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Diagnostic stewardship seeks to improve ordering, collection, performance, and reporting of tests. Test results play an important role in reportable HAIs. The inclusion of HAIs in public reporting and pay for performance programs has highlighted the value of diagnostic stewardship as part of infection prevention initiatives. Inappropriate testing should be discouraged, and approaches that seek to alter testing solely to impact a reportable metric should be avoided. HAI definitions should be further adapted to new testing technologies, with focus on actionable and clinically relevant test results that will improve patient care.

Genomic surveillance is crucial for tracking emergence and spread of novel variants of pathogens, such as SARS-CoV-2, to inform public health interventions and to enforce control measures. However, in some settings especially in low- and middle- income counties, where sequencing platforms are limited, only certain patients get to be selected for sequencing surveillance. Here, we show that patients with multiple comorbidities potentially harbour SARS-CoV-2 with higher mutation rates and thus deserve more attention for genomic surveillance. The relationship between the patient comorbidities, and type of amino acid mutations was assessed. Correlation analysis showed that there was a significant tendency for mutations to occur within the ORF1a region for patients with higher number of comorbidities. Frequency analysis of the amino acid substitution within ORF1a showed that nsp3 P822L of the PLpro protease was one of the highest occurring mutations. Using molecular dynamics, we simulated that the P822L mutation in PLpro represents a system with lower Root Mean Square Deviation (RMSD) fluctuations, and consistent Radius of gyration (Rg), Solvent Accessible Surface Area (SASA) values-indicate a much stabler protein than the wildtype. The outcome of this study will help determine the relationship between the clinical status of a patient and the mutations of the infecting SARS-CoV-2 virus., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Azzeri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Food environment (FE), an interface where people interact with a broader food system, is critical to health. Understanding the Asian FE may help to tackle the "triple burden of malnutrition" through informed research and policy. This review identifies FE domains assessed in the Asian context and collates the tools/measures used in these evaluations. We further synthesized the reported associations of FE with diet and health outcomes and identified knowledge gaps. Forty-two articles were reviewed (East Asia, n = 25, 60%; South Asia, n = 8, 19%; and Southeast Asia, n = 9, 21%). The results showed that FE was frequently examined in children, adolescents, or adults, but data were scarce in older adults. Food availability ( n = 30) and accessibility ( n = 19) were popularly studied domains. Furthermore, FE was measured using geographic information systems ( n = 18), market ( n = 7), or stakeholder ( n = 21) surveys. Twenty-eight (67%) articles assessed associations of FE exposures with diet ( n = 12) and health ( n = 21). Increased food availability and accessibility were associated with poorer dietary and health outcomes despite nonexisting validity and reliability reporting in 62% of articles. Limited high-quality studies emphasize the need for harmonized definitions, better study designs, and validated FE measures/tools in Asia. Improving the quality of FE research is critical to designing effective interventions to improve public health nutrition in Asia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Despite the notable advancements made over the past decade in achieving carbon-carbon bonds by transition-metal-catalyzed cross-coupling processes, metal-free cross-coupling reactions for hydroacylation of aromatic alkynes via C(sp 3 )-H functionalization are still rare and highly desired. Here we report a metal-free reliable approach for the synthesis of α,β-unsaturated ketones (chalcones) via C(sp 3 )-H functionalization using MeCN:H 2 O as green solvent, Eosin Y as organic photocatalyst, and ambient air as oxidant. More significantly, this strategy can effectively transform a variety of methyl arenes and aromatic alkynes into the desired product. With high atom efficiency, use of green solvents, metal-free nature, environmental friendliness, and visible light as a renewable energy source, this method is compatible with biologically active molecules.

The elucidation of the C -arylation of active methylene compounds under visible light conditions without a photocatalyst presents an intellectual challenge. The photo-induced C -arylation of active methylene compounds via electron donor-acceptor (EDA) complexes shows a strategic path for the synthesis of pharmacologically relevant compounds. This expansive and efficacious methodology facilitates C -arylation under environmentally conscientious conditions, exhibiting exemplary compatibility with diverse functional groups and yielding numerous compounds. This environmentally sustainable transformation underscores the merits of the procedural simplicity and benign reaction conditions. Notably, all resultant products were judiciously derived from active methylene compounds and diazonium salts through the intermediacy of the EDA complex.

As the global population and living standards rise, it pushes the demand for basic amenities like food, health, and energy resources. Additionally, manufacturing automation has led to mass production and consumption, triggering waste production. The existing linear economy approach has led to increasing waste production and resource depletion, posing significant environmental and public health threats. To overcome these impediments, an alternative model called the circular economy concept has gained popularity in the global industry community. This closed-loop, restorative, waste-free concept has the potential to protect the environment and improve economics by reducing energy and resource consumption. Thus, major impetus should be given to strengthening the backbone of the economy where tools such as green technologies, decarbonization strategies, bio refinery processes, material flow analysis, life cycle assessment, ecological footprints (water, carbon, and material), substance flow analysis, circularity index, eco-designing, bioresource management, new business models, and policy play an essential role in the areas of socio-economic sustainability, ecological facts, and industrial aspects to enhance socio-economic growth in a sustainable manner. Sectoral awareness, collaborations, and partnerships among the Government, stakeholders, policymakers, and competent authorities are also essential to enabling circularity within the eco-systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

The demand for effective microwave-absorbing materials has recently surged due to rapid advancements in electromagnetic (EM) devices. Recently, engineering oxygen vacancies has also become one of the effective ways to develop efficient microwave-absorbing materials. So, understanding the EM absorption mechanism of these materials has become crucial for better engineering of such materials. This article investigates the magnetic properties along with the EM absorption mechanism of M-type hexaferrite, with optimal incorporation of rare-earth element La 3+ and doping of transition metal Al 3+ cation. The presence of La 3+ ions at an optimal level promotes the reduction of Fe 3+ to Fe 2+ cations and creating oxygen vacancies to offset the electrical charge imbalance. This phenomenon impacts both the magnetic and EM characteristics of the materials. The presence of Fe 2+ cations enhanced the spin-orbital interaction, resulting in a strong magnetic anisotropy field along the c -axis. The lowest reflection loss of -36.37 dB at 14.19 GHz, is observed with a bandwidth of 3.61 GHz below -10 dB for x = 0.6. These microwave absorption properties can be attributed to the adequate compensation between dielectric and magnetic losses, which arise from phenomena like dielectric relaxation, magnetic resonance, and conduction loss due to electron hopping between Fe 3+ and Fe 2+ with proper incorporation of the attenuating constant and excellent impedance matching, along with microstructure of the materials. Furthermore, the material's exceptional absorption properties are also influenced by the rapid movement of oxygen vacancies from its interior to its surface when exposed to high frequencies, thereby impacting its conductivity. Therefore, it is believed that the regulation of oxygen vacancies can serve as a versatile strategy for developing materials with efficient microwave-absorbing capabilities., (© 2023 IOP Publishing Ltd.)

Introduction: A growing body of evidence suggests that older adults are particularly vulnerable to poor care as they transition across care environments. Thus, they require transitional care services as they transition across healthcare settings. To help make intervention research meaningful to the older adults the intervention aims to serve, many researchers aim to study their experiences, by actively involving them in research processes. However, collecting data from older adults with various forms of disability often assumes that the research methods selected are appropriate for them. This scoping review will map the evidence on research methods to collect data from older adults with disabilities within the transitional care literature., Methods: The proposed scoping review follows the framework originally described by the Joanna Briggs Institute (JBI) Manual: (1) developing a search strategy, (2) evidence screening and selection, (3) data extraction; and (4) analysis. We will include studies identified through a comprehensive search of peer-reviewed and empirical literature reporting on research methods used to elicit the experiences of older adults with disabilities in transitional care interventions. In addition, we will search the reference lists of included studies. The findings of this review will be narratively synthesized. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews will guide the reporting of the methods and results., Discussion: The overarching goal of this study is to develop strategies to assist the research community in increasing the inclusion of older adults with disabilities in transitional care research. The findings of this review will highlight recommendations for research to inform data collection within future intervention research for older adults with disabilities. Study findings will be disseminated via a publication and presentations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kokorelias et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Health care solutions are needed to meet the need of an ageing population. Health care champions are people who endorse the adoption of new initiatives being implemented within health care settings. Although the role of champions has been cited as key to the success of numerous community-based interventions implemented to improve the care of older adults with chronic conditions, no synthesis of their implementation experiences have been conducted. We report on a scoping review protocol that will be applied to collect evidence on the role of champions within community-based health interventions to support older adults with chronic conditions. Specifically, we will identify how the term 'champion' is used and defined (i.e., conceptualized) and identify the roles (i.e., professional background) and functions of champions (i.e., responsibilities). We will also explore how this role impacts program implementation., Methods: This is a scoping review protocol informed by guidelines for Scoping Reviews (PRISMA-ScR) and a six-stage scoping review methodology. Peer-review literature will be retrieved from Medline, CINAHL, PubMed, PsycInfo, Cochrane JBI and Scopus databases, using a peer-reviewed search strategy developed in collaboration with an Information Specialist. The scoping review will consider all empirical studies published in English. Two reviewers will pilot-test the screening criteria and data abstraction forms, and then independently screen the literature. Extracted data will be analyzed numerically and thematically. Self-identified champions will be consulted to refine the practice recommendations from this work., Discussion: This scoping review will broadly and systematically identify, define and expand existing knowledge on champions' impact in implementing community-based interventions to support older adults with chronic conditions. We anticipate that our results will lead to a greater understanding of the characteristics and role champions play within these interventions, which will be relevant to a wide range of knowledge users, including researchers, decision-makers, and health care providers., Competing Interests: This study was supported by the Healthy Ageing and Geriatrics Program, Sinai Health and University Health Network in the form of a salary to KK., (Copyright: © 2023 Kokorelias et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Single isolated molecules and supramolecular host-guest systems, which consist of π-π stacking interactions, are emerging as promising building blocks for creating molecular electronic devices. In this article, we have investigated the noncovalent π-π interaction and intermolecular electron charge transport involved in a series of host-guest complexes formed between a cage-like host (H 6+ ) and polycyclic aromatic hydrocarbon (PAH) guests (G1-G7) using different quantum chemical approaches. The host (H 6+ ) consists of two triscationic π-electron-deficient trispyridiniumtriazine (TPZ 3+ ) units that are bridged face-to-face by three ethylene-triazole-ethylene. Our theoretical calculations show that the perylene and naphthalene inclusion complexes G7⊂H and G1⊂H have the highest and lowest interaction energies, respectively. In addition, energy decomposition analysis (EDA) indicated that the dispersion interaction term, Δ E disp , significantly contributes to the host-guest interaction and is correlated with the existence of π-π van der Waals interaction. Using the nonequilibrium Greens function (NEGF) method in combination with density functional theory (DFT), the current-voltage ( I-V ) curves of the complexes were estimated. The conductance values increased when the guests were embedded inside the host cavity. Notably, the complex G7⊂H has the maximum conductance value. Overall, this study provided the electron transport of the PAH inclusion host-guest complex through π-π interaction and provided a direction for the fabrication of future supramolecular molecular devices.

The importance of noncovalent interaction has gained attention in various domains covering drug and novel catalyst design. The present study mainly characterizes the role of hydrogen bond (H-bond) and other intermolecular interactions in different (1:1) complex analogues formed between the N-aryl-thiazol-2-ylidene (YR) and five proton donors (HX). The analysis of the singlet-triplet energy gap (∆E(S-T )) confirmed the stability of the singlet state for this class of N-aryl-thiazol-2-ylidenes than the triplet state. The interaction energy values of the YR-HX complexes follow the order: YR-NH3< YR-HCN< YR-H2O< YR-MeOH< YR-HF. In addition, substituting the H-atom of the N-H bond with bulky groups (-R) leads to an increase in the interaction energy of the YR-HX complexes. Hence, it was found that the replacement of N-atom in N-heterocyclic carbene (NHC) by S-atom forming N-aryl-thiazol-2-ylidene results in comparable intermolecular interactions with proton donor molecules similar to imidazole-2-ylidene (NHC). The current study enlightened the role of noncovalent interactions in carbene complexes with proton donor molecules. We hope that our work on carbene chemistry will pave the way for its application in the designing and synthesis of efficient catalysts., (© 2023 Wiley-VCH GmbH.)

Uncontrolled amyloid aggregation is a frequent cause of neurodegenerative disorders such as prions and Alzheimer's disease (AD). As a result, many drug development approaches focus on evaluating novel molecules that can alter self-recognition pathways. Herein, we designed and synthesized the cyclometallated pyrene (Pd-1 and Pd-3) and anthracene (Pd-2) based palladium complexes ([Pd((L 1 )Cl] Pd-1, [Pd(L 2 )Cl](Pd-2), and [Pd(L 3 )Cl] (Pd-3)). This study explores the effect of these complexes on the aggregation, fibrillation, and amyloid formation of bovine serum albumin (BSA) and Aβ 1 - 42 peptide. Several spectroscopic methods were used to characterize all the Pd-complexes, and the molecular structure of Pd-3 was determined by X-ray crystallography. The secondary structures were studied using circular dichroism (CD) and transmission electron microscopy (TEM), while amyloid aggregation and inhibitory activities were investigated using the Thioflavin-T (ThT) fluorescence assay. Molecular docking of the Pd-complex (Pd-3) was done using fibril (PDB: 2BEG) and monomeric (PDB: 1IYT) peptides using Auto-dock Vina. As a result, the hydrogen bonding and hydrophobic interaction between the aromatic rings of the Pd-complexes and the amino acids of amyloid-β peptides significantly reduced the production of ordered β-sheets of amyloid fibrils and protein aggregation in the presence of Pd-2 and Pd-3 complexes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Vibrational spectroscopy in supersonic jet expansions is a powerful tool to assess molecular aggregates in close to ideal conditions for the benchmarking of quantum chemical approaches. The low temperatures achieved as well as the absence of environment effects allow for a direct comparison between computed and experimental spectra. This provides potential benchmarking data which can be revisited to hone different computational techniques, and it allows for the critical analysis of procedures under the setting of a blind challenge. In the latter case, the final result is unknown to modellers, providing an unbiased testing opportunity for quantum chemical models. In this work, we present the spectroscopic and computational results for the first HyDRA blind challenge. The latter deals with the prediction of water donor stretching vibrations in monohydrates of organic molecules. This edition features a test set of 10 systems. Experimental water donor OH vibrational wavenumbers for the vacuum-isolated monohydrates of formaldehyde, tetrahydrofuran, pyridine, tetrahydrothiophene, trifluoroethanol, methyl lactate, dimethylimidazolidinone, cyclooctanone, trifluoroacetophenone and 1-phenylcyclohexane- cis -1,2-diol are provided. The results of the challenge show promising predictive properties in both purely quantum mechanical approaches as well as regression and other machine learning strategies.

The GENCOV study aims to identify patient factors which affect COVID-19 severity and outcomes. Here, we aimed to evaluate patient characteristics, acute symptoms and their persistence, and associations with hospitalization. Participants were recruited at hospital sites across the Greater Toronto Area in Ontario, Canada. Patient-reported demographics, medical history, and COVID-19 symptoms and complications were collected through an intake survey. Regression analyses were performed to identify associations with outcomes including hospitalization and COVID-19 symptoms. In total, 966 responses were obtained from 1106 eligible participants (87% response rate) between November 2020 and May 2022. Increasing continuous age (aOR: 1.05 [95%CI: 1.01-1.08]) and BMI (aOR: 1.17 [95%CI: 1.10-1.24]), non-White/European ethnicity (aOR: 2.72 [95%CI: 1.22-6.05]), hypertension (aOR: 2.78 [95%CI: 1.22-6.34]), and infection by viral variants (aOR: 5.43 [95%CI: 1.45-20.34]) were identified as risk factors for hospitalization. Several symptoms including shortness of breath and fever were found to be more common among inpatients and tended to persist for longer durations following acute illness. Sex, age, ethnicity, BMI, vaccination status, viral strain, and underlying health conditions were associated with developing and having persistent symptoms. By improving our understanding of risk factors for severe COVID-19, our findings may guide COVID-19 patient management strategies by enabling more efficient clinical decision making.

Background: Berberine (BER) and mangiferin are known natural dipeptidyl peptidase (DPP-IV) inhibitors. Hence, the study was designed to elucidate the mechanism of action of natural DPP-IV inhibitors (BER and MNG) in experimentally induced diabetes with metabolic syndrome., Aim: The aim of this study was to observe mechanism through which natural DPP-IV inhibitor works in diabetes with metabolic syndrome rat model., Materials and Methods: Wistar rats were fed high-fat diet for 10 weeks and challenged with streptozotocin (STZ) (40 mg/kg) at the 3 rd week (high-fat diabetic control [HF-DC] group). After the confirmation of metabolic syndrome in the setting of diabetes, monotherapy (metformin [MET], vildagliptin [VIL], BER, and MNG) and combination (MET + VIL, MET + BER, and MET + MNG) therapy was orally fed to these rats from the 4 th to 10 th weeks., Results: Insulin resistance (IR) was seen in the HF-DC group as indicated by raised homeostasis model assessment of IR (HOMA-IR) in HF-DC group as compared with normal control (NC) groups. The treatment groups reduced IR as shown by a decrease in HOMA-IR as compared with HF-DC group rats. The marked reduction ( P < 0.001) of beta-cell function was observed in the HF-DC group as a reduced level of HOMA for beta-cell function (HOMA-β) was found as compared with the NC group. Increases in HOMA-β as compared to the HFDC group were observed in the therapy groups. The treatment group significantly reduced cholesterol and atherogenic index. The treatment group showed significant preservation of beta-cell mass as per immunohistochemistry and significant anti-apoptotic activity as per Terminal Deoxyribonucleotidyl Transferase-Mediated dUTP Nick End Labeling assay report. The treated rats significantly ( P < 0.05) reduced high-sensitivity C-reactive protein. Lipid peroxidation (thiobarbituric acid reactive substances) marker ( P < 0.001) was significantly reduced in the treatment group., Conclusion: The natural DPP-IV inhibitors BER and MNG treatment showed beneficial effects on various components of metabolic syndrome., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Applied and Basic Medical Research.)

A cost-effective and competent approach has been established for the synthesis of pyrimido[4,5- b ]quinolines and pyrido[2,3- d ]pyrimidines via a multicomponent reaction of 1,3 diketones (dimedone, barbituric acid, and Meldrum's acid), 6-aminouracil and aromatic aldehyde, through mechanochemical synthesis using a ball-mill. This transformation involves a one pot, catalyst-free, and solvent-free pathway to develop the desired products under mild reaction conditions.

Noncovalent interactions due to the presence of heteroatoms in supramolecular compounds have gained a lot of attention. These different heteroatom-based supramolecular compounds have inspired us to examine the noncovalent interaction in the isolated host and host-guest complexes. In view of this, in the current manuscript, we investigated the stability and torsional energy barrier of different conformers of the ditopic receptor host 1,6-bis(2,6-bis(benzothiazol-2-yl) pyridine-4-yloxy) hexane (bbh). The conformer that is accompanied by intramolecular C-H⋯N and C-H⋯S interactions is relatively more stable than the others. Due to torsional angle rotation within the host, the C-H⋯N and C-H⋯S interactions get disrupted and exhibit different binding sites for capturing guest molecules. In addition, we have extended the investigation to understand the interaction energy and nature of interaction in host-guest (1 : 1 and 1 : 2) complexes formed between the host (bbh) and guest (resorcinol) by using different DFT functionals. Extended transition state-natural orbital chemical valence (ETS-NOCV) analysis of complexes revealed that the electrostatic interaction significantly contributes to the host-guest interaction energy. The noncovalent (NCI) analysis provides the existence of intermolecular hydrogen bonding and other weak interactions within the complexes., (© 2023 Wiley-VCH GmbH.)

Misfolding and protein aggregation have been linked to numerous human neurodegenerative disorders such as Alzheimer's, prion, and Parkinson's diseases. Ruthenium (Ru) complexes have received considerable attention in studying protein aggregation due to their interesting photophysical and photo properties. In this study, we have synthesized the novel Ru complexes ([Ru(p-cymene)Cl(L-1)][PF 6 ](Ru-1), and [Ru(p-cymene)Cl(L-2)][PF 6 ](Ru-2)) and investigated their inhibitory activity against the bovine serum albumin (BSA) aggregation and the Aβ 1 - 42 peptides amyloid formation. Several spectroscopic methods were used to characterize these complexes, and the molecular structure of the complex was determined by X-ray crystallography. Amyloid aggregation and inhibition activities were examined using the Thioflavin-T (ThT) assay, and the secondary structures of the protein were analyzed by circular dichroism (CD) spectroscopy and transmission electron microscopy (TEM). The cell viability assay was carried out on the neuroblastoma cell line, revealing that the complex Ru-2 showed better protective effects against Aβ 1 - 42 peptide toxicity on neuro-2a cells than the complex Ru-1. Molecular docking studies elucidate the binding sites and interactions between the Ru-complexes and Aβ 1 - 42 peptides. The experimental studies revealed that these complexes significantly inhibited the BSA aggregation and Aβ 1 - 42 amyloid fibril formation at 1:3 and 1:1 molar concentrations, respectively. Antioxidant assays demonstrated that these complexes act as antioxidants, protecting from amyloid-induced oxidative stress. Molecular docking studies with the monomeric Aβ 1 - 42 (PDB: 1IYT) show hydrophobic interaction, and both complexes bind preferably in the central region of the peptide and coordinate with two binding sites of the peptide. Hence, we suggest that the Ru-based complexes could be applied as a potential agent in metallopharmaceutical research against Alzheimer's disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Curriculum revision in healthcare programs occurs frequently, but to undergo a whole degree transformation is less common. Also, the outcomes of curriculum redesign interventions on the selfreported clinical decision making, experiences, and perceptions of graduates of health education programs is unclear. This study evaluated these factors as an outcome of a pharmacy degree whole-curriculum transformation., Methods: A 25-item cross-sectional end-of-course survey was developed to evaluate pharmacy student decisions, experiences, and perceptions upon completion of degree, pre- and post- curriculum transformation. A two-way analysis of variance (ANOVA) was used to determine whether the responses to the items classed within the main factors differed across the two cohorts. Independent t-tests were used to examine the student responses to the individual questions between the two cohorts., Results: Graduates from the transformed degree had greater self-efficacy in clinical activities, were more satisfied with their education, found course activities more useful, and were more confident in their career choice. Transformed pharmacy degree students also reported spending more time on weekdays and weekends on activities such as attending lectures and working. Student satisfaction with their choice to attend pharmacy school was also significantly higher in transformed degree students., Conclusions: Responses to the end of degree survey indicate that students who completed the transformed pharmacy curriculum have had positive experiences throughout their degree and felt more prepared for practice as pharmacists in comparison to students who completed the established degree. These results add value to those collected from other sources (e.g., student evaluations, assessment scores, preceptors focus groups, and other stakeholder inputs) consistent with a comprehensive quality improvement model., (© 2023. The Author(s).)

The present study describes an epidemiological investigation into a carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, which had occurred in a neonatal intensive care unit (NICU), and the subsequent strengthening of infection control interventions. Upon the onset of the outbreak, existing infection control interventions were reviewed, and a set of containment measures were instituted. All CRAB isolates were characterized in terms of antimicrobial susceptibility testing and their genetic relatedness. The investigation process identified gaps within the NICU's existing infection control measures, which had likely resulted in the outbreak. CRAB was isolated from nine preterm infants: five colonized and four infected. All five colonized patients were discharged well. However, three out of four of the infected infants died. Outbreak investigation and genomic subtyping of environmental swabs revealed that mini syringe drivers shared between patients and a sink in the milk preparation room had served as CRAB reservoirs with possible transmission via the hands of healthcare workers. Implementation of immediate actions such as reinforcement of hand hygiene practices, intensified environmental cleaning, geographical cohorting, reviewing of milk handling practices and sink management protocol had resulted in no further CRAB isolation. The CRAB outbreak in the NICU underlines the importance of consistent compliance with infection-control interventions. Integration of epidemiological and microbiological data, together with comprehensive preventive measures, successfully brought the outbreak to a halt.

Kojic acid (KA), a fungal secondary metabolite, is commonly used in the cosmetic industry as a skin-whitening agent because of its ability to inhibit tyrosinase, the enzyme involved in melanin production. However, KA has shown poor depigmenting effects and becomes unstable after prolonged storage. Its use in cosmetics products has also been restricted due to its hydrophilic nature. To overcome these limitations, the structure of KA can be altered to form KA derivatives, such as KA ester (KAE), with improved chemical and biological properties. For instance, multiple studies have shown that KAE is more effective at inhibiting tyrosinase, is less toxic and more stable than KA, thus making it more beneficial. Aside from structural modification, nanotechnology applications such as nanoemulsion, and others have shown the ability to strengthen the efficacy of both KA and KAE by increasing skin permeability and delivering the drug more precisely to the targeted site with better controlled release rate. Therefore, the aim of this review article is to discuss the importance of modifying KA's chemical structure as well as the role of nanoemulsion, solid lipid nanoparticles (SLN), nanostructured lipid carrier (NLC), liposomes and ethosomes in improving topical delivery of KA and KAE for cosmetic and pharmaceutical applications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

An efficient C-N cross-coupling approach for the synthesis of hydrazones was developed through C(sp 2 )-H and C(sp 3 )-H functionalization of indole and methylarene under visible light irradiation using photocatalyst eosin Y, ethanol:water as a green solvent and atmospheric air as an oxidant. With the aid of eosin Y, the C-H bonds of indole and methylarenes were activated followed by coupling with arylhydrazines. The procedure was applied to a wide variety of substrates with good functional group compatibility, offering a creative way to make hydrazones from inexpensive and easily accessible raw materials. The absence of metals, low cost, environmental friendliness, green solvent, non-toxicity, ease of handling, and utilization of renewable energy sources like visible light are some of this method's primary advantages.

Background: MyDispense is a simulation software developed by Monash University that has been utilized by over 200 institutions worldwide to educate pharmacy students. However, little is known about the processes by which it is used to teach dispensing skills to students and how they use it to facilitate critical thinking in an authentic environment. This study aimed to understand and investigate how simulations are used to teach dispensing skills in pharmacy programs globally, and to determine the opinions, attitudes and experiences of pharmacy educators towards MyDispense and other simulation software within their pharmacy program., Methods: Purposive sampling was used to identify pharmacy institutions for the study. A total of 57 educators were contacted, 18 responded to the study invitation, 12 were MyDispense users and 6 were non-users. Two investigators conducted an inductive thematic analysis to generate key themes and subthemes to provide insight into the opinions, attitudes and experiences towards MyDispense and other simulation software used specifically for dispensing within pharmacy programs., Results: 26 pharmacy educators were interviewed, of which 14 were individual interviews and four were group interviews. Intercoder reliability was investigated and a Kappa coefficient of 0.72 indicated substantial agreement between both coders. Five main themes were identified: "dispensing and counseling", which encompassed discussions about how dispensing techniques were taught, the time allocated for students to practice their skills and the use of software other than MyDispense; "description of MyDispense use" includes discussions about the setup of the software, how dispensing skills were taught prior to using MyDispense as well as its use in student assessments; "barriers to MyDispense use", covers discussions about the obstacles users have faced; "facilitators to use MyDispense", includes discussion about the various motivators to using MyDispense and lastly "future use and suggested improvements" of MyDispense are covered by the interviewees., Conclusion: The initial outcomes of this project evaluated the awareness and utilization of MyDispense and other dispensing simulations by pharmacy programs globally. By addressing the barriers of use, promotion of the sharing of MyDispense cases can assist in creating more authentic assessments, as well as improving staff workload management. The outcomes of this research will also facilitate the development of a framework for MyDispense implementation, thus streamlining and improving the uptake of MyDispense by pharmacy institutions globally., (© 2023. The Author(s).)

The conical intersection (CI) governs the ultra-fast relaxation of excited states in a radiationless manner and are observed mainly in photochemical processes. In the current work, we investigated the effects of substituents on the reaction dynamics for the conversion of gauche-1,3-butadiene to bicyclobutane via photochemical electrocyclization. We incorporated both electron withdrawing (-F) and donating (-CH 3 ) groups in the conjugated system. In our study, we optimized the minimum energy conical intersection (MECI) geometries using the multi-configurational state-averaged CASSCF approach, whereas, to study the ground state reaction pathways for the substituted derivatives, dispersion corrected, B3LYP-D3 functional was used. The non-adiabatic surface hopping molecular dynamics simulations were performed to observe the behaviour of electronic states involved throughout the photoconversion process. The results obtained from the multi-reference second-order perturbation correction of energy at the XMS-CASPT2 level of theory, topography analysis, and non-adiabatic dynamics suggest that the -CH 3 substituted derivatives can undergo faster thermal conversion to the product in the ground state with a smaller activation energy barrier compared to -F substituted derivative. Our study also reveals that the GBUT to BIBUT conversion follows both conrotatory and disrotatory pathways, whereas, on substitution with -F or -CH 3 , the conversion proceeds via the conrotatory pathway., (© 2022 Wiley-VCH GmbH.)

We investigate the properties of the degree of cross-polarization (DOCP) for an electromagnetic Gaussian-Schell model (EMGSM) beam in the radial direction of the cross section of the beam. The coherence and polarization features of a partially coherent light beam are engineered to construct the isotropic and non-isotropic EMGSM beams, and the resulting changes in the DOCP are examined. For experimental realization, a double-slit interferometer is utilized at the output to probe the coherence properties for different polarization components across the beam diameter of an electromagnetic source. Experimental observations infer that variation in DOCP does not become apparent for isotropic coherence widths in the orthogonal polarization directions, whereas the variation can be apparent only once both the coherence widths are distinct. Furthermore, experimentally, a special case is also investigated for which the value of DOCP goes beyond unity. The DOCP finds application in areas such as second-order intensity interference, imaging, and characterization of non-homogeneously polarized beams.

Based on first-principles calculations, the anomalous Hall conductivity (AHC) and anomalous Nernst conductivities (ANCs) of the XMnP (X = Ti, Zr, Hf) compounds are evaluated, and the possibility to tailor such properties in compounds susceptible to changing the magnetization directions is also investigated. We observe large changes in the calculated AHC and ANC for different magnetization directions that are originating from changes in the band structure all over the whole Brillouin zone. Our study gives a promising clue on engineering magnetic intermetallic compounds for tunable transverse thermoelectric applications., (Creative Commons Attribution license.)

Background: The impact of laparoscopic inguinal hernia repair (IHR) on chronic groin pain (CGP) prevalence, risk and daily activities compared to open IHR is still unclear., Methods: A meta-analysis of randomised controlled trials comparing CGP rates in laparoscopic and open IHR was performed., Results: 22 trials were included. CGP prevalence decreases significantly 1-2 years post-op and reaches rates as low as 4.69% (laparoscopic) and 6.91% (open) at >5 years. There is a significantly lower risk of CGP following totally extraperitoneal (TEP) than open mesh repair at all follow-up periods (p < 0.05) except for >5 years (p = 0.32). The same trend is not seen when compared to open non-mesh repair or for transabdominal pre-peritoneal repair (TAPP). There is no difference between techniques when CGP is described as moderate and/or affecting daily activities (p = 0.08)., Conclusion: CGP rates continue to decrease at >5 years follow up. TEP consistently results in a reduction in CGP rates compared to open mesh repair however, this is not functionally significant., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: BK polyomavirus (BKPyV) infection and BK polyomavirus nephropathy (BKPyVAN) are important causes of allograft dysfunction and premature allograft loss in renal transplant recipients., Results and Discussion: Controlled clinical trials to evaluate new agents for prevention and treatment are needed but are hampered by the lack of outcome measures that accurately assess the effect of the intervention, are clinically relevant, and are acceptable from a regulatory perspective., Methods: To facilitate consistent end points in clinical trials and to support clinical research and drug development, definitions of BKPyV infection and disease have been developed by the BK Disease Definitions Working Group of the Transplantation Associated Virus Infection Forum with the Forum for Collaborative Research, which consists of scientists, clinicians, regulators, and industry representatives., Conclusions: These definitions refine established principles of "proven" BKPyV disease and introduce a "probable" disease category that could be used in clinical trials to prevent or treat BKPyVAN in renal transplant recipients., Competing Interests: Potential conflicts of interest. P. B. has received salary, stock options, and support for attending meetings or travel from Roche Diagnostics. D. C. B. has received grants/research support from CareDx (to John Hopkins for research on donor-derived cell-free DNA and relation to BK infection), Natera, Amplyx Pharmaceuticals (to John Hopkins for research on BK), and AlloVir (to John Hopkins for research on BK); consulting fees from CareDx, Medeor, Natera, and Sanofi (use of donor-derived cell-free DNA); honoraria from CareDx (use of donor-derived cell-free DNA), Sanofi (Infections in Transplantation), and Veloxis; and has served on the editorial boards of Transplantation and UpToDate. M. R. H. has received salary and consulting fees from Amplyx Pharmaceuticals and consulting fees from Pfizer, Hybridize Therapeutics, and AlloVir. P. L. has participated in a contract for a clinical trial with AlloVir (planned clinical trial at institution). V. M. receives support as part of the TAVI Forum from Amplyx Pharmaceuticals, Everys Bio, Mikrogen GmbH, Merck, Quest Diagnostics, Roche, SymBio Pharmaceuticals, and Viracor. V. N. has received grants or contracts with AlloVir and is on the advisory board for Hybridize Therapeutics. P. S. R. has a leadership role (president) of the Renal Pathology Society. A. P. L. has received consulting fees and contracts with Amplyx Pharmaceuticals (grant for being site investigator for BKPyV therapy and consulting fees for providing guidance on study design for BKPyV therapies) and has received consulting fees from AlloVir (for providing guidance on study design for immune therapies for viral infectious including BKPyV). All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objectives: In the fall of 2020, US medical centers were running out of rapid coronavirus disease 2019 (COVID-19) tests. The aim of this study is to evaluate the impact of an intervention to eliminate rapid test misutilization and to quantify the effect of the countermeasures to control rapid test ordering using a test utilization dashboard., Methods: Interventions were made to preserve a severely limited supply of rapid diagnostic tests based on real-time analysis of a COVID-19 test utilization dashboard. This study is a retrospective observational study evaluating pre- and postintervention rates of appropriate rapid test use, reporting times, and cost/savings of resources used., Results: This study included 14,462 severe acute respiratory syndrome coronavirus 2 reverse transcriptase polymerase chain reaction tests ordered during the study period. After the intervention, there was a 27.3% decrease in nonconforming rapid tests. Rapid test reporting time from laboratory receipt decreased by 1.47 hours. The number of days of rapid test inventory on hand increased by 39 days., Conclusions: Performing diagnostic test stewardship, informed by real-time review of a test utilization dashboard, was associated with significantly improved appropriate utilization of rapid diagnostic COVID-19 tests, improved reporting times, implied cost savings, and improved reagent inventory on hand, which facilitated the management of scarce resources during a pandemic., (© The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Disease-specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD-specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3-item Likert-scale adapted from a previous disease stress measure and a 10-item Likert-scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health-related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self-defined vaso-occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three-item and 10-item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6-month stress for the 10-item scale. Cronbach's alpha was high for both the 3-item (0.73) and 10-item (0.83) SCD stress scales, test-retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary-measured healthcare utilization over 6 months. The correlations with the 3-item scale were stronger, but only statistically significant for depression-anxiety. The correlation between the two stress scales was 0.59. Both the 3-item and the 10-item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test-retest reliability. Further scale validation should determine population norms and response to interventions., (© 2022 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.)

The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching., (© 2021 John Wiley & Sons Ltd.)

Background: Most of the red blood cell (RBC) storage lesions can be attributed to oxidative stress encountered by the RBCs throughout the duration of their storage. Various donor variables at the time of donation may be responsible for the total antioxidant capacity of the supernatant and thus, the "storability" and the magnitude of development of these RBC storage lesions. It is known that uric acid (UA) is responsible for more than 60% of the TAC of the blood. This study aims to explore the relationship between donor UA levels and the difference in percentage hemolysis, an important RBC storage lesion, on day 1 and day 21, in stored packed RBCs (PRBCs) units., Materials and Methods: The serum UA of 100 healthy voluntary male blood donors was estimated at the time of blood donation. The percentage hemolysis in the supernatant of the leukoreduced citrate phosphate dextrose/saline-adenine-glucose-mannitol RBC units ( n = 100) prepared from these donors was calculated on day 1 and day 21. The difference in percentage hemolysis between donors with high normal serum UA levels (>7 mg/dL) was compared to that of the donors with low normal serum UA levels (<5 mg/dL) to observe the effect of donor UA levels on the difference in percentage hemolysis., Results: The mean of the differences in percentage hemolysis in the supernatant in low UA group (<5 mg/dL) was higher than the mean of the differences in percentage hemolysis in the supernatant in high UA group (>7 mg/dL) and this was statistically significant ( P < 0.001). The donor serum UA level and difference in percentage hemolysis on day 21 and day 1 were found to be negatively co-related., Conclusion: Higher levels of serum UA of blood donors seem to have a protective effect on the stored PRBC units as shown in this study. Hence, the potential of UA as one of the constituents of RBC additive solutions might lead to the enhancement of the quality of stored PRBC units by decreasing the RBC storage lesions., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Asian Journal of Transfusion Science.)

Aim: This study aimed to assess the impact of treatment sequencing on long-term survival, in distal gastric cancers (GCs) (stage IB/II/III)., Methods: This retrospective study included patients with distal GC undergoing D2 resection. Outcomes were compared between group 1 (surgery with adjuvant chemotherapy) and group 2 (perioperative chemotherapy with surgery). 1:1 matching for baseline characteristics (age, cT, and cN stage) was performed for outcome comparison., Results: At a median follow-up of 47.5 months in the included 342 patients, the 5-year overall survival (OS) was 61.1% and disease-free survival (DFS) was 50.5%. OS was comparable in the unmatched (group 1, n = 118; group 2, n = 224) (HR 0.905, 95%CI 0.64-1.33, P = 0.615) and matched groups (group 1, n = 97; group 2, n = 97) (HR 0.77, 95% CI 0.48-1.26, P = 0.3)., Conclusion: D2 resection followed by adjuvant chemotherapy provides similar long-term outcomes as compared to perioperative chemotherapy approach for stage IB/II/III distal GCs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Issue Addressed: Australian pharmacists are increasingly moving towards the provision of patient-centred professional pharmacy services for chronic disease management. Some of these services are targeted towards improving patients' health and wellbeing through the facilitation of patient-driven health behaviour change. This paper investigates whether the provision of behaviour change interventions by Australian pharmacists is adequately underpinned by the current competency framework., Methods: The foundation and behaviour change competences within each of the domains in the generic health behaviour change competency framework (GHBC-CF), was mapped to the Australian pharmacist competency framework., Results: Although the Australian competency framework underpins most of the foundation and behaviour change competences of the GHB-CF required to undertake low-intensity interventions, for medium to high-intensity interventions four specific task-related competences need to be addressed. These are F12 'Ability to recognise barriers to and facilitators of implementing interventions', BC4 'ability to agree on goals for the intervention', BC5 'capacity to implement behaviour change models in a flexible but coherent manner' and BC6 'capacity to select and skilfully apply most appropriate intervention method'., Conclusion: Additional training is necessary if pharmacists aspire to provide behaviour change interventions for chronic disease management, in particular those that are complex as they involve changes to multiple health behaviours. SO WHAT?: The identification of these gaps is critical and can potentially be addressed in postgraduate training programs and as pharmacy curricula are updated., (© 2021 Australian Health Promotion Association.)

Background: Various strategies have been made to make vaccines universally available including to most hard-to-reach and vulnerable population. However, change in coverage level never reached upto expected level in spite of giving so much effort by the Govt. of India and World bodies. Therefore, there is the need to look beyond. Hence, the process evaluation of Universal Immunization Program (UIP) was conducted to evaluate the process of UIP using selected variables., Methods: A cross-sectional observation was done during the period from May 2017 to April 2020 among the 14 health-care facilities and 36 selected session sites, and interview was done to 48 health-care providers working at different levels, located in Imphal East district of Manipur. Both checklist and pretested semi-structured questioners were used for collection of data. Descriptive statistics such as frequency, proportion, and percentage were used., Results: Ice-lined refrigerator and Deep-freezer were found to be present in working condition in 11 (100%) centers. The use of vaccine carrier was found in all 36 (100%) centers. Way of vaccine administration was found to be correct in 26 (72.2%) centers. Availability of up-to-date microplan was found in 18 (78.3%) centers., Conclusions: Barriers in the UIP were not uniform throughout the villages and districts. Hence, area-specific measures need to be taken up for overcoming the barriers and challenges., Competing Interests: None

Objective: A systematic review was undertaken in order to evaluate the competencies of primary healthcare professionals who are engaged with health coaching patients with chronic health conditions., Methods: The databases CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched to identify peer reviewed papers referring to competencies of health professionals engaged in health coaching., Results: Nine key competencies that health professionals met and which resulted in successful patient outcomes from health coaching were identified. Comparisons of the core health coaching competencies to the competencies for coaches established by the International Coaching Federation and European Mentoring and Coaching Council showed considerable overlap. However, the comparison also reiterated the need for competencies specific to health coaches to be made explicit., Discussion: Health coaching has been shown to improve the health outcomes in patients with chronic health conditions. As such, there is a need to build an evidenced-based competency framework specific to health coaches. At present, the lack of a competency framework on which to base health coach training could significantly impact the outcomes of patients receiving health coaching. Practical implications include improving regulation and quality of health coaching, and more importantly, the health outcomes of patients receiving the service.

Background: Penicillin allergy is commonly reported, but true allergy is rare. Inpatients with reported beta-lactam allergy are often treated with alternative antibiotics. Penicillin skin testing (PST) is not universally available for inpatients., Methods: We designed a four-phase quality improvement project aimed to increase the percentage of inpatients on medical services with reported beta-lactam allergy who safely receive beta-lactam antibiotics at two hospitals with limited access to PST. First, we updated our hospital guideline to allow for cephalosporin graded challenge without antecedent PST. Second, we educated physicians, physician assistants, and nurses about the new guideline and beta-lactam allergy classification and management. Third, we designed a pocket card to reinforce the education. Last, we used antimicrobial stewardship software to screen our daily census to identify opportunities to improve management of patients with reported beta-lactam allergies., Results: We observed a 29.2% increase in the percentage of patients who received beta-lactam antibiotics (excluding carbapenems) among those with reported beta-lactam allergy, from 42.2% (470/1,115) at baseline to 54.5% (379/696), p < 0.001, during the project period. There was a decrease in the use of alternative antibiotics, no change in hospital-onset Clostridioides difficile cases, and no increase in the number of infectious disease or allergy consults. The number of graded challenges increased during the project period, without any anaphylaxis events., Conclusion: A multiphase quality improvement project aimed to improve management of beta-lactam allergies and access to graded challenges led to an increase in beta-lactam utilization without an increase in anaphylaxis, even with limited access to PST., (Copyright © 2021 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Metastasis from breast cancer to the head and neck region is a rare occurrence. However, of all the cancers that metastasise to the orbit, breast cancer is the leading cause in women. Usually, breast cancer metastasises to the fat and muscles in the orbit, and involvement of the bony orbital wall is rare. We report a case of a 52-year-old woman who presented with metastasis to the left greater wing of the sphenoid and adjacent squamous temporal bone. Ophthalmoplegia and proptosis were the initial manifestations in this patient, which lead to the diagnosis of the underlying breast cancer., Competing Interests: No potential conflict of interest was reported by the authors., (© 2022 Taylor & Francis Group, LLC.)

In this paper, we investigate both theoretically and experimentally the statistical properties of an electromagnetic Gaussian-Schell model (EMGSM) beam propagating through polluted atmosphere specifically containing smoke aerosol medium. Experimentally, a glass chamber of 1 m length is constructed to mimic the smoky atmosphere inside the laboratory, in which incense sticks are used for smoke aerosol production inside the chamber in a time-controlled manner. An input EMGSM beam having a variable degree of coherence and degree of polarization (DOP) propagates through the aerosol medium, and its coherence and polarization features after propagation are probed. The results show that the coherence features of the vectorial beam are modified significantly by the smoke aerosol medium, while, for the given propagation length of 1 m, the polarization features remain unaffected. We also investigate the coherence features of the EMGSM beam through smoke aerosols in a particular condition when the DOP of the beam is kept zero. These results are expected to provide insights into atmospheric effects on free-space optical communication in real situations when the medium contains air pollution.

Background: Collapsing focal segmental glomerulosclerosis (FSGS) has various underlying etiologies and often leads to renal failure. The impact of biopsy-proven renal comorbidities in promoting collapsing glomerulopathy (CG) has not been systematically evaluated in large comparative studies. Those data are reported here., Methods: Biopsies with the initial diagnosis of CG in native (n = 321) or transplant kidneys (n = 30) were identified in the University of North Carolina nephropathology database (1 January 2011 to 1 January 2016). Two cohorts were defined: 'sole' CG without and 'accompanied' CG with significant morphologic renal comorbidities. Tip-variant FSGS (T-FSGS) and time-matched biopsies served as control cohorts for comparative analyses., Results: CG was significantly more common in native (4.4%) and transplant biopsies (4.1%) compared with T-FSGS (0.7 and <0.1%, respectively, difference versus CG P < 0.01). 'Associated' disease was significantly more common in CG (native: 151/321; 47.0%, transplant: 21/30; 70%, P < 0.05) versus T-FSGS (native: 14/51; 27.5%, transplant: exceptional; all differences versus CG P < 0.05). In native biopsies with 'accompanied' CG but not in control groups, stenosing vasculopathies including thrombotic microangiopathies were significantly more prevalent (P < 0.01). In transplants, the high incidence of 'accompanied' CG was linked to de novo diseases, mainly rejection and vascular injury. In native kidneys, membranous glomerulopathies were prevalent in 'accompanied' T-FSGS (36%) and CG (14%) (difference versus time-matched controls P < 0.01 and P < 0.05, respectively); they were uncommon in transplants., Conclusions: CG but not T-FSGS shows a high rate of comorbidities, with prominent vasculopathies presumably driving 'ischemic' CG-specific glomerular injury and also the disease course. These findings facilitate future studies into therapy, prognosis and reversibility of 'accompanied' CG., (© The Author(s) 2020. Published by Oxford University Press on behalf of the ERA.)

Deep understanding of the SARS-CoV-2 effects on host molecular pathways is paramount for the discovery of early biomarkers of outcome of coronavirus disease 2019 (COVID-19) and the identification of novel therapeutic targets. In that light, we generated metabolomic data from COVID-19 patient blood using high-throughput targeted nuclear magnetic resonance (NMR) spectroscopy and high-dimensional flow cytometry. We find considerable changes in serum metabolome composition of COVID-19 patients associated with disease severity, and response to tocilizumab treatment. We built a clinically annotated, biologically-interpretable space for precise time-resolved disease monitoring and characterize the temporal dynamics of metabolomic change along the clinical course of COVID-19 patients and in response to therapy. Finally, we leverage joint immuno-metabolic measurements to provide a novel approach for patient stratification and early prediction of severe disease. Our results show that high-dimensional metabolomic and joint immune-metabolic readouts provide rich information content for elucidation of the host's response to infection and empower discovery of novel metabolic-driven therapies, as well as precise and efficient clinical action., Competing Interests: OE is scientific advisor and equity holder in Freenome, Owkin, Volastra Therapeutics and OneThree Biotech. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Rendeiro, Vorkas, Krumsiek, Singh, Kapadia, Cappelli, Cacciapuoti, Inghirami, Elemento and Salvatore.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to the healthcare systems worldwide. This uncharted territory has changed the practices in modern healthcare delivery; this is particularly true in the case of minimally invasive surgery (MIS) where various changes are being adopted. This survey was conducted to determine the impact of the pandemic and the changes being adopted in the field of MIS, from a resource-limited developing country, India., Materials and Methods: The survey was carried out from 27 July to 22 August 2020, amongst MIS surgeons in India using an online questionnaire generated on Google Forms., Results: The survey was completed by 251 MIS surgeons nationwide. There was a proportional reduction of overall elective surgeries and MIS. Approximately 30% of the surgeons continued to use MIS, as during the pre-pandemic era. Pre-operative tests for COVID-19 (96.1%) and personal protective equipment (PPE, 66%-86%), including respirators (95.2%), are used uniformly across the nation. Almost half (43.1%) of the MIS surgeons are using ≥6 recommended intraoperative modifications in MIS to mitigate the COVID-19 transmission., Conclusion: MIS surgeons in India have adapted within a short time to the challenge of the pandemic by embracing pre-operative testing, PPE and new techniques/technologies to continue patient care. Innovations and low-cost indigenous customisations are the need of the hour for a developing country like India. Further studies are required to establish the true risk of viral transmission involved in MIS and the efficacies of the techniques/devices to reduce the spread of the virus., Competing Interests: None

Background: Conventional optical colonoscopy is considered the gold standard investigation for colorectal tract pathology including colorectal malignancy, polyps and inflammatory bowel disease. Inherent limitations exist with current generation endoscopic technologies, including, but not limited to, patient discomfort, endoscopist fatigue, narrow field of view and missed pathology behind colonic folds. Rapid developments in medical robotics have led to the emergence of a variety of next-generation robotically-augmented technologies that could overcome these limitations., Aim: To provide a comprehensive summary of recent developments in the application of robotics in lower gastrointestinal tract endoscopy., Methods: A systematic review of the literature was performed from January 1, 2000 to the January 7, 2021 using EMBASE, MEDLINE and Cochrane databases. Studies reporting data on the use of robotic technology in ex vivo or in vivo animal and human experiments were included. In vitro studies (studies using synthetic colon models), studies evaluating non-robotic technology, robotic technology aimed at the upper gastrointestinal tract or paediatric endoscopy were excluded. System ergonomics, safety, visualisation, and diagnostic/therapeutic capabilities were assessed., Results: Initial literature searching identified 814 potentially eligible studies, from which 37 were deemed suitable for inclusion. Included studies were classified according to the actuation modality of the robotic device(s) as electromechanical (EM) ( n = 13), pneumatic ( n = 11), hydraulic ( n = 1), magnetic ( n = 10) and hybrid ( n = 2) mechanisms. Five devices have been approved by the Food and Drug Administration, however most of the technologies reviewed remain in the early phases of testing and development. Level 1 evidence is lacking at present, but early reports suggest that these technologies may be associated with improved pain and safety. The reviewed devices appear to be ergonomically capable and efficient though to date no reports have convincingly shown diagnostic or therapeutic superiority over conventional colonoscopy., Conclusion: Significant progress in robotic colonoscopy has been made over the last couple of decades. Improvements in design together with the integration of semi-autonomous and autonomous systems over the next decade will potentially result in robotic colonoscopy becoming more commonplace., Competing Interests: Conflict-of-interest statement: All authors have no conflict of interests to declare., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Severe leaf curl disease of tomato (ToLCD) was noticed recently in the central parts of India and is an emerging threat to the cultivation of tomato. The genomic components of the begomovirus isolate, DNA A and betasatellite associated with ToLCD were cloned by rolling circle amplification method and sequenced. The sequence analysis revealed that the DNA A (2766 nt) of this isolate had the nucleotide identity of >91% with other strains of Tomato leaf curl Karnataka virus (ToLCKV), hence this isolate is proposed as a strain of ToLCKV, named as ToLCKV-Raipur. Similarly, the betasatellite molecule (1355 nt) had the highest identity of 91.1% with Corchorus yellow vein mosaic betasatellite (CoYVMB) and named as CoYVMB-Raipur. The full-length dimerized clones of these two genomic components were agroinoculated on natural (tomato), experimental (Nicotiana benthamiana) hosts and other 20 plant species belong to six different families. The severe leaf curl symptoms appeared only in the hosts, N. benthamiana, and in tomato inoculated with ToLCKV-Raipur alone and ToLCKV-Raipur with CoYVMB-Raipur after 8 and 16-18 days inoculation, respectively. This isolate was also transmissible to healthy tomato plants by whitefly from the tomato plant agroinoculated with ToLCKV-Raipur alone and with CoYVMB-Raipur and produced symptoms within 14-16 days after inoculation. Interestingly, this isolate infects horse gram and chilli by whitefly transmission and both the hosts showed positive for DNA A alone but not for betasatellite. Quantification of the genomic components of this isolate with the agroinoculated N. benthamiana samples by qRT-PCR results showed that the quantity of ToLCKV-Raipur was enhanced by three-fold while inoculated with CoYVMB-Raipur compared to ToLCKV-Raipur alone inoculated plants. However, CoYVMB-Raipur did not enhance the levels of ToLCKV-Raipur in the agroinoculated tomato plants. This is the first evidence of the natural co-occurrence of ToLCKV with betasatellite, CoYVMB causing ToLCD., (Copyright © 2021. Published by Elsevier B.V.)

Background: The standard for SARS-CoV-2 diagnosis is RT-PCR from nasopharyngeal or oropharyngeal swabs. Major airports require COVID-19 screening, and saliva has the potential as a substitute specimen for SARS-CoV-2 diagnosis. We investigated the utility of fresh drooled saliva against NPS for COVID-19 screening of travelers., Methods: We recruited 81 travelers and 15 non-travelers (including ten controls) prospectively within a mean of 3·22 days of RT-PCR confirmed COVID-19. Each study participant provided 2 mls of early morning fresh drooled whole saliva separately into a sterile plastic container and GeneFiX™ saliva collection kit. The saliva specimens were processed within 4 h and tested for SARS-CoV-2 genes (E, RdRP, and N2) and the results compared to paired NPS RT-PCR for diagnostic accuracy., Results: Majority of travellers were asymptomatic (75·0%) with a mean age of 34·26 years. 77 travelers were RT-PCR positive at the time of hospitalization whilst three travelers had positive contacts. In this group, the detection rate for SARS-CoV-2 with NPS, whole saliva, and GeneFiX™ were comparable (89·3%, 50/56; 87·8%, 43/49; 89·6%, 43/48). Both saliva collection methods were in good agreement (Kappa = 0·69). There was no statistical difference between the detection rates of saliva and NPS (p > 0·05). Detection was highest for the N2 gene whilst the E gene provided the highest viral load (mean = 27·96 to 30·10, SD = 3·14 to 3·85). Saliva specimens have high sensitivity (80·4%) and specificity (90·0%) with a high positive predictive value of 91·8% for SARS-CoV-2 diagnosis., Conclusion: Saliva for SARS-CoV-2 screening is a simple accurate technique comparable with NPS RT-PCR., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Utilizing the molecular beam epitaxy technique, a nanoscale thin-film magnet of c -axis-oriented Sm 2 Co 17 and SmCo 5 phases is stabilized. While typically in the prototype Sm(Co, Fe, Cu, Zr) 7.5-8 pinning-type magnets, an ordered nanocomposite is formed by complex thermal treatments, here, a one-step approach to induce controlled phase separation in a binary Sm-Co system is shown. A detailed analysis of the extended X-ray absorption fine structure confirmed the coexistence of Sm 2 Co 17 and SmCo 5 phases with 65% Sm 2 Co 17 and 35% SmCo 5 . The SmCo 5 phase is stabilized directly on an Al 2 O 3 substrate up to a thickness of 4 nm followed by a matrix of Sm 2 Co 17 intermixed with SmCo 5 . This structural transition takes place through coherent atomic layers, as revealed by scanning transmission electron microscopy. Highly crystalline growth of well-aligned Sm 2 Co 17 and SmCo 5 phases with coherent interfaces result in strong exchange interaction, leading to enhanced magnetization and magnetic coupling. The arrangement of Sm 2 Co 17 and SmCo 5 phases at the nanoscale is reflected in the observed magnetocrystalline anisotropy and coercivity. As next-generation permanent magnets require designing of materials at an atomic level, this work enhances our understanding of self-assembling and functioning of nanophased magnets and contributes to establishing new concepts to engineer the microstructure for beyond state-of-the-art magnets.

Aim: Colorectal cancer (CRC) screening reduces mortality but variation exists in uptake, with poorer uptake in ethnic minority groups. The aim of this work was to evaluate the relationship between ethnicity and uptake of CRC screening in West London., Method: Results of CRC screening from the Central London, West London, Hammersmith and Fulham, Hounslow and Ealing Clinical commissioning group collaborative between 2012 and 2017 were retrospectively analysed. These five clinical commissioning groups (CCGs) are located in West London. Compliance with screening according to ethnic group was evaluated compared with White British as the control., Results: A total of 155 038 individuals were screened. White British individuals had the highest compliance (52.6%). A maximum difference in compliance of 8.2% was seen between CCGs. The odds of being less likely to participate were significant (p < 0.05) in all ethnic minorities except for Asian Chinese on univariate and multivariate analysis (adjusted OR 1.091, p = 0.88)., Conclusion: This is the largest retrospective study focusing on the role of ethnicity in the uptake of CRC screening in England. Poor uptake of screening in all ethnic minorities in West London, with the exception of Asian Chinese individuals in particular, is a novel finding. A mandate to routinely collect ethnicity data, the use of a single more diverse census and further intervention are needed to understand this disparity and reduce health inequity., (© 2021 The Association of Coloproctology of Great Britain and Ireland.)

Objective: Screening programmes based on the faecal occult blood test (FOBT) can reduce mortality from colorectal cancer (CRC). However, a significant variation exists in uptake of the test within the UK. Disproportionate uptake risks increasing inequity during staging at diagnosis and survival from CRC. This study aims to evaluate the impact of socioeconomic deprivation on the uptake of CRC screening (FOBT) in London., Methods: A retrospective review of the "Vanguard RM Informatics" database was performed to identify eligible individuals for CRC screening across all general practices across London over 30 months (2014-2017). The postcodes of the general practices were used to obtain the deprivation data via the "Indices of Deprivation" database. A Spearman's rho correlation was performed to quantify the impact of the deprivation variables on FOBT uptake., Results: Overall, 697,402 individuals were eligible for screening across 1359 London general practices, within 5 Clinical Commissioning Groups (CCGs); 48.4% (range: 13%-74%) participated in CRC screening with the lowest participation rates in North West (46%) and North East (47%) London CCGs. All indices of deprivation had a significant correlation with the uptake of FOBT ( p  < 0.01)., Conclusion: This is the largest study across London to date demonstrating a significant positive correlation between deprivation indices and FOBT uptake, highlighting areas of particular risk. Further studies are imperative to quantify the impact of deprivation on CRC morbidity and mortality, together with focused strategies to reduce socioeconomic inequalities in screening in these high risk areas.

Background: Rosai-Dorfman-Destombes (RDD) is also known as sinus histiocytosis with massive lymphadenopathy (SHML). It is a benign proliferative disorder of histiocytes, affecting lymph nodes, rarely with extra-nodal involvement. Rapid on-site evaluation (ROSE) with fine-needle aspiration cytology (FNAC) can be utilized as a minimally invasive investigation to avoid unnecessary surgery of this self-limiting disease., Case Presentation: A 65-year-old female presented with complaints of bilateral cervical lymphadenopathy since 1 year. Rapid on-site stain with FNAC from bilateral cervical lymph nodes revealed features of Rosai-Dorfman-Destombes (RDD) disease., Conclusion: FNAC with rapid on-site evaluation can provide a simple and cost-effective method for looking at the unique cytological features of the disease and act as a first-line investigation.