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The pervasive business competition in the last decade has compelled researchers to continuously focus on the measurement of innovative work behaviour (IWB). It is also vital to comprehend the employees’ IWB, as their activities/actions are of critical significance for constant improvement and innovation in the organisations. Understanding the concept and development of the theories on IWB, along with the measurement of IWB, is a prerequisite for developing models for enhancing IWB knowledge. With this backdrop, the present study seeks to test five different factorial structures of IWB on a sample of 372 employees working in Indian apparel manufacturing organisations. The data was collected through survey method in two phases (sample 1 = 192 employees and sample 2 = 180 employees) and were analysed for dimensionality and validity of IWB scale. The analysis of psychometric properties of scale revealed the reliability and validity of the correlated five -factor model and high order model of IWB consisting of 20 items. Moreover, the findings indicate the feasibility of IWB in measuring work behaviour related to innovation in the Indian apparel sector, which is a novel contribution in the field. The results can help employees and organisations to measure, evaluate and promote various dimensions or stages of IWB. Also, they can understand how to really practice innovation in the organisational environment of the apparel sector. In this way, by offering valuable insights into the dimensions of IWB, this study contributes to individual behavioural aspects of innovation research, informing theoretical models using data-driven information.

Background: Acute changes in glomerular filtration rate (GFR) can occur following initiation of interventions for chronic kidney disease (CKD) progression. These complicate the interpretation of treatment effects on long term progression of (CKD). We sought to assess the magnitude and consistency of acute effects in randomized clinical trials (RCT) and explore factors that might impact them. Methods: We performed a meta-analysis of 53 RCTs for CKD progression enrolling 56,413 participants that had at least one estimated GFR measurement by six months following randomization. We defined acute treatment effects as the mean difference in GFR slope from baseline to 3 months between randomized groups. We performed univariable and multivariable meta-regression to assess the impact of intervention type, disease state, baseline GFR and albuminuria on the magnitude of acute effects. Results: The mean acute effect across all studies was -0.21 mL/min/1.73m2 (95% CI -0.63 to 0.22) over three months, with substantial heterogeneity across interventions (95% coverage interval across studies, -2.50 to +2.08 mL/min/1.73m2). Negative average acute effects were observed in renin angiotensin system blockade, blood pressure lowering and sodium-glucose cotransporter 2 inhibitor trials while positive acute effects were observed in trials of immunosuppressive agents. Larger negative acute effects were observed in trials with higher mean baseline GFR. Conclusion: The magnitude and consistency of acute GFR effects varies across different interventions, and is larger at higher baseline GFR. Understanding the nature and magnitude of the acute effects can help inform the optimal design of RCTs in CKD evaluating kidney disease progression.

Sepsis is a clinical syndrome resulting from infection followed by inflammation and is one of the significant causes of mortality worldwide. The underlying reason is the host's uncontrolled inflammatory response due to an infection led to multiple organ dysfunction/failure. Neutrophils, an innate immune cell, are forerunners to reach the site of infection/inflammation for clearing the infection and resolute the inflammation during sepsis. A relatively new neutrophil effector function, neutrophil extracellular traps (NETs), have been demonstrated to kill the pathogens by releasing DNA decorated with histone and granular proteins. A growing number of pieces of shreds of evidence suggest that unregulated incidence of NETs have a significant influence on the pathogenesis of sepsis-induced multiple organ damage, including arterial hypotension, hypoxemia, coagulopathy, renal, neurological, and hepatic dysfunction. Thus, excessive production and improper resolution of NETs are of significant therapeutic value in combating sepsis-induced multiple organ failure. The purpose of this review is intended to highlight the role of NETs in sepsis-induced organ failure. Furthermore, the current status of therapeutic strategies to intersect the harmful effects of NETs to restore organ functions is discussed.

Ischemic stroke (IS) is the leading cause of disability and contributes to a significant socio-economic cost in the western world. Brain repair strategies investigated in the pre-clinical models include the delivery of drug or cell-based therapeutics; which is hindered by the complex anatomy and functional organization of the brain. Biomaterials can be instrumental in alleviating some of these challenges by providing a structural support, localization, immunomodulation and/or modulating cellular cross-talk in the brain. This review addresses the significance of and challenges associated with cell therapy in an ischemic brain. This is followed by a detailed insight into the biomaterial-based delivery systems which have been designed to provide sustained trophic factor delivery for endogenous repair and to support transplanted cell survival and integration. A biomaterial intervention uses a multifaceted approach in enhancing the survival and engraftment of cells during transplantation and this has driven them as potential candidates for the treatment of IS. The biological processes that are activated as a response to the biomaterials and how to modulate them is one of the key factors contributing to the success of the biomaterial-based therapeutic approach. Future perspectives highlight the need of a combinative approach of merging the material design with disease biology to fabricate effective biomaterial-based intervention of stroke.

COVID-19 is currently threatening the globe. SARS-CoV-2 is the cause of COVID-19, which spreads via droplets/airborne and direct contact. Health care workers (HCWs) are the frontline workers, which are directly involved in taking care of patients affected by COVID-19. HCWs are at a higher risk of infection during the caring of COVID-19 patients. This focused review highlighted the higher risk for COVID-19 infection among health care professionals during close contact with patients and their preventive management in COVID-19 pandemic.

The stock market occurs from the interaction of a group of buyers (investors) and sellers of shares (companies), who represent ownership of the business. This includes a security listed on a public stock exchange under government supervision. Shares or stock market can be classified according to the country where the company is domiciled, for example Gudang Garam (company in Indonesia) which is domiciled in Indonesia and traded on the Indonesia Stock Exchange. The stock market has become an attractive and profitable investment today for investors and the stock market has grown rapidly over the years and is getting more and more attention because it deals with the future of money. However, a lot of investors are still worried to invest in stock market today, even investing in stock market results a huge profit. This reason can be the volatility in stock market. Therefore, this study focused on the investors’ perceptions towards stock market in different geographical areas. The data collected through online interview and distributing questionnaires to respondents in order to understand their behaviors, attitudes, desires, perspectives and level of awareness towards the stock market. The results showed that investors’ perceptions on buying shares in Asia are represented by several indicators, such as neutral information, accounting information, and social relevance, in which these three indicators generate impressions of the company’s activities based on profits and fundamental thinking patterns. Therefore, this will have an influence on investors in making decisions on the shares which will be chosen by them in the future.

Spirituality is a living and vital component of mankind in which people are looking for ultimate meaning, purpose, and mastery while engaging in connections with themselves, their family members, others, their communities, society, nature, and the divine or spiritual. Health, illness, beliefs, knowledge, and medical practices are all influenced by culture, and dentistry is no exception. Everyone, whether rural or urban, has its own health and illness beliefs and practices. The only way to provide culturally sensitive health care is to be aware of, listen to, and be attentive to each patient, as well as to inquire about personal needs and wishes when appropriate. Spiritual well- being is regarded as the fourth dimension of health. It helps people realize their greatest potential, find meaning and purpose in life, and find fulfillment from within. The individual's lifestyle may have a significant impact on his or her oral health behaviour. Caries and plaque-induced periodontal illnesses are linked to personal hygiene, food intake frequency, motivation to preserve oral health, and in certain circumstances, religious commitment Dental myths are widespread and unquestioned misleading ideas that often arise as a result of a lack of education, spiritual beliefs, and traditional factors based on non-scientific information. Despite global advances in diagnosis, treatment, and prevention, some people continue to hold on to their traditional values, practices, beliefs, and myths. If these myths are exposed in a timely manner, it may be possible to reduce the costs and time required for dental treatment, thereby converting an operative treatment into conservative dental management and improve patient satisfaction.

Adherence has been defined as the “voluntary, active, and collaborative involvement of the patients in mutually acceptable courses of behaviour to produce desired therapeutic effects”. Medication adherence generally illustrates the term as to whether the patients take their medicines as per prescription instruction and either they keep on to take a prescribed medication. Medication adherence performance has thus been classified into two head conceptions, namely, adherence and persistence. Whilst theoretically similar, adherence refers to concentration of drug utilization for the duration of the ongoing treatment, whereas persistence refers to the general interval of drug therapy. Improving prescription adherence may impact the well-being of the populace than the revelation of any new treatment. Indian patients are not adherent to their medication half the time, mainly due to lack of proper education and patient counselling. Albeit most doctors do not accept adherence basically because of the absence of access or neglect, and no adherence can frequently be a purposeful decision made by the Indian patients. Persistent covering of their medicine taking conduct is regularly persuaded by feelings with respect to both supplier and the patient, prompting possible desperate outcomes. On time medicine taking behaviour of the patients have great impact on the health of people than the need for new treatment option. KEY WORDS Medication Adherence, Drug Therapy, Prescription, Wellbeing, Compliance, Chronic Disease

Purpose Systemic risk has been a cause of concern for the bank regulatory authorities worldwide since the global financial crisis. This study aims to identify systemically important banks (SIBs) in India by using SRISK to measure the expected capital shortfall of banks in a systemic event. The sample size comprises a balanced data set of 31 listed Indian commercial banks from 2006 to 2019. Design/methodology/approach In this study, the authors have used SRISK to identify banks that have a maximum contribution to the systemic risk of the Indian banking sector. Leverage, size and long-run marginal expected shortfall (LRMES) are used to compute SRISK. Forward-looking LRMES is computed using the GJR-GARCH-dynamic conditional correlation methodology for early prediction of a bank’s contribution to systemic risk. Findings This study finds that public sector banks are more vulnerable to macroeconomic shocks owing to their capital inadequacy vis-à-vis the private sector banks. This study also emphasizes that size should not be used as a standalone factor to assess the systemic importance of a bank. Originality/value Systemic risk has attracted a lot of research interest; however, it is largely limited to the developed nations. This paper fills an important research gap in banking literature about the identification of SIBs in an emerging economy, India. As SRISK uses both balance sheet and market-based information, it can be used to complement the existing methodology used by the Reserve Bank of India to identify SIBs.

Objective This study aimed to develop a classifier for infants at 12 months of age based on a parent-report measure (the First Year Inventory 2.0 [FYI]), for the following reasons: (1) to classify infants at elevated risk, above and beyond that attributable to familial risk status for ASD; and (2) to serve as a starting point to refine an approach for risk estimation in population samples. Method A total of 54 high−familial risk (HR) infants later diagnosed with ASD (HR-ASD), 183 HR infants not diagnosed with ASD at 24 months of age (HR-Neg), and 72 low-risk controls participated in the study. All infants contributed FYI data at 12 months of age and had a diagnostic assessment for ASD at age 24 months. A data-driven, cross-validated analytic approach was used to develop a classifier to determine screening accuracy (eg, sensitivity) of the FYI to classify HR-ASD and HR-Neg. Results The newly developed FYI classifier had an estimated sensitivity of 0.71 (95% CI: 0.50, 0.91) and specificity of 0.72 (95% CI: 0.49, 0.91). Conclusion This classifier demonstrates the potential to improve current screening for ASD risk at 12 months of age in infants already at elevated familial risk for ASD, increasing opportunities for detection of autism risk in infancy. Findings from this study highlight the utility of combining parent-report measures with machine learning approaches.

As the infectivity of the SARS-CoV-2 virus is higher compared with other coronaviruses reported so far, so effective therapeutics and vaccines are the best way to control the proliferation of this infection The COVID-19 mortality rate is lower compared with other similar viral diseases such as severe acute respiratory Ssndrome (SARS) and Middle East respiratory syndrome (MERS). However, due to the evolution of SARS-CoV-2 mutants that are responsible for the subsequent waves, mortality due to COVID-19 has increased across the globe. Currently, the magnitude of SARS-CoV-2 infection is highly severe and is leading to a tremendously increased number of deaths globally. Scientists expect that SARS-CoV-2 has the potential to become a seasonal disease like influenza and may persist with humanity in the future. Currently, preventive strategies such as sanitation, social distancing, use of masks, potential chemotherapies (pathogen-centric and host-centric), and vaccines are the only option to fight against COVID-19. Many groups of Indian government-public private consortia had set up different strategies (development of multiple vaccines) for combat of this unique threat through stepssuch as an increase in vaccinations and sample testing per day. In this focused review, we have discussed the challenges faced and success stories employed to manage COVID-19.

Aims: The aim of this study was to evaluate the effect of PowerScopeTM (Class II Corrector) on skeletal, dental and oro-pharyngeal airway dimensions in class II malocclusion with retrusive mandible. Materials and Methods: Twenty patients with age group of 11 to 14 were selected for this study. Experimental group underwent Power scope class II corrector therapy and control group, alignment of only upper arch respectively. Lateral cephalometric radiographs were taken in both experimental group and control group before and after 6 month of treatment. Sixteen measurements in that eight skeletal, five dental and three pharyngeal airway were assessed to know the effect of PowerScopeTM Class II corrector on skeletal, dental and pharyngeal airway Results: PowerScopeTM Class II corrector after treatment showed significant change in SNB (P = 0.01*), ANB (P=0.001*), Inferior airway space (IAS) (P=0.006*), lower incisors position (P=0.0001*) and overjet (P=0.0001*) where as these values were insignificant on comparison with control group except for lower incisors position (P=0.001*) and overjet (P=0.0001*) indicating that PowerScopeTM corrects class II malocclusion mainly by dento alveolar changes not have significant effect on skeletal and oro-pharyngeal airway. Conclusion: Power ScopeTM (Class II corrector) corrects skeletal class II malocclusion mainly by dental changes and has insignificant effect on skeletal and oro-pharyngeal airway. Keywords: Class II malocclusion, PowerScope TM Class II corrector, Oropharyngeal airway.

In an uncanny, seemingly precognitive coincidence, Steven Taylor, a Professor and clinical psychologist in the Department of Psychiatry, at the University of British Columbia, Canada, published a b...

Treatment options for dialysis access steal syndrome (DASS) include distal revascularization with interval ligation (DRIL), proximalization of arterial inflow (PAI), access banding, and access ligation. This study examines the efficacy of DRIL in treating DASS and reports short-term bypass patency, access patency, and wound infection rates.A retrospective analysis was performed on adults diagnosed with DASS following hemo-dialysis access creation who underwent DRIL procedures between January 1, 2009 and May 11, 2017. Patients18 years and those with lower extremity accesses or HeRO grafts that developed DASS were excluded. Data was obtained using electronic medical records and analyzed using SPSS software. Residual steal was defined as reintervention for DASS within 60 days of DRIL. Recurrent steal was defined as reintervention beyond 60 days.Eighty-nine DRIL procedures were performed for correction of DASS. Population included 59.6% female (n = 53), 47.2% current/former smokers (n = 42), 76.4% diabetic (n = 68), and 79.8% AVF (n = 71). Symptom resolution was complete for 69.7% (n = 62), and partial for 25.8% (n = 23), with no improvement in 4.5% (n = 4). Following DRIL, mean DBI improved from 0.43 to 0.67 (P= 0.002). Mean steal classification improved from 3.04 to 0.64 (P0.001). Five patients required a subsequent procedure for DASS symptoms - 3 for residual steal and 2 for recurrent steal. Bypass patency at 6 months post DRIL was 93.3% (n = 83) primary, 97.8% (n = 87) primary-assisted, and 100% (n = 89) secondary patency. Access patency at 6 months post DRIL was 78.7% (n = 70) primary, 91% (n = 81) primary-assisted, and 94.4% (n = 84) secondary. Twenty-one patients (23.5%) had 24 cases of surgical site infections, with 70.8% (n = 17) occurring at the saphenectomy site. Wound infections re-solved within 60 days postoperatively in 23 out of 24 patients.DRIL is highly effective in relieving symptoms of DASS and has excellent rates of short-term access and bypass patency. However, consideration must be given to the high wound infection rate and the potential need for subsequent procedures.

Purpose Autoimmune connective tissue disease (CTD) has historically represented a relative contraindication to breast conservation (BC) among patients with early-stage breast cancer. Controversy exists regarding the use of hypofractionated radiation therapy (RT) among patients with CTDs. We evaluated acute and late toxicity in patients with breast cancer and CTD treated with BC. Methods and Materials Of 1983 patients treated with BC from 2012 to 2016, we identified 91 patients with an autoimmune disease (AD). Each patient was matched to a control without AD based on age, RT field, and fractionation. RT toxicity and clinician-rated cosmesis were compared between cases and controls. Overall survival, disease-free survival, and local recurrence-free survival were estimated using the Kaplan-Meier method. Results The median follow-up was 49.9 months for cases and 53.0 months for controls, and 67% of cases and controls were treated with hypofractionated RT. There was no difference in grade 2/3 acute toxicity between cases and controls (26.4% vs. 16.5%, respectively; P = .148). There was a significantly higher rate of grade 2/3 late toxicity among cases (25.8% vs 12.1% among controls; P = .049). Active AD at the time of RT increased the rate of grade 2/3 late toxicity compared with controls (41.7% in cases vs. 11.4% in controls; P = .018). Among patients treated with hypofractionated RT, there was no difference in acute or late grade 2/3 toxicity between cases and controls (acute: 13.1% in cases vs. 11.5% in controls [P > 0.9]; late: 11.9% in cases vs. 13.1% in controls [P > 0.9]). The rates of good/excellent clinician-rated cosmesis were similar between groups (92.9% in cases vs. 98.9% in controls; P = .142). Conclusions In the largest matched case-control study of patients with CTD treated with conventional and hypofractionated RT, we demonstrate low rates of radiation toxicity, with good to excellent clinician-rated cosmesis. There was increased late toxicity in cases, especially in patients with active AD at time of RT. There was no increase in acute or late toxicity in the patients treated with hypofractionation.

PurposeThe purpose of this study is to empirically examine the impact of technology-enabled service co-creation on patients' service patronage behaviour in healthcare retailing. The first objective is to examine the mediating roles of spatial presence and co-presence in the relationship between technology enabled co-creation and service experience. The second objective is to investigate if healthcare service experience impacts patients' relationship value with hospitals and subsequent patronage intention.Design/methodology/approachData were collected from a sample of 516 customers of three leading hospitals in India during the social isolation period of COVID-19. The data were analysed using structural equation modelling.FindingsThe study results demonstrate that customers' favourably perceived technology-enabled co-creation generates feelings of spatial presence and co-presence in the technology-enabled platform. The feeling of presence enhances patients' health care service experiences which in turn predict their relationship value perceptions towards the healthcare service provider. Co-presence dominates as a mediator in terms of magnitude over spatial presence. The favourable value perception positively impacts patients' intention to come back to the same hospital.Research limitations/implicationsThe study uses cross-sectional data, which does not incorporate any temporal variations in the investigated relationships. The study does not account for differences in government vs. private undertakings of healthcare system.Practical implicationsThe findings envisage a digital healthcare retail system, where hospitals can enhance patients' perceptions of healthcare service experience, relational value and re-patronage intention, based on the digital mediated environment design elements, i.e. spatial presence and co-presence. As co-presence is a dominant factor, ensuring that human healthcare experts (rather than technology based e-service elements like chatbots) participate in healthcare service co-creation is of prime importance to provide enriching service experience to the patients.Originality/valueThe value of the research lies in extending the theories of presence, UTAUT and S-O-R to understand digital healthcare retailing, in order to identify the mechanism of how online co-creative platform can generate hospital patronage behaviour among patients through the serial mediation of presence, augmented service experience and relationship value.

Fibroid is the most common tumor encountered during cesarean section. Cesarean myomectomy is a potential option in such cases but it was discouraged in the past due to the fear of intractable intraoperative hemorrhage. We report 3 cases of fibroid uterus during pregnancy in which cesarean myomectomy was performed successfully with no intraoperative and postoperative complications. To minimise intraoperative hemorrhage during myomectomy, diluted vasopressin was used with routine oxytocin infusion. Cesarean myomectomy is a safe procedure and can be performed in selected cases by expert obstetricians at a tertiary care centre. The most worrisome complication is intraoperative hemorrhage which can be minimised with vasopressin, uterotonics, bilateral uterine artery ligation or uterine artery embolisation, and/or bilateral internal iliac artery ligation. Furthermore, it is cost effective being one-time surgery.

This paper describes about implementing absolute battery monitoring system using IoT (Internet of things) for enhanced battery life of BFEV. Cuk converter is used to give ripple less voltage to the battery and also the converter operates in both normal and regenerating modes. The converter is designed as Vs=20V, fs=50kHz with 80% of duty cycle for a 12V battery. For enhanced battery life, proper battery monitoring is important to analyze the battery performance. For SOC determination of battery, voltage method is used to identify the battery status by Proteus simulation software. The main aim is to analyze the sensitivity of the electrochemical model parameters under a real-world driving cycle for not only the terminal voltage, but also the essential states in an ABMS including the smart alerting and notification system through SMS using SIMCOM GSM modem in order to intimate the user regarding the battery level status.

In the Coronavirus circumstance hungry individuals confronting food issues and loads of individuals kicked the bucket in the Coronavirus lockdown by considering this continuous issue we are attempting to give a constant answer for that. We are attempting to construct the system 'Zero Hunger' utilizing ML and IoT innovation with the mission to end food wastage and craving is a food wastage decrease based innovation in which gets surplus food from public capacity café, birthday celebrations show corridors home, and so on and convey to those who are directing NGOs.

Summary The increasing global prevalence of SARS‐CoV‐2 and the resulting COVID‐19 disease pandemic pose significant concerns for clinical management of solid organ transplant recipients (SOTR). Wearable devices that can measure physiologic changes in biometrics including heart rate, heart rate variability, body temperature, respiratory, activity (such as steps taken per day) and sleep patterns, and blood oxygen saturation show utility for the early detection of infection before clinical presentation of symptoms. Recent algorithms developed using preliminary wearable datasets show that SARS‐CoV‐2 is detectable before clinical symptoms in >80% of adults. Early detection of SARS‐CoV‐2, influenza, and other pathogens in SOTR, and their household members, could facilitate early interventions such as self‐isolation and early clinical management of relevant infection(s). Ongoing studies testing the utility of wearable devices such as smartwatches for early detection of SARS‐CoV‐2 and other infections in the general population are reviewed here, along with the practical challenges to implementing these processes at scale in pediatric and adult SOTR, and their household members. The resources and logistics, including transplant‐specific analyses pipelines to account for confounders such as polypharmacy and comorbidities, required in studies of pediatric and adult SOTR for the robust early detection of SARS‐CoV‐2, and other infections are also reviewed.

Penetrating trauma to the thorax involving the heart is usually fatal. Discovery and management of intrathoracic missiles especially in the close vicinity of the heart is a major challenge. Retained intracardiac missiles are exceptionally unusual, and there are 322 reported cases over 60 years, from 1940 to 2009.1 We present two patients who presented with penetrating gunshot wounds to the chest with retained intracardiac bullets. The management of hemodynamically stable patients with retained intrapericardial foreign body remains controversial. Management options of thoracic firearm injuries are based on patient stability, course and location of the missile. We report our experience of two patients with delayed presentation of a retained intrapericardial bullet from firearm injuries. In this paper, we discuss the management strategies of such injuries in light of the available literature and summarize our clinical experience.

Background: Oral submucous fibrosis is a treacherous, devastating state of the mouth bringing about critical wellbeing and social issues, which may meddle with the standard assessment of the oral depression for malignancy, satisfactory nourishing admission, dental cleanliness and discourse. Medicines proposed for OSMF have been palliative instead of remedial. They are pointed toward improving the patient’s capacity to open the mouth, which becomes confined when more scar tissue is shaped as the illness advances. Various unions are accessible today to cover the post fibrotic discharge deformity however none of them alone gave a drawn out victories. In our investigation we looked at two modalities as they were generally advantageous and convey less postoperative morbidity. Collagen sheet as a join to cover the careful deformity and the buccal cushion of fat turned onto the imperfection as a unite to cover it. Aims and Objectives: The current investigation was led to assess the clinical viability of collagen film and buccal cushion of fat join for careful administration of Oral Submucous fibrosis with extraction of third molars, two-sided coronoidotomy, masticatory muscle myotomy with arrival of fibrosis and remaking by collagen layer unite in five patients and buccal fat cushion join in five patients of clinically analyzed stage III, IV Oral Submucous fibrosis with a subsequent time of a half year from September 2010 to September 2012 at Department of Oral and maxillofacial Surgery in Al Badar Rural Dental College and Hospital. Materials and Methods: Ten patients with chief complaint of difficulty in mouth opening with no previous history of any medical or surgical line of treatment and clinically diagnosed as stage III, IV Oral submucous fibrosis were included in this study. Preoperative clinical findings, radiological investigations and maximum incisal distance were assessed for the need of surgical procedure for Oral submucous fibrosis. All the patients u

Objective: Male infertility refers to a male’s inability to cause pregnancy in a fertile female. Infertility is a widespread problem for about one in five infertile couples. Male infertility is usually caused by a problem that affects either sperm production or sperm transport. The aim of the study was to evaluate prolactin levels in the serum and comparing the levels of fructose in the semen of infertile males and normal healthy controls of reproductive age of 20–45 years respectively. Methods: Hemoglobin (Hb) level in the blood of both groups was calculated by Sahli’s method using Sahli’s Hemoglobinometer. The Erythrocyte Sedimentation Rate (ESR) was determined using the modified Westergren’s method and total leukocyte count (TLC) in the blood was determined by microdilution method. Semen analysis was performed by the method specified in the World Health Organization Laboratory Manual. Morphology and motility of sperm and their counts were determined by microscopy. Fructose drop test in semen was estimated colorimetrically by the Semen Fructose Estimation Kit and determination of serum prolactin involved the use of Electrochemiluminescence immunoassay using Cobas e 411 analyzer. Results: Hb in infertile males was less than healthy controls. However, ESR in infertile men was considerably high and TLC, serum prolactin levels did not show much variation in infertile men. Seminal analysis of infertile men revealed high fructose levels and low sperm count with decreased motility. Conclusion: The concentration of seminal fructose in control group is lower than infertile males. High fructose levels in infertile men and less sperm count indicate oligozoospermia.

Introduction: Enteric fever continues to carry a high burden of morbidity and mortality in India. There have been reports of emergence of ceftriaxone resistant typhoidal Salmonella from Asia. Monitoring of antimicrobial resistance trends in typhoidal Salmonella is crucial to support in clinical decision making. Aim: To study the current susceptibility pattern of typhoidal salmonella isolates in our setup. Methods: This retrospective study was conducted on 144 non-repeat blood-culture isolates of S. Typhi, and S. Paratyphi A obtained from 3926 blood cultures received at 510-bedded tertiary-care hospital of North-India from 2017-2019. Identification and antibiograms were obtained by Vitek-2 compact and Kirby-Bauer’s disc diffusion with sensitivity to azithromycin, and chloramphenicol. Result: S. Typhi and S. Paratyphi A in a ratio of 5.2:1 were seen between months of June and July predominantly distributed between 1-10 years age group. S. Typhi resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 21.4%, 25.6%, 12.3% and 28% respectively. S. Paratyphi A resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 4.3%, 17.3%, 34.7% and 21.7% respectively. Conclusion: Enteric-fever is a major public-health problem in India. Emergence of ceftriaxone-resistant Salmonella mandates appropriate investigation of all febrile illnesses with blood culture whenever possible. Provision of safe drinking water, good sanitation, hygiene and vaccination strategies are needed to sustain herd-immunity. How to cite this article:Taneja J, Khatter S, Paul M, Pandey A, Kaur I. Antimicrobial Resistance in Typhoidal Salmonella in a Tertiary Care Teaching Centre in North India. J Commun Dis 2021; 53(1): 1-4. DOI: https://doi.org/10.24321/0019.5138.202101

BACKGROUND Sepsis remains an important cause of hospitalisation and mortality worldwide among patients admitted in intensive care units (ICU). Due to increasing mortality and morbidity of sepsis early diagnosis and treatment are essential. This can be achieved with the help of biomarkers–haematological and inflammatory i.e., C-reactive protein (CRP) and pro calcitonin (PCT). They are found to be highly sensitive and useful markers for early detection and management of sepsis. METHODS This is a cross-sectional study conducted from May 2019 to March 2020 in the Department of Biochemistry, ESI Hospital, Okhla. A total of 104 subjects were recruited for the study. Of them, 52 subjects were healthy controls, and 52 cases were ICU patients. Samples were taken to evaluate differential leucocyte count (DLC), red cell distribution width standard deviation (RDW SD), platelet count (PLT), absolute neutrophil count (ANC) and platelet crit as haematological markers whereas Creactive protein, fibrinogen and pro calcitonin indices were chosen as inflammatory. markers. RESULTS There was significant increase in the TLC (21583.51 ± 2240.36), total neutrophil count (7889.48 ± 1482.83), immature neutrophil (2.97 ± 1.67), fibrinogen levels (518.07 ± 66.74), CRP (0.048 ± 0.01) and pro calcitonin levels (0.062 ± 0.22) of the cases as compared to the healthy controls. The platelet count was observed to be higher in healthy subjects as compared to the patients in ICU. CONCLUSIONS The study results showed that clinical examination along with laboratory testing which include hematologic and inflammatory biomarkers is the most effective combination of parameters for rapidly and accurately predicting or diagnosing sepsis in a critically ill patient. KEY WORDS Sepsis, Haematological, Inflammatory, CRP, PCT, Fibrinogen

Aggressive posterior retinopathy of prematurity (APROP) is the most severe form of retinopathy of prematurity (ROP), with rapid progression to tractional retinal detachment. Exudative retinal detachment (ERD) has rarely been described as a primary presentation in ROP. We present a case of unlasered zone 1 APROP in a 34-week infant presenting with bilateral ERD, which was treated with intravitreal ranibizumab. After injection, the left eye developed acute endophthalmitis, which was managed by intravitreal antibiotic therapy and early vitrectomy. Subsequent laser photocoagulation of the avascular areas resulted in regression of ROP. This case highlights the role of intravitreal anti-vascular endothelial growth factor in treating ERD in APROP and the need for close observation for endophthalmitis after injection.

Development without any defect is unsubstantial. Timely detection of software defects favors the proper resource utilization saving time, effort and money. With the increasing size and complexity of software, demand for accurate and efficient prediction models is increasing. Recently, search-based techniques (SBTs) have fascinated many researchers for Software Defect Prediction (SDP). The goal of this study is to conduct an empirical evaluation to assess the applicability of SBTs for predicting software defects in object-oriented (OO) softwares. In this study, 16 SBTs are exploited to build defect prediction models for 13 OO software projects. Stable performance measures — GMean, Balance and Receiver Operating Characteristic-Area Under Curve (ROC-AUC) are employed to probe into the predictive capability of developed models, taking into consideration the imbalanced nature of software datasets. Proper measures are taken to handle the stochastic behavior of SBTs. The significance of results is statistically validated using the Friedman test complied with Wilcoxon post hoc analysis. The results confirm that software defects can be detected in the early phases of software development with help of SBTs. This paper identifies the effective subset of SBTs that will aid software practitioners to timely detect the probable software defects, therefore, saving resources and bringing up good quality softwares. Eight SBTs — sUpervised Classification System (UCS), Bioinformatics-oriented hierarchical evolutionary learning (BIOHEL), CHC, Genetic Algorithm-based Classifier System with Adaptive Discretization Intervals (GA_ADI), Genetic Algorithm-based Classifier System with Intervalar Rule (GA_INT), Memetic Pittsburgh Learning Classifier System (MPLCS), Population-Based Incremental Learning (PBIL) and Steady-State Genetic Algorithm for Instance Selection (SGA) are found to be statistically good defect predictors.

Mineral and bone disorder (MBD) and growth impairment are common complications of pediatric chronic kidney disease (CKD). Chronic inflammation detrimentally affects bone health and statural growth in non-CKD settings, but the impact of inflammation on CKD-MBD and growth in pediatric CKD remains poorly understood. This study assessed associations between inflammatory cytokines with biomarkers of CKD-MBD and statural growth in pediatric CKD. This is a cross-sectional study of children with predialysis CKD stages II–V. Cytokines (IL-1b, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, TNF-α, interferon-γ), bone alkaline phosphatase (BAP), and procollagen type 1 N-terminal propeptide (P1NP) were measured at the same time as standard CKD-MBD biomarkers. Associations between cytokines, CKD-MBD biomarkers, and height z-score were assessed using linear regression analysis. Among 63 children, 52.4% had stage 3 CKD, 76.2% non-glomerular CKD etiology, and 21% short stature. TNF-α was the only cytokine associated with parathyroid hormone (PTH) independent of glomerular filtration rate. After stratification by low, medium, and high TNF-α tertiles, significant differences in PTH, serum phosphorus, alkaline phosphatase, BAP, P1NP, and height z-score were found. In a multivariate analysis, TNF-α positively associated with phosphorus, PTH, and alkaline phosphatase and inversely associated with height z-score, independent of kidney function, age, sex, and active vitamin D analogue use. TNF-α is positively associated with biomarkers of CKD-MBD and inversely associated with height z-score, indicating that inflammation likely contributes to the development of CKD-MBD and growth impairment in pediatric CKD. Prospective studies to definitively assess causative effects of inflammation on bone health and growth in children with CKD are warranted.

In this paper, 2 D hexagonal photonic nano crystal cavity is structured and simulated after infiltrating hemoglobin and urine samples for refractive index biosensing application. The proposed senso...

Transition metal oxides (TMOs) have gained interest in photovoltaic community for their usages as dopant-free carrier-selective contacts in silicon based solar cells. TMOs such as MoOx, WOx, V2Ox, NiOx with high work function are used as hole-selective contacts whereas TiO2, ZnO are used as electron-selective contacts. We have fabricated solar cells using molybdenum trioxide (MoO3-x, x 88% in visible region and have band gap of 3.43 eV. As molybdenum trioxide has high work function ∼6.6 eV, it helps in the transport of holes in this structure. We have achieved power conversion efficiency of 4.44%, current density 28.44 mA/cm2 and open-circuit voltage 391 mV. Further optimization of processing parameter is necessary to improve the performance of these solar cells.

Background Infections are a common cause of childhood stroke with variable presentation. The current case describes a rare infective cause of venous and arterial stroke in an immunocompetent girl with management implications. Case description A 12 year old girl, presented with history of fever for 10 days, painful swelling of right eye for 7 days and altered sensorium for 2 days. On examination, she had right eye orbital cellulitis and fullness of right paranasal area. On nervous system examination, she was delirious, had right eye ophthalmoparesis, left upper motor neuron facial palsy and signs of meningeal inflammation. Her contrast enhanced CT head and subsequent MRI brain with arteriography and venography revealed right cavernous sinus and distal internal carotid artery thrombosis. She was started on intravenous ceftriaxone and vancomycin and subcutaneous heparin. In view of persistent symptoms, endoscopic debridement of right nasal cavity was done, which showed growth of aspergillus flavus. Subsequently, she was started on intravenous voriconazole. Within a week, she was afebrile, her inflammatory and neurological signs started improving. She was discharged after 3 weeks of intravenous voriconazole which was continued for 3 more weeks orally. Her procoagulant and immunodeficiency work up were normal. At 4 months follow up, she showed both clinical and radiological resolution. Conclusions Despite high mortality described in sino-orbital aspergillosis, early and appropriate treatment led to optimal outcome. In deep seated infections, isolation of etiological organism should be attempted, particularly when patient doesn’t respond to conventional antimicrobial therapy.

Background: Tobacco use is responsible for 3 million deaths globally every year. Tailored counseling by a specialist increases quit rates additionally by 4%–7% compared to normal. Now, tobacco cessation is a part of oral health assessment. Hence, brief advice from dental health professionals as part of their routine consultations or interactions is an approach that makes use of existing health-care systems. Purpose: A study was carried out among the dental professionals of Bhopal to assess their knowledge, preparedness, and perceived barriers regarding tobacco cessation counseling. Materials and Methods: A cross-sectional questionnaire study was conducted among dental professionals which include academicians (Group 1), clinicians (Group 2), and both clinicians and academicians (Group 3) of Bhopal City over a period of 3 month's from May to July 2019. Two-hundred dental professionals were approached, in which 145 participated in the study. Self-administered structured, semi-open, and coded questionnaire was mailed to them and analysis was done. Results: The findings of the study suggest that almost all the groups agreed that they have a role in helping patients regarding tobacco cessation. Our study has overcome all the perceived barriers as 75.9% of Group 3 professionals got positive feedback from the patients after counseling and 70.9% of academicians feel chances of quitting tobacco have increased after they advised the patient to quit the habit, but 42.9% of Group 3 professionals think that they don't get time to counsel patients. Conclusion: As concluded in our study, Group 3 dental professionals (both academicians and clinicians) have better knowledge and actively participate in cessation of patients as compared to academicians and clinicians. Hence, there is an urgent need to sensitize and train clinicians and academicians at community and institutional levels.

Purpose: We examined whether patients are appropriately screened for previous prolonged erections or priapism and counseled about trazodone complications, specifically prolonged erections and priapism, prior to trazodone treatment. Materials and Methods: We identified patients under the age of 50 on trazodone as of February 27, 2019 at the VA New Jersey Health Care System. Patients were asked about information provided to them prior to medication initiation, occurrence of prolonged erections/priapism, and reporting rate of side effects. Results: Two hundred and twenty nine out of five hundred and twenty four male patients agreed to participate in the study. Forty three out of two hundred and twenty nine of patients were informed about the side effects of prolonged erections and 37/229 of patients were informed of risk of priapism prior to treatment. Only 17/229 of patients were asked if they had had any episodes of prolonged erection or priapism in the past. Eighteen patients developed prolonged erection while taking trazodone. Only 5/18 patients who had developed prolonged erections informed their physicians. Conclusions: Only a fraction of patients were properly screened for previous prolonged erections or priapism and properly informed about the side effects of trazodone. Urologist should better educate trazodone prescribers, such as family medicine and psychiatric colleagues, regarding the side effects of trazodone. It is imperative that prescribing physicians appropriately screen and educate patients prior to trazodone initiation and instruct patients to report any treatment side effects to avoid potential long-term adverse outcomes.

Background: Oral and perioral piercing when performed under unhygienic conditions, can cause certain complications. Hence, a study was conducted in dental colleges of Davanagere city among postgraduate students with the aim to assess their knowledge and attitude towards oral and peri-oral piercing.Methods: Across-sectional survey involved 212 dental postgraduate students of dental colleges in Davanagere city who consented to participate. A pretested, validated, self-administered questionnaire containing 15 multiple-choice items assessing the postgraduate students’ knowledge and attitude towards oral and peri-oral piercing practices was used for data collection. Data was presented in the form of frequencies and percentages.Results: Participants had fair knowledge regarding oral and perioral piercing. Majority of participants (75%) felt oral and peri-oral piercing practices as a sign of style /fashion statement. Around 45-50% felt tongue piercing and nose piercing (66%) as most prevalent type among oral and perioral piercing practices and canine was the most preferred tooth for piercing (43%). Majority (55%) felt that piercing practices were performed by unlicensed people. Many (79%) were aware of complications associated with piercing and suggested removal of pierced metal in such conditions (58%). Around 76.7% said they preferred Cosmetic dentist for piercing and 94% felt that dentists with oral and perioral piercing strongly influence the perception of their patients towards oral piercing.Conclusion: Dental postgraduates had fair knowledge regarding oral and peri-oral piercing practice and its possible complications. However, the attitude towards the practice which is highly prevalent in the society was affirmative and positive among postgraduates which is a cause of concern.

Aim: To evaluate the choroidal thickness in patients with different refractive status measured by spectral-domain optical coherence tomography. Material and methods: This cross-sectional observational study consisted of 60 subjects, who visited the out-patient department of Ophthalmology, Chattrapati Shivaji Subharti Hospital, Meerut, India and were randomly selected over a period of 1 year. Subjects were classified into three groups based on refractive error: those with a +1 diopter or greater refractive power were assigned to the hyperopia group; those with a diopter lower than +1 and greater than –1 were assigned to the emmetropia group; and those with a –1 diopter or lower diopter were assigned to the myopia group. All patients underwent a clinical history taking and a complete ophthalmic examination. OCT scanning was performed using Optovue RTvue 100 which utilises spectral domain (SD)-OCT. The choroid was visualized by enhanced depth imaging (EDI) technique. Choroidal scans were obtained for all the eyes using enhanced depth imaging (EDI) using spectral-domain optical coherence tomography (SD-OCT). Data was recorded in excel sheet and subjected to statistical analysis. Results: Compared to emmetropic participants, myopic subjects had significantly thinner choroid in all the regions. Choroid of hyperopic subjects was significantly thicker than that of emmetropic subjects in most regions. Linear correlation testing revealed a close correlation between refractive error and choroidal thickness in all of the regions. Conclusion: High myopes have significantly thinner choroids than the emmetropic controls at all the retinal points studied, with the thinnest choroid at 1.5 mm nasal to the fovea.

It is of interest to document data on the push – out bond strength of three different root canal treatment sealers such as MTA Fillapex (MTA based), AH plus (Epoxy Resin based) and Apexit plus (Calcium hydroxide based). Forty-five freshly extracted human maxillary central incisors with closed apices were selected randomly. All the teeth were sectioned at cement-enamel junction using a diamond disc before starting the root canal preparation to obtain root length of 12 mm. All teeth were instrumented using ProTaper rotary instruments. 5.25% sodium hypoclorite was used for irrigation between instrumentation followed by 17% EDTA, and final rinse by saline. Obturation procedures were done using the gutta-percha single cone technique. 45 roots were randomly assigned to 3 groups of 15 for obturation with gutta-percha cones and 1 of the 3 sealers (n=15). Group 1 = MTA Fillapex sealer + gutta-percha: Group 2 = AH plus sealer + gutta-percha: Group 3 = Apexit plus sealer + gutta-percha. The roots were sectioned horizontally to its canal into 3 sections: Coronal, Mid-root and Apical-thirds using a precision cutting machine, with a thickness of 3 mm. The specimens were subjected to push-out test using a universal testing machine that carried a plunger. The loading speed was 1mm/min until the dislodgment of the material occurred. The independent t- test was used to compare the mean scores among the study groups. The level of significance was set at 5% for all tests. After the push-out bond strength test, each sample was evaluated under stereomicroscope (40x) to determine the mode of failure and recorded as one of the following categories: adhesive, cohesive or mixed. The observations thus obtained were subjected to statistical analysis using Student - t test. AH Plus showed significantly higher values than MTA Fillapex and Apexit plus (p < 0.05). Amongst the push-out bond strength AH Plus sealer showed significant difference from MTA Fillapex and Apexit plus groups. There was no significant difference between MTA Fillapex and Apexit plus however (p>0.05). Microscopic analysis displayed that the majority of the modes were cohesive failures for AH Plus, adhesive failures for MTA Fillapex and mixed failures for Apexit Plus. . Thus, AH Plus had the highest bond strength and MTA Fillapex had the lowest bond strength to root dentin. Mean push-out bond strength values were ranked as follows; AH Plus >Apexit Plus > MTA Fillapex. Microscopic analysis displayed that the majority of the modes were cohesive failures of AH Plus, adhesive failures for MTA Fillapex and mixed failures for Apexit Plus.

Aim: The aim of this study is to evaluate the change in the position of hyoid bone, pharyngeal airway, and tongue position in subjects with skeletal Class II malocclusion treated with Twin block therapy. Materials and Methods: This study was performed on pre and post treatment lateral cephalograms of 21 patients with class II malocclusion treated with Twin block appliance, (mean age of (12.24± 1.22). Paired-t test was used to compare the amount of differences of mean value before and after treatment. A value of P

Development of drought-tolerant cultivars is one of the challenging tasks for the plant breeders due to its complex inheritance and polygenic regulation. Evaluating genetic material for drought tolerance is a complex process due to its spatiotemporal interactions with environmental factors. The conventional breeding approaches are costly, lengthy, and inefficient to achieve the expected gain in drought tolerance. In this regard, genomics-assisted breeding (GAB) offers promise to develop cultivars with improved drought tolerance in a more efficient, quicker, and cost-effective manner. The success of GAB depends upon the precision in marker-trait association and estimation of genomic estimated breeding values (GEBVs), which mostly depends on coverage and precision of genotyping and phenotyping. A wide gap between the discovery and practical use of quantitative trait loci (QTL) for crop improvement has been observed for many important agronomical traits. Such a limitation could be due to the low accuracy in QTL detection, mainly resulting from low marker density and manually collected phenotypes of complex agronomic traits. Increasing marker density using the high-throughput genotyping (HTG), and accurate and precise phenotyping using high-throughput digital phenotyping (HTP) platforms can improve the precision and power of QTL detection. Therefore, both HTG and HTP can enhance the practical utility of GAB along with a faster characterization of germplasm and breeding material. In the present review, we discussed how the recent innovations in HTG and HTP would assist in the breeding of improved drought-tolerant varieties. We have also discussed strategies, tools, and analytical advances made on the HTG and HTP along with their pros and cons.

Background Establishment and improvement of glomerular filtration rate estimating equations requires accurate and precise laboratory measurement procedures (MPs) for filtration markers. The Advanced Research and Diagnostic Laboratory (ARDL) at the University of Minnesota, which has served as the central laboratory for the Chronic Kidney Disease Epidemiology Collaboration since 2009, has implemented several quality assurance measures to monitor the accuracy and stability of filtration marker assays over time. Methods To assess longitudinal stability for filtration marker assays, a 40-sample calibration panel was created using pooled serum, divided into multiple frozen aliquots stored at −80 °C. ARDL monitored 4 markers—creatinine, cystatin C, beta-2-microglobulin (B2M) and beta-trace protein—measuring 15 calibration panel aliquots from 2009 to 2019. Initial target values were established using the mean of the first 3 measurements performed in 2009–10, and differences from target were monitored over time. New MPs for cystatin C and B2M were added in 2012, with target values established using the first measurement. Results The mean percentage difference from mean target values across time was Conclusions Close monitoring of filtration marker trends with a calibration panel at ARDL demonstrates remarkable long-term stability of the MPs. Routine use of a calibration panel for both research studies and clinical care is recommended for filtration markers where longitudinal monitoring is important to detect analytical biases, which can mask or confound true clinical trends in patients.

Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.

Nowadays, the heart-related disease is rapidly rising. Most patients, in some cases, may not identify their health condition. Even in rural areas, doctors are not available 24x7. Due to the advancement of modern technology, these diseases can be detected early and can be treated on time. So, the developed device can continuously track the patient's heartbeat and temperature, and the recorded data can be sent to the concerned doctor so that treatment can be provided to the patient. Here the IoT (Internet of Things) is being used for monitoring the patient's health status and send wirelessly to the IoT server. This device can also be monitored from remote places. This device is mainly helpful for aged and disabled people who find it difficult to go to doctors daily or for patients who need continuous monitoring of their health status. The designed hardware will capture the real-time heartrate and temperature value and send the data to the concern IoT server using any mobile or Wi-Fi network having with internet facility. Before sending the data the preprocessing is being done by the attached microcontroller in the respective sensors module. The value sent in the IoT server will be used for generating the online graph through the Application Program Interface (API) that are used in developing the web and mobile application. In this system the authenticated user can view the output trough developed mobile application web application.

Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH)2 D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH)2 D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).

Summarise outcomes following cochlear implantation (CI) in patients with post-meningitis deafness. Systematic review and narrative synthesis. Databases searched: Medline, Pubmed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Studies with a minimum of 20 individuals with post-meningitis deafness were included. Review conducted in accordance with the PRISMA statement. Searches identified 906 abstracts and 291 full texts. Of these, 19 studies met the inclusion criteria, reporting outcomes in 610 patients with 650 implants. Audiological outcomes improved across all studies following cochlear implantation. 7 studies demonstrated a statistically significant difference between pre and post-CI outcomes. Patients with no cochlear ossification, full electrode insertion, shorter duration of deafness and no neurological sequelae generally appeared to perform best. A total of 31 minor and 19 major complications were reported, with 15 cases of reimplantation. The methodological quality of the included studies was sufficient, predominantly consisting of cohort studies. 15 studies were OCEBM grade III and 4 studies were OCEBM grade IV. All studies had a minimum of 20 individuals with post-meningitic deafness and used multi-channel cochlear implant devices. Audiological outcomes following cochlear implantation in meningitis are satisfactory, providing functional levels of speech perception and intelligibility. Improvement in hearing is dependent on the amount of cochlear ossification, duration of deafness prior to implantation, electrode insertion depth and presence of neurological sequalae. Cochlear implantation in meningitis patients can be challenging due to the presence of ossification and inaccuracies of pre-operative imaging. Therefore, early and bilateral implantation is recommended in all patients with post-meningitis hearing loss to improve the likelihood of full electrode insertion.

© 2020 The Authors. Research Synthesis Methods published by John Wiley & Sons Ltd. The involvement of non-researcher contributors (eg, stakeholders, patients and the public, decision and policy makers, experts, lay contributors) has taken a variety of forms within evidence syntheses. Realist reviews are a form of evidence synthesis that involves non-researcher contributors yet this practice has received little attention. In particular, the role of patient and public involvement (PPI) has not been clearly documented. This review of reviews describes the ways in which contributor involvement, including PPI, is documented within healthcare realist reviews published over the last five years. A total of 448 papers published between 2014 and 2019 were screened, yielding 71 full-text papers included in this review. Statements about contributor involvement were synthesized across each review using framework analysis. Three themes are described in this article including nomenclature, nature of involvement, and reporting impact. Papers indicate that contributor involvement in realist reviews refers to stakeholders, experts, or advisory groups (ie, professionals, clinicians, or academics). Patients and the public are occasionally subsumed into these groups and in doing so, the nature and impact of their involvement become challenging to identify and at times, is lost completely. Our review findings indicate a need for the realist review community to develop guidance to support researchers in their future collaboration with contributors, including patients and the public.

Objectives Overdiagnosis of urinary tract infections (UTI) among people living with dementia is a nationally recognized problem associated with morbidity from antibiotics as well as multidrug‐resistant bacteria. However, whether this problem also exists in the emergency department (ED) is currently unknown. Methods To examine the association between dementia and UTI diagnosis in the ED we performed a retrospective analysis of Medicare beneficiaries older than 65 years old who presented to an ED in 2016. A diagnosis of UTI was present in 58,580 beneficiaries, and 321,479 beneficiaries without a diagnosis of UTI served as the comparison group. Our logistic regression model controlled for dementia, older age, female sex, Medicaid status, skilled nursing facility residence, history of prostate cancer, recent urinary catheter use, recurrent UTI, and multiple comorbidities. Results In our model, people living with dementia had over twice the odds (odds ratio = 2.27, 95% confidence interval = 2.21, 2.33) of being diagnosed with a UTI in the ED compared to those without dementia despite their lower prevalence of symptoms and signs localizing to the genitourinary tract (3.8% vs 8.9%, respectively). Conclusion This is the first study from a national database that examines the association of dementia with UTI diagnosis among older adults who visit the ED. Our study could not establish whether the UTI diagnoses in the ED were accurate but does imply a disproportionate burden of UTI diagnoses in people living with dementia despite their lower prevalence of clinical criterion. Antimicrobial stewardship in the ED should address the complexity of UTI diagnosis in dementia.

Hepatocellular carcinoma (HCC) occurs in chronic liver disease, most often secondary to viral hepatitis. There is as increasing incidence of HCC in HIV patients independent of viral hepatitis, implicating HIV as a direct cause of underlying chronic liver disease. In this report, the first case of a ruptured HCC in an HIV positive patient with underlying chronic liver disease not due to hepatitis is presented.