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Background The best surgical treatment for adult Chiari malformation type 1 remains widely debated. Objective This study aimed to assess the efficacy of posterior fossa decompression and duraplasty with arachnoid preservation compared with arachnoid dissection for the treatment of adult Chiari malformation type 1. Methods Two reviewers (M.O.-G. and M.A.) performed a PubMed, MEDLINE, and Embase literature search using the following terms: (“Chiari” OR “Chiari 1”) AND (“duraplasty” OR “arachnoid preservation” OR “arachnoid spar∗” OR “posterior fossa surgery” OR “posterior fossa decompression” OR “foramen magnum decompression”). Studies assessing the efficacy of posterior fossa decompression with duraplasty for the treatment of patients aged >18 years with Chiari malformation type 1 were included. Case reports with Results Of 195 studies identified, 24 were included for meta-analysis. In the 1006 participants, there was no difference in postoperative clinical or radiologic improvement between the 2 techniques. Patients who underwent posterior fossa decompression with duraplasty and arachnoid dissection had a greater prevalence of total complications (0.20, 95% confidence interval [CI], 0.13–0.29 vs. 0.09, 95% CI, 0.05–0.14; Q = 6.47; P = 0.01) and cerebrospinal fluid–related complications (0.15, 95% CI, 0.10–0.22 vs. 0.05, 95% CI, 0.02–0.12; Q = 4.88; P = 0.03) compared with arachnoid preservation. Furthermore, the prevalence of reoperation in the arachnoid dissection group was 25 times greater than in the arachnoid preservation group (0.08, 95% CI, 0.06–0.10 vs. 0.003, 95% CI, 0.00–0.02; Q = 10.73; P > 0.001). Conclusions Posterior fossa decompression and duraplasty with arachnoid preservation is a beneficial technique to treat Chiari malformation type 1 and reduces the risk of complications, particularly cerebrospinal fluid–related complications and the rate of reoperation.

Background Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with whiplash injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. Methods We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planned methods of reporting. Discussion This paper will provide a detailed description of the planned analyses for the Whiplash ImPaCT trial.

Introduction: Cauda equina syndrome (CES) has significant medical, social, and legal consequences. Understanding the number of people presenting with CES and their demographic features is essential for planning healthcare services to ensure timely and appropriate management. We aimed to establish the incidence of CES in a single country and stratify incidence by age, gender, and socioeconomic status. As no consensus clinical definition of CES exists, we compared incidence using different diagnostic criteria. Methods: All patients presenting with radiological compression of the cauda equina due to degenerative disc disease and clinical CES requiring emergency surgical decompression during a 1-year period were identified at all centres performing emergency spinal surgery across Scotland. Initial patient identification occurred during the emergency hospital admission, and case ascertainment was checked using ICD-10 diagnostic coding. Clinical information was reviewed, and incidence rates for all demographic and clinical groups were calculated. Results: We identified 149 patients with CES in 1 year from a total population of 5.4 million, giving a crude incidence of 2.7 (95% CI: 2.3–3.2) per 100,000 per year. CES occurred more commonly in females and in the 30–49 years age range, with an incidence per year of 7.2 (95% CI: 4.7–10.6) per 100,000 females age 30–39. There was no association between CES and socioeconomic status. CES requiring catheterization had an incidence of 1.1 (95% CI: 0.8–1.5) per 100,000 adults per year. The use of ICD-10 codes alone to identify cases gave much higher incidence rates, but was inaccurate, with 55% (117/211) of patients with a new ICD-10 code for CES found not to have CES on clinical notes review. Conclusion: CES occurred more commonly in females and in those between 30 and 49 years and had no association with socioeconomic status. The incidence of CES in Scotland is at least four times higher than previous European estimates of 0.3–0.6 per 100,000 population per year. Incidence varies with clinical diagnostic criteria. To enable comparison of rates of CES across populations, we recommend using standardized clinical and radiological criteria and standardization for population structure.

Self-reported cross-sectional data for the Australian cohort participating in the International Spinal Cord Injury Community survey. To contextualise post-injury employment for people with spinal cord injury (SCI) in Australia, including work participation rates, time to resuming work, underemployment and pre- and post-SCI employment changes. Australian survey data from four state-wide SCI services, one government insurance agency and three not-for-profit consumer organisations across New South Wales, Queensland, South Australia and Victoria. Data were analysed from 1579 participants with SCI who are at least 1-year post discharge from an inpatient facility. Survey measures included 16-items dedicated to employment. Pre- and post-injury job titles were based on the International Standard Classification of Occupations (ISCO-08) major classification. A mix of chi-squared, t-test and negative binomial regression were used to analyse data. The absolute post-injury employment rate was 49.9%, with one-third of the sample currently working. Pre-injury employment and engagement with vocational rehabilitation resulted in higher employment rates. Individuals who were unable to return immediately following inpatient rehabilitation took mean 28 months (SD, 35.9) to return. Time to employment was significantly lengthier for those without pre-injury jobs, at 59.7 months [SD, 43.8] (p

A study was conducted to investigate the effects of chemical treatment in characterizing the tensile strength, durability, and application of untreated/treated coir geotextile in low-volume roads. ...

The 2014–2016 El Nino Southern Oscillation (ENSO) caused a prolonged marine heatwave that led to widespread coral bleaching and mortality across the Indo-pacific coral reefs. Prediction of coral bl...

Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into "positive" or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with "outcomes" to better inform management of mental health after SCI.

T-cell acute lymphoblastic leukemia (T-ALL) is a genetically heterogeneous disease, characterized by an abnormal transformation of T cells into highly proliferative leukemic lymphoblasts. Identification of common genetic alterations has provided promising opportunities for better risk stratification in T-ALL. Current treatment in T-ALL still poses the major challenge of integrating the knowledge of molecular alterations in the clinical setting. We utilized the Multiplex Ligation Dependent Probe Amplification (MLPA) method to determine the frequency of common copy number alterations (CNAs) in 128 newly diagnosed T-ALL patients. We also studied the association of these CNAs with patient's clinical characteristics and survival. The highest frequency of deletion was observed in CDKN2A (59.38%), followed by CDKN2B (46.88%), LMO1 (37.5%), and MTAP (28.12%). PTPN2 (22.66%), PHF6 (14.06%), and MYB (14.06%) had the highest number of duplication events. A total of 89.06% patients exhibited CNAs. STIL::TAL1, NUP214::ABL1, and LMO2::RAG2 fusions were observed in 5.47%, 3.12%, and 0.78% of patients, respectively. CDKN2A, CDKN2B, and PTPN2 gene deletions were mainly observed in pediatric patients, while CNAs of NF1 and SUZ12 were observed more frequently in adults. In pediatric patients, alterations in CDKN2B, CASP8AP2, and AHI1 were associated with poor prognosis, while SUZ12 and NF1 CNAs were associated with favorable prognosis. In adult patients, ABL1 CNA emerged as an independent indicator of poor prognosis. The observed molecular heterogeneity in T-ALL may provide the basis for variations observed in clinical response in T-ALL and MLPA based CNA detection may help in risk stratification of these patients.

Background: Inequality in health is a prevalent and growing concern among countries where people with disabilities are disproportionately affected. Unmet healthcare needs explain a large part of the observed inequalities between and within countries; however, there are other causes, many non-modifiable, that also play a role.Aim: This article explores the difference in health across income levels in populations with spinal cord injury (SCI). SCI is of special interest in the study of health systems, as it is an irreversible, long-term health condition that combines a high level of impairment with subsequent comorbidities. Methods: We analyzed the importance of modifiable and non-modifiable factors related to inequalities through a direct regression approach to decomposing socioeconomic health inequality. We used two health outcomes: years after injury and a comorbidity index. Data come from the International Spinal Cord Injury Survey (InSCI), which include 22 countries around the world. Results: The results show that for the years after injury, the differences are mainly explained by the age of the injury of the participants (non-modifiable factor). However, for the comorbidities, modifiable factors as unmet healthcare needs and cause of the injury explain most inequalities observed. Results vary by country exhibiting a prevalence of pro-rich inequalities which means better health outcomes are observed in high-income groups.Conclusions: The probability to suffer and injury or accident, and the provisions of health services are not equally between and within countries, and even in high-income countries, the presence of inequality is still a problem, especially in vulnerable populations like people with SCI. To reduce inequity, it is important not only to address problems from public health but from inequalities of opportunities, risks and income in the population.

Prothymosin-α (PTMA), a nuclear protein, is strikingly associated with unfavorable clinical outcomes in many cancers. However, no information about its clinical relevance in glioma was available. Therefore in the present study, we evaluated the prognostic utility of this protein in a cohort of 81 glioma patients. The PTMA expression was assessed by immunohistochemical analysis, quantitative PCR, and Western blotting. Furthermore, the association of PTMA with clinicopathological features and molecular alterations were assessed in the patient cohort and validated in multiomics datasets, The Cancer Genome Atlas (TCGA; n=667) and Chinese Glioma Genome Atlas (CGGA; n=1013). We observed an increase in PTMA expression with increasing histological grades of this malignancy. PTMA immunostaining also displayed a strong positive association with the MIB-1 index. Univariate analysis revealed a superior prognostic value of PTMA to predict overall survival (OS) as compared with the routinely used markers (p53, isocitrate dehydrogenase (IDH) 1 (IDH1), α-thalassemia/intellectual disability syndrome X-linked (ATRX), and Ki-67). Interestingly, in Cox regression analysis it emerged as an independent predictor of OS (hazard ratio (HR) = 13.71, 95% CI = 5.96–31.52, P

Thymocyte selection-associated high mobility group box protein (TOX) is a transcription factor implicated in the regulation of T cell exhaustion during chronic infection and cancer. While TOX is being targeted for cancer immunotherapy, limited information is available about its significance in breast cancer and other solid tumors. We performed a comprehensive analysis of TOX gene expression, its epigenetic regulation, protein localization, relation to tumor infiltrating immune cell composition, and prognostic significance in breast cancer using publicly available datasets. Our results suggest an inverse correlation between TOX expression and DNA methylation in tumor cells. However, its expression is elevated in tumor infiltrating immune cells (TIICs), which may compensates for the total TOX levels in the tumor as a whole. Furthermore, higher TOX levels in tumors are associated with T cell exhaustion signatures along with presence of active inflammatory response, including elevated levels of T cell effector cytokines. Survival analysis also confirmed that higher expression of TOX is associated with better prognosis in breast cancer. Therefore, expression of TOX may serve as a novel prognostic marker for this malignancy.

Study Design: Retrospective analysis. Objective: Lumbar disc herniation is one the most common condition responsible for low back and radicular pain. Although the symptoms are not proportional to the size of disc prolapse but massive disc herniation frequently needs surgical management. According to literature, the incidence of low back pain, recurrent disc herniation and segmental instability are more in discectomy whereas incidence of adjacent segment degeneration (ASD) is more after fusion surgery. There are very few studies that directly compare long-term functional outcome of both these procedures. We compared the functional outcome of both the procedures in this study. Methods: All patients of massive disc prolapse, operated at our center between 2011 to 2017, were contacted. All the patients underwent either discectomy or transforaminal lumbar interbody fusion (TLIF). Functional outcomes of all the patients were collected using visual analogue scale (VAS) (back), VAS (leg), modified Oswestry Disability Index (mODI), Sciatica Bothersomeness Index (SBI), and McNab’s criterion. Various complications were also analyzed. Results: There were 144 patients in the discectomy group and 123 patients in the TLIF group. Mean duration of follow-up was 55.07 months and 51.86 months, respectively. Both the groups show no significant difference in VAS. Significant difference was seen in mODI and SBI favoring discectomy. McNab’s criterion showed excellent result in 80% of patients of discectomy compared with 68% patients of TLIF. Overall complication rate in discectomy group was 11% whereas 13% in TLIF group. Conclusion: Both show good functional outcome but better in discectomy. Recurrent herniation and instability were noticed more with discectomy and ASD was more common after fusion surgeries. The choice of procedure should be individualized, and it also depends on surgical expertise, but in developing countries where resources are constrained, discectomy should be preferred.

Background and Objectives:Estimates of the prevalence (10-60%) of cognitive impairment in individuals with spinal cord injury (SCI) are too broad and which domains of cognition are most affected is unclear. We performed a meta-analysis to investigate impairments across domains of cognitive functioning to provide a nuanced picture of research conducted to date into cognitive impairment following SCI.Methods:Results of peer reviewed studies published in English between 1980 and 2021 comparing ≥20 participants with SCI to able-bodied controls were synthesized using meta-analysis. The primary outcomes were neurocognitive test scores categorized into five cognitive domains as listed in the Diagnostic and Statistical Manual of Mental Disorders: Complex Attention, Executive Functioning, Learning and Memory, Language, and Perceptual Motor Function. Two researchers independently assessed and verified extracted data to comply with meta-analytic reporting guidelines. Robust variance estimation (RVE) meta-analysis was conducted to determine an overall pooled effect size across all cognitive domains using data extracted from studies. Using network meta-analysis, we synthesised eligible studies and made comparisons with the five domains of cognitive functioning serving as the outcomes and SCI as the condition.Results:Of 4,783 potential studies, 13 met final inclusion criteria. Studies met 6 of 8 quality assessment criteria generally. Results suggested that adults with SCI have reduced cognitive functioning (effect size:-0.84; 95%CI: -1.24, -0.44, p < .001) compared to able-bodied individuals, with deficits mostly in attention (g= -0.64; 95%CI: -0.92, -0.38) and executive functioning (g= -0.61, 95%CI: -0.89, -0.04). Publication bias and high heterogeneity (I2:86%) qualify these findings and highlight the need to improve research methods in this area.Discussion:Adults with SCI appear more likely than adults who are able-bodied to display cognitive impairments mostly in areas of attention and executive functioning. Research practices must become consistent to reduce heterogeneity so that the validity and reliability of the results of future studies into cognitive impairment following SCI improves.

To explore the association between sociodemographic, health, functional independence, and environmental variables with engagement in paid work for people with spinal cord injury (SCI).Self-reported, cross-sectional Australian data from a large international SCI survey.Community-based.1189 working-age people with SCI (18-67 years) or aged67 years and engaged in paid employment. Respondents were community based and at least 1 year after injury.Not applicable.Employment and work integration variables. Bayesian penalized regression was used to determine associations between 23 predictor variables and engagement in paid work.Most participants (87%) were employed pre-injury, with 39% in paid employment at the time of the survey. Participants who attained a master's/doctoral degree (odds ratio [OR]=3.01; 95% credible interval [CrI], 1.63, 5.44) and those married (OR=1.68; 95% CrI, 1.13, 2.49) were more likely to be engaged in paid work. Women (OR=0.55; 95% CrI, 0.37, 0.81), people receiving a disability pension (OR=0.17; 95% CrI, 0.13, 0.24), and older participants (OR=0.75; 95% CrI, 0.63, 0.90) were less likely to be in paid work. Working participants identified hardships including problems completing their work (60%) and accessing the workplace (32%), as well as unmet needs relating to assistive devices required for completing their work (50%).Findings from the current study can assist in directing resources to subgroups within the SCI population who need greater assistance or intervention related to employment outcomes, including through vocational rehabilitation services/programs. Unmet needs and workplace issues expressed by employed individuals identify gaps in work integration and satisfaction that could affect employment sustainability that need to be addressed.

Industrially packaged whole wheat flour (

Acute myeloid leukemia with normal cytogenetics (CN-AML) is the largest group of AML patients which is associated with a variegated patient outcome. Multiple molecular markers have been used to risk-stratify these patients. Estimation of expression of BAALC gene (Brain and Acute Leukemia, Cytoplasmic) mRNA level is one of the predictive markers which has been identified in multiple studies. In this study, we examined the clinical and prognostic value of BAALC gene expression in 149 adult CN-AML patients. We also utilized multi-omics databases to ascertain the association of BAALC gene expression with comprehensive molecular and clinicopathologic features in AML. BAALC overexpression was associated with CD34 positivity on leukemic blasts (p = 0.0026) and the absence of NPM1 gene mutation (p 0.0001), presence of RUNX1 gene mutation (p 0.001) and poor patient outcomes, particularly in NPM1-wild type/FLT3-ITD negative adult CN-AML patients. Additionally, BAALC expression was associated with the alteration of methylation of its promoter. Further, pathway analysis revealed that BAALC expression is correlated with MYC targets and Ras signalling. We conclude that high BAALC expression associates with poor patient outcome in NPM1-wild type/FLT3-ITD negative adult CN-AML patients.

With significant efforts made to consider water reuse in cities, a robust and replicable framework is needed to quantify the degree of urban water circularity and its impacts from a systems perspective. A quantitative urban water circularity framework can benchmark the progress and compare the impacts of water circularity policies across cities. In that pursuit, we bring together concepts of resource circularity and material flow analysis (MFA) to develop a demand- and discharge-driven water circularity assessment framework for cities. The framework integrates anthropogenic water flow data based on the water demand in an urban system and treated wastewater discharge for primary water demand substitution. Leveraging the water mass balance, we apply the framework in evaluating the state of water circularity in Singapore from 2015 to 2019. Overall, water circularity has been steadily increasing, with 24.9% of total water demand fulfilled by secondary flows in 2019, potentially reaching 39.6% at maximum water recycling capacity. Finally, we discuss the wider implications of water circularity assessments for energy, the environment, and urban water infrastructure and policy. Overall, this study provides a quantitative tool to assess the scale of water circularity within engineered urban water infrastructure and its application to develop macro-level water systems planning and policy insights.

The construction industry remains under immense pressure to reduce its material and climate related impacts. Increasing material demand and reduced building lifetimes have therefore motivated efforts for urban mining in buildings. Even though urban mining has been projected as a crucial measure for improving resource efficiency, its adoption as a practice in the construction industry remains at a very symbolic stage. Upscaling secondary resource recovery and reuse in the construction sector requires further efforts to understand urban mining feasibility from the perspective of project timelines, salvage time, skills and costs. Hence, this study develops an empirical research approach to measure urban mining feasibility and applies it to demolition-ready urban residential buildings stock in Singapore with semi-skilled construction workers. It develops indicators for urban mining feasibility based on planning stages, process change, behavioural practices and reuse-driven economic considerations. Based on urban mining of over 350 building components from 34 categories, results show an average of 1 to 12 min recovery time with an estimated urban mining cost from S$0.8 to S$9 per building component. Further, regulatory requirements for demolition permits can provide sufficient time for urban mining without affecting project timelines. Even though the mining skills of workers seem important, results highlights significant improvement in mining skills based on repeated salvage of specific building components. Results also provide robust evidence of reuse-driven urban mining feasibility in the case under study with significant prospects for embodied carbon savings. Overall, urban mining of buildings can contribute to net-zero targets and climate mitigation efforts with greater multi-stakeholder involvement and market push for reuse in the construction sector.

The continuous development of information technology along with the communication devices like mobiles and tablets which are available for daily use have increased many folds in the recent year. A variety of companies are providing these devices with different specifications. A lot of these specifications roam around the storage available in these devices. The continuous development in these devices and applications has potentially increased the need for having sufficient storage capacity. Communication applications like WhatsApp, Hike, Signal, Telegram, etc. are used worldwide to stay connected. Almost all of the phone users use these apps to communicate with their close people or for business purposes. These chat apps have become an ingrained part of daily life of the phone users these days. These social communication apps allow the phone users to receive several media files. One such media file which is frequently used is images. Images of greetings like ‘Good Morning’, ‘Good Night’ or wishes for the festivals like ‘Happy Diwali”, ‘Merry Christmas' fill up the storage of the user's devices. These images have emotions attached to them from the sender, but it is actually just simply eating up space in the devices. Day by day these images fill up a sizable amount of space which leads to actually going back and deleting them in bulk manually to free up space. The objective of this project is to assist the user out instead of manually deleting these greetings to automate this process. The application is designed so that it searches these greeting images and gives the user the option to delete them or not. The automated process of searching the images saves the user time and effort and it helps in recovering the storage which can be used by the device.

Testing in software is based on detect bugs. This is the fundamental advance of the Software improvement life cycle. In the testing we compare results with predicted results to guarantee that our program is free of bugs or not. It also helps to recognize mistakes and incomplete provision. Test case optimization is used to diminish the effort needed to test the modification by detecting the correct test required for the test cycles. In this rag, we present the Genetic-Cuckoo Algorithm, a job planning algorithm for lattice. This research work proposes a hybrid approach for the optimization of the test case, which offers the best possible solutions. The proposed approach is giving better results from the previous methods in context to the accuracy. In this paper, the proposed algorithm shows the accuracy of hybrid approach with comprising of genetic and cuckoo approach.

ATM machine is a great piece of technology used by millions of people around the world. It makes our daily transactions easier without loading up the banking systems However, it is important to keep them secure from thefts and other malicious activities. Traditional ATM system uses PIN (personal identification number) for the authentication purpose and nowadays smart card with magnetic stripes and PIN is in use. Thereby taking care of security from user's front. However, securing ATMs from bank's front needs a lot of work to be done. Merely deploying security personnel at the ATM is not enough. This project comprises an advanced security system that can monitor and activate various security measures in case of robbery and theft. This security system detects malicious activities inside the ATM booth. The security system check different parameters of the security and keep the concerned authorities updated. It uses sensors like Reed Switch, Ultrasonic Sensor, and Cameras to do so. If any unauthorized person is trying to move or open the ATM machine, due to reed switch, the circuit gets open. The ultrasonic sensor is used to sense to presence of intruder. If there is any change in these two parameters, the surveillance camera takes the picture and concerned authority is inform via SMS and can check the face of intruder via an IP address.

The COVID-19 pandemic has caused an unprecedented crisis for the air transportation industry, affecting millions of aviation users and stakeholders. As the aviation sector has faced disease outbreaks and extreme events before-albeit not at the same scale-and will, in all likelihood, face them again, we provide an assessment in this study that a) gives an overview of the effects of the pandemic, b) categorizes the response mechanisms that were observed, and c) proposes a framework for a coordinated global response to future disease outbreaks. We highlight that of the many lessons, recommendations, and suggestions that emerged during previous outbreaks, few were introduced effectively into civil aviation practices and operations. Based on multiple data sources for passengers, cargo, and flight schedules, we assess the impact of COVID-19 on the global aviation industry and compare the data of some prominent airports to highlight the need for a coordinated response to effectively deal with future disruptions. As global aviation navigates its ongoing recovery, we discuss different responses during the pandemic including guidelines issued by bodies such as the International Civil Aviation Organization (ICAO), operational decisions such as closing terminals, increased cleaning frequencies, and mask mandates etc. We emphasize the need for resilience to accommodate disease outbreaks in future planning, design, and preparedness strategies for airports and airlines. We further argue that the existing civil aviation system needs a coordinated global response mechanism to combat future outbreaks and propose a framework with a threat response matrix to keep aviation safe and operational during future pandemics and mitigate socioeconomic fallout.

Sperm-associated Antigen 5 (SPAG5, also called astrin) is a mitotic spindle protein. SPAG5 has emerged as a promising biomarker and therapeutic target in a variety of cancers. However, its expression and role in endometrial cancer (EC) remain to be studied. Using multi-omic authoritative datasets from the TCGA and CPTAC studies, we characterized theexpression, regulation of SPAG5 and its association with clinicopathological and molecular features in EC. SPAG5 was observed to be overexpressed in tumor tissues compared to controls and receiver operating characteristic analysis suggested that its mRNA levels are an excellent predictor of tumor presence (AUC>0.98). SPAG5 overexpression was associated with serous histology and The Cancer Genome Atlas (TCGA) defined molecular subtypes. Analysis of DNA methylation levels at SPAG5 genomic regions exhibiting negative correlation to SPAG5 expression. Further, SPAG5 expression was associated with copy number gain in EC. Univariate and multivariate survival analysis revealed that higher SPAG5 expression was independently associated with poor patient outcomes in EC. Additionally, gene set enrichment analysis of SPAG5 correlated genes revealed its association with numerous oncological pathways which suggest its critical involvement in this malignancy.

The number of systematic reviews on the effects of exercise on aerobic fitness and muscle strength in people with spinal cord injury (SCI) has recently increased. However, the results of some of these reviews are inconclusive or inconsistent. To strengthen recommendations, this overview was undertaken to assimilate evidence about the effectiveness of different types of physical activities, exercises, and therapeutic interventions for improving aerobic fitness and muscle strength in people with SCI. Cochrane Overview of reviews methods were adopted to undertake this overview. An online search was conducted in August 2018 on eight databases based on predefined search criteria. Potential systematic reviews were screened, selected, and assessed on methodological quality by two independent authors, and discussed and resolved with a third author, when necessary. Only systematic reviews published in the English language were included. The protocol was registered on PROSPERO. Overall, 16 systematic reviews were included (aerobic fitness

The paper presents the bearing ratio behavior of sand overlying silty sandy with two woven and two non-woven treated coir geotextiles at the interface under unsoaked and soaked condition. T...

Sea Surface Temperature is a critical physical attribute of coastal marine habitats. Remote sensing from satellite is the most widely used approach for monitoring the stress on coral reef ecosystem...

Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how individuals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI.

The assessment of mild cognitive impairment (MCI) following spinal cord injury (SCI) is vital. However, there are no neurocognitive screens which have been developed specifically to meet the unique requirements for SCI, nor are there consistent MCI criteria applied to determine the rates of MCI. The aim of this study was to determine the suitability of a neurocognitive screen for assessing MCI in adults with SCI. A total of 127 participants were recruited. Socio-demographic and injury related variables were assessed. All participants completed the screen. Descriptive statistics are provided for total/domain screen scores and all items, and the screen’s ability to distinguish MCI was examined. Congeneric confirmatory factor analyses (CFA) were employed to investigate structural validity. The screen total score was sensitive to differences in neurocognitive capacity, as well as for time since the injury occurred (p < 0.01). The MCI rate ranged between 17–36%. CFA revealed attention and visuoconstruction domains had an adequate model fit and executive function had poor fit, while CFA models for memory and language did not fit the data (did not converge), hence could not be determined. While the screen differentiated between those with MCI and those without, and MCI as a function of time since injury, limitations of its suitability for assessing MCI after SCI exist, demonstrating the need for a specialized neurocognitive screen for adults with SCI.

China is in a critical stage of ambient air quality management after global attention on pollution in its cities. Industrial development and urbanization have led to alarming levels of air pollution with serious health hazards in densely populated cities. The quantification of cause-specific PM2.5-related health impacts and corresponding economic loss estimation is crucial for control policies on ambient PM2.5 levels. Based on ground-level direct measurements of PM2.5 concentrations in 338 Chinese cities for the year 2016, this study estimates cause-specific mortality using integrated exposure-response (IER) model, non-linear power law (NLP) model and log-linear (LL) model followed by morbidity assessment using log-linear model. The willingness to pay (WTP) and cost of illness (COI) methods have been used for PM2.5-attributed economic loss assessment. In 2016 in China, the annual PM2.5 concentration ranged between 10 and 157 μg/m3 and 78.79% of the total population was exposed to >35 μg/m3 PM2.5 concentration. Subsequently, the national PM2.5-attributable mortality was 0.964 (95% CI: 0.447, 1.355) million (LL: 1.258 million and NPL: 0.770 million), about 9.98% of total reported deaths in China. Additionally, the total respiratory disease and cardiovascular disease-specific hospital admission morbidity were 0.605 million and 0.364 million. Estimated chronic bronchitis, asthma and emergency hospital admission morbidity were 0.986, 1.0 and 0.117 million respectively. Simultaneously, the PM2.5 exposure caused the economic loss of 101.39 billion US$, which is 0.91% of the national GDP in 2016. This study, for the first time, highlights the discrepancies associated with the three commonly used methodologies applied for cause-specific mortality assessment. Mortality and morbidity results of this study would provide a measurable assessment of 338 cities to the provincial and national policymakers of China for intensifying their efforts on air quality improvement. Keywords: China, Spatial distributions of PM2.5, Long-term mortality, Morbidity, Economic loss

The advancement in the material of spinal implant and technique of spinal instrumentation has led to an increase in spine surgeries. The final desired outcome of spine surgery involving instrumentation is fusion. There is a race among implants to fail and bone to fuse. If there is a formation of pseudoarthrosis or failure to fuse then implants are bound to fail. The most common presentation of pseudoarthrosis is implant breakage. Hence, should we label every implant that has presented with breakage as a "failure"? In this article, we have discussed our experience of two cases presented to us with implant breakage but which were managed successfully with conservative methods. Both of our cases did well without any surgical intervention. We have follow-ups of seven years in one case and five years in the other. Every patient with pseudoarthrosis does not require surgical management and hence, every implant breakage should not be labeled as implant "failure".

Coral reefs are one of the most sensitive, productive, and invaluable biological resources on the earth. However, coral reefs are facing unprecedented stress due to ongoing climate changes and intensified anthropogenic disturbances globally. Elevated Sea Surface Temperature (SST) has emerged as the most imminent threat to the thermos-sensitive reef-building corals. The 2010–2014-2016 El Niño Southern Oscillation (ENSO) caused prolonged marine heat waves (MHWs) that led to the most widespread coral bleaching and mortality in the tropical Indi-Pacific regions. Coral bleaching prediction is vital for the management of the reef biodiversity, ecosystem functioning, and services. Recent decades, satellite remote sensing has emerged as a convenient tool for large-scale coral reef monitoring programs. As thermal stress is a critical physical attribute for coral bleaching hence, the present study examines the effectiveness of the elevated SSTs as a proxy to predict coral bleaching in shallow water marginal reefs. Advanced Very High-Resolution Radiometer (AVHRR) satellite data from the NOAA Coral Reef Watch’s (CRW) platform has been used for this study. Coral bleaching indices like Bleaching Threshold (BT), Positive SST Anomaly (PA), and Degree Heating Weeks (DHW) are computed to analyze the thermal stress on the coral reefs. The computed thermal stress from satellite-derived SST data over regions concurrence with the mass coral bleaching (MCB) events. This study concludes that in the last decades (2010 to 2019) the coral cover around these regions has dramatically declined due to higher SST, which indicates that the thermal stress induced recurrent bleaching events attributed to the coral loss.

PURPOSE: This research sought to translate and culturally adapt the content of the original Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) into the Thai language and to assess its inter- and intra-rater reliability. METHODS: This study was divided into two parts; (i) translation and cross-cultural adaptation, using a six-step guideline-based translation-validation process and (ii) reliability assessment of the translated survey tool using intraclass correlation coefficients (ICCs), Bland-Altman plots and one-way ANOVA analyses. RESULTS: The Thai-PARA-SCI was successfully developed. The results revealed an excellent inter-rater reliability (ICC = 0.99, 95% CI range from 0.959-0.999) and the Bland-Altman plots showed little difference in times spent engaged physical activity. Intra-rater reliability results were affected inadvertently by testing across an unusual period, demonstrating poor to moderate scores (ICC ranged from 0.05-0.69, 95% CI ranged from -0.067-0.830) with the Bland-Altman plots showing very different ranges of time spent on physical activity. CONCLUSION: This study achieved its aims of culturally and systematically translating the English PARA-SCI interview script into the Thai version with excellent scores for inter-rater reliability and was proven to be understandable by prospective users (Thai-PT) and participants (Thai-SCI).Implications for RehabilitationA robust cross-cultural translation and adaptation of the Physical Activity Recall Assessment for people with Spinal Cord Injury (PARA-SCI) into the Thai context has been undertaken, providing an effective exemplar for converting patient reported health outcome measures between languages of different root origins.When using the PARA-SCI as a pre- and post-intervention outcomes survey, clinicians should ensure that the timing of interview administration does not coincide with any unintended alterations in work-life balance, to ensure that the data are representative of the habitual physical activity levels performed by participants in their daily lives.Due to the possibility that physical activity levels could vary day-by-day or week-to-week, using the same day measurement findings may be a more reliable way to deploy the PARA-SCI than repeated assessments week(s) apart.

Background Social relationships are powerful determinants of health and inequalities in social relationships across socioeconomic status (SES) groups may contribute to social inequalities in health. This study investigates inequalities in social relationships in an international sample of persons with spinal cord injury and explores whether social gradients in relationships are moderated by the countries’ socioeconomic development (SED). Methods Data from 12,330 participants of the International SCI Community Survey (InSCI) performed in 22 countries were used. We regressed social relationships (belongingness, relationship satisfaction, social interactions) on individual SES (education, income, employment, financial hardship, subjective status) and countries’ SED (Human Development Index) using multi-level models (main effects). To test potential moderation of the SED, interaction terms between individual SES and countries’ SED were entered into multi-level models. Results Paid work, absence of financial hardship and higher subjective status were related to higher belongingness (OR, 95% CI: 1.50, 1.34–1.67; 1.76, 1.53–2.03; 1.16, 1.12–1.19, respectively), higher relationship satisfaction (OR, 95% CI: 1.28, 1.15–1.42; 1.97, 1.72–2.27; 1.20, 1.17–1.24, respectively) and fewer problems with social interactions (Coeff, 95% CI: 0.96, 0.82–1.10; 1.93, 1.74–2.12; 0.26, 0.22–0.29, respectively), whereas associations with education and income were less consistent. Main effects for countries’ SED showed that persons from lower SED countries reported somewhat higher relationship satisfaction (OR, 95% CI: 0.97, 0.94–0.99) and less problems with social interactions (Coeff, 95% CI: -0.04, -0.09- -0.003). Results from moderation analysis revealed that having paid work was more important for relationships in lower SED countries, while education and subjective status were more important for relationships in higher SED countries (interaction terms p<0.05). Conclusion Social relationships in persons with spinal cord injury are patterned according to individual SES and the countries’ SED and larger socioeconomic structures partly moderate associations between individual SES and social relationships.

Hepatocellular carcinoma (HCC) is an aggressive gastrointestinal malignancy with a high rate of mortality. Multiple studies have individually recognized members of RAP gene family as critical regulators of tumor progression in several cancers, including hepatocellular carcinoma. These studies suffer numerous limitations including a small sample size and lack of analysis of various clinicopathological and molecular features. In the current study, we utilized authoritative multi-omics databases to determine the association of RAP gene family expression and detailed molecular and clinicopathological features in hepatocellular carcinoma (HCC). All five RAP genes were observed to harbor dysregulated expression in HCC compared to normal liver tissues. RAP2A exhibited strongest ability to differentiate tumors from the normal tissues. RAP2A expression was associated with progressive tumor grade, TP53 and CTNNB1 mutation status. Additionally, RAP2A expression was associated with the alteration of its copy numbers and DNA methylation. RAP2A also emerged as an independent marker for patient prognosis. Further, pathway analysis revealed that RAP2A expression is correlated with tumor-infiltrating immune cell composition and oncogenic molecular pathways, such as cell cycle and cellular metabolism.

Glucocorticoid (GC), such as prednisolone, is an essential component of multidrug chemotherapy regimen for pediatric acute lymphoblastic leukemia (ALL). Resistance to GC in leukemia cells is associated with disease progression and poor prognosis. Despite the extensive use of GC for many years, molecular mechanisms underlying its resistance in ALL have not been fully uncovered. Recent studies have shown a potential role of EMP1, CASP1, and NLRP3 genes in prednisolone response. In this study on 148 pediatric B-ALL patients, we studied these three genes to assess their association with prednisolone response measured by day 8 blast count after 7 days of induction therapy with prednisolone. Intriguingly, ALL samples exhibited higher expression of EMP1 along with a low expression of CASP1 and NLRP3 compared to disease free normal bone marrow collected from patients with solid tumors. Among the three analyzed genes, only EMP1 was found to be overexpressed in prednisolone poor responders (p=0.015). Further, a comparison of gene expression between cytogenetic subtypes revealed higher expression of EMP1 in BCR-ABL subtype. Expression of EMP1 in multiple gene expression datasets was used for gene set enrichment analysis, which revealed TNF-α, IL-2-STAT5 signaling, inflammatory responses and hypoxia as the major positively associated pathways and E2F targets as negatively associated pathways. Interestingly, the clinical remission rate was higher in CASP1 high patients (p=0.048). In univariate survival analysis, higher EMP1 expression was associated with poor prognostic measures while higher expression of NLRP3 and CASP1 was associated with better prognostic measures in our data. Further, multivariate analysis revealed an independent association of high CASP1 and NLRP3 with a better prognosis. This study strengthens the available evidence that mRNA expression of EMP1, CASP1, and NLRP3 may serve as potential biomarkers for risk stratification of pediatric B-ALL patients.

L-selectin is a cell adhesion molecule that plays an important role in modulating immune cell trafficking. The expression of L-selectin has been found to be upregulated in several human cancers. However, the association of L-selectin expression with the immune profile and its prognostic value in breast cancer has not been explored in detail. We utilized TCGA and Oncomine datasets to compare SELL (L-selectin gene) expression between tumor and normal breast tissues. The association of SELL expression with its promoter DNA methylation and infiltrating immune cells was evaluated by using Wanderer, TIMER, and CIBERSORT tools. Single cell RNA sequencing data was utilised to determine the cell specific expression of L-selectin in breast cancer. Furthermore, the relationship between SELL expression and patient survival was evaluated using the Kaplan–Meier plotter. Gene set enrichment analysis was performed to determine functional associations of SELL expression. We found that SELL expression was significantly higher in breast tumors and regulated by DNA methylation. L-selectin exhibited a strong positive correlation with markers of the inflammatory microenvironment, including M1 macrophages. Interestingly, single cell sequencing data analysis revealed that B-cells and T-cells exhibited comparable expression levels of SELL, suggesting both B-cells and T cells contribute to SELL expression in breast cancer. Higher expression of SELL was associated with better survival outcome in basal, Her2 + and luminal B subtypes of breast cancer. GSEA revealed association of SELL expression with several immunological features in breast cancer. SELL expression increases in breast tumor tissues with reduced DNA methylation and associated inflammatory microenvironment. Also, high SELL expression is associated with favorable survival outcomes in breast cancer. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13205-020-02549-y) contains supplementary material, which is available to authorized users.

Background Spinal cord injury (SCI) is associated with autonomic imbalance and significant secondary conditions, including cardiac and brain dysfunction that adversely impact health and wellbeing. This study will investigate the effectiveness (intention-to-treat) of a neuro-cardiac self-regulation therapy to improve autonomic and neural/brain activity in adults with SCI living in the community. Methods A two-arm parallel, randomised controlled trial in which adults with SCI living in the community post-rehabilitation will be randomly assigned to a treatment or control group. The treatment group (N = 60) aged 18–70 years with a chronic traumatic or non-traumatic SCI, will receive intervention sessions once per week for 10 weeks, designed to regulate autonomic activity using computer-based feedback of heart rate variability and controlled breathing (called HRV-F). Comprehensive neurophysiological and psychological assessment will occur at baseline, immediate post-treatment, and 6 and 12-months post-treatment. Primary outcome measures include electrocardiography/heart rate variability (to assess autonomic nervous system function) and transcranial doppler sonography (to assess cerebral blood circulation in basal cerebral arteries). Secondary outcomes measures include continuous blood pressure, electroencephalography, functional near-infrared spectroscopy, respiration/breath rate, electrooculography, cognitive capacity, psychological status, pain, fatigue, sleep and quality of life. Controls (N = 60) will receive usual community care, reading material and a brief telephone call once per week for 10 weeks and be similarly assessed over the same time period as the HRV-F group. Linear mixed model analysis with repeated measures will determine effectiveness of HRV-F and latent class mixture modelling used to determine trajectories for primary and selected secondary outcomes of interest. Discussion Treatments for improving autonomic function after SCI are limited. It is therefore important to establish whether a neuro-cardiac self-regulation therapy can result in improved autonomic functioning post-SCI, as well as whether HRV-F is associated with better outcomes for secondary conditions such as cardiovascular health, cognitive capacity and mental health. Trial registration The study has been prospectively registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12621000870853.aspx). Date of Registration: 6th July 2021. Trial Sponsor: The University of Sydney, NSW 2006. Protocol version: 22/07/2021.

Wetland plays a vital role in sustainable ecological development. They hold balanced environment conditions and filter the surface and sub-surface water and moderate the local weather condition. But now-a-days wetlands are shrinking quickly all over world due to climate change & anthropogenic activities and extinction of wetlands agitates the local environmental conditions with contexts to water and soil conditions. This study is mainly focused on climate change impacts on wetland ecosystems over Harike and Keshopur wetland in Punjab region, India. Harike wetland is one of largest wetland in northern part of India, which is designated as Ramsar site. The Landsat imageries and climate parameters (includes land surface temperature and rainfall) have been used to extract spatial and temporal information over wetlands during period from 2009 to 2020. Landsat data have been analysed in two phases: Pre-monsoon and Post-Monsoon. Wetland area has been classified into five different classes: agriculture, water, built-up, aquatic vegetation1, and aquatic vegetation2. These analyses showed that wetland area has been reduced over a period of ten years and much area has been converted in agricultural land and built-up. The intense anthropogenic activities have resulted more changes in the wetland over both regions. The present study specifies that wetland ecosystem monitoring is essential for policy makers for sustainable management and also concluded that the significant reduction of highly biodiversity wetland area is required to conserve.

Urban metabolism (UM) is fundamentally an accounting framework whose goal is to quantify the inflows, outflows, and accumulation of resources (such as materials and energy) in a city. The main goal of this chapter is to offer an introduction to UM. First, a brief history of UM is provided. Three different methods to perform an UM are then introduced: the first method takes a bottom-up approach by collecting/estimating individual flows; the second method takes a top-down approach by using nation-wide input–output data; and the third method takes a hybrid approach. Subsequently, to illustrate the process of applying UM, a practical case study is offered using the city-state of Singapore as an exemplar. Finally, current and future opportunities and challenges of UM are discussed. Overall, by the early twenty-first century, the development and application of UM have been relatively slow, but this might change as more and better data sources become available and as the world strives to become more sustainable and resilient.

Adaptive Neuro-Fuzzy Inference System (ANFIS) blends advantages of both Artificial Neural Networks (ANNs) and Fuzzy Logic (FL) in a single framework. It provides accelerated learning capacity and adaptive interpretation capabilities to model complex patterns and apprehends nonlinear relationships. ANFIS has been applied and practiced in various domains and provided solutions to commonly recurring problems with improved time and space complexity. Standard ANFIS has certain limitations such as high computational expense, loss of interpretability in larger inputs, curse of dimensionality, and selection of appropriate membership functions. This paper summarizes that the standard ANFIS is unsuitable for complex human tasks that require precise handling of machines and systems. The state-of-the-art and practice research questions have been discussed, which primarily focus on the applicability of ANFIS in the diversifying field of engineering sciences. We conclude that the standard ANFIS architecture is vastly improved when amalgamated with metaheuristic techniques and further moderated with nature-inspired algorithms through calibration and tuning of parameters. It is significant in adapting and automating complex engineering tasks that currently depend on human discretion, prominent in the mechanical, electrical, and geological fields.

Self-reported cross-sectional data for the Australian cohort participating in the International Spinal Cord Injury Community survey.To contextualise post-injury employment for people with spinal cord injury (SCI) in Australia, including work participation rates, time to resuming work, underemployment and pre- and post-SCI employment changes.Australian survey data from four state-wide SCI services, one government insurance agency and three not-for-profit consumer organisations across New South Wales, Queensland, South Australia and Victoria.Data were analysed from 1579 participants with SCI who are at least 1-year post discharge from an inpatient facility. Survey measures included 16-items dedicated to employment. Pre- and post-injury job titles were based on the International Standard Classification of Occupations (ISCO-08) major classification. A mix of chi-squared, t-test and negative binomial regression were used to analyse data.The absolute post-injury employment rate was 49.9%, with one-third of the sample currently working. Pre-injury employment and engagement with vocational rehabilitation resulted in higher employment rates. Individuals who were unable to return immediately following inpatient rehabilitation took mean 28 months (SD, 35.9) to return. Time to employment was significantly lengthier for those without pre-injury jobs, at 59.7 months [SD, 43.8] (p 0.001). Engagement in less manual roles increased post-injury, accounting for three quarters of post-SCI jobs. Underemployment was identified by 16.6% of those currently working.While there are current services and programmes in place in Australia that support post-injury employment, findings indicate a need for more comprehensive early intervention focused services targeted towards employers and individuals.