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This work presents a green, cost-effective and eco-friendly strategy to reduce noise pollution by developing biopolymer-based 3D-printed acoustic panels. We successfully fabricated two series of composites by varying the weight percentage (wt%) of cellulose fibers of water hyacinth (WH) and pineapple leaf (PAL), with polylactic acid (PLA) as the matrix via the heat-press method. All samples were characterized using Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and scanning electron microscopy (SEM). Physico-mechanical properties, including hardness, tensile, and impact strength, were improved with increasing fiber loading. Filaments of 1 wt% water hyacinth fibers (WHFs) in PLA (1 WHF/PLA) and 1 wt% pineapple leaf fibers (PALFs) in PLA (1 PALF/PLA) were prepared and tested for 3D printability. The sound absorption coefficients (α) of the 3D-printed panels were investigated from 500 to 5000 Hz sound frequency range. The 3D-printed 1 WHF/PLA and 1 PALF/PLA acoustic panels achieve a maximum α (α-max) of 0.55 and 0.83 at 5000 and 4000 Hz, respectively, featuring the first work to report α-max > 0.5 at low fiber loadings in the high-frequency sound range. The tensile strength of the 3D-printed versions is significantly higher than non-3D-printed counterparts and commercial acoustic absorbers. Our data suggest the prepared 3D-printed panels are excellent candidates for acoustic applications at high-frequency noises. This study exhibits a facile, environmentally benign and sustainable approach to construct highly efficient and mechanically robust biopolymer-based 3D-printed sound-proof panels, which have promising potential as green engineering materials. Interestingly, this research also proposes a mitigation technology for the freshwater invader, Eichhornia crassipes (water hyacinths).

Oral Squamous Cell Carcinoma (OSCC) poses a significant health challenge, with early detection being crucial for effective treatment and improved survival rates. While previous studies have examined the use of standard photographs, such as those from smartphones, for oral lesion classification, they typically rely solely on images, overlooking the potential benefits of incorporating multiple modalities. This study addresses this gap by proposing a multimodal deep-learning pipeline incorporating diverse data sources, including patient metadata, which mimics the diagnostic approach of clinicians in the early detection of oral cancer. The study leverages state-of-the-art image encoders to classify oral lesions into benign and potentially malignant categories. A performance comparison of six pre-trained deep-learning models (MobileNetV3-Large, MixNet-S, ResNet-50, HRNet-W18-C, DenseNet-121, and Inception_v3) is presented. The performance of the proposed pipeline achieved an overall accuracy of 81%, precision of 79%, recall of 79%, F1-score of 78%, and a Matthews Correlation Coefficient (MCC) of 0.57 using the MobileNetV3-Large image encoder. The findings highlight the efficacy of integrating multiple data modalities for more accurate early detection of potential malignancies compared to using only image data. The outcomes could pave the way for improved clinical decision-making and patient outcomes.

Nanotechnology has applications in a variety of scientific specialties, encompassing health, technological devices, and now cosmetics under the generic term of nanocosmetics. Due to the improved particle qualities, such as color, transparency, and solubility, acquired at the nanoscale, nanotechnology significantly affects the cosmetic industry. Skin penetration mechanism depends heavily on the nanoparticles’ physicochemical properties, including stiffness, hydrophobicity, size, and charge. An expanding industry that requires more research and development has been created by nanoparticle production technologies. Liposomes, solid lipid nanoparticles, cubosomes, dendrimers, and other nanomaterials offer advanced skincare properties. Cosmetics made using nanotechnology have the advantages of product diversity, increased bioavailability of active compounds, and enhanced pleasing appearance of cosmetics with long-lasting benefits. The various cosmetic brands’ utilization of various types of nanomaterials in their products is highlighted in this review.

Optimising the use of resources through scientific methods is critical for efficiency and accurate pricing in the logistics industry. Analytical techniques (AT) play a decisive role in providing such analytical solutions. This paper explores the use of Analytical Techniques for decision making in the Sri Lankan manufacturing logistics industry through a survey of practices in leading companies in the manufacturing logistics industry. The questionnaire focused on the familiarity of ATs and their use in the different logistics operations. The research reviewed and classified the different AT's most widely used in solving common logistics problems (LP). Closing the gap between the theory and practice of AT in the logistics industry was aimed at through this research, by offering areas in which the industry could successfully adopt appropriate ATs. In this respect, different ATs in seven selected logistics decisions, regularly made in manufacturing firms, were discussed. The current practice in ATs was captured by interviewing leading practitioners in the logistics industry, bringing together the reasons for these gaps and their suggestions for overcoming them. The findings of the research could open up exciting areas for future research on optimisation using ATs in manufacturing logistics.

Cutaneous leishmaniasis (CL) is known to Sri Lanka from 1992. The distribution of the disease is increasing and large numbers of CL cases are reported from Hambantota district. This study was focused on selected clinical features and socio-demographic factors of CL positive patients in Hambantota district and this information were collected using a questionnaire from CL suspected patients who attended to the Tangalle Hospital from June, 2016 to January, 2017. For selecting the CL positivity, slit skin smears were obtained from lesions of suspected patients. These smears were stained and examined for Leishmania amastigotes. Smears were positive in 183 patients. Majority of them had one lesion on the body and 117 patients were males (p50 years. House-wives and students were identified as highly affected occupants. The higher number of CL patients lived in rural areas (p

The spin-structure functions g1 and g2, and the spin-dependent partial cross-section σTT have been extracted from the polarized cross-sections differences, Δσ∥(ν,Q2) and Δσ⊥(ν,Q2) measured for the He3→(e→,e′)X reaction, in the E97-110 experiment at Jefferson Lab. Polarized electrons with energies from 1.147 to 4.404 GeV were scattered at angles of 6∘ and 9∘ from a longitudinally or transversely polarized 3He target. The data cover the kinematic regions of the quasi-elastic, resonance production and beyond. From the extracted spin-structure functions, the first moments Γ1‾(Q2), Γ2(Q2) and ITT(Q2) are evaluated with high precision for the neutron in the Q2 range from 0.035 to 0.24GeV2. The comparison of the data and the chiral effective field theory predictions reveals the importance of proper treatment of the Δ degree of freedom for spin observables.

Background and Aims: Non-adherence to standard fasting guidelines may result in perioperative complications. We aimed to determine the association between pre-operative over-fasting and post-operative vomiting amongst children undergoing bone marrow aspiration under general anaesthesia. Methods: A prospective cohort study was conducted from May 2015 to April 2016 in children undergoing bone marrow aspiration under general anaesthesia and their caregivers. Children fasted for ≥3 hours from last clear fluid intake constituted the exposed group (n = 202) while children fasting for

BackgroundMorbid jealousy is a relatively common and disabling mental health entity. Psychological theories suggest experiences of being cheated-on in previous relationships and childhood experience of parents having or being accused of having extramarital relationships as aetiological factors of morbid jealousy. However this has not been studied adequately. MethodA retrospective case control study was conducted based on clinical records of patients admitted to the psychiatric unit in a tertiary care hospital in Sri Lanka over a 14 month period. Patients with morbid jealousy were considered as cases and those admitted with other psychiatric diagnoses were considered as controls. ResultsOf 2708 patients, 131 (4.8%) were identified to have morbid jealousy. In patients with morbid jealousy, a majority were males, average age was 42.8 years and schizophrenia was the commonest diagnosis. There was a statistical significant association between morbid jealousy and past experiences of being cheated-on or childhood experiences of parents having or being accused of having extra-marital relationships. DiscussionMorbid jealousy was a common presentation. The significant association between morbid jealousy and above experiences could be due to a true association, recall or interpretation bias by patients with morbid jealousy, or more diligent exploration by clinicians when it comes to patient with morbid jealousy. Except for the last explanation, this association has treatment implications.

Burkholderia cepacia complex (BCC) is an opportunistic pathogen in immunocompromised patients and well distributed in the natural environment. Nosocomial outbreaks of BCC are due to contaminated solutions and medical devices. However, in Sri Lanka, there have been no nosocomial outbreaks of BCC reported in the past. We report here an outbreak investigation of bacteraemia due to BCC in the wards and ICUs of the National Hospital of Sri Lanka (NHSL) during the period of August 14th 2017 to September 13th 2017 which an extensive investigation traced to a contaminated nebulizer solution of a particular brand of ipratropium bromide. The blood culture isolates from the patients with bacteraemia and from the particular nebulizer solution were found to be identical and confirmed as BCC. There had been outbreaks in other hospitals with the same organism in the recent past but they were not able to find the common source for the outbreak. The incident was reported officially to the relevant authorities and other hospitals, and an alternative agent for the use of nebulization was strongly recommended to prevent further cases immediately.

We report the first measurement of the (e,e′p) reaction cross-section ratios for Helium-3 (He3), Tritium (H3), and Deuterium (d). The measurement covered a missing momentum range of 40≤pmiss≤550MeV/c, at large momentum transfer (〈Q2〉≈1.9 (GeV/c)2) and xB>1, which minimized contributions from non quasi-elastic (QE) reaction mechanisms. The data is compared with plane-wave impulse approximation (PWIA) calculations using realistic spectral functions and momentum distributions. The measured and PWIA-calculated cross-section ratios for He3/d and H3/d extend to just above the typical nucleon Fermi-momentum (kF≈250 MeV/c) and differ from each other by ∼20%, while for He3/H3 they agree within the measurement accuracy of about 3%. At momenta above kF, the measured He3/H3 ratios differ from the calculation by 20%−50%. Final state interaction (FSI) calculations using the generalized Eikonal Approximation indicate that FSI should change the He3/H3 cross-section ratio for this measurement by less than 5%. If these calculations are correct, then the differences at large missing momenta between the He3/H3 experimental and calculated ratios could be due to the underlying NN interaction, and thus could provide new constraints on the previously loosely-constrained short-distance parts of the NN interaction.

BackgroundChild maltreatment is increasingly being recognized as an important public health issue in` Sri Lanka. Most public knowledge in Sri Lanka on this issue, and direction for public policy, originate from mass media, which may sensationalise the issue.AimsThis paper evaluates the themes and major discourses present in Sri Lankan print media on child abuse, and aims to determine if content, style and frequency of these news items have been affected by the tragic child abuse-murder incidents in 2015.MethodsArticles on child abuse and their readers’ comments were manually selected from the websites of the two daily newspapers with highest readership in Sri Lanka during two 3-month periods, before and after the above mentioned incidents. A combination of qualitative and quantitative methods were used to analyze the findings.ResultsThe number of articles relating to child abuse increased significantly from 0.6% to 5% of the total articles reviewed in the two periods. The focus of the articles changed from merely reporting facts and highlighting the evil nature of child abuse perpetrators, to inefficiency of law enforcement authorities in finding and punishing perpetrators. Readership and online comments on these articles increased significantly in the post-incident period. Capital punishment for perpetrators was suggested by many readers in the post-incident period.ConclusionThe Sri Lankan public is very sensitive to news on child abuse with formation of firm, at times extreme, viewpoints on how to manage this issue. Thus responsible and accurate depiction of child abuse by the media is important.

Dye-sensitized solid-state solar cells (DSSCs) replacing the liquid electrolyte with a p-type semiconductor have been extensively examined to solve the practical problems associated with wet-type solar cells. Here, we report the fabrication of a solid-state solar cell using copper iodide (CuI) as the hole conductor and alkyl-functionalized carbazole dye (MK-2) as the sensitizer. A DSSC sensitized with MK-2 showed a solar-to-electrical power conversion efficiency of 3.33% with a Voc of 496 mV and a Jsc of 16.14 mA cm-2 under AM 1.5 simulated sunlight. The long alkyl chains act as a barrier for charge recombination, and the strong accepting and donating abilities of the cyanoacrylic and carbazole groups, respectively, enhance the absorption of light at a longer wavelength, increasing the short-circuit current density. The efficiency recorded in this work is higher than similar DSSCs based on other hole collectors.

We have performed precision measurements of the double-spin virtual-photon asymmetry A1 on the neutron in the deep inelastic scattering regime, using an open-geometry, large-acceptance spectrometer and a longitudinally and transversely polarized 3He target. Our data cover a wide kinematic range 0.277≤x≤0.548 at an average Q2 value of 3.078 (GeV/c)2, doubling the available high-precision neutron data in this x range. We have combined our results with world data on proton targets to make a leading-order extraction of the ratio of polarized-to-unpolarized parton distribution functions for up quarks and for down quarks in the same kinematic range. Our data are consistent with a previous observation of an A1n zero crossing near x=0.5. We find no evidence of a transition to a positive slope in (Δd+Δd¯)/(d+d¯) up to x=0.548. Keywords: Spin structure functions, Nucleon structure, Parton distribution functions, Polarized electron scattering

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Cytopaenias are known to be associated with clozapine treatment. Thrombocytosis maybe mediated by immune reaction and can be of use as potential markers for clozapine induced agranulocytosis, in the future. There are only few case reports of clozapine induced thrombocytosis in the literature. This article discusses two case reports of secondary thrombocytosis associated with clozapine.

The electromagnetic form factors of the proton and neutron encode information on the spatial structure of their charge and magnetization distributions. While measurements of the proton are relatively straightforward, the lack of a free neutron target makes measurements of the neutron's electromagnetic structure more challenging and more sensitive to experimental or model-dependent uncertainties. Various experiments have attempted to extract the neutron form factors from scattering from the neutron in deuterium, with different techniques providing different, and sometimes large, systematic uncertainties. We present results from a novel measurement of the neutron magnetic form factor using quasielastic scattering from the mirror nuclei ^{3}H and ^{3}He, where the nuclear effects are larger than for deuterium but expected to largely cancel in the cross-section ratios. We extracted values of the neutron magnetic form factor for low-to-modest momentum transfer, 0.6

Social workers involved in interdisciplinary orthopedic trauma care can benefit from the knowledge of providers' perspectives on healthcare disparities in this field. Using qualitative data from focus groups conducted on 79 orthopedic care providers at three Level 1 trauma centers, we assessed their perspectives on orthopedic trauma healthcare disparities and discussed potential solutions. Focus groups originally aimed to detect barriers and facilitators of the implementation of a trial of a live video mind-body intervention to aid in recovery in orthopedic trauma care settings (Toolkit for Optimal Recovery-TOR). We used the Socio-Ecological Model to analyze an emerging code of "health disparities" during data analysis to determine at which levels of care these disparities occurred. We identified factors related to health disparities in orthopedic trauma care and outcomes at the Individual (Education- comprehension, health-literacy; Language Barriers; Psychological Health- emotional distress, alcohol/drug use, learned helplessness; Physical Health- obesity, smoking; and Access to Technology), Relationship (Social Support Network), Community (Transportation and Employment Security), and Societal level (Access- safe/clean housing, insurance, mental health resources; Culture). We discuss the implications of the findings and provide recommendations to address these issues, with a specific focus on their relevance to the field of social work in health care.

Background: The COVID-19 pandemic may have negatively affected medical care for and self-management of chronic hypertension. We sought to examine the impact of the pandemic on blood pressure (BP) among individuals with hypertension., Methods: Using an interrupted time series analysis, we compared the level and trend (slope) of BP outcomes before the public health emergency declaration (prepandemic period: August 2018 through January 2020) versus after the stay-at-home orders (pandemic period: April 2020 through November 2020) among adults with hypertension followed at 3 large health systems (n=137 593). Outcomes include systolic and diastolic BP recorded in electronic health records and the proportion of individuals with BP <140/90 mm Hg., Results: The number of BP measurements substantially dropped early in the pandemic and then gradually increased. During the pandemic period, systolic and diastolic BP increased by 1.79 mm Hg (95% CI, 1.57-2.01; P <0.001) and 1.30 mm Hg (95% CI, 1.18-1.42; P <0.001), respectively, compared with the prepandemic period. Similarly, the proportion of patients with controlled BP decreased by 3.43 percentage points (95% CI, -3.97 to -2.90; P <0.001). A trend showing increasing control in the prepandemic period (+3.19 percentage points per year [95% CI, +2.96 to +3.42]; P <0.001) flattened during the pandemic period (+0.27 percentage points per year [95% CI, -0.81 to -1.37]; P =0.62)., Conclusions: The first 8 months of the pandemic were associated with worsening BP outcomes among individuals with hypertension. Opportunities to ensure ongoing access to health care with telemedicine and home BP monitoring may mitigate adverse impacts on BP control for future disasters/emergencies.

Background: Obstructive sleep apnea (OSA) is associated with neurocognitive impairment - a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty., Methods: We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were [Formula: see text]0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea-hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery., Results: Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups., Conclusions: We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty., Trial Registration: This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016., (© 2022. The Author(s).)

When protons and neutrons (nucleons) are bound into atomic nuclei, they are close enough to feel significant attraction, or repulsion, from the strong, short-distance part of the nucleon-nucleon interaction. These strong interactions lead to hard collisions between nucleons, generating pairs of highly energetic nucleons referred to as short-range correlations (SRCs). SRCs are an important but relatively poorly understood part of nuclear structure 1-3 , and mapping out the strength and the isospin structure (neutron-proton (np) versus proton-proton (pp) pairs) of these virtual excitations is thus critical input for modelling a range of nuclear, particle and astrophysics measurements 3-5 . Two-nucleon knockout or 'triple coincidence' reactions have been used to measure the relative contribution of np-SRCs and pp-SRCs by knocking out a proton from the SRC and detecting its partner nucleon (proton or neutron). These measurements 6-8 have shown that SRCs are almost exclusively np pairs, but they had limited statistics and required large model-dependent final-state interaction corrections. Here we report on measurements using inclusive scattering from the mirror nuclei hydrogen-3 and helium-3 to extract the np/pp ratio of SRCs in systems with a mass number of three. We obtain a measure of the np/pp SRC ratio that is an order of magnitude more precise than previous experiments, and find a marked deviation from the near-total np dominance observed in heavy nuclei. This result implies an unexpected structure in the high-momentum wavefunction for hydrogen-3 and helium-3. Understanding these results will improve our understanding of the short-range part of the nucleon-nucleon interaction., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

We describe an infant presenting with intermittent discolouration and swelling of her fingers and toes occurring with changes in ambient temperature. Extensive investigations revealed raised inflammatory markers as well as sclerotic lesions within the phalanges and diffuse marrow oedema. Infectious and inflammatory causes were considered and excluded based on the clinical presentation and investigation findings. The persistence of symptoms prompted further investigation with MRI. Correlation of the MRI findings with previous case reports resulted in a diagnosis of microgeodic disease-an uncommon, self-limiting condition thought to be due to cold-induced vasospasm leading to avascular necrosis of the bone., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

We report a precise measurement of the parity-violating (PV) asymmetry A&#95;{PV} in the elastic scattering of longitudinally polarized electrons from ^{48}Ca. We measure A&#95;{PV}=2668±106(stat)±40(syst) parts per billion, leading to an extraction of the neutral weak form factor F&#95;{W}(q=0.8733  fm^{-1})=0.1304±0.0052(stat)±0.0020(syst) and the charge minus the weak form factor F&#95;{ch}-F&#95;{W}=0.0277±0.0055. The resulting neutron skin thickness R&#95;{n}-R&#95;{p}=0.121±0.026(exp)±0.024(model)  fm is relatively thin yet consistent with many model calculations. The combined CREX and PREX results will have implications for future energy density functional calculations and on the density dependence of the symmetry energy of nuclear matter.

The ratio of the nucleon F&#95;{2} structure functions, F&#95;{2}^{n}/F&#95;{2}^{p}, is determined by the MARATHON experiment from measurements of deep inelastic scattering of electrons from ^{3}H and ^{3}He nuclei. The experiment was performed in the Hall A Facility of Jefferson Lab using two high-resolution spectrometers for electron detection, and a cryogenic target system which included a low-activity tritium cell. The data analysis used a novel technique exploiting the mirror symmetry of the two nuclei, which essentially eliminates many theoretical uncertainties in the extraction of the ratio. The results, which cover the Bjorken scaling variable range 0.19

The 2018 American College of Cardiology/American Heart Association Guideline on the Management of Blood Cholesterol recommends statin therapy for eligible patients to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). We extracted electronic health record data for patients with at least one primary care or cardiology visit between October 2018 and January 2020 at an urban, academic medical center in New York City. Clinical and demographic data were used to identify patients eligible for primary prevention statin therapy. Statin prescription status was extracted from the electronic health record, and multivariate logistic regression was used to assess the association between statin prescription and age, gender, race, ethnicity, and other clinical and demographic covariables. In 7,550 patients eligible for primary prevention statin therapy, 3,994 (52.9%) were prescribed statins on at least 1 visit. Statin prescription was highest in patients with diabetes mellitus (73.6%) and with a 10-year ASCVD risk ≥20% (60.6%) and was lowest for those with a 10-year ASCVD risk between 5% and 7.5% (18.7%). Compared with those never prescribed statins, patients prescribed statins were less likely to be women, mainly driven by lower statin prescription rates for women with diabetes. In a fully adjusted model, women remained less likely to be prescribed statin therapy (adjusted odds ratios 0.79, 95% confidence interval 0.71 to 0.88). In conclusion, primary prevention statin therapy remains underutilized., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The Marie-Skłodowska-Curie Actions' (MSCA) Innovative Training Network (ITN) is a doctoral training programme jointly implemented by academic institutions and industries from countries across Europe and beyond. To our knowledge no study has examined the experience of students participating in MSCA-ITNs. This study aims to evaluate and report MSCA-ITN Early Stage Researcher (ESR) experiences. Methods: The Innovative Training Network - Evaluation Questionnaire (ITN-EQ) was developed to assess supervision, training, collaborations and experiences of ESRs and forwarded to two tinnitus-related ITNs and seven ITNs of other disciplines. Results: Key advantages identified included better career prospects, multidisciplinary research opportunities/collaborations, international exposure, personal/professional development, plus generous salaries and research budgets. However, lack of a common EU framework resulted in the experience being largely dependent on the host institution, country and supervisor. Moreover, managing the dual requirements of ITNs and host institutions while completing a three-year PhD seemed challenging for most ESRs. ESR involvement in workshop and training school planning was desirable. More than 80% of ESRs rated the overall ITN experience favourably and 98.3% would recommend the same to prospective PhD students. Conclusions: This report could provide valuable insights in planning and management of future ITNs and could assist prospective students in their decision of joining an ITN for their PhD., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Biswas R et al.)

Tinnitus can be a burdensome condition on both individual and societal levels. Many aspects of this condition remain elusive, including its underlying mechanisms, ultimately hindering the development of a cure. Interdisciplinary approaches are required to overcome long-established research challenges. This review summarizes current knowledge in various tinnitus-relevant research fields including tinnitus generating mechanisms, heterogeneity, epidemiology, assessment, and treatment development, in an effort to highlight the main challenges and provide suggestions for future research to overcome them. Four common themes across different areas were identified as future research direction: (1) Further establishment of multicenter and multidisciplinary collaborations; (2) Systematic reviews and syntheses of existing knowledge; (3) Standardization of research methods including tinnitus assessment, data acquisition, and data analysis protocols; (4) The design of studies with large sample sizes and the creation of large tinnitus-specific databases that would allow in-depth exploration of tinnitus heterogeneity., Competing Interests: KA is employed by Cochlear Company. MJ is employed by WS Audiology. CC is employed by Oticon A/S. These relationships have not influenced the work reported in this paper. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Simoes, Daoud, Shabbir, Amanat, Assouly, Biswas, Casolani, Dode, Enzler, Jacquemin, Joergensen, Kok, Liyanage, Lourenco, Makani, Mehdi, Ramadhani, Riha, Santacruz, Schiller, Schoisswohl, Trpchevska and Genitsaridi.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

Background: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity., Objective: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness., Design: Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73)., Limitations: Single-center study; assignment to remote monitoring was not randomized., Conclusions: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.

Background and Purpose: Posttraumatic stress disorder (PTSD) symptoms are common after stroke/transient ischemic attack (TIA) and have been associated with medication nonadherence, potentially because medications serve as traumatic reminders of the prior stroke/TIA. This study examined associations between stroke/TIA-induced PTSD and aversive cognitions toward preventive medications., Methods: We enrolled a cohort of patients presenting to the emergency department with suspected stroke/TIA. One month posthospitalization, we assessed PTSD symptoms specific to the index stroke/TIA using the PTSD checklist specific and asked patients how often (1) did thinking about your stroke medication make you feel nervous or anxious?; (2) did thinking about your stroke medication make you think about your risk for future strokes?; and (3) did you skip or avoid taking your stroke medication so you would not have to think about your stroke? Logistic regression models tested the association between PTSD symptoms and each aversive cognition, adjusting for age, sex, ethnicity, and depression., Results: Among 408 included patients, 11.0% had elevated PTSD symptoms. These patients were more likely to report that thinking about their stroke medication made them feel nervous or anxious (37.8% versus 9.9%, P <0.001) that thinking about their stroke medication made them think about their risk for future stroke/TIA (60.0% versus 24.0%, P <0.001), and that they skipped or avoided their stroke medication to not think about their prior stroke/TIA (11.1% versus 2.2%, P =0.009). In adjusted analyses, higher PTSD checklist specific scores were associated with increased nervousness/anxiety (odds ratio, 1.33 [95% CI, 1.18-1.50], P <0.001) and thoughts of future stroke (odds ratio, 1.27 [95% CI, 1.14-1.41], P <0.001), with a trend toward significance for skipping medications to avoid reminders of stroke (odds ratio, 1.20 [95% CI, 0.99-1.44], P =0.06)., Conclusions: Medications may serve as traumatic reminders after stroke/TIA-induced PTSD, potentially leading to medication nonadherence.

We report the first measurement of the (e,e^{'}p) three-body breakup reaction cross sections in helium-3 (^{3}He) and tritium (^{3}H) at large momentum transfer [⟨Q^{2}⟩≈1.9  (GeV/c)^{2}] and x&#95;{B}>1 kinematics, where the cross section should be sensitive to quasielastic (QE) scattering from single nucleons. The data cover missing momenta 40≤p&#95;{miss}≤500  MeV/c that, in the QE limit with no rescattering, equals the initial momentum of the probed nucleon. The measured cross sections are compared with state-of-the-art ab initio calculations. Overall good agreement, within ±20%, is observed between data and calculations for the full p&#95;{miss} range for ^{3}H and for 100≤p&#95;{miss}≤350  MeV/c for ^{3}He. Including the effects of rescattering of the outgoing nucleon improves agreement with the data at p&#95;{miss}>250  MeV/c and suggests contributions from charge-exchange (SCX) rescattering. The isoscalar sum of ^{3}He plus ^{3}H, which is largely insensitive to SCX, is described by calculations to within the accuracy of the data over the entire p&#95;{miss} range. This validates current models of the ground state of the three-nucleon system up to very high initial nucleon momenta of 500  MeV/c.

Elastic electron-proton scattering (e-p) and the spectroscopy of hydrogen atoms are the two methods traditionally used to determine the proton charge radius, r p . In 2010, a new method using muonic hydrogen atoms 1 found a substantial discrepancy compared with previous results 2 , which became known as the 'proton radius puzzle'. Despite experimental and theoretical efforts, the puzzle remains unresolved. In fact, there is a discrepancy between the two most recent spectroscopic measurements conducted on ordinary hydrogen 3,4 . Here we report on the proton charge radius experiment at Jefferson Laboratory (PRad), a high-precision e-p experiment that was established after the discrepancy was identified. We used a magnetic-spectrometer-free method along with a windowless hydrogen gas target, which overcame several limitations of previous e-p experiments and enabled measurements at very small forward-scattering angles. Our result, r p  = 0.831 ± 0.007 stat  ± 0.012 syst  femtometres, is smaller than the most recent high-precision e-p measurement 5 and 2.7 standard deviations smaller than the average of all e-p experimental results 6 . The smaller r p we have now measured supports the value found by two previous muonic hydrogen experiments 1,7 . In addition, our finding agrees with the revised value (announced in 2019) for the Rydberg constant 8 -one of the most accurately evaluated fundamental constants in physics.

Purpose: The purpose of this analysis of patient-reported outcomes from the ELECT (Evaluation of Lanreotide Depot/Autogel Efficacy and Safety as a Carcinoid Syndrome Treatment) trial (NCT00774930) was to explore the effect of lanreotide on symptoms of carcinoid syndrome. Specifically, this post hoc analysis was designed to identify the most important patient-reported outcomes for patients in ELECT., Methods: The post hoc analysis of ELECT, a placebo-controlled study of lanreotide in patients with neuroendocrine tumors, evaluated patient-reported outcomes during the double-blind phase of the trial, specifically daily diarrhea and flushing symptoms, octreotide rescue use, and the EORTC QLQ-C30 and QLQ-GINET21 questionnaires at baseline and week 12. Principal component (PC) analysis was applied on baseline data to identify independent variable clusters and clinically meaningful summary measures that highly correlated to these PCs. From those, the minimum clinical important differences were derived so to perform a responder analysis., Results: The three largest PCs captured 42.9% of the variation among baseline variables. The C30 summary score (C30-SS), diarrhea burden, and flushing burden were highly correlated with PC1, PC2, and PC3, respectively. Lanreotide patients were more likely to experience an improvement on the C30-SS (risk ratio [RR] 2.42; P =0.023), diarrhea burden (RR 2.85; P =0.005), and flushing burden (RR 1.39; P =0.31) compared to placebo patients. Lanreotide-treated patients have a higher probability of being a responder on at least one of the three domains of C30-SS, diarrhea burden, or flushing burden compared to placebo patients (RR 1.48; P =0.06)., Conclusion: The higher response rates in the diarrhea burden are consistent with the previously reported effects of lanreotide on octreotide rescue medication use, while the findings of a greater efficacy of lanreotide vs placebo in the quality-of-life domains represent a novel aspect in the benefits of lanreotide., Trial Registration: ClinicalTrials.gov identifier: NCT00774930., Competing Interests: David Ray, Beloo Mirakhur, and Nilani Liyanage were paid employees of Ipsen Biopharmaceuticals, Inc. Luc Duchateau was financially supported by Ipsen to perform the analysis. Benedicte Lescrauwaet is an employee of Xintera Bvba. The authors report no other conflicts of interest in this work., (© 2019 Blot et al.)

Eating disorders are becoming more common in nonwestern societies and some of these presentations are atypical variants such as atypical anorexia nervosa. There is very little data on how to treat these patients. This case study reports the treatment of a young adult female in Sri Lanka who presented with atypical anorexia nervosa and moderate depressive disorder. She was successfully treated with nine sessions of enhanced cognitive-behavioural therapy (CBT-E). According to our knowledge this is the first case report that describes the management of a patient with atypical anorexia nervosa using psychological therapy specifically adapted to nonwestern context., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Nisansala Liyanage et al.)

Objectives: This systematic review provides an overview of the available studies (published by January 29, 2018) with descriptive data analysis about the influence of cochlear implantation on tinnitus in patients with single-sided deafness (SSD)., Data Sources: PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar., Review Methods: Original studies about the influence of cochlear implantation on tinnitus, measured with different tinnitus questionnaires or visual analog scale, in patients with SSD were included. The pre- and postimplantation tinnitus scores of the included studies were extracted for the further systematic review., Results: The systematic search yielded 1028 studies. After evaluating titles, abstracts, and full texts, 1011 of these were dismissed. From the remaining 17 studies, 4 showed a low directness of evidence or high risk of bias and were therefore excluded. Due to the nature of cochlear implantation in SSD, only cohort studies and no randomized trials exist, which limits the evaluation in a systematic review. Generally, the mean tinnitus questionnaire scores decreased after cochlear implantation in these 13 studies with a total of 153 patients. The most widely used tinnitus questionnaire was the Tinnitus Handicap Inventory. In these studies, 34.2% of patients demonstrated complete suppression, 53.7% an improvement, 7.3% a stable value, and 4.9% an increase of tinnitus, and none of the patients reported an induction of tinnitus., Conclusion: This review shows a clear improvement of tinnitus complaints after cochlear implantation in patients with SSD. Therefore, tinnitus might be considered as an additional indication for cochlear implantation in SSD.

Background: The heterogeneity of tinnitus is substantial. Its numerous pathophysiological mechanisms and clinical manifestations have hampered fundamental and treatment research significantly. A decade ago, the Tinnitus Research Initiative introduced the Tinnitus Sample Case History Questionnaire, a case history instrument for standardised collection of information about the characteristics of the tinnitus patient. Since then, a number of studies have been published which characterise individuals and groups using data collected with this questionnaire. However, its use has been restricted to a clinical setting and to the evaluation of people with tinnitus only. In addition, it is limited in the ability to capture relevant comorbidities and evaluate their temporal relationship with tinnitus., Method: Here we present a new case history instrument which is comprehensive in scope and can be answered by people with and without tinnitus alike. This 'European School for Interdisciplinary Tinnitus Research Screening Questionnaire' (ESIT-SQ) was developed with specific attention to questions about potential risk factors for tinnitus (including demographics, lifestyle, general medical and otological histories), and tinnitus characteristics (including perceptual characteristics, modulating factors, and associations with co-existing conditions). It was first developed in English, then translated into Dutch, German, Italian, Polish, Spanish, and Swedish, thus having broad applicability and supporting international collaboration., Conclusions: With respect to better understanding tinnitus profiles, we anticipate the ESIT-SQ to be a starting point for comprehensive multi-variate analyses of tinnitus. Data collected with the ESIT-SQ can allow establishment of patterns that distinguish tinnitus from non-tinnitus, and definition of common sets of tinnitus characteristics which might be indicated by the presence of otological or comorbid systemic diseases for which tinnitus is a known symptom., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Urinary 5-hydroxyindoleacetic acid (5-HIAA) is an established biomarker in neuroendocrine tumors and carcinoid syndrome; however, its role in nonfunctional neuroendocrine tumors is not defined. We present post hoc data on urinary 5-HIAA and plasma chromogranin A (CgA) from the CLARINET study., Methods: Patients with well- or moderately differentiated, nonfunctioning, locally advanced or metastatic enteropancreatic neuroendocrine tumors were randomized to deep subcutaneous lanreotide depot/autogel 120 mg or placebo once every 28 days for 96 weeks. Tumor response, evaluated centrally (RECIST 1.0), and progression-free survival (PFS) were assessed by treatment and biochemical response, defined as (a) baseline >upper limit of normal (ULN, 41.6 μmol per day 5-HIAA; 98.1 μg/L CgA) and (b) ≥50% decrease from baseline and to ≤ULN value on study., Results: Forty-eight percent (82 of 171; lanreotide, n = 45; placebo, n = 37) and 66% (129 of 195; lanreotide, n = 65; placebo, n = 64) of randomized patients had 5-HIAA and CgA > ULN at baseline. Among patients with >ULN baseline values who did not progress after 96 weeks of treatment, significantly greater reductions in 5-HIAA and CgA were observed in lanreotide-treated versus placebo-treated patients throughout the study (all p < .05). PFS was significantly prolonged among 5-HIAA responders versus nonresponders (median not reached vs. 16.2 months, p < .0001; hazard ratio [HR] = 0.21, 95% confidence interval [CI], 0.09-0.48) and CgA responders versus nonresponders (median not reached vs. 16.2 months, p = .0070; HR = 0.30, 95% CI, 0.12-0.76), regardless of treatment arm. PFS was also significantly prolonged among lanreotide-treated 5-HIAA responders versus nonresponders ( p = .0071) but was not significantly different among placebo-treated 5-HIAA responders versus nonresponders. There were no significant differences in PFS between lanreotide-treated CgA responders versus nonresponders or between placebo-treated CgA responders versus nonresponders., Conclusions: The 5-HIAA findings are noteworthy because they occurred in patients with nonfunctioning enteropancreatic neuroendocrine tumors. Monitoring 5-HIAA and CgA may be useful when treating patients with nonfunctional neuroendocrine tumors., Implications for Practice: Current guidelines focus only on the monitoring of 5-hydroxyindoleacetic acid (5-HIAA) in the diagnosis and management of functional neuroendocrine tumors with carcinoid syndrome. The current post hoc analysis of patients with nonfunctional enteropancreatic neuroendocrine tumors in the CLARINET study demonstrated that measuring and following both 5-HIAA and chromogranin A as biomarkers of disease progression may be useful in the management of patients with nonfunctional neuroendocrine tumors., Competing Interests: Disclosures of potential conflicts of interest may be found at the end of this article., (© AlphaMed Press 2018.)