Search

Background: The case fatality rate (CFR) for neonatal sepsis and its determinants vary from unit to unit. Sepsis may have a detrimental impact on neurodevelopment too. Materials and Methods: It is a descriptive observational study of neonates with culture-proven sepsis to determine the CFR, prevalence, predictors of mortality, and neurological morbidity. A neurological examination (Hammersmith neonatal neurological examination) was done at discharge. Results: The prevalence and CFR of proven sepsis were 24.5% (314/1282) and 24%, respectively. The greatest CFR was seen in neonates with Acinetobacter sepsis. On logistic regression, decreased movements (OR-5.48; 95% CI-2.17–13.83), convulsions at admission (OR-2.42; 95% CI-1.19–4.92), and Acinetobacter in blood culture (OR-1.42; 95% CI-0.65-3.10) were the significant predictors of mortality. Twenty-four (11%) neonates had abnormal neurological examination at discharge and convulsions at admission (OR 3.12; 95% CI 1.04–9.35), and Acinetobacter in blood culture (OR 4.87; 95% CI 1.51–5.66) were the significant predictors of neurological morbidity. Conclusion: A quarter of neonates with sepsis die, and more than a tenth have neurological morbidity.

We have examined the ionospheric response to a magnitude 6.6 earthquake that occurred in the Hindu Kush region of Afghanistan on March 21, 2023. This seismic event impacted the ionosphere in the Indian region. Our analysis utilized critical parameters of the F2 layer (foF2, h’F), obtained through Digisonde measurements from a low-mid latitude Indian station located in New Delhi (28.6°N, 77.2°E, 19.2°N geomagnetic latitude, 42.4°N dip).The routine day-to-day fluctuations in the ionosphere are removed by computing variations in the critical frequency and peak height of the F layer (ΔfoF2, Δh’F) in comparison to its standard normal behaviour during quiet periods. We observe noteworthy disturbances in the ionospheric F2 region over Delhi about 8 days before the earthquake event, leading to a substantial variation in peak electron density of approximately 90%. These observed perturbations suggest the potential existence of seismo-ionospheric coupling, given the solar and geomagnetic indices remained relatively quiet and stable during the period. Notably, the precursory impact of the earthquake was observed beyond the earthquake preparation zone, as given by Dobrovolsky et al. (1979).

We analyzed the impact of minor Arctic sudden stratospheric warming (SSW) event of 2017 on the ionospheric F2 region, using Digisonde data from a low-mid latitude Indian station, Delhi (28.6°N, 77.2°E, 19.2°N geomagnetic latitude, 42.4°N dip). Our study revealed significant ionospheric changes, with electron densities exhibiting variations of more than 200% during this warming event. To further investigate, we examined the deviation in critical frequency ΔfoF2 from median values in the first six months of 2017 and found that the F2 layer critical frequency experiences maximum and minimum variations during the SSW period. Additionally, we observed periodicities of 7, 11, 14 and 30 days in characteristic F2 layer frequency during this event.

Abstract Condensate ring formation can be used as a benchmark in welding processes to assess the efficiency and quality of the weld. Condensate formation is critical as the resulting condensate settles into the powder thereby altering the quality of unconsolidated powder. This study investigates the intricate relationship between alloy composition, vapor pressure, and condensate ring thickness as seen in a two-dimensional micrograph. To study the process, laser spot welding was performed on 9 different alloys, and the inner spot weld diameter along with the condensate ring formation was studied. Leveraging machine learning models, experimental observations, and molecular dynamics simulations, we explore the fundamental factors governing condensate ring formation. The models, adept at predicting weld spot diameter and condensate ring thickness, identify laser power as a primary determinant for weld spot diameter followed by physical properties like hardness and density. Conversely, for condensate ring thickness, vapor pressure and melting point descriptors consistently emerge as paramount, as validated across all models. Molecular dynamics simulations on Ni-Cr alloys elucidate the vaporization dynamics, confirming the role of vapor pressure in governing surface vaporization. Our findings underscore the pivotal influence of vapor pressure and melting point descriptors in condensate ring formation. The convergence of machine learning predictions and simulation insights elucidates the dominance of these descriptors, offering crucial insights into alloy design strategies to minimize condensate ring formation in laser welding processes.

Abstract Cell states are modulated by intrinsic driving forces such as gene expression noise and extrinsic signals from the tissue microenvironment. The distinction between intrinsic and extrinsic cell state determinants is essential for understanding the regulation of cell fate in tissues during development, homeostasis and disease. The rapidly growing availability of single-cell resolution spatial transcriptomics makes it possible to meet this challenge. However, available computational methods to infer topological tissue domains, spatially variable genes, or ligand-receptor interactions are limited in their capacity to capture cell state changes driven by crosstalk between individual cell types within the same niche. We present NiCo, a computational framework for integrating single-cell resolution spatial transcriptomics with matched single-cell RNA-sequencing reference data to infer the influence of the spatial niche on the cell state. By applying NiCo to mouse embryogenesis, adult small intestine and liver data, we demonstrate the ability to predict novel niche interactions that govern cell state variation underlying tissue development and homeostasis. In particular, NiCo predicts a feedback mechanism between Kupffer cells and neighboring stellate cells dampening stellate cell activation in the normal liver. NiCo provides a powerful tool to elucidate tissue architecture and to identify drivers of cellular states in local niches.

Abstract In the last decade, carbon quantum dots (CQDs), a novel class of carbon-based nanomaterials, have received increasing attention due to their distinct properties. Carbon Quantum Dots/Titanium Dioxide (CQDs/TiO2) Nanocomposites were reported as potent compounds against SARS-COV-2. In this manuscript, citric acid is the carbon precursor used to synthesize carbon quantum dots (CQDs). Using a green approach, the synthesized CQD fabricates the Carbon Quantum Dots/Titanium Dioxide (CQDs/TiO2) Nanocomposites. Synthesized composites were characterized by using a UV–visible spectrophotometer, Fourier-transformed infrared (FTIR) spectrometry, X-ray diffractometry (XRD), and Scanning electron microscopy with energy dispersive X-ray analysis (SEM–EDX). Methylene blue was used to check the Photocatalytic activity of synthesized (CQDs/TiO2) nanocomposites of different concentrations. Computational modeling of agglomerates of CQD and TiO2 nanoparticles with the formula TiO2…….. Ti253O506 demonstrated two stages of the nanocomposite formation, including the formation of agglomerates with the neutral and salt-like structures with the total gain in the Gibbs free energy − 38.397 kcal/mole. In silico, Molecular docking studies of citric acid were evaluated against SARS-COV-2 protein to understand their mechanism and key amino acid interactions along with standard drug remdesivir. The photocatalytic activity of CQDs/TiO2 showed extremely promising results. Based on this study, the proposed mechanism of action of these compounds is reported. A detailed investigation of CQDs/TiO2 against SARS-CoV-2 is needed, which is another part of the research in our next manuscript.

The safety of railways is ensured by the regular maintenance of tracks, signals and rolling stocks. This mainly involves manual inspection by skilled maintainers and automated inspection systems are not commonly used. The development of an automated inspection system is crucial for maintaining good rail conditions. In this study on automatic surface defect detection systems, we focused on wheels as the target because they are critical components of rolling stocks, and any wheel defects can cause severe safety problems. Wheel-tread-profile dimensions have been measured using laser instruments in previous studies. In this research, to validate the accuracy of the measurement equipment, special test pieces with surface defects are prepared. We propose a combined inspection system using laser sensors, and a machine vision technique to confirm the effectiveness of the proposed system. An artificial intelligence (AI)-based surface defect detection system is employed to improve the proposed system. Combining edge detection through image transformation with an AI-based surface defect detection system offers remarkable benefits. The effectiveness of the system is experimentally confirmed using test pieces that simulate different materials and passing speeds of wheels.

Frailty is an age-associated state of increased vulnerability due to declines in physiologic systems, leading to compromised ability to withstand stressors. Given India’s rapidly aging population, our study aims to estimate the pooled prevalence of frailty and its associated factors in hospital settings. An extensive search was conducted across four databases, up to January 2024. A random-effects model was utilized. To quantify heterogeneity, the I² statistic, prediction interval, and the Chi-square-based Q test were employed. Outliers were identified using a Baujat plot and influence analysis. Doi plot, luis furuya kanamori (LFK) index and funnel plot were used to assess publication bias. The current meta-analysis determined a pooled frailty prevalence of 42.3% (95%CI: 34.8%−50.1%) and prefrailty prevalence of 39.8% (95%CI: 30.4%−49.8%), both exhibiting high heterogeneity (I² values of 96.9% and 95.3%, respectively). A high degree of variability was indicated by a prediction interval ranging from 9% to 76%, while Egger’s test suggested no evidence of publication bias. Our systematic review and meta-analysis, encompassing 6,856 individuals, revealed a considerable prevalence of frailty at 42.3%, underscoring its ubiquity across health spectra and demographics in India.

Background: Thalassemia is a hemoglobinopathy-associated genetic disease resulting due to defective synthesis of globin chains, causing defects in the skeletal and oral structures. Aim: This cross-sectional study was designed to analyze the prevalence of dental caries, oral health status, malocclusion status, and dental treatment needs in thalassemic children. Materials and Methods: Institutional Ethical committee clearance was obtained before starting the study. The study sample comprised 100 thalassemic and 100 normal children in which oral disease markers like dmft/DMFT index, plaque index, gingival index, and Angle’s classification for malocclusion were used. The statistical tool used was ‘one-way ANOVA’ with the probability set at 0.05. Results and Observations: Statistically significant differences in prevalence of dental caries, periodontal disease, malocclusion, and treatment needs were noted in thalassemic individuals when compared to normal subjects. Conclusion: The present study has given an insight into the various oral and dentomaxillofacial manifestations of thalassemia, thus considering the importance of routine oral examination for the prevention of dental caries and periodontal diseases.

Context: Child abuse and neglect can be described as all kinds of physical, emotional, and sexual abuse, neglect, commercial and/or any other type of exploitation resulting in any potential of causing hurt or an actual form of harm to a child’s general health, growth, survival, and dignity. The dentist is in a position to identify physical signs of physical abuse in a child hence, it is important to gauge the knowledge level and perception regarding child abuse and neglect. Aim: The aim of the present study was to ascertain the knowledge, attitude, and experience regarding child abuse and neglect among dentists in India. Materials and Methods: This cross-sectional, descriptive, survey-based study was conducted on 100 dental practitioners all over India using a pre-validated questionnaire. The study was approved by the institutional ethics committee. Responses received were recorded in an Excel Worksheet and analyzed using descriptive statistics and Chi-square statistical tool using SPSS software (version 21.0). Results: We found that 85% of respondents reported child abuse cases of a physical and sexual nature and 87% had knowledge that law enforcement agencies are responsible for reporting such cases. Also, 56% believed that such cases could be reported using electronic mail while other sources were telephone, letters, or personal intervention. Only 12% were fearful of litigation and 24% were concerned about such exposure to a child. Conclusion: A total of 11% of dentists experienced barriers in reporting such cases while 17% reported with no barriers. Child abuse and neglect are often underreported due to various reasons. This survey has attempted to assess the knowledge, attitude, and experience about child abuse and neglect and has found a few prominent reasons for not reporting such incidents.

Background: Many public health topics in the subject of Community Medicine have a psycho sociocultural aspect to them, and these are taught by traditional methods like didactic lectures with little or no interaction of faculty and students. This limits the comprehensive understanding of the students regarding sensitive issues. There is a felt need to improve the knowledge and understanding of many of these competencies among students through available cinema movies addressing these concepts. Objectives: 1. To assess effectiveness of “Cinemeducation” as a tool to teach identified competencies in Community Medicine subject. 2. To assess perception of students for “Cinemeducation” to enhance learning and communication skills. Methodology: Study Design: Nonrandomized intervention study. Setting: Department of Community Medicine, Government Medical College, Pali, Rajasthan. Participants: Year 2 from 2020 Batch. Sample Size: 159 students. Sampling: Complete enumeration. Intervention: All 159 students were divided into two groups and alternately shown movies, Toilet–Ek Prem Katha, Padman, Outbreak, and Steel Magnolias, or exposed to didactic lecture and were assessed using pre- and post-tests and student satisfaction and self-confidence in learning scale. Results: The post-test scores of cinemeducation showed an improvement by a mean of 1.88 ± 0.7 points. The self-confidence and learning scale showed that 86% of students agreed that cinemeducation was better than didactic lectures. The mean satisfaction index of cinemeducation as a teaching–learning method was 97.6. Three out of the four movies addressed the competency well, and the difference between the pre- and post-test scores was statistically significant following cinemeducation as compared to lectures. Conclusions: As the student correlates real-life situations in movies like Toilet–Ek Prem Katha, Outbreak, and Padman, they definitely understood the topic better with cognitive scores showing an increase.

Guillain–Barre syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, often triggered by infections. This important medical emergency can also have noninfectious causes, such as trauma, surgery, medication (including vaccinations), and other systemic disorders. Here, we present a rare case of GBS following a snakebite. A 19-year-old man presented to the emergency department with quadriparesis and areflexia after showing initial recovery from a snakebite. Nerve conduction studies revealed motor axonal polyneuropathy. He was treated with intravenous immunoglobulin, which improved his clinical condition. This case report highlights a rare cause of GBS and emphasizes that timely recognition and treatment can significantly reduce morbidity and mortality. Additionally, we reviewed past literature of this rare association.

Background: Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition with high cost of management and significant impact on the patient and healthcare system. Hence, there is a need to estimate and analyze the economic impact of RA. Materials and Methods: It was a cross-sectional prospective follow-up single-center study at a tertiary care hospital conducted over a period of 02 years and 06 months from September 2019 to February 2022 after ethical committee clearance. Results: A total of 189 RA patients were included after excluding 15 patients. The male-to-female ratio was 0.687. The mean age of the study population was 44.74 ± 5.2 years. The mean yearly average cost of management of RA was Rs 29155.1 ± 18234.1, of which 49.6% was direct medical, 19.4% was direct non-medical, and 31% was indirect costs. Of average direct medical costs, cost toward non-steroidal anti-inflammatory drugs (NSAIDs) was 3.1%; conventional disease-modifying antirheumatic drugs (DMARDs) was 36.3%; and laboratory, radiology investigations, and consultations was 6.4%, 1.48%, and 12.3%, respectively. Factors, such as longer duration of treatment, use of biologic DMARDs, loss of productive workdays, extraarticular manifestations, and management of complications, were associated with higher cost of treatment of RA. Conclusions: This study quantifies the economic burden of the RA by measuring costs incurred toward all aspects of the patient’s life including the indirect costs due to loss of workdays. The knowledge of cost will help in financial management by patients and healthcare providers.

Highlights 1. Temperature and precipitation time series data from 1950 to 2020 were analyzed for the states of Haryana and Punjab. 2. SARIMA models provided the most accurate temperature predictions for both states, though precipitation predictions in July were sometimes overestimated. 3. SARIMA provided better results than machine learning-based models, with lower RMSE, AIC, and BIC values. 4. Model forecasts can improve flood prediction, urban planning, and water resource management, benefiting scientists and decision-makers.

Abstract Reinforcement Learning (RL) is a machine learning paradigm that enhances clinical decision-making for healthcare professionals by addressing uncertainties and optimizing sequential treatment strategies. RL leverages patient-data to create personalized treatment plans, improving outcomes and resource efficiency. This review introduces RL to a clinical audience, exploring core concepts, potential applications, and challenges in integrating RL into clinical practice, offering insights into efficient, personalized, and effective patient care.

Abstract Landslide susceptibility map (LSM) plays an important role in providing the knowledge of slopes prone to future landslides. However, the applicability of LSM is often hindered due to high cost of data collection especially in mountainous region such as Himalayas. Therefore, this study proposes transfer learning approach (TL) to improve the performance of LSM by transferring the information from the data rich region (source) to data scare region (target). Two machine learning based model are trained in source area which is then transferred for prediction in target area and a source trained model combined with the knowledge of target is used for the prediction in the target area. The applicability of the proposed approach is tested considering Mandi district as source area and Kullu and Rudraprayag districts as target areas. Independent variables which included 11 landslide conducive factors from the source and target area, the independence was critically analysed using multi-collinearity test, while the geomorphic similarity was assessed using KL divergence method. Efficient machine learning method such as random forest (RF) and multi-layer perceptron (MLP) was used to train the models in both areas, statistical measure such as AUC-ROC, precision, recall, F-score, and accuracy were used to evaluate the performance of the LSMs. The results demonstrated the proposed approach for target area 1, the AUC value increased from 0.908 (Target trained on itself), to 0.942 (Target-Transfer Learned (TL)) and 0.959 (Target Combined) for RF and 0.896, 0.907 and 0.946 for MLP. Additionally, an increase in the precision was observed in RF while all other statistical measures increased to 0.023 for precision, 0.022 for recall, 0.023 for F-score and 0.066 for accuracy in the case of MLP. While on the other hand, in the case of target area 2, the AUC value for RF, ranged from 0.95 (Target area trained on itself), 0.80 (target TL) and 0.98 (target combined) and for MLP the AUC ranged from 0.82 for the source trained model while 0.84 for LSM obtained when both target and source data was used. Thus, the results revealed that proposed TL approach can be effective in improving the performance of LSM in data scare region in Himalayan region, thereby providing a promising approach in overcoming the issue of data limitation.

Abstract The present analysis examines the effect of thermal radiation on the stream of Maxwell liquid past a stretchy surface in the presence of a zero-mass flux condition. The effect of waste discharge concentration, thermophoresis-Brownian motion, and porous media on the fluid motion is also considered. Investigation of the liquid flow with waste discharge concentration in stretched sheets may lead to the growth of effective methods for disposing of waste and preventing pollution. Due to their extensive applicability, the mechanisms of flow and heat transmission in the context of thermal radiation play a crucial role in research and industry. This phenomenon often occurs in spacecraft, nuclear reactor cooling, power production, aerospace technologies, combustion applications, gas turbines, hypersonic flights, and high-temperature processes. The modelled governing partial differential equations (PDEs) are converted into dimensionless ordinary differential equations (ODEs) utilizing appropriate similarity variables. Further, the Keller–Box approach is utilized to solve the resultant ODEs numerically. The influence of several parameters on the temperature, concentration and velocity profiles is shown via graphic representations. The intensification in Deborah’s number and porous parameter values declines the velocity profile. As the values of the radiation, thermophoresis, and Brownian motion parameters increase, the thermal profile increases. The concentration profile increases as the pollutant external source parameter value upsurges.

Abstract In some specific cheesemaking protocols, pre-acidification of milk is practiced to solve the quality problems otherwise faced in cheesemaking (from membrane-processed milk). Partial acidification (pre-acidification of milk or post-acidification of cheese curd) of Pizza cheesemaking utilizing the starter culture (SC) method may favourably influence the physico-chemical and functional properties of the resultant cheese with reduction in cheese production time. The Pizza cheeses were evaluated in terms of changes in their physico-chemical and functional properties during refrigerated storage. A marked increasing trend was noticed with regard to titratable acidity, soluble nitrogen, meltability and fat leakage during the storage period. A marked decrease in the moisture content of cheeses was noted with advancement in the storage period. The stretch value of cheese E2 (experimental cheese 2 prepared employing post-acidification step) increased during the storage period, while this property remained unchanged for cheese E1 (experimental cheese 1 prepared employing pre-acidification step). Contrary to the above findings, a decrease in the stretch value was noted for the two control cheeses on the 21st day of storage. It is advisable to prepare Pizza cheese using a ‘dual acidification’ process involving use of SC followed by post-acidification of cheese curd with Glucono delta-lactone (GDL) as per the standardized protocol with the resultant cheese possessing desirable functional properties throughout refrigerated storage.

Abstract We introduce a novel Einstein–Rosen BTZ wormhole metric as a solution to the Einstein field equations with a negative cosmological constant and explore in detail its various phenomenological aspects. We show that the wormhole metric is characterized by a horizon at the throat, resembling a black hole horizon. This implies that our wormhole metric describes a one-way traversable wormhole at the throat, with Hawking radiation observed by an observer located at some distance from the wormhole. It is also found the same Hawking temperature using the BTZ-like coordinates and Kruskal-like coordinates. This temperature is invariant not only on the type of coordinates but also the nature of the spin of quantum fields. Importantly, we find that at the wormhole throat, the spacetime is not a pure vacuum solution, but rather contains an exotic string matter source with negative tension, which may stabilize the wormhole geometry. To this end, we found that the size of the wormhole throat is proportional to the number of quantum bits suggesting a possible implications on ER=EPR. Further we studied the particle dynamics and, finally, we tested the ANEC with a test scalar and vector fields. For the double null-component computed in BTZ coordinates, we found an apparent divergence at the wormhole throat, which is then shown to be regularized by means of Kruskal-like coordinates. The ANEC for such a scalar/vector field is violated at the wormhole throat.

Abstract Large language models (LLMs) can optimize clinical workflows; however, the economic and computational challenges of their utilization at the health system scale are underexplored. We evaluated how concatenating queries with multiple clinical notes and tasks simultaneously affects model performance under increasing computational loads. We assessed ten LLMs of different capacities and sizes utilizing real-world patient data. We conducted >300,000 experiments of various task sizes and configurations, measuring accuracy in question-answering and the ability to properly format outputs. Performance deteriorated as the number of questions and notes increased. High-capacity models, like Llama-3–70b, had low failure rates and high accuracies. GPT-4-turbo-128k was similarly resilient across task burdens, but performance deteriorated after 50 tasks at large prompt sizes. After addressing mitigable failures, these two models can concatenate up to 50 simultaneous tasks effectively, with validation on a public medical question-answering dataset. An economic analysis demonstrated up to a 17-fold cost reduction at 50 tasks using concatenation. These results identify the limits of LLMs for effective utilization and highlight avenues for cost-efficiency at the enterprise scale.

Abstract Background An importance of tillage, inorganic and organic nutrient sources in the mustard - soybean cropping system lies in their ability to enhance soil fertility, improve nutrient availability, optimize crop growth and yield, and promote sustainable agricultural practices. Any cropping system’s sustainability could be increased by implementing better management techniques like zero and reduced tillage with residue retention and better nutrient sources. Results A field experiment was conducted for four consecutive seasons (Winter 2019 to Rainy 2021) to compare the two enhanced management practices, zero and reduced tillage to conventional tillage across four levels of nutrient sources: 75 and 100% recommended dose of nitrogen through FYM and 75 and 100% recommended dose of fertilizers through urea, single super phosphate and muriate of potash in a two years experiment. Experiment results were evaluated in terms of nutrient status, profitability and productivity of Mustard-Soybean cropping system. The results show a substantial improvement in yield, nutrient status, and overall yield performance of mustard and soybean when using the full recommended dose of fertilizers combined with reduced tillage and mulching, compared to other treatment methods. The implementation of reduced tillage practices recorded significantly higher yield of mustard and soybean over conventional and zero tillage. Conclusion System productivity and profitability i.e. mustard equivalent yield, productivity, gross returns, net returns, profitability and B: C (benefit: cost) was found to be improved with reduced tillage and 100% recommended dose of fertilizer under reduced tillage practices. To enhance cropping system productivity in various sub-humid regions worldwide, farmers can adopt reduced tillage techniques combined with the full recommended dose of fertilizers (100% RDF).

Abstract A non-Newtonian liquid motion across a stretchable surface is relevant to various industrial applications, including extruding plastic sheets and stretching plastic films. In connection with this, the impact of endothermic and exothermic chemical reactions on the flow of rate-type liquid via an oscillatory stretching sheet in the presence of permeable media with the Maxwell liquid model is elucidated in the present study. Scientists and engineers may enhance the efficiency of chemical reactions or heat transmission by optimising system flow and investigating the effect of reactions on flow dynamics. The present study’s governing partial differential equations (PDEs) are transformed into their non-dimensional form using similarity variables. The resulting equations are numerically solved using the finite difference method (FDM). Outcomes disclose that the temperature profile declines as the activation energy and unsteadiness parameters increase. The influence of the Maxwell and unsteadiness parameters on the fluid’s velocity with respect to time is represented. The rise in the values of chemical reaction parameter upsurges the thermal profile. As the activation energy and unsteadiness parameters upsurge, the thermal profile declines. As the chemical reaction parameter and the ratio of oscillation frequency to stretching rate values rise, the concentration profile falls.

Introduction: Endotracheal intubation often triggers a sympathetic response, leading to an increase in Heart Rate (HR) and blood pressure. Dexmedetomidine (DEX) and lignocaine have shown the potential to mitigate cardiovascular changes secondary to intubation. Aim: To compare the efficacy of 0.25 mcg/kg and 0.5 mcg/kg DEX with 1.5 mg/kg lignocaine in attenuating haemodynamic responses during the peri-intubation period. Materials and Methods: This randomised double-blind study included 90 patients classified as American Society of Anaesthesiologists (ASA) I and II, aged 16-65 years. Patients were divided into three groups: Group A received lignocaine (1.5 mg/kg); Group B received DEX (0.25 mcg/kg); and Group C received DEX (0.5 mcg/kg). Haemodynamic parameters were recorded at various intervals before and after laryngoscopy. Data were checked for normality before statistical analysis using the Shapiro-Wilk test. Normally distributed continuous variables were compared using Analysis of Variance (ANOVA), while categorical variables were analysed using the Chi-square test. For all statistical tests, a p-value of less than 0.05 was considered indicative of a significant difference. Results: All groups were found to be comparable in terms of age, weight, and gender distribution. The mean age in Group A was 36.10±12.60 years, in Group B was 36.10±13.47 years, and in Group C was 37.37±11.49 years. Inter-group comparisons between Group A and Group C showed statistically significant lower HR values in Group C (79.23±10.37 vs. 90.7±17.68) at T0 as well as T1 (90.07±14.65 vs. 99.93±17.02, p-value 0.019). The comparison between Groups A and C revealed significantly lower Systolic Blood Pressure (SBP) values in Group C at T0, T1, T3, and T5. Inter-group comparisons between Groups A and B showed that Diastolic Blood Pressure (DBP) values were significantly lower at T5 in Group B (69.33±10.09 vs. 62.33±9.11, p-value 0.006). Between Groups A and C, significant differences were noted at T0, T1, T3, and T5 in Mean Arterial Pressure (MAP). Conclusion: DEX at a dose of 0.5 mcg/kg appears to be a more effective option for managing haemodynamic responses compared to lignocaine. Nevertheless, the haemodynamic stability achieved with 0.25 mcg/kg of DEX is nearly equivalent to that observed with both 0.5 mcg/kg of DEX and 1.5 mg/kg of lignocaine.

Abstract Glycerol kinase deficiency (GKD) is an X‐linked recessive disorder due to glycerol kinase (GK) gene mutations resulting in hyperglycerolermia, hyperglyceroluria, and “pseudohypertriglyceridemia.” In vivo glycerol metabolism has not been assessed in GKD. A 62‐year‐old man with suspected GKD and his extended family underwent whole exome sequencing and fasting blood work with two modes of lipid measurements: (1) standard lipase‐based methodology and (2) nuclear magnetic resonance (NMR). Two overnight fasted men with GKD and a heterozygote female carrier then underwent 13C3‐glycerol infusion. Affected family members had a novel two‐nucleotide deletion in exon 5 of the GK gene (c.373_374del). Compared to their family members (n = 14), men with GKD (n = 5) had significantly lower total cholesterol levels (3.72 ± 0.70 vs. 4.77 ± 0.85 mmol/L, p = 0.024). Compared to NMR, lipase‐based assays overreported triglycerides (5.28 ± 1.38 vs. 0.81 ± 0.32, mmol/L, p

Background: Inflammatory bowel disease (IBD) is a chronic condition characterized primarily by inflammation of the gastrointestinal tract. Pericarditis is a rare but important extraintestinal manifestation of IBD that is poorly understood yet is associated with significant morbidity. The objectives of this study were to identify the factors associated with pericarditis in IBD and associated complications. Methods: Hospitalized adult patients (aged ≥ 18 years) with a diagnosis of acute pericarditis in the IBD cohort, 2011-2020, were identified from the National Inpatient Sample using codes from the International Classification of Diseases (revision 9 or 10). Multivariable logistic regression was performed to identify clinical factors associated with pericarditis among IBD patients and in-hospital complications. Results: During the period 2011-2020, among 3,236,747 IBD patients, 9113 (0.28%) had pericarditis, with a mean patient age of 54.08 ± 0.48 years, and 53.1% females. Patients with IBD and coexisting diagnoses of systemic lupus erythematosus (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.03-2.15, P = 0.033), rheumatoid arthritis and/or collagen vascular disorders (OR 1.75, 95% CI [1.41-2.17], P < 0.001), or postcardiotomy syndrome (OR 67.13, 95% CI [30.08-149.80], P < 0.001), were each associated with a higher risk of pericarditis. Compared to IBD patients without pericarditis, patients with IBD and pericarditis had an increased associated incidence of inpatient mortality (OR 1.65, 95% CI [1.25-2.18], P < 0.001). Conclusions: Pericarditis is an uncommon but important manifestation of IBD. The presence of a concomitant autoimmune condition led to a higher likelihood of developing pericarditis among IBD patients, and IBD patients who develop pericarditis had a higher incidence of inpatient mortality compared to IBD patients without pericarditis. Providers should be aware of the connection between IBD and pericarditis to identify individuals at risk of adverse complications. Résumé: Contexte: Les maladies inflammatoires de l'intestin (MII) sont des affections chroniques caractérisées principalement par une inflammation du tractus gastro-intestinal. La péricardite est une manifestation extra-intestinale rare mais importante des MII, mal comprise et pourtant associée à une morbidité importante. Les objectifs de cette étude étaient d'identifier les facteurs associés à la péricardite dans les MII, ainsi que les complications associées. Méthodes: Les patients adultes hospitalisés (âgés de ≥ 18 ans) avec un diagnostic de péricardite aiguë dans la cohorte MII, 2011-2020, ont été identifiés à partir de l'Échantillon National américain des Patients Hospitalisés (NIS) en utilisant les codes de la Classification Internationale des Maladies (révision 9 ou 10). Une régression logistique multivariée a été réalisée pour identifier les facteurs cliniques associés à la péricardite chez les patients atteints de MII et aux complications hospitalières. Résultats: Au cours de la période 2011-2020, parmi les 3 236 747 patients atteints de MII, 9 113 (0,28 %) ont eu une péricardite, avec un âge moyen de 54,08 ± 0,48 ans, 53,1 % étant des femmes. Les patients atteints de MII et présentant des diagnostics concomitants de lupus érythémateux systémique ((rapport de cotes [RC] 1,49, intervalle de confiance [IC] à 95 % 1,03-2,15, p = 0,033), de polyarthrite rhumatoïde et/ou de troubles vasculaires du collagène (RC 1,75, IC à 95 % [1,41-2,17], p < 0,001), ou de syndrome post-cardiotomie (RC 67,13, IC à 95 % [30,08-149,80], p < 0,001), étaient tous associés à un risque plus élevé de péricardite. Par rapport aux patients atteints de MII sans péricardite, les patients atteints de MII et de péricardite présentaient une incidence associée accrue de mortalité chez les patients hospitalisés (RC 1,65, IC à 95 % [1,25-2,18], p < 0,001). Conclusions: La péricardite est une manifestation peu fréquente mais importante des MII. La présence d'une maladie auto-immune concomitante augmente la probabilité de développer une péricardite chez les patients atteints de MII, et les patients atteints de MII qui développent une péricardite ont une incidence plus élevée de mortalité chez les patients hospitalisés, par rapport aux patients atteints de MII qui n'ont pas de péricardite. Les prestataires de soins doivent être conscients du lien entre les MII et la péricardite afin d’identifier les personnes à risque de complications indésirables.

Pediatric headache is a common condition that often results in frequent outpatient visits. There are two broad etiological groups of headaches—primary and secondary headaches—with the former being more prevalent. Migraine, a type of primary headache, shares similarities with those experienced by adults, albeit with some variations in diagnostic criteria. The secondary causes of headache should be differentiated from the primary headaches with proper clinical evaluation and focussed investigations. The management of migraine focusses on lifestyle modifications, behavioral therapy, and pharmacotherapy for acute episodes and long-term preventive therapy. There are many novel promising treatment modalities. This review article provides an overview of pediatric headache epidemiology, classification, and pathophysiology and then elaborates on management and prevention strategies.

Study Design A retrospective cohort study. Purpose To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease. Overview of Literature Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management. Methods In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All p-values

Abstract Recent progress in deep learning has significantly impacted materials science, leading to accelerated material discovery and innovation. ElemNet, a deep neural network model that predicts formation energy from elemental compositions, exemplifies the application of deep learning techniques in this field. However, the “black-box” nature of deep learning models often raises concerns about their interpretability and reliability. In this study, we propose XElemNet to explore the interpretability of ElemNet by applying a series of explainable artificial intelligence (XAI) techniques, focusing on post-hoc analysis and model transparency. The experiments with artificial binary datasets reveal ElemNet’s effectiveness in predicting convex hulls of element-pair systems across periodic table groups, indicating its capability to effectively discern elemental interactions in most cases. Additionally, feature importance analysis within ElemNet highlights alignment with chemical properties of elements such as reactivity and electronegativity. XElemNet provides insights into the strengths and limitations of ElemNet and offers a potential pathway for explaining other deep learning models in materials science.

Abstract This research study evaluates the impact of low-density polyethylene (LDPE) modified asphalt binder on the mechanical performance and economical feasibility of asphalt concrete (AC) mixtures. LDPE-modified mixtures were compared with conventional mixes prepared with various binders commonly used in India, i.e., VG 30, VG 40, Polymer-Modified Binder (PMB), and Crumb Rubber Modified Binder (CRMB). LDPE-modified mixtures exhibit superior mechanical performance, increasing the stiffness of AC mixtures by 171% and 125% at 25 °C and 35 °C, respectively, compared to VG 30 base binder. Additionally, the indirect tensile strength (ITS) improved by 51% over VG 30. LDPE-modified mixtures also showed improved resistance to permanent deformation, with RT Index values up to 133.46% higher than VG 30, and higher fatigue resistance, as indicated by increased CT Index values compared to VG 30 and CRMB. However, the CT Index values for LDPE-modified mixtures were 26.32% and 56% lower than those for VG 40 and PMB, respectively. Pavement analysis using 3D-Move showed lesser deflections at pavement layer interfaces, resulting in higher rutting and fatigue life for LDPE-modified pavements. Furthermore, LDPE-modified pavements showed up to 57% higher fatigue life (Nf) and up to 42.33% higher rutting life (Nr) than other pavements. The economic analysis showed that the cost of LDPE-modified pavements is comparable to VG 40 and around 10% more economical than pavements containing PMB. Using LDPE also offers environmental benefits by repurposing up to 750 kg for every kilometer of single-lane pavement section having 50mm thick surface course. Overall, LDPE-modified asphalt mixtures present a sustainable and high-performance solution for asphalt pavement construction.

Abstract Background The date of sowing is a non-monetary input factor that plays a crucial role in field crop management. Based on the sowing time, management practices of crop production affect crop growth, development, and yield. Under varied environmental conditions, this factor may be useful in addressing low yields and combating/escaping stresses either due to diseases or due to any unfavourable environment. Results A field experiment was conducted during the rabi season of 2017–18 and 2018–19 to study the accumulated growing degree days (GDD) and performance of six wheat cultivars (HS 562, HD 2967, HD 3086, HI 1544, MACS 6222 and WR 544) under four sowing dates (5th November, 25th November, 15th December and 5th January). The study revealed that 5th November is the best date for sowing resulting in higher pooled grain yield of 4.85 Mg ha−1 and 3.94 Mg ha−1 at Bajaura and Malan, respectively. Significant reductions in the grain yield and yield attributes were observed when the date of sowing was set beyond 5th November. Among the cultivars tested, HS 562 gave a significantly higher pooled grain yield of 4.46 and 3.75 Mg ha−1 at Bajaura and Malan, respectively. Pooled data on physiological maturity revealed that variety HS 562 took the highest calendar days (168 days) and GDD (1573.42 °C days) to attain physiological maturity at Bajaura while at Malan HI 1544 and HD 3086 took the highest calendar days (156 and 155 days, respectively) and GDD (2055.41 and 2051.81 °C days, respectively) to attain their physiological maturity. Conclusion From the study, it can be concluded that the early date of sowing provides the crop with ample duration to accumulate growing degree days resulting in a higher accumulation of photosynthates resulting in significantly higher yield attributes and grain yield. Therefore, 5th November is recommended as the best time for sowing of wheat crop whereas the sowing must not be delayed beyond 25th November. HS 562 was superior among the cultivars and is recommended for Malan and Bajaura regions for attaining higher yield.

Abstract Background Some evidence suggests that fluid resuscitation with lactated Ringer’s solution (LR) may have an anti-inflammatory effect on acute pancreatitis (AP) when compared to normal saline (NS) and may be associated with a decrease in severity, but existing single-center randomized controlled trials showed conflicting results. The WATERLAND trial aims to investigate the efficacy and safety of fluid resuscitation using LR compared to NS in patients with AP. Methods The WATERLAND trial is an international multicenter, open-label, parallel-group, randomized, controlled, superiority trial. Patients will be randomly assigned in a 1:1 ratio to receive LR versus NS-based fluid resuscitation for at least 48 h. The primary outcome will be moderately severe or severe AP, according to the revision of the Atlanta classification. The secondary objectives of the WATERLAND trial are to determine the effect of LR versus NS fluid resuscitation on several efficacy and safety outcomes in patients with AP. A total sample of 720 patients, 360 in the LR group and 360 in the NS group, will achieve 90% power to detect a difference between the group proportions of 10%, assuming that the frequency of moderately severe or severe AP in the LR group will be 17%. A loss to follow-up of 10% of patients is expected, so the total sample size will be 396 patients in each treatment arm (792 patients overall). The test statistic used is the two-sided Z test with pooled variance set at a 0.05 significance level. Discussion The WATERLAND study aims to improve the early management of AP. Fluid resuscitation is an inexpensive treatment available in any hospital center worldwide. If a better evolution of pancreatitis is demonstrated in one of the treatment arms, it would have important repercussions in the management of this frequent disease. Trial registration ClinicalTrials.gov, NCT05781243. Registration date on January 4, 2023. EudraCT number 2023–000010-18, first posted March 23, 2023.

Splenic Lymphoma (SL) is a lymphoproliferative disorder characterised by involvement of the spleen, with or without bone marrow involvement. However, advancements in imaging modalities have led to more frequent diagnosis of isolated splenic lesions. There is always a dilemma in diagnosis as to whether the pathology truly originates from the spleen or if it is part of systemic involvement in Non-Hodgkin Lymphoma (NHL). Clinical manifestations vary widely, and treatment outcomes for SL depend on accurate diagnosis. However, prognosis still remains poor in these cases compared to systemic NHL. The present case series provide a comprehensive overview of patients diagnosed with SL, focusing on their clinicopathological characteristics, therapeutic details, prognosis and outcomes. Previously isolated case reports have been published, and there is still a lack of consensus on the management of this entity. The present case series included seven cases over a two-year period, from January 2022 to December 2023. In the current case series, authors have highlighted the heterogeneity and variability in the presentation of SL and how the clinical behaviour ranges from indolent to highly aggressive. Nevertheless, the presenting clinical, laboratory and pathological features of these diseases often display significant overlaps and pose confusion in arriving at an exact diagnosis. The authors emphasise how flow cytometry helps facilitate the diagnosis and systemic therapy is the modality of choice for treatment decided based on the histology type; however, outcomes still remain dismal, highlighting the unmet need to improve accurate diagnosis and explore newer treatment options. The novelty in this series lies in the detailed analysis and comparison of different subtypes of SL, a rare group of lymphomas primarily originating in the spleen. The present case series discusses the latest World Health Organisation (WHO) classification, which redefines the Hairy Cell Leukaemia (HCL) variant as Splenic B-cell Leukaemia/Lymphoma with Prominent Nucleoli (SBLPN). Detailed molecular and genetic characteristics of various SLs are highlighted, such as the presence of the v-raf murine sarcoma viral oncogene homolog B1 (BRAF) p.V600E mutation in HCL, Mitogen-activated Protein Kinase 1 (MAP2K1) and Immunoglobulin Heavy Variable 4-34 (IGHV4-34) mutations in the HCL-variant, and 7q distortion in Splenic Marginal Zone Lymphoma (SMZL). Emphasis is placed on the individualised treatment approach based on specific patient profiles, genetic markers and disease characteristics. The study underscores the need for further research and clinical trials to validate emerging therapies, such as the use of Rituximab plus Doxorubicin, Bleomycin, Vinblastine and Dacarbazine (R-ABVD) in Hodgkin lymphoma and combinations of novel agents in aggressive SLs like HCL-variant and CD20-negative B-cell NHL.

Abstract Resistive Random Access Memory (RRAM) has gained considerable momentum due to its non-volatility and energy efficiency. Material and device scientists have been proposing novel material stacks that can mimic the “ideal memristor” which can deliver performance, energy efficiency, reliability and accuracy. However, designing RRAM-based systems is challenging. Engineering a new material stack, designing a device, and experimenting takes significant time for material and device researchers. Furthermore, the acceptability of the device is ultimately decided at the system level. We see a gap here where there is a need for facilitating material and device researchers with a “push button” modeling framework that allows to evaluate the efficacy of the device at system level during early device design stages. Speed, accuracy, and adaptability are the fundamental requirements of this modelling framework. In this paper, we propose a digital twin (DT)-like modeling framework that automatically creates RRAM device models from device measurement data. Furthermore, the model incorporates the peripheral circuit to ensure accurate energy and performance evaluations. We demonstrate the DT generation and DT usage for multiple RRAM technologies and applications and illustrate the achieved performance of our GPU implementation. We conclude with the application of our modeling approach to measurement data from two distinct fabricated devices, validating its effectiveness in a neural network processing an Electrocardiogram (ECG) dataset and incorporating Fault Aware Training (FAT).

Abstract The objective of this study was to assess the impact of incorporating Saccharomyces boulardii yeast (a known probiotic culture) as an adjunct culture on the quality characteristics of Mozzarella cheese, prepared using two different cheesemaking protocols. Protocol I employed unhomogenized milk with cheddaring prior to plasticizing (CUMC), while Protocol II used a blend of homogenized and unhomogenized milk (1:1; BHMC) and obviating cheddaring step. A control cheese (UMC) was produced from unhomogenized milk. The study aimed to determine which cheesemaking protocol better supports S. boulardii survival and produces sensorily satisfactory cheese quality. Key findings showed that cheese made with Protocol II, particularly BHMC4.2 with a higher level of yeast, exhibited the highest yield. Textural properties of cheeses CUMC and BHMC were similar, with UMC and CUMC cheeses demonstrating superior baking characteristics such as shredding, melting, and controlled fat leakage. Sensory evaluation indicated that cheese made with a lower level of adjunct culture scored higher during pizza applications. Furthermore, higher adjunct yeast level produced cheeses having increased S. boulardii as well as Lactic Acid Bacteria counts. The study recommends using cheesemaking Protocol II, as it fosters a S. boulardii count of ~ 105 CFU/g through use of milder cheese curd plasticizing conditions, enhancing the survival of the probiotic yeast. These findings have practical implications for production of Mozzarella cheese having viable probiotic yeast count.

Cerclage wiring may be used to optimize the stability of intramedullary nail or plate fixations in comminuted proximal femoral fractures, periprosthetic fractures, and other selected cases. In this article, we presented a novel case of iatrogenic sciatic nerve entrapment from cerclage wiring used to supplement intramedullary nail fixation. We also illustrate and highlight the role of ultrasound in assessing the sciatic nerve to make a timely diagnosis.

Background: The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19. Methods: All patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment. Results: The prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (−16.21 ± 1.96 vs −18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> −20 %) vs controls (6.6 %).Average GLS was significantly lesser in severe post COVID patients (viz −14.25 ± 1.92 vs −16.63 ± 1.61 vs −17.63 ± 1.91, p

Continuous renal replacement therapy (CRRT) in children is quite challenging to manage because of their increased propensity for circuit clotting. The anticoagulant strategies are paramount in reducing the downtime in pediatric CRRT. The most commonly used anticoagulants in pediatrics are unfractionated heparin and citrate anticoagulation. The other less explored options include regional heparin protamine anticoagulation, prostacyclin, low-molecular-weight heparin, and thrombin antagonists. The choice of anticoagulant primarily depends on the patient’s condition, availability and cost of the anticoagulant, potential side effects, and the local expertise for troubleshooting. This article aims to bring about the merits and demerits of the different anticoagulants available for CRRT and the available evidence for the use of each of these anticoagulants.

Abstract We compute the exact thermal partition functions of a massive scalar field on flat spacetime backgrounds of the form ℝ d−q × 𝕋 q+1 and show that they possess an SL(q + 1, ℤ) symmetry. Non-trivial relations between equivalent expressions for the result are obtained by doing the computation using functional, canonical and worldline methods. For q = 1, the results exhibit modular symmetry and may be expressed in terms of massive Maass-Jacobi forms. In the complex case with chemical potential for U(1) charge turned on, the usual discussion of relativistic Bose-Einstein condensation is modified by the presence of the small dimensions.

Abstract The present paper introduces the development of dynamic stiffness method for analyzing small-scale sandwich functionally graded nanoplates resting on elastic foundation in thermal environments. The mathematical formulation is based on classical plate theory in conjunction with nonlocal elasticity theory. The governing equation is derived using Hamilton’s principle. The dynamic stiffness matrix is obtained through the application of the Levy displacement approach and assembled to form the global stiffness matrix. The final matrix is solved for natural frequency of the plates using the Wittrick–Williams algorithm. The proposed methodology is validated against existing literature, demonstrating a strong agreement. Various parametric studies explore the effects of thermal environments, volume fraction index, sandwich configurations, elastic foundation characteristics, nonlocal parameter and boundary conditions. The results show the versatility of the proposed approach in addressing small scaled complex engineering structures. This research significantly contributes to the understanding and analysis of sandwich functionally graded nanoplates, providing valuable insights for applications in aerospace, structural systems, sensors, actuators, and energy harvesting devices.

Abstract The intricate interplay of cancer stem cell plasticity, along with the bidirectional transformation between epithelial-mesenchymal states, introduces further intricacy to offer insights into newer therapeutic approaches. Differentiation therapy, while successful in targeting leukemic stem cells, has shown limited overall success, with only a few promising instances. Using colon carcinoma cell strains with sequential p53/p73 knockdowns, our study underscores the association between p53/p73 and the maintenance of cellular plasticity. Morphological alterations corresponding with cell surface marker expressions, transcriptome analysis and functional assays were performed to access stemness and EMT (Epithelial-Mesenchymal Transition) characteristics in the spectrum of cells exhibiting sequential p53 and p73 knockdowns. Notably, our investigation explores the effectiveness of esculetin in reversing the shift from an epithelial to a mesenchymal phenotype, characterized by stem cell-like traits. Esculetin significantly induces enterocyte differentiation and promotes epithelial cell polarity by altering Wnt axes in Cancer Stem Cell-like cells characterized by high mesenchymal features. These results align with our previous findings in leukemic blast cells, establishing esculetin as an effective differentiating agent in both Acute Myeloid Leukemia (AML) and solid tumor cells.

Background and Aims: The second-generation supraglottic airway device is conventionally inserted blindly, which might result in suboptimal placement. Limited literature exists on under-vision insertion techniques, particularly in paediatric patients. The primary objective of this study was to compare the oropharyngeal leak pressure (OPLP) between the blind insertion of the LMA Blockbuster® and the Miller laryngoscope-guided insertion in children. Secondary outcomes included the number of insertion attempts, haemodynamic disturbances, insertion time and airway complications. Methods: This randomised controlled trial study enroled 100 patients aged 1–4 years undergoing elective surgery. Patients were randomised into blind insertion (Group A) or Miller laryngoscope-guided insertion (Group B) of the LMA Blockbuster®. The primary outcome measure was OPLP. Insertion time, haemodynamic changes and postoperative complications were also assessed. The Chi-square, Fisher’s exact and t-test were applied appropriately, with the significance level set at P < 0.05. Results: Significantly higher mean OPLP was observed in Group B compared to Group A - 27.9 [standard deviation (SD): 1.58] cmH2O versus 25.94 (SD: 0.63) cmH2O [mean difference (MD): 1.96 (95% confidence interval {CI}: 1.48, 2.44; P < 0.001)]. Mean insertion time was longer in Group B, that is, 11.9 (SD: 1.91) s versus 8.7 (SD: 0.6) s [MD: 3.2 s; (95% CI: 2.63, 3.76; P < 0.001)]; however, the difference was not clinically relevant. First-attempt insertion, haemodynamic stability and postoperative complications were comparable (P > 0.05). Conclusion: Miller laryngoscope-guided under-vision insertion of LMA Blockbuster® improves alignment with epiglottic structures compared to blind insertion.

Recognizing and understanding human activities in real-time videos is a challenging task due to the complex nature of video data and the need for efficient and accurate analysis. This research pioneers a breakthrough in video activity recognition by introducing a robust framework leveraging the power of a stacked Bidirectional Long Short-Term Memory (Bi-LSTM) and Gated Recurrent Unit (GRU) architecture, harmonized within a fusion-based deep model. The stacked Bi-LSTM-GRU model capitalizes on its dual recurrent architecture, capturing nuanced temporal dependencies within video sequences. The fusion-based deep architecture synergizes spatial and temporal features, enabling the model to discern intricate patterns in human activities. To further enhance the discriminative power of the model, we introduce a fusion module in the proposed deep architecture. The fusion module integrates multi-modal features extracted from different levels of the network hierarchy, allowing for a more comprehensive representation of video activities. We demonstrate the efficacy of our approach through rigorous experimentation on UCF50, UCF101, and HMDB51 datasets. In experiments on the UCF50 dataset, our model achieves an accuracy of 97.01% and 95.86% on training and validation sets respectively, showcasing its proficiency in discerning activities across a diverse range of scenarios. The evaluation extends to the UCF101 dataset, where the proposed approach achieves a competitive accuracy of 97.62% and 96.93% on training and validation sets, surpassing previous benchmarks by a margin of approx 1%. Further-more, on the challenging HMDB51 dataset, the model demonstrates a robust accuracy of 89.71%and 88.88% on training and validation sets, solidifying its efficacy in intricate action recognition tasks.

Introduction: The key objective of Total Hip Replacement (THR) is to deliver a hip joint that is pain-free, mobile, and stable. For this procedure, both cemented and uncemented methods are offered. Aim: To compare the mid-term functional outcomes of uncemented Total Hip Arthroplasty (THA) versus cemented THA. Materials and Methods: A hospital-based retrospective cohort study was conducted on 60 cases of THA (both cemented and uncemented) operated at a tertiary-level medical institute in north India between January 2012 to December 2018. In this retrospective cohort study, sixty (60) hip replacements (both cemented and uncemented) were performed on patients between the ages of 25 to 70 at a tertiary care institute in rural north India between 2012 and 2018. Patients over the age of 25 who were diagnosed with pure hip arthritis due to conditions such as avascular necrosis, osteoarthritis, or hip developmental dysplasia and who were eligible for either an uncemented or a cemented THA were taken into consideration for inclusion. Retrospective patient monitoring was done based on Harris Hip Score (HHS) from January 2019 to August 2020. Results: In the cemented group, the mean age of the patients was 58.90±8.97, whereas in the uncemented group, it was 52.47±10.29. Out of 30 participants, 17 were male and 13 were female in the cemented group, and 19 male and 11 female participants were included in the study in the uncemented group. The difference between the cemented and uncemented groups’ HHS was significant during the immediate postoperative period (p=0.01). Nevertheless, there was no discernible difference at the long-term follow-up at one year (p=0.76), two years (p=0.20), three years (p=0.29), four years (p=0.86), and five years (p=0.47). Three years following surgery, radiographic evidence of osteolysis and loosening was observed in two instances (6.6%) in the uncemented group and two case (6.6%) in the cemented group. Conclusion: While cemented fixation offers better immediate functional results than uncemented fixation- such as less pain and faster pain-free full weight-bearing. Both have proven to be equally successful in the long run, with statistically insignificant differences.

Abstract Background Reflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose laryngopharyngeal reflux disease(LPRD). However many patients do visit the outpatient department with minimal symptoms not sufficient to fit the criteria described by Belafsky et al. for diagnosing LPRD. Most of these patients are provisionally diagnosed and treated for LPRD. Reflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose(LPRD) (Belafsky PC et al., J Voice 16(2):274–7, 2002, Belafsky PC et al, Laryngoscope 111(8):1313–7, 2001). RSI has nine questions that the patient must grade from 0 to 5. An abnormal score is greater than 13. Laryngopharyngeal reflux (LPR) may or may not be diagnosed using the RSI and RFS especially when patients present with minimum symptoms not sufficient to score more than 13 and 7 respectively. These patients may miss the diagnosis and have to be treated empirically. Pepsin’s presence in the saliva is indicative of reflux as pepsin is a gastric enzyme (NICE advice on Peptest for diagnosing gastro-oesophageal reflux, 2015, Wood JM et al., J Laryngol Otol 125(12):1218–24, 2011). Patients with minimum symptoms may be missed if diagnosis relies only on RSI AND RFS. The present study aims to see the correlation of pepsin-proven LPRD and RSI and RFS. Methods This is a prospective study, 49 patients with symptoms suggestive of LPRD who tested positive for the pepsin test were further analysed for RSI and RFS. A cut-off value of > 25 ng/mL was considered diagnostic of LPRD (Dhillon VK et al., Curr Gastroenterol Rep 18(8):44, 2016). Result The average RSI and RFS were respectively 10 and 4. The mean age of the patients in the study was 39 years and the mean weight was 60 kg. The association between RSI and PEPSIN detection is considered to be not statistically significant. Chi-squared equals 0.086 with 1 degree of freedom. The two-tailed P value equals 0.7698. Chi-squared equals 0.233 with 1 degree of freedom. The two-tailed P value equals 0.6295. The association between RFS and PEPSIN detection is considered to be not statistically significant. In terms of correlation analysis, neither the RSI nor the RFS had Pearson’s correlation coefficient that was statistically significant. Conclusion Since salivary pepsin detection and the RSI do not have any significant correlation, the RSI is not a valid diagnostic method for LPR and should not be used exclusively. Level of evidence 4.

Abstract We propose an optical read-out method for extracting faradaic current in electrochemical (EC) reactions and analyze its performance using opto-EC simulations. Our approach utilizes structured electrodes to generate composite optical vortex (COV) beams upon optical illumination. Through opto-EC simulations, we demonstrate that the EC reaction of 10 mM potassium ferricyanide induces a refractive index (RI) change, $$\Delta$$ Δ RI, of approximately $$10^{-4}$$ 10 - 4 RI units, leading to the rotation of the COV beam’s intensity profile with a peak rotation of $$40^{\circ }$$ 40 ∘ . This rotation’s magnitude is proportional to $$\Delta$$ Δ RI, while the rate correlates with the faradaic current ( $$I_f$$ I f ) density responsible for $$\Delta$$ Δ RI. As the opto-EC information is from bulk $$\Delta$$ Δ RI, it remains unaffected by interfering non-faradaic components at the interface and is advantageous for studying intermediate species and bulk homogeneous reactions. Furthermore, as rotation depends on $$I_f$$ I f density rather than $$I_f$$ I f itself, this method proves beneficial in low $$I_f$$ I f scenarios, such as when employing micro-electrodes to decrease solution resistance or obtain localized EC data. Even in low $$I_f$$ I f density scenarios, like monitoring slow EC reactions, our method enables signal amplification by accumulating rotation over time. This interdisciplinary approach holds promise for advancing EC research and addressing critical challenges across various fields, including energy storage, corrosion protection, environmental remediation, and biomedical sciences.

Abstract Background Biliary dilatation without obvious etiology on cross sectional imaging warrants further investigation. This study aimed to assess yield of endoscopic ultrasound in providing etiologic diagnosis in such situation. Methods Prospective cohort of consecutive patients with biliary dilatation & non diagnostic computed tomography (CT) and /or magnetic resonance imaging (MRI) underwent endoscopic ultrasound (EUS) with/without fine needle aspiration cytology (FNAC) and were followed clinically, biochemically with/without radiology for up to six months. The findings of EUS were corroborated with histopathology of surgical specimens and endoscopic retrograde cholangiography (ERCP) findings in relevant cases. Results Median age of 121 patients completing follow up was 55 years. 98.2% patients were symptomatic and median common bile duct (CBD) diameter was 13 mm. EUS was able to identify lesions attributable for biliary dilatation in (67 out of 121) 55.4% cases with ampullary neoplasm being the commonest (29 out of 67 i.e. 43%). Multivariate logistic regression analysis identified jaundice as the predictor of positive diagnosis on EUS, of finding ampullary lesion and pancreatic lesion on EUS. EUS had sensitivity, specificity, positive predictive value and diagnostic accuracy of 95.65%, 94.23%, 95.65% and 95.04% respectively in providing etiologic diagnosis. Threshold value for baseline bilirubin of 10 mg%, for baseline CA 19.9 of 225 u/L and for largest CBD diameter of 16 mm were determined to have specificity of 98%, 95%, 92.5% respectively of finding a positive diagnosis on EUS. Conclusion EUS provides considerable diagnostic yield with high accuracy in biliary dilatation when cross sectional imaging fails to provide etiologic diagnosis.

Abstract Backgroud Before fertilization, spermatozoa undergo a crucial maturation step called capacitation, which is a unique event regulates the sperm’s ability for successful fertilization. The capacitation process takes place as the spermatozoa pass through the female reproductive tract (FRT). Dihydrolipoamide dehydrogenase (DLD) protein is a post-pyruvate metabolic enzyme, exhibiting reactive oxygen species (ROS) production which causes capacitation. Additionally, other vital functions of DLD in buffalo spermatozoa are hyperactivation and acrosome reaction. DLD produces the optimum amount of ROS required to induce capacitation process in FRT. Depending on physiological or pathophysiological conditions, DLD can either enhance or attenuate the production of reactive oxygen species (ROS). Aim of this study was to investigate whether changes in the production of ROS in sperm cells can impact their ability to fertilize by triggering the capacitation and acrosome reaction. Results In this study, abundance of DLD protein was quantified between high (n = 5) and low fertile bull (n = 5) spermatozoa. It was found that compared to high-fertile (HF) bulls, low-fertile (LF) bulls exhibited significantly (P

Abstract Although continuum-scale segregation is a well-documented behavior in multi-species materials, detailed site-specific behavior remains largely unexplored. This is partially due to the complexity of analyzing materials at the requisite time and length scales for describing segregation with full atomic accuracy. Here, we better evaluate the segregation behavior of disordered grain boundary (GB) atomic environments through leveraging a set of Strain Functional Descriptors (SFDs) to generate an atomic descriptor (i.e., fingerprint). Using this atomic fingerprint, we resolve key relationships between atomic structure and segregation energy. Machine learning (ML) techniques are utilized in concert with this SFD fingerprint to elucidate complex relationships relating segregation potential to changes in specific features of the local Gaussian density captured by the SFDs. Finally, we identify relationships that indicate both individual and joint structure-property correlations. Linking atomic segregation energy to key structural features demonstrates the value of higher-order descriptors for uncovering complex structure-property relationships at an atomic scale.

Abstract Background The healthcare system in India is tiered and has primary, secondary and tertiary levels of facilities depending on the complexity and severity of health challenges at these facilities. Evidence suggests that emergency services in the country is fragmented. This study aims to identify the barriers and facilitators of emergency care delivery for patients with time-sensitive conditions, and develop and implement a contextually relevant model, and measure its impact using implementation research outcomes. Methods We will study 85 healthcare facilities across five zones of the country and focus on emergency care delivery for 11 time-sensitive conditions. This implementation research will include seven phases: the preparatory phase, formative assessment, co-design of Model “Zero”, co-implementation, model optimization, end-line evaluation and consolidation phase. The “preparatory phase” will involve stakeholder meetings, approval from health authorities and the establishment of a research ecosystem. The “formative assessment” will include quantitative and qualitative evaluations of the existing healthcare facilities and personnel to identify gaps, barriers and facilitators of emergency care services for time-sensitive conditions. On the basis of the results of the formative assessment, context-specific implementation strategies will be developed through meetings with stakeholders, providers and experts. The “co-design of Model ‘Zero’” phase will help develop the initial Model “Zero”, which will be pilot tested on a small scale (co-implementation). In the “model optimization” phase, iterative feedback loops of meetings and testing various strategies will help develop and implement the final context-specific model. End-line evaluation will assess implementation research outcomes such as acceptability, adoption, fidelity and penetration. The consolidation phase will include planning for the sustenance of the interventions. Discussion In a country such as India, where resources are scarce, this study will identify the barriers and facilitators to delivering emergency care services for time-sensitive conditions across five varied zones of the country. Stakeholder and provider participation in developing consensus-based implementation strategies, along with iterative cycles of meetings and testing, will help adapt these strategies to local needs. This approach will ensure that the developed models are practical, feasible and tailored to the specific challenges and requirements of each region.

Abstract Tuberculosis (TB) is the leading cause of mortality among infectious diseases globally. Effectively managing TB requires early identification of individuals with TB disease. Resource-constrained settings often lack skilled professionals for interpreting chest X-rays (CXRs) used in TB diagnosis. To address this challenge, we developed “DecXpert” a novel Computer-Aided Detection (CAD) software solution based on deep neural networks for early TB diagnosis from CXRs, aiming to detect subtle abnormalities that may be overlooked by human interpretation alone. This study was conducted on the largest cohort size to date, where the performance of a CAD software (DecXpert version 1.4) was validated against the gold standard molecular diagnostic technique, GeneXpert MTB/RIF, analyzing data from 4363 individuals across 12 primary health care centers and one tertiary hospital in North India. DecXpert demonstrated 88% sensitivity (95% CI 0.85–0.93) and 85% specificity (95% CI 0.82–0.91) for active TB detection. Incorporating demographics, DecXpert achieved an area under the curve of 0.91 (95% CI 0.88–0.94), indicating robust diagnostic performance. Our findings establish DecXpert's potential as an accurate, efficient AI solution for early identification of active TB cases. Deployed as a screening tool in resource-limited settings, DecXpert could enable early identification of individuals with TB disease and facilitate effective TB management where skilled radiological interpretation is limited.