain A. schaalii CCUG 27420 was promoted by the addition of a chemically defined lipid media to BHI (brain heart infusion) broth, specifically arachidonic and myristic acid. We generated high-resolution electron microscopy images of A. schaalii to characterize its cellular morphology. Scanning electron micrographs determined the shape of A. schaalii as a coccobacillus. Transmission electron micrographs detected the presence of an s-layer, metal storage organelles, and intracellular vesicles. We detected Actinotignum spp. in urine samples from subjects across a range of ages and medical conditions, suggesting that Actinotignum is prevalent and not limited to specific disease states. Our preliminary data indicates that A. schaalii growth is promoted by lipids. To date, no study has investigated the prevalence of Actinotignum in the community or its growth conditions. This study underscores the importance of leveraging high-throughput sequencing and culturing techniques for a comprehensive understanding of microbial dynamics in the urobiome. The identification of growth conditions for Actinotignum species expands our knowledge of urobiome ecology and sets the stage for mechanistic studies on the interactions of Actinotignum with the urobiome. Ultimately, elucidating the role of Actinotignum in the urobiome may pave the way for targeted therapeutic interventions and personalized approaches to urinary tract health management. [ABSTRACT FROM AUTHOR]

Candida spp. are a common cause of healthcare-associated infections globally and Candida bloodstream infections (BSI) are associated with ∼30% mortality. Candida auris, a multidrug-resistant yeast which can be challenging to detect using traditional laboratory methods, was first reported in Botswana in 2022. This study aimed to analyze surveillance data to characterize patterns of Candida BSI and colonization among hospitalized patients in Botswana. We reviewed microbiology surveillance records over a 16-month period (October 2022 – January 2024) from a 530-bed tertiary referral hospital in Botswana. Blood cultures were collected per routine work-up for sepsis, incubated in an automated system (BacT/ALERT, bioMérieux), and identified using a combination of manual and automated methods (e.g. VITEK 2). Colonization samples (skin and perirectal swabs) were collected during twice-monthly point prevalence surveys in the hospital's intensive care unit (ICU) and neonatal intensive care unit (NICU), transported in ESwab media (COPAN Diagnostics), and cultured with chromogenic media (CHROMagar, Candida Plus). Identification of preserved presumptive Candida spp. isolates from both BSIs and colonization samples was confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) at the National Institute for Communicable Diseases, South Africa. A total of 70 Candida BSI were detected during the surveillance period, making it the 6th leading cause of BSI (995 all-cause BSIs detected from a total of 6895 blood cultures). Of 43 preserved BSI isolates which underwent confirmation, C. albicans was most commonly identified species (20%), followed by C. auris (17%), C. krusei (15%), C. parapsilosis (10%) and C. glabrata (10%) (Figure 1). Among 190 samples collected from ICU, Candida colonization was identified from 181 (95%) patient samples, most commonly C. albicans (35% of 181), followed by C. auris (32% of 181). Among 116 samples collected from ICU, Candida colonization was identified from 103 (89%) patient samples, most commonly C. albicans (56% of 103), followed by C. parapsilosis (17% of 103). The relative frequency of Candida spp. causing BSI [data not shown] roughly aligned with the species identified through concurrent colonization screening, with the exception of C. krusei, which can be attributed to a neonatal C. krusei outbreak linked to contaminated medication (Figure 2). Candida spp. accounted for a significant portion of BSIs at this hospital and were responsible for at least one hospital outbreak during this time period. The repeated detection of C. auris among hospitalized patients, including neonates, over several months demonstrates the potential for sustained transmission. Routine colonization screening may serve as an early signal for disease transmission and help in the development of targeted containment strategies by infection prevention/control teams. Further analysis with whole genome sequencing could be used to produce a phylogenetic comparison with other clinical isolates in the southern African region. [ABSTRACT FROM AUTHOR]

The emergence of the pandemic severe acute respiratory syndrome coronavirus (SARS-CoV)-2, following significant outbreaks of SARS-CoV-1 and MERS-CoV, serves as a stark reminder of the potential for future outbreaks. This underscores the urgent need for the development of rapid and effective therapeutic and vaccine strategies to mitigate such threats. In this study, our objective is to characterize the spike protein of CoVs and explore vaccine strategies that can target multiple virus variants, aiming to bolster our defences against potential future outbreaks. In vitro studies were conducted to investigate the interactions between the SARS-CoV-2 spike protein and its receptors, along with assessing the mechanisms of viral entry using pseudotyped CoVs. Using a group of 74 experimentally proven neutralizing monoclonal antibodies, this method made it possible to find escape variants and map out the epitopes of SARS-CoV-2 variants. Furthermore, a self-assembled nanoparticle decorated with the SARS-CoV-2 spike protein, including escape mutants, as well as SARS-CoV-1 and MERS-CoV, was developed and subjected to various biochemical analyses for characterization. Subsequently, mice were immunized with these nanoparticles to evaluate their immunological responses. In this study, we fully characterized the spike proteins of SARS-CoV-1, SARS-CoV-2, and MERS-CoV. This led to the creation of pseudotyped CoVs that bind specifically to their receptors, making entry into cells easier. In addition, our study includes mapping 74 experimentally proven neutralizing monoclonal antibodies (mAbs) binding epitopes for all major variants of SARS-CoV-2, such as Delta and Omicron, and structural annotation of these variants. Most of these neutralizing epitopes (87.84%) are found in the receptor-binding domain (RBD), where they overlap with other epitopes. A smaller percentage (12.16%) is found in the N-terminal domain (NTD), but it works less well than RBD antibodies. Moreover, we observed mutations in the antibody-binding epitope residues of 69 out of 74 mAbs, with the most potent RBD epitopes displaying higher mutation rates (4-10 amino acids) than less effective antibodies, indicating potential co-evolution with immune pressure. Subsequently, we engineered a self-assembled nanoparticle decorated with a SARS-CoV-2 spike and variants, demonstrating significantly enhanced immune responses against SARS-CoV-2 and its variants. Similarly, SARS-CoV-1 and MERS-CoV spike decorated nanoparticles elicit potent neutralizing antibodies against both viruses. Our research underscores the invaluable utility of pseudotyped viruses in unraveling the intricacies of viral entry mechanisms. Furthermore, the multimeric presentation of self-assembled protein nanoparticles has shown to be very effective at producing strong antibodies that can neutralize SARS-CoV-2 antibody escape variants and also SARS-CoV-1, and MERS-CoV. In conclusion, the development of self-assembled protein nanoparticle vaccines represents a promising approach in our ongoing battle against coronaviruses. These innovative vaccines hold significant potential to serve as effective countermeasures, offering a versatile and robust strategy for combating future outbreaks. [ABSTRACT FROM AUTHOR]

Respiratory infections, affecting mainly young children and the elderly, pose significant global health threats. While protection from related strains of viruses like influenza is well-documented, cross-protection among different viruses remains less understood. The disappearance of influenza during the COVID-19 pandemic prompted investigation into viral interference and non-pharmaceutical interventions' role. Studies suggest interactions between different viruses and host responses influence infection rates. In a large retrospective review, we assessed the impact of initial respiratory infections on subsequent viral infections, studying prevalent viruses including Influenza, Adenovirus, EV/RV, Parainfluenza, RSV, and coronaviruses. This aimed to elucidate the dynamics of viral interference independent of pandemic-related interventions. We analysed all patients tested for positive respiratory viruses between January 2016– December 2019 just prior to the pandemic in the National University Hospital laboratory, Singapore. Nasal, throat, and/ or nasopharyngeal swabs were collected by treating clinicians and tested by either multiplex PCR or immunofluorescence. Survival plots were created to study the time for a second viral infection following the initial respiratory viral detection. RSV (HR: 0.63, 95%CI: 0.43–0.92; p<0.01) and influenza (HR: 0.41, 95%CI: 0.27-0.61; p<0.001) -positive cases showed a greater delay in subsequent respiratory infections compared to other pathogens, suggesting relative protection, while enterovirus/ rhinovirus (HR: 2.05, 95%CI: 1.52-2.77; p<0.001) and Parainfluenza (HR: 1.76, 95%CI: 1.18-2.63; p<0.001) showed heightened susceptibility. No significant associations were found for Adenovirus (HR 0.66; 95% CI 0.30 to 1.44; p=1), seasonal coronaviruses (HR 1.39; 95% CI 0.75 to 2.59; p=1), and other viruses (Bocavirus, Metapneumovirus) (HR 1.37; 95% CI 0.85 to 2.21; p=0.539). In our retrospective analysis, we discovered a notable trend: patients previously infected with Influenza or RSV showed reduced likelihood of subsequent viral infections within four years. While this aligns with findings by Chen et al., our study diverged in revealing that prior RSV infection, not adenovirus, conferred protective effects. This discrepancy may stem from demographic variations; our cohort encompassed diverse demographics, primarily children prone to RSV-related hospitalizations. Variations in circulating viruses and host immune responses could also influence outcomes. Notably, laboratory studies indicate cross-protection mechanisms, with Rhinovirus and Influenza inhibiting SARS-CoV-2 replication. This underscores the complexity of viral interactions and immune responses, warranting further investigation, especially regarding cytokine involvement. Our findings shed light on the intricate dynamics of viral interference, urging comprehensive exploration to elucidate underlying mechanisms and implications for clinical practice. We found that it is possible that prior infections with Influenza virus or RSV conferred significant cross-protection against subsequent circulating respiratory viral infections for the next 4 years. Larger studies are needed to explore mechanisms behind this possible broad-spectrum antiviral response in human hosts as this may have implications for vaccination strategies. [ABSTRACT FROM AUTHOR]

The recent emergence and re-emergence of infectious diseases across Africa have emphasised the critical need for vigorous pathogen genomic surveillance systems on the continent. Effective pathogen genomic surveillance relies heavily on training and capacity development in genomic sequencing and bioinformatics, as rapid public health responses to disease outbreaks depend on the continuous enhancement of these skills. Over the past four years, we have developed and conducted hybrid training in pathogen genomic surveillance and bioinformatics, for different personas in various national public health institutions across Africa. To date, we have trained over 290 participants from 36 African countries, utilising trainers and facilitators from across the continent to address various competency levels. We have also implemented comprehensive resources to support our training initiatives, including a user-friendly helpdesk ticketing system for ongoing assistance, a robust trainer database for easy access to expert knowledge, and user intuitive websites that host training materials. These tools work jointly to ensure that training and related resources are widely accessible, while also providing participants with support and engagement opportunities long after receiving training. Feedback on our training initiatives, from 75% of participants via post-training evaluation surveys, have underscored the necessity for ongoing efforts in training and capacity building in pathogen genomic surveillance and bioinformatics across the continent. The qualitative feedback emphasised the necessity of further developing improved course materials, sustaining support for participants, and enhancing engagement between trainers and participants. Based on our post-training feedback, we are currently consolidating a standardised pathogen genomics surveillance training curriculum to strengthen training and capacity development in Africa. The curriculum is designed to serve as a comprehensive resource for trainers, encompassing content that ranges from foundational courses in generic, wet-lab, and bioinformatics topics to advanced pathogen-specific courses that include tailored genomic surveillance workflows. A future step involves the implementation of more training initiatives across public health institutes in Africa, utilising the standardised pathogen genomics surveillance training curriculum to reinforce training and capacity development. The critical necessity for effective pathogen genomic surveillance systems in Africa has motivated our training and capacity development initiatives in pathogen genomic surveillance and bioinformatics across the continent over the past four years. By maintaining a focus on these training initiatives in the future, Africa's capacity to respond to infectious disease threats can be enhanced, ultimately contributing to the safeguarding of public health throughout the region. [ABSTRACT FROM AUTHOR]

Russia is a high burden country for multidrug-resistant tuberculosis (MDR-TB) but some of its regions such as, Siberia and Far East, have especially high prevalence rate of primary MDR-TB (35.4% and 31.8%, respectively, in 2021). Mycobacterium tuberculosis Beijing genotype is the most prevalent here and its B0/W148 subtype is strongly MDR and transmissible. In addition, epidemic strains of the Euro-American lineage also circulate. We aimed to perform molecular characterization of MDR M. tuberculosis isolates in the Omsk province in West Siberia, to identify the most epidemically relevant strain clusters. A total of 617 M. tuberculosis isolates were recovered from newly diagnosed patients with TB. The Beijing genotype and its main sublineages and Russian epidemic and endemic clusters (B0/W148 and Central Asian/Russian), and ancient Beijing sublineage were detected by PCR assays. Non-Beijing isolates were spoligotyped and compared to SITVIT2 database. This research was supported by Russian Science Foundation (grant 24-44-00004). Of the 617 M. tuberculosis strains, 250 (40.5%) were MDR, of which 83 (33.2%) were pre-extensively drug-resistant (pre-XDR). Resistances only to fluoroquinolones (FQs) and only to injectable drugs were detected in 17.6% (44) and in 15.2% (38) of MDR strains, respectively. Resistance to FQs and the injectable drugs together was found in 15.6% (39) of MDR strains. The majority of MDR strains belonged to the Beijing family (86.8%; 217/250). Main Beijing subtypes were Central Asian/Russian (34.4%; 86) and B0/W148 (39.2%; 98). Twenty-nine (11.6%) MDR strains of the ancient Beijing sublineage belonged to the 1071-32 cluster (24) and 14717-15 cluster (5), respectively. The 33 non-Beijing strains represented LAM (12), Ural (12), T/L4-unclassified (7), S (1) and 'unknown' family (1). The most common LAM spoligotypes were SIT254 (4) and SIT803 (4). All Ural genotype isolates had the SIT262 spoligotype. Beijing B0/W148 strains were more frequently pre-XDR than Central Asian/Russian strains: 43.9% vs. 26.7%, p=0.0165. The resistance to the injectable drugs and FQs together was more common among B0/W148 vs. Central Asian/Russian subtypes (24.5% vs. 9.3%, p=0.0039). The genotypes identified in this study are known to be endemic for Russia and former Soviet Union countries: "Russian successful Beijing B0/W148 strain", LAM SIT254 that is widespread across all Russia, and Ural SIT262 that is epidemic MDR strain in Eastern Europe. On the other hand, some MDR subtypes are endemic for Siberia and Asian Russia, as a whole, such as hypervirulent Beijing 14717-15-cluster; low-virulent Beijing 1071-32 although the latter was already detected in southern and eastern Europe. Beijing genotype strains are highly prevalent (86.8%) in МDR M. tuberculosis population in West Siberia, Russia. Among Beijing B0/W148 strains, 43.9% were pre-XDR. Thus, increasing proportion of primary MDR-TB in Siberia, Russia, is due to active transmission of Beijing strains, mostly MDR B0/W148 strains. [ABSTRACT FROM AUTHOR]

In many areas of Africa, recent investigations underscore the great influence of ticks on the health of both animals and humans across the continent. Identification of ticks and tick-borne diseases is crucial for epidemiological research and assessing the risks associated with disease transmission among humans and animals. Matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS) has emerged as an alternative method for tick species identification, based on leg protein spectra. This study aimed to characterize tick species collected from domestic and wild animals in Malawi, employing morphological, MALDI-TOF MS and molecular tools. Ticks were systematically harvested from various locations across Malawi, covering diverse sources such as wild animals in protected areas, as well as ticks found on domestic animals and in the surrounding environment. The collected ticks were grouped by animal host, stored in labelled vials and preserved in 95% ethanol. Ticks were morphologically identified at genus level using dichotomous keys. Subsequently, ticks were individually dissected in three subsets of samples: four legs for MALDI-TOF identification, four legs for biomolecular identification amplifying and sequencing the 16S gene, and the remaining idiosome was preserved for further analysis. Ticks were subjected to MALDI-TOF MS analysis to evaluate the intraspecies reproducibility and interspecies specificity of MS profiles obtained from the different species. In this study we present preliminary results from MALDI-TOF MS analysis. In total, 995 ticks were collected from Malawi. Morphologically, the ticks belonged to five different genera Amblyomma spp., Hyalomma spp., Boophilus spp., Rhipicephalus spp., Haemaphysalis spp. To date, 171 African ticks have been processed, resulting in the identification of 13 species through 16S analysis. Moreover, within the processed ticks, 17 new spectra have been incorporated into the MALDI-TOF library, belonging to 5 different tick species (Amblyomma tholloni, Amblyomma variegatum, Rhipicephalus sanguineus, Rhipicephalus/Boophilus microplus, Rhipicephalus maculatus). These spectra were obtained from samples collected from African bush elephants (Loxodonta africana), Zebras (Equus quagga), Impalas (Aepyceros melampus), Bell's hinge-back tortoises (Kinixys belliana), domestic dogs, Malawi Zebu cattle, and Black rhinos (Diceros bicornis). In addition, after incorporating these 17 new spectra into the library, further specimens were tested. Among these, 20 specimens produced high-quality scores (>1.70), facilitating their identification. The library is continually expanded to include new species. Our efforts focus on creating a comprehensive database for identifying tick species in Malawi and potentially across other Sub-Saharan African countries. This database will enable thorough risk analysis for vector-borne diseases at the human-animal interface. In conclusion, accurate identification of tick species and their associated pathogens is crucial for improving vector control measures aimed at surveillance and prevention of tick-borne disease outbreaks. MALDI-TOF MS emerges as a promising tool for arthropod identification, offering advantages like simple specimen processing and low consumable costs. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) is strongly associated with mortality in young children, and infections are thought to be a major driver of that mortality. The World Health Organization (WHO) therefore recommends that all children hospitalized with SAM receive empiric intravenous broad-spectrum antibiotics. Most data on the burden of infections in children with SAM are outdated given recent dramatic changes in antimicrobial resistance (AMR) and HIV epidemiology. The aim of this study was to give a contemporary description of the prevalence of treatable infections and AMR in children hospitalized with SAM. This prospective cohort study enrolled children 6-59 months old hospitalized with SAM at a tertiary referral hospital in Malawi. The prevalence of various infections was estimated with a combination of routine testing and clinical diagnoses, plus study-specific testing that included: blood and urine cultures; gastric aspirate Xpert MTB/RIF Ultra; and for participants with concern for central nervous system infection, cell counts, microscopy, culture, and Xpert MTB/RIF Ultra on cerebrospinal fluid. From February 2023 to January 2024, 212 participants were enrolled. Mean age was 21 months, 48% were female, and 12% were HIV-infected. In-hospital mortality rate was 11%. The composite outcome of serious bacterial infection (SBI: bacteremia, meningitis, or pneumonia) was found in 24% of participants, and SBI was strongly associated with mortality (odds ratio, OR: 3.4; 95% confidence interval, CI: 1.4-8.3). Tuberculosis disease (TB) was diagnosed in 9% and was also associated with mortality (OR: 3.4, 95% CI: 1.1-10.4). Blood cultures detected likely pathogens for 10% of participants. Urine for culture was obtained on 136 participants and 20% had urinary tract infection (UTI). For the bacteria isolated from bacteremia and UTI cases, resistance to first-line antibiotics was 88% for ampicillin and 41% for gentamicin, and 38% for second-line antibiotics (third-generation cephalosporins). This contemporary evaluation of infections in children hospitalized with SAM at a single site in Malawi reconfirms high rates of SBI, UTI, and TB that have been demonstrated in older studies of this vulnerable population in other settings. Given the persistently high mortality of children hospitalized with SAM and the demonstrated association of mortality with SBI and TB, more research is urgently needed to improve early diagnosis and optimized treatment of these deadly infections. High rates of resistance to first- and second-line antibiotics raises the question of whether alternative empiric antibiotics should be recommended in SAM. These results support the WHO recommendation of treating children hospitalized with SAM with empiric broad spectrum antibiotics. To improve antibiotic stewardship, better tools are needed to identify those children at high risk for severe infection (including TB). In addition, reconsideration of the recommended empiric antibiotic regimens may be required to reflect increases in the prevalence of AMR. [ABSTRACT FROM AUTHOR]

The increasing incidence of Neisseria gonorrhoeae (NG) has become a global health threat due to drug resistance and potentially invasive disease. Few studies in Brazil have analyzed the presence of resistance genes and its correlation with invasive clinical presentations. To assess the genotypic virulence profile in both invasive and non-invasive N. gonorrhoeae strains from patients with gonococcal disease at Hospital das Clínicas of the Faculdade de Medicina of the University of São Paulo, Brazil (HC-FMUSP). To analyze genotypic profiles of 25 NG clinical isolates from 25 hospitalized patients at Hospital das Clínicas da FMUSP from January 2017 to March 2020. The isolates were submitted to whole genome sequencing, typed by MLST and resistome analysis was performed. Of the 25 isolates, 10 (40%) were from sterile sites (blood, biopsy and articular fluid) and classified as invasive. The phylogenetic tree analyses showed that invasive specimens were grouped in 5 STs (8143, 1588, 16704, 14939, 12894) and noninvasive specimens clustered in 11 STs, with 3 STs in common between the groups. The resistance genes blaTEM-1B (7% vs. 50%, p = 0.023) and the tetM (13% vs. 80%, p = 0.002) were more frequently found in isolates from patients with invasive disease and they were always accompanied by the mobile genetic elements pJD4 and pEP5289, respectively. Those elements were also associated with toxins and resistance elements described previously as possible virulence factors in vitro studies. Our results observed that invasive strains of NG are genotypically clustered and frequently harbor two plasmids that had never been associated with invasive disease before. These results evidence the need for more NG surveillance projects in Brazil. [ABSTRACT FROM AUTHOR]

Ferrets are widely recognized as valuable small animal models for studying respiratory viruses, including influenza and SARS-CoV, due to their susceptibility to these viruses and the similarity of their respiratory tract to that of humans. Despite their importance in virology, there is a notable lack of established cellular assays to detect cellular responses in ferrets. This limitation hinders our detailed understanding of immune mechanisms and the development of targeted therapies. In this study, we established and optimized various cellular assays for ferrets and developed monoclonal antibodies against ferret IL-2. To validate the qRT-PCR assay, we synthesized plasmid constructs encoding 13 ferret cytokine genes, in viro transcribed RNA transcripts of IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12b, IL-17, IFN-α, IFN-β, IFN-γ, and TNF-α. By using this assay, we then measured cytokine expression from PBMCs of four ferrets, stimulated with or without ConA and PMA+Iono. For intracellular cytokine staining and T-cell quantification, influenza virus-infected ferret tissue sections were stained with cross-reactive antibodies. Recombinant ferret cytokines IL-2, IFN-α, and IFN-β were cloned and produced. Mice immunized with these proteins provided spleen cells to generate hybridomas. Selected clones facilitated the development of ELISA, immunofluorescent staining, epitope prediction, and western blot assays. Our study validates a qRT-PCR assay enabling the detection of 13 diverse ferret cytokines. Notably, PMA+Iono stimulation elicited significantly higher levels of IFN-γ compared to ConA. Utilizing cDNA from PMA+Iono-stimulated PBMCs, we successfully detected a range of cytokines including IL-2, IL-4, IL-6, IL-10, IFN-α, IFN-β, and TNF-α using gene-specific primers. Furthermore, a PCR-based assay was established, facilitating amplification of TNF-α, IFN-α, IFN-B, TNF-α, IL-2, and IL-4 from ferret PBMCs, albeit excluding IL-6 and IL-10. In influenza-infected ferret lymph nodes, we observed significant levels of TNF-α, IFN-γ, and infiltrating T cell populations (CD4+ and CD8+). Immunization with recombinant ferret cytokines, specifically IL-2, IFN-α, and IFN-β, elicited a robust immune response. Furthermore, from spleen cells, we generated multiple monoclonal antibodies targeting IL-2. These antibodies demonstrated binding affinity to both linear and conformational epitopes, facilitating assays including western blotting, ELISA, and immunofluorescent staining. We developed robust cellular assays for detecting ferret cytokines, useful for measuring immune responses during viral infections and vaccine efficacy in ferrets. Our study validated a reliable qRT-PCR assay for 13 ferret cytokines, revealing differential responses and highlighting key immune players in ferret immunology. The successful use of recombinant cytokine immunization and monoclonal antibody development presents promising tools for advancing future ferret immunological research. We developed robust cellular assays for detecting ferret cytokines, enabling precise measurement of ferret immune responses during viral infections, and assessing vaccine efficacy in ferrets. [ABSTRACT FROM AUTHOR]

Haemophilus influenzae (Hi) is a significant cause of invasive infections, including meningitis and sepsis. The emergence of resistant strains has prompted the World Health Organization to include Hi on its priority list for research and development of new antibiotics. The objective of this study was to describe the epidemiology of invasive Hi strains in Belgium, with a particular focus on beta-lactam resistance. A retrospective analysis of invasive Hi strains referred to the NRC from 2018 to 2023 was conducted. All national laboratories are required to submit invasive Hi strains to the NRC. There, the strains are identified using MALDI-TOF MS and antimicrobial susceptibility testing is performed following EUCAST guidelines. For isolates showing reduced susceptibility to beta-lactams, the ftsI gene is sequenced. Selected isolates (e.g. in the case of suspicion of a cluster) undergo whole-genome sequencing. A total of 804 strains were included, with the lowest incidence rate per 100.000 population observed in 2020 and 2021 (0.75/100.000 inhabitants). The male-to-female ratio was 1.13, with a male predominance observed in individuals under the age of 5. Over 75% of strains were non-typeable Hi (NTHi). The resistance rates for ampicillin and amoxicillin-clavulanic acid were 18.7% and 4.6%, respectively. Mutations in the ftsl gene associated with decreased susceptibility to beta-lactams varied from 11.5% to 17.7%. In 2023, mutations associated with high levels of beta-lactam resistance (group III/III-like) were detected in six NTHi strains (3.3%), five of which exhibited identical ftsI mutations (D350N, S357N, M377I, S385T, R517H, T532S). Four of the five isolates belonged to the MLST clonal complex 3 and exhibited a similar phenotypic profile namely biotype II, absence of beta-lactamase, resistance to cefuroxime and trimethoprim-sulfamethoxazole. Three of the four isolates were recovered at the beginning of the year from patients with pneumonia residing in Limburg. A whole genome single nucleotide polymorphism (SNP) analysis demonstrated they had less than four SNPs of difference. This study provides a comprehensive overview of the epidemiology of invasive Hi infections in Belgium. As with other respiratory pathogens, the COVID-19 pandemic has had a significant impact on the epidemiology of invasive Hi infections. The distribution of sex and age was consistent with global trends, as was the prevalence of NTHi. The prevalence of beta-lactam resistance was comparable to that observed in other European countries. It is noteworthy that, for the first time in Belgium, six strains of Hi have emerged, displaying mutations associated with high-level beta-lactam resistance. Furthermore, WGS analysis has confirmed the existence of a cluster of three of these strains. Vigilant surveillance of circulating Hi strains and research are fundamental to addressing evolving challenges and guiding future interventions, including the adaptation of treatment guidelines. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii (Ab) is one the major threat, causing nosocomial infections and getting resistant to almost all the available antibiotics. Biofilm formation is one the strategy opted by Ab to overcome the limited sensitivity against various small molecules, AMPs, antibiotics etc. Hence, deciphering the role of biofilm in AMR, we must study the composition of Ab biofilm. We employed various methodologies to elucidate the precise composition of Acinetobacter baumannii biofilm. These included topological analyses (AFM, SEM, Confocal microscopy), biochemical assays (Phenol-sulfuric assay (PSA), BCA, and gel electrophoresis for eDNA), chemical composition studies (XPS, FTIR, Zeta Potential), and molecular investigations (Proteomics and Metabolomics). After growing A. baumannii biofilms for three days on 2xYT agar, AFM, SEM, and confocal microscopy showed increased biofilm density, with cells completely encapsulated. PSA and BSA assays indicated higher carbohydrate and protein levels in the biofilm matrix. Agarose gel electrophoresis revealed the presence of eDNA. Chemical composition analysis using XPS, FTIR, and zeta potential showed consistent percentages of carbon, oxygen, and nitrogen over three days, but an increase in phosphorus. FTIR data indicated peaks for water, DNA, RNA, proteins, carbohydrates, phosphorylated proteins, phospholipids, and Amide I and II. Zeta potential measurements confirmed the net charge of the biofilm. Metabolomic studies shows upregulated fatty acid biosynthesis, cell structure synthesis and carbohydrate biosynthesis pathways. This study represents the first comprehensive analysis of the biofilm composition of Acinetobacter baumannii. Biofilm formation by bacteria enhances their stability and survivability under adverse conditions, such as antimicrobial pressure and nutrient-depleted environments. Biofilms serve as a source of nutrition, shelter, and protection against a variety of antimicrobial agents. Our investigation reveals the detailed composition of the extracellular matrix (ECM) of A. baumannii biofilms, which includes phosphorylated proteins, phospholipids, extracellular DNA (eDNA), water, DNA, RNA, proteins, and carbohydrates. Topological analysis indicates that the bacteria are completely encased within the matrix, providing robust structural support. Zeta potential measurements indicate that the A. baumannii biofilm carries a net charge, which aids in neutralizing various antimicrobial peptides (AMPs), small molecules, immune responses, and antibiotics. This study comprehensively characterize the biofilm composition of A. baumannii. It provides deep insight into the nature of pathogenic material, potentially generating a complex cascade of immune escape events. From this study, we can conclude that the biofilm composition of Ab is so complex and yet to explore because there are so many components of biofilm which help bacteria in escaping antibiotics and host mediated immune responses. Net charge of biofilm, physical shelter formation by biofilm over bacteria, various modified proteins, lipids and carbohydrates may putatively enables bacteria to survive under antibiotic stress and escape host immune response. [ABSTRACT FROM AUTHOR]