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Present study attempted to determine the prevalence of pathogenic microorganisms among the frozen sea fish samples: shrimp and prawn, and the canned sea fish samples: tuna and salmon, collected from local markets in Dhaka city, Bangladesh. Most of the samples were found to be heavily contaminated with pathogenic bacteria ranging from 1.6x105 to 6.7 x 109 cfu/g. Fungal growth was observed in all samples within a range of 1.3x104 - 3.8x106cfu/g. The study of antibiogram showed a number of pathogenic isolates to be drug-resistant. Such a prevalence of pathogens including the antibiotic resistant ones among the studied fish samples may claim a serious public heath risk. [ABSTRACT FROM AUTHOR]

The CD225/Dispanin superfamily contains membrane proteins that regulate vesicular transport and membrane fusion events required for neurotransmission, glucose transport, and antiviral immunity. However, how the CD225 domain controls membrane trafficking has remained unknown. Here we show that the CD225 domain contains a SNARE-like motif that enables interaction with cellular SNARE fusogens. Proline-rich transmembrane protein 2 (PRRT2) encodes a SNARE-like motif that enables interaction with neuronal SNARE proteins; mutations in this region disrupt SNARE binding and are linked to neurological disease. Another CD225 member, interferon-induced transmembrane protein 3 (IFITM3), protects cells against influenza A virus infection. IFITM3 interacts with SNARE proteins that mediate late endosome-late endosome (homotypic) fusion and late endosome-lysosome (heterotypic) fusion. IFITM3 binds to syntaxin 7 (STX7) in cells and in vitro, and mutations that abrogate STX7 binding cause loss of antiviral activity against influenza A virus. Mechanistically, IFITM3 disrupts assembly of the SNARE complex controlling homotypic fusion and accelerates the trafficking of endosomal cargo to lysosomes. Our results suggest that SNARE modulation plays a previously unrecognized role in the diverse functions performed by CD225 proteins., Competing Interests: Disclosure and competing interests statement. The authors declare no competing interests., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

SARS-CoV-2 is a highly transmissible virus that causes COVID-19 disease. Mechanisms of viral pathogenesis include excessive inflammation and viral-induced cell death, resulting in tissue damage. Here we show that the host E3-ubiquitin ligase TRIM7 acts as an inhibitor of apoptosis and SARS-CoV-2 replication via ubiquitination of the viral membrane (M) protein. Trim7 -/- mice exhibit increased pathology and virus titers associated with epithelial apoptosis and dysregulated immune responses. Mechanistically, TRIM7 ubiquitinates M on K14, which protects cells from cell death. Longitudinal SARS-CoV-2 sequence analysis from infected patients reveal that mutations on M-K14 appeared in circulating variants during the pandemic. The relevance of these mutations was tested in a mouse model. A recombinant M-K14/K15R virus shows reduced viral replication, consistent with the role of K15 in virus assembly, and increased levels of apoptosis associated with the loss of ubiquitination on K14. TRIM7 antiviral activity requires caspase-6 inhibition, linking apoptosis with viral replication and pathology., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Micro- and nanostructured surfaces offer the potential to enhance two-phase heat transfer. However, the mechanisms behind these enhancements are not well-understood due to insufficient diagnostic methods, leading to reliance on trial-and-error surface development. We introduce in situ boroscopy to investigate microscale bubble dynamics during flow boiling nucleation and subsequent flow regime development. This method was applied in saturated flow boiling experiments within chemically etched aluminum and copper tubes. Although the surfaces have self-similar surface structures, our findings revealed varied heat transfer coefficient enhancements, with increases of up to 391% on aluminum and 41% on copper. Using boroscopy, we identified key mechanisms of heat transfer enhancement. We further used mercury porosimetry to determine the impact of pore size distribution on thermal performance. The boroscopy technique introduced here not only elucidates the underlying processes of flow boiling heat transfer enhancement but also has potential applications for the study of other two-phase phenomena.

The misuse and overuse of steroid hormones in fish is an emerging problem worldwide. The data on hormonal residue in fish was less due to a lack of effective monitoring programs on hormonal use in fish production. This review revealed the findings of previously published data on different hormonal use and their residue and impact. Steroid hormones were frequently used in fish production to promote growth and reproduction. It was suggested that hormones should be used carefully to ensure environmental, biological, and food safety. The most commonly used steroid hormones in fish production were testosterone, estrogen, progesterone, and cortisol. However, the indiscriminate use left residue in the fish flesh above the FAO/WHO permissible limits. This residue in fish caused many health hazards in consumers, like early puberty in children, advances in bone age, negative repercussions on growth, modification of sexual characteristics, and cancer development such as breast, ovarian, and prostate cancer. It also harmed fish and the aquatic environment. The most common detection methods for these hormones were GC-MS, LC-MS, and UHPLC-MS. Many countries permitted the use of hormones in fish production upon monitoring, whereas many countries prohibited it. Moreover, many countries did not have any rules and regulations on the use of hormones in fish production. Thus, this review is a wake-up call for researchers, policymakers and consumers on the impacts of hormonal residues in food commodities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Even though death due to COVID-19 is no longer a public health emergency, less virulent but highly transmissible forms of SARS-CoV-2 continue to spread in many countries leading to outbreaks and rise in hospitalizations in the affected regions. Lessons learned during the pandemic must be put into action to protect the world's population from another catastrophe like COVID-19. Novel approaches that were developed for tracking the spread of SARS-CoV-2 included analysis of wastewater, air samples, and various environmental surfaces. We conducted a study in Kuwait during the peak of COVID-19 pandemic to examine if SARS-CoV-2 could be detected in swabs taken from frequently touched environmental surfaces. We selected 12 Cooperative Society Stores-two from each governorate of Kuwait-for collection of surface samples. The Cooperative Society Stores are widely distributed across the whole country and cater to daily household needs including groceries and other essential items. These stores operated even during the "lockdown" imposed at the height of the pandemic. We collected swabs from high-touch surfaces including the handles of the shopping carts and freezers, the elevators, the keypads of the point-of-service terminals of cash counters, and the automated teller machines. All the surfaces tested showed a variable presence of SARS-CoV-2 by reverse transcriptase quantitative PCR, showing the validity of the proof-of-concept study. Monitoring of the presence of SARS-CoV-2 by surface sampling thus offers a cheap but effective means of environmental surveillance for coronaviruses. We therefore strongly recommend the addition of surface environmental sampling as a strategy for pandemic preparedness everywhere., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jamil, Abdulrazack, Fakhraldeen, Kamal, Al-Mutairi, Al-Feili, Ahmed and Kumar.)

The emergence of bacteria that is resistant to several drugs of clinical importance poses a threat to successful treatment, a phenomenon known as multidrug resistance that affects diverse classes of antibiotics. The purpose of this study was to evaluate the prevalence of multidrug-resistant Escherichia coli , Salmonella spp. and Staphylococcus aureus in chicken egg, meat and faeces from four districts of Bangladesh. A total of 120 chicken samples were collected from different poultry farms. Conventional culture and molecular detection methods were used for identification of bacterial isolates from the collected samples followed by antibiotic susceptibility test through the disc diffusion method, finally antibiotic resistant genes were detected by PCR. E. coli, Salmonella spp. and Staphylococcus aureus were detected in meat, egg and faecal samples. Antimicrobial susceptibility results revealed isolates from faeces were 100 % resistant to amoxicillin, while all S. aureus and Salmonella sp. from faeces were resistant to doxycycline, tetracycline and erythromycin. Salmonella spp. isolates from eggs indicated 100 % resistance to erythromycin, amoxycillin, while E. coli were 100 % resistant to erythromycin. E. coli and S. aureus from meat were 100 % resistant to amoxicillin and erythromycin. However, Salmonella spp. from eggs were 100 % susceptible to doxycycline, gentamicin, levofloxacin and tetracycline. The mecA and aac(3)-IV genes were only found in S. aureus and E. coli , respectively. The Sul1, tetB , and aadA1 were highest in Salmonella spp. and S. aureus, while the sul1, tet A and bla SHV were higher in E. coli . Isolates from all samples were multidrug resistant. These findings indicate a high risk of transmission of resistance genes from microbial contamination to food of animal origin. The study emphasizes the need for effective biosecurity measures, responsible antibiotic use, and strict regulations in poultry production to prevent the spread of antibiotic resistance., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kazi Rafiq reports financial support, administrative support, and equipment, drugs, or supplies were provided by 10.13039/100020982Bangladesh Agricultural Research Council, Dhaka, Bangladesh. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

In this study, a hybrid Machine Learning (ML) approach is proposed for Relative Humidity (RH) prediction with a combination of Empirical Mode Decomposition (EMD) to improve the prediction accuracy over the traditional prediction technique using a Machine Learning (ML) algorithm called Support Vector Machine (SVM). The main objective of proposing this hybrid technique is to deal with the extremely nonlinear and noisy humidity pattern in Khulna, Bangladesh, which is experiencing rapid urbanization and environmental change. To develop the model, data on temperature, relative humidity, rainfall, and wind speed were collected from the Bangladesh Meteorological Department (BMD), and the data was divided into three phases: 70 % of the historical dataset as training data for the model, 15 % of the data set as the validation phase, and the remaining 15 % of the data set as the test phase of the model. Employing the Particle Swarm Optimization (PSO) algorithm, the SVM model determines its best hypermeters within this research. In the present research, performance analysis is carried out utilizing the Mean Square Error (MSE), Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Absolute Percentage Error (MAPE) and Coefficient of Determination (R2). Results show that the increase in R2 values resulting from the EMD-based approach is significant: 21.05 % in H1(Traditional model), 19.48 % in H2 (Traditional model), 76.92 % in H3 (Traditional model), 55.93 % in H4 (Traditional model), and 64.29 % in H5 (Traditional model) and H6 (Traditional model). The analytical results show that the proposed EMD-based technique efficiently filters and processes noisy, highly nonlinear humidity data during prediction in the Khulna region. It is recommended that this technique could be applied to other geological areas., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The relationship between English proficiency (EP), Glasgow Coma Scale (GCS) and traumatic brain injury (TBI) is not well characterized. We aimed to understand the impact of limited English proficiency (LEP) on the evaluation and outcomes of TBI., Methods: Retrospective comparative study in a single institution of patients aged ⪰65 who presented to the emergency department after a fall with head strike between January 2018 and December 2021. TBI was defined as documented loss of consciousness or intracranial hemorrhage (ICH). Relationships between EP, GCS, and TBI were analyzed with multivariable and propensity score-matched models., Results: Of the 2905 included, 1233 (42%) had LEP. Most LEP patients were Asian (60%) while the majority of EP patients were non-Hispanic Caucasians (72%). In a univariate analysis, LEP had higher incidence of decreased GCS and was strongly correlated with risk of TBI (OR 1.47, CI 1.26 to 1.71). After adjusting for multiple covariates including race, LEP did not have a significantly increased risk for GCS score <13 (OR 1.66, CI 0.99 to 2.76) or increased risk of TBI. In the matched analysis, LEP had a small but significantly higher risk of GCS score <13 (OR 1.03, CI 1.02 to 1.05) without an increased risk in TBI. Decreased GCS remained strongly correlated with presence of ICH in LEP patients in the adjusted model (OR 1.39, CI 1.30 to 1.50)., Conclusions: LEP correlated with lower GCS in geriatric patients with TBI. This association weakened after adjusting for factors like race, suggesting racial disparities may have more influence than language differences. Moreover, GCS remained effective for predicting ICH in LEP individuals, highlighting its value with suitable translation resources., Level of Evidence: This is a Level III evidence restrospective comparative study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This paper examines the impact of the Monetary Policy Uncertainty (MPU) of the United States on Asian developed, emerging, and frontier stock markets using a Quantile-on-Quantile (QQR) approach by using monthly data from January 2006 to December 2022 of 14 Asian countries. The study finds that US monetary policy significantly negatively influences Asian stock markets. This is primarily due to the widespread use of the US dollar as a universal currency, resulting in substantial ripple effects on other nations through trade relationships. In Asian developed markets, MPU is negatively related to Australia and New Zealand. At the same time, it has a positive relationship with Hong Kong and Japan at the upper quantiles. Among Asian emerging markets, MPU negatively impacts Taiwan's, India's, and China's returns, increasing this negative relationship at higher MPU quantiles. Additionally, MPU has a significant negative relationship with Thailand, Indonesia, Korea, and Malaysia returns. In contrast, higher quantiles of MPU have no discernible impact on the Philippines stock returns. In Asian frontier markets, MPU negatively impacts Pakistan's and Sri Lanka's returns. The implications of these findings are twofold: for investors, this study provides valuable insights for hedging activities, allowing for more informed decisions based on the MPU of other countries to identify profitable stocks. For policymakers, this research aids in formulating effective monetary policy strategies. Furthermore, future studies can build upon these results by exploring other markets and comparing their outcomes with the findings presented in this study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Dr. Ronald Joseph Garst, a distinguished spine surgeon and missionary, significantly impacted the field of orthopaedic surgery in Bangladesh, especially during and after the country's Liberation War, when the nation had no orthopaedic specialists. His experiences during Bangladesh's struggle for independence inspired him to establish rehabilitation centers for injured freedom fighters and to found the Rehabilitation Institute and Hospital for the Disabled (RIHD), which later became the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Bangladesh's first tertiary-level trauma center. In Bangladesh, Dr. Garst was critical in organizing care for injured freedom fighters, setting up a central limb and brace center, and launching a post-graduate training program for orthopaedics, physiotherapists, and occupational therapists. He successfully raised funds, attracted international support, and provided essential training to Bangladeshi doctors, nurses, and limb-makers.  Dr. Garst's legacy extends beyond his medical achievements; his humanitarian spirit and dedication to helping the underprivileged earned him honorary citizenship in Bangladesh. He remained committed to supporting ongoing efforts at RIHD, frequently visiting Bangladesh and contributing equipment and training materials until his passing. Dr. Garst's contributions, such as initiating morning academic sessions at RIHD, continue to influence the orthopaedic community in Bangladesh. This article explores Dr. Garst's remarkable journey, his influence on orthopaedic surgery in Bangladesh, and the enduring impact of his work., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hasibuzzaman et al.)

This empirical research study aims to investigate the asymmetric spillovers among crypto and key financial assets such as gold, equity, bonds, and the dollar-to-ruble exchange rate volatility, focusing on new developments during the Russia-Ukraine conflict in 2022. Utilizing time- and frequency-domain methodologies, this study conducts an in-depth analysis employing daily frequency data from January 01, 2018, to May 30, 2023. The study employs value at risk and conditional value at risk estimations to assess potential losses in the portfolio during the crisis. The findings reveal that Bitcoin exhibits hedging ability, enabling investors to diversify risk among the underlying financial assets. The study observes a significant increase in Bitcoin investments during the crisis, leading to heightened volatility and uncertainty. Negative news has a stronger impact compared to positive news, underscoring the importance of prudent asset allocation for risk mitigation. The implications of our findings are particularly significant for financial policymakers and trade partners of Russia. The study urges them to differentiate their short- and long-term strategies and procurement contracts. In the long run, policymakers should be cognizant of the influence of the riskiness of crypto assets during economic crises, guiding the formulation of prudent policies and investment decision-making initiatives., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This study was conducted to evaluate the effects of chia seed extract on CCl 4 -induced hepatotoxicity, hematological profile, and carrageenan-induced inflammation in rats. Water-ethanol-acetone extract of chia seeds at the doses of 200 and 400 mg/kg body weight/day were applied to evaluate the comparative protective roles. Hematological profile and serum biochemical parameters were measured to evaluate the hematoprotective, and hepatoprotective effects of chia seed extract. Paw thickness and motility level were assessed at 0, 1, 3, 5, and 7 h after sub-planter injection of carrageenan to evaluate the anti-inflammatory potential. Tissue histopathology was performed in both cases. Chia seed extract reduced the elevated level of serum AST and ALT significantly in a dose-dependent manner following intra-peritoneal injection of CCl 4 . Histopathological study of the liver tissue exhibited acute impairment of the hepatocytes and liver parenchyma following CCl 4 exposure, which was markedly regenerated by the chia seed extract treatment. Protective effects of the extracts were also evidenced by the RBC count, Hb (%), PCV (%), ESR, and neutrophil count. Chia seed extract was found to inhibit the carrageenan-induced paw edema and increase motility level in a dose-oriented fashion. Histological examination of the paw tissue revealed severe inflammation characterized by massive infiltration of inflammatory cells in the carrageenan group, which was significantly reduced by chia seed extract treatment. The higher dose of chia seed extract showed significant increases in bodyweight gain and feed efficiency ratio but decrease in visceral fat deposition. These results suggest that chia seeds possess potentials for hematoprotective, hepatoprotective, and anti-inflammatory activities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Shigellosis remains a common gastrointestinal disease mostly in children < 5 years of age in developing countries. Azithromycin (AZM), a macrolide, is currently the first-line treatment for shigellosis in Bangladesh; ciprofloxacin (CIP) and ceftriaxone (CRO) are also used frequently. We aimed to evaluate the current epidemiology of antimicrobial resistance (AMR) and mechanism(s) of increasing macrolide resistance in Shigella in Bangladesh. A total of 2407 clinical isolates of Shigella from 2009 to 2016 were studied. Over the study period, Shigella sonnei was gradually increasing and become predominant (55%) over Shigella flexneri (36%) by 2016. We used CLSI-guided epidemiological cut-off value (ECV) for AZM in Shigella to set resistance breakpoints (zone-diameter ≤ 15 mm for S. flexneri and ≤ 11 mm for S. sonnei). Between 2009 and 2016, AZM resistance increased from 22% to approximately 60%, CIP resistance increased by 40%, and CRO resistance increased from zero to 15%. The mphA gene was the key macrolide resistance factor in Shigella; a 63MDa conjugative middle-range plasmid was harboring AZM and CRO resistance factors. Our findings show that, especially after 2014, there has been a rapid increase in resistance to the three most effective antibiotics. The rapid spread of macrolide (AZM) resistance genes among Shigella are driven by horizontal gene transfer rather than direct lineage., (© 2024. The Author(s).)

Objective: Cancer is a major cause of death globally, and places a substantial burden on both patients and their caregivers. Frequent stress among caregivers often affects their mental well-being. This study was aimed at assessing anxiety and depression levels among informal caregivers of patients with cancer treated at selected tertiary hospitals in Nepal. An additional aim was to identify socio-demographic factors associated with these mental health outcomes., Methods: In this cross-sectional study, 383 informal caregivers were surveyed with the Hospital Anxiety and Depression Scale (HADS). Statistical analyses, including descriptive analysis and binary logistic regression, were conducted to explore associations with socio-demographic variables., Results: The mean age of participants was 36.1 ± 13.1 years, and 56.1% were 12-36 years old. Most participants were married (81.5%), were unemployed (66.6%), and had primary to secondary education (66.6%). The prevalence of moderate to severe anxiety (52%) and depression (45%) among caregivers was notable. Caregivers of patients treated at non-governmental hospitals were six times more likely (OR 6.3, 95% CI: [3.62-10.95], P  = 0.001) to have anxiety and five times more likely (OR 5.3, 95% CI: [8.28-19.32], P  = 0.001) to have depression., Conclusion: People who take care of patients with cancer in Nepal often feel substantial stress. Determining the causes of these feelings can aid in the creation of programs to support caregivers' mental health. Caring for mental well-being among caregivers is critical to achieving better cancer care and quality of life., (© 2024 The Authors.)

Objective: The study was primarily conducted to assess the stakeholders' knowledge regarding the contamination caused by heavy metals in poultry feedstuffs. The concentration of some heavy metals (lead, chromium, cadmium, and nickel) and macro-minerals (sodium, potassium, and calcium) was also analyzed in poultry feeds collected from selected local markets in Sherpur district, Bangladesh., Materials and Methods: A well-structured questionnaire survey was used to investigate different stakeholders' perspectives in relation to metal contamination in feed. Heavy metals and calcium were determined by atomic absorption spectrophotometry. The flame emission spectrophotometric technique was applied to determine sodium and potassium., Results: The majority of the stakeholders (90%) were found to have no knowledge regarding heavy metal contamination. Lead and nickel concentrations were below the detectable level in the collected samples. The average concentration of chromium in Jhenaigati upazila was four times higher than in Nalitabari upazila, at 21.806 mg kg -1 and 5.452 mg kg -1 , respectively. The concentrations of cadmium in both brand and nonbrand samples exceeded the maximum allowable limit set by the European Union at 1.329 mg kg -1 and 1.328 mg kg -1 , respectively. Sodium, potassium, and calcium were found in the ranges of 0.0011%-0.0035%, 0.0010%-0.0013%, and 0.0080%-0.0305%, which were extremely low in concentration compared to the minimum requirement in poultry feed., Conclusion: Regular surveillance and governance systems should be incorporated into national policy to cease the hazardous impacts of heavy metals through feed contamination. From a nutritional viewpoint, poultry feeds need to be critically formulated., Competing Interests: The authors have declared that there is no conflict of interest in this research., (Copyright: © Journal of Advanced Veterinary and Animal Research.)

Several environmental pollutants, mostly chemicals and plasticizers, have an effect on the reproduction of small ruminants, causing abortion, delayed estrus, and decreased fertility. Phthalates are common in our environment and have been identified as endocrine disrupting chemicals (EDCs). The research work investigated the impact of dietary exposure to a phthalate mixture on physical and hemato-biochemical parameters in pregnant Black Bengal (BB) goats. A total of 20 clinically healthy, 1-2 months pregnant, aged 6-8 months with a body weight of 10-12 kg BB goats were collected and divided into two (n = 10) groups. The treatment group received a standard goat ration with a combination of different phthalates mixture while the control group was provided the same ration with the vehicle of aphthalatemixture until parturition. The physical parameters were measured with appropriate tools and blood samples were collected for hemato-biochemical tests. The results showed that the physiological parameters (body condition score, respiration rate and heart rate) were significantly (P < 0.05) reduced in phthalate-exposed goats without altering rectal temperature and rumen motility. The hematological parameters: RBC count, WBC count, hemoglobin concentration, hematocrit values and RBC indices were significantly (P < 0.05) lower in phthalate-exposed goats. Phthalate-exposed BB goats had significantly (P < 0.05) higher neutrophil and lower lymphocyte counts. Serum glucose, total protein, albumin and total cholesterol levels were significantly (P < 0.05) lower in phthalate-exposed BB goats but higher the values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and blood urea nitrogen (BUN) levels in treated BB goats. It may be concluded that exposure to a phthalate mixture during pregnancy alters the physical, hematological and biochemical parameters in BB goats., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This paper aims to investigate the responsiveness of renewable energy production (REP) to fluctuations in geopolitical risks, oil prices and economic policy uncertainty (EPU). It applies a cross-quantilogram framework to examine monthly data of the US economy for the period of 1986-2022. The findings illustrate the asymmetric effect of historical geopolitical risk (GPRH) on REP under long memory. The findings also hold after different subcategories of GPRH, including geopolitical threats and geopolitical acts, are considered. A positive shock in GPRH has the most decisive positive impact on REP when the policies are driven by both energy security and environmental commitments. A positive shock in GPRH can negatively impact REP when policies are driven by energy security causes only. EPU exerts strong negative effects on REP in bearish and bullish states of the market under medium and long memory across different measures of EPU. Dynamic connectedness analysis applying TVP-VAR method between pairwise variables indicates that net REP is a volatility receiver to the changes in GPRH, its subcomponents, oil prices and different measures of EPU., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Tumor microenvironment (TME) plays a pivotal role in immuno-oncology, which investigates the intricate interactions between tumors and the human immune system. Specifically, tumor-infiltrating lymphocytes (TILs) are crucial biomarkers for evaluating the prognosis of breast cancer patients and have the potential to refine immunotherapy precision and accurately identify tumor cells in specific cancer types. In this study, we conducted tissue segmentation and lymphocyte detection tasks to predict TIL scores by employing self-supervised learning (SSL) model-based approaches capable of addressing limited labeling data issues. Our experiments showed a 1.9% improvement in tissue segmentation and a 2% improvement in lymphocyte detection over the ImageNet pre-training model. Using these SSL-based models, we achieved a TIL score of 0.718 with a 4.4% improvement. In particular, when trained with only 10% of the entire dataset, the SwAV pre-trained model exhibited a superior performance over other models. Our work highlights improved tissue segmentation and lymphocyte detection using the SSL model with less labeled data for TIL score prediction.

Objectives: Emergency Departments (EDs) play a major role in managing acute and chronic illnesses, especially in low-to-middle-income countries like Pakistan, which lacks effective primary healthcare. This study reports the epidemiology and clinical characteristics of patients presenting over a two-year period at the Indus Hospital and Health Network (IHHN) adult ED in Karachi, Pakistan., Methods: This is a retrospective observational study conducted through chart review of 264,859 patients, aged 16 years and above, who presented to the IHHN ED, Korangi Campus, from January 2019 to December 2020 after obtaining approval from IHHN IRB., Results: Men were found to be the predominant presenting gender, with a slight rise in the number of women in 2020. The most frequent age group in 2019 was 15-25 (27.7%), whereas it was 25-35 years in 2020 (24.1%), with a decline in total number of elderly visits seen in comparison to previous years. The most frequently seen disposition was 'referral to clinic' in 2019 (48.4%) and 'discharged' in 2020 (39%). Out of all dispositions, maximum Length of stay (LOS) was seen in patients who left against medical advice in both years. Patient acuity showed the highest number of P3 (moderately ill) patients in both years. Infectious diseases accounted for greater than 10% of patients in both years (17.2% and16.5%), followed by gastrointestinal complaints (15.7% and 11.3%), genitourinary complaints (14.9% and 7.9%), and trauma (11.9% and 12.4%)., Conclusion: Knowledge of epidemiology and clinical characteristics of patients can help facilitate timely planning of staff deployment and allocation of resources to avoid overcrowding, improve patient outcomes, and increase patient satisfaction through timely management., Competing Interests: Conflict of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Objective: Still's disease is more frequently observed in the paediatric context, but a delayed onset is not exceptional both in the adulthood and in the elderly. However, whether paediatric-onset, adult-onset and elderly-onset Still's disease represent expressions of the same disease continuum or different clinical entities is still a matter of controversy. The aim of this study is to search for any differences in demographic, clinical features and response to treatment between pediatric-onset, adult-onset and elderly-onset Still's disease., Methods: Subjects included in this study were drawn from the International AutoInflammatory Disease Alliance Network registry for patients with Still's disease., Results: A total of 411 patients suffering from Still's disease were enrolled; the disease occurred in the childhood in 65 (15.8%) patients, in the adult 314 (76.4%) patients and in the elderly in 32 (7.8%) patients. No statistically significant differences at post-hoc analysis were observed in demographic features of the disease between pediatric-onset, adult-onset and elderly-onset Still's disease. The salmon-coloured skin rash (p=0.004), arthritis (p=0.009) and abdominal pain (p=0.007) resulted significantly more frequent among paediatric patients than in adult cases, while pleuritis (p=0.015) and arthralgia (p<0.0001) were significantly more frequent among elderly-onset patients compared with paediatric-onset subjects. Regarding laboratory data, thrombocytosis was significantly more frequent among paediatric patients onset compared with adult-onset subjects (p<0.0001), while thrombocytopenia was more frequent among elderly-onset patients although statistical significance was only bordered. No substantial differences were observed in the response to treatments., Conclusions: Despite some minor difference between groups, overall, demographic, clinical, laboratory and treatments aspects of Still's disease were similarly observed in patients at all ages. This supports that pediatric-onset, adult-onset and elderly-onset Still's disease is the same clinical condition arising in different ages., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In this report, we present our studies on mRNA, which was modified by introducing various halogen substituents at the C(5) position of the pyrimidine base. Specifically, we synthesized C(5)-halogenated (F, Cl, Br, I) pyrimidine ribonucleoside triphosphates and incorporated them into mRNA during in-vitro transcription. The efficiency of the in-vitro transcription reaction of halogenated pyrimidine was observed to decrease as the size of the halogen substituent increased and the electronegativity thereof decreased (F > Cl > Br) except for iodine. Interestingly, we found that, among the C(5)-halogenated pyrimidine ribonucleotides, mRNA incorporating C(5)-halogenated cytidine (5-F rCTP and 5-Cl rCTP) exhibited more prominent protein expression than mRNA modified with C(5)-halogenated uridine and unmodified mRNA. In particular, in the case of mRNA to which fluorine (5-F rCTP) and chlorine (5-Cl rCTP) were introduced, the protein was dramatically expressed about 4 to 5 times more efficiently than the unmodified mRNA, which was similar to pseudouridine (ψ). More interestingly, when pseudouridine(ψ) and fluorocytidine nucleotides (5-F rCTP), were simultaneously introduced into mRNA for dual incorporation, the protein expression efficiency dramatically increased as much as tenfold. The efficiency of cap-dependent protein expression is much higher than the IRES-dependent (internal ribosome entry site) expression with mRNA incorporating C(5)-halogenated pyrimidine ribonucleotide. We expect these results to contribute meaningfully to the development of therapeutics based on modified mRNA., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: According to the World Health Organization (WHO), dementia is the seventh leading reason of death among all illnesses and one of the leading causes of disability among the world's elderly people. Day by day the number of Alzheimer's patients is rising. Considering the increasing rate and the dangers, Alzheimer's disease should be diagnosed carefully. Machine learning is a potential technique for Alzheimer's diagnosis but general users do not trust machine learning models due to the black-box nature. Even, some of those models do not provide the best performance because of using only neuroimaging data., Objective: To solve these issues, this paper proposes a novel explainable Alzheimer's disease prediction model using a multimodal dataset. This approach performs a data-level fusion using clinical data, MRI segmentation data, and psychological data. However, currently, there is very little understanding of multimodal five-class classification of Alzheimer's disease., Method: For predicting five class classifications, 9 most popular Machine Learning models are used. These models are Random Forest (RF), Logistic Regression (LR), Decision Tree (DT), Multi-Layer Perceptron (MLP), K-Nearest Neighbor (KNN), Gradient Boosting (GB), Adaptive Boosting (AdaB), Support Vector Machine (SVM), and Naive Bayes (NB). Among these models RF has scored the highest value. Besides for explainability, SHapley Additive exPlanation (SHAP) is used in this research work., Results and Conclusions: The performance evaluation demonstrates that the RF classifier has a 10-fold cross-validation accuracy of 98.81% for predicting Alzheimer's disease, cognitively normal, non-Alzheimer's dementia, uncertain dementia, and others. In addition, the study utilized Explainable Artificial Intelligence based on the SHAP model and analyzed the causes of prediction. To the best of our knowledge, we are the first to present this multimodal (Clinical, Psychological, and MRI segmentation data) five-class classification of Alzheimer's disease using Open Access Series of Imaging Studies (OASIS-3) dataset. Besides, a novel Alzheimer's patient management architecture is also proposed in this work., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jahan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Different patient clusters were preliminarily suggested to dissect the clinical heterogeneity in Still's disease. Thus, we aimed at deriving and validating disease clusters in a multicentre, observational, prospective study to stratify these patients., Methods: Patients included in GIRRCS AOSD-study group and AIDA Network Still Disease Registry were assessed if variables for cluster analysis were available (age, systemic score, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and ferritin). K-means algorithm with Euclidean metric and Elbow plot were used to derive an adequate number of clusters., Results: K-means clustering assessment provided four clusters based on means standardised according to z-scores on 349 patients. All clusters mainly presented fever, skin rash and joint involvement. Cluster 1 was composed by 115 patients distinguished by lower values of age and characterised by skin rash myalgia, sore throat and splenomegaly. Cluster 2 included 128 patients identified by lower levels of ESR, ferritin and systemic score; multiorgan manifestations were less frequently observed. Cluster 3 comprised 31 patients categorised by higher levels of CRP and ferritin, they were characterised by fever and joint involvement. Cluster 4 contained 75 patients derived by higher values of age and systemic score. Myalgia, sore throat, liver involvement and life-threatening complications, leading to a high mortality rate, were observed in these patients., Conclusions: Four patient clusters in Still's disease may be recognised by a multidimensional characterisation ('Juvenile/Transitional', 'Uncomplicated', 'Hyperferritinemic' and 'Catastrophic'). Of interest, cluster 4 was burdened by an increased rate of life-threatening complications and mortality, suggesting a more severe patient group., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Most researchers consider CO 2 emissions to be the primary indicator of environmental degradation. Similarly, ecological footprint appears to be a significant proxy for environmental degradation in recent research due to its multifaceted impact on the natural environment. With this in mind, this study investigates fluctuations in CO 2 emissions and ecological footprint as indicators of environmental degradation in Bangladesh from 1980 to 2020, and how they are influenced by net savings, natural resource depletion, technological innovation, and democracy. The non-linear ARDL (NARDL)-based asymmetric analysis finds that positive changes in net savings, natural resource depletion, and democracy positively impact both parameters of environmental degradation in the long run. On the other hand, a positive change in technological innovation reduces these parameters in the long run. Likewise, negative changes in net savings and technological innovation reduce environmental degradation. In contrast, negative changes in natural resource depletion and democracy exacerbate these two parameters and degrade environmental quality in the long run. However, there are some variations in the short-run influence of the predictors on the predicted variable. Overall, the findings of this study suggest that policymakers must strategically exploit natural resources, net savings, technology diffusion, and democratic principles to preserve the natural environment in Bangladesh., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Long noncoding RNAs (lncRNAs) play crucial roles in regulating various hallmarks in cancers. Triple-negative (Estrogen receptor, ER; Human epidermal growth factor receptor 2, HER2; Progesterone receptor, PR) breast cancer (TNBC) is the most aggressive form of breast cancers with a poor prognosis and no available molecular targeted therapy., Methods: We reviewed the current literature on the roles of lncRNAs in the pathogenesis, therapy resistance, and prognosis of patients with TBNC., Results: LncRNAs are associated with TNBC pathogenesis, therapy resistance, and prognosis. For example, lncRNAs such as small nucleolar RNA host gene 12 (SNHG12), highly upregulated in liver cancer (HULC) HOX transcript antisense intergenic RNA (HOTAIR), lincRNA-regulator of reprogramming (LincRNA-ROR), etc., are aberrantly expressed in TNBC and are involved in the pathogenesis of the disease. LncRNAs act as a decoy, scaffold, or sponge to regulate the expression of genes, miRNAs, and transcription factors associated with pathogenesis and progression of TNBC. Moreover, lncRNAs such as ferritin heavy chain 1 pseudogene 3 (FTH1P3), BMP/OP-responsive gene (BORG) contributes to the therapy resistance property of TNBC through activating ABCB1 (ATP-binding cassette subfamily B member 1) drug efflux pumps by increasing DNA repair capacity or by inducing signaling pathway involved in therapeutic resistance., Conclusion: In this review, we outline the functions of various lncRNAs along with their molecular mechanisms involved in the pathogenesis, therapeutic resistance of TBNC. Also, the prognostic implications of lncRNAs in patients with TNBC is illustrated. Moreover, potential strategies targeting lncRNAs against highly aggressive TNBC is discussed in this review., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

We propose a completely non-invasive and highly accurate portable blood glucose estimator, which is simple hardware that anyone, regardless of their prior experience or knowledge, can use to obtain an immediate reading of their blood sugar level. Glucose levels can be monitored in real time and displayed on the device thanks to its infrared LED light source, sensor with built-in amplification unit, processing unit with blood glucose regression model, power management unit for autonomous operation, and display. The device was initially used to create a dataset of photoplethysmography (PPG) signals collected from the fingertip of 50 subjects. The extracted signal features were correlated with the subject's glucose level, which was measured at the same time using a commercial glucometer, and several regression models were constructed. The models were evaluated using signals from up to 110 subjects across three datasets, and the most optimized model was implemented in the device to predict the subject's blood glucose level solely based on PPG in real-time. The device with the built-in model has been subjected to extensive testing to gauge its efficacy. The device's clinical accuracy is encouraging. The pricey strips and needles that must be purchased along with the hardware in the conventional method will no longer be necessary with this device., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background and Aim: Informal prescribers (IPs) significantly contribute to the development of antimicrobial resistance and in disseminating pathogens from poultry to humans and other animals through the food chain, posing a serious global health threat. Therefore, this study aimed to assess whether the knowledge of IPs has an impact on their attitude and practice toward antimicrobial use, antibiotic residues, and antimicrobial resistance., Materials and Methods: In this cross-sectional study, we conducted a pre-tested and questionnaire-based survey to investigate the knowledge, attitude, and practice of IPs in selected parts of the Mymensingh division, Bangladesh. Then, we used the linear regression model test with R-squared (R 2 ) to measure the association between the study variables., Results: Our investigation revealed that 70% of the IPs knew about antibiotics and 75% had good knowledge about antibiotic resistance, whereas only 50% were aware of withdrawal periods. Informal prescribers also displayed good attitudes toward the use and sale of antibiotics with withdrawal periods and completion of medication (50%). Analysis of their practice on the sale and prescription of antibiotics showed that 70% and 30% of IPs use antibiotics against bacterial infections and other conditions, respectively. Most of them do not consult a veterinarian before selling or prescribing antibiotics, although 80% claim to do so. This is because 75% of IPs gave other options regarding their consultations. However, 95% of IPs uses antibiotics only for therapeutic purposes. Furthermore, only 10% sell antibiotics based on a veterinarian's recommendation. Approximately 45% of IPs use single antibiotics at a time, while the rest use multiple antibiotics, individually or combined. Approximately 15% use antibiotics monthly, while 85% use them whenever the need arises. The knowledge and attitude of IPs are significantly affected by their age (p ≤ 0.025). The district of domicile also impacted their knowledge. Surprisingly, IPs from Jamalpur had significantly better knowledge compared to those from Mymensingh and Sherpur (p ≤ 0.01). The attitude of IPs from Jamalpur and Netrokona also differed significantly (p ≤ 0.001) from that of Mymensingh and Sherpur. The knowledge of IPs influenced their attitude up to 80.5% (r 2 = 0.628) and their practice up to 75.4% (r 2 = 0.545)., Conclusion: The knowledge of IPs greatly influenced their attitude and practice, while sociodemographics also influenced their knowledge and attitude toward antimicrobial use, antibiotic residues, and antimicrobial resistance., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Sani, et al.)

Background: Amiodarone is underutilized due to significant off-target toxicities. We hypothesized that targeted delivery to the heart would lead to the lowering of the dose by utilizing a cardiomyocyte-targeting peptide (CTP), a cell-penetrating peptide identified by our prior phage display work., Methods: CTP was synthesized thiolated at the N-terminus, conjugated to amiodarone via Schiff base chemistry, HPLC purified, and confirmed with MALDI/TOF. The stability of the conjugate was assessed using serial HPLCs. Guinea pigs (GP) were injected intraperitoneally daily with vehicle (7 days), amiodarone (7 days; 80 mg/kg), CTP-amiodarone (5 days; 26.3 mg/kg), or CTP (5 days; 17.8 mg/kg), after which the GPs were euthanized, and the hearts were excised and perfused on a Langendorff apparatus with Tyrode's solution and blebbistatin (5 µM) to minimize the contractions. Voltage (RH237) and Ca 2+ -indicator dye (Rhod-2/AM) were injected, and fluorescence from the epicardium split and was captured by two cameras at 570-595 nm for the cytosolic Ca 2+ and 610-750 nm wavelengths for the voltage. Subsequently, the hearts were paced at 250 ms with programmed stimulation to measure the changes in the conduction velocities (CV), action potential duration (APD), and Ca 2+ transient durations at 90% recovery (CaTD 90 ). mRNA was extracted from all hearts, and RNA sequencing was performed with results compared to the control hearts., Results: The CTP-amiodarone remained stable for up to 21 days at 37 °C. At ~1/15th of the dose of amiodarone, the CTP-amiodarone decreased the CV in hearts significantly compared to the control GPs (0.92 ± 0.05 vs. 1.00 ± 0.03 ms, p = 0.0007), equivalent to amiodarone alone (0.87 ± 0.08 ms, p = 0.0003). Amiodarone increased the APD (192 ± 5 ms vs. 175 ± 8 ms for vehicle, p = 0.0025), while CTP-amiodarone decreased it significantly (157 ± 16 ms, p = 0.0136), similar to CTP alone (155 ± 13 ms, p = 0.0039). Both amiodarone and CTP-amiodarone significantly decreased the calcium transients compared to the controls. CTP-amiodarone and CTP decreased the CaTD 90 to an extent greater than amiodarone alone ( p < 0.001). RNA-seq showed that CTP alone increased the expression of DHPR and SERCA2a, while it decreased the expression of the proinflammatory genes, NF-kappa B, TNF-α, IL-1β, and IL-6., Conclusions: Our data suggest that CTP can deliver amiodarone to cardiomyocytes at ~1/15th the total molar dose of the amiodarone needed to produce a comparable slowing of CVs. The ability of CTP to decrease the AP durations and CaTD 90 may be related to its increase in the expression of Ca-handling genes, which merits further study.

Background and Aim: Antibiotic residues in livestock farming have been identified as a potential cause of antimicrobial resistance in humans and animals. This study aimed to determine whether antibiotic residues were present in the chicken meat, eggs, feces, and feed collected from all four districts in the Mymensingh division of Bangladesh., Materials and Methods: To detect antibiotic residues in the collected samples, qualitative thin-layer chromatography (TLC) and quantitative high-performance liquid chromatography (HPLC) were used. A total of 230 samples were analyzed for antibiotic residues of commonly used 11 antibiotics. Out of these, 40 meat and 40 feces samples were collected from broilers and layers, 30 egg samples from ducks and layers, and 120 feed samples from broilers and layers from the study area. Thin-layer chromatography was used to screen the presence of antibiotic residues; TLC-positive samples were then subjected to further HPLC analysis to determine the residue concentrations., Results: Thin-layer chromatography analysis revealed that 23.5% of the tested samples contained residues from six different antibiotic classes (tetracyclines, quinolones, beta-lactams, sulfonamides, aminoglycosides, and macrolides). Thin-layer chromatography analysis showed that 35% and 25% of the meat samples were positive for residues from the broiler and layer, respectively. About 15% and 30% of layer and duck egg samples had positive residues, respectively. Out of 120 feed samples analyzed, about 15.8% had various antibiotic residues. In addition, feces samples from broilers and layers had 50% and 35% antibiotic residues, respectively. A total of 2.5% meat and 3.3% egg samples had antibiotic residues above the maximum residue limit (MRL). Based on the findings of this study, the highest percentage of oxytetracycline, followed by doxycycline and ciprofloxacin, were detected in feed samples, and oxytetracycline was detected in meat and egg samples., Conclusion: This study clearly showed the misuse of antibiotics in the poultry sector in Bangladesh. Although antibiotic residues below the MRL level are suitable for human consumption, they may result in antimicrobial drug resistance to pathogens., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Sani, et al.)

Background: Fractional flow reserve-computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown., Objectives: The purpose of this study was to audit the use of FFR-CT in clinical practice against England's National Institute for Health and Care Excellence guidance and assess its diagnostic accuracy and cost., Methods: A multicenter audit was undertaken covering the 3 years when FFR-CT was centrally funded in England. For coronary computed tomographic angiograms (CCTAs) submitted for FFR-CT analysis, centers provided data on symptoms, CCTA and FFR-CT findings, and subsequent management. Audit standards included using FFR-CT only in patients with stable chest pain and equivocal stenosis (50%-69%). Diagnostic accuracy was evaluated against invasive FFR, when performed. Follow-up for nonfatal myocardial infarction and all-cause mortality was undertaken. The cost of an FFR-CT strategy was compared to alternative stress imaging pathways using cost analysis modeling., Results: A total of 2,298 CCTAs from 12 centers underwent FFR-CT analysis. Stable chest pain was the main symptom in 77%, and 40% had equivocal stenosis. Positive and negative predictive values of FFR-CT were 49% and 76%, respectively. A total of 46 events (2%) occurred over a mean follow-up period of 17 months; FFR-CT (cutoff: 0.80) was not predictive. The FFR-CT strategy costs £2,102 per patient compared with an average of £1,411 for stress imaging., Conclusions: In clinical practice, the National Institute for Health and Care Excellence criteria for using FFR-CT were met in three-fourths of patients for symptoms and 40% for stenosis. FFR-CT had a low positive predictive value, making its use potentially more expensive than conventional stress imaging strategies., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. All rights reserved.)

Modern medicine has developed a myriad of therapeutic drugs against a wide range of human diseases leading to increased life expectancy and better quality of life for millions of people. Despite the undeniable benefit of medical advancements in pharmaceutical technology, many of the most effective drugs currently in use have serious limitations such as off target side effects resulting in systemic toxicity. New generations of specialized drug constructs will enhance targeted therapeutic efficacy of existing and new drugs leading to safer and more effective treatment options for a variety of human ailments. As one of the most efficient drugs known for the treatment of cardiac arrhythmia, Amiodarone presents the same conundrum of serious systemic side effects associated with long term treatment. In this article we present the synthesis of a next-generation prodrug construct of amiodarone for the purpose of advanced targeting of cardiac arrhythmias by delivering the drug to cardiomyocytes using a novel cardiac targeting peptide, a cardiomyocyte-specific cell penetrating peptide. Our in vivo studies in guinea pigs indicate that cardiac targeting peptide-amiodarone conjugate is able to have similar effects on calcium handling as amiodarone at 1/15th the total molar dose of amiodarone. Further studies are warranted in animal models of atrial fibrillation to show efficacy of this conjugate., Competing Interests: MZ holds a patent on the use of cardiac targeting peptide as a novel cardiac vector along with Dr. Paul Robbins and University of Pittsburgh. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yurko, Islam, Weber, Salama and Zahid.)

Physician categorizations of electronic health record (EHR) data (e.g., depression) into sensitive data categories (e.g., Mental Health) and their perspectives on the adequacy of the categories to classify medical record data were assessed. One thousand data items from patient EHR were classified by 20 physicians (10 psychiatrists paired with ten non-psychiatrist physicians) into data categories via a survey. Cluster-adjusted chi square tests and mixed models were used for analysis. 10 items were selected per each physician pair (100 items in total) for discussion during 20 follow-up interviews. Interviews were thematically analyzed. Survey item categorization yielded 500 (50.0%) agreements, 175 (17.5%) disagreements, 325 (32.5%) partial agreements. Categorization disagreements were associated with physician specialty and implied patient history. Non-psychiatrists selected significantly ( p = .016) more data categories than psychiatrists when classifying data items. The endorsement of Mental Health and Substance Use categories were significantly ( p = .001) related for both provider types. During thematic analysis, Encounter Diagnosis (100%), Problems (95%), Health Concerns (90%), and Medications (85%) were discussed the most when deciding the sensitivity of medical information. Most (90.0%) interview participants suggested adding additional data categories. Study findings may guide the evolution of digital patient-controlled granular data sharing technology and processes.

Background: Pulmonary embolism (PE) is a fatal form of venous thromboembolism (VTE), with an overall untreated mortality of up to 30%. Greater than 50% of patients with lower extremity proximal DVT have concurrent PE at presentation. VTE has been seen in up to one-third of patients with COVID-19 infections requiring intensive care unit (ICU) admission. The objective of this study is to determine the correlation between CT pulmonary angiography, pulmonary embolism clot burden, and the Qanadli scoring system with clinically severe COVID-19 pneumonia and cytokine storm., Material and Method: 153 COVID-19 hospitalized patients who underwent CT pulmonary angiography (CTPA) for likely PE on pretest probability modified Wells criteria were enrolled. COVID-19 pneumonia was classified as URTI (upper respiratory tract infection), mild, severe, and critical COVID pneumonia. For data analysis, we categorized into two groups: (1) the non-severe group included URTI and mild pneumonia, and (2) the severe group included severe and critical pneumonia. We used the Qanadli scoring system to assess the PE percentages of pulmonary vascular obstruction using CTPA.  Results: 41.8% (64) of COVID-19 patients were diagnosed with pulmonary embolism (PE) on CTPA. The majority of 51.6% of pulmonary vascular occlusions using the Qanadli scoring system for pulmonary embolism were at segmental arterial levels. Out of 104 COVID-19 cytokine storm patients, 45 (43%) were associated with pulmonary embolism. Overall, a 25% (16) mortality rate was observed in COVID-19 patients with pulmonary embolism., Discussion: The pathogenesis of hypercoagulability in COVID-19 may include direct endothelial cell invasion by the virus, microvascular inflammation, endothelial exocytosis, and endotheliitis. A meta-analysis of 71 studies to investigate the occurrence of PE on CTPA in COVID-19 patients found 48.6% in ICU settings and 65.3% of patients have clots in the peripheral pulmonary vasculature., Conclusions: There is a significant correlation between pulmonary embolism and high clot burden Qanadli CTPA scores, as well as between the severity of COVID-19 pneumonia and mortality. The association between critically ill COVID-19 pneumonia and pulmonary embolism may result in higher mortality and a poor prognostic marker., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ali et al.)

Deep learning techniques have recently demonstrated remarkable success in numerous domains. Typically, the success of these deep learning models is measured in terms of performance metrics such as accuracy and mean average precision (mAP). Generally, a model's high performance is highly valued, but it frequently comes at the expense of substantial energy costs and carbon footprint emissions during the model building step. Massive emission of CO2 has a deleterious impact on life on earth in general and is a serious ethical concern that is largely ignored in deep learning research. In this article, we mainly focus on environmental costs and the means of mitigating carbon footprints in deep learning models, with a particular focus on models created using knowledge distillation (KD). Deep learning models typically contain a large number of parameters, resulting in a 'heavy' model. A heavy model scores high on performance metrics but is incompatible with mobile and edge computing devices. Model compression techniques such as knowledge distillation enable the creation of lightweight, deployable models for these low-resource devices. KD generates lighter models and typically performs with slightly less accuracy than the heavier teacher model (model accuracy by the teacher model on CIFAR 10, CIFAR 100, and TinyImageNet is 95.04%, 76.03%, and 63.39%; model accuracy by KD is 91.78%, 69.7%, and 60.49%). Although the distillation process makes models deployable on low-resource devices, they were found to consume an exorbitant amount of energy and have a substantial carbon footprint (15.8, 17.9, and 13.5 times more carbon compared to the corresponding teacher model). The enormous environmental cost is primarily attributable to the tuning of the hyperparameter, Temperature (τ). In this article, we propose measuring the environmental costs of deep learning work (in terms of GFLOPS in millions, energy consumption in kWh, and CO2 equivalent in grams). In order to create lightweight models with low environmental costs, we propose a straightforward yet effective method for selecting a hyperparameter (τ) using a stochastic approach for each training batch fed into the models. We applied knowledge distillation (including its data-free variant) to problems involving image classification and object detection. To evaluate the robustness of our method, we ran experiments on various datasets (CIFAR 10, CIFAR 100, Tiny ImageNet, and PASCAL VOC) and models (ResNet18, MobileNetV2, Wrn-40-2). Our novel approach reduces the environmental costs by a large margin by eliminating the requirement of expensive hyperparameter tuning without sacrificing performance. Empirical results on the CIFAR 10 dataset show that the stochastic technique achieves an accuracy of 91.67%, whereas tuning achieves an accuracy of 91.78%-however, the stochastic approach reduces the energy consumption and CO2 equivalent each by a factor of 19. Similar results have been obtained with CIFAR 100 and TinyImageNet dataset. This pattern is also observed in object detection classification on the PASCAL VOC dataset, where the tuning technique performs similarly to the stochastic technique, with a difference of 0.03% mAP favoring the stochastic technique while reducing the energy consumptions and CO2 emission each by a factor of 18.5., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rafat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)