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We study the chaotic signatures of the geodesic dynamics of a non-spinning test particle in the effective-one-body (EOB) formalism for the inspiral process of spinning binary black holes. We first show that the second order post-Newtonian (2PN) EOB dynamics is non-integrable by demonstrating that the EOB metric does not satisfy the criterion for the existence of Carter constant. We then employ the numerical study to find the plateaus of the rotation curve, which are associated with the existence of Birkhoff islands in the Poincar\'e surface of section, signifying the chaotic dynamics in the system. Our results show the signatures of chaos for the EOB dynamics, especially in the regime of interest for which the Kerr bounds of the component black holes hold. We also find that chaotic behavior is more obvious as the spin parameter $a$ of the deformed EOB background metric increases. Our results can help to uncover the implications of dynamical chaos in gravitational wave astronomy. Finally, we also present some preliminary results due to corrections at 3PN order., Comment: 19 pages, 11 figures. Improvements and references added. Accepted for publication in Phys. Rev. D

Advancing Health Equity Through Innovations and Technology This year’s summit was unique given the COVID-19 pandemic: a major global outbreak that has imposed severe restrictions in all aspects of our life. At the outset, we were faced with three mutually exclusive options. First option was to cancel the summit in its entirety: this was the easiest and most obvious choice once the COVID-19 pandemic forced a near total lockdown all over the country with unprecedented disruptions of normal daily activities as the disease announced its thunderous touchdown on United States (US) soil. It was also the most-logical response faced with uncertainty regarding summit logistics and expected poor attendance due to the raging pandemic. Second option was to conduct a digital summit restricted to local audiences at Baylor College of Medicine: this option entailed implementing a virtual summit with attendance restricted to participants from our institution only. It sounded like a reasonable choice but that would impede the presence of diversity of topics, perspectives, insights and experiential learning opportunities, which are what render the summit exciting and worth attending. And finally, the last option was to conduct a digital unrestricted summit open to all interested audiences throughout the US. The conduct of a virtual summit open to all participants from around the country was initially considered daunting given the likelihood of amplified technical problems associated with an array of internet access differentials around the country, which would require a strong Information Technology (IT) presence throughout the sessions. Nonetheless, the attractiveness of going national with a virtual summit, despite the pandemic and logistical challenges, slowly gained converts and became the dominant choice. The response and level of participation in this first virtual summit showed an unanticipated surge despite the increase in registration fees to cover IT costs. This year, we had attendees from all regions of the US as well as from the United Kingdom. The range of topics was quite diverse encompassing health disparities in relation to cancers, nutrition, musculo-skeletal disorders, amputation rates, vaccination uptakes and COVID-19 infections. Various solutions were passionately presented to address these disparities including novel health technologies, community engagement and partnerships, improvement in health literacy and alternative therapeutics. There were no hitches despite the complex breakout sessions, and above all, attendees were satisfied and offered outstanding evaluation scores. This was definitely a summit that metamorphosed from pessimism to a triumphant success! Copyright © 2020 Salihu 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) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Background and purpose Design-based research (DBR) processes aim to connect educational research with instructional techniques by focusing on the development and evaluation of multiple iterations of learning activities for systematic improvement within learning environments. Desirable difficulties (DD) are purposeful challenges introduced to facilitate deeper learning of material. The purpose of this work was to evaluate a second iteration of a sterile compounding DD study in the context of DBR in order to allow for the identification and refinement of the educational methods. Educational activity and setting In this second iteration, doctor of pharmacy students in their second professional year were exposed to both a mechanical and mathematical difficulty in sterile compounding training. Afterwards, students completed a questionnaire to rate their change in confidence and reflect on the activity. Findings An increase in confidence in sterile compounding skills was seen by the majority (97.9%) of students. Students' reflections highlighted gains in strategic knowledge, split between internal and external strategies. Summary Course instructors saw value in the refinement of a DD sterile compounding activity and plan to continue incorporating DBR processes in order to allow for the further improvement of this educational method. Faculty at other institutions could apply these processes to further refine a variety of educational activities.

Bacterial infections represent a major cause of mortality and morbidity in patients with cirrhosis that can alter the clinical course of compensated cirrhosis. The most common infections are spontaneous bacterial peritonitis by gram-negative organisms, urinary-tract infection, and pneumonia. In this case report, we raise the question of considering infections in the prognosis scoring in this patient group.

Pregnancy is a happy time for most women. While most mothers experience an average pregnancy, there are certain child problem occur in case of future life of baby. so given knowledge of anemia and dietary patterns may help to mothers for making bright future of her child. A study was conducted a comparative study to assess the knowledge regarding anemia and dietary pattern between anemic and non anemic antenatal mothers at selected hospital, Rajkot. The hypothesis of the study was There will be significant relationship between knowledge and dietary pattern among anemic and non anemic antenatal mothers. The extensive review of literature facilitates the investigator to collect the relevant information of facts to support the study. The conceptual framework of this study was based on health belief model.

Background: Dengue is a mosquito-borne human viral disease, which has become a major public health problem recently. The clinical manifestation of dengue infection varies from asymptomatic to severe fatal condition in the form of dengue hemorrhagic fever/dengue shock syndrome. Objectives: The objectives of this study were to study the clinical profile and hematological changes in dengue fever. Materials and Methods: This prospective observational study was carried out at a tertiary care hospital from March 2017 to August 2018. The study population included dengue positive patients admitted to the pediatric ward. All the children age up to 12 years with positive dengue test either NS1 antigen or IgM/IgG antibodies by rapid serological test kit or ELISA were included in the study. Results: Of 105 cases, the most common clinical feature was fever (100%) with raised hematocrit value (45.8%), leukopenia (38.1%), and thrombocytopenia (74%). Conclusion: Hematological profile with thrombocytopenia, raised hematocrit, and leukopenia with raised serum glutamic-pyruvic transaminase gives enough clues to test for dengue serology to reduce the morbidity and mortality by early diagnosis and management of dengue illness.

Drug development of transformative medicine has compounding complexity as researchers seek to address the varying needs of patients, providers, payers, and policymakers. Patient engagement frameworks and guidance are under development with health authorities that will further guide patient engagement in drug research. Patient insights have been captured in registries, online health networks, and other forums to inform evidence on disease progression and identify gaps in care. Patient representation and disease awareness have improved in partnership with patient advocacy groups that have led to patient-informed drug development. One effort to incorporate the patient voice into early research and development (R&D) is the Patient Insights Database (PID). Currently comprising 102 indications, the PID was developed to uncover trends in mixed methods research data, including direct patient interviews and evidence-based medicine. The database is used to understand patient symptomology, diagnosis, treatment, health-related quality of life (HR-QoL), economic burden, and hope for new therapies, based on patient interviews, patient testimonials, real-world evidence studies, and HR-QoL research. A deep understanding of the patient experience informs internal R&D decisions to bring forth healthcare solutions that address patient needs.

Atrial fibrillation (AF) carries substantial morbidity and mortality. Evidence-based guidelines have been synthesized into emergency department (ED) AF care pathways, but the effectiveness and scalability of such approaches are not well established. We thus evaluated the impacts of an algorithmic care pathway for ED management of non-valvular AF (EDAFMP) on hospital use and care process measures.We deployed a voluntary-use EDAFMP in 4 EDs (1 tertiary hospital, 1 cardiac hospital, 2 community hospitals) of an integrated delivery organization using a multifaceted implementation approach. We compared outcomes between patients with AF treated using the EDAFMP and historical and contemporaneous "usual care" controls, using a propensity-score adjusted generalized estimating equation. Patients with an index ED encounter for a primary visit reason of non-valvular AF (and no excluding concurrent diagnoses) were eligible for inclusion.Preimplementation (January 1, 2016-December 31, 2016), 628 AF patients were eligible; postimplementation (September 1, 2017-June 30, 2019), 1296, including 271 (20.9%) treated with the EDAFMP, were eligible. EDAFMP patients were less likely to be admitted than both historical (adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.45, 0.29-0.71) and contemporaneous controls (aOR, 95%CI: 0.63, 0.46-0.86). ED visits and hospital readmissions over 90 days subsequent to index ED encounters were similar between postimplementation EDAFMP and usual care groups. EDAFMP patients were more likely to be prescribed anticoagulation (38% v. 5%,EDAFMP use is associated with decreased hospital admission during an index ED encounter for non-valvular AF, and improved delivery of AF care processes.

Cortexolone 17 alpha-propionate, also known as clascoterone, is a potent androgen receptor inhibitor intended for the topical treatment of skin diseases associated with androgenic pathway alterations. In nonclinical studies, cortexolone 17 alpha-propionate was found to have a weak inhibitory effect on human Ether-a-go-go-Related Gene (hERG) potassium channels, which are vital for normal electrical activity in the heart. When used in a cream formulation, little cortexolone 17 alpha-propionate is absorbed. However, the solution formulation developed for the treatment of androgenetic alopecia leads to a measurable systemic concentration and accumulation of the antiandrogen. This phase 1 study assessed the effect of cortexolone 17 alpha-propionate on the QTc interval using concentration-effect analysis and the effect of a meal on QTc to confirm assay sensitivity. Thirty-two volunteers were randomly assigned to receive the active drug or a matching vehicle as placebo. Participants were dosed twice daily on days 1 to 3 (225 mg applied topically as a 7.5% solution 12 hours apart) and once on day 4. Pharmacokinetic and electrocardiogram assessments were performed after supratherapeutic doses. Assay sensitivity was successfully confirmed by using the food effect on the QTc interval. The results of this concentration-QTc analysis demonstrate that cortexolone 17 alpha-propionate and its metabolite/degradation product had no effect on the QTc interval in the concentration range tested.

The strong gravitational field near massive blackhole is an interesting regime to test General Relativity(GR) and modified gravity theories. The knowledge of spacetime metric around a blackhole is a primary step for such tests. Solving field equations for rotating blackhole is extremely challenging task for the most modified gravity theories. Though the derivation of Kerr metric of GR is also demanding job, the magical Newmann-Janis algorithm does it without actually solving Einstein equation for rotating blackhole. Due to this notable success of Newmann-Janis algorithm in the case of Kerr metric, it has been being used to obtain rotating blackhole solution in modified gravity theories. In this work, we derive the spacetime metric for the external region of a rotating blackhole in a nonlocal gravity theory using Newmann-Janis algorithm. We also derive metric for a slowly rotating blackhole by perturbatively solving field equations of the theory. We discuss the applicability of Newmann-Janis algorithm to nonlocal gravity by comparing slow rotation limit of the metric obtained through Newmann-Janis algorithm with slowly rotating solution of the field equation., Comment: 8 pages, 1 figure, minor corrections, references added; to appear in EPJC

Background: Ovarian tumours account for 30% of all cancers of female genital tract. The study of histology of ovarian masses therefore is of prime importance. The objective of the study was the clinical and histopathological presentation of ovarian masses. Methods: This is a retrospective analysis of 44 patients with ovarian masses from January 2014 to December 2014 at P. D. U. Medical College, Rajkot. Patients with ovarian masses who were surgically managed were included in the study. Patients with non-ovarian masses and those who were conservatively managed were excluded. The data was collected in Excel Sheet and analyzed by descriptive statistics and Chi-Square Test. Results: Incidence of Ovarian masses was 20.85 % in our Institute. Among 44 cases 54.5 % were neoplastic. Among the neoplasms 95.83% were benign and 4.16% were malignant. Mean age of presentation of benign neoplasm was 38years and that of malignant was 50 years. Incidence of non-neoplastic ovarian masses was 45.5 %. Mean age of presentation of non-neoplastic ovarian masses was 31 years. Pain in abdomen was the most common clinical presentation of both neoplastic and non-neoplastic ovarian masses. Mucinous Cystadenoma and Teratoma-Dermoid Cyst were the commonest benign tumor followed by Serous Cystadenoma. Conclusions: In our study, non-neoplastic ovarian masses presented in equal proportions as that of neoplastic ovarian masses. 31-40 years age group showed the highest propensity of occurrence of Ovarian Masses. Mucinous Cystadenoma was highly emerged most common benign Ovarian Mass in this study.

Background: The indications for cesarean sections have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economic and medico legal factors play a role in this rising trend of cesarean section. Initially it was performed mainly for maternal interest but recently the health of the fetus has played a significant role in making the decision for a cesarean birth. This study was conducted to determine the rate, indications and complications of primary cesarean section in primi and multiparae. Methods: This was a cross sectional study carried out on primary cesarean section in the Department of Obstetrics and Gynecology, P.D.U. Medical College and Hospital, Rajkot during one year period from April 1, 2014 to March 31, 2015. During this study, patients (booked or unbooked) attending the labour room, undergoing primary cesarean section in the department will be selected according to the inclusion criteria. Their intraoperative and postoperative complications would be noted and also maternal and fetal morbidities and complications if any. The study does not include women who had Gestational age of less than 28 weeks, who underwent cesarean section in previous pregnancy, previous uterine surgery or hysterotomy and who had multiple gestations. Results: Out of 7295 deliveries performed during one year period, overall 1349 CS were performed with an incidence of 18.5%. The frequency of primary cesarean section was higher in primipara (72.4%) than multipara (27.6%) women. Emergency cesarean section (79.3%) was performed more than elective cesarean section (20.7%) in both the study group and most of them, did not taken ANC. 28.5% of the patients were unbooked and 46.6% of the patients were referred. Illiteracy was present in 31.7% cases and 62.6% cases belonged to rural areas. Anemia, malpresentations, oligohydramnios, eclampsia and preeclampsia were more common antenatal complications in primipara patients than multipara patients, while APH was more common complication in multiparity. In unbooked patients, anemia was found more commonly. Malpresentation (34.3%) was the commonest indication for cesarean sections in both the study groups. Intraoperative complications like extension of uterine incision, placenta praevia, PPH were found more in caesarean section done in emergency than electively and more in multipara patients. Maternal morbidity was seen in 18.5% of cases and more in multipara (25.4%) than primipara (15.9%). Abdominal distension, wound gap and fever were the common morbidities while no maternal mortality in the present study. 330 out of 685 babies were admitted in NICU and majority of them were for jaundice, preterm care and birth asphyxia. Perinatal mortality in the study was 6.6% and among them antepartum hemorrhage has the highest perinatal mortality rate. Prematurity was the most common cause of neonatal deaths. Conclusions: From this tudy, we concluded that overall CS rate is 18.5% and rate of vaginal delivery is 82.1% of the present study from 1st April 2014 to 31st March 2015. While primary cesarean section rate is 55.8%, more in primipara as compared to multipara. The malpresentation was the major indication in primary cesarean section, in both primipara and multipara women in our community, while APH is still a major problem of the multiparity. Anemia, malpresentation, eclampsia and preeclampsia were more common antenatal complications in primipara while APH was antenatal complication in multiparity. Malpresentation (34.3%) was the commonest indication for cesarean section in both the groups.

Here, we derive the metric for the spacetime around rotating object for the gravity action having nonlocal correction of $R\Box^{-2} R $ to the Einstein-Hilbert action. Starting with the generic stationary, axisymmetric metric, we solve the equations of motion in linearized gravity limit for the modified action including energy-momentum tensor of the rotating mass. We also derive the rotating metric from the static metric using the Demanski-Janis-Newmann algorithm. Finally, we obtain the constraint on the value of $M$ by calculating the frame dragging effect in our theory and comparing it with that of General Relativity and Gravity Probe B results, where $M$ is the mass scale of the theory., 13 pages, 3 figures

Background Joint Commission mandates that prescribers document indication for antibiotics at the time of prescribing. Antibiotic indications may offer opportunities for pharmacists to optimize dosing and frequency or provide alternative therapeutic options. We examined the impact of antibiotic indications during order entry on frequency and type of pharmacist interventions, time to order verification, and time to administration of antibiotics. Methods Number of pharmacist interventions documented in EPIC from 4/28/17 through 4/28/18 (pre-intervention) were compared with interventions from 4/29/18 through 2/28/19 (post-intervention). All pharmacist interventions involving antibiotic orders were included. For antibiotic orders involving a pharmacist intervention, data collected included antibiotic prescribed, indication for antibiotic (post-intervention only) and reason for intervention. For administered antibiotics, data collected included order time, time of arrival of order in pharmacist queue, pharmacist verification time, patient administration time. Statistical analysis involved chi-squared test (compare the reason for intervention) and t-test (compare difference in time). Results There were 790 orders and 638 orders that involved a pharmacist’s interventions, pre-intervention and post-intervention, respectively (Tables 1 and 2). Pre-intervention, there were 200 antibiotic orders that had a documented pharmacist intervention and were administered. Post-intervention, there were 184 orders that had a documented pharmacist intervention and were administered. Abdominal/pelvic (29 orders, 16%), sepsis (19 orders, 10%), and surgical prophylaxis (18 orders, 9.7%) were the most frequent indications selected during order entry. Average time to order verification was 119 minutes pre-intervention and 123 minutes post-intervention (P =0.97). Average time to administration of antibiotics was 313 minutes and 360 minutes pre-intervention and post-intervention, respectively (P =0.45). Conclusion Inclusion of the selection of antibiotic indications during order entry did not significantly impact the number of pharmacist interventions, time to order verification nor time to administration. Disclosures All authors: No reported disclosures.

BACKGROUND: Infertility is social stigma. Male infertility also has significant contribution in Toto. Different habits among males i.e. smoking, tobacco chewing and alcohol intake have found adverse influence on sperm count and sperm motility. AIMS AND OBJECTIVES: To identify the role of smoking, tobacco chewing and alcohol in decreasing sperm count or motility. MATERIALS AND METHODS: Total 100 semen samples from the case of male infertility reported at C U Shah Medical College & Hospital were taken in this study. The results of alcoholics, tobacco chewers and smokers were studied and compared according to WHO guidelines, to that of non-alcoholics and non-smokers. RESULTS: Of 100 samples 68 showed decreased sperm count of which 39 men were chronic smokers, 26 men tobacco chewers and none drank chronically. 38 out of 100 samples showed decreased progressive motility, of which 21 men were addicted to either tobacco chewing or smoking. CONCLUSION: Smoking and tobacco chewing have a role in deteriorating the sperm quality and therefore in infertility of the male partners.

$f(R)$ modification of Einstein's gravity is an interesting possibility to explain the late-time acceleration of the Universe. In this work we explore the cosmological viability of one such $f(R)$ modification proposed by Kruglov [Phys. Rev. D 89, 064004 (2014)]. We show that the model violates fifth-force constraints. The model is also plagued with the issue of a curvature singularity in a spherically collapsing object, where the effective scalar field reaches the point of diverging scalar curvature.

Background: Inflammation substantially contributes to the development and progression of malignancies. cancer-related inflammation, has been proposed to promote tumor progression and serve as the seventh hallmark of tumor. Tumor microenvironment, products of inflammatory cells influence almost every aspect of tumorigenesis and tumor progression. Objective: The aim of this study was to design and evaluate drug candidates targeting cancer-related inflammation. Method: A series of 4-hydroxy- 3-(2- (2-[2- [(substituted phenyl)methylidene]hydrazin-1- yl]-1,3- thiazol-5- yl)-1- phenylethyl)-2H-chromen- 2-one (4a-j) were synthesized for its potential activity towards COX-2 inhibition and anticancer activity against MCF-7 and EAC cell lines. The structures of the synthesized compounds were elucidated using spectral data. Docking study was also performed to determine the probable binding mode of the compounds into the active site. Results: Compound 4b showed significant anti-inflammatory and anticancer activity. Conclusion: According to the results, it was concluded that designing compounds targeting cancer-related inflammation could be helpful in developing promising drug candidates for the treatment of cancer.

We propose a new model of f(R) gravity containing Arctan function in the lagrangian. We show here that this model satisfies fifth force constraint unlike a similar model in Kruglov 2013. In addition to this, we carry out the fixed point analysis as well as comment on the existence of curvature singularity in this model. The cosmological evolution for this f(R) gravity model is also analyzed in the Freidmann Robertson Walker(FRW) background. To understand observational significance of the model, cosmological parameters are obtained numerically and compared with those of Lambda cold dark matter ({\Lambda}CDM) model. We also scrutinize the model with supernova data. We apply Om diagnostic given by Sahni et al. 2008 to the model. Using this diagnostic, we detect the distinction between cosmic evolution caused by the f(R) model and {\Lambda}CDM. We find best-fit parameter values of the model using Baryon Acoustic Oscillations data., Comment: 22 pages, 22 figures, 2 table

Background: Dengue Fever (DF) is a self-limiting disease caused by arbovirus and transmitted by Aedes mosquitoes (Aedes aegypti and Aedes albopictus). It is one of the 17 neglected tropical diseases by WHO. Diagnosis of dengue depends mainly on the detection of IgM and IgG antibody, and NS1 antigen.Methods: The study was carried out in Department of Pathology, affiliated with a government hospital. It includes 82 dengue patients, admitted from August 2015 to August 2016. Haematological, biochemical profile, clinical signs and symptoms were recorded. The Tourniquet test was performed in all the patients on admission. Grading of dengue: DF/DHFI/DHFII/DHFIII/DHFIV. Grade III and IV were collectively called as Dengue Shock Syndrome.Results: Total 82 Dengue positive cases were studied, 52 (63%) were males and 30 (37%) were females. 24 (29%) patients were recorded in September 22 (27%) in October 19 (23%) in August. 12 (14.60%) had positive tourniquet test. Thrombocytopenia was present in 86.5 % patients. Majority cases were of classical dengue fever 51 (62.20%), 14 (17.07%) were of DHF I, 12 (14.63%) were of DHF II, 3 (3.66%) were of DHF III and 2 (2.44%) were of DHF IV.Conclusions: It is very important to correlate clinical examination with haematological and biochemical profile in dengue patients. Hematocrit value, leucopenia, thrombocytopenia, raised liver enzymes is very important to monitor dengue cases in their initial stages and thus facilitate early treatment. This would minimize morbidity and mortality arising out of serious complications of dengue fever.

Although $f(R)$ modification of late time cosmology is successful in explaining present cosmic acceleration, it is difficult to satisfy the fifth-force constraint simultaneously. Even when the fifth-force constraint is satisfied, the effective scalar degree of freedom may move to a point (close to its potential minima) in the field space where the Ricci scalar diverges. We elucidate this point further with a specific example of $f(R)$ gravity that incorporates several viable $f(R)$ gravity models in the literature. In particular, we show that the nonlinear evolution of the scalar field in pressureless contracting dust can easily lead to the curvature singularity, making this theory unviable., 15 pages, 4 figures, 1 table, minor changes in the text, a few references added

Reports of combined congenital abnormalities of gastric duplication cysts and accessory pancreatic lobes are rarely reported. Patients with such anomalies may require appropriate surgical intervention tailored to the individual patient for complete cure. A multimodality diagnostic approach using ultrasonography, CT and MRI is useful for appreciation of the relevant anatomy of the congenital abnormality and for proper surgical planning. We present a case of a gastric duplication cyst with accessory pancreatic lobe and ectopic pancreatic rest in a 5-year-old child presenting with symptoms of recurrent pancreatitis.