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AbstractBackgroundThis study was undertaken to evaluate if there are differences between visual estimation of blood loss (EBL) and quantitative blood loss (QBL) for maternal outcomes related to obstetrical hemorrhage.MethodsThis retrospective study compared EBL (n = 500) to QBL (n = 501) for outcomes of length of stay, readmission within 30 days of discharge, percent receiving blood transfusions, time between delivery to receiving blood transfusion, and postpartum hemoglobin level.ResultsThe QBL group had a significantly lower mean length of stay than the EBL group (2.6 vs 3.2 days, P < 0.001). Multivariate linear regression analysis adjusting for relevant covariates had a similar finding of lower length of stay for QBL vs EBL (B = −0.13, SE = 0.01, P < 0.001). Readmission within 30 days, blood transfusion, time to transfusion since delivery, and postpartum hemoglobin did not significantly differ between the QBL and EBL groups.ConclusionWe recommend that clinicians adopt QBL over EBL as standard practice since QBL is associated with lower length of stay and does not negatively impact other clinical outcomes.

Byline: Kartik. Doshi, Bharati. Shriyan, Manjunath. Nookala, Sadhana. Kannan, Amit. Joshi, Vanita. Noronha, Vikram. Gota, Kumar. Prabhash Background: Recent studies have shown pretreatment sodium level to be a predictive and [...]

Highly nonlinear optical materials with fast third-order nonlinear optical response are crucial for the operation of all-optical photonic devices, such as switches for signal processing and computation, power limiters, and saturable absorbers. The nonlinear response of traditional optical materials is weak, thus requiring large light intensities to induce significant changes in their properties. Here we show that optical control of the coupling rate in subwavelength patch antennas coupled to intersubband transitions in multi-quantum-well semiconductor heterostructures can provide a giant third-order nonlinear response, on the order of ${{3.4 \times 10}}^{- 13}{{{m}}^2}/{{\rm{V}}^2}$, with a response time ${\lt}{{2}}\;{\rm{ps}}$. We utilize this effect to realize intersubband polaritonic metasurfaces and demonstrate their operation as highly nonlinear saturable and reverse saturable absorbers, enabling optical power limiters and other elements for all-optical modulation and control. Our approach enables a plethora of compact, low-power, highly nonlinear devices with spectral, temporal, and structured wavefront responses tailored by design.

Mie-resonant dielectric metasurfaces are excellent candidates for both fundamental studies related to light–matter interactions and for numerous applications ranging from holography to sensing to nonlinear optics. To date, however, most applications using Mie metasurfaces utilize only weak light-matter interaction. Here, we go beyond the weak coupling regime and demonstrate for the first time strong polaritonic coupling between Mie photonic modes and intersubband (ISB) transitions in semiconductor heterostructures. Furthermore, along with demonstrating ISB polaritons with Rabi splitting as large as 10%, we also demonstrate the ability to tailor the strength of strong coupling by engineering either the semiconductor heterostructure or the photonic mode of the resonators. Unlike previous plasmonic-based works, our new all-dielectric metasurface approach to generate ISB polaritons is free from ohmic losses and has high optical damage thresholds, thereby making it ideal for creating novel and compact mid-infrared light sources based on nonlinear optics.

The rapid spread of the coronavirus disease 2019 (COVID-19) epidemic has significantly impacted global health. So far, the evidence regarding the risk factors that predict the outcomes of COVID-19 patients is limited. In this study, we identified several risk factors that are associated with increased mortality in COVID-19 patients.

Background: Beta amyloid (Aβ) peptide containing plaque aggregations in the brain are a hallmark of Alzheimer’s Disease (AD). However, Aβ is produced by cell types outside of the brain suggesting that the peptide may serve a broad physiologic purpose. Objective: Based upon our prior work documenting expression of amyloid β precursor protein (APP) in intestinal epithelium we hypothesized that salivary epithelium might also express APP and be a source of Aβ. Methods: To begin testing this idea, we compared human age-matched control and AD salivary glands to C57BL/6 wild type, AppNL-G-F, and APP/PS1 mice. Results: Both male and female AD, AppNL-G-F, and APP/PS1 glands demonstrated robust APP and Aβ immunoreactivity. Female AppNL-G-Fmice had significantly higher levels of pilocarpine stimulated Aβ 1-42 compared to both wild type and APP/PS1 mice. No differences in male salivary Aβ levels were detected. No significant differences in total pilocarpine stimulated saliva volumes were observed in any group. Both male and female AppNL-G-Fbut not APP/PS1 mice demonstrated significant differences in oral microbiome phylum and genus abundance compared to wild type mice. Male, but not female, APP/PS1 and AppNL-G-Fmice had significantly thinner molar enamel compared to their wild type counterparts. Conclusion: These data support the idea that oral microbiome changes exist during AD in addition to changes in salivary Aβ and oral health.

Photoassisted electrolysis of water is considered as an effective way of storing solar energy in the form of hydrogen fuel. This overall reaction involves the oxidation of water to oxygen at the anode and the reduction of protons to hydrogen at the cathode. Cobalt–phosphate-based catalyst (Co–Pi) is a potentially useful material for oxygen evolution reaction. In the present study, electrochemical deposition of Co–Pi catalyst is carried out on Au-coated quartz crystal from 0.1 M phosphate buffer (pH 7) containing 0.5 mM Co2+ion, along with the simultaneous measurement of mass changes at the electrode surface. Cyclic voltammograms and mass variations are recorded during the course of deposition. A current peak is observed at 0.92 V vs Ag/AgCl, 3 M KCl corresponding to oxidation of Co2+ion. The mass of the electrode starts increasing at this potential, suggesting the deposition of a Co(III)-based insoluble product on the electrode surface. The stability of the catalyst is also studied at several potentials in both buffered and nonbuffered electrolyte by monitoring the real-time mass variations.

The Si-compatibility of perovskite heterostructures offers the intriguing possibility of producing oxide-based quantum well (QW) optoelectronic devices for use in Si photonics. While the SrTiO3/LaAlO3(STO/LAO) system has been studied extensively in the hopes of using the interfacial two-dimensional electron gas in Si-integrated electronics, the potential to exploit its giant 2.4 eV conduction band offset in oxide-based QW optoelectronic devices has so far been largely ignored. Here, we demonstrate room-temperature intersubband absorption in STO/LAO QW heterostructures at energies on the order of hundreds of meV, including at energies approaching the critically important telecom wavelength of 1.55 μm. We demonstrate the ability to control the absorption energy by changing the width of the STO well layers by a single unit cell and present theory showing good agreement with experiment. A detailed structural and chemical analysis of the samples viascanning transmission electron microscopy and electron energy loss spectroscopy is presented. This work represents an important proof-of-concept for the use of transition metal oxide QWs in Si-compatible optoelectronic devices.

Alstonia scholarisis one of the most important medicinal plants and herein, we present the synthesis of zinc oxide nanoparticles using the bark extract of Alstonia scholaris,and evaluation of their antimicrobial efficacy. Stable ZnO nanoparticles were formed by treating 90 mL of 1 mM zinc nitrate aqueous solution with 10 mL of 10% bark extract. The formation of Alstonia scholarisbark extract mediated zinc oxide nanoparticles was confirmed by UV–visible spectroscopic analysis and recorded the localized surface plasmon resonance (LSPR) at 430 nm. Fourier transform infrared spectroscopic (FT-IR) analysis revealed that primary and secondary amine groups in combination with the proteins present in the bark extract is responsible for the reduction and stabilization of the ZnONPs. The crystalline phase of the nanocrystals was determined by XRD analysis and morphology was studied using transmission electron microscopy (TEM). The hydrodynamic diameter (26.2 nm) and a positive zeta potential (43.0 mV) were measured using the dynamic light scattering technique. The antimicrobial activity of Alstonia scholarisZnONPs was evaluated (in-vitro) using disc diffusion method against fungi, Gram-negative and Gram-positive bacteria which were isolated from the biofilm formed in drinking water PVC pipelines. The results obtained suggested that ZnO nanoparticles exhibit a good anti-fungal activity than bactericidal effect towards all pathogens tested in in-vitrodisc diffusion method (170 ppm, 100 ppm and 50 ppm). Further, the toxicity of biosynthesized ZnONPs was tested against Alstonia scholaristo evaluate the cytotoxic effect that displayed LC50value of 95% confidence intervals.

A novel Ni–Co–S-based material prepared by the potentiodynamic deposition from an aqueous solution containing Ni2+, Co2+, and thiourea is studied as an electrocatalyst for the hydrogen evolution reaction (HER) in a neutral phosphate solution. The composition of the catalyst and the HER activity are tuned by varying the ratio of the concentrations of Ni2+and Co2+ions in the electrolytes. Under optimized deposition conditions, the bimetallic Ni–Co–S exhibits higher electrocatalytic activity than its monometallic counterparts. The Ni–Co–S catalyst requires an overpotential of 150 mV for the HER onset, and 10 mA cm–2current density is obtained at 280 mV overpotential. The catalyst exhibits two different Tafel slopes (93 and 70 mV dec–1) indicating two dissimilar mechanisms. It is proposed that the catalyst comprises two types of catalytic active sites, and they contribute selectively toward HER in different potential regions.

In the pursuit to develop practical sodium-ion batteries, safe negative insertion (anode) materials are essential. Recently, Na2Ti6O13 has been unveiled by conventional solid-state synthesis as a 0.85 V anode with 1-dimensional Na+ diffusion pathways. Here, an energy-savvy autocombustion synthesis has been successfully implemented to produce the target compound Na2Ti6O13 by restricting the annealing duration within 2 h. This drastic reduction in heat-treatment time involves minimal grain-growth hence forming homogeneous nanostructured particles ([?]100 nm). It benchmarks the shortest synthesis of Ti-based anodes for sodium-ion batteries. The current work describes various aspects of autocombustion route. The as-prepared compound delivers near theoretical capacity (ca. 40 mAh g[?]1) involving a Ti4+/Ti3+ redox potential centered at 0.83 V (vs. Na/Na+) with excellent reversibility. Using both experiment and bond valence site energy (BVSE) modeling, the electrochemical, Na+ diffusion pathways and corresponding energy barriers have been explained.

The Internet of Things (IoT) is an innovative technology that makes it possible for physical objects like sensors, cameras, household appliances, and other objects to interact and communicate with one another. The Internet of Things (IoT) devices may exchange critical data, which makes battery/power, connectivity, and security issues crucial. An automated system for identifying and reporting abnormalities to a central controller is a prerequisite for this. In order to distinguish between approved and legitimate IoT devices, this method should be able to. IoT devices that are malicious, non-IoT devices that are malicious, and other man-in-the-middle traffic sources must all be isolated to prevent noncompliance. For improved QoS management, this aids in the formulation of administrative rules and the regulation and enforcement of network traffic. A framework-based Convolutional Neural Network (CNN) is suggested in this research to discover the aforementioned problems in IoT devices. A system that classifies IoT devices into their respective categories and reliably identifies new entries has been developed based on CNN. The findings demonstrate that CNN is capable of classifying IoT devices into the appropriate categories with the necessary accuracy as well as identifying between IoT and non-IoT devices with better accuracy.

Internet applications nowadays combine globally shared resources into a single software platform. It's a difficult technology issue to supply reports for the resource consumption among those World Wide Web applications. The formulation and simulation of spread levels were introduced in this report. Spread frequency operates together again to impose a worldwide speed restriction over revenue aggregated at several locations allowing for the synchronized monitoring of an internet company's activity. Assures that traffic delays mass transit streams act as passing through a unique, common limitation network. We describe two models overall and the other TCP-optimized—that permits network operators to expressly balance away transmission cost with network correctness, speed, and scaling. All these approaches could speed restrict 1000s of streams with little expense (less than 3% in the tested configuration). We show that with us TCP-centric architecture could scale to hundreds of servers whilst remaining resilient towards both outages and transmission postponement, suitable for countrywide telecom operators.

Exploring future cathode materials for sodium-ion batteries, alluaudite class of Na2FeII2(SO4)3has been recently unveiled as a 3.8 V positive insertion candidate (Barpanda et al. Nat. Commun. 2014, 5, 4358). It forms an Fe-based polyanionic compound delivering the highest Fe-redox potential along with excellent rate kinetics and reversibility. However, like all known SO4-based insertion materials, its synthesis is cumbersome that warrants careful processing avoiding any aqueous exposure. Here, an alternate low temperature ionothermal synthesis has been described to produce the alluaudite Na2+2xFeII2-x(SO4)3. It marks the first demonstration of solvothermal synthesis of alluaudite Na2+2xMII2-x(SO4)3(M = 3d metals) family of cathodes. Unlike classical solid-state route, this solvothermal route favors sustainable synthesis of homogeneous nanostructured alluaudite products at only 300 °C, the lowest temperature value until date. The current work reports the synthetic aspects of pristine and modified ionothermal synthesis of Na2+2xFeII2-x(SO4)3having tunable size (300 nm ∼5 μm) and morphology. It shows antiferromagnetic ordering below 12 K. A reversible capacity in excess of 80 mAh/g was obtained with good rate kinetics and cycling stability over 50 cycles. Using a synergistic approach combining experimental and ab initio DFT analysis, the structural, magnetic, electronic, and electrochemical properties and the structural limitation to extract full capacity have been described.

Gradient metasurfaces have recently been demonstrated to provide control of the phase of scattered fields over subwavelength scales, enabling a broad range of linear optical components in a flat, ultrathin, integrable platform. Additionally, the development of nonlinearmetasurfaces has disrupted conventional nonlinear optical device design by relaxing phase matching constraints, reducing size and dimensionality, and providing record values of localized nonlinear responses. However, extending the “flat optics” paradigm to the nonlinear case faces important challenges, since we are required to simultaneously achieve efficient frequency conversion and sub-diffractive phase control. Here, we experimentally demonstrate continuous phase control of the giant nonlinear second harmonic optical response from metasurfaces tied to intersubband transitions in semiconductor multi-quantum wells, establishing an exciting path toward realizing the vision of flat, nonlinear optics.

This paper proposes a novel image segmentation using Multi-Hyperbolic Tangent Fuzzy C-Means (HTFCM) algorithm, with spatial information for medical image segmentation. The proposed method uses two hyperbolic tangent functions with the spatial information of neighbouring pixels for clustering of images. The performance of the proposed algorithm is tested on OASIS-MRI image data set. The performance is tested in terms of score, number of iterations (NI) and execution time (TM) under different Gaussian and salt & pepper noises on OASIS-MRI data set. The results after investigating the proposed method show a significant improvement as compared to other existing methods in terms of score, NI and TM under different Gaussian and salt & pepper noises on OASIS-MRI data set.

Large-scale production of hydrogen gas by water electrolysis is hindered by the sluggish kinetics of oxygen evolution reaction (OER) at the anode. The development of a highly active and stable catalyst for OER is a challenging task. Electrochemically prepared amorphous metal-based catalysts have gained wide attention after the recent discovery of a cobalt-phosphate (Co-Pi) catalyst. Herein, an amorphous iridium-phosphate (Ir-Pi) is investigated as an oxygen evolution catalyst. The catalyst is prepared by the anodic polarization of carbon paper electrodes in neutral phosphate buffer solutions containing IrCl3. The Ir-Pi film deposited on the substrate has significant amounts of phosphate and Ir centers in an oxidation state higher than +4. Phosphate plays a significant role in the deposition of the catalyst and also in its activity toward OER. The onset potential of OER on the Ir-Pi is about 150 mV lower in comparison with the Co-Pi under identical experimental conditions. Thus, Ir-Pi is a promising catalyst for electrochemical oxidation of water.

Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant condition caused by mutations in the FLCNgene and characterized by benign hair follicle tumors, pneumothorax, and renal cancer. Folliculin (FLCN), the protein product of the FLCNgene, is a poorly characterized tumor suppressor protein, currently linked to multiple cellular pathways. Autophagy maintains cellular homeostasis by removing damaged organelles and macromolecules. Although the autophagy kinase ULK1 drives autophagy, the underlying mechanisms are still being unraveled and few ULK1 substrates have been identified to date. Here, we identify that loss of FLCN moderately impairs basal autophagic flux, while re-expression of FLCN rescues autophagy. We reveal that the FLCN complex is regulated by ULK1 and elucidate 3 novel phosphorylation sites (Ser406, Ser537, and Ser542) within FLCN, which are induced by ULK1 overexpression. In addition, our findings demonstrate that FLCN interacts with a second integral component of the autophagy machinery, GABA(A) receptor-associated protein (GABARAP). The FLCN-GABARAP association is modulated by the presence of either folliculin-interacting protein (FNIP)-1 or FNIP2 and further regulated by ULK1. As observed by elevation of GABARAP, sequestome 1 (SQSTM1) and microtubule-associated protein 1 light chain 3 (MAP1LC3B) in chromophobe and clear cell tumors from a BHD patient, we found that autophagy is impaired in BHD-associated renal tumors. Consequently, this work reveals a novel facet of autophagy regulation by ULK1 and substantially contributes to our understanding of FLCN function by linking it directly to autophagy through GABARAP and ULK1.

Methamphetamine (MA), which remains one of the widely used drugs of abuse, is metabolized by the cytochrome P450 (P450) family of enzymes in humans. However, metabolism of methamphetamine in macaques is poorly understood. Therefore, we first developed and validated a very sensitive liquid chromatography with tandem mass spectrometry (LC-MS/MS) method using solid phase extraction of rhesus plasma with a lower limit of quantitation at 1.09 ng/ml for MA and its metabolites, 4-hydroxy methamphetamine (4-OH MA), amphetamine (AM), 4-OH amphetamine (4-OH AM), and norephedrine. We then analyzed plasma samples of MA-treated rhesus, which showed >10-fold higher concentrations of AM (∼29 ng/ml) and 4-OH AM (∼28 ng/ml) than MA (∼2 ng/ml). Because the plasma levels of MA metabolites in rhesus were much higher than in human samples, we examined MA metabolism in human and rhesus microsomes. Interestingly, the results showed that AM and 4-OH AM were formed more rapidly and that the catalytic efficiency (Vmax/Km) for the formation of AM was ∼8-fold higher in rhesus than in human microsomes. We further examined the differences in these kinetic characteristics using three selective inhibitors of each human CYP2D6 and CYP3A4 enzymes. The results showed that each of these inhibitors inhibited both d- and l-MA metabolism by 20%–60% in human microsomes but not in rhesus microsomes. The differences between human and rhesus CYP2D6 and CYP3A4 enzymes were further assessed by docking studies for both d and l-MA. In conclusion, our results demonstrated an enhanced MA metabolism in rhesus compared with humans, which is likely to be caused by differences in MA-metabolizing P450 enzymes between these species.

Introduction:The oral mucosa is an appropriate route for drug delivery systems, as it evades first-pass metabolism, enhances drug bioavailability and provides the means for rapid drug transport to the systematic circulation. This delivery system offers a more comfortable and convenient delivery route compared with the intravenous route. Although numerous drugs have been evaluated for oral mucosal delivery, few of them are available commercially. This is due to limitations such as the high costs associated with developing such drug delivery systems.Areas covered:The present review covers recent developments and applications of oral transmucosal drug delivery systems. More specifically, the review focuses on the suitability of the oral soft palatal site as a new route for drug delivery systems.Expert opinion:The novelistic oral soft palatal platform is a promising mucoadhesive site for delivering active pharmaceuticals, both systemically and locally, and it can also serve as a smart route for the targeting of drugs to the brain.

The specific ionic conductivities for a thin film of dilithium phthalocyanine (Li2Pc) dried at 160degC and for a pressed pellet of single crystals of Li2Pc have been determined via impedance analysis as a function of temperature. The specific ionic conductivity of the thin film is on the order of mS/cm from -50 to +50degC with an energy of activation of 0.063 eV. The specific ionic conductivity for the pressed pellet is on the order of 10-4 S/cm from 0 to +50degC with an energy of activation of 0.038 eV. The results suggest that lithium ion conduction takes place between the planes of the complex anions of Li2Pc, parallel to the a-axis.

Francisella tularensis, a gram‐negative, facultative, intracellular bacterium, is the etiologic agent of tularemia and a category A bioterrorism agent. Little is known about the mechanism of pathogenesis of tularemia. In this paper, we describe the interaction of the live vaccine strain of F. tularensiswith the innate immune system. We have found that in human and mouse dendritic cells, F. tularensiselicited a powerful inflammatory response, characterized by production of a number of cytokines and chemokines. Using cells derived from TLR2‐deficient mice and in vitro transfection assays, we demonstrated that this response was mediated by TLR2 and did not require the LPS‐binding protein. F. tularensisappeared to activate TLR2/TLR1 and TLR2/TLR6 heterodimers. IL‐1β secretion, a reflection of caspase‐1 activation, was induced by live but not heat‐killed F. tularensis, despite the fact that both forms of the bacterium equally induced the IL‐1β transcript. Our results identified activation of TLR2 and caspase‐1 as the two main cellular pathways responsible for the inflammatory response to F. tularensis.

To investigate the consequences of the impaired parasite-specific immune response in lymphatic filariasis, the effect of concurrent Wuchereria bancrofti infection on the immune response to tetanus toxoid (TT) following tetanus vaccination was studied in 20 asymptomatic microfilaremic (MF) patients, 20 patients with chronic lymphatic obstruction/elephantiasis (chronic pathology [CP]), and 10 endemic normal (EN) control individuals at baseline and at 3 and 6 months after TT vaccination. Peripheral blood mononuclear cell (PBMC) proliferative responses to TT before vaccination were not significantly different between the EN control and CP groups, but the MF group showed significantly lower baseline proliferative responses to TT compared with either the EN or CP group. Six months following vaccination, the change in proliferative response to TT was significantly greater in the EN and CP groups than in the MF group. This difference in proliferative response was reiterated in the gamma interferon (IFN-gamma) response in the EN group, in that they increased IFN-gamma production by 400% at 6 months, in contrast to that seen in the filaria-infected groups. In contrast to the IFN-gamma responses, PBMCs from the MF group produced significantly increased levels of TT-specific IL-10 compared with PBMCs from the EN group. Although there was significantly greater TT-specific immunoglobulin G (IgG) production at baseline between the EN and MF groups, postvaccination IgG (and IgG1 isotype) responses did not differ among the groups, whereas TT-specific IgG2, IgG3, and IgG4 were all increased in the EN group compared with the filaria-infected groups. These studies indicate that concurrent infection with W. bancrofti can diminish the immune response to an unrelated antigen by a mechanism that is likely to involve IL-10.

Although the BCG vaccine offers partial protection, tuberculosis remains a leading cause of infectious disease death, killing ∼1.5 million people annually. We developed mucosal vaccines expressing the autophagy-inducing peptide C5 and mycobacterial Ag85B-p25 epitope using replication-defective human adenovirus (HAdv85C5) and bovine adenovirus (BAdv85C5) vectors. BAdv85C5-infected dendritic cells (DCs) expressed a robust transcriptome of genes regulating antigen processing compared to HAdv85C5-infected DCs. BAdv85C5-infected DCs showed enhanced galectin-3/8 and autophagy-dependent in vitroAg85B-p25 epitope presentation to CD4 T cells. BCG-vaccinated mice were intranasally boosted using HAdv85C5or BAdv85C5followed by infection using aerosolized Mycobacterium tuberculosis(Mtb). BAdv85C5protected mice against tuberculosis both as a booster after BCG vaccine (>1.4-log10reduction in Mtb lung burden) and as a single intranasal dose (>0.5-log10reduction). Protection was associated with robust CD4 and CD8 effector (TEM), central memory (TCM), and CD103+/CD69+lung-resident memory (TRM) T cell expansion, revealing BAdv85C5as a promising mucosal vaccine for tuberculosis.

Presents several letters to the editor about issues concerning software patterns and black marketing, published in the January 1, 1997 issue of the journal "Communications of the ACM." Implications of junk mail for the Internet privacy; Questions raised over the enforceability of laws governing the use of personal information; Drawbacks of software patterns developed by software engineers.

Aim: Accurate causality assessment (CA) of adverse events (AEs) is important in clinical research and routine clinical practice. The Naranjo scale (NS) used for CA lacks specificity, leading to a high rate of false positive causal associations. NS is a simple scale for CA; however, its limitations have reduced its popularity in favour of other scales. We therefore attempted to improvise the algorithm by addressing specific lacunae in NS.Methods: We attempted to modify the existing NS by (a) changing the weightage given to certain responses, (b) achieving higher resolution to certain responses for delineating drug related and unrelated AEs and (c) modifying the slabs for classification of association as ‘likely’ and ‘unlikely’. The new scale, named as the Sharma-Nookala-Gota (SNG) algorithm, was evaluated in a training set of 19 AEs in a tertiary care cancer hospital in western India, and further validated in a set of 104 AEs. Consensus of four physician opinion was taken as gold standard for comparison.Results: Of the 19 AEs in the training set, 6 were described by the treating physician as ‘not related’ and 13 as related to the drug. The SNG algorithm had 100% concordance with physician opinion, whereas the NS had only 73.7% concordance. NS showed a tendency to misclassify AEs as ‘related’ when they were indeed ‘not related’. In the validation set of 104 AEs, NS and SNG algorithms misclassified 30 and 2 AEs, respectively, leading to a concordance of 70.2% and 98.1%, respectively, with physician opinion.Conclusion: Decisive modifications of the NS resulted in the SNG scale, with superior specificity while retaining sensitivity against the gold standard.Plain Language Summary SNG algorithm – A novel tool for causality assessment of adverse drug reactions Adverse events (AEs) can cause increased morbidity, hospitalisation, and even death. Hence it is essential to recognise AEs and to establish their correct causal relationship to a drug. Many causality assessment methods, scales and algorithms are available to assess the relationship between an AE and a drug. The Naranjo algorithm is most commonly employed in spite of its many drawbacks as it is simple to use. Concerns have been raised regarding the performance of the scale, and researchers have tried to answer them, but none of them could address all issues satisfactorily. We too experienced many problems while using it in our routine clinical practice and in clinical trials. For instance, the Naranjo scale is non-specific and shows a bias toward implicating the drug as the causal factor for AEs. This improper assessment has often led to drug discontinuation, thereby compromising the efficacy of treatment. Hence, we modified the existing Naranjo scale to a new one (the Sharma-Nookala-Gota – SNG algorithm) to address these shortcomings. We piloted the SNG causality assessment algorithm in patients suffering from AEs due to various drugs. The SNG algorithm was found to have good concordance with the physicians’ assessment of causality. As a next step, we validated the SNG algorithm in patients receiving a standard drug combination of pemetrexed and carboplatin for lung cancer combination. Out of the 104 AEs observed in 65 patients, the SNG causality assessment algorithm showed good concordance (except in two cases) with the physicians’ decision of causality assessment, while the Naranjo algorithm was not so successful. Hence, the SNG algorithm can be a better guide for causality assessment of AEs.

One of the main domains of paediatric dentistry is providing oral health care, especially to the children with special needs, like those affected with autism spectrum disorder (ASD). Such children exhibit poor oral hygiene primarily due to their limited communication ability, lack of joint attention, oversensitivity to sensory stimuli and motor coordination deficits. In such cases, multiple studies suggest and emphasize on the importance of early use of interventional services. Children affected with ASD tend to be visual learners, and therefore, are better suited for visual interventional methods. Amongst which, picture exchange communication system (PECS), originally developed by Bondy-Frost, is gaining rapid momentum. It is suggested to help individuals to initiate requests and communicate their needs via picture cards; hence aid in acquiring functional communication and speech, improve socio-communicative impairments, and decrease the behavioural problems. This scoping review aims to raise awareness on PECS amongst the dental fraternity, by emphasizing its usage pertaining to dentistry. PECS though rated hard, has proved to be beneficial in improving oral hygiene practices among autistic children.

A universally accepted strategy for therapeutic drug monitoring (TDM) of mycophenolate mofetil (MMF) in the prevention of acute graft-versus-host disease (aGVHD) in allogenic hematopoietic stem cell transplantation (alloHSCT) does not exist. We explored the feasibility of developing a limited sampling strategy (LSS) for TDM of MMF in this setting. Patients undergoing alloHSCT received standard MMF-cyclosporine prophylaxis, with MMF administered twice daily (BD) for matched transplant recipients or thrice daily (TID) in haploidentical transplantation. Intensive blood sampling was carried out on day 7 and area under the concentration–time curve (AUC) of mycophenolic acid (MPA), the active metabolite, was estimated using noncompartmental analysis. The ability of MPA exposure defined by AUC0-12to discriminate between responders (patients who did not develop GVHD) and nonresponders (patients who developed GVHD) was determined by receiver operating characteristic curve analysis. Patients were divided into training and validation sets within BD and TID groups. Mathematical equations were developed from the training set to predict AUC0-12from an abbreviated AUC involving a limited number of sampling points. The equations were validated in the validation set by comparing the MPA AUC0-12predicted from LSS with the observed AUC0-12. It was observed that patients with AUC0-12≤18.99 mg*h/L had a higher risk of developing aGVHD [odds ratio (OR) = 2.63 (1.17 to 5.87), P= 0.06]. The benefit was more in matched transplant recipients [OR = 3.5 (1.30 to 9.49), P= 0.05] as compared to haploindentical transplant [OR = 2.8 (0.49 to 15.91), P= NS]. Using the mathematical equations, the observed AUC0-12was predicted with 92.31% accuracy in the BD subset and 100% accuracy in the TID subset for a combined accuracy of 94.76%. A set of just three samples that constituted the abbreviated AUC1-4was used to develop the predictive models. The LSS could be employed for the therapeutic monitoring of MMF particularly in patients undergoing matched hematopoietic stem cell transplantation.

Invasive group A streptococcus (GAS) infections include necrotizing soft tissue infections (NSTI) and streptococcal toxic shock syndrome (STSS). We have previously shown that host HLA class II allelic variations determine the risk for necrotizing fasciitis (NF), a dominant subgroup of NSTI, and STSS by modulating responses to GAS superantigens (SAgs).

In the pursuit to develop practical sodium-ion batteries, safe negative insertion (anode) materials are essential. Recently, Na2Ti6O13has been unveiled by conventional solid-state synthesis as a 0.85 V anode with 1-dimensional Na+diffusion pathways. Here, an energy-savvy autocombustion synthesis has been successfully implemented to produce the target compound Na2Ti6O13by restricting the annealing duration within 2 h. This drastic reduction in heat-treatment time involves minimal grain-growth hence forming homogeneous nanostructured particles (∼100 nm). It benchmarks the shortest synthesis of Ti-based anodes for sodium-ion batteries. The current work describes various aspects of autocombustion route. The as-prepared compound delivers near theoretical capacity (ca. 40 mAh g−1) involving a Ti4+/Ti3+redox potential centered at 0.83 V (vs. Na/Na+) with excellent reversibility. Using both experiment and bond valence site energy (BVSE) modeling, the electrochemical, Na+diffusion pathways and corresponding energy barriers have been explained.