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The widespread rise in popularity of cryptocurrencies over the past few years has the potential to have sparked new revolutions in the global ecosystem. The investors face both new opportunities and challenges as a result of this ecosystem. The modern era makes it simple for people to make financial decisions regarding investments, payments, and other financial services via the internet. This development in technology makes it easier for inventors to create and process crypto currencies around the world. Decentralization is the fundamental principle of digital currency. Financial regulations and control are virtually non-existent for digital currencies. As a result, investors are increasingly using it as a decentralized financial instrument. Investors can use it to conduct unregulated financial transactions from one location to any location worldwide. Digital currencies also cause financial instability, despite growth and gains. Every nation in the world faces a serious threat as a result of financial instability.

Background Evidence-based medicine (EBM) has long been taught to physician trainees for critical appraisal of research manuscripts. There is no parallel or similar framework to guide trainees in the appraisal of quality improvement (QI) literature. Objective To adapt existing guidelines of QI manuscript reporting into an educational QI-EBM appraisal tool to help residents distinguish research and QI manuscripts, assess QI designs and methodologies, and evaluate QI manuscripts' strengths and weaknesses. Methods Between 2018 and 2021, we developed a QI-EBM critical appraisal tool (QI-EBM-CAT) and performed 3 plan-do-study-act cycles to refine the tool based on JAMA and SQUIRE 2.0 guidelines. We then surveyed residents regarding the usefulness of the tool and their confidence in evaluating QI manuscripts before and after completing a QI-EBM workshop using the QI appraisal tool. Results Sixty-six of 74 internal medicine postgraduate year (PGY)-1 to PGY-3 residents (89.2%) completed the workshop and assessment surveys in 2021. The workshop was found to be moderately to very useful by 85.1% (63 of 74) of residents as a framework for QI manuscript critical analysis. The summary confidence score in QI manuscript critical appraisal improved from a 64% rating of moderately to very confident in the pre-period to 94.6% in the post-period (P Conclusions The QI-EBM-CAT, designed to teach residents how to critically assess QI manuscripts using EBM principles, resulted in subjective improvements in confidence of QI manuscript analysis.

Drug resistance and damage caused to the normal cells are the drawbacks which have limited the use of the existing effective anticancer drugs. Attainment of a steady and extended release by encapsulating dual drugs into biocompatible and biodegradable vehicles is the key to enable the use of these drugs for effective inhibition of cancer. In this study, carboxymethyl chitosan (CMCS), a proficient water-soluble derivative of chitosan has been synthesized using chemical route and used for the delivery of 5-Fluorouracil and doxorubicin individually as well as in combination. Carboxymethylation occuring at –NH2 and OH sites of chitosan, has been confirmed using FTIR. EDX and Fluorescence studies elucidate the encapsulation of 5-Fluorouracil and doxorubicin into CMCS. The capability of CMCS to release the drugs in a more sustained and prolonged manner is evident from the obtained release profiles. About 14.9 µg/ml is enough to cause 50% cell death by creating oxidative stress and effectuating DNA fragmentation. Amidst the existing reports, the uniqueness of this work lies in using this rare coalition of drugs for the suppression of breast cancer and in reducing the side effects of drugs by encapsulating them into CMCS, which is evidenced by the high hemocompatibilty of the samples.

Background Autoinflammatory disorders are the group of inherited inflammatory disorders caused due to the genetic defect in the genes that regulates innate immune systems. These have been clinically characterized based on the duration and occurrence of unprovoked fever, skin rash, and patient’s ancestry. There are several autoinflammatory disorders that are found to be prevalent in a specific population and whose disease genetic epidemiology within the population has been well understood. However, India has a limited number of genetic studies reported for autoinflammatory disorders till date. The whole genome sequencing and analysis of 1029 Indian individuals performed under the IndiGen project persuaded us to perform the genetic epidemiology of the autoinflammatory disorders in India. Results We have systematically annotated the genetic variants of 56 genes implicated in autoinflammatory disorder. These genetic variants were reclassified into five categories (i.e., pathogenic, likely pathogenic, benign, likely benign, and variant of uncertain significance (VUS)) according to the American College of Medical Genetics and Association of Molecular pathology (ACMG-AMP) guidelines. Our analysis revealed 20 pathogenic and likely pathogenic variants with significant differences in the allele frequency compared with the global population. We also found six causal founder variants in the IndiGen dataset belonging to different ancestry. We have performed haplotype prediction analysis for founder mutations haplotype that reveals the admixture of the South Asian population with other populations. The cumulative carrier frequency of the autoinflammatory disorder in India was found to be 3.5% which is much higher than reported. Conclusion With such frequency in the Indian population, there is a great need for awareness among clinicians as well as the general public regarding the autoinflammatory disorder. To the best of our knowledge, this is the first and most comprehensive population scale genetic epidemiological study being reported from India.

Background and aim Regional differences in gallstone (GS) composition are well documented in the Indian subcontinent. The reasons for the same are unknown. Etiopathogenesis of GS remains elusive despite advances in instrumentation. This was an in-depth analysis of the chemical, structural, and elemental composition of GS with special reference to synchroton studies. Methods We used high-end sensitive analytical complementary microscopic and spectroscopic methods techniques, such as X-ray diffraction, scanning electron microscopy, Fourier transform infrared, synchrotron X-ray fluorescence spectroscopy (SR-XRF), and 2D and 3D synchrotron microtomography (SR-μCT), to study the ultra structure and trace element composition of three major types of GS (cholesterol, mixed, and pigment). SR-XRF quantified the trace elements in GS. Results The cholesterol GS (monohydrate and anhydrate) were crystalline, with high calcium content. The pigment GS were amorphous, featureless, black, and fragile, with high calcium bilirubinate and carbonate salts. They had the highest concentration of iron (average 31.50 ppm) and copper (average 92.73 ppm), with bacterial inclusion. The mixed stones had features of both cholesterol and pigment GS with intermediate levels of copper (average 20.8 ppm) and iron (average 17.78 ppm). Conclusion SR-μCT has, for the first time, provided cross-sectional computed imaging delineating the framework of GS and mineral distribution. It provided excellent mapping of cholesterol GS. SR-XRF confirmed that pigment GS had high concentrations of copper and iron with bacterial inclusions, the latter possibly serving as a nidus to the formation of these stones.

Nitrogen ions (70 keV) were implanted on composite coatings containing polymer/Mg (magnesium)–Ag (silver) ions co-incorporated hydroxyapatite which is developed by microwave irradiation. Average crystallite size of modified coatings is reduced to 80% compared to pristine. The variation of bond strength of modified coatings is realized. The electrical resistance (77%), microhardness (4.3%), roughness (4.5 times) and pore size are enhanced on the modified coatings. Superhydrophilic surface is tuned to hydrophobic on implantation. At higher fluence (1×1017 ions/cm2) depicted an enhanced corrosion potential compared to the other coatings. Thus, the new insight of modified coatings is realized by correlating phase-structure, surface and anticorrosion.

Additional file 1. Implicit bias attitude scale.

Microgrid is a solution to the problem of power crisis which makes use of abundantly available distributed energy resources. In microgrid system there is onsite generation of power and hence the transmission and distribution losses will be less. In this paper a inverter control strategy is proposed for the AC microgrid under grid-connected mode. For the control of active and reactive power of the microgrid, decoupling vector control sinusoidal pulse width modulation is applied to the inverter interfacing the microgrid with the utility grid. The power that is injected from the microgrid to the utility grid and power that is extracted from the utility grid due to increase in load demand was analyzed. The power profiles of microsources, utility grid and load was studied. FFT(Fast fourier transform) analysis of the grid voltage and grid current was carried out. The microgrid system of 50kW windturbine and 50kW photovoltaic system was implemented. To validate the results MATLAB/SIMULINK tool was used.

Microgrid is a integration of distributed energy resources which can be tied to the utility grid through power electronic interface. The proposed system can be employed for rural electrification. In this paper active (P) and reactive (Q) power control is implemented for AC microgrid system in grid- connected mode. The power electronic interface used in the sytem is the multilevel inverter. The sources are coupled through three level inverter and connected to the utility grid. The selected microgrid configuration includes a 24kW of photovoltaic cell module, 20kW of PMSG based wind turbine module, fuel cell stack of 9.6kW. The PQ control strategy is applied to the three level inverter to maintain the system voltage and frequency. A phase locked loop is employed in the control strategy to synchronize utility grid and the microsources. The decoupled current (Id & Iq) is used to control active and reactive power through PQ control algorithm and it is applied to inverter. Active and reactive power is controlled using Id and Iq respectively. The control strategy is simulated in MATLAB/Simulink.

Background: Poor adherence to prescribed regimens can result in serious health consequence. Antiepileptic medication non-adherence leads to disease progression, reduced functional abilities, lower quality of life. Medication non-adherence can have negative consequences not only for the patient but also for the provider, the physician, and even the medical researchers who are working to establish the value of the medication on the target population. Aim and Objective: This study aims to evaluate adherence of study participants on antiepileptic medication using Morisky Medication Adherence Scale (MMAS-8) and to identify factors associated with non-adherence and its impact on quality of life. Materials and Methods: The study was approved by the Institutional Ethics Committee. The prospective study was conducted for a period of 2 months from March 2019 to April 2019 in neurology outpatient department in Tirunelveli Medical College Hospital. Patients of both sexes more than 18 years of age who were diagnosed as epilepsy and on antiepileptic medication therapy for at least 3 months were included as study participants. Data were collected from sample of 110 patients. Adherence was measured using MMAS-8. Results: The observational study recruited 110 participants which included 69 (63%) males and 41 (37%) females, 47 (43%) on monotherapy and 63 (57%) on combination therapy, 92 (84%) generalized seizures and 18 (16%) focal seizures, 69 (63%) highly adherent, 18 (16%) medium adherent, and 23 (21%) poorly adherent to antiepileptic medication. Forgetfulness (46%) was the most common reason within non-adherent patients and statistical significance was noted. Among the non-adherent patients, recurrence of seizures occurred in 66% of patients that affected daily activities, 10% of them experienced injury due to seizures, 17% of patients discontinued studies, and 7% discontinued job which impacted their quality of life. Conclusion: The current study shows that 63% of epileptic patients were highly adherent to treatment. Adverse events were experienced by one-third of the non-adherent patients. Overcoming non-adherence done by appropriate counseling, health education, and explaining consequences of poor adherence to the patients.

Recycled high-density polyethylene (HDPE) was incorporated with graphene nanoflakes in a solvent at different concentrations (0, 1, 2, 4, and 8 wt%), and then the mechanical, thermal, electrical, and surface hydrophobic properties of the resultant nanocomposites were determined using universal tensile testing, thermal comparative, capacitance bridge, and goniometer techniques, respectively. The test results revealed that the mechanical, thermal, and dielectric properties of the polymer matrix nanocomposites were increased as a function of graphene concentrations, whereas the surface hydrophobic values were slightly increased at lower concentrations and then reduced at higher concentrations. These improvements occur mainly because of the excellent properties of graphene nanoflakes, such as tensile strength (150 GPa), Young's modulus (1.0 TPa), thermal conductivity (4,840–5,300 W/m K), electrical conductivity (1.3 × 106 S/cm), electrical current density (1013 A/cm2), surface hydrophobicity (>120°), and surface smoothness/roughness (

In this work, α-Fe2O3, Polyaniline (PANi), MoS2 sheets and DNA are integrated as a versatile platform by a simple chemical route for the detection of environmental pollutants. The structure and morphology of the hybrid characterized by Raman, XRD, UV–Vis, SEM and CH instrument revealing that the hybrid nanostructure was composed of few-layered MoS2 nanosheets with enlarged interlayer distance, suitable for electron transfer process. PANi-α-Fe2O3–MoS2-DNA hybrid nanostructure significantly exhibited better electro catalytic activity toward simultaneous detection of pollutants such as hydroquinone (HQ), catechol (CC), resorcinol (RS) and nitrite (NO2−). The hybrid electro catalyst shows simultaneous linear response of HQ, CC, RS and NO2− in the concentration range of 500 nM–300 μM, 400 nM–300 μM, 200 nM-300 μM and 300 nM-300 μM with lowest detection limits 180, 178, 95 and 102 nM respectively. In addition, the biosensor exhibited excellent sensitivity, selectivity and stability. The real time application of PANi-α-Fe2O3–MoS2-DNA hybrid nanostructure demonstrated with satisfactory results in detecting HQ, CC, RS and NO2− in well water and pond water samples.

Background: The main objective of prescription pattern analysis is to assess the rationality of drug use. It has been found that cardiovascular disease is the most frequent cause of morbidity and mortality throughout the world. This study is to estimate the prescribing pattern and adverse drug reactions in patients with cardiovascular diseases.Methods: This prospective observational study was conducted for a period of 2 months in cardiology outpatient department.100 patients who fulfilled the study criteria were observed. The central drug standard control organisation (CDSCO) reporting forms were used for the collection of adverse drug reactions. Causality assessment was done by using the World Health Organization Collaborating Centre for International Drug Monitoring, the Uppsala Monitoring Centre (WHO-UMC) scoring system and severity assessment by modified Hartwig and Siegel scale.Results: The study group consists of 79% male and 21% females. Average number of drugs per prescription was 4.65. Most commonly prescribed drugs were antiplatelets (32%) followed by statins (18.27%) and the least common were calcium channel blockers (1.72%) and cardiac glycosides (0.86%). A total of 174 adverse drug reactions were reported out of which 24.7% were myalgia due to statins, 15.5% were cough due to angiotensin converting enzyme inhibitors and 14.3% were gastritis due to antiplatelets.Conclusions: Antiplatelets, statins and angiotensin converting enzyme inhibitors dominated the prescribing pattern. Myalgia, cough, gastritis, insomnia by atorvastatin, enalapril, aspirin, beta blockers respectively were found to be the most commonly reported ADRs among the cardiovascular drugs.

Background: Dermatophytosis is a common cutaneous infection in India with prevalence varying from 36.6% to 78.4%. Topical azoles and allylamines are used to treat localized dermatophytosis but has disadvantages such as long duration of therapy, poor compliance, and high relapse rate. Luliconazole is a newer topical imidazole antifungal applied once daily with greater reservoir property in stratum corneum. Aims and Objective: The aim of the study was to compare the efficacy of topical luliconazole versus topical clotrimazole in tinea corporis and tinea cruris. Materials and Methods: An open-labeled randomized comparative study in the Dermatology Outpatient Department of Tirunelveli Medical College done from September 2015 to September 2016. Patients with tinea corporis/tinea cruris were randomized into two groups to receive topical luliconazole cream once daily for 2 weeks or topical clotrimazole cream twice daily for 4 weeks. Scrapings from lesion were taken for mycological assessment. Clinical and mycological cure was assessed at each visit. Results: Each group had 50 patients. At the end of 1st week, the mycological cure was 78% in luliconazole and 12% in clotrimazole (P < 0.05) and complete clearance was achieved in 11 patients (22%) in luliconazole group. By the end, 98% got cured in luliconazole group and 80% in the clotrimazole group (P < 0.05). Relapse occurred in 20% in clotrimazole group as against 4% in luliconazole group (P < 0.05). Both groups showed only mild application site reactions except one patient who developed hypersensitivity to clotrimazole. Conclusions: Topical luliconazole was better in achieving faster mycological and clinical cure with lower relapse.