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Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries.

Herein, the electrochemical sensing efficacy of carboxylic acid functionalized multiwalled carbon nanotubes (C-MWCNT) intertwined with coexisting phases of gadolinium monosulfide (GdS) and gadolinium oxide (Gd2O3) nanosheets is explored for the first time. The nanocomposite demonstrated splendid specificity for nonenzymatic electrochemical detection of uric acid (UA) in biological samples. It was synthesized using the coprecipitation method and thoroughly characterized. The presence of functional groups and disorder in the as-synthesized nanocomposite are confirmed using Fourier transform infrared spectroscopy and Raman spectroscopy. Furthermore, field emission scanning electron microscopy, high-resolution transmission electron microscope, X-ray powder diffraction, and X-ray photoelectron spectroscopy provides a clear understanding of the morphology, coexisting phases, and elemental composition of the as-synthesized nanocomposites. The differential pulse voltammetry technique was utilized to elaborate the electrochemical sensing of UA using a GdS-Gd2O3/C-MWCNT modified glassy carbon electrode (GCE), The sensor showed an enhanced current response by more than 2-fold compared to bare GCE. Also, the sensor’s performance was further improved by dispersing the nanocomposite in an ionic liquid with the exceptional reproducibility (SD = 0.0025, n= 3). The fabricated UA sensor GdS-Gd2O3/C-MWCNT/IL/GCE demonstrated a wide linear detection range from 0.5–30 μM and 30–2000 μM, effectively covering the entire physiological range of UA in biological fluids with a limit of detection (LOD) of 0.380 μM (+3SD of blank) and a sensitivity of 356.125 μA mM–1cm–2. Moreover, the electrodes exhibited storage stability for 2 weeks with decrease in zero-day current by only 4.5%. The sensor was validated by quantifying UA in 12 unprocessed clinical human urine and serum samples, and its comparison with the gold standard test yielded remarkable results (p< 0.05). Hence, the proposed nonenzymatic electrochemical UA sensor is selective, sensitive, reproducible, and stable, making it reliable for point-of-care diagnostics.

Hepatitis E is a common, mainly water-borne hepatotropic virus prevalent mainly in Southeast Asia, Africa, the Middle East, and Central America. In the eastern part of India epidemics of acute hepatitis E are well reported. Hepatitis E commonly presents as self-limiting acute viral hepatitis among young adults, except for some critical clinical complications during pregnancy. In epidemiological research, subclinical acute hepatitis E infection is also reported from different parts of the world, including developed nations such as the USA (predominantly in the population aged >60 years). Though primarily hepatotropic, in the literature there are reports of rare extrahepatic manifestation of acute hepatitis E. Here we present an elderly lady with acute hepatitis E who primarily presented with acute myocarditis.

Digital games can be used as a productive and engaging medium to foster scientific expertise and have shown promise in supporting the co-development of scientific concepts and representational practices. This study focuses on the integration of a disciplinarily-integrated game, SURGE NextG, with complementary model-based activities to support the development of scientific modeling in Newtonian mechanics. Two pedagogical approaches were designed. Students in both approaches modeled the motion of an object inside and outside the game environment. One approach involved the material integration of virtual game play through a physical modeling activity in the classroom. The second approach involved a complementary modeling tool using an agent-based computational programming platform. While both modeling activities demonstrated affordances to support productive student learning, this study highlights the significance of designing multiple complementary representations of the same phenomenon as a core element of game play and related modeling activities.

As digital games and simulations become more commonplace in educational settings, it is important to document and analyze the way such digital learning environments merge with the traditional discourses and spaces of classroom-based learning environments. The current study contributes toward this goal by analyzing a representative transcript from a veteran traditional teacher's discussion with her class about the Newtonian relationships at the heart of a digital learning game she has integrated into her physics curriculum. This article presents an interaction analysis of the material, virtual, and abstract spaces employed and navigated across by the teacher to clarify common challenges as well as opportunities. The authors then analyze subsequent transcripts of student-teacher interactions for evidence of impact on student learning and understanding.

Disciplinarily-integrated games represent a generalizable genre and template for designing games to support science learning with a focus on bridging across formal and phenomenological representations of core science relationships (Clark, Sengupta, Brady, Martinez-Garza, and Killingsworth, 2015; Clark, Sengupta, & Virk, 2016; Sengupta & Clark, 2016). By definition, disciplinarily-integrated games (DIGs) are therefore multirepresentational systems with the affordances and challenges associated with that medium. The current paper analyzes the DIG structure through the focal parameters framed by the DeFT framework (Ainsworth, 2006) to synthesize effective design considerations for DIGs in terms of the specific design and intended functions of the representations themselves as well as the overarching environment and activity structures. The authors leverage the literatures on embodied cognition, adaptive scaffolding, representations in science education, and learning from dynamic visualizations to address the challenges, tradeoffs, and questions highlighted by the framework. They apply these research-derived design considerations to an existing DIG (SURGE Symbolic) and to hypothetical examples of other DIGs in other domains to explore generalizability of the design considerations and the genre.

The authors extend the theory of disciplinary integration of games for science education beyond the virtual world of games, and identify two key themes of a practice-based theoretical commitment to science learning: (1) materiality in the classroom, and (2) iterative design of multiple, complementary, symbolic inscriptions (e.g., graphs and agent-based programs). They also identify the affordances of their proposed approach for facilitating student learning and teacher agency. [ABSTRACT FROM AUTHOR]

Plasmapheresis has been used widely in the treatment of myasthenia gravis and also in symptomatic thymectomized patients with short-term clinical improvement. But the utility of preoperative plasmapheresis in the outcome has not been widely studied. The authors analyzed its impact in the surgical outcome of thymic tumors with myasthenia gravis. We studied a total of 19 patients, who were operated on in the period from January 2000 to July 2006 for thymic tumors with myasthenia gravis. Of these 19 patients, preoperative plasmapheresis was performed in 10 patients (group B) and the remaining nine patients (group A) had no preoperative plasmapheresis based on risk factors for requirement of postoperative ventilation. Outcome in the form of requirement of ventilation, symptomatic improvement, hospital stay and requirement of drugs were assessed at the end of one year and compared between the two groups. Six out of nine patients (67%) in group A required ventilatory support in the immediate postoperative period, whereas two out of ten patients (20%) in group B required it. Significant and sustained symptomatic improvement was noted in group B as compared with group A (P<0.01). Preoperative plasmapheresis in the patients of thymic tumors with myasthenia gravis is beneficial and can cause a significant difference in the postoperative outcome.

Human kidney is a sophisticated organ with 1 Million nephrons arranged in subtle form. Kidney has the most failure cases in the world compared to the rest of the body organs. Kidney failure is a severe problem, where cardiac blood output is not filtered. Dialysis is one available substitute for kidney failure, which seems to help the patient incompletely. There is a great necessity for a device (artificial kidney) that can be implanted into the body to resume the kidney function. In replicating kidney function there are many potential challenges, which must be addressed for faithful regeneration. This paper primarily focuses on regenerating the proximal convoluted tubule (PCT) size dependent re-absorption, mimicking this function using microfluidics is not reported earlier. Different structural changes in the design have been adopted and the accomplishments are discussed. It is observed that the total flow (the total of flow through all 1000 channels) in straight is 0.4 × 10−16m3/s, in the diagonal channel is 0.4 × 10−16m3/s, in step is 0.32 × 10−16m3/s and in serpentine is 0.38 × 10−16m3/s. The size-dependent re-absorption of solutes, proteins, and urea with the help of array of channels has been achieved. The dimensions of the main tubule and channel are selected to replicate cell–cell interactions. The re-absorption rate obtained is around 48%, which is closely reaching the PCT re-absorption rate. The increase in the number of channels shows increase in re-absorption rate. The novelty of reported work lies in regenerating the human kidney proximal tubule cell function of size and shape dependent re-absorption using microfluidics technology. The proposed device performance proves its prevalence in kidney-on-chip applications.

Protein energy wasting (PEW) is a prevalent problem among hemodialysis patients. Lack of adherence to dietary principle based conventional diet charts often fail to satisfy the nutritional requirements of the patients. We studied the effect of simple nutritional training and empowerment of the patients to formulate their own dietary menu in nutritional parameters of hemodialysis patients in 68 stable non diabetic End stage renal disease (ESRD) patients who are on maintenance hemodialysis. The factors which otherwise can affect the nutritional status like sepsis, malignancy,tuberculosis were excluded. At the beginning patient's baseline nutritional status was assessed by anthropometric measurements, Subjective Global Assessment and serum albumin level. Body composition was assessed by linear regression equation (Durin-Womersley) and Siri equation. The patients were divided in two comparable groups (Group-A&B). In group A patients were prescribed individualized dietary prescription; based on their nutritional allowance as per KDOQI guideline. In Group-B the patients were initially made familiar with the dietary principals of the commonly consumed food. Then they were trained by renal nutritionist by study material, visual aid, and proportional food models and one to one discussion to formulate a dietary menu, by these they were empowered to formulate their own dietary menu. They were constantly assisted when faced any problem. In both the group the nutritional parameters were reassessed after three months of intervention. The results were analyzed statistically. There was statistically significant mean increment in the fat free mass index in GroupB[0.8%(Gr.-A)Vs1.0%(Gr.-B),(p<0.05)], the mean increment in the serum albumin in the GroupB was also significantly higher than GroupA[(0.6gm/dl(Gr.A) Vs 0.9 gm/dl(Gr.B), p<0.0]).Compared to Group-A there was statistically favorable anthropometric changes in Group-B. In conclusion patient empowerment and self nutrition care is proved to be an effective intervention for improving nutritional status in hemodialysis patients.