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Miller Fisher Syndrome (MFS) is a rare variant of Guillain-Barré Syndrome (GBS), characterised by a unique clinical triad of ophthalmoplegia, ataxia, and areflexia. MFS, which was first described in 1956 by Charles Miller Fisher , is frequently preceded by an infection, usually respiratory or gastrointestinal, and is believed to be triggered by an autoimmune reaction targeting peripheral nervous system components. However the MFS is further categorised into incomplete forms which can be present without the classical triad, such as acute ophthalmoparesis, acute ataxic neuropathy, acute ptosis and acute mydriasis. We report a case of a 50-year-old man presenting with dilated and unresponsive pupils, which progressed rapidly to ophthalmoplegia, ataxia, and areflexia. Given the clinical history supported by the cyto-protein dissociation in cerebrospinal fluid, the patient was diagnosed to have MFS and successfully treated with intravenous immunoglobulin. This case underscores the importance of recognising atypical features of MFS, such as primary mydriasis, and highlights the variable clinical spectrum within the syndrome. Clinicians should maintain a high index of suspicion for MFS, particularly when faced with unusual neurological presentations, to ensure timely intervention and optimal patient outcomes.

ndocarditis due to non-toxigenic Corynebacterium diphtheriae is emerging as a rare subtype of endocarditis, with limited case reports available. It has been related to the presence of prosthetic valves, underlying cardiac disease, or the use of injectable drugs. We present a fatal case of endocarditis due to non-toxigenic Corynebacterium diphtheriae in a native aortic valve complicated with microangiopathic haemolytic anaemia and multiple septic emboli in the brain causing infarctions in a patient with smear-positive pulmonary tuberculosis who was on anti-tuberculosis therapy (ATT). Following blood culture positivity and suggestive evidence from the echocardiogram, the patient was initially treated with intravenous ceftriaxone and vancomycin along with ATT. Evolution was assessed by sterile blood cultures post therapy and follow-up transthoracic echocardiograms (TTE) and transesophageal echocardiograms (TOE). Even though the patient's condition improved with intravenous antibiotic therapy, it later deteriorated with disseminated intravascular coagulation and liver injury followed by prerenal acute kidney injury and multiple septic emboli causing the patient’s demise, which may have necessitated surgical interventions.

Abstract Amyotrophic lateral sclerosis causes degeneration of motor neurons, resulting in progressive muscle weakness and impairment in motor function. Promising drug development efforts have accelerated in amyotrophic lateral sclerosis, but are constrained by a lack of objective, sensitive, and accessible outcome measures. Here we investigate the use of wearable sensors, worn on four limbs at home during natural behavior, to quantify motor function and disease progression in 376 individuals with amyotrophic lateral sclerosis. We use an analysis approach that automatically detects and characterizes submovements from passively collected accelerometer data and produces a machine-learned severity score for each limb that is independent of clinical ratings. We show that this approach produces scores that progress faster than the gold standard Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (−0.86 ± 0.70 SD/year versus −0.73 ± 0.74 SD/year), resulting in smaller clinical trial sample size estimates (N = 76 versus N = 121). This method offers an ecologically valid and scalable measure for potential use in amyotrophic lateral sclerosis trials and clinical care.

Abstract Amyotrophic Lateral Sclerosis (ALS) disease severity is usually measured using the subjective, questionnaire-based revised ALS Functional Rating Scale (ALSFRS-R). Objective measures of disease severity would be powerful tools for evaluating real-world drug effectiveness, efficacy in clinical trials, and for identifying participants for cohort studies. We developed a machine learning (ML) based objective measure for ALS disease severity based on voice samples and accelerometer measurements from a four-year longitudinal dataset. 584 people living with ALS consented and carried out prescribed speaking and limb-based tasks. 542 participants contributed 5814 voice recordings, and 350 contributed 13,009 accelerometer samples, while simultaneously measuring ALSFRS-R scores. Using these data, we trained ML models to predict bulbar-related and limb-related ALSFRS-R scores. On the test set (n = 109 participants) the voice models achieved a multiclass AUC of 0.86 (95% CI, 0.85–0.88) on speech ALSFRS-R prediction, whereas the accelerometer models achieved a median multiclass AUC of 0.73 on 6 limb-related functions. The correlations across functions observed in self-reported ALSFRS-R scores were preserved in ML-derived scores. We used these models and self-reported ALSFRS-R scores to evaluate the real-world effects of edaravone, a drug approved for use in ALS. In the cohort of 54 test participants who received edaravone as part of their usual care, the ML-derived scores were consistent with the self-reported ALSFRS-R scores. At the individual level, the continuous ML-derived score can capture gradual changes that are absent in the integer ALSFRS-R scores. This demonstrates the value of these tools for assessing disease severity and, potentially, drug effects.

Examining urban growth in metropolitan areas from both morphological and functional perspectives is paramount for sustainable development in developing and developed countries. As a collaborative and critical approach, polycentrism operates concurrently at local, regional, and national levels. However, the decentralized morphologies and functional attributes of polycentric urban spaces are yet to be adequately explored, despite their significant influence on sustainable urban planning and management. Colombo, the only metropolitan area in Sri Lanka, has experienced considerable yet ambiguously imbalanced spatial growth due to insufficient data. This study employed time-series satellite imagery from 1988 to 2022, in conjunction with a network model, to elucidate Colombo's uneven urban patterns, while achieving an accuracy of over 80% throughout the period. The results revealed that the metropolis has evolved into a polynuclear city, complicating the identification of centers and their corresponding developmental stages. Nevertheless, the study successfully pinpointed the morphological and functional Grama Niladhari divisions, disclosing the morphological features of centralized dispersion and the functional traits of decentralized concentration. These insights provide significant implications for local government, guiding urban planning initiatives to achieve sustainable development goals. [ABSTRACT FROM AUTHOR]

The present study determined the most applicable high-grade metamorphic rocks as the sources for manufactured sand and coarse aggregates production to apply in the construction industry. As the first stage of this study, representative samples of the most common ten types of metamorphic rock were collected and tested for mineralogical and chemical compositions to select the favorable rock types in concrete and mortar production. XRD diffraction patterns and quantitative analysis results of XRF were referred for identifying the mineral and chemical contents respectively. Secondly, among the favorable rock types, based on the geology, the area contribution by each rock was calculated and few abundantly available rocks were considered for further investigation. Finally, the compatibility of rocks was checked by analyzing the physical, mechanical, and durability characteristics. As the physical parameters, the specific gravity, water absorption, loose and packing density, and water content were checked. Mechanical properties of rocks were determined by investigating compressive and tensile strength, impact resistance, abrasion resistance, and crushing value. The durability of rocks against weather fluctuations was probed through the slake durability indexes. Results from the first stage revealed that Charnockite, Hornblende-Gneiss, Intrusive Charnockite, and Granitic-Gneiss were favorable rocks rich with concrete and mortar friendly minerals such as albite, k-feldspar, and quartz. Among the above four rocks, Charnockite contributed around 40% and Hornblende-Gneiss covered approximately 9.5% of the area, which were then considered for the next stage of the investigation. Charnockite and Hornblende-Gneiss showed similar porosities and water absorption in the range of 0.25–0.26%. Each mechanical property of both rocks complied with the requirements provided by the standards; moreover, they manifested excellent durability performance against cyclic wetting and drying as well.

Dengue is a mosquito borne, flavivirus, endemic infection in Sri Lanka which presents with a wide spectrum of clinical presentations, ranging from asymptomatic infection to haemorrhagic fever and severe shock. Neurological manifestations due to dengue are very rare but can be caused by serotypes 2 and 3. Here we present a patient with Guillain-Barre syndrome occurring as a manifestation of dengue haemorrhagic fever (DHF). She presented with symmetrical bilateral ascending weakness of the lower limbs which was confirmed by nerve conduction study, cerebrospinal fluid analysis and serological findings. The patient was treated according to the dengue national guidelines and intravenous immunoglobulin therapy. She had complete recovery without residual neurological deficit.

Abstract Global sea-level changes have been a major topic among scientists. Sea-level changes are not globally uniform. Reconstruction of paleo sea-level changes and monitoring of variations in regional sea-level are important to (i) evaluate future sea-level changes, and (ii) predict risk assessment. In this study, we examined sea-level inundation during the middle Holocene highstands based on paleo sea-level indicators along the south and southwest coasts of Sri Lanka. Besides, future sea-level inundation was predicted considering the calculated sea-level trends based on tidal gauge data and high-resolution surface elevation data. Light Detection and Ranging (LiDAR) is one of the most accurate optical remote sensing methods currently available to obtain high-resolution land surface elevation data. Therefore, in this study, Digital Elevation Models (DEMs) were prepared using LiDAR data for estimating the risk assessment in coastal lowlands. Tide gauge data of Colombo in Sri Lanka (from 2006 to 2017), Gan in the Maldives (from 1995 to 2017), and Hulhule in the Maldives (from 1995 to 2017) showed that sea-level has increased with a rate of 0.288 ± 0.118, 0.234 ± 0.025, and 0.368 ± 0.027 mm/month, respectively. DEMs based on LiDAR data suggested that south and southwest coasts are a risk of future sea-level inundation (height = 0.1–0.2 m during next 50 years and about 0.7 m in height during next 200 years, and distance = about 3.5–15.0 m from the present sea-level towards the inland). Consequently, it is important to consider future sea-level changes in disaster management and mitigation activities along the south and southwest coasts of Sri Lanka.

Stimulated Raman scattering (SRS) microscopy enables label-free chemical imaging at high speed, but has been limited by low sensitivity. Here, the authors demonstrate plasmon-enhanced SRS microscopy and achieve single molecule detection sensitivity.

Sri Lanka is one of the wealthiest countries in terms of gems. Therefore, gem mining is extensively carried out in many areas of Sri Lanka, including districts such as Ratnapura, Monaragala, Matale, and Kalutara. During the mining process, only valuable gemstones are collected, and the remaining gravel fraction with many heavy minerals is discarded. Therefore, the gem mining industry produces a large amount of waste that is mainly used only for backfilling. To sustainably manage this waste stream, gem mining waste collected from a gem pit at Wagawatta in the Kalutara district in Sri Lanka was investigated for value recovery, specifically for rare-earth elements (REEs). The gem-bearing alluvial layer contained 0.3% rare-earth oxide (REO) that could easily be upgraded up to 2.8% (LREEs = 94%) with wet sieving and subsequent density separation via a shaking table. Therefore, the concentrates of gem mine tailings with REE-bearing minerals have the potential to be a secondary source for LREEs. The organic-rich clay layer underlying the gem-bearing alluvial layer contained 0.6% REO with 49% HREEs, including Gd, Dy, Er, Yb, and especially Y enrichments. Detailed explorations are thus necessary to assess the REE potential in Sri Lanka’s gem mining waste, and value recovery flowsheets should be subsequently developed to economically extract REEs. In addition, the presence of high U concentrations (800 mg/kg) in the concentrated samples could be alarming when considering the health and safety of the people engaged in gem mining. This aspect also requires detailed research studies.

Hexanucleotide repeat expansion (G4C2n) mutations in the gene C9ORF72 account for approximately 30% of familial cases of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), as well as approximately 7% of sporadic cases of ALS. G4C2n mutations are known to result in the production of five species of dipeptide repeat proteins (DRPs) through non-canonical translation processes. Arginine-enriched dipeptide repeat proteins, glycine-arginine (polyGR), and proline-arginine (polyPR) have been demonstrated to be cytotoxic and deleterious in multiple experimental systems. Recently, we and others have implicated methylation of polyGR/polyPR arginine residues in disease processes related to G4C2n mutation-mediated neurodegeneration. We previously reported that inhibition of asymmetric dimethylation (ADMe) of arginine residues is protective in cell-based models of polyGR/polyPR cytotoxicity. These results are consistent with the idea that PRMT-mediated arginine methylation in the context of polyGR/polyPR exposure is harmful. However, it remains unclear why. Here we discuss the influence of arginine methylation on diverse cellular processes including liquid-liquid phase separation, chromatin remodeling, transcription, RNA processing, and RNA-binding protein localization, and we consider how methylation of polyGR/polyPR may disrupt processes essential for normal cellular function and survival.

Repeat expansion mutations in the C9ORF72 gene are the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Repeat-associated non-AUG translation of this expansion produces dipeptide repeat proteins (DRPs). The arginine containing DRPs, polyGR and polyPR, are consistently reported to be the most toxic. Here we demonstrated that small molecule inhibition of type I protein arginine methyltransferases (PRMT) protects against polyGR and polyPR toxicity. Furthermore, our findings suggest that asymmetric dimethylation of polyGR and polyPR by Type I PRMTs plays important roles in their cytotoxicity.

Adding fibers to concrete helps enhance its tensile strength and ductility. Synthetic fibres are preferable to steel ones which suffer from corrosion that reduces their functionality with time. More consideration is given to synthetic fibres as they can be sourced from waste plastics and their incorporation in concrete is considered a new recycling pathway. Thus, this work investigates the potential engineering benefits of a pioneering application using extruded macro polyfibres in concrete. Two different fiber dosages, 4 kg/m3 and 6 kg/m3, were used to investigate their influence based on several physical, mechanical and microstructural tests, including workability, compressive strength, modulus of elasticity, splitting-tensile strength, flexural test, CMOD, pull-out test and porosity. The test results revealed a slight decrease in the workability of the fibre-reinforced concrete, while all the mechanical and microstructural properties were enhanced significantly. It was observed that the compressive, splitting tensile and bonding strength of the concrete with 6 kg/m3 fibre dosage increased by 19.4%, 41.9% and 17.8% compared to the plain concrete specimens, respectively. Although there was no impact of the fibres on the modulus of rupture, they significantly increased the toughness, resulting in a progressive type of failure instead of the sudden and brittle type. Moreover, the macroporosity was reduced by the fibre addition, thus increasing the concrete compressive strength. Finally, simplified empirical formulas were developed to predict the mechanical properties of the concrete with fibre addition. The outcome of this study will help to increase the implementation of the recycled plastic waste in concrete mix design and promote a circular economy in the waste industry.

The Eppawala area in Sri Lanka has an agriculturalbased economy. As a result, the recent agricultural intensification could increase the risk of heavy metal contamination in lakes in the area as the main water canal in the area, i.e., Jaya Ganga, flows across these lakes. Therefore, this study focuses on the risk assessment of heavy metals in the freshwater lake sediments in the Eppawala area and the identification of potential sources for heavy metal contamination in the lakes. Nine heavy metals (Cr, Mn, Co, Ni, Cu, Zn, As, Cd, and Pb) were investigated in surface sediments (n = 22) of the upstream and downstream lakes of the Eppawala Phosphate Deposit (EPD). The average heavy metal concentrations in the upstream lake sediments were higher than those downstream. Eppawala lake sediments were heavily polluted by As along with moderate to high Cr pollution. However, only As and Cd indicated considerable to moderate ecological risk levels to the local environment. The downstream lake sediments showed lower heavy metal contents compared to those upstream and had negative correlations between heavy metals and P2O5 contents. This reveals that the EPD does not contribute to the heavy metal contamination in the Eppawala lake sediments. However, the statistical analysis showed that heavy metals were mostly derived from similar pollution sources. Agrochemicals used in paddy cultivation in the vicinity might be a potential source of heavy metals. This study highlights the importance of implementing remediation to control the heavy metal pollution prevailing in the Eppawala lakes. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the effectiveness of inter-teaching; a student engagement pedagogy associated with behavioural and engagement theories and designed to engage students in their own learning. This methodology was introduced as a response to create a more positive outcome for students studying an auditing course who have historically experienced difficulties with successfully completing the subject. Inter-teaching was implemented and its effectiveness measured by comparing the final exam grade distributions from inter-teaching and the lecture tutorial teaching methods. Using a quantitative research methodology, students fail grade distributions were significantly lower in the inter-teaching semesters compared to previous semesters where the instructional method of teaching was the lecture model. The results suggested that inter-teaching may be a more effective method of teaching, resulting in an improved academic performance in the auditing course. It is expected that this study will contribute towards the effectiveness of student learning, an improvement in pass rates, and overall greater student satisfaction in advanced accounting courses.

Palliative care is the holistic approach to provide relief to patients suffering from life threatening diseases and their families throughout the disease. This is mainly through the prevention and relief of suffering by means of early identification, comprehensive assessment and management of physical, psychosocial and spiritual problems. With the rise of elderly population in the world patients needing palliative care will also increase. Family physicians who are closest to the community and easily accessible has a major role to play in providing palliative care. Their broad knowledge, long standing relationship with patients and their families, ability to carry out home visits and communicate and coordinate with other health care resources place them in an ideal position to address complex issues faced by patients. Keeping up to date with knowledge, acquiring counseling skills, non availability of guide lines and medications, lack of support from team and time constraints are the challenges faced by family physicians in providing palliative care. With the aging population, demand on palliative care resources will increase markedly in the next few decades. Developing palliative care models, improving the skills and opportunities for doctors to learn sound palliative care principles have to be initiated without a delay in order to meet the challenges of the future.

Abstract Rubber (Hevea brasiliensis) one of the main plantation crops in Sri Lanka is the only plant species cultivated commercially for natural rubber harvesting. Novel systems for harvesting have been introduced but spatial distribution of photosynthetic potential determining key factor for sustainable cultivation has not been properly explored. Use of such techniques such as Satellite Remote Sensing (RS) and Geographic Information System (GIS) to analyse spatial and biological factors related to the productivity of rubber plantation with different harvesting systems is the main objective of the present study. Quikebird high resolution satellite images were used for RS analysis. Chlorophyll content of rubber leaves was measured using a SPAD-502 chlorophyll meter. Chlorophyll content and satellite images were analysed using GIS and spatial statistical methods to determine the variation in different harvesting systems. Yield data were collected from the study site and yield parameters were correlated with chlorophyll content and Normalized Difference Vegetation Index (NDVI) values. Results revealed all systems exhibited promising yield performance without significant deviation but slightly higher yield per hectare per year (YPH) and dry rubber content of latex (DRC) were recorded in quarter spiral based once in three days (S/3 d4) and weekly (S/2 d1 2d7) harvesting systems. Chlorophyll content and rubber yield showed direct correlation in all systems. NDVI vs chlorophyll showed positive correlation r2=0.65 and spatial distribution of chlorophyll and NDVI values demonstrated sound physiological status of plants across the plantation with different harvesting systems. Cost effective LIH systems showed better production trend demonstrating relatively higher yield while reducing tapping cost and labour. Satellite based remote sensing technique is an easy and efficient tool to estimate productivity of rubber plantation over a large area. Keywords: Chlorophyll, NDVI, harvesting, Remote Sensing, Rubber.