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Abstract Background High flow nasal cannula (HFNC) has been increasingly adopted in the past 2 decades as a mode of respiratory support for children hospitalized with bronchiolitis. The growing use of HFNC despite a paucity of high-quality data regarding the therapy’s efficacy has led to concerns about overutilization. We developed an electronic health record (EHR) embedded, quality improvement (QI) oriented clinical trial to determine whether standardized management of HFNC weaning guided by clinical decision support (CDS) results in a reduction in the duration of HFNC compared to usual care for children with bronchiolitis. Methods The design and summary of the statistical analysis plan for the REspiratory SupporT for Efficient and cost-Effective Care (REST EEC; “rest easy”) trial are presented. The investigators hypothesize that CDS-coupled, standardized HFNC weaning will reduce the duration of HFNC, the trial’s primary endpoint, for children with bronchiolitis compared to usual care. Data supporting trial design and eventual analyses are collected from the EHR and other real world data sources using existing informatics infrastructure and QI data sources. The trial workflow, including randomization and deployment of the intervention, is embedded within the EHR of a large children’s hospital using existing vendor features. Trial simulations indicate that by assuming a true hazard ratio effect size of 1.27, equivalent to a 6-h reduction in the median duration of HFNC, and enrolling a maximum of 350 children, there will be a > 0.75 probability of declaring superiority (interim analysis posterior probability of intervention effect > 0.99 or final analysis posterior probability of intervention effect > 0.9) and a > 0.85 probability of declaring superiority or the CDS intervention showing promise (final analysis posterior probability of intervention effect > 0.8). Iterative plan-do-study-act cycles are used to monitor the trial and provide targeted education to the workforce. Discussion Through incorporation of the trial into usual care workflows, relying on QI tools and resources to support trial conduct, and relying on Bayesian inference to determine whether the intervention is superior to usual care, REST EEC is a learning health system intervention that blends health system operations with active evidence generation to optimize the use of HFNC and associated patient outcomes. Trial registration ClinicalTrials.gov NCT05909566. Registered on June 18, 2023.

Background: The poor aqueous solubility and low bioavailability of antineoplastic drugs restrict the oral route for the cancer therapy. However, specific nanotechnologies developed to address this issue. The self-micro emulsifying drug delivery system (SMEDDS) is an imperative tool in solving a lipophilic drug's low solubility and bioavailability issue. Paclitaxel (PTX) is an antineoplastic drug used to treat various kinds of cancer, especially ovarian and breast cancers. It has low aqueous solubility (0.3 μg/ml in water), resulting in poor bioavailability. This study focuses upon formulating SMEDDS incorporating PTX to increase the drug's aqueous solubility. Castor oil (Surfactant), Tween 80 (surfactant), and Transcutol (co-surfactant) were used to formulate SMEDDS. Two independent factors, concentrations of oil and surfactant, were chosen. Two dependent factors, emulsification time and in vitro drug release, were chosen. 32 factorial design analyses give a mathematical expression, which helps to study the effect of an independent factor on a dependent factor. All the nine formulations B1-B9 evaluated for globule size, zeta potential, and present drug content. Results: The globule size found is 127–217 nm range, which indicates the formation of the transparent microemulsion; zeta potential fields between −4.29 ± 1.1 and −33.05 ± 4.5 indicate suitable stable formulation. Nearly 63%–84% drug content suggests that the drug, incorporated into prepared SMEDDS. Statistical analysis shows that an increasing amount of surfactant decreases emulsification time; this may also reduce the average droplet size of the resultant microemulsion. With the increase in the concentration of tween 80, PTX release also increased. Rapid and more extent of PTX released from formulated SMEDDS indicate that the aqueous solubility of PTX has increased. B9 formulation is the optimized formulation based on higher per cent cumulative drug release 98% at the end of 60 min, 58% of pure PTX powder solubilized in the dissolution medium. Conclusion: In vitro drug release study proved that the prepared SMEDDS has acceptable properties of immediate release dosage forms. The enhanced solubility of PTX will increase its bioavailability.

In most societies, as in India, small scale fishing and fish farming households are considered to be one of the most underprivileged and vulnerable groups. Micro finance programmes are seen as a means for these households to gain access to much needed credit services that are appropriate for their needs. Since women comprises of a significant proportion of such households, microfinance should serve as an effective tool to assist and empower women in fishing communities. This paper tries to analyze recent experiences with micro finance programmes in support of the coastal konkan fishing communities in India and draw conclusions with regard to best practices in this field. [ABSTRACT FROM AUTHOR]

Abstract Background High lipophilicity and poor aqueous solubility are the endemic problems of new drug molecules. Sixty to seventy percent of these drugs are unable to solubilize completely in aqueous media, or have very low permeability. This hampers their oral absorption and further leads to their poor bioavailability. Various researches are in progress to overcome these limitations. Novel technologies like nano-carrier systems have become popular for improving the solubility of drugs. Main body Lipid-based formulations, among nano systems, are taking pace for the enhancement of solubility, oral absorption, and hence the bioavailability of drugs. Among the lipid formulations, self-emulsification systems are gaining popularity by offering various advantages to delivery systems. Self-emulsifying drug delivery systems (SEDDS) are isotropic blends of oil and surfactant/co-surfactants. These ingredients upon gentle agitation in aqueous media results in the formation of o/w emulsion. In spite of many works published in SEDDS, the major concerns of this article are to discuss the various approaches to formulate a good lipid-based carrier system for poorly aqueous soluble drugs, role of various polymers, and their categories used in the formulation along-with the modern technologies used for enhancing the stability of liquid SEDDS. This review majorly focuses upon the problems related to the poor aqueous solubility of the newer lipid molecules and the solutions to overcome their solubility and in addition bioavailability. Conclusion As per the researches done in formulation and optimization of SEDDS for the enhancement of bioavailability of lipophilic molecules, it can be stated that the aqueous solubility as well as bioavailability can be increased by many folds compared to their marketed or other oral formulations.

A simple and highly efficient synthetic route has been developed for analogue of HMGCo A reductase inhibitor (1). The strategy utilizesS-Corey–Bakshi–Shibata (CBS) reduction, FeCl3-catalyzed C-H insertion of ethyl diazoacetate. [Supplementary materials are available for this article. Go to the publisher's online edition ofSynthetic Communications®for the following free supplemental resource: Full experimental and spectral details.] [ABSTRACT FROM AUTHOR]

Examines the efficient synthesis of unsymmetrical ketones and enantiomerically pure spiroketals using Isopinocampheyldichloroborane. Experimental procedures utilized; Details on the preparation of Unsymmetrical Ketones; Results and discussion on the findings.

Presents a quantitative study on the preparation of optically pure isopinocampheylchloroborane for the asymmetric hydroboration of prochiral alkenes. Rate of hydroboration of the alkene in representative solvents; Discussion on the methods for asymmetric hydroboration of prochiral alkenes; Noting of identical results in the two methods.

Studies chiral synthesis via organoboranes. Optically active homoallylic alcohols; Lactone functionality; Transformation of chiral natural products.

Copyright of American Potato Journal is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of American Potato Journal is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of American Potato Journal is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of American Potato Journal is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: A simple and highly efficient first total synthesis of cytotoxic (+)-crassalactone A starting from (R)-mandelic acid is described. The strategy involves the osmium tetroxide-catalyzed cis-hydroxylation and the stereoselective addition of ethyl lithiopropiolate to a chiral aldehyde intermediate as key steps. [Copyright &y& Elsevier]

The veracity of a message from a sensor node must be verified in order to avoid a false reaction by the sink. This verification requires the authentication of the source node. The authentication process must also preserve the privacy such that the node and the sensed object are not endangered. In this work, a ring signature was proposed to authenticate the source node while preserving its spatial privacy. However, other nodes as signers and their numbers must be chosen to preclude the possibility of a traffic analysis attack by an adversary. The spatial uncertainty increases with the number of signers but requires larger memory size and communication overhead. This requirement can breach the privacy of the sensed object. To determine the effectiveness of the proposed scheme, the location estimate of a sensor node by an adversary and enhancement in the location uncertainty with a ring signature was evaluated. Using simulation studies, the ring signature was estimated to require approximately four members from the same neighbor region of the source node to sustain the privacy of the node. Furthermore, the ring signature was also determined to have a small overhead and not to adversely affect the performance of the sensor network.

Abstract Background Computational methods utilizing the structural and functional information help to understand specific molecular recognition events between the target biomolecule and candidate hits and make it possible to design improved lead molecules for the target. Results Sanjeevini represents a massive on-going scientific endeavor to provide to the user, a freely accessible state of the art software suite for protein and DNA targeted lead molecule discovery. It builds in several features, including automated detection of active sites, scanning against a million compound library for identifying hit molecules, all atom based docking and scoring and various other utilities to design molecules with desired affinity and specificity against biomolecular targets. Each of the modules is thoroughly validated on a large dataset of protein/DNA drug targets. Conclusions The article presents Sanjeevini, a freely accessible user friendly web-server, to aid in drug discovery. It is implemented on a tera flop cluster and made accessible via a web-interface at http://www.scfbio-iitd.res.in/sanjeevini/sanjeevini.jsp. A brief description of various modules, their scientific basis, validation, and how to use the server to develop in silico suggestions of lead molecules is provided.

It is not known if cytokines, which are cell-derived mediators released during the host immune response to stress, affect metabolic response to stress during critical illness. The aim of this prospective study was to determine whether the metabolic response to stress is related to the inflammatory interleukin-6 (IL-6), 10 (IL-10), and other stress mediators' responses and to assess their relationships with different feeding patterns, nutritional markers, the severity of illness as assessed by the Multiple Organ System Failure (MOSF), the Pediatric Risk of Mortality Score (PRISM), systemic inflammatory response syndrome (SIRS), and mortality in critically ill children. Patients were classified as hypermetabolic, normometabolic, and hypometabolic when the measured resting energy expenditures (REE) were >110%, 90–110% and,

Abstract: A simple and highly efficient stereoselective total synthesis of cytotoxic agent sporiolide A has been achieved starting from d-mannitol; the strategy of synthesis utilizes stereoselective zinc-mediated allylation, aldol coupling and ring-closing metathesis as key steps. [Copyright &y& Elsevier]

The article presents chemical equations for the article "Synthesis of Aryl β-Ketoesters by Opening of Aryl Epoxides with Ethyl Diazoacetate Catalyzed by BF2·OEt3" by D.C. Rao and others, published in the section B of the "Indian Journal of Chemistry" in 2014.

Background: Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients., Methods: We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST)., Results: Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078)., Conclusion: The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies., (© 2024. The Author(s), under exclusive licence to The Japanese Breast Cancer Society.)

For the last two decades, the aromatic aldehyde 5-hydroxymethyl-furfural (5-HMF) has been the subject of several investigations for its pharmacologic potential. In 2004, the Safo group reported that 5-HMF has potent antisickling activity by targeting and ameliorating the primary pathophysiology of hypoxia-induced sickling of erythrocytes (red blood cells [RBC]). Following the encouraging outcome of the preclinical and phase I/II clinical studies of 5-HMF for the treatment of sickle cell disease (SCD), there have been multiple studies suggesting 5-HMF has several other biological or pharmacologic activities, including anti-allergic, antioxidant, anti-hypoxic, anti-ischemic, cognitive improvement, anti-tyrosinase, anti-proliferation, cytoprotective, and anti-inflammatory activities. The wide range of its effects makes 5-HMF a potential candidate for treating a variety of diseases including cognitive disorders, gout, allergic disorders, anemia, hypoxia, cancers, ischemia, hemorrhagic shock, liver fibrosis, and oxidative injury. Several of these therapeutic claims are currently under investigation and, while promising, vary in terms of the strength of their evidence. This review presents the research regarding the therapeutic potential of 5-HMF in addition to its sources, physicochemical properties, safety, absorption, distribution, metabolism, and excretion (ADME) profiles., (© 2024 The Author(s). Medicinal Research Reviews published by Wiley Periodicals LLC.)

Objectives: This study aimed to evaluate whether individualized homeopathic medicines have a greater adjunctive effect than adjunctive placebos in the treatment of moderate and severe cases of coronavirus disease 2019 (COVID-19)., Methods: The study was a randomized, single-blind, prospective, placebo-controlled clinical trial set in the clinical context of standard care., Intervention: Patients of either sex, admitted in a tertiary care hospital, suffering from moderate or severe COVID-19 and above 18 years of age were included. In total, 150 patients were recruited and then randomly divided into two groups to receive either individualized homeopathic medicines or placebos, in addition to the standard treatment of COVID-19., Outcome Measures: The primary outcome was time taken to achieve RT-PCR-confirmed virus clearance for COVID-19. Secondary outcomes were changes in the Clinical Ordinal Outcomes Scale (COOS) of the World Health Organization, the patient-reported MYMOP2 scale, and several biochemical parameters. Parametric data were analyzed using unpaired t -test. Non-parametric data were analyzed using the Wilcoxon signed rank test. Categorical data were analyzed using Chi-square test., Results: In total, 72 participants of the add-on homeopathy (AoH) group showed conversion of RT-PCR status to negative, in an average time of 7.53 ± 4.76 days (mean ± SD), as compared with 11.65 ± 9.54 days in the add-on placebo (AoP) group ( p  = 0.001). The mean COOS score decreased from 4.26 ± 0.44 to 3.64 ± 1.50 and from 4.3 ± 0.46 to 4.07 ± 1.8 in the AoH and AoP groups respectively ( p  = 0.130). The mortality rate for the AoH group was 9.7% compared with 17.3% in the AoP group. The MYMOP2 scores between the two groups differed significantly ( p  = 0.001), in favor of AoH. Inter-group differences in the pre- and post- mean values of C-reactive protein, fibrinogen, total leukocyte count, platelet count and alkaline phosphatase were each found to be statistically significant ( p <0.05), favoring AoH; six other biochemical parameters showed no statistically significant differences., Conclusion: The study suggests homeopathy may be an effective adjunct to standard care for treating moderate and severe COVID-19 patients. More rigorous, including double-blinded, studies should be performed to confirm or refute these initial findings., Competing Interests: None declared., (Faculty of Homeopathy. This article is published by Thieme.)

Objectives: Cancer pain has all the components of total pain such as physical, social, psychological, and spiritual. These components contribute to the overall pain experience in cancer patients. Many instruments have been developed till date to assess the effect of pain in cancer patients but none of the instruments include all components of total pain. In this article, we describe the development and validation of the total pain scale (TPS) for the evaluation of total pain in cancer patients with pain. This study aimed to develop and validate a questionnaire for the evaluation of total pain in cancer patients with pain., Material and Methods: This study included a review of existing pain questionnaires for cancer pain for item pool generation. Items were generated in the Hindi language by six stakeholders to create 23 items to develop TPS. TPS was applied to 300 Hindi-speaking cancer patients. Bivariate correlation was used to reduce the number of items as well as construction of the domain followed by factor analysis to finalise TPS. Confirmatory factor analysis (CFA) was performed for testing the validity and reliability of TPS., Results: TPS is an 18-item scale composed of four domains (physical, social, spiritual and psychological domain). The internal consistency of TPS and its subscales was found to be very good (a = 0.84-0.88). CFA and structural equation modeling Goodness of fit has confirmed that model 4 is the best fit as it yielded a lesser root-mean-squared error of approximation value of 0.062 and a greater comparative fit index, Tucker-Lewis index value of 0.944. The convergent and divergent validity of TPS and its domain was good., Conclusion: This study reports TPS to be a brief (18-item), valid, and reliable questionnaire in the Hindi language for assessment of all components of total pain in cancer patients with pain., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Indian Journal of Palliative Care.)

Objective: To review the literature regarding non-invasive objective measurements of pain. Measuring pain is of uttermost importance, but it can be an inconvenient task, especially in terms of the interpretation of patient's information. Reiterating, there is no "standard" that provides the physician with a method to objectively quantify this problem of patient's pain. For assessing the pain, physician relies solely on unidimensional assessment tools or questionnaire-based pain assessment. Although pain is a subjective experience of the patient, but there is a need to measure pain sometimes in the individuals who cannot communicate their quality and severity of pain., Material and Methods: The articles from PubMed and Google Scholar without any year and age limit were searched in the current narrative review. A total of 16 markers were searched and their relation to pain was studied., Results: Studies have shown that these markers change in relation to pain and it can be considered a valuable tool for pain measurement but there are multiple factors like psychological and emotional factors which affect these markers., Conclusion: There is lack of evidence to show which marker can be used for measuring pain accurately. This narrative review is an attempt to look into the various pain-related markers that can be used and it calls for further studies including clinical trials with different diseases and taking into accounts different factors affecting pain to give an accurate measurement of pain., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Indian Journal of Palliative Care.)

The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling-up scientifically proven, cost-effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost-effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large-scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly., Competing Interests: None

Recently, Wang (2017) has introduced the K -nonnegative double splitting using the notion of matrices that leave a cone K ⊆ ℝ n invariant and studied its convergence theory by generalizing the corresponding results for the nonnegative double splitting by Song and Song (2011). However, the convergence theory for K -weak regular and K -nonnegative double splittings of type II is not yet studied. In this article, we first introduce this class of splittings and then discuss the convergence theory for these sub-classes of matrices. We then obtain the comparison results for two double splittings of a K -monotone matrix. Most of these results are completely new even for K = ℝ + n . The convergence behavior is discussed by performing numerical experiments for different matrices derived from the discretized Poisson equation., (© Institute of Mathematics, Czech Academy of Sciences 2021.)

Plant roots acquire nutrients and water while managing interactions with the soil microbiota. The root endodermis provides an extracellular diffusion barrier through a network of lignified cell walls called Casparian strips, supported by subsequent formation of suberin lamellae. Whereas lignification is thought to be irreversible, suberin lamellae display plasticity, which is crucial for root adaptative responses. Although suberin is a major plant polymer, fundamental aspects of its biosynthesis and turnover have remained obscure. Plants shape their root system via lateral root formation, an auxin-induced process requiring local breaking and re-sealing of endodermal lignin and suberin barriers. Here, we show that differentiated endodermal cells have a specific, auxin-mediated transcriptional response dominated by cell wall remodelling genes. We identified two sets of auxin-regulated GDSL lipases. One is required for suberin synthesis, while the other can drive suberin degradation. These enzymes have key roles in suberization, driving root suberin plasticity.