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Abstract Breastfeeding provides many health benefits, but its impact on respiratory health remains unclear. This study addresses the complex and dynamic nature of the mother-milk-infant triad by investigating maternal genomic factors regulating human milk oligosaccharides (HMOs), and their associations with respiratory health among human milk-fed infants. Nineteen HMOs are quantified from 980 mothers of the CHILD Cohort Study. Genome-wide association studies identify HMO-associated loci on chromosome 19p13.3 and 19q13.33 (lowest P = 2.4e–118), spanning several fucosyltransferase (FUT) genes. We identify novel associations on chromosome 3q27.3 for 6′-sialyllactose (P = 2.2e–9) in the sialyltransferase (ST6GAL1) gene. These, plus additional associations on chromosomes 7q21.32, 7q31.32 and 13q33.3, are replicated in the independent INSPIRE Cohort. Moreover, gene-environment interaction analyses suggest that fucosylated HMOs may modulate overall risk of recurrent wheeze among preschoolers with variable genetic risk scores (P

Abstract Introduction The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018–2022. Methods We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care. Results The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018–2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types. Conclusion We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.

Abstract Introduction Physicians need an accurate understanding of diabetic retinopathy (DR) severity to optimally manage patients. The aim of this prospective study is to correlate the severity of macular and peripheral retinal vascular abnormalities seen on widefield (WF) optical coherence tomography angiography (OCTA) with DR grading based on WF fundus photography. Methods The study included 150 eyes from 82 patients with treatment-naïve DR. All patients were imaged with WF fundus photography and swept-source WF OCTA. Quantitative and qualitative analyses of the foveal avascular zone (FAZ) size and shape, and measurement of capillary nonperfusion (CNP) areas, were performed from the OCTA images. The mixed-effects model was used to compare the DR grading from WF photography with the vascular changes seen on WF-OCTA, and Bonferroni correction was applied to the gradings. Results The mean [± standard deviation (SD)] age of patients was 55.5 (± 9.4) years. The WF-OCTA showed that an increasing size of the FAZ (from 0.442 (± 0.059) µm to 0.933 (± 0.086) µm) correlated with increasing severity of the DR (as determined with WF photography). The deep capillary plexus, FAZ size, and CNP areas in eyes with proliferative diabetic retinopathy (PDR) differed from those with mild nonproliferative diabetic retinopathy (NPDR) (p

Background: Sparse recent data are available regarding the aetiological causes of the right iliac fossa (RIF) mass from Andhra Pradesh. Methods: We prospectively studied the clinical presentation, diagnosis and management of consecutive cases (n = 100) presenting to our tertiary care teaching hospital with a RIF mass over 2 years. Results: Majority of RIF masses were seen in the third and fourth decades of life, and the male-to-female ratio was 2.8:1; 64% of the cases were due to appendicular pathology (appendicular mass [48%] and appendicular abscess [16%]), followed by ileocaecal tuberculosis (TB) (12%) and carcinoma caecum (10%) among others. Carcinoma caecum was more common in males (70%) as compared to females (30%). The majority (78%) were managed surgically; 4% died. Post-operative complications included wound infection and respiratory tract infection. Conclusions: Our observations suggest that appendicular pathology, ileocaecal TB and carcinoma caecum are common aetiological causes for RIF mass. Abdominal ultrasonography and computed tomography will facilitate early localisation.

Abstract Background Epigenetic modifications, particularly DNA methylation (DNAm) in cord blood, are an important biological marker of how external exposures during gestation can influence the in-utero environment and subsequent offspring development. Despite the recognized importance of DNAm during gestation, comparative studies to determine the consistency of these epigenetic signals across different ethnic groups are largely absent. To address this gap, we first performed epigenome-wide association studies (EWAS) of gestational age (GA) using newborn cord blood DNAm comparatively in a white European (n = 342) and a South Asian (n = 490) birth cohort living in Canada. Then, we capitalized on established cord blood epigenetic GA clocks to examine the associations between maternal exposures, offspring characteristics and epigenetic GA, as well as GA acceleration, defined as the residual difference between epigenetic and chronological GA at birth. Results Individual EWASs confirmed 1,211 and 1,543 differentially methylated CpGs previously reported to be associated with GA, in white European and South Asian cohorts, respectively, with a similar distribution of effects. We confirmed that Bohlin’s cord blood GA clock was robustly correlated with GA in white Europeans (r = 0.71; p = 6.0 × 10–54) and South Asians (r = 0.66; p = 6.9 × 10–64). In both cohorts, Bohlin’s clock was positively associated with newborn weight and length and negatively associated with parity, newborn female sex, and gestational diabetes. Exclusive to South Asians, the GA clock was positively associated with the newborn ponderal index, while pre-pregnancy weight and gestational weight gain were strongly predictive of increased epigenetic GA in white Europeans. Important predictors of GA acceleration included gestational diabetes mellitus, newborn sex, and parity in both cohorts. Conclusions These results demonstrate the consistent DNAm signatures of GA and the utility of Bohlin’s GA clock across the two populations. Although the overall pattern of DNAm is similar, its connections with the mother's environment and the baby's anthropometrics can differ between the two groups. Further research is needed to understand these unique relationships.

Introduction: Variety and adequacy of intake of food are required to meet the nutritional needs of the children. Due to poverty/illiteracy, poor families depend on a single food group that is, cereals. Due to the pandemic also, the nutrition of the growing children is affected. Objective: To know the effect of quantity and quality of diet on the nutritional status of under-five children. Methodology: This study had 270 children aged between 1 and 4 years registered at Anganwadi as study participants. Information on sociodemographic variables, quantity of calories and proteins consumed, quality of diet, and anthropometry of children was collected. Percentages and paired t-tests were used to find the difference between nutritional status and diet at different intervals, which was found to be statistically significant (P < 0.05). Results: In our study, we found that as the quantity and quality of diet improved nutritional status, especially weight for age, body mass index (BMI) for age Z score also improved. There was a significant difference between calories consumed at the baseline, 6 months and 1 year with P < 0.05. Protein intake was significant between baseline and six months with P < 0.005. Conclusion: Our study found a high percentage of undernutrition and wasting in the under-five population when diet was not sufficient in quality and quantity. As the quality and quantity of diet improved nutritional status also improved.

The response of retinal pathology to interventions in diabetic retinopathy (DR) is often independent of the glycated hemoglobin (HbA1c) values at the point of care. This is despite glucose control being one of the strongest risk factors for the development and progression of DR. Previous preclinical and clinical research has indicated metabolic memory, whereby past cumulative glucose exposure may continue to impact DR for a prolonged period. Preclinical studies have evaluated punitive metabolic memory through poor initial control of DM, whereas clinical studies have evaluated protective metabolic memory through good initial control of DM. In this narrative review, we evaluate the preclinical and clinical evidence regarding metabolic memory and discuss how this may form the basis of preventive care for DR by inducing “metabolic amnesia” in people with a history of uncontrolled diabetes in the past. While our review suggested mitochondrial biology may be one such target, research is still far from a possible clinical trial. We discuss the challenges in such research.

Introduction: Location or distance from healthcare facilities affects the use of health facilities of households. Use of health facilities also have an impact on the socioeconomic conditions. Distance from healthcare facilities significantly affects catastrophic health expenditures. This study aimed to determine the association of physical distance to healthcare facilities with the economic deprivation of households. Objective: This study aims to analyze the distance of healthcare facilities from households in different wealth index categories of Odisha. The study argues that the household wealth index is associated with the distance to healthcare facilities. Methodology: This study is based on six purposively selected districts in Odisha: Rayagada, Kalahandi, Angul, Keonjhar, Khordha, and Kendrapara. A cross-sectional household survey was conducted to collect the data. A total of 902 household data points were collected. Data analysis was carried out in SPSS version 25. Results: A difference is observed among households that need to travel more than one hour to reach a private doctor or private hospital: 42.6% of poor households face this challenge, whereas only 25% of wealthy households do. Among those who cannot reach a public hospital in less than an hour, a larger proportion are from poor households (62.6%). The poor and wealthy segments of the population have nearly equal access to NGO-run healthcare facilities in terms of proximity. We observe that poor households are less likely than wealthy households to reach private pharmacists in less than an hour and are more likely to require over an hour to reach them. Conclusion: Ensuring healthcare facilities is the minimum requirement within one hour of reach for every household in India. Underreporting of illnesses and diseases is one of the major factors of high mortality in the population. Physical accessibility to healthcare facilities can reduce the mortality burden on the population.

Objective: The complex relationship between cancer care and poverty was examined in this study. This study identified the associations of various demographic factors with cancer care. The study also analyzes the family's role and support network in cancer care. Methodology: This study employed a mixed-method approach to understand cancer care in Jharkhand, India, comprehensively. The study was conducted as a cross-sectional survey with 204 reproductive cancer patients. The structured interview schedule covered the socio-demographic variables and cancer care facilities. The study also used case study methods with three eligible adults who underwent or are currently receiving cancer treatment. Descriptive statistics were used to summarize the study findings. The narratives of each case study provide a comprehensive understanding of each patient's journey to cancer care. The study received ethical approval from the Institutional Review Board (IRB) and the Cancer Hospital. Results: The survey results show that 47 percent of the respondents access the treatment. Only 12.7 percent of the respondents had taken the HPV vaccine, and 44.6 percent had received physiotherapy during the treatment. Forty-four percent of the respondents accessed counseling services from health service providers. The respondents' characteristics, such as age and gender, were strongly associated with access to counseling services. Education and family income were statistically associated with access to cancer care treatment. Only 7.4 percent of respondents arranged transport for treatment, and 11.8 percent arranged logistics and various treatment therapies for cancer care. Cancer patients from Jharkhand frequently face discrimination in receiving health care because of their economic condition. The case study revealed differences in wealth, social class and family role in cancer care. As a result, cancer patients often feel hopeless and isolated, leading to depression and anxiety. Conclusion and Implications: Poverty plays a negative role in providing and accessing cancer care in the state of Jharkhand. The role of family and society is essential for cancer survival. Psychological support from the family gives hope to the life of cancer patients. To address the complex relationship between financial burden and cancer care, both government agencies and social structures must implement comprehensive strategies.

Access to reproductive cancer care in India is significantly affected by social determinants of health. Reproductive cancers, including cervical, ovarian, and uterine cancers, constitute a significant health challenge for women in India. This cross-sectional survey aims to comprehensively assess the landscape of reproductive cancer care among women in India, exploring access, awareness, and barriers to timely diagnosis and treatment. This study highlights challenges in delivering care for reproductive cancers among women in India. A cross-sectional survey design was adopted, involving a representative sample of women from four diverse geographical regions, urban and rural settings, and varying socioeconomic backgrounds. Structured interviews were conducted, and questionnaires were used to collect data on participants’ awareness of reproductive cancers, utilization of healthcare facilities, and experiences related to access to cancer care. The study adopted a convenient sampling approach and captured data from 509 women diagnosed with reproductive cancer. The collected data were analysed using the SPSS 25 version. Univariate, bivariate and multivariate analyses were performed. The survey identified one-fourth of the respondents as having ovarian cancer, and 23.4% were diagnosed with cervical cancer. One-third of the study respondents were diagnosed with breast cancer, and 18% had other reproductive system cancers. The survey also assesses the prevalence of risk factors contributing to the incidence of reproductive cancers. Socioeconomic status, education level, rural‒urban settings, and cultural beliefs influence the healthcare-seeking behavior of the study participants. Insufficient knowledge, the stigma of reproductive health problems, and a lack of family income frequently discourage women from obtaining timely medical treatment.

Background: Maternal smoking has been linked to adverse health outcomes in newborns but the extent to which it impacts newborn health has not been quantified through an aggregated cord blood DNA methylation (DNAm) score. Here, we examine the feasibility of using cord blood DNAm scores leveraging large external studies as discovery samples to capture the epigenetic signature of maternal smoking and its influence on newborns in White European and South Asian populations. Methods: We first examined the association between individual CpGs and cigarette smoking during pregnancy, and smoking exposure in two White European birth cohorts (n=744). Leveraging established CpGs for maternal smoking, we constructed a cord blood epigenetic score of maternal smoking that was validated in one of the European-origin cohorts (n=347). This score was then tested for association with smoking status, secondary smoking exposure during pregnancy, and health outcomes in offspring measured after birth in an independent White European (n=397) and a South Asian birth cohort (n=504). Results: Several previously reported genes for maternal smoking were supported, with the strongest and most consistent association signal from the GFI1 gene (6 CpGs with p0.05) among South Asians, likely due to a lack of smoking in this group. The same score was consistently associated with a smaller birth size (–0.37±0.12 cm, p=0.0023) in the South Asian cohort and a lower birth weight (–0.043±0.013 kg, p=0.0011) in the combined cohorts. Conclusions: This cord blood epigenetic score can help identify babies exposed to maternal smoking and assess its long-term impact on growth. Notably, these results indicate a consistent association between the DNAm signature of maternal smoking and a small body size and low birth weight in newborns, in both White European mothers who exhibited some amount of smoking and in South Asian mothers who themselves were not active smokers. Funding: This study was funded by the Canadian Institutes of Health Research Metabolomics Team Grant: MWG-146332.

Summary: The prevalence of type 2 diabetes (T2D), associated systemic disorders, diabetic retinopathy (DR) and current health policies in south Asian countries were analysed to assess country-specific preparedness to meet the 2030 Sustainable Development Goals. The south Asian countries were classified by human development index, socio-demographic index, multidimensional poverty indices, and eye health resources for epidemiological resource-level analysis. In south Asia, the prevalence of diagnosed and undiagnosed T2D in adults aged 40 years or above, was higher in Pakistan (26.3%) and Afghanistan (71.4%), respectively; India has the highest absolute number of people with DR, and Afghanistan has the highest prevalence of DR (50.6%). In this region, out-of-pocket spending is high (∼77%). This Health Policy is a situational analysis of data available on the prevalence of DR and common eye diseases in people with T2D in south Asia and available resources to suggest tailored health policies to local needs. The common issues in the region are insufficient human resources for eye health, unequal distribution of available workforce, and inadequate infrastructure. Addressing these challenges of individuals with T2D and DR, a 10-point strategy is suggested to improve infrastructure, augment human resources, reduce out-of-pocket spending, employ targeted screening, and encourage public-private partnerships.

Aim: The aim of this in vitro study was to evaluate and compare the effect of preheating on microhardness and depth of cure of three bulk-fill composite resins. Methods: Three bulk-fill composite resins were used; Group I: Filtek Bulk Fill, Group II: Beautifil Bulk Restorative and Group III: Tetric N Ceram Bulk Fill. Further each group was divided into two subgroups, Sub Group A: Discs were prepared using nonheated composite, Sub Group B: Discs were prepared using preheated composite. A total of 60 disc shaped specimens were prepared and microhardness (Vickers Microhardness Number [VHN]) of the top and bottom surfaces of the disc specimens were measured by Vickers microhardness tester. The ratio of the bottom surface VHN to the top surface VHN was used to calculate the depth of cure. Results: Preheated groups showed higher VHN values as compared to nonheated groups. Group II showed higher VHN value as compared to Group I in both subgroups. Group III showed the least VHN values in both subgroups. VHN values were maximum on top surfaces and minimum on the bottom surfaces for all the groups. It was found that the highest depth of cure was 0.71 while lowest depth of cure was 0.62. Conclusion: Preheating resulted in higher VHN values compared to nonheating. Top surface VHN values were better as compared to bottom surface VHN values for all groups. The depth of cure showed satisfactory results for all groups.

Abstract Background A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p

Introduction: Training young doctors is essential for carrying out need-based research. The field of Traditional Medicine (TM) has made significant contributions to modern medicine, and there is unlimited scope for exploring it further in search of improved treatment options. However, there is a lack of systematic research studies on traditional medicines. It was, therefore, considered necessary to assess the interest and awareness among modern medicine practitioners regarding Traditional Medicine Research (TMR). Aim: To assess the need for training in TMR among modern medicine practitioners. Materials and Methods: A cross-sectional questionnaire-based study was conducted in the Department of Pharmacology and Therapeutics at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India, from March 2020 to September 2020 among modern medicine practitioners from the Western region of India. A validated questionnaire was used to collect data regarding the level of training in research methodology, research experience including TMR, areas for training, attitude towards training in TMR, challenges in TMR, and therapeutic areas to focus TMR efforts. The data were analysed using descriptive statistics. Results: Out of 109 participants, 96 (88.1%) were trained in research methodology. At least one research project was undertaken by 91 (83.5%) participants. Ninety-seven percent of participants felt that TMR was necessary. TMR was conducted by 19 (17.4%) participants. Approximately 65 (59.6%) participants felt that conducting TMR poses challenges such as lack of funds, infrastructure, lack of belief in TM, unavailability of literature pertaining to TM, lack of expertise, and lack of corporate attention and marketing. Therapeutic areas identified to focus research efforts included lifestyle-related disorders, diabetes mellitus, cancer, ageing, allergic disorders, osteoarthritis, and obesity. Conclusion: All the participants expressed the need to undergo training in TMR. However, the experience of conducting TMR was limited. Lack of funds, infrastructure, and expertise were mentioned as the main hurdles in undertaking TMR. It is essential to conduct systematic and need-based training programs for modern medicine practitioners in basic research methodology and TMR.

Finding a balance between the loads and generating demands in power systems is a significant challenge since power producers require important inputs such as security, reliability and quality. In this study, a unique method for balanced load frequency control (BLFC) is proposed in two-area power systems, integrating a customized World Cup Algorithm (CWCA)-Driven PID optimization. The primary objective is to enhance the stability and performance of power systems. For this purpose, the integral time-multiplied absolute error (ITAE) is minimized by evaluating the objective function using time-domain simulation. The proposed methodology aims to improve the overall response of the control system, ensuring a reliable and stable power supply. Within the scope of two-area power systems with BLFC, simulation results show the effectiveness and resilience of the CWCA-Driven PID Optimization. The outcomes of the proposed PID controller-based CWCA approach are contrasted with the existing methods.

Abstract We hypothesize that children characterized by deprived factors have poorer health outcomes. We aim to identify clustering of determinants and estimate risk of early childhood diseases. This 1993–2019 longitudinal cohort study combines three Canadian pediatric cohorts and their families. Mothers and children are clustered using latent class analysis (LCA) by 16 indicators in three domains (maternal and newborn; socioeconomic status [SES] and neighbourhood; environmental exposures). Hazard ratios (HR) of childhood asthma, allergic rhinitis (AR), and eczema are quantified with Cox proportional hazard (PH) regression. Rate ratios (RR) of children’s health services use (HSU) are estimated with Poisson regression. Here we report the inclusion of 15,724 mother–child pairs; our LCA identifies four mother-clusters. Classes 1 and 2 mothers are older (30–40 s), non-immigrants with university education, living in high SES neighbourhoods; Class 2 mothers have poorer air quality and less greenspace. Classes 3 and 4 mothers are younger (20–30 s), likely an immigrant/refugee, with high school-to-college education, living in lower SES neighborhoods with poorer air quality and less greenspace. Children’s outcomes differ by Class, in comparison to Class 1. Classes 3 and 4 children have higher risks of asthma (HR 1.24, 95% CI 1.11–1.37 and HR 1.39, 95% CI 1.22–1.59, respectively), and similar higher risks of AR and eczema. Children with AR in Class 3 have 20% higher all-cause physician visits (RR = 1.20, 95% CI 1.10–1.30) and those with eczema have 18% higher all-cause emergency department visits (RR = 1.18, 95% CI 1.09–1.28) and 14% higher all-cause physician visits (RR = 1.14, 95% CI 1.09–1.19). Multifactorial-LCA mother-clusters may characterize associations of children’s health outcomes and care, adjusting for interrelationships.

Polo‐like kinase 1 (PLK1; also known as serine/threonine‐protein kinase PLK1) serves as a central player in cell proliferation, exerting critical regulatory roles in mitotic processes and cell survival. We conducted an analysis of PLK1 protein expression in a large cohort of samples from papillary thyroid carcinoma (PTC) patients and examined its functional significance in PTC cell lines, both in vitro and in vivo. PLK1 overexpression was noted in 54.2% of all PTC and was significantly associated with aggressive clinicopathological parameters; it was also found to be an independent prognostic marker for shorter recurrence‐free survival. Given the significant association between PLK1 and forkhead box protein M1 (FoxM1), and their concomitant overexpression in a large proportion of PTC samples, we explored their correlation and their combined inhibitions in PTC in vitro and in vivo. Inhibition of PLK1 expression indeed suppressed cell proliferation, leading to cell cycle arrest and apoptosis in PTC cell lines. Significantly, the downregulation of PLK1 reduced the self‐renewal capability of spheroids formed from PTC cells. Immunoprecipitation analysis shows that PLK1 binds to FoxM1 and vice versa in vitro. Mechanistically, PLK1 knockdown suppresses FoxM1 expression, whereas inhibition of FoxM1 does not affect PLK1 expression, which suggests that PLK1 acts through the FoxM1 pathway. The combined treatment of a PLK1 inhibitor (volasertib) and a FoxM1 inhibitor (thiostrepton) demonstrated a synergistic effect in reducing PTC cell growth in vitro and delaying tumor growth in vivo. This study highlights the important role of PLK1 in PTC tumorigenesis and prognosis. It also highlights the synergistic therapeutic potential of dual‐targeting PLK1 and FoxM1 in PTC, unveiling a potential innovative therapeutic strategy for managing aggressive forms of PTC.

Abstract Objective Breastfeeding is associated with reduced postpartum depression, stronger parent-child relationships, and fewer behavioral disorders in early childhood. We tested the mediating roles of postpartum depression and parent-child relationship in the association between breastfeeding practices and child behavior. Study design We used standardized questionnaire data from a subset of the CHILD Cohort Study (n = 1,573) to measure postpartum depression at 6 months, 1 year and 2 years, parent-child relationship 1 year and 2 years, and child behavior at 5 years using the Child Behavior Checklist (range 0-100). Breastfeeding practices were measured at 3 months (none, partial, some expressed, all direct at the breast), 6 months (none, partial, exclusive), 12 months, and 24 months (no, yes). Confounders included birth factors, maternal characteristics, and socioeconomic status. Results Breast milk feeding at 3 or 6 months was associated with − 1.13 (95% CI: -2.19-0.07) to -2.14 (95% CI: -3.46, -0.81) lower (better) child behavior scores. Reduced postpartum depression at 6 months mediated between 11.5% and 16.6% of the relationship between exclusive breast milk feeding at 3 months and better child behavior scores. Together, reduced postpartum depression at 1 year and reduced parent-child dysfunction at 2 years mediated between 21.9% and 32.1% of the relationship between breastfeeding at 12 months and better child behavior scores. Conclusion Postpartum depression and parent-child relationship quality partially mediate the relationship between breastfeeding practices and child behavior. Breastfeeding, as well as efforts to support parental mental health and parent-child relationships, may help to improve child behavior.

Purpose: To evaluate the feasibility and outcome of a real-time retinopathy of prematurity (ROP) telescreening strategy using videoconferencing in a community setting in India. Method: In a prospective study, trained allied ophthalmic personnel obtained the fundus images in the presence of the parents and local childcare providers. Analysis of images and parental counseling were done in real time by an ROP specialist located at a tertiary center using videoconferencing software. A subset of babies was also examined using bedside indirect ophthalmoscopy by an ROP care-trained ophthalmologist. The data were analyzed using descriptive statistics, sensitivity, specificity, positive and negative predictive values, and correlation coefficient. Results: Over 9 months, we examined 576 babies (1152 eyes) in six rural districts of India. The parents accepted the model as they recognized that a remotely located specialist was evaluating all images in real time. The strategy saved the travel time for ROP specialists by 477 h (47.7 working days) and for parents (47,406 h or 1975.25 days), along with the associated travel cost. In a subgroup analysis (100 babies, 200 eyes), the technology had a high sensitivity (97.2%) and negative predictivity value (92.7%). It showed substantial agreement (k = 0.708) with the bedside indirect ophthalmoscopy by ROP specialists with respect to the detection of treatment warranting ROP. Also, the strategy helped train the participants. Conclusion: Real-time ROP telescreening using videoconferencing is sensitive enough to detect treatment warranting ROPs and saves skilled workforce and time. The real-time audiovisual connection allows optimal supervision of imaging, provides excellent training opportunities, and connects ophthalmologists directly with the parents.

Abstract Links between human milk (HM) and infant development are poorly understood and often focus on individual HM components. Here we apply multi-modal predictive machine learning to study HM and head circumference (a proxy for brain development) among 1022 mother-infant dyads of the CHILD Cohort. We integrated HM data (19 oligosaccharides, 28 fatty acids, 3 hormones, 28 chemokines) with maternal and infant demographic, health, dietary and home environment data. Head circumference was significantly predictable at 3 and 12 months. Two of the most associated features were HM n3-polyunsaturated fatty acid C22:6n3 (docosahexaenoic acid, DHA; p = 9.6e−05) and maternal intake of fish (p = 4.1e−03), a key dietary source of DHA with established relationships to brain function. Thus, using a systems biology approach, we identified meaningful relationships between HM and brain development, which validates our statistical approach, gives credence to the novel associations we observed, and sets the foundation for further research with additional cohorts and HM analytes.

Abstract Background The gut microbiome undergoes primary ecological succession over the course of early life before achieving ecosystem stability around 3 years of age. These maturational patterns have been well-characterized for bacteria, but limited descriptions exist for other microbiota members, such as fungi. Further, our current understanding of the prevalence of different patterns of bacterial and fungal microbiome maturation and how inter-kingdom dynamics influence early-life microbiome establishment is limited. Results We examined individual shifts in bacterial and fungal alpha diversity from 3 to 12 months of age in 100 infants from the CHILD Cohort Study. We identified divergent patterns of gut bacterial or fungal microbiome maturation in over 40% of infants, which were characterized by differences in community composition, inter-kingdom dynamics, and microbe-derived metabolites in urine, suggestive of alterations in the timing of ecosystem transitions. Known microbiome-modifying factors, such as formula feeding and delivery by C-section, were associated with atypical bacterial, but not fungal, microbiome maturation patterns. Instead, fungal microbiome maturation was influenced by prenatal exposure to artificially sweetened beverages and the bacterial microbiome, emphasizing the importance of inter-kingdom dynamics in early-life colonization patterns. Conclusions These findings highlight the ecological and environmental factors underlying atypical patterns of microbiome maturation in infants, and the need to incorporate multi-kingdom and individual-level perspectives in microbiome research to improve our understandings of gut microbiome maturation patterns in early life and how they relate to host health. Video Abstract

Abstract Purpose To study the role of artificial intelligence (AI) in developing diabetic macular edema (DME) management recommendations by creating and comparing responses to clinicians in hypothetical AI-generated case scenarios. The study also examined whether its joint recommendations followed national DME management guidelines. Methods The AI hypothetically generated 50 ocular case scenarios from 25 patients using keywords like age, gender, type, duration and control of diabetes, visual acuity, lens status, retinopathy stage, coexisting ocular and systemic co-morbidities, and DME-related retinal imaging findings. For DME and ocular co-morbidity management, we calculated inter-rater agreements (kappa analysis) separately for clinician responses, AI-platforms, and the “majority clinician response” (the maximum number of identical clinician responses) and “majority AI-platform” (the maximum number of identical AI responses). Treatment recommendations for various situations were compared to the Indian national guidelines. Results For DME management, clinicians (ĸ=0.6), AI platforms (ĸ=0.58), and the ‘majority clinician response’ and ‘majority AI response’ (ĸ=0.69) had moderate to substantial inter-rate agreement. The study showed fair to substantial agreement for ocular co-morbidity management between clinicians (ĸ=0.8), AI platforms (ĸ=0.36), and the ‘majority clinician response’ and ‘majority AI response’ (ĸ=0.49). Many of the current study’s recommendations and national clinical guidelines agreed and disagreed. When treating center-involving DME with very good visual acuity, lattice degeneration, renal disease, anaemia, and a recent history of cardiovascular disease, there were clear disagreements. Conclusion For the first time, this study recommends DME management using large language model-based generative AI. The study’s findings could guide in revising the global DME management guidelines.

AIM: To explore the usage of choroidal thickness measured by swept-source optical coherence tomography (SS-OCT) to detect myopic macular degeneration (MMD) in high myopic participants. METHODS: Participants with bilateral high myopia (≤−6 diopters) were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study. SS-OCT was performed to determine the choroidal thickness, and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia (META-PM) Classi?cation. Presence of MMD was defined as META-PM category 2 or above. RESULTS: A total of 568 right eyes were included for analysis. Eyes with MMD (n=106, 18.7%) were found to have older age, longer axial lengths (AL), higher myopic spherical equivalents (SE), and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study (ETDRS) grid sector (P

ABSTRACTChildhood obesity is linked to maternal smoking during pregnancy. Gut microbiota may partially mediate this association and could be potential targets for intervention; however, its role is understudied. We included 1,592 infants from the Canadian Healthy Infants Longitudinal Development Cohort. Data on environmental exposure and lifestyle factors were collected prenatally and throughout the first three years. Weight outcomes were measured at one and three years of age. Stool samples collected at 3 and 12 months were analyzed by sequencing the V4 region of 16S rRNA to profile microbial compositions and magnetic resonance spectroscopy to quantify the metabolites. We showed that quitting smoking during pregnancy did not lower the risk of offspring being overweight. However, exclusive breastfeeding until the third month of age may alleviate these risks. We also reported that maternal smoking during pregnancy significantly increased Firmicutes abundance and diversity. We further revealed that Firmicutes diversity mediates the elevated risk of childhood overweight and obesity linked to maternal prenatal smoking. This effect possibly occurs through excessive microbial butyrate production. These findings add to the evidence that women should quit smoking before their pregnancies to prevent microbiome-mediated childhood overweight and obesity risk, and indicate the potential obesogenic role of excessive butyrate production in early life.

Knowledge, Attitudes, and Practices (KAP) studies offer valuable insights into the socio-cultural, psychological, and behavioral determinants of nutrition. This study aims to assess nutrition KAP during pregnancy and lactation in selected areas of Adilabad and Kumaram Bheem Asifabad districts, Telangana, India. A cross-sectional KAP survey was conducted on 536 individuals from February to March 2020, employing tablet-based data collection for pregnant women, lactating mothers, young mothers, and frontline staff. Departing from the standard equal-weight approach, we assigned different weights to responses based on existing literature and stakeholder consultation, acknowledging the varying significance of each response. This novel approach aims to mitigate the risk of overestimating or underestimating factors, thereby designing more effective policy interventions tailored to societal complexities. The results reveal that regarding the three micronutrients (Iron, vitamin A, and Iodine), the knowledge levels of pregnant women, lactating mothers, and young mothers were low, that is, less than 50% when compared with the functionaries/frontline staff. Pregnant women scored low on attitudes regarding micronutrients compared to lactating mothers, young mothers, and functionaries/frontline staff. Attitudes translate into practices; however, the data revealed that pregnant women, lactating mothers, and young mothers were not adopting appropriate dietary and nutrition practices except for the micronutrient iodine. The inadequate knowledge of all categories of respondents indicates a gap in nutrition literacy and education. The results point to the urgent need for policy action for nutrition education interventions among the vulnerable population.

This study explores the impact of CaTiO3 and LiNbO3 crystals on the optical and dielectric properties of polyvinylidene fluoride (PVDF) films. Our investigation employs UV–Visible Spectroscopy to characterize the n-π* C-F related electronic transition within the PVDF matrix. We find that CaTiO3 crystals significantly decrease the composite’s band gap and dielectric properties, enhancing its electronic and optical attributes. Conversely, LiNbO3 crystals increase the band gap energy. These variations align with observed DC conductivity changes, suggesting novel functionalities for optoelectronic, sensing, and energy storage applications.

Single walled SiC nanotubes have gain centre of attraction due to the unique behaviours and potential application in the field of optoelectronics devices, LED, storage materials, and Photovoltaic materials. Electronic and structural properties of intrinsic and Manganese (Mn) doped SiC Zigzag nanotubes verified using first principle calculations associated with Density functional theory (DFT). Band gap of SiC Zigzag nanotubes influenced the structural and optical properties which play a crucial role in semiconductor application and create new opportunities in optoelectronic components. Electronic band plot of intrinsic SiC Zigzag nanotubes indicates band gap increased with the increase diameter of the nanotubes. PDOS plot shows 2p orbitals and 3p orbitals has major contribution on mostly filled valence band and lowest filled conduction band region whereas 2 s and 3 s orbitals of C atom and Si atom has minor contribution. Band structure plot of Mn doped SiC Zigzag nanotube introduced an extra energy layer in conduction band and resulting decrease the band gap value and valence band and conduction band cross the Fermi energy level in DOS plot representing the half-metallic characteristics which has different potential applications specially in photovoltaic materials. Half-metallic materials have outstanding spin transport characteristics. Spin-polarized electrons can effectively have conducted by Sic Zigzag nanotubes that controlled transport of spins. These half-metallic properties are essential for spintronic materials where electron spin used for information storage and processing. PDOS plot of Mn doped SiC Zigzag nanotube indicate 2p and 3p states of C atom and Si atom has major contribution compared to the 2 s and 2p states of C atom and Si atom whereas 3d orbitals of dopant Mn atom has major contribution near Fermi level of both conduction and valence band. This study highlights the potential optoelectronic applications of Mn doped SiC Zigzag nanotubes.

Abstract Elucidating how cell populations promote onset and progression of intervertebral disc degeneration (IDD) has the potential to enable more precise therapeutic targeting of cells and mechanisms. Single‐cell RNA‐sequencing (scRNA‐seq) is performed on surgically separated annulus fibrosus (AF) (19,978; 26,983 cells) and nucleus pulposus (NP) (20,884; 24,489 cells) from healthy and diseased human intervertebral discs (IVD). In both tissue types, depletion of cell subsets involved in maintenance of healthy IVD is observed, specifically the immature cell subsets – fibroblast progenitors and stem cells – indicative of an impairment of normal tissue self‐renewal. Tissue‐specific changes are also identified. In NP, several fibrotic populations are increased in degenerated IVD, indicating tissue‐remodeling. In degenerated AF, a novel disease‐associated subset is identified, which expresses disease‐promoting genes. It is associated with pathogenic biological processes and the main gene regulatory networks include thrombospondin signaling and FOXO1 transcription factor. In NP and AF cells thrombospondin protein promoted expression of genes associated with TGFβ/fibrosis signaling, angiogenesis, and nervous system development. The data reveal new insights of both shared and tissue‐specific changes in specific cell populations in AF and NP during IVD degeneration. These identified mechanisms and molecules are novel and more precise targets for IDD prevention and treatment.

Abstract The editorial outlines an integrated approach to managing diabetic ocular complications, combining advanced scientific research with practical public health strategies to improve the prevention, diagnosis, and treatment of diabetic retinopathy and macular edema globally.

Background: Diabetic nephropathy is a progressive condition and a leading cause of end-stage renal disease. Oxidative stress and inflammation play an important role in its pathogenesis. In pre-clinical studies, Montelukast had shown renoprotective and anti-oxidant properties, hence the study was planned to evaluate the effect of Montelukast in a Streptozotocin (STZ) induced model of diabetic nephropathy. Methods: 40 Wistar rats of either sex were randomly divided into four groups viz. 1. Vehicle control group, 2. Enalapril (5 mg/kg), 3. Montelukast low-dose (10 mg/kg) and 4. High-dose (20 mg/kg) group. On day 1, diabetes was induced using a single dose of STZ (60 mg/kg) intraperitoneally. Diabetes induction was verified based on fasting blood glucose (FBG) levels on day 7 and from day 8 to day 42, rats were given study drugs. FBG, serum creatinine, blood urea nitrogen (BUN) and urine microalbumin levels were assessed pre-study and post-study. Assessments of kidney malondialdehyde (MDA), reduced glutathione (GSH) and renal histopathology were carried out at the end of the study. Results: Montelukast 10 mg/kg group showed significantly lower urine microalbumin levels compared to the vehicle control group (p < 0.05). Montelukast 20 mg/kg group showed significantly lower levels of FBG, serum creatinine, BUN and urine microalbumin compared to the vehicle control group (p < 0.05). In addition, Montelukast 20 mg/kg group also showed better effects on kidney MDA and GSH levels (p < 0.05) and histopathological scores compared to the vehicle control group. Conclusion: Montelukast showed a protective effect in the model of diabetic nephropathy because of its antioxidant effect.

PURPOSE: To evaluate the factors influencing the refractive outcomes following silicone oil tamponade (SOT) and silicone oil removal (SOR) in different lens statuses post-vitreoretinal surgery. DESIGN: Retrospective analysis of three different lens statuses. MATERIALS AND METHODS: This was a descriptive study that included 150 eyes of 147 patients who had undergone pars plana vitrectomy with SOT and SOR between January 2017 and June 2021. Demographic profile, spherical equivalent refraction (SER), and its association with clinical features were evaluated with SOT and post-SOR. RESULTS: The mean (±standard deviation [SD]) age was 47 ± 17.8 years, including all three groups. SER was represented in diopters (D). The mean ± SD refraction with SOT in phakic, pseudophakic, and aphakic was 4.28 ± 2.59 D, 2.94 ± 2.58 D, and 3.98 ± 4.82 D. The mean SER post-SOR in phakic, pseudophakic, and aphakic was −2.72 ± 2.03 D, −1.12 ± 1.41 D, and 8.22 ± 3.70 D. The diagnosis of rhegmatogenous retinal detachment (RRD) among 96 eyes (64%) is the common indicator to perform vitreoretinal (VR) surgery. A minority of subjects were managed with retinal lasers before VR surgery (14%). The macula was attached in 100 eyes (67.6%), the belt buckle was done in 37 eyes (24.7%), and the silicone oil viscosity with 1000 centistoke was chosen in 129 eyes (86%). CONCLUSION: SOT was used as a tamponade in VR surgeries irrespective of lens status. The significant predictor for post-SOR refraction in phakic and aphakic is post-SOT refraction. In pseudophakic, gender and diagnosis of RRD are the predictors of SOR refraction.

Purpose: To analyze the outcome of intervention versus observation for vitreous cavity hemorrhage occurring after a 2-month period of blood-free cavity (late postoperative vitreous cavity hemorrhage—POVCH) in eyes operated by vitrectomy for complications of proliferative diabetic retinopathy (PDR). Methods: This study was a 10-year retrospective, observational, multi-center study involving eight major vitreoretinal surgical centers across India from January 2010 to December 2019. The primary objective of the study was to assess the visual and clinical outcomes of various management approaches for late POVCH. The key secondary objective was to determine the best management option that prevented recurrence. Patients with follow-up of less than 6 months of POVCH management were excluded. Results: The occurrence of late POVCH was studied in 261 eyes. The median time to occurrence was 7 months (range: 2–87) postvitrectomy/silicone oil removal. The majority (58%) experienced a single, nonrecurring POVCH event. Visual acuity outcome was independent of all management approaches (P = 0.179; mean follow-up 20.7 ± 14.1 months). With watchful observation, spontaneous resolution was noted in 83% (60/72 eyes) of eyes in 81.5 days (interquartile range, 169.75). Silicone oil injection was most effective in preventing recurrence (P < 0.001). Conclusion: The current treatment practice of late POVCH management in PDR suggests that watchful observation for at least 3 months could be as efficacious as any surgical intervention.

Abstract Purpose To study the role of artificial intelligence (AI) to identify key risk factors for diabetic retinopathy (DR) screening and develop recommendations based on clinician and large language model (LLM) based AI platform opinions for newly detected diabetes mellitus (DM) cases. Methods Five clinicians and three AI applications were given 20 AI-generated hypothetical case scenarios to assess DR screening timing. We calculated inter-rater agreements between clinicians, AI-platforms, and the “majority clinician response” (defined as the maximum number of identical responses provided by the clinicians) and “majority AI-platform” (defined as the maximum number of identical responses among the 3 distinct AI). Scoring was used to identify risk factors of different severity. Three, two, and one points were given to risk factors requiring screening immediately, within a year, and within five years, respectively. After calculating a cumulative screening score, categories were assigned. Results Clinicians, AI platforms, and the “majority clinician response” and “majority AI response” had fair inter-rater reliability (k value: 0.21–0.40). Uncontrolled DM and systemic co-morbidities required immediate screening, while family history of DM and a co-existing pregnancy required screening within a year. The absence of these risk factors required screening within 5 years of DM diagnosis. Screening scores in this study were between 0 and 10. Cases with screening scores of 0–2 needed screening within 5 years, 3–5 within 1 year, and 6–12 immediately. Conclusion Based on the findings of this study, AI could play a critical role in DR screening of newly diagnosed DM patients by developing a novel DR screening score. Future studies would be required to validate the DR screening score before it could be used as a reference in real-life clinical situations. Clinical trial registration Not applicable.

Purpose: Opioid stewardship ensures effective pain management while avoiding overprescribing of opioids after surgery. This prospective randomized study investigates the efficacy of a multimodal postoperative pain regimen compared to a traditional opioid-only pain regimen following elective outpatient orthopedic hand surgery. We hypothesized that patients receiving multimodal pain management would consume fewer opioids and report greater satisfaction than patients receiving only opioids. Methods: Consecutive patients undergoing outpatient hand and upper extremity surgery performed by two board-certified fellowship-trained orthopedic hand surgeons at one institution were recruited and randomized into either a study or control group. The study group received a standing multimodal postoperative regimen consisting of scheduled oral acetaminophen and naproxen as well as oxycodone to be taken as needed. The control group received only oxycodone to be taken as needed. Postoperatively, daily pain levels, medication usage, refills, satisfaction, and adverse events were recorded. Descriptive statistics were performed. Results: Of the 112 patients enrolled, 54 were randomized to the control group, and 58 were randomized to the study group. Study and control group patients did not differ significantly based on daily average pain scores or daily worst pain scores. However, study group patients reported fewer average daily oxycodone intake and total oxycodone pill count (7.0 vs 2.4 total pills, P

Background: COVID-19 infection has been implicated in millions of deaths worldwide. The respiratory distress occurs with cytokine storm around 2ndweek of symptom onset. Tocilizumab, a humanized monoclonal antibody directed against the interleukin 6(IL-6) receptor has been used at varying extents in suppressing it, however, limited literature exists about the timing of its administration. We contemplated this study with the primary objective to establish whether tocilizumab favourably affected the outcome when given in the early stages of complication. The secondary objectives were to assess the importance of ROX score and the effect of age on outcome. Methods: We conducted a retrospective study in a tertiary care hospital. Patients who received tocilizumab were divided into two groups depending on whether they received the drug in ≤ 10 days (Group 1) or≥ 11 days (Group 2) of onset of symptoms. The patient’s demographic data and co-morbidities, on- admission vitals, ROX score, and laboratory parameters, outcome etc. were collected from the electronic health records. Results: Both groups were comparable with regard to demographic and baseline parameters on admission. The outcome was significantly better in patients of Group-1(P=0.01) with better survival. The outcome was also significantly higher in ages ≤ 50yrs age(P=0.02) who received tocilizumab. Failure to improve ROX score after 24hrs. of administration of tocilizumab was associated with poor outcomes (p=0.001). Conclusion: Tocilizumab when given in the early stages of COVID-19-related complications may be associated with decreasing mortality. Age may be an indicator of favourable effect, and failure to improve ROX score after tocilizumab is associated with poor outcomes

Purpose – This paper examines whether farmers' knowledge of the minimum support prices (MSPs) affects farm-gate prices. MSP is the minimum guaranteed price for agricultural commodities announced by the Government of India for 24 commodities. Most farmers in India prefer to sell their produce at the farm-gate due to a small marketable surplus and hence do not directly benefit from MSP. The authors test the common argument in the political discourse that if farmers have knowledge of MSP, then they can bargain with traders during the farm-gate transaction and demand a better price close to MSP. Design/methodology/approach – The authors use matching methods to examine the impact of knowledge of MSP on farm-gate prices. Findings – Using nationally representative data, the authors show that there is no empirical evidence that the knowledge of MSP of the crops leads to higher bargaining power and better farm-gate prices. Practical implications – Price information (MSP in this case) alone cannot improve the bargaining power of farmers and result in a better price realization. As a safety net, MSP fails in the absence of procurement of products by the government. This also raises the question of the equitability of the price support system in India and calls for a rethink of the MSP policy. Originality/value – This study is the first of its kind to examine the anchoring effect of knowledge of MSP on farm-gate prices using a nationally representative dataset.

BACKGROUND: Health and QoL are essential for every individual. Regardless of their psychological status, every individual needs an optimum level of Self-satisfaction, Happiness, and QoL. The paper aimed to explore the QoL of the Indian population concerning their day-to-day needs. MATERIAL AND METHODS: The study used an online survey method to assess the QoL of Indian adults. The Questionnaires have been sent to more than 3000 participants through social media like Emails, Facebook, Instagram, Telegram, and WhatsApp. A total of 200 participants filled out the Google form completely. The data was collected from March 2022 to June 2022. The collected data was analyzed by using SPSS (version 24). RESULTS: The Overall mean was found to be 3.25 [N = 200, Range 18-36 above, Mean = 3.25 and SD = 1.04]. A few important dimensions are mentioned, such as QoL (50% people with mean = 4.00), Self-satisfaction (38% people with mean = 4.00), enjoyment in life (45% people with mean = 4.00), sleep (42% people with mean = 4.00), sex life (36.5% people with mean = 3.00), constant strain (33.5% people with mean = 3.00), loss of self-confidence (26% people with mean = 3.00). CONCLUSION: The study indicates low scores on self-satisfaction, QoL, and above-average scores for happiness. There must be interventions to improve the levels of psychological functioning among adults concerning these variables, which would, in turn, help improve the overall adults’ functioning. The relevant interventions need to be planned to improve self-satisfaction, happiness, and QoL by improving daily activities.

Background: This study aims to assess systemic risk factors in diabetes mellitus (DM) patients and predict diabetic retinopathy (DR) using a Random Forest (RF) classification model. Methods: We included DM patients presenting to the retina clinic for first-time DR screening. Data on age, gender, diabetes type, treatment history, DM control status, family history, pregnancy history, and systemic comorbidities were collected. DR and sight-threatening DR (STDR) were diagnosed via a dilated fundus examination. The dataset was split 80:20 into training and testing sets. The RF model was trained to detect DR and STDR separately, and its performance was evaluated using misclassification rates, sensitivity, and specificity. Results: Data from 1416 DM patients were analyzed. The RF model was trained on 1132 (80%) patients. The misclassification rates were 0% for DR and ~20% for STDR in the training set. External testing on 284 (20%) patients showed 100% accuracy, sensitivity, and specificity for DR detection. For STDR, the model achieved 76% (95% CI-70.7%–80.7%) accuracy, 53% (95% CI-39.2%–66.6%) sensitivity, and 80% (95% CI-74.6%–84.7%) specificity. Conclusions: The RF model effectively predicts DR in DM patients using systemic risk factors, potentially reducing unnecessary referrals for DR screening. However, further validation with diverse datasets is necessary to establish its reliability for clinical use.

In the title compound, C18H16ClN3O5S2, the dihedral angles between the oxadiazole ring and the phenyl and chlorobenzene rings are 23.4 (2) and 45.4 (2)°, respectively. The C—S—N—C and Cox—C—S—C (ox = oxadiazole) torsion angles are 89.3 (5) and −69.1 (3)°, respectively. A short intramolecular C—H...O contact closes an S(6) ring. In the crystal, molecules are linked by N—H...O hydrogen bonds, generating C(10) chains propagating in [001]. The packing is consolidated by C—H...O, C—H...π and very weak aromatic π–π stacking interactions [centroid–centroid separation = 4.085 (2) Å].

Foreign Direct Investment (FDI) plays a pivotal role in the economic development of countries and institutional quality encompassing aspects such as political stability, regulatory environment, and the rule of law, plays a vital role in attracting and retaining foreign investment. This study investigates the impact of institutional quality on the level of FDI inflows in the South Asian and Southeast Asian countries over the period 2002–2019. We have constructed an institutional quality index by using Principal Component Analysis (PCA) on six governance indicators. Iterated generalized least squares (I-GLS) in the fixed effect model has been employed for the estimation of the results. The results show that the institutional quality index has a positive and significant impact on the FDI inflows in both the regions. This implies that an ideal governance system comprising of low corruption, political stability, absence of violence, voice and accountability, regulatory quality and proper judicial system helps to attract FDI inflows in the South Asian and Southeast Asian countries. It also has positive spillovers to other economic activities such as GDP growth, international trade and financial development that are vital for economic growth and development.

The lifestyle of any person depends on his ability to hear his surrounding sounds or voices. This is because each of our sense organs works interrelated. Without an ability to proper hearing, he/she cannot respond to the other person leading to a very less or no communication to the society. Although he has a good talent and knowledge within, he cannot be able to communicate or express unless he has a good hearing ability. Also, he faces emotive problems caused by a reduction in self-confidence. So, a requirement of designing an efficient hearing aid is much necessary to resolve the hearing loss problem. In this paper, design of an efficient alterable ten band Finite Impulse Response filter bank for the hearing aid is achieved. Among the various windowing techniques available, Hamming window is preferred to design the FIR filter owing to its relatively sharp main lobe width and also the first few lobes have good attenuation. In this filterbank, variability in the subband bandwidths is achieved by simply altering each subband's bandwidth and center frequency. Unlike fixed filterbank, the proposed design provides the advantage of matching most of the audiograms of different hearing-impaired persons more accurately with simple procedure leading to low cost and low hardware complexity. Also using an FIR filter in the filterbank leads to highly stable design. Thus, a design of highly qualitative filterbank compared to fixed bandwidth designs with high audiogram matching and less matching error is implemented.

Introduction A high percentage about 55–75 % of women with PCOS have an elevated LH/FSH ratio presumably due to high levels of Luteinizing harmone (LH) rather than reduced production of Follicular stimulating hormone (FSH).

In today's digital age, speed, and area are the primary design concerns. Increasing the rate at which multiplication and addition are performed has always been a need for developing cutting-edge technologies. Wallace multipliers, and Dadda multipliers, are one of the fastest multipliers used in many processors to accomplish fast arithmetic operations. A novel approach to design a LookUp Table (LUT) multiplier was proposed and implemented in Finite Impulse Response (FIR) filter. To improve the Residue Number System (RNS) based FIR filter's performance, several adders like Carry Look ahead (CLA) adder, Kogge Stone adder (KSA) and proposed adder architectures have been implemented. When compared with the 16 tap with 32 bit proposed adder with LUT multiplier, the hardware resource utilization (Logic Elements) is decreased by 5.97 % and in 32 tap with 16 bit combination, it decreases by 7.60 %.When compared with 32 tap with 4 bit word length, the proposed adder with LUT multiplier in the highlighted combinations, the Fmax is increased by 19.28 % and in 32 tap with 16 bit, it increases by 29.74 %. The Low-pass RNS FIR filter is designed for a cut-off frequency of 50 Hz and generated filter coefficients in MATLAB and implemented to denoising the ECG signal.

The digital twin is referred to as a virtual representation of the physical object and its representation of real-world objects in a virtual manner. The recognition of the digital twin is obtained from real-time data with artificial intelligence techniques. Virtual reality is a three-dimensional environment that enables the users to utilize and explore the virtual environment and is achieved through the combination of hardware and software systems. Augmented reality is enabled in the form of text, audio, and video format representations. It only gets in touch with a combination of the physical and the real world whereas virtual reality proceeds in a frictional world. The increasing usage of smart manufacturing systems using digital twin is providing versatile usages. This incorporates physical and virtual environments and is enabled with the obtained data that helps in the modification of the physical counterpart. Incorporating huge amounts is a bigger challenge, therefore augmented and virtual reality is implemented that helps the users to utilize digital data with higher interest through augmented reality.

Training healthcare professionals in research methodology is essential to promote research and innovation. This is particularly relevant in India, where there is a wealth of potential drug candidates from Indian Traditional Medicine (TM) systems that await exploration and scientific validation using modern medicine principles. Surprisingly, there is a lack of reported activities to train modern medicine practitioners in TM research in the literature. Recognising this need, a structured training program was planned and conducted under the auspices of the Indian Council of Medical Research (ICMR) to train modern medicine practitioners in TM research. A survey was conducted among modern medicine practitioners to assess training gaps and identify key areas to be covered in the workshop modules. The workshop received a positive response, as evidenced by the numerous registration applications and positive feedback from participants. The present article shares the experiences of conducting the pilot workshop, which may serve as a valuable resource for planning similar workshops.

Tuberous xanthomas are nontender, yellow to red papules to nodules that occur on the extensor surface, and trauma-prone areas such as the elbows, knees, Achilles tendon, and buttocks. A 10-year-old female child born out of second-degree consanguineous marriage presented with multiple skin-colored nodular lesions on axillary folds, both elbows, cubital fossa, medial side of the wrist, interphalangeal joints, buttocks, knees, popliteal fossa, and Achilles tendons. After complete evaluation, diagnosis of familial hypercholesterolemia type IIa with tuberous xanthoma was made. Tuberous xanthoma usually presents in combined type III dyslipidemias, but in our case, it is presented in type IIa familial hypercholesterolemia. Early diagnosis and treatment of familial hypercholesterolemia are important for preventing complications.

Gamma-aminobutyric acid (GABA), a nonpeptide amino acid transmitter, is a major component of modern neuropharmacology and one of the most crucial target sites for general anesthetics and therapeutic drugs. GABA type A receptors (GABAARs) are the most abundant inhibitory neurotransmitter receptors in the central nervous system. They are part of the rapid-acting, ligand-gated ion channel (LGIC) receptor category, a pentameric Cys-loop superfamily member that mediates inhibitory neurotransmission in the mature brain. GABAARs mainly consist of two α subunits, two β subunits, and one additional subunit from either γ or δ arranged around a central chloride (Cl-) selective channel. Multiple GABAAR subunit subtypes and splice variants have been identified. Each variant of GABAAR exhibits distinct biophysical and pharmacologic properties. Several compounds allosterically modulate the GABAAR positively or negatively. The widely used positive GABAAR modulators include benzodiazepines (anxiolytic and anticonvulsant), general anesthetics (volatile agents like isoflurane, and intravenous agents like barbiturates, etomidate, and propofol), long-chain alcohols, some anticonvulsants, and neuroactive steroids. The binding sites for each drug are distinctly different. The anesthetic drugs enhance receptor-mediated synaptic transmission and thus interrupt the thalamocortical transmission, which controls the sleep–wake patterns. Abnormality in the GABAAR function has been implicated in several neurological conditions, such as sleep disorders, seizures, depression, cognitive function, neurological recovery after injury, and neuroplasticity. Understanding the GABAAR lays the foundation for the development of highly specific drugs in the treatment of neurological disorders and general anesthesia.