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Katherine A Meese,1,2 Laurence M Boitet,1,2 Katherine L Sweeney,2,3 C Allen Gorman,4 Lauren B Nassetta,2,5 Nisha Patel,2 David A Rogers2,6 1Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA; 2UAB Medicine Office of Wellness, UAB, Birmingham, AL, USA; 3Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Management, Information Systems, & Quantitative Methods, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; 5Department of Pediatrics, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; 6Department of Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USACorrespondence: Katherine A Meese, Email kameese@uab.eduIntroduction: Healthcare workers tend to have a strong sense of altruism in their work, which may be protective against turnover despite poor working conditions. Due to the increased distress noted during the pandemic, the challenges of working in healthcare and changing attitudes about work may have surpassed the protective effect of meaning and purpose in work. This study empirically examines perceived meaning in work, and specific work-related factors that contribute to employees’ intent to stay and to recommend working at the organization to others as COVID-19 transitions from a pandemic to endemic phase.Methods: Data from a survey of 4451 clinical and non-clinical healthcare workers were analyzed using regression and dominance analyses to identify specific predictors of turnover intention and net promoter score.Results: The variables that explained the greatest contribution to variance in turnover intention from highest to lowest were burnout, trust and confidence in senior leadership, perceived organizational support, sense of belonging, and sense of recognition. The variables that explained the greatest overall contribution to variance for net promoter score from highest to lowest were perceived organizational support, trust and confidence in senior leadership, resource availability, sense of recognition, and sense of belonging. While meaning in work was associated with turnover intent, organizational and team level factors such as trust and belonging were more predictive of the outcomes.Discussion: While meaning and purpose are important job resources, they are not sufficient to retain employees in the absence of trust, organizational support, belonging, recognition and access to necessary resources. Leaders must seek to foster environments that support trust, belonging and recognition in their retention efforts.Keywords: healthcare, turnover, retention, meaning, work environment

Rafael Robles,1 Nikhil Patel,2 Emily Neag,2 Ajay Mittal,3 Zahra Markatia,2 Kambiz Ameli,2 Benjamin Lin2 1Department of Ophthalmology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; 2Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; 3Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USACorrespondence: Benjamin Lin, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL, 33136, USA, Tel +1 305 326-6000, Fax +1 305 326-6000, Email brl65@miami.eduPurpose: Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs, including smartphone (SP), desktop, and handheld ophthalmoscopes, and evaluate their applications.Methods: A literature review was performed by searching PubMed (pubmed.ncbi.nlm.nih.gov), Web of Science (webofknowledge.com), and Science Direct (sciencedirect.com). All English-language papers that resulted from the search terms “digital ophthalmoscope”, “screening tool”, “glaucoma screening”, “diabetic retinopathy screening”, “cataract screening”, and “papilledema screening” were reviewed. Studies that contained randomized clinical trials with human participants between January 2010 and December 2020 were included. The Risk of Bias in Systematic Reviews (ROBIS) tool was used to assess the methodological quality of each included paper.Results: Of the 1307 studies identified, 35 met inclusion and exclusion criteria. The ROBIS tool determined that 29/35 studies (82.8%) had a low risk of bias, 3/35 (8.5%) had a moderate risk of bias, and 3/35 (8.5%) had a high risk of bias.Conclusion: The continued adoption of DOs remains uncertain because of concerns about the image quality for non-mydriatic eyes and the confidence in data captured from the device. Likewise, there is a lack of guidelines for the use of DOs, which makes it difficult for providers to determine the best device for their practice and to ensure appropriate use. Even so, DOs continue to gain acceptance as technology and practice integration improve, especially in underserved areas with limited access to ophthalmologists.Keywords: fundoscopy, teleophthalmology, diagnostics, screening, referral

Adolescence is considered as critical period for the development of obesity. The frequency of childhood obesity has increased over the last 3 decades, and it has emerged as a public health concern in multiple places around the world. A number of factors interact in a complex way to cause obesity, which is still not fully understood. Therefore, the purpose of this review was to identify and assess the scientific literature on the prevalence of obesity, and behavioural, contextual and biological factors associated with obesity in adolescents. The search was carried out using PubMed, Web of Science, Embase and Scopus considering articles published from the establishment of the databanks until December, 2022. Data on the prevalence of overweight and obesity among children and adolescents, and articles on the determinants and factors affecting obesity were reviewed. The results obtained and the association observed among the factors studied will be helpful to support the planning, implementation and evaluation of preventive activities and interventions.

Jorge F Maspero,1 Claus Bachert,2,3 Fernando J Martinez,4 Nicola A Hanania,5 Benjamin Ortiz,6 Naimish Patel,7 Leda P Mannent,8 Amy Praestgaard,7 Nami Pandit-Abid,9 Shahid Siddiqui,6 Megan Hardin7 1Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina; 2Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; 3Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden; 4Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY, USA; 5Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA; 6Immunology and Allergy Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA; 7Immunology and Inflammation, Sanofi, Cambridge, MA, USA; 8Global Clinical Development, Sanofi, Chilly-Mazarin, France; 9Immunology and Inflammation, Sanofi, Bridgewater, NJ, USACorrespondence: Jorge F Maspero, Allergy and Respiratory Research Unit, Fundación CIDEA, Paraguay 2035, Buenos Aires, C1121ABE, Argentina, Tel +54 91141837294, Email jorge.maspero@fundacioncidea.org.arPurpose: To provide a descriptive summary of clinical efficacy and health-related quality of life (HRQoL) measures in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and clinical features of obstructive lung disease in the Phase III dupilumab studies SINUS-24 and SINUS-52 (NCT02912468, NCT02898454).Patients and Methods: Patients met a “broad” definition of having clinical features of obstructive lung disease with any of 3 criteria: (i) pre-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 0.70 and smoking history; (ii) patient-reported medical history of chronic obstructive pulmonary disease (COPD); or (iii) asthma with > 10 pack-years’ smoking history. A “narrow” definition including criteria (i) or (ii) was also analyzed. CRSwNP and HRQoL measures were evaluated in all patients and lung function (FEV1; FEV1/FVC ratio) was captured and analyzed only in those patients who had a self-reported history of asthma.Results: Across both studies, 131 patients met the “broad” definition, of whom 90 also had asthma, and 115 patients met the “narrow” definition, of whom 74 had asthma. CRSwNP outcomes and HRQoL were improved with dupilumab vs placebo in both the broad and narrow subgroups. Among the 90 patients who met the broad definition and had asthma, dupilumab improved pre-bronchodilator FEV1 and FEV1/FVC ratio at Week 16 (least squares mean differences vs placebo: 0.38 L [95% confidence interval: 0.17, 0.59; p = 0.0004] and 4.8% [1.7%, 7.9%; p = 0.0024], respectively) sustained through Week 24. Similar results were seen in the “narrow” subgroup with asthma.Conclusion: In a population of patients with CRSwNP and clinical features of obstructive lung disease, dupilumab improved CRSwNP and HRQoL outcomes, and, among those with a history of asthma, also improved lung function. These results support further analyses of dupilumab in patients with evidence of type 2 inflammation and obstructive lung disease such as COPD.Keywords: obstructive lung disease, chronic obstructive pulmonary disease, dupilumab, type 2 inflammation, interleukin-4, interleukin-13

Veshesh Patel,1 Parastou Pakravan,1 James Lai,1 Arjun Watane,1,2 Divy Mehra,1 Tiffany Alyssa Eatz,1 Nimesh Patel,1,3 Nicolas A Yannuzzi,1 Jayanth Sridhar1 1Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA; 3Mass, Eye and Ear, Harvard Medical School, Boston, MA, USACorrespondence: Jayanth Sridhar, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA, Tel +1 305-326-6124, Fax +1 305-326-6417, Email jsridhar1@med.miami.eduPurpose: To describe the indications, outcomes, and complications associated with intraocular lens (IOL) exchange.Patients and Methods: To determine the relative frequency of postoperative complications between techniques for all patients undergoing IOL exchange from May 1, 2014 through August 31, 2020.Results: IOL exchange was performed in 511 eyes of 489 patients (59.7% men; mean age: 67.0 ± 13.9 years, median time from cataract procedure to IOL exchange: 47.5 months). Mean uncorrected visual acuity significantly improved from 20/192 Snellen equivalent (logMAR 0.981) preoperatively to 20/61 (logMAR 0.487) at last follow-up (P < 0.001). Overall, 384 eyes (78.7%) met their desired refractive outcome within ± 1.0 diopter (D). The most frequent complication was cystoid macular edema (CME) (n=39, 7.6%). Iris-sutured technique was associated with significantly greater frequency of subsequent IOL dislocation (10.3%) than 4-point scleral sutured (0%, P = 0.002), anterior chamber IOL (ACIOL, 1.5%, P = 0.01), and 2-point scleral sutured (0%, P = 0.03) techniques. Yamane scleral-fixation technique was associated with significantly greater frequency of developing IOL tilt (11.8%) than ACIOL (0%, P = 0.002), 4-point scleral sutured (1.1%, P = 0.01), 2-point scleral sutured (0%, P = 0.04), and iris-sutured (0%, P = 0.04) techniques.Conclusion: IOL exchange significantly improved uncorrected visual acuity and more than three-quarters of eyes met the refractive goal. Certain techniques were associated with complications, including subsequent dislocation associated with iris-sutured technique and IOL tilt associated with Yamane scleral-fixation technique. This information may help guide surgeons in deciding between procedural techniques for individual patients during IOL exchange preoperative planning.Keywords: intraocular lens, dislocation, Yamane, techniques, cataracts, complications

The endocrine condition known as polycystic ovarian syndrome (PCOS) is complicated and diverse. It impacts between 4 to 20 % of women of reproductive age and is linked to a significant risk of infertility, obesity, and insulin resistance. The aetiology of PCOS remains unclear and can be multifactorial, including genetic, neuroendocrine, and metabolic causes. Recent studies in humans have shown an association between changes in the gut and vaginal microbiome and the metabolic and clinical parameters of PCOS. The aim of this review was to understand the relationship between PCOS and the microbiome, including any potential underlying mechanisms, and to look at potential therapeutic strategies to improve the therapeutic approach for patients. As a result, a hypothesis is postulated that changes in the microbiota contribute to the development of PCOS and explored the therapeutic opportunities which include probiotics, prebiotics, synbiotics, fecal microbiota transplantation and IL-22.

Hyun Kyoo Yoo,1 Nikunj Patel,2 Seongjung Joo,3 Suvina Amin,2 Rowena Hughes,4 Rajinder Chawla5 1Health Economics & Payer Evidence AstraZeneca, Cambridge, UK; 2Oncology Business Unit, AstraZeneca, Gaithersburg, MD, USA; 3MRL, Center for Observational & Real-World Evidence (CORE), Oncology, Merck Sharp & Dohme LLC, a Subsidiary of Merck & Co., Inc, Rahway, NJ, USA; 4AccuScript Consultancy, Reading, Berkshire, UK; 5AccuScript Consultancy, Ludhiana, Punjab, IndiaCorrespondence: Hyun Kyoo Yoo, Global Value, Access and Pricing, Alexion, AstraZeneca Rare Disease, City House, 130 Hills Road, Cambridge, CB2 1RE, UK, Email HyunKyoo.Yoo@alexion.comBackground: Metastatic pancreatic cancer (mPaC) has a poor prognosis and available treatments provide only moderate improvements in survival. Preserving or improving health-related quality of life (HRQoL) is therefore an important treatment outcome for patients with mPaC. This systematic review identified HRQoL data in patients with mPaC before and after treatment, compared these with data from the general population, and reported the effects of different mPaC treatments on HRQoL.Methods: Searches were performed in Embase, PubMed, and the Cochrane Library from January 2008 to May 2021, and the articles identified were screened for HRQoL data in patients with mPaC. Abstracts from relevant congresses were also manually searched. Publications included were randomized controlled trials and observational studies written in English that reported HRQoL data for adult patients with non-resectable mPaC who were on or off treatment.Results: Thirty relevant publications were identified and HRQoL scores were collected. Overall, baseline mean scores from the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), 5-dimension EuroQol questionnaire (EQ-5D), and Functional Assessment of Cancer Therapy-General (FACT-G) for newly diagnosed and previously treated patients with mPaC were worse than those of the general population. Baseline scores were generally better for previously treated patients than for newly diagnosed patients, indicating that mPaC treatments preserve or improve HRQoL. Identified publications also reported changes in HRQoL following first- or subsequent-line chemotherapy. When reported, 10 studies found improvements in overall HRQoL compared with baseline scores, four reported no changes in overall HRQoL after treatment, and six found deteriorations in overall HRQoL.Conclusion: Patients with mPaC had worse HRQoL than the general population. Available anti-cancer therapies can improve or preserve HRQoL.Keywords: health-related quality of life, metastatic pancreatic cancer, symptoms

Clinically type 2 diabetes mellitus (T2DM) without serum creatinine microalbuminuria, macroalbuminuria lacks predictors for diabetic nephropathy (DN). We utilized a meta-analysis technique to review the literature to evaluate whether serum cystatin C may be used as an early marker of diabetic nephropathy in light of the differing opinions regarding the utility of serum cystatin C as such. PubMed, Google Scholar, Web of Science, EMBASE, and Scopus Database were searched using various key search terms. Studies involving T2DM patients and containing serum cystatin C levels and the estimated glomerular filtration rate (eGFR) data were included. Pooled sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The pooled sensitivity and specificity of serum cystatin C for predicting DN were 0.87 (95% CI 0.84 - 0.91) and 0.84 (95% CI 0.83 - 0.88) respectively. The pooled positive and negative predictive values of serum cystatin C for predicting DN were 7.035 (95 % CI 4.30 – 11.43) and 0.15 (95% CI 0.09 - 0.21) respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.9548 and the diagnostic odds ratio was 67.10 (95% CI 28.12 - 156.84). Serum cystatin C is a significant biomarker of DN among patients with T2DM. It can also positively monitor kidney function progression and prediction of adverse outcomes among T2DM patients.

Othman AlOmeir, Nilesh Patel, Parastou Donyai Department of Pharmacy, University of Reading, Reading, Berkshire, UKCorrespondence: Othman AlOmeir; Parastou Donyai, Email aalomear@su.edu.sa; p.donyai@reading.ac.ukObjective: Non-adherence to adjuvant hormone therapy prescribed orally in the treatment of breast cancer is complex as the literature has shown. Many women find it hard to adhere to the hormonal medicines they are prescribed and expected to take for at least 5 years following the initial management of their breast cancer. Arguably, communicating other women’s ‘trials, tribulations, and triumphs’ with medication-taking could help newly-diagnosed patients to better prepare for the journey ahead. Our objective was to visually represent women’s experiences with these medicines using data synthesized in the literature.Methods: Three schematics were drawn for each phase of medication-taking, namely, starting out, adherence, and cessation. The schematics were validated by interviewing a panel of healthcare professionals (n=10) and calculating a Content Validity Index (CVI). The edited drawings were discussed with a separate panel of breast cancer survivors (n=14) whose responses were elicited qualitatively in one-to-one interviews.Results: A total of 76 individual pictograms were drawn across the three schematics. The 13 pictograms that had an item-level CVI< 0.8 were modified according to feedback resulting in three final schematics with an overall CVI of 87%, 87% and 80%, respectively.Conclusion: Synthesised summaries of women’s experiences with oral hormone therapy for breast cancer were visualised via three validated schematics. The schematics could aid patient-professional communication to help anticipate and tackle negative experiences and support decisions to take hormone medication in breast cancer.Keywords: adherence, medication, breast cancer, hormone therapy, qualitative research, pictogram

Wendy Y Cheng,1 Sujata P Sarda,2 Nikita Mody-Patel,2 Sangeeta Krishnan,2 Mihran Yenikomshian,1 Colin Kunzweiler,1 Jensen Duy Vu,1 Hoi Ching Cheung,1 Mei Sheng Duh1 1Analysis Group, Inc., Boston, MA, USA; 2Apellis Pharmaceuticals, Inc., Waltham, MA, USACorrespondence: Wendy Y Cheng, Analysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA, 02199, USA, Tel +1 617 425 8219, Fax +1 617 425 8000, Email Wendy.Cheng@analysisgroup.comPurpose: Current pharmacologic management of paroxysmal nocturnal hemoglobinuria (PNH) consists of C5 inhibitors, eculizumab and ravulizumab; however, because patients experience incomplete symptom control, off-label doses may be utilized. We conducted a retrospective, longitudinal cohort study of provider-based claims data to assess the real-world eculizumab dosing patterns in PNH patients.Patients and Methods: Patients were ≥ 12 years, received ≥ 2 eculizumab infusions between January 1, 2015 and September 30, 2019, and had ≥ 3 months of continuous clinical activity prior to index. The index date was the first claim for eculizumab. Patients with ≥ 1 diagnosis of another indication for eculizumab were excluded. Treatment patterns including the proportion with high, label-recommended, and low dosages during induction (first 28 days) and maintenance (beginning day 29) phases were described. The proportion and time-to-first dose escalation, defined as an increase in dose or frequency of infusion, were assessed among a subset of patients (ie, escalation analysis cohort).Results: A total of 707 patients were examined. Mean (standard deviation [SD]) starting dose was 862mg (412mg) and was higher than label-recommended 600mg for 64% of the patients. Mean (SD) dose per infusion was 859mg (391mg) during the induction phase; average dose was higher than label-recommended 600mg for 68%. Mean (SD) dose per infusion during the maintenance phase was 1005mg (335mg); average dose was higher than label-recommended 900mg for 43%. Dose escalation occurred in 40/121 escalation analysis cohort patients. Median time-to-first dose escalation was ∼ 12 months.Conclusion: Results suggest that deviations from label-recommended dosing patterns were common. Future budget impact assessments of eculizumab should account for real-world dosing patterns to comprehensively assess costs and benefits.Keywords: complement inhibitors, dose escalation, dosing patterns, eculizumab, paroxysmal nocturnal hemoglobinuria

Nimesh Patel,1 David Jacobs,1 Jessin John,1 Mohamed Fayed,1 Lakshmi Nerusu,2 Marissa Tandron,2 William Dailey,2 Ricardo Ayala,2 Nabil Sibai,1,2 Patrick Forrest,1,2 Jason Schwalb,2,3 Rohit Aiyer1,2 1Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA; 2Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA; 3Department of Neurological Surgery, Henry Ford Health System, Detroit, MI, USACorrespondence: Nimesh Patel, Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA, Tel +1 313-932-5756, Fax +1 313-916-9434, Email patelnimesh112@gmail.comPurpose of Review: This systematic review comprehensively compared balloon kyphoplasty and vertebroplasty with respect to height restoration and pain relief.Recent Findings: PRISMA guidelines were utilized to compare balloon kyphoplasty and vertebroplasty, focusing on the primary outcome of height restoration and the secondary outcomes of pain relief and functionality. A total of 33 randomized controlled trials were included; 20 reviewed balloon kyphoplasty, 7 reviewed vertebroplasty, and 6 compared vertebroplasty to balloon kyphoplasty. Both treatments restored some vertebral body height and showed benefits in pain reduction and improved patient-reported functionality.Summary: Balloon kyphoplasty and vertebroplasty are effective treatments for vertebral compression fractures and this review suggests that balloon kyphoplasty may be favored for vertebral height restoration. Further studies are needed to conclude whether balloon kyphoplasty or vertebroplasty is superior for alleviating pain.Keywords: chronic pain, compression fracture, kyphoplasty, low back pain, pain management, post-operative pain, vertebroplasty

Neil Patel,1,2 Kathryn Kinmond,1,3 Pauline Jones,1 Pamela Birks,1 Monica A Spiteri1 1Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK; 2Directorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK; 3Department of Health & Social care, Staffordshire University, Stoke-on-Trent, Staffordshire, UKCorrespondence: Neil PatelDirectorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UKTel +44 7852 318157Email neil.patel@heartofengland.nhs.ukBackground: COPDPredict™ is a novel digital application dedicated to providing early warning of imminent COPD (chronic obstructive pulmonary disease) exacerbations for prompt intervention. Exacerbation prediction algorithms are based on a decision tree model constructed from percentage thresholds for disease state changes in patient-reported wellbeing, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP) levels. Our study determined the validity of COPDPredict™ to identify exacerbations and provide timely notifications to patients and clinicians compared to clinician-defined episodes.Methods: In a 6-month prospective observational study, 90 patients with COPD and frequent exacerbations registered wellbeing self-assessments daily using COPDPredict™ App and measured FEV1 using connected spirometers. CRP was measured using finger-prick testing.Results: Wellbeing self-assessment submissions showed 98% compliance. Ten patients did not experience exacerbations and treatment was unchanged. A total of 112 clinician-defined exacerbations were identified in the remaining 80 patients: 52 experienced 1 exacerbation; 28 had 2.2± 0.4 episodes. Sixty-two patients self-managed using prescribed rescue medication. In 14 patients, exacerbations were more severe but responded to timely escalated treatment at home. Four patients attended the emergency room; with 2 hospitalised for < 72 hours. Compared to the 6 months pre-COPDPredict™, hospitalisations were reduced by 98% (90 vs 2, p< 0.001). COPDPredict™ identified COPD-related exacerbations at 7, 3 days (median, IQR) prior to clinician-defined episodes, sending appropriate alerts to patients and clinicians. Cross-tabulation demonstrated sensitivity of 97.9% (95% CI 95.7– 99.2), specificity of 84.0% (95% CI 82.6– 85.3), positive and negative predictive value of 38.4% (95% CI 36.4– 40.4) and 99.8% (95% CI 99.5– 99.9), respectively.Conclusion: High sensitivity indicates that if there is an exacerbation, COPDPredict™ informs patients and clinicians accurately. The high negative predictive value implies that when an exacerbation is not indicated by COPDPredict™, risk of an exacerbation is low. Thus, COPDPredict™ provides safe, personalised, preventative care for patients with COPD.Keywords: COPD acute events, preventative care, digital enabled-healthcare, automated health-status algorithms, diagnostic accuracy, reduced hospitalisations

Nirav Nimavat,1 Shruti Singh,2 Nilesh Fichadiya,3 Parul Sharma,4 Nilesh Patel,1 Manoj Kumar,1 Grishma Chauhan,1 Niraj Pandit1 1Department of Community Medicine, Smt. B.K. Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India; 2Department of Pharmacology, All India Institute of Medical Sciences, Patna, Bihar, India; 3Department of Community Medicine, P. D. U. Government Medical College, Rajkot, Gujarat, India; 4GMERS Medical College, Patan, Gujarat, IndiaCorrespondence: Nirav NimavatDepartment of Community Medicine, SBKS MIRC, Sumandeep Vidyapeeth Deemed to Be University, Piparia, Vadodara, 391760, Gujarat, IndiaTel +91 8866271087Email nkniraj1529@gmail.comIntroduction: During the COVID-19 pandemic, most educational institutions have opted for online education rather than traditional modes of education to protect their employees and students. Online education has been gaining momentum in almost all countries around the world. This coincides with the recently introduced competency-based medical education in India which has embraced online education. This poses a new challenge for the institutions involved, the instructors or teachers, and the students since they must adapt quickly to the new mode of learning. Online education requires teachers to improve their competency in three major areas; pedagogy, technology, and content knowledge. Some of the challenges include; lack of technological skill, poor time management and lack of infrastructure. As technology rapidly advances, health care education systems must also advance in tandem. To implement the new competency-based system and online education, the institutions and the individuals must realize the importance of online education, identify the barriers and quickly work on solutions for success.Methods: This review was conducted based on various research papers on the topic of online medical education, the challenges faced by faculty members, and the opinion of students on this dilemma. Search terms included online medical education, COVID19, competency-based medical education.Conclusion: This review identified various challenges posed by online education on the current medical curriculum, faced by both faculty members and students, especially under the light of the Competency-Based Undergraduate Curriculum for Indian Graduates. Different solutions were proposed to overcome these challenges.Keywords: online medical education, COVID-19, competency-based medical education

In 1940, the stability problem of functional equations was arose due to a question of Stanisaw Ulam concerning the stability of group homomorphisms. Significant work was done by Donald H. Hyers about HYERS-ULAM STABILITY and obtained a partial affirmative answer to the question of Ulam in the context of banach spaces in the case of additive mappings. In 1978, T. M. Rassias expanded Hyers's theorem for mappings between Banach spaces by considering an unbounded Cauchy difference subject to a continuity condition upon the mapping. After that, Many Researchers had studied about Hyers-Ulam stability of an additive quadratic type functional equations. In this research article, the Hyers-Ulam stability of an additive quadratic type functional equation was discussed and obtained the generalization of Hyers-Ulam stability of an additive quadratic type functional equation f(x + ay) + af(x - y) = f(x - ay) + af(x + y) for any integer a with a ≠ 1; 0; 1 in 2-Banach space. [ABSTRACT FROM AUTHOR]

Effective management of water resources is crucial for sustainable development in any region. When considering computer-aided analysis for resource management, geospatial technology, i.e., the use of remote sensing (RS) combined with Geographic Information Systems (GIS) proves to be highly valuable. Geospatial technology is more cost-effective and requires less labor compared to ground-based surveys, making it highly suitable for a wide range of agricultural applications. Effectively utilizing the timely, accurate, and objective data provided by RS technologies presents a crucial challenge in the field of water resource management. Satellite-based RS measurements offer consistent information on agricultural and hydrological conditions across extensive land areas. In this study, we carried out a detailed analysis focused on addressing agricultural water management issues in India through the application of RS and GIS technologies. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed published research articles, providing a comprehensive and detailed analysis. This study aims to explore the use of RS and GIS technologies in crucial agricultural water management practices with the goal of enhancing their effectiveness and efficiency. This study primarily examines the current use of geospatial technology in Indian agricultural water management and sustainability. We revealed that considerable research has primarily used multispectral Landsat series data. Cutting-edge technologies like Sentinel, Unmanned Aerial Vehicles (UAVs), and hyperspectral technology have not been fully investigated for the assessment and monitoring of water resources. Integrating RS and GIS allows for consistent agricultural monitoring, offering valuable recommendations for effective management. [ABSTRACT FROM AUTHOR]

Ian D Pavord,1 Salman Siddiqui,2 Alberto Papi,3 Jonathan Corren,4 Lawrence D Sher,5 Philip Bardin,6 David Langton,7 Hae-Sim Park,8 Megan S Rice,9 Yamo Deniz,10 Paul Rowe,11 Heribert W Staudinger,11 Naimish Patel,11 Marcella Ruddy,10 Neil MH Graham,10 Ariel Teper11 1Respiratory Medicine Unit and Oxford Respiratory National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, UK; 2University of Leicester and Leicester National Institute for Health Research Biomedical Research Centre (Respiratory Theme), Leicester, UK; 3Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy; 4David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 5Peninsula Research Associates, Rolling Hills Estate, CA, USA; 6Department of Lung and Sleep Medicine, Monash University and Medical Centre, Clayton, Melbourne, VIC, Australia; 7Department of Thoracic Medicine, Frankston Hospital, Frankston, Melbourne, VIC, Australia; 8Ajou University Hospital, Suwon, South Korea; 9Sanofi, Cambridge, MA, USA; 10Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA; 11Sanofi, Bridgewater, NJ, USACorrespondence: Ian D PavordNDM Research Building, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UKTel +44 (0)1865 612897Email ian.pavord@ndm.ox.ac.ukPurpose: The Phase 3 LIBERTY ASTHMA QUEST study in patients aged ≥ 12 years with uncontrolled, moderate-to-severe asthma demonstrated the efficacy and safety of dupilumab 200 mg and 300 mg every 2 weeks (q2w) vs matched placebo in the overall population. This post hoc analysis assessed dupilumab efficacy by disease severity as evidenced by baseline % predicted forced expiratory volume in 1 second (FEV1) and dose of inhaled corticosteroids (ICS).Patients and Methods: Severe asthma exacerbation rates, change from baseline in FEV1, asthma control, quality of life, and fractional exhaled nitric oxide (FeNO) levels over the 52-week treatment period were assessed in patients with elevated type 2 inflammation biomarkers stratified by ICS dose and FEV1% predicted at baseline.Results: In patients with elevated baseline eosinophils, dupilumab 200 mg and 300 mg q2w vs placebo reduced severe exacerbation rates by 50% (P=0.06) and 67% (P=0.001), respectively, in those with medium-dose ICS/FEV1% predicted 60– 90%, and by 59% (P< 0.001) and 47% (P=0.006) in those with high-dose ICS/FEV1% predicted < 60%, improved pre-bronchodilator FEV1 at Week 12 by 0.16L (P=0.005) and 0.08L (P=0.13), and by 0.20L (P=0.003) and 0.21L (P< 0.001), respectively, in the same subgroups. Dupilumab vs placebo also improved asthma control and quality of life and suppressed FeNO levels in all patient subgroups with similar results observed irrespective of baseline biomarker status or disease severity.Conclusion: Dupilumab reduced severe exacerbations and improved lung function, asthma control and quality of life in patients with elevated baseline eosinophils irrespective of baseline ICS dose or FEV1% predicted.Keywords: asthma, biomarkers, dupilumab, exacerbation, FEV1

Ollie Yiru Yu,1 Ahmed Mohamed Zaeneldin,1 Hamdi Hosni Hamda Hamama,2 May Lei Mei,3 Neil Patel,4 Chun-Hung Chu1 1Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, People’s Republic of China; 2Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt; 3Faculty of Dentistry, University of Otago, Dunedin, Otago, New Zealand; 4Division of Dentistry, University of Manchester, Manchester, UKCorrespondence: Chun-Hung ChuThe University of Hong Kong, 3B26, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, People’s Republic of ChinaTel +852 2859 0287Fax +852 2559 4194Email chchu@hku.hkAbstract: The paradigms of contemporary caries management have shifted to minimal intervention dentistry. Conservative restorative procedures are recommended to replace the complete removal of all carious tissues in the management of dental caries. This article reports two clinical cases of conservative restorations of proximal caries. Different conservative cavity designs and restorative techniques were performed in the two cases. Proximal caries in posterior teeth were prepared using the box-only preparation technique or the proximal tunnel preparation technique. The cavities were restored directly with resin composites. The advantages of using the box-only preparation with fissure sealant included the maximum conservation of tooth hard tissues and the prevention of unnecessary tissue removal in the occlusal surface. The tunnel preparation preserved the marginal ridge and protected the restored tooth from fracture. The filling of composites into the tunnel demonstrated a better marginal adaptation than other restorative materials. These two techniques allowed for the preservation of more healthy dental hard tissue compared with traditional techniques. Potential problems in the restoration included the high incidence of the inappropriate removal of dental hard tissue, damage of the vital pulp and the microleakage due to the polymerization shrinkage. The solutions to minimize the risk of these problems in the operative procedures were discussed.Keywords: case report, caries, restoration, resin composite, minimally invasive dentistry

Laura J Wood,1,2,* Jasleen K Jolly,1,2,* Markus Groppe,3 Larry Benjamin,3 James F Kirwan,4 Nishal Patel,5 Mostafa A Elgohary,6 Robert E MacLaren1,2 1Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; 2Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; 3Stoke Mandeville Hospital, Buckingham Healthcare NHS Trust, Walton, UK; 4Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK; 5Kent and Canterbury Hospital, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK; 6Kingston Hospital, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, UK*These authors contributed equally to this workCorrespondence: Laura J WoodNuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UKEmail enquires@ndcn.ox.ac.ukBackground/Aim: An increasing number of pre-presbyopic patients are undergoing uniocular cataract extraction. We aim to compare the binocular status of subjects with uniocular cataracts, implanted either with a multifocal or a monofocal intraocular lens (IOL).Materials and Methods: Subjects were recruited from outpatient ophthalmology clinics and randomized to an IOL type. Corrected and uncorrected LogMAR distance visual acuity (VA) and near and intermediate VA using the Radner reading test were completed. The binocular tests included the Worth Four Dot Test, fixation disparity, TNO stereoacuity and foveal suppression assessment. In addition to the near activity vision questionnaire. The trial was closed early because the chosen multifocal lens had been superseded by newer models. We report two subjects, one receiving the multifocal IOL and a monofocal IOL control with the most comparable baseline characteristics.Results: Both subjects experienced uncomplicated cataract surgery, showing clinically significant improved corrected distance VA, 0.06 LogMAR and − 0.16 LogMAR in the monofocal and multifocal IOL, respectively. The multifocal subject had 30 seconds of arc stereoacuity indicating normal binocular vision. Only gross binocular single vision with no stereopsis was found in the monofocal IOL subject. The latter subject also had reduced near vision quality-of-life questionnaire results.Conclusion: This two-patient case series demonstrates greater binocular near ability, with the multifocal IOL, in the pre-presbyopic patient undergoing uniocular cataract surgery. The case series highlights the need, and methodology for investigating further the functional and quality-of-life benefits of implanting multifocal IOLs in pre-presbyopic patients, those in their twenties and thirties, undergoing uniocular cataract surgery.Keywords: binocular vision, cataracts, pseudophakia, multifocal intraocular lens, accommodation

Vipul D Yagnik,1 Sushil Dawka,2 Nitin Patel3 1Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India; 2Department of Surgery, SSR Medical College, Belle Rive, Mauritius; 3Department of Surgical Gastroenterology, Gujarat Superspeciality Hospital, Baroda, Gujarat, IndiaCorrespondence: Vipul D YagnikDepartment of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat 384265, IndiaEmail vipul.yagnik@gmail.comBackground: Gallbladder hydatid cyst (GBHC) is highly uncommon with an incidence of 0.3– 0.4% of all atypically located hydatid cysts. Our personal experience of one case of primary GBHC (PGBHC) managed laparoscopically motivated this systematic review. This study aimed to analyze the demographic characteristics, types [whether primary GBHC (PGBHC) or secondary GBHC (SGBHC)], clinical presentation, laboratory investigations, imaging studies, operative procedure, hospital stay, follow-up and recurrence.Methods: A systematic review was performed using preferred reporting items for systematic reviews and meta-analyses guidelines.Results: Twenty studies, including 22 cases plus one more case managed by us, were included in the review. For PGBHC, the mean age was 48.61 years while for SGBHC it was 47.9 years. PGBHC was more common in females (69.23%) while SGBHC was more common in males (55.55%). Overall, GBHC was more common in females (56.52%). The most common presentation overall was abdominal pain (100%) followed by nausea/vomiting (43.47%). The other common symptoms were nausea/vomiting (61.53%) and Murphy’s sign (38.46%) in PGBHC, but jaundice (50%) and fever (30%) in SGBHC. In PGBHC, 50% patients had normal liver function while this was deranged in 66.66% patients with SGBHC. Serology was positive in 50% of PGBHC and 100% in SGBHC. Ultrasonography was positive in 50%, while CT-scan showed 70%. CT-scan was better at detection of SGBHC (100%). The most common operation was open cholecystectomy (78.26%) either isolated or combined. Isolated open cholecystectomy was commonly done in PGBHC (69.23%). Overall, only 56.52% of patients received albendazole, but no recurrence was reported. The average hospital stay was 7.25 days and follow-up ranged from 1 month to 10 years.Conclusion: GBHC mostly affects females with abdominal pain being the most common symptom. Ultrasonography is expedient though CT-scan is more sensitive. Albendazole monotherapy has questionable value. Open cholecystectomy is the most common operation. However, laparoscopy is safe in experienced hands.Keywords: hydatid, cyst, gallbladder, primary, secondary

Yuxia Deng,1 Ting Qiu,1 Nishant Patel,1 Shi Zhou,1 Tao Xue,2 Haijun Zhang1,3 1Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People’s Republic of China; 2Department of Cardiothoracic Surgery, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People’s Republic of China; 3Precision Medical Center, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Haijun ZhangPrecision Medical Center, Zhongda Hospital, Medical School of Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, Jiangsu, People’s Republic of ChinaTel|Fax +86 25 8327 2216Email zhanghaijunseu@163.comTao XueDepartment of Cardiothoracic Surgery, Medical School of Southeast University, 87 Dingjiaqiao Road, Nanjing, Jiangsu 210009, People’s Republic of ChinaTel|Fax +86 25 8326 2381Email taoxuezdyy@163.comPurpose: Risk of radiation pneumonia (RP) could not be effectively detected due to non-specific clinical symptoms in the early stage. The purpose of this investigation was to evaluate serum biomarkers of cytokines interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT) for its early detection in patients with thoracic malignant tumors receiving radiotherapy.Patients and methods: The clinical data of 105 patients with thoracic malignant tumors (lung cancer, esophageal carcinoma and mediastinal tumors) treated by radiotherapy were retrospectively analyzed. The patients were divided into RP group and non-RP group according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). The serum level of IL-6 was detected by chemiluminescence, and the level of CRP was measured by nephelometry during radiotherapy. The level of PCT, one of the specific indicators to distinguish infection and non-infectious etiologies, was also detected by chemiluminescence.Results: Among 105 patients treated by radiotherapy, 28 developed RP, and the other 77 had no RP. There was no significant difference in the risk of RP between patients’ factors (age, sex, PS score, smoking, tumor type) and treatment factors (chemotherapy, V5, GTV dose). However, chronic obstructive pulmonary disease (COPD), V20 and mean lung dose (MLD) were significantly different between the two groups (χ2 = 4.131, 3.986, 7.830, P < 0.05). Furthermore, PCT levels were also found to have insignificant differences between RP group and non-RP group (P > 0.05). However, there were significant differences between the groups in the levels of IL-6 and CRP (P < 0.05). The IL-6 levels significantly increased earlier than that of conventional CT imaging when patients suffering from RP and peaked at 6 weeks during radiotherapy. CRP had a similar change as IL-6. Single cytokine and combination of IL-6 and CRP possessed a good ability to predict RP with the AUC of IL-6 of 0.89±0.04 (95% CI, 0.80–0.95, P

This study was carried out to understand the pattern of surface energy fluxes over a periodical scale and energy balance closure using Large Aperture Scintillometer and Micrometeorological tower. The standalone technique as 'Scintillometry' which observes the structure parameter of refractive index based on Monin-Obukhov Similarity theory, has the potential to measure the sensible heat flux precisely. This paper discusses the surface energy balance components and energy balance closure over a period of August 2017 to June 2018. The maximum mean energy fluxes Rn, G, H and LE were observed in September (98.6 Wm-2), May (13.9 Wm-2), June (53.3 Wm-2) and August (82.1 Wm-2), respectively. The overall mean ET was observed at the rate of 1.36 mm day-1 during the study period. This scintillometry technique may further use in evapotranspiration modelling from polar orbiting satellite to geostationary satellite over a heterogeneous and undulated landscape. [ABSTRACT FROM AUTHOR]

Samuel H Kim,1 Nimesh Patel,2 Kanika Thapar,2 Ananda V Pandurangadu,3 Amit Bahl1 1Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA; 2Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 3Department of Emergency Medicine, Rush University, Chicago, IL, USA Objectives: Greater saphenous vein (GSV) thrombosis is concerning due to its close proximity to the deep femoral vein. This study sought to identify the risk of propagation to deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with isolated proximal GSV superficial thrombosis and describe provider practice patterns related to treatment. Materials and methods: This is an Institutional Review Board-approved retrospective multicenter study. Patients presented to one of three possible emergency departments in a large health system. About 21,716 patients were queried through the electronic medical record. Ninety-five patients or 0.4% of study subjects met inclusion criteria of isolated proximal GSV thrombosis. Forty-five patients were excluded, leaving a final data set of 40 patients. Investigators recorded radiology impressions, patient demographics, past medical history, DVT/PE risk factors, and treatment plans. Propagation of GSV thrombosis to DVT/PE was also noted. Follow-up methods included chart review, primary care physician follow-up, and direct, scripted patient follow-up phone calls. Descriptive statistics were applied to study subjects using SAS for Windows, version 9.3. Results: Three patients (7.5%) had progression of GSV thrombosis to DVT/PE. Twenty percent of patients without malignancy were treated with anticoagulation compared to 14% of those with preexisting malignancy upon initial diagnosis of isolated GSV thrombosis. Forty-five percent of patients were prescribed some type of supportive therapy to aid in the treatment of GSV thrombosis. Conclusion: Isolated proximal GSV thrombosis, while uncommon, may frequently progress to DVT or PE. Our work suggests clinicians should consider anticoagulation for isolated GSV thrombosis. Keywords: greater saphenous vein thrombosis, superficial vein thrombosis, venous throm­boembolism

Bhavin K Patel, Rajesh H Parikh, Nilesh Patel Department of Pharmaceutics and Pharmaceutical Technology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India Abstract: Mannosylated polymeric nanoparticles (NPs) enable improvement of brain bioavailability and reduction of dosing due to efficient drug delivery at the target site. Mannose receptors are present on the surface of macrophages, and therefore, in this study, it is expected that mannosylated NPs of anti-human immunodeficiency virus drug may target the macrophages, which may improve the therapeutic outcome and reduce the toxicity of antiretroviral bioactives. Poly(lactic-co-glycolic acid) (PLGA) and mannosylated-PLGA NPs (Mn-PLGA NPs) were prepared and administered by intravenous route in a dose of 10 mg/kg. After predetermined time period, the pharmacokinetics and biodistribution of NPs were analyzed using high-performance liquid chromatography and confocal microscopy, respectively. Results of this study indicated that Mn-PLGA NPs would be a promising therapeutic system for efficient delivery of the drug into brain macrophages. Keywords: mannosylated poly(lactic-co-glycolic acid) nanoparticles, brain targeting, macrophage targeting, human immunodeficiency virus

Anushka Sharma, Natasha Patel, Lorita Krasniqi Imperial College School of Medicine, Imperial College London, London, UKCorrespondence: Anushka SharmaImperial College School of Medicine, Imperial College London, London, UKTel +44 7427404135Email as7316@ic.ac.uk We read, with great interest, the article by Taylor-Robinson et al discussing whether bullying remains a pertinent issue in the medical profession.1 Shedding light on this matter is more critical now than ever before due to the significant mental health challenges brought upon us by the COVID-19 pandemic.2 View the original paper by Taylor-Robinson and colleagues