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Elayna Kirsch,1 Sadiq Rahman,2 Katrina Kerolus,2 Rabale Hasan,1 Dorota B Kowalska,1 Amruta Desai,2 Sergio D Bergese2 1Department of Obstetrics and Gynecology, Stony Brook University Hospital, Stony Brook, NY, USA; 2Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY, USACorrespondence: Sergio D Bergese, School of Medicine, Stony Brook University, Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794, USA, Tel +631444-2979, Fax +631444-2907, Email sergio.bergese@stonybrookmedicine.eduAbstract: Dysmenorrhea is the most common pathology women of childbearing age face. It is defined as painful uterine cramping associated with menstruation. Primary dysmenorrhea occurs in the absence of an organic cause, whereas secondary dysmenorrhea is pelvic pain associated with an underlying pelvic pathology. The purpose of this review is to discuss the pathophysiology of dysmenorrhea and provide a discussion of pharmacologic and non-pharmacologic treatment options. Prostaglandins play a large role in the pathophysiology of dysmenorrhea by causing myometrial contraction and vasoconstriction. The first-line treatment for dysmenorrhea is with nonsteroidal anti-inflammatory drugs due to the inhibition of cyclooxygenase enzymes, thereby blocking prostaglandin formation, as well as hormonal contraception. Other pharmacologic treatment options include Paracetamol, as well as Gonadotrophic Release Hormone Analogs, which are typically used in the treatment for endometriosis. Non-pharmacologic treatments with strong evidence include heat therapy and physical exercise. There are less evidence-based data behind other modalities for treating dysmenorrhea, such as dietary supplements, acupuncture, and transcutaneous nerve stimulation, and these methods should be used in conjunction with first-line therapy after a discussion of risks and benefits. Lastly, for women who fail medical management, surgical options include endometrial ablation, presacral neurectomy, and laparoscopic uterosacral nerve ablation. Further research is needed to measure the socioeconomic burden of dysmenorrhea on the healthcare system and to evaluate the efficacy of treatment combinations, as a multi-modal approach likely provides the most benefit for women who suffer from this condition.Keywords: dysmenorrhea, prostaglandin, NSAIDs, hormonal contraception, pelvic pain, pharmacologic management, behavioral interventions, surgical intervention

Sarah A Elliott,1,2 Sholeh Rahman,1 Shannon D Scott,3 Wiliam R Craig,4 Lisa Knisley,5,6 Kathleen Shearer,7 Lisa Hartling1,2 1Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada; 2Cochrane Child Health, University of Alberta, Edmonton, Alberta, Canada; 3Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; 4Division of Pediatric Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; 5The Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; 6College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada; 7Pediatric Parents’ Advisory Group, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Lisa Hartling, 4-472 Edmonton Clinic Health Academy, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada, Tel +1 780-492-6124, Email hartling@ualberta.caAbstract: The objective of this review was to explore parents’ experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents’ self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child’s IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child’s condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents’ desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents’ experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.Keywords: child, developmental disabilities, parents, emergency service, communication

Background: This study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). Methods: In this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. Results: A total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ≥65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ≥65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). Conclusion: This study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.

Aims: The escalating demands for traditional fossil fuels with unsecured deliverance and issues of climate change compel the researchers to develop alternative fuels like bioethanol. This study examines the prospect of biofuel production from high carbohydrate containing lignocellulosic material, e.g. sugarcane bagasse through biological means. Methodology and Results: Cellulolytic enzymes were collected from the culture filtrate of thermotolerant Trichodermaviride grown on variously pre-treated sugarcane bagasse. CMCase and FPase enzyme activities were determined as a measure of suitable substrate pre-treatment and optimum condition for cellulolytic enzyme production. The highest CMCase and FPase activity was found to be 1.217 U/ml and 0.109 U/ml respectively under the production conditions of 200 rpm, pH 4.0 and 50 °C using steamed NaOH treated bagasse as substrate. SEM was carried out to compare and confirm the activity of cellulolytic enzymes on sugarcane bagasse. Saccharification of pre-treated bagasse was carried out with crude enzymes together using a two-factor experimental design. Under optimized conditions the pre-treated bagasse was saccharified up to 42.7 % in 24 h. The hydrolysate was concentrated by heating to suitable concentration and then used for fermentation by an indigenous isolate of Saccharomyces cerevisiae. With 50 and 80 % brix containing liquor the concentration of alcohol was 0.579 % and 1.15 % respectively. Conclusion, significance and impact of study: This is the first report in Bangladesh for the production of cellulosicethanol using local isolates. Though the rate of alcohol production was very low, a great impetus in this field can maximize the production thereby meet the demand for fuel in future.

BackgroundEvidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application.MethodsThe study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work.DiscussionSuccessful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD.Trial registrationClinicalTrials.gov. (NCT05027789, posted 8/30/2021).

Experienced middle school mathematics and science teachers were recruited for a pilot study. The teachers separately responded to a survey related to determining expected learning outcomes based on their traditional teaching, classroom experiences and observations, and self-brainstorming. The teachers then received training on how to design, develop, and implement robotics-enabled lessons under a design-based research approach for experiential learning, and taught robotics-enabled lessons to a selected student population in classroom settings. The teachers then responded to the survey for the robotics-enabled teaching. For each case (traditional and robotics-enabled), the survey responses were analyzed, and a set of expected learning outcomes of math and science lessons was derived separately. The thematic analysis results showed that the expected learning outcomes for the robotics-enabled lessons were not only related to the educational gains (content knowledge) observed in traditional teaching, but also to the improvements in the behavioral, social, scientific, cognitive, and intellectual aptitudes of the students. Then, a set of metrics and methods were proposed for assessing the learning outcomes separately. To validate the assessment metrics and methods, teachers from different schools taught two selected robotics-enabled lessons (one math, one science) to same grade students, and separately assessed the learning outcomes of each student using the proposed metrics and methods. The learning outcomes were then compared and benchmarked between schools and subjects. The results of a user study with the teachers showed user acceptance, effectiveness, and suitability of the assessment metrics and methods. The proposed scheme of assessing learning outcomes can be used to assess and justify the benefits and advantages of robotics-enabled STEM education, benchmark the outcomes, help improve teaching preparations, motivate decision-makers to confer on robotics-enabled STEM education and curricula development, and promote robotics-enabled STEM education.

IntroductionBlood parasites pose a significant threat to livestock production in southern Egypt, yet there is a scarcity of information regarding their circulation and epidemiology in sheep in this region. This study aimed to investigate the seroprevalence of blood parasite infections in sheep in Assiut governorate, Upper Egypt.MethodsA total of 400 blood samples were collected from sheep of varying ages and genders. The preliminary screening for the presence of piroplasms, mainly Babesia and Theileria spp., via microscopic examination, followed by investigation of the potential risk factors linked with the exposure to infection. Moreover, molecular identification of both parasites on some of positive samples was performed using PCR targeting Babesia 18S rRNA and Theileria annulata Tams1 gene.ResultsThe microscopic examination revealed that among the examined sheep, there was an overall prevalence of blood parasites at 44% (176 out of 400), with Babesia spp. observed in 14% (56 out of 400) and Theileria spp. in 30% (120 out of 400). Furthermore, the infection rate was non-significantly higher in young animals (50%) compared to adults (38.5%) (P = 0.246). Male sheep exhibited a significantly higher vulnerability to both parasites' infection (63.3%) compared to females (35.7%) (P = 0.011). Interestingly, the prevalence of both blood parasites was significantly higher during the cold season (66.1%) compared to the hot season (15.9%) (P = < 0.001). The molecular analysis identified the presence of Babesia ovis and Theileria annulata among a subsample of the positive sheep's bloods films. The identified species were recorded in the GenBank™ databases and assigned specific accession numbers (OQ360720 and OQ360719 for B. ovis), and (OP991838 for T. annulata).ConclusionsTaken together, this study confirms a high prevalence of piroplasmosis and offers epidemiological and molecular insights into blood parasites in sheep from Upper Egypt, highlighting the importance of detecting these parasites in various hosts and their competent vectors (ticks).

Abstract Background Candida auris is an emerging yeast pathogen that can cause invasive infections, particularly candidemia, in healthcare settings. Candida auris is characterized by resistance to multiple classes of antifungal drugs and high mortality. Objective To describe the risk factors, clinical characteristics, antifungal susceptibility pattern and outcomes of Candida auris blood stream infection. Methods We conducted a retrospective review of electronic medical records of C. auris fungemia cases in the facilities under Hamad Medical corporation, Qatar from 1/11/2018 to 31/7/2021. Demographic data, risk factors, antibiogram and 30-day outcome are described. Results We identified 36 patients with C. auris fungemia. Most of the patients were in intensive care unit following severe COVID-19 pneumonia and had received steroids and broad-spectrum antibiotics. Most cases were central line related. Over 90% of isolates were non-susceptible to fluconazole, while amphotericin B resistance reached 85%. Factors associated with high mortality included initial SOFA score of 9 or above and absence of source control. Conclusion Our study reveals a concerning 41.6% mortality rate within 30 days of C. auris candidemia. Furthermore, the prevalence of amphotericin B resistance in Qatar exceeds what has been reported in the literature necessitating further exploration. Echinocandins retains nearly 100% susceptibility and should be prioritized as the treatment of choice. These findings emphasize the need for vigilant monitoring and appropriate management strategies to combat C. auris infections and improve patient outcomes.

Abstract Background Several studies have highlighted the possible positive effects of soluble receptor for advanced glycation end products (sRAGE) against obesity. However, due to their inconsistent results, this systematic review and meta-analysis aimed to quantitatively evaluate and critically review the results of studies evaluating the relationship between sRAGE with obesity among adult population. Methods In the systematic search, the eligibility criteria were as follows: studies conducted with a cross-sectional design, included apparently healthy adults, adults with obesity, or obesity-related disorders, aged over 18 years, and evaluated the association between general or central obesity indices with sRAGE. Results Our systematic search in electronic databases, including PubMed, Scopus, and Embase up to 26 October, 2023 yielded a total of 21,612 articles. After removing duplicates, screening the titles and abstracts, and reading the full texts, 13 manuscripts were included in the final meta-analysis. According to our results, those at the highest category of circulating sRAGE concentration with median values of 934.92 pg/ml of sRAGE, had 1.9 kg/m2 lower body mass index (BMI) (WMD: -1.927; CI: -2.868, -0.986; P

Mangrove waters in Pagatan Besar Village are an important ecosystem for the life of living creatures and the surrounding environment. The number of species of organisms in a body of water can provide an overview of the complex community in that water. However, heavy metal pollution poses a threat to ecosystems and even humans. Heavy metals in the waters will one day fall and settle to the bottom of the waters, forming sedimentation, this will cause demersal biota that search for food at the bottom of the waters (shrimp, crabs, crabs or shellfish) will have a great probability to be exposed to heavy metals. The objectives of this research are: (1) Analyze the concentration of heavy metals (Hg, Cu, Zn, Cd, Fe and Pb) in water and sediment in mangrove waters; (2) Confirming the types of heavy metals (Hg, Cu, Zn, Cd, Fe and Pb) which have the highest concentrations in the demersal biota of mangrove waters; (3) Analyzing the level of pollution in the Mangrove Waters of Pagatan Besar Village. The results showed that the concentration of the heavy metals Hg and Cu had exceeded water quality standards at all stations, and Cd at station 3. The levels of the heavy metal Fe in the sediment were high at all stations, while in the flesh of the kapah mussel (Polymesoda erosa), the heavy metals Cu and High Fe for all stations. The heavy metal content in shellfish meat will have a bad impact on humans if consumed. Non-essential metals (Pb, Cd, Hg) that enter the body will cause a decline in health and can even result in the emergence of chronic diseases such as dysfunction of the nerves, liver, kidneys and reproductive system.

Purpose: This study aimed to evaluate the lumbar annular tears prevalence regarding the patient’s history factors, and Magnetic Resonance Imaging (MRI) recorded data. Materials and Methods: In this study, 218 patients (106 men and 112 women) were evaluated; 136 cases (63 men and 73 women, 20-80 years, mean: 45.4±14.8 years) with Lower Back Pain (LBP) and High-Intensity Zone (HIZ) were diagnosed based on MR images. The diagnosed annular tears from the MRI data, Body Mass Index (BMI, kg/m2), and physical activity of the patients were recorded, and the prevalence of lumbar annular tears was evaluated regarding the mentioned parameters. Results: The prevalence of annular tears was 31.6% at L5/S1 (43/136 patients), 43.4% at L4/L5 (59/136 patients), 16.9% at L3/L4 (23/136 patients), 4.4% at L2/L3 (6/136 patients), and 3.7% at L1/L2 spinal disc space (5/136 patients). Most patients with annular tears had LBP (>60%). Based on the patient's history, 25% of patients had BMI above 30, 8.8% had post-traumatic history, 15.4% had a history of falling down, 19.1% had slipped down history, 16.2% were athletes, and 15.4% performed heavy work. Conclusion: The prevalence of lumbar annular tears was higher in patients having LBP and a BMI over 30, which should be considered possible risk factors. This study demonstrated that annular tears are more likely to occur in lower lumbar discs, especially in L4/L5 and L5/S1 discs.