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Community-acquired infections (CAIs) represent a major burden for health-care system. This directly aids the emergence of antibiotic-resistant organisms. India is not immune to it. This review assessed the current guideline recommendations for the usage of oral cephalosporins in the management of common CAIs. The researchers conducted iterative searches in PubMed, SCOPUS, and Google Scholar for published articles using various keywords. The search was conducted in November 2022 and considered articles published till date. Different CAIs are caused by similar organisms, susceptible to first-line antibiotics such as penicillin and cephalosporins. Most of the guidelines recommend the use of oral cephalosporins for the management of the commonly prevalent CAIs. These antibiotics however should be used as a monotherapy and not as fixed-dose combinations (FDCs), as FDCs with oral cephalosporins lack scientific basis and may be detrimental. For burden of CAIs intensified by anti-microbial resistance, guidelines are useful for the management of CAIs to educate the prescribers and preserve currently available antibiotics.

Hemophilia is an X-linked recessive genetic disorder which affects approximately 400,000 people globally. Differing healthcare reimbursement systems, budgetary constraints and geographical and cultural factors make it difficult for any country to fully deliver ideal care. Although developed countries have sufficient treatment products available, they are burdened by the higher expectation of outcomes, coupled with insufficient supportive care to monitor adherence and outcomes and to implement regular follow-up. In contrast, developing regions may not have ready access to factor replacement, but have developed excellent physiotherapy and rehabilitation programs. Although there are multiple studies that have attempted to assess country-specific variations in hemophilia care, very few compare hemophilia care between economically unequal countries and the challenges in achieving optimal hemophilia care. This literature review tries to bridge this gap and throws light on the country-specific differences in epidemiology, standard of hemophilia care and challenges faced in Canada and China. Data sources resulted in 20 studies (11 from Canada and 9 from China), which were reviewed. In a developed country, the main advantages are: the early treatment of bleeding episodes and the presence of a specialized interdisciplinary and comprehensive treatment concept. This is not the case in most developing countries, where the government does not have the resources to buy the necessary quantities of coagulation factors in the face of more urgent health priorities and hardly a few patients can afford to pay for their own treatment, even the on-demand home therapy.

Abstract Evapotranspiration and water availability are driven by changing climate and land cover parameters. In the present study, climatological records and land cover data were analysed simultaneously to accomplish the spatial distributions of climate change effects on water resources in Varanasi district, north India. Humidity–aridity was assessed by Lang's rain factor and De Martonne's aridity index, based on mean monthly rainfall and air temperature from seven meteorological stations. The climate change effect on water resources was evaluated using a 5 × 5 matrix that includes water availability and the aridity index by considering two time periods: 1941–1970 (1950s) and 1971–2000 (1980s). The methodology is based on seasonal crop evapotranspiration (ETc) (initial, mid‐season, end season and cold season) and annual water availability calculations. The high values (≤ 1,045 mm) of ETc were identified during the mid‐season stage. Water availability indicates decreases in the maximums from 718 to 636 mm during the two analysed periods, with a negative impact at the spatial scale. Lang's rain factor ( 40) in the south. De Martonne's aridity index indicates rapid aridization from south to north (28.3 in the 1950s and 25.6 in the 1980s). The high and very high climate effects on water resources in Varanasi district were found mainly in the crop lands, while in the urban areas the climate effect is low. The much affected area by climate change and land cover was depicted during the recent period (1980s). This statement was proved also by the Mann and Kendall test, which indicates a negative trend for annual precipitation at all stations (for the period 1941–2000), while the mean annual temperature had a positive trend for four stations. These findings suggest that climate change had a negative effect on water resources during the last 60 years in the study area.

Testosterone deficiency is associated with autoimmunity and increased B cell numbers, but the underlying mechanism is unclear. Here the authors show that testosterone may modulate the production of B cell survival factor BAFF by fibroblastic reticular cells via regulation of splenic neurotransmitter levels.

Abstract Recently, the use of phototrophs for wastewater treatment has been revisited because of new approaches to separate them from effluent streams. One manifestation uses oxygenic photogranules (OPGs) which are dense, easily-settleable granular biofilms of cyanobacteria, which surrounding populations of heterotrophs, autotrophs, and microalgae. OPGs can remove COD and nitrogenous compounds without external aeration. To better grow and maintain biomass in the proposed wastewater process, this study seeks to understand the factors that contribute to successful granulation. Availability of initial inorganic nitrogen, particularly ammonium, was associated with successful cultivation of OPGs. In the first days of granulation, a decrease in ammonium coupled with an increase in a cyanobacterial-specific 16S rRNA gene, may suggest that ammonium was assimilated in cyanobacteria offering a competitive environment for growth. Though both successful and unsuccessful OPG formation demonstrated a shift from non-phototrophic bacterial dominated communities on day 0 to cyanobacterial dominated communities on day 42, the successful community had a greater relative abundance (46%) of OTUs associated with genera Oscillatoria and Geitlernema than the unsuccessful community (27%), supporting that filamentous cyanobacteria are essential for successful OPG formation. A greater concentration of chlorophyll b in the unsuccessful OPG formation suggested a greater abundance of algal species. This study offers indicators of granulation success, notably availability of inorganic nitrogen and chlorophyll a and b concentrations for monitoring the health and growth of biomass for a potential OPG process.

Virus infections induce CD8+ T cell responses comprised of a large population of terminal effector cells and a smaller subset of long-lived memory cells. The transcription factors regulating the relative expansion versus the long-term survival potential of anti-viral CD8+ T cells are not completely understood. We identified ZBTB32 as a transcription factor that is transiently expressed in effector CD8+ T cells. After acute virus infection, CD8+ T cells deficient in ZBTB32 showed enhanced virus-specific CD8+ T cell responses, and generated increased numbers of virus-specific memory cells; in contrast, persistent expression of ZBTB32 suppressed memory cell formation. The dysregulation of CD8+ T cell responses in the absence of ZBTB32 was catastrophic, as Zbtb32-/- mice succumbed to a systemic viral infection and showed evidence of severe lung pathology. We found that ZBTB32 and Blimp-1 were co-expressed following CD8+ T cell activation, bound to each other, and cooperatively regulated Blimp-1 target genes Eomes and Cd27. These findings demonstrate that ZBTB32 is a key transcription factor in CD8+ effector T cells that is required for the balanced regulation of effector versus memory responses to infection.

Abstract Climate variability significantly affects rainfall, air temperature, relative humidity, and solar radiation. In subtropical regions like India, intense monsoon rainfall primarily causes floods. This study aims to analyze the climatic factors contributing to flood occurrence in the Middle Ganga Plain (MGP) by examining meteorological parameters through various analyses, including monthly and yearly trends, spatial variability, exceedance probability, historical highest intensity rainfall, and wind trajectory analysis. By establishing a strong link between climatic variables and flood events, this research provides valuable insights into the impact of climate variability on flood patterns in the MGP. Results indicate that monsoon rainfall peaks from July to October, correlating with major flood events. During these months, high relative humidity increases the likelihood of rainfall. Spatial analysis shows higher rainfall in the northern Middle Ganga Plain (MGP), which aligns with observed flood patterns. Trend detection tests reveal increasing annual rainfall and rising average temperatures. Geostatistical analysis identifies the western and eastern MGP as areas prone to extreme rainfall. Exceedance probability analysis confirms the occurrence of substantial monsoon rainfall events. Wind trajectory analysis uncovers seasonal shifts that lead to low-pressure systems and heavy monsoon rainfall. The study establishes a strong link between climatic variables and flood events in the MGP region.

Abstract Rajasthan faces significant environmental challenges, including the pressing need for effective climate change mitigation strategies. Recognizing afforestation as a vital tool in this endeavor, this study leverages the latest in remote sensing and geospatial analysis to map out the state's afforestation potential. The goal is to assess land suitability across Rajasthan for afforestation projects and evaluate the potential carbon sequestration capabilities of different tree species. This aims to inform sustainable land management strategies that can contribute to climate change mitigation. By integrating satellite imagery, land cover data, terrain analysis, and vegetation indices, the study evaluates environmental factors such as slope, soil moisture, and vegetation health to identify areas optimal for tree planting. A carbon sequestration model was also developed to estimate sequestration rates based on species-specific growth patterns. Findings indicate that approximately 40% of Rajasthan is suitable for afforestation, with potential carbon sequestration rates ranging from 2 to 8 tons per hectare per year. Species such as Azadirachta indica (Neem) and Prosopis cineraria (Khejri) are identified as particularly effective for short-term sequestration, while Phyllanthus emblica (Amla) and Ziziphus mauritiana (Ber) are better suited for long-term carbon capture. This research highlights the importance of targeted afforestation using suitable tree species as a nature-based solution (NBS) for climate change mitigation in Rajasthan. The study offers a data-driven approach to enhancing ecosystem resilience and supports decision-making for climate adaptation in arid regions, highlighting the significant potential of Rajasthan's land for carbon sequestration through afforestation.

This study employs the Soil and Water Assessment Tool (SWAT) model to evaluate soil loss within the Shilabati and Dwarkeswar River Basin of West Bengal, serving as a pilot investigation into soil erosion levels at ungauged stations during the post-monsoon season. Detailed data for temperature, precipitation, wind speed, solar radiation, and relative humidity for 2000–2022 were collected. A land use map, soil map, and slope map were prepared to execute the model. The model categorizes the watershed region into 19 sub-basins and 227 Hydrological Response Units (HRUs). A detailed study with regard to soil loss was carried out. A detailed examination of soil erosion patterns over four distinct time periods (2003–2007, 2007–2012, 2013–2017, and 2018–2022) indicated variability in soil loss severity across sub-basins. The years 2008–2012, characterized by lower precipitation, witnessed reduced soil erosion. Sub-basins 6, 16, 17, and 19 consistently faced substantial soil loss, while minimal erosion was observed in sub-basins 14 and 18. The absence of a definitive soil loss pattern highlights the region’s susceptibility to climatic variables. Reduced soil erosion from 2018 to 2022 is attributed to diminished precipitation and subsequent lower discharge levels. The study emphasizes the intricate relationship between climatic factors and soil erosion dynamics.

Purpose: To evaluate patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction using allograft in patients 40 years of age or older divided by sex. Methods: Patients age 40 years of age or older who underwent ACL reconstruction by the same surgeon using allograft via anteromedial portal technique were retrospectively identified. Patient-reported outcomes (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score, Tegner, Lysholm, Marx, and Single Assessment Numeric Evaluation) were evaluated and recorded, and outcomes were analyzed by sex. Results: In total, 159 patients undergoing primary ACL reconstruction were reviewed. Two-year outcomes were obtained. All patients noted improvement in patient-reported outcome measures. Male patients had overall greater postoperative patient-reported outcomes measures at all time points for IKDC, Tegner, Lysholm, Marx, and Single Assessment Numeric Evaluation scores; however, the only significant time points were IKDC 6 months (P = .016), 1 year (P = .012) and Marx 1 year (P = .007) and 2 year (P = .016). Knee Injury and Osteoarthritis Outcome Score scores similarly showed greater postoperative scores at all time points and statistical significance at 3 months (P = .002), 6 months (P = .033), and 1 year (P = .031). Conclusions: ACL reconstruction in individuals older than the age of 40 years using allograft results in good outcomes compared with preoperative status. Patient-reported outcomes were similar between male and female patients regarding most patient-reported outcome measures. Level of Evidence: Level III, retrospective cohort study.

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is one of the major leading causes of liver diseases, comprising a spectrum of conditions ranging from simple steatosis to cirrhosis. In the era of preventive medicine, it is of utmost importance to recognise the subset of NAFLD patients at high risk of progressing to liver cirrhosis. A newly emerging concept of myosteatosis is now suspected to be an early manifestation of NAFLD disease progression. Aim: To find the correlation between myosteatosis and liver fibrosis among patients with NAFLD. Materials and Methods: This was a cross-sectional study conducted in the Department of Radiodiagnosis and Department of Gastroenterology at Amala Institute of Medical Sciences in Thrissur, Kerala, India, from January 2021 to June 2022. A total of 57 subjects with Magnetic Resonance Imaging-proven (MRI) NAFLD were included in the study. Body weight and height were measured. Liver fat and myosteatosis were measured using the MRI-derived Proton Density Fat Fraction (PDFF) method {Iterative Decomposition of Water and Fat with Echo (IDEAL-IQ sequence)}. Liver fibrosis was assessed using 2D shear wave elastography. The proportion of myosteatosis and liver fibrosis among NAFLD patients was estimated. Partial correlation, controlling for gender, was evaluated using partial Spearman’s rho correlation coefficients. An Reciever Operating Characteristic (ROC) curve was plotted to assess muscle fat fraction in predicting liver fibrosis outcome among patients. Results: Out of the 57 subjects studied, 17 were females and 40 were males. The median Interquartile Range (IQR) age of the subjects was 43.0 (16.5). The median MRI hepatic fat fraction was 10.8. The median muscle PDFF in males was 8.4, and in females, it was 16.9. The median H-PDFF was 18.8. Myosteatosis correlated positively with liver fibrosis (r=0.558; p

In an effort to reduce harmful effects of green house gas emissions, ammonia is being pursued as a fuel for power generation as it is a carbon-free energy source. However, the use of ammonia-air mixtures in premixed swirl combustors poses challenges due to low flame speed, reactivity, and high Nitrous oxide emissions. This study attempts to overcome lean blowout limits of methane-ammonia-air mixtures by a novel, multipoint(O(10³)) injection strategy, whereby micron-sized holes on the swirler vanes generate a coflowing stream of fuel and air, which is then injected into swirling air cross-flow. The resulting improvement in mixing facilitated by increases in momentum flux ratio and fine-scale turbulence is found to reduce LBO limits to equivalence ratios between 0.65-0.7 for mixtures containing ammonia as high as 80-90% by volume. The measurements carried out using a model-swirl combustor setup are analyzed further using 0-D chemical kinetic models as well as CH* and OH* chemiluminescence. Chemiluminescence imaging shows the heat release zone to move downstream and broaden with an increase in ammonia content, as a result of decreasing flame speed. This forms a precursor to lean blow out through the action of instabilities at the flame front, which is potentially alleviated by the improved mixing achieved through the multipoint injection strategy. The resulting ultrashort mixing length can lead to a compact combustor design with the ability to lower LBO limits and improve Nitrous oxide emissions while utilizing carbon-free ammonia. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relation between hemoglobin A1c (HbA1c) levels and postoperative complications after primary anterior cruciate ligament reconstruction (ACLR). Methods: A retrospective review was performed of consecutive patients with an isolated anterior cruciate ligament tear, preoperative diagnosis of diabetes, and documented HbA1c within 90 days of primary ACLR between 2000 and 2019. Data collected included demographic and surgical characteristics, 90-day medical complications, and subsequent surgeries on the ipsilateral knee. A receiver operating curve was constructed for each HbA1c level in relation to postoperative complications and the optimal cutoff identified via Youden’s J statistic. Multivariable logistic regression was performed to assess the relation between postoperative complications and age, sex, graft type, diabetes subtype, and HbA1c. Results: Nineteen patients (7 females, 12 males) fulfilled inclusion criteria with preoperative HbA1c ranging from 5.5 to 10. Complications included septic knee (n = 1) and cyclops lesions requiring arthroscopic lysis (n = 3). Patients with HbA1c of 6.7% or higher were 25 times more likely to experience any postoperative complication (P = .04) and 16 times more likely to require lysis of adhesions (P = .08). On multivariable regression, HbA1c remained significantly associated with any complication (P = .005) and developing arthrofibrosis (P = .02) independent of age, sex, graft type, and diabetes subtype. Conclusions: Diabetic patients undergoing primary ACLR with a preoperative HbA1c of 6.7% or higher were 25 times more likely to require repeat surgical intervention for a postoperative complication. These complications included arthrofibrosis and infection. Strict glycemic control may help minimize the risk of postoperative complications after ACLR. Level of Evidence: Level III, retrospective cohort study.

Introduction: Atherosclerosis is a leading cause of cardiovascular mortality worldwide. According to American Cancer Society (ACS) guidelines, screening mammography is optional for all women above the age of 40 years to detect breast cancer early. Incidentally, Breast Arterial Calcification (BAC) can be observed in mammograms. Women with BAC and additional risk factors like diabetes or hypertension may be referred for cardiovascular risk assessment in the future if there is a significant correlation between Carotid Intima Media Thickness (CIMT) and BAC. Aim: To assess BAC among women undergoing screening mammography and determine the correlation between BAC and CIMT. Materials and Methods: A cross-sectional study was conducted on 152 women who underwent screening mammography in the Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India from May 2021 to October 2022. The presence and grading of BAC were determined using the Seimens Mammomat 1000 mammography unit, which captured two standard views: the Mediolateral Oblique (MLO) and Craniocaudal (CC) views. CIMT was measured using B-mode ultrasonography with an 8-13 MHz linear transducer, taking measurements from two contiguous sites at 1 cm intervals and calculating the average. Statistical significance was assessed at a 5% level, and the association was determined using Spearman’s rho correlation. Results: The mean age of the study population was 55.7±11.05 years. Among them, only 37 (24.3%) showed the presence of calcification in the breast arteries. The mean CIMT was 0.92±0.25 mm in the BAC (+) group and 0.72±0.24 mm in the BAC (-) group (p-value=0.001). Conclusion: The authors developed a BAC grading method after studying various previous studies and the present study found a significant positive correlation between the presence of BAC and CIMT

In this work, the authors report the fabrication and characterization of CeO2 -HfO2 mixed oxide thin film based oxygen gas sensors. The atomic concentrations of the individual elements Ce and Hf in the mixed oxide (CeO2 -HfO2) thin films were controlled and tuned using a novel method in RF sputtering to achieve better oxygen sensing characteristics. The characteristics of the sensing film were evaluated using various characterization techniques such as TEM-EDS, FESEM-EDS, XPS and XRD. The XPS and EDS data revealed that the Hf concentration increases with an increase in size as well as number of the HfO2 pellets that are placed on a 3-inch CeO2 target during sputtering. From the XRD and XPS analysis, it was found that the mixed oxide film with 10-11% Hf atomic concentration has the best sensing characteristics. The superior sensing characteristics of the CeO2 -HfO2 film can be attributed to the existence of a highly reactive plane (200) with the highest surface energy and a strongly reduced surface with oxygen vacancy formation due to the presence of Ce3+ ions and HfOx, x < 2 on the surface of the mixed oxide film. The sensor film detected the presence of oxygen gas even at low temperatures (< 400°C); however, the response time and recovery time were slightly higher. The sensor film of thickness 220 nm with Hf concentration between 10-11% showed excellent sensitivity (~15), fast response and recovery times of 8 s and 10 s respectively at an operating temperature of 400°C, which are the best values reported till date for CeO2 based oxygen sensors. [ABSTRACT FROM AUTHOR]

Introduction Indications for flow diversion for the treatment of cerebral aneurysms have increased remarkably in recent years.1 This has been particularly useful for aneurysms that are difficult to treat via endosaccular or open approaches, such as pseudoaneurysms.2 Flow diversion, however, typically requires dual antiplatelet therapy (DAPT), which can contribute to greater morbidity particularly in patients with ruptured aneurysms or other comorbidities.3 The third‐generation iteration of the Pipeline Embolization Device (PED) incorporates Shield technology, a phosphorylcholine coating designed to reduce thrombogenicity via mimicry of native cell membranes.4 In light of this reduced thrombogenicity, there have been reports of early transition to single antiplatelet therapy (SAPT), or other variations on DAPT, in patients treated with PED Shield. We therefore aim to characterize the antiplatelet regimens, and associated thromboembolic/hemorrhagic outcomes, utilized in patients with aneurysms treated with PED Shield. Methods Factors including demographics, comorbidities, rupture status, devices placed, and antiplatelet regimen, among others, were collected. Follow‐up data including aneurysm thromboembolic complication, hemorrhagic complication, new neurological deficit, aneurysm occlusion, and in‐stent thrombosis were also recorded. Results One‐hundred and eighty patients were included in analysis, 18 of which were acutely ruptured. One hundred and sixty‐two patients had a single device placed, while the remaining had two devices placed. Three patients were maintained on SAPT post‐procedurally (aspirin or clopidogrel), with two additional patients treated with SAPT plus an anticoagulant for other purposes. One hundred and seventy‐two patients were maintained on DAPT, most commonly aspirin/clopidogrel (115), followed by aspirin/ticagrelor (40), and aspirin/prasugrel (16). Seven patients had strokes of any kind, three of which were unrelated to the treatment territory, and two of the remaining 4 were non‐compliant with antiplatelet therapy. One patient had a new intraparenchymal hemorrhage, but no appreciable deficit. Of the 135 patients with 6‐month follow‐up, 77 had complete aneurysm occlusion, and 116 demonstrated no in‐stent thrombosis. Conclusion We demonstrate herein the similar safety profile and efficacy of PED Shield with varying antiplatelet regimens, including SAPT in isolated cases.

The objective of this paper is to improve the voltage profile of the grid in pertinence to grid due to power injection from distributed solar photovoltaic (PV) arrays. Weak grids are modeled as worldwide adaptation of net metering, transactive energy systems, and the possibility of further deterioration of power quality with higher grid penetration. In this paper, a solar PV integrated weak distribution grid modelled as the PV arrays being frequently connected in rural areas, due to various reasons like cheap real estate and lack of accessibility. In this paper, three case studies of PV generation are simulated, i.e., scheduled solar PV generation less than load requirement, PV generation equal to load requirement, and PV generation more than load requirement, by considering the daily solar irradiation and load demand profiles of a residential area under study. [ABSTRACT FROM AUTHOR]

Building back colonic crypts: Restoration of the colonic epithelium after mucosal injury depends on cell renewal initiated by intestinal stem cells (ISCs) and their progeny. Stromal cells near the base of colonic crypts secrete trophic factors for ISCs, but regulation of this process by proinflammatory mediators is not well understood. Cox et al. used mouse models of pathogen- or chemical-induced epithelial damage to investigate the contribution of IL-1 and its receptor (IL-1R1) to epithelial restitution. IL-1 release induced GREM1+ mesenchymal cells to produce R-spondin 3, a Wnt agonist supporting ISC renewal and proliferation. IL-1 also promoted innate lymphoid cell production of IL-22, a cytokine supporting colonocyte proliferation. These findings illustrate the need to consider the desirable regenerative properties of IL-1 when designing therapeutic approaches for chronic inflammatory diseases. Repair of the intestinal epithelium is tightly regulated to maintain homeostasis. The response after epithelial damage needs to be local and proportional to the insult. How different types of damage are coupled to repair remains incompletely understood. We report that after distinct types of intestinal epithelial damage, IL-1R1 signaling in GREM1+ mesenchymal cells increases production of R-spondin 3 (RSPO3), a Wnt agonist required for intestinal stem cell self-renewal. In parallel, IL-1R1 signaling regulates IL-22 production by innate lymphoid cells and promotes epithelial hyperplasia and regeneration. Although the regulation of both RSPO3 and IL-22 is critical for epithelial recovery from Citrobacter rodentium infection, IL-1R1–dependent RSPO3 production by GREM1+ mesenchymal cells alone is sufficient and required for recovery after dextran sulfate sodium–induced colitis. These data demonstrate how IL-1R1–dependent signaling orchestrates distinct repair programs tailored to the type of injury sustained that are required to restore intestinal epithelial barrier function. [ABSTRACT FROM AUTHOR]

The tuning of robotic prosthesis control is essential to provide personalized assistance to individual prosthesis users. Emerging automatic tuning algorithms have shown promise to ease the device personalization procedure. However, very few automatic tuning algorithms consider the user preference as the tuning goal, which may limit the adoptability of the robotic prosthesis. In this study, we propose and evaluate a novel prosthesis control tuning framework for a robotic knee prosthesis, which could enable user preferred robot behavior in the device tuning process. The framework consists of 1) a User-Controlled Interface that allows the user to select their preferred knee kinematics in gait and 2) a reinforcement learning-based algorithm for tuning high-dimension prosthesis control parameters to meet the desired knee kinematics. We evaluated the performance of the framework along with usability of the developed user interface. In addition, we used the developed framework to investigate whether amputee users can exhibit a preference between different profiles during walking and whether they can differentiate between their preferred profile and other profiles when blinded. The results showed effectiveness of our developed framework in tuning 12 robotic knee prosthesis control parameters while meeting the user-selected knee kinematics. A blinded comparative study showed that users can accurately and consistently identify their preferred prosthetic control knee profile. Further, we preliminarily examined gait biomechanics of the prosthesis users when walking with different prosthesis control and did not find clear difference between walking with preferred prosthesis control and when walking with normative gait control parameters. This study may inform future translation of this novel prosthesis tuning framework for home or clinical use.

This paper presents a twin dual-axis robotic platform system which is designed for the characterization of postural balance under various environmental conditions and quantification of bilateral ankle mechanics in 2 degrees-of-freedom (DOF) during standing and walking. Methods: Validation experiments were conducted to evaluate performance of the system: 1) to apply accurate position perturbations under different loading conditions; 2) to simulate a range of stiffness-defined mechanical environments; and 3) to reliably quantify the joint impedance of mechanical systems. In addition, several human experiments were performed to demonstrate the system’s applicability for various lower limb biomechanics studies. The first two experiments quantified postural balance on a compliance-controlled surface (passive perturbations) and under oscillatory perturbations with various frequencies and amplitudes (active perturbations). The second two experiments quantified bilateral ankle mechanics, specifically, ankle impedance in 2-DOF during standing and walking. The validation experiments showed high accuracy of the platform system to apply position perturbations, simulate a range of mechanical environments, and quantify the joint impedance. Results of the human experiments further demonstrated that the platform system is sensitive enough to detect differences in postural balance control under challenging environmental conditions as well as bilateral differences in 2-DOF ankle mechanics. This robotic platform system will allow us to better understand lower limb biomechanics during functional tasks, while also providing invaluable knowledge for the design and control of many robotic systems including robotic exoskeletons, prostheses and robot-assisted balance training programs. Clinical and Translational Impact Statement— Our robotic platform system serves as a tool to better understand the biomechanics of both healthy and neurologically impaired individuals and to develop assistive robotics and rehabilitation training programs using this information.

The amount of information that a noisy channel can transmit has been one of the primary subjects of interest in information theory. In this work we consider a practically-motivated family of optical quantum channels that can be implemented without an external energy source. We optimize the Holevo information over procedures that encode information in attenuations and phase-shifts applied by these channels on a resource state of finite energy. It is shown that for any given input state and environment temperature, the maximum Holevo information can be achieved by an encoding procedure that uniformly distributes the channel's phase-shift parameter. Moreover for large families of input states, any maximizing encoding scheme has a finite number of channel attenuation values, simplifying the codewords to a finite number of rings around the origin in the output phase space. The above results and numerical evidence suggests that this property holds for all resource states. Our results are directly applicable to the quantum reading of an optical memory in the presence of environmental thermal noise.

The Mountainous terrain,in the Himalayas is experiencing rapid development in a bewildering manner, which makes it more susceptible to landslides. Management and mitigation of landslide hazard begin with its mapping by integrating numerous methods and Geographic Information System (GIS) tools. However, it is difficult to produce reliable landslide susceptibility maps (LSM) with traditional remote sensing and GIS methods due to complexity of the mountainous terrain environments and huge datasets. Therefore, the present study investigates the applicability of Mamdani’s fuzzy inference system (FIS) to produce LSM in Himalayan terrain in India. It is compared with commonly used frequency ratio (FR) and information value method (IVM) approaches. Several causative factors were extracted and used to prepare thematic layers, including slope, aspect, curvature, solar radiance, SPI, TWI, rainfall, soil depth and NDVI. Landslide inventory was also created using google earth images and previously published work. The accuracy estimates for FR, IVM and FIS were performed based on ROC curves. FIS was found to provide an accuracy of 77.7%, followed by IVM (72%) and FR (71%) for LSM. The current study is a prototype for further studies in the Garhwal Himalayas and similar terrains, based on the vigorous Mamdani’s techniques of fuzzy inference theory. The outcomes of this work propose that an expert’s knowledge-based FIS method can produce an accurate LSM in such a complex terrain. Planners and concerned authorities can use the results further for landslide management and mitigation.

Evapotranspiration and water availability are driven by changing climate and land cover parameters. In the present study, climatological records and land cover data were analysed simultaneously to accomplish the spatial distributions of climate change effects on water resources in Varanasi district, north India. Humidity–aridity was assessed by Lang's rain factor and De Martonne's aridity index, based on mean monthly rainfall and air temperature from seven meteorological stations. The climate change effect on water resources was evaluated using a 5 × 5 matrix that includes water availability and the aridity index by considering two time periods: 1941–1970 (1950s) and 1971–2000 (1980s). The methodology is based on seasonal crop evapotranspiration (ETc) (initial, mid‐season, end season and cold season) and annual water availability calculations. The high values (≤ 1,045 mm) of ETc were identified during the mid‐season stage. Water availability indicates decreases in the maximums from 718 to 636 mm during the two analysed periods, with a negative impact at the spatial scale. Lang's rain factor (< 40) indicates an arid climate in the northwest, west, east and central parts of the district and a humid climate (Lang's rain factor > 40) in the south. De Martonne's aridity index indicates rapid aridization from south to north (28.3 in the 1950s and 25.6 in the 1980s). The high and very high climate effects on water resources in Varanasi district were found mainly in the crop lands, while in the urban areas the climate effect is low. The much affected area by climate change and land cover was depicted during the recent period (1980s). This statement was proved also by the Mann and Kendall test, which indicates a negative trend for annual precipitation at all stations (for the period 1941–2000), while the mean annual temperature had a positive trend for four stations. These findings suggest that climate change had a negative effect on water resources during the last 60 years in the study area. [ABSTRACT FROM AUTHOR]

Pulsed direct current (PDC) gas tungsten arc welding (GTAW) of 12 mm thick plates of naval, marine-grade high strength low alloy steel (HSLA) using ER80S–Ni3 filler metal was investigated. The microstructural characteristics were examined by both optical microscopy and field-emission scanning electron microscopy (FE-SEM) techniques. The fusion zone is comprised of mixed microstructures of acicular ferrite (AF), polygonal ferrite (PF), grain boundary ferrite (GBF), and bainite ferrite (BF) laths in the various welding passes. The yield and tensile strengths of the PDCGTA weld joints were found to be superior to that of the base metal. A joint efficiency of 122% was observed for the weld seams while conducting the notch tensile studies (NTS). The impact toughness of the weld joints was higher than that of the base metal. The tensile and impact properties in the room temperature (RT) conditions were superior due to the formation of acicular ferrite (AF) and bainite ferrite (BF) laths in the weld seam microstructure. A higher toughness value of 173 J and ductile fracture mode was observed when the joints were impact loaded at −40 °C. On the other hand, the brittle cleavage fracture was observed for the joints subjected to impact loading at −196 °C. The impact toughness data indicated that the joints experienced a transition from a ductile to a brittle mode of fracture on lowering the temperature.

The aim of this study is to analyze land cover changes and their effects on land surface temperature (LST) and normalized difference vegetation index (NDVI) in Muzaffarpur district, Bihar, India. The research utilized Landsat 5 and 8 satellite images taken every five years from 1990 to 2020 to classify seven land cover types, namely built-up areas, wetlands, fallow lands, croplands, vegetation, and water bodies, using the Artificial Neural Network technique in ENVI 5.1. The resulting land cover maps reveal a significant decrease in cropland area during the studied period, while fallow land area decreased from 48.06% to 35.79%. Analysis of LST and NDVI data showed a strong negative correlation (R2 < -0.0057) for all years, except for a weak positive correlation (R2 > 0.006). NDVI values were highest in agricultural lands with the lowest LST values, while fallow land areas showed the opposite trend. The study suggests that vegetation and fallow land are crucial determinants of the spatial and temporal variations in NDVI and LST, relative to urban and water cover categories.

The global COVID-19 pandemic has challenged health care delivery in many ways. One solution from the pandemic that offers potential upside is the expansion of telehealth as a means to provide high quality, cost-effective, and safe care while also maintaining excellence in patient and family experience. While most examinations of the use of telehealth over the pandemic have focused on the expansion of outpatient telehealth, few have explored the use of telehealth for hospitalized patients. This article will examine the influence of telehealth use on patient experiences among acute care patients. Inpatient telehealth acute care (ITAC) is a novel modality for hospitalized patients that enables providers to engage with a remote medical unit to ask questions regarding the care plan, medications, and discharge instructions. This case study will compare the experiences of two inpatient hospital units within the same institution to determine the degree to which patient experiences are influenced by telehealth capabilities. The results find that the telehealth unit has negligible differences in patient evaluations of provider communication but shows significant differences in patients’ experiences of staff responsiveness and the environmental aspects of care captured via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (quietness and cleanliness of care). Future scholarship should seek to determine the extent to which these capabilities influence nurses and other care providers. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Quantum information-processing techniques enable work extraction from a system's inherently quantum features, in addition to the classical free energy it contains. Meanwhile, the science of computational mechanics affords tools for the predictive modeling of non-Markovian classical and quantum stochastic processes. We combine tools from these two sciences to develop a technique for predictive work extraction from non-Markovian stochastic processes with quantum outputs. We demonstrate that this technique can extract more work than non-predictive quantum work extraction protocols, on the one hand, and predictive work extraction without quantum information processing, on the other. We discover a phase transition in the efficacy of memory for work extraction from quantum processes, which is without classical precedent. Our work opens up the prospect of machines that harness environmental free energy in an essentially quantum, essentially time-varying form.

The monitoring of wheat crop growth plays a crucial role in ensuring effective agricultural management and enhancing food security. Valuable insights into the spatial distribution and various growth stages of wheat crop can be obtained through the combination of multi-spectral remote sensing datasets, data analysis, and ground-truth verification. This work aims to monitor wheat crops at farm level in the Bathinda district of India during the agricultural year 2022–23. It involves collecting and analyzing multispectral satellite data over five selected farmlands in the study region. Preprocessing of the multispectral satellite data is performed, including radiometric and atmospheric corrections. The wheat crops’ health and growth are examined, utilizing various indices such as the Land Surface Water Index (LSWI), Normalized Difference Red Edge (NDRE), and Normalized Difference Vegetation Index (NDVI) retrieved from time series remote sensing datasets. Furthermore, wheat crop monitoring is performed, using fortnightly data encompassing its health, moisture levels, and growth stages on individual farmlands. Different farmlands have shown varied LSWI, NDRE, and NDVI values. Variations in crop growth and productivity were observed among farmlands due to differences in soil properties and sowing dates. The findings from this study offer valuable insights into the importance of timely sowing, crop health monitoring, irrigation management, and soil suitability in optimizing wheat crop production.

One of the rarest anomalies of the renal collecting system is ureteral triplication along with the presence of a complex ureteral cyst. We describe an unusual case of a 37-year-old man who presented with fever and abdominal pain. Computed tomography urography (CTU) revealed triplication of the ureter in association with renal ectopia and a ureteral cyst which was complicated by calculi formation. Following treatment with antibiotics, the patient was managed by open ureterolithotomy with resection of the ureteral cyst and tailoring of the ureter.

Cervical cancer is a leading cause of cancer among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in other low-resource settings similar to Rwanda has shown that HPV-based self-collection is an effective cervical cancer screening method. This study aims to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from one urban and one rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. We reported descriptive statistics stratified by urban and rural sites. In total, 169 urban and 205 rural women completed the survey. The majority of respondents at both sites had a primary school or lower education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value

Objective: To compare glycaemic profiles in women with mild gestational diabetes (GDM) and those with a healthy pregnancy.Design: Observational study.Setting: Hospital-based.Population: Healthy nonpregnant, healthy pregnant, and women with GDM, diagnosed by oral glucose tolerance test.Methods: Nine nonpregnant women, 33 healthy pregnant women, 29 pregnant women with GDM between 24 and 36 weeks' gestation, received ambulatory glucose profile (AGP) monitoring for a 2-week period. AGP values were compared in the three groups: 100 days (9600 data points) for nonpregnant women, 396 days (33 792 data points) for healthy pregnant women, and 348 days (34 408 data points) for women with GDM.Results: Mean glucose values for fasting and postmeals were highest in nonpregnant healthy women and lowest in healthy pregnant women (P < 0.001). Women with mild GDM had significantly higher blood glucose values than did healthy pregnant women, though still within the target range. Blood glucose values >160 mg/dl were observed in 41.4% (12/29) in the GDM group compared with 18.2% in women with a healthy pregnancy. The maximum peak of day and night time glucose was respectively 234 and 215 mg/dl in women with GDM compared with 183 and 171 mg/dL in the control group. Glycaemic variability as measured by interquartile range was higher in GDM pregnancies.Conclusions: Although the blood glucose level remained within the target levels in women with mild GDM, glycaemic variability and mean blood glucose levels were significantly higher among women with GDM than among women with a healthy pregnancy.Tweetable Abstract: Average blood glucose levels and glycaemic variability are significantly higher in women with GDM than in women with a healthy pregnancy. [ABSTRACT FROM AUTHOR]

Aims. The main goal of this work is to analyze the structural and temporal evolution of small-scale magnetic structures (SSMSs) observed in the solar atmosphere, such as solitary faculae and pores, and reveal long quasi-periodic oscillations of these structures. Methods. The statistical method of regression analysis and the wavelet transform were used to obtain the periods of oscillations and dependences between the parameters of magnetic structures and periods of oscillations. Results. Long-period oscillations with periods in the interval of 18−260 min are found for the structurally stable phase of SSMSs at the level of the solar photosphere. These long-period oscillations were interpreted as natural oscillations of the structurally stable long-lived magnetic structures around their equilibrium position. These oscillations, which are of similar nature, are observed in the chromospheric bright formations associated with photospheric SSMSs. Dependences between the magnetic field and the continuum intensity of the facula elements were found. It is shown that the continuum intensity of a SSMS decreases when its magnetic field increases. [ABSTRACT FROM AUTHOR]

Apoptosis of CD8 T cells is an essential mechanism that maintains immune system homeostasis, prevents autoimmunity, and reduces immunopathology. CD8 T cell death also occurs early during the response to both inflammation and costimulation blockade (CoB). In this article, we studied the effects of a combined deficiency of Fas (extrinsic pathway) and Bim (intrinsic pathway) on early T cell attrition in response to lymphocytic choriomeningitis virus infection and during CoB during transplantation. Loss of Fas and Bim function in Bcl2l11-/-Faslpr/lpr mice inhibited apoptosis of T cells and prevented the early T cell attrition resulting from lymphocytic choriomeningitis virus infection. Bcl2l11-/-Faslpr/lpr mice were also resistant to prolonged allograft survival induced by CoB targeting the CD40-CD154 pathway. These results demonstrate that both extrinsic and intrinsic apoptosis pathways function concurrently to regulate T cell homeostasis during the early stages of immune responses and allograft survival during CoB. [ABSTRACT FROM AUTHOR]

Context: Primary percutaneous coronary intervention (PCI) is the most effective reperfusion therapy with low complication rate in comparison to thrombolysis. Aims: We aimed to study the short-term outcomes of primary PCI at a large tertiary care center in India. Settings and Design: A prospective cohort of patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI was enrolled between December 2015 and November 2016. Subjects and Methods: The demographic profile, risk factors, clinical characteristics, inhospital complications, and outcomes at 30 days were assessed. The primary outcome was a composite of death, reinfarction, and repeat revascularization. Acute left ventricular failure (LVF), complete heart block (CHB) or bradyarrhythmia, ventricular tachycardia (VT) or ventricular fibrillation, stroke, and major thrombolysis in myocardial infarction bleeding were the inhospital complications that were considered the secondary outcomes. Results: A total of 237 STEMI patients with primary PCI were enrolled, accounting for 7.5% of all PCI procedures performed during this period. The mean age was 55.4 ± 11.9 years, and 86.5% were male. The mean window period was 5.1 ± 3.18 h, and the mean door-to-balloon time was 58.4 ± 11.5 min. Prior to PCI, the most often administered antiplatelets were clopidogrel in 54.4% of patients and prasugrel in 55.6%. The aspiration thrombectomy was done in 70.8% of patients. Predilatation with balloon was required in 41.8% of patients. Drug-eluting stents were implanted in 98.3% of patients. The primary outcome was found in 3.3% of patients (deaths – 2.9% and reinfarction – 0.4%) and the secondary outcomes were observed in 13%. The common inhospital complication was CHB or bradyarrhythmia in 5.0% followed by acute LVF in 4.6% and then VT in 2.1%. Conclusions: The primary outcome rate is as good as reported in developed Western countries in contemporary treatment practices of STEMI. CHB and acute LVF were the major inhospital complications among patients of STEMI treated with primary PCI.

Testosterone deficiency in men is associated with increased risk for autoimmunity and increased B cell numbers through unknown mechanisms. Here we show that testosterone regulates the cytokine BAFF, an essential survival factor for B cells. Male mice lacking the androgen receptor have increased splenic B cell numbers, serum BAFF levels and splenic Baff mRNA. Testosterone deficiency by castration causes expansion of BAFF-producing fibroblastic reticular cells (FRCs) in spleen, which may be coupled to lower splenic noradrenaline levels in castrated males, as an α-adrenergic agonist decreases splenic FRC number in vitro. Antibody-mediated blockade of the BAFF receptor or treatment with the neurotoxin 6- hydroxydopamine revert the increased splenic B cell numbers induced by castration. Among healthy men, serum BAFF levels are higher in men with low testosterone. Our study uncovers a previously unrecognized regulation of BAFF by testosterone and raises important questions about BAFF in testosterone-mediated protection against autoimmunity. [ABSTRACT FROM AUTHOR]