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We investigated the in vitro and in vivo uses of pamoic acid functionalized gold nanoparticles (PA@AuNPs), with a focus on determining their safety and potential toxicity in living beings. To test this theory, the bacterial interaction of PA@AuNPs was studied using Escherichia coli , Staphylococcus aureus , and Pseudomonas aeruginosa cultures, as well as the inhibition of the bovine serum albumin (BSA) protein. The real-time polymerase chain reaction (RT-PCR) is used to measure the expression of target genes. PA@AuNPs caused dose-dependent cell death in MDA-MB-231, a triple-negative breast cancer (BC) cell line, with an LC 50 of -42.23 μL mL -1 . It also caused apoptosis in BC cells. The results indicated that in the early weeks, inflammatory cells (mostly neutrophils and macrophages) penetrated the connective tissue, but in the latter weeks, a substantial number of fibroblasts and fibrocytes were identified. Changes in vascular channels, extravasated red blood cells (RBCs), and necrosis are all indicators of growing tissue pathology. These data could point to a dynamic process including an anti-inflammatory response followed by tissue remodeling or repair. These findings show that PA@AuNPs were not hazardous to the tested Sprague Dawley rats, are highly biocompatible, and can be used in a variety of biological applications.

Cardiomyopathies, often caused by mutations in genes encoding muscle proteins, are traditionally treated by phenotyping hearts and addressing symptoms post irreversible damage. With advancements in genotyping, early diagnosis is now possible, potentially introducing earlier treatment. However, the intricate structure of muscle and its myriad proteins make treatment predictions challenging. Here, we approach the problem of estimating therapeutic targets for a mutation in mouse muscle using a spatially explicit half sarcomere muscle model. We selected nine rate parameters in our model linked to both small molecules and cardiomyopathy-causing mutations. We then randomly varied these rate parameters and simulated an isometric twitch for each combination to generate a large training data set. We used this data set to train a conditional variational autoencoder, a technique used in Bayesian parameter estimation. Given simulated or experimental isometric twitches, this machine learning model is able to then predict the set of rate parameters that are most likely to yield that result. We then predict the set of rate parameters associated with twitches from control mice with the cardiac troponin C (cTnC) I61Q variant and control twitches treated with the myosin activator Danicamtiv, as well as model parameters that recover the abnormal I61Q cTnC twitches., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) exacerbations often lead to hospitalizations and subsequent readmissions. Steroid therapy is a common approach in managing COPD exacerbations, yet a considerable proportion of patients experience readmissions within a short timeframe, highlighting the persistent and complex nature of COPD exacerbations. The aim of this retrospective study is to investigate risk factors for all-cause hospital readmissions in COPD patients discharged on steroid tapers following exacerbations, emphasizing the need for personalized management strategies to reduce readmission rates., Methods: Patient demographics and treatment histories were collected in a retrospective study of electronic medical records for patients in our hospital system for the calendar year 2023. Descriptive statistics were calculated, and univariate logistic regression were conducted for potential predictors., Results: Data analysis revealed that higher exacerbation frequency significantly increased the likelihood of readmission within a year, with patients experiencing three or more exacerbations facing 11 times and 25 times greater risks compared to those with 0 exacerbations. Early re-exacerbations within 30 days of discharge also emerged as strong predictors of long-term prognosis., Conclusions: Existing prognostic tools lack specificity for predicting short-term readmissions, highlighting the need for comprehensive risk assessment tools tailored to individual patient needs. Proactive monitoring of exacerbation frequency and personalized management strategies are essential for optimizing care delivery and reducing readmission rates in COPD patients. Targeted interventions aimed at mitigating identified risk factors and optimizing post-discharge management can enhance patient outcomes and alleviate the overall burden of COPD on patients and healthcare systems. Further research is warranted to address limitations and refine risk assessment tools to support personalized COPD care., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-932/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Cardiomyopathies, often caused by mutations in genes encoding muscle proteins, are traditionally treated by phenotyping hearts and addressing symptoms post irreversible damage. With advancements in genotyping, early diagnosis is now possible, potentially introducing earlier treatment. However, the intricate structure of muscle and its myriad proteins make treatment predictions challenging. Here we approach the problem of estimating therapeutic targets for a mutation in mouse muscle using a spatially explicit half sarcomere muscle model. We selected 9 rate parameters in our model linked to both small molecules and cardiomyopathy-causing mutations. We then randomly varied these rate parameters and simulated an isometric twitch for each combination to generate a large training dataset. We used this dataset to train a Conditional Variational Autoencoder (CVAE), a technique used in Bayesian parameter estimation. Given simulated or experimental isometric twitches, this machine learning model is able to then predict the set of rate parameters which are most likely to yield that result. We then predict the set of rate parameters associated with twitches from control mice with the cardiac Troponin C (cTnC) I61Q variant and control twitches treated with the myosin activator Danicamtiv, as well as model parameters that recover the abnormal I61Q cTnC twitches., Competing Interests: DECLARATION OF INTERESTS The authors declare no competing interests.

Purpose: Mobility impairments are a common consequence of stroke and spinal cord injury (SCI). Assistive products (APs) such as wheelchairs are often needed for activities and participation. The aim of the study was to explore the provision and use of APs in Germany and to identify associated factors underlying this practice., Materials and Methods: Semi-structured interviews were conducted with 19 professionals from outpatient neurorehabilitation services (three general practitioners, five physical therapists, five occupational therapists, one speech therapist, one neuropsychologist, two outpatient nurses, one rehab technician and one social worker), two patient advocates (long-term survivors, each stroke and SCI) and 20 patients (10 each after stroke and SCI with mobility impairment, and first-ever affected). Analysis was performed by qualitative content analysis., Results: Reported experiences were mixed, varying from high satisfaction to unusable APs and unmet needs. Identified factors associated with these experiences were related to care pathways, care coordination, inter-professional collaboration, professionals' knowledge and patient information, cost coverage, and approval procedures., Conclusion: Overall, patients seem satisfied with the APs they receive, but patients with more severe mobility impairments in particular experience deficits in the provision and use of APs. Further research is needed to develop and test strategies for the provision and use of APs.

Carbon dot-based fluorescence sensors have attracted research interest for the selective determination of anti-inflammatory drugs in biological fluids and environments. The overdose and accumulation of anti-inflammatory drugs in tissues can cause chronic side effects including abdominal pain, and renal damage. Herein, we report a new fluorescent probe, bamboo stem waste-derived carbon dots (BS-CDs) for highly sensitive detection of Flufenamic acid (FA), a hazardous anti-inflammatory drug. The UV-vis absorption spectra of BS-CDs show a redshifted absorption peak at 283 nm upon the addition of FA suggesting strong binding interaction between BS-CDs and FA molecule. The BS-CDs showed a fluorescence enhancement (∼2-fold) detection for FA (400 μM) in the linear concentration range (0.40 → 0.65 μM) with a limit of detection (LoD; 17 nM) and binding constant (K a  = 1.33 × 10 -3 M -1 ). The time-resolved fluorescence decay analysis showed that the average lifetime of BS-CDs has slightly changed (4.42 → 4.67 ns) by the interaction with FA through the aggregation-induced emission (AIE) process. The interference, pH, and effect of time results suggest that BS-CDs are highly selective probes for FA detection and do not show any interference involvement during FA detection. The confirmation of the structure and morphology changes of BS-CDs after interaction with FA was carried out by XRD, FESEM, HRTEM, FTIR, and Raman spectroscopy. The practicability of the BS-CDs probe was proved by the detection of FA in human urine samples with recovery of 103-109 %. This suggests that the proposed BS-CDs-based 'turn-on' sensor could be used to determine the FA in biological fluids., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Imidazole ligation of metals through histidine is extensive among metalloproteins, yet the role of the imidazolate conjugate base is often neglected, despite its potential accessibility when bonded to an oxidized metal center. Using synthetic models of oxygenated tyrosinase enzymes ligated exclusively by monodentate imidazoles, we find that deprotonation of the μ 2 -η 2 :η 2 -peroxidodicopper(II) species triggers redox isomerization to an imidazolate-ligated bis(μ 2 -oxido)dicopper(III) species. Formal two-electron oxidation to Cu(III) remains biologically unprecedented, yet is effected readily by addition of base. Spectrophotometric titrations by UV/Visible/near-IR and copper K-edge X-ray absorption spectroscopies are interpreted most simply as two cooperative, 2H + transformations in which the peroxide O-O is cleaved in the first step. Elaboration from simple imidazoles to a protected histidine extends this isomerization into an amino acid environment. The role of phenolate as a base suggests this four-electron reduction of O 2 is energetically viable in a biological context and requires only two copper centers, which act as two-electron shuttles when imidazole deprotonation assists. This existential precedent of viable imidazolate intermediates invites speculation into an alternative mechanism for phenol hydroxylation not previously considered at Type 3 copper sites such as tyrosinases. Structural biological evidence suggests imidazolate ligation of copper may be more widespread than generally understood., (© 2024 Wiley-VCH GmbH.)

Diagnosis of most ophthalmic conditions, such as diabetic retinopathy, generally relies on an effective analysis of retinal blood vessels. Techniques that depend solely on the visual observation of clinicians can be tedious and prone to numerous errors. In this article, we propose a semi-supervised automated approach for segmenting blood vessels in retinal color images. Our method effectively combines some classical filters with a Generalized Linear Model (GLM). We first apply the Curvelet Transform along with the Contrast-Limited Histogram Adaptive Equalization (CLAHE) technique to significantly enhance the contrast of vessels in the retinal image during the preprocessing phase. We then use Gabor transform to extract features from the enhanced image. For retinal vasculature identification, we use a GLM learning model with a simple link identity function. Binarization is then performed using an automatic optimal threshold based on the maximum Youden index. A morphological cleaning operation is applied to remove isolated or unwanted segments from the final segmented image. The proposed model is evaluated using statistical parameters on images from three publicly available databases. We achieve average accuracies of 0.9593, 0.9553 and 0.9643, with Receiver Operating Characteristic (ROC) analysis yielding Area Under Curve (AUC) values of 0.9722, 0.9682 and 0.9767 for the CHASE_DB1, STARE and DRIVE databases, respectively. Compared to some of the best results from similar approaches published recently, our results exceed their performance on several datasets., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The future of warfare is changing with anticipation of moving toward Agile Combat Employment in contested, degraded, and operationally limited environments. This will require some changes for behavioral health provision within the Air Force during deployments. With over a century of development and refinement, Combat and Operational Stress Control (COSC) has proven to be a sustainable model for behavioral health asset utilization to maximize unit combat effectiveness and individual personnel performance. It allows flexibility of implementation across the force generation cycle through outreach efforts, unit integration, prevention services, and command consultation. COSC teams are versatile: Both enlisted and officer providers have a dynamic opportunity to influence and shape the wellness of an entire population of service members. To maximize this potential, the Air Force needs to formally train for the COSC mission and consider realigning the active duty mental health personnel from working almost exclusively in the Mental Health clinic to primarily working in the units. Employing the key principles of COSC in garrison is possible; however, it will take significant effort and purpose to change from the current policy., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Furaltadone (FTD), a nitrofuran drug, was primarily utilized as a very effective oral veterinary antibiotic, especially in poultry production farms. As a result, FTD, a form of carcinogen, might easily enter people via the food chain, leading to fatal cancers. As a result, it is critical to develop a quick and efficient approach for detecting FTD at extremely low concentrations. Considering the aforementioned purpose, pamoic acid (PA) capped gold nanoparticles (PA@AuNPs) were synthesized in spherical morphology (size 10-15 nm) using the method of chemical reduction and used as a fluorescent probe to detect FTD. The interaction between PA@AuNPs and FTD was validated by UV-vis, XRD, and FTIR methods. Microscopic images (FESEM and HRTEM) show that PA@AuNPs have varying morphologies including rod, triangle, hexagonal, and pentagonal, and average sizes of 20-50 nm after sensing FTD. The average surface roughness of PA@AuNPs was determined to be 46.75 nm using the AFM technique. The addition of FTD (0 → 100 μM) quenched the fluorescence emission intensity of PA@AuNPs at 436 nm ( λ ex 353 nm) by 4-fold. This static quenching was confirmed by the formation of a ground state complex, PA@AuNPs·FTD, between AuNPs and FTD using fluorescence lifetime analysis. The presence of an isosbestic point at 412 nm in the UV-visible titration, as well as FTIR data, further demonstrated the existence of this ground state complex. PA@AuNPs revealed high sensitivity (LoD = 9.78 nM; K a = 1.0615 × 10 2 M -1 ) to FTD in water, resulting in a decrease in predicted quantum yield ( Φ F ) from 3.36% to 0.35%. To establish PA@AuNPs as a first-generation fluorescence probe for real samples, FTD in blood serum was measured (LoD = 6.07 nM; K a = 1.0595 × 10 2 M -1 ). The non-toxic cytotoxicity and bioimaging in live zebrafish broadened the practical uses of PA@AuNPs. Furthermore, the surface interactions between PA@AuNPs and FTD were studied theoretically using time-dependent density functional theory (TD-DFT) at the B3LYP/6-31G(d,p) level of theory to support the findings from the experiment., Competing Interests: There is no conflict of interest to declare., (This journal is © The Royal Society of Chemistry.)

The COVID-19 pandemic has caused the death of 7.1 million people worldwide as of 7 July 2024. In Nigeria, the first confirmed case was reported on 27 February 2020, subsequently followed by a nationwide spread of SARS-CoV-2 with morbidity and mortality reaching 267 173 and 3155, respectively, as of 7 July 2024. At the beginning of the pandemic, only a few public health laboratories in Nigeria had the capacity for SARS-CoV-2 molecular diagnosis. The National Veterinary Research Institute (NVRI), already experienced in influenza diagnosis, responded to the public health challenge for the diagnosis of COVID-19 samples from humans. The feat was possible through the collective utilisation of NVRI human and material resources, including biosafety facilities, equipment, reagents and consumables donated by international partners and collaborators. Within 6 months of the reported COVID-19 outbreak in Nigeria, over 33 000 samples were processed in NVRI facilities covering five states. Thereafter, many field and laboratory projects were jointly implemented between NVRI and collaborating sectors including the Nigerian Centre for Disease Control (NCDC) and the National Institute for Medical Research (NIMR), which brought together professionals in the health, veterinary, education and socio-sciences. In addition, One Health grants were secured to enhance surveillance for coronavirus and other zoonoses and build capacity in genomics. Bio-surveillance for coronaviruses and other emerging zoonotic pathogens at the human-animal interface was activated and continued with sample collection and analysis in the laboratory for coronaviruses, Lassa fever virus and Mpox. One Health approach has shown that inter-sectoral and multinational collaboration for diagnosis, research and development in animals, and the environment to better understand pathogen spillover events at the human-animal interface is an important global health priority and pandemic preparedness.

Whole-exome sequencing of two unrelated kindreds with systemic autoimmune disease featuring antinuclear antibodies with IgG4 elevation uncovered an identical ultrarare heterozygous TNIP1 Q333P variant segregating with disease. Mice with the orthologous Q346P variant developed antinuclear autoantibodies, salivary gland inflammation, elevated IgG2c, spontaneous germinal centers and expansion of age-associated B cells, plasma cells and follicular and extrafollicular helper T cells. B cell phenotypes were cell-autonomous and rescued by ablation of Toll-like receptor 7 (TLR7) or MyD88. The variant increased interferon-β without altering nuclear factor kappa-light-chain-enhancer of activated B cells signaling, and impaired MyD88 and IRAK1 recruitment to autophagosomes. Additionally, the Q333P variant impaired TNIP1 localization to damaged mitochondria and mitophagosome formation. Damaged mitochondria were abundant in the salivary epithelial cells of Tnip1 Q346P mice. These findings suggest that TNIP1-mediated autoimmunity may be a consequence of increased TLR7 signaling due to impaired recruitment of downstream signaling molecules and damaged mitochondria to autophagosomes and may thus respond to TLR7-targeted therapeutics., (© 2024. The Author(s).)

Two critical components of patient support systems for people with TB are regular counseling and locally managed nutritional support. As part of an ongoing differentiated TB care initiative called Tamil Nadu Kasanoi Erappila Thittam (meaning TB death-free initiative in Tamil, TN-KET) to reduce TB deaths, adults with TB with very severe undernutrition, respiratory insufficiency, or poor performance status are identified at diagnosis (triage-positive) and prioritized for referral, comprehensive clinical assessment, and inpatient care. Between January and June 2023, in 6 districts, a pilot exercise was conducted in which trained TB survivors, known as TB champions, provided baseline counseling and additional counseling (if required) to triage-positive people with TB at diagnosis. Additionally, people with TB with severe undernutrition were prioritized for nutritional supplementation for at least 3 months. Among 652 people with TB who were triage-positive at diagnosis, the program staff shared details of 145 (22%), and all were counseled by TB champions (baseline counseling). Program staff identified 74 (11%) triage-positive people with TB who required additional counseling (i.e., those refusing referral or admission or continued admission), and 71 (96%) were counseled by TB champions. Among these, 54 (76%) were admitted or readmitted and successfully discharged. In addition, among 1,042 people with TB with severe undernutrition, program staff shared details of 390 (38%), of which 60% received nutritional supplementation through the efforts of TB champions. We conclude that TB champions were able to provide quality and timely peer support through direct counseling and by mobilizing local resources for nutritional support. The engagement of TB champions can be further strengthened by establishing robust coordination mechanisms with the TB program. Lessons from this pilot will contribute to the Tamil Nadu State TB Cell's plans to expand the role of TB champions and enhance community participation to end TB in India., (© Shewade et al.)

Introduction: Modern warfare operations are volatile, highly complex environments, placing immense physiological, psychological, and cognitive demands on the warfighter. To maximize cognitive performance and warfighter resilience and readiness, training must address psychological stress to enhance performance. Resilience in the face of adversity is fundamentally rooted in an individual's psychophysiological stress response and optimized through decreased susceptibility to the negative impact of trauma exposure. The current project aims to optimize warfighter expertise, resilience, adaptability, and performance by utilizing a validated Full Dive Virtual Reality (FDVR) training platform to provide high-fidelity, safe, and scalable, controlled stress exposure in highly realistic simulated training scenarios with the most advanced, immersive technology available., Materials and Methods: Following Institutional Review Board approval and consent, 2 operators were fitted with high-fidelity virtual reality headsets with hand and eye tracking, full-body haptic feedback suits, a 360° omnidirectional treadmill, and Food and Drug Administration (FDA) cleared biometric monitors. Following acclimation, operators were placed in an industrial fire scenario and instructed to respond as a firefighter and paramedic, to search for and resuscitate any casualties, extinguish the fire, and exfiltrate safely. Following initial acclimation and after each demonstration (n = 2), 3 semistructured interviews asked operators their perceptions and experiences related to FDVR, focusing on usability, feasibility, and safety. Biometric data were continuously recorded using the Caretaker Medical VitalStream., Results: Proof-of-concept (POC) testing proved that the FDVR training platform is usable, safe, and feasible. It creates an immersive environment with physiological responses to mimic realistic Mass Casualty Events (MCEs). Using a case study approach, transcript data were analyzed using thematic analysis. Three major themes emerged: Sensory deficits reduced realism, but sensory feedback improved fidelity, vestibular discord affected the virtual reality experience but only when the system did not respond naturally to operator movement after acclimation, and movement accommodations were made by operators to enhance usability, especially for fine motor movements. Biometric data analysis correlated timestamps from the VitalStream unit with operator responses to stress-inducing events (i.e., explosions, fires, and a deceased victim). Both operators exhibited significant physiological responses, including elevated heart rate, systolic blood pressure, and mean arterial pressure, particularly following explosions, encountering fire, and encountering the deceased victim within the training environment., Conclusions: The FDVR training platform overcomes the obstacles of in-person simulation training and provides the closest to real-life experience available. It will allow warfighters to train with their teams in immersive environments that replicate the conditions in which they are expected to perform their duties. The POC demonstrated that physiological responses can be mapped to scenario events to allow tracking of stress responses, cognitive load, as well as performance, and decision-making of the warfighter. The POC only involved 2 operators, but served to prove that the platform was safe and effective. Future testing plans to include 200 warfighters in operational teams of 10 to 12 to further validate the training effectiveness of the FDVR platform., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

We present the first single-reference calculations of the atomic axial tensors (AATs) with wave function-based methods including dynamic electron correlation effects using second-order Møller-Plesset perturbation theory (MP2) and configuration interaction doubles (CID). Our implementation involves computing the overlap of numerical derivatives of the correlated wave functions with respect to both nuclear displacement coordinates and the external magnetic field. Out test set included three small molecules, including the axially chiral hydrogen molecule dimer and ( P )-hydrogen peroxide, and the achiral H 2 O. For our molecular test set, we observed deviations of the AATs for MP2 and CID from that of the Hartree-Fock (HF) method upward of 49%, varying with the choice of basis set. For ( P )-hydrogen peroxide, electron correlation effects on the vibrational circular dichroism (VCD) rotatory strengths and corresponding spectra were particularly significant, with maximum deviations of the rotatory strengths of 62 and 49% for MP2 and CID, respectively, using our largest basis set. The inclusion of dynamic electron correlation to the computation of the AATs can have a significant impact on the resulting rotatory strengths and VCD spectra.

Treating children with acute malnutrition can be challenging, particularly regarding access to healthcare facilities during treatment. Task shifting, a strategy of transferring specific tasks to health workers with shorter training and fewer qualifications, is being considered as an effective approach to enhancing health outcomes in primary healthcare. This study aimed to assess the effectiveness of integrating the treatment of acute malnutrition by community health volunteers into integrated community case management in two sub-counties in northern Kenya (Loima and Isiolo). We conducted a two-arm non-inferiority cluster-randomized controlled trial across 20 community health units. Participants were children aged 6-59 months with uncomplicated acute malnutrition. In the intervention group, community health volunteers used simplified tools and protocols to identify and treat eligible children at home and provided the usual integrated community case management package. In the control group, community health volunteers provided the usual integrated community case management package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for 2 consecutive weeks). Results show that children in the intervention group were more likely to recover than those in the control group [73 vs 50; risk difference (RD) = 26% (95% CI 12 to 40) and risk ratio (RR) = 2 (95% CI 1.2 to 1.9)]. The probability of defaulting was lower in the intervention group than in the control group: RD = -21% (95% CI -31 to -10) and RR = 0.3 (95% CI 0.2 to 0.5). The intervention reduced the length of stay by about 13 days, although this was not statistically significant and varied substantially by sub-county. Integrating the treatment of acute malnutrition by community health volunteers into the integrated community case management programme led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment into integrated community case management and review policies to allow community health volunteers to treat uncomplicated acute malnutrition., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Purpose: When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice., Methods: This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used., Results: Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator., Conclusion: Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated.

Background: Many ophthalmic disorders such as diabetic retinopathy and hypertension can be early diagnosed by analyzing changes related to the vascular structure of the retina. Accuracy and efficiency of the segmentation of retinal blood vessels are important parameters that can help the ophthalmologist to better characterize the targeted anomalies., Method: In this work, we propose a new method for accurate unsupervised automatic segmentation of retinal blood vessels based on a simple and adequate combination of classical filters. Initially, contrast of vessels in retinal image is significantly improved by adding the Curvelet Transform to commonly used Contrast-Limited Adaptive Histogram Equalization technique. Afterwards, a morphological operator using Top Hat is applied to highlight vascular network. Then, a global threshold-based Otsu technique using minimum of intra-class variance is applied for vessel detection. Finally, a cleanup operation based on Match Filter and First Derivative Order Gaussian with fixed parameters is used to remove unwanted or isolated segments. We test the proposed method on images from two publicly available STARE and DRIVE databases., Results: We achieve in terms of sensitivity, specificity and accuracy the respective average performances of 0.7407, 0.9878 and 0.9667 on the DRIVE database, then 0.7028, 0.9755 and 0.9507 on the STARE database., Conclusions: Compared to some recent similar work, the obtained results are quite promising and can thus contribute to the optimization of automatic tools to aid in the diagnosis of eye disorders., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Post-operative sore throat is the common complaint and uncomfortable side effect in patients receiving general anesthesia with endotracheal intubation. Drugs with analgesic and anti-inflammatory properties, like steroids and local anesthetics, are the best options for postoperative sore throat prophylaxis. Therefore, this study aimed to compare the effects of intravenous lidocaine and dexamethasone in reducing postoperative sore throat following endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2023 G.C., Methods: A prospective cohort study was carried out at Tikur Anbessa Specialized Hospital. Data from 50 patients in the lidocaine (1.5 mg/kg), 50 in the dexamethasone (8 mg), and 49 in the control groups were analyzed. The data were collected using observation based on structured questionnaires. A systematic random sampling technique was applied to select respondents. The data were entered into EpiData version 4.6.0.6 and transferred to STATA version 17 statistical software for analysis. A comparison of continuous data among the groups were performed using a one-way ANOVA test for parametric data. The Kruskal-Wallis rank test was used for non-parametric data. Associations between variables were tested using chi-squared test, Fisher's exact test, and binary logistic regression. Bivariable and multivariable logistic regression was used to determine degree of association., Results: The incidence of POST was 40%, 32%, and 57.1% in the lidocaine, dexamethasone, and control groups, respectively (P = .0356). Dexamethasone reduced the incidence of POST during the first 24 h (AOR: 0.374, 95% CI: 0.149-0.939). However, no difference was observed in the severity of POST at 3 h (p = 0.130), 6 h (p = 0.096), 12 h (p = 0.313), and 24 h (p = 0.525) of the post-extubation period among the three groups. IV lidocaine did not effectively reduce the incidence and severity of postoperative sore throat at different time intervals. CONCLUSION AND RECOMMENDATION: Intravenous dexamethasone is more effective than intravenous lidocaine in reducing the incidence of postoperative sore throat among the groups. Based on these findings, intravenous dexamethasone is recommended to decrease the incidence of postoperative sore throat., (© 2024. The Author(s).)

The management of wasting in Ethiopia is heavily reliant on the Community-based Management of Acute Malnutrition (CMAM) programme that has been implemented in more than 18,000 service delivery points scattered across the country. Despite the full-scale implementation of the CMAM, the number of child death averted, and the cost per child death averted remains unknown. This study aimed to estimate the cost and the number of child death averted by the CMAM programme between 2008 and 2020. Using data from routine monitoring of the CMAM programme, we estimated the excess mortality averted by the programme and estimated the cost per averted child death based on supply and labour. Over the past 13 years between 2008 and 2020, 3.6 million children under 5 years were admitted to the Ethiopian CMAM programme. The yearly average admission of 317,228 was achieved since 2011. On average, ~34,000 child deaths were averted yearly. The CMAM programme was estimated to have saved 437,654 (95% confidence interval [CI]: 320,161; 469,932) child deaths between 2008 and 2020, approximately 12% of the admitted cases. The average cost of the programme per adverted death was estimated at US$762/child death averted (95% CI = 639; 1001). The CMAM programme in Ethiopia is cost-effective and has continued to avert a significant number of child death. Given the high short- and long-term economic and health consequences of child wasting, concerted multi-sectoral efforts are needed to accelerate progress not only in its treatment but also in its prevention., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: Thrombocytopenia in pregnancy is a common multifactorial abnormality of the hematological system, next to anemia. It leads to more increased risk of bleeding during delivery, labour, or the postpartum period. Despite being a significant public health concern, there are limited studies done concerning thrombocytopenia during pregnancy., Objective: To assess the magnitude and associated factors of thrombocytopenia among pregnant women at Mizan Tepi University Teaching Hospital from September 2023 to November 2023., Methods: An institutional-based cross-sectional study was carried out on 230 systematic randomly selected pregnant women who attended antenatal visits from September 2023 to November 2023 G.C using data collection tools. The pretested structured questionnaires were employed to obtain clinical, nutritional, and sociodemographic information. Additionally, three millilitres of venous blood were collected from each participant and analyzed using a Sysmex hematology analyzer. The data was entered into Epidata version 4.6 and analyzed using STATA version 14. Descriptive statistics were computed, and logistic regression was used to identify predictors with a significance level of less than 0.05., Results: Two hundred thirty pregnant women participated in the study. Among study participants, the magnitude of thrombocytopenia was 55(24.35%) with 32 (57.14%) mild, 19 (33.93%) moderate, and 5 (8.93%) severe thrombocytopenia. The determinant factors which shown significant association were Malaria parasite infection (AOR 9.27 at 95% CI 7.42, 10.87), one-year Inter-birth interval (AOR 1.7 at 95% CI 1.24, 2.14), History of abortion (AOR 3.94 95% CI 3.13, 4.86), History of hypertension (AOR 3.12 95% CI 1.56, 4.12), HIV infection (AOR 1.81 95% CI 1.32.2.52) and HBV infection (AOR 3.0 95% CI 2.82, 3.34)., Conclusion: Thrombocytopenia is a public health problem and mild type of thrombocytopenia was the most predominant. The determinant factors that showed significant association with thrombocytopenia were Malaria Parasitic infection, one-year Inter-birth interval, History of abortion, History of hypertension, HIV infection, and HBV infection. Therefore, pregnant women should be continuously screened for thrombocytopenia to avoid excessive bleeding. Increasing Inter-birth interval, preventing abortion as well as timely diagnosis and treatment of underlying causes such as malaria infection, hypertension, HBV, and HIV is important to reduce the burden of thrombocytopenia., (© 2024. The Author(s).)

Superabsorbent polymers (SAPs) are a key constituent in baby diapers and adult incontinence products. To develop new SAPs, lab tests are used to measure properties that are considered important for these products. However, these manual tests are often time-consuming and tedious. This paper introduces an automatic method to measure absorption under pressure (aAUP) using industry robots. The new robotic method addresses limitations in an industry standard absorption under pressure (AUP) method. The new aAUP method can run continuously, generating more and better data to aid in product development. It enables to put the Buchholz theory on SAPs for predicting their properties to practice by reduction of manual effort and by producing excellent data quality. This has been shown on commercial polymers from different production processes, with varied particle size distributions and shapes. The aAUP data has also been shown to accurately predict other properties of SAPs relevant for their application in hygiene articles, making it a useful tool for understanding the underlying science and facilitating product development., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Wilson disease (WD) is a progressive, potentially fatal degenerative disease affecting the liver and central nervous system. Given its low prevalence, collecting data on large cohorts of patients with WD is challenging. Comprehensive insurance claims databases provide powerful tools to collect retrospective data on large numbers of patients with rare diseases., Aim: To describe patients with WD in the United States, their treatment and clinical outcome, using a large insurance claims database., Methods: This retrospective, longitudinal study was performed in the Clarivate Real-World Data Product database . All patients with ≥ 2 claims associated with an International Classification of Diseases 10 (ICD-10) diagnostic code for WD (E83.01) between 2016 and 2021 were included and followed until death or study end. Patients were divided into two groups by whether or not they were documented to have received a specific treatment for WD. Clinical manifestations, hospitalisations, liver transplantation and death were documented., Results: Overall, 5376 patients with an ICD-10 diagnostic code for WD were identified. The mean age at inclusion was 41.2 years and 52.0% were men. A specific WD treatment was documented for 885 patients (15.1%), although the number of patients taking zinc salts may be underestimated due to over the counter purchase. At inclusion, the mean age of patients with a documented treatment was 36.6 ± 17.8 years vs 42.2 ± 19.6 years in those without a documented treatment. During follow-up, 273 patients (5.1%) died. Compared with the American general population, the standardised mortality ratio was 2.19. The proportion of patients with a documented WD-specific treatment who died during follow-up was 4.0% and the mean age at death 52.7 years., Conclusion: Patients treated for WD in the United States had an excess early mortality compared with the American population. These findings indicate that there is a significant unmet need for effective treatment for WD in the United States., Competing Interests: Conflict-of-interest statement: TDR, BB and JPC are employees and shareholder of Vivet Therapeutics, a biotechnology company involved in the development of gene therapies for rare diseases, including Wilson’s disease. PK is an employee of Clarivate, a company which owns the RWD database and which performed the analysis on behalf of Vivet Therapeutics., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Nonclassical crystallization represents an innovative pathway that utilizes nanoparticles, enabling the generation of single crystals, going beyond a classical mechanism dependent on atoms, ions, or molecules. Our investigation has revealed hierarchical structures emerging via the aggregation and fusion of primary silicon quantum dots (SiQDs). In contrast to the classical ion-by-ion crystallization process, the primary SiQDs initially undergo aggregation, followed by fusion and their subsequent crystallization, leading to the ultrafast crystal growth of sodium hexafluorosilicate (SHFS) microrods with diverse morphologies. A comprehensive fluorescence microscopy study is performed to examine the mechanism of microrod formation through the primary aggregation and fusion of SiQDs at room temperature in the presence of hydrogen fluoride (HF). The different concentrations of HF play a crucial role in the formation of flower-, block-, and hexagonal-shaped SHFS microrods. However, the presence of a high-concentration HF causes a reduction in microrod size, elucidated through a range of analytical and spectroscopic techniques., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Green hydrogen from water electrolysis is a key driver for energy and industrial decarbonization. The prediction of the future green hydrogen cost reduction is required for investment and policy-making purposes but is complicated due to a lack of data, incomplete accounting for costs, and difficulty justifying trend predictions. A new AI-assisted data-driven prediction model is developed for an in-depth analysis of the current and future levelized costs of green hydrogen, driven by both progressive and disruptive innovations. The model uses natural language processing to gather data and generate trends for the technological development of key aspects of electrolyzer technology. Through an uncertainty analysis, green hydrogen costs have been shown to likely reach the key target of <$2.5 kg -1 by 2030 via progressive innovations, and beyond this point, disruptive technological developments are required to affect significantly further decease cost. Additionally, the global distribution of green hydrogen costs has been calculated. This work creates a comprehensive analysis of the levelized cost of green hydrogen, including the important balance of plant components, both now and as electrolyzer technology develops, and offers a likely prediction for how the costs will develop over time., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wambui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Highly stable nitrogen-doped Graphene Quantum Dots (N-GQD) functionalized with Pamoic Acid (PA@N-GQD) are utilized for nanomolar detection of radioactive elements, Uranium (VI) and Thorium (IV), in pH ± 5.0. The absorption, fluorescence, crystalline nature, elemental composition, functional groups, and morphological state of as-prepared PA@N-GQD are evaluated by UV-visible absorption, photoluminescence, XRD, XPS, FTIR, HRTEM, FESEM, and AFM characterizations. The aqueous solution of PA@N-GQD is characterized by its spherical morphology, averaging 6.5 nm in size. PA@N-GQD exhibits a gradual decrease in fluorescence intensity at 438 nm (λ ex 344 nm) upon the addition of Uranium (VI) and Thorium (IV) ions. The selectivity, sensitivity, competitivity, pH, time effect, and reversibility studies of PA@N-GQDs have been carried out using the photoluminescence technique. The attained fluorescence Limit of Detection (LoD) of PA@N-GQD for Uranium (VI) and Thorium (IV) ions are 2.009 × 10 -9 and 1.351 × 10 -9  M, respectively. From the fluorescence titration studies of U(VI) and Th(IV), the binding constant, Stern-Volmer constant, Modified Stern-Volmer constant, association constant, and dissociation constants have been calculated separately. These aforementioned results indicate that the PA@N-GQD has a higher binding affinity towards Th(IV) than U(VI) in aqueous medium. This current research represents the development of advanced materials for environmental and analytical applications, specifically focusing on the precise detection and quantification of radioactive elements., Competing Interests: Declaration of competing interest We the undersigned declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We understand that the Corresponding Author is the sole contact for the Editorial process. He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Abstract: Code status (CS) is often overlooked while admitting patients to the hospital. This is important for patients with end-stage disease. This quality improvement project investigated whether a CS pop-up alert in the electronic medical record, combined with provider education, improved addressing CS. The project consisted of a baseline chart review, implementation of the alert and physician education, and a postintervention chart review. We reviewed 1828 charts at baseline and 1,775 at postintervention. From univariable analysis, there were improvements in addressing CS, being full code, cardiopulmonary resuscitation, intubation, use of vasopressors, and cardioversion technique categories (all p < .001). Documentation of do not resuscitate did not change. From logistic regression, after controlling for age, race, end-stage liver disease, stroke, cancer, hospital unit, and sepsis, patients in the postintervention period were two times more likely to have CS addressed (odds ratio [OR] = 2.04, p < .001). There was a significant improvement in CS documentation from our interventions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 National Association for Healthcare Quality.)

Introduction: Elderly individuals are the segment of the population that needs special care. The quality of care provided for elderly individuals is highly determined by the knowledge of nurses in elderly care. Hence, there are limited studies conducted to determine the level of knowledge of nurses regarding elderly care. Therefore, this study aimed to assess determinant factors of nurses' knowledge of elderly care., Methods: A facility-based cross-sectional study design was employed from April 1 to 10, 2021, among 345 nurses. Respondents were selected by a simple random sampling technique. The data were collected through a self-administered structured questionnaire. The collected data were entered and analyzed by using Statistical Package for Social Science software version 25.0. A multivariable binary logistic regression was used to identify factors significantly associated with the knowledge of nurses about elderly care., Result: The response rate of this study was 98.3%. More than half of the respondents were female (51.6%) and 38.3% were single in marital status. Being knowledgeable among nurses about elderly care was 51.9%. Ever living with the elderly (adjusted odd ratio [AOR]: 3.62; 95% CI: 1.661, 7.89) and taking geriatric care training (AOR: 5.209, 95% CI: 2.771, 9.79) were positively associated with the knowledge of nurses toward elderly care while work experience <5 years (AOR: 0.305; 95% CI: 0.134, 0,696), and work experience 5-10 years (AOR: 0.359; 95% CI: 0.15, 0.864) were negatively associated with the knowledge of nurses toward elderly care., Conclusion: The knowledge of nurses about elderly care was moderate. Ever lived with the elderly, work experience, and taking geriatric care training contributed to nurses' knowledge about elderly care. Therefore, hospital administrators and the Ministry of Health should facilitate training, design, and implement standard guidelines on nursing practice for elderly care., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

To reduce TB deaths, Tamil Nadu, a southern Indian state, implemented the first state-wide differentiated TB care strategy starting April 2022. Triage-positive severely ill patients are prioritised for comprehensive assessment and inpatient care. Routine program data during October-December 2022 revealed that documentation of total score after comprehensive assessment was available in only 39%, possibly indicating poor quality of comprehensive assessment. We confirmed this using operational research. The case record form to record comprehensive assessment was used only in 26% and among these, the completeness and correctness in filling out the form were sub-optimal. There is a clear need to enhance the quality of comprehensive assessments., Competing Interests: Conflict of interest: none declared., (© 2024 The Authors.)

For cyclic conjugated structures, erratic computational results have been obtained with Hartree-Fock (HF) molecular orbital (MO) methods as well as density functional theory (DFT) with large HF-exchange contributions. In this work, the reasons for this unreliability are explored. Extensive computations on [18]annulene and related compounds highlight the pitfalls to be avoided and the due diligence required for such computational investigations. In particular, a careful examination of the MO singlet-stability eigenvalues is recommended. The appearance of negative eigenvalues is not (necessarily) problematic, but near-zero (positive or negative) eigenvalues can lead to dramatic errors in vibrational frequencies and related properties. DFT approaches with a lower HF admixture generally appear more robust in this regard for the description of benzenoid structures, although they may exaggerate the tendency toward planarity and C-C bond-equalization. For the iconic [18]annulene, the results support a nonplanar equilibrium structure. The density-fitted frozen natural orbital coupled-cluster singles and doubles with perturbative triples [DF-FNO CCSD(T)] method of electron correlation with an aug-pVQZ/aug-pVTZ basis set places the C 2 global minimum 1.1 kcal mol -1 below the D 6 h stationary point.

Purpose: To compare the risks of adverse outcomes, including mortality, gastrointestinal bleeding, and venous thromboembolism, between COVID-19 patients with inflammatory bowel disease (IBD) and those without IBD., Methods: We analyzed data from the National Inpatient Sample between January and December 2020. The study included adult patients with Crohn's disease (CD) and ulcerative colitis (UC) who contracted COVID-19. Inpatient outcomes were compared between the IBD and non-IBD COVID-19 cohorts., Results: Out of 1,050,045 COVID-19 hospitalizations, 0.28% had CD (2954 patients) and 0.26% had UC (2794 patients). After adjusting for confounding factors, UC patients had a significantly higher risk of deep vein thrombosis compared to non-IBD patients, with an adjusted odds ratio (aOR) of 2.55 ( P  < 0.001). However, CD patients did not show a significant association with deep vein thrombosis (aOR 1.29, P  = 0.329). There were no significant associations between IBD patients (both UC and CD) and pulmonary embolism, nonvariceal gastrointestinal bleeding, or in-hospital mortality. UC patients had a longer average hospital stay (8.25 days) compared to non-IBD patients (adjusted mean difference 0.89, P  = 0.007). Healthcare resource utilization was similar among the three groups., Conclusion: Our national study on COVID-19 hospitalizations indicates that patients with IBD have comparable rates of gastrointestinal bleeding, pulmonary embolism, and mortality as those without IBD. However, patients with UC hospitalized with COVID-19 have a higher risk of deep vein thrombosis than COVID-19 patients hospitalized without UC. Further research is needed to better understand the relationship between COVID-19 and IBD., Competing Interests: The authors report no funding or conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Objective: To evaluate the effects of liposomal bupivacaine use for interscalene blocks on postoperative analgesia in total shoulder arthroplasty patients., Methods: De-identified total or reverse total shoulder arthroplasty patients between 2018 and 2021 were analyzed. Patients were grouped into single shot interscalene block with liposomal bupivacaine (LB) with plain bupivacaine, other block (OB) with other local anesthetics (mepivacaine, ropivacaine, or plain bupivacaine), or no block (NB). The primary outcome was the proportion of patients with clinically tolerable pain scores (mean VAS ≤4) from 0 to 24 ​h in each group. Secondary outcomes included averaged visual analog pain scores (VAS) and opioid consumption measured in morphine milligram equivalents (MMEs) from 0 to 24 ​h. We also analyzed the proportion of patients with clinically tolerable pain, mean VAS, and opioid consumption from 0 to 72 ​h in those patients with at least a 3-day hospital length of stay., Results: A total of 491 de-identified total shoulder arthroplasty patients, 285 liposomal bupivacaine group (LB), 178 other block group (OB), and 28 no block group (NB), were analyzed. The primary outcome showed a statistically significant different proportion of patients with clinically tolerable pain from 0 to 24 ​h in the LB group (69 ​%) vs. OB group (39 ​%) vs. NB group (11 ​%) (<0.001). Secondary outcomes included statistically significant differences in VAS (LB median ​= ​3.35, OB median ​= ​4.38, NB median ​= ​5.25 (p ​< ​0.001, <0.001)) and total MME opioid consumption (LB median ​= ​40, OB median ​= ​60, NB median ​= ​88 (p ​< ​0.001, 0.001)) between groups from 0 to 24 ​h. For patients who had hospital stays of at least 3 days, a significant association was found with having achieved clinically tolerable pain 0-72 ​h and the LB group (51 ​%) vs. OB group (21 ​%) vs. NB group (11 ​%) (P ​= ​0.006). However, there was no statistical difference in mean VAS or opioid consumption between these groups., Conclusion: A greater proportion of total shoulder arthroplasty patients that received liposomal bupivacaine in interscalene block have clinically tolerable pain scores from 0 to 24 ​h, lower VAS, and lower MME consumption in patients following total shoulder arthroplasty., Level of Evidence: Level III - Clinical Study., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

Accurate modeling of the response of molecular systems to an external electromagnetic field is challenging on classical computers, especially in the regime of strong electronic correlation. In this article, we develop a quantum linear response (qLR) theory to calculate molecular response properties on near-term quantum computers. Inspired by the recently developed variants of the quantum counterpart of equation of motion (qEOM) theory, the qLR formalism employs "killer condition" satisfying excitation operator manifolds that offer a number of theoretical advantages along with reduced quantum resource requirements. We also used the qEOM framework in this work to calculate the state-specific response properties. Further, through noiseless quantum simulations, we show that response properties calculated using the qLR approach are more accurate than the ones obtained from the classical coupled-cluster-based linear response models due to the improved quality of the ground-state wave function obtained using the ADAPT-VQE algorithm.

Acute febrile diseases transmitted by mosquitos are a diagnostic challenge for pediatricians working in sub-Saharan Africa. Misclassification due to the lack of rapid, reliable diagnostic tests leads to the overuse of antibiotics and antimalarials. Children presenting with acute fever and suspected of having malaria were examined at health care facilities in the Mwanza Region of Tanzania. The sensitivity and specificity of blood smear microscopy and malaria rapid diagnostic tests that targeted histidine-rich protein 2 and Plasmodium lactate dehydrogenase were compared with a multiplex reverse transcriptase-polymerase chain reaction (PCR)-ELISA. Six hundred ninety-eight children presented with acute fever and met the criteria for inclusion; 23% received antibiotics and 23% received antimalarials prior to admission. Subsequently, 20% were confirmed by PCR to have Plasmodium falciparum infection. Blood smear microscopy exhibited 33% sensitivity and 93% specificity. The malaria rapid test provided 87% sensitivity and 98% specificity in detecting acute malaria infections. Only 7% of malaria-negative children received antimalarials at Sengerema Designated District Hospital when treatment was guided by the results of rapid testing. In contrast, 75% of malaria-negative patients were treated with antimalarial drugs at health facilities that used blood smears as the standard diagnostic test. Misclassification and premedication of nonmalarial, febrile illnesses contribute to the emergence of antimalarial and antimicrobial resistance. The incorporation of malaria rapid diagnostic tests into the clinical routine translated into improved treatment and a significant reduction in antimalarial drug prescriptions.

Hyaline protoplasmic astrocytopathy (HPA) describes a rare histologic finding of eosinophilic, hyaline cytoplasmic inclusions in astrocytes, predominantly in the cerebral cortex. It has mainly been observed in children and adults with a history of developmental delay and epilepsy, frequently with focal cortical dysplasia (FCD), but the nature and significance of these inclusions are unclear. In this study, we review the clinical and pathologic features of HPA and characterize the inclusions and brain tissue in which they are seen in surgical resection specimens from five patients with intractable epilepsy and HPA compared to five patients with intractable epilepsy without HPA using immunohistochemistry for filamin A, previously shown to label these inclusions, and a variety of astrocytic markers including aldehyde dehydrogenase 1 family member L1 (ALDH1L1), SRY-Box Transcription Factor 9 (SOX9), and glutamate transporter 1/excitatory amino acid transporter 2 (GLT-1/EAAT2) proteins. The inclusions were positive for ALDH1L1 with increased ALDH1L1 expression in areas of gliosis. SOX9 was also positive in the inclusions, although to a lesser intensity than the astrocyte nuclei. Filamin A labeled the inclusions but also labeled reactive astrocytes in a subset of patients. The immunoreactivity of the inclusions for various astrocytic markers and filamin A as well as the positivity of filamin A in reactive astrocytes raise the possibility that these astrocytic inclusions may be the result of an uncommon reactive or degenerative phenomenon., (© 2023 The Authors. Neuropathology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Neuropathology.)

Background: Aphallia (absent penis) is an extremely rare congenital anomaly happening in 1 in 30 million births worldwide. It can occur alone or in combination with other congenital anomalies., Case Presentation: A two-day-old neonate presented to Arba Minch General Hospital with an absent penis. The delivery was performed at home by a 34-year-old primigravida mother with no antenatal follow-up. As the mother described, the baby cried immediately after birth. The baby was sucking initially but failed to suck hours after delivery. The neonate died of neonatal distress syndrome after two hours of resuscitation., Conclusion: Aphallia is a complex, extremely rare congenital anomaly that is commonly associated with other congenital anomalies. Sometimes, it may be associated with a lethal anomaly and requires sophisticated workup to diagnose and treat grave anomalies early., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Daniel and Abera.)

Real-time coupled cluster (CC) methods have several advantages over their frequency-domain counterparts, namely, response and equation of motion CC theories. Broadband spectra, strong fields, and pulse manipulation allow for the simulation of complex spectroscopies that are unreachable using frequency-domain approaches. Due to the high-order polynomial scaling, the required numerical time propagation of the CC residual expressions is a computationally demanding process. This scaling may be reduced by local correlation schemes, which aim to reduce the size of the (virtual) orbital space by truncation according to user-defined parameters. We present the first application of local correlation to real-time CC. As in previous studies of locally correlated frequency-domain CC, traditional local correlation schemes are of limited utility for field-dependent properties; however, a perturbation-aware scheme proves promising. A detailed analysis of the amplitude dynamics suggests that the main challenge is a strong time dependence of the wave function sparsity.

Acute febrile syndrome is a frequent reason for medical consultations in tropical and subtropical countries where the cause could have an infectious origin. Malaria and dengue are the primary etiologies in Colombia. As such, constant epidemiological surveillance and new diagnostic tools are required to identify the causative agents. A descriptive cross-sectional study was conducted to evaluate the circulation and differential diagnosis of six pathogens in two regions of Colombia. The results obtained via multiplex reverse transcription polymerase chain reaction combined with a microwell hybridization assay (m-RT-PCR-ELISA) were comparable to those obtained using rapid tests conducted at the time of patient enrollment. Of 155 patients evaluated, 25 (16.1%) and 16 (10.3%) were positive for malaria and dengue, respectively; no samples were positive for any of the other infectious agents tested. In most cases, m-RT-PCR-ELISA confirmed the results previously obtained through rapid testing.

Mn-doped CdTe (Mn-CdTe) quantum dot (QD) as well as quantum dot solid (QD solid) nanostructures are formed and the established structures are confirmed through HR-TEM analysis. The dynamics of charge carriers in both doped & undoped QD and QD solid structures were investigated by transient absorption (TA) spectroscopy. A slow band edge bleach recovery is obtained for Mn-doped CdTe QD and CdTe QD solid systems at room temperature. Additionally, a blue shifted broad bleach behaviour is identified for the Mn-CdTe QD solid system, which is attributed to hot exciton formation in the solid upon photoexcitation with a higher photon energy than the band gap energy ( hν > E g ). This noteworthy process of generation of hot excitons and slow charge recombination occurs by means of a synergetic action of the Mn dopant in the host CdTe QD solid system as well as the extended electronic wave function between the coupled QD solid. Apart from the Mn-assisted delayed relaxation of hot electrons in the QD solid, a suppression in dark current as well as a high I ON / I OFF ratio of 3203.12 at 1 V is observed in the Mn-CdTe QD-solid based photosensitized device in the visible region. Furthermore, we were able to improve the UV photon harvesting property in a narrow band gap Mn-CdTe QD solid through reducing the higher excited carrier's energy losses.

Background: Informed consent discussions are individualized not only with regard to the patients' surgical condition and goals but also with their varying information needs, health literacy, and anxiety. Information is lacking regarding the views of patients and concerned healthcare professionals on the informed consent process., Objective: This study is aimed to explore patients' and healthcare professionals' perceived barriers during informed consent process and identify suggested solutions for improvement., Methods: Patients who underwent elective surgery, anesthetists, and surgeons were the subjects of a qualitative study employing focused group discussions and in-depth interviews. The study participants were chosen through the use of purposeful sampling., Results: The main barriers identified by the patients include: inadequate explanation about the intended procedure, family's influence in the decision-making, fear of surgery, fear of light/power interruption, inadequate time for discussion, and not letting the family members attend the discussion. On the other hand, healthcare professionals also identified various barriers, which includes: inability of patients to understand the information, limited time to discuss with patients in detail, poorly designed informed consent form, poor awareness of patients, fear of patient refusal for surgery if the risks and associated health problems are explained, lack of adequate investigation to confidently explain about the disease condition, use of medical jargons, poor documentation habit of professionals and lack of legal system regarding ethical dilemmas., Conclusions and Recommendation: Patients and healthcare professionals have identified avoidable barriers that need the attention of concerned health professionals, educators, and the healthcare delivery system., Competing Interests: The authors report no competing of interests in this study., (© 2023 Negash et al.)