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We develop new rate-type constitutive relations on a set of orthonormal tensor basis and the corresponding set of Lode invariants, which require only 9 material parameters to predict the mechanical response of the human brain tissue. The mode-dependent response of the tissue is captured by invoking the Hill-stable elastic potential of Prasad and Kannan (2020) and constructing a new form for the rate of dissipation, thus introducing the mode-of-deformation dependent modulus terms and the mode-of-deformation-rate dependent viscosities into the rate-type thermodynamic framework of Rajagopal and Srinivasa (2000). Through the analysis-driven construction of the rate of dissipation, we incorporate maximum change in the viscosities with respect to the mode-of-deformation rates and limit the number of material parameters. Our model satisfactorily predicts the complicated load-unload cycles (pre-conditioned and conditioned) and the stress relaxation data under multiple modes of deformation and multiple rates for the Corona Radiata (CR) region of the brain tissue. It also captures the tension–compression asymmetry in the response and the higher relaxation time in compression loading than in shear loading.

The clinicopathologic conditions of the long head of the biceps tendon vary, encompassing tendinitis, peritendinous inflammation, hypertrophy, and partial or complete tears. These symptoms are typically linked with SLAP tears and instability of the long head of the biceps tendon, often resulting in partial displacement or complete dislocation. The choice between tenotomy and tenodesis depends on varied factors. The choice of suprapectoral or subpectoral tenodesis is a difficult decision and should be weighed on a tailored basis. Our approach to suprapectoral tenodesis presents a blend of factors, maintaining uniform tension in the bicipital groove, limiting the number of portals for arthroscopy, re-tensioning the tendon after initial anchor placement, and preserving the inherent length of the functional biceps tendon without compromising its quality.

Allergic rhinitis (AR) is a common disorder caused by immune system dysregulation. The present contribution describes a randomized, double-blind, placebo-controlled comparative evaluation of the influence of a unique food-grade co-delivery form of curcumin and ashwagandha extracts (CQAB) in comparison to a bioavailable curcumin formulation (CGM) and placebo employing healthy participants, (n = 96), characterized with mild AR. The subjective measurements (TNSS, BIS and POMS-SF questionnaires) clearly demonstrated the efficacy of CQAB over CGM in the alleviation of AR symptoms and hence the quality of life. Further, CQAB administration also showed significant modulation of biochemical parameters (significant decrease in Th2 cytokines, pro-inflammatory cytokines, CD4+/CD8+ ratio and IgE, and a significant increase in Th1 cytokines, anti-inflammatory cytokine IL-10 as well as for the immunoglobulins IgG, IgM, and IgA) in support of its improved immune-balancing effect, compared to CGM. Both CQAB and CGM were well tolerated without any adverse events.

This study examines the use of layer by layer (LbL) coated coir (CC) systems to eliminate bacterial pathogens and emerging contaminants from water. Bacterial and chemical contaminants found in river water pose risks to human health and aquatic ecosystems. The study initially compared the effectiveness of CC to uncoated coir (UC) treatment in removing bacterial pathogens. CC treatment demonstrated superior removal efficacy compared to UC treatment. For samples with a bacterial concentration of 3.6×103 CFU/mL, CC treatment achieved a removal rate exceeding 90% and viability losses of over 60% for E. coli and over 90% for S. aureus. As the number of bilayers increased, the regrowth potential of bacteria decreased, leading to mortality rates of ∼ 97% for S. aureus and 65% for E. coli respectively. Furthermore, the superiority of CC over UC in removing emerging contaminants were demonstrated. CC attained removal efficiencies of over 99% for isoniazid, 95.08% for lidocaine, 95.21% for mefenamic acid, and 87.73% for caffeine. The reproducibility of the CC system was tested and showed stable removal efficiency over multiple cycles. These findings highlight the potential of CC systems as effective eco-friendly alternatives for water purification to remove bacterial pathogens and emerging contaminants.

Determination of “Age” – the time elapsed since the last chemical purification – of a nuclear material is an important parameter in Nuclear Forensic analysis. Estimation of age may give crucial acumen of the possible production facility and the declared origin – if available – in case of a suspected nuclear material which is out of regulatory control. Mass spectrometry is the most common analytical technique used for chronological studies due to its superior precision (lower uncertainty). Though alpha spectrometry can be used for age determination, it better suits for irradiated fuel based radio-chronology because of higher specific activity of irradiated actinides (actinides formed by irradiation of actinides within a reactor) like plutonium. This paper describes the application of alpha spectrometry for the age determination in some natural U-metal samples with known history. The method utilises the radioactive non-equilibrium existing between 234U and 230Th isotopes in the sample for the elucidation of age of the material. Optimisation of a chemical procedure for the separation of ultra-trace amount of thorium isotopes from bulk uranium material using double column anion exchange chromatography is also presented. The chemical recoveries of uranium and thorium obtained with the present method were >95%. The uncertainty in age determination was

Objectives: There is limited literature on the prevalence and determinants of sarcopenia in the Indian predialysis chronic kidney disease (CKD) population. The current study attempts to characterize sarcopenia in CKD stages 3 & 4 using 3-compartment model dual-energy X-ray absorptiometry (DXA). Methods: This is secondary data from a randomized trial on bicarbonate supplementation for preserving muscle mass. A 3-compartment DXA was done to assess body composition in 188 subjects aged 18 to 65, with stable kidney function. Sarcopenia was defined by Asian Working Group criteria - appendicular skeletal mass index

Summary: Background: Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal cancer. Methods: A prospective, multicentre, cohort study was conducted in five tertiary hospitals in India from December 2020 to March 2022. Consecutive patients with a new treatment plan for colorectal cancer were followed-up for six months. The total cost of treatment was reported, including out-of-pocket payments (OOPP, paid by patients at the time-of-service use) and covered by third parties (insurance, public funds). The primary outcome was catastrophic expenditure, defined as OOPPs greater than 25% of patient's annual household income and the secondary outcome was treatment attrition, defined as unplanned interruption of the treatment course not recommended by the clinical team. Findings: Of 226 patients included, 20 died within six months of being offered a treatment plan and four were lost to follow-up. The median total cost of colorectal cancer treatment was 407,508 Indian Rupees (INR/5340 USD), to which the biggest contributor was the patient's OOPP (median 330,277 INR/4328 USD). Surgery and anaesthesia costs (median 85,944 INR/1126 USD) were higher than radiotherapy (median 55,525 INR/728 USD) and chemotherapy (median 14,780 INR/194 USD). The overall catastrophic expenditure rate was 90.1% (182/202) and the treatment attrition rate was 9.4% (19/202). Patients with treatment attrition made lower OOPPs than those who completed treatment (median 205,926 vs 349,398 INR, p

This study develops a clinical decision support system to assist physicians with monitoring Polycystic Ovarian Syndrome (PCOS). The proposed method uses a classification model with optimization techniques and machine learning algorithms. The existence of irrelevant features can deteriorate the performance of any classifiers. This work analyses the impact of such features on classification accuracy and automatically identifies and removes the irrelevant features from the dataset. A wrapper approach is employed for feature selection. It uses Red Deer Algorithm (RDA) to find the optimal features and a random forest (RF) classifier to evaluate them. RDA is an optimization algorithm inspired by red deer’s mating and roaring behaviour. Experiments were carried out on the PCOS dataset, which is available in the Kaggle dataset repository. The optimal dataset is trained and tested using an RF classifier with 50 estimators. RDA’s improved exploration and exploitation capabilities are the rationales behind using it as the search method. The novelty of the proposed method lies in the novel fitness function used, which considers both accuracy of the classification and the optimized number of features. The proposed CDSS displays accuracy of 89.81%. The results of the proposed work were compared with the performance of competing methods in the literature. Logistic Regression classifier, k-Nearest Neighbour (k-NN), Decision tree, Naïve Bayes, Support Vector Machine (SVM) classifier, RF-PSO, RF-Ant Colony Optimization, and RF-Genetic Algorithm and are found to be superior in terms of accuracy, sensitivity, and specificity. The statistical significance of the suggested feature selection approach is confirmed using McNamer’s test.

Affective computing plays an important role in simulating human affects through multimedia stimuli. To provide appropriate responses and quantify emotions, it is essential to identify and interpret emotions accurately. Often the audience is influenced by media content and it has an impact on the audience's emotions. The authors aim to develop a machine vision based smart affective system that investigates the correlation between the basic facial expressions and corresponding ratings given by the audience. For the same, a notion of emotion vector is introduced to measure the elicited emotion. The idea of measuring attention is also suggested to find if the con- tent could keep the audience engaged. Our results reveal that such systems are useful in capturing and analyzing individual and collective sentiment.

Sensor node location information is critical in many Wireless Sensor Network (WSN) applications with random sensor node deployment. In such applications, node localization using a faster area exploration mechanism is needed to initiate precise sensing and communication. In this paper, faster area exploration approach for mobility-assisted localization scheme is proposed for mission-critical WSN applications. Each Mobile Anchor (MA) node embedded with a localization module moves in the sensor field in a coordinated manner while localizing the deployed static nodes. The proposed area exploration scheme is implemented using a hybrid of max-gain approach and cost-utility based frontier (HMF) approach. The paper addresses the issue of sparse anchor node condition during the localization process. The simulation results obtained using Cooja simulator shows that the proposed mobility-assisted localization scheme results in accurate localization with minimum delay. The proof-of-concept of the proposed scheme is demonstrated using Berkeley static nodes and custom designed MA nodes.

Background: Multivariate meta-analysis is used when multiple correlated outcomes are reported in a systematic review. This study explored the application of multivariate meta-analysis in such a context. The objectives of the present study were to compare the summary findings and decisions between univariate and bivariate meta-analyses, as well as to assess how much sensitive the results are towards the strength of the correlation between the outcome variables. Methods: A systematic review that reported two correlated outcomes, Intact parathyroid hormone levels and serum phosphate was chosen for demonstrating the applications of bivariate meta-analysis. Both univariate and bivariate meta-analyses with fixed effect and random effect models were carried out and the results were compared. A sensitivity analysis was performed for a wide spectrum of correlations from −1 to +1 to assess the impact of correlation on pooled effect estimates and its precision. Results: Pooled effect estimates generated through bivariate meta-analysis were found to be varying when compared to those obtained through univariate meta-analysis. The confidence interval of the pooled effect estimates obtained through bivariate meta-analysis was wider than in univariate meta-analysis. Further, the value of the pooled effect estimates along with its confidence intervals also differed for varied levels of correlations. Conclusions: This study observed that when we have multiple correlated outcome variables to answer a single question bivariate meta-analysis could be a better approach. The magnitude of the correlation between the outcome variables also plays a vital role in meta-analysis.

Ce promoted Cu/γ-Al2O3 catalysts were prepared with varying amounts of Cu (x = 0–10 wt%) and Ce (y = 0–15 wt%). The prepared catalysts were characterized and tested for the conversion of aqueous glucose (5 wt%) to 1,2-propanediol in a batch reactor. 10%Ce-8%Cu/γ-Al2O3 showed the complete conversion of glucose with 62.7% selectivity of 1,2-propanediol and total glycols (1,2-propanediol, ethylene glycol & 1,2-butanediol) of 81% at milder reaction conditions. Cu facilitated the hydrogenation activity and Ce loading optimize the acid/base sites of Cu/γ-Al2O3 which obtain high selectivity of 1, 2-propanediol. Catalyst reusability is reported.

Vaidya Manorama is a folklore Kerala Ayurveda literature that encompasses time- tested low-budget formulations that can be prepared from easily available resources. Ayurveda Ophthalmology has been described in Chapter twenty-eight of the literature. Many unique formulations like eating firefly (khadyota), preparing ghee from fresh-water shellfish (tadaka-shuktika), Kadali phala (a special type of banana) bidalaka, dropping of juice of palasha (Butea monosperma) into eyes for various clinical conditions are described. We review the unique ophthalmology formulations in this chapter to bring them to limelight. Few herbo-mineral formulations are also described for which toxicity and safety studies are warranted. All these handy formulations may help clinicians in day-to-day practice or may be a lead for novel research.

A sustainable and green method to impart antimicrobial properties to materials or devices made of Poly (propylene) (PP) is of great interest to many in academia and the industry. Herein, we demonstrate a simple strategy to impart antimicrobial property to PP filter materials by interfacial self-assembly of an ionic liquid (IL), 1-hexyl-3-methylimidazolium iodide (HMIMI). HMIMI was found to have a minimum inhibitory concentration (MIC) of 8.5 mM against Escherichia coli (E. coli) and a critical micelle concentration (CMC) of 465 mM. Self-assembly of HMIMI over PP was found to prevent the adhesion of E. coli, which was illustrated by Agar diffusion assay, Confocal Raman Microscopy, and Scanning Electron Microscopy. The green strategy employed here would be helpful to generate cost-effective antimicrobial surfaces for various biomedical applications.

Kerala, located at the southwest tip of India, witnessed disastrous floods during the monsoon seasons of two consecutive years, 2018 and 2019. This paper provides a detailed analysis of these two flood events using data from multiple sources. The unusually unstable and convective nature of the 2019 event, as detectable in its higher cloud tops and evidently fuelled by anomalously warm local sea temperatures, raises concerns regarding the changing patterns of rainfall over the southern parts of the west coast of India. Specifically, our analysis reveals that the flood of 2019 in Kerala satisfies the criteria for a mesoscale cloudburst (MsCB) event, more common in the north but a very rare and never before reported phenomenon in the Kerala region. Rainfall exceeding 50 mm in 2 h has been reported from many places between 8.00 and 22.00 UTC on the August 8, 2019. Satellite-derived rainfall and cloud microphysical parameters further reveal the uniqueness of the 2019 MsCB event. If 2019 is a harbinger of how global warming may continue to affect this region, transformations of the cloud structure and the recurrence and character of intense rainfall events could pose a major threat to the highly vulnerable Western Ghats ecosystems.

Apical membrane antigen 1 (AMA1) is a surface protein of Plasmodium sp. that plays a crucial role in forming moving junction (MJ) during the invasion of human red blood cells. The obligatory presence of AMA1 in the parasite lifecycle designates this protein as a potential vaccine candidate and an essential target for the development of novel peptide or protein therapeutics. However, due to multiple cysteine residues in the protein sequence, attaining the native fold with correct disulfide linkages during the refolding process after expression in bacteria has remained challenging for years. Although several approaches to obtain the refolded protein from bacterial expression have been reported previously, achieving high yield during refolding and proper functional validation of the expressed protein was lacking. We report here an improved method of refolding to obtain higher quantity of refolded protein. We have also validated the refolded protein's functional activity by evaluating the expressed AMA1 protein binding with a known inhibitory peptide, rhoptry neck protein 2 (RON2), using surface plasmon resonance (SPR) and isothermal titration calorimetry (ITC).

Problem: As WHO recommends, timely and optimal introduction of complementary feeding (CF) at 6th month as it complements additional energy and growth needs of young children. We know relatively little about CF practices of tribal mothers in the context of high rate of poor health and under nutrition in tribal children of Kerala. This study therefore examined the factors influencing CF practices to tribal infants and young children. Methods: We conducted a community based cross-sectional survey of 1150 tribal mother-infant pairs from five districts. We used pre-tested interview schedule for data collection. Alongside descriptive statistics, we used multiple linear regression for data analyses. Results: Around 76.2% continued BF at 6th month, 62.7% introduced CF at 6th month, 22.7% children received low or potentially harmful CF, 48.4% children received harmful CF and merely 8.6% received optimal CF. The maternal education, marital status, age at first pregnancy optimized CF and occupational status, hours of work per day, work status before pregnancy and age at marriage were inversely associated with 40% of variance (R2 = 0.40). Tribal mothers' breastfeeding duration and frequency of child bathing significantly increased optimal CF and children’ age at CF initiation. The poor breastfeeding at public place inversely associated with 44.7% variance (R2 = 0.447). Tribal mothers’ perceived difficulty for breastfeeding at public space increased CF scores and mothers who early initiated CF were more likely to feed children less-optimal (R2 = 0.365). Conclusion: Tribal mothers practice predominantly poor and potentially harmful CF to young children aged 6–24 months.

Introduction: Urine β2 microglobulin (β2m) is a validated marker to diagnose sepsis and toxin-related acute kidney injury (AKI). In the current study, we used urine β2m as a potential marker to identify persistent tubular dysfunction following a clinical recovery from snake venom–related AKI. Methods: A total of 42 patients who developed AKI following hemotoxic envenomation were followed up for a period of 6 months. Urine albumin excretion, estimated glomerular filtration rate (eGFR), and urine β2m levels were measured at 2 weeks, 3 months, and 6 months following discharge. Results: At the end of 6 months of follow-up, 6 patients (14.3 %) progressed to chronic kidney disease (CKD) (eGFR < 60 ml and/or urine albumin excretion > 30 mg/d). The urine β2m levels were 1590 μg/l (interquartile range [IQR] 425–5260), 610 μg/l (IQR 210–1850), 850 μg/l (IQR 270–2780) at 2 weeks, 3 months, and 6 months, respectively (P = 0.020). The levels of urine β2m in the study population at the end of 6 months remained significantly higher compared with the levels in healthy control population (850 μg/l [IQR 270–2780] vs. 210 μg/l [IQR 150–480]; P = 0.001). The proportion of patients with urine β2m levels exceeding the 95th percentile of control population (>644 µg/l) during the 3 follow-up visits were 70.7% (n = 29), 48.8 % (n = 20), and 51.2% (n = 21). Similar trends were noticed in a sensitivity analysis, after excluding patients with CKD. Conclusions: Urine β2m levels remain persistently elevated in approximately half of the individuals who recover from AKI due to snake envenomation. Keywords: acute kidney injury, beta 2 microglobulin

Soil organic carbon (SOC), greenhouse gas (GHG) emissions and water footprint (WF) are the key indicators of environmental sustainability in agricultural systems. Increasing SOC while reducing GHG emissions and WF are effective measures to achieve high crop productivity with minimum environmental impact (i.e. a multi-pronged approach of sustainable intensification (SI) and climate-smart agriculture (CSA) to achieve food security). In conventional agricultural systems, intensive soil tillage and removal of crop residues can lead to increase negative environmental impact due to reduce SOC, GHG emission and high water consumption. Conservation agriculture (CA) based conservation tillage systems (CTS) with crop residue retention is often suggested as a resource conserving alternative to increase crop productivity without compromising soil health and environmental sustainability of cereal cropping systems. The environmental impact of CTS in terms of SOC, WF and GHG emissions nonetheless remains understudied in Bangladesh. A two-year field experiment was carried out to evaluate the impacts of CTS with retention of crop residue on SOC accumulation, GHG emission and WF in wheat cultivation of Bangladesh. In the experiment, CTS such as zero tillage (ZT) and minimum tillage (MT) were compared with the conventional tillage (CT) practice. Result observed that the SOC accumulation in the soil was 0.11 t ha−1, 0.97 t ha−1, and 1.3 t ha−1 for CT, MT and ZT practices, respectively. A life cycle GHG emission estimation by farm efficiency analysis tool (FEAT) calculated 1987, 1992 and 2028 kg CO2eq ha−1 for ZT, MT and CT practices, respectively. Among the studied tillage options, lowest WF was achieved by MT (570.05 m3 t−1) followed by ZT (578.56 m3 t−1) and CT (608.85 m3 t−1). Since the results are in favor of CTS, this study recommends MT and ZT practice to reduce negative environmental externalities in wheat cultivation in Bangladesh. In comparison between the methods, the MT, which retains crop residue (20 cm), and involves principles of CA, is suitable for both CSA and SI of wheat cultivation in Bangladesh due to its ability to increase SOC accumulation, prevent both water loss, and GHG emission without compromising yield.

There is an urgent need to identify antivirals against the coronavirus SARS-CoV-2 in the current COVID-19 pandemic and to contain future similar emergencies early on. Specific side-chain cholesterol oxidation products of the oxysterols family have been shown to inhibit a large variety of both enveloped and non-enveloped human viral pathogens. Here we report on the in vitro inhibitory activity of the redox active oxysterol 27-hydroxycholesterol against SARS-CoV-2 and against one of the common cold agents HCoV-OC43 human coronavirus without significant cytotoxicity. Interestingly, physiological serum levels of 27-hydroxycholesterol in SARS-CoV-2 positive subjects were significantly decreased compared to the matched control group, reaching a marked 50% reduction in severe COVID-19 cases. Moreover, no correlation at all was observed between 24-hydroxycholesterol and 25-hydroxycholesterol serum levels and the severity of the disease. Opposite to that of 27-hydroxycholesterol was the behaviour of two recognized markers of redox imbalance, i.e. 7-ketocholesterol and 7β-hydroxycholesterol, whose serum levels were significantly increased especially in severe COVID-19. The exogenous administration of 27-hydroxycholesterol may represent in the near future a valid antiviral strategy in the worsening of diseases caused by present and emerging coronaviruses.

Summary: Cisplatin is an antineoplastic drug administered at suboptimal and intermittent doses to avoid life-threatening effects. Although this regimen shortly improves symptoms in the short term, it also leads to more malignant disease in the long term. We describe a multilayered analysis ranging from chromatin to translation—integrating chromatin immunoprecipitation sequencing (ChIP-seq), global run-on sequencing (GRO-seq), RNA sequencing (RNA-seq), and ribosome profiling—to understand how cisplatin confers (pre)malignant features by using a well-established ovarian cancer model of cisplatin exposure. This approach allows us to segregate the human transcriptome into gene modules representing distinct regulatory principles and to characterize that the most cisplatin-disrupted modules are associated with underlying events of super-enhancer plasticity. These events arise when cancer cells initiate without ultimately ending the program of drug-stimulated death. Using a PageRank-based algorithm, we predict super-enhancer regulator ISL1 as a driver of this plasticity and validate this prediction by using CRISPR/dCas9-KRAB inhibition (CRISPRi) and CRISPR/dCas9-VP64 activation (CRISPRa) tools. Together, we propose that cisplatin reprograms cancer cells when inducing them to undergo near-to-death experiences. : Ovarian tumors acquire new phenotypic features when exposed to anticancer therapy, which helps them endure the struggle for survival and increase malignancy. Using a six-layered multiomic approach, Ma et al. find that selective super-enhancer redistribution is a major driver of the acquisition of new phenotypic features. Keywords: multi-omic approach, gene dysregulation, super-enhancer, cisplatin, drug resistance, ovarian cancer, GRO-seq, ribosome profiling, Seurat, PageRank

Simulation is carried out to find the performance of airfoil E216 using Transition γ-Reθ model at Reynolds number of 100,000. Flow behaviour and effect of angle of attack (AOA) on laminar separation bubble (LSB) formation are examined. The results are validated with wind tunnel experimental results. LSB formation is clearly spotted in the velocity vector plot and coefficient of pressure distribution over airfoil. LSB moved upstream towards the leading edge with increase in AOA. Effect of boundary layer trip on LSB formation over the airfoil and performance of airfoil are studied. Two different trip locations, 17% of chord and 10% of chord from leading edge, and different trip heights (0.3 mm, 0.5 mm, 0.7 mm, 1 mm) are investigated in this study. Results showed that boundary layer trip could eliminate LSB partially or completely and improve aerodynamic performance of the airfoil. Maximum improvement in drag by 15.48% and lift to drag ratio by 21.62% are obtained at angle of attack of 60. In all the cases, improvement in performance is observed only up to trip height of 0.5 mm.

This work assesses the hygrothermal and ventilation performance of two ‘hard-to-treat’ historic, clay brick, solid wall houses that are internally insulated. Retrofit A is a two bedroom bungalow with the addition of internal plasterboard and air cavity and Retrofit B is a 5 bedroom house with sheep wool, phenolic and plasterboard insulation. To evaluate the long term performance of the retrofit measures, the testing is carried out 7 and 8 years respectively after completion. The first part of the work investigates whole building hygrothermal performance, ventilation and internal conditions. It was found that both retrofits are operating below specification in regards to their ventilation performance. An in-situ performance based specification for mechanical ventilation via CO2 monitoring is proposed. The second part focuses on the hygrothermal behaviour of the clay brick wall assembly. Both presented high relative humidity within critical layers of the wall make up. In Retrofit A the wall thermal transmittance was found to be much higher than designed due to inappropriate construction detailing while Retrofit B showed excellent thermal performance and minimal effects of thermal bridging.

Transfemoral balloon mitral valvotomy (BMV) is the standard treatment of severe symptomatic rheumatic mitral stenosis. However, in subjects with anatomic distortions, transfemoral BMV is difficult. We are presenting a case of severe rheumatic mitral stenosis who had a successful transjugular BMV using standard femoral hardware and Inoue balloon.

Summary: Background: The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: The number of people with diabetes in India increased from 26·0 million (95% UI 23·4–28·6) in 1990 to 65·0 million (58·7–71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9–6·1) in 1990 to 7·7% (6·9–8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1–46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6–49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7–9·3) in 1990 to 20·4% (19·9–20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016. Interpretation: The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

A study has been conducted to estimate the concentration of natural radioactive polonium in commercially available packaged infant food formulae available in Mumbai, India and the corresponding daily dose normalized based on its shelf life. Eleven most popular international brands of infant formulae were sourced from market and three aliquots from each sample were analysed for concordant results. Autodeposition method onto a silver planchet from hot dilute acid solution followed by alpha spectrometry was performed for estimation of polonium. Radiochemical recovery was ascertained by the addition of 209Po tracer. Radiochemical recovery of 209Po tracer was ranged from 14.7 to 98.1 %. The 210Po concentration in the samples was in the range of 0.08–0.23 Bq kg−1 on measured date and the corresponding daily dose, calculated on normalized date which is at mid-point of the shelf life of the sample, was ranged from 0.04 to 0.89 μSv d−1 as per the recommended daily consumption. The annual committed effective dose estimated based on the average of daily dose was found to be 150 μSv.

Background: Excessive Daytime Sleepiness (EDS) is inferred as persistent sleepiness and often a general lack of energy during the day even after apparently adequate or even prolonged nighttime sleep. The subjects may not be identifying excessive daytime sleepiness but may present as feeling tired, lack of energy etc. They may seem apparently healthy and without any other systemic illness. In the current health scenario there is a need for alternative interventions to manage this disease. Objective: This study was aimed to assess the combined effect of Vamana (therapeutic vomiting) and Sarasvata Churna in reducing Excessive Daytime Sleepiness. Materials and methods: This was a single-arm exploratory open-label clinical trial. 10 subjects having EDS diagnosed using Modified Epworth Sleepiness Scale (MESS) with a score of 10–24 with proper exclusion were recruited from OPD and IPD, Department of Kāyacikitsa, Amrita School of Ayurveda. All the participants were clinically examined, sought for medical history and further checked biochemically to exclude any other systemic illness that may lead to this condition. Only healthy subjects with quality night sleep (assessed by PSQI) and without any other systemic illness were selected. The treatment protocol adopted was Vamana Karma followed by 30 days of Sarasvata Churna as Shamana Aushadha (medicine for pacification). Assessment was done using MESS on 0th day and after 30 days of Shamana Aushadha Sevana. After completion of treatment, the results were statistically analysed using Wilcoxon Signed Rank Test and final conclusion was drawn. Results: On analysis of the symptoms using Modified Epworth Sleepiness Scale, the mean total score reduced from 14.8 to 2.8 with 81.08 % relief in these 10 subjects and a significant p value

The incidence of a subscapularis tear combined with any other rotator cuff tear is around 19% to 49% among all rotator cuff lesions. On the contrary, less attention has been given to the treatment of anterosuperior rotator cuff tears, particularly by arthroscopic methods. Subscapularis lesions are hard to access and require advanced surgical technique along with optimum visualization to achieve an anatomic repair. Use of an anterior portal helps in obtaining a good visualization with a 30° arthroscope in viewing the tendon along its axis as well as the posterior, superior, and anterior sides. Incorporation of the biceps tendon along with supraspinatus repair helps strengthen the supraspinatus repair as well as preserve the acromiohumeral index. Double-row repair of both subscapularis and supraspinatus ensures an adequate bone bed for tendon healing.

In today's rapidly digitising world, organisations often face challenges in achieving successful technology implementation, with low returns on investment and a significant gap between technology utilisation and acceptance. Electronic Health Record (EHR) software provides a comprehensive platform for storing, managing, and gaining access to patient data, enabling healthcare providers to provide high-quality care and make informed decisions. Conducting a comprehensive analysis of EHR software decision-level user reviews can contribute to improving and optimising EHR systems. Incorporating principles of user innovation, the study aims to investigate the significance of online review analysis in product development and reduce the technology acceptance gap. The study employs document-topic theme mining techniques, specifically BERTopic, a topic modelling technique, VADER sentiment analysis, and NRCLex Affect dictionary-based emotion analysis to extract meaningful aspect-based insights from the vast unstructured data of online reviews about EHR software. The study helps healthcare organisations get insights from user perspectives and highlights the importance of user review evaluation in purchasing or switching EHR software. It contributes to the existing literature on software evaluation, software requirement analysis, marketing and positioning strategy analysis, and online user review analysis. In addition to the challenges faced in the healthcare sector, the study recognises that technology transition issues are pervasive across various domains. Common challenges include the need for seamless integration with existing workflows, addressing resistance to change, navigating data security and privacy concerns, and fostering a technology-friendly culture. By exploring these challenges within the context of EHR software, the research contributes valuable insights with broader implications for diverse industries undergoing digital transformation.

Introduction: Insomnia is common among cancer patients, affecting about 50% undergoing cancer treatment. Insomnia can be due to various reasons, such as physical-pain, psychological-distress and medication side-effects. Insomnia has significant impact on quality of life of cancer patients. Even-though managed with hypnotics and antipsychotic drugs, they cause dependency with various short-term and long-term complications. Presenting a case throwing light on Ayurveda topical intervention as add-on to standard-of-care in insomnia during cancer chemotherapy. Method: A 51-year-old female patient with breast-cancer with extensive necrosis extending to subcutaneous areas was due for second cycle chemotherapy and was diagnosed with moderate-insomnia with a score of 21 as per Insomnia Severity Index in the Out-Patient-Department. Quality of sleep was assessed using Pittsburgh-Sleep-Quality-Index. Treated for 14 days during the break between cycle two and cycle three with Shirothalam (applied on the vertex) using Kachuradi Churnam with Kshirabala 101 and Padabhyangam (foot massage) using Kshirabala thailam as add-on to Tab Zolpidem5mg. Assessment was conducted on baseline and after 14 days of intervention. Results: Assessment for insomnia before and after intervention was conducted with Insomnia-Severity-Index. The score improved from 21 to 2. Quality of sleep before and after intervention was assessed using global PSQI. It improved from 20 to 8. Discussion: In Ayurveda, Nidranasam (loss of sleep) results from aggravation of Vata-Pitta (body humors responsible for movement and cognition and digestion, metabolism and heat of body), depletion of Kapha (body humor responsible for structural cohesion of body), derangement of Manasika-Dosa (mental constituents) and other diseases. All these etiological factors are attributed by Tikshna(sharp)- Uṣhna(hot potency) and Ruksha(dry) chemotherapy regimens. Vata-Pitta-hara (normalising Vata and Pitta) and Indriyaprasadaka (clearing senses) action of medicines used could induce sleep and effectively improve quality of sleep. Conclusion: Integrative-intervention was found to be beneficial in improving insomnia and quality of sleep without any reported complications or dependency in this case. After 14 days of ayurvedic intervention, the patient could get sleep even without taking zolpidem 5mg and external therapies. Same protocol could be considered for generalization so that it could modify or reduce usage of hypnotics and antipsychotic-drugs.

Intraoperative vertical coracoid graft fractures during the Latarjet procedure are well-described complications, which typically have a poor prognosis or may necessitate further iliac crest bone grafting for stabilization. The vertical split coracoid fractures are reasoned to be caused by excessive tightening of the screws, poor bone quality, especially in females and the smaller dimension of the coracoid graft. In this technical note, we propose an arthroscopic salvage technique for salvaging the fractured coracoid graft and to avoid the need for additional bone graft, thereby reducing morbidity to the patient. We use two double-loaded, all-suture anchors (Stryker, India) on either side of the split coracoid graft, and double-pulley configuration of suture tightening is done, providing compression and stability to the fractured graft.

Superior capsular reconstruction is a joint salvage treatment option for retracted irreparable rotator cuff tears in relatively young patients. Various graft options have been described in the literature, including autologous fascia lata graft, synthetic graft, and dermal patches. Superior capsular reconstruction using long head of biceps tendon autograft alone has also been described by few authors. In this technical note, we describe a modified technique of performing arthroscopic superior capsular reconstruction using both fascia lata graft and the intra articular portion of the long head of biceps tendon. Our technique resembles central beam concept over which the fascia lata graft is anchored, providing good structural support to the graft and enabling graft healing and improved clinical outcomes.

Rosehip oil (REO) contains excessive amounts of polyunsaturated fatty acids (PUFA), such as Omega-3 fatty acids (OFA). OFA exhibits instability, poor solubility, and limited bioavailability upon addition to food. In this study, REO nanoemulsion was prepared by probe ultrasonication. Statistically designed experiments were used to optimize Ultrasonication time (5 min), ultrasonication amplitude (37.26 %), and the surfactant (1 %Tween 20) concentration (surfactant to oil ratio of 1.17:1). The spherical morphology of the nanoemulsion was studied using scanning electron microscopy. REO was further characterized by dynamic light scattering (DLS), transmission electron microscopy (TEM), and Fourier transform infrared (FTIR) spectroscopy. The droplet size of REO nanoemulsion increased from 60 to 88 nm during storage at 4 ⁰C for 28 days. The nanoemulsion had an encapsulation efficiency of 89.7 %, and it was stable based on thermodynamical study. The fatty acid profile confirmed that REO nanoemulsion could preserve linoleic acid compared to the direct addition of REO in yogurt. The sensory study revealed that REO nanoemulsion could mask the tartness of REO when incorporated into yogurt. This study proved that nanoemulsion is a potential tool to enhance the stability of OFA in food systems.

The exponential growth in the global population and significant advancements in healthcare broadened the scope of intervention for e-Healthcare through decentralized data access and information exchange, making complex clinical decisions. e-Healthcare can perform several functionalities, including EHR communication, telemedicine, and complex clinical decision systems (CCDS), but large-scale users still find it challenging to maintain interoperability, stability, and scalability. Accommodating an extensive array of stakeholders, which includes patients, doctors, hospitals, and laboratories, demands interoperability to serve scalable services. FHIR frameworks have played a vital role in e-Healthcare designs. Most of the existing HL7-FHIR frameworks have used REST-API using HTTP-query for CRUD tasks that impose numerous rules and constraints, making the process more complex and time-consuming, violating the quality-of-service (QoS) standards on different levels. This paper develops a novel, robust Smart-Contract Authentication Assisted HL7-FHIR framework toward an interoperable e-Healthcare solution. Unlike classical REST API-based FHIR, our proposed method applies a Graph-mapping concept that transforms each resource variable into an equivalent Graph-Mapped Data Structure (GMS), which is subsequently stored in the NoSQL MongoDB database, reducing computational costs and time to meet QoS demands. The proposed model employs three key components, GMS-driven HL7 FHIR Gateway Model, Smart Contract Authentication and Client Model. The Smart Contract function helped verify and authenticate users to ensure privacy and secure EHR exchange. The assessment of the performance of the proposed model reveals a significant reduction in computational time with optimal resource utilization making it a significant and viable option to better the real-world e-Healthcare mechanisms.

Tobacco etch virus Protease (TEVp), a cysteine protease, is renowned for its remarkable specific proteolysis, making it an invaluable tool for removing fusion tags from recombinant proteins. However, TEV protease's inherent insolubility limits its broad application. Fusion constructs like an N-terminal MBP fusion, known for its improved solubility, have been employed for TEVp production to address this issue. In this study, we fused the TEVp with the N-terminal domain of the spider silk protein, specifically utilizing a charge-reversed mutant (D40K/K65D) of the N-terminal domain of major ampullate spidroin-1 protein from Euprosthenops australis, referred to as NT*. This fusion construct contains a TEVp cleavage site, enabling intracellular self-processing and the release of a His7-tagged protease. The significant increase in soluble protein expression allowed us to purify approximately 90–100 mg of TEVp from a 1-L E. coli culture, surpassing previous findings by a considerable margin. The enzyme remained stable and catalytically active even after several months of storage in a deep freezer (−80 °C).

The assignment of aromatic side-chain spins has always been more challenging than assigning backbone and aliphatic spins. Selective labeling combined with mutagenesis has been the approach for assigning aromatic spins. This manuscript reports a method for assigning aromatic spins in a fully protonated protein by connecting them to the backbone atoms using a low-power TOBSY sequence. The pulse sequence employs residual polarization and sequential acquisitions techniques to record HN- and HC-detected spectra in a single experiment. The unambiguous assignment of aromatic spins also enables the characterization of 1H–1H distance restraints involving aromatic spins. Broadband (RFDR) and selective (BASS-SD) recoupling sequences were used to generate HN-ΗC, HC-HN and HC-HC restraints involving the side-chain proton spins of aromatic residues. This approach has been demonstrated on a fully protonated U-[13C,15N] labeled GB1 sample at 95–100 kHz MAS.