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To explore the ways in which Latinx older siblings support younger siblings during shared reading, researchers investigated the following question with three Latinx families in the U.S.: "How are older siblings modeling and intentionally supporting focal children's cognitive self-regulation in the context of shared reading?" Analyses of video recorded interactions across six visits revealed that older siblings intentionally supported focal children's cognitive self-regulation by fostering autonomy and choice through the use of verbal and nonverbal cues to guide attention, using prosody to engage their sibling, and to initiate reading beyond resistance, and vicarious modeling of metacognitive processes by engaging in self-corrections and demonstrating positive affect during shared reading interactions. Findings highlight the importance of older siblings, particularly sisters, as key figures in the sociocultural context of development for Latinx younger siblings in the U.S.

Background: Preeclampsia (PE) is a hypertension condition that often manifests after 20 weeks of gestation. It is regarded as a leading cause of death among mothers and babies globally. Aim: To evaluate how serum kallistatin affects PE severity. Patients and Methods: A case–control study that included three groups of 95 third trimester pregnant women with viable fetuses was chosen. Group M (32 mild PE), Group S (31 severe PE), and Group C (32 control pregnant normotensives). Serum kallistatin, complete blood count, liver, and renal functions were compared between groups, at An Al-Yarmouk Teaching Hospital Obstetrics and Gynecology. Results: The concentrations of serum kallistatin in severe PE were markedly lower than those in mild and normotensive pregnant women. (1.79, 3.24, and 4.55, P < 0.001). Kallistatin accurately predicted mild, severe, and normotensive PE. All healthy women’s parameters did not correlate with kallistatin. In PE, age, gestational age, and platelets correlated directly with kallistatin, but systolic and diastolic blood pressure, alanine transaminase, aspartate aminotransferase, and total serum bilirubin correlated inversely. Kallistatin had higher sensitivity than specificity and comparable negative to positive predictive values. Conclusions: Mother’s serum kallistatin is inversely related to PE severity and significantly lower in PE patients than normotensives. Kallistatin’s sensitivity and specificity for predicting PE in normotensive women were 93.7% and 68.8%, respectively, using a threshold value ≤3.92 ng/ml using a threshold value ≤2.136 ng/ml, 90.3%, and 93.8% predicted severe PE from mild PE, respectively.

The detection of viral DNA is considered crucial in both diagnosis and prognosis. Nowadays, molecular diagnostic approaches represent the most promising tools for the clinical detection of viral infections. This review aims to investigate the most used and promising DNA-based technologies for viral detection, focusing on herpesviruses because of their ability to undergo latent and reactivation cycles, persisting lifelong in the host in association with several diseases. Molecular technologies, such as PCR-based assays, enhance sensitivity and specificity in identifying viral DNA from clinical samples such as blood, cerebrospinal fluid and saliva, indicating PCR and its derivatives as the gold standard methods for herpesvirus detection. In conclusion, this review underscores the need for continuous innovation in diagnostic methodologies to address the complexities of herpesvirus identification in different clinical samples.

Purpose The traditional method of oral examination, though a good tool for assessing the depth and breadth of student’s knowledge, has its shortcomings. A variable number of questions with variable difficulty levels by different examiners with different expectations can introduce bias in scores. The process aspect of oral examinations of first-year undergraduate medical students was improved by structuring them and by creating uniformity in the number, time, and difficulty level of questions for assessment, and feedback was taken regarding its acceptance as an improved tool of assessment. Methods After finalizing the topics, questions from a viva viewpoint were structured and categorized into three difficulty levels covering all aspects of chosen topics validated by subject experts. The number of questions asked per difficulty level, time, and marks given to each question was pre-decided. After briefing the students, the structured viva was conducted, and feedback was taken from students and examiners. Results The majority (87%) of first-year undergraduate students undertook the structured viva and filled in the feedback form. Nearly all students felt that the structured oral examination was a fair and unbiased assessment tool with less subjectivity compared to traditional viva. Most students (83.9%) felt that the topics were comprehensively covered, and 96.4% of students felt less stressed. Among examiners, there was 100% agreement on the uniformity of questions asked, topics covered, less subjectivity, and no carryover effect. Conclusion The examiners have accepted it as one of the formative assessment tools for future batches of students and are ready to explore its utility as a summative assessment tool.

Sarah Cook,1 David Osborn,2,3 Arti Maini,1 Ravi Parekh,1 Shamini Gnani,1 Thomas Beaney,1 Ana Luisa Neves,1 Sonia Saxena,1 Jennifer K Quint1 1School of Public Health, Imperial College London, London, UK; 2Division of Psychiatry, University College London, London, UK; 3Camden and Islington NHS Foundation Trust, London, UKCorrespondence: Sarah Cook, White City Campus, Imperial College London, 9th Floor Michael Uren Building, London, W12 0BZ, UK, Email sarah.cook@imperial.ac.ukPurpose: Electronic health records (EHR) are valuable resources for health research; however, their use is challenging. A validated alcohol use disorder (AUD) codelist for UK primary care is needed to improve population-based research in this patient group. We aimed to develop an AUD codelist for use in the Clinical Practice Research Datalink (CPRD) Aurum database, a UK EHR primary-care database.Methods: The CPRD code browser was searched using keywords related to alcohol use using a previously developed search strategy. The resulting codes were categorised as AUD if they were: a) diagnostic of AUD, b) indicated alcohol withdrawal, or c) indicated chronic alcohol-related harm (physical or mental). Codes related to alcohol use but not used to define AUD were also classified into relevant categories (alcohol status, acute harm, and alcohol screening). All codes were categorised independently by at least two reviewers (one person reviewed all codes and five reviewers (all practising GPs) each reviewed a subset of codes (100– 200 codes each). Disagreements in categorisation were discussed by at least three coders and a consensus was reached. The reliability of categorisation was assessed using kappa statistics.Results: In total, 556 potential codes related to alcohol use were identified. The Kappa for reliability between coders was moderate for both AUD (0.72) and across all categories (0.62), with substantial variability between coders (AUD: 0.33– 0.97; all categories 0.36– 0.74). In the final codelist, 138 codes were included as indicating AUD: 38 codes identified which indicated diagnosis of AUD, 14 indicating withdrawal plus 85 codes indicating chronic alcohol-related harm (41 physical health and 44 mental health).Conclusion: Many codes are used in primary care to record alcohol use and associated harms, and there is substantial variability in how clinicians categorise them. While future work formally validating the codelist against gold standard clinical reviews and qualitative work with General Practitioners is needed for a deeper understanding of coding processes, we have documented here the process used for the development of an AUD codelist within primary care which can be used as a reference for future research.Keywords: alcohol use disorder, electronic health records, primary care, clinical practice research datalink

Extensively drug-resistant (XDR) and pre-XDR- tuberculosis (TB) account for approximately a third of pediatric MDR-TB cases globally. Clinical management is challenging; recommendations are based on limited evidence. We assessed the clinical outcomes for children and adolescents treated for XDR-and pre-XDR-TB. We performed a systematic review and meta-analysis of published studies reporting treatment outcomes for children and adolescents with XDR-and pre-XDR-TB. MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and trial registries up to 31 December 2023 were searched. Eligible studies included children and adolescents aged

Training educators and learners in person-centred, solution-orientated coaching approaches may facilitate the development of a learner-centred mindset. Imperial College London developed a Massive Open Online Course (MOOC) in coaching skills for learner-centred conversations. A mixed methodology (post-course survey and semi-structured interviews) was used to evaluate the MOOC. Survey participants (n=1521) scored the MOOC highly on scales for intrinsic motivation and critical reflection and felt the MOOC aligned well with their cultural beliefs. Interview participants (n= 16) reported development of a learner-centred mindset and described applying coaching skills within a range of contexts, challenges encountered and how they addressed these.

Fever in older adults poses unique challenges due to atypical symptoms, weakened immune responses, and comorbidities. This chapter explores the diverse presentations of fever in the elderly, emphasizing the importance of vigilant monitoring and tailored interventions by healthcare providers and caregivers. Challenges in temperature measurement, communication barriers, and polypharmacy further complicate fever management. The chapter discusses the differences between fever presentations in young and older individuals and addresses the complexities of managing fever in long-term care facilities. In addition, it highlights fever of unknown origin in older persons, stressing the need for timely diagnosis and tailored investigations. Finally, preventive strategies, including vaccination campaigns and infection control measures, are proposed to mitigate fever occurrences in older adults.

Aims: To study demographic and clinical profiles of Guillain Barre syndrome (GBS) in the pre-pandemic and coronavirus disease 2019 (COVID-19) pandemic era and to compare the GBS incidence, severity, and its outcome in the pre-pandemic and pandemic eras. Methodology: This is a 4-year retrospective study done in a tertiary care hospital in Delhi, India, between March 2018 and March 2022. Patients were divided into the pre-pandemic era and pandemic era (2 years before and 2 years after March 2020). Results: The number of patients (N) was 25 in the pandemic/vaccine era, while N = 49 in the pre-pandemic era. The mean duration of hospitalization was significantly higher (P = 0.03) during the pandemic era (10.68 ± 6.67 days) compared to the pre-pandemic era (7.59 ± 3.55 days). There was no statistical difference in age (P = 0.56), gender (P = 0.70), GBS variants (P = 0.40), clinical spectrum, antecedent infection (P = 0.91), Hughes Disability Score on admission and discharge (P = 0.93 and P = 0.52, respectively), respiratory involvement requiring a ventilator (P = 0.19), and mortality (P = 0.26) in both the eras. Conclusion: Our study showed no association of the incidence of GBS with the ongoing COVID-19 pandemic. The mean hospitalization days were significantly increased during COVID-19 in view of associated respiratory involvement. The commonly held hypothesis of the increase in GBS cases during the pandemic/vaccine era has not been observed in our study.

We present a case demonstrating metastases of malignant melanoma (MM) to the urinary bladder (UB) and descending colon (DC). With review of literature, it was determined that the metastases of MM to both the urinary bladder and descending colon in a single case is rare in occurrence.

Summary: Hepatocellular carcinoma (HCC) is a major global healthcare challenge, with >1 million patients predicted to be affected annually by 2025. In contrast to other cancers, both incidence and mortality rates continue to rise, and HCC is now the third leading cause of cancer-related death worldwide. Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for advanced HCC, with trials demonstrating a superior overall survival benefit compared to sorafenib in the first-line setting. Combination therapy with either atezolizumab (anti-PD-L1) and bevacizumab (anti-VEGF) or durvalumab (anti-PD-L1) and tremelimumab (anti-CTLA-4) is now recognised as standard of care for advanced HCC. More recently, two phase III studies of ICI-based combination therapy in the early and intermediate disease settings have successfully met their primary end points of improved recurrence- and progression-free survival, respectively. Despite these advances, and in contrast to other tumour types, there remain no validated predictive biomarkers of response to ICIs in HCC. Ongoing research efforts are focused on further characterising the tumour microenvironment in order to select patients most likely to benefit from ICI and identify novel therapeutic targets. Herein, we review the current understanding of the immune landscape in which HCC develops and the evidence for ICI-based therapeutic strategies in HCC. Additionally, we describe the state of biomarker development and novel immunotherapy approaches in HCC which have progressed beyond the pre-clinical stage and into early-phase trials.

Abstract Core–shell fuel@oxidizer nanocomposite can combust in oxygen‐starved environment. A ferrimagnetic reactive particle, being successfully engineered, allows for manipulation using an external magnetic field and facilitates target heat or gas production. This research reports on interesting flame dynamics of newly synthesized core–shell Al@Fe3O4 nanoparticles under the influence of a magnetic field. Serving as an oxidizer and a functional ferrimagnetic component, iron oxide nanoparticles (IONPs) are grown in situ on nano‐sized Al (n‐Al) particles. Electron microscopic images demonstrate nearly monodispersed IONPs ≈7 nm decorating the surface of n‐Al. X‐ray diffractogram and X‐ray photoelectron spectroscopy confirm the formation of Fe3O4. Thermal analysis suggests the as‐prepared core–shell particles predominantly go through a solid‐state reaction mechanism that exhibits 30% lower activation energy compared to physically‐mixed nanocomposite (215.0 vs 310.8 kJ mol−1). The core/shell particles can be ignited and combust under laser irradiation with or without the effect of a magnetic field. When suspended in the middle of the tube by the magnetic field, an interesting combustion process is observed, highlighting a grow‐shrink‐grow flame resulted from the interactions between the combustion products and the external magnetic field, as well as backfiring at the bottom of the sample without major changes in burning rate and ignition delay.