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Artificial intelligence (AI) has great potential for diagnosing and managing glaucoma, a disease that causes irreversible vision loss. Early detection is paramount to prevent visual field loss. AI algorithms demonstrate promising capabilities in analyzing various glaucoma investigations. In analyzing retinal fundus photographs, AI achieves high accuracy in detecting glaucomatous optic nerve cupping, a hallmark feature. AI can also analyze optical coherence tomography (OCT) images of the retinal nerve fiber layer(RNFL) and ganglion cell complex, identifying structural changes indicative of glaucoma and also Anterior Segment OCT(AS-OCT) for angle closure disease. OCT interpretation may even be extended to diagnose early features of systemic neurodegenerative diseases such as Alzheimer’s Disease and Parkinson’s Disease. Furthermore, AI can assist in interpreting visual field (VF) tests, including predicting future VF loss patterns for the next 5 years. The ability of AI to integrate data from multiple modalities, including fundus photographs, Intra Ocular Pressure(IOP) measurements, RNFL OCT, AS-OCT, and VF tests, paves the way for a more comprehensive glaucoma assessment. This approach has the potential to revolutionize ophthalmology by enabling teleophthalmology and facilitating the development of personalized treatment plans. However, the authors emphasize the crucial role of human judgement and oversight in interpreting AI-generated results. Ultimately, ophthalmologists must make the final decisions regarding diagnosis and treatment strategies.

Slit lamp biomicroscope is the right hand of an Ophthalmologist. Even though precise, its bulky design and complex working process are limiting constraints, making it difficult for screening at outreach camps, which are an integral part of this field for the purpose of eliminating needless blindness. The torchlight is the main tool used for screening. Recently, the integration of smartphones with instruments and the digitization of slit lamp has been explored, to provide simple and easy hacks. By bringing the slit of the slit lamp to traditional torchlight, we have created “The Slitscope”. It combines the best of both worlds as a simple innovative do-it-yourself novel technique for precise cataract screening. It is especially useful in peripheral centers, vision centers, and outreach camps. We present two prototypes which can also be 3D printed.

Introduction: In recent times, there is an increase in life expectancy leading to demographic transition toward aging population in both developed and developing countries. Oral health represents a major concern for general health; hence, the oral health of older people is increasingly important. One particularly meaningful factor is the number of teeth which provide information about the functionality of the masticatory system, an esthetic smile as well as an esthetic profile. Losing teeth can be psychologically traumatic, socially damaging, and functionally limiting, thereby affecting the quality of life (QoL). Aim: The aim of this study was to assess the oral health status and factors associated with poor oral health-related QoL in geriatric population (aged >60 years) in rural South India. Materials and Methods: A community-based cross-sectional study was conducted among 437 elderly in Kaniyambadi block of Vellore district. Sociodemographic details were collected directly by face-to-face interview, and the elderly were subjected to oral examination for oral health status. Oral health-related quality of life (OHrQoL) was measured using the Geriatric Oral Health Assessment Index (GOHAI). Factors associated with poor OHrQoL were analyzed using multiple logistic regression. Results: The study population comprised 31.1% (n = 136) of males and 68.9% (n = 301) of females, with a mean age of 68 (standard deviation – 6.9) years. On oral examination, the prevalence of dental caries and any type of edentulism was 51.5% (n = 225) and 82.4% (n = 360), respectively. The prevalence of complete edentulism was 10.1% (n = 44). By assessing oral health-related quality of life using the revised GOHAI tool, 30 (6.9%) had high scores between 34 and 36, 166 (38%) had scores between 31 and 33, and 241 (55.1%) had low scores (≤30). In the multivariate analysis, age >70 years (odds ratio [OR] =1.92, 95% confidence interval [CI] = 1.2–3.06, P = 0.006), male gender (OR = 1.78, 95% CI = 1.05–3.3, P = 0.033), and edentulism/severe tooth loss (OR = 8.64, 95% CI = 3.19–23.87, P < 0.001) had significantly higher odds for poor OHrQoL. Edentulism/severe tooth loss was also significantly associated with undernutrition (OR = 12.5, 95% CI = 6.56–23.81, P < 0.001). Conclusion: The burden of dental caries and edentulism in rural South India was high. The prevalence of edentulism had a significant impact on the OHrQoL. This study highlights the need for researchers to understand the importance of edentulism and its impact on overall health of the elderly, thereby focusing on health programs inclusive of oral health promotion and prevention.

BackgroundIndividuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. ObjectiveThis paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey’s clinical implementation and evaluation of validity. MethodsSources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers’ psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. ResultsFocus group members (n=17) expressed positive feedback overall about the survey’s content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. ConclusionsCaregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey’s impact on the psychiatric and medical management of distress in individuals with DD.

Dysregulated food craving is a complex weight-related behavior. To identify novel targets for enhancing the efficacy of weight loss interventions, we examined whether food craving varies across the menstrual cycle according to the abdominal obesity type and premenstrual dysphoric disorder (PMDD) diagnosis, and, if so, whether it is related to affective symptomatology. Reproductive-age women were classified into one of the four study groups according to whether they have abdominal obesity (AO) or are abdominally lean (AL), and the presence of PMDD: (1) AO:PMDD+ (n = 13), (2) AL:PMDD+ (n = 14), (3) AO:PMDD− (n = 15), and (4) AL:PMDD− (n = 16). Self-report measures as well as urinary luteinizing hormone (LH) tests were provided by the participants across 2–3 menstrual cycles. The ratings of food cravings were similar across the menstrual cycle, except the last, late luteal subphase as the AO:PMDD+ participants had the highest food craving rating. Irritability and depression were correlated with food cravings, but not in a distinctive manner across the menstrual cycle by group. Our study found that women with abdominal obesity and PMDD display a temporal vulnerability to a food-related behavior. The possibility of shared neurobiology between the two conditions is discussed and should be examined in future studies.

There is an ongoing explosion of scientific datasets being generated, brought on by recent technological advances in many areas of the natural sciences. As a result, the life sciences have become increasingly computational in nature, and bioinformatics has taken on a central role in research studies. However, basic computational skills, data analysis, and stewardship are still rarely taught in life science educational programs, resulting in a skills gap in many of the researchers tasked with analysing these big datasets. In order to address this skills gap and empower researchers to perform their own data analyses, the Galaxy Training Network (GTN) has previously developed the Galaxy Training Platform (https://training.galaxyproject.org), an open access, community-driven framework for the collection of FAIR (Findable, Accessible, Interoperable, Reusable) training materials for data analysis utilizing the user-friendly Galaxy framework as its primary data analysis platform. Since its inception, this training platform has thrived, with the number of tutorials and contributors growing rapidly, and the range of topics extending beyond life sciences to include topics such as climatology, cheminformatics, and machine learning. While initially aimed at supporting researchers directly, the GTN framework has proven to be an invaluable resource for educators as well. We have focused our efforts in recent years on adding increased support for this growing community of instructors. New features have been added to facilitate the use of the materials in a classroom setting, simplifying the contribution flow for new materials, and have added a set of train-the-trainer lessons. Here, we present the latest developments in the GTN project, aimed at facilitating the use of the Galaxy Training materials by educators, and its usage in different learning environments.

The directional learning path our Indigenous Knowloegde (IK) reveals, is happening and emerging in a way that is based in our lore and systems. What I refer to here in Australia is over 60, 000 years of continuous cultural knowledge connected around 60,000 years’ worth of campfires. The pattern which we gather and sit around these campfires is in circle. And the circle pattern we have gathered around these times creates a distinct flow of energy and knowledge transfer. The distinct pattern of IK transfer at Deakin’s Indigenous Knowledge System Lab (IKSL) now, can be understood in four ways, IK in Production; Transmission; Application and Regeneration. We see emergence through the patterns and stories that are brought through following the whisps of smoke from the fire – the unseen made known through the form of smoke - dgumge. To pay homage to our beginnings in shares and development of knowledge’s we write together as part of the ‘IK pattern’ of yarning (Yunkaporta, 2019), we use in Labs – us/only, us/twos and us/all ways of communicating. This paper is a way for us/two, Dr. Rhonda Coopes – palawa and Dr. John Davis – Cobble Cobble, as fellow countrywomen and men, camped around these IKSL fires, to give some markers, lay some tracks, make sense of the paths we take through the ever-emerging patterns of IKSL yarns, actions, and project activities.

The fifth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was held on May 17, 2022. The theme of this year’s summit was ‘Academic-Community Partnerships: Change Agents for Advancing Health Equity.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity, and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, and individuals involved in talent acquisition and development, such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States as well as from Saudi Arabia. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows, and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse, encompassing disparities in relation to maternal and child health (MCH), immigrant health, cancers, vaccination uptakes, and COVID-19 infections. Various solutions were ardently presented to address these disparities, including community engagement and partnerships, improvement in health literacy, and the development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research, and cultural competence as they relate to minority health issues and social determinants of health. The year’s summit was a great success! Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Objective:: To characterize factors that contribute to a delay in regaining continence after robot-assisted laparoscopic prostatectomy (RALP) at a single tertiary cancer center. Subjects and methods:: In a retrospective analysis of patients with pathologically proven prostate cancer treated by two surgeons with a curative intent, patient demographics, operative details, and postoperative continence were extracted from the electronic medical record. Time to dry was defined as the time interval between the date of prostatectomy and the first evaluation at which patients present with zero pad use. Patients were evaluated for pad usage at four time points. All statistical analyses were conducted in SAS and Splus. Results:: From 2008 to 2015, 1275 patients were analyzed. The median follow-up time was 32 (19–48) months. Univariate analysis demonstrated that older age at RALP (HR 0.98, p

(1) Background: High-frequency heart rate variability (HF-HRV) is an essential ultradian rhythm that reflects the activity of the PNS to decelerate the heart. It is unknown how HF-HRV varies across the menstrual cycle (MC), and whether progesterone mediates this potential variation. (2) Methods: We enrolled 33 women in the study to attend eight clinic visits across the MC, during which we measured their resting HF-HRV and collected samples for the analysis of luteinizing hormone (LH) and progesterone. We realigned the study data according to the serum LH surge to the early follicular, mid-follicular, periovulatory, early luteal, mid-luteal and late luteal subphases. (3) Results: Pairwise comparisons between all the subphases showed significant differences between the early follicular and periovulatory subphases (β = 0.9302; p ≤ 0.001) and between the periovulatory and early luteal subphases (β = −0.6955; p ≤ 0.05). Progesterone was positively associated with HF-HRV in the early follicular subphase but not the periovulatory subphase (p ≤ 0.05). (4) Conclusions: The present study shows a significant drop in HF-HRV in the anticipation of ovulation. Further research in this area is critical given the marked cardiovascular disease mortality in women.

Background: Allopregnanolone is one of the most studied neuroactive steroids; yet, despite its relevance to neuropsychiatric research, it is not known how it, as well as its ratio to progesterone, varies across all six subphases of the menstrual cycle. Two enzymes—5α-dihydroprogesterone and 5α-reductase—convert progesterone to allopregnanolone, and, based on immunohistochemical studies in rodents, the activity of 5α-reductase is considered the rate-limiting step in the formation of allopregnanolone. It is not clear, however, whether the same phenomenon is observed across to the menstrual cycle, and, if so, at what point this takes place. Methods: Thirty-seven women completed the study during which they attended eight clinic visits across one menstrual cycle. We analyzed their allopregnanolone and progesterone serum concentrations using ultraperformance liquid chromatography–tandem mass spectrometry, and we implemented a validated method to realign the data from the original eight clinic study visits, following which we imputed the missing data. Hence, we characterized allopregnanolone concentrations, and the ratio of allopregnanolone:progesterone at six menstrual cycle subphases: (1) early follicular, (2) mid-follicular, (3) periovulatory, (4) early luteal, (5) mid-luteal, and (6) late luteal. Results: There were significant differences in allopregnanolone levels between (1) early follicular and early luteal, (2) early follicular and mid-luteal, (3) mid-follicular and mid-luteal, (4) periovulatory and mid-luteal, and (5) mid-luteal and late luteal. We detected a sharp drop in allopregnanolone:progesterone ratio in the early luteal subphase. Within the luteal subphase, the ratio was the lowest in the mid-luteal subphase. Conclusions: Allopregnanolone concentrations are the most distinct, relative to the other subphases, in the mid-luteal subphase. The shape of the allopregnanolone trajectory across the cycle is similar to that of progesterone; however, the proportion of the two neuroactive steroid hormones is drastically different due to enzymatic saturation, which takes place at the start of the early luteal subphase, but continuing through, and peaking, in the mid-luteal subphase. Hence, the estimated activity of 5α-reductase decreases, but does not cease, at any point across the menstrual cycle.

Purpose: Ophthalmologists often need to use a compound microscope to see slides of corneal scrapings, Demodex blepharitis, histopathology, or tear ferning test for diagnostic purposes. While such a microscope may be available in tertiary care centers, most eye clinics do not have it due to cost, space required, and infrequent use. These tests are often not done or delayed till a tertiary referral is possible. We demonstrate an alternative method using smartphone and an inexpensive attachment. Materials and Methods: Using the smartphone microscope attachment, the authors were able to capture excellent photographs and videos of corneal scrapings, histopathology, and Demodex. Photographs of the same slides were taken with a standard compound microscope as well. Trypan blue dye was used for staining the corneal scraping specimens to make the fungal hyphae in it clearly visible. Results: Photographs and videos captured by the smartphone microscope were compared with those from a compound microscope and found to be of adequate quality. They were determined to be good enough for diagnostic use. Conclusions: We determined that smartphone microscope attachment can be a useful adjunctive diagnostic tool for eye clinics corneal scrapings, histopathology, and Demodex, perhaps even for more applications.

Clinical grading scales help us to objectively document clinical findings. Even though there are several good clinical grading scales, it is not feasible to memorize all of them. It would be very convenient to have all this information at your fingertips. Noting the absence of any existing app, the authors programmed a smartphone app with all the necessary grading systems. This app should be useful for all ophthalmic clinicians to quickly lookup these grading systems and helps in objective documentation.

Spinal cord injury (SCI) population with injury below T10 or injury to the cauda equina region is characterized by denervated muscles, extensive muscle atrophy, infiltration of intramuscular fat and formation of fibrous tissue. These morphological changes may put individuals with SCI at higher risk for developing other diseases such as various cardiovascular diseases, diabetes, obesity and osteoporosis. Currently, there is no available rehabilitation intervention to rescue the muscles or restore muscle size in SCI individuals with lower motor neuron denervation. We, hereby, performed a review of the available evidence that supports the use of electrical stimulation in restoration of denervated muscle following SCI. Long pulse width stimulation (LPWS) technique is an upcoming method of stimulating denervated muscles. Our primary objective is to explore the best stimulation paradigms (stimulation parameters, stimulation technique and stimulation wave) to achieve restoration of the denervated muscle. Stimulation parameters, such as the pulse duration, need to be 100–1000 times longer than in innervated muscles to achieve desirable excitability and contraction. The use of electrical stimulation in animal and human models induces muscle hypertrophy. Findings in animal models indicate that electrical stimulation, with a combination of exercise and pharmacological interventions, have proven to be effective in improving various aspects like relative muscle weight, muscle cross sectional area, number of myelinated regenerated fibers, and restoring some level of muscle function. Human studies have shown similar outcomes, identifying the use of LPWS as an effective strategy in increasing muscle cross sectional area, the size of muscle fibers, and improving muscle function. Therefore, displaying promise is an effective future stimulation intervention. In summary, LPWS is a novel stimulation technique for denervated muscles in humans with SCI. Successful studies on LPWS of denervated muscles will help in translating this stimulation technique to the clinical level as a rehabilitation intervention after SCI.

The Internet has made information available and accessible by all. Specialized knowledge of all sorts is now available literally at one's fingertips. The students of today may actually learn more online than in a conventional classroom. This is true in the medical field and in ophthalmology as well. The vast amount of high-quality multimedia content helps to augment the understanding of the subjects. In this article, we discuss the various types of e-learning resources available to ophthalmologists at present and review a handful of the best online ophthalmology resources.

It is not clear whether progesterone and estradiol associate with premenstrual food cravings, which significantly contribute to cardiometabolic adverse effects associated with obesity. We sought to investigate this question in the present study based on the prior literature showing a protective effect of progesterone on drug craving and extensive neurobiological overlaps between food and drug cravings. We enrolled 37 non-illicit drug- or medication-using women in the study to provide daily ratings of premenstrual food cravings and other symptoms across two-three menstrual cycles, based on which we classified them as premenstrual dysphoric disorder (PMDD) or control participants. In addition, the participants provided blood samples at eight clinic visits across the menstrual cycle. We aligned their mid-luteal progesterone and estradiol using a validated method which relies upon the peak serum luteinizing hormone and analyzed estradiol and progesterone using ultraperformance liquid chromatography tandem mass spectrometry. Hierarchical modeling, adjusted for BMI, showed a significant inverse effect of progesterone (p = 0.038) but no effect of estradiol on premenstrual food cravings. The association was not unique to PMDD or control participants. Results of research to date in humans and rodents showing that progesterone has dampening effects on the salience of the reinforcer translate to premenstrual food cravings.

The unfolding crises of mass extinction and climate change call for urgent action in response. To limit biodiversity losses and avert the worst effects of climate disruption, we must greatly expand nature protection while simultaneously downsizing and transforming human systems. The conservation initiative Nature Needs Half (or Half Earth), calling for the conservation of half the Earth's land and seas, is commensurate with the enormous challenges we face. Critics have objected to this initiative as harboring hardship for people near protected areas and for failing to confront the growth economy as the main engine of global ecological destruction. In response to the first criticism, we affirm that conservation policies must be designed and implemented in collaboration with Indigenous and local communities. In response to the second criticism, we argue that protecting half the Earth needs to be complemented by downscaling and reforming economic life, humanely and gradually reducing the global population, and changing food production and consumption. By protecting nature generously, and simultaneously contracting and transforming the human enterprise, we can create the conditions for achieving justice and well-being for both people and other species. If we fail to do so, we instead accept a chaotic and impoverished world that will be dangerous for us all.

The regulation of DHEA-sulfate by steroid sulfotransferase (SULT) and steryl-sulfatase (STS) enzymes is a vital process for the downstream formation of many steroid hormones. DHEA-sulfate is the most abundant steroid hormone in the human body; thus, DHEA-sulfate and its hydrolyzed form, DHEA, continue to be evaluated in numerous studies, given their importance to human health. Yet, a basic question of relevance to the reproductive-age female population—whether the two steroid hormones vary across the menstrual cycle—has not been addressed. We applied a validated, multi-step protocol, involving realignment and imputation of study data to early follicular, mid-late follicular, periovulatory, and early, mid-, and late luteal subphases of the menstrual cycle, and analyzed DHEA-sulfate and DHEA serum concentrations using ultraperformance liquid chromatography tandem mass spectrometry. DHEA-sulfate levels started to decrease in the early luteal, significantly dropped in the mid-luteal, and returned to basal levels by the late luteal subphase. DHEA, however, did not vary across the menstrual cycle. The present study deep-mapped trajectories of DHEA and DHEA-sulfate across the entire menstrual cycle, demonstrating a significant decrease in DHEA-sulfate in the mid-luteal subphase. These findings are relevant to the active area of research examining associations between DHEA-sulfate levels and various disease states.

Artificial intelligence (AI) and machine learning (ML) have entered several avenues of modern life, and health care is just one of them. Ophthalmology is a field with a lot of imaging and measurable data, thus ideal for application of AI and ML. Many of these are still in research stage, but show promising results. The ophthalmic diseases where AI is being used are diabetic retinopathy, glaucoma, age-related macular degeneration, retinopathy of prematurity, retinal vascular occlusions, keratoconus, cataract, refractive errors, retinal detachment, squint, and ocular cancers. It is also useful for intraocular lens power calculation, planning squint surgeries, and planning intravitreal antivascular endothelial growth factor injections. In addition, AI can detect cognitive impairment, dementia, Alzheimer's disease, stroke risk, and so on from fundus photographs and optical coherence tomography. We will surely see many more innovations in this rapidly growing field.

Ophthalmology is a very visual science; therefore, visualizing the eye and its pathology in good clarity is essential for a diagnosis. Over the past several years, smartphones have evolved to replace several gadgets in our daily life, including cameras. In ophthalmology, they have been very useful to take good quality photographs through slit lamp, gross photographs and also fundus photos using low-cost smartphone fundus cameras. In this article, we elaborate on the techniques, tips, and tricks to obtain excellent smartphone ophthalmic photographs and videos with a mid-level smartphone camera. We teach how to take diffuse and slit photographs, with and without an adapter, in addition, how to take Gonioscopy, specular microscopy, and fundus via 90D. These photos and videos can also be edited on the smartphone itself and used for case discussion, second opinion, teaching, presentations, and publications.

As ophthalmologists, we often come across visually impaired persons (VIPs) whose poor vision we cannot improve. They would benefit with low-vision aids (LVA), but most are reluctant to use them. The visually impaired find it difficult to use advanced technology, as it is often not designed with them in mind. When the world switched from phones with keyboards to full-screen touchscreens, VIPs found it difficult without the tactile feedback of physical keyboard buttons. However, in recent years, there have been numerous innovative apps to assist people with low vision, to not only navigate their smartphone but also their environment and daily life. Programmers have made the use of the high-resolution cameras, gyroscope sensor, vibration feedback, and audio feedback to convert smartphones into LVA, often for free and with no additional hardware. The authors review some of the smartphone apps available for those with low vision. These apps can bring a certain level of independence and self-confidence in these people who are otherwise often dependent on others.

Enacting high expectations for all students in the classroom is a complex undertaking. Underlying, out-of-awareness assumptions may lead to actions, behaviours or pedagogic choices that do not support these high expectations beliefs and intentions. For Indigenous education, this is compounded by public and professional discourses around deficit positioning, and by historical conditioning, where many Indigenous students do not see achieving in school as part of their cultural identity. High expectations are usually considered as a performance agenda — in terms of effort, learning and achievement. In this paper, we introduce the concept of high-expectations relationships where viewing and enacting high expectations through a relational lens equips educators with strategies to support such performance outcomes. We describe this relational lens where fair, socially just relating establishes a relational space of trust, thus enabling both student motivation and the firm, critically reflective relating necessary for quality learning. Using the voices of educators, we describe how high-expectations relationships can promote collegiate staff environments, strong teacher–student relationships and trusting and supportive relationships with parents and carers. We show how these positive educational attributes of any school community, seeded through a focus on high-expectations relationships, work to support the performance outcomes of a high-expectations educational agenda.

There is evidence of disrupted cerebral blood flow in patients with a skull defect due to decompressive craniectomy though the pathophysiologic mechanism is yet to be established. Here we report on a patient who suffered one episode of transient ischemic attack (TIA) when developing early stage sinking skin flap syndrome (SSFS) post decompressive craniectomy due to a severe traumatic brain injury. This case report of TIA as a clinical presentation of SSFS indicates a potentially increased risk of stroke in patients with this condition. The theories of the pathophysiology underlining neurological manifestations post craniectomy are reviewed. Early cranioplasty is recommended, particularly for those with other known stroke risk factors. Keywords: Decompressive craniectomy, Sinking skin flap syndrome, Transient ischemia attack, Cranioplasty

Necessity and opportunity in the form of rapidly advancing technology has made affordable innovations possible at a fast pace in ophthalmology. This article tries to cover a few of the recent frugal innovations which have a clinical potential for ophthalmologists.

The technology of three-dimensional (3D) printing has evolved over the past few years with cumulative improvements in the resolution, accuracy, cost-effectiveness, and speed of this highly customizable manufacturing process. Ophthalmologists have designed multiple 3D printed smartphone based fundus cameras with some of the designs available as open-source for all to download and 3D-print. Now, the technology has been used for anything from eyewear and medical devices to printing of live cells and tissues like an artificial cornea. It also has uses in education and surgical planning. The author had the opportunity to work with a 3D printer and make some of these models. The future is bright for innovations in this field as we are only beginning to understand the capabilities of this technology.

The first iPhone was released in 2007 and the first Android phone in 2008. Ten years later, smartphones are becoming ubiquitous. They now have more advanced sensors, cameras and more processing power, which have allowed several innovative apps to be made, which were not possible a few years ago. These apps will change the way we interact with patients and with clinical data, provide affordable and advanced testing, enhance the way we learn, and hopefully improve doctor–patient interactions. However, most of these apps are made without professional input and needvalidation before use. We try to review the current landscape of Smartphone Apps in Ophthalmology.

The last decade has seen an innovation boom across the nation and what is special is that these hack inventions are not just creative, they are tailor made to suit our Indian scenario. Doctors are the most trained health care providers of any nation and it is time that we realize that the responsibility of innovation heavily lies on our shoulders too. MedHacks is the start, with a focus on Smart Innovations that are efficient, cost effective, user friendly and 'take to field' portable, this initiative is one of its kind. These frugal innovations pave the path to healthcare access for all. A Medical hackathon is an event in which people from various backgrounds such as clinicians, engineers, designers and software developers come together in an intense three-day workshop to develop solutions that address challenges facing healthcare today. Participants form teams, collaborate within a limited time frame, and focus on a specific health care problem to come up with ideas or solutions. In this manuscript we will be discussing 2 such hackathon events that were conducted in the past during the conferences and the device prototypes developed during these events.

We conducted a retrospective observational study to describe the clinical profile and outcomes of patients admitted with a diagnosis of dengue fever in a tertiary hospital in South India. A total of 159 patients admitted from April 2014 to October 2018 were included in the study. Vomiting (70.4%), myalgia (60.4%), headache (42.1%), abdominal pain (38.4%), bleeding (38%), and rash (37.1%) were the most common symptoms at presentation. The mean duration of hospital stay was 4.9 days (SD ± 2.4), and the median cost was INR 19,708 ($285) (IQR INR 12,968–32,056 ($188–$305)). Major bleeding was associated with elevated SGOT and SGPT, severe dengue, and secondary dengue. Mortality was associated with elderly age; elevated total leukocyte count, serum bilirubin, serum creatinine, SGOT, and SGPT; and high SOFA score. In view of these observations, we recommend stratifying patients according to the WHO classification of dengue and avoiding the use of thrombocytopenia as a single marker of the severity of the illness.

Adipose stromal cells (ASC) have been shown to migrate to tumours and promote tumour growth. Using animal models and human tissue samples, the authors show here that ASC recruitment to prostate cancers is mediated by the chemokine CXCL1, which is secreted from tumour cells, and acts on CXCR1 on ASCs.

The recent failures of cholesteryl ester transport protein inhibitor drugs to decrease CVD risk, despite raising HDL cholesterol (HDL-C) levels, suggest that pharmacologic increases in HDL-C may not always reflect elevations in reverse cholesterol transport (RCT), the process by which HDL is believed to exert its beneficial effects. HDL-modulating therapies can affect HDL properties beyond total HDL-C, including particle numbers, size, and composition, and may contribute differently to RCT and CVD risk. The lack of validated easily measurable pharmacodynamic markers to link drug effects to RCT, and ultimately to CVD risk, complicates target and compound selection and evaluation. In this work, we use a systems pharmacology model to contextualize the roles of different HDL targets in cholesterol metabolism and provide quantitative links between HDL-related measurements and the associated changes in RCT rate to support target and compound evaluation in drug development. By quantifying the amount of cholesterol removed from the periphery over the short-term, our simulations show the potential for infused HDL to treat acute CVD. For the primary prevention of CVD, our analysis suggests that the induction of ApoA-I synthesis may be a more viable approach, due to the long-term increase in RCT rate.

This article describes the method to make a do it yourself smartphone-based fundus camera which can image the central retina as well as the peripheral retina up to the pars plana. It is a cost-effective alternative to the fundus camera.

Background: the role of innate immunity in human sepsis must be fully clarified to identify potential avenues for novel immune adjuvant sepsis therapies. Methods: A prospective observational study was performed including patients with sepsis (septic group), infection without sepsis (infection group), and healthy controls (control group) in the setting of acute medical wards and intensive care units in a 1000-bed university hospital. A total of 42 patients with sepsis, 30 patients with infection, and 30 healthy controls were studied. The differentiation states of circulating mucosal associated invariant T (MAIT) cells and Natural Killer T (NKT) cells were characterised as naive (CD45RA+, CD197+), central memory (CD45RA−, CD197+), effector memory (CD45RA−, CD197−), or terminally differentiated (CD45RA+, CD197−). The differentiation states of circulating gamma-delta T lymphocytes were characterised as naive (CD45RA+, CD27+), central memory (CD45RA−, CD27+), effector memory (CD45RA−, CD27−), or terminally differentiated (CD45RA+, CD27−). The expression of IL-12 and IL-23 receptors, the transcription factors T-Bet and RORγt, and interferon-γ and IL-17a were analysed. Results: MAIT cell counts were lower in the septic group (p = 0.002) and the infection group (p < 0.001) than in the control group. The MAIT cell T-Bet expression in the infection group was greater than in the septic group (p = 0.012). The MAIT RORγt expression in the septic group was lower than in the control group (p = 0.003). The NK cell counts differed in the three groups (p < 0.001), with lower Natural Killer (NK) cell counts in the septic group (p < 0.001) and in the infection group (p = 0.001) than in the control group. The NK cell counts increased in the septic group in the 3 weeks following the onset of sepsis (p = 0.028). In lymphocyte stimulation experiments, fewer NK cells expressed T-Bet in the septic group than in the infection group (p = 0.002), and fewer NK cells expressed IFN-γ in the septic group than in the control group (p = 0.002). The NKT cell counts were lower in the septic group than both the control group (p = 0.05) and the infection group (p = 0.04). Fewer NKT cells expressed T-Bet in the septic group than in the infection group (p = 0.004). Fewer NKT cells expressed RORγt in the septic group than in the control group (p = 0.003). Fewer NKT cells expressed IFN-γ in the septic group than in both the control group (p = 0.002) and the infection group (p = 0.036). Conclusion: The clinical presentation of infection and or sepsis in patients is linked with a mosaic of changes in the innate lymphocyte Th1 and Th17 phenotypes. The manipulation of the innate lymphocyte phenotype offers a potential avenue for immune modulation in patients with sepsis.

A rare case of partial cranial nerve 3 (CN3) paresis following a traumatic brain injury presented with isolated ptosis and mydriasis due to a hemorrhagic lesion in the ipsilateral tegmentum of midbrain. All the extraocular muscles that control eye movements were spared. The anatomy of CN3 nuclei and their fascicular organization is reviewed. Keywords: Traumatic brain injury, Diffuse axonal injury, Oculomotor nerve palsy

Foot-and-mouth disease (FMD) poses a serious threat to the agricultural sector due to its highly contagious nature. Outbreaks of FMD can lead to substantial disruptions to livestock markets due to loss of production and access to international markets. In a previously FMD-free country, the use of vaccination to augment control of an FMD outbreak is increasingly being recognized as an alternative control strategy to direct slaughtering [stamping-out (SO)]. The choice of control strategy has implications on production, trade, and hence prices of the sector. Specific choice of eradication strategies depends on their costs and benefits. Economic impact assessments are often based on benefit–cost framework, which provide detailed information on the changes in profit for a farm or budget implications for a government (1). However, this framework cannot capture price effects caused by changes in production due to culling of animals; access to international markets; and consumers’ reaction. These three impacts combine to affect equilibrium within commodity markets (2). This paper provides assessment of sectoral level impacts of the eradication choices of FMD outbreaks, which are typically not available from benefit–cost framework, in the context of the UK. The FAPRI-UK model, a partial equilibrium model of the agricultural sector, is utilized to investigate market outcomes of different control strategies (namely SO and vaccinate-to-die) in the case of FMD outbreaks. The outputs from the simulations of the EXODIS epidemiological model (number of animals culled/vaccinated and duration of outbreak) are used as inputs within the economic model to capture the overall price impact of the animal destruction, export ban, and consumers’ response.

The objective of this study was to determine whether kinematic data collected by the Microsoft Kinect 2 (MK2) could be used to quantify postural stability in healthy subjects. Twelve subjects were recruited for the project, and were instructed to perform a sequence of simple postural stability tasks. The movement sequence was performed as subjects were seated on top of a force platform, and the MK2 was positioned in front of them. This sequence of tasks was performed by each subject under three different postural conditions: "both feet on the ground" (1), "One foot off the ground" (2), and "both feet off the ground" (3). We compared force platform and MK2 data to quantify the degree to which the MK2 was returning reliable data across subjects. We then applied a novel machine-learning paradigm to the MK2 data in order to determine the extent to which data from the MK2 could be used to reliably classify different postural conditions. Our initial comparison of force plate and MK2 data showed a strong agreement between the two devices, with strong Pearson correlations between the trunk centroids "Spine_Mid" (0.85 ± 0.06), "Neck" (0.86 ± 0.07) and "Head" (0.87 ± 0.07), and the center of pressure centroid inferred by the force platform. Mean accuracy for the machine learning classifier from MK2 was 97.0%, with a specific classification accuracy breakdown of 90.9%, 100%, and 100% for conditions 1 through 3, respectively. Mean accuracy for the machine learning classifier derived from the force platform data was lower at 84.4%. We conclude that data from the MK2 has sufficient information content to allow us to classify sequences of tasks being performed under different levels of postural stability. Future studies will focus on validating this protocol on large populations of individuals with actual balance impairments in order to create a toolkit that is clinically validated and available to the medical community.