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The development of a scalable process for a complex intermediate featuring a chiral, quaternary cyclopropane moiety presented significant challenges. We report two generations of synthetic strategies appropriate for the respective stages of development. The initial approach utilized a stereoselective Simmons–Smith cyclopropanation of (R)-pyroglutamic acid ester, which predominantly yielded the undesired stereoisomer. To circumvent this issue, we implemented a strategy that combined isomerization, recycling of the undesired isomer, and selective crystallization to improve the yield of the desired product. An important insight was that the Simmons–Smith cyclopropanation exhibited opposite stereoselectivity with a benzoyl ester of a prolinol substrate, resulting in the desired stereoisomer as the major product. This understanding enabled the development of a second-generation process that facilitated the large-scale production of the targeted intermediate, thus supporting the advancement of clinical trials.

Byline: Pooja. Tiwari, Ram. Shukla, Maneesh. Joleya, Sarvagya. Jain, Ashok. Ladda, Shashi. Sharma, Vinod. Raj, Brijesh. Lahoti, Manoj. Joshi Introduction: Hernia of the umbilical cord (HUC) is an uncommon problem [...]

Exploring the trends of sustainability science research is vital for advancing our understanding of creating a more sustainable and resilient future for our planet and society. This overview article explores a segment of the sustainability science research landscape from 2006 to 2023 by examining articles published in the Sustainability Sciencejournal. The initial step involved categorizing articles into four distinct periods, each representing a phase in the journal and field’s evolution. The changing research topics and their interconnectedness were investigated by involving natural language processing, non-negative matrix factorization topic modeling, and Jaccard similarity analysis in Python. The study reveals shifting emphases over these periods: 2006–2010 focused on human–environment links; 2011–2015 shifted to practical solutions, such as climate adaptation; 2016–2020 focused on the integration of transdisciplinary knowledge, SDGs, and sustainability transitions; and 2021–2023 centered on transformative changes in sustainability. Based on the Sustainability Sciencejournal publications, the field has evolved from foundational principles to current priorities such as transdisciplinary approaches, deep sustainability transformations, bioeconomy, and intergenerational narratives. The evolving landscape responds to environmental, societal, cultural, and technological changes. While the Sustainability Sciencejournal has played an essential role, there remains potential to further concentrate on emerging topics and transformative methodologies. This study offers valuable insights into propelling sustainability science forward to address global challenges and pave the way for a sustainable and equitable future.

Background Cerebro-costo-mandibular syndrome (CCMS) is a rare congenital syndrome consisting of the main features of micrognathia and posterior rib gaps. Due to multiple abnormalities, patients almost have difficulty breathing with upper airway obstruction, decreased thoracic capacity, spina bifida, and scoliosis.Case presentation We describe a case of a late preterm neonate boy presenting with low Apgar, respiratory distress, and complicated orofacial anomalies that had a poor outcome. His radiographic findings showed mandibular hypoplasia (micrognathia), chest deformity, multiple posterior rib gap defects, and abnormal costotransverse articulation. Based on physical examination and radiologic findings, the diagnosis of CCMS confirmed for the patient.Conclusion Physicians should always consider the diagnosis of CCMS in all infants with micrognathia and rib-gap defects. These infants need careful respiratory function monitoring. Early airway management improves growth and development. In addition, their physical and psychological development should be assessed regularly.

Byline: Vivek. Chaitanya, Divyansh. Mishra, Mahesh. Shanmugam, Rajesh. Ramanjulu, Keshav. Lahoti A 58-year-old female presented with macular telangiectasia (MacTel) type 2 with proliferative diabetic retinopathy (PDR) and also showed vitreomacular [...]

Identifying research gaps and priorities is paramount to advance sustainability science and contribute to a sustainable future. This editorial contributes to this effort by contemplating the sustainability science research agenda and aligning it with recent changes in global dynamics. Drawing on consultations with the editorial board members of the Sustainability Science journal and a review of relevant literature, we identified 12 key research topics. These topics are interpreted within a strategic framework encompassing three key themes: (1) goals that drive sustainability science, (2) approaches to attain these goals, and (3) tools to advance sustainability science research. In so doing, this editorial emphasizes a sustainable development agenda extending beyond 2030, fostering equity and justice, and tackling issues related to power dynamics and geopolitical conflicts. It underscores the significance of research approaches to attaining sustainability goals, in particular, theorizing, co-production of knowledge and action, attaining clarity in conceptual descriptions, and developing systems-oriented analytical frameworks. Additionally, it highlights the value of place-based approaches, learning from significant systemic shocks, and nurturing inner transformations. It also underlines the need to explore emerging technologies and data-intensive methodologies as a tool to address sustainability concerns. The systematic contemplation of the sustainability science research agenda presented in this editorial piece aims to invoke further discussion among researchers and practitioners about a fresh and relevant agenda that promotes the sustainable integration of nature and society.

ABSTRACT Geopolymer is an emerging alternative green binder to Portland cement. Geopolymer is often more brittle and thus it is highly desirable to impart self-healing into geopolymer. Unlike Portland cement [...]

Byline: Ekta. Sahu, Animesh. Sahu, Pranav. Ghodgaonkar, Keshav. Lahoti, Arun. Bhargava Rhino-orbital-cerebral mucormycosis (ROCM) with intracranial extension is a fatal disease. A case of extensive ROCM, with rare intracranial fungal [...]

ABSTRACT This paper reports on an innovative way to utilize alkali-silica reactive (ASR) rocks as a natural resource to produce high strength geopolymer binder. Excavation of the Jurong rock caverns [...]

Byline: Nandita. Saxena, Akshay. Nair, Bharati. Kulkarni, Pooja. Multani, Hemant. Lahoti, Shyam. Borwankar, Dipesh. Goel We present a rare case of an intraorbital dermoid which was associated with a small [...]

Febuxostat is a novel, non-purine, selective inhibitor of xanthine oxidase for hyperuricemia in patients with gout. It is the first promising substitute for allopurinol in 40 years. Various synthetic routes [...]

In this article, we propose a feature detection approach that employs an adaptive sampling technique coupled with a convolutional neural network (CNN) model, to detect sparse features of interest in high-dimensional input data. Adaptive sampling criterion smartly explores the high-dimensional input and exploits the regions of interest. The CNN model determines the likelihood of the presence of the desired features, which guides the exploitation component of the sampling strategy. The effectiveness of the approach is illustrated using case studies, where emotions in a candidate’s interview video are detected for evaluation purpose and anomalies in a product’s image are extracted for quality control. The approach reduces evaluation time and minimizes amount of input data to be accessed and processed while effectively identifying desired sparse features.

Background: Cystic fibrosis is the predominant autosomal recessive disorder known to reduce life expectancy. Research findings indicate that around 60 to 70% of adult individuals with this condition carry infections of Pseudomonas aeruginosa.Objective: The ongoing research investigates the potential synergy of merging ivacaftor and ciprofloxacin to address bacterial infections.Methods: The two drugs were spray-dried into microparticles, which were then coated with Lsalbutamol and were to be delivered by a dry powder inhaler. Microparticles were generated by applying the spray drying method, utilizing bovine serum albumin and L-leucine in their preparation. Additionally, L-salbutamol was mixed and adsorbed onto the surface of the spray-dried microparticles, and it acted as a bronchodilator.Results: The microparticles produced via spray drying exhibited a particle size measuring 1.6 ± 0.04 µm, along with a polydispersity ratio of 0.33. Their zeta potential measured -27.3 ± 1.1 mV, while the mass median aerodynamic diameter of these microparticles was 3.74 ± 0.08 µm. SEM, XRD, and FTIR studies confirmed the entrapment of ivacaftor and ciprofloxacin. The morphology was observed by SEM and TEM scans. Antibacterial synergy was confirmed through the agar broth and dilution method, and the formulation's safety was established based on the outcomes of the MTT assay.Conclusion: Using spray-dried microparticles containing ciprofloxacin, ivacaftor, and L-salbutamol presents a novel approach to the treatment of cystic fibrosis.

Social–ecological production landscapes and seascapes (SEPLS) are an essential source of livelihood for people worldwide; however, they are experiencing challenges due to climate and ecological systems’ change affecting their bioproduction mechanisms. These externally influenced drivers challenge their relevance, which calls for the revitalization of these systems focusing on sustainable use and management of resources with increased socio-ecological resilience and improved economic viability. In response, this study was conducted by reviewing the literature on 90 bioproduction systems in SEPLS across three countries in Asia, Japan, Philippines and Indonesia. Through a solution scanning exercise, the study aims to identify the driver of change, the involvement of stakeholders, and the prominent response types considered during their revival. The recorded 348 policy responses are filtered using the Millennium Ecosystem Assessment-based response typology to systematically categorize the scanned solutions, and the Nature Futures Framework (NFF) to capture the linked pluralistic values. In addition to the solutions, the study captured the drivers of change and other characteristics of the bioproduction system. Overall, the stakeholder engagement, the solution type, and pathways to achieve the NFF perspectives vary across the countries. In all study countries, the change in natural, physical, and biological systems and challenges posed by land use change are the key direct driver. Indirect drivers in Japan are mainly associated with demographic change, while in the Philippines and Indonesia, they are socio-political and technological challenges, respectively. The NFF filtering indicates a stronger lean toward a ‘Nature as Culture/One with Nature’ perspective, achieved through solutions targeting sociocultural and behavioral change and community-based management. The solutions and the filtering allowed an understanding of the differing approaches, which can guide other bioproduction systems in enhancing their socio-economic resilience and bringing transformative change to SEPLS.

•Novel clinker-free CaO–silica fume pavement binder proposed.•Offers better mechanical properties than OPC-silica fume at very low dosage.•Lower embodied energy and embodied carbon than OPC-silica fume.•Overall 5D analysis reveals CSF-30 to be the most optimum mix.

Byline: Abir. Nath, Nandita. Saxena, Bharati. Kulkarni, Shyam. Borwankar, Hemant. Lahoti, Sanjay. Oak The syndrome described by Zollinger and Ellison in 1955 is a rare clinical entity which is even [...]

Plastic waste is a significant issue for the planet, with demand for plastic expected to triple by 2060. While mechanical recycling is effective for some plastics, it does not account for all types, such as plastic films used in food packaging. Advanced recycling, including hybrid recycling, can capture and convert these hard-to-recycle items into feedstock for new plastic products. Dow is collaborating with companies like Freepoint Eco-Systems to invest in advanced recycling facilities and transform plastic waste into circular feedstock. These collaborations are essential for building a circular economy and reducing reliance on fossil feedstocks. [Extracted from the article]

Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes (T1D). In established T1D patients, DKA is frequently a result of insulin omission or inadequate insulin administration during illness or stress. Ethnic minorities and patients with lower socioeconomic status are affected disproportionately. We hypothesized that implementation of intensive sick day rules with frequent reinforcement would reduce hospitalizations secondary to DKA in T1D youth irrespective of their demographics.

Bat is the only mammal capable of powered flight. The most distinctive feature of the batwing is the ability to fold and unfold the wing during the upstroke and downstroke respectively, giving them high maneuverability and energy efficiency. We aim to mimic this folding capability of the batwing in a robotic counterpart. In this paper we have presented a novel single degree of freedom mechanism for wing folding and unfolding, taking into account the kinematics of a biological batwing. We discuss the aerodynamic loading and structural integrity analysis of the mechanism and utilize this to design and fabricate a working prototype.

Suppression of menstruation and/or ovarian function in adolescent girls may be desired for a variety of reasons. Numerous medical options exist. The choice of the appropriate modality for an individual patient depends on several factors based on differences in the efficacy of achieving menstrual suppression as well as in their side effect profiles. Adolescence is also a period of bone mass accrual in girls, and several of these modalities may negatively influence peak bone mass. This review focuses on the efficacy of achieving menstrual suppression and the effect on bone health of the various options through an overview of the current literature and also highlights areas in need of further research.

AbstractPixel-level feature detection from images is an essential but challenging task encountered in domains such as detecting defects in manufacturing systems and detecting tumors in medical imaging. Often, the real image contains multiple feature types. The types with higher pixel intensities are termed as positive (extreme) features and the ones with lower pixel intensities as negative (extreme) features. For example, when planning a medical treatment, it is important to identify, (a) calcification (a pathological feature which can result in a post-surgical complications) as positive features, and (b) soft tissues (organ morphology, knowledge of which can support pre-surgical planning) as negative features, from a preoperative computed tomography image of the human heart. However, this is not an easy task because (a) conventional segmentation techniques require manual intervention and post-processing, and (b) existing automatic approaches do not distinguish positive features from negative. In this work, we propose a novel, automatic image decomposition-based sparse extreme pixel-level feature detection model to decompose an image into mean and extreme features. To estimate model parameters, a high-dimensional least squares regression with regularization and constraints is utilized. An efficient algorithm based on the alternating direction method of multipliers and the proximal gradient method is developed to solve the large-scale optimization problem. The effectiveness of the proposed model is demonstrated using synthetic tests and a real-world case study, where the model exhibits superior performance over existing methods.

Byline: Lukesh. Patil, Ashok. Laddha, Shashi. Sharma, Brajesh. Lahoti Sir, Primary hydatid cyst of head and neck region is a rare presentation even in the geographical areas known to be [...]

Focusing on the utilization of industrial wastes and greener construction practices, this experimental study investigates the integration of high-volume fly ash, steel slag (SS) aggregates, and basalt fibres (BF) to advance the performance and sustainability of cementitious composites. The cementitious composite was tested at 28 and 360 days for mechanical and durability properties. Reduction in BF content by 1% increased the compressive strength by 14.10% and decreased the flexural strength and water absorption by 20.14% and 20.29% respectively at 360 days. SS aggregates, incorporated as 30% and 100% replacement of river sand, improved the strength of the composite significantly at 28 days and no volumetric instability was observed even at 100% replacement levels. The highlight of the paper is extremely high chloride ion penetration resistance of the developed mixes. Furthermore, incorporation of SS aggregates did not cause any dimensional instability even after 360 days. A scanning electron microscope was used to further analyse the influence of individual composite components. In particular, the effects of Interfacial Transition Zone at the aggregate-matrix and fibre-matrix on the mechanical and durability properties of the developed composite were explored.

Carbon Nanotubes (CNT) are the allotropes of carbon in nanosize dimension and are popular in medicinal field. These nano-based technologies are gaining high interest in the recent years for the treatment of diseases that are previously considered to be impossible to cure. CNTs have gained significance in the treatment of the majority of disorders such as Malaria, Alzheimer’s disease, Infectious disease, and Asthma. Moreover, patient’s responsiveness also increased in cardiovascular and pulmonary diseases. To date, a number of reviews are available in the literature covering applications of CNT in cancer. However, the purpose of this review is to focus on the use of CNTs in drug delivery of non-cancerous diseases. The novelty of this review is that it is focused on the applicability of CNT in the various non-cancerous diseases. Detailed information was collected from the literature which will guide and encourage researchers to explore the applicability of CNT in various non-cancerous diseases in the future.

The bidirectional relationship between cancer and chronic kidney disease (CKD) is complex. Patients with cancer, particularly those with hematological malignancies such as multiple myeloma and lymphoma, are at increased risk of developing acute kidney injury and CKD. On the other hand, emerging evidence from large observational registry analyses have consistently shown that cancer risk is increased by at least 2- to 3-fold in kidney transplant recipients, and the observed increased risk occurs not only in those who have received kidney transplants but also in those on dialysis and with mild- to moderate-stage CKD. The interactions between cancer and CKD have raised major therapeutic and clinical challenges in the management of these patients. Given the magnitude of the problem and uncertainties, and current controversies within the existing evidence, Kidney Disease: Improving Global Outcomes (KDIGO) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology to identify key management issues in nephrology relevant to patients with malignancy. This report covers the discussed controversies in kidney disease in hematological malignancies, as well as cancer after kidney transplantation. An overview of future research priorities is also discussed.

The association between kidney disease and cancer is multifaceted and complex. Persons with chronic kidney disease (CKD) have an increased incidence of cancer, and both cancer and cancer treatments can cause impaired kidney function. Renal issues in the setting of malignancy can worsen patient outcomes and diminish the adequacy of anticancer treatments. In addition, the oncology treatment landscape is changing rapidly, and data on tolerability of novel therapies in patients with CKD are often lacking. Caring for oncology patients has become more specialized and interdisciplinary, currently requiring collaboration among specialists in nephrology, medical oncology, critical care, clinical pharmacology/pharmacy, and palliative care, in addition to surgeons and urologists. To identify key management issues in nephrology relevant to patients with malignancy, KDIGO (Kidney Disease: Improving Global Outcomes) assembled a global panel of multidisciplinary clinical and scientific expertise for a controversies conference on onco-nephrology in December 2018. This report covers issues related to kidney impairment and solid organ malignancies as well as management and treatment of kidney cancer. Knowledge gaps, areas of controversy, and research priorities are described.

Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient’s HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient’s home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.

A series of (E)-4-((4-alkoxyphenyl)diazenyl)pyridine (AZ-n) derivatives were synthesized with varying alkoxy spacers (n= 8, 9, and 10), and their halogen-bonded complexes were obtained with 1,3,5-trifluoro-2,4,6-triiodobenzene in different stoichiometric ratios, which were further characterized by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), single-crystal X-ray diffraction (SC-XRD), and powder X-ray diffraction (P-XRD) techniques. The structural analysis revealed the presence of Py-N···I halogen bond (XB) interactions in the complexes, resulting in a bent-shaped architecture rather than a star-shaped one. Hirshfeld surface analysis revealed the contribution of XB along different intermolecular interactions in the crystal packing. Computational analyses such as noncovalent index (NCI), quantum theory of atoms in molecules (QTAIM), electron localization function (ELF), and natural bond orbital (NBO) were carried out to understand the nature, strength, and electronic characteristics of XBs in these complexes. Further, these XB complexes show excellent photoresponsive behavior upon UV illumination, introducing a new range of supramolecular photoresponsive materials self-assembled by halogen bonding, thereby broadening the scope of potential applications within their respective systems.

Study Design Retrospective cohort study.Objectives This study assessed the effectiveness of a popular large language model, ChatGPT-4, in predicting Current Procedural Terminology (CPT) codes from surgical operative notes. By employing a combination of prompt engineering, natural language processing (NLP), and machine learning techniques on standard operative notes, the study sought to enhance billing efficiency, optimize revenue collection, and reduce coding errors.Methods The model was given 3 different types of prompts for 50 surgical operative notes from 2 spine surgeons. The first trial was simply asking the model to generate CPT codes for a given OP note. The second trial included 3 OP notes and associated CPT codes to, and the third trial included a list of every possible CPT code in the dataset to prime the model. CPT codes generated by the model were compared to those generated by the billing department. Model evaluation was performed in the form of calculating the area under the ROC (AUROC), and area under precision-recall curves (AUPRC).Results The trial that involved priming ChatGPT with a list of every possible CPT code performed the best, with an AUROC of .87 and an AUPRC of .67, and an AUROC of .81 and AUPRC of .76 when examining only the most common CPT codes.Conclusions ChatGPT-4 can aid in automating CPT billing from orthopedic surgery operative notes, driving down healthcare expenditures and enhancing billing code precision as the model evolves and fine-tuning becomes available.

Byline: Mukesh. Sharma, B. Lahoti, Gaurav. Khandelwal, R. Mathur, S. Sharma, Ashok. Laddha Aim: To assess the various epidemiological parameters that influence the causation of trauma as well as the [...]

Byline: Brijesh. Lahoti, Gaurav. Aggarwal, Arvind. Diwaker, Shashi. Sharma, Ashok. Laddha Aim: Report of our experience with topical feracrylum citrate to minimize hemorrhage-related complications in pediatric hypospadiac patients. Materials and [...]

Byline: Manoj. Kela, Sangram. Singh, Brijesh. Lahoti Cystic pancreatic tumors are rare in children and the immature cystic teratoma of the pancreas is even rarer. A review of the world [...]

Table of Contents Abstract Introduction Case Report 1 Case Report 2 Discussion Conclusion References Abstract Conjoined twins occur in approximately one in 50,000 births. Considerable debate persists over the development [...]

Table of Contents Abstract Introduction Patients And Methods Results Discussion Conclusion References Abstract Background: Empyema thoracis remains a common problem in the pediatric age group. We undertook the present study [...]

Table of Contents Abstract Introduction Material and methods Results Discussion References Abstract Purpose: To study the outcome of hypospadias cases operated using modified tubularized incised plate urethroplasty with vascularized prepucial [...]

Byline: Manoj. Kela, Rajiv. Jain, Sangram. Sing, Brijesh. Lahoti, Prakash. Raje Leiomyoma of the mesentery is an uncommon tumor among gastrointestinal stromal tumors. This has been documented in adults and [...]

We revisit the notion of individual fairness proposed by Dwork et al. A central challenge in operationalizing their approach is the difficulty in eliciting a human specification of a similarity metric. In this paper, we propose an operationalization of individual fairness that does not rely on a human specification of a distance metric. Instead, we propose novel approaches to elicit and leverage side-information on equally deserving individuals to counter subordination between social groups. We model this knowledge as a fairness graph, and learn a unified Pairwise Fair Representation (PFR) of the data that captures both data-driven similarity between individuals and the pairwise side-information in fairness graph. We elicit fairness judgments from a variety of sources, including human judgments for two real-world datasets on recidivism prediction (COMPAS) and violent neighborhood prediction (Crime & Communities). Our experiments show that the PFR model for operationalizing individual fairness is practically viable.

The article compares the metal forging manner of ancient people to the modern way of deforming metal shapes. According to the author, ancient people shaped a piece of metal by holding it on the anvil and pound it using a hammer. Nowadays, deforming a metal is done by compressive deformation of materials using a dies or cutting tools. This new change is based on the new knowledge about deformation properties of metal and the increasing application of computer in designing forging tools.