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Growing human population is a solemn risk to biodiversity at a global level. Massive anthropogenic pressure and invasion in the natural habitats initiated the human-wildlife conflict in rural areas. Present study aimed to assess human-wildlife conflict in Musk Deer National Park (MDNP) from 2013 to 2018. Results revealed an estimated 241784 nomadic and 5589 residential livestock heads grazed in different areas of MDNP during the summer season. A total of 126 heads were depredated by carnivores during the study period. Majority (n=39) of livestock heads were killed in May (n=29). Livestock depredation resulted in economic losses worth 3.115 million PKRs (25744 US$) to the herder community while farmers received 1.629 million PKRs (13466 US$) losses due to crop raiding. Most (64%) of the respondents believed human-wildlife conflict heightened due to scarcity of food or prey in the natural habitats of carnivores. Majority (92%) of the respondents did not like the presence of predators in MDNP. Loss compensation schemes could turn this negative attitude into the positive one and increase tolerance about the presence of carnivores in their vicinity. This study provides an insight into the human-wildlife conflict in MDNP and paves a way for understanding the conflict and conservation of carnivore species in the study area. Resumo O crescimento da população humana é um risco solene para a biodiversidade em nível global. A pressão antrópica maciça e a invasão nos habitats naturais iniciaram o conflito homem-vida selvagem nas áreas rurais. O presente estudo teve como objetivo avaliar o conflito entre humanos e animais selvagens no Parque Nacional Musk Deer (MDNP) de 2013 a 2018. Os resultados revelaram uma estimativa de 241.784 cabeças de gado nômades e 5.589 residenciais pastando em diferentes áreas do MDNP durante a temporada de verão. Um total de 126 cabeças foi depredado por carnívoros durante o período de estudo. A maioria (n = 39) das cabeças de gado foi morta em maio (n = 29). A depredação do gado resultou em perdas econômicas no valor de 3,115 milhões de PKRs (US$ 25.744) para a comunidade de pastores, enquanto os agricultores receberam 1,629 milhões de PKRs (US$ 13.466) perdas devido à invasão de plantações. A maioria (64%) dos entrevistados acredita que o conflito entre humanos e animais selvagens aumentou devido à escassez de alimentos ou presas nos habitats naturais dos carnívoros. A maioria (92%) dos entrevistados não gostou da presença de predadores no MDNP. Esquemas de compensação de perdas podem transformar essa atitude negativa em positiva e aumentar a tolerância com a presença de carnívoros em suas proximidades. Este estudo fornece uma visão sobre o conflito homem-vida selvagem no MDNP e abre caminho para a compreensão do conflito e conservação de espécies carnívoras na área de estudo.

Non-obstructive azoospermia is reported to affect 1 in 100 men, and despite advances in surgical practice, the succesful sperm retrieval rate for microdissection testicular sperm extraction surgery (mTESE) is only 46%. This article reviews the potential causes for mTESE failure and provides a management strategy to guide the clinicians on how to treat this challenging cohort of patients.

Objective: To corelate the Hb F levels with clinical parameters of patients with sickle cell disease and sickle beta thalassemia. Study Design: Cross Sectional study. Setting: Chughtai Institute of Pathology. Period: June 2020 to December 2021. Material & Methods: A total of 150 diagnosed cases of sickle cell disease and sickle beta thalassemia were included in the study. Hemoglobin electrophoresis was performed and Hb F levels were noted. Detailed history of patients regarding their complications was taken. Data analysis was done using SPSS 23.0. Correlation of Hb F with Hb levels, splenomegaly, other symptoms and number of transfusions required was observed using Pearson test taking P value

Today we are heading toward materialistic progress at the cost of our health, physical as well as mental. In this blind pursuit, instead of peace we end up in stressed life. Unfortunately, neither we understand that we are under stress nor get any trainingof stress management while we study or work. In this modern world there are many diseases, disorders and complications but some complications are commonest and almost each and every human being in this modern world has it, it is stress, depression and there are many medications which claims to get relief from it but only for some duration and that too has some of its side effects but, “OM” (AUM)chanting is such a traditional practice which has beneficial effects not just in relieving stress and depressionbut can also give relief from many mental and physical complications and has of course no side effects and once if learnt properly do not need any guidance. Regularly chanting of OM) can be used in daily lifestyle can be more beneficial.Present review compiles the studies which evaluated that chanting OM mantrahas the positive effect on the human health

Women who conceive through assisted reproductive technology (ART) have a known increased risk of obstetric complications. However, whether ART is also associated with higher risk of developing cardiovascular complications during delivery admissions has not been well established. We used data from the National Inpatient Sample (2008 to 2019) and used the International Classification of Diseases codes to identify delivery hospitalizations and ART procedures. A total of 45,867,086 weighted delivery cases were identified, of which 0.24% were among women who conceived through ART (n = 108,542). Women with an ART history were older at the time of delivery (median 35 vs 28 years, p0.01) and had a higher prevalence of hypertension, gestational diabetes, and dyslipidemia (all, p0.01). After adjustment for age, race/ethnicity, co-morbidities, multiple gestation, insurance, and income, ART remained an independent predictor of peripartum cardiovascular complications, including pre-eclampsia/eclampsia (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.45 to 1.51), heart failure (aOR 1.94, 95% CI 1.10 to 3.40), and cardiac arrhythmias (aOR 1.39, 95% CI 1.30 to 1.48), compared with natural conception. Likewise, the risk of acute kidney injury (aOR 2.57, 95% CI 2.25 to 2.92), ischemic stroke (aOR 1.73, 95% CI 1.24 to 2.43), hemorrhagic stroke (aOR 1.63, 95% CI 1.27 to 2.11), pulmonary edema (aOR 2.29, 95% CI 2.02 to 2.61), and venous thromboembolism (aOR 1.92, 95% CI 1.63 to 2.25) were higher with ART. However, odds of developing peripartum cardiomyopathy or acute coronary syndrome were not associated with ART. Length of stay (3 vs 2 days, p0.01) and cost of hospitalization ($5,903 vs $3,922, p0.01) were higher for deliveries among women with a history of ART. In conclusion, women who conceived with ART had higher risk of pre-eclampsia, heart failure, arrhythmias, stroke, and other complications during their delivery hospitalizations. This may, in part, contribute to their increased resource utilization seen.

Among people who inject drugs (PWID), 60% have HCV and 50-90% of HIV-infected PWID are co-infected with HCV. Data comparing adherence to direct-acting antiviral (DAA) therapy among HCV mono-infected and HIV/HCV co-infected PWID is limited. The impact of HCV treatment initiation on HIV antiretroviral therapy (ART) adherence is also poorly understood. We assessed DAA adherence in HCV mono-infected and HIV/HCV co-infected PWID and examined changes in ART adherence and HIV outcomes following HCV treatment. Study was conducted in three Medication for Opioid use Disorder (MOUD) programs in Bronx, New York. HCV treatment adherence was measured using electronic blister packs. 2-week DAA adherence rates were compared and controlled for study arm, psychiatric illness and alcohol intoxication within the past 30 days. ART adherence was measured using participant self-report and dichotomized to "excellent" or "other". ART adherence, CD4 count, and HIV viral load were identified six months prior to, during, and six months after HCV treatment. Statistical significance was assessed with mixed-effects regression linear or logistic models. Overall DAA adherence rates among HCV mono-infected and HIV/HCV co-infected PWID were 74% (95% CI=71-78%) and 76% (95%CI=70-83%), respectively (p=.55). There were no significant changes in ART adherence, CD4 counts, or HIV viral loads prior to, during, or after HCV treatment. This is the first study assessing the impact of DAA therapy on ART adherence and HIV treatment outcomes among PWID. It is one of the first to compare DAA adherence among HCV and HIV/HCV co-infected PWID. Our data demonstrate no significant difference in DAA adherence and no significant impact of HCV treatment on ART adherence or HIV outcomes.

BACKGROUND The beneficial effects of hormonal therapy in stimulating spermatogenesis in patients with non-obstructive azoospermia (NOA) and either normal gonadotrophins or hypergonadotropic hypogonadism prior to surgical sperm retrieval (SSR) is controversial. Although the European Association of Urology guidelines state that hormone stimulation is not recommended in routine clinical practice, a significant number of patients undergo empiric therapy prior to SSR. The success rate for SSR from microdissection testicular sperm extraction is only 40–60%, thus hormonal therapy could prove to be an effective adjunctive therapy to increase SSR rates. OBJECTIVE AND RATIONALE The primary aim of this systematic review and meta-analysis was to compare the SSR rates in men with NOA (excluding those with hypogonadotropic hypogonadism) receiving hormone therapy compared to placebo or no treatment. The secondary objective was to compare the effects of hormonal therapy in normogonadotropic and hypergonadotropic NOA men. SEARCH METHODS A literature search was performed using the Medline, Embase, Web of Science and Clinicaltrials.gov databases from 01 January 1946 to 17 September 2020. We included all studies where hormone status was confirmed. We excluded non-English language and animal studies. Heterogeneity was calculated using I2 statistics and risk of bias was assessed using Cochrane tools. We performed a meta-analysis on all the eligible controlled trials to determine whether hormone stimulation (irrespective of class) improved SSR rates and also whether this was affected by baseline hormone status (hypergonadotropic versus normogonadotropic NOA men). Sensitivity analyses were performed when indicated. OUTCOMES A total of 3846 studies were screened and 22 studies were included with 1706 participants. A higher SSR rate in subjects pre-treated with hormonal therapy was observed (odds ratio (OR) 1.96, 95% CI: 1.08–3.56, P = 0.03) and this trend persisted when excluding a study containing only men with Klinefelter syndrome (OR 1.90, 95% CI: 1.03–3.51, P = 0.04). However, the subgroup analysis of baseline hormone status demonstrated a significant improvement only in normogonadotropic men (OR 2.13, 95% CI: 1.10–4.14, P = 0.02) and not in hypergonadotropic patients (OR 1.73, 95% CI: 0.44–6.77, P = 0.43). The literature was at moderate or severe risk of bias. WIDER IMPLICATIONS This meta-analysis demonstrates that hormone therapy is not associated with improved SSR rates in hypergonadotropic hypogonadism. While hormone therapy improved SSR rates in eugonadal men with NOA, the quality of evidence was low with a moderate to high risk of bias. Therefore, hormone therapy should not be routinely used in men with NOA prior to SSR and large scale, prospective randomized controlled trials are needed to validate the meta-analysis findings.

Metallic nanoparticles have received a significant amount of reflection over a period of time, attributed to their electronic, specific surface area, and surface atom properties. The biogenic synthesis of iron oxide nanoparticles (FeONPs) is demonstrated in this study. The green synthesis of metallic nanoparticles (NPs) is acquiring considerable attention due to its environmental and economic superiorities over other methods. Leptolyngbya sp. L-2 extract was employed as a reducing agent, and iron chloride hexahydrate (FeCl3·6H2O) was used as a substrate for the biogenic synthesis of FeONPs. Different spectral methods were used for the characterization of the biosynthesized FeONPs, ultraviolet-visible (UV-Vis) spectroscopy gave a surface plasmon resonance (SPR) peak of FeONPs at 300 nm; Fourier transform infrared (FTIR) spectral analysis was conducted to identify the functional groups responsible for both the stability and synthesis of FeONPs. The morphology of the FeONPs was investigated using scanning electron microscopy (SEM), which shows a nearly spherical shape, and an X-ray diffraction (XRD) study demonstrated their crystalline nature with a calculated crystallinity size of 23 nm. The zeta potential (ZP) and dynamic light scattering (DLS) measurements of FeONPs revealed values of −8.50 mV, suggesting appropriate physical stability. Comprehensive in-vitro pharmacogenetic properties revealed that FeONPs have significant therapeutic potential. FeONPs have been reported to have potential antibacterial and antifungal properties. Dose-dependent cytotoxic activity was shown against Leishmania tropica promastigotes (IC50: 10.73 µg/mL) and amastigotes (IC50: 16.98 µg/mL) using various concentrations of FeONPs. The cytotoxic potential was also investigated using brine shrimps, and their IC50 value was determined to be 34.19 µg/mL. FeONPs showed significant antioxidant results (DPPH: 54.7%, TRP: 49.2%, TAC: 44.5%), protein kinase (IC50: 96.23 µg/mL), and alpha amylase (IC50: 3745 µg/mL). The biosafety of FeONPs was validated by biocompatibility tests using macrophages (IC50: 918.1 µg/mL) and red blood cells (IC50: 2921 µg/mL). In conclusion, biogenic FeONPs have shown potential biomedical properties and should be the focus of more studies to increase their nano-pharmacological significance for biological applications.

Due to industrial advancement, a variety of toxic chemicals including metals are released into the aquatic environment which not only disturbs the physico-chemical properties of the water bodies but also influences the aquatic food chain to cause physiological and cytogenetic alternations in the aquatic animals. Metals have the ability to produce reactive oxygen species (ROS) that would cause the oxidative of nucleic acid. Micronucleus test has been commonly used for the estimation of biological impacts of water pollutants on genotoxic damage in fish. Therefore, the present research work was designed to check the genotoxic potential of cobalt for fish Cirrhinus mrigala by using a micronuclei assay. Fish were exposed to the various sub-lethal concentrations of cobalt metal such as 2/3rd, 1/3rd, 1/4th, and 1/5th of LC50 concentration for one month and sampling was done after 10 days intervals. Blood sample from the caudal vein of fish was collected to see the micronuclei and binucleated nuclei. Results showed that all test concentrations induced micronuclei and binucleated nuclei in peripheral erythrocytes of C. mrigala. Maximum nuclear abnormalities in peripheral erythrocytes of C. mrigala were observed in 2/3rd concentration followed by the orders: 1/3rd 1/4th 1/5th.Due to industrial advancement, a variety of toxic chemicals including metals are released into the aquatic environment which not only disturbs the physico-chemical properties of the water bodies but also influences the aquatic food chain to cause physiological and cytogenetic alternations in the aquatic animals. Metals have the ability to produce reactive oxygen species (ROS) that would cause the oxidative of nucleic acid. Micronucleus test has been commonly used for the estimation of biological impacts of water pollutants on genotoxic damage in fish. Therefore, the present research work was designed to check the genotoxic potential of cobalt for fish Cirrhinus mrigala by using a micronuclei assay. Fish were exposed to the various sub-lethal concentrations of cobalt metal such as 2/3rd, 1/3rd, 1/4th, and 1/5th of LC50 concentration for one month and sampling was done after 10 days intervals. Blood sample from the caudal vein of fish was collected to see the micronuclei and binucleated nuclei. Results showed that all test concentrations induced micronuclei and binucleated nuclei in peripheral erythrocytes of C. mrigala. Maximum nuclear abnormalities in peripheral erythrocytes of C. mrigala were observed in 2/3rd concentration followed by the orders: 1/3rd 1/4th 1/5th.

The present study aims to investigate the impact of tourism on the economic growth of the South Asian region. By employing panel data of six South Asian economies spanning from 1998 to 2017, our empirical investigation relies upon the panel cointegration and Fully Modified Ordinary Least Squares (FMOLS) techniques. Consistent with the “Tourism Led Growth Hypothesis”, the results prove a significant positive and long-run association between tourism and economic growth. The novelty of our study is the presentation of two models which confirm that tourism is an independent accelerator of economic growth, and it performs the same role even in the presence of standard income determinants. These findings are robust when we apply alternate statistical techniques, such as, dynamic ordinary least square method and Granger Causality Test. It implies that the South Asian economies should focus on the development of the tourism sector with permanent development in public infrastructures, like public transport, airports, road system and telecommunication to surge their economic growth.

Purpose This paper aims to address a gap in investigating specific impacts of climate change on mental health in the Pacific region, a region prone to extreme events. This paper reports on a study on the connections between climate change, public health, extreme weather and climate events (EWEs), livelihoods and mental health, focusing on the Pacific region Islands countries. Design/methodology/approach This paper deploys two main methods. The first is a bibliometric analysis to understand the state of the literature. For example, the input data for term co-occurrence analysis using VOSviewer is bibliometric data of publications downloaded from Scopus. The second method describes case studies, which outline some of the EWEs the region has faced, which have also impacted mental health. Findings The results suggest that the increased frequency of EWEs in the region contributes to a greater incidence of mental health problems. These, in turn, are associated with a relatively low level of resilience and greater vulnerability. The findings illustrate the need for improvements in the public health systems of Pacific nations so that they are in a better position to cope with the pressures posed by a changing environment. Originality/value This paper contributes to the current literature by identifying the links between climate change, extreme events, environmental health and mental health consequences in the Pacific Region. It calls for greater awareness of the subject matter of mental health among public health professionals so that they may be better able to recognise the symptoms and relate them to their climate-related causes and co-determinant factors.

Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone (T)/estradiol (E2) ratio, is associated with worse CVD outcomes in women and might be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age.We performed a cross-sectional analysis of 2979 women with data on parity and endogenous sex hormone levels from the Multi-Ethnic Study of Atherosclerosis (MESA), a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥ 5. Our outcome measures were T, E2, sex hormone binding globulin, dehydroepiandrosterone, and T/E2 ratio. Progressively adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones.In multivariable adjusted models, there were no significant associations of parity with E2, dehydroepiandrosterone, and sex hormone binding globulin. Compared with nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥ 5 live births). However, grand multigravidity (≥ 5 pregnancies) was associated with 10% (95% confidence interval [CI], 1%-20%) higher T and 14% (95% CI, 1%-29%) higher T/E2, compared with null gravidity. Grand multiparity was associated with an 18% (95% CI, 4%-34%) higher T/E2 ratio compared with nulliparity, after adjustment for CVD risk factors.In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies on sex hormones' influence on the relationship between multiparity and CVD are warranted.

Purpose: Screening can help in early detection of osteoporosis and osteopenia and help in recommending appropriate treatment thus reducing fracture-related morbidity and mortality. The aim of this study was to assess the contributing factors to osteoporosis and osteopenia among out-patients aged above 55 years. Methodology: The study employed randomized clinical trials (RCTs). The identified patients were screened using bone tests such as DXA, quantitative ultrasound, and the Bone Mineral Density (BMD) as the standard. This was measured using the Calcaneal Quantitative Ultra Sound (QUS). The study also used a structured questionnaire to identify the socio-demographic profile of the patients and clinical risk assessments for osteoporosis or fracture risk. The sample size was 250 out-patients aged above 55 years. Findings: The study found out that lower back pain and knee pain were the common musculoskeletal presentations. It was evident that osteoporosis and osteopenia was common in out-patients who had low exposure to sunlight (71%). The study found that major contributing factors to osteoporosis and osteopenia are advanced age, low bone mineral density score, hysterectomy, gender, and educational status. Conclusion: The study conclude that people aged above 55 years are at high risk of suffering from osteoporosis and osteopenia. Recommendation: The study recommend people above 55 years to undergo screening to facilitate early detection of osteoporosis and osteopenia. This will help them in getting appropriate and timely management of symptoms and improve their quality of life.

Mitotic count in breast cancer is an important prognostic marker. Unfortunately, substantial inter- and intraobserver variation exists when pathologists manually count mitotic figures. To alleviate this problem, we developed a new technique incorporating both haematoxylin and eosin (HE) and phosphorylated histone H3 (PHH3), a marker highly specific to mitotic figures, and compared it to visual scoring of mitotic figures using HE only.Two full-face sections from 97 cases were cut, one stained with HE only, and the other was stained with PHH3 and counterstained with HE (PHH3-HE). Counting mitoses using PHH3-HE was compared to traditional mitoses scoring using HE in terms of reproducibility, scoring time, and the ability to detect mitosis hotspots. We assessed the agreement between manual and image analysis-assisted scoring of mitotic figures using HE and PHH3-HE-stained cells. The diagnostic performance of PHH3 in detecting mitotic figures in terms of sensitivity and specificity was measured. Finally, PHH3 replaced the mitosis score in a multivariate analysis to assess its significance.Pathologists detected significantly higher mitotic figures using the PHH3-HE (median ± SD, 20 ± 33) compared with HE alone (median ± SD, 16 ± 25), P 0.001. The concordance between pathologists in identifying mitotic figures was highest when using the dual PHH3-HE technique; in addition, it highlighted mitotic figures at low power, allowing better agreement on choosing the hotspot area (k = 0.842) in comparison with standard HE (k = 0.625). A better agreement between image analysis-assisted software and the human eye was observed for PHH3-stained mitotic figures. When the mitosis score was replaced with PHH3 in a Cox regression model with other grade components, PHH3 was an independent predictor of survival (hazard ratio [HR] 5.66, 95% confidence interval [CI] 1.92-16.69; P = 0.002), and even showed a more significant association with breast cancer-specific survival (BCSS) than mitosis (HR 3.63, 95% CI 1.49-8.86; P = 0.005) and Ki67 (P = 0.27).Using PHH3-HE-stained slides can reliably be used in routine scoring of mitotic figures and integrating both techniques will compensate for each other's limitations and improve diagnostic accuracy, quality, and precision.

The current study was aimed to investigate the relationship between principals’ human skills and job satisfaction of secondary school teachers with mediating role of school climate. A sample of 271 Secondary School Teachers (SSTs) was selected through stratified sampling method. A questionnaire was developed for data collection purpose. Pearson-Product Correlation and mediation analysis was used. The results of the study indicated that school climate partially mediated in the relationship between principals’ human skills and teacher’ job satisfaction. The study recommended that school principals may emphasis and develop their human skills.

Objective: To assess the effect of intravenous ketamine on postoperative pain control, opioid consumption, and the incidence of postoperative adverse events in gynaecological surgeries. Method: The systematic review and meta-analysis was conducted in July 2020 and the search was repeated in July 2021 to ensure accuracy. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in July 2020. The search, done on online databases Medline and Science Direct, comprised studies on patients who underwent general anaesthesia for gynaecological surgeries and received intravenous ketamine intraoperatively, and the findings included opioid consumption, postoperative pain control, and associated side-effects. Results: Of the 79 randomised controlled trials found, 9(11.4%) were subjected to meta-analysis. The use of intravenous ketamine reduced pain score at 2h (p=0.003) and 24h (p=0.002) postoperatively in gynaecological surgeries. In laparoscopic gynaecological surgeries, lower pain scores were reported at 1h (p=0.01) and 2h (p=0.002) hours postoperatively. Lower pain scores were reported at 24h postoperatively in open gynaecological surgeries (p=0.002). Intravenous ketamine increased the time to first-request analgesia postoperatively (p=0.03), and reduced postoperative 24h opioid consumption (p=0.002). Conclusion: The use of intravenous ketamine significantly reduced postoperative pain at 2h and 24h after gynaecological surgeries and at 1h and 2h after laparoscopic gynaecological surgeries. Key Words: Ketamine, Pain score, Gynaecological surgery, Opioid consumption.

The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.

ObjectivesTo identify predictors regarding the type and severity of malocclusion that affect total Invisalign treatment duration based on an intraoral digital scan.Materials and MethodsThe subjects of this retrospective clinical cohort were 116 patients treated with Invisalign. A deep learning method was used for automated tooth segmentation and landmark identification of the initial and final digital models. The changes in the six degrees of freedom (DOF), representing types of malalignment, were measured. Linear regression was performed to find the contributing factors associated with treatment time. In addition, the Peer Assessment Rating (PAR) score and a composite score combining 6 DOF were correlated separately to the treatment time.ResultsThe number of trays differed between sexes (P = .0015). The absolute maximum torque was marginally associated with the total number of trays (P = .0518), while the rest of the orthodontic tooth movement showed no correlation. The composite score showed a higher correlation with the total number of trays (P = .0045) than did individual tooth movement. Pretreatment upper and lower anterior segment PAR scores were positively associated with the treatment time (P < .001).ConclusionsThere is not enough evidence to conclude that certain types of tooth movement affect the total aligner treatment time. A composite score seems to be a better predictor for total treatment time than do individual malalignment factors in aligner treatment. Upper and lower anterior malalignment factors have a significant effect on the treatment duration.

Building on recent developments in the literature, this article addresses a prominent research question in the study of civil conflict: what explains violence against civilians? We use a novel computational model to investigate the strategic incentives for victimization in a network setting; one that incorporates civilians’ strategic behavior. We argue that conflicts with high network competition—where conflict between any two actors is more likely—lead to higher rates of civilian victimization, irrespective of the conflict's overall intensity or total number of actors. We test our theory in a cross-national setting using event data to generate measures of both conflict intensity and network density. Empirical analysis supports our model's finding that conflict systems with high levels of network competition are associated with a higher level of violence against the civilian population.

Background: In atrial fibrillation patients undergoing left atrial appendage occlusion with a Watchman device, surveillance imaging with a transesophageal echocardiogram (TEE) is typically performed at 45 days and 1 year to evaluate for device-related thrombus (DRT) and peri-device leak (PDL) before cessation of oral anticoagulation. The incidence of these complications is relatively low, and the ideal timing and duration of surveillance is unknown. We sought to evaluate the incidence of DRT and PDL after Watchman placement at 45 days and 1 year to determine the necessity of surveillance TEEs. Methods: We retrospectively analyzed 361 patients who received a Watchman device between January 2016 and January 2020. Baseline clinical and echocardiographic data, post-procedure antithrombotic therapy and surveillance echocardiographic data were collected from the NCDR LAAO Registry. Nested backward variable elimination regression was performed to derive independent predictors of the composite outcome of DRT and PDL. Results: A total of 286 patients who had post-procedure TEEs were included in the analysis. At 45 days, 9 patients had DRT (3.2%) and 44 patients had PDL (15.0%). At 1 year, 5 patients had DRT (5.6%) and 8 patients had PDL (8.9%). All DRT at 45 days was treated with continued anticoagulation while no change in protocol occurred with PDL. All DRT at 1 year occurred in new patients without prior thrombus. A history of prior transient ischemic attack (TIA) and thromboembolism were significantly associated with DRT or PDL at 1 year. Conclusions: We identified several patients with device-related complications at 45 days and 1 year despite appropriate device sizing and adequate use of antithrombotic therapy. The incidence of DRT increased from 45 days to 1 year and occurred in patients without prior thrombus. These findings highlight the importance of surveillance imaging and suggest the potential need for extended surveillance in select patients.

The U.S. population is aging with concurrent increases in heart failure (HF) burden. However, HF-related mortality trends among adults ≥75 years have not been investigated.The purpose of this study was to assess the trends and regional differences in HF-related mortality among older adults in the United States.Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2019 for HF-related mortality in adults ≥75 years of age. Age-adjusted mortality rates (AAMRs) per 10,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, and geographic region.Between 1999 and 2019, 5,014,919 HF-related deaths occurred among adults ≥75 years. The AAMR declined from 141.0 in 1999 to 108.3 in 2012 (APC: -2.1; 95% CI: -2.4 to -1.9), after which it increased to 121.3 in 2019 (APC: 1.7; 95% CI: 1.2-2.2). Men had consistently higher AAMR than women from 1999 (AAMR men: 158.3 vs women: 131.0) to 2019 (AAMR men: 141.1 vs women: 107.8). Non-Hispanic (NH) White adults had the highest overall AAMR (127.2), followed by NH Black (108.7), NH American Indian/Alaska Native (102.0), Hispanic or Latino (78.0), and NH Asian or Pacific Islander adults (57.1) AAMR also varied substantially by region (overall AAMR: Midwest 133.9; South: 119.2; West: 116.3; Northeast: 113.5), and nonmetropolitan areas had higher HF-related AAMR (147.0) than metropolitan areas (115.2). States in the top 90th percentile of HF-related AAMR were Mississippi, Oklahoma, West Virginia, Oregon, and Indiana, which had approximately double the AAMRs compared with states that fell into the lower 10th percentile.Following a period of steady decline, HF-related mortality in U.S. adults ≥75 years has increased since 2012. The highest AAMRs were observed among White adults and men, and among patients living in the Midwestern and nonmetropolitan United States. Targeted strategies are needed to prevent and treat HF among older adults to curb increasing levels of HF-related mortality.

Objective To perform a systematic review of the literature exploring magnetic resonance imaging (MRI) methods for measuring natural brain tissue pulsations (BTPs) in humans. Methods A prospective systematic search of MEDLINE, SCOPUS and OpenGrey databases was conducted by two independent reviewers using a pre-determined strategy. The search focused on identifying reported measurements of naturally occurring BTP motion in humans. Studies involving non-human participants, MRI in combination with other modalities, MRI during invasive procedures and MRI studies involving externally applied tests were excluded. Data from the retrieved records were combined to create Forest plots comparing brain tissue displacement between Chiari-malformation type 1 (CM-I) patients and healthy controls using an independent samples t-test. Results The search retrieved 22 eligible articles. Articles described 5 main MRI techniques for visualisation or quantification of intrinsic brain motion. MRI techniques generally agreed that the amplitude of BTPs varies regionally from 0.04 mm to ~ 0.80 mm, with larger tissue displacements occurring closer to the centre and base of the brain compared to peripheral regions. Studies of brain pathology using MRI BTP measurements are currently limited to tumour characterisation, idiopathic intracranial hypertension (IIH), and CM-I. A pooled analysis confirmed that displacement of tissue in the cerebellar tonsillar region of CM-I patients was + 0.31 mm [95% CI 0.23, 0.38, p Discussion MRI techniques used for measurements of brain motion are at an early stage of development with high heterogeneity across the methods used. Further work is required to provide normative data to support systematic BTPs characterisation in health and disease.

We sought to determine utilization and outcomes of perioperative temporary mechanical circulatory support (tMCS) in the current practice of cardiac surgery.tMCS is an evolving adjunct to cardiac surgery not fully characterized in contemporary practice.Using the nationwide inpatient sample we retrospectively analyzed hospital discharge data between January 1, 2016 and December 31, 2019. ICD-10-CM procedure codes were used to identify and divide patient hospitalizations into those who had preoperative tMCS (pre-tMCS) versus tMCS instituted the day of surgery or afterwards (sd/post-tMCS).In all, 1,383,520 hospitalizations met inclusion criteria. 86,445 (6.25%) had tMCS. tMCS was utilized in 8.74% of coronary artery bypass grafting (CABG), 2.58% of isolated valve, and 9.71% of valve/CABG; operations. 29,325 (33.9%) had pre-tMCS while 57,120 (66.1%) had sd/post-tMCS. The use of tMCS was associated with greater inpatient mortality (15.66% vs. 1.53%, p .001), longer length of stay (LOS) (14.4 vs. 8.5 days, p .001), and higher mean inflation-adjusted costs ($93,040 ± 1038 vs. $51,358 ± 296, p .001) compared to no use. Inpatient mortality (5.98% vs. 20.63%, p .001), LOS (13.87 vs. 14.68, p .001), and cost ($82,621 ± 1152 SEM vs. $98,381 ± 1242) were all significantly lower with pre-tMCS compared to sd/post tMCS. When analyzed separately, mortality was higher with later utilization of tMCS (5.98% pre, 17.1% sd, and 49.05% postsurgical date insertion, p .001).Perioperative tMCS is utilized in 6.25% of modern cardiac surgery, with two-thirds of cases instituted on the day of surgery or afterwards. The use of tMCS is associated with significantly higher mortality, longer LOS, and higher costs. Among patients undergoing tMCS, earlier utilization is associated with better outcomes.

This research work investigates the association between psychological ownership and innovative behaviour with knowledge hiding and knowledge sharing as mediators. The latter variables are presented as focal antecedents of preventive and promotive psychological ownership. To conduct the study, a theoretical framework was proposed, and data was collected from professionals working in complex management systems in Pakistan. The analysis revealed that knowledge hiding and knowledge sharing can exist simultaneously, and psychological ownership can evoke both positive and negative feelings in employees, which poses a challenge for the management. The results illustrate that psychological ownership has significant associations with knowledge hiding, knowledge sharing, and innovative behaviour. Consequent theoretical contributions and important managerial implications are discussed at the end.

Despite improvements in treatment options for advanced colorectal cancer (CRC), survival outcomes are still best for patients with non-metastasised disease. Diagnostic tools to identify blood-based biomarkers and assist in CRC subtype classification could afford a means to track CRC progression and treatment response. Cancer cell-derived small extracellular vesicles (EVs) circulating in blood carry an elevated cargo of lipids and proteins that could be used as a signature of tumour suppressor/promoting events or stages leading up to and including metastasis. Here, we used pre-characterised biobanked plasma samples from surgical units, typically with a low volume (~100 µL), to generate and discover signatures of CRC-derived EVs. We employed nanostructured porous silicon (pSi) surface assisted-laser desorption/ionisation (SALDI) coupled with high-resolution mass spectrometry (HR-MS), to allow sensitive detection of low abundant analytes in plasma EVs. When applied to CRC samples, SALDI-HR-MS enabled the detection of the peptide mass fingerprint of cancer suppressor proteins, including serine/threonine phosphatases and activating-transcription factor 3. SALDI-HR-MS also allowed the detection of a spectrum of glycerophospholipids and sphingolipid signatures in metastatic CRC. We observed that lithium chloride enhanced detection sensitivity to elucidate the structure of low abundant lipids in plasma EVs. pSi SALDI can be used as an effective system for label-free and high throughput analysis of low-volume patient samples, allowing rapid and sensitive analysis for CRC classification.

Cannabis use is prevalent and concerns about cannabis misuse are increasing. A reinforcer pathology approach emphasizes the roles of drug reinforcing value (demand) and overvaluation of immediate rewards (delay discounting [DD]) in drug use but has been applied to a lesser extent to cannabis. The present study investigated the independent and interactive roles of these processes in relation to cannabis misuse in a community sample of adult cannabis users (N = 324; 44.8% female; Mage = 33.25). Participants completed a Marijuana Purchase Task (MPT), the Monetary Choice Questionnaire (MCQ), and the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) to assess demand, DD, and cannabis misuse, respectively. Zero-order correlations revealed significant associations between CUDIT-R scores and both the demand indices (|rs | = .21-.56, p < .01-.001) and DD (r = .21, p < .01). In multivariate analyses, lower elasticity (i.e., price insensitivity) was robustly associated with higher CUDIT-R scores, while other demand indicators did not explain additional unique variance. However, as elasticity, intensity, and Omax exhibited robust zero-order intercorrelations, shared variance appeared to drive the association. An interactive relationship between elasticity and DD was not significant. These findings indicate that cannabis misuse is associated with both cannabis demand, particularly as measured by insensitivity to escalating costs, and immediate reward orientation, but the relationship was not synergistic. These results support a reinforcer pathology approach to cannabis misuse and, although causality cannot be inferred cross-sectionally, suggest that evaluating the longitudinal significance of these indicators is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Every technology with its powerful uses has issues connected to it and security is at the top of it. As for the changing environment, the world has been shifting to Virtual Reality, the new coming world seems to be the internet and blockchain technology which is more powerful than others and has its applications in every field, be it quantum computing, internet of things, security or others. This survey paper covers the blockchain and its security in different fields of sciences and technology. We begin with the introduction of blockchain and then discuss its structure. After that security issues have been highlighted which include attacks and their behavior in quantum computing, internet of things, cloud computing. Furthermore, we have discussed the most common types of attacks and the SRM model of blockchain followed by the conclusion.

ContextThe use of scrotal ultrasound (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy.ObjectiveTo define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre or post pubertal males with indeterminate testicular masses.Evidence acquisitionThis SR was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 - March 26, 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression-free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS - 2).Evidence synthesis32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, 4 studies and 142 masses reported MRI features. Meta-analysis of different SUS B mode values in post pubertal men demonstrated size of ≤0.5cm had a significant lower OR of malignancy compared to masses >0.5cm (p 1.5cm also demonstrated a significant lower OR of malignancy (p = 0.04). No significanct difference was observed between masses of 0.6-1.0cm and 1.1-1.5cm. SUS in post pubertal men also had a statistically significant lower odds of malignancy for heterogenous masses vs. homogenous masses (p = 0.04), hyperechogenic vs. hypoechogenic masses (p ConclusionsThis meta-analysis identifies radiological characteristics that have a lower odds of malignancy and may be of value in the management of the indeterminate testis mass.

PURPOSE: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. MATERIALS AND METHODS: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. RESULTS: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. CONCLUSIONS: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

The autosomal dominant trait hereditary hemorrhagic telangiectasia (HHT) causes multiorgan dysplastic lesions of the vasculature that can activate multiple physiological cascades leading to a broad array of cardiovascular diseases. Up to 78% of patients with HHT develop hepatic arteriovenous malformations (AVMs), which cause a hyperdynamic circulatory state secondary to hepatic/portal shunting. This condition can eventually progress to high-output cardiac failure (HOCF) with continued peripheral tissue hypoxemia. Treatment for HOCF is often limited to supportive measures (diuretics and treatment of anemia); however, recent studies using systemic bevacizumab have shown promise by substantially reducing the cardiac index. In the context of liver AVMs and high cardiac output, the pulmonary vasculature can also experience high flow. Without adequate dilation of pulmonary vessels, post-capillary pulmonary hypertension can develop. Another form of pulmonary hypertension observed in HHT, pulmonary arterial hypertension, is caused by HHT-related mutations in

Background: The sclera is the outer strong opaque covering of the eye that functions as protective layer and provides site for attachment of extra ocular muscles. Aim: To study the microscopic anatomy of sclera in chick at various stages of embryological development keeping in mind the practical application of this information in understanding human development and disease processes. Methodology: It was an experimental study. The study was carried out at department of Anatomy, CPSP Regional Centre, Islamabad. Eyeballs were collected from group A, B and C (n=30 each) on day 10, 12 and 15 of incubation respectively. Dissected out tissues were processed and stained with Hematoxylin & Eosin and Alizarin red. The prepared specimens for group A and C were analysed under light microscope while the specimens from group B were observed via stereomicroscope. Data was evaluated by using SPSS version 23. Independent t-test was applied with p-value of less than 0.05 was considered significant. Results: As the chondrocytes in cartilaginous layer of sclera became mature, they change their shape from flattened to more rounded cells. The proteoglycan content in the cartilaginous matrix increased. The mean number of chondrocytes increased from 17.4 ±1.4/unit area on day 10 to 10.0 ±0.8/unit area on day 15. The mean thickness of cartilaginous layer increased from 44 ±2.4µm on day 10 to 77 ±8.3 µm on day 15 of development. Calcification of scleral ossicles became obvious at about 12 days of incubation when seen under stereomicroscope. Practical Implication: This study highlighted that understanding for the development of scleral elements (understudied tissue of the eye) can be critical in research involving autoimmune diseases and neural crest defects. Considering similar developmental stages among humans as in chick embryo. Conclusion: It was concluded that growth of sclera in eye of chick has been indicated by increase in thickness of its layers and increase in the number of chondrocytes/unit area and progressing calcification of ossicles in its bony part. Keywords: Chick Embryo, Chondrocytes, Hyaline Cartilage and Ossicular Ring.

Inducible nitric oxide synthase (iNOS) plays an important role in the inflammatory processes via accelerating the production of nitric oxide (NO). The efforts to develop small molecules as selective inhibitors of iNOS are being reported across the globe. The current study explores varied benzimidazole-coumarin derivatives as anti-iNOS agents. Literature survey suggests 2-aminobenzimidazole, coumarin nucleus, and 4-atom linker as important structural components for iNOS inhibition. Target compounds were designed and synthesized by coupling 2-aminobenzimidazole with (un)substituted coumarin through different linkers. These were docked in iNOS (1QW4) and nNOS (1QW6) targets to ascertain their iNOS selectivity, and evaluated for NO and iNOS inhibitory activities in vitro. The most active inhibitors were subsequently evaluated for acute toxicity and anti-inflammatory activity using carrageenan-induced rat paw edema model in vivo. All compounds possessed moderate to good NO and iNOS inhibitory activities. Compounds 14a, 14b, 14d, and 14e were the most potent inhibitors in vitro. These were found to significantly reduce the inflammation. Compounds 14d and 14e have been identified as the most potent iNOS inhibitors to combat inflammation. These derivatives may serve as potential compounds as such against iNOS, or as leads for the development of novel anti-iNOS agents.

Introduction. Some groups of Asian Americans, especially Asian Indians, experience higher rates of atherosclerotic cardiovascular disease (ASCVD) compared with other groups in the U.S. Barriers in accessing medical care partly may explain this higher risk as a result of delayed screening for cardiovascular risk factors and timely initiation of preventive treatment. Methods. Cross-sectional data were utilized from the 2006 to 2015 National Health Interview Survey (NHIS). Barriers to accessing medical care included no place to seek medical care when needed, no healthcare coverage, no care due to cost, delayed care due to cost, inability to afford medication, or not seeing a doctor in the past 12 months. Results. The study sample consisted of 18,150 Asian individuals, of whom 20.5% were Asian Indian, 20.5% were Chinese, 23.4% were Filipino, and 35.6% were classified as “Other Asians”. The mean (standard error) age was 43.8 (0.21) years and 53% were women. Among participants with history of hypertension, diabetes mellitus, or ASCVD (prevalence = 25%), Asian Indians were more likely to report delayed care due to cost (2.58 (1.14,5.85)), while Other Asians were more likely to report no care due to cost (2.43 (1.09,5.44)) or delayed care due to cost (2.35 (1.14,4.86)), compared with Chinese. Results among Filipinos were not statistically significant. Conclusions. Among Asians living in the U.S. with cardiovascular risk factors or ASCVD, Asian Indians and Other Asians are more likely to report delayed care or no care due to cost compared with Chinese.

This study examines the relationship of e-procurement i.e., e-payment, e-tendering, e-invoicing and e-customer relationship management on the performance of supply chain management. It is observed that previously it is quite a time-consuming and energy absorbing activity as well as it is inefficient too. With the introduction of e-procurement in the organization, the overall process can be less time consuming as well as it is also very much efficient in order to do all procurement related activities in a timely manner. In this research it has been analyzed that e-procurement is a key role in future for companies as there are many companies already switching their supply chain management process into e-procurement activities as it can be proved in the previous studies that shows how important e-procurement is on the supply chain management and its performance. Present studies attempt the best possibilities with the effect of e-procurement steps which are in practices in supply chain process in Pakistan and manufacturing sector. Through the help of SPSS software, we are able to find the impact of supply chain with e-procurement variables which has a positive impact on supply chain management and results are agreed with the findings of research. The results show that the four electronic variables of E-Procurement are essential factor which directly reduce uncertainty in supply chain functions increase supply chain activities and practices, fast moving process, fast moving supply chain order, fulfillment of orders with quick and improve supply chain performance.