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In the present investigation, a detailed numerical investigation of the flow and heat transfer characteristics of a channel with an elastic fin (vortex generator) and an elastic wall has been carried out using finite element method. The Fluid-Structure Interaction (FSI) model is used to capture the interaction between the fluid and the solid structure. A sinusoidal time dependent velocity profile has been imposed at the inlet of the channel and the right half of the upper wall of the channel is heated and exposed to constant temperature boundary condition. Due to the sinusoidal velocity profile at the inlet, the elastic fin oscillates periodically and act as a vortex generator, which causes more turbulence in the flow. The obtained results showed that the Nusselt number over the heated wall is affected by the position of the flexible fin, height of flexible fin and elasticity modulus of elastic fin. Moreover, due to the elasticity of the elastic wall and sinusoidal behavior of the inlet velocity, the elastic wall oscillates periodically upward and downward. The Nusselt number values over the heated wall are increased with decrease of the elastic modulus value of the elastic wall. However, the decrease in elastic modulus value of the elastic wall contributes to an increase in the pressure drop inside the channel. It should be added that the interplay between the fluid motion and the deformable structures leads to enhanced turbulence, as the flexible fin and elastic wall introduce additional disturbances and fluctuations into the flow regime. Consequently, this heightened turbulence level has profound implications for heat transfer processes within the system.

Introduction: Acute upper gastrointestinal bleeding is one of the most common medical emergencies that present to the hospital, and delineating the underlying etiology is essential to provide adequate definitive treatment. The purpose of this case report was to review the diagnosis and treatment of a rare complication known as radiation-induced hemorrhagic gastritis (RIHG) that can occur in patients with prior radiation exposure. The motivation for this study arose from the identification of a case within our institution. Case Presentation: The study involved a review of the diagnosis and management of a patient who presented with anemia and recurrent episodes of gastrointestinal bleeding at our institution after undergoing treatment for metastatic biliary adenocarcinoma. With the advent of new therapies, we aimed to investigate the various techniques utilized to manage these patients and highlight the importance of maintaining a high index of suspicion for RIHG as a potential etiology of gastrointestinal bleeding in patients with a relevant medical history of radiation exposure. Despite the literature review, we found that there is a lack of guidelines in the approach to the management of these patients. Conclusion: This case report underscores the rarity of radiation-induced gastritis and the complications that may arise from its diagnosis, including recurrent GI bleeding. Further investigation into identifying definitive treatment and creating guidelines for its management is desperately needed.

BackgroundIn PAH metabolic abnormalities in multiple pathways are well-recognized features of right ventricular dysfunction, however, prior work has focused mainly on the use of a single “omic” modality to describe a single deranged pathway. We integrated metabolomic and epigenomic data using transcriptomics in failing and non-failing RVs from a rodent model to provide novel mechanistic insight and translated these findings to accessible human specimens by correlation with plasma from PAH patients.MethodsStudy was conducted in a doxycycline-inducible BMPR2 mutant mouse model of RV failure. Plasma was collected from controls and PAH patients. Transcriptomic and metabolomic analyses were done on mouse RV tissue and human plasma. For mouse RV, we layered metabolomic and transcriptomic data for multiple metabolic pathways and compared our findings with metabolomic and transcriptomic data obtained for human plasma. We confirmed our key findings in cultured cardiomyocyte cells with BMPR2 mutation.ResultsIn failing mouse RVs, (1) in the glycolysis pathway, glucose is converted to lactate via aerobic glycolysis, but may also be utilized for glycogen, fatty acid, and nucleic acid synthesis, (2) in the fatty acid pathway, FAs are accumulated in the cytoplasm because the transfer of FAs to mitochondria is reduced, however, the ß-oxidation pathway is likely to be functional. (3) the TCA cycle is altered at multiple checkpoints and accumulates citrate, and the glutaminolysis pathway is not activated. In PAH patients, plasma metabolic and transcriptomic data indicated that unlike in the failing BMPR2 mutant RV, expression of genes and metabolites measured for the glycolysis pathway, FA pathway, TCA cycle, and glutaminolysis pathway were increased. Lactate was the only metabolite that was increased both in RV and circulation. We confirmed using a stable isotope of lactate that cultured cardiomyocytes with mutant BMPR2 show a modest increase in endogenous lactate, suggesting a possibility of an increase in lactate production by cardiomyocytes in failing BMPR2 mutant RV.ConclusionIn the failing RV with mutant BMPR2, lactate is produced by RV cardiomyocytes and may be secreted out, thereby increasing lactate in circulation. Lactate can potentially serve as a marker of RV dysfunction in PAH, which warrants investigation.

Abstract Chronic dysregulation of peripheral lipids has been found to be associated with depression and cognition, but their interaction has not been investigated. Growing evidence has highlighted the association between peripheral lipoprotein levels with depression and cognition with inconsistent results. We assessed the association between peripheral lipids, depression, and cognition while evaluating their potential interactions using robust clinically relevant predictors such as lipoprotein levels and chronic medical disorders that dysregulate lipoproteins. We report an association between peripheral lipids, depression, and cognition, suggesting a common underlying biological mechanism driven by lipid dysregulation in two independent studies. Analysis of a longitudinal study of a cohort at high or low familial risk for major depressive disorder (MDD) (n = 526) found metabolic diseases, including diabetes, hypertension, and other cardiovascular diseases, were associated with MDD and cognitive outcomes. Investigating a cross-sectional population survey of adults in the National Health and Nutrition Examination Survey 2011–2014 (NHANES) (n = 2377), depression was found to be associated with high density lipoprotein (HDL) and cognitive assessments. In the familial risk study, medical conditions were found to be associated with chronic lipid dysregulation and were significantly associated with MDD using the structural equation model. A positive association between chronic lipid dysregulation and cognitive scores was found in an exploratory analysis of the familial risk study. In a complementary study, analysis of NHANES revealed a positive association of HDL levels with cognition. Further analysis of the NHANES cohort indicated that depression status mediated the interaction between HDL levels and cognitive tests. Importantly, the protective effect of HDL on cognition was absent in those with depressive symptoms, which may ultimately result in worse outcomes leading to cognitive decline. These findings highlight the potential for the early predictive value of medical conditions with chronic lipid dyshomeostasis for the risk of depression and cognitive decline.

AbstractCarbon Dioxide Removal (CDR) is an emerging activity with extremely limited deployment to date, but which is mathematically required to achieve net (rather than true) zero or negative anthropogenic contribution to climate change. The required scale of CDR, however, depends on decisions about what activities will be allowed to emit greenhouse gases – the “residual emissions” that must be compensated via CDR. Simultaneously, CDR’s availability is limited by resource needs and feasibility, much like conventional depletable resources. Governance and institutions, especially related to how CDR is allocated and paid for, will fundamentally shape CDR efforts, including by structurally incentivizing particular approaches and monitoring, reporting, and verification (MRV) objectives. We argue that the emerging tendency toward market-based, unconstrained, and for-profit CDR presents fundamental and predictable risks for climate and justice goals. Such a model incentivizes growth in profitable compensatory removal applications, effectively allocating limited resources based on ability to pay rather than public good, while also increasing the amount of CDR required to meet global climate targets. “Luxury” removals that could otherwise be mitigated not only displace, but actively disincentivize deployment for compensatory removals in high priority but low wealth applications, and for drawdown. Meeting these needs would likely become a socialized cost. Markets also establish unit-level property rights that require specific kinds of MRV that are misaligned with climate outcomes and face incentives for poor quality verification. We describe the need, development context, function, and resource limitations of CDR, then characterize the major challenges with the emerging unconstrained, for-profit governance model. We argue that instead implementing CDR as a centrally planned sector, with publicly deliberated and adaptable volumetric targets integrated with other climate action, could enable more just and effective outcomes.

This work investigated the efficiency of CoFe2O4 nanoparticles in removing diclofenac and naproxen drugs from aqueous solutions. At first, the Taguchi method was performed to choose the most important factors among the investigated factors affecting the removal efficacy of these drugs. Afterward, the optimal conditions of the effective factors were investigated and modeled by the central composite design-based response surface method. The results revealed that the maximum drug removal was obtained at pH = 7, temperature of 25 °C, adsorbent dosage of 215 mg, sonication time of 21 min, and diclofenac and naproxen concentrations of 15 mg L−1. The removal efficacy of diclofenac and naproxen under these optimal conditions was 99.42 % and 95.11 %, respectively. Based on the results, it is concluded that CoFe2O4 nanoparticles can be applied as an easy-available and effective adsorbent for removing diclofenac and naproxen from water samples.

An elderly female presented with the complaint of a right sided breast lump since six months, found to be Invasive Ductal Carcinoma (IDC) of the Right Breast. Examination also revealed another lesion of suspected Basal Cell Carcinoma (BCC) in the same region, which was later confirmed by histopathological examination. Both these lesions were excised during the same procedure of Modified Radical Mastectomy. Review of literature of this rare coexistence showed no such documentations from India. Genetic basis for the same was reviewed, but could not be evaluated in our patient.

Background: Toluene exposure in construction workers can lead to several health problems, primarily affecting the nervous system, respiratory system, and skin. Utilizing advanced photocatalytic materials to degrade gaseous toluene aims to significantly mitigate its negative impact. Methods: In this research, photocatalysts based on pure TiO2 and modified TiO2 were synthesized to evaluate their efficacy in degrading gaseous toluene, a prevalent air pollutant in construction settings. Two synthesis methods were employed. Sonoprecipitation was used to create Fe-N co-doped TiO2 nanoparticles in the first method, while the second method utilized co-precipitation and hydrothermal techniques without ultrasonic assistance to achieve Fe-N co-doping. Seven types of nanophotocatalysts were synthesized, including TiO2-U (with ultrasonic assistance), NTiO2-U, FeNTiO2 (2.5)-U, FeNTiO2 (5)-U, FeNTiO2 (7.5)-U, FeNTiO2 (10)-U, and FeNTiO2 (5) without ultrasonic assistance. Characterization of the synthesized photocatalysts involved various analyses, including XRD, SEM, EDX, UV–VIS DRS, FT–IR, BET, and N2 adsorption-desorption isotherm. Results: Ultrasonic assistance notably improved particle dispersion and prevented agglomeration on the photocatalyst surface. UV–VIS DRS analysis indicated a reduction in band gap energy due to Fe and N doping of TiO2. The study also investigated the influence of Fe doping, initial toluene concentration, light source, and residence time on the degradation rate of gaseous toluene. Experimental findings showed that FeNTiO2 (5)-U exhibited a higher degradation rate of toluene (63.5%) compared to FeNTiO2 (5) (50%) under visible light irradiation over 15 s. Conclusions: The study underscores the significant enhancement in photocatalytic activity for toluene degradation achieved through the combined effects of ultrasound and co-doping methods.

There are numerous cardiac imaging modalities which aid in the diagnosis and management of coronary artery disease (CAD). Each modality has variable efficacy in detecting stenosis and stratifying risk among those with CAD. Clinicians must evaluate these methods in light of their patients’ clinical presentations, to choose the most appropriate imaging technique. Understanding the unique benefits and indications of each modality aids in the selection of high-value imaging. Following is a review of the available cardiac imaging methods for the identification and risk stratification of CAD.

Background: Previous investigations that have examined associations between family history (FH) of alcohol/substance use and adolescent brain development have been primarily cross-sectional. Here, leveraging a large population-based sample of youths, we characterized frontal cortical trajectories among 9- to 13-year-olds with (FH+) versus without (FH−) an FH and examined sex as a potential moderator. Methods: We used data from 9710 participants in the Adolescent Brain Cognitive Development (ABCD) Study (release 4.0). FH+ was defined as having ≥1 biological parents and/or ≥2 biological grandparents with a history of alcohol/substance use problems (n = 2433). Our primary outcome was frontal cortical structural measures obtained at baseline (ages 9–11) and year 2 follow-up (ages 11–13). We used linear mixed-effects models to examine the extent to which FH status qualified frontal cortical development over the age span studied. Finally, we ran additional interactions with sex to test whether observed associations between FH and cortical development differed significantly between sexes. Results: For FH+ (vs. FH−) youths, we observed increased cortical thinning from 9 to 13 years across the frontal cortex as a whole. When we probed for sex differences, we observed significant declines in frontal cortical thickness among boys but not girls from ages 9 to 13 years. No associations were observed between FH and frontal cortical surface area or volume. Conclusions: Having a FH+ is associated with more rapid thinning of the frontal cortex across ages 9 to 13, with this effect driven primarily by male participants. Future studies will need to test whether the observed pattern of accelerated thinning predicts future substance use outcomes.

This study examined the steady, two-dimensional, incompressible, and laminar viscous fluid flow between two porous disks in an external magnetic field. The main objective of this article is to propose a novel model that utilizes the numerical and analytical method (VIM) to solve the coupled differential equations of temperature and velocity while considering repeated changes. Furthermore, the finite element method is employed to analyze the pressure and temperature gradient variations for aluminum oxide and ethylene glycol nanoparticles flowing over two parallel discs. The finite element method has been used in both FlexPDE and CFD software to analyze these parameters. The results show that the velocity in the center of the space between the discs decreases as the Reynolds number increases. In simpler terms, the shape of the radial velocity patterns resembles a parabola. As it approaches the lower disc, the velocity gradually increases. The gradient of average velocity in the r-direction for ethylene glycol nanotubes around parallel disks is approximately 18.32 % greater than that of aluminum oxide nanotubes.

The major cause for skin cancer is the excessive and unprotected exposure to ultraviolet radiation (UVR), which can be prevented by engaging in sun protection behaviours. As longitudinal studies on both adolescents’ and adults’ performances of sun protection behaviours are limited, the current study aimed to investigate changes in sun protection in these population segments in Western Australia, a region with high annual UVR. During six summer seasons (2015/16 to 2020/21), cross-sectional surveys were conducted among 1806 adolescents (14 to 17 years old) and 1808 adults (18–45 years old), investigating the frequency of five sun protection behaviours (wearing clothing, applying sunscreen, wearing a hat, wearing sunglasses, and seeking shade) and sun avoidance (staying indoors). Over the six-year period, staying indoors increased in both groups. Among adolescents, a decrease in wearing clothing and sunglasses and an increase in seeking shade was demonstrated, and hat and sunscreen use remained relatively stable. Among adults, an increase in sunscreen use was shown, whereas all other sun-related behaviours remained consistent over the six-year period. The results from this study can provide directions for health communications focusing on improving sun protection behaviours among both adolescent and adult populations.

Abstract Background Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants in pregnancy. Animal and some clinical studies have suggested potential increases in depression and anxiety following prenatal SSRI exposure, but the extent to which these are driven by the medication remains unclear. We used Danish population data to test associations between maternal SSRI use during pregnancy and children outcomes up to age 22. Methods We prospectively followed 1,094,202 single-birth Danish children born 1997–2015. The primary exposure was ≥ 1 SSRI prescription filled during pregnancy; the primary outcome, first diagnosis of a depressive, anxiety, or adjustment disorder, or redeemed prescription for an antidepressant medication. We used propensity score weights to adjust potential confounders, and incorporated data from the Danish National Birth Cohort (1997–2003) to further quantify potential residual confounding by subclinical factors. Results The final dataset included 15,651 exposed and 896,818 unexposed, children. After adjustments, SSRI-exposed had higher rates of the primary outcome than those of mothers who either did not use an SSRI (HR = 1.55 [95%CI:1.44,1.67] or discontinued the SSRI use ≥ 3 months prior to conception (HR = 1.23 [1.13,1.34]). Age of onset was earlier among exposed (9 [IQR:7–13] years) versus unexposed (12 [IQR:12–17] years) children (p

Plankton diversity plays an essential role in aquatic wetlands. Phytoplankton and zooplankton communities were assessed in three permanent water bodies: Petli (S1), Deva (S2) and Heranj (S3) of the Anand and Kheda districts. Sampling was done from December 2020 to March 2021. Collection of plankton and identification of planktons was done using various published plankton manuals. A total of 32 phytoplankton have been recorded during the study period, from which 36 % belong to class Chlorophyta, 32 % belong to class Bacillariophyta, 16 % belong to Cyanophyta, 10 % belong to Charophyte, 3 % belong to Dinophyta, and 3 % belong to Euglenophyta. In addition, a total of 27 zooplankton species have been found, from which 46 % belong to Maxillopoda, 23 % belong to Monogononta, 19 % belong to Branchiopoda, 8 % belong to Eurotatoria, and 4 % belong to Hexanauplia. S1 has the maximum number of phytoplankton (24), followed by S3 with 18 and S2 with 15 species. Zooplankton were at the maximum in S1 (19), followed by S2 with 16, and S3 with 11 species. Results of the present study indicate that the studied wetlands have rich plankton diversity.

Abstract Objective: We aimed to assess risk of COVID-19 infection & seroprotection status in healthcare workers (HCWs) in both hospital and community settings following an intensive vaccination drive in India. Setting: Tertiary Care Hospital Methods: We surveyed COVID-19 exposure risk, personal protective equipment (PPE) compliance, vaccination status, mental health & COVID-19 infection rate across different HCW cadres. Elecsys® test for COVID-19 spike (Anti-SARS-CoV-2S; ACOVs) and nucleocapsid (Anti-SARS-CoV-2; ACOV) responses following vaccination and/or COVID-19 infection were measured in a stratified sample of 386 HCW. Results: We enrolled 945 HCWs (60.6% male, age 35.9 ± 9.8 years, 352 nurses, 211 doctors, 248 paramedics & 134 support staff). Hospital PPE compliance was 90.8%. Vaccination coverage was 891/945 (94.3%). ACOVs neutralizing antibody was reactive in 381/386 (98.7%). ACOVs titer (U/ml) was higher in the post-COVID-19 infection group (N =269; 242.1 ± 35.7 U/ml) than in the post-vaccine or never infected subgroup (N = 115, 204.1 ± 81.3 U/ml). RT PCR + COVID-19 infections were documented in 224/945 (23.7%) and 6 HCWs had disease of moderate severity, with no deaths. However, 232/386 (60.1%) of HCWs tested positive for nucleocapsid ACOV antibody, suggesting undocumented or subclinical COVID-19 infection. On multivariate logistic regression, only female gender [aOR 1.79, 95% CI 1.07–3.0, P = .025] and COVID-19 family contact [aOR 5.1, 95% CI 3.84–9.5, P < .001] were predictors of risk of developing COVID-19 infection, independent of association with patient-related exposure. Conclusion: Our HCWs were PPE compliant and vaccine motivated, with immunization coverage of 94.3% and seroprotection rate of 98.7%. There was no relationship between HCW COVID-19 infection to exposure characteristics in the hospital. Vaccination reduced disease severity and prevented death in HCW.

There is a significant need for additional therapy to improve outcomes for newborns with acute Hypoxic-ischemic (HI) encephalopathy (HIE). New evidence suggests that insulin could be neuroprotective. This study aimed to investigate whether intranasal insulin attenuates HI-induced brain damage and neurobehavioral dysfunction in neonatal rats. Postnatal day 10 (P10), Sprague-Dawley rat pups were randomly divided into Sham + Vehicle, Sham + Insulin, HI + Vehicle, and HI + Insulin groups with equal male-to-female ratios. Pups either had HI by permanent ligation of the right common carotid artery followed by 90 min of hypoxia (8% O2) or sham surgery followed by room air exposure. Immediately after HI or Sham, pups were given fluorescence-tagged insulin (Alex-546-insulin)/vehicle, human insulin (25 μg), or vehicle in each nare under anesthesia. Shortly after administration, widespread Alex-546-insulin-binding cells were detected in the brain, primarily co-localized with neuronal nuclei-positive neurons on double-immunostaining. In the hippocampus, phospho-Akt was activated in a subset of Alex-546-insulin double-labeled cells, suggesting activation of the Akt/PI3K pathway in these neurons. Intranasal insulin (InInsulin) reduced HI-induced sensorimotor behavioral disturbances at P11. InInsulin prevented HI-induced increased Fluoro-Jade C+ degenerated neurons, cleaved caspase 3+ neurons, and volume loss in the ipsilateral brain at P11. There was no sex-specific response to HI or insulin. The findings confirm that intranasal insulin provides neuroprotection against HI brain injury in P10 rats associated with activation of intracellular cell survival signaling. If further pre-clinical research shows long-term benefits, intranasal insulin has the potential to be a promising non-invasive therapy to improve outcomes for newborns with HIE.

ABSTRACTObesity and the metabolic syndrome are complex disorders resulting from multiple factors including genetics, diet, activity, inflammation, and gut microbes. Animal studies have identified roles for each of these, however the contribution(s) specifically attributed to the gut microbiota remain unclear, as studies have used combinations of genetically altered mice, high fat diet, and/or colonization of germ-free mice, which have an underdeveloped immune system. We investigated the role(s) of the gut microbiota driving obesity and inflammation independent of manipulations in diet and genetics in mice with fully developed immune systems. We demonstrate that the human obese gut microbiota alone was sufficient to drive weight gain, systemic, adipose tissue, and intestinal inflammation, but did not promote intestinal barrier leak. The obese microbiota induced gene expression promoting caloric uptake/harvest but was less effective at inducing genes associated with mucosal immune responses. Thus, the obese gut microbiota is sufficient to induce weight gain and inflammation.

IntroductionPulmonary arterial hypertension is a fatal cardiopulmonary disease. Leptin, a neuroendocrine hormone released by adipose tissue, has a complex relationship with cardiovascular diseases, including PAH. Leptin is thought to be an important factor linking metabolic syndrome and cardiovascular disorders. Given the published association between metabolic syndrome and RV dysfunction in PAH, we sought to determine the association between leptin and RV dysfunction. We hypothesized that in PAH-RV, leptin influences metabolic changes via leptin receptors, which can be manipulated by metformin.MethodsPlasma leptin was measured in PAH patients and healthy controls from a published trial of metformin in PAH. Leptin receptor localization was detected in RV from PAH patients, healthy controls, animal models of PH with RV dysfunction before and after metformin treatment, and cultured cardiomyocytes with two different BMPR2 mutants by performing immunohistochemical and cell fractionation studies. Functional studies were conducted in cultured cardiomyocytes to examine the role of leptin and metformin in lipid-driven mitochondrial respiration.ResultsIn human studies, we found that plasma leptin levels were higher in PAH patients and moderately correlated with higher BMI, but not in healthy controls. Circulating leptin levels were reduced by metformin treatment, and these findings were confirmed in an animal model of RV dysfunction. Leptin receptor expression was increased in PAH-RV cardiomyocytes. In animal models of RV dysfunction and cultured cardiomyocytes with BMPR2 mutation, we found increased expression and membrane localization of the leptin receptor. In cultured cardiomyocytes with BMPR2 mutation, leptin moderately influences palmitate uptake, possibly via CD36, in a mutation-specific manner. Furthermore, in cultured cardiomyocytes, the Seahorse XFe96 Extracellular Flux Analyzer and gene expression data indicate that leptin may not directly influence lipid-driven mitochondrial respiration in BMPR2 mutant cardiomyocytes. However, metformin alone or when supplemented with leptin can improve lipid-driven mitochondrial respiration in BMPR2 mutant cardiomyocytes. The effect of metformin on lipid-driven mitochondrial respiration in cardiomyocytes is BMPR2 mutation-specific.ConclusionIn PAH, increased circulating leptin can influence metabolic signaling in RV cardiomyocytes via the leptin receptor; in particular, it may alter lipid-dependent RV metabolism in combination with metformin in a mutation-specific manner and warrants further investigation.

Background: Deep brain stimulation (DBS) surgery is a neurosurgical procedure that implants electrodes into the brain to treat a variety of neurological and psychiatric conditions. The COVID-19 pandemic resulted in significant disruptions in elective surgeries, but the impact on DBS surgeries remains largely unknown. Methods: The National Inpatient Sample (NIS), an all-payors database of inpatient hospitalizations in the US, was queried for DBS implantation procedural codes in 2019 and 2020. Results: There were a total of 7,625 hospitalizations (95% CI: 6,664 to 8,586) for the implantation of a DBS lead in the 2019 NIS, which reduced by 11.9% to 6,715 hospitalizations (95% CI: 5,872 to 7,558) in the 2020 NIS. Procedural numbers declined in March 2020, with a peak 92.7% decline in volume in April of 2020 relative to 2019. Case numbers for July through December 2020 were 96.1% of the 2019 volume. Overall patient demographics and primary discharge diagnoses for hospitalizations involving DBS implantation were similar in the two study years. Conclusions: Surgical volume for DBS implantation reduced by 92.7% in April of 2020 relative to 2019, which is among the highest declines reported for any surgical procedure. While procedural volume increased in the second half of 2020, this did not make up for the reduction in procedures earlier in the year, highlighting the disruption in DBS surgeries in 2020.

Objectives: In this cross-sectional study, we intended to assess grief, impact of event, and coping strategies of doctors who were working in the COVID-19 ward/intensive care unit (ICU), and to compare it with controls (people not working in COVID-19 ward/ICU). Methods: Online survey was done in the western state of India. Study participants completed structured quantitative interview for grief, Impact of Event Scale Revised and Brief Cope Inventory (BCOPE). Results: We found that 11 study doctors (9.8%) had severe grief (n = 112) and 28 controls (27.2%) had severe grief. We also found that 28 study doctors (25%) and 58 controls (56.3%) had a severe impact of event. Overall grief (t = −3.75) and impact of event (t = −5.07) were significantly higher in controls than doctors (p < 0.001). Hyperarousal type of impact of event significantly predicted grief in study doctors (β = 0.450, p < 0.01). A higher level of avoidance type of impact of the event (β = 0.430, p < 0.001), a higher level of seeking social support type of coping strategies (β = 0.190, p < 0.05), and lesser level of problem-solving type coping (β = −0.193, p < 0.05) significantly predicted a higher level of grief in controls. Conclusion: We found a clear evidence of higher grief and event impact in controls than in study doctors. In this study, doctors, who had experienced the hyperarousal type of impact of event predicted the development of grief, whereas, in controls, the avoidance type of impact of event predicted grief. In the study doctors, self-distraction and self-blame were the coping mechanisms associated with more severe grief, while coping with humor lessened grief. Self-blame coping increased grief in controls, and a higher seeking of social help and less problem-solving could predict grief. In the study of doctors, the most commonly used coping strategies were acceptance, positive reframing, and religion, while controls used acceptance, positive reframing, and active coping.

Three types of payments confront in business dealings viz. advance, cash and credit. A cash payment is ubiquitously practiced, while a credit payment scheme escalates sales and advance payment technique is implemented to avoid cancellation of orders. These are recognized as advance-cash-credit (ACC) payment scheme which is conventional in business transactions. By implicating ACC the aim is to determine optimal pricing and ordering policies. Inventory items observes quadratic demand being sensitive to unit selling price. Promising concavity of the profit function for both selling price and cycle time is posed numerically. Managerial insights are revealed as a concluding note.

Abstract Hispanic patients have been reported to have an increased incidence of AML and possibly inferior outcomes compared to non‐Hispanics. We conducted a retrospective study of 225 AML patients (58 Hispanic and 167 non‐Hispanic) at two academic medical centers in Florida. Disease characteristics, cytogenetics, mutation profiles, and clinical outcomes were assessed. Hispanic patients were younger at presentation than non‐Hispanics (p = 0.0013). We found associations between single gene mutations and ethnicity, with IDH1 mutations being more common in non‐Hispanics (95.2% vs. 4.8%, p = 0.0182) and WT1 mutations more common in Hispanics (62.5% vs. 37.5%, p = 0.0455). We also found an emerging trend towards adverse risk cytogenetics in Hispanic patients (p = 0.1796), as well as high risk fusions such as MLL‐r (70% vs. 30%, p = 0.004). There was no difference in overall survival (OS) between Hispanic and non‐Hispanics patients. When examining only newly diagnosed patients (n = 105), there was improved OS in Hispanics (median 44.7 months vs. 14 months, p = 0.026) by univariate analysis and equivalent OS by multivariate analysis (hazard ratio = 1.52 [95% CI = 0.74–3.15]). Hispanics with a driver mutation not class‐defining had improved survival compared to non‐Hispanics. Our study demonstrates significant genetic differences between Floridian Hispanics and non‐Hispanics, but no difference in OS in patients treated at an academic medical center.

Abstract Background Rare diseases are a new global health priority, requiring evidence-based estimates of the global prevalence of diseases to inform public policymakers and provide a serious challenge to the healthcare system that must not be ignored. The purpose of this study is to investigate Iranian future healthcare professionals' knowledge and opinions about rare diseases. Results A total of 6838 students responded to the questionnaire. Nursing and medical students had the highest participation. Almost 85% of participants rated their knowledge about rare diseases as poor or insufficient. While nearly 70 percent of participants took courses about rare diseases at university. Finally, 72.7% of future healthcare professionals did not feel ready to take care of a patient with a rare disease. Conclusion The present study has indicated a gap in Iranian medical students’ knowledge of rare diseases. The researchers believe that health science policymakers should make a joint effort to improve knowledge about rare diseases. Including courses with regard to rare diseases would be of benefit to future healthcare professionals.

Late Cryogenian–Ediacaran magmatism represents the latest Precambrian tectonothermal event in the Tarim Craton. However, its geodynamic setting and geological significance are controversial. Here, we report the geochronology, whole-rock geochemistry, and Sr-Nd-Hf isotopic compositions of newly identified late Cryogenian A-type and highly fractionated S-type granites from two locations in the northern Tarim Craton. LA-ICP-MS zircon U-Pb analyses yield ages of 642 ± 7 Ma for a syenogranite and 643 ± 4.5 Ma for a mylonitized granite. The syenogranite is weakly peraluminous and shows an A-type granite affinity, as indicated by its high K2O + Na2O contents (8.35–8.64 wt.%), high field strength elements (Zr + Nb + Ce + Y = 435.8 − 463.4 × 10−6), Ga/Al ratios (2.79−2.83), and zircon saturation temperatures (829–844 °C). In contrast, the mylonitized granite contains Al-oversaturated minerals (e.g., garnet) and has high a differentiation index (DI = of 98.9–99.4), with lower zircon saturation temperatures (786–792 °C); the samples display high SiO2 contents (72.99–74.00 wt.%) and A/CNK values (1.16–1.17) and low Nb/Ta and Zr/Hf ratios and are enriched in Rb and depleted in Ba, Sr, which all point to a highly fractionated S-type granite affinity. The granites are characterized by elevated large-ion lithosphere elements (LILEs) and flat high-field-strength elements (HFSEs) patterns, with deep Nb and Ta troughs and pronounced negative Eu anomalies (Eu/Eu* = 0.17–0.38). They show apparently negative εNd(t) values (−10.1 to −9.8 and −6.8 to −7.9, respectively) and εHf(t) values (−9.66 to −1.77 and −33.5 to −1.3, respectively) with Paleoproterozoic crustal model ages, indicating that they were mainly generated by the partial melting of mature crustal materials with a minor contribution from a mantle-derived magmatic source. By integrating with previously published geological, sedimentological, and structural data, we suggest that the granites formed due to a high-temperature gradient in a syn-subduction extensional setting that was probably induced by northward slab rollback of the Paleo-Asian Oceanic lithosphere. Our new data highlight an upper-plate extension in the northern Tarim Craton that constitutes the northern periphery of the Rodinia supercontinent. The linear distribution of late Cryogenian magmatic rocks provides critical evidence for the orogen strike extension of the terminal suture between the Tarim Craton and southwestern Altaids.

Abstract Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high‐impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.

Abstract The current World Health Organization (WHO) classification of myeloid malignancies includes myelodysplastic/myeloproliferative neoplasms with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T) as a distinct entity. Previous literature on predictors of survival was based on the provisional category of refractory anemia with ring sideroblast and thrombocytosis (RARS-T), which was not subject to MDS/MPN-RS-T exclusionary criteria such as PB blast% ≥1, BM blast% ≥5 or cytogenetic abnormalities such as t(3;3)(q21.2;q26.2), inv(3)(q21.23q26.2) or isolated del(5q). We examined overall (OS) and leukemia-free (LFS) survival and its predictors, among 158 patients with WHO-defined MDS/MPN-RS-T. In univariate analysis, age ≥70 years (P = 0.006), hemoglobin (Hb) ≤10 g/dL (P = 0.03) and abnormal karyotype (excluding -Y, P = 0.008) were associated with shortened OS, which was otherwise not affected by either ASXL1 (P = 0.7), SF3B1 (P = 0.4) or JAK2 V617F (P = 0.7) mutations; in multivariable analysis, Hb ≤ 10 g/dL (P = 0.03) and abnormal karyotype (P = 0.001) remained significant, and thus allowed the development of an operational survival model with low (0 risk factors, median OS 10.5 years), intermediate (1 risk factor, median OS 4.8 years) and high risk (2 risk factors, median OS 1.4 years) categories (P = 0.0009). Comparison of MDS/MPN-RS-T (n = 158) and MDS/MPN-U with BM RS ≥ 15% (MDS/MPN-U-RS; n = 25) did not reveal significant differences in frequency of thrombosis, OS, or LFS, although SF3B1 mutation frequency was higher in the former (93% versus 59%; P = 0.0005). These data suggest limited survival impact for molecular abnormalities and the morphological distinction between MDS/MPN-RS-T and MDS/MPN-U-RS.

Background: Pulmonary hypertension (PH) is a common comorbidity in infants with bronchopulmonary dysplasia (BPD). Sildenafil is a widely recognized therapy for PH, but its efficacy in infants with BPD is questionable. We propose to assess the efficacy of sildenafil in BPD-associated PH as evaluated based on transthoracic echocardiography (TTE) changes and clinical measures. Methods: Data were retrospectively and prospectively collected. Inclusion criteria were gestational age (GA) < 32 weeks, birth weight (BW) < 1500 g with severe BPD, diagnosis of PH via TTE on sildenafil treatment. PH was evaluated via TTE, which was performed monthly after 36 weeks post-menstrual age (PMA) as a standard of care, and re-reviewed by a single pediatric cardiologist, who was blind to the initial reading. Results: In total, 19 patients were enrolled in the study, having a median GA of 24 3/7 weeks (IQR 23 5/7–25 5/7) and a median BW of 598 g (IQR 572–735). Sildenafil treatment was started at a median PMA of 40.4 weeks. The median respiratory severity score (RSS) at 28 d was 6.5, RSS and FiO2 showed improvement about 12 weeks after starting sildenafil treatment. Conclusions: Improvement in PH was noted via TTE, and patients had improvement in their RSS and FiO2 after prolonged therapy. However, TTE improvements did not correlate with clinical improvements.

Introduction: India is facing a dual burden of malnutrition with high prevalence of underweight and increasing prevalence of overweight/obesity. Methodology: This study reports anthropometric findings (body mass index, waist circumference [WC], and waist–hip ratio [WHR]) from the screening of 3296 students admitted during 2018–2019. Results: Majority of the students were male (70%), with a mean age of 18.57 years. About 31% and 19% of students were underweight and overweight, respectively. Given sex-specific cutoffs for WC and WHR, about 5% and 21% of students were at substantially increased risk of metabolic complications. About 14.5% of normal and underweight students were also found to be at substantially increased risk of metabolic complications. Multivariate analysis found increasing age (odds ratio [OR] = 0.92; 95% confidence interval [CI]: 0.88–0.98) and being male (OR = 0.74; 95% CI: 0.62–0.88) to be protective factors against underweight. We did not find any statistically significant correlation for overweight, for WHR among males, and WC and WHR among females. Conclusion: It has been noted that the college environment increases the risk of weight gain. Hence, it makes a case to periodically study changes in anthropometric measures through a longitudinal study, and accordingly develop life cycle-based interventions for prevention/management of undernutrition, obesity, and related complications.

The COVID 19 pandemic ravaged the globe with a remarkable ferocity and has not entirely abated till now with cases flaring up at various places at different times. The expected course is for it to become endemic with recurring exacerbations. Over the past two years, we have become wiser to its pathology, diagnosis, and treatment. However, it is imperative for us to regularly and consistently reassess our protocols to assimilate the current and ever-growing knowledge in this direction. Doing so will help us to use our resources judiciously, improve patient care, and enhance the overall benefit to stakeholders. In this article, we aim draw the researchers' attention to few issues which may not be at the forefront at this point in time but important nevertheless. These include the use of personal protective equipment (PPE), universal gloving, isolation criteria, and handling of dead bodies, among others. We hope that a reassessment of the challenges involved in the said procedures will help us to be better prepared to face and tackle potential future waves and the multiple challenges that would potentially ensue post-spikes in infection incidences.

Aim: To compare marginal bone loss (MBL), implant survival rate and prosthetic complications of implant-supported splinted and non-splinted restorations (NSR). Settings and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). The PROSPERO registry, which keeps track of prospective systematic reviews, also received this paper (CRD42021229477). Material and Methods: An electronic search was done in PubMed, the Cochrane Central Trials Register, Scopus, Science Direct, and Google Scholar searches were carried out. The search was limited to articles published in English and covered the period from January 2010 to August 2020. Statistical Analysis Used: To conduct the meta analysis, researchers employed methodologies such as continuous measurement and odds ratios. Results: For both qualitative and quantitative analysis, 19 scientific studies were chosen. 3682 implants were placed in 2099 patients with a mean age of 59 years (splinted, 2529; non-splinted, 1153); the mean age was not provided in 5 trials. For splinted restorations, there were statistically significant differences in MBL, indicating the former has less MBL than for NSR. Splinted restorations had much greater survival rates than NSR, according to a qualitative study. Rest prosthesis complications with or without splinting were essentially the same. Conclusions: Splinted implant restorations lost less bone than non-splinted implant restorations, according to this meta analysis. This was particularly true for posterior restorations. Lower implant failure was associated with splinted restorations. Restorations with and without splinting had the same level of prosthetic problems.