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Video is an increasingly important resource in higher education. A key limitation of lecture video is that it is fundamentally a sequential information stream. Quickly accessing the content aligned with specific learning objectives in a video recording of a classroom lecture is challenging. Recent research has enabled automatic reorganization of a lecture video into segments discussing different subtopics. This paper explores AI generation of visual and textual summaries of lecture video segments to improve navigation. A visual summary consists of a subset of images in the video segment that are considered the most unique and important by image analysis. A textual summary consists of a set of keywords selected from the screen text in the video segment by analyzing several factors including frequency, font size, time on screen, and existence in domain and language dictionaries. Evaluation was performed against keywords and summary images selected by human experts with the following results for the most relevant formulations. AI driven keyword selection yielded an F-1 score of 0.63 versus 0.26 for keywords sampled randomly from valid keyword candidates. AI driven visual summary yielded an F-1 score of 0.70 versus 0.59 for K-medoid clustering that is often employed for similar tasks. Surveys showed that 79% (72%) of the users agreed that a visual (textual) summary made a lecture video more useful. This framework is implemented in Videopoints, a real-world lecture video portal available to educational institutions.

The pilot study reflects perceptions from higher education students in an experimental new online teaching program at a mid-sized Southeastern United States University. The research focused on the effectiveness of an embedded tutoring pilot program in online and hybrid learning management systems (LMS). The research was focused on information technology students' (n=46) perceptions of comfort, confidence, and utilization of the pilot program to understand its value in student retention. The research notes student comfort, confidence, and utilization of the program. Additionally, it supports the notion that the program can construct student retention aspects by reducing anxieties and stress from distance learning spatial inconsistencies. The findings suggest similar results or parallel considerations of students' perceptions in the literature on embedded librarian programs. However, the results fail to mirror students receiving more significant levels of self-efficacy.

Catastrophic spontaneous spinal epidural hematoma (SSEH) following thrombolysis poses a complex intersection of neurosurgical and cardiological challenges. This case report presents the institutional experience of a 66-year-old female who developed rapid-onset compressive myelopathy after thrombolysis for inferior wall myocardial infarction with injection streptokinase. SSEH, although rare, demands prompt recognition due to its potential for permanent neurologic injury and mortality. The discussion highlights the clinical significance, anatomical considerations, and multidisciplinary approach requisite for accurate diagnosis and effective management of SSEH. The conclusion underscores the necessity for clinicians, particularly cardiologists administering thrombolytic therapies, to consider SSEH in postthrombolysis patients presenting with neurological deficits.

Abstract Crystal violet dye poses significant health risks to humans, including carcinogenic and mutagenic effects, as well as environmental hazards due to its persistence and toxicity in aquatic ecosystems. This study focuses on the efficient removal of crystal violet dye from aqueous media using novel Co3O4/Co3(BO3)2 nanostructures synthesized via the Pechini sol–gel approach. The nanostructures, which were abbreviated to EN600 and EN800, were fabricated at calcination temperatures of 600 and 800 °C, respectively. X-ray diffraction (XRD) analysis revealed that the synthesized samples have a cubic Co3O4 phase and an orthorhombic Co3(BO3)2 phase, with mean crystal sizes of 43.82 nm and 52.93 nm for EN600 and EN800 samples, respectively. The Brunauer–Emmett–Teller (BET) surface areas of EN600 and EN800 samples were 65.80 and 43.76 m2/g, respectively, indicating a significant surface area available for adsorption. Optimal removal of crystal violet dye was achieved at a temperature of 298 K, a contact time of 70 min, and a pH of 10. The maximum adsorption capacities were found to be 284.09 mg/g for EN600 and 256.41 mg/g for EN800, which are notably higher compared to many conventional adsorbents. The adsorption process followed the pseudo-second-order kinetic model and fitted well with the Langmuir isotherm. The adsorption was exothermic, spontaneous, and physical in nature. Moreover, the adsorbents exhibited excellent reusability, retaining high efficiency after multiple regeneration cycles using 6 mol/L hydrochloric acid. These findings highlight the potential of these Co3O4/Co3(BO3)2 nanostructures as effective and sustainable materials for water purification applications.

Left ventricular hypertrophy (LVH) can occur as a result of increase in the left ventricular (LV) wall thickness or increase in the LV cavity size, thus leading to increase in the LV mass. Strength training and aerobic exercise lead to physiological LVH, whereas conditions such as hypertension and aortic stenosis (AS) cause pathological LVH. It is one aspect of ventricular remodeling. LVH can also occur because of some primary myocardial diseases as well as due to certain infiltrative disorders. LVH is not a disease in itself, but a manifestation of some other disease. LVH is a marker of adverse cardiovascular health and remodeling and is associated with a high risk of adverse cardiac outcomes. Besides this, LVH itself can lead to heart failure or sudden cardiac death. Hence, a thorough assessment of LVH is important for proper management of the underlying condition. Echocardiography and cardiac magnetic resonance imaging are the two most important imaging modalities used for the assessment of LVH. This review describes various echocardiography techniques for LVH assessment as well as echocardiographic recognition of the underlying etiological condition.

This qualitative study aims to learn about the experiences of first year teachers as they rapidly transitioned to remote teaching during the global COVID-19 crisis in March 2020. Additionally, the murder of George Floyd shortly thereafter exacerbated racial turmoil, impacting communities, students and families simultaneously. As the shift was sudden and drastic, and the first year of teaching is already quite challenging with a large learning curve, we seek to highlight the experiences of beginning teachers during COVID-19, and specifically focus on their strengths, assets and resilience, adding to the literature on asset-based perspectives of beginning teachers. Using data from individual journals and focus groups involving 15 first year urban and suburban teachers, we assert that first year teachers were assets to their school communities due to their technological strengths and their equity-based teacher preparation.

This study uses an interpretive, qualitative research design to highlight beginning teacher perspectives of their experiences teaching during the COVID-19 pandemic. In this study, we share the experiences of 15 K-12 educators who began their teaching careers in the 2019-2020 school year, whose first two years of teaching were marred by frequent changes and a constant unknown. Despite this, and perhaps because of this, they changed as educators--their own beliefs, their expectations for families and students, their pedagogy, and philosophy for the future. Findings from this study help highlight the strengths of beginning teachers (particularly during a pandemic) and ways a pandemic can affect the beliefs and practices of beginning teachers.

Abstract Cardiovascular diseases, including heart failure, stroke, and hypertension, affect 608 million people worldwide and cause 32% of deaths. Combination therapy is required in 60% of patients, involving concurrent Renin–Angiotensin–Aldosterone-System (RAAS) and Neprilysin inhibition. This study introduces a novel multi-target in-silico modeling technique (mt-QSAR) to evaluate the inhibitory potential against Neprilysin and Angiotensin-converting enzymes. Using both linear (GA-LDA) and non-linear (RF) algorithms, mt-QSAR classification models were developed using 983 chemicals to predict inhibitory effects on Neprilysin and Angiotensin-converting enzymes. The Box-Jenkins method, feature selection method, and machine learning algorithms were employed to obtain the most predictive model with ~ 90% overall accuracy. Additionally, the study employed virtual screening of designed scaffolds (Chalcone and its analogues, 1,3-Thiazole, 1,3,4-Thiadiazole) applying developed mt-QSAR models and molecular docking. The identified virtual hits underwent successive filtration steps, incorporating assessments of drug-likeness, ADMET profiles, and synthetic accessibility tools. Finally, Molecular dynamic simulations were then used to identify and rank the most favourable compounds. The data acquired from this study may provide crucial direction for the identification of new multi-targeted cardiovascular inhibitors.

Tetanus, once prevalent worldwide, has become rare in developed nations since the advent of active immunization. However, in India, where population density and healthcare challenges persist, the burden of adult tetanus remains largely unexplored. Here, authors present a suspected case of adult tetanus in an 18-year-old male from suburban Mumbai, highlighting the ongoing public health concern. The patient, a daily-wage worker, presented with chest pain, back spasms, and progressive muscle rigidity following trauma to his foot Despite aggressive medical intervention, including immunoglobulin therapy and intensive care, the patient succumbed to cardiac arrest ten days’ post-admission. This case underscores the persistent threat of tetanus in India, even after the successful elimination of maternal and neonatal tetanus. Delayed diagnosis due to ambiguous symptoms and neglect of basic hygiene practices contribute to severe complications and mortality. Efforts to combat tetanus should focus on enhancing public awareness, promoting vaccination, and ensuring prompt wound care.

Abstract Objective The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers’ ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas. Methods A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver’s knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator’s knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content. Results The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents’ oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure. Conclusions The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Background: “Detect–Treat–Prevent–Build” to achieve tuberculosis (TB)-free India is envisaged in the National Tuberculosis Elimination Program (NTEP). To be able to achieve this, it is important to address the fact that the most vulnerable and hard-to-reach groups need to undertake screening. The present review aimed to examine the vulnerability in connection with TB disparities faced by distinct sub-populations generally viewed as vulnerable and follow these for testing. Materials and Methods: The community-based cross-sectional study was conducted in the field practice area of sub-center Carambolim in a rural area of Goa for 3 months. The households were visited, and data collected via personal interviews were recorded on the questionnaire study tool. Based on the data, the participants’ vulnerability mapping was done per the parameters identified. Results: Among 223 households, 528 persons were screened for vulnerability. The 47 highly vulnerable participants were advised sputum CBNAAT, of which 9 (19%) tested positive for pulmonary TB, while of the 86 moderately vulnerable participants, 4 (5%) tested positive for pulmonary TB. Among the 34 with symptoms suggestive of TB, 3 (9%) tested positive for pulmonary TB. Conclusions: The study detected 16 new TB patients from the population and found a higher incidence of pulmonary TB among the vulnerable group with no symptoms of Pulmonary TB. A further state-wide survey is recommended to diagnose such cases.

Foreign body ingestion and its natural elimination are common in children. However, this is uncommon for long foreign bodies. Here, we report the spontaneous removal of an ingested pencil in an asymptomatic child. To our knowledge, this is the first case report of asymptomatic spontaneous elimination of a normally-sized ingested pencil. A 7-year-old male child presented with a history of ingestion of a pencil 4 hours back, without any complaints. Immediate abdominal radiography revealed a pencil in the stomach with an estimated length of approximately 10 cm and no signs of complications. He was conservatively treated under a semi-solid diet, presumably due to lack of available endoscopic option. Subsequently, he passed the pencil in stool within 24 hours of ingestion. He was asymptomatic and playful during the course and at discharge. Conservative management of a quickly moving long foreign body initially located below the esophagus in an asymptomatic child is possible with the help of imaging guidance, particularly in settings lacking an endoscopy. Although, this should not be considered a norm. However, this suggests that the treatment of ingested foreign bodies must be individualized. Thus, multiple factors related to the child and the foreign body must be assessed before committing to invasive procedures like laparotomy. Similarly, plain X-rays can be helpful even for radiolucent foreign bodies, for diagnosis and ruling out complications. All of these are vital in underdeveloped countries, where endoscopy and computed tomography facilities might be either lacking or unaffordable by patients.

One may observe depressed tibial plateau fractures alone or in conjunction with intricate proximal tibia fractures. Traditionally, in complex fractures, the depressed fragment can be elevated by passing a bone tamp through the fracture itself. Even though a number of tools have been used for this specific purpose, it can be challenging in isolated fractures due to difficulty in aiming and tracking minor depression, as well as the risks of the elevating device becoming intraarticularly penetrated or expansion of the medial metaphyseal window. We described a simple and effective technique with the use of a Steinmann pin for the elevation of lateral tibial plateau depressed fractures (Schatzker type III). We have successfully treated twentyfour cases so far.

Background:. As HIV-positive individuals utilizing highly active antiretroviral therapy live longer, the burden of breast cancer increases in the population. Breast reconstruction is an integral aspect of surgical treatment for many patients after a breast cancer diagnosis, prompting this examination of the characteristics and outcomes of breast reconstruction in this growing patient population. Methods:. Using Merative MarketScan Research Databases, a large multipayer database, HIV-positive adult patients who underwent autologous or implant-based breast reconstruction between 2007 and 2021 were identified using International Classification of Disease codes and Common Procedural Terminology codes. In both HIV-positive and -negative cohorts, patient demographics, procedure-related complications, and postoperative revisions were recorded. Shapiro-Wilk, chi-square, Wilcoxon-Mann-Whitney, and multivariable logistic regression tests were used for statistical analysis. Results:. Of 173,421 patients who underwent breast reconstruction, 1816 had an HIV diagnosis. HIV-positive patients were younger (P < 0.001), underwent surgery more recently (P < 0.001), more often underwent immediate breast reconstruction (P < 0.001), and had higher comorbidity levels (P < 0.001). There was a regional variation in which the patient cohorts underwent breast reconstruction. There was no significant difference in overall complication rates between patient groups, but HIV-negative patients more often underwent revision procedures (P = 0.009). Conclusions:. When compared to their HIV-negative counterparts, breast reconstruction can be considered safe and efficacious in patients living with HIV. HIV-positive patients are a growing demographic who seek breast reconstruction, and surgeons must continue to further understand the unique implications of breast reconstruction in this population.

Introduction A data monitoring committee (DMC) is an independent group of experts who assess the ongoing scientific and ethical integrity of a study through periodic analyses of study data. The objective of this study was to explore the extent to which the structure, membership and deliberations of DMCs enable them to address ethical issues.Methods We conducted qualitative individual interviews (n=22) with DMC members from countries across Africa, the Americas, South Asia and the UK. We selected interview respondents through purposive sampling, managed data using NVivo (Release V.1.7) and analysed data thematically.Results All respondents were highly experienced professionals; many (18/22) had received training in medicine and/or statistics. One respondent had academic qualifications in ethics, and four indicated that they served on DMCs as ethicists. While respondents generally felt DMCs should be required for studies that were high-risk or enrolled vulnerable populations, some were concerned about the overuse of DMCs. There were divergent views on the necessity of geographical and disciplinary representation in DMC membership, including about whether ethicists were helpful. Many respondents described a DMC member recruitment process that they felt was somewhat exclusive. While one respondent received DMC-specific training, most described learning on the job. Respondents generally agreed that study protocols and DMC charters were key guiding documents for addressing ethical issues and described DMC deliberations that often, but not always, involved consensus-building.Conclusion This study is one of the first to consider the ethical implications of DMC structure, membership and deliberations. The potential overuse of DMCs, DMC member recruitment processes that seem somewhat insular, limited training for DMC members, and divergent approaches to deliberation may limit the capacity of DMCs for addressing ethical issues. Further research on DMC structure and processes could help enhance the ethical preparedness of DMCs.

Salmonella enterica serovar Newport is a human pathogen underreported in most developing countries. It is known for causing gastroenteritis and extraintestinal infections. In this case report, we report the case of ceftriaxone-resistant Salmonella enterica serovar Newport from South India, causing acute gastroenteritis in a sixty-year-old female patient having a history of antimicrobial therapy and recent hospital admission. Serovar Newport, especially among antibiotic-exposed patients, poses a significant public health threat due to its ability to acquire multidrug resistance. This emphasizes the necessity for robust surveillance and monitoring of nontyphoidal Salmonella infections, particularly given the limited data on serovar Newport in India. Vigilance in clinical practice and public health initiatives is crucial to effectively address the emergence and spread of multidrug-resistant strains.

Long-lived “bubbles” of wildfire smoke or volcanic aerosol have recently been observed in the stratosphere, co-located with ozone, carbon monoxide, and water vapour anomalies. These bubbles often survive for several weeks, during which time they ascend through vertical distances of 15 km or more. Meteorological analysis data suggest that this aerosol is contained within strong, persistent anticyclonic vortices. Absorption of solar radiation by the aerosol is hypothesised to drive the ascent of the bubbles, but the dynamics of how this heating gives rise to a single-sign anticyclonic vorticity anomaly have thus far been unclear. We present a description of heating-driven stratospheric vortices, based on an axisymmetric balanced model. The simplest version of this model includes a specified localised heating moving upwards at fixed velocity and produces a steadily translating solution with a single-signed anticyclonic vortex co-located with the heating, with corresponding temperature anomalies forming a vertical dipole, matching observations. A more complex version includes the two-way interaction between a heating tracer, representing the aerosol, and the dynamics. An evolving tracer provides heating which drives a secondary circulation, and this in turn transports the tracer. Through this two-way interaction an initial distribution of tracer drives a circulation and forms a self-lofting tracer-filled anticyclonic vortex. Scaling arguments show that upward velocity is proportional to heating magnitude, but the magnitude of peak quasigeostrophic vorticity is O(f) (f is the Coriolis parameter) and independent of the heating magnitude. Estimates of vorticity from observations match our theoretical predictions. We discuss 3-D effects such as vortex stripping and dispersion of tracer outside the vortex by the large-scale flow, which cannot be captured explicitly by the axisymmetric model and are likely to be important in the real atmosphere. The large O(f) vorticity of the fully developed anticyclones explains their observed persistence and their effective confinement of tracers. To further investigate the early stages of formation of tracer-filled vortices, we consider an idealised configuration of a homogeneous tracer layer. A linearised calculation reveals that the upper part of the layer is destabilised due to the decrease in tracer concentrations with height there, which sets up a self-reinforcing effect where upward lofting of tracer results in stronger heating and hence stronger lofting. Small amplitude disturbances form isolated tracer plumes that ascend out of the initial layer, indicative of a self-organisation of the flow. The relevance of these idealised models to formation and persistence of tracer-filled vortices in the real atmosphere is discussed, and it is suggested that a key factor in their formation is the time taken to reach the fully developed stage, which is shorter for strong heating rates.

Artificial Intelligence (AI) is a revolutionary technology that has the potential to develop into a widely implemented system that could reduce the dependence on qualified professionals/experts for screening the large at-risk population, especially in the Indian scenario. Deep learning involves learning without being explicitly told what to focus on and utilizes several layers of artificial neural networks (ANNs) to create a robust algorithm that is capable of high-complexity tasks. Convolutional neural networks (CNNs) are a subset of ANNs that are particularly useful for image processing as well as cognitive tasks. Training of these algorithms involves inputting raw human-labeled data, which are then processed through the algorithm’s multiple layers and allow CNN to develop their own learning of image features. AI systems must be validated using different population datasets since the performance of the AI system would vary according to the population. Indian datasets have been used in AI-based risk model that could predict whether an infant would develop treatment-requiring retinopathy of prematurity (ROP). AI also served as an epidemiological tool by objectively showing that a higher ROP severity was in Neonatal intensive care units (NICUs) that did not have the resources to monitor and titrate oxygen. There are rising concerns about the medicolegal aspect of AI implementation as well as discussion on the possibilities of catastrophic life-threatening diseases like retinoblastoma and lipemia retinalis being missed by AI. Computer-based systems have the advantage over humans in not being susceptible to biases or fatigue. This is especially relevant in a country like India with an increased rate of ROP and a preexisting strained doctor-to-preterm child ratio. Many AI algorithms can perform in a way comparable to or exceeding human experts, and this opens possibilities for future large-scale prospective studies.

Abstract A coordinated set point automatic adjustment with correction enabled (C‐SPAACE) framework that uses 5G communication for real‐time control coordination between inverter‐based resources (IBR) in microgrids is proposed. Utilising slicing capability, 5G offers low‐latency communication to C‐SPAACE under normal conditions. However, given the multitude of power grid use cases, a certain 5G slice for C‐SPAACE may have access only to limited radio spectrum resources, which if not managed well, greatly undermines the communication needs of C‐SPAACE framework. Thus, optimally scheduling the available spectrum resources among IBRs in a sliced 5G network‐based C‐SPAACE framework becomes a critical problem. To address this issue, the authors utilise a novel age of information (AoI) metric and designs an AoI‐based 5G scheduler to provide low‐latency communication to C‐SPAACE. Following this, a co‐simulation environment is designed using PSCAD/EMTDC and Python to simulate a microgrid supported by 5G communication. Time‐domain simulation case studies are performed using the proposed co‐simulation environment to evaluate the performance of C‐SPAACE using 5G with both AoI‐based and other baseline (non‐AoI) schedulers.

Abstract Purpose The aim of the present study is to define the minimal clinically important difference (MCID) for International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) for patients undergoing tibial tubercle osteotomy (TTO) for either (1) patellofemoral pain or (2) patellar instability. Methods Patients undergoing TTO for either patellofemoral pain or patellar instability by one of two sports medicine fellowship‐trained surgeons at a single institution between September 2014 and May 2023 were included in the study. IKDC and KOOS scores were collected preoperatively and minimum 1 year postoperatively. Distribution‐based methods were used to calculate the MCID. Results Seventy‐seven patients (82 knees) were included, with a median age of 29.3 years (interquartile range [IQR]: 22.2−36.3 years) and a median BMI of 24.5 kg/m2 [IQR: 22.3−28.3 kg/m2]. Fifty‐seven patients (74%) were female, and there were 40 right knees (49%). The median time to IKDC and KOOS score was 1.8 and 1.7 years, respectively. Forty‐five patients (46 knees) underwent TTO for patellofemoral instability, and 32 patients (36 knees) underwent TTO for patellofemoral pain. The MCID was 11.5 for IKDC, 10.2 for KOOS pain, 10.1 for KOOS symptoms, 9.9 for KOOS ADL, 14.2 for KOOS sport and 14.2 for KOOS QoL for patients undergoing TTO for patellofemoral pain. The MCID was 11.2 for IKDC, 10.1 for KOOS pain, 10.6 for KOOS symptoms, 10.2 for KOOS ADL, 16.0 for KOOS sport and 13.2 for KOOS QoL for patients undergoing TTO for patellar instability. Conclusion We define the MCIDs for commonly used patient‐reported outcome measures for patients undergoing TTO for either patellofemoral pain or patellar instability. Level of Evidence Level II.

Background The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown. Methods Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group. Results A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p

Ionic conductivity plays an important role towards the application of ionic liquids as electrolytes in next-generation batteries and electrochemical processes and is often estimated using the Nernst–Einstein formalism in molecular simulation-based studies. The Nernst–Einstein formalism is useful for dilute systems where ions do not interact with each other, restricting its applicability to dilute solutions. However, this approximation fails in concentrated solutions where ion interactions become significant, which is usually encountered for pure ionic liquids. These ion-ion correlations can dramatically affect ionic conductivity predictions in comparison to that computed under the Nernst–Einstein formalism. This study highlights the challenges associated with calculating ionic conductivity using Einstein formalism and subsequently provides a workflow for such calculations. It has been found that a minimum trajectory length of 60 ns is required to achieve converged results for Einstein ionic conductivity. Guidance is also given to reduce the computational resource requirements for Einstein conductivity determination. This simplification will enable researchers to estimate Einstein conductivity in ionic liquids more efficiently.

Interaction of ionic liquids with iron porphyrin (FeP) arises in a number of application of ionic liquids such as dye-sensitized solar cells, batteries, and conversion of CO2 to value-added products, etc. Furthermore, ionic liquid-FeP interactions are thought to be responsible for ionic liquid biodegradation and catalytic breakdown of ionic liquids. Despite the importance of ionic liquid-FeP interactions, there is a lack of information on what conformations ionic liquids adopt when presented to FeP and how thermodynamics of subsequent electron transfer reaction is affected. To begin to answer these questions, electronic structure calculations are performed to assess how the binding propensity of the homologous series of 1-n-alkyl-3-methylimidazolium [Cnmim]Cl (n = 2, 4, 6, 8, 10) to FeP is affected as the alkyl chain length and the initial conformation of the cation presented to FeP are varied. The conceptual density functional theory framework is then invoked to compute the electrophilicity index of the ionic liquid-FeP complex to glean insight into the ability of the complex to acquire an electron. Calculations suggest two equally likely conformations of ionic liquids with similar Gibbs free energy change; however, the enthalpic and entropic contributions differ based on the conformation adopted by ionic liquids which in turn affects the propensity of the subsequent electron transfer process. The importance of results is discussed in terms of experimentally observed alkyl chain length-dependent biodegradability of ionic liquids.

Background Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.Objectives To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.Methods In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.Results From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).Conclusion Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.Trail registration number ISRCTN10980107.

Monkeypox, a recently developed viral infectious disease, has become a concern for the general public. This predicament has emerged because of the increased incidence of human monkeypox infections. It was previously a serious zoonotic virus native to just sections of Central and Western Africa and was never recorded outside endemic areas. In this review, the author presented considerable data on this disease and offered a detailed summary of MPXV. More recently, as of October 27, 2022, Monkeypox cases spread quickly across the globe, infecting 76713 people globally, with the majority of cases from Europe, the United Kingdom, North and South America, Asia, and the Middle East. By October 27, 2022, the disease had spread to almost 109 countries. In the United States, there were 28244 (36.82%) cases of Monkeypox; in Brazil, 9045 (11.79%); in Spain, 7317 (9.53%); in the United Kingdom, 3698 (4.82%); in France, 4094 (5.34%); in Germany, 3662 (4.77%); in Colombia, 3298 (4.29%); in Peru, 3048 (3.92%); in Canada, 1436 (1.87%); in Belgium, 786 (1.02%) and Portugal, 944 (1.23%). In terms of the overall number of deaths, 36 deaths were reported, with the maximum eight deaths being from Brazil (22.22%), seven from Nigeria (19.44%), and six deaths from the United States (16.67%). However, human Monkeypox epidemiological trends are rapidly changing, leaving endemic areas and moving to non-endemic countries. Therefore, international health authorities must implement priority-based preventive measures to prevent the spread of Monkeypox infection worldwide.

Abstract Background Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. Methods PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. Results Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. Conclusions Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients’ ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.

Protein kinases, a family of enzymes responsible for regulating various cellular processes, have been implicated in the development and progression of various heart diseases, making them attractive therapeutic targets. This review focuses on the role of protein kinases induced phosphorylation and protein phosphatase-induced dephosphorylation in cardiovascular disorders, including heart failure, ischemic heart disease, arrhythmias, hypertension, and diabetic cardiomyopathy. This paper explores the potential of novel kinase-targeted therapies and emerging technologies for the prevention and treatment of these conditions. It also discusses the involvement of protein kinase A (PKA), protein kinase C (PKC), phosphoinositide 3-kinases (PI3Ks), mitogen-activated protein kinases (MAPKs), and Ca2+/calmodulin-dependent protein kinase II (CaMKII) in heart dysfunction and alterations in their function that contribute to their respective cardiac disorders. Furthermore, this article presents a comprehensive overview of protein kinases in cardiac disorders and the potential of innovative kinase-targeted therapies, advanced technologies, and multidisciplinary approaches for the effective prevention and treatment of cardiovascular diseases, ultimately aiming to improve patient outcomes and quality of life.

Abstract Background Patients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants’ treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care. Methods This is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described. Results There were 226 unique participants who completed the e-PROMs (mean age 62 years, 69% males, 78% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54% and 68%, respectively, and 89% and 97% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months. Conclusions Electronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway. Trial registration ACTRN12618001976279 (07/12/2018).

Introduction: Carcinoma of the gallbladder is extremely rare, papillary adenocarcinoma comprises 90% of these cases. Although neuroendocrine neoplasms (NENs) comprise 0.5% of the cases of gallbladder cancer, the incidence is rising. NEN is classified into a well-differentiated neuroendocrine tumor and poorly differentiated neuroendocrine cancer (NEC). Histologically, NEC is small-cell or large-cell carcinoma. We present the extremely rare case, 15th in the literature to be precise, of large cell neuroendocrine carcinoma of the gallbladder. Case Presentation: A 72-year-old male presented to the emergency department with constipation and right upper quadrant pain for 3 months. Computed tomography scan of the abdomen demonstrated an ill-defined 7.2 × 4.9 cm hypodense lesion in the gallbladder fossa with extension into the liver. Histopathological and immunohistochemical analysis of the biopsy specimen confirmed the diagnosis of large cell neuroendocrine carcinoma of the gallbladder. He was started on palliative chemotherapy. Conclusion: The plethora of tumors present in the gallbladder necessitates a search for risk factors for gallbladder neoplasia, and underscores the need to more carefully examine the nature of “asymptomatic gallstones.” Further studies may reveal subclasses of cholelithiasis, gallbladder morphology, or imaging to define which patients should be followed more carefully, and may clarify additional risk factors for cancer of the gallbladder.

Abstract Introduction In recent years, there has been a significant increase in the development of artificial intelligence (AI) algorithms aimed at reviewing radiographs after total joint arthroplasty (TJA). This disruptive technology is particularly promising in the context of preoperative planning for revision TJA. Yet, the efficacy of AI algorithms regarding TJA implant analysis has not been examined comprehensively. Methods PubMed, EBSCO, and Google Scholar electronic databases were utilized to identify all studies evaluating AI algorithms related to TJA implant analysis between 1 January 2000, and 27 February 2023 (PROSPERO study protocol registration: CRD42023403497). The mean methodological index for non-randomized studies score was 20.4 ± 0.6. We reported the accuracy, sensitivity, specificity, positive predictive value, and area under the curve (AUC) for the performance of each outcome measure. Results Our initial search yielded 374 articles, and a total of 20 studies with three main use cases were included. Sixteen studies analyzed implant identification, two addressed implant failure, and two addressed implant measurements. Each use case had a median AUC and accuracy above 0.90 and 90%, respectively, indicative of a well-performing AI algorithm. Most studies failed to include explainability methods and conduct external validity testing. Conclusion These findings highlight the promising role of AI in recognizing implants in TJA. Preliminary studies have shown strong performance in implant identification, implant failure, and accurately measuring implant dimensions. Future research should follow a standardized guideline to develop and train models and place a strong emphasis on transparency and clarity in reporting results. Level of Evidence Level III.

Introduction: With modern advances, Ultrasonography (USG)- guided regional block techniques have improved nerve blockade with lesser drug usage and maximum safety for patient care. The widely appreciated outpatient surgical care has compelled us to apply the fastest and safest anaesthesia technique. For lower limb surgeries, USG-guided Sciatic Femoral Nerve Block (SFNB) is an emerging alternative to Spinal Anaesthesia (SA). Aim: To compare the safety and efficacy of both techniques in terms of haemodynamic stability, quality of block, and postoperative analgesia. Materials and Methods: A randomised double-blind study conducted at GCS Medical College, Hospital, and Research Centre, Ahmedabad, Gujarat, India, on 80 patients aged 18 to 70 years of either sex, with American Society of Anaesthesiology (ASA) Grade 1 to 3, undergoing below-knee surgeries was divided into two groups. Group A received USA with 1.5 mL hyperbaric inj. ropivacaine 0.75%, and Group B received USGguided SFB with inj. ropivacaine 0.5% 30 mL (15 mL for sciatic nerve and 15 mL for femoral nerve block). Preparation Time (PT), Surgical Anaesthesia Time (SAT), haemodynamic changes, quality of block, Longevity of Anaesthesia (LoA), time of first rescue analgesia, time of spontaneous urination, readiness to discharge, and patient satisfaction were recorded. The statistical analysis was carried out using Statistical Package for Social Sciences version 23.0 (SPSS Inc., Chicago II, USA). The p-value was derived by unpaired t-test and Chi-square test. Results: PT and SAT were higher in Group B (12.10±2.02 mins and 15.74±1.58 mins) than in Group A (6.15±1.12 mins and 8.23±1.45 mins). LoA time and time to first rescue analgesic were higher in Group B (284.10±54.44 mins and 265.71±33.69 mins) than in Group A (138.75±23.30 mins and 132.40±17.41 mins). Time to first spontaneous urination and readiness to discharge were shorter in Group B (136.42±18.40 mins and 158.39±10.78 mins) than in Group A (162.20±26.54 mins and 181.53±18.18 mins). Haemodynamic stability was excellent in both groups with no significant fluctuation. Motor blockade of Bromage 3 grade was achieved in 40 and 38 patients in Group A and B, respectively. The development of VAS score >3 was faster in Group A than in Group B (35 versus 2) at the end of three hours. No adverse events were observed in any patient. Conclusion: USG-guided SFB offers a safe and efficient alternative to Unilateral SA (USA) with satisfactory blockage, stable haemodynamics, and better postoperative analgesia for below-knee surgeries.

Vitamins are known to affect the regulation of several biochemical and metabolic pathways that influence cellular function. Adequate amounts of both hydrophilic and lipophilic vitamins are required for maintaining normal cardiac and vascular function, but their deficiencies can contribute to cardiovascular abnormalities. In this regard, a deficiency in the lipophilic vitamins, such as vitamins A, D, and E, as well as in the hydrophilic vitamins, such as vitamin C and B, has been associated with suboptimal cardiovascular function, whereas additional intakes have been suggested to reduce the risk of atherosclerosis, hypertension, ischemic heart disease, arrhythmias, and heart failure. Here, we have attempted to describe the association between low vitamin status and cardiovascular disease, and to offer a discussion on the efficacy of vitamins. While there are inconsistencies in the impact of a deficiency in vitamins on the development of cardiovascular disease and the benefits associated with supplementation, this review proposes that specific vitamins may contribute to the prevention of cardiovascular disease in individuals at risk rather than serve as an adjunct therapy.

Unmanned aerial vehicles (UAVs) are widely used for missions in dynamic environments. Deep Reinforcement Learning (DRL) can find effective strategies for multiple agents that need to cooperate to complete the task. In this article, the challenge of controlling the movement of a fleet of UAVs is addressed by Multi-Agent Deep Reinforcement Learning (MARL). The collaborative movement of the UAV fleet can be controlled centrally and also in a decentralized fashion, which is studied in this work. We consider a dynamic military environment with a fleet of UAVs, whose task is to destroy enemy targets while avoiding obstacles like mines. The UAVs inherently come with a limited battery capacity directing our research to focus on the minimum task completion time. We propose a continuous-time-based Proximal Policy Optimization (PPO) algorithm for multi-aGent Learning In Dynamic Environments (GLIDE). In GLIDE, the UAVs coordinate among themselves and communicate with the central base to choose the best possible action. The action control in GLIDE can be controlled in a centralized and decentralized way, and two algorithms called Centralized-GLIDE (C-GLIDE), and Decentralized-GLIDE (D-GLIDE) are proposed on this basis. We developed a simulator called UAV SIM, in which the mines are placed at randomly generated 2D locations unknown to the UAVs at the beginning of each episode. The performance of both the proposed schemes is evaluated through extensive simulations. Both C-GLIDE and D-GLIDE converge and have comparable performance in target destruction rate for the same number of targets and mines. We observe that D-GLIDE is up to 68% faster in task completion time compared to C-GLIDE and could keep more UAVs alive at the end of the task.

Introduction The prevalence of metabolic disorders is rising, diabetes prevalence doubled during 1990-2017. In 2020, 7.8% of US pregnancies were complicated by Gestational Diabetes Mellitus (GDM). Our aim is to assess the impact this increase has on childhood developmental disorders and understand the link between maternal metabolic disorders and neurodevelopmental disorders in children with focus on Autism Spectrum Disorder (ASD) and ADHD. Objectives Our aim is to assess the impact this increase has on childhood developmental disorders and understand the link between maternal metabolic disorders and neurodevelopmental disorders in children with focus on Autism Spectrum Disorder (ASD) and ADHD. Methods A literature search was conducted using medical subject heading (MeSH) terms in PubMed, database from Jan 1 2014 to Feb 15, 2023. Only large-scale (n>20,000) were reviewed. A total of 3 articles were included in our final qualitative synthesis review. Results An increased rate of ASD and ADHD are observed in children of mothers with insulin resistance, demonstrated by Type 2 Diabetes (T2DM) and GDM (Kuan-Ru Chen, et al.). T2DM had the strongest association with ASA and ADHD when looking at other neurodevelopmental disorders (Chen, et al.). GDM severity correlates to increased risk of ADHD (Xiang, et al.). Maternal obesity as a risk factor for ASA and ADHD has confidence intervals in the same ranges as immune dysregulatory disorders including Asthma and Autoimmune disorders (Woolfenden, et al.). Conclusions Pathomechanism of neurodevelopmental disorders involves maternal oxidative stress and inflammation. Maternal T2DM and obesity are pro-inflammatory states that can be targeted as modifiable risk factors of ASD and ADHD in children. Preconception metabolic optimization and tight glycemic control in pregnancy are two ways clinicians can start to address the rates of rising ASD and ADHD. Disclosure of Interest None Declared

Introduction Anxiety disorder affects nearly 9.4% of children aged 3-17 years.1 Virtual Reality (VR) provides an alternative for managing anxiety due to immersive, multisensory, and excellent distraction. Objectives The aim is to evaluate the efficacy of VR therapy in managing anxiety in children. Methods We searched PubMed, Medline, Embase, Web of Science, and Biosisdatabases with the keywords “Virtual Reality” in the context of “AnxietyDisorders” and included 8 relevant studies published in English until February 10, 2023, for our qualitative synthesis. Results The VR-Guided relaxation (VR-GR) effectively decreased anxiety immediately after administration. In another trial, 4 of the 9 patients completely overcame their fears, and 8 of 9 saw an improvement in target behaviors in the autism population even after six weeks after the therapy, and the effect lasted 1 year post-treatment. In another study, VR-based therapy helped reduce anxiety and behavioral scores significantly in the VR group vs. the control. In another study, they found during pediatric intravenous catheter placement, patients who received VR therapy showed significantly less anxiety and pain compared to those who did not. In another study, they found VR therapy helped reduce anxiety during the induction of pre-operative anesthesia in children undergoing elective surgery. Conclusions A study discovered benefits with statistically significant results in reducing anxiety in children immediately after VR-based therapy. To explore the full spectrum of benefits and efficacy of VR-based therapy for anxiety as a standalone or adjunct to pharmacotherapy, we recommend future trials with robust study designs. Disclosure of Interest None Declared

Introduction Anorexia Nervosa (AN) is common in adolescents and has a high mortality and morbidity rate with a lifetime prevalence of 0.5% to 2%.1,2 We aim to review the neurobiology correlation of Anorexia Nervosa in Autism Spectrum Disorder as they are often associated together. Objectives 1. Understand the correlation between the neurobiology of Autism Spectrum Disorder (ASD) and Anorexia Nervosa. 2. Assess the association and prevalence of Anorexia nervosa in the ASD population. 3. To focus on the implications for the pathogenesis of Anorexia Nervosa and treatment of this disorder in the ASD population. Methods We searched PubMed, APA PscyINFO, Embase, CINAHL, and Google scholar databases with the keywords Autism Spectrum Disorder AND Anorexia Nervosa and included 6 relevant human studies out of 187 published in English. Results Neilson et al. studied the outcome of ASD in teenage onset AN, and a statistically significant negative dose-response relationship is found in all the 3 Morgan-Russell Outcome Assessment Schedule (MROAS) domains in stable ASD over time, and the results on the subscales ‘mental state,’ ‘psychosexual state’ and ‘socio-economic state, “personal contacts,’ ‘social activities’ and ‘employment record.’3 The outcome of AN onset in adolescence is generally favorable regarding mortality and the persistence of eating disorders in adulthood. A study by Pruccoli et al. noted a high prevalence of ASD traits in a group of young AN patients, predominantly seen in 4 specific EDI-3 subscales and independent of BMI.4 Margari et al. found only AN diagnosis had a statistically significant difference (p = 0.04) in females vs. males when comparing sex differences for comorbidities.5 Conclusions Morphological changes in brain areas are linked to social cognition and increase the risk of eating disorders in ASD. We recommend future studies with robust study design to explore the full spectrum of pathogenesis and association of AN in ASD. Disclosure of Interest None Declared

Hypoxia is the key pathobiological trigger of tubular oxidative stress and cell death that drives the transition of acute kidney injury (AKI) to chronic kidney disease (CKD). The mitochondrial-rich proximal tubular epithelial cells (PTEC) are uniquely sensitive to hypoxia and thus, are pivotal in propagating the sustained tubular loss of AKI-to-CKD transition. Here, we examined the role of PTEC-derived small extracellular vesicles (sEV) in propagating the ‘wave of tubular death’.Ex vivo patient-derived PTEC were cultured under normoxia (21 % O2) and hypoxia (1 % O2) on Transwell inserts for isolation and analysis of sEV secreted from apical versus basolateral PTEC surfaces. Increased numbers of sEV were secreted from the apical surface of hypoxic PTEC compared with normoxic PTEC. No differences in basolateral sEV numbers were observed between culture conditions. Biological pathway analysis of hypoxic-apical sEV cargo identified distinct miRNAs linked with cellular injury pathways. In functional assays, hypoxic-apical sEV selectively induced ferroptotic cell death (↓glutathione peroxidase-4, ↑lipid peroxidation) in autologous PTEC compared with normoxic-apical sEV. The addition of ferroptosis inhibitors, ferrostatin-1 and baicalein, attenuated PTEC ferroptosis. RNAse A pretreatment of hypoxic-apical sEV also abrogated PTEC ferroptosis, demonstrating a role for sEV RNA in ferroptotic ‘wave of death’ signalling. In line with these in vitro findings, in situ immunolabelling of diagnostic kidney biopsies from AKI patients with clinical progression to CKD (AKI-to-CKD transition) showed evidence of ferroptosis propagation (increased numbers of ACSL4+ PTEC), while urine-derived sEV (usEV) from these ‘AKI-to-CKD transition’ patients triggered PTEC ferroptosis (↑lipid peroxidation) in functional studies.Our data establish PTEC-derived apical sEV and their intravesicular RNA as mediators of tubular lipid peroxidation and ferroptosis in hypoxic kidney injury. This concept of how tubular pathology is propagated from the initiating insult into a ‘wave of death’ provides novel therapeutic check-points for targeting AKI-to-CKD transition.

Abstract. Objectives:. To compare mortality rates between patients treated surgically for periprosthetic fractures (PPF) after total hip arthroplasty (THA), total knee arthroplasty (TKA), peri-implant (PI), and interprosthetic (IP) fractures while identifying risk factors associated with mortality following PPF. Design:. Retrospective. Setting:. Single, Level II Trauma Center. Patients/Participants:. A retrospective review was conducted of 129 consecutive patients treated surgically for fractures around a pre-existing prosthesis or implant from 2013 to 2020. Patients were separated into 4 comparison groups: THA, TKA, PI, and IP fractures. Intervention:. Revision implant or arthroplasty, open reduction and internal fixation (ORIF), intramedullary nailing (IMN), percutaneous screws, or a combination of techniques. Main Outcome Measurements:. Primary outcome measures include mortality rates of different types of PPF, PI, and IP fractures at 1-month, 3-month, 6-month, 1-year, and 2-year postoperative. We analyzed risk factors associated with mortality aimed to determine whether treatment type affects mortality. Results:. One hundred twenty-nine patients were included for final analysis. Average follow-up was similar between all groups. The overall 1-year mortality rate was 1 month (5%), 3 months (12%), 6 months (13%), 1 year (15%), and 2 years (22%). There were no differences in mortality rates between each group at 30 days, 90 days, 6 months, 1 year, and 2 years (P-value = 0.86). A Kaplan–Meier survival curve demonstrated no difference in survivorship up to 2 years. Older than 65 years, history of hypothyroidism and dementia, and discharge to a skilled nursing facility (SNF) led to increased mortality. There was no survival benefit in treating patients with PPFs with either revision, ORIF, IMN, or a combination of techniques. Conclusion:. The overall mortality rates observed were 1 month (5%), 3 months (12%), 6 months (13%), 1 year (15%), and 2 years (22%), and no differences were found between each group at all follow-up time points. Patients aged 65 and older with a history of hypothyroidism and/or dementia discharged to an SNF are at increased risk for mortality. From a mortality perspective, surgeons should not hesitate to choose the surgical treatment they feel most comfortable performing. Level of Evidence:. Level III.

Abstract Background Over the past year, the world has been captivated by the potential of artificial intelligence (AI). The appetite for AI in science, specifically healthcare is huge. It is imperative to understand the credibility of large language models in assisting the public in medical queries. Objective To evaluate the ability of ChatGPT to provide reasonably accurate answers to public queries within the domain of Otolaryngology. Methods Two board‐certified otolaryngologists (HZ, RS) inputted 30 text‐based patient queries into the ChatGPT‐3.5 model. ChatGPT responses were rated by physicians on a scale (accurate, partially accurate, incorrect), while a similar 3‐point scale involving confidence was given to layperson reviewers. Demographic data involving gender and education level was recorded for the public reviewers. Inter‐rater agreement percentage was based on binomial distribution for calculating the 95% confidence intervals and performing significance tests. Statistical significance was defined as p

Since the FDA’s approval of chimeric antigen receptor (CAR) T cells in 2017, significant improvements have been made in the design of chimeric antigen receptor constructs and in the manufacturing of CAR T cell therapies resulting in increased in vivo CAR T cell persistence and improved clinical outcome in certain hematological malignancies. Despite the remarkable clinical response seen in some patients, challenges remain in achieving durable long-term tumor-free survival, reducing therapy associated malignancies and toxicities, and expanding on the types of cancers that can be treated with this therapeutic modality. Careful analysis of the biological factors demarcating efficacious from suboptimal CAR T cell responses will be of paramount importance to address these shortcomings. With the ever-expanding toolbox of experimental approaches, single-cell technologies, and computational resources, there is renowned interest in discovering new ways to streamline the development and validation of new CAR T cell products. Better and more accurate prognostic and predictive models can be developed to help guide and inform clinical decision making by incorporating these approaches into translational and clinical workflows. In this review, we provide a brief overview of recent advancements in CAR T cell manufacturing and describe the strategies used to selectively expand specific phenotypic subsets. Additionally, we review experimental approaches to assess CAR T cell functionality and summarize current in silico methods which have the potential to improve CAR T cell manufacturing and predict clinical outcomes.

Abstract We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2–3p44p 2D3/2), 473.59 nm (3p44s 4P5/2–3p44p 4P3/2), 476.49 nm (3p44s 2P1/2–3p44p 2P3/2), 480.60 nm (3p44s 4P5/2–3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2–2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0–2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.

Abstract Background Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. Methods We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of agreement among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item’s mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. Results Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. Conclusions Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research.

Objective Accumulating evidence suggests increased cardiovascular risk in women with polycystic ovarian syndrome (PCOS) due to a cluster of factors, such as obesity, lipid abnormalities, impaired glucose tolerance (IGT), and hypertension. Markers such as high-sensitivity C-reactive protein (hs-CRP) and plasminogen activator inhibitor-1 (PAI-1) can provide an adjunctive method for the assessment of cardiovascular risk and can indicate future coronary heart diseases in women with lean PCOS.

The objective of this work was to develop a population physiologically based pharmacokinetic (popPBPK) model to characterize the variability in the clinical PK of monoclonal antibodies (mAbs) following intravenous (IV) and subcutaneous (SC) administration. An extensive literature search was conducted and clinical PK data for FDA-approved as well as non-approved mAbs were collected. Training and validation datasets of 44 and 9 mAbs exhibiting linear pharmacokinetics were used for model development. The variability in antibody PK was captured by accounting for different rate constants of pinocytosis (CLup) and intracellular degradation (kdeg) for different mAbs. Typical values for CLup and kdeg and their respective inter-antibody variabilities (ωClup, ωKdeg) were estimated to be 0.32 L/h/L and 26.1 h−1 (73% and 46%). Varied absorption profiles following SC dosing were characterized by incorporating inter-antibody variability in local degradation (kSC) and rate of lymphatic uptake (S_Lu) of mAbs. Estimates for typical kSC and S_Lu values, and ωKsc,ωS_Lu, were found to be 0.0015 h−1 and 0.54 (193%, and 49%). FDA-approved mAbs showed less local degradation (0.0014 h−1 vs. 0.0038 h−1) compared with other clinically tested mAbs, whereas no substantial differences in physiological processes involved in disposition were observed. To evaluate the generalizability of estimated PK parameters and model validation, the final popPBPK model was used to simulate the range of expected PK for mAbs following SC administration of nine different mAbs that were not used for model-building purposes. The predicted PK of all nine mAbs was within the expected range specified a priori. Thus, the popPBPK model presented here may serve as a tool to predict the clinical PK of mAbs with linear disposition before administering them to humans. The model may also support preclinical-to-clinical translation and ‘first-in-human’ dose determination for mAbs.