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Abstract Background Indoor lighting, exposure to outdoor daylight, physical activity and sleep interact to influence functioning, mood and cicadian rhythm. Older adults (≥ 65 years), who often spend more time at home, are less physically active and experience more sleep problems, could benefit from strategies to support behavioural change and self-managed modifications in the home. The study’s primary objective was to assess the usability and feasibility of the ‘Light, activity and sleep in my daily life’ intervention, delivered as a web-based course. Methods This 9-week intervention was delivered in a municipality in Sweden (55.70° N). Participants were eight healthy women (age 71–84), community-living in one-person households. We recruited through municipal staff and posters at senior citizen meeting points. Both qualitative and quantitative data were collected before and after the intervention. The outcome measures were intervention usability (ease of use, usefulness) and study feasibility (e.g., recruitment procedure, online engagement). Measures also included changes to routines and self-managed home adjustments to determine whether the participants applied what they had learnt. Results All participants completed the intervention. Time logged in varied between 25 min and 3 h (M = 1 h 50 min) per week. Seven participants’ system usability scores were between 90 and 100 (‘Excellent’) out of 100. When interviewed, participants reported overall high satisfaction with what they had learnt. Six participants were particularly satisfied with the modules targeting light. Seven participants made changes to their lighting or darkness conditions, such as replaced bulbs with either 3-step dimming or higher colour temperature LEDs (samples were included in the intervention test kit). One suggestion to improve the online delivery was to enable participants to add text comments to the weekly evaluation form. Conclusions The web-based intervention was feasible to deliver but time for recruitment should be extended and advertisement in the local newspaper should be considered. Participants’ computer proficiency and access to the internet at home will be critical in a future study with a larger sample. Only minor changes to the online content of the intervention are needed based on participants’ feedback. The intervention will be possible to evaluate in a future pilot study.

We report the results of first ever spectropolarimetric analyses of the Galactic ultraluminous X-ray pulsar Swift J0243.6+6124 during the 2023 outburst using quasi-simultaneous IXPE, NICER, and NuSTAR observations. A pulsation of period ∼9.79 s is detected in IXPE and NuSTAR observations with pulse fractions (PFs) ∼18% (2–8 keV) and ∼28% (3–78 keV), respectively. Energy-dependent study of the pulse profiles with NuSTAR indicates an increase in PF from ∼27% (3–10 keV) to ∼50% (40–78 keV). Further, epoch-dependent polarimetric measurements during the decay phase of the outburst confirm the detection of significant polarization, with the polarization degree (PD) and polarization angle ranging between ∼2%–3.1% and ∼8.°6–10.°8, respectively, in the 2–8 keV energy range. We also observe that the PD increases up to ∼4.8% at higher energies (≳5 keV) with dominating bbodyrad flux contribution (1.5 ≲ F _BB / F _PL ≲ 3.4) in the IXPE spectra. The phase-resolved polarimetric study yields PD as ∼1.7%–3.1% suggesting a marginal correlation with the pulse profiles. Moreover, the broadband (0.6–70 keV) energy spectrum of combined NICER and NuSTAR observations is well described by the combination of bbodyrad and cutoffpl components with seed photon temperature ( kT _bb ) ∼0.86 ± 0.03 keV and photon index (Γ) ∼0.98 ± 0.01. With the above findings, we infer that the observed “low” PD in Swift J0243.6+6124 is attributed possibly due to the “vacuum resonance” effect between the overheated and relatively cooler regions of the neutron star boundary layer.

Abstract Objective To determine the prevalence of mitochondrial diseases (MD) in Hong Kong (HK) and to evaluate the clinical characteristics and genetic landscape of MD patients in the region. Methods This study retrospectively reviewed the phenotypic and molecular characteristics of MD patients from participating public hospitals in HK between January 1985 to October 2020. Molecularly and/or enzymatically confirmed MD cases of any age were recruited via the Clinical Analysis and Reporting System (CDARS) using relevant keywords and/or International Classification of Disease (ICD) codes under the HK Hospital Authority or through the personal recollection of treating clinicians among the investigators. Results A total of 119 MD patients were recruited and analyzed in the study. The point prevalence of MD in HK was 1.02 in 100,000 people (95% confidence interval 0.81–1.28 in 100,000). 110 patients had molecularly proven MD and the other nine were diagnosed by OXPHOS enzymology analysis or mitochondrial DNA depletion analysis with unknown molecular basis. Pathogenic variants in the mitochondrial genome (72 patients) were more prevalent than those in the nuclear genome (38 patients) in our cohort. The most commonly involved organ system at disease onset was the neurological system, in which developmental delay, seizures or epilepsy, and stroke-like episodes were the most frequently reported presentations. The mortality rate in our cohort was 37%. Conclusion This study is a territory-wide overview of the clinical and genetic characteristics of MD patients in a Chinese population, providing the first available prevalence rate of MD in Hong Kong. The findings of this study aim to facilitate future in-depth evaluation of MD and lay the foundation to establish a local MD registry.

Understanding factors leading to death following the onset of symptoms of tuberculosis (TB) is important to predict prognosis among patients with TB. With aiming the End TB strategy, mortality is declining not as expected globally and in India. Although India is one of the highest incidence countries globally, India lacks evidence of understanding of the factors for TB death. Thus, this study aims to document the characteristics of deaths due to TB in the Western state of India, Gujarat.About 74 deaths were randomly documented from 7 different geographic regions of Gujarat through a community-based death review from Oct 2021 to February 2022. The trained researchers administered a semi-structured questionnaire to capture the demographic, socioeconomic, history of comorbidity and addiction, medical history, case records, and chronology of events preceding death.Most deaths happened within 24 weeks from the onset of symptoms, which reduced to half (12 weeks) in the other cascades, i.e., diagnosis and treatment initiation to the death. Out of 74 reviewed deaths, 47 (64%) deaths had the cause of death as TB, with an average duration of 87 days from onset of symptoms to death. The study observed the time, place, and person distribution on different epidemiological parameters. While analyzing narratives from the relative, the gaps between the system (service provider) and demand (patient perspective) sides were synthesized.It is recommended to conduct such kind of community-based death reviews in the routine practices of the National TB Elimination Program to ensure the appropriate review of the underlying causes of deaths due to TB. The matrix developed in this study is easy to replicate in any other death reviews to understand the intercept of the supply-demand side determinants for the deaths.

Abstract Background The link between mental health difficulties and terrorist behaviour has been the subject of debate for the last 50 years. Studies that report prevalence rates of mental health difficulties in terrorist samples or compare rates for those involved and not involved in terrorism, can inform this debate and the work of those responsible for countering violent extremism. Objectives To synthesise the prevalence rates of mental health difficulties in terrorist samples (Objective 1—Prevalence) and prevalence of mental health disorders pre‐dating involvement in terrorism (Objective 2—Temporality). The review also synthesises the extent to which mental health difficulties are associated with terrorist involvement compared to non‐terrorist samples (Objective 3—Risk Factor). Search Methods Searches were conducted between April and June 2022, capturing research until December 2021. We contacted expert networks, hand‐searched specialist journals, harvested records from published reviews, and examined references lists for included papers to identify additional studies. Selection Criteria Studies needed to empirically examine mental health difficulties and terrorism. To be included under Objective 1 (Prevalence) and Objective 2 (Temporality), studies had to adopt cross‐sectional, cohort, or case‐control design and report prevalence rates of mental health difficulties in terrorist samples, with studies under Objective 2 also needing to report prevalence of difficulties before detection or involvement in terrorism. For Objective 3 (Risk Factor) studies where there was variability in terrorist behaviour (involved vs. not involved) were included. Data Collection and Analysis Captured records were screened in DisillterSR by two authors. Risk of bias was assessed using Joanna Briggs Institute checklists, and random‐effects meta‐analysis conducted in Comprehensive Meta‐Analysis software. Results Fifty‐six papers reporting on 73 different terrorist samples (i.e., studies) (n = 13,648) were identified. All were eligible for Objective 1. Of the 73 studies, 10 were eligible for Objective 2 (Temporality) and nine were eligible for Objective 3 (Risk Factor). For Objective 1, the life‐time prevalence rate of diagnosed mental disorder in terrorist samples (k = 18) was 17.4% [95% confidence interval (CI) = 11.1%–26.3%]. When collapsing all studies reporting psychological problems, disorder, and suspected disorder into one meta‐analyses (k = 37), the pooled prevalence rate was 25.5% (95% CI = 20.2%–31.6%). When isolating studies reporting data for any mental health difficulty that emerged before either engagement in terrorism or detection for terrorist offences (Objective 2: Temporality), the life‐time prevalence rate was 27.8% (95% CI = 20.9%–35.9%). For Objective 3 (Risk Factor), it was not appropriate to calculate a pooled effect size due the differences in comparison samples. Odds ratios for these studies ranged from 0.68 (95% CI = 0.38–1.22) to 3.13 (95% CI = 1.87–5.23). All studies were assessed as having high‐risk of bias which, in part, reflects challenges conducting terrorism research. Author's Conclusions This review does not support the assertion that terrorist samples are characterised by higher rates of mental health difficulties than would be expected in the general population. Findings have implications for future research in terms of design and reporting. There are also implications for practice with regards the inclusion of mental health difficulties as indicators of risk.

Abstract This is the protocol for a Campbell systematic review. The objectives are as follows: the first objective of the review (Objective 1—Prevalence) is to present a synthesis of the reported prevalence rates of mental health difficulties in terrorist samples. Where sufficient data is available, the synthesis will be sensitive to the heterogeneity of the terrorism phenomenon by exploring the rates of mental health difficulties for different forms of terrorism and for different terrorist roles (e.g., bombing, logistics, finance, etc.). The second objective (Objective 2—Temporality) will synthesise the extent to which mental health difficulties pre‐date involvement in terrorism within prevalence studies. Finally, the third objective (Objective 3—Risk) aims to further establish temporality by examining the extent to which the presence of mental disorder is associated with terrorist involvement by comparing terrorist and non‐terrorist samples.

The construction industry is currently dealing with a number of major issues. These include of shortage of river sand and large amount of energy required for manufacturing of cement produces free CO2 in air, accordingly use of manufactured sand and industrial waste in concrete increases. In construction of hilly topography long carrying of concrete is required, In outside location providing of concrete from inner mixing place, in construction of road, in lengthy tunneling work, manual transportation of concrete by labor, directly affect the flow property and concrete get stiff at the time of casting on real site work and in several conditions concrete get rejected by engineers. The paper discusses effects of replacing cement with 20% of industrial waste silica fumes and partially replacing natural sand with manufactured sand in the context of properties of retempered concrete like flow, water absorption, sorptivity, tensile, compressive, flexural, shear, impact strengths and chloride permeability. The work demonstrates that the flow property inversely proposition with retempering time. Water absorption, sorptivity and chloride permeability for retempered concrete made by 20% substitute of cement by silica fume with additional 5% cement and water are lesser up to 60 min of retempering time. Compression, tension and flexural, shear, impact strengths for retempered concrete made by 20% substitute of cement by industrial waste silica fume with additional 5% cement and water are increased up to 60 min of retempering time, having strong microstructure than in the reference concrete. The prospect of substituting manufactured sand for natural sand and industrial by-products silica fume for cement has significant technical, economic, and environmental benefits, all of which are critical in today's construction climate also Instead of squandering bulk concrete, retempering using industrial waste and manufactured sand is advised.

Cells can sense and respond to different kinds of continuous mechanical strain in the human body. Mechanical stimulation needs to be included within the in vitro culture system to better mimic the existing complexity of in vivo biological systems. Existing commercial dynamic culture systems are generally two-dimensional (2D) which fail to mimic the three-dimensional (3D) native microenvironment. In this study, a pneumatically driven fiber robot has been developed as a platform for 3D dynamic cell culture. The fiber robot can generate tunable contractions upon stimulation. The surface of the fiber robot is formed by a braiding structure, which provides promising surface contact and adequate space for cell culture. An in-house dynamic stimulation using the fiber robot was set up to maintain NIH3T3 cells in a controlled environment. The biocompatibility of the developed dynamic culture systems was analyzed using LIVE/DEAD™ and alamarBlue™ assays. The results showed that the dynamic culture system was able to support cell proliferation with minimal cytotoxicity similar to static cultures. However, we observed a decrease in cell viability in the case of a high strain rate in dynamic cultures. Differences in cell arrangement and proliferation were observed between braided sleeves made of different materials (nylon and ultra-high molecular weight polyethylene). In summary, a simple and cost-effective 3D dynamic culture system has been proposed, which can be easily implemented to study complex biological phenomena in vitro.

Polymer scaffolds are increasingly ubiquitous in the field of tissue engineering in improving the repair and regeneration of damaged tissue. Natural polymers exhibit better cellular adhesion and proliferation than biodegradable synthetics but exhibit inferior mechanical properties, among other disadvantages. Synthetic polymers are highly tunable but lack key binding motifs that are present in natural polymers. Using collagen and poly(lactic acid) (PLA) as models for natural and synthetic polymers, respectively, an evaluation of the cellular response of embryonic mouse fibroblasts (NIH 3T3 line) to the different polymer types was conducted. The samples were analyzed using LIVE/DEAD™, alamarBlue™, and phalloidin staining to compare cell proliferation on, interaction with, and adhesion to the scaffolds. The results indicated that NIH3T3 cells prefer collagen-based scaffolds. PLA samples had adhesion at the initial seeding but failed to sustain long-term adhesion, indicating an unsuitable microenvironment. Structural differences between collagen and PLA are responsible for this difference. Incorporating cellular binding mechanisms (i.e., peptide motifs) utilized by natural polymers into biodegradable synthetics offers a promising direction for biomaterials to become biomimetic by combining the advantages of synthetic and natural polymers while minimizing their disadvantages.

Subependymal giant cell astrocytomas (SEGAs) are the most common intracranial tumors in Tuberous Sclerosis Complex (TSC). Very few cases of solitary SEGA without a diagnosis of TSC have been described. Most of these previously reported solitary SEGAs were located near the caudothalamic groove or in close proximity to the lateral ventricles. Here, we describe a unique case of solitary extraventricular SEGA in a 17-year-old boy who presented with new-onset seizures in the absence of the clinical and genetic diagnosis of TSC. This extraventricular SEGA was involving white matter and cortex of the occipital lobe and was predominantly hypointense on T1 and T2-weighted images with a markedly hypointense signal on susceptibility-weighted images likely secondary to dense internal calcifications. Solitary SEGA can occur in the extraventricular location in patients without TSC and should be included in the differential diagnosis of a densely calcified supratentorial intra-axial tumor in children, especially during the second decade of life.

A surgical heater–cooler unit has been implicated as the source for Mycobacterium chimaera infections among cardiac surgery patients in several countries. We isolated M. chimaera from heater–cooler units and patient infections in the United States. Whole-genome sequencing corroborated a risk for these units acting as a reservoir for this pathogen.

Executive summary/Abstract Background In the field of terrorism research, the violent radicalisation of individuals towards perpetrating acts of terror has been the subject of academic enquiry for some time. One core focus by social scientists has been the role of narratives in this process. Narratives have the ability to present a socially constructed version of reality which serves the interest of the narrator(s). In the context of terrorism, by depicting violence as a viable antidote to individual vulnerabilities, the narratives purported for propagandistic purposes have the potential to thwart perceptions of instrumentality (a key characteristic of violent radicalisation). In order to prevent this from happening, researchers and counter‐terrorism practitioners have increasingly sought to explore the potential for counter‐narratives; targeted interventions that challenge the rationalisation(s) of violence purported in dominant narratives which, in turn, reconstructs the story. However, there is overwhelming consensus in both government and academic spheres that the concept of the counter‐narrative is underdeveloped and, to date, there has been no synthesis of its effectiveness at targeting violent radicalisation‐related outcomes. Objectives The objective of this review was to provide a synthesis of the effectiveness of counter‐narratives in reducing the risk of violent radicalisation. Search Methods After a scoping exercise, the literature was identified through four search stages, including key‐word searches of 12 databases, hand searches of reference lists of conceptual papers or books on the topic of counter‐narratives, as well as direct contact with experts and professional agencies in the field. Selection Criteria Studies adopting an experimental or quasiexperimental design where at least one of the independent variables involved comparing a counter‐narrative to a control (or comparison exposure) were included in the review. Data Collection and Analysis Accounting for duplicates, a total of 2,063 records were identified across two searches. Nineteen studies across 15 publications met the inclusion criteria. These studies were largely of moderate quality and 12 used randomised control trial designs with varying types of controls. The publication years ranged from 2000 to 2018, with the majority of studies published after 2015. The studies represented a range of geographical locations, but the region most heavily represented was North America. In most cases, the dominant narrative(s) “to‐be‐countered” comprised of hostile social constructions of an adversary or “out‐group”. The majority of studies challenged these dominant narratives through the use of stereotype‐challenging, prosocial, or moral “exemplars”. Other techniques included the use of alternative accounts, inoculation and persuasion. Results In terms of risk factors for violent radicalisation, there was some disparity on intervention effectiveness. Overall, when pooling all outcomes, the intervention showed a small effect. However, the observed effects varied across different risk factors. Certain approaches (such as counter‐stereotypical exemplars) were effective at targeting realistic threat perceptions, in‐group favouritism and out‐group hostility. However, there was no clear reduction in symbolic threat perceptions or implicit bias. Finally, there was a sparse yet discouraging evidence on the effectiveness of counter‐narrative interventions at targeting primary outcomes related to violent radicalisation, such as intent to act violently. Authors' Conclusions The review contributes to existing literature on violent radicalisation‐prevention, highlighting the care and complexity needed to design and evaluate narrative‐based interventions which directly counter existing, dominant narratives. The authors note the challenges of conducting high‐quality research in the area, but nonetheless encourage researchers to strive for experimental rigour within these confines

Abstract Background Previous studies have reported on positive and negative psychological outcomes associated with the use of social networking sites (SNSs). Research efforts linking Facebook use with depression and low self-esteem have indicated that it might be the manner in which people engage with the site that makes its use problematic for some people. The aim of the current study was to test a theoretical model of problematic Facebook use, using adult attachment style as the predictor variable of interest. Method A cross-sectional design was employed wherein adult Facebook users (n = 717) completed measures of psychological distress, self-esteem, and adult attachment, in addition to measures of problematic Facebook use (i.e. social comparison, self-disclosures, impression management, & intrusive Facebook use). Data were analysed using hierarchical multiple regression and mediation analyses. Results The results of this study indicated that attachment anxiety was predictive of all facets of problematic Facebook use, and that attachment avoidance was predictive of impression management, and social consequences of intrusive Facebook use. Further analyses confirmed the mediating influences of psychological distress and self-esteem on these relationships. Conclusions Users of Facebook with higher levels of attachment insecurity may be gravitating towards the site in order to fulfil their attachment needs. This tendency is likely to be particularly prevalent for those individuals with low self-esteem who are experiencing psychological distress.

Invasive nontuberculous mycobacteria (NTM) infections may result from a previously unrecognized source of transmission, heater–cooler devices (HCDs) used during cardiac surgery. In July 2015, the Pennsylvania Department of Health notified the Centers for Disease Control and Prevention (CDC) about a cluster of NTM infections among cardiothoracic surgical patients at 1 hospital. We conducted a case–control study to identify exposures causing infection, examining 11 case-patients and 48 control-patients. Eight (73%) case-patients had a clinical specimen identified as Mycobacterium avium complex (MAC). HCD exposure was associated with increased odds of invasive NTM infection; laboratory testing identified patient isolates and HCD samples as closely related strains of M. chimaera, a MAC species. This investigation confirmed a large US outbreak of invasive MAC infections in a previously unaffected patient population and suggested transmission occurred by aerosolization from HCDs. Recommendations have been issued for enhanced surveillance to identify potential infections associated with HCDs and measures to mitigate transmission risk.

Recurrent rhabdomyolysis is frequently ascribed to fatty acid ß-oxidation defects, mitochondrial respiratory chain disorders and glycogen storage-related diseases. In recent years, autosomal recessive LPIN1 mutations have been identified as a prevailing cause of severe rhabdomyolysis in children in Western countries. We report the first probable Hong Kong Chinese case of recurrent severe rhabdomyolysis in early childhood caused by LPIN1 variants. Compound heterozygous novel variants NM_145693.2(LPIN1):c.[1949_1967dupGTGTCACCACGCAGTACCA]; [2410G>C] (p.[Gly657Cysfs*12];[Asp804His]) were detected. The former variant was classified as likely pathogenic while the latter variant was classified as a variant of uncertain significance (VUS) based on the guideline published by the American College of Medical Genetics and Genomics (ACMG) in 2015. Although the genetic findings were inconclusive, the patient’s presentation was compatible with LPIN1-related acute recurrent rhabdomyolysis, and the patient was treated as such. The early recognition, timely diagnosis and management of this condition are important to avoid fatal consequences. To our knowledge, there has been no previous report in the English-language literature of a child with Chinese ethnicity and LPIN1-related acute recurrent rhabdomyolysis (MIM #268200). Functional characterization of the novel variants detected in this study are warranted in future studies.

Nanoworld is an attractive sphere with the potential to explore novel nanomaterials with valuable applications in medicinal science. Herein, we report an efficient and ecofriendly approach for the synthesis of Nickel oxide nanoparticles (NiO NPs) via a solution combustion method using Areca catechu leaf extract. As-prepared NiO NPs were characterized using various analytical tools such as powder X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and UV-Visible spectroscopy (UV-Vis). XRD analysis illustrates that synthesized NiO NPs are hexagonal structured crystallites with an average size of 5.46 nm and a hexagonal-shaped morphology with slight agglomeration. The morphology, size, and shape of the obtained material was further confirmed using SEM and TEM analysis. In addition, as-prepared NiO NPs have shown potential antidiabetic and anticancer properties. Our results suggest that the inhibition of α-amylase enzyme with IC 50 value 268.13 µg/mL may be one of the feasible ways through which the NiO NPs exert their hypoglycemic effect. Furthermore, cytotoxic activity performed using NiO NPs exhibited against human lung cancer cell line (A549) proved that the prepared NiO NPs have significant anticancer activity with 93.349 μg/mL at 50% inhibition concentration. The biological assay results revealed that NiO NPs exhibited significant cytotoxicity against human lung cancer cell line (A549) in a dose-dependent manner from 0–100 μg/mL, showing considerable cell viability. Further, the systematic approach deliberates the NiO NPs as a function of phenolic extracts of A. catechu with vast potential for many biological and biomedical applications.

Abstract Background Health communications often present graphic, threat-based representations of the potential consequences of health-risk behaviours. These ‘threat appeals’ feature prominently in public health campaigns, but their use is controversial, with studies investigating their efficacy reporting inconsistent, and often negative, findings. This research examined the impact of a threat-based road safety advertisement on the driving behaviour of young male drivers. Methods To address limitations of previous research, we first identified a road safety advertisement that objectively and subjectively elicited fear using physiological and subjective measures. Study 1 (n = 62) examined the effect of this advertisement, combined with a manipulation designed to increase perceived efficacy, on speed choice. Study 2 (n = 81) investigated whether a state emotion, anger, impacts on the effectiveness of the advertisement in changing four distinct driving behaviours. Both studies examined short-term effects only. Results Study 1 findings indicated that a high threat message, when combined with high perceived efficacy, can lead to a decrease in speed choice. Study 2 results suggested that increased levels of state anger may counteract the potential value of combining fear-arousing threats and efficacy-building messages. Conclusions Findings suggest that threat-based road safety communications that target affective (fear) and cognitive (perceived efficacy) mechanisms can positively affect driving behaviours. State emotions, such as anger, may negatively impact on the effectiveness of the message. Taken together, these findings provide additional support for the use of efficacy-building messages in threat-based communications, but highlight the need for further research into the complex array of affective influences on driving.

The reformulated learned helplessness model proposes that people who tend to make internal, stable, and global attributions in response to uncontrollable aversive events are more likely to develop depression. The present study sought to investigate the nature of the relationship between attributional style and depression in a male prison sample. One hundred and one adult male prisoners from four medium security prisons in Ireland completed the Attributional Style Questionnaire and measures of depression (BDI-II) and anxiety (BAI). Severity of self-reported depressive symptoms in the present sample was comparable to other prison and clinical samples, but higher than community samples. Participants were more severely affected by depressive symptoms than anxiety. The original attributional dimensions (i.e. internal, stable, and global) predicted a significant amount of variance in depression, but the model was not significant after controlling for anxiety. A subsequent regression model, comprising attributional dimensions for both negative events and positive events including a measure of 'uncontrollability', accounted for 35% of the variance in depression and the model retained significance while controlling for anxiety. An attributional model of depression may be relevant to the prison population and could provide a valid insight into the development and treatment of depressive symptoms in prisoners. The findings are interpreted in relation to previous research and implications for theory, clinical practice, and rehabilitation are discussed.

This study investigated the stories of heterosexual women who experienced a husband coming out as gay and a consequential marital separation. Interpretative phenomenological analysis (IPA) was used. Loss, anger, spousal empathy and concerns regarding societal prejudice were reported. Additional stress was experienced when others minimised the experience due to the gay sexual orientation of their husband. Experiencing positive communication with their husband during and after the disclosure aided the resolution of the emotional injury experienced by them. They all eventually 'let go' of their husband. This involved a process of reconceptualising the self as separated. Findings indicate the importance of supporting women to re-focus on their needs during and following marital dissolution. The importance of non-judgemental support for marital loss, rather than a focus on the gay sexual orientation of the spouse, was highlighted.

A growing body of empirical research has confirmed an association between chronic pain and cognitive dysfunction. The aim of the present study was to determine whether cognitive function is affected in patients with a diagnosis of chronic neuropathic or radicular pain relative to healthy control participants matched by age, gender, and years of education. We also examined the interaction of pain with age in terms of cognitive performance. Some limitations of previous clinical research investigating the effects of chronic pain on cognitive function include differences in the pain and cognitive scale materials used, and the heterogeneity of patient participants, both in terms of their demographics and pathological conditions. To address these potential confounds, we have used a relatively homogenous patient group and included both experimental and statistical controls. We have also specifically investigated the interaction effect of pain and age on cognitive performance. Patients (n = 38) and controls (n = 38) were administered a battery of cognitive tests measuring IQ, spatial and verbal memory, attention, and executive function. Educational level, depressive symptoms, and state anxiety were assessed as were medication usage, caffeine, and nicotine consumption to control for possible confounding effects. Both the level of depressive symptoms and the state anxiety score were higher in chronic pain patients than in matched control participants. Chronic pain patients had a lower estimated IQ than controls, and showed impairments on measures of spatial and verbal memory. Attentional responding was altered in the patient group, possibly indicative of impaired inhibitory control. There were significant interactions between chronic pain condition and age on a number of cognitive outcome variables, such that older patients with chronic pain were more impaired than both age-matched controls and younger patients with chronic pain. Chronic pain did not appear to predict performance on the Wisconsin Card Sorting Task, which was used a measure of executive function. This study supports and extends previous research indicating that chronic pain is associated with impaired memory and attention.Perspective: Compared to healthy control participants, patients with chronic neuropathic or radicular pain showed cognitive deficits which were most pronounced in older pain patients.

Introduction: National Health Mission (NHM) was envisaged with the core objective of decentralization and health systems strengthening. The study tried to assess the utilization pattern of untied fund allocated to Rogi Kalyan Samitis of community health centers and primary health centres across the Gujarat. Methodology: Routine reporting of the Financial Management Reports was analysed to assess utilization pattern of financial year 2013-14. Results: RKS is predominantly using the fund to cover up the local needs at facility levels like outsourcing of the staff (10%), minor civil works (12%), drugs-consumables and logistics (24%). The contingency expenditure takes a large section too. Miniature part has been utilised for the day to day expenses of the facilities like printing, linen & training. This can be attributed to structural and managerial role of the system. Moreover NHM need to improve the mechanism for benefitting local community and utilization of the funds through RKS. Conclusion: Study emphasize a need for devising strategies and planning to fulfil the civil works, shortfall of staff, drugs procurement & efficient supply chain management to overcome the burden. Knowledge base of members needs to be strengthened for a clear understanding of the objectives, functioning and roles of RKS.

The diagnosis of acute right lower quadrant pain in a pediatric population is challenging. Acute appendicitis is the most common cause of an acute surgical abdomen. The common mimics of acute appendicitis are acute gastrointestinal and gynecologic diseases. This article reviews the sonographic findings of the spectrum of common acute abdominal emergencies in children with a focus on imaging clues to a specific diagnosis. This awareness can impact on diagnostic accuracy and impact patient management.

Alternative splicing of tau pre-mRNA is regulated by a 5′ splice site (5′ss) hairpin present at the exon 10−intron 10 junction. Single mutations within the hairpin sequence alter hairpin structural stability and/or the binding of splicing factors, resulting in disease-causing aberrant splicing of exon 10. The hairpin structure contains about seven stably formed base pairs and thus may be suitable for targeting through antisense strands. Here, we used antisense peptide nucleic acids (asPNAs) to probe and target the tau pre-mRNA exon 10 5′ss hairpin structure through strand invasion. We characterized by electrophoretic mobility shift assay the binding of the designed asPNAs to model tau splice site hairpins. The relatively short (10−15 mer) asPNAs showed nanomolar binding to wild-type hairpins as well as a disease-causing mutant hairpin C+19G, albeit with reduced binding strength. Thus, the structural stabilizing effect of C+19G mutation could be revealed by asPNA binding. In addition, our cell culture minigene splicing assay data revealed that application of an asPNA targeting the 3′ arm of the hairpin resulted in an increased exon 10 inclusion level for the disease-associated mutant C+19G, probably by exposing the 5′ss as well as inhibiting the binding of protein factors to the intronic spicing silencer. On the contrary, the application of asPNAs targeting the 5′ arm of the hairpin caused an increased exon 10 exclusion for a disease-associated mutant C+14U, mainly by blocking the 5′ss. PNAs could enter cells through conjugation with amino sugar neamine or by cotransfection with minigene plasmids using a commercially available transfection reagent.

This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and initiating surveillance to ensure that interventions were effective. While not all investigations of mucormycosis infections will identify a single source, all can potentially lead to improvements in infection control.

Background: Low back pain is a very common phenomenon in computer users. More than 80% people using computers for more than 4 h complain of back pain. Objective: To compare the effectiveness of multidisciplinary treatment approach and conventional treatment approach amongst computer users. Materials and Methods: A prospective interventional study was carried out at a private spine clinic amongst the computer users with the complaint of low back pain. The study participants were randomly distributed in two groups. The first group comprised the study participants treated by conventional approach and the second group was treated by multidisciplinary approach. Primary outcomes analyzed were pain intensity, sick leave availed, and quality of life. Statistical analysis was done using proportions, unpaired "t" test, and Wilcoxon signed-rank test. Results: Totally 44 study participants were randomly assigned to groups I and II, and each group had 22 study participants. Intensity of pain was reduced significantly in the group treated by multidisciplinary approach (t = 5.718; P = 0.0001). Similarly only 4 (19.19%) of the study participants of the group treated by multidisciplinary approach availed sick leave due to low back pain, while 14 (63.63%) study participants availed sick leave in the other group (P = 0.02). The quality of life amongst the study participants treated by multidisciplinary approach was significantly improved compared to the group treated by conventional approach (t = 7.037; P = 0.0001). Conclusion and Recommendation: The multidisciplinary treatment approach was better than the conventional treatment approach in low back pain cases when some factors like pain and quality of life were assessed. The multidisciplinary approach for treatment of low back pain should be promoted over conventional approach. Larger studies are required to confirm the findings in different settings.

This paper undertakes a comparative examination of contextual and individual-level antecedents to network building behaviors of leaders. Taking insights from social network and motivation theories, the proposed model suggests that while the institutional environment plays an important role in shaping individuals’ network building behaviors, there are certain individual attributes — such as individuals’ volitional tendencies and networking efficacy levels — that moderate the relationship between institutional backgrounds and networking behaviors of individuals. Using hierarchical regression models to test the hypotheses on a sample of ninety leaders from the Post Soviet countries and the United States, the results obtained highlight the roles of context and individual attributes in network building behaviors of leaders.

One of the recent diagnostic tests to assess the function of otolithic organs is through vestibular evoked myogenic potential (VEMP) testing. There are equivocal findings on effect of aging on ocular VEMP (oVEMP) parameters with reference to latencies. Hence this study was taken up to investigate the age related changes in oVEMP parameters. This present study considered 30 participants in each age group i.e., young adults, middle-aged adults and older adults. oVEMP were recorded using insert earphone at 100dBnHL at 500hZ short duration tone burst. The results showed in older adult significant difference in response rate, latencies and amplitude as compared to young and middle adult. Hence age should be taken into consideration when interpreting oVEMP results.

Background: An occupational exposure to blood can result from percutaneous (needle stick or other sharps injury) and mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth), or blood contact with non-intact skin. Beside transmission of infectious diseases, it indirectly affects health care delivery services especially in developing countries where demand is high in compare with manpower resources. Materials and method: The study was a cross sectional conducted among health care workers from a district of Gujarat. During the study, only one injection per health worker was taken into the consideration for better analysis. Results: Out of 251, 147 (58.56%) had needle stick injury in last one year and majority health workers were nursing staff. It was found that there was significant association who had NSIs previously before one year and injuries within last year and injuries occurred while giving the injections (48%). Only 32% of HCWs had done reporting about their NSIs to the concern authority and 20% followed the protocols of post exposure prophylaxis guidelines. Conclusion: Under reporting and lack of sensitivity on needles tick injuries had layered up during the study along with safe injection practices. Close monitoring on injection practices, surveillance on NSIs by quality assurance committee and structured communication plan should be in place to avoid health worker at risk and hazard of needle stick injuries.

The experiences of Irish sons and daughters born into heterosexually-organised parental partnerships/unions whose parents have separated and one has come out as Lesbian, Gay or Bisexual (LGB) were explored through a grounded theory approach. 15 adult children (over the age of 18 years), who varied in age when their parents separated and one disclosed as LGB, were interviewed. The primary concern that emerged centred on participants having to adjust to their parents' being separated, as opposed to their parent being LGB. This involved engaging with the tension that arose from the loss of the parental union, which involved changes to the home environment and adapting to new parental partners and family units. Heightened reflection on sexual orientation and an increased sensitivity to societal LGB prejudice were specifically associated with a parent coming out as LGB. How parents negotiated disclosing the changes to others, the level of support available to parents, and how capable parents were at maintaining the parent-child relationship had an impact on the tension experienced by sons and daughters. Participants moved from initially avoiding and resisting the family changes that were occurring to gradual consonance with their altered family environments. Concluding directions for research and clinical considerations are suggested.

The existing empirical research exploring the impact of threat appeals on driver behavior has reported inconsistent findings. In an effort to provide an up-to-date synthesis of the experimental findings, meta-analytic techniques were employed to examine the impact of threat-based messages on fear arousal and on lab-based indices of driving behavior. Experimental studies (k = 13, N = 3044), conducted between 1990 and 2011, were included in the analyses. The aims of the current analysis were (a) to examine whether or not the experimental manipulations had a significant impact on evoked fear, (b) to examine the impact of threat appeals on three distinct indices of driving, and (c) to identify moderators and mediators of the relationship between fear and driving outcomes. Large effects emerged for the level of fear evoked, with experimental groups reporting increased fear arousal in comparison to control groups (r = .64, n = 619, p

Fractures of the mandible and maxilla are usually treated by reduction and immobilization by interdental wiring and intermaxillary fixation. Inability to open the mouth for a period of 5-6 weeks is a disadvantage of this method. Recent techniques like rigid plate fixation help to reduce this period of immobilization of the jaws but it required the necessary equipment and may prove to be expensive in a public hospital system. We have fabricated wire acrylic occlusal splint which has been used in 18 patients for the management of mandibular or maxillary fractures over a period of one year. The mouth remains open during the course of treatment and it greatly helps in oral hygiene. Patient is permitted to take liquids and swallow semi-solid diets by mouth. The splint is removed after bony union is confirmed. We have used this technique in 5 children and 13 adults and has been used both for mandibular and maxillary fractures. There has only been one complication of an occlusal disturbance which was corrected later by dental treatment.