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Background: This study aimed to assess the accuracy of tricuspid spectral Doppler (E/A) and tissue Doppler parameters (E/E’) to diagnose right ventricular diastolic dysfunction (RVDD) in comparison to American Society of Echocardiography (ASE criteria) in pediatric tetralogy of Fallot (TOF) patients after surgical repair. Methods: This prospective, observational study was done at a tertiary care hospital involving 40 pediatric TOF patients aged less than 2 years who underwent complete intracardiac repair with cardiopulmonary bypass (CPB). Echocardiographic observations were made using a pediatric transesophageal echocardiography probe after surgical repair in the post-CPB period. The ASE-described parameters (late diastolic forward flow in the main pulmonary artery, right atrial dilatation, inferior vena cava dilatation, and hepatic venous flow reversal) were acquired to diagnose the RVDD. The tricuspid Doppler parameters (E/A and E/E’) were measured, and its predictive ability to diagnose RVDD was analyzed and compared with the ASE criteria. Results: Based on the ASE criteria, 13 patients (32.5%) were diagnosed to have RVDD. We found that an E/E’ ratio of ≥ 6.26 and an E/A ratio of >1.34 can be taken as the cutoff for diagnosing the RVDD. Based on the tricuspid Doppler parameters (E/A > 1.34 and E/E’ >6.26), 17 patients (42.5%) were diagnosed to have RVDD, which was comparable to that of the diagnosis by ASE criteria (P > 0.05). Conclusion: The results suggested that the use of tricuspid Doppler parameters can be equally accurate and reproducible to the current ASE-described echocardiographic parameters for diagnosing RVDD after surgical repair of TOF.

Abstract Propagation of membrane tension mediates mechanical signal transduction along surfaces of live cells and sets the time scale of mechanical equilibration of cell membranes. Recent studies in several cell types and under different conditions revealed a strikingly wide variation range of the tension propagation speeds including extremely low ones. The latter suggests a possibility of long-living inhomogeneities of membrane tension crucially affecting mechano-sensitive membrane processes. Here, we propose, analyze theoretically, and support experimentally a mechanism of tension propagation in membranes crumpled by the contractile cortical cytoskeleton. The tension spreading is mediated by the membrane flow between the crumples. We predict the pace of the tension propagation to be controlled by the intra-cellular pressure and the degree of the membrane crumpling. We provide experimental support for the suggested mechanism by monitoring the rate of tension propagation in cells exposed to external media of different osmolarities.

Schools in New Zealand (NZ) have a range of disciplinary options when dealing with challenging behaviours, one of which is excluding students by way of stand-downs, suspensions, exclusions or expulsions. Following marginal downward trend from 2006 to 2015, the numbers of stand-downs and suspensions have been on the rise again since 2016 despite well-established evidence of strong links between poor academic achievement, educational exclusions and youth justice encounters. One of the key reasons cited by schools for excluding students in New Zealand is for continual disobedience (CD). According to the NZ Ministry of Education Guidelines to schools, behaviours must be persistent and set a harmful or dangerous example to other students to meet the criteria for CD, and it is up to schools to interpret these guidelines. This paper reports the findings from a national study in New Zealand, that sought to understand how the category of CD was interpreted in high schools and the type of behaviours they associated with this category. The findings highlighted the need to question the existence of this category (CD) in the guidelines, as it provides a carte blanche to schools to exclude students.

This case report on recurrent urinary tract infections (UTIs) caused by multidrug-resistant (MDR) Klebsiella pneumoniae in a post-renal transplant patient underscores the significant clinical challenge of managing MDR infections in immunocompromised individuals, particularly in the context of renal transplantation. The patient was treated with an extended infusion of meropenem, which offers prolonged drug exposure and enhances bactericidal activity against MDR pathogens. This approach is critical in overcoming the resistance mechanisms inherent to Klebsiella pneumoniae, thereby improving the likelihood of therapeutic success. The findings presented here highlight the potential efficacy of extended meropenem infusion in treating MDR infections, providing a valuable therapeutic option for clinicians facing similar cases. This report contributes to the growing evidence supporting advanced antibiotic administration techniques in managing complicated urinary tract infections in transplant in resource limited countries.

BACKGROUND: Ceftazidime-avibactam (CZA) represents a novel therapeutic approach for combating infections caused by multidrug-resistant Gram-negative bacteria. With the rise of antimicrobial resistance posing a significant challenge in hospital settings, this study aims to evaluate the utilization of CZA in hospitals and its subsequent outcomes. METHODS: A retrospective study was conducted, analyzing data from medical records of patients who received CZA treatment in a large tertiary care hospital over a six-month period. Demographic information, clinical characteristics, Charlson comorbidity scale, PITT bacteremia score, microbiological data, treatment regimens, and outcomes were collected and analyzed. Descriptive statistics were used to summarize patient characteristics and outcomes. RESULTS: A total of 104 patients received ceftazidime avibactam, with a mean age of 57years. The most common indication is given as definite63.46%(66) and 36.53% (38) were received as empirical. The mean of 6days. In this 65.38%(68) patients were improved &discharged and declared patients were 34.61%(36),as shown in the table below. CONCLUSION: In conclusion, antimicrobial stewardship accepted in only 14.42%, empirical employment of ceftazidime-avibactam in hospitals faces significant drawbacks. Issues including escalating resistance, sparse clinical evidence, and economic burdens raise doubts about its utility. Prudent consideration of alternatives and continued monitoring are essential to navigate uncertainties surrounding its effectiveness in tackling multidrug-resistant infections.

BACKGROUND: Diagnosing sepsis is challenging due to its complex onset. Despite various scoring systems, diagnostic inconsistencies persist. The Surviving Sepsis Campaign (SSC) 2021 recommends the SOFA score, but it relies on lab tests often unavailable in low-resource settings. Conversely, the NEWS2 score, based on vital signs alone, presents a practical alternative. AIM: To compare the diagnostic accuracy of NEWS2 and SOFA scores in predicting sepsis in Low resource Hospitals. METHODS: This 6-month Prospective Observational study conducted in a South Indian tertiary care hospital's Emergency Department (ED) and ICUs from. Patients with signs of infection were screened for sepsis as per SSC 2021 guidelines are included. NEWS2 and SOFA scores were used to screen sepsis on admission day. Lab parameters and Vitals are collected, analyzed using SPSS for sensitivity, specificity and Area Under Receiver Operating Curve (AUROC). RESULTS: Of 568 patients with signs of infection scores were applied, 131 (23.06%) were diagnosed with sepsis and 32 (24.4%) died. NEWS2 had higher AUROC of 0.78, compared to SOFA's AUROC of 0.61. (Table 1). For predicting mortality, both scores were significant, NEWS2 ≥5 had a higher AUROC. Results in (Table 2), ROC curves in Figures 1 and 2. CONCLUSION: The NEWS2 score showed superior performance over SOFA in predicting sepsis, with higher AUROC, sensitivity, and specificity. This highlights NEWS2 as a significant tool for early sepsis detection and management in low resource hospital settings as it relies only on vital sign. Further large studies should validate its effectiveness against other early warning scores.

AIM: To examines public perceptions, attitudes and knowledge concerning antibiotics, with a particular focus on the impact of OTC accessibility and affordability. BACKGROUND: The availability of over-the-counter (OTC) medicines including antibiotics and economic disparities encourages unsupervised self-medication which may pose a threat to increase antibiotic resistance. METHOD: This cross-sectional survey utilized random sampling, stratified by demographics, to assess adults' perceptions, attitudes and understanding of antibiotics in our region. The questionnaire, covered demographics, usage patterns, resistance knowledge, OTC availability and affordability concerns. Data were gathered through face-to-face interactions and social media. RESULT: Out of 1,024 invited participants, 719 respondents were participated in the survey. Our study reveals that 225(31.2%) of daily and monthly wage earners opt to self-medication, primarily due to the high cost of consultations with 121(16.8%) of respondents citing this as their reason. Despite 195(27.1%) being satisfied with OTC medications, common issues persist such as affordability with 263(36.5%) of daily wage earners finding antibiotics too costly. Compounding the issue, 372(51.7%) do not complete their full course of antibiotics, increasing the risk of resistance. 58.5% of respondents believed that antibiotics are used to treat viral infection such as common cold and influenza. CONCLUSION: The findings of our study indicate that daily wage earners struggle to afford medications. It's important to implement the national pharmaceutical policy more effectively. Increasing the availability and accessibility of generic drugs is essential. Additionally, policies to restrict the purchase of antibiotics without prescription and to educate on their proper use are urgently needed.

Association of Ebstein’s anomaly of tricuspid valve (TV) with tetralogy of Fallot (TOF) is extremely rare. Their coexistence is unique as they modify each other’s physiology. We report a case of a girl child having this rare combination along with Diamond–Blackfan syndrome awaiting a bone marrow transplant. She underwent intracardiac repair for TOF along with cone reconstruction of the TV, as tricuspid regurgitation of Ebstein’s anomaly would worsen with TOF correction alone. Through this surgery, we aimed to achieve a competent pulmonary valve using a transannular patch with a monocusp and adequate relief of the right ventricular tract obstruction, thus preserving the right ventricular function, as both can affect the repaired TV function in the long term. The child had an uneventful postoperative course and is asymptomatic on follow-up.

A 10-year-old girl underwent successful device closure of a 15-mm atrial septal defect with a short and thick retroaortic rim using a 16-mm atrial septal occluder from the conventional approach under transesophageal echocardiographic guidance. There were no periprocedural complications. The aortic valve was noted to be trileaflet and competent. Transthoracic echocardiography at a routine 2-year follow-up visit demonstrated new-onset moderate aortic regurgitation. There was no pericardial effusion.

Introduction: Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems. Methods: We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute. Results: The median age at implantation was 2 days (interquartile range 1–9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2–123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period. Conclusions: PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction.

BackgroundLevels of plasma SARS-CoV-2 nucleocapsid (N) antigen may be an important biomarker in patients with COVID-19 and enhance our understanding of the pathogenesis of COVID-19.ObjectiveTo evaluate whether levels of plasma antigen can predict short-term clinical outcomes and identify clinical and viral factors associated with plasma antigen levels in hospitalized patients with SARS-CoV-2.DesignCross-sectional study of baseline plasma antigen level from 2540 participants enrolled in the TICO (Therapeutics for Inpatients With COVID-19) platform trial from August 2020 to November 2021, with additional data on day 5 outcome and time to discharge.Setting114 centers in 10 countries.ParticipantsAdults hospitalized for acute SARS-CoV-2 infection with 12 days or less of symptoms.MeasurementsBaseline plasma viral N antigen level was measured at a central laboratory. Delta variant status was determined from baseline nasal swabs using reverse transcriptase polymerase chain reaction. Associations between baseline patient characteristics and viral factors and baseline plasma antigen levels were assessed using both unadjusted and multivariable modeling. Association between elevated baseline antigen level of 1000 ng/L or greater and outcomes, including worsening of ordinal pulmonary scale at day 5 and time to hospital discharge, were evaluated using logistic regression and Fine-Gray regression models, respectively.ResultsPlasma antigen was below the level of quantification in 5% of participants at enrollment, and 1000 ng/L or greater in 57%. Baseline pulmonary severity of illness was strongly associated with plasma antigen level, with mean plasma antigen level 3.10-fold higher among those requiring noninvasive ventilation or high-flow nasal cannula compared with room air (95% CI, 2.22 to 4.34). Plasma antigen level was higher in those who lacked antispike antibodies (6.42 fold; CI, 5.37 to 7.66) and in those with the Delta variant (1.73 fold; CI, 1.41 to 2.13). Additional factors associated with higher baseline antigen level included male sex, shorter time since hospital admission, decreased days of remdesivir, and renal impairment. In contrast, race, ethnicity, body mass index, and immunocompromising conditions were not associated with plasma antigen levels. Plasma antigen level of 1000 ng/L or greater was associated with a markedly higher odds of worsened pulmonary status at day 5 (odds ratio, 5.06 [CI, 3.41 to 7.50]) and longer time to hospital discharge (median, 7 vs. 4 days; subhazard ratio, 0.51 [CI, 0.45 to 0.57]), with subhazard ratios similar across all levels of baseline pulmonary severity.LimitationsPlasma samples were drawn at enrollment, not hospital presentation. No point-of-care test to measure plasma antigen is currently available.ConclusionElevated plasma antigen is highly associated with both severity of pulmonary illness and clinically important patient outcomes. Multiple clinical and viral factors are associated with plasma antigen level at presentation. These data support a potential role of ongoing viral replication in the pathogenesis of SARS-CoV-2 in hospitalized patients.Primary funding sourceU.S. government Operation Warp Speed and National Institute of Allergy and Infectious Diseases.

Objective: We sought to explore the lived experience of people with Debilitating Symptom Complexes Attributed to Ticks (DSCATT) to inform the development of a potential treatment intervention. Methods: We conducted one-to-one in-depth, semi-structured interviews with 13 people living in Australia affected by DSCATT. Interviews were transcribed and analysed using thematic analysis. Results: Although participants attributed the origin of their illness to tick bites, not all were adamant they had Lyme disease. Negative experiences in conventional healthcare were marked and were reported to exacerbate the impact of the illness and affect mental health. Further, these negative experiences propelled participants to seek unapproved treatments (by Australian standards). The desire for the illness to be acknowledged and causative agents identified was pronounced among the participant group. Conclusions: Individuals with DSCATT experience significant challenges amid a contentious healthcare landscape surrounding chronic symptoms attributed to ticks in Australia. Our findings suggest the need for empathetic, supportive and patient-centred treatments for this cohort. Implications for public health: DSCATT results in a considerable burden across multiple domains for those affected. Negative experiences with healthcare exacerbate the suffering of people with DSCATT in Australia. New approaches that acknowledge the illness experience of people with DSCATT, alongside evidence-based treatments that encompass biopsychosocial models of care, are needed to tackle this debilitating condition.

Type IV pili (T4P) are versatile proteinaceous protrusions that mediate diverse bacterial processes, including adhesion, motility, and biofilm formation. Aeromonas hydrophila, a Gram-negative facultative anaerobe, causes disease in a wide range of hosts. Previously, we reported the presence of a unique Type IV class C pilus, known as tight adherence (Tad), in virulent Aeromonas hydrophila (vAh). In the present study, we sought to functionalize the role of Tad pili in the pathogenicity of A. hydrophila ML09-119. Through a comprehensive comparative genomics analysis of 170 A. hydrophila genomes, the conserved presence of the Tad operon in vAh isolates was confirmed, suggesting its potential contribution to pathogenicity. Herein, the entire Tad operon was knocked out from A. hydrophila ML09-119 to elucidate its specific role in A. hydrophila virulence. The absence of the Tad operon did not affect growth kinetics but significantly reduced virulence in catfish fingerlings, highlighting the essential role of the Tad operon during infection. Biofilm formation of A. hydrophila ML09-119 was significantly decreased in the Tad operon deletant. Absence of the Tad operon had no effect on sensitivity to other environmental stressors, including hydrogen peroxide, osmolarity, alkalinity, and temperature; however, it was more sensitive to low pH conditions. Scanning electron microscopy revealed that the Tad mutant had a rougher surface structure during log phase growth than the wildtype strain, indicating the absence of Tad impacts the outer surface of vAh during cell division, of which the biological consequences are unknown. These findings highlight the role of Tad in vAh pathogenesis and biofilm formation, signifying the importance of T4P in bacterial infections.

Tetraspanin 4, a protein with four transmembrane helices and three connecting loops, senses membrane curvature and localizes to membrane tubes. This enrichment in tubular membranes enhances its diverse interactions. While the transmembrane part of the protein likely contributes to curvature sensitivity, the possible roles of the ectodomains in curvature sensitivity of tetraspanin 4 are still unknown. Here, using micropipette aspiration combined with confocal microscopy and optical tweezers, we show that the extracellular loop 2 contributes to the curvature sensitivity and curvature-induced interactions of tetraspanin 4. To this end, we created truncated tetraspanin 4 mutants by deleting each of the connecting loops. Subsequently, we pulled membrane tubes from giant plasma membrane vesicles containing tetraspanin 4-GFP or its mutants while maintaining controllable membrane tension and curvature. Among the mutations tested, the removal of the extracellular loop 2 had the most significant impact on both the curvature sensitivity and interactions of tetraspanin 4. Based on the results, we suggest that the extracellular loop 2 regulates the affinity of tetraspanin 4 towards curved membranes and affects its lateral interactions.

All children have the right to an education and a voice, to be heard and to influence aspects of their lives and their education. Children and young people in foster care face unique and often challenging experiences that can make them vulnerable to having these basic rights eroded. This paper presents the findings from an in-depth study exploring the educational experiences and self-determined educational successes of young people who spent time in foster care in New Zealand. Findings from semi-structured interviews with seven young people reflected broad and holistic experiences of educational success. Relationships with teachers, foster caregivers and friends were key supports to success, along with having a voice, influence over decisions and having an advocate. Young people demonstrated marked resilience throughout the challenges they faced, which was both supportive to success, and a success in itself. Given the unique life experiences of children and young people in foster care, there is an imperative to create space for their voices to determine and define what educational success means. They need their rights to share these perspectives to enhance their own educational experiences, and to influence both the policy and practice agendas around foster care and education.

With a conservative estimate of 1 in 100 children thought to be on the autism spectrum (Ministry of Health, n.d.), this article reports on findings from a preliminary exploratory national study of parents of children aged 0-21 with ASD. Using an e-survey questionnaire and focus groups, the study sought to understand the supports that were available to children with autism and their families. More importantly, it explored the supports parents perceived were most useful and effective for their children at home, after school, and in educational settings. The key findings highlighted the need for autism-specific knowledge and training for educators and caregivers, and flexibility of funding for parents to access supports and services that they perceived to be the most useful. These findings were juxtaposed by issues of "availability," "accessibility" and "affordability" of services and supports. There was unequivocal support from participants for a one-stop-shop for better coordination of services, funding flexibility and closer partnerships with families. Implications are discussed and limitations identified.

Abstract Background Many causes of vascular rings may present as stridor among children. Co-occurrence of tracheal anomaly in left pulmonary artery sling (LPAS) is very common and needs special attention. Case presentation We report a case of an infant who presented with expiratory stridor and wheezing. A preliminary chest x-ray revealed no significant findings. CT and virtual bronchoscopy confirmed the diagnosis of LPAS with associated distal tracheal stenosis. He underwent surgical correction with good results in the follow-up period. Conclusions Virtual bronchoscopy may help to decide the type of operation and to avoid a potentially invasive bronchoscopy in LPAS.

Grounded in the Conservation of Resources (COR) theory, this study explored the contribution of flexible work arrangements within the increasing digitalization of workplaces. In particular, with a specific focus on what happened when employees teleworked, it examined whether flextime perceptions, accounting for employees’ perception of control over their working hours, were related to job performance and if family–work conflict mediated this relationship. Additionally, the study investigated if the ability to cope with work tasks moderated the relationships between flextime and both family–work conflict and job performance. The study was conducted in an Italian research institute involving 598 respondents engaged in hybrid work with over two years of remote working experience. The SPSS Process macro was used, and findings showed a positive direct association between flextime and job performance. Intriguingly, no indirect effect of flextime on job performance through family–work conflict was observed. However, the introduction of the ability to cope in the model generated a significant mediation at specific levels of the moderator. The study highlighted the moderating role of the ability to cope in the relationships between flextime and family–work conflict on one side and job performance on the other. This research provides insights into the complexities of hybrid work and discusses the advantages of flextime and the intricate interplay it has with family–work conflict and job performance. The study concludes with theoretical and practical implications, offering guidance for both researchers and practitioners navigating the multifaceted realm of flexible work arrangements.

Objective: This article describes a case of polymicrobial Arcanobacterium haemolyticum pharyngitis and sinusitis complicated by intracranial complications and reviews similar cases in the literature Case summary: A 21-year-old immunocompetent male presented with symptoms of sore throat, rhinorrhoea, lethargy, headache, and rash. Imaging demonstrated sinusitis, pre-septal sinusitis, peritonsillar abscess formation, subdural empyema and cerebritis. He was managed with endoscopic sinus surgery, craniotomy for evacuation of subdural empyema and antibiotics. Microbiological samples demonstrated growth of A. haemolyticum, strep. anginosus, and fusobacterium necrophorum. He subsequently developed a cerebral abscess requiring stereotactic needle drainage. After a prolonged course of antibiotics, the patient was discharge and made a good recovery. Discussion: A. haemolyticum is an uncommon cause of non-streptococcal pharyngitis that may occur alongside other microorganisms and is rarely associated with severe intracranial complications. This organism and its antibiotic susceptibility patterns should be considered in complicated upper respiratory tract infections in immunocompetent hosts. Penicillins and macrolide antibiotics form the mainstay of therapy for A. haemolyticum.

This work explores the challenging task of identifying emotions from the eyes through the analysis of nonverbal cues and facial expressions. The study investigates the various emotions that the eyes can convey and their significance in emotional expression, including happiness, sadness, anger, fear, surprise, and contempt. The practical applications of this research include the potential use of computer vision algorithms to analyze images or videos of the eye region to identify emotions. The coevolution theory suggests that humans and robots can collaborate to achieve a shared goal. Therefore, this study aims to develop algorithms that can identify variations in pupil size, eye movements, and other traits linked to various emotional states, such as arousal, surprise, and disgust. The results of the research show that these algorithms can accurately identify emotions from the eyes, and a human expert can validate their interpretations. The methods used in this study include analyzing facial expressions and nonverbal cues, developing computer vision algorithms, and working with human experts to validate the results. The conclusions drawn from this work suggest that emotional identification from the eyes is a promising area of research that has practical applications in various fields, such as robotics, psychology, and human-computer interaction.

The amount of particles and organic matter in wash-waters and effluent from the processing of fruits and vegetables determines whether they need to be treated to fulfil regulatory standards for their intended use. This research proposes a novel technique in photovoltaic cell-based renewable energy in saline water analysis using the oxidation process and deep learning techniques. Here, the saline water oxidation is carried out based on photovoltaic cell-based renewable and saline water analysis is done using Markov fuzzy-based Q-radial function neural networks (MFQRFNN). The plan is entirely web-oriented to enable better control and effective monitoring of water consumption. This monitoring makes use of a communication system that collects data in the form of irregularly spaced time series. Experimental analysis has been carried out based on water salinity data in terms of accuracy, precision, recall, specificity, computational cost, and kappa coefficient. HIGHLIGHTS This research proposes a novel technique in photovoltaic cell-based renewable energy in saline water analysis using the oxidation process and deep learning techniques.; Forecasting energy demand is an essential component of PV that aids in the planning of power generation as well as energy trading with a commercial grid.; Deep learning-based models hold great promise for forecasting consumer demands and RES energy generation.;

The term "school discipline" includes student self-management, classroom management, behaviour management, and school exclusion practices. This article is based on the perspectives of rangatahi on disciplinary practices from two different high schools. Ten Years 9-11 students from one school who had experienced exclusion, and 10 fully engaged Year 13 students in another school reflected on their strategic navigation of the culture of classroom and school discipline. Students were aware of how to exercise agency within their school's disciplinary regime and called for more democratic and equitable processes and dialogical relationships with their teachers.