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The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed “pre-burst suppression” (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3–35 Hz power (dB) during the 1-s preceding BSup relative to the average 3–35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman’s ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: −0.10 [−0.19, −0.01], p = 0.024; −0.04 [−0.06, −0.01], p = 0.009; −0.04 [−0.06, −0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk.

Improved cookstoves and fuels, such as advanced gasifier stoves, carry the promise of improving health outcomes, preserving local environments, and reducing climate-forcing air pollutants. However, low adoption and use of these stoves in many settings has limited their benefits. We aimed to improve the understanding of improved stove use by describing the patterns and predictors of adoption of a semi-gasifier stove and processed biomass fuel intervention in southwestern China. Of 113 intervention homes interviewed, 79% of homes tried the stove, and the majority of these (92%) continued using it 5–10 months later. One to five months after intervention, the average proportion of days that the semi-gasifier stove was in use was modest (40.4% [95% CI 34.3–46.6]), and further declined over 13 months. Homes that received the stove in the first batch used it more frequently (67.2% [95% CI 42.1−92.3] days in use) than homes that received it in the second batch (29.3% [95% CI 13.8−44.5] days in use), likely because of stove quality and user training. Household stove use was positively associated with reported cooking needs and negatively associated with age of the main cook, household socioeconomic status, and the availability of substitute cleaner-burning stoves. Our results show that even a carefully engineered, multi-purpose semi-gasifier stove and fuel intervention contributed modestly to overall household energy use in rural China.

Introduction: Progression of articular cartilage loss and wear and strain are the usual causes of Osteoarthritis (OA), sometimes referred to as degenerative joint disease. India had roughly 200,000 knee arthroplasty procedures in 2020 in which nearly 72% were because of OA. Rebuilding the knee joint through knee arthroplasty is a great alternative for treating symptomatic OA in patients who have not responded to conservative treatment. Aim: To determine the effect of Virtual Reality (VR)- based rehabilitation and high-intensity exercise program for Total Knee Arthroplasty (TKA). Materials and Methods: In this double-blinded randomised controlled trial, 36 participants matched the inclusion criteria who underwent Total Knee Replacement (TKR) at the Department of Physiotherapy, Saveetha College of Physiotherapy, SIMATS, Chennai, Tamil Nadu, India. The study was started in the month of October 2023 and ended in January 2024. Then the participants were randomly allotted to an experimental group-VR (n=18) and a conventional group-high-intensity exercises (n=18). Outcome measures used are the Numeric Pain Rating Scale (NPRS) pain scale, knee range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG) test. A paired t-test was utilised to evaluate significant variations between the pre- and post-test measurements. In order to find any meaningful differences between the two groups, an unpaired t-test was employed. Result: The average mean±Standard Deviation (SD) of age and Body Mass Index (BMI) was found to be 51.2±5.2 yearsand 28.3±2.0 kg/m². The experimental group and the conventional group both exhibited notable changes in terms of within-group differences. Numeric Pain Rating Scale (NPRS) significantly showed the same between the groups, but the range of motion showed better output in VR-based rehabilitation than indifferently supporting the pain outcome of the experimental group (p≥0.0001). Balance, gait and functional activities were improved in the experimental group compared to the conventional group and in the VR-based rehabilitation, the functional independence of the patient was achieved in nine weeks compared to the High-intensity (HI) exercises. Conclusion: The VR-based rehabilitation showed better outcomes in pain, range of motion, balance, gait and functional independence than a high-intensity exercise programme.

Rationale: This case highlights the rare yet critical diagnosis of hypermagnesemia in a preterm infant, who presented with symptoms mimicking necrotizing enterocolitis. It underscores the importance of considering hypermagnesemia as a differential diagnosis in neonatal respiratory distress and gastrointestinal symptoms, even when the cause is not immediately apparent. Patient’s Concern: An extremely low birth infant with respiratory distress further had episodes of apnoea and cyanosis. The infant eventually exhibited abdominal distension and bilious vomiting, symptoms mimicking necrotizing enterocolitis. Diagnosis: The infant’s clinical features were attributed to hypermagnesemia, despite no magnesium being administered and no apparent cause identified. Screening the apparently asymptomatic mother confirmed a serum magnesium level of 4 mg/dL, suggesting transplacental transfer as the likely cause of the neonate’s condition. Interventions: The newborn was treated supportively with adequate hydration and maintenance calcium gluconate. Outcomes: Magnesium levels decreased, and the baby showed signs of improvement. Lessons: Hypermagnesemia, though uncommon, should be investigated and considered even when the symptoms are not apparent.

This study investigates the mechanical properties of Al6061-TiB _2 -fly ash reinforced monolithic and hybrid composites, fabricated using the stir casting technique. The experiment involved the preparation of both monolithic composites by varying TiB2 (3–6 wt%) and hybrid composites by varying TiB _2 (1–3 wt%) and fly ash (3–5 wt%) within the Al6061 matrix. Preheated reinforcement particles were introduced to the matrix alloy under controlled stirring conditions to ensure proper dispersion. Mechanical testing was conducted on the fabricated composites to evaluate their hardness and tensile strength. The results indicate that the hybrid composites exhibit superior mechanical properties compared to the base Al6061 alloy and the monolithic composites. The hardness of the hybrid composites A1T3F (Al6061 + 1%TiB _2 + 3% fly ash) and A3T5F (Al6061 + 3%TiB _2 + 5% fly ash) were significantly improved, reaching 134 HV and 146 HV, respectively, compared to 74 HV for the base alloy. The tensile strength of the hybrid composites also exceeded that of the monolithic composites, demonstrating the synergistic reinforcement effect of TiB _2 and fly ash. However, attempts to incorporate higher levels of reinforcement (TiB _2 5% and fly ash 7%) were unsuccessful due to agglomeration issues. The results indicate that the hybrid composites provide a cost-effective solution with enhanced mechanical properties, making them a more economical and efficient alternative to monolithic composites reinforced solely with TiB _2 .

Long-read sequencing is driving rapid progress in genome assembly across all major groups of life, including species of the family Drosophilidae, a longtime model system for genetics, genomics, and evolution. We previously developed a cost-effective hybrid Oxford Nanopore (ONT) long-read and Illumina short-read sequencing approach and used it to assemble 101 drosophilid genomes from laboratory cultures, greatly increasing the number of genome assemblies for this taxonomic group. The next major challenge is to address the laboratory culture bias in taxon sampling by sequencing genomes of species that cannot easily be reared in the lab. Here, we build upon our previous methods to perform amplification-free ONT sequencing of single wild flies obtained either directly from the field or from ethanol-preserved specimens in museum collections, greatly improving the representation of lesser studied drosophilid taxa in whole-genome data. Using Illumina Novaseq X Plus and ONT P2 sequencers with R10.4.1 chemistry, we set a new benchmark for inexpensive hybrid genome assembly at US $150 per genome while assembling genomes from as little as 35 ng of genomic DNA from a single fly. We present 183 new genome assemblies for 179 species as a resource for drosophilid systematics, phylogenetics, and comparative genomics. Of these genomes, 62 are from pooled lab strains and 121 from single adult flies. Despite the sample limitations of working with small insects, most single-fly diploid assemblies are comparable in contiguity (>1 Mb contig N50), completeness (>98% complete dipteran BUSCOs), and accuracy (>QV40 genome-wide with ONT R10.4.1) to assemblies from inbred lines. We present a well-resolved multi-locus phylogeny for 360 drosophilid and 4 outgroup species encompassing all publicly available (as of August 2023) genomes for this group. Finally, we present a Progressive Cactus whole-genome, reference-free alignment built from a subset of 298 suitably high-quality drosophilid genomes. The new assemblies and alignment, along with updated laboratory protocols and computational pipelines, are released as an open resource and as a tool for studying evolution at the scale of an entire insect family.

Endometrial stromal tumours are tumours of endometrial stromal origin and are classified into Endometrial Stromal Nodule (ESN), Low-Grade Endometrial Stromal Sarcoma (LG-ESS), and High-Grade Endometrial Stromal Sarcoma (HG-ESS). LG-ESS and HGESS are rare tumours, accounting for 1% of uterine malignancies and 10% of uterine sarcomas. These tumours commonly occur in perimenopausal women between the ages of 45 and 50 years. Their incidence is rare in younger women. Endometrial stromal tumours are usually confused with leiomyoma, uterine Leiomyosarcoma (LMS), or other sarcomas. The authors here present a case report of a 28-year-old nulligravid patient who presented with a history of heavy menstrual bleeding and dysmenorrhea for a duration of six months. Ultrasonography of the abdomen and pelvis suggested fibroid with degenerative changes, and Magnetic Resonance Imaging (MRI) indicated leiomyoma variants such as: i) Stromal Tumours of Uncertain Malignant Potential (STUMP)/ atypical/cellular leiomyoma; ii) myxoid degeneration of leiomyoma. To arrive at a definitive diagnosis, myomectomy was performed considering the woman’s young age and nulliparity. Histopathology allowed for a differential diagnosis of LG-ESS, LMS, and cellular leiomyoma. Consequently, the patient underwent total abdominal hysterectomy with left salphingo opherectomy, right salpingectomy, and preservation of the right ovary. The definitive diagnosis is made by histopathological examination coupled with immunohistochemistry of the hysterectomy specimen. Hysterectomy is the definitive treatment of LG-ESS considering their ability to infiltrate and become malignant.

Background and Objective: Traditional methods of medical education, despite being easy to implement, do not have long-lasting efficiency. The main aim of this study is to use the help of the learners to teach parts of the medical pharmacology course using role-playing pedagogy. This was done for the first time in Babol University of Medical Sciences with the cooperation of medical students who entered the university in 2016. Methods: Students were divided into 5 groups and a group leader was introduced for each group. Five topics were selected and corresponding scenarios were written. There were three to seven people in each group. The physician together with the hypothetical resident or student examined the patient's problems and prescribed medicine and gave them the necessary recommendations. All participants were given a pre-test and a post-test, and then the findings were statistically analyzed. Findings: 101 students (49 girls and 52 boys) with a mean age of 21.43±1.14 years participated in the study. Except for the topic of poisoning, the mean difference in pre- and post-test scores of female students was lower than that of male students. For example, this difference was observed in the topic of Parkinsonism (p

Background and Objective: Traditional methods of medical education, despite being easy to implement, do not have long-lasting efficiency. The main aim of this study is to use the help of the learners to teach parts of the medical pharmacology course using role-playing pedagogy. This was done for the first time in Babol University of Medical Sciences with the cooperation of medical students who entered the university in 2016. Methods: Students were divided into 5 groups and a group leader was introduced for each group. Five topics were selected and corresponding scenarios were written. There were three to seven people in each group. The physician together with the hypothetical resident or student examined the patient's problems and prescribed medicine and gave them the necessary recommendations. All participants were given a pre-test and a post-test, and then the findings were statistically analyzed. Findings: 101 students (49 girls and 52 boys) with a mean age of 21.43±1.14 years participated in the study. Except for the topic of poisoning, the mean difference in pre- and post-test scores of female students was lower than that of male students. For example, this difference was observed in the topic of Parkinsonism (p

Introduction: Osteoarthritis (OA) is classically described as a noninflammatory, degenerative joint disease most commonly occurring in the elderly population. It is characterized by the deterioration of articular cartilage and by the formation of new bone at joint surfaces and margins. Our study aims at evaluating the efficacy of intra-articular platelet-rich plasma (PRP) injections in Grade I and II OA knees. Materials and Methods: A total of 46 patients with Grade I and II (Kellgren and Lawrence grading) primary OA knee were enrolled for a prospective study. Prior consent was taken for intra-articular injection of PRP from all patients. The study group was evaluated using the Oxford Knee Score (OKS) at 3 months and 6 months. Results: In our study, we found decreasing pain and improvement in activities of daily living with an increase in OKS at 3 and 6 months, follow-up indicating long-term pain relief, improvement in function, and decreased stiffness. Conclusion: Our study shows that intra-articular injection of PRP is safe and effective in treating Grade I and Grade II OA knee. We also observed improvement in daily living activities and a reduction in pain in patients with OA of the knee treated with two doses of PRP. PRP therapy is an easy, affordable, and minimally invasive treatment, which is practical to administer for treating degenerative OA of the knee with minimal associated adverse events.

BackgroundSubstance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. ObjectiveTeen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. MethodsAdolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. ResultsWe recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). ConclusionsThese findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. Trial RegistrationClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434

The present field experiment was conducted to investigate the impact of various combinations of organic inputs on the growth of fodder grass in a coconut [Cocos nucifera (L.)]-based mixed farming during 2013–17 at ICAR-Central Plantation Crops Research Institute, Regional Station, Kayamkulam, Kerala and refined in farmer’s field during 2018–21. The experiment was conducted in randomized block design with seven treatments and three replications with one control [chemical fertilizer (CF) alone] and six organic recycling options with combination of a native strain of Azospirillum sp. [L8(3)] isolated from the coconut rhizosphere, [100% RDN through cow dung slurry (CDS), 100% RDN through coconut leaf vermicompost (CLVC), 100% RDN through CDS + CLVC (1:1), 100% RDN through CDS + CLVC (1:1) + Azospirillum sp., 75% RDN through CDS + CLVC (1:1) + Azospirillum sp. and 50% RDN through CDS + CLVC (1:1) + Azospirillum sp.]. Basal application of 15 tonnes of dried cow dung, 400 kg lime and 90:30:24 kg NPK/ha were supplied irrespective of the treatments. The plants supplied with 100% RDN through CF and CDS + CLVC + Azospirillum sp. recorded the higher yield during the first year, followed by a yield decline in subsequent years which may be due to the nitrogen-induced reduction in soil pH as evident from the soil analysis. The significantly higher fresh fodder yield (126.9 tonnes/ha/year), dry matter yield (22.7 tonnes/ha/year), neutral and acid detergent fibres, crude protein and plant nutrient uptake were recorded by plants supplied with 75% RDN through CDS + CLVC + Azospirillum sp. Technological refinement by adding additional lime (400 kg/ha) during second and third years resulted in 24.59% higher yield. This system of recycling resulted 50% reduction in external physical inputs during the first year and 90% reduction in subsequent two years.

The authors of this study have built an outstanding data mining model for the classification of respiratory issues in children and adults, which they have applied in their research. Deep learning ensembles are built by utilising support vector regression (SVR), long short-term memory neural networks (LSTMs), and a metaheuristic optimization strategy that incorporates nonlinear learning in the DL ensemble (MHO). A collection of LSTMs with variable hidden layers and neurons is used to detect and exploit the underlying relationships in order to overcome the limitations of a single deep learning approach limited generalisation skills and robustness when faced with diverse input. The LSTM classification is then combined with a nonlinear-learning SVR and MHO to optimise the top-layer parameters. Nonlinear-learning meta-layer and LSTM classification. Finally, the final classification of the ensemble is provided by the fine-tuning meta-layer. Using data from six benchmark studies as well as energy consumption data sets, the proposed EDL is put to the test in two classification scenarios: ten-ahead and one-ahead classification.

Heterozygous chromosome inversions suppress meiotic crossover (CO) formation within an inversion, potentially because they lead to gross chromosome rearrangements that produce inviable gametes. Interestingly, COs are also severely reduced in regions nearby but outside of inversion breakpoints even though COs in these regions do not result in rearrangements. Our mechanistic understanding of why COs are suppressed outside of inversion breakpoints is limited by a lack of data on the frequency of noncrossover gene conversions (NCOGCs) in these regions. To address this critical gap, we mapped the location and frequency of rare CO and NCOGC events that occurred outside of the dl-49 chrX inversion in D. melanogaster. We created full-sibling wildtype and inversion stocks and recovered COs and NCOGCs in the syntenic regions of both stocks, allowing us to directly compare rates and distributions of recombination events. We show that COs outside of the proximal inversion breakpoint are distributed in a distance-dependent manner, with strongest suppression near the inversion breakpoint. We find that NCOGCs occur evenly throughout the chromosome and, importantly, are not suppressed near inversion breakpoints. We propose a model in which COs are suppressed by inversion breakpoints in a distance-dependent manner through mechanisms that influence DNA double-strand break repair outcome but not double-strand break formation. We suggest that subtle changes in the synaptonemal complex and chromosome pairing might lead to unstable interhomolog interactions during recombination that permits NCOGC formation but not CO formation.

Objectives: This study examines the sanitation and hand-washing behavior of slum dwellers before coronavirus disease 2019 (pre-COVID-19) and during the COVID-19 period. The study also examines health-seeking behavior. Materials and Methods: Purposive sampling method was used to select the study area and household. Out of 49 registered slums in the Vellore municipality corporation, three slums were selected, which represent the highest number of slum households. The names of the urban slum settlement were Salavanpet, Old Town, and Makkan. After selecting the study areas, households were selected on snowball techniques through telephonic conversation with a structured interview schedule. The total samples were 75 households. The study period was from June 2021 to August 2021. Results: The study shows that Vellore has the 18th highest number of positive COVID-19 cases in Tamil Nadu. This study found that regular wage incomes in urban slum dwellers have been severely affected by COVID-19 lockdowns. The majority of households without a toilet in slums have used open defecation during COVID-19. Hand washing behaviors for people living in the urban slums have increased during the COVID-19 than the pre-COVID-19 pandemic. This study found that middle-aged (age 31–40 years) people’s habit of hand washing as a precautionary measure against coronavirus disease increased during COVID-19 compared with pre-COVID-19. Suggestion and Conclusion: The study suggests that improving hand-washing habits could aid in the prevention of the COVID-19 virus and other illnesses and suggests advancing hand washing habits after the pandemic as basic protective measures, which continues to remain essential in urban areas.

IntroductionAlthough great strides have been made in maternal and newborn health in Nepal, the maternal mortality ratio (MMR) is still high at 186 per 100,000 births. Many maternal deaths are preventable if there is access to a skilled birth attendant (SBA). The Ministry of Health and Population of Nepal launched the in-service SBA training program in 2007 and has trained over 10,000 SBAs to date. Evidence shows that one episode of training is not enough to retain skills. Therefore, the Nick Simons Institute (NSI) in collaboration with National Health Training Center (NHTC) devised a Follow-Up and Enhancement Program (FEP) in 2011 where the knowledge, clinical skills, and working environment of SBA graduates were assessed directly at their worksites. FEP allows on-site coaching and feedback so that graduates may continue to improve upon any gaps in their knowledge, skills, and working environment. This study aims to assess the effectiveness of FEP.MethodsWe used a mixed-methods research design. A total of 73 SBAs who had a pre-FEP assessment in 2016 were followed up for a post-FEP assessment in 2017. We also collected data from 3 additional districts (115 SBAs) that had not previously had FEP, to compare SBAs in FEP versus non-FEP districts. Qualitative data was collected from 16 health facilities on the perceptions, motivation, and satisfaction of stakeholders.ResultsOf the total 188 SBAs that were sampled, a one-time FEP increased knowledge scores by 9%, clinical skills scores by 29%, and enabling environment scores by 7%. The number of deliveries conducted improved with a one-time FEP, although this increase was not statistically significant. We found a trickle-down effect of working in a facility that has had prior FEP, with SBAs that have never had FEP improving their clinical skills. FEP was found to be a highly accepted program and is beneficial to SBAs, trainers, and the Hospital Management Committee (HFOMC). However, a one-time FEP is not sufficient in retaining clinical skills and knowledge.ConclusionFEP is a highly effective program by both quantitative and qualitative evaluation. Our study suggests that FEP should be frequent and continuous to retain the knowledge and clinical skills of SBAs, motivate them through on-site coaching, and improve their working environment through direct feedback to the Ministry of Health and Population.

Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the main unknown factors that may be involved, and the main targets for future intervention, include more accurate and less invasive diagnostic options, more thorough and accurate debridement protocols, and more potent and targeted antimicrobials. The underlying biology dominates the clinical management of bone infections, with features such as biofilm formation, osteolysis and vascularisation being particularly influential. Based on the persistence of this problem, an improved understanding of the basic biology is deemed necessary to enable innovation in the field. Furthermore, from the clinical side, better evidence, documentation and outreach will be required to translate these innovations to the patient. This review presents the findings and progress of the AO Trauma Clinical Priority Program on the topic of bone infection.

Acinetobacter baumannii is an opportunistic pathogen and an emerging global health threat. Within healthcare settings, major presentations of A. baumannii include bloodstream infections and ventilator-associated pneumonia. The increased prevalence of ventilated patients during the COVID-19 pandemic has led to a rise in secondary bacterial pneumonia caused by multidrug resistant (MDR) A. baumannii. Additionally, due to its MDR status and the lack of antimicrobial drugs in the development pipeline, the World Health Organization has designated carbapenem-resistant A. baumannii to be its priority critical pathogen for the development of novel therapeutics. To better inform the design of new treatment options, a comprehensive understanding of how the host contains A. baumannii infection is required. Here, we investigate the innate immune response to A. baumannii by assessing the impact of infection on host gene expression using NanoString technology. The transcriptional profile observed in the A. baumannii infected host is characteristic of Gram-negative bacteremia and reveals expression patterns consistent with the induction of nutritional immunity, a process by which the host exploits the availability of essential nutrient metals to curtail bacterial proliferation. The gene encoding for lipocalin-2 (Lcn2), a siderophore sequestering protein, was the most highly upregulated during A. baumannii bacteremia, of the targets assessed, and corresponds to robust LCN2 expression in tissues. Lcn2-/- mice exhibited distinct organ-specific gene expression changes including increased transcription of genes involved in metal sequestration, such as S100A8 and S100A9, suggesting a potential compensatory mechanism to perturbed metal homeostasis. In vitro, LCN2 inhibits the iron-dependent growth of A. baumannii and induces iron-regulated gene expression. To elucidate the role of LCN2 in infection, WT and Lcn2-/- mice were infected with A. baumannii using both bacteremia and pneumonia models. LCN2 was not required to control bacterial growth during bacteremia but was protective against mortality. In contrast, during pneumonia Lcn2-/- mice had increased bacterial burdens in all organs evaluated, suggesting that LCN2 plays an important role in inhibiting the survival and dissemination of A. baumannii. The control of A. baumannii infection by LCN2 is likely multifactorial, and our results suggest that impairment of iron acquisition by the pathogen is a contributing factor. Modulation of LCN2 expression or modifying the structure of LCN2 to expand upon its ability to sequester siderophores may thus represent feasible avenues for therapeutic development against this pathogen.

Even though a small number of published single patient reports have more recently reported pulmonary cavitation in COVID-19 disease, it is still considered a rare radiology feature. We report a 45-year-old man with COVID 19 disease and a pulmonary cavity.

BackgroundDuring the second wave of the COVID-19 pandemic in India, the Ministry of Ayush conducted a community study to provide therapeutic care to patients with asymptomatic, mild, and moderate COVID-19 in home isolation based on the empirical evidence generated on the efficacy of AYUSH-64 in COVID-19.ObjectiveTo document disease characteristics, care-seeking behavior, and outcomes in patients with asymptomatic, mild, or moderate COVID-19 in home isolation who used AYUSH-64 for COVID-19.MethodsCross-sectional analysis of the data generated through a community study conducted in India from 08 May to 31 August 2021 was performed to study the disease characteristics, care-seeking behavior during home isolation, clinical outcomes, adverse events, and the association between various risk factors and clinical recovery during the study period. The data were collected through semi-structured questionnaires, available in electronic data collection format at the baseline, 7, 14, and 21 days. A logistic regression was performed to explore the relationship between relevant variables and clinical recovery.ResultsData from 64,642 participants were analyzed for baseline assessment, and final analysis was done for 49,770 participants. The mean age of the enrolled participants was 38.8 ± 11.7 years, and 8.4% had co-morbidities. AYUSH-64 was utilized as an add-on to the standard care by 58.3% of participants. Comparable clinical outcomes were observed in participants utilizing AYUSH-64 either as a standalone or as an add-on to standard care, in terms of clinical recovery, disease progression, the requirement for oxygen supplementation, hospitalization, ICU admission, and need for ventilator support. Younger age, having no co-morbidities or substance abuse, and having been vaccinated were associated with early clinical recovery than those who were older and not vaccinated.ConclusionsThe study findings suggest that AYUSH-64 use, either standalone or as an adjunct to standard care, in asymptomatic, mild, or moderate COVID-19 is associated with good clinical outcomes. Ayush services and interventions can be effectively integrated into the mainstream public health architecture to serve public health goals.

Background: Caries is the most prevalent affliction of children and is dependent on various factors such as social, economic, demographic and nutritional factors. Aim: This study was conducted to determine the prevalence of dental caries in school going children and its association with risk factors. Materials and Methods: A cross-sectional study was conducted during the period from August 2019 to December 2019. Study subjects were 1947 school children. The examination was done by a single examiner and the data was entered by trained assistants. A semi-structured questionnaire was used to record the risk factors for dental caries in children. The components of Decayed, missing, filled (DMF) and Decayed, extracted, filled (def) were recorded as per the criteria of WHO (1997) for diagnosing caries. Using SPSS version 22 (IBM Corporation Chicago, USA) data were analyzed. Chi-square test were done to find the relationship of prevalence with the risk factors. P < 0.05 is considered as statistically significant. Results: Total Caries prevalence was found to be 49.1%.The highest rate of caries occurrence, 55.4% was observed in children who belonged to the age group of 6–8 years. The def was shown to be more in the 9–11 age group and DMF in 12–15 age groups with 3.34 ± 3.74 and 2.18 ± 2.65 respectively. Statistically significant increase in caries is found in children whose both the parents were working (P < 0.001) and also in children who take sweets twice a day or more (P < 0.001). Conclusion: The prevalence of caries in 6–15 year old school children at Kannur is 49.1%. Working parents and high sugar consumption were found to be risk factors for caries in school going children.

Background: Down syndrome which is also known as “trisomy 21” is the commonest chromosomal defect that has been associated with intellectual disability or impairment. Clinically, it has been characterized by the generalized presence of hypotonic musculature, variety of neurobiological alterations, numerous respiratory diseases, and significantly higher risk of developing infection along with various dental abnormalities and oro-facial dysmorphological changes. Periodontal diseases are the most prominent oral health issue among individuals diagnosed with Down Syndrome. Aim: The objective of the present prevalence analysis was to study the implications of Down's syndrome on oral health status among patients. Materials and Methods: This was a descriptive and cross-sectional prevalence analysis conducted within a duration of 1 year. A total of 100 children diagnosed with Down syndrome (aged between 5 and 16 years) were selected as the study sample. Inclusion criteria were (a) cytogenetic positive trisomy 21, (b) cooperative behavior, and (c) written informed consent obtained from the legal care-takers. Exclusion criteria were (a) any debilitating form of systemic diseases, (b) any other disability, and (c) extremely uncooperative children. The gingival health status was assessed using gingival index (GI) [Loe and Silness], calculus index (CI) [Ramfjord], and plaque index (PI) [Silness and Loe]. Information involving the practice of oral hygiene maintenance, diet plans, and parental educational status was derived from each parent. Based upon their intelligence quotient (I. Q.) values, the subjects were classified into three groups: a) mild (I. Q. level = 50 to 70), b) moderate (I. Q. level = 35 to 50), and c) severe (I. Q. level ≤35). Statistical analysis was performed using the statistical software tool Statistical Package for Social Sciences (SPSS) version 20.0. Qualitative data were recorded as frequencies, and percentages and quantitative data were recorded as mean and standard deviation values. All categorical outcomes were analyzed by means of the Chi-square test. The quantitative outcomes of Calculus Index, Gingival Index, and Plaque Index were analyzed by either student's t-test or one-way analysis of variance (ANOVA). Significance was set at a cut-off value of P < 0.05. Results: Down syndromic children between 12 and 16 years were reported to have statistically significant higher Calculus Index, Gingival Index, and Plaque Index values in comparison with younger age syndromic children (P < 0.01). Those with severe mental retardation had significantly higher Plaque Index (P < 0.001) and Gingival Index (P < 0.04) values when compared with those with mild and moderate mental retardation. No significant difference in comparing Calculus Index was noted. Conclusion: Higher age group children with Down syndrome require close monitoring by parents for assisting in maintaining oral hygiene practices just as in younger age group children.

Lymphedema is a common complication of breast cancer treatment. Yoga is a nonconventional and noninvasive intervention that is reported to show beneficial effects in patients with breast cancer-related lymphedema (BCRL). This study attempted to systematically review the effect of yoga therapy on managing lymphedema, increasing the range of motion (ROM), and quality of life (QOL) among breast cancer survivors. The review search included studies from electronic bibliographic databases, namely Medline (PubMed), Embase, and Google Scholar till June 2019. Studies which assessed the outcome variables such as QOL and management of lymphedema or related physical symptoms as effect of yoga intervention were considered for review. Two authors individually reviewed, selected according to Cochrane guidelines, and extracted the articles using Covidence software. Screening process of this review resulted in a total of seven studies. The different styles of yoga employed in the studies were Iyengar yoga (n = 2), Satyananda yoga (n = 2), Hatha yoga (n = 2), and Ashtanga yoga (n = 1). The length of intervention and post intervention analysis ranged from 8 weeks to 12 months. Four studies included home practice sessions. QOL, ROM, and musculoskeletal symptoms showed improvement in all the studies. Yoga could be a safe and feasible exercise intervention for BCRL patients. Evidence generated from these studies was of moderate strength. Further long-term clinical trials with large sample size are essential for the development and standardization of yoga intervention guidelines for BCRL patients.

Pericardial effusion is an accumulation of fluid in the pericardial sac. It is caused by exudative or transudative collections. Large effusions can lead to a life-threatening condition called tamponade if not intervened properly. Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis are life-threatening cutaneous drug reactions in which the epidermis is separated from the dermis. The diagnosis mainly relies on the clinical signs and histopathology of skin lesions. Immunological mechanisms, reactive drug metabolites, or interactions between these two are proposed. Here, we report a case of recurrent cardiac tamponade with SJS secondary to empirical antituberculous therapy.

Objectives: To develop a standardised template to support physiotherapist reporting of lower limb kinematic waveform data Design: Within and between user agreement identification of movement compensation strategies. Setting: University Health Board Physiotherapy Department Participants: Fourteen individuals with anterior cruciate ligament reconstruction performed overground gait, double-leg squat, and stair ascent wearing body-worn sensors. Six users viewed 252 kinematic waveforms of hip, knee and ankle joint angles in the sagittal and frontal planes. Main outcome measures: Between and within-user observed agreement and themes from movement analysis reports Results: Between-user observed agreement for presence of a movement compensation was 0.6–0.9 for the sagittal plane and 0.75–1.0 for the frontal place. Within-user observed agreement was 0.57–1.00 for the sagittal plane and 0.71–1.00 for the frontal plane. Three themes and seven categories were identified from the waveform interpretations: Amount (qualitative and quantitative description), timing (phase, discrete time point, cycle), and nature (peak, range of motion, timing) of the compensation. Conclusion: There was good agreement between users at identifying the presence of movement compensation from the kinematic waveforms, but there was variation in how movement compensations were described. An interactive report, a standardised template for interpretation of kinematic waveforms, and training to support the clinical application of a movement analysis toolkit are proposed.

You Many of the construction industries have accepted increasing importance of economic crisis management to control risks. Economic crisis and their management have been critical issues which are related with projects, the construction company and their customers are related with higher chances of risk. The reason for their higher risk is their construction process and activities, their background and their organization. This study is related to economic crisis which immediately taken part in the construction project. The risk in the construction projects is usually identified as an event that highlights objectives of manpower, material and money. The ideas at various levels of construction industries have been collected through literature survey and their results have been analyzed in this paper. From this literature study, the situations influencing economic crisis were studied and recommendation has been expressed to devastate those economic crisis situations.

An effective prophylactic hepatitis B virus (HBV) vaccine has long been available but is ineffective for chronic infection. The primary cause of chronic hepatitis B (CHB) and greatest impediment for a therapeutic vaccine is the direct and indirect effects of immune tolerance to HBV antigens. The resulting defective CD4+/CD8+ T cell response, poor cytokine production, insufficient neutralizing antibody (nAb) and poor response to HBsAg vaccination characterize CHB infection. The objective of this study was to develop virus-like-particles (VLPs) that elicit nAb to prevent viral spread and prime CD4+/CD8+ T cells to eradicate intracellular HBV. Eight neutralizing B cell epitopes from the envelope PreS1 region were consolidated onto a species-variant of the HBV core protein, the woodchuck hepatitis core antigen (WHcAg). PreS1-specific B cell epitopes were chosen because of preferential expression on HBV virions. Because WHcAg and HBcAg are not crossreactive at the B cell level and only partially cross-reactive at the CD4+/CD8+ T cell level, CD4+ T cells specific for WHcAg-unique T cell sites can provide cognate T-B cell help for anti-PreS1 Ab production that is not curtailed by immune tolerance. Immunization of immune tolerant HBV transgenic (Tg) mice with PreS1-WHc VLPs elicited levels of high titer anti-PreS1 nAbs equivalent to wildtype mice. Passive transfer of PreS1 nAbs into human-liver chimeric mice prevented acute infection and cleared serum HBV from mice previously infected with HBV in a model of CHB. At the T cell level, PreS1-WHc VLPs and hybrid WHcAg/HBcAg DNA immunogens elicited HBcAg-specific CD4+ Th and CD8+ CTL responses.

Background: In India, opportunistic screening is routinely conducted for cervical cancer, but systematic, community-based screening is relatively new. Hence, the uptake and follow-up for community-based screening remain poor. Objectives: In this study, we aimed to explore the barriers to community-based screening and suggest possible solutions for mitigating the loss to follow-up among screen-positive women from the perspectives of both, the community women (CWs) and service providers (SPs). Materials and Methods: This descriptive, qualitative study conducted at a non-governmental organization in Tirunelveli district of Tamil Nadu between December 2017 and January 2018 included 11 CWs who completed various stages of screening and five SPs involved in community-based screening. The participants were purposively identified and interviewed face to face using a semi-structured questionnaire. Interviews were conducted in Tamil, following which the transcripts were validated by the participants, translated to English, and analyzed. The reporting was based on the Consolidated Criteria for Reporting Qualitative Research guidelines. Results: Unawareness and poor understanding of the screening process, fear associated with the procedures and the disease, no financial and family support, and sociocultural beliefs were identified as the barriers to follow-up. Persistent follow-up through phone calls and home visits along with increasing the awareness about the screening process and its benefits, establishing a rapport with the community, and using local community-based organizations to track the CWs are suggested as possible measures to mitigate the loss to follow-up. Conclusion: Sociocultural, economic, and psychological factors are the main barriers to follow-up after initial screening in cervical cancer screening programs. Conducting population-based systematic screening and awareness programs and keeping the local public healthcare professionals on the frontline along with incentivizing the healthcare professionals and screen-positive women are recommended to improve the adherence to follow-up.

We present a rare case of pathological shaft of femur fracture in an 18-year-old male, with an underlying arteriovenous malformation (AVM). Magnetic resonance imaging showed extensive intraosseous femoral involvement of the vascular malformation, and the canal was deemed to be wide enough for a nail based on the radiograph templates and computed tomography (CT) scan. The patient was given four sessions of stereotactic external beam radiotherapy preoperatively, and closed reduction and internal fixation was performed using a proximal femoral nail without any complications. Radiographic evidence of fracture union was observed at 4 months. Fracture fixation by closed reduction can be either intramedullary fixation or external fixation based on the adequacy of the canal as determined by radiograph and CT scan. Preoperative measures to decrease vascularity such as stereotactic radiotherapy and angiographic embolization can be undertaken to reduce bleeding. A multidisciplinary approach is essential to improve the management of fractures in a patient with AVM.

Polymerase theta-mediated end joining (TMEJ) is a chromosome break repair pathway that is able to rescue the lethality associated with the loss of proteins involved in early steps in homologous recombination (e.g., BRCA1/2). This is due to the ability of polymerase theta (Pol θ) to use resected, 3' single stranded DNA tails to repair chromosome breaks. These resected DNA tails are also the starting substrate for homologous recombination. However, it remains unknown if TMEJ can compensate for the loss of proteins involved in more downstream steps during homologous recombination. Here we show that the Holliday junction resolvases SLX4 and GEN1 are required for viability in the absence of Pol θ in Drosophila melanogaster, and lack of all three proteins results in high levels of apoptosis. Flies deficient in Pol θ and SLX4 are extremely sensitive to DNA damaging agents, and mammalian cells require either Pol θ or SLX4 to survive. Our results suggest that TMEJ and Holliday junction formation/resolution share a common DNA substrate, likely a homologous recombination intermediate, that when left unrepaired leads to cell death. One major consequence of Holliday junction resolution by SLX4 and GEN1 is cancer-causing loss of heterozygosity due to mitotic crossing over. We measured mitotic crossovers in flies after a Cas9-induced chromosome break, and observed that this mutagenic form of repair is increased in the absence of Pol θ. This demonstrates that TMEJ can function upstream of the Holiday junction resolvases to protect cells from loss of heterozygosity. Our work argues that Pol θ can thus compensate for the loss of the Holliday junction resolvases by using homologous recombination intermediates, suppressing mitotic crossing over and preserving the genomic stability of cells.

Los resultados del ejercicio de control de calidad de la Sociedad Latinoamericana de Genética Forense 2016-2017 reflejan el avance paulatino de los laboratorios de Genética Forense de Latinoamérica en el uso de plataformas automatizadas y de reactivos comerciales; sin embargo promover la validación interna de métodos y el análisis de muestras complejas como las mezclas, sigue siendo un reto para los mismos.

Los resultados del ejercicio de control de calidad de la Sociedad Latinoamericana de Genética Forense 2016-2017 reflejan el avance paulatino de los laboratorios de Genética Forense de Latinoamérica en el uso de plataformas automatizadas y de reactivos comerciales; sin embargo promover la validación interna de métodos y el análisis de muestras complejas como las mezclas, sigue siendo un reto para los mismos.

We present the report of a 17-year-old girl, with a history of recurrent headaches, diagnosed as meningitis on two occasions 2 years apart. She was extensively evaluated for all systemic and local causes of the same, which was finally diagnosed as Sjogren's syndrome (SS). SS presenting with recurrent, aseptic meningitis as the only manifestation in the pediatric age group is a very rare occurrence.

Abstract Background and Aim: Multiple sclerosis (MS) is an autoimmune, inflammatory, chronic and progressive disease of central nervous system in which myelin sheath and axons of nerve cells in the brain and spinal cord destroyed by immune system. The change in concentration of cytokines is the major physiological symptom of the disease; whereas physical activity and exercise is an important non-pharmacological method in maintain homeostasis of physiological symptom in MS disease. The aim of this study was to determine the effect of eight weeks of exercise training combined with Q10 supplementation on serum TNF-α and IL-10 in patients with multiple sclerosis. Methods: In the present experimental research, twenty eight MS patients (EDSS=3-5) were selected by using available sampling method and randomly divided into three experimental groups (combined exercise training + Q10 supplementation, combined exercise training + placebo & Q10 supplementation) and one control group (5 female and 2 male in each group). Two groups of three experimental groups performed a combined exercise program include two sessions of endurance training (%50-60 max HR at beginning to end) and one session of resistance training (%50-60 1RM at beginning to end) three sessions per week. 200 mg of CoQ10 supplement was prescription per day. Blood samples (after 10 hours fasting) were collected 24 hours before the first and 24 hours after the last session of exercise for evaluation of serum levels of IL-10 and TNF-α. Data were analyzed with Shapiro - Wilk and analysis of covariance at a significance level of P

Categorization of cognitively uniform and consistent documents such as University question papers are in demand by e-learners. Literature indicates that Standard Cauchy distribution and the derived values are extensively used for checking uniformity and consistency of documents. The paper attempts to apply this technique for categorizing question papers according to four selective cognitive dimensions. For this purpose cognitive dimensional keyword sets of these four categories (also termed as portrayal concepts) are assumed and an automatic procedure is developed to quantify these dimensions in question papers. The categorization is relatively accurate when checked with manual methods. Hence simple and well established term frequency / inverse document frequency ‘tf/ IDF’ technique is considered for automating the categorization process. After the documents categorization, standard Cauchy formula is applied to rank order the documents that have the least differences among Cauchy value, (according to Cauchy theorem) so as obtain consistent and uniform documents in an order or ranked. For the purpose of experiments and social survey, seven question papers (documents) have been designed with various consistencies. To validate this proposed technique social survey is administered on selective samples of e-learners of Tamil Nadu, India. Results are encouraging and conclusions drawn out of the experiments will be useful to researchers of concept mining and categorizing documents according to concepts. Findings have also contributed utility value to e-learning system designers.

Background: Chronic kidney disease (CKD) is defined as glomerular filteration rate < 60 ml/min/1.73 m2 for a minimum of 3 months irrespective of the cause. Accelerated atherosclerosis is the main cause of morbidity and mortality in CKD patients. Visfatin is a 52 kDa protein predominantly secreted by the visceral adipose tissue which has proinflammatory, insulin-mimetic and anti-apoptotic activities. Aims and Objective: To estimate the levels of serum visfatin in patients with CKD and to correlate it with serum highly sensitive C-reactive protein (hsCRP), creatinine clearance (Ccr), and lipid profile. Materials and Methods: The study was conducted at Thanjavur Medical College Hospital. 50 patients of CKD as cases and 50 age and gender matched healthy individuals were selected as controls. Serum visfatin and serum hsCRP were estimated by enzyme immunoassay and immunoturbidimetric method, respectively. Serum total cholesterol (TC), triglycerides (TGLs), very low density lipoprotein-cholesterol (VLDL-C), and high density lipoprotein-cholesterol (HDL-C) were estimated by enzymatic method. Ccr and LDL-C were calculated using formula. Results: The mean value of visfatin in cases and controls were 27.42 ± 8.92 and 10.62 ± 1.57 ng/ml (t = 13.11; P < 0.05 significant), respectively. The level of serum visfatin is inversely correlated with Ccr (r = −0.898; P < 0.01). Serum hsCRP, TGL, and VLDL-C were significantly increased, and HDL-C was significantly decreased in cases when compared to controls (P < 0.05). There is no significant difference of TC between cases and controls. Conclusion: This study demonstrated that serum visfatin levels are significantly increased in patients with CKD. Visfatin may be considered as the novel marker of mortality predictor in CKD patients.

Background: Obesity is a chronic nutritional disorder characterized by excess accumulation of adipose tissue. Adipose tissues being energy depots also act as an endocrine organ and secrete adipokines. Adipocyte fatty acid binding protein (AFABP) is a newer adipokine associated with obesity and metabolic syndrome. Aim: The aim of the study is to measure serum level of AFABP in obese individuals and to compare it with lean individuals. Further, to analyze the correlation between AFABPs with insulin resistance. Materials and Methods: Study group included 50 obese individuals, aged 30-50 years whose body mass index (BMI) is >30 kg/m2 and the control group included 50 healthy lean individuals age and sex matched whose BMI < 25 kg/m2. Assay of serum AFABP and insulin were done using enzyme-linked immunosorbent assay method. Plasma blood glucose was estimated by semi auto analyzer. Results: The mean AFABP level in the study group (31.27 ± 5.04) was significantly high when compared to the control group (16.07 ± 1.10). Pearson’s correlation revealed positive correlation with insulin resistance (r = 0.371). Conclusion: Our study showed increase in level of AFABP in obese individuals compared to control group. It also showed with increase in mean level of serum AFABP concentration there is increased insulin resistance. Insulin resistance places a role in connecting obesity with metabolic syndrome. Hence, adipocyte fatty acid binding protein can be taken as marker of obesity and a predictor of metabolic syndrome. Hence, it can be targeted therapeutically in future.

With natural resources depleting, sustainable solutions are becoming more and more a necessity. To deal with the depleting resources, the Dutch government aims to generate 14% of country’s energy consumption through natural resources by 2020. The Dutch built environment is estimated to be responsible for 38.1% of the total energy consumption. This means that investments and innovation within this area have high potential. However, there are some indications that these goals cannot be met. New houses often meet these requirements but, with a growth of 0.8% per year, these only make up for a small portion of all projects. As a result, a strong focus lays on improving and renovating the existing housing market towards a sustainable and low energy environment. For this transition, information on the current housing market, possible renovation options and insight on the investments costs are required. Within this PDEng-project the aim is to further develop WoonConnect, a digital tool that can help to speed up this transition for both renovation projects and new buildings.

With natural resources depleting, sustainable solutions are becoming more and more a necessity. To deal with the depleting resources, the Dutch government aims to generate 14% of country’s energy consumption through natural resources by 2020. The Dutch built environment is estimated to be responsible for 38.1% of the total energy consumption. This means that investments and innovation within this area have high potential. However, there are some indications that these goals cannot be met. New houses often meet these requirements but, with a growth of 0.8% per year, these only make up for a small portion of all projects. As a result, a strong focus lays on improving and renovating the existing housing market towards a sustainable and low energy environment. For this transition, information on the current housing market, possible renovation options and insight on the investments costs are required. Within this PDEng-project the aim is to further develop WoonConnect, a digital tool that can help to speed up this transition for both renovation projects and new buildings.

With natural resources depleting, sustainable solutions are becoming more and more a necessity. To deal with the depleting resources, the Dutch government aims to generate 14% of country’s energy consumption through natural resources by 2020. The Dutch built environment is estimated to be responsible for 38.1% of the total energy consumption. This means that investments and innovation within this area have high potential. However, there are some indications that these goals cannot be met. New houses often meet these requirements but, with a growth of 0.8% per year, these only make up for a small portion of all projects. As a result, a strong focus lays on improving and renovating the existing housing market towards a sustainable and low energy environment. For this transition, information on the current housing market, possible renovation options and insight on the investments costs are required. Within this PDEng-project the aim is to further develop WoonConnect, a digital tool that can help to speed up this transition for both renovation projects and new buildings.

Many farms in northeast California are experimenting with organic production to take advantage of price premiums and niche markets. A common challenge in organic farming is finding dependable nitrogen sources to meet the needs of vegetable and grass crops, especially in fields with low soil nitrogen. This study assessed the use of cover crops and organic amendments for increasing soil nitrogen for potato production at the Intermountain Research and Extension Center in Tulelake. Researchers evaluated several cover crop species, three planting dates and multiple cover crop mixes. Amendments included composts, manures, bloodmeal and soymeal. The data collected in the study included total nitrogen from cover crops and amendments, plant-available nitrogen in the soil, potato petiole nitrate and crop yield and quality. Vetches and field peas, managed as green manure, were successful at satisfying potatoes' in-season nitrogen demand. These cover crops, grown alone or in mixes with non-legume species, produced potato crops whose yield and quality were similar to crops grown with conventional fertilizers. The cover crops' influence on potato pest pressure was neutral. Chicken manure was the most cost-effective amendment for satisfying potatoes' in-season nitrogen demand.

Background: Acute coronary syndrome (ACS) denotes the acute phase of ischemic coronary artery disease with or without myocardial necrosis. It is the initial working diagnosis later refined by electrocardiography and biomarkers. Diagnostic sensitivity and specificity for ACS, especially at the earliest stage remains insufficient. Pentraxin 3 (PTX3) is the inflammatory protein and has the potential to be a biomarker in the diagnosis of ACS, as it is elevated in the early hours (6-8 h) of ACS. The aim of the study is to estimate serum PTX3 level in patients with ACS and to correlate with serum creatine kinase-MB (CK-MB) and lipid parameters. Materials and Methods: A study group includes 50 patients who were admitted in Intensive Cardiac Care Unit with ACS and 50 participants of age- and sex-matched healthy individuals were taken as control. Assay of serum PTX3 was done by ELISA method and CK-MB by kinetic immune inhibition method. Serum lipid profile was measured by colorimetric method. Results: Serum PTX3 levels (mean: 5.607 ± 2.82 ng/ml) were elevated in the ACS compared to normal healthy persons (mean: 1.38 ± 0.52 ng/ml) and are statistically significant (P < 0.05), and there is no correlation between serum PTX3 levels, CK-MB, and lipid profile. Conclusion: The elevated concentration of serum PTX3, in early hours (6-8 h) of ACS, is a novel biomarker for diagnosing patients.

With the broadening legislative changes surrounding legalized recreational marijuana in the United States, tracking the impact of such changes is imperative. As such, in a recent article published in Addictive Behaviors , we identified several emerging trends in the first state to legalize recreational marijuana, Colorado. Since our publication, similar research from other states that have legalized recreational marijuana (Oregon and Washington) has emerged. Here, we attempt to expand on our findings and identify patterns across the research, by comparing and contrasting our results to research in other states with legalized recreational marijuana. We identified several trends including, but not limited to, the rates of marijuana use rising after decriminalization, but not the retail sale of recreational marijuana; recreational marijuana legalization leading to a decrease in the relationship between marijuana and alcohol use; and the identification of binge drinkers as a high-risk population for marijuana use after recreational legalization. We also explore the complicated relationship between marijuana use and academic performance, and point out areas where future research is needed.

Background: Determining the relative risk of cleft lip and palate (CL[P]) on the basis of lip prints and dermatoglyphics as genetic background may be useful for genetic counseling, and the development of future preventive measures. Aims and Objectives: (1) To analyze the various pattern types of lip prints and dermatoglyphics in parents of CL(P) children and to detect if any specific type can be contemplated as a genetic marker in the transmission of CL(P). (2) To compare these patterns with that of parents of unaffected children. Materials and Methods: 31 parents of children with CL(P) as a study group, and 31 parents of unaffected children as control group were included. Lip prints and finger prints were collected from all subjects and analysis of both patterns was carried out followed by a comparison of the patterns of unaffected parents with the controls statistically. Results: Among the mothers of the study group, type O followed by type IIa lip patterns were found to be significantly higher in upper and lower lips, and in fathers type IIa followed by type O were significantly higher. In the control group, type IIb followed by type III were higher in both fathers and mothers. Dermatoglyphic analysis of palm and finger prints revealed no significant difference in the pattern types and total ridge counts, but the Atd angle asymmetry was found to be significant between study and control group. Conclusion: Types IIa and O lip patterns, asymmetry of Atd angles can be considered as genetic markers for the transmission of CL(P) deformity to offsprings.

BACKGROUND AND OBJECTIVE: Recently, the use of mobile technology has significantly increased in a number of fields. With regard to the increasing development of information and communication technologies and the pervasive use of mobile devices for educational purposes, we aimed to evaluate the factors affecting the acceptance of mobile learning use. METHODS: This cross-sectional study was conducted on the medical students of Babol University of Medical Sciences during 2013-2014. Data related to the acceptance of mobile learning including age, gender, type of device, as well as the time and place of device use, were collected using a questionnaire afterwards, the obtained data were evaluated. FINDINGS: Mobile learning was not significantly correlated with age, gender, or time of device use among the students of Babol University of Medical Sciences. However, mobile learning was significantly correlated with the type of device and the place of use. CONCLUSION: The results showed that the type of device and the place of use had significant impacts on the acceptance of mobile learning.

Abstract Background & Aim: Professional ethic has a significant effect on individual and group performance and organizational results. The aim of this study was to investigate the relationship between organizational commitment and professional ethics. Materials & Methods: It was a descriptive-correlational study. The sample consisted of 226 persons including nurses and administrative personnel (ward clerks, medical records employees…) of Imam Reza hospital in Amol city. They were randomly selected according to Krejcie and Morgan table and responded to Ali professional ethic questionnaire and Allen and Myer organizational commitment questionnaire. Data was analyzed by Pearson correlation and simple linear regression analysis tests using SPSS-PC (v. 16). ‎ Results: The results showed that professional ethic has a positive significant relationship with organizational commitment and it’s three dimensions (Affective, Continuance, Normative). Professional ethic also could predict organizational commitment (P

Melioidosis is an emerging disease in our country caused by the bacteria Burkholderia pseudomallei. Melioidosis can virtually affect any organ. It has varying clinical presentations ranging from pneumonia to fatal sepsis. Central nervous system (CNS) involvement in melioidosis is rare. We present a case of CNS melioidosis from South India. As the incidence of diabetes is increasing in our country varying manifestations of melioidosis will be seen in routine clinical practice. Melioidosis should be considered in the differential diagnosis of intracranial abscess and meningoencephalitis, especially in diabetics.