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With the rise in load demand, improving the voltage profile and reducing line loss is vital to ensure reliable power delivery to the customer. However, increasing power plant generation capacity is limited by environmental and economic factors, requiring a careful assessment of locally optimal options. Distributed Generation (DG) installation into the electricity grid is one of the reliable remedial actions to ensure a smooth power delivery. Installation of DG requires an optimization process to identify the appropriate placement and sizing. Inaccurate sizing and placement of the DG installation may result to over-compensation or under-compensation phenomena. This paper proposes a novel approach termed the Integrated Immune Moth Flame Evolutionary Programming technique (IIMFEP) for optimizing the installation of DG sources in distribution systems. It handles various scenarios, including multi-DG single-type and multi-DG multi-type installations, with the main objective of minimizing power loss in the system. This technique employs a hybrid approach that combines elements of immune algorithms, moth flame optimization, and evolutionary programming to achieve more accurate and efficient results. Two cases were considered in this study termed Case 1 and Case 2. Results in Case 1 discovered that the optimal sizing and placement of four Type III DGs exhibit the lowest power loss worth 2.74 kW (98.78 % reduction) for the 69-Bus RDS, while for the 118-Bus RDS the power loss is 319.89 kW (75.36 % reduction). In Case Study 2, the combination of DG Types I and III provided the highest power loss reduction. With one DG Type I and two DG Type III units installed, power loss was reduced by 97.15 % to 6.41 kW for the 69-Bus RDS and by 62.01 % to 493.21 kW for the 118-Bus RDS. The proposed IIMFEP managed to alleviate the setback experienced in the traditional EP, AIS and MFO which found to be stuck at local optimum. The IIMFEP method is compared to Moth Flame Optimization, Artificial Immune System and Evolutionary Programming and validated using the IEEE 69-Bus and 118-Bus Radial Distribution Systems, resulting in outstanding performance.

Abstract Background Mesenchymal stem cells (MSCs) have emerged as promising candidates for immune modulation in various diseases that are associated with dysregulated immune responses like Graft-versus-Host-Disease (GVHD). MSCs are pleiotropic and the fate of MSCs following administration is a major determinant of their therapeutic efficacy. Methods Human MSCs were derived from bone marrow (BM) and Wharton’s Jelly (WJ) and preconditioned through exposure to hypoxia and induction of apoptosis, either sequentially or simultaneously. The immune programming potential of preconditioned MSCs was evaluated by assessing their effects on T cell proliferation, induction of Tregs, programming of effector T-cell towards Th2 phenotype, macrophage polarization in the direct co-culture of MSCs and aGVHD patients-derived PBMNCs. Additionally, efferocytosis of MSCs and relative change in the expression of immunomodulatory soluble factors were examined. Results Our study demonstrated that hypoxia preconditioned apoptotic MSCs (BM-MSCs, WJ-MSCs) bear more immune programming ability in a cellular model of acute Graft-versus-Host-Disease (aGVHD). Our findings revealed that WJ-MSCsHYP+APO were superior to BM-MSCsHYP+APO for immune regulation. These induced the differentiation of CD4+T-cell into Tregs, enhanced Th2 effector responses, and simultaneously mitigated Th1- and Th17 responses. Additionally, this approach led to the polarization of M1 macrophages toward an M2 phenotype. Conclusion Our study highlights the potential of WJ-MSCs conditioned with hypoxia and apoptosis concurrently, as a promising therapeutic strategy for aGVHD. It underscores the importance of considering MSC apoptosis in optimizing MSCs-based cellular therapy protocols for enhanced therapeutic efficacy in aGvHD. Graphical Abstract

Abstract Background Medical education is tasked with shaping how medical students and physicians think, feel and act as professionals, or their Professional Identity Formation (PIF). This process has traditionally rested upon imparting knowledge; integrating sociocultural, professional and organizational expectations and codes of conduct; inculcating program and practice beliefs, values and principles (belief systems); and imbuing shared identities – quintessential elements that, together, comprise the socialization process. Key to supporting this socialization process is reflective practice. However, regnant approaches to mobilizing reflective cycles are faced with resource, personnel and time constraints, hindering efforts to nurture PIF. Group non-written reflections (GNWR) – broadly defined as facilitator-led discussions of shared reflective experiences within groups of learners – may prove to be an effective compromise. To address diverse approaches and a lack of effective understanding, we propose a systematic scoping review (SSR) to map the current use of GNWR in medical training and its role in shaping PIF. Methods Guided by the Systematic Evidence-Based Approach (SEBA)’s constructivist ontological and relativist epistemological position, this SSR in SEBA searched for articles on GNWR published in PubMed, Embase, Psychinfo, CINAHL, ERIC, ASSIA, SCOPUS, Google Scholar, Open Grey, GreyLit and ProQuest databases. The data found was concurrently analyzed using thematic and direct content analysis. Complementary themes and categories identified were combined, creating the domains that framed the discussion. Results Of the 8560 abstracts and 336 full-text articles reviewed, 98 articles were included. The four domains identified were: (1) Indications of use and their value; (2) Structure and how they can be used; (3) Models of reflective practice in GNWR; and (4) Features of communities of practice and the socialisation process. Conclusion This SSR in SEBA concludes that GNWR does impact PIF when effectively structured and supported. The Krishna-Pisupati Model for PIF platforms a model that explains GNWR’s effects of PIF and advances fourteen recommendations to maximize GNWR use.

Abstract Background Mentoring can help shape how medical students think, feel, and act as physicians. Yet, the mechanism in which it influences this process of professional identity formation (PIF) remains poorly understood. Through the lens of the ecological systems theory, this study explores the interconnected and dynamic system of mentoring relationships and resources that support professional development and growth within the Palliative Medicine Initiative (PMI), a structured research peer mentoring program. Methods A secondary analysis of transcripts of semi-structured interviews with peer mentors and mentees and a review of their mentoring diaries was conducted to explore the impact of participation in a longitudinal peer mentoring program on both mentees and peer mentors on their personal and professional development through the lens of the mentoring ecosystem model. The Systematic Evidence-Based Approach was adapted to analyze the data via content and thematic analysis. Results Eighteen mentees and peer mentors participated and described a supportive community of practice within the research program, with discrete micro-, meso-, and macro-environments that are dynamic, reflexive, and interconnected to form a mentoring ecosystem. Within this ecosystem, reflection is fostered, and identity work is done—ultimately shaping and refining self-concepts of personhood and identity. Conclusion This study underscores the nuances and complexities of mentorship and supports the role of the mentoring ecosystem in PIF. A deeper understanding of the multiple factors that converge to facilitate the professional development of mentees can help educators develop and implement structured peer mentorship programs that better support reflective practice and identity work.

Background: The induced activity is produced in the target, monitor chamber, flattening filter (FF), collimating jaws, etc., when a high-energy photon beam is utilized for radiation therapy. This may result in add-on exposure to radiation professionals. Objective: This study aims to measure the radiation level (RL) at the treatment plane due to induced activity in the linear accelerator head. Materials and Methods: In this study, RLs were measured close to the isocenter (I), LINAC head (H), and 0.5 m lateral to the isocenter (L) inside the radiation bunker. The RLs were measured for field sizes (FS) 5 cm × 5 cm, 10 cm × 10 cm, 20 cm × 20 cm, 30 cm × 30 cm, and 40 cm × 40 cm, using 50, 100, 200, 300, 400, 500, and 1000 monitor units (MUs) at above said locations inside the bunker using 10 mega-voltage (MV), 10 MV FF free, and 15 MV radiation beam. Results: RL increases with an increase in FS and MUs at all mentioned locations inside the bunker, except for 40 cm × 40 cm FS. The present study shows that RL increases with an increase in radiation beam energy, and there was significant RL inside the bunker at the mentioned location, even after the 1 min of high-energy radiation exposure. Conclusion: Therefore, treatment with a high-energy beam should be scheduled in the later evening of the working day and the jaw should be closed to a minimum before entering the bunker and a sufficient time gap should be followed to minimize the additional exposure due to induced activation in high-energy treatment.

Abstract Background Journeying with patients throughout their cancer trajectory and caring for them at the end of life can lead to emotional and moral distress in oncologists, negatively impacting their personal and professional identities. A better understanding of how transitions in care goals affect oncologists can shed light on the challenges faced and the support required. This study explored the impact of care transitions on oncologists’ professional identity formation (PIF). Methods From September to December 2023, semi-structured interviews were conducted with oncologists in a palliative care center in Singapore. The Ring Theory of Personhood (RToP) was used as a framework to capture the effects of experiences with patients transitioning from curative to palliative care on the oncologists’ sense of self and identity. Data were analyzed using both inductive and deductive qualitative analysis. Results Participants included six female and six male physicians, aged 30 to 53 years (mean 38 years), with an average of 9.75 years of experience as oncologists. The main domains identified were 1) challenges faced in transitioning patients to palliative care, 2) the impact of dealing with dying patients on oncologists, and 3) coping mechanisms. Conclusion Oncologists experience self-doubt and moral distress as they manage transitions in care. The PIF of oncologists can be supported through reflection and introspection, peer support, and interventions to promote self-care — ultimately enabling them to make meaning of their experiences, renew family ties, and reaffirm their commitment to the profession.

Abstract The emergent role of nucleic acid-based biomarkers—microRNAs(miRNAs), long non-coding RNAs(lncRNAs), and messenger RNAs(mRNAs), is becoming increasingly prominent in disease diagnostics and risk assessment. qRT-PCR is the primary analytical method for quantitative measurement of biomarkers. Yet, the relative infancy of non-coding RNAs recognition as biomarkers poses a challenge due to the absence of a consensus on a universally accepted normalizer gene, an absolute requirement for accurate quantification. Current tools normalizer selection are fraught with statistical limitations and suboptimal graphical user interface for data visualisation. These deficiencies underscore the necessity for a balanced tool tailored to handle qRT-PCR datasets. Addressing the identified challenges, we have developed 'gQuant' tool crafted to address these limitations. We employed voting classifiers that combine predictions from multiple statistical methods. Tool's efficacy was validated through different available and in house data derived from urinary exosomal miRNAs datasets. Comparative analysis with existing tools revealed that their integrated methodologies could skew the ranking of normalizer genes, whereas 'gQuant' consistently yielded rankings characterised by lower standard-deviation, reduced covariance, and enhanced kernel density estimation values. Given 'gQuant's' promising performance, normalizer gene identification will be greatly improved, improving precision of gene expression quantification in a variety of research scenarios. The gQuant tool developed for this study is available for public use and can be accessed at [ https://github.com/ABHAYHBB/gQuant-Tool ]."

Background: Pemphigus is a potentially life-threatening autoimmune blistering disease which characteristically affects skin and mucosae. Pulse therapy for the treatment of pemphigus has been in vogue for several years and considered better than conventional corticosteroids. Aims and objectives: This study was conducted to evaluate the efficacy and safety of pulse therapy in pemphigus patients treated over a period of 10 years. Materials and Methods: This retrospective study was based on medical records of Pemphigus patients treated at Department of Dermatology from January 2008 to December 2017. Diagnosis of pemphigus was made on clinical ground, Tzanck smear and histopathology of skin/mucous membrane lesions. Patients were put on DCP/DAP depending on the completion of family. Results: A total of 124 patients were included in the study. Age of patients ranged from 18 years to 72 years with mean of 41.21±12.71 years. Amongst 124 patients, 114 (92%) had pemphigus vulgaris and 10 (8%) had pemphigus foliaceous. 89 patients received DCP and 35 patients received DAP therapy. Number of pulses received by patients in phase I ranged from 4 to 27, average being 8.16±4.63. 106 patients completed the phase I of which 83 completed the phase II. 54 patients had successfully completed phase III of which 22 are currently in phase IV and 28 patients have completed their five year follow up period and considered as cured. Conclusion: Pulse therapy is a cheap and easily available mode of therapy in treatment of pemphigus in India even in the present era of modern molecules like Rituximab. With pulse therapy, it is now possible to induce and maintain remission, and achieve cure, provided the patients strictly adhere to the prescribed schedule.

Background: Prior research has highlighted the adverse effects of extensive Internet usage among adolescents and college students. However, these concerns have not been thoroughly examined through cross-sectional studies focusing on Indian higher secondary, undergraduate, and postgraduate students following the COVID-19 pandemic. Objectives: The present investigation aimed to assess the prevalence of Internet addiction among students at both secondary and university levels in India. Materials & Methods: In this research, a total of 128 students were involved, comprising 47 from higher secondary, 50 undergraduates and 31 postgraduate students. A self-administered measure consisting of two parts assessed sociodemographic variables and the levels of internet usage. The Internet addiction test (IAT) was administered to assess internet addiction levels. Descriptive analysis, one-way analysis of variance and chi-square test were employed for data analyses. Results: In our study, the Mean±SD age of the participants was 20.50±1.20 years (min=16, max=23 years). Approximately, 67.2% of the participants surpassed the established normal scores for the IAT. Specifically, 32.80%, 47.7%, 18% and 1.56% of participants fell into categories indicating normal, mild, moderate, and severe levels of Internet addiction according to the IAT. Internet addiction was significantly higher among urban-dwelling students (70%) compared to 30% of normal Internet users. About 69.70% of males were Internet addicts compared to 30.20% of males belonging to regular Internet users. Conclusion: The study revealed a significant prevalence of internet addiction among Indian higher secondary, undergraduate, and postgraduate students in the wake of the COVID-19 pandemic. Internet addiction was notably higher among students living in cities and men than ordinary Internet users. These findings suggest that there is an urgent need for targeted interventions and preventative measures to combat Internet addiction in educational institutions, particularly among male and urban students.

Abstract Background Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring’s personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS). Methods A systematic scoping review using Krishna’s Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion. Results Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring’s CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes. Conclusion Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.

Purpose: The metal present in the implant creates artifacts during the treatment simulation, which impacts the treatment planning and delivery of the prescribed dose to the target and sparing normal tissues. This retrospective study evaluated the uncertainties in the planning and delivery of doses for prosthesis cases with dedicated phantom. Materials and Methods: In this retrospective study, 11 patients with a hip prosthesis having cervix carcinoma were selected. Two treatment plans were generated on treatment planning system (TPS) for each case. Plan_No_Res was without any beam restriction, and Plan_exit_only was the plan with restricted beam entry through the metallic implant. An indigenous phantom was utilized to verify the accuracy of the treatment. In the phantom, some groves were present, which could be filled by implants that mimic the patient’s geometries, like left, right and bilateral femur implants. The delivered doses were recorded using optically stimulated luminescence dosimeters (OSLDs), which were placed at different positions in the phantom. The plans were further calculated using megavoltage computed tomography (MVCT) scans acquired during treatment. Results: The patient data showed no significant dose changes between the two planning methods. The treatment time increases from 412.18 ± 86.65 to 427.36 ± 104.80 with P = 0.03 for Plan_No_Res and Plan_exit_only, respectively. The difference between planned and delivered doses of various points across phantom geometries was within ± 9.5% in each case as left, right, and bilateral implant. The variations between OSLDs and MVCT calculated doses were also within ± 10.8%. Conclusion: The study showed the competency of tomotherapy planning for hip prosthesis cases. The phantom measurements demonstrate the errors in dosimetry near the implant material, suggesting the need for precise methods to deal with artifact-related issues.

Geopolymer materials, alternatives to cement that are synthesized using industrial byproducts, have emerged as some of the leading champion materials due to their environmentally friendly attributes. They can significantly reduce pollution by utilizing a plethora of waste products and conserving natural resources that would otherwise be used in the production of conventional cement. Much work is being carried out to study geopolymers’ characteristics under different conditions. Here, a geopolymer derived from fly ash (FA) was synthesized using a combination of sodium silicate and potassium hydroxide (KOH) (2.5:1 ratio) as an alkali activator (AA) liquid. The FA/AA ratios were optimized, resulting in distinct geopolymer samples with ratios of 1.00, 1.25, 1.50, and 1.75. By adjusting the contribution of alkaline liquid, we investigated the impacts of subtle changes in the FA/AA ratio on the morphology and microstructure using X-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM) techniques. The FESEM analysis illustrated a mixed matrix and morphology, with the sample with a ratio of 1.00 displaying consistently fused and homogenous morphology. The XRD results revealed the prevalent amorphous nature of geopolymer with a few crystalline phases of quartz, sodalite, hematite, and mullite. An electrical study confirmed the insulating nature of the geopolymer samples. Insulating geopolymers can provide energy-efficient buildings and resistance to fire, hurricanes, and tornadoes. Additionally, using KOH as a part of the alkali activator introduced a less-explored aspect compared to conventional sodium hydroxide-based activators, highlighting the novelty in the synthesis process.

Introduction: Tinea capitis (TC) is a common fungal infection of the scalp, especially in children. Trichoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the hair with the visualization of morphologic features that are often imperceptible to the naked eye. Aim: This study aimed to evaluate the usefulness of trichoscopy in clinical diagnosis and to study various clinico-morphological patterns of TC. Materials and Methods: This cross-sectional, observational study included 140 clinically diagnosed cases of TC seen during a period of 1 year (April 2021 to March 2022). All patients were evaluated using a dermoscope (DermLite DL4 Multispectral 3 Gen, San Juan Capistrano, CA, USA,10×). Results: The prevalence rate of TC in this study was 2.69 per thousand population. The most common clinical variant was gray patch followed by kerion and black dot, and the most common etiological agent was Trichophyton tonsurans. The characteristic trichoscopic features were as follows: comma hairs (80%), followed by corkscrew hairs (68.6%), bent hairs (54.2%), zigzag hairs (35.7%), and morse code-like hairs (15%). Other findings included scaling (89.2%), followed by black dot (67.1%), broken hairs (42.8%), and crusting and pustules (32.1% each). Comma and corkscrew-shaped hairs were most common in the black dot type, whereas zigzag, bent hairs, and morse code hairs were common in the gray patch type of TC. There was a significant association between trichoscopic findings and type of TC. Conclusion: Trichoscopy can be considered a novel tool for rapid diagnosis and selection of the appropriate therapy and in the monitoring of treatment efficacy in TC.

Abstract Background Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician’s professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate ‘protected time’ for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. Methods A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. Results 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. Conclusions Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.

The skin is the body’s largest organ and serves as a site of administration for various medications. Transdermal drug delivery systems have several advantages over traditional delivery systems. It has both local and systemic therapeutic properties. Controlled plasma drug levels, reduced dosing frequency, and avoidance of hepatic first-pass metabolism are just a few of these systems’ advantages. To achieve maximum efficacy, it is critical to understand the kinetics, physiochemical properties of the drug moiety, and drug transport route. This manuscript focused on the principles of various physical means to facilitate transdermal drug delivery. Some examples are iontophoresis, electrophoresis, photomechanical waves, ultrasound, needleless injections, and microneedles. Mechanical, chemical, magnetic, and electrical energy are all used in physical methods. A major advantage of physical methods is their capability to abbreviate pain, which can be used for effective disease management. Further investigation should be carried out at the clinical level to understand these methods for effective drug delivery.

Introduction: Breast cancer is the most frequent cancer among women. The CD34 immunohistochemical antigen serves as a tool in differentiating between benign and malignant breast lesions. It has been suggested that CD34 may be related to invasive potential. Aim: To evaluate the expression of the CD34 antigen in the stroma of benign and malignant breast lesions using the Immunohistochemistry (IHC) method. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology in collaboration with the Department of Surgery at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India over a period of 18 months (from January 2021 to June 2022), involving a total of 50 histopathologically confirmed cases of benign and malignant breast lesions. Postsurgical specimens, including biopsies and mastectomies, were fixed in 10% neutral buffered formalin. The initial diagnosis was made by Haematoxylin and Eosin (H&E)- stained tissue sections. Sections from the same block were subjected to IHC staining using a monoclonal antibody to the CD34 antigen, and the intensity of expression in stromal cells was graded from 0 to 3+ based on nuclear positivity: up to 5% stromal cells immunoreactive (grade-0), >5% and up to 25% (grade-1), >25% and up to 50% (grade-2), and > 50% (grade-3). The data was entered into Microsoft Excel 2007 and analysed using Statistical Package for Social Sciences (SPSS) statistical software version 19.0. The inferential statistics included the use of the Chi-square test. Results: Out of the total 50 cases evaluated, 25 (50%) were categorised as benign, and rest 25 (50%) were categorised as malignant lesions. Among the benign lesions, the most common lesion was fibroadenoma, accounting for 9 (36%) cases, followed by benign phyllode tumour, with 6 (24%) cases. Among malignant lesions, the most common lesion was Invasive Ductal Carcinoma (IDC), accounting for 23 (92%) cases. The intensity of CD34 expression was found to be significantly higher in benign as compared to malignant breast lesions. Out of the 25 benign breast cases, the maximum number of cases (19) showed Grade-3+ positivity, 5 cases showed Grade-2+, and 1 case showed Grade-0 positivity. However, among malignant lesions, maximum cases (23, 92%) showed Grade-0 on CD34 immunostaining. Conclusion: This study was undertaken to evaluate the CD34 expression in benign and malignant breast lesions which might be able to distinguish between the benign and malignant breast lesions. The most benign breast lesions express CD34 in the stroma, while it is almost totally lost in all malignant neoplasms. Loss of CD34 is associated with the tumour’s capacity for invasion. However, to determine its function as a therapeutic target in cases of breast cancer, additional research can also be done.

Abstract Background Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. Methods Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. Results Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45–60 years and females (49.3–58.3%). Most patients were found to be in stage III (40–40.6%) or stage IV (29.4–37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value

In the western arid regions, where monsoon seasons often include regular and extended dry spells, agricultural practices need to be tailored to these challenging conditions. This research aimed to understand the effects of foliar urea application and different irrigation scheduling on crop productivity, profitability, and quality in arid region, and was conducted over two consecutive Kharif seasons of 2020 and 2021. The use of 2% urea at flowering + pod formation stages resulted in a notable improvement in yield parameters, number, weight, and buildup of dry matter. Improvement in these parameters led to significantly higher moth bean yield, by a margin of 20 – 22% as compared to other treatments. On the basis of pooled mean of two years, foliar spray of 2% urea at flowering + pod formation stages improved the protein content by 6 to 7%, protein productivity by 27–31%, physical water productivity by ∼20% and net monetary returns by 31–34% as compared to single foliar application. Similarly, irrigation at branching + pod formation stages registered higher growth parameters, grain yield (8%), profitability (13%), nutrient uptake, and residual soil fertility in moth bean as compared to other irrigation treatments. In conclusion, it is recommended that the application of urea (2%) by foliar spray at the flowering + pod formation stages and the modification of irrigation to the branching stage + pod formation stage, from the existing recommendation (flowering + pod formation), were more profitable and productive during early, prolonged dry spells with high temperatures, which are more typical in western dry regions for moth beans. Notably, it assists in fulfilling the protein needs of the vegetarian populace of western Rajasthan, India, where moth beans play a vital role in the diet.

Summary: Eosinophils are involved in host protection against multicellular organisms. However, their recruitment to the mesenteric lymph node (mLN) during type 2 immunity is understudied. Our results demonstrate that eosinophil association with lymphoid stromal niches constructed by fibroblastic reticular cells (FRCs) and lymphatic endothelial cells is diminished in mice selectively lacking interleukin (IL)-4Rα or lymphotoxin-β (LTβ) expression on B cells. Furthermore, eosinophil survival, activation, and enhanced Il1rl1 receptor expression are driven by stromal cell and B cell dialogue. The ligation of lymphotoxin-β receptor (LTβR) on FRCs improves eosinophil survival and significantly augments IL-33 expression and eosinophil homing to the mLN, thus confirming the significance of lymphotoxin signaling for granulocyte recruitment. Eosinophil-deficient ΔdblGATA-1 mice show diminished mLN expansion, reduced interfollicular region (IFR) alarmin expression, and delayed helminth clearance, elucidating their importance in type 2 immunity. These findings provide insight into dialogue between stromal cells and B cells, which govern mLN eosinophilia, and the relevance of these mechanisms during type 2 immunity.

Abstract Background Reports of emotional, existential and moral distress amongst medical students witnessing death and suffering of patients during their clinical postings have raised awareness on the need for better psycho-emotional support during medical school. Furthermore, the stress experienced by medical students stemming from the rigours of their academic curriculum underlines the need for greater awareness on mental health issues and better self-care practices across medical training. With such programmes lacking in most medical schools, we propose a systematic scoping review (SSR) to map and address our research question, “what is known about self-care education interventions amongst medical students?”. Methods We adopted the Systematic Evidence-Based Approach to guide a systematic scoping review (SSR in SEBA) of relevant articles published between 1st January 2000 and 30th June 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles were independently and concurrently thematically and content analysed, with complementary categories and themes combined using the Jigsaw Approach. The domains created from the Funnelling Process framed the discussion. Results A total of 6128 abstracts were identified, 429 full-text articles evaluated, and 147 articles included. The 6 domains identified were definition, topics, pedagogy, influences, outcomes and assessment. Most interventions were promising, though peer-led mindfulness-based interventions showed most promise in enhancing engagement, positively impacting personal wellbeing, and improving patient care. Overall, however, self-care education was poorly recognized, adopted and integrated into curricula. Conclusion Greater dedicated time and conducive practice environments within medical school curricula is required to enhance medical student wellbeing. Host organizations must ensure faculty are appropriately selected to instil the importance of self-care, be trained to assess and personalize self-care interventions and provide longitudinal assessment and support. Further study into assessing self-care capabilities is required.

Fly ash (FA)-based geopolymer was prepared using sodium hydroxide and sodium silicate (in 2.5ratio) as an alkali activator liquid (AL). The condition of FA/AL was optimized for achieving 1.00, 1.25, 1.5, and 1.75 ratios by varying the alkali concentrations, which are referred to as GP1, GP2, GP3, and GP4, respectively. The influence of slight variations in the FA/AL ratio on microstructure, morphology, functional groups, and composition was investigated by X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), X-ray fluorescence (XRF), and Fourier transform infrared spectroscopy (FTIR). FESEM detected a homogeneous fused matrix of fly ash and alkali activator solution up to 1.5 ratios; GP3 showed a dense morphology. FTIR confirmed that the formation of aluminosilicate gel induced a shift in the T–O (T = Si or Al) asymmetric stretching band, nearing a lower frequency. XRD showed an amorphous structure with phases, including quartz, mullite, hematite, and sodalite. The thermogravimetry and differential thermal analysis (TGA–DTA) indicated that the geopolymer samples were thermally stable. The electrical study concluded that the geopolymer possessed insulating properties.

Introduction and Aim: Antepartum hemorrhage (APH) is one of the deadliest complications in obstetrics. It can complicate about 2–5% of pregnancies. It contributes significantly to maternal and perinatal mortality and morbidity during pregnancy and childbearing worldwide. The aim of this study was to determine maternal and fetal outcomes in patients presenting with APH. Materials and Methods: This was a retrospective study. Pregnant women with >28 weeks gestation reporting to the Department of Obstetrics and Gynecology from May 2021 to April 2022 were included in the study. Ethical approval from the institutional ethical committee was taken. Result: This study included 76 patients of APH. Most patients in the analysis were found to be second gravida (30%). Anemia was the most common associated morbidity (51.31%). 58% of these patients were of placenta previa, 14% were of abruption, and 10% were of accreta. Among all patients, 94.74% recovered well. 2.63% of cases could not be saved and resulted in maternal mortality. The proportions of babies alive, intra-uterine death (IUD), and intubated were 86.84%, 11.84%, and 1.32%, respectively. 17.1% of patients required a lifesaving cesarean hysterectomy. Conclusion: APH is an obstetrical emergency that requires timely diagnosis and early intervention. Swift management is required to improve maternal and fetal outcomes.

The present study developed an integrated hydrologic model for sustainable utilisation and water management in two complex watersheds with varying physioclimatic features and reservoirs. The soil and water assessment tool (SWAT) is used for predicting integrated inflows into the Hatnur reservoir from the Burhanpur and Purna watersheds of the Upper Tapi River basin, while outflows are simulated using a rule curve. The influence of watershed complexities on hydrological model parameters and the watershed processes are investigated using extensive multisite and multivariable calibration (1998–2007) and validation (2008–2013) approaches, including sensitivity and uncertainty analyses. The sensitive parameters are related to curve number (CN), groundwater, slope, and main channel characteristics. The annual streamflow (m3/km2/mm of rainfall) in the Burhanpur watershed is 568.7, which is 4.2 times higher than the Purna watershed's streamflow of 136.2. The hypsometric analysis, areal rainfall, and flow duration curves revealed a substantially different streamflow pattern and a larger coefficient of variation in the spatial distribution of water balance components over sub-watersheds in the Burhanpur watershed compared to the Purna watershed due to diverse topographic features. The developed model would be useful for planning controlled releases from the terminal reservoir to mitigate hazards in the downstream reaches of the Tapi River basin. HIGHLIGHTS Integrated hydrological modelling of two complex watersheds and terminal reservoir.; Extensive multisite and multivariable model calibration and uncertainty analyses.; Assimilating watershed's physioclimatic heterogeneity through sensitive parameters.; Role of physiographic diversity on spatial patterns of hydrologic water balance.;

Abstract Background Patients’ stories provide Palliative Care physicians with a glimpse into the former’s lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients’ stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this ‘care influencing’ practice in medicine. Methods This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach’s concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. Results Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. Conclusion Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this ‘care influencing’ practice.

Background: Sodium hypochlorite serves as the most efficient root canal irrigating fluid. Objectives: This study's goal was to assess the replenished NaOCl's capacity to dissolve the tissue of pulp when combined with 9% tetrasodic etidronate (Na4HEBP), 18% tetrasodic etidronate (Na4HEBP), and 17% disodic ethylenediaminetetraacetate (Na2EDTA) under continuous controlled administration. Materials and Methods: Hundred and twenty complete undamaged teeth of the anterior mandible extracted due to periodontal problems within forty-eight hours were taken as a source of the pulp tissue. Results: It was found that there was a decrease in the weight of pulp tissue in all groups except negative control. Conclusion: NaOCl's potential to dissolve tissue with chelating agents like EDTA and HEBP inside the root canal was unaffected when there was controlled administration of EDTA and HEBP.

This study explored co-occurring climate-scale changes across the physioclimatically heterogeneous Tapi River basin (TRB) for baseline (1991–2020) and future periods (2021–2100). We used a novel multivariate framework comprising multi-model ensembles of bias-corrected rainfall and temperature from five global climate models (CMIP-5), 12 climate indices (six for each variable), and principal component analysis (PCA). The univariate assessment showed statistically significant warming of 1.1–1.8 °C (1.5–4.0 °C) under RCP-4.5 (RCP-8.5) scenarios. The Middle Tapi basin showed a substantial shift towards a wetter climate regime in the future. The multivariate assessment of spatially varying climate indices resulted in four significant principal components (PCs). The relative evaluation of these PCs showed that nearly 41.6% (47.0%) of the TRB is vulnerable to the transition of the current climatic patterns to the dry–warm (wet–warm) regime under RCP-8.5 (RCP-4.5) in the near (distant) future. On the optimistic side, under RCP-4.5 and RCP-8.5, 53.0% and 69.8% of the TRB displayed signs of uniform temporal distribution with wet rainfall regimes and profound warming towards the end of the 21st century, respectively. The study outcomes would help to devise policies for regional sustainability and adopt mitigation measures to enhance resiliency in a changing climate. HIGHLIGHTS Principal component analysis for proficient hydroclimatic variability assessments.; Warming-induced changes in spatial patterns of hydroclimatic variables.; Pronounced night-time warming over day-time warming.; Spatially heterogeneous climate transitions towards dry–warm and wet–warm regimes in the future.; Exposure of human health, agriculture, and water resources to climate risk in future.;

Abstract The trans-Himalayan region of India, although have xeric features, still supports a unique assemblage of biodiversity, including some of the charismatic and endemic species. In the present study, we studied blue sheep (Pseudois nayaur) across the distribution range in the Western trans Himalayas of India and found about 18,775 km2 area suitable for blue sheep. The explicit Bayesian based spatial and non-spatial population structure analysis assigned blue sheep into two genetic populations, i.e., Ladakh and Lahaul-Spiti. We found relatively high genetic divergence in blue sheep which is also supported by the low current flow in Circuitscape model. With the multiple evidences, we explain landscape resistance facilitated by the landscape heterogeneity, and large patches of unsuitable habitats forced population divergence and poor functional connectivity. We found that blue sheep population has been demographically stable in the past, but showed a slight decline within the last few decades. This study is the first range-wide attempt to exhibit landscape features in shaping the spatial distribution, genetic structure and demography patterns of blue sheep in Western Himalayas, and will be of use in the conservation and management planning of blue sheep.

Abstract Background Medical education has enjoyed mixed fortunes nurturing professional identity formation (PIF), or how medical students think, feel and act as physicians. New data suggests that structured mentoring programs like the Palliative Medicine Initiative (PMI) may offer a means of developing PIF in a consistent manner. To better understand how a well-established structured research mentoring program shapes PIF, a study of the experiences of PMI mentees is proposed. Methodology Acknowledging PIF as a sociocultural construct, a Constructivist approach and Relativist lens were adopted for this study. In the absence of an effective tool, the Ring Theory of Personhood (RToP) and Krishna-Pisupati Model (KPM) model were used to direct this dual Systematic Evidence-Based Approach (Dual-SEBA) study in designing, employing and analysing semi-structured interviews with PMI mentees and mentoring diaries. These served to capture changes in PIF over the course of the PMI’s mentoring stages. Transcripts of the interviews and mentoring diaries were concurrently analysed using content and thematic analysis. Complementary themes and categories identified from the Split Approach were combined using the Jigsaw Approach and subsequently compared with mentoring diaries in the Funnelling Process. The domains created framed the discussion. Results A total of 12 mentee interviews and 17 mentoring diaries were analysed, revealing two domains—PMI as a Community of Practice (CoP) and Identity Formation. The domains confirmed the centrality of a structured CoP capable of facilitating longitudinal mentoring support and supporting the Socialisation Process along the mentoring trajectory whilst cultivating personalised and enduring mentoring relationships. Conclusion The provision of a consistent mentoring approach and personalised, longitudinal mentoring support guided along the mentoring trajectory by structured mentoring assessments lay the foundations for more effective mentoring programs. The onus must now be on developing assessment tools, such as a KPM-based tool, to guide support and oversight of mentoring relationships.

Abstract Background Mentoring plays a pivotal yet poorly understood role in shaping a physician’s professional identity formation (PIF) or how they see, feel and act as professionals. New theories posit that mentoring nurtures PIF by functioning as a community of practice through its structured approach and its support of a socialisation process made possible by its assessment-directed personalized support. To test this theory and reshape the design, employ and support of mentoring programs, we evaluate peer-mentor experiences within the Palliative Medicine Initiative’s structured research mentoring program. Methods Semi-structured interviews with peer mentors under the Palliative Medicine Initiative (PMI) at National Cancer Centre Singapore were conducted and triangulated against mentoring diaries to capture longitudinal data of their PMI experiences. The Systematic Evidence-Based Approach (SEBA) was adopted to enhance the trustworthiness of the data. SEBA employed concurrent content and thematic analysis of the data to ensure a comprehensive review. The Jigsaw Perspective merged complementary themes and categories identified to create themes/categories. The themes/categories were compared with prevailing studies on mentoring in the Funnelling Process to reaffirm their accuracy. Results Twelve peer-mentors participated in the interviews and eight peer-mentors completed the mentoring diaries. The domains identified were community of practice and identity work. Conclusions The PMI’s structured mentoring program functions as a community of practice supporting the socialisation process which shapes the peer-mentor’s belief system. Guided by a structured mentoring approach, stage-based assessments, and longitudinal mentoring and peer support, peer-mentors enhance their detection and evaluation of threats to their regnant belief system and adapt their self-concepts of identity and personhood to suit their context. These insights will help structure and support mentoring programs as they nurture PIF beyond Palliative Medicine.

The present research article deals with the study of a boundary value problem of a one-dimensional semi-infinite hygro-thermoelastic rod of length l. The deformation of the rod is under consideration when the left boundary of the hygro-thermoelastic rod is subjected to a sudden heat source. The solutions of the considered variables are decomposed in terms of normal modes. Analytical expressions of displacement, moisture concentration, temperature field, and stresses are obtained and presented graphically for different periods. By studying the one-dimensional thermal shock problem for a semi-infinite hygrothermoelastic rod, the authors aim to gain insights into the fundamental behavior of materials subjected to rapid temperature changes and moisture effects.

The safe and appropriate disposal of waste generated during mining operations makes mining waste management a crucial concern for the mining sector. This waste includes waste rock, tailing, and other mining wastes that can cause health and environmental issues if improperly managed. To avoid this issue, challenges in sustainable waste management were studied and DEMATEL analysis was conducted.

Recognising the impact of medical errors on patients and the doctor-patient relationship has underscored the need for better communication.1,2 For the most part, these efforts are informed by Chafe et al.’s 6 steps that entail: (1) the identification of the error in a timely fashion; (2) determination of the extent of the error; (3) constitution of a workgroup to establish the scope of the review; (4) identification of affected patients; (5) scrutiny of clinical records; and (6) the act of informing patients and other stakeholders.3-6 The apology and open disclosure are then said to be built upon this platform.

Abstract This article presents internal model control (IMC) based decentralized reinforce‐control of renewable dynamic virtual power plant (DVPP) so that, it can be integrated into the power system as a substitution of fuel‐based conventional generators. Such grid integration towards net‐zero targets could not be possible without providing additional ancillary service (AS) to the power system, as the traditional AS would fall short with the retirement/substitution of conventional generators. The theory of DVPP from a technical perspective (i.e., TDVPP) is presented in a detailed and simplified manner, including the formulation of a generalized control objective (desired specification) for DVPP integration. The solution approach includes two steps: (1) disaggregation of desired specification and (2) decentralized reinforce‐control to match the disaggregated specification. The theory and solution approach for DVPP integration is presented in a generalized manner enabling the DVPP to offer multiple ASs, but the case study is limited only to frequency control AS (FCAS) in this article. The study is performed on the ‘western system coordinating council (WSCC)’ test system, in which an attempt is made towards net‐zero targets by substituting the largest thermal generator with renewable DVPP ensuring the grid's operation or dynamics safe.

Abstract There are disparities in outcomes for patients with multiple myeloma (MM). We evaluated the influence of sociodemographic factors on global disparities in outcomes for patients with MM. This rapid evidence assessment (PROSPERO, CRD42021248461) followed PRISMA-P guidelines and used the PICOS framework. PubMed and Embase® were searched for articles in English from 2011 to 2021. The title, abstract, and full text of articles were screened according to inclusion/exclusion criteria. The sociodemographic factors assessed were age, sex, race/ethnicity, socioeconomic status, and geographic location. Outcomes were diagnosis, access to treatment, and patient outcomes. Of 84 articles included, 48 were US-based. Worldwide, increasing age and low socioeconomic status were associated with worse patient outcomes. In the US, men typically had worse outcomes than women, although women had poorer access to treatment, as did Black, Asian, and Hispanic patients. No consistent disparities due to sex were seen outside the US, and for most factors and outcomes, no consistent disparities could be identified globally. Too few studies examined disparities in diagnosis to draw firm conclusions. This first systematic analysis of health disparities in patients with MM identified specific populations affected, highlighting a need for additional research focused on assessing patterns, trends, and underlying drivers of disparities in MM.

Globally, cervical cancer (CxCa) ranks 4th common cancer among females and led to 569,847 incidences and 311,365 deaths in 2018. 80% of CxCa cases occur due to persistent infection with a high-risk subtype of human papillomavirus (HPV-16 and 18). Smoking, high parity, and co-infection with type 2 herpes simplex or HIV are other known risk factors for CxCa. Major histological subtypes are squamous (70%) and adenocarcinoma (25%). Presently, concurrent radiation plus cisplatin (CDDP)-based chemotherapy is the standard treatment for CxCa patients. However, CDDP resistance and toxic side effects limit its efficacy, leading to a poorer response rate and an expected overall survival ranging from 10 to 17.5 months. Reduced drug uptake, increased DNA damage repair, increased CDDP inactivation, and overexpressed Bcl-2 or caspase inhibition, are primarily accountable mechanisms for CDDP resistance and improving CDDP’s efficacy remains the major challenge. Poly (ADP-ribosyl) polymerase-1, an effective mediator of nucleotide excision repair pathway, is involved in DNA repair as well as maintaining genomic stability and is significantly expressed in malignant lymphomas, hepatocellular-, cervical- and colorectal carcinoma, which has been approved effective in maintenance therapy and may serve as an effective target to enhance CDDP sensitivity in CxCa. Here, we summarize the etiology and epidemiology of and treatment for CxCa, the mechanism responsible for chemotherapy resistance, PARP inhibitor as a possible therapy for CxCa, and other possible chemotherapeutic options for CxCa treatment.

Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper 'themes/categories' using the Jigsaw Perspective. The 'themes/categories' from each review were combined using the Funnelling Process to create domains that guide the discussion. The 'themes/categories' identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.

Most bridge failures occur due to the development of scour holes around the abutment and pier. Therefore, accurate prediction of abutment scour depth is critical for designing and maintaining bridges to ensure their safety and longevity. Traditional methods for predicting abutment scour depth, such as empirical formulas and physical models, have accuracy, applicability, and cost limitations. Machine learning (ML), on the other hand, has the potential to overcome these limitations by leveraging large amounts of data and identifying complex patterns and relationships that are difficult to detect using traditional methods. ML models can be trained on various data sources, including field measurements, laboratory experiments, and numerical simulations, to predict abutment scour depth accurately. Therefore, the present study aims to develop a novel-tuned Custom ensemble ML model for predicting abutment scour depth in clear-water conditions. The proposed Custom ensemble model outperforms the ML models used to predict non-dimensional scour depth at abutments with an accuracy of 95.93%. HIGHLIGHTS Develop a novel machine learning model that understands the physics involved in abutment scour depth and accurately predicts abutment scour depth at abutments.; The proposed Custom ensemble model outperforms the machine learning models used to predict non-dimensional scour depth at abutments with an accuracy of 95.93.;

Abstract Background Nurturing effective physician-patient relationships is essential to the provision of patient-centred care. Palliative care physicians may apply boundary-crossings or breaches in professional standards to nurture effective physician-patient relationships. Being highly individualized and shaped by the physician’s narratives, clinical experience, and contextual considerations, boundary-crossings are susceptible to ethical and professional violations. To better appreciate this concept, we employ the Ring Theory of Personhood (RToP) to map the effects of boundary-crossings on the physician’s belief systems. Methods As part of the Tool Design SEBA methodology, a Systematic Evidence-Based Approach (SEBA) guided systematic scoping review was employed to guide the design of a semi-structured interview questionnaire with palliative care physicians. The transcripts were simultaneously content and thematically analysed. The themes and categories identified were combined using the Jigsaw Perspective and the resulting domains formed the basis for the discussion. Results The domains identified from the 12 semi-structured interviews were catalysts and boundary-crossings. Boundary-crossings attempt to address threats to a physician’s belief systems (catalysts) and are highly individualized. Employ of boundary-crossings depend on the physician’s sensitivity to these ‘catalysts’, their judgement and willingness to act, and their ability to balance various considerations and reflect on their actions and their ramifications. These experiences reshape belief systems, understandings of boundary-crossings and may influence decision-making and practice, underscoring the potential for greater professional breaches when unchecked. Conclusion Underlining its longitudinal effects, the Krishna Model underscores the importance of longitudinal support, assessment and oversight of palliative care physicians, and lays the foundation for a RToP-based tool to be employed within portfolios.

This article proposes a novel approach to measure the performance of Safety-Critical Systems (SCS). Such systems contain multiple processing nodes that communicate with each other is modeled by a Petri nets (PN). The paper uses the PN for the performance evaluation of SCS. A set of ordinary differential equations (ODEs) is derived from the Petri net model that represent the state of the system, and the solutions can be used to measure the system's performance. The proposed method can avoid the state space explosion problem and also introduces new metrics of performance, along with their measurement: deadlock, liveness, stability, boundedness, and steady state. The proposed technique is applied to Shutdown System (SDS) of Nuclear Power Plant (NPP). We obtained 99.887% accuracy of performance measurement, which proves the effectiveness of our approach.

In 2023, global data revealed that approximately 2.2 billion people are affected by some form of vision impairment. By addressing the specific challenges faced by individuals who are blind and visually impaired, this research paper introduces a novel system that integrates Google Speech input and text-to-speech technology. This innovative approach enables users to perform a variety of tasks, such as reading, detecting weather conditions, and finding locations, using simple voice commands. The user-friendly application is designed to significantly improve social interaction and daily activities for individuals who are visually impaired, underscoring the critical role of accessibility in technological advancements. This research effectively demonstrates the potential of this system to enhance the quality of life for those with visual impairments.

The meningeal space is a critical brain structure providing immunosurveillance for the central nervous system (CNS), but the impact of infections on the meningeal immune landscape is far from being fully understood. The extracellular protozoan parasite Trypanosoma brucei, which causes human African trypanosomiasis (HAT) or sleeping sickness, accumulates in the meningeal spaces, ultimately inducing severe meningitis and resulting in death if left untreated. Thus, sleeping sickness represents an attractive model to study immunological dynamics in the meninges during infection. Here, by combining single-cell transcriptomics and mass cytometry by time-of-flight (CyTOF) with in vivo interventions, we found that chronic T. brucei infection triggers the development of ectopic lymphoid aggregates (ELAs) in the murine meninges. These infection-induced ELAs were defined by the presence of ER-TR7+ fibroblastic reticular cells, CD21/35+ follicular dendritic cells (FDCs), CXCR5+ PD1+ T follicular helper-like phenotype, GL7+ CD95+ GC-like B cells, and plasmablasts/plasma cells. Furthermore, the B cells found in the infected meninges produced high-affinity autoantibodies able to recognise mouse brain antigens, in a process dependent on LTβ signalling. A mid-throughput screening identified several host factors recognised by these autoantibodies, including myelin basic protein (MBP), coinciding with cortical demyelination and brain pathology. In humans, we identified the presence of autoreactive IgG antibodies in the cerebrospinal fluid (CSF) of second stage HAT patients that recognised human brain lysates and MBP, consistent with our findings in experimental infections. Lastly, we found that the pathological B cell responses we observed in the meninges required the presence of T. brucei in the CNS, as suramin treatment before the onset of the CNS stage prevented the accumulation of GL7+ CD95+ GC-like B cells and brain-specific autoantibody deposition. Taken together, our data provide evidence that the meningeal immune response during chronic T. brucei infection results in the acquisition of lymphoid tissue-like properties, broadening our understanding of meningeal immunity in the context of chronic infections. These findings have wider implications for understanding the mechanisms underlying the formation ELAs during chronic inflammation resulting in autoimmunity in mice and humans, as observed in other autoimmune neurodegenerative disorders, including neuropsychiatric lupus and multiple sclerosis.

Human expansion and anthropogenic activities are causing the conversion of forests to other land uses in the Himalayas, which is threatening species with extinction. To address this issue, we used an ensemble model to simulate the future landscape and assess its impact on the Kashmir Musk Deer (KMD) distribution in the context of land use change. Our simulation suggests a decline in croplands and shrublands and increase of mixed forests in the future scenario. Evergreen broad-leaf and needle-leaf forests are likely to convert to mixed forests, while croplands and barren areas transform into savannas. Precipitation, elevation, and mixed forests were found to be the most significant factors influencing KMD distribution. Only 20,690 km2 out of the total area of 324,666 km2 is currently suitable for KMD, but this is projected to increase to 22,701.47 km2 in the future. We predict a habitat gain of about 2,722 km2 in new areas and a loss of 711 km2 in existing habitats for KMD by 2030, with Uttarakhand state losing much of the suitable habitat. However, new habitats in future will become available for the species in Jammu and Kashmir. Our landscape configuration investigation indicates a decline in the number of patches and aggregation index in the future scenario. Most of the suitable KMD habitats are outside the current protected areas (PA), making the current PA network insufficient for long-term conservation. Therefore, we suggest forest managers to rationalize the boundary of the PAs to include suitable habitats that are currently not protected for the long-term survival of the KMD.

Coronavirus disease 2019 (COVID-19) pandemic has led to a significant worldwide impact on general surgical practice. Since the beginning of this pandemic, hospitals have become a hot zone for the transmission of coronavirus. Routine and emergency surgical services have been severely disrupted worldwide due to this pandemic and may continue to be so for some time if more mutations take place in the virus. As of February 27, 2022, at 9 a.m., 43.5 crore positive cases were confirmed worldwide with over 6 million deaths. In India, 42,916,117 positive cases were confirmed to this date with 513,756 deaths. The impact of the COVID-19 pandemic on surgery daily practice and surgical patients was very high. There was a high impact on elective, semi-elective, cancer surgery, transplant programs, and education programs in our institution during the COVID-19 era. The most common reasons were being reduced number of availabilities of non-COVID-19 beds in the general surgical ward, difficulty in separating COVID-19 and non-COVID-19 patients, high transmission, and infection rate of COVID-19, reduced number of surgical intensive care unit beds and operation theatre due to allotment of these exclusively for COVID-19 patients. The reduced number of staff and health-care workers due to posting in the COVID-19 ward was also a major factor in the reduced number of electives and other surgeries in our institution. We need to find ways to continue providing essential medical services to patients while fighting this pandemic since it might take longer than expected to end. The present report summarizes the impact of the COVID-19 pandemic on our surgical services and the changes that we have adopted for better care of surgical patients and safe surgical practice to provide valuable information worldwide. This article also summarizes current evidence and recommendations for changes to surgical practice in our hospital according to the World Health Organization, Ministry of Health and Family Welfare, Indian Council of Medical Research, and Centers for Disease Control and Prevention guidelines to minimize the effect of the COVID-19 pandemic on surgical services.

Low reliability of the inverter is caused by high failure rates of semiconductor components and capacitors as well as high requirements for these components in the design of multilevel inverter topologies. The primary challenges in the reported fault-tolerant topology solutions include high component count, handling single and multiple switch faults, handling open and short switch failures on all fault locations, and achieving natural voltage balancing of the capacitors. This paper proposes a highly resilient fault-tolerant topology to accomplish the above challenges without compromising efficiency during faulty conditions. The acquired experimental results verify the proposed topology’s robustness and efficacy. The proposed topology is evaluated by considering multiple instances of switch failures to encompass various fault locations and types. A comparison with the recently reported fault-tolerant MLI topologies verifies the superiority of the proposed topology.

Additive Manufacturing (AM) has tremendous applications in this decade, which speeding up various design, engineering, and manufacturing processes. AM encompasses 3D Printing, 3D Scanning, and software support for designing, printing, and post-processing. It is helpful to the specific stages of the product development cycle by allowing manufacturers to produce better sustainable products than those previously limited by the limitations of traditional production techniques. This technological platform enables engineers and scientists to develop more robust and lighter functional geometries. It triggers an innovative surge in design. AM allows firms to produce complicated components that could not be produced through conventional technologies. 3D printers speed up tool cycles, improve measures and tests, and deliver customised solutions in every element of the development process. 3D printing lays the material in several layers until the product is manufactured per the requirements. This study provides a quick overview of AM, its substantial benefits, and the various types of AM that have been researched. Materials from the three polymers, ceramics, and metals classes have been utilised in all AM processes. This study also discussed the latest developments, featured AM-based process classes, and identified materials used in AM technologies. The authors have identified and discussed seventeen significant potentials of AM and finally discussed AM's potential for Sustainability. 3D printing offers incredible design flexibility, enabling us to build passageways that enhance performance, giving customers and operations great value. The benefits of AM for sustainability are evident in the manufacturing environment today. Readers should be able to access the knowledge structure of the subject through this study, which will assist them in recognising past research, the most active research clusters, and the strength of research relationships.

The objective of reducing the size and cost of the grid-connected photovoltaic system has led to advancements in the field of transformerless grid-connected inverters and gained high popularity in recent years. However, in such systems, the major limitation lies in realizing maximum power from individual modules. In this regard, this paper proposes a modular transformerless grid-connected photovoltaic multilevel inverter that realizes the individual maximum power point (MPP) of each module under different operating scenarios. The presented configuration is simple and modular, providing flexibility to increase the number of inputs with less component count. A single-phase synchronous reference frame PI (SRF-PI) controller has been designed and realized for the proposed system. The systematic procedure for designing the controller has been detailed. The converter and controller allow the system to realize individual MPP of the modules and simultaneously achieve the load demand maintaining the desired grid voltage. This has been verified under different operating scenarios in the MATLAB/Simulink environment. The same has been validated on a 300W laboratory prototype under source and load intermittencies. The proposed configuration has been compared with the similar works reported in the literature and it has been observed that it employs only 18 components. Also, the efficiency of the converter has been observed in the range of 89-95%. Further, the common-mode voltage and the leakage current have been measured to verify their suitability for grid-connected systems as per German VDE 0126-1-1 standards.

Reducing ripples on the capacitor voltage has two benefits: improved output waveform quality and accurate converter size. During the generation of a given output voltage level, the factor “Inherent Redundant Paths (IRPs)” has a considerable impact on the characteristics of multilevel inverter design. The consistent distribution of power loss derives from the Active Neutral Point-Clamed Inverter’s intrinsic redundant route at zero-voltage level generation. Even though it has been claimed that adding intrinsically redundant routes might give fault-tolerance capabilities to MLI topologies, the utilization of these pathways at intermediate voltage levels has not yet been studied. Based on this, the current research provides a unique charging and discharging technique is known as the alternating charging and discharging approach, which reduces capacitor voltage ripple. In addition, the suggested technique permits the inherent voltage balancing of capacitors without the need for supplemental components. The suggested alternative charging and discharging approach is implemented under both healthy and varied switch failure circumstances. In a laboratory prototype, the efficacy of the suggested alternative charging and discharging technique has been empirically tested.

Background: The promising use of lignocellulosic materials as a substrate for the synthesis of biochemical and biofuels has long been recognized. The bioconversion of all lignocellulosic sugars into useful products results in high sugar yields, which makes lignocelluloses appealing for use. Pretreatment and hydrolysis of lignocelluloses at high solids loadings are vital throughout industrial processes, making them more cost-effective and ecologically friendly by lowering the need for capital expenditures, energy use, and water use. The high expense of fermentation medium hinders heterotrophic oleaginous microorganisms' ability to metabolically synthesize single-cell oils for biodiesel use. This study's objective was to ascertain whether bagasse hydrolysate could be used as a cost-effective feedstock for oleaginous Rhodococcus opacus to produce microbial lipids. Methods: R. opacus a strain was used in this study. The culture was first of all maintained at soytone nutrient growth medium (i.e. GROTH MEDIUM 56) and subcultured at regular intervals and as well as preserved at 4°C. For the production media, a minimal salt medium is used. Sugarcane bagasse is pretreated by acidic hydrolysis followed by detoxification of hydrolysate and lipid extraction is done by Folch's extraction process. Results: After a brief adaptation/lag phase, the strain showed a viable growth pattern once the nutrients were detoxicated through the removal of inhibitors (e.g. hydroxymethyl-furfural [HMF]). R. opacus was grown via shake flask fermentation in bagasse hydrolysate with different sugar concentrations. When cultivated in S2 experiment, R. opacus obtained over 50% of its dry cell weight as a lipid with a lipid yield of 64.47% and productivity is 0.015 g/L/h. Conclusions: Depending on the available substrates, different microbial oils had different compositions. These findings suggest that lignocellulosic hydrolysate can be utilized as an inexpensive fermentation substrate for the R. opacus to produce microbial lipids. As a result, the range of uses for aqueous liquors produced by lignocellulosic pretreatment has increased, enabling further improvement.

Multilevel inverters are used in a number of high-power applications, including industrial motor drives, flexible power transmission, and, renewable energy systems. Since the MLI design incorporates a large number of devices, the system’s reliability suffers. This has caught the interest of academics all over the world, who are searching for methods to increase the dependability of the MLI design and include fault-tolerant qualities into it, either through software or hardware. Redundancy is a method that has recently gained popularity in solid-state transformer applications where fault tolerance is a highly desired quality. This is because the method provides for greater fault tolerance. The goal of this research is to offer a complete knowledge of the fault tolerance capabilities of MLIs created by the research community over the last few years