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Background: Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation. Aim: To assess trends in general practice prescribing of five high-risk medications and their relationship with deprivation. Design & setting: An observational study was conducted using general practice data from three English regions with varied sociodemographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE). Method: Practice-level prescribing data were obtained from 2016–2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibacterials. Prescribing trends were demonstrated using a linear model. Results: Reduction in NSAID, opioid, hypnotic and antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age. When adjusting for IMD and population, region was independently associated with prescribing rate. Compared with WY, IMD had a smaller association with prescribing in BC for NSAIDs (coefficient = −0.01578, P = 0.004) and antibacterials (coefficient = −0.02769, P = 0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (coefficient = 0.02443, P<0.001), opioids (coefficient = 0.08919, P<0.001), hypnotics (coefficient = 0.09038, P<0.001), gabapentinoids (coefficient = 0.1095, P<0.001), and antibacterials (coefficient = 0.01601, P = 0.19). Conclusion: The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status. [ABSTRACT FROM AUTHOR]

Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40–60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period. [ABSTRACT FROM AUTHOR]

This paper examines the role of Generative AI (GenAI) and Large Language Models (LLMs) in penetration testing exploring the benefits, challenges, and risks associated with cyber security applications. Through the use of generative artificial intelligence, penetration testing becomes more creative, test environments are customised, and continuous learning and adaptation is achieved. We examined how GenAI (ChatGPT 3.5) helps penetration testers with options and suggestions during the five stages of penetration testing. The effectiveness of the GenAI tool was tested using a publicly available vulnerable machine from VulnHub. It was amazing how quickly they responded at each stage and provided better pentesting report. In this article, we discuss potential risks, unintended consequences, and uncontrolled AI development associated with pentesting. [ABSTRACT FROM AUTHOR]

The performance of self-compacting concrete (SCC) is gaining popularity in construction due to its exceptional strength and durability. However, the properties of combined steel and concrete at elevated temperatures lack experimental data from previous research. This study aimed to investigate the behavior of the SCC core with a steel tube at ambient and elevated temperatures varying from 100 °C to 800 °C with 100 °C intervals for each test specimen. Tests were conducted on circular steel tubes filled with SCC for different grades (M25, M30, and M40) under compression at elevated temperatures. Experimental observations revealed that the stress–strain curve increased with increasing the cross-sectional area and grade of concrete. However, increasing the temperature and length-to-diameter ratio reduced the stress–strain curve. At elevated temperatures, confined SCC experienced a smaller decrease in the overall modulus of elasticity when compared to unconfined concrete. Within the compressive elastic region (from 30 °C to 400 °C), there was a significant relationship between lateral strain and longitudinal strain, which was followed by a sudden increase beyond 400 °C. Equations for various design parameters were proposed based on the peak load and confinement factor of confined SCC-filled steel tubes (SCCFSTs) via multiple regression. Moreover, this study developed load–axial shortening curves, identifying significant properties such as the yield strength of confined SCCFSTs, including the load-carrying capacity. The predicted numerical analysis results were well aligned with the experimental results, and the findings contributed valuable insights for designing resilient and durable combined SCC and steel tube infrastructures. [ABSTRACT FROM AUTHOR]

Introduction: Sinus Augmentation has proven to be a predictable and popular approach to overcome bone volume deficiency in the posterior maxilla for patients seeking dental implants. The most common surgical methods utilized for maxillary sinus augmentations are the lateral window approach and crestal osteotome technique, which may cause many complications like sinus membrane tear, bleeding, sinusitis, etc. the purpose of this study is to compare complications rates of different sinus lift techniques in dental implant surgery. Aims and Objective: To assess the intraoperative and postoperative complications between the conventional direct or indirect method with alternative sinus lift techniques using Modified Crestal and Lateral (CAS & LAS KIT) ®method (Osstem/Hiossen). Materials and Methods: This is a retrospective study where in all the sinus lift cases done during 3year duration in the center data was collected and analyzed a total of 61 sinus lift procedure was done and all the data is tabulated and analyzed. Results: Results show of the total 61 cases 25 (40%) male patients and 36(59%)female patients traditional techniques like summers osteotome and conventional direct or indirect method had 7 cases (33.3%-37.5%) complication rates compared to Modified Lateral osteotome had 2 complications (14.2%) & Modified Crestal osteotome had only 3 case(3.7%) infections, wound dehiscence, membrane tear etc Conclusion: Modified Crestal & Lateral Osteotome (CAS KIT & LAS KIT) ® technique does reduce the incidence of complications like sinus membrane tear compared to conventional Direct and Indirect techniques, because of stopper system used in hydraulic lift and the special design of drill head of these instruments. [ABSTRACT FROM AUTHOR]

Background: COVID 19 resurgence in multiple waves and the highly infectious variant of SARS-CoV-2 (B.1.617) has wreaked havoc across healthcare systems in India. We conducted a study to delineate the clinico-epidemiological profile of COVID-19 patients in this second wave of the pandemic. Methods: This was a retrospective, single centre, observational study at the Emergency Department(ED) of a teaching institute in North India. The ED health records were screened for patient files with the diagnosis of COVID -19, age > 14 years, presenting from 10th April to 30th of May. ED clinical notes, disposition, and mortality data were retrieved and analysed. Results: 1647 files were screened and 253 eligible patients of COVID-19 were included in the study. 60% patients were male, mean age (+ SD) was 54 (+ 14.8 years). Shortness of breath (74.7%), fever (71.9%), cough (57.7%) were the common presenting symptoms. 20% of patients were nil comorbid; Diabetes (44.7%) and Hypertension (41.5%) were the common comorbid illnesses. 73.1% patients had severe COVID illness, 39.9% had oxygen saturation <90% on arrival and 33.2% had <70%. More than 90% patients required respiratory support on arrival. 25% of people presented to hospital after home isolation, of which 81% had severe COVID at presentation. 39 % patients of mild illness had received corticosteroids. Conclusion: The second wave of COVID-19 with rapid upsurge of cases overwhelmed the healthcare system with a higher proportion of severe COVID-19 cases and higher mortality, thus stressing the need for prior planning, preparation and strengthening healthcare systems across tiers. [ABSTRACT FROM AUTHOR]

Type1 diabetes mellitus, also known as juvenile diabetes is an autoimmune disorder. It is a chronic condition in which there is a destruction of pancreatic beta cells by autoimmune response. Here, a case of a 13-year-old girl, weighing 32 kg and with a Body Mass index (BMI) of 13.9 kg/m² was reported to the family medicine clinic with complaints of weakness, increased appetite and thirst, and increased frequency of micturition for the past two months. Personal history revealed a consistent weight loss over the past six months with the problem of lice in the hair from the past two months. A family history of diabetes, hypertension, and allergies was present. General physical examination reveals no abnormality and vitals were within normal limits. Blood investigations revealed increased levels of random blood sugar levels, glycated Haemoglobin (HbA1c) and Immunoglobulin (Ig)E. Hormonal assay was within normal limits, and skin prick test result revealed strong positive reactions to some allergens. The treatment included subcutaneous insulin, regular physical exercise and immunologic desensitisation of food allergens through Sublingual Immunotherapy (SLIT). The treatment resulted in controlled blood glucose levels with a reduction in insulin dose, a decrease in HbA1c levels, increased body weight and an improved BMI. [ABSTRACT FROM AUTHOR]

The efficient monitoring of the environment is currently gaining a continuous growing interest in view of finding solutions for the global pollution issues and their associated climate change. In this sense, two-dimensional (2D) materials appear as one of highly attractive routes for the development of efficient sensing devices due, in particular, to the interesting blend of their superlative properties. For instance, graphene (Gr) and graphitic carbon nitride g-C3N4 (g-CN) have specifically attracted great attention in several domains of sensing applications owing to their excellent electronic and physical-chemical properties. Despite the high potential they offer in the development and fabrication of high-performance gas-sensing devices, an exhaustive comparison between Gr and g-CN is not well established yet regarding their electronic properties and their sensing performances such as sensitivity and selectivity. Hence, this work aims at providing a state-of-the-art overview of the latest experimental advances in the fabrication, characterization, development, and implementation of these 2D materials in gas-sensing applications. Then, the reported results are compared to our numerical simulations using density functional theory carried out on the interactions of Gr and g-CN with some selected hazardous gases' molecules such as NO2, CO2, and HF. Our findings conform with the superior performances of the g-CN regarding HF detection, while both g-CN and Gr show comparable detection performances for the remaining considered gases. This allows suggesting an outlook regarding the future use of these 2D materials as high-performance gas sensors. [ABSTRACT FROM AUTHOR]

In the current study, we investigated the effect of processing temperature in chemical vapor deposition (CVD) on the formation of carbon nanomaterials over the hollow glass microsphere. The surface morphology and structural information of the carbon nanomaterials (CNM)‐coated hollow glass microsphere (HGM) were analyzed through scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Then, the 5‐CH [CNF‐coated HGM (Synthesizing temperature in CVD being 500 °C)], 6‐CH [MWCNT‐coated HGM (Synthesizing temperature in CVD being 600 °C)], and 7‐CH [MWCNT‐coated HGM (Synthesizing temperature in CVD being 700 °C)] were individually used as fillers in the epoxy composite foam. Thorough characterization of mechanical and thermo‐mechanical behavior suggests that compression stress, compression modulus, and storage modulus of 6‐CH‐based composite foam are higher than the 5‐CH‐ and 7‐CH‐based composite foam with the contribution of 10%, 15%, and 20%, respectively. The electromagnetic interference (EMI) shielding effectiveness over the frequency of 8–12 GHz increased from 15 dB for without HGM to 21 dB, 25 dB, and 23 dB for 5‐CH, 6‐CH‐, and 7‐CH‐based composite foam, respectively. It is also noticed that, 6‐CH‐based composite foams presented the highest EMI‐SE compared to 5‐CH‐ and 7‐CH‐based composite foams. Enhanced mechanical, thermo‐mechanical, and shielding properties of 6‐CH‐based composite foams are due to improved morphology and quality of CNT grown at 600°C. [ABSTRACT FROM AUTHOR]

The development of smart sensors towards monitoring health and environmental has been receiving growing attention in the recent past. In particular, development of wearable, flexible, stretchable, and semitransparent sensors are desirable for modern technological applications. In this work, we present a simple strategy towards preparation of highly flexible and stretchable composite sensors based on poly (3,4-ethylenedioxythiophene: poly(styrene sulfonic acid)) (p-PEDOT–PSS) and titanium dioxide (n-TiO2) treated with diethylene Glycol (DEG) using a simple bar coating technique. The surface morphology, distribution of TiO2 nanoparticles, thermal stability, and various functional groups present in the composite were characterized by SEM, TEM, TGA, and FT-IR techniques. Presence of TiO2 and DEG treatment in PEDOT–PSS enhances the electrical conductivity (2 S/cm to 515 S/cm) and mechanical stability of the composite films. This ultra-sensitive, highly flexible, and stretchable thin layer of PEDOT–PSS:TiO2 treated with (DEG) was employed as a resistive sensor for the detection of Nitric Oxide (NO) (1–250 ppm) at room temperature. These ultra-sensitive nanocomposite films exhibit a sensitivity of 96% (@ 250 ppm) with excellent sensitivity retention under mechanical deformations such as bending and stretching. For the first time, this report presents the simultaneous determination of conductivity and NO-sensing performance of rolled and stretched sensing films based on conductive PEDOT–PSS composites. Owing to its low-cost fabrication, excellent conductivity, high sensitivity under mechanical deformations and long-term stability, the composite films studied in this work could potentially be used as a wearable and flexible gas sensor in organic electronics towards detection of NO gas. [ABSTRACT FROM AUTHOR]

The Rationale: Undifferentiated pleomorphic sarcoma originally known as malignant fibrous histiocytoma was declassified by the World Health Organization in 2002 as a formal diagnostic entity and renamed as an undifferentiated pleomorphic sarcoma. It accounts for <1% of malignant tumours of the long bone. Patient Concerns: A 33-year-old male patient reported with swelling and pain in the lower left posterior jaw region for 3 months with a history of fall on the floor 3 months back. Diagnosis: On examination, diffuse solitary swelling was present on the left lower third of the face and was diagnosed radiographically and histopathologically as undifferentiated pleomorphic sarcoma of the mandible. Treatment and Outcomes: Selective neck dissection, followed by reconstruction with fibula osteomyocutaneous flap and then referred for adjuvant radiotherapy. Take-away Lessons: Vimentin staining plays a substantial role in the diagnosis of undifferentiated pleomorphic sarcoma. A long-term follow-up after treatment is required to increase the chances of disease-free survival for the patients. [ABSTRACT FROM AUTHOR]

In this paper the concepts of pullback attractor and pullback absorbing family in (deterministic) dynamical system are defined in (random) dynamical systems. Also some main results such as (existence) of pullback attractors, upper semi-continuous of pullback attractors, uniform and global attractors are proved in random dynamical system. [ABSTRACT FROM AUTHOR]

Addition of fillers in polyurethane foams enhances the mechanical properties of polymeric foams. However, fillers can be loaded to a certain extent, as higher percentage of fillers in polymeric foam causes structural instability leading to the collapse of foam. In this article, we report the use of hollow glass microspheres as a possible co-filler which enables higher loading of nano-clay in flexible polyurethane foam. It has been observed that the structural and mechanical properties of nano-clay-loaded foams were found to cause instability at 5 wt% loading of nano-clay. Therefore, upon addition of hollow glass microspheres in 5 wt%, nano-clay-loaded polyurethane foam shows remarkable enhancement in terms of stability and mechanical properties of the resultant foams. A 100-fold increment in tensile strength has been observed for 2 wt% hollow glass microspheres and 5 wt% nano-clay-loaded flexible polyurethane foams as compared to conventional (unloaded) polyurethane foams. [ABSTRACT FROM AUTHOR]

Objectives: To assess the adverse effects of propranolol therapy in infantile hemangioma. Methods: An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria. Results: A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions. Conclusion: Young children with low body weight were at higher risk for adverse effects of propranolol. [ABSTRACT FROM AUTHOR]

The processing of hollow glass microsphere (HGM) based composites is one of the growing areas in materials research due to the potential of significantly changing material properties even at low HGM concentrations. HGM‐epoxy composites are prepared by sonication method. Four weight ratio configurations are considered (1, 3, 5 wt% HGM and 5 wt% NH2 functionalized HGM) and compared with neat epoxy to study the micro‐enrichment effect. The influence of low volume HGM and functionalized HGM reinforcement on epoxy in the compressive and thermo‐mechanical behavior of the composites were characterized by thermo‐gravimetric analysis, dynamic mechanical analysis, and compression testing. The compressive strength of HP5% sample decreased in 101%, as compared with that of EP sample, whereas, storage modulus of HP5% and f‐HP5% sample is increased by 27.7 and 32.5%, as compared with the EP sample, but did not significantly affected the thermal stability of the obtained composites. Scanning electron microscope images of the fractured samples had shown a good dispersion and interaction of the HGM in the matrix. By introducing HGM content, there was a remarkable difference in the surface morphology of the fractured surface of epoxy. POLYM. COMPOS., 40:3493–3499, 2019. © 2019 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Background: Suxamethonium chloride (scoline) is a short acting depolarizing muscle relaxant; it was discovered early in the nineteenth century but not used in clinical practice until 1951. Scoline became a popular muscle relaxant due to its rapid onset of action, quick metabolism and hence shorter duration of action. It is metabolized by cholinesterase. Scoline apnoea was described within a few years of clinical use of Suxamethonium due to inherited or acquired deficiency of the cholinesterase enzyme resulting in prolonged muscle relaxation. Now scoline is used in prehospital and emergency intubating conditions, in pregnancy fetal distress or cord prolapse due to obvious advantages in these circumstances. The aim of our study was to investigate the trends and incidence of scoline apnoea in pregnant patients. Patients and methods: All patients admitted with scoline apnoea during pregnancy in the surgical intensive care unit of a tertiary healthcare facility were included retrospectively in our study. Patients demographic data, duration of apnoea and intubation, intensive care unit stay and trends of scoline apnoea were recorded. Results: A total of 32 pregnant patients post-lower segment caesarean section were admitted to the surgical intensive care unit during the study period. The indications for general anaesthesia in the majority of patients were obstetrical emergencies (n = 23, 71.87%), refused regional anaesthesia (n = 7, 21.87%), and required general anaesthesia after the regional anaesthesia (n = 2, 6.25%) patients. Twenty-nine (90.62%) patients received premedication with metoclopramide and sodium citrate (Table 1a). Thirty (93.75%) patients received reversal combination of neostigmine and atropine. Four (12.50%) patients received fresh frozen plasma (Table 1a). The mean age of the patients was 31.7 ± 6.4 years old (minimal age was 25 years), all patients belonged to ASA class 1 and the mean duration of apnoea time was 4 ± 2.5 hours. The duration of intubation was 6 ± 4.5 hours and the length of surgical intensive care stay was 1.2 ± 0.7 days (Table 1b). As shown in Figure 1a, the majority of patients were found to belong to the age group of 31 to 35 years (n = 12, 37.5%), followed by 9 (28.12%) patients in the age group of 26 to 30 years. It was also found that the Qatari locals and Egyptians formed the majority nationality (n = 12, 37.5% and n = 7, 21.87%) of patients (Figure 1b). The overall Arab patient population had a higher incidence of scoline apnoea compared to the Asian group of patients. All patients were found to have cholinesterase levels below 3500 units/litre (normal range varies from 5400 to 13,200 units/litres), which is less than 70% of the normal value (Figure 2a). There was a decreasing trend of scoline apnoea patients in recent years. From 2013 to 2016, there were no patients admitted to SICU with scoline apnoea and in 2017, only one patient with scoline apnoea was admitted (Figure 2b). Conclusion: Scoline apnoea incidence and trend in our parturient population is decreasing. The majority of our patients received premedication and reversal medication which decreases the cholinesterase levels. The decreasing trend may be attributable to increased regional anaesthesia practice and frequent use of rocuronium. [ABSTRACT FROM AUTHOR]

Background: The global incidence of oral cancer occurs in low-resource settings. Community-based oral screening is a strategic step toward downstaging oral cancer by early diagnosis. The mobile health (mHealth) program is a technology-based platform, steered with the aim to assess the use of mHealth by community health workers (CHWs) in the identification of oral mucosal lesions.Materials and Methods: mHealth is a mobile phone-based oral cancer-screening program in a workplace setting. The participants were screened by two CHWs, followed by an assessment by an oral medicine specialist. A mobile phone-based questionnaire that included the risk assessment was distributed among participants. On specialist recommendation an oral surgeon performed biopsy on participants. The diagnosis by onsite specialist that was confirmed by histopathology was considered as gold standard. All individuals received the standard treatment protocol. A remote oral medicine specialist reviewed the uploaded data in Open Medical Record System. Sensitivity, specificity, positive and negative predictive values were calculated. Inter-rater agreement was analyzed with Cohen's kappa coefficient (κ) test, and the diagnostic ability of CHWs, onsite specialist, and remote specialist was illustrated using receiver operating characteristic curve.Results: CHWs identified oral lesions in 405 (11.8%) individuals; the onsite specialist identified oral lesions in 394 (11.4%) individuals; and the remote specialist diagnosed oral lesions in 444 (13%). The inter-rater agreement between the CHW and the onsite specialist showed almost perfect agreement with the κ score of 0.92, and a substantial agreement between CHW and remote specialist showed a score of 0.62. The sensitivity, specificity, positive and negative predictive values of CHWs in the identification of oral lesion were 84.7, 97.6, 84.8, and 97.7%, respectively.Conclusion: The trained CHWs can aid in identifying oral potentially malignant disorders and they can be utilized in oral cancer-screening program mHealth effectively. [ABSTRACT FROM AUTHOR]

Objectives: The proper assessment orients learning in the desired direction. The structuring of assessment tools helps in minimizing the examination bias. However, the structuring of viva voce (SVV) has not been tried much. Therefore, this study was conducted to comparatively evaluate the structured written theory examination (STE) outcome with structured and unstructured viva voce assessments in third semester MBBS students. Methodology: Twenty uniform viva voce cards each containing eight structured questions with equitable, progressive cognitive levels were prepared. The random permutation (randomization) was done by shuffling the cards before the student picked up one card in a double-blind fashion. Of 135 students, 33-35 students per day were assessed for 4 continuous days through checklist-based evaluation by the same examiner following the STE. Parallel unstructured practical viva voce assessment was done for a major practical exercises held. Results: The intragroup percentage coefficient of variance values progressively increased in order of unstructured practical viva assessment (UPA%, 18.25) < structured written theory examination (STE%, 47.26) < structured theory viva voce (SVV%, 63.91). Thus, SVV% is more discriminatory than UPA%. The students in appropriate categories were 72 (53%) in%vSTE-SVV, 18(13%) in %vSTE-UPA, and 20 (14%) in %vSVV-UPA, respectively. A very high statistically significant correlation (P = 0.001) is seen between STE% and SVV% and highest erroneous results are seen in %vSVV-UPA (110, 81%). Conclusion: The SVV provides uniform, equitable, unbiased, and reflective assessment of students. Thus, a comprehensive objective and meaningful assessment can be achieved by structuring of written theory, practical, and viva voce. [ABSTRACT FROM AUTHOR]

Tooth impaction is a pathological situation where a tooth is unable to achieve its normal functional position within the expected time span. The removal may be associated with intra-operative or post-operative complications. The Le Fort I osteotomy is a procedure used by maxillofacial surgeons to correct a wide range of dentofacial deformities. Due to its versatility and simplicity, it has gained popularity for a wide range of uses. This case report describes the location and surgical removal of a right maxillary third molar which was accidentally displaced into the infratemporal fossa in a 26-year-old female while performing Le Fort I osteotomy. The patient underwent a second surgery for the retrieval of tooth using modified Gillie's temporal approach. The important role of the cone beam computed tomography in determining the localization of the displaced tooth is demonstrated. [ABSTRACT FROM AUTHOR]

Purpose Economic hardship and crime is always a debatable issue in the political economy literature. Some authors define poverty leads to crime some are completely opposite. The purpose of this paper is to find out the impact of poverty on crime in the USA.Design/methodology/approach Using time series data of USA over the period from 1965 to 2016, this study applies autoregressive distributed lag approach to identify the effect of poverty on crime.Findings The outcomes confirm a positive co-integrating relationship between poverty and property crime. It can be argued that poverty ultimately leads property crime in long run in the USA. However, unemployment and GDP exhibit neither long-run nor short-run relationship with property crime and they are not cointegrated for the calculated period.Research limitations/implications The subject of this paper helps to explain and analyze the nexus between poverty and crime in the USA.Practical implications Government and policymakers should focus more on poverty rather than unemployment alone to control property crime.Originality/value This study attempts to identify the consequences of economic hardship and poverty on the crime in the advanced economy like USA. [ABSTRACT FROM AUTHOR]

There is a little available literature on injuries sustained due to bear attacks and their management. Bears are agile wild animals and injuries sustained after a bear attack have varying patterns. In general, such cases present to the emergency department with severe maxillofacial injuries with varying patterns, thereby limiting the use of common protocol for the management of such injuries. The aim of this article is to add to the current available literature on bear attacks, a present case of management of maxillofacial injury involving the orbit sustained after a bear attack. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to compare the efficacy of Obwegeser’s pterygoid osteotome and Laster shark-fin osteotome by measurement of strain adjacent to the pterygomaxillary suture and the amount of force required for dysjunction.Materials and Methods: Two popular instruments Obwegesser’s pterygoid and shark-fin osteotome were tested on dry human skulls. The external force required for separation of the pterygomaxillary suture with these osteotomes was generated by an electronically controlled ‘Instron’ tester Bi-06-108. Tests were performed with pterygoid osteotome placed on one randomly chosen side and shark-fin osteotome on the other side of the same specimen. The amount of strain developed by each of these instruments was recorded using two strain gauges on the right and left lateral pterygoid plates. Results: Instrument used Mean force to achieve dysjunction Mean strain developed Pterygoid osteotome 169 N 887.66 microstrain Shark-fin osteotome 175.5 N 677.33 microstrain Conclusion: Based on the distribution of strain, from this study, we conclude that Laster shark-fin osteotome is efficacious over Obwegeser’s Pterygoid osteotome, in Le fort I osteotomy. [ABSTRACT FROM AUTHOR]

Thirty five Indian sesame genotypes were evaluated for their genetic diversity for seed yield and yield attributing characters as well as capsule shattering characters. The genotypes were classified into eleven clusters, based on Mahalanobis D2 statistic. Results on inter-cluster distances revealed maximum diversity between genotypes of cluster II and IV. A perusal of the results on cluster means revealed high capsule number per plant, seed weight per capsule and potential seed weight for cluster IV, the earliest genotype possessing maximum branches per plant and retained seed number for cluster VI, while maximum values for plant height, capsule width and thousand seed weight for cluster VIII indicating the desirability of genotypes from these clusters for improvement of respective traits. Further, potential seed weight has the highest contribution to total divergence followed by capsule split before drying, retained seed weight, unattached seed weight and seed weight per capsule indicating their importance in the choice of parents for developing semi shattering genotypes. [ABSTRACT FROM AUTHOR]

Retraction Note to: Development of high-performance flexible and stretchable sensor based on secondary doped PEDOT-PSS:TiO2 nanocomposite for room-temperature detection of nitric oxide 2(c) "PEDOT-PSS: PVA doped TiO SB 2 sb (8wt.%) thin" in another article by the same author group [[1]]. Mohammed Imran, Syed Khasim and Apsar Pasha disagree to this retraction. [Extracted from the article]

Background: Stress is the psycho-physiologic reaction of the body to diverse stimuli including emotional or physical stimuli that imbalance the homeostasis and is also known to trigger various stress markers. Despite the stressors of different types, chronic stress in particular, is known to influence the physiological milieu and breakdown of adaptive mechanisms consequently aggravating the morbid states. Aims and Objectives: The present study was designed to evaluate the modulatory role of stress marker by N-nitro-L-arginine-methyl ester (L-NAME) and L-Ascorbic acid (L-AA) in experimental model of chronic restraint stress (RSx21) in Wistar rats. Material and Methods: MDA and GSH levels were determined by the method of Okhawa et al. 1979 and Ellman 1959 respectively, the SOD and catalase levels were estimated by the method of Nandi and Chatterjee 1988 and Aebi 1984 respectively. Results: Results from our study reveal the significant enhancement of malondialdehyde (MDA) level while significant attenuation of superoxide dismutase (SOD), reduced glutathione (GSH) and catalase levels in chronic stress group compared with vehicle (non-stress) group. The MDA level was found to be increased by L-NAME (10 and 50 mg/kg) in chronic restraint (RSx21) induced rats as compared to vehicle treated RS group. Antioxidant L-AA (100 and 200 mg/kg) significantly reduced MDA level in chronic stress situation. However, L-NAME and L-Ascorbic Acid were found to cause an increase in level of plasma SOD, GSH and catalase when compared with vehicle treated RS group. On the other hand, L-AA (100 and 200 mg/kg) reversed these RS induced changes in these oxidative parameters. Conclusions: Hence, results from the study underlined the intricate role of antioxidants as evidenced by reversal of oxidative stress markers that command a vital role in the development of morbid condition. [ABSTRACT FROM AUTHOR]

A rare case of monostotic ossifying fibroma of the dorsal spine in a postpartum woman is being described. Ossifying fibromas of the spine are very rare tumors. They are components of benign fibro-osseous lesions. We report a case of an 18-year-old woman, who presented with complaints of weakness of both the lower limbs in the immediate postpartum period and was diagnosed with ossifying fibroma of the dorsal [D3] vertebral body. The tumor was excised followed by spinal stabilization. Histopathologic findings were consistent with ossifying fibroma. Postoperative period was uneventful. Monostotic variant of ossifying fibroma in the dorsal spine is an extremely rare tumor, and its presence in the postpartum period adds on to the diagnostic dilemma. Hence this case report can be kept in mind while evaluating a case presenting with complaints of weakness of both the lower limbs in the immediate postpartum period. [ABSTRACT FROM AUTHOR]

Background: Child fever or puerperal sepsis is a significant cause of maternal morbidity and mortality. It is a preventable maternal postpartum complication. Group A streptococcus (GAS) infection remains a significant cause for postpartum sepsis as it causes septic shock and multiple organ dysfunction (MODS). There has been a resurgence of severe puerperal GAS infections over the past two decades, although rare, it must be recognized early and treated aggressively. GAS is a common bacteria causing necrotizing fasciitis (NEF) in our region, but it caused NEF in only one postpartum patient which is a rarity. We report a case of puerperal GAS infection-causing NEF where the patient underwent multiple surgical debridements complicated with septic shock and MODS, and had a fairly positive outcome. Case presentation: A 26-year old female presented to the emergency department 5 days postpartum with fever, tachycardia, tachypnea, borderline blood pressure, vaginal discharge, and severe pain in the right leg. Her physical examination revealed reddish discoloration of the right lower leg, which was edematous, warm, and extremely tender. The episiotomy wound looked dirty and infected. She had leukocytosis (29.2 × 10³/#956;L), thrombocytopenia (44 × 10³/#956;L), C-Reactive protein was elevated (322 mg/L), and serum lactic acid was 3.8 mmol/L. Her hepatic and renal parameter were elevated. She had a deranged coagulation profile. Post-partum sepsis was suspected and blood cultures were done. She was started on Tazocinw (Tazobactum + piperacillin), supplemented with oxygen, and resuscitated with intravenous fluids. She was immediately taken for emergency surgical intervention, right leg debridement, and fasciotomy with exploration of the episiotomy wound was performed. Surgical findings were dirty colored fluid collection and loss of facial resistance which corroborated with NEF. Necrotic tissues were sent for histopathology and cultures, and clindamycin was started. Intraoperatively the patient became unstable, requiring double vasopressor (noradrenaline and vasopressin) to maintain the hemodynamics. Postoperatively the patient was kept sedated and ventilated in the intensive care unit (ICU). She required four debridements in the next two days despite which her right leg was not improving. Magnetic resonance imaging showed necrotizing fasciitis of the right thigh and leg. Tissue biopsy confirmed the diagnosis. Her blood and tissues showed growth of group A streptococcus. With family agreement, she underwent above right knee amputation, lateral and medial thigh compartment fasciotomy, and debridement on day five. She was oozing from the fasciotomy wounds and needed resuscitation with blood and blood products. She started to show signs of improvement and was weaned off from vasopressors and ventilator. Hepatic and renal functions improved (Figure 1 and Table 1). She was extubated on day 12, awake, hemodynamically stable, tolerated oral feeding, and was transferred to the surgical ward on day 19. She was discharged home on day 24 and was followed in surgical outpatient clinics. Conclusion: Despite developments in infection control and strict aseptic precautions, GAS puerperal sepsis remains a potentially life-threatening infection especially when they present with rare conditions like NEF in the postpartum period. Early diagnosis, aggressive surgical management, and supportive medical care are important for a positive outcome. [ABSTRACT FROM AUTHOR]

Introduction: The fixed dose combinations used in chronic obstructive pulmonary disease (COPD) patients need their rationale evaluation. If there is no added benefit; then it amounts economic burden on the society, reduced compliance, and unsuccessful therapy. This study evaluated the effectiveness of three regimens of dry powder inhaled preparations including tiotropium 18 µg once a day; tiotropium 18 µg plus formoterol 12 µg once a day, and tiotropium 18 µg once a day plus formoterol 12 µg twice a day in moderate COPD patients. Materials and Methods: A randomized, double-blind, placebo-controlled, active drug controlled parallel design study was conducted in 42 moderate COPD patients without any other comorbidity. Three (R1, R2, and R3) regimens were evaluated in patients to assess the appropriate evidence-based pharmacotherapy regimen. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Borg's scale of dyspnea, and vital signs (blood pressure and pulse rate) were measured on serial time points for 24 h. Results: The trough FEV1 values of R1, R2, and R3 in liters were 1.836 ± 0.51, 1.886 ± 0.47, and 1.805 ± 0.37, respectively and did not show any statistical difference. No statistical significance was observed in FVC (liters), FEV1% predicted, ΔFEV1 (liters), ΔFEV1% predicted, ΔFVC % predicted, and Δ FVC (liters) except in 24 h FVC percentage predicted values where P - value for R3 is in the range between 0.05 and 0.1 over R1. Conclusions: Study shows that tiotropium alone once a day is the evidence based and rationale pharmacotherapy in moderate COPD. There is no advantage or statistical significance of adding long acting β2 agonists (LABA) such as formoterol to tiotropium either for 12 h (once daily) or 24 h (twice daily). [ABSTRACT FROM AUTHOR]

Background: The epidemic of HIV/AIDS is now progressing at a rapid pace among young people (15 - 24 years) accounting for 40% of new infections in 2006. Education has been described as social vaccine and it can serve as a powerful preventive tool. Objective: 1. To assess the knowledge and attitude about HIV/AIDS among college students 2. To study the role of Information Education Communication (IEC) in improvement of their knowledge and attitude Materials and Method: A prospective study was carried out among 270 college students aged between 16 - 18 years, where knowledge and attitude towards HIV/AIDS was assessed at baseline using pre tested questionnaires. Health education sessions were conducted on HIV/AIDS. Post Health education questionnaires were later distributed to assess the change in knowledge and attitude towards HIV/ AIDS among study participants. Results: The overall general knowledge regarding HIV/AIDS, knowledge regarding its mode of transmission, prevention and treatment was poor among the study participants. Following educational sessions a significant improvement was observed in knowledge and attitude of the students towards patients living with HIV/AIDS. Some misconceptions about HIV/AIDS were corrected through the health education intervention, as detected by improved correct response rates. Conclusion: A planned HIV/AIDS education program has significantly improved the HIV/AIDS knowledge and attitude towards patients living with HIV/AIDS. However, a small proportion still exists and needs to be addressed by other health education programmes. [ABSTRACT FROM AUTHOR]

Background: Rapid response team (RRT) has been implemented in developed countries with the aim of early recognition and response to critical care triggers for the better patient outcome. However, the data concerning their efficacy is hardly available until date from Indian subcontinent. Aims: To evaluate the impact of RRT implementation on patient outcome during medical emergencies. Settings and Design: Retrospective observational study of RRT records of in-bed patients of super specialty academic teaching hospital. Materials and Methods: RRT record forms during the first half of the year from January 2012 to June 2012 were included for all inpatients and out-patients irrespective of their age, gender and diseases profile after their inclusion in the system. Outcomes such as patient stayed in the room, patient transfer to intensive care unit (ICU), patient discharge and generation of code blue event, mortality and length of stay in hospital/ICU were measured. Statistical Analysis: Descriptive analysis was performed with the help of statistical software STATA 9.0 and R 2.13.2 (StataCorp LP, Lakeway Drive College Station, Texas, USA). Results: Analysis of 41 RRT calls showed decreased code blue calls by 2.44% and decrease in mortality by 4.88%. Average length of stay in ICU and hospital post RRT assistance for patients was 2.55 and 6.95 days respectively. Conversely percentage of patients requiring a higher level of care was more (75.61%) than those who stayed in their rooms/wards (24.39%). Conclusion: Implementation of RRT in this hospital was associated with reduced code blue events and its attendant mortality outside the ICU settings. However, more number of patient requiring higher levels of care delineates the need for a larger evidence based medicine study. [ABSTRACT FROM AUTHOR]

Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Nazi Experiments in Germany and compulsory sterilization program in India were the studies where States used physicians for the advancement of their rationality or belief. Conversely victimization of physicians in Kosovo, Sri Lanka and incarcerating physicians for treating human immunodeficiency virus/acquired immunodeficiency syndrome patients in some countries is concerning. The Nuremberg code, the Declaration of Geneva, Belmont Report and Declaration of Helsinki are ethical documents while active involvement of Food and Drug Administration through "common rule" resulted in guidelines like International Conference on Harmonization and Good Clinical Practices. Still unethical studies are found in developing countries. Studies such as experimental anticancer drugs in 24 cancer patients without adequate prior animal testing and informed consent in Kerala, studies at All India Institute of Medical Sciences in New Delhi resulted in 49 deaths of children and many more suspicious studies are rampant. Reverting back to the fundamentals of the medical profession; teaching medical ethics and enforcement of "medical neutrality" by embarking some grade of "medical immunity" on the basis of the oath is necessary for ethical conduct of physicians. [ABSTRACT FROM AUTHOR]

The Central Drugs Standard Control Organisation and its chairman Drug Controller general of India are bequeathed to protect the citizens from the marketing of unsafe medication. The startling findings, of the 59th report of the Parliamentary Standing Committee on Health and Family Welfare, have uncovered the lax standards followed by the regulatory authorities in India. The growing clinical research after the product patents rights for the pharmaceutical industries as per the trade related aspects of intellectual property rights agreement and adverse drug reaction monitoring of the marketed drugs have raised many ethical and regulatory issues regarding the promotion of new drugs in Indian markets. Many controversial group of medicines; unauthorised and irrational FDCs not relevant to India's medical needs, are available which are not sold in any of the countries with matured regulatory bodies. It becomes vital to understand the history, growth and evolution of the regulatory aspects of drugs which are handled by multiple Ministries and Departments of the Government of India. Although amendment to Schedule Y, registration of Contract Research Organisations, registration of Clinical Trials, Speeding up review process, Pharmacovigilance (PhV) programme for India and Inspection of clinical trial sites have been started by the various regulatory agencies. However due to casual approach in marketing approval for sale of the drugs, the unethical steps taken by some pharmaceutical companies and medical practitioners has reiterated the need to get appropriate understanding of present regulation of drugs and clinical research especially regarding the practical rules and regulations. [ABSTRACT FROM AUTHOR]

Methicillin Resistant Staphylococcus aureus (MRSA) is a worldwide increasing problem and difficult to cure because MRSA are resistant against almost all the clinically available antibiotics, Synergistic effects of Ocimum sanctum extract and antibiotics on MRSA isolated clinically from swabs from pus, wound, nasal cavity, burn wound at Swaroop Rani Nehru Hospital, and Nazareth Hospital, Allahabad, were explored. MRSA were screened for resistance against selected antibiotics such as Penicillin, Gentamicin, Cephalexin, Ciprofloxacin and Tetracycline by using disc diffusion method. Synergetic effect of acetone extract of Ocimum sanctum and antibiotics were evaluated Zone of inhibition were increased significantly with all antibiotics. [ABSTRACT FROM AUTHOR]

Background: During postnatal murine and rodent cerebellar development, cerebellar granule precursors (CGP) gradually stop proliferating as they differentiate after migration to the internal granule layer (IGL). Molecular events that govern this program remain to be fully elucidated. GPR3 belongs to a family of Gs-linked receptors that activate cyclic AMP and are abundantly expressed in the adult brain. Methodology/Principal Findings: To investigate the role of this orphan receptor in CGP differentiation, we determined that exogenous GPR3 expression in rat cerebellar granule neurons partially antagonized the proliferative effect of Sonic hedgehog (Shh), while endogenous GPR3 inhibition by siRNA stimulated Shh-induced CGP proliferation. In addition, exogenous GPR3 expression in CGPs correlated with increased p27/kip expression, while GPR3 knock-down led to a decrease in p27/kip expression. In wild-type mice, GPR3 expression increased postnatally and its expression was concentrated in the internal granular layer (IGL). In GPR3 -/- mice, the IGL was widened with increased proliferation of CGPs, as measured by bromodeoxyuridine incorporation. Cell cycle kinetics of GPR3-transfected medulloblastoma cells revealed a G0/G1 block, consistent with cell cycle exit. Conclusions/Significance: These results thus indicate that GPR3 is a novel antiproliferative mediator of CGPs in the postnatal development of murine cerebellum. [ABSTRACT FROM AUTHOR]