Search

Context Late intervention to open an occluded infarct-related artery (IRA) after initial acute myocardial infarction was postulated to lead to clinical benefit. Objective To conduct a meta-analysis of the randomized trials. Study Selection Eligibility criteria were: 1) randomized trials comparing percutaneous coronary intervention (PCI) in a totally occluded artery (TIMI flow 0-1) versus medical therapy, 2) in stable post myocardial infarction (MI) patients without spontaneous or low level exercise induced ischemia, 3) trials with a time from the onset of symptoms to randomization >24 hours, but

Secure communication has always been a key concern while sharing information between two parties. Traditional and lightweight cryptography primitives and protocols are insecure against quantum attacks. The objective of cryptography is to ensure confidentiality, integrity, authentication and non-repudiation between both parties. Quantum key distribution is a safe and sound method for communication between two parties to share their information. However early applications with applied limitations lead to open ambiguities, permitting an eavesdropper to breach the security of quantum cryptographic system. This research proposes a framework for quantum key distribution using B92 protocol. The B92 protocol allows two different users A to share their polarized photons with high security and without any interruption of Eavesdropper. While B92 protocol generates a secrete key, that is known to just sender and receiver. The use of QuVis framework can provide this secure communication and photons are transferred to Bob securely without any Eavesdropper. [ABSTRACT FROM AUTHOR]

Among the established breeds of buffalo in Pakistan, the Nili-Ravi breed is dominant in the Punjab Province. The purpose of the study is to determine the chemical composition and fatty acid profile of buffalo milk. Milk is a complete food and contains all the nutritional components in balanced form. It helps to meet important nutritional needs of the human body. The buffaloes were divided into 3 groups on the basis of lactation period i.e. early, middle and late lactation. A total of 90 milk samples were obtained for analysis. Buffalo milk samples were analyzed for proximate analysis, parameters like fat, crude protein, lactose, ash, solids not fat (SNF), total solids (TS), pH and acidity were determined. Fatty acid profile of buffalo milk was determined by the method, Association of Office of Agricultural Chemists (AOAC, 2000). Milk fat content (%) was found to be significantly (p<0.05) lower in the early (6.52) and mid lactation (6.61) stages than the late lactation stage (6.85). The content of TS (%) was found to be significantly (p<0.05) higher in the late lactation (14.62 and 15.45) stage than the early (12.94 and 13.65)) and mid lactation (13.76 and 14.14) stages. In contrast, the content of total protein (4.31% to 4.78%), Solid not fat (8.40% to 8.70%), lactose (4.36% to 4.74%) and ash (0.18% to 0.19%) did not vary significantly among the different lactation stages. The values of Butyric acid, Caproic acid, Myristic acid, Stearic acid and Oleic acid showed significant increase towards end of lactation. These values of fatty acids also revealed that there is significant difference among the animals and lactation stages of Nili Ravi buffalo milk. Results showed that Capric acid, Lauric acid, Palmitic acid, Linoleic acid and Linolenic acid decreased in early to middle and increased towards end of lactation. [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure patients with stable angina, acute coronary syndromes and valvular heart disease may benefit from revascularisation and/or valve surgery. However, the mortality rate is increased- 5-30%. Biventricular pacing using temporary epicardial wires after surgery is a potential mechanism to improve cardiac function and clinical endpoints. Method/design A multi-centred, prospective, randomised, single-blinded, intervention-control trial of temporary biventricular pacing versus standard pacing. Patients with ischaemic cardiomyopathy, valvular heart disease or both, an ejection fraction ≤ 35% and a conventional indication for cardiac surgery will be recruited from 2 cardiac centres. Baseline investigations will include: an electrocardiogram to confirm sinus rhythm and measure QRS duration; echocardiogram to evaluate left ventricular function and markers of mechanical dyssynchrony; dobutamine echocardiogram for viability and blood tests for renal function and biomarkers of myocardial injury- troponin T and brain naturetic peptide. Blood tests will be repeated at 18, 48 and 72 hours. The principal exclusions will be subjects with permanent atrial arrhythmias, permanent pacemakers, infective endocarditis or end-stage renal disease. After surgery, temporary pacing wires will be attached to the postero-lateral wall of the left ventricle, the right atrium and right ventricle and connected to a triple chamber temporary pacemaker. Subjects will be randomised to receive either temporary biventricular pacing or standard pacing (atrial inhibited pacing or atrial-synchronous right ventricular pacing) for 48 hours. The primary endpoint will be the duration of level 3 care. In brief, this is the requirement for invasive ventilation, multi-organ support or more than one inotrope/vasoconstrictor. Haemodynamic studies will be performed at baseline, 6, 18 and 24 hours after surgery using a pulmonary arterial catheter. Measurements will be taken in the following pacing modes: atrial inhibited; right ventricular only; atrial synchronous-right ventricular; atrial synchronous-left ventricular and biventricular pacing. Optimisation of the atrioventricular and interventricular delay will be performed in the biventricular pacing group at 18 hours. The effect of biventricular pacing on myocardial injury, post operative arrhythmias and renal function will also be quantified. Trial Registration ClinicalTrials.gov: NCT01027299

This study evaluated the effects of a ferulic acid esterase ( FAE) and a non- FAE-producing inoculant applied alone or in combination with exogenous fibrolytic enzymes ( EFE) on the fermentation and nutritive value of mixed grain (barley, oats and spring triticale) silage. The mixed crop was ensiled in laboratory mini-silos either untreated ( CON), or treated with a FAE inoculant ( FAE), a non- FAE inoculant ( NFAE) or NFAE + EFE. Inoculated silages were lower ( P < 0·01) in water-soluble carbohydrate, whereas NFAE and NFAE + EFE silages had higher ( P < 0·001) DM loss than other silages. FAE and NFAE silage had higher neutral detergent fibre ( NDF), but were lower in NFAE + EFE than other silages ( P < 0·001). Copy numbers of 16S rRNA associated with Lactobacillus buchneri were higher ( P < 0·001) in NFAE and NFAE + EFE silages than in others, resulting in higher ( P < 0·001) acetic acid in these silages. NFAE + EFE silage had lower ( P < 0·001) in vitro gas production and NDF digestibility ( NDFD) than other silages. FAE silage had higher ( P < 0·01) in situ NDFD than CON and NFAE + EFE silages. Inoculation of mixed small-grain silage with NFAE-producing inoculants combining EFE reduced NDFD. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to determine whether cardiac resynchronization therapy (CRT) by means of biventricular pacing (BiVP) alters the QT interval (QTc) and QT dispersion (QTD), and whether such changes relate to the risk of developing major arrhythmic events (MAE). Background: Prolonged QTc is associated with MAE. Left ventricular pacing and BiVP alter QTc. Methods: A total of 75 patients with drug-resistant heart failure (New York Heart Association functional class III/IV) and QRS duration ≥120 ms underwent CRT. The QTc and QTD were measured before and 48 days after BiVP. Results: Over 807 days (range 93 to 1,543 days), 11 patients had a MAE. Compared to baseline, at 48 days after CRT, QTD increased in 47% of patients and QTc decreased in 53%. The QTc at follow-up was higher in MAE patients compared with no-MAE patients (35.9 ± 14.2 ms vs. 0.52 ± 6.0 ms; p = 0.0323). Similar differential responses for QTD were observed (46.4 ± 13.5 ms in MAE vs. −5.1 ± 4.1 ms in no MAE, p < 0.0001). The MAE occurred in 29% of patients exhibiting an increase in QTD and in 3% of those exhibiting a decrease (p = 0.0017). In multiple regression analyses, change in QTD from baseline (ΔQTD) strongly predicted MAE, independent of ΔQTc, QRS duration, and left ventricular ejection fraction and end-diastolic volume (p < 0.001). Differences in survival curves were observed when patients were dichotomized according to whether QTD increased or decreased in relation to baseline values (p < 0.0001). Conclusions: The MAE in patients with BiVP are related to pacing-induced increases in QTD. Measures of ventricular repolarization at the time of pacemaker implantation may guide selection of patients for combined CRT and defibrillator therapy. [Copyright &y& Elsevier]

: ObjectiveWe sought to conduct a randomized trial comparing late revascularization with conservative therapy in symptom-free patients after acute myocardial infarction (AMI).: BackgroundIn the absence of ischemia, the benefits of reperfusion late after AMI remain controversial. However, the possibility exists that an open infarct related artery benefits healing post AMI.: MethodsOf 223 patients enrolled with Q-wave anterior AMI, 66 with isolated persistent occlusion of the left anterior descending coronary artery (LAD) were randomized to the following treatments: 1) medical therapy (closed artery group; n = 34) or 2) late intervention and stent to the LAD + medical therapy (open artery group; n = 32). The study was powered to compare left ventricular (LV) end-systolic volume between the two groups 12 months post AMI.: ResultsLate intervention 26 ± 18 days post AMI resulted in significantly greater LV end-systolic and end-diastolic volumes at 12 months than medical therapy alone (106.6 ± 37.5 ml vs. 79.7 ± 34.4 ml, p < 0.01 and 162.0 ± 51.4 ml vs. 130.1 ± 46.1 ml, p < 0.01, respectively). Exercise duration and peak workload significantly increased in both groups from 6 weeks to 12 months post AMI, although absolute values were greater in the open artery group. Quality of life scores tended to deteriorate during this time interval in the closed artery patients but remained unchanged in the open artery patients. Coronary angiography at 1 year documented a low incidence of intergroup cross-over (spontaneous recanalization in 19% and closure in 11%).: ConclusionsIn the present study, recanalization of occluded infarct-related arteries in symptom-free patients approximately 1 month post AMI had an adverse effect on remodeling but tended to increase exercise tolerance and improve quality of life. [Copyright &y& Elsevier]

ABSTRACT: The goal of this study was to evaluate the Perception of dental undergraduates regarding need of psychological and psychosocial support throughout their undergraduate life. A total sample of 300 dental students participated from 3 private dental colleges of Lahore. A cross sectional study was done to evaluate their needs for psychological counseling. A questionnaire was made comprising of 15 questions regarding various aspects and perceptions of counseling to evaluate its need and outcomes. The data showed 62.2% of undergraduate dental students need counseling sessions and 84.4% believes that mentoring has high impact on dentist health and practice. Data showed 71.2% will attend if confidentiality is provided and 80.1% believes these sessions will be productive. Confidentiality in counseling sessions is the most important part as there is a reluctance seen for counseling because of lack of confidentiality. [ABSTRACT FROM AUTHOR]

Background: In 2012, it has been estimated that almost 527,600 new patients were diagnosed with cervical cancer causing over 265,000 deaths worldwide. Locally, the disease is affecting a substantial number of women in Qatar, placing it fifth in terms of the most common cancers among females in the country. Unfortunately, most cases are diagnosed at advanced stages, making the treatment more challenging. This is mainly due to the poor knowledge of the disease and the lack of awareness campaigns about cervical cancer. Aim: To raise the awareness about cervical cancer among women in Qatar to promote prevention and early detection. Methods: Qatar Cancer Society (QCS) launched a population-based campaign aimed at raising the public awareness about cervical cancer. In January 2018, health educators from QCS conducted 15 workshops in numerous public and private sectors across Qatar including companies, hotels, hospitals, and healthcare centers to educate the public about the signs and symptoms of the disease, its risk factors, as well as methods of prevention and early detection. In addition, the campaign was advertised in 10 local newspapers, 4 TV programs, 3 radio programs, social media, and 2 Web sites to deliver the educational material to a larger audience as possible. A hotline number was also reserved to answer women's questions and concerns about the disease. To promote the prevention and early detection of cervical cancer, women were encouraged to do Pap tests for free in Al-Ahli and Al-Emadi hospitals. Moreover, QCS organized a closing ceremony at the end of the campaign for all women who did the Pap test and a raffle draw was done to appreciate their participation. Results: A total of 635 women attended the various awareness workshops that were delivered over a month period. Interestingly, 100 women aged 21-65 years visited Al-Ahli and Al-Emadi hospitals to have Pap tests for cervical cancer screening. All of these women reported that they have never done the test before and they became aware of it from QCS campaign. Of note, participants indicated that it was the first time for them to learn about human papilloma virus (HPV) vaccine which prevents 70% of all cervical cancer cases. In addition, about 150 calls were received inquiring about different aspects of the disease. The closing ceremony came to reinforce the awareness messages delivered by QCS where an educational video about cervical cancer was presented, followed by a speech by a cervical cancer survivor who talked about her battle with the disease and her treatment journey. Conclusion: Despite the widespread of cervical cancer among women in Qatar, little was known about its signs and symptoms, prevention, and early detection methods. This population-based awareness campaign was very effective in raising the awareness about cervical cancer, which will help in detecting the disease at earlier stages, and will ultimately result in higher survival rates. [ABSTRACT FROM AUTHOR]

Our study compared the dissipation of antimicrobials and resistance genes (ARG) during composting of cattle manure fortified with antimicrobials versus manure from cattle administered the same antimicrobials in feed. Manure was collected from cattle fed diets containing (kg-1 dry feed): (1) 44 mg chlortetracycline (CTC), (2) a mixture of 44 mg each of chlortetracycline and sulfamethazine (CTCSMZ), (3) 11 mg tylosin (TYL) or (4) Control, no antimicrobials. Fortified treatments were generated by adding antimicrobials to control manure. All manures were composted for 30 d with a single mixing after 16 d. Quantitative PCR (qPCR) measured the concentration of 16S rDNA and genes associated with tetracycline (tet), erythromycin (erm), and sulfamethazine (sul) resistance. Over 95% of antimicrobials dissipated over 30 d of composting, but CTC and SMZ remained higher in fed than fortified treatments, with a reverse trend observed for tylosin. Copy numbers of 16S rDNA decreased (P < 0.05) over 30 d, but were not altered by the presence of antimcrobials. Levels of all ARG except tet(L) decreased by 0.1-1.6 log10 copies g dry matter-1 in the first compost cycle, but some genes [tet(B), tet(L), erm(F), and erm(X)] increased (P < 0.05) by 1.0-3.1 log10 copies g dry matter-1 in the second. This pattern aligned with the positive correlation of these ARG with residue concentrations in the first cycle and the negative correlation in the second. During 30 d of composting, levels of tet(M) and tet(W) in CTC, erm(A), erm(B) and erm(X) in TYL, and sul(1) in CTCSMZ remained higher (P < 0.05) in fed than fortified treatments. Our results suggest that dissipation of ARG during composting of manure fortified with antimicrobials differs from manure generated by cattle that are administered antimicrobials in feed and does not always align with the dissipation of antimicrobial residues. [ABSTRACT FROM AUTHOR]

OBJECTIVES Optimized temporary bi-ventricular (BiV) pacing may benefit heart failure patients after on-pump cardiac surgery compared with conventional dual-chamber right ventricular (RV) pacing. An improvement in haemodynamic function with BiV pacing may reduce the duration of ‘Level 3’ intensive care. METHODS Thirty-eight patients in sinus rhythm, ejection fraction ≤35%, undergoing on-pump surgical revascularization, valve surgery or both were enrolled in this study. Before closing the sternum, temporary epicardial pacing wires were attached to the right atrium, RV outflow tract and basal posterolateral wall of the left ventricle. Patients were randomly assigned to postoperative BiV pacing with the optimization of the atrio- (AV) and inter-ventricular (VV) pacing intervals (Group 1) or conventional dual-chamber right AV pacing (Group 2). The primary end-point was the duration of ‘Level 3’ intensive care. Secondary end-points included cardiac output which was measured by thermodiluation at admission to the intensive care unit and at 6 and 18 h later, in five different pacing modes. RESULTS The duration of ‘Level 3’ care was similar between groups (40 ± 35 vs 54 ± 63 h; Group 1 vs 2; P = 0.43). Cardiac output was similar in all pacing modes at baseline. At 18 h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3 l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval produced a further 4% increase in cardiac output compared with baseline settings (P = 0.005). CONCLUSIONS Postoperative haemodynamic function may be enhanced by temporary BiV pacing of high-risk patients after on-pump cardiac surgery. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article "Angiotensin receptor blockers and myocardial infarction," in the Nov. 27, 2004 issue of "British Medical Journal."

Abstract Background It is apparent that despite lack of family history, patients with the morphological characteristics of left ventricular non-compaction develop arrhythmias, thrombo-embolism and left ventricular dysfunction. Methods Forty two patients, aged 48.7 ± 2.3 yrs (mean ± SEM) underwent cardiovascular magnetic resonance (CMR) for the quantification of left ventricular volumes and extent of non-compacted (NC) myocardium. The latter was quantified using planimetry on the two-chamber long axis LV view (NC area). The patients included those referred specifically for CMR to investigate suspected cardiomyopathy, and as such is represents a selected group of patients. Results At presentation, 50% had dyspnoea, 19% chest pain, 14% palpitations and 5% stroke. Pulmonary embolism had occurred in 7% and brachial artery embolism in 2%. The ECG was abnormal in 81% and atrial fibrillation occurred in 29%. Transthoracic echocardiograms showed features of NC in only 10%. On CMR, patients who presented with dyspnoea had greater left ventricular volumes (both p < 0.0001) and a lower left ventricular ejection fraction (LVEF) (p < 0.0001) than age-matched, healthy controls. In patients without dyspnoea (n = 21), NC area correlated positively with end-diastolic volume (r = 0.52, p = 0.0184) and end-systolic volume (r = 0.56, p = 0.0095), and negatively with EF (r = -0.72, p = 0.0001). Conclusion Left ventricular non-compaction is associated with dysrrhythmias, thromboembolic events, chest pain and LV dysfunction. The inverse correlation between NC area and EF suggests that NC contributes to left ventricular dysfunction.

Several areas of the world suffer a notably high incidence of Shiga toxin-producing Escherichia coli . To assess the impact of persistent cross-species transmission systems on the epidemiology of E. coli O157:H7 in Alberta, Canada, we sequenced and assembled E. coli O157:H7 isolates originating from collocated cattle and human populations, 2007-2015. We constructed a timed phylogeny using BEAST2 using a structured coalescent model. We then extended the tree with human isolates through 2019 to assess the long-term disease impact of locally persistent lineages. During 2007-2015, we estimated that 88.5% of human lineages arose from cattle lineages. We identified 11 persistent lineages local to Alberta, which were associated with 38.0% (95% CI 29.3%, 47.3%) of human isolates. During the later period, six locally persistent lineages continued to be associated with human illness, including 74.7% (95% CI 68.3%, 80.3%) of reported cases in 2018 and 2019. Our study identified multiple locally evolving lineages transmitted between cattle and humans persistently associated with E. coli O157:H7 illnesses for up to 13 y. Locally persistent lineages may be a principal cause of the high incidence of E. coli O157:H7 in locations such as Alberta and provide opportunities for focused control efforts., Competing Interests: GT, LC, KS, EB, RZ, VL, SF, CL, TM No competing interests declared, (© 2024, Tarr et al.)

The Canadian Genomics Research and Development Initiative for Antimicrobial Resistance (GRDI-AMR) uses a genomics-based approach to understand how health care, food production and the environment contribute to the development of antimicrobial resistance. Integrating genomics contextual data streams across the One Health continuum is challenging because of the diversity in data scope, content and structure. To better enable data harmonization for analyses, a contextual data standard was developed. However, development of standards does not guarantee their use. Implementation strategies are critical for putting standards into practice. This work focuses on the development of implementation strategies to better operationalize data standards across the Canadian federal genomics ecosystem. Results include improved understanding of complex data models that can create challenges for existing systems. Technical implementation strategies included spreadsheet-based solutions, new exchange formats, and direct standards integration into new databases. Data curation exercises highlighted common data collection and sharing issues, which informed improved practices and evaluation procedures. These new practices are contributing to improved data quality and sharing within the GRDI-AMR consortium as evidenced by publicly available datasets. The implementation strategies and lessons learned described in this work are generalizable for other standards and can be applied more broadly within other initiatives.

Dillenia indica , commonly known as Elephant Apple, is a significant medicinal plant found in Assam, North-East India. This evergreen shrub or small to medium-sized tree possesses not only tasty components but also a plethora of beneficial therapeutic characteristics. This review article aims to explore the potential use of Dillenia indica in the treatment of diabetes and other diseases, as well as discuss various patents associated with this plant. The study focuses on identifying different formulations derived from various parts of Dillenia indica . These formulations encompass a range of dosage forms, including mucoadhesive buccal dosage forms, buccal patches, microbeads, emulgel, and mucoadhesive nasal gel. Each of these dosage forms offers unique advantages and applications. Mucoadhesive buccal dosage forms are designed to adhere to the oral mucosa, allowing for controlled drug release and enhanced absorption. Buccal patches provide a convenient and localized delivery system for specific therapeutic agents. Microbeads offer a versatile approach for encapsulating drugs and facilitating their controlled release. Emulgels combine the benefits of both emulsions and gels, providing improved drug delivery and stability. Mucoadhesive nasal gels offer a non-invasive route for drug administration, allowing for rapid absorption through the nasal mucosa. By exploring these different formulations, researchers aim to harness the therapeutic potential of Dillenia indica in a variety of diseases, including diabetes. The study also highlights the importance of patents associated with Dillenia indica , indicating the growing interest in its medicinal properties and potential commercial applications. Dillenia indica holds promise as a valuable medicinal plant, with its diverse therapeutic characteristics and tasty components. The study discussed various formulations derived from different parts of the plant, showcasing their potential applications in the treatment of diseases. Further research and development in this field may lead to the discovery of novel treatments and contribute to the advancement of pharmaceutical science., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

High-grain diets promote polymicrobial liver infections in cattle, commonly involving the bacterium Trueperella pyogenes . We have isolated T. pyogenes from the purulent material of abscesses and sequenced their genomes. These data enhance our understanding of the mechanisms underlying liver abscess development in cattle., Competing Interests: The authors declare no conflict of interest.

Background: Plasmids play a major role in the transfer of antimicrobial resistance (AMR) genes among bacteria via horizontal gene transfer. The identification of plasmids in short-read assemblies is a challenging problem and a very active research area. Plasmid binning aims at detecting, in a draft genome assembly, groups (bins) of contigs likely to originate from the same plasmid. Several methods for plasmid binning have been developed recently, such as PlasBin-flow, HyAsP, gplas, MOB-suite, and plasmidSPAdes. This motivates the problem of evaluating the performances of plasmid binning methods, either against a given ground truth or between them., Results: We describe PlasEval, a novel method aimed at comparing the results of plasmid binning tools. PlasEval computes a dissimilarity measure between two sets of plasmid bins, that can originate either from two plasmid binning tools, or from a plasmid binning tool and a ground truth set of plasmid bins. The PlasEval dissimilarity accounts for the contig content of plasmid bins, the length of contigs and is repeat-aware. Moreover, the dissimilarity score computed by PlasEval is broken down into several parts, that allows to understand qualitative differences between the compared sets of plasmid bins. We illustrate the use of PlasEval by benchmarking four recently developed plasmid binning tools-PlasBin-flow, HyAsP, gplas, and MOB-recon-on a data set of 53 E. coli bacterial genomes., Conclusion: Analysis of the results of plasmid binning methods using PlasEval shows that their behaviour varies significantly. PlasEval can be used to decide which specific plasmid binning method should be used for a specific dataset. The disagreement between different methods also suggests that the problem of plasmid binning on short-read contigs requires further research. We believe that PlasEval can prove to be an effective tool in this regard. PlasEval is publicly available at https://github.com/acme92/PlasEval., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

With antimicrobial resistance (AMR) rapidly evolving in pathogens, quick and accurate identification of genetic determinants of phenotypic resistance is essential for improving surveillance, stewardship, and clinical mitigation. Machine learning (ML) models show promise for AMR prediction in diagnostics but require a deep understanding of internal processes to use effectively. Our study utilised AMR gene, pangenomic, and predicted plasmid features from 647 Enterococcus faecium and Enterococcus faecalis genomes across the One Health continuum, along with corresponding resistance phenotypes, to develop interpretive ML classifiers. Vancomycin resistance could be predicted with 99% accuracy with AMR gene features, 98% with pangenome features, and 96% with plasmid clusters. Top pangenome features overlapped with the resistance genes of the vanA operon, which are often laterally transmitted via plasmids. Doxycycline resistance prediction achieved approximately 92% accuracy with pangenome features, with the top feature being elements of Tn 916 conjugative transposon, a tet (M) carrier. Erythromycin resistance prediction models achieved about 90% accuracy, but top features were negatively correlated with resistance due to the confounding effect of population structure. This work demonstrates the importance of reviewing ML models' features to discern biological relevance even when achieving high-performance metrics. Our workflow offers the potential to propose hypotheses for experimental testing, enhancing the understanding of AMR mechanisms, which are crucial for combating the AMR crisis., Competing Interests: The authors declare no competing interests.

Background: Cephalometric analysis has been used as one of the main tools for orthodontic diagnosis and treatment planning. The analysis can be performed manually on acetate tracing sheets, digitally by manual selection of landmarks or by recently introduced Artificial Intelligence (AI)-driven tools or softwares that automatically detect landmarks and analyze them. The use of AI-driven tools is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility., Objective: To conduct intra- and inter-group comparisons of the accuracy and reliability of cephalometric tracing and evaluation done manually and with AI-driven tools that is WebCeph and CephX softwares., Methods: Digital and manual tracing of lateral cephalometric radiographs of 54 patients was done. 18 cephalometric parameters were assessed on each radiograph by 3 methods, manual method and by using semi (WebCeph) and fully automatic softwares (Ceph X). Each parameter was assessed by two investigators using these three methods. SPSS was then used to assess the differences in values of cephalometric variables between investigators, between softwares, between human investigator means and software means. ICC and paired T test were used for intra-group comparisons while ANOVA and post-hoc were used for inter-group comparisons., Results: Twelve out of eighteen variables had high intra-group correlation and significant ICC p-values, 5 variables had relatively lower values and only one variable (SNO) had significantly low ICC value. Fifteen out of eighteen variables had minimal detection error using fully-automatic method of cephalometric analysis. Only three variables had lowest detection error using semi-automatic method of cephalometric analysis. Inter-group comparison revealed significant difference between three methods for eight variables; Witts, NLA, SNGoGn, Y-Axis, Jaraback, SNO, MMA and McNamara to Point A., Conclusion: There is a lack of significant difference among manual, semiautomatic and fully automatic methods of cephalometric tracing and analysis in terms of the variables measured by these methods. The mean detection errors were the highest for manual analysis and lowest for fully automatic method. Hence the fully automatic AI software has the most reproducible and accurate results., (© 2024. The Author(s).)

Background: There is conflicting evidence on the suicide rates of different public safety personnel (PSP). There have been few studies that compare suicides in PSP with the general population and none that have used a detailed comparison of coroner records. Aims: The current study estimates suicide rates among different PSP and compares PSP suicides with the general population. Method: We identified coroner records of PSP suicides from January 2014 to December 2018 and compared each one to two matched general population controls. Results: We identified 36 PSP suicides and 72 general population controls. Police had a higher suicide rate than other PSP groups. PSP were more likely to die by firearm, be separated/divorced or married, die in a motor vehicle, have problems at work, and have a PTSD diagnosis. PSP were less likely to die by jumping. Limitations: The study may have not identified all PSP suicides. Apart from the cause of death, data in coroner records are not systematically collected, so information may be incomplete. Conclusion: PSP suicides appear different than the general population. Death records need to have an occupation identifier to enable monitoring of trends in occupational groups, such as PSP.

Introduction: The oncological safety of a submental (SM) flap is thought to be controversial. The objective of our study was to validate our previous study regarding the oncological safety of SM flaps in oral cavity reconstruction., Materials and Methods: An electronic database was searched from 2015 to 2021 for all head-and-neck tumor patients, where reconstruction was performed using a SM flap., Results: Eighty-eight oral cavity squamous cell carcinoma patients, among whom 71 were males (81.8%), with a mean age of 55.3 years (range: 25-79 years), were retrieved from the database. The sites of involvement were 37 buccal mucosa, 27 lower alveolus, and 24 tongues. The mean follow-up was 33.5 months. The SM flap reconstruction was done for 88 patients; 3 had complete loss of flap, 17 had incomplete loss/partial necrosis, and 68 patients had uneventful recovery of the flap. We had 16 patients with local recurrence. Of these, 4 (4.5%) patients had clear margins and no lymphadenopathy at the level I at the final histopathology report., Conclusion: This study provides validation of the oncological safety of the SM flap and establishes that nodal positivity at level I alone does not contribute to recurrence at the primary site., (Copyright: © 2024 Qayyum MU, et al.)

The rapid increase of antimicrobial-resistant bacteria in humans and livestock is concerning. Antimicrobials are essential for the treatment of disease in modern day medicine, and their misuse in humans and food animals has contributed to an increase in the prevalence of antimicrobial-resistant bacteria. Globally, antimicrobial resistance is recognized as a One Health problem affecting humans, animals, and environment. Enterococcal species are Gram-positive bacteria that are widely distributed in nature. Their occurrence, prevalence, and persistence across the One Health continuum make them an ideal candidate to study antimicrobial resistance from a One Health perspective. The objective of this review was to summarize the role of enterococci as an indicator of antimicrobial resistance across One Health sectors. We also briefly address the prevalence of enterococci in human, animal, and environmental settings. In addition, a 16S RNA gene-based phylogenetic tree was constructed to visualize the evolutionary relationship among enterococcal species and whether they segregate based on host environment. We also review the genomic basis of antimicrobial resistance in enterococcal species across the One Health continuum., Competing Interests: The authors declare no competing interests.

Introduction: The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges., Methods: In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed., Results: This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD., Discussion: The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An increase in chronic, non-responsive bovine respiratory disease (BRD) infections in North American feedlot cattle is observed each fall, a time when cattle are administered multiple antimicrobial treatments for BRD. A number of factors are responsible for BRD antimicrobial treatment failure, with formation of biofilms possibly being one. It is widely accepted that biofilms play a role in chronic infections in humans and it has been hypothesized that they are the default lifestyle of most bacteria. However, research on bacterial biofilms associated with livestock is scarce and significant knowledge gaps exist in our understanding of their role in AMR of the bacterial BRD complex. The four main bacterial species of the BRD complex, Mannheimia haemolytica , Pasteurella multocida , Histophilus somni , and Mycoplasma bovis are able to form biofilms in vitro and there is evidence that at least H. somni retains this ability in vivo . However, there is a need to elucidate whether their biofilm-forming ability contributes to pathogenicity and antimicrobial treatment failure of BRD. Overall, a better understanding of the possible role of BRD bacterial biofilms in clinical disease and AMR could assist in the prevention and management of respiratory infections in feedlot cattle. We review and discuss the current knowledge of BRD bacteria biofilm biology, study methodologies, and their possible relationship to AMR., Competing Interests: The 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 © 2024 Andrés-Lasheras, Zaheer, Jelinski and McAllister.)

Background: The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social distancing regulations. The purpose of this study was to obtain the perspectives of CPD leaders on the impact of the pandemic to elucidate trends, innovations, and potential future directions in the field., Methods: Semi-structured interviews were conducted between April-September 2022 with 23 CPD leaders from Canada and the USA. Interviews were audio-recorded, transcribed, and de-identified. A thematic analysis approach was used to analyse the data and generate themes., Results: Participants characterised COVID-19 as compelling widespread change in the field of CPD. From the interviews, researchers generated six themes pertaining to the impact of the pandemic on CPD: (1) necessity is the mother of innovation, (2) the paradox of flexibility and accessibility, (3) we're not going to unring the bell, (4) reimagining design and delivery, (5) creating an evaluative culture, and (6) a lifeline in times of turmoil., Conclusion: This qualitative study discusses the impact of the pandemic on the field of CPD and leaders' vision for the future. Despite innumerable challenges, the pandemic created opportunities to reform design and delivery. Our findings indicate a necessity to maintain an innovative culture to best support learners, to improve the healthcare system, and to prepare for future emergencies., (© 2024. The Author(s).)

Bovine respiratory disease (BRD) is an important health and economic burden to the cattle industry worldwide. Three bacterial pathogens frequently associated with BRD (Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni) can possess integrative and conjugative elements (ICEs), a diverse group of mobile genetic elements that acquire antimicrobial resistance (AMR) genes (ARGs) and decrease the therapeutic efficacy of antimicrobial drugs. We developed a duplex recombinase polymerase amplification (RPA) assay to detect up to two variants of ICEs in these Pasteurellaceae. Whole genome sequence analysis of M. haemolytica, P. multocida, and H. somni isolates harbouring ICEs revealed the presence of tnpA or ebrB next to tet(H), a conserved ARG that is frequently detected in ICEs within BRD-associated bacteria. This real-time multiplex RPA assay targeted both ICE variants simultaneously, denoted as tetH&#95;tnpA and tetH&#95;ebrB, with a limit of detection (LOD) of 29 (95% CI [23, 46]) and 38 genome copies (95% CI [30, 59]), respectively. DNA was extracted from 100 deep nasopharyngeal swabs collected from feedlot cattle on arrival. Samples were tested for ICEs using a real-time multiplex RPA assay, and for M. haemolytica, P. multocida, H. somni, and Mycoplasma bovis using both culture methods and RPA. The assay provided sensitive and accurate identification of ICEs in extracted DNA, providing a useful molecular tool for timely detection of potential risk factors associated with the development of antimicrobial-resistant BRD in feedlot cattle., Competing Interests: Declaration of competing interest The 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 © 2024. Published by Elsevier B.V.)

Background: The Toronto Transit Commission (TTC) operates the public transit system in Toronto, Canada. From 1954 to 1980, there were 430 suicide deaths/attempts on the TTC subway system. In 2011, TTC implemented Crisis Link, a suicide helpline to connect subway passengers with counsellors. Upstream factors such as media reporting about suicide incidents may also influence suicidal behaviour. Our objectives were to investigate how Crisis Link and media reports about TTC suicide incidents influenced suicide rates., Methods: Suicide data were obtained from the TTC and Coroner, with Crisis Link data provided by Distress Centres of Greater Toronto (1998-2021). Media articles were identified through a database search of Toronto media publications. Interrupted time-series analysis investigated the association between Crisis Link calls, media articles, and quarterly suicide rates on the subway system., Findings: There were 302 suicides on TTC's subway system from 1998 to 2021. The introduction of Crisis Link was associated with a large but non-significant decrease in TTC-related suicide rate in the same quarter (IRR = 0.64, 95% CI = 0.36-1.12). Each subsequent post-Crisis-Link quarter experienced an average 2% increase in suicide rate (IRR = 1.02, 95% CI = 1.004-1.04). Furthermore, for each TTC-related media article in the previous quarter, the suicide rate on the TTC increased by 2% (IRR = 1.02, 95% CI = 1.004-1.04)., Interpretation: The Crisis Link helpline was associated with a large but non-significant short-term decrease in suicide rates. However, this outcome was not sustained; this may, in part, be attributable to media reporting which was associated with increased suicides. This should inform suicide prevention policies in Canada and worldwide., Funding: No funding., Competing Interests: CT is the Director of Safety, Health and Environment Policy and Strategy at the Toronto Transit Commission. ME works at the Distress Centres of Greater Toronto, the organization which oversees Crisis Link operations. MS has acted as an unpaid consultant to the TTC on some of its suicide prevention initiatives but has no relationship with Crisis Link., (© 2024 The Authors.)

Type 2 inflammation is characterized by overexpression and heightened activity of type 2 cytokines, mediators, and cells that drive neuroimmune activation and sensitization to previously subthreshold stimuli. The consequences of altered neuroimmune activity differ by tissue type and disease; they include skin inflammation, sensitization to pruritogens, and itch amplification in atopic dermatitis and prurigo nodularis; airway inflammation and/or hyperresponsiveness, loss of expiratory volume, airflow obstruction and increased mucus production in asthma; loss of sense of smell in chronic rhinosinusitis with nasal polyps; and dysphagia in eosinophilic esophagitis. We describe the neuroimmune interactions that underlie the various sensory and autonomic pathologies in type 2 inflammatory diseases and present recent advances in targeted treatment approaches to reduce type 2 inflammation and its associated symptoms in these diseases. Further research is needed to better understand the neuroimmune mechanisms that underlie chronic, sustained inflammation and its related sensory pathologies in diseases associated with type 2 inflammation., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Liver abscesses (LA) resulting from bacterial infection in cattle pose a significant global challenge to the beef and dairy industries. Economic losses from liver discounts at slaughter and reduced animal performance drive the need for effective mitigation strategies. Tylosin phosphate supplementation is widely used to reduce LA occurrence, but concerns over antimicrobial overuse emphasize the urgency to explore alternative approaches. Understanding the microbial ecology of LA is crucial to this, and we hypothesized that a reduced timeframe of tylosin delivery would alter LA microbiomes. We conducted 16S rRNA sequencing to assess severe liver abscess bacteriomes in beef cattle supplemented with in-feed tylosin. Our findings revealed that shortening tylosin supplementation did not notably alter microbial communities. Additionally, our findings highlighted the significance of sample processing methods, showing differing communities in bulk purulent material and the capsule-adhered material. Fusobacterium or Bacteroides ASVs dominated LA, alongside probable opportunistic gut pathogens and other microbes. Moreover, we suggest that liver abscess size correlates with microbial community composition. These insights contribute to our understanding of factors impacting liver abscess microbial ecology and will be valuable in identifying antibiotic alternatives. They underscore the importance of exploring varied approaches to address LA while reducing reliance on in-feed antibiotics., (© His Majesty the King in Right of Canada, as represented by the Minister of Agriculture and Agri-Food Canada, 2024.)

Cattle are the primary reservoir for STEC O157, with some shedding >10 4 CFU/g in feces, a phenomenon known as super-shedding (SS). The mechanism(s) responsible for SS are not understood but have been attributed to the environment, host, and pathogen. This study aimed to compare genetic characteristics of STEC O157 strains from cattle in the same commercial feedlot pens with SS or low-shedding (LS) status. Strains from SS (n = 35) and LS (n = 28) collected from 11 pens in three feedlots were analyzed for virulence genes, Shiga toxin-carrying bacteriophage insertion sites, and phylogenetic relationships. In silico analysis showed limited variation regarding virulence gene profiles. Stx -encoding prophage insertion sites mrlA and wrbA for stx1a and stx2a , respectively, were all occupied, but two isolates had fragments of the stx -carrying phage in mrlA and wrbA loci without stx1a and stx2a . All strains screened for lineage-specific polymorphism assay (LSPA-6) were 111111, lineage I. Of the isolates, 61 and 2 were clades 1 and 8, respectively. Phylogenetic analysis revealed that pens with more than one SS had multiple distantly related clusters of SS and LS isolates. Although virulence genes and lineage were largely similar within and across feedlots, multiple genetic origins of strains within a single feedlot pen illustrate challenges for on-farm control of STEC.

Objective: To determine the role of heated humidified high flow therapy (HHHFT) as primary respiratory support in spontaneously breathing moderate-late, very and extreme preterm neonates with respiratory distress syndrome (RDS) at a tertiary care hospital from a developing country., Design: Retrospective cohort study., Setting: Neonatal intensive care unit of Indus Hospital and Health Network, Karachi, Pakistan., Patients: All preterm neonates with RDS and who received HHHFT as primary respiratory support were included retrospectively, while neonates with orofacial anomalies, congenital heart and lung diseases other than RDS, abdominal wall defects, encephalopathy, congenital pneumonia and received continuous positive airway pressure or invasive ventilation were excluded., Interventions: HHHFT as primary respiratory support for RDS., Main Outcome Measures: Effectiveness, duration, failure rate and complications of HHHFT as a primary respiratory support in moderate-late, very and extremely preterm neonates were evaluated., Results: The cohort included 138 neonates during a period of 12 months. The median gestational age was 32 weeks, and the median birth weight was 1607 g. Grade 1-2 RDS was seen in 97%, surfactant instillation was done in 10.8% and HHHFT was provided in all the neonates as primary respiratory support. The total duration of HHHFT support was <1 week in 94% of neonates. Bronchopulmonary dysplasia and pneumothorax until discharge or death were observed in one neonate, haemodynamically significant Patent Ductus Artriosus (HsPDA) in two neonates and intraventricular haemorrhage Grade ≥2 in five neonates, while only one neonate died., Conclusion: This study appears to show that HHHFT is a simple, safe, efficient and cheap mode of primary respiratory support that can be given to spontaneously breathing moderate-late, very and extremely preterm neonates with RDS, especially in low- or middle-income countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Antimicrobial use (AMU) in the livestock industry has been associated with increased levels of antimicrobial resistance. Recently, there has been an increase in the number of "natural" feedlots in the beef cattle sector that raise cattle without antibiotics. Shotgun metagenomics was employed to characterize the impact of AMU in feedlot cattle on the microbiome, resistome, and mobilome. Sequenced fecal samples identified a decline (q < 0.01) in the genera Methanobrevibacter and Treponema in the microbiome of naturally vs. conventionally raised feedlot cattle, but this difference was not (q > 0.05) observed in catch basin samples. No differences (q > 0.05) were found in the class-level resistome between feedlot practices. In fecal samples, decreases from conventional to natural (q < 0.05) were noted in reads for the antimicrobial-resistant genes (ARGs) mef A, tet 40, tet O, tet Q, and tet W. Plasmid-associated ARGs were more common in feces from conventional than natural feedlot cattle. Interestingly, more chromosomal- than plasmid-associated macrolide resistance genes were observed in both natural and conventional feedlots, suggesting that they were more stably conserved than the predominately plasmid-associated tetracycline resistance genes. This study suggests that generationally selected resistomes through decades of AMU persist even after AMU ceases in natural production systems.