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Abstract Neurological and cardiac injuries are significant contributors to morbidity and mortality following pediatric in-hospital cardiac arrest (IHCA). Preservation of mitochondrial function may be critical for reducing these injuries. Dimethyl fumarate (DMF) has shown potential to enhance mitochondrial content and reduce oxidative damage. To investigate the efficacy of DMF in mitigating mitochondrial injury in a pediatric porcine model of IHCA, toddler-aged piglets were subjected to asphyxia-induced CA, followed by ventricular fibrillation, high-quality cardiopulmonary resuscitation, and random assignment to receive either DMF (30 mg/kg) or placebo for four days. Sham animals underwent similar anesthesia protocols without CA. After four days, tissues were analyzed for mitochondrial markers. In the brain, untreated CA animals exhibited a reduced expression of proteins of the oxidative phosphorylation system (CI, CIV, CV) and decreased mitochondrial respiration (p

Reverse transcription-quantitative PCR (RT-qPCR)-based assays are extensively being utilized to detect coronavirus disease 2019 (COVID-19). However, due to a lack of RT-qPCR testing capability, these tests cannot be carried out in community clinics. The intention of our study was to evaluate the specificity and sensitivity of Rapid Antigen Detection (RAT) tests versus those of RT-qPCR using nasopharyngeal and oropharyngeal specimens. Respiratory swab specimens were collected from the COVID-19 patients admitted at Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, CG, India, during March to April 2022. RAT and RT-qPCR were performed using standard methods as per guidebook instructions, and subjects were chosen using a convenience sample technique. 100 swabs from patients, who had earlier verified positive and 100 from who had earlier verified negative for SARS-CoV-2 via RT-qPCR, were taken for study. Study was approved by the institutional ethical committee before data collection and initiation of the study. We evaluated for the sensitivity and specificity of the STANDARD Q COVID-19 Ag test kit (SD Biosensor). On testing, an over-all sensitivity and specificity of the kit was recorded as 74% and 100%, respectively in comparison to the RT-qPCR kit. Further, the assay’s sensitivity was shown to be 100%, 94.87%, 77.27%, and 55.56%, respectively, for samples with cycle thresholds (Ct) of 15-25, 25-30, 30-35, and >35. We draw the conclusion that the RT-qPCR assay has superior sensitivity and specificity to the antigen assay. However, in all situations where RT-qPCR testing is difficult, the antigen assay could serve as a rapid and simple option for separating SARS-CoV-2 contagious from non-contagious patients.

Hepatitis C virus infection is one of the main causes of liver disease that can lead to liver cirrhosis and finally to the chronic development of Hepatocellular Carcinoma (HCC). With 8 different HCV genotypes circulating, it becomes necessary to characterize the pathogenesis caused by each one of the HCV genotypes infecting population of a particular setting. Present study aims to identify the circulating Hepatitis C virus (HCV) genotypes in the different areas of State of Uttar Pradesh, India and understand their clinical etiology and related co-morbidities. The patients reporting to Sharda Hospital, Uttar Pradesh, India who were diagnosed positive for HCV were included in the study. The informed consent was obtained and then blood was drawn. In-house primers, for all the 8 genotypes were prepared and RT-PCR was performed. The amplified product was subjected to Agarose gel electrophoresis to identify the genotypes present in individual samples. Total 30 serum samples were taken. Of these, 21 (70%) showed presence of multiple genotypes, while 7 (23.33%) showed positivity for single genotype and two did not show any bands. Presence of multiple genotypes in individual patient has been reported for the first time. The pathological consequences of multiple genotypes within one host need to be studied further in terms of increased risk of developing a chronic liver disease. Further studies are being undertaken to study association of specific HCV genotype and multiple genotypes, Core, NS3 and NS5 viral proteins with the disease progression to develop predictors of liver cirrhosis and HCC.

Background Kite string injuries (manja cut injuries), particularly those caused by Chinese manja, are new culprit of emergencies especially in the month of January in Maharashtra region. These injuries commonly affect the neck, face, hands, and legs, especially among individuals traveling on two wheelers. The visibility challenge, where the kite's thread is difficult to see, further exacerbates the risk.

Objectives: Hand function impairment causes limitations in activities of daily living among stroke survivors. Dexteria app therapy is a game-based therapy with the use of a touchscreen gadget that involves various hand movements. This study evaluates the effect of Dexteria app therapy on hand function in sub-acute stroke survivors. Methods: This study included 26 subacute stroke survivors, randomly allocated into 2 groups as follows: Group A (n=13) received conventional hand therapy while group B (n=13) received Dexteria app therapy. Both groups received 21 sixty-min therapy sessions. Gross hand function and fine manipulative hand function were assessed using the Brunnstrom hand recovery voluntary control grades and the Jebsen hand function test, respectively. Results: Inter-group comparison using the Wilcoxon rank sum test of the mean difference between groups A and B showed a significant difference in the Brunnstrom hand recovery voluntary control grades Z value which equaled -3.272 with P=0.001 and Jebsen hand function test Z=-3.0 and P=0.002. Discussion: Dexteria app therapy showed significant improvement in gross motor function and fine motor hand function than conventional therapy in sub-acute stroke survivors.

Purpose – This paper aims to examine the impact of online reviews on behavioral intentions via perceived risk. Perceived risk is both analytical and emotional. Stimulus–organism–response (S–O–R) framework guided this study to explore the interaction between online reviews, perceived risk and behavioral intentions. Design/methodology/approach – The conceptual model proposed in this research has been validated using confirmatory factor analysis (CFA) and structural equation modeling to assess the measurement model and the validity of the scale, based on primary responses collected from 473 travelers. Findings – Findings of this study suggest the role of online consumer reviews in reducing the perceived risk associated with experience dominant services like tourism. Process model test proves the mediating role of perceived risk between online reviews and behavioral intentions. Results indicate the significance of online review in lowering the perceived risk leading to positive behavioral intentions. Practical implications – Destination marketing organizations (DMOs) should understand the role of online reviews in effectively reducing risk and uncertainty, thereby influencing behavioral intentions. Originality/value – This paper is unique in attempting to empirically examine the mediating role of perceived risk between online reviews and behavioral intentions. The study is a forerunner in using S–O–R framework to test the interaction between online review, perceived risk and behavioral intention.

Silver oak, Grevillea robusta A. Cunn. is an important exotic tree species component of urban forestry in India. However, the occurrence of insect-pests in exotics causes tremendous impact on the production and yield in nurseries as well-established plantations; consequently, reducing profits and inducing high expense to stakeholders. Thus, a detailed account of insect-pests infestation and their impact becomes important. Therefore, present study was undertaken to find out the insect pest occurrence on G. robusta in the nursery, plantation established at different geographical region of northern India from 2018-2022. The study result exhibited infestation of ten insect-pests for the first time on G. robusta. Six species were defoliator in nature viz. Ascotis selenaria, Chrysodeixis includens, Ectropis bhurmitra, Helicoverpa armigera, Hyposidra talaca, and Olene inclusa; while infestation of four species of sap sacking nature viz. Asterolecanium sp., Ceroplastes rusci, Drosicha stebbingi, and Oxyrachis tarandus. The seasonal incidence and nature of damage were also recorded for the first time of these insects on G. robusta. This is the first attempt to report insect-pests of G. robusta, which gave an overview of the possible potential threat in India. The study would be beneficial for future reference with respect to pest management of G. robusta, when the species is taken up for tree improvement program in the long run.

BackgroundEarly warning systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increased risks of clinical deterioration, thus facilitating timely and appropriate interventions. EWSs can mitigate the impact of global infectious diseases by enhancing information exchange, monitoring, and early detection. ObjectiveWe aimed to evaluate the effectiveness of EWSs in acute respiratory infections (ARIs) through a scoping review of EWSs developed, described, and implemented for detecting novel, exotic, and re-emerging ARIs. MethodsWe searched Ovid MEDLINE ALL, Embase, Cochrane Library (Wiley), and CINAHL (Ebsco). The search was conducted on October 03, 2023. Studies that implemented EWSs for the detection of acute respiratory illnesses were included. Covidence was used for citation management, and a modified Critical Appraisal Skills Programme (CASP) checklist was used for quality assessment. ResultsFrom 5838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSs within community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms. Five studies focused on EWSs that used data from hospitalization and emergency department visits. These systems leveraged clinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused on the effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats and how they could be improved based on past performance. Four studies highlighted the integration of machine learning models to improve the predictive accuracy of EWSs. Three studies explored the applications of national EWSs in different health care settings and emphasized their potential in predicting clinical deterioration and facilitating early intervention. Lastly, 3 studies addressed the use of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and responding to health threats in environments housing vulnerable populations. The CASP tool revealed that most studies were relevant, reliable, and of high value (score 6: 11/29, 38%; score 5: 9/29, 31%). The common limitations included result generalizability, selection bias, and small sample size for model validation. ConclusionsThis scoping review confirms the critical role of EWSs in enhancing public health responses to respiratory infections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologies suggest a need for continued innovation and standardization in EWS development.

Skin cancer is a widespread and perilous disease that necessitates prompt and precise detection for successful treatment. This research introduces a thorough method for identifying skin lesions by utilizing sophisticated deep learning (DL) techniques. The study utilizes three convolutional neural networks (CNNs)—CNN1, CNN2, and CNN3—each assigned to a distinct categorization job. Task 1 involves binary classification to determine whether skin lesions are present or absent. Task 2 involves distinguishing between benign and malignant lesions. Task 3 involves multiclass classification of skin lesion images to identify the precise type of skin lesion from a set of seven categories. The most optimal hyperparameters for the proposed CNN models were determined using the Grid Search Optimization technique. This approach determines optimal values for architectural and fine-tuning hyperparameters, which is essential for learning. Rigorous evaluations of loss, accuracy, and confusion matrix thoroughly assessed the performance of the CNN models. Three datasets from the International Skin Imaging Collaboration (ISIC) Archive were utilized for the classification tasks. The primary objective of this study is to create a robust CNN system that can accurately diagnose skin lesions. Three separate CNN models were developed using the labeled ISIC Archive datasets. These models were designed to accurately detect skin lesions, assess the malignancy of the lesions, and classify the different types of lesions. The results indicate that the proposed CNN models possess robust capabilities in identifying and categorizing skin lesions, aiding healthcare professionals in making prompt and precise diagnostic judgments. This strategy presents an optimistic avenue for enhancing the diagnosis of skin cancer, which could potentially decrease avoidable fatalities and extend the lifespan of people diagnosed with skin cancer. This research enhances the discipline of biomedical image processing for skin lesion identification by utilizing the capabilities of DL algorithms.

Background Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management. Methods and Results A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021. Baseline characteristics and lipid‐lowering therapy patterns were assessed. Multivariable regression modeling was used to determine factors associated with lipoprotein (a) testing. Among 595 684 patients with atherosclerotic cardiovascular disease, only 2587 (0.4%) were tested for lipoprotein (a). Those who were older or Black individuals were less likely to have lipoprotein (a) testing, while those with familial hypercholesterolemia, ischemic stroke/transient ischemic attack, peripheral artery disease, prior lipid‐lowering therapy, or low‐density lipoprotein cholesterol ≥130 mg/dL were more likely to be tested. Those with a lipoprotein (a) test, regardless of the lipoprotein (a) value, were more frequently initiated on any statin therapy (30.3% versus 10.6%, P

Introduction Appropriate and healthy feeding practices can enhance a child’s health, prevent obesity and reduce chronic metabolic disease risks. Given the ethnic variations in feeding practices and metabolic risk, interventions must be community specific. Culturally tailored grassroots interventions targeting infant feeding can induce behavioural changes, mitigating chronic metabolic disease risks in later life.The aim of this study was to explore participant feedback and inform intervention delivery methods within marginalised communities.Methods A pilot three-arm cluster randomised controlled trial was conducted in the Tower Hamlets and Newham boroughs of London, involving community participatory learning and action groups. The study recruited 186 South Asian (Indian, Bangladeshi, Pakistani and Sri Lankan) mothers or carers of children aged 0–2 years. Participants in intervention arms were invited to either face to face or online intervention arms, facilitated by trained multilingual community facilitators (CFs), offering culturally informed discussions on child nutrition and care practices. The qualitative study was embedded within this trial, collecting feedback through interviews and focus groups. Thematic analysis was employed to identify key themes, focusing on intervention fidelity and acceptance.Results Of the initial attendees, 42 (from the remaining 153 at the study’s conclusion) and 9 CFs offered feedback on the intervention’s delivery and suggestions for enhancing community-based interventions’ success. Key findings highlighted the need for a more flexible approach to boost participation and the significance of providing accessible, translated documents and resources. Participants expressed a strong preference for a hybrid model of intervention delivery, combining face-to-face and online sessions to accommodate diverse needs.Conclusion Parenting interventions, particularly for new mothers, may engage more of the target population by adopting a hybrid design. This would provide attendees with the flexibility to select the delivery method, session timings and the option to participate at any stage of the intervention. The study underscores the importance of cultural tailoring and flexible delivery methods in enhancing participation and engagement in community-based health interventions.

Post-transplant lymphoproliferative disorders (PTLDs) remain a feared complication of transplantation, with significant morbidity and mortality. The oncogenic Epstein-Barr virus (EBV) is a key pathogenic driver in 50%–80% of cases. Numerous prognostic indices, comprising multiple clinical, epidemiological and tumor characteristics, including EBV tumor positivity, do not consistently associate with worse patient survival, suggesting a potential role for EBV genome variants in determining outcome. However, the precision medicine tools for determining if a viral genome variant is pathogenic are very limited compared with human genome variants. Further, targeted studies have not implicated a specific viral etiological agent in EBV-negative PTLD. Using novel cutting-edge technologies, we are extracting viral nucleic acids from formalin-fixed, paraffin-embedded archived, or frozen PTLD tissues or plasma, to test for all vertebrate viruses simultaneously in an unbiased fashion, using metagenomic shotgun sequencing (MSS). We are collecting such samples from multiple transplant centers to address the following specific aims and close the following knowledge gaps: (1) Validate our novel observation that PTLD tissue positivity by MSS for anellovirus (and confirmed by PCR) serves as a biomarker for higher transplant recipient mortality after the diagnosis of PTLD; (2) determine the role of other oncogenic viruses in EBV-negative PTLD by unbiased MSS of multiple viral groupings, confirmed by other techniques; and (3) develop the necessary computational, algorithmic and software analytic tools required to determine association of EBV genome variants with worse presentations or outcomes in PTLD. Study completion will contribute to better patient care and may provide avenues for novel therapies.

ObjectiveThe objective of this study was to develop and evaluate a low-cost 3D-printed simulator to improve the ability of neurosurgical residents to handle and coordinate endoscopes in performing technically demanding procedures such as neuroendoscopic removal of ventricular tumors or endoscopic third ventriculostomy (ETV).MethodsThe simulator was developed, printed in-house, and evaluated in a trial involving neurosurgery residents who performed ETV and intraventricular tumor resection tasks using it. Participants completed a questionnaire that assessed various aspects of the simulator's effectiveness, including anatomical visualization, procedural understanding, competency enhancement, and subjective impressions.ResultsA total of 12 participants were included in the evaluation. The majority (n = 7, 53.85%) were male, with a mean age of 29.8 ± 3.27 years and 4 ± 2 years of neurosurgical experience. All participants agreed or strongly agreed (4.5 ± 0.50) that the 3D printed simulator helped develop systematic intraventricular visualization and understanding of surgical steps (4.42 ± 0.64). The handling of the endoscope was rated as realistic (4.5 ± 0.50), while the haptic qualities of the tumor were rated lower (3.83 ± 0.80; 3.92 ± 0.64). Training increased competence (4.25 ± 0.45) and coordination skills (4.5 ± 0.50), with 75% (n = 9) feeling more confident with neuroendoscopic instruments and 91.7% (n = 11) in future procedures.ConclusionThe developed 3D-printed simulator offers an accessible and practical training resource for neurosurgical residents, addressing the limitations of traditional training methods. The simulator appears to improve procedural skills and the competence of future neurosurgeons, potentially improving patient safety and outcomes in neurosurgical practice.

Background: Pilates, a low-to-moderate intensity workout provides an alternative to traditional methods that stimulate both the mind and the body. Adolescent girls often experience sub optimal sleep quality, especially on school days, posing significant health risks. This study aims to investigate the effects of Pilates on the sleep quality of adolescent females. Methods: A single-blinded Randomized Controlled Trial was conducted at a Physiotherapy OPD. Eligible adolescent girls (aged 10–19) with PSQI scores exceeding 5 were enrolled. Sixty participants were allocated each to Group A (Control) or Group B (Mat Pilates) via convenience sampling. Parental consent and participant assent were obtained. Group A maintained daily activities with ergonomic exercises, while Group B underwent Mat Pilates training three times weekly for eight weeks. Data were collected at baseline, at the end of 4th and 8th week. Result: Between-group analysis at the 4th and 8th weeks showed significant differences. Post hoc analysis with Bonferroni adjustment revealed notable improvements from baseline to both time points (p

Bridelia retusa is a medicinal plant widely used to treat diabetes by ethnic populations worldwide, has been subjected to GC–MS-based profiling for the bark and fruit and identified 96 phytochemicals using ethyl acetate and methanol solvents. The DPPH antioxidant assay recorded that methanolic fruit extract had a maximum antioxidant activity of 83.01 % (IC50-103.03 µg/ml). The α-amylase inhibition activity was found maximum in ethyl acetate bark extract with 76.34 % (127.37 µg/ml), while methanolic fruit extract exhibited the highest α-glucosidase inhibition activity with 86.18 % (106.15 µg/ml). Subsequently, we have compared the antidiabetic potential for 3 pharmacologically significant bioactive constituents friedelin, imidazole & sylvestrene through docking and drug likeliness study and found friedelin has a maximum binding affinity with different protein targets followed by sylvestrene and is most suitable candidate for drug development for hyperglycemia. Molecular dynamics simulations revealed friedelin as the most stable binder to anti-diabetic target proteins, with notable structural insights provided by RMSD, RMSF, SASA, and PCA analyses. MM-PBSA calculations emphasized the significance of various energies with the α-amylase-Friedelin complex exhibiting the highest binding energy.

With the increasing use of artificial intelligence (AI) applications in decision making, there are heightened concerns about the fairness of such decisions. Initiatives like Responsible AI, Fair ML, Ethics in AI have provided guidelines for developing AI as an attempt to address these challenges. These approaches have been criticized for taking a top down approach by applying abstract principles to practice without taking into account the context and particularities of the algorithm development. Using the sociotechnical lens, we propose a framework for developing Fair algorithm. We apply this framework to mitigate unfairness in three distinct datasets: COMPAS (Correctional Offender Management Profiling for Alternative Sanctions), Crimes and Community, and a synthetic dataset. Our methodology involves nonconvex optimization for regression with fairness constraints. The experimentation examines the correlation coefficient, Area Under the Curve (AUC), and Root Mean Square Error (RMSE) in relation to a fairness parameter, epsilon. Our findings suggest three objectively testable propositions namely, 1) Fairness Constraint and Predictive power, 2) Fairness Constraints and Discriminatory Ability, 3) Fairness Constraints and Prediction Accuracy.

Pediatric regional anesthesia (RA) has emerged as a rapidly advancing dimension within pediatric anesthesia, demanding a continual commitment to knowledge acquisition. This review underscores the contemporary significance of this specialty, focusing on its application in neonates and infants. The primary objective of RA is to address perioperative pain effectively while preserving the delicate physiological balance, thereby enhancing overall patient care. This review explores the advantages offered by RA in this age group. Furthermore, conventional, and recently introduced techniques of RA are examined by exploring the advantages and disadvantages of these methods. The aim is to provide clinicians with a nuanced understanding of their applicability in different clinical scenarios. Additionally, the review elucidates the unique considerations associated with pediatric RA, acknowledging pediatric patients’ distinctive anatomical and physiological characteristics. The exceptional cases of congenital anomalies and their implications for the choice of RA are considered. An aspect of the review is its focus on dosages of local anesthetics and the volumes required for various blocks in neonates and infants. The dosages for continuous infusion and practical issues with infusions are considered. Complications associated with RA are described, along with their prevention and treatment. The review offers pragmatic insights into the selection criteria for various regional blocks, aiding anesthesiologists in making informed decisions tailored to individual patient needs.

Background Physical activity trackers possess the potential to encourage increased physical activity. However, users often exhibit poor long-term adherence to these devices, which may stem from a lack of understanding of the factors influencing their use, as well as changes in health behavior. This study aims to provide new insights into the types of health-related apps and devices that young people discover, select, and utilize, along with the underlying reasons for their choices. Methods Young adults aged between 18-25 years reporting the use and nonuse of health apps and wearables were recruited and participated in focus group discussions about app choice, features, their perceptions towards the physical activity trackers, and reasons for continued use and for not using one. A total of Nine FGDS were conducted among users, nonusers, and former users of physical activity tracker usage. Data was recorded, transcribed, and analyzed for themes in an iterative approach. Results The physical activity tracker users group stated that they had a sense of achievement, validation, and other motivational feedback, which helped with adherence. All three groups (user, non-user, and former user) had similar concerns about cost, reliability, accuracy, and dependency. Former users also reported that the idea of accomplishing the goals would create anxiety and, in turn, harm the body. Former users and nonusers expressed their concerns regarding lack of time and loss of motivation to track their physical activity. Nonusers had issues with the functionality of the device (ease of use, battery, notifications, apps hang) and were also aware of all the health benefits of using wearables. Conclusion Physical activity users group, former users group, and nonusers group shared concerns about accuracy, cost, and battery.

Abstract The vaccine is a premier healthcare intervention strategy in the battle against infectious infections. However, the development and production of vaccines present challenges in terms of complexity, cost, and time consumption. Alternative methodologies, such as nonthermal plasma and plant‐based technologies, have emerged as potential alternatives for conventional vaccine manufacturing processes. While plasma‐based approaches offer a rapid and efficient pathogen inactivation method devoid of harsh reagents, plant‐based techniques present a more economically viable and scalable avenue for vaccine production. The imperative urges these approaches to address pressing global health challenges posed by emerging and recurring infectious diseases, surpassing the limitations of traditional vaccine fabrication methods. The primary goal of this review is to provide a comprehensive overview of the current research landscape, covering conceptualization, production, and potential advantages of plasma‐based and plant‐based vaccines. Furthermore, exploring the obstacles and opportunities intrinsic to these strategies is undertaken, elucidating their potential impact on vaccination strategies. This systematic presentation specifies a detailed outline of recent vaccine research and developments, emphasizing the possibility of advanced green approaches to produce effective and secure vaccination programs.

BackgroundParkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunctions and nonmotor symptoms. Current treatments do not alter disease progression, highlighting the need for alternative therapies. Music, dance, and mindfulness meditation have shown the potential to improve symptoms and quality of life in patients with PD. ObjectiveThis study aims to evaluate the effectiveness of dance or music and meditation on PD progression, cognitive functions, mood, behavior, and caregiver burden. MethodsThis study is a single-blinded, longitudinal, parallel, randomized controlled trial. The participants consist of 30 patients with mild to moderate PD residing in Mumbai, India, who can physically participate in the activities. The exclusion criteria include advanced PD, severe balance issues, age >80 years, and other movement disorders. Participants in the intervention group will engage in dance or music sessions and guided meditation thrice weekly for 6 months. The control group will continue their usual activities and medication. The primary outcome is the progression of PD symptoms, measured using the Unified Parkinson’s Disease Rating Scale I-III, and quality of life, measured using the Parkinson’s Disease Questionnaire-39. The secondary outcomes include cognitive functions (Mini-Mental State Examination), mood (Beck Depression Inventory and Parkinson Anxiety Scale), mobility (timed up and go and Berg Balance Test), behavioral disorders (Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale), and caregiver burden (Zarit Burden Interview and Parkinson’s Disease Questionnaire-Carer). ResultsData collection was completed in February 2024, with 28 participants finishing the study (intervention group: n=15, 54% and control group: n=13, 46%). Data analysis is underway, with results expected to be published in December 2024. ConclusionsThis study aims to provide significant insights into the effectiveness of dance or music and meditation in improving the quality of life and slowing the progression of PD. The findings are anticipated to support using these nonpharmaceutical therapies as complementary approaches to managing PD. Trial RegistrationCTRI/2023/03/051064; https://tinyurl.com/2xdus53j International Registered Report Identifier (IRRID)DERR1-10.2196/59018

Abstract The endothelial glycocalyx (eGC) is a carbohydrate‐rich layer on the vascular endothelium, and its damage can lead to endothelial and organ dysfunction. Heparanase (HPSE) degrades the eGC in response to cellular stress, but its role in organ dysfunction remains unclear. This study investigates HPSE's role in lung ischemia–reperfusion (I/R) injury. A left lung hilar occlusion model was used in B6 wildtype (WT) and HPSE genetic knockout (−/−) mice to induce I/R injury in vivo. The left lungs were ischemic for 1 h followed by reperfusion for 4 h prior to investigations of lung function and eGC status. Data were compared between uninjured lungs and I/R‐injured lungs in WT and HPSE−/− mice. WT lungs showed significant functional impairment after I/R injury, whereas HPSE−/− lungs did not. Inhibition or knockout of HPSE prevented eGC damage, inflammation, and cellular migration after I/R injury by reducing matrix metalloproteinase activities. HPSE−/− mice exhibited compensatory regulation of related gene expressions. HPSE facilitates eGC degradation leading to inflammation and impaired lung function after I/R injury. HPSE may be a therapeutic target to attenuate graft damage in lung transplantation.

Ion channels are biological transistors that control ionic flux across cell membranes to regulate electrical transmission and signal transduction. They are found in all biological membranes and their conductive state kinetics are frequently disrupted in human diseases. Organelle ion channels are among the most resistant to functional and pharmacological interrogation. Traditional channel protein reconstitution methods rely upon exogenous expression and/or purification from endogenous cellular sources which are frequently contaminated by resident ionophores. Here, we describe a fully synthetic method to assay functional properties of polycystin channels that natively traffic to primary cilia and endoplasmic reticulum organelles. Using this method, we characterize their oligomeric assembly, membrane integration, orientation, and conductance while comparing these results to their endogenous channel properties. Outcomes define a novel synthetic approach that can be applied broadly to investigate channels resistant to biophysical analysis and pharmacological characterization.

IntroductionAlzheimer’s disease (AD) is marked by the accumulation of fibrillary aggregates composed of pathological tau protein. Although neuroinflammation is frequently observed in conjunction with tau pathology, current preclinical evidence does not sufficiently establish a direct causal role in tau tangle formation. This study aimed to evaluate whether chronic Toll-like receptor 4 (TLR4) stimulation, induced by a high dose of lipopolysaccharide (LPS, 5 mg/kg), exacerbates neurofibrillary tangle (NFT) pathology in a transgenic mouse model of tauopathy that expresses human truncated 151-391/3R tau, an early feature of sporadic AD.MethodsWe utilized a transgenic mouse model of tauopathy subjected to chronic TLR4 stimulation via weekly intraperitoneal injections of LPS over nine consecutive weeks. Neurofibrillary tangle formation, microglial activation, and tau hyperphosphorylation in the brainstem and hippocampus were assessed through immunohistochemistry, immunofluorescence, and detailed morphometric analysis of microglia.ResultsChronic LPS treatment led to a significant increase in the number of Iba-1+ microglia in the LPS-treated group compared to the sham group (p

Bowen's disease is under-recognised, in situ - squamous cell carcinoma usually presenting as a single, well demarcated, slow growing erythematous patch or plaque with a scaly or crusted surface. It has a limited potential of invasion. It mainly occurs over the sun-exposed parts of the body (typical variant). Genitals, back, finger, trunk & thigh are the peculiar sites for pigmented, verrucous, atrophic & hyperkeratotic variants which are considered as atypical variants. A total of 3 patients (2 males and 1 female; average age: 57 years) were noted over a span of one year. Rarity, atypical variants and limited case series on Bowen disease in literature prompt us to report this interesting case series.

Introduction Non-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia.Methods A pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ2 tests and multivariate random-effects logistic regression models were conducted. Thirty in-depth interviews were conducted with pharmacists, staff and owners as well as other relevant stakeholders to understand any persistent barriers to prescription-based dispensing of antibiotics.Findings Eighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4%) consultations in the participating group compared with 469/570 (82.3%) in the non-participating group (p value

Not available.

Neonatal outcomes encompass a range of outcome measures, including mortality rates, physical and mental health morbidities, and long-term neurodevelopmental statistics. These outcomes are influenced by non-modifiable factors, such as sex and race, and modifiable factors, such as social determinants of health and racism. There is a known bias toward worse outcomes for male infants in terms of preterm birth, low birth weight, and mortality, with several biological and physiological factors contributing to these sex-related differences. In relation to racial disparities, wherein race is a social construct, maternal and infant healthcare continues to lag behind for minority populations compared with the white population, despite advances in medical care. Infants born to Black women have higher infant mortality rates and lower birth weights than infants of white women. These differences can be largely attributed to social and environmental factors, rather than racial and ethnic differences. Furthermore, we emphasize the role of social determinants of health in neonatal outcomes. Factors such as economic stability, education access and quality, healthcare access and quality, the physical neighborhood environment, and the social and community context all contribute to these outcomes. Overall, this article highlights the complex interactions between sex, race(ism), and social determinants of health in neonatal outcomes. It underscores the need for a comprehensive understanding of these factors to improve maternal–neonatal care and reduce disparities in outcomes. Healthcare providers, policymakers, and communities need to work together to combat these complex issues and improve neonatal outcomes for all infants, while understanding the complex interplay between sex, racism, and/or social determinants of health.

Objective: The objectives of this study were to explore the cytotoxic potential of different fractions (Hexane, chloroform, ethyl acetate and methanol) of Plumbago zeylanica L. root powder. Methodology: In this study, PzMH, PzMC, PzME, and PzMM fractions from the root powder of P. zeylanica were obtained through the cold maceration technique. The cytotoxic properties of these fractions on MG-63 cells were assessed using the MTT assay. The most potent fraction was further analyzed to understand its cytotoxic mechanism. To explore its apoptosis-inducing potential, microscopic and flow cytometric studies were conducted. Additionally, western blot analysis was used to examine the expression levels of proteins associated with apoptotic pathways. Results: PzMH showed the highest cytotoxicity against MG-63 osteosarcoma cells, with a GI50 value of 53.07 µg/ml. Flow cytometric studies revealed an upsurge in reactive oxygen species and disruption of mitochondrial membrane potential. The highest concentration of PzMH fraction (183.48 µg/ml) led to 62 % cell population arrest at G0/G1 stage. The anti-apoptotic protein Bcl2 was downregulated, with p53, cleaved-caspase 9, cleaved-caspase3, Bad and Bax expression upregulated. HPLC analysis revealed the presence of lawsone, p-coumaric acid, plumbagin, and 4-hydroxy benzaldehyde, indicating that the quinone-rich fraction of Plumbago zeylanica L. attenuates the proliferation of MG-63 osteosarcoma cells through the Bax/Bcl-2 pathway. Conclusion: To the best of our current knowledge, this marks the first documented case where the hexane fraction enriched with quinones extracted from the roots of P. zeylanica demonstrates its ability to induce apoptosis by influencing the Bax/Bcl2 pathway.

Vulvo-vaginal stromal tumours are a rare and diverse group of mesenchymal neoplasms unique to hormone-responsive stroma of the vulva and vagina. These tumours are mostly benign, except for the locally aggressive deep angiomyxomas. Often these tumours pose diagnostic challenges, resembling certain malignant vulvo vaginal tumours.This case series highlights clinicopathological features of four angiomyxomas; a single angiomyofibroblastoma, and another superficial myofibroblastoma, including their clinical outcomes. All patients were in their 4th or 5th decade of life. Only 1/4 angiomyxomas was correctly diagnosed at the referring hospitals. Three out of four patients harbouring angiomyxomas achieved clinical remission post-surgery, while one patient was lost to follow-up. By immunohistochemistry, tumor cells showed variable positivity for desmin, SMA, ER, and PR, and negativity for S100P and CD34. The angiomyofibroblastoma was initially misdiagnosed as a liposarcoma, and the patient was lost to follow-up after diagnosis. Immunohistochemically, the tumor cells were diffusely positive for SMA and ER; weakly and focally positive for desmin, and negative for AE1/AE3, CD34, and S100P. The patient with superficial myofibroblastoma is in clinical remission post-excision with an 18-month follow-up. Immunohistochemically, the tumor cells showed CD34 positivity. Therapeutically, none of the patient received adjuvant treatment, except for a single patient with angiomyxoma, who underwent chemoradiation for a synchronous cancer cervix post-surgery.This case series provides valuable insights into the clinical heterogeneity, diagnostic intricacies, and outcomes of vulvo-vaginal stromal tumours from an oncology centre in India, further contributing to a better understanding of these rare tumours.

Abstract Background Despite increased attention on treatment and prevention for suicidal adolescents, we know little about potential intervention targets. Episodic future thinking—the ability to imagine detailed, personal, and future‐oriented events—is a modifiable cognitive process that has been linked with suicidal ideation (SI) in adolescents. However, until now its modifiability has only been tested in adults. Method Adolescents (N = 176, ages 15–19; 71% SI) completed performance‐based measures of episodic future thinking (i.e., Experimental Recombination Paradigm) and memory immediately before and after an Episodic Specificity Induction (ESI). Results Adolescents produced a greater number of future episodic details after (vs. before) the ESI but showed no change in non‐episodic details (e.g., semantic information). Patterns of change in episodic future thinking were not moderated by SI history. Adolescents overall did not demonstrate change in past episodic detail counts after the ESI. However, there were select moderating effects of SI history on this effect. Conclusion Results show that episodic future thinking can change immediately following an episodic specificity induction among adolescents, regardless of whether they have previously experienced SI. This demonstration of within‐person change constitutes a foundational first step in examining malleability of episodic future thinking in adolescents and offers preliminary evidence of a cognitive mechanism that may be leveraged in service of reducing adolescents' SI.

Current ischemic models strive to replicate ischemia-mediated injury. However, they face challenges such as inadequate reproducibility, difficulties in translating rodent findings to humans, and ethical, financial, and practical constraints that limit the accuracy of extensive research. This study introduces a novel approach to inducing persistent ischemia in 3-day-old chicken embryos using endothelin-1. The protocol targets the right vitelline arteries, validated with Doppler blood flow imaging and molecular biology experiments. This innovative approach facilitates the exploration of oxidative stress, inflammatory responses, cellular death, and potential drug screening suitability utilizing a 3-day-old chicken embryo.

In tumors with WT p53, alternate mechanisms of p53 inactivation are reported. Here, we have identified a long noncoding RNA, PITAR (p53 Inactivating TRIM28 Associated RNA), as an inhibitor of p53. PITAR is an oncogenic Cancer/testis lncRNA and is highly expressed in glioblastoma (GBM) and glioma stem-like cells (GSC). We establish that TRIM28 mRNA, which encodes a p53-specific E3 ubiquitin ligase, is a direct target of PITAR. PITAR interaction with TRIM28 RNA stabilized TRIM28 mRNA, which resulted in increased TRIM28 protein levels and reduced p53 steady-state levels due to enhanced p53 ubiquitination. DNA damage activated PITAR, in addition to p53, in a p53-independent manner, thus creating an incoherent feedforward loop to inhibit the DNA damage response by p53. While PITAR silencing inhibited the growth of WT p53 containing GSCs in vitro and reduced glioma tumor growth in vivo, its overexpression enhanced the tumor growth in a TRIM28-dependent manner and promoted resistance to Temozolomide. Thus, we establish an alternate way of p53 inactivation by PITAR, which maintains low p53 levels in normal cells and attenuates the DNA damage response by p53. Finally, we propose PITAR as a potential GBM therapeutic target.

Abstract Background Climate change poses a significant threat to agricultural production worldwide, with developing countries being particularly vulnerable to its negative impacts. Agriculture, which is a crucial factor in ensuring food security and livelihoods, is particularly vulnerable to changes in climate patterns, such as increased temperatures, drought, and extreme weather events. One approach to addressing these challenges is by promoting the adoption of climate‐smart agriculture (CSA) practices among farmers. CSA combines traditional agricultural practices with innovative techniques and technologies to adapt to and mitigate the impacts of climate change. infrastructure. By adopting CSA practices, farmers can enhance their resilience to climate variability and improve their productivity. Objectives This review examines the effectiveness of interventions promoting CSA to enhance farmers' knowledge of the benefits of CSA approaches, subsequent adoption of CSA, and disadoption of harmful agricultural practices in low‐ and middle‐income countries (LMICs). Search Methods We searched 39 academic and online databases, websites, and repositories and screened over 19,000 experimental and quasi‐experimental publications to identify studies promoting CSA practices to women farmers. We conducted a citation tracking process on included studies and contacted experts to ensure a thorough search. Selection Criteria The review focused on studies that included interventions promoting climate‐smart agricultural approaches. Using EPPI Reviewer 4, two review authors independently screened the impact evaluation using a standardized screening tool. Data Collection and Analysis Information about participant characteristics, intervention characteristics, control conditions, research design, sample size, bias risk, outcomes, and results were gathered. Data collection and quantitative analysis were conducted using standard Campbell Collaboration methods. Main Results Eight impact evaluations were found (two randomized controlled trials) evaluating the effects of CSA practices on farmer's knowledge gains of the benefits of CSA practices and subsequent adoption. Knowledge dissemination approaches such as Farmer Field Schools and weather and climate information services were found to positively impact farmers' knowledge and adoption of specific CSA practices. However, the evidence supporting this claim is uncertain as a high risk of bias was assessed for five of the eight included studies. However, we found no effects on the disadoption of harmful practices such as pesticide overuse. Authors' Conclusions The evidence base for studies promoting climate‐smart agricultural approaches (CSA) to farmers in LMICs is small, and there is a lack of studies reporting sex‐disaggregated data and studies explicitly targeting women farmers. The review suggests that knowledge dissemination techniques are significantly effective in improving CSA knowledge and adoption, including integrated pest management techniques and their benefits, adoption of climate‐resilient rice seed varieties (STRVs), and use of botanical pesticides by farmers. More and better confidence studies are needed to inform policy and programming, including those that look at a wider range of interventions, including changing norms, values, and institutional arrangements.

Abstract Background Value chain interventions have become widespread throughout the international development sector over the last 20 years, and there is a need to evaluate their effectiveness in improving women's welfare across multiple dimensions. Agricultural value chains are influenced by socio‐cultural norms and gender dynamics that have an impact on the distribution of resources, benefits, and access to opportunities. While women play a critical role in agriculture, they are generally confined to the least‐valued parts of the value chain with the lowest economic returns, depending on the local, social and institutional contexts. Objectives The review assesses the effectiveness of approaches, strategies and interventions focused on women's engagement in agricultural value chains that lead to women's economic empowerment in low‐ and middle‐income countries. It explores the contextual barriers and facilitators that determine women's participation in value chains and ultimately impact their effectiveness. Search Methods We searched completed and on‐going studies from Scopus, Web of Science Core Collection (Social Sciences Citation Index [SSCI], Science Citation Index Expanded [SCI‐EXPANDED], Conference Proceedings Citation Index – Science [CPCI‐S], Conference Proceedings Citation Index – Social Science & Humanities [CPCI‐SSH], and Emerging Sources Citation Index [ESCI]), International Bibliography of the Social Sciences, EconLit, Business Source Premier, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane, Database of Systematic Reviews, CAB Abstracts and Sociological Abstracts. We also searched relevant websites such as Consortium of International Agricultural Research Centers (CGIAR); the International Fund for Agricultural Development (IFAD); AgriProFocus; the Bill & Melinda Gates Foundation (BMGF); Donor Committee for Enterprise Development; the UN Food and Agriculture Organisation (FAO); the International Labour Organisation (ILO); the Netherlands Development Organisation; USAID; the Swiss Agency for Development and Cooperation; the International Food Policy Research Institute; World Agroforestry; the International Livestock Research Institute; the Foreign, Commonwealth & Development Office; the British Library for Development Studies (BLDS); AGRIS; the IMMANA grant database; the 3ie impact evaluation database; Innovations for Poverty Action (IPA); The Abdul Latif Jameel Poverty Action Lab (J‐PAL); the World Bank IEG evaluations; the USAID Development Data Library; Experience Clearinghouse; the proceedings of the Agriculture, Nutrition and Health Academy conference; the proceedings of the Centre for the Study of African Economies (CSAE) Conference; the proceedings of the North East Universities Development Consortium (NEUDC) Conference; and the World Bank Economic Review. The database search was conducted in March 2022, and the website search was completed in August 2022. Selection Criteria The review includes value chain interventions evaluating the economic empowerment outcomes. The review includes effectiveness studies (experimental and non‐experimental studies with a comparison group) and process evaluations. Data Collection and Analysis Two review authors independently assessed studies for inclusion, extracted data, critically appraised the studies, and synthesised findings. Results We found that value chain interventions are successful in improving the economic conditions of their intended beneficiaries. The interventions were found to improve women's economic outcomes such as income, assets holdings, productivity, and savings, but these effects were small in size and limited by low confidence in methodological quality. The meta‐analysis suggests that this occurs more via the acquisition of skills and improved inputs, rather than through improvement in access to profitable markets. The qualitative evidence on interventions points to the persistence of cultural barriers and other constraints. Those interventions implemented in Sub‐Saharan Africa and South Asia are consistently more successful for all outcomes considered, although there are few studies conducted in other areas of the world. Conclusions The review concludes that value chain interventions empower women, but perhaps to a lesser extent than expected. Economic empowerment does not immediately translate into empowerment within families and communities. Interventions should either moderate their expectations of empowerment goals, or they should be implemented in a way that ensures higher rates of participation among women and the acquisition of greater decision‐making power.

IntroductionGreen banking (GB) strategies are a set of financial practices and activities implemented by banks to encourage sustainability, environmental responsibility, and low-carbon impact. This bibliometric study examines the present state of research in this field by utilizing the Scopus database for data retrieval and VosViewer for network analysis.MethodA total of 149 researches were retrieved from the Scopus and analyzed using the VosViewer software following the PRISMA guidelines. The study examines year-by-year publication patterns, top-cited articles, contributing countries, journals, co-citation analysis of authors, and co-occurrence analysis of keywords.ResultStrategies such as online banking, solar ATMs, construction of green buildings, and making provisions for green loans are identified as the key GB strategies that can be adopted by the banks. Furthermore, the fundamental challenges banking organizations encounter while implementing GB strategies are underlined.DiscussionThe study suggests that “green brand image,” “green audit,” “environmental economics,” and “carbon footprint” can be considered as an area of interest in future. The study provides researchers, policymakers, regulators, and financial institutions with valuable insights by presenting the current state of green banking research and identifying emerging areas for further exploration. These findings will help others to discover the areas of interest in GB and advancing sustainable finance practices that can foster environmental responsibility in the financial sector.

Introduction: Early childhood caries is highly prevalent worldwide. The International Caries Detection and Assessment System incorporates both the non-cavitated and cavitated carious lesions with acceptable reliability. The objective of the present study was to assess the severity and pattern of early childhood caries among children visiting outpatient department of a dental college in Nepal. The study also aimed to compare the severity and pattern based on individual tooth type. Methods: A cross-sectional study was conducted among children of age group 24-71 months in primary dentition stage. The International Caries Detection and Assessment System II criteria was used to detect dental caries, and its severity and pattern. The ethical approval was taken from the institutional ethical committee (IRC Ref. No.: 1, 36, 2079/2080 IRC PDCH 2022 21). Results: The dental cries in children of age group 48-60 months was 1338 (33.46%) and dentinal caries (Code 5) was observed in 112 (8.37%). Multi-surface caries was 644 (16.15%), and occlusal surface caries was 481 (12.06%). Among the study population, 227 (5.69%) of the teeth assessed were associated with restoration and sealants. Enamel caries among the maxillary second molars (55/65) (Code 3) was in 94 (23.5%), and the dentinal caries (Code 5) in maxillary central incisors (51/61)was in 90 (22.78%). Conclusions: Majority of the children enrolled in the study had multiple cavitated and non-cavitated carious teeth involving different surfaces. Severity and pattern of caries also varied among individual tooth type.

Human papillomavirus (HPV) affects approximately 80% of individuals, irrespective of gender, and is implicated in various cancers. Existing HPV vaccines, while safe and effective, do not sufficiently protect males when administered solely to females. This review, triggered by the urgent need to address this gap and reduce the associated stigma, aims to evaluate the introduction of a gender-neutral HPV vaccine, GARDASIL-9, in India. The primary objective is to assess the necessity and feasibility of incorporating the gender-neutral HPV vaccine into India’s national immunization program. This integration is crucial to ensure equitable access for all children and to mitigate the substantial burden of HPV. A literature search was conducted using databases such as Google Scholar, PubMed, government websites, and relevant publications. Keywords included “gender-neutral vaccine”, “HPV vaccine”, and “Indian population”. The central research question guiding this review is: How necessary and feasible is the inclusion of a gender-neutral HPV vaccine in India’s national immunization schedule to ensure equitable access for all children and reduce the HPV burden? The review inclusion criteria comprised studies addressing the prevalence of HPV infections, HPV vaccination awareness among both genders, the cost-effectiveness of gender-neutral vaccines, current HPV vaccination status, and future perspectives specific to India. Studies not meeting these criteria were excluded. The review highlights that introducing a gender-neutral HPV vaccine in India is imperative. Including males in vaccination efforts significantly reduces the overall disease burden and helps in reducing the stigma associated with HPV. A comprehensive vaccination program, bolstered by education and awareness campaigns, and its inclusion in the national immunization schedule is essential. This approach ensures equitable access to the vaccine for all children, fostering a healthier community, preventing HPV-related cancers, and enhancing public health outcomes in India.

ABSTRACT Introduction Assessing patient satisfaction is an effective way to provide an evaluation of the quality of healthcare services. As a result, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient Survey was established as the first standardized national survey to publicly report patient ratings on hospital care. There remains a lack of research that examines rural–urban distinctions in patient satisfaction. The objective of this study was to investigate if there is a difference in hospital determinants of patient satisfaction among hospitals based on rural status. Methods The study utilized two public datasets containing HCAHPS survey results from 4714 US hospitals and from eligible cancer hospitals that participate in the Prospective Payment System‐Exempt Cancer Hospital Quality Reporting. The data were collected from July 1, 2021 to June 30, 2022 and published by Centers for Medicare & Medicaid Services. Rural status of each hospital was determined by matching zip codes with data provided by the Health Resources & Services Administration. Results A total of 3248 hospitals were included in the analysis, with approximately 51.14% located in rural areas. There was a significant difference across every hospital determinant when comparing rural and non‐rural status. Rural hospitals had a higher score for every hospital determinant (Cleanliness, Nurse communication, Doctor communication, Staff responsiveness, Communication about medicines, Discharge information, Care transition, Overall hospital rating, Quietness, and Willingness to recommend the hospital), indicating better performance. Conclusion Rural hospitals demonstrated better HCAHPS performance across every hospital determinant in comparison to urban hospitals, suggesting possible recent improvements. Future research is necessary to investigate this trend and its consistency, which can inform targeted interventions to better address the healthcare needs of diverse populations in the United States.

IntroductionIn human-robot interaction (HRI), understanding human intent is crucial for robots to perform tasks that align with user preferences. Traditional methods that aim to modify robot trajectories based on language corrections often require extensive training to generalize across diverse objects, initial trajectories, and scenarios. This work presents ExTraCT, a modular framework designed to modify robot trajectories (and behaviour) using natural language input.MethodsUnlike traditional end-to-end learning approaches, ExTraCT separates language understanding from trajectory modification, allowing robots to adapt language corrections to new tasks–including those with complex motions like scooping–as well as various initial trajectories and object configurations without additional end-to-end training. ExTraCT leverages Large Language Models (LLMs) to semantically match language corrections to predefined trajectory modification functions, allowing the robot to make necessary adjustments to its path. This modular approach overcomes the limitations of pre-trained datasets and offers versatility across various applications.ResultsComprehensive user studies conducted in simulation and with a physical robot arm demonstrated that ExTraCT’s trajectory corrections are more accurate and preferred by users in 80% of cases compared to the baseline.DiscussionExTraCT offers a more explainable approach to understanding language corrections, which could facilitate learning human preferences. We also demonstrated the adaptability and effectiveness of ExTraCT in a complex scenarios like assistive feeding, presenting it as a versatile solution across various HRI applications.

Key Clinical Message This case illustrates sarcoidosis as a potential complication of COVID‐19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post‐COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms. Abstract Severe Acute Respiratory Syndrome Coronavirus‐ 2 (SARS‐CoV‐2), a positive‐sense single‐stranded RNA virus, causes COVID‐19 and has been linked to autoimmune disorders. Sarcoidosis is a multi‐system disease that is frequently triggered by infections. It is characterized by non‐necrotizing granulomas in multiple organs. We present a case of sarcoidosis as rare sequelae of COVID‐19. A 26‐year‐old man presented with mild COVID‐19 symptoms, followed by prolonged fever and cough despite initial therapy, prompting a provisional diagnosis of post‐COVID fibrosis. A subsequent assessment at a tertiary hospital revealed dyspnea, weight loss, and abnormal chest imaging, all of which were consistent with pulmonary sarcoidosis with pulmonary tuberculosis as a differential diagnosis. A biopsy taken during bronchoscopy confirmed pulmonary sarcoidosis and treatment with inhalation steroids resulted in symptom relief, which was followed by remission with oral steroid therapy. Sarcoidosis is a systemic disease of unknown etiology, characterized by non‐necrotizing granulomas in multiple organs. It may be triggered by infections and involves an abnormal immune response. COVID‐19 can potentially initiate sarcoidosis, with both sharing common immune mechanisms. Diagnosis involves imaging and biopsy, and treatment typically includes glucocorticoids and regular monitoring. This case report emphasizes the potential link between COVID‐19 and autoimmune conditions like sarcoidosis, highlighting the need for a comprehensive diagnostic approach and long‐term observation to distinguish between sarcoidosis and post‐COVID fibrosis.

Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of subcategories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants’ discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders’ discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the “Four Cs of Physician Leadership”: character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

Background and objectiveExtrathyroidal extension (ETE) is the term used to describe the growth of the primary thyroid tumor beyond the thyroid capsule. ETE is a critical prognostic marker for thyroid tumors, necessitating accurate preoperative assessment. This study aims to evaluate the diagnostic performance of computed tomography (CT)-based grading for ETE and tracheal invasion (TI) for preoperative prediction in patients with differentiated papillary thyroid carcinoma (PTC) and compare the diagnostic accuracy with ultrasound (US).Materials and methodsThis retrospective study was approved by our institutional review board. Preoperative US and CT were performed for 83 patients who underwent surgery for PTC between 1 January 2010 and 31 December 2020. The US and CT features of ETE and TI of each case were retrospectively and independently investigated by two radiologists. The diagnostic performances of US and CT, including their specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for ETE, and their accuracy in predicting ETE and TI were analyzed. As per the grading for ETE on USG and CT, lesions were graded into three grades and Mahajan grading was also devised on CT to predict the TI and graded into four grades.ResultsThe accuracy and specificity of CT are relatively good for identifying tumor infiltration into the adjacent structures and range from 82% to 87% and 95% to 98%, respectively. It, however, has a low sensitivity, between 14.3% and 77.78%, when compared to US, which suggests that in case of any doubt regarding CT evidence of tumor infiltration into surrounding structures, additional clinical examination must be performed. CT showed better sensitivity (78%) and specificity (75%) in detecting TI compared to previous studies. The diagnostic accuracy of CT Mahajan grading was 91.5% with p

Background: Cardiopulmonary exercise testing (CPET) is used in evaluation of repaired tetralogy of Fallot (rTOF), particularly for pulmonary valve replacement need. Oxygen pulse (O2P) is the CPET surrogate for stroke volume and peripheral oxygen extraction. Objectives: This study assessed O2P curve properties against non-invasive cardiac output monitoring (NICOM) and clinical testing. Methods: This cross-sectional study included 44 rTOF patients and 10 controls. Three new evaluations for O2P curve analysis during CPET were developed. Best fit early and late regression slopes of the O2P curve were used to calculate: 1) the early to late ratio, or “O2 pulse response ratio” (O2PRR); 2) the portion of exercise until slope inflection, or “flattening fraction” (FF); 3) the area under the O2P response curve, or “O2P curve area”. Results: rTOF patients (median age 35.2 (27.6–39.4); 61% female) had a lower VO2 max (23.4 vs 45.6 ml/kg/min; p 50%. FF and O2P curve area significantly correlated with peak cardiac index, stroke volume, left and right ventricular ejection fraction, and right ventricular systolic pressure. Conclusion: CPET remains an integral part in the evaluation of rTOF. We introduce three non-invasive methods to assess exercise hemodynamics using the O2P curve data. These evaluations demonstrated significant correlations with stroke volume, cardiac output, and right ventricular pressure.

In this research paper, we investigate the variables that impact the behavioural intention of cryptocurrency investors in India. The analysis of the data was done using smart partial least square-structural equation modelling. The study was carried out in India using purposive sampling and included investors who had a fundamental understanding of cryptocurrency. It has been established that factors such as financial literacy, facilitating conditions, social influence, effort expectancy and performance expectancy have a significant influence on the investment behaviour of these individuals. The study looks at how the Unified Theory of Acceptance and Use of Technology model with financial literacy affects the behaviour of cryptocurrency investment.

Background This study proposes a modification to the traditional Hunt and Hess (tHH) grading scale for prognostication in aneurysmal subarachnoid hemorrhage (aSAH), which differentiates the most severe‐grade patients based on the presence or absence of brainstem dysfunction [determined by Glasgow Coma Scale (GCS) scores 3‐5]. Methods Weighted aSAH hospitalizations were retrospectively identified in the National Inpatient Sample from 2015 to 2019 and were stratified by tHH and modified HH (mHH) grades. mHH grade 5 was defined as tHH grade 5 with GCS score 3–5, while mHH grade 4 comprised tHH grade 5 with GCS score 6–8 and tHH grade 4. HH grades 1–3 do not differ between the traditional and modified scales. Measures of diagnostic performance were compared for the primary study end point [poor outcome as determined by the previously validated NIS‐SAH Outcome Measure (NIS‐SOM), shown to have high concordance with modified Rankin Scale scores > 2]. External validation of the mHH was performed using data from a prospectively maintained aSAH registry. Results Among 6130 aSAH hospitalizations, 2245 (36%) were tHH grade 5. Seven hundred and eighty‐five (35%) of these had a GCS 3–5 and were designated as mHH grade 5. Poor outcomes were identified in 78% and 77% of grade 4 tHH and mHH, respectively, and in 83% and 95% of grade 5 tHH and mHH, respectively. In comparison with the tHH, the mHH achieved superior discrimination [c‐statistic 0.793 (95% CI 0.768, 0.818) versus 0.780 (95% CI 0.750, 0.807); DeLong p < 0.001] for poor outcome, as well as improved specificity (0.929 versus 0.304) and positive predictive value (PPV) (0.949 versus 0.827). External registry validation of the mHH demonstrated excellent discrimination [c‐statistic 0.835 (95% CI 0.801, 0.870)], with a specificity of 0.950 and PPV of 0.905. Conclusion The mHH achieved a favorable diagnostic performance profile using retrospective data and may aid in the prognostication of high‐severity patients with aSAH.

Summary: Background: Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes. Methods: UPF intake was assessed through food frequency questionnaires in the Nurses’ Health Study (NHS; n = 75,735), Nurses’ Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle–Ottawa Scale, funnel plots, and Egger’s tests, and meta-evidence was evaluated using NutriGrade. Findings: The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06–1.16), 1.16 (1.09–1.24), and 1.04 (0.96–1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%–24%), 23% (12%–34%), and 9% (3%–15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke. Interpretation: Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations. Funding: National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.

Summary: To gain insight into how an adjuvant impacts vaccination responses, we use systems immunology to study human H5N1 influenza vaccination with or without the adjuvant AS03, longitudinally assessing 14 time points including multiple time points within the first day after prime and boost. We develop an unsupervised computational framework to discover high-dimensional response patterns, which uncover adjuvant- and immunogenicity-associated early response dynamics, including some that differ post prime versus boost. With or without adjuvant, some vaccine-induced transcriptional patterns persist to at least 100 days after initial vaccination. Single-cell profiling of surface proteins, transcriptomes, and chromatin accessibility implicates transcription factors in the erythroblast-transformation-specific (ETS) family as shaping these long-lasting signatures, primarily in classical monocytes but also in CD8+ naive-like T cells. These cell-type-specific signatures are elevated at baseline in high-antibody responders in an independent vaccination cohort, suggesting that antigen-agnostic baseline immune states can be modulated by vaccine antigens alone to enhance future responses.

Struvite (NH4MgPO4·6H2O) is a slow-release phosphorus (P) fertilizer hypothesized to reduce nutrient leaching losses relative to highly water-soluble counterparts such as monoammonium phosphate (MAP). We assessed the leaching fate of P from struvite relative to MAP using soil column experiments for two soils representative of the United States Maize Belt, an Arguidoll and a Fragiudalf. Inorganic P and N in leachate (49.8 pore volumes (vp)) were directly quantified for synthesized 33P-labeled struvite and 33P-labeled MAP directly and indirectly by omission method (i.e., by difference with a P-unfertilized treatment). By 8.3 vp, less than 0.02 % of struvite-P was leached in the Fragiudalf according to both methods of determination, compared to 11.1 % MAP-P determined directly by 33P tracing and 14.1 % of MAP-P by the omission method. Fertilizer-P leached quantified directly by 33P labeling was on average 1.2- to 3.7-fold lower than by indirectly by omission for both fertilizers at 2.8–13.9 vp across both soils, indicating consistent overestimation in P leaching by the commonly used omission method. Leaching of struvite-N was an order of magnitude lower than MAP-N in the Fragiudalf after 8.3 vp. Struvite entailed 17.4 %–20.4 % lower P leaching and 22.1–46 % lower N leaching compared to MAP across soils under simulated extreme precipitation events, supporting the hypothesized ability of struvite to reduce P as well as N leaching relative to more water-soluble ammonium phosphate fertilizers such as MAP. Additionally, our results point to a methodological need to validate fertilizer P leaching estimated by the commonly used omission method using direct quantification by radioisotopic labeling.