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Background: TikTok is a mobile application that had become very popular among youth in college and adults alike. Many people have used TikTok as an alternate form of social media and share videos from there on different social media platforms. This study was aimed as survey to ascertain the knowledge, attitudes, and practices toward TikTok as an application. Methodology: A semi-structured questionnaire was prepared to consist of questions regarding demographic details, knowledge regarding TikTok, frequency of usage of TikTok, attitudes toward its use and suggestions for change required in it. The questionnaire was circulated among students through e-mails and Whatsapp. The form was distributed three times in all within a gap of 7 days. The data collected were subjected to descriptive statistical analysis and percentages. Results: Seven hundred students in all were mailed and received the questionnaire. We received 583 responses, of which 81 responses being incomplete were removed, and the final analysis was done with 502 responses. Three hundred and three (60.4%) participants felt that it could be used for entertainment and only 11 (2.2%) mentioned education or awareness. Two hundred and seventy-two (54.2%) participants felt that TikTok use could be a media for boosting self-esteem and self-image. Conclusion: Further studies in detail about various facets of TikTok need to be studied in diverse population to generalize our findings and know how this application has influenced the youth in various sectors.

Curcumin is a complex molecule with substantial activity against a number of diseases but its limited water solubility and low skin penetration offer significant challenges to its transdermal distribution and performance thus for enhancing its transdermal application curcumin-loaded invasomes were prepared using mechanical dispersion process. Invasomes were characterised and optimised in terms of entrapment efficiency, vesicle size, in vitro drug release, ex vivo permeation and skin retention studies. A topical gel was prepared from the optimized invasomal formulation. In vitro release study of invasomal gel affirmed well with Higuchi kinetic model for release. Ex vivo study confirmed that the curcumin permeation across the pig ear skin from the invasomal gel was 2.60 times higher and had a flux of 166.02 ± 0.13 µg/cm2/h. The study's findings suggest that invasomes have a high potential for transdermal administration of curcumin which can increase the topical utility of curcumin in several skin diseases.

Introduction: Fever is a common symptom with multifactorial aetiologies. In tropical country like India, most of the cases of acute febrile illness are due to seasonal viral diseases and vector-borne infections. Aim: To know the causes of acute onset fever in immunocompetent adults and to study the prevalence of neutropaenia. Materials and Methods: A cross-sectional study was done on 403 patients presenting with Acute Febrile Illness (AFI) of

Introduction: Endoscopy is a minimally invasive procedure for visualisation of gastrointestinal tract performed under topicalisation with or without sedation. Lignocaine is one of the most popular local anaesthetic used for topicalisation for endotracheal intubation in different forms like spray, gargles, nebulisation, gel. Recently ketamine has emerged as an effective antinociceptive and anti-inflammatory agent. Aim: To observe and compare the effect of ketamine and lignocaine gargles for decreasing sore throat, coughing and change in voice. Also to observe various side-effects following use of ketamine and lignocaine. Materials and Methods: This prospective double-blind randomised clinical trial was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India, from January 2020 to June 2021. Total 70 patients undergoing oesophagogastroduodenoscopies under sedation were included in the study. They were divided into two groups i.e, 35 patients in each group. Group L received lignocaine 2% viscous gargles 3 mg/kg and group K received ketamine gargles 3 mg/kg ideal body weight diluted in Normal Saline (NS) up to total 30 mL. Sore throat, coughing, change in voice, side-effects were observed. Student’s t-test was used for continuous data. Results: In group L, 11.4% of patients and in group K 22.9% of patients complained of mild sore throat (grade 1) immediate postprocedure but this was statistically insignificant (p-value=0.2). For both the groups, grade 1 coughing was observed in 2.9% patients (p-value >0.995). In both the groups 5.71% of patients complained about change of voice, statistically insignificant (p-value >0.995). Vomiting was observed as a side-effect in 2.9% of patients in both the groups but there were no other side-effects. Conclusion: Gargling with ketamine was as effective as lignocaine for prevention of sore throat, coughing and change in voice in patients undergoing oesophagogastroduodenoscopies and thus improved patient compliance.

Objectives To determine whether hydroxychloroquine when used with personal protective equipment reduces the proportion of laboratory-confirmed COVID-19 among healthcare workers in comparison to the use of personal protective equipment alone.Design Multicentre, parallel-group, open-label randomised trial. Enrolment started on 29 June 2020 and stopped on 4 February 2021. Participants randomised in HydrOxychloroquine Prophylaxis Evaluation were followed for 6 months.Setting 9 hospitals across India.Participants Healthcare workers in an environment with exposure to COVID-19 were randomised in a 1:1 ratio to hydroxychloroquine plus use of personal protective equipment or personal protective equipment alone. 886 participants were screened and 416 randomised (213 hydroxychloroquine arm and 203 personal protective equipment).Intervention Participants in intervention arm received 800 mg of hydroxychloroquine on day of randomisation and then 400 mg once a week for 12 weeks in addition to the use of personal protective equipment. In the control arm, participants continued to use personal protective equipment alone.Main outcome Proportion of laboratory-confirmed COVID-19 in the 6 months after randomisation.Results Participants were young (mean age 32.1 years, SD 9.1 years) with low-comorbid burden. 47.4% were female. In the 6 months after randomisation (primary analysis population=413), 11 participants assigned to the hydroxychloroquine group and 12 participants assigned to the standard practice group met the primary endpoint (5.2% vs 5.9%; OR 0.85, 95% CI 0.35 to 2.07, p=0.72). There was no heterogeneity of treatment effect in any prespecified subgroup. There were no significant differences in the secondary outcomes. The adverse event rates were 9.9% and 6.9% in the hydroxychloroquine and standard practice arms, respectively. There were no serious adverse events in either group.Conclusions and relevance Hydroxychloroquine along with personal protective equipment was not superior to personal protective equipment alone on the proportion of laboratory-confirmed COVID-19. Definitive conclusions are precluded as the trial stopped early for futility, and hence was underpowered.Trial registration number CTRI/2020/05/025067.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has notably changed the working and community environment for health-care workers (HCWs) leading to burnout and feeling of being stigmatized by the community due to their work. This study aims at assessing the prevalence of burnout, perceived social stigma, and their demographic and work-related predictors. Methods: A cross-sectional study using Oldenburg Burnout Inventory and perceived stigma scale was carried out among 348 HCWs in COVID-19 designated hospital at Ahmedabad about 6 months after the onset of the outbreak in September 2020. The prevalence of burnout was assessed in two dimensions: disengagement and exhaustion. Severity of each was measured on low, moderate, and high levels. Results: Total 348 HCWs participated in study with a mean age of 28.05 ± 6.75 years. Two hundred and sixty-five (76.15%) HCWs experienced burnout and 200 (57.47%) high levels of perceived stigma. The level of burnout was measured on three severities. Factors which predict high burnout are female gender, lower education, unmarried status, living in a nuclear family, and high perceived stigma. Work characteristics such as duty hours, days of working, monthly income, and work experience does not predict burnout. Intern doctors had high burnout (87.25%, χ2 = 28.067, P < 0.001) while nurses had high perceived stigma (70.97%, χ2 = 14.307, P < 0.05). Perceived stigma is positively correlated with burnout (r = 0.26, P < 0.001) with its both components, disengagement (r = 0.19, P < 0.001) and exhaustion (r = 0.30, P < 0.001). Conclusion: Burnout and stigmatization are prevalent among HCWs. Psychological interventions needed to reduce their burden and improve quality care during pandemic.

Background: In explosions, mass disasters, and warfare, human remains are got in fragmented states. Only strong bones that resist fracture can be used for personal identification in forensics. The foramen magnum (FM) dimension at the base of the skull is one such region that can be used for sex discrimination using radiographs. Aim and Objectives: To test evaluate sexual dimorphism in FM morphometric measurements and shape using digital submentovertex (SMV) radiograph among the Sri Ganganagar population. Materials and Methods: 100 digital SMV radiographs (50 males and 50 females) were randomly selected from the daily radiographic record of the patients with an age range of 25 to 65 years who visited the OPD and require SMV radiographs for diagnosis. The selected SMV radiographs were assessed for FM dimensions (longitudinal and transverse diameters, circumference, area, and FM index). Also, one particular shape was assigned to FM based on the radiographic image according to Chethan et al. classification. All the measurements were performed by two maxillofacial radiologists independently, and the data thus obtained were subjected to discriminant analysis for the evaluation of sexual dimorphism. Results: Values of four parameters out of five (transverse diameter, circumference, area, and foramen index) were found statistically significantly higher in males. The most common morphology of FM was an egg shape (50%), whereas round (3%) was the least common morphology. Circumference FM was the best indicator of gender determination followed by area, transverse diameter. and foramen index. The SMV radiographs for FM showed an overall accuracy of 69.73% in sex determination. Conclusion: The study showed that SMV radiographic FM morphometric measurements can be used for sex determination among the Sri Ganganagar population.

Background: Inadequate obturation techniques of the root canal system have been found to be the most frequent reason of failure post root canal treatment. An ideal endodontic sealer should fulfill all ideal requisites. The present study aimed to compare apical sealing ability between bioceramic (BC) sealer, GuttaFlow, and AH Plus. Methodology: One hundred and twenty-five curved roots of maxillary and mandibular third molar teeth with fully formed apex were collected for this study. The root canals were cleaned and shaped using a standard single-cone preparation to file at the established working length and divided into five groups of 25 each. Dye leakage was carried out. Group A: with GP, using EndoSequence BC sealer with conventional with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group B: with ceramic coated with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group C: with GP, using AH Plus sealer (Dentsply, De-Trey Konstanz, Germany) with 4% gutta-percha; Group D: with GuttaFlow bioseal (Roeko-Coltène/Whaledent, Langenau, Germany) with 4% Gutta-percha; and Group E is a negative control group. Statistical analysis was done using the Statistical Package for the Social Sciences software and Student's unpaired t-test. Results: The group AH Plus showed more leakage values than the GuttaFlow group and of two groups of BC sealer and negative control. Student's unpaired t-test disclosed no significant difference (P < 0.05) between the groups. Conclusion: None of the sealers used in the study could completely seal the apical foramen to have a fluid-tight seal.

Abstract G-proteins are implicated in plant productivity, but their genome-wide roles in regulating agronomically important traits remain uncharacterized. Transcriptomic analyses of rice G-protein alpha subunit mutant (rga1) revealed 2270 differentially expressed genes (DEGs) including those involved in C/N and lipid metabolism, cell wall, hormones and stress. Many DEGs were associated with root, leaf, culm, inflorescence, panicle, grain yield and heading date. The mutant performed better in total weight of filled grains, ratio of filled to unfilled grains and tillers per plant. Protein–protein interaction (PPI) network analysis using experimentally validated interactors revealed many RGA1-responsive genes involved in tiller development. qPCR validated the differential expression of genes involved in strigolactone-mediated tiller formation and grain development. Further, the mutant growth and biomass were unaffected by submergence indicating its role in submergence response. Transcription factor network analysis revealed the importance of RGA1 in nitrogen signaling with DEGs such as Nin-like, WRKY, NAC, bHLH families, nitrite reductase, glutamine synthetase, OsCIPK23 and urea transporter. Sub-clustering of DEGs-associated PPI network revealed that RGA1 regulates metabolism, stress and gene regulation among others. Predicted rice G-protein networks mapped DEGs and revealed potential effectors. Thus, this study expands the roles of RGA1 to agronomically important traits and reveals their underlying processes.

Abstract Background Micronutrient deficiency affects the health and development of vulnerable population such as children and pregnant women. Measures such as fortification of food and supplementation have been implemented to prevent or control deficiencies related to micronutrients. Objective To assess the effect of vitamin A, vitamin D, and calcium fortification and supplementation on nutritional status of women in reproductive age group. To assess the toxicities and adverse events related to intervention. Methodology Systematic reviews including RCTs on women of reproductive age group provided with vitamin A, vitamin D, and calcium supplementation or fortified food were included, to report all malnutrition-related outcomes due to deficiency of the abovementioned micronutrients. The Cochrane Database of Systematic Reviews, EPPI Centre, Campbell Collaboration, PubMed, Web of Science, and Scopus were searched electronically for English language publications, until 31 March 2018. Hand searching of the articles was done from the Journal of Food Science and Technology. Two independent reviewers selected the systematic reviews, extracted data, and assessed for the quality. Results A total of 16 systematic reviews were included in narrative synthesis. Supplementation of vitamin A was reported to result in increased maternal serum retinol concentrations and increased breast milk retinol concentration. It reduced the risk of anemia (Hb < 11 g/dL) and reduced maternal clinical infection. Vitamin D supplementation increased 25-hydroxy vitamin D levels. There was insufficient evidence for the effect on bone mineral density and serum calcium levels. Calcium supplementation did not have any significant effect on body weight, weight gain, and body mass index of the participants. Conclusion This overview of systematic reviews reiterates the nutritional importance of vitamin A, vitamin D, and calcium supplementation for the reproductive age women. However, there was no empirical evidence available for fortification of food with vitamin A, vitamin D, and calcium and nutritional benefits of the same for reproductive age women, therefore thrusting upon the need of conducting future quality research, i.e., clinical trials and systematic reviews for food fortification. Systematic review registration A priori protocol for this overview of systematic reviews was registered in PROSPERO with registration number CRD42018089403 .

Abstract Background Breast cancer is the most frequent cancer and one of the most common causes of death in women, impacting almost 2 million women each year. Tenacity or perseverance of breast cancer in women is very high these days with an extensive increasing rate of 3 to 5% every year. Along with hurdles faced during treatment of breast tumor, one of the crucial causes of delay in treatment is invasive and poor diagnostic techniques for breast cancer hence the early diagnosis of breast tumors will help us to improve its management and treatment in the initial stage. Main body Present review aims to explore diagnostic techniques for breast cancer that are currently being used, recent advancements that aids in prior detection and evaluation and are extensively focused on techniques that are going to be future of breast cancer detection with better efficiency and lesser pain to patients so that it helps to a physician to prevent delay in treatment of cancer. Here, we have discussed mammography and its advanced forms that are the need of current era, techniques involving radiation such as radionuclide methods, the potential of nanotechnology by using nanoparticle in breast cancer, and how the new inventions such as breath biopsy, and X-ray diffraction of hair can simply use as a prominent method in breast cancer early and easy detection tool. Conclusion It is observed significantly that advancement in detection techniques is helping in early diagnosis of breast cancer; however, we have to also focus on techniques that will improve the future of cancer diagnosis in like optical imaging and HER2 testing.

Background: Universal access to maternal new-born and child healthcare services (MNCH) is detrimental for attainment of Sustainable Development Goal (SDG) three pertaining to promotion of health at all ages. Incentivization in the form of cash, vouchers, and goods have been used as part of strategies to improve maternal and neonatal health outcomes around the world. However, there exists uncertainties regarding the effectiveness of various incentive-based programmes targeted for pregnant mothers in low- and middle-income countries during their antenatal period. Methods: We will search six electronic databases, namely the Medical Literature Analysis and Retrieval System Online (Medline), Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, and Embase in addition to Google Scholar. Manual searching of the reference lists of included studies will also be done. The reporting of this protocol will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 statement [29]. Only interventional studies that follow randomized, quasi randomized, and cluster randomized controlled study designs will be included. A three-stage screening process will be adopted to select articles. Risk of bias for the included studies will be assessed using the tools and criteria specified in the Cochrane handbook. In addition, the GRADE approach will be used to assess the quality of evidence for the maternal and neonatal health outcomes. Conclusion: This review of trials is essential to inform the effectiveness of incentive-based programmes targeted for pregnant women in low- and middle-income countries. It will help the policy makers to utilise the resources more effectively and to integrate the evidence based public health initiatives into the health system. This can also help build the continuum of care financial packages for all pregnant women.

Objective: To assess the prevalence of tooth decay and it’s associated factors among the age group of 15-20 years old visiting Ayder Comprehensive Specialized Hospital. Material and Methods: An epidemiological cross-sectional descriptive study was conducted among 384 subjects aged 15-20 years. A closed-ended questionnaire, according to the World Health Organization methodology was used to collect the data. The subjects were examined for the presence of tooth decay using the DMFT Index. One examiner was trained and standardized using a Kappa test (K=0.90). To test the differences in the DMF-T index related to socioeconomic variables, the Chi-square and the Mann-Whitney tests were employed. For all tests, the level of significance was set at p≤0.05 with 95% Confidence level. Results: The magnitude of tooth decay among study participants was 57.8%. The mean decayed, missed and filled was 1.26 and prevalence was higher in males (34.1%). Poor oral hygiene practice was strongly associated factor with tooth decay. 56.2% of visitors from the urban area were mainly affected by tooth decay. Conclusion: Tooth decay is highly prevalent among visitors between15-20 years of age. Tooth brushing habit, residency, and consumption of sugary food and drinks were significantly associated with the occurrence of tooth decay. Early diagnosis and prompt treatment can prevent further damage.

BackgroundDespite routine review of medication lists during patient encounters, patients’ medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources. ObjectiveWe aim to evaluate the effectiveness of and satisfaction with an electronic health record (EHR)-integrated web-based medication reconciliation application, MedTrue (MT). MethodsWe conducted a cluster-randomized controlled trial of MT in 6 primary care clinics within an integrated health care delivery system. Our primary outcome was medication list accuracy, as determined by a pharmacist-collected best-possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semistructured interviews. ResultsOverall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score=8/10). Staff found MT beneficial but difficult to implement. ConclusionsThe use of a web-based application integrated into the EHR which combines EHR, patient-reported data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application.

Populations of ecological systems generally have demographic fluctuations due to birth and death processes. At the same time, they are exposed to changing environments. We studied populations composed of two phenotypes of bacteria and analyzed the impact that both types of fluctuations have on the mean time to extinction of the entire population if extinction is the final fate. Our results are based on Gillespie simulations and on the WKB approach applied to classical stochastic systems, here in certain limiting cases. As a function of the frequency of environmental changes, we observe a non-monotonic dependence of the mean time to extinction. Its dependencies on other system parameters are also explored. This allows the control of the mean time to extinction to be as large or as small as possible, depending on whether extinction should be avoided or is desired from the perspective of bacteria or the perspective of hosts to which the bacteria are deleterious.

Dental caries remains the most common chronic disease in children, and the respective etiology is not fully understood. Though Streptococcus mutans is an important factor in the initiation and progression of caries, its presence is not always associated with the disease. The existence of caries discordant populations, in which S. mutans counts do not correlate with caries experience, poses a challenging problem. This study explored the possible correlation of S. mutans and other microorganism levels on caries-associated ecology of caries-concordant and discordant populations. A total of forty-seven children were analyzed in this study and stratified into four clinical groups based on their S. mutans levels in saliva (HS/LS: High/low S. mutans) and caries experience. Streptococcus mutans levels were determined by culture-based selective plating. The salivary microbiome of caries concordant and discordant populations was investigated by 16S rRNA gene sequencing and downstream bioinformatics analysis. The salivary microbial communities significantly clustered based on S. mutans levels and independent of their caries experience. In addition to S. mutans levels, significant differences in the abundance of other species were observed between HS and LS groups. Interestingly, disease-associated species such as Veillonella dispar, Streptococcus spp., and Prevotella spp. were significantly increased in HS groups and may contribute, in combination with S. mutans, to the caries progression. Furthermore, health-associated species exhibited higher abundance in the LS groups, such as Veillonella rogosae, Haemophilus sp., and Alloprevotella spp. but their possible contribution to the caries process remains to be elucidated. This study provides evidence that S. mutans may play a role in shaping the salivary microbial community. Our results highlight that future caries research should consider additional species as health/disease microbial markers in conjunction with S. mutans to improve diagnosis and caries management of the caries-discordant population.

Eltrombopag, an FDA-approved non-peptidyl thrombopoietin receptor agonist, is clinically used for the treatment of aplastic anemia, a disease characterized by hematopoietic stem cell failure and pancytopenia, to improve platelet counts and stem cell function. Eltrombopag treatment results in a durable trilineage hematopoietic expansion in patients. Some of the eltrombopag hematopoietic activity has been attributed to its off-target effects, including iron chelation properties. However, the mechanism of action for its full spectrum of clinical effects is still poorly understood. Here, we report that eltrombopag bound to the TET2 catalytic domain and inhibited its dioxygenase activity, which was independent of its role as an iron chelator. The DNA demethylating enzyme TET2, essential for hematopoietic stem cell differentiation and lineage commitment, is frequently mutated in myeloid malignancies. Eltrombopag treatment expanded TET2-proficient normal hematopoietic stem and progenitor cells, in part because of its ability to mimic loss of TET2 with simultaneous thrombopoietin receptor activation. On the contrary, TET inhibition in TET2 mutant malignant myeloid cells prevented neoplastic clonal evolution in vitro and in vivo. This mechanism of action may offer a restorative therapeutic index and provide a scientific rationale to treat selected patients with TET2 mutant–associated or TET deficiency–associated myeloid malignancies.

Modernization leads to frequent and remarkable alterations in the environmental factors which consequently affect the global agricultural productivity. Environmental factors can be broadly categorized into biotic and abiotic components. Biotic factors, which are represented by pests, bacteria, viruses, fungi, nematodes, etc., pose a severe threat to plants growth and development, thereby adversely impact the productivity. Taking this into consideration, crop improvement may prove to be a leading approach to ensure the sustainability of food and plant products. Modern agricultural practices rely upon agrochemicals and formulations for disease control that are responsible for causing environmental pollution and have detrimental effect on human health. Thus, development of stress resistance crop varieties must be a better approach in the current agriculture system. An array of genetic, biochemical and metabolic variations is required to produce such desirable alleles for appropriate crop improvement. Moreover, increasing genetic variation beyond natural variation is a crucial aspect of plant breeding programs. In connection, mutagenesis is one of the most prevalent tools to control plant stresses. To induce mutagenesis, techniques such as physical (gamma radiation, ultra-violet rays, etc.), chemical (ethyl methane sulfonate, methyl methane sulfonate, sodium azide, etc.) and gene editing (ZFN, TALEN, and CRISPR) are highly preferred by plant breeders. This review aims to provide an insight into mutation breeding techniques that facilitate the variable spectrum of agronomic and economic characters which is a prerequisite for successful crop improvement programs.

Objective Universal Health Coverage aims to address the challenges posed by healthcare inequalities and inequities by increasing the accessibility and affordability of healthcare for the entire population. This review provides information related to impact of public-funded health insurance (PFHI) on financial risk protection and utilisation of healthcare.Design Systematic review.Data sources Medline (via PubMed, Web of Science), Scopus, Social Science Research Network and 3ie impact evaluation repository were searched from their inception until 15 July 2020, for English-language publications.Eligibility criteria Studies giving information about the different PFHI in India, irrespective of population groups (above 18 years), were included. Cross-sectional studies with comparison, impact evaluations, difference-in-difference design based on before and after implementation of the scheme, pre–post, experimental trials and quasi-randomised trials were eligible for inclusion.Data extraction and synthesis Data extraction was performed by three reviewers independently. Due to heterogeneity in population and study design, statistical pooling was not possible; therefore, narrative synthesis was performed.Outcomes Utilisation of healthcare, willingness-to-pay (WTP), out-of-pocket expenditure (including outpatient and inpatient), catastrophic health expenditure and impoverishment.Results The impact of PFHI on financial risk protection reports no conclusive evidence to suggest that the schemes had any impact on financial protection. The impact of PFHIs such as Rashtriya Swasthy Bima Yojana, Vajpayee Arogyashree and Pradhan Mantri Jan Arogya Yojana showed increased access and utilisation of healthcare services. There is a lack of evidence to conclude on WTP an additional amount to the existing monthly financial contribution.Conclusion Different central and state PFHIs increased the utilisation of healthcare services by the beneficiaries, but there was no conclusive evidence for reduction in financial risk protection of the beneficiaries.Registration Not registered.

Background The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine are sympathomimetic drugs with therapeutic use. They are designated in the United States as Schedule II substances, defined by the 1970 Controlled Substances Act as having a “high potential for abuse”. Changing criteria for the diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and the approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns. This report compared the pharmacoepidemiology of these stimulants in the United States from 2010–2017. Methods Distribution of amphetamine, methylphenidate, lisdexamfetamine were examined via weights extracted from the Drug Enforcement Administration’s (DEA) Automated Reports and Consolidated Ordering System (ARCOS). Median stimulant Daily Dosage per patient was determined for a regional analysis. The percent of cost and prescriptions attributable to each stimulant and atomoxetine in Medicaid from the “Drug Utilization 2018 - National Total” from the Centers for Medicare and Medicaid was determined. Results There was a rise in amphetamine (+67.5%) and lisdexamfetamine (+76.7%) from 2010–2017. The change in methylphenidate (−3.0%) was modest. Persons/day stimulant usage was lower in the West than in other US regions from 2014-2017. There was a negative correlation (r(48) = −0.43 to −0.65, p < .05) between the percent Hispanic population per state and the Daily Dosage/population per stimulant. Methylphenidate formulations accounted for over half (51.7%) of the $3.8 billion reimbursed by Medicaid and the plurality (45.4%) of the 22.0 million prescriptions. Amphetamine was responsible for less than one-fifth (18.4%) of cost but one-third of prescriptions (33.6%). Lisdexamfetamine’s cost (26.0%) exceeded prescriptions (16.3%). Conclusion The rising amphetamine and lisdexamfetamine distribution may correspond with a rise in adult ADHD diagnoses. Regional analysis indicates that stimulant distribution in the West may be distinct from that in other regions. The lower stimulant distribution in areas with greater Hispanic populations may warrant further study.

This paper aims at analyzing the performance of reinforcement learning (RL) agents when trained in environments created by a generative adversarial network (GAN). This is a first step towards the greater goal of developing fast-learning and robust RL agents by leveraging the power of GANs for environment generation. The RL techniques that we tested were exact Q-learning, approximate Q-learning, approximate SARSA and a heuristic agent. The task for the agents was to learn how to play the game Super Mario Bros (SMB). This analysis will be helpful in suggesting which RL techniques are best suited for augmented experience training (with synthetic environments). This would further help in establishing a reinforcement learning framework using the agents that can learn faster by bringing a greater variety in environment exploration.

Globally, the increasing human population has resulted in land use conversions and caused habitat loss to large carnivores leading to their presence in human-dominated landscapes. Because of the shared resources in human-dominated landscape, the interactions between the human and carnivore often becomes negative which becomes a challenging aspect to conservation practitioners. Mitigating these negative interactions has become a priority for wildlife managers to conserve large carnivores, human lives, and livelihoods. Moreover, it poses a challenge to execute effective mitigation measures, especially in areas where these interactions are persistent. Junnar Forest Division in western Maharashtra has a history of livestock damages and attacks on humans by leopard, which may be attributed to change in land use patterns in the past couple of decades assisted by the development of linear infrastructure. In this study we used machine learning to understand the spatio-temporal dynamics of the negative interactions of two decades (1999–2018) using compensation records. We found a significant increase in reporting of cases, especially livestock depredation after the year 2014, with annual depredation cases rising from 66/year to 599/year. A total of 34 human deaths (~1.79/year) and 99 human injuries (~5.21/year) due to leopard attacks were also recorded. Our analysis revealed different categories and clusters of negative human-leopard interactions hot spots in the landscape across the decades. The different categories of hot spots will be crucial for helping in the management interventions and site-specific approaches in the targeted areas for implementing effective mitigation strategies to minimize the chances of negative human leopard interactions in the landscape.

Introduction People with cognitive impairments often have difficulties in managing their time for daily activities. In older adults with cognitive impairments such as dementia and stroke, these may present as disorientation, poor time awareness, time perception, daily time management and so on. Time-related deficits and associated behaviours impede independent living and add considerably to caregiver strain. Several interventions are being investigated to help people with cognitive impairments orient and navigate time and do their daily activities. The provision of interventions requires the use of sound assessment tools. However, it is not clear how time-related concepts are specifically evaluated in practice, what are the available assessments and how these assessments should be selected.Method and analysis This protocol follows the Joanna Briggs Institute Reviewer’s Manual (2020) for scoping reviews and is registered with the Open Science Framework (https://osf.io/4ptgy/). We will include the following databases: PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Two reviewers will independently screen eligible studies for inclusion against the selection criteria and then review the full-text of the selected studies. We will extract the bibliographic data, study design and setting, and details of assessments used in the studies to evaluate time-related concepts including format, mode and duration of administration, psychometric properties and so on. The identified assessments will be mapped with regard to time-related concepts being evaluated and described using narrative synthesis.Ethics and dissemination As secondary data analysis, ethics approval is not required for this scoping review. We plan to disseminate the results through peer-reviewed journals and conferences targeting health professionals working with older adults.

Background: Acrylic resin has been successfully used for complete denture fabrication for many years. Color stability is very crucial clinical properties for dental materials, and color change may be an indicator of aging or damaging of materials. Aim and Objectives: This study has been designed to determine the color stability of heat cure denture base acrylic resins in commonly consumed solutions causing stains. Methodology: Four hundred disc samples of four commercially used heat cure denture base resins (Trevalon®, DPI®, Veracril®, and Pyrax®) were fabricated (100 in each group). These were checked for any change in optical density by immersing them in four different staining solutions (tea, coffee, turmeric, and betel leaf, i.e., paan) and synthetic saliva for 1-month synthetic saliva was taken as control. The denture cleansers were also evaluated for their efficacy determined by their ability to remove the stains caused by the staining solutions. Results: It was observed that Trevalon® showed least change in optical density and coffee illustrated the maximum potential for staining the denture base resins and is the most difficult to be removed using a denture cleanser. Conclusion: It can be concluded that Trevalon® demonstrated maximum color stability. Among the staining solutions, coffee caused maximum stains.

Background: Fiber posts are broadly used due to their good esthetics and elasticity close to that of dentin, which allows for uniform stress distribution within a root and lowers the possibility of nonrestorable root fractures. Aim and Objectives: The study assessed the layer of cement thickness and interfacial nanoleakage of luted fiber posts which were fabricated with CAD/CAM technology following direct scanning of the post space (DS) method, scanning of a polyether impression of the post space (IS), and scanning of a plaster model of the post space (MS). Methodology: Ninety premolars were chosen randomly and were assigned to three groups according to the scanning technique. Posts were computer designed and milled from experimental fiber-reinforced composite blocks. Results: The mean and standard deviation values of cement thickness, respectively, were: DS 172 ± 39 = m; IS 199 ± 55 = m, and MS MPa 272 ± 81 = m. The fiber posts fabricated following DS technique demonstrated superior performance compared to posts fabricated upon IS and MS, in terms of the post retention. The cement thickness did not differ between DS and IS, whereas in MS group, the cement layer was significantly thicker than in the remaining two groups. The scanning technique did not influence the sealing ability, as all groups showed comparable nanoleakage. Conclusion: Fiber posts fabricated following DS technique demonstrated superior performance. Furthermore, scanning technique did not influence the sealing ability, as all groups showed comparable nanoleakage.

Background: Association of psoriasis with other autoimmune diseases remains an ongoing research subject. Objectives: To investigate the association of psoriasis with other autoimmune disorders. Materials and Methods: We studied 80 (M: F 57:23) psoriasis patients aged 13–75 years for concurrent autoimmune disorders. After clinical examination, hemogram, fasting blood sugar, HbA1c, thyroid function tests, anti-TPO antibody, rheumatoid factor, anti-tTG antibody, anti-CCP antibody, ANA, anti-dsDNA antibody, anti-Ro antibody, and fecal calprotectin were estimated. Results: Mild-to-moderate and severe psoriasis was present in 86.3% and 13.8% patients, respectively. Psoriatic arthritis was present in 3.8% patients, all of whom also had severe psoriasis. Only 37 (46.3%) patients had clinical and/or sero-abnormality suggestive of autoimmune disorders; vitiligo in 3.8%, type-1 diabetes mellitus (DM) in 1.3%, and type-2 DM in 6.3% patients. Sero-positivity reflecting subclinical autoimmunity was noted for anti-CCP antibodies (in 2.5%), rheumatoid factor (in 2.5%), hypo- or hyper-thyroidism (in 8.8%), anti-TPO antibodies (in 5.0%), anti-tTG antibody (in 1.3%), ANA (in 5.0%), anti-dsDNA antibody (in 2.5%), and anti-Ro antibody in 11.3% patients. Elevated fecal calprotectin levels suggestive of inflammatory bowel disease (IBD) occurred in 11.2% of 27 patients. Multiple abnormalities happened in 2.5% patients. Conclusion: Apparently psoriasis patients seem to have a predilection for other autoimmune disorders particularly for vitiligo, diabetes mellitus, autoimmune thyroiditis, rheumatoid arthritis, and IBD. However, association between psoriasis and other autoimmune disorders at best remains tenuous for want of strong evidence. Nevertheless, screening for them will improve overall management of these patients. Cross-sectional study design and small number of study subjects remain important limitations.

Establishing anatomic reduction of an edentulous mandible fracture is a frequently acknowledged challenge in craniomaxillofacial trauma surgery in elderly patients due to compromised medical condition, lack of occlusive dental surfaces to capitalize on maxillomandibular fixation and various contraindications for the surgical approach. The solution is to overcome such problems in an edentulous mandible is to create occlusal guidance by either making dentures or by fabricating intraoral splints to guide in the reduction of jaws in correct alignment. For such conditions, “Gunning splint” is a better option as it provides close reduction and stabilization of mandibular fracture. A case report is presented here where close collaboration between an oral surgeon and a prosthodontist comes into role. The oral surgeon, after assessing the exact nature and extent of fracture, must communicate with the prosthodontist regarding the type of splint and management of fracture for the improvement of the patient's prognosis.

Integrated Gasification Combined Cycle (IGCC) is a promising technology for effective control of green-house gas emission through CO2 capture pre-combustion process. This article describes the relative advantage of a novel energy efficient process configuration for desorption and compression of CO2 (previously absorbed by physical solvent Di-Methyl-Ether of poly-Ethylene-Glycol (DMEPEG)). DMEPEG is a blend of several polymeric chain length (n = 3 to 9) of CH3-O-[C2H4O]n-CH3 which is a polar organic liquid solvent.Desorption of dissolved CO2 from solvent at highest possible pressure is helpful to minimize the power consumption for subsequent compression of CO2. This article quantifies the effect of heating the DMEPEG solvent to 120 °C for CO2 desorption (compared to CO2 desorption at 35 °C) on the regeneration (desorption) of CO2 at various pressure stages.CO2 desorption performance of DMEPEG solvent is assessed using ProTreat® simulation software. Depressurization of 4.455 kmol/s DMEPEG solvent (with dissolved gas) beginning at 120 °C results in desorption of 2.077 kmol/s CO2 capture (91.4 kg/s) out of initially dissolved 2.194 kmol/s CO2 (94.66%). Solvent heating upto 120 °C (instead of 35 °C) can compress the 97.1 kg/s CO2 from 3 barA to 34.7 barA consuming 6 MW (instead of 8.15 MW) power for CO2 compression, thus resulting in 15% saving for CO2 compression upto 120 barA consuming 14.1 MW power consumption.

Acid gas removal from syngas is an important process step upstream of its further processing for combustion or further processing of syngas. Integrated Gasification Combined Cycle (IGCC) power plant or chemical production (such as urea or petrochemicals, etc.). The process of absorbing the H2S in Di-Methyl-Ether of poly-Ethylene-Glycol (DMEPEG) solvent and the process of enriching the DMEPEG solvent with dissolved H2S has been described in literature (including the publications by the Author). This publication describe the process of stripping out the dissolved H2S from the DMEPEG solvent using a thermal stripper designed using the rate based mass transfer simulations carried out using ProTreat software.Basic process design and equipment size is described in this publication. 20 MW heat input is needed to strip out 19.13 kmol/s H2S from the 1.136 kmol/s DMEPEG solvent thus resulting in overall heat consumption of 30.7 GJ/Ton H2S capture.Limitations of this process design are also described. Various options of packed tower configuration have been suggested for tower internals resulting in similar performance.

Underwater sensor networks (UWSNs) have become among the most interesting research areas, since they open the door wide to researchers to conduct research in this field. There are so many issues in underwater sensor networks. The most serious issue is the void region that degrades the performance of networks. It is an issue, where a node doesn’t have any forwarder node to forward the packets to another node. Here, the objective of this work is to avoid the void region. For the same purpose, this work proposes an algorithm named “An Energy-Efficient Quality of Service (QoS) Based Void Avoidance Routing Technique”. The proposed work uses two-hop node information to avoid the problem of void region. This approach uses depth information, distance to next, holding time and residual energy as Quality of Service (QoS) parameters in order to find the best forwarder node to forward the data packets to their destination. The proposed algorithm has been implemented in MATLAB. Results show a better performance in terms of packet delivery ratio, energy tax and number of dead nodes as compared to Energy-Efficient Void Avoidance Routing Scheme for Underwater Wireless Sensor Network (E2RV)

Aim: This study aimed to find out the prevalence of active infection of Leptospira spp. in Rattus norvegicus from Grenada, West Indies, through polymerase chain reaction (PCR). Materials and Methods: One hundred and forty-nine rats were trapped, anesthetized and their kidneys collected aseptically. DNA was extracted from the kidney tissue of each rat. PCR was performed targeting LipL32 gene. Eighteen PCR-positive amplicons for LipL32 gene segment were purified and sent for direct sequencing to the sequencing facility of MCLAB (South San Francisco, USA). Results of sequencing were read and interpreted. The prevalence of Leptospira spp. in relation to sex and age was also recorded. Results: All amplified sequences were compared to the sequences present in GenBank using basic local alignment search tool (BLAST) from the online website National Center for Biotechnology Information, the results revealed that six samples had similarity to Leptospira interrogans strain 1399/2016 and eight samples had similarity with Leptospira borgpetersenii serovar Hardjo-bovis strain L49. Of 149 kidney samples, only 14 were positive for Leptospira spp. by PCR giving an incidence of 9.3%. There was no significant difference found in relation to sex and age. Conclusion: This is the first report confirming active infection of Leptospira spp. in Rattus norvegicus in Grenada using PCR. The presence of active infection in rats can be considered as high risk for humans. Further research to understand the epidemiology of leptospirosis in Grenada is suggested.

Abstract. Background:. In China, the prevalence of allergic rhinitis (AR) and asthma has increased in the past decade. As these two diseases frequently coexist, the Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR) study aimed to assess physicians’ beliefs and treatment patterns of coexistent asthma-AR across six Asian countries. This analysis presents the results from China. Methods:. The 200 hospital-based general physicians and pediatricians were interviewed from five cities in China. Physicians were questioned in-person about their knowledge, beliefs and management practices for patients with coexistent asthma-AR. Results:. Approximately 70% of the physicians interviewed routinely evaluated their patients with asthma or AR for signs of coexistent disease. While the majority of physicians (>90% of physicians) recognized the increased burden of coexistent asthma-AR vs. one condition alone and that coexistent disease requires additional treatment, most physicians (96%) also believed that patients with coexistent asthma-AR were well managed if either condition alone improved. Similarly, although 71% of physicians selected a combination of intranasal and inhaled corticosteroids as their preferred treatment for coexistent asthma-AR, in line with treatment guidelines, two fifths of physicians indicated that treatment for coexistent disease requires too much medication and that their patients prefer oral medications and a third of physicians believed that corticosteroids should be delayed in children. Conclusions:. This survey demonstrates that physicians interviewed in China have a broad understanding of coexistent asthma-AR and its impact on patients. A holistic approach to patient management with informed decisions regarding patients’ overall treatment will benefit patients who suffer from coexistent disease.

Despite remarkable progress toward gender equality over the past half-century, the stalled convergence in the gender wage gap after the mid-1990s remains a puzzle. This study provides new insights into this puzzle by conducting the first large-scale investigation of the uneven impact of the rise of programming in the labor market for men and women since the mid-1990s. We argue that the increasing reliance on programming has favored men’s economic status relative to women’s and therefore may help explain the slow convergence of the gender wage gap. We differentiate between two effects: (1) the composition effect, wherein men experience a greater employment growth in programming-intensive occupations relative to women, and (2) the price effect, wherein the wage returns to programming intensity increase more for men than women. Our empirical analysis documents a strong relationship between the rise of programming and the slow convergence of the gender wage gap among college graduates. Counterfactual simulations indicate that the absence of the composition and price effects would have reduced the gender wage gap over the past two decades by an additional 14.70 percent. These findings call attention to the role gender institutions play in shaping the uneven labor market impact of technological change.

The oral cavity contains a variety of ecological niches with very different environmental conditions that shape biofilm structure and composition. The space between the periodontal tissue and the tooth surface supports a unique anaerobic microenvironment that is bathed in the nutrient-rich gingival crevicular fluid (GCF). During the development of periodontitis, this environment changes and clinical findings reported a sustained level of calcium ion concentration in the GCF collected from the periodontal pockets of periodontitis patients. Here, we report the effect of calcium ion supplementation on human oral microbial biofilm formation and community composition employing an established SHI medium-based in vitro model system. Saliva-derived human microbial biofilms cultured in calcium-supplemented SHI medium (SHICa) exhibited a significant dose-dependent increase in biomass and metabolic activity. The effect of SHICa medium on the microbial community composition was evaluated by 16S rRNA gene sequencing using saliva-derived microbial biofilms from healthy donors and periodontitis subjects. In this study, intracellular microbial genomic DNA (iDNA) and extracellular DNA (eDNA) were analyzed separately at the genus level. Calcium supplementation of SHI medium had a differential impact on iDNA and eDNA in the biofilms derived from healthy individuals compared to those from periodontitis subjects. In particular, the genus-level composition of the eDNA portion was distinct between the different biofilms. This study demonstrated the effect of calcium in a unique microenvironment on oral microbial complex supporting the dynamic transformation and biofilm formation.

Introduction: Anaemia, due to iron deficiency, is very common in India. In many cases, the underlying cause of iron deficiency remains unknown even after detailed laboratory investigations. It is often due to malabsorption of iron from the gut and occult blood loss from the Gastrointestinal (GI) tract. Bidirectional GI endoscopy can help in finding these causes. Aim: To study the upper and lower GI endoscopic lesions in patients with unexplained Iron Deficiency Anaemia (IDA). Materials and Methods: This was a cross-sectional observational study, conducted on 75 patients with unexplained IDA in Dr. DY Patil Medical College and Hospital, Pune, Maharashtra, India, between June 2019 to June 2020. Patients above the age of 18 years and with Haemoglobin (Hb) of less than 13 g/dL (males) and less than 12 g/dL (females) underwent upper GI endoscopy and colonoscopy with biopsies, after ethics committee approval and informed consent. Complete haemogram with blood indices, iron studies and faecal Occult Blood Test (OBT) were conducted for all the patients. The patients were divided into Group A, those with upper/lower GI endoscopy lesions thought to be responsible for IDA and Group B, those without GI endoscopic lesions. Statistical analysis was performed using IBM, Statistical Package for the Social Sciences (SPSS), version 21.0 and statistical tests (Chisquare test, Student’s t-test and multivariate logistic regression analysis, with 95% Confidence Interval (CI) and p-value

Introduction South Asian countries are ageing and experiencing a rapid increase in proportion of the older population. Income support programmes are of central importance for the older adults as they may help to mitigate the poverty risks associated with ageing and losing the ability to generate income from labour. Evidence related to the income support programmes can help in understanding whether the programmes have been impactful. This scoping review will map the evidence (and gaps) related to income support programmes and create a base to identify the feasibility of future primary research and/or the scope of systematic reviews in the areas where evidence is available.Methods and analysis The Joanna Briggs Institute scoping review methodology will be followed. Eligibility criteria for the scoping review will be based on the ‘PCC’ or the ‘Population–Concept–Context’ concept. Advanced search for the relevant articles will be conducted in MEDLINE (via PubMed), Embase, Scopus, Campbell Collaboration, 3ie International Initiative for Impact Evaluation and Web of Science. Additional resources search will be conducted in important organisational websites. Findings of the scoping review will be summarised using descriptive information (frequencies and percentages) for the available evidence on concept (ie, income support programmes), population characteristics and other study variables.Ethics and dissemination The review is based on data from available literature, hence an ethical approval is not necessary. With this review, we attempt to provide recommendations to the research community and the policymakers about the currently available evidence and the research required for income support of older adults in South Asia, so that resources can be directed towards addressing the same. We plan to disseminate the findings through presentation in international conference and publication in a peer-reviewed journal.Review registration Not registered.

Background: ZyCoV-D is a DNA vaccine candidate, which comprises a plasmid DNA carrying spike-S gene of SARS-CoV-2 virus along with gene coding for signal peptide. The spike(S) region includes the receptor-binding domain (RBD), which binds to the human angiotensin converting Enzyme (ACE)-2 receptor and mediates the entry of virus inside the cell. Methods: We conducted a single-center, open-label, non-randomized, Phase 1 trial in India between July 2020 and October 2020. Healthy adults aged between 18 and 55 years were sequentially enrolled and allocated to one of four treatment arms in a dose escalation manner. Three doses of vaccine were administered 28 days apart and each subject was followed up for 28 days post third dose to evaluate safety and immunogenicity. Findings: Out of 126 individuals screened for eligibility. Forty-eight subjects (mean age 34·9 years) were enrolled and vaccinated in the Phase 1 study Overall, 12/48 (25%) subjects reported at least one AE (i.e. combined solicited and unsolicited) during the study. There were no deaths or serious adverse events reported in Phase 1 of the study. The proportion of subjects who seroconverted based on IgG titers on day 84 was 4/11 (36·36%), 4/12 (33·33%), 10/10 (100·00%) and 8/10 (80·00%) in the treatment Arm 1 (1 mg: Needle), Arm 2 (1 mg: NFIS), Arm 3 (2 mg: Needle) and Arm 4 (2 mg: NFIS), respectively. Interpretation: ZyCoV-D vaccine is found to be safe, well-tolerated and immunogenic in the Phase 1 trial. Our findings suggest that the DNA vaccine warrants further investigation. Funding: Development of ZyCoV-D was supported by a grant-in-aid from COVID-19 Consortium under National Biopharma Mission, Department of Biotechnology, Government of India, to Cadila Healthcare Ltd. (Grant no. BT/COVID0003/01/20).

Background: Neonatal pneumonia is one of the leading factors contributing to neonatal mortality. The objective of this review was to identify the barriers associated with case management of neonatal pneumonia in India by conducting a scoping review. Methods: Nine databases (PubMed, ProQuest, Ovid Medline, CINAHL, Web of Science, EMBASE, IndMED, SCOPUS and WHOLIS) were searched to identify relevant studies in India. The population of interest were neonates. Outcome of interest was barriers associated with case management of neonatal pneumonia. Data was charted and reported in accordance with the ‘guidance for conducting systematic scoping reviews’. Results: From 5942 citations screened, 244 articles underwent full text screening and two studies with qualitative information met the eligibility criteria. Barriers were classified as patient-related, caregiver-related and healthcare delivery system-related. Delay in seeking care was due to spiritual healers being first point of contact in addition to traditional and home remedies tried by mothers at home and inaccessible healthcare mostly owing to healthcare delivery system were some of the major barriers associated with case management of neonatal pneumonia. Conclusion: This scoping review concludes that there is a paucity of studies on neonatal pneumonia in India particularly with respect to barriers to case management and that many of the barriers described here are applicable to a broad range of neonatal disease conditions which occur in the community and not just specific to neonatal pneumonia.

Implant-related oral diseases such as peri-implantitis and peri-mucositis are largely initiated by bacterial colonization on artificial implant surfaces. Therefore, implant and abutment material characteristics that minimize bacterial attachment and subsequent biofilm formation are important factors in reducing the risk of infection-related implant failure. This study compares the properties of two different titanium-based implant coating materials, titanium nitride (TiN) and titanium carbon nitride (TiCN). Surface hydrophilicity/ hydrophobicity and roughness were evaluated via contact angle measurements and surface profiling with white light interferometry, respectively. TiN-coated surfaces were hydrophobic according to its contact angle higher than 72.7°, whereas TiCN-coated surfaces were hydrophilic with its contact angle of 53.6°. The average roughness (Ra) was greater for TiCN than TiN with the root mean square roughness (Rq) being significantly higher. These findings are in contrast to the common understanding for titanium-based materials that surface roughness and hydrophobicity are positively correlated. A well-established saliva-based oral microbial biofilm model was employed to compare bacterial attachment and biofilm formation on TiN and TiCN. Growth conditions included relevant host components such as blood as well as the presence or absence of dietary carbohydrates. The accumulated biomass was measured by crystal violet staining and the bacterial community profiles of the attached biofilms were determined via 16S rRNA gene microbiome sequencing at different time points over a 7-day period. At all time points, TiCN showed significantly less bacterial attachment and biofilm formation compared to TiN. This implied the importance of the hydrophilic state over surface roughness as parameter for the prevention of oral microbial attachment. Although, the biofilm community composition was very similar on both materials, environmental growth conditions resulted in significantly different bacterial profiles independent of the surface. In conclusion, TiCN coating produced a unique titanium surface which is rougher but more hydrophilic. TiCN-coated surfaces exhibited reduced bacterial attachment and biofilm formation in comparison to TiN coating. This coating technique can be further explored to improve implant and abutment success.

TCR repertoire diversification constitutes a foundation for successful immune reconstitution after allogeneic hematopoietic cell transplantation (allo-HCT). Deep TCR Vβ sequencing of 135 serial specimens from a cohort of 35 allo-HCT recipients/donors was performed to dissect posttransplant TCR architecture and dynamics. Paired analysis of clonotypic repertoires showed a minimal overlap with donor expansions. Rarefied and hyperexpanded clonotypic patterns were hallmarks of T cell reconstitution and influenced clinical outcomes. Donor and pretransplant TCR diversity as well as divergence of class I human leukocyte antigen genotypes were major predictors of recipient TCR repertoire recovery. Complementary determining region 3–based specificity spectrum analysis indicated a predominant expansion of pathogen- and tumor-associated clonotypes in the late post–allo-HCT phase, while autoreactive clones were more expanded in the case of graft-versus-host disease occurrence. These findings shed light on post–allo-HCT adaptive immune reconstitution processes and possibly help in tracking alloreactive responses.

Corona Virus Disease 2019 (COVID-19) caused by SARS Cov-2 is an Ribonucleic Acid (RNA) virus which spreads through respiratory route. It was first detected in Wuhan, China in December 2019. World Health Organisation (WHO) declared it as worldwide pandemic in March 2020. Clinically, it can present from mild flu like disease to severe respiratory illness. Reverse Transcription Polymerase Chain Reaction (RT-PCR) is the method for confirmation. Chronic lymphocytic leukaemia is a lymphoproliferative disorder that presents as absolute lymphocytosis with proliferation of monoclonal mature B lymphocytes, unlike other causes of reactive lymphocytosis. Patients with chronic lymphocytic leukaemia often have defects in humoral and cellular immune system. Therefore, these patients have strong predisposition to recurrent infections and in this case for COVID-19. The relationship between chronic lymphocytic leukaemic and COVID-19 is not very clearly understood. A 77-year-old male with no significant co-morbidities presented with cough, fever and shortness of breath. His High-Resolution Computed Tomography (HRCT) chest revealed nonspecific interstitial pneumonia and was tested positive for COVID-19 infection on RT-PCR. A Complete Blood Count (CBC) showed a high Total Leukocyte Count (TLC) with absolute lymphocytosis. There was absence of lymphadenopathy or splenomegaly. Flow cytometry confirmed the diagnosis of Chronic lymphocytic leukaemia. He was offered convalescent plasma therapy and later had to be incubated because of multiorgan failure. His Absolute Lymphocyte Counts (ALC) more than doubled in a week’s time. COVID19 infection usually presents with lymphopenia, lymphocytosis should always raise a suspicion of underlying haematological malignancy or secondary infection.

BackgroundPrimary immunodeficiency is common among patients with autoimmune cytopenia.ObjectiveThe purpose of this study is to retrospectively identify key clinical features and biomarkers of primary immunodeficiency (PID) in pediatric patients with autoimmune cytopenias (AIC) so as to facilitate early diagnosis and targeted therapy.MethodsElectronic medical records at a pediatric tertiary care center were reviewed. We selected 154 patients with both AIC and PID (n=17), or AIC alone (n=137) for inclusion in two cohorts. Immunoglobulin levels, vaccine titers, lymphocyte subsets (T, B and NK cells), autoantibodies, clinical characteristics, and response to treatment were recorded.ResultsClinical features associated with AIC-PID included splenomegaly, short stature, and recurrent or chronic infections. PID patients were more likely to have autoimmune hemolytic anemia (AIHA) or Evans syndrome than AIC-only patients. The AIC-PID group was also distinguished by low T cells (CD3 and CD8), low immunoglobulins (IgG and IgA), and higher prevalence of autoantibodies to red blood cells, platelets or neutrophils. AIC diagnosis preceded PID diagnosis by 3 years on average, except among those with partial DiGeorge syndrome. AIC-PID patients were more likely to fail first-line treatment.ConclusionsAIC patients, especially those with Evans syndrome or AIHA, should be evaluated for PID. Lymphocyte subsets and immune globulins serve as a rapid screen for underlying PID. Early detection of patients with comorbid PID and AIC may improve treatment outcomes. Prospective studies are needed to confirm the diagnostic clues identified and to guide targeted therapy.

Introduction Health insurance is one of the important approaches that can help in boosting universal healthcare coverage through improved healthcare utilisation and financial protection. This objectives of this review are to identify various interventions implemented in India to promote awareness of health insurance, and to provide evidence for the effectiveness of such interventions on the awareness and uptake of health insurance by the resident Indian population.Methods and analysis A systematic review will be carried out based on the Cochrane handbook for systematic reviews of interventions. The review will include experimental and analytical observational studies that have included adult population (>18 years) in India. We will include any intervention, policy or programme that directly or indirectly affects awareness or uptake of health insurance. The following outcomes will be eligible to be included: awareness or health insurance literacy, attitude such as readiness to buy health insurance or decision making, uptake of health insurance, demand-side and supply-side factors for awareness of health insurance, and awareness as a factor for uptake and re-enrolment in health insurance. Databases such as MEDLINE (PubMed), Web of Science, Scopus, 3ie impact evaluation repository and Social Science Research Network will be searched from January 2010 to 15 July 2020. Additionally, important government websites and references of the included studies will be scanned to identify potential records. Three authors, independently, will carry out screening and data extraction. Studies will be categorised into quantitative and qualitative, and mixed-methods synthesis will be employed to analyse the findings.Ethics and dissemination This review will be based on published studies and will not recruit human participants directly, therefore, ethical clearance is not applicable. We will disseminate the final review findings in a national or international conference and publish in a peer-reviewed journal.

Partitioning a picture is an imperative idea in picture preparation. Partitioned pictures are fundamental for various picture preparing techniques. In this paper, we are endeavouring to obtained the components to procure the sections of a boisterous picture with density bunching built approach. At first we input a boisterous RGB picture and perform RGB to Grayscale transformation on it. We perform median percolation on it to evacuate salt and pepper commotion. To find the spatial availability of the pixels, density built bunching is utilized which is a compelling grouping strategy utilized in information digging for finding spatial databases. Test outcomes employing projected procedure by presenting empowering execution. We estimate the values of similarity matrices for segmented images to assess the similarity between original and segmented images which is essential to sustained the loading of segmented images in cloud space.