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Background: Tobacco use among health professionals implies failure on the part of both the beneficiaries and health-care delivery system. This research aimed to assess the knowledge, behavior, and attitude among health professional students. Materials and Methods: A cross-sectional questionnaire-based survey was carried out among health-care students (medical, dental, nursing, physiotherapy, and pharmacy) of NIMS University. The final version of the questionnaire had 43 questions divided into six sections: tobacco use prevalence, secondhand smoke exposure, opinions toward tobacco product prohibition, behavioral/cessation, curriculum/training, and demographics. Data were analyzed using SPSS software. The Chi-square test was applied to find any significant association between smoking and qualitative variables among different health professional students. Results: Five hundred and twenty-five students submitted the response to the online survey. One hundred and five (20%) health-care students were smokers. Pharmacy students had the highest percentage of smokers (50%) and also secondhand smoking exposure (46.87%) was highest among them. Nonsmokers had more favorable attitudes toward banning tobacco products. Medical and dental students were highly trained in tobacco cessation compared to other courses (P < 0.05). Conclusion: In the present study, the prevalence of smoking and exposure to secondhand smoking was high among pharmacy students, whereas knowledge toward tobacco cessation and training for the same was high among medical and dental students. The study concluded that comprehensive tobacco preventive and cessation training among all health professionals should be mandatory to improve their effectiveness in tobacco cessation and as role models also.

Background and Aims: There is limited literature wherein the hypotensive drugs have been compared to know the cerebral effects by monitoring regional cerebral oxygen saturation (rScO2). This study aimed to compare the effects of dexmedetomidine and nitroglycerin on rScO2 during controlled hypotensive anaesthesia using near-infrared spectroscopy (NIRS). The primary objective was to evaluate the non-inferiority of dexmedetomidine versus nitroglycerin in the occurrence of cerebral desaturation events (CDEs) during hypotensive anaesthesia. Methods: Adult patients scheduled to undergo head and neck surgery under general anaesthesia randomised to receive either dexmedetomidine or nitroglycerin infusion for controlled hypotensive anaesthesia. Cerebral oximetry was monitored with NIRS, and data regarding CDEs, bilateral rScO2, and peri-operative haemodynamics were collected. Continuous data were analysed using unpaired Student's t-tests except for intra-group analyses, which were analysed using paired t-tests. Categorical data were analysed using the Chi-square test. For comparison of time to CDEs, Kaplan–Meier survival analysis with log-rank test was performed. Results: Of the 82 patients in both groups, CDEs were observed in 15 patients each. A decrease from baseline by 20% was observed in three patients: one in Group N and two in Group D. Statistically, there was an equal risk of getting CDEs in the groups. The time to CDE was comparable (P > 0.05). The difference in heart rate was statistically significant (P < 0.001). Conclusion: Dexmedetomidine is non-inferior to nitroglycerin in terms of the occurrence of cerebral desaturation events when used for controlled hypotensive anaesthesia in head and neck surgeries.

Background and Aims: Single-shot erector spinae plane block (ESPB) provides excellent analgesia in mastectomy in the immediate post-operative period but is not sufficient to maintain for prolonged duration. This study compares the efficacy of programmed intermittent bolus (PIB) versus continuous infusion (CI) techniques after ESPB by placing a catheter for mastectomy. Methods: After ethical approval and patient consent, ESPB was performed at the T4 level in 50 patients with an initial bolus of 20 mL 0.375% ropivacaine and a catheter placed 30 min before surgery. In the postoperative period, they were randomised to Group I - intermittent bolus of 20 mL 0.2% ropivacaine every 4 h for 24 h and Group C - continuous infusion of 0.2% ropivacaine at 5 mL/h for 24 h. The primary outcome was the 24-h fentanyl consumption by patient-controlled analgesia device. Data was analysed using Stata 14.0. Results: Group I patients had reduced post-operative fentanyl consumption {mean [standard deviation (SD)]: 166 (139.17) μg vs 332 (247.96) μg, P = 0.002} and lower median NRS scores (1 h: 3 vs 5), (2 h: 3 vs 5), (4 h: 3 vs 5), (6 h: 4 vs 5) with a higher mean (SD) Quality of Recovery-15 score {134.4 (8.53) vs 127 (12.89), P = 0.020} compared to Group C, respectively. The 24-h dermatomal sensory coverage was more comprehensive in Group I compared to Group C. Conclusion: The PIB technique after ESPB provides decreased postoperative opioid consumption, better post-operative analgesia and quality of recovery compared to the CI technique in patients undergoing mastectomy.

Background and Aims: Dexmedetomidine has been used as an anti-shivering agent in the perioperative period in pregnant patients undergoing caesarean section (CS), but its effectiveness remains inconclusive. This systematic review and meta-analysis aimed to assess the efficacy of intravenous Dexmedetomidine in the management of shivering. Methods: PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were explored for the randomised controlled trials (RCTs), which compared intravenous administration of Dexmedetomidine with normal saline (placebo) or other anti-shivering agents for the prevention or treatment of shivering in pregnant patients undergoing CS under central neuraxial blockade. The primary outcome was either incidence and/or severity (for prevention) and duration and/or success rate (for treatment) of shivering between the two groups. The secondary outcome measures were adverse effects (bradycardia, hypotension, sedation, nausea and vomiting, and effect on the APGAR scores of the baby) if observed. Data were synthesised using a random effect model. We calculated the odds ratio (95% CI) for presenting the categorical outcome and standardized mean difference (95% CI) for continuous outcomes. Heterogeneity was assessed using I2 statistics and was investigated using sensitivity analysis. Results: A total of 15 RCTs were included in the present systematic review and data from 10 RCTs comparing Dexmedetomidine with normal saline were pooled into the meta-analysis for primary outcome measure. The incidence and severity of shivering at 30 and 60 minutes weresignificantly less in the Dexmedetomidine group compared to the normal saline group [OR = 0.30, 95% CI: 0.19 to 0.47, P < 0.0001; MD = -0.54, 95% CI: -0.81 to -0.26, Z = 3.78, P = 0.0002 and MD = -1.06, 95% CI: -1.46 to -0.66, Z = 5.23, P < 0.0001 respectively]. Similarly, the time to reduce shivering was significantly lower and the success rate of treatment was higher in the Dexmedetomidine group compared to the normal saline group [MD = -13.55, 95% CI: −17.78 to -9.12, Z = 6.0, P < 0.0001 and OR = 0.03, 95% CI: 0.02 to 0.07, P < 0.0001 respectively]. There was no heterogeneity among the studies for incidence, severity at 60 minutes, and success rate of treatment outcome, while the severity of shivering at 30 minutes and time to reduce shivering demonstrated moderate heterogeneity. The side effect profile was comparable between the Dexmedetomidine and control (active and passive) group. Conclusion: This meta-analysis shows that intravenous administration of Dexmedetomidine for both prophylaxis and treatment is superior to normal saline in the management of perioperative shivering during CS, but is comparable to other most commonly used anti-shivering agents. There is no statistically significant difference in the incidence of side effects between the two groups.

Abstract Background Women’s health is usually looked upon in terms of their reproductive health. However, cardio-vascular diseases are one of the leading causes of death and disability among women, globally as well as in India. Risk factors of today can be disease of tomorrow. Gradience in level of epidemiological transition is observed across different states. The study aims to estimate the national and regional prevalence, and sociodemographic determinants of biological and behavioural risk factors for cardiovascular diseases. Materials and methods The present study was conducted among women in the age group of 15 to 49 years using nationally representative sample from fifth round National Family Health Survey in India. The data analysis in the current study included 7,24,115 women in the age group of 15 to 49 years. SPSS version 20 was used for the purpose of analysis. Weighted prevalence was computed for the studied behavioral and biological (dependent variable) risk factors using women specific weights as provided in the dataset. Binary logistic regression model was employed to calculate the adjusted odds ratio (OR) with the corresponding 95% confidence interval (CI) to study the sociodemographic determinants (independent variables) of these risk factors. Results Highest prevalent risk factor for cardiovascular diseases was reported to be central obesity (78.2%), followed by overweight/obesity (23.9%), oral contraceptive use (13.4%), raised blood pressure (11.8%), raised blood sugar (8.6%), tobacco use (4.0%), and alcohol use (0.7%). Higher odds of all the studied risk factors were reported with increasing age. All of the studied risk factors, except for alcohol consumption [OR (95%CI): 0.9 (0.8–0.96)], had higher odds in rural areas compared to urban areas. Compared to other castes, the odds of tobacco [OR (95% CI): 2.01 (1.91–2.08)] and alcohol consumption [OR (95% CI): 5.76 (5.12–6.28)], and raised blood pressure [OR (95% CI): 1.07(1.04–1.11)] was significantly higher among the people belonging to schedule tribe. Conclusion and recommendation The present study highlights the state-wise disparities in the burden and predictors of risk factors for cardio-vascular diseases among women of reproductive age. The study provides insights to these disparities, and focuses on the need of tailoring the disease prevention and control measures suiting to the local needs.

Blockchain networks provide a reliable and secure mode of communication due to their decentralized and distributed nature. The emergence of amalgamated blockchain-based internet-of-things (IoT) systems has generated a huge amount of data to be online. Though blockchains show potential for ensuring transparency, traceability, and immutable records, the privacy of online data in blockchains becomes a question. The privacy of blockchain transactions is at stake as various privacy breaching methods are used by attackers such as linking the transactions, deanonymization, etc. However, the benefits of blockchain make the technology a dominator in the present and future technological paradigms. The other side of the coin deals with privacy information retrieval (PIR), which is necessary to retrieve private information from servers without much revealing. However, the conjunction of blockchain privacy and PIR is very critical and an important aspect of blockchain solutions. In this present survey, we pioneer in analyzing the privacy factors of existing blockchain solutions. We discuss the privacy parameters and important privacy enhancement techniques for blockchains comprehensively. We show the applicability of privacy in various domains including e-commerce, supply chain, healthcare, and IoT. We also discuss PIR-related issues and solutions in the existing literature. We highlight open research problems and discuss the benefits of collaborating with PIR and blockchain systems to improve privacy in blockchains. Our survey is beneficial for academia and industries to be aware of the present status of privacy solutions in blockchains and to address the identified loopholes to make the systems better.

Takotsubo cardiomyopathy (TTC), commonly known as “broken heart syndrome” or “stress cardiomyopathy,” is characterized by transient left ventricular (LV) systolic dysfunction, usually in the absence of significant obstructive coronary artery stenosis. The pathophysiology of TTC remains elusive; however, the three most common plausible mechanisms include catecholamine surge causing myocardial stunning, multivessel coronary spasm, and microvascular dysfunction. Although initially thought to be a benign, reversible, and transient disorder, newer research data demonstrate that TTC may sometimes have severe short-term complications and some long-term residual effects. Several risk factors have been associated with the outcomes of TTC. In this review, we aim to provide a comprehensive review of the prognostication of TTC in the context of different clinical variables presented in multiple research studies. Various clinical factors, including the types of TTC triggers, the patient's sex, the presence of cardiogenic shock, atrial arrhythmias, LV tract obstruction, and the presence of certain other clinical comorbidities may significantly impact patient outcomes in TTC patients. A thorough understanding of these factors helps clinicians to better prognosticate the outcome of their patients. Furthermore, early institution of aggressive treatment interventions in the presence of these risk factors may improve the subsequent clinical course.

We detected a novel GII.4 variant with an amino acid insertion at the start of epitope A in viral protein 1 of noroviruses from the United States, Gabon, South Africa, and the United Kingdom collected during 2017–2022. Early identification of GII.4 variants is crucial for assessing pandemic potential and informing vaccine development.

Background: The American Thoracic Society has published general guidelines for sterility when testing for bronchodilator responsiveness. However, the extent to which practicing allergists implement sterility measures is currently unknown. Objective: This study aims to understand the adherence to the American Thoracic Society guidelines for sterility among practicing allergists. Methods: In 2015, a questionnaire was approved and distributed by the American Academy of Allergy, Asthma & Immunology to all its members. The anonymous responses were recorded and tabulated after a 3-week period. Results: Of the 6800 allergists who received surveys from the American Academy of Allergy, Asthma & Immunology members, 496 participated in the survey (response rate 7.3%). Using metered dose inhalers with a spacer and nebulizers were the most common bronchodilator administration techniques, as indicated by 59.35% and 58.52% of responses, respectively. Whereas 69.25% of the allergists considered their bronchodilator administration techniques to be sterile, 14.05% did not consider their administration technique to be sterile and 16.70% were unsure. For maintaining sterility, 38.75% of the respondents indicated using a new disposable attachment for reused inhalers, 18.71% indicated using a new inhaler for each patient, and 9.13% reported wiping inhalers with a cleaning agent. Conclusions: When asked about the sterility of the techniques used by them, nearly one-third of the allergists either stated that the measures used by them were unsterile or stated that they were were unsure. To increase adherence to sterility measures among North American allergists, promoting guideline awareness and proposing updated guidelines focused on the most common bronchodilator administration techniques is essential.

Purpose: To use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts, between 2008 and 2019. Methods: Data were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to ACL reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019. Results: Linear models for respective search terms were statistically significant for the quadriceps (P < .001) and patellar (P = .007) tendon autograft groups but not the hamstring group (P = .129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; P < .001) and patellar tendon (0.168; P < .001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (P = .20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group. Conclusions: This study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume, greater linear correlation, and larger percent change between 2008 and 2019 compared with patellar tendon or hamstring autograft groups. Clinical Relevance: Awareness of patient perceptions has value in informing shared decision-making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.

With the rapid growth of online property rental and sale platforms, the prevalence of fake real estate listings has become a significant concern. These deceptive listings waste time and effort for buyers and sellers and pose potential risks. Therefore, developing effective methods to distinguish genuine from fake listings is crucial. Accurately identifying fake real estate listings is a critical challenge, and clustering analysis can significantly improve this process. While clustering has been widely used to detect fraud in various fields, its application in the real estate domain has been somewhat limited, primarily focused on auctions and property appraisals. This study aims to fill this gap by using clustering to classify properties into fake and genuine listings based on datasets curated by industry experts. This study developed a K-means model to group properties into clusters, clearly distinguishing between fake and genuine listings. To assure the quality of the training data, data pre-processing procedures were performed on the raw dataset. Several techniques were used to determine the optimal value for each parameter of the K-means model. The clusters are determined using the Silhouette coefficient, the Calinski-Harabasz index, and the Davies-Bouldin index. It was found that the value of cluster 2 is the best and the Camberra technique is the best method when compared to overlapping similarity and Jaccard for distance. The clustering results are assessed using two machine learning algorithms: Random Forest and Decision Tree. The observational results have shown that the optimized K-means significantly improves the accuracy of the Random Forest classification model, boosting it by an impressive 96%. Furthermore, this research demonstrates that clustering helps create a balanced dataset containing fake and genuine clusters. This balanced dataset holds promise for future investigations, particularly for deep learning models that require balanced data to perform optimally. This study presents a practical and effective way to identify fake real estate listings by harnessing the power of clustering analysis, ultimately contributing to a more trustworthy and secure real estate market.

Abstract Objectives To examine real‐world characteristics, journey, and outcomes among patients with locoregional, nonmetastatic renal cell carcinoma (RCC). Methods A retrospective analysis of medical records from the ConcertAI Oncology Dataset was performed on adults in the United States with newly diagnosed nonmetastatic RCC between January 2012–December 2017 who received surgical treatment, and were followed until August 2021. Patients were stratified based on the risk of recurrence after nephrectomy. Recurrence rate and survival outcomes were assessed. Results The cohort (n = 439) had a median age of 64 years, 66.1% were male, and 76.5% had clear‐cell histology. The median follow‐up time from nephrectomy was 39.3 months overall, 41.0 months for intermediate‐high‐risk patients (n = 377; 85.9%) and 24.1 months for high‐risk patients (n = 62; 14.1%). For intermediate‐high‐ and high‐risk patients, respectively, 68.4% and 56.5% had ≥1 medical oncologist visit after nephrectomy. Of 260 patients with documentation of postoperative imaging assessments, 72% were ordered by medical oncologists, and the median time from initial nephrectomy to the first scan was 110 days (intermediate‐high‐risk) and 51 days (high‐risk). Provider‐documented recurrence occurred in 223 (50.8%) patients, of whom 41.7% had ≥1 medical oncologist visit before the recurrence. Three‐year disease‐free survival (DFS), and overall survival rates were 49.4% and 80.8% (all patients): 27.7% and 64.7% (high‐risk); and 52.9% and 83.3% (intermediate‐high‐risk). Conclusions Our study reports low DFS after nephrectomy for patients with intermediate‐high‐ and high‐risk RCC. Subsequent approval and use of new and newly approved adjuvant therapeutic options could potentially delay or prevent recurrence.

A study was carried out to analyze 500 bovine milk samples collected from Haryana, India and 37% samples were found to be associated with E. coli as a causative agent for mastitis. Out of it, 53 (10.6%) isolates were found to be positive for ESBL production by Double-Disk Synergy test and Epsilon test. However, the ESBL-encoding gene blaCTX-M was detected in the 51 (10.2%) isolates. The antibiotic susceptibility test revealed 13.72% of the isolates were multidrug resistant, with MAR index varying from 0.06 to 0.46. The maximum sensitivity was observed towards gentamicin (90.19%) followed by chloramphenicol (78.4%). Fluoroquinolones antibiotics were found to be resistant between 84.31% to 76.47%. The resistance profile underscores the importance of antibiotic stewardship and the need for ongoing surveillance using one health approach to guide therapy and manage the spread of resistant bacteria.

Background: Very limited literature on the clinical course of COVID-19 among liver transplant recipients (LT) is available from India. The present study aimed to evaluate the clinical and mutational profile of SARS-CoV-2 among LT. Methodology: This was a retrospective study including LT cases in whom SARS-CoV-2 RT-PCR testing was requested between April 2020 and December 2022. Detailed mutational analysis was performed by comparing LT COVID-19 positive study group i.e. LT-CoV(+) with two control groups. One including COVID-19 positive with underlying chronic liver disease (CLD) i.e. CLD-CoV(+) and other including COVID-19 positive outpatients without any underlying LD i.e. NLD-CoV(+) Results: Among 213 cases, 48 (22.5 %) were positive [LT-CoV(+)] and the remaining 165 (77.5 %) were negative [LT-CoV(-)] for SARS-CoV-2. Of these, 49 % had mild, 14 % moderate and 37 % had severe COVID-19. Mortality was recorded in 11 (23 %) cases, the majority being non-vaccinated. Severe COVID-19 with intensive care requirement was significantly higher among recipients with >5 years since transplant compared to recipients with ≤5 years (p = 0.02). Among 40 samples subjected to whole genome sequencing, 19 (47.5 %) were Delta, 15 (37.5 %) Omicron, and 6 (15 %) were other variants. COVID-19 severity was significantly higher in LT-CoV(+/D) with no significant difference in mortality (p = 0.122). No significant differences in mutational load and in fraction of deleterious mutations were observed between LT-/CLD-/NLD-CoV(+) groups for either Delta or Omicron. Conclusion: An overall fatality rate of 23 % was recorded among LT recipients. Longer duration since transplant was associated with severe clinical course. However, no significant difference in mutation load between studied groups was observed.

Summary: Background: Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population. Methods: A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses. Findings: Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3–43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4–28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42–0.58) or no indication (aOR 0.24, 95% CI 0.20–0.28) or with contraindications (aOR 0.12, 95% CI 0.07–0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner’s occupation) were independently associated with labour induction and augmentation. Interpretation: Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research. Funding: The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1).

There is an increasing risk of outbreaks escalating into epidemics, despite huge advances in medical science. Epidemics like COVID-19, Monkeypox, Influenza and HIV have been affecting people and public health infrastructure at an alarming rate around the world. COVID-19 alone has infected more than 500 million people out of which 6 million have died over 100 countries. HIV is also a major global public health issue and has claimed 85.6 million lives till 2023. Forecasting the trends of these epidemics is important in order to efficiently manage national and global health risks by improving early warning systems. Therefore an intelligent framework to forecast epidemic diseases is proposed and a detailed comparative analysis is conducted using different time-series models. This study contributes to (Sustainable Development Goal) SDG-3 by predicting epidemics disease trends precisely using ARIMA, Polynomial Regression, SARIMA, Holt’s, Fb-Prophet time-series models, which can decrease the burden on healthcare systems. Using the best-suited models, the Mean Absolute Percentage Error (MAPE) values for Monkeypox, HIV, COVID-19 and Influenza forecasting were 0.0129, 0.0035, 0.0011, and 0.024 respectively.

Purpose: For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy. Methods and Materials: We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival. Results: The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention. Conclusions: Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population.

Background Empathy is a crucial component of clinical practice and professionalism. Quantitative studies have reported empathy erosion in medical students. However, studies investigating medical students' perspectives on their understanding and behavioral expressions of empathy with patients are limited. Objective This study aimed to explore medical students' perspectives on the nature, significance, and expressions of empathy during their undergraduate training. Methods The study used a qualitative phenomenological approach. Twenty-five medical students (out of a total of 45) were invited to participate. Semi-structured online interviews were conducted to elicit experiential details from participants. The recorded interviews were transcribed verbatim, and data were analyzed using Braun and Clarke's thematic analysis method. Results Students described their beliefs and understanding about empathy and reflected on the process of empathizing with patients. Most students defined empathy as having four interrelated and overlapping dimensions: cognitive, affective, behavioral, and moral. In addition, they believed that empathizing with patients was a bidirectional relational process, necessitating empathic inclination, adequate time, a non-judgmental approach, and effective communication and listening skills. Conclusion Empathy is more than a personal attribute; it is a multi-faceted, dynamic, and bidirectional relational process. Adequate time, support, stress management strategies, formal training, and encouragement from experienced teachers are crucial elements to fostering genuine or deep empathy in medical students. In addition, students should be trained in developing emotional regulation and maintaining an appropriate balance between professional detachment and empathic connections.

Abstract Voice is an essential component of human communication, serving as a fundamental medium for expressing thoughts, emotions, and ideas. Disruptions in vocal fold vibratory patterns can lead to voice disorders, which can have a profound impact on interpersonal interactions. Early detection of voice disorders is crucial for improving voice health and quality of life. This research proposes a novel methodology called VDDMFS [voice disorder detection using MFCC (Mel-frequency cepstral coefficients), fundamental frequency and spectral centroid] which combines an artificial neural network (ANN) trained on acoustic attributes and a long short-term memory (LSTM) model trained on MFCC attributes. Subsequently, the probabilities generated by both the ANN and LSTM models are stacked and used as input for XGBoost, which detects whether a voice is disordered or not, resulting in more accurate voice disorder detection. This approach achieved promising results, with an accuracy of 95.67%, sensitivity of 95.36%, specificity of 96.49% and f1 score of 96.9%, outperforming existing techniques.

Objective: To determine the diagnostic accuracy of the initial telestroke consultation in a large academic hub-and-spoke telemedicine network. Patients and Methods: This retrospective study includes all patients evaluated for cerebral ischemia through video telestroke consultation in a large academic hub-and-spoke telemedicine network from January 1, 2019 to December 31, 2020. A detailed chart review was conducted to identify the initial suspected diagnosis and final diagnosis. Cerebral ischemia was defined as acute ischemic stroke and transient ischemic attack. All other diagnoses were defined as stroke mimics. Data were organized into continuous and categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the curve (AUC), and likelihood ratio (LR+) for the telestroke-consultation diagnosis were calculated while using the final diagnosis as the gold standard diagnosis. Results: A total of 1043 patients met the inclusion criteria. The final diagnosis of cerebral ischemia was made in 63.5% of all patients (539 of the 1043 with acute ischemic stroke,123 of the 1043 with transient ischemic attack). Stroke mimic was diagnosed in 36.5% patients (381 of the 1043). The sensitivity and specificity of telestroke evaluation for diagnosis of cerebral ischemia were 97.1% and 81.4%, respectively. Positive predictive value was 90.1%, and negative predictive value was 94.2%. Overall diagnostic accuracy was 91.4%, with an LR+ of 5.21 and AUC of 0.89. Conclusion: This study highlights the high diagnostic accuracy of telestroke providers in diagnosing cerebral ischemia. Further research exploring the application of teleneurology in the nonstroke setting and other medical subspecialties is warranted.

The paper focuses on the use of Artificial Neural Networks (ANNs) for forecasting time series data of the stock market since ANNs are dynamic and are more capable of handling complex data sets in comparison to conventional forecasting techniques such as regression, Logistic regression, and have massive potential for the prediction of stock market prices.

ABSTRACT: Objectives: Drug resistance in leprosy is an emerging concern, leading to treatment failures, recurrences, and potential spread of resistant Mycobacterium leprae in the community. In this study, we aimed to assess drug resistance prevalence and patterns amongst leprosy patients at a tertiary care referral hospital in India. Methods: Mutations in drug resistance determining regions for dapsone, rifampicin, and ofloxacin of the M. leprae genome in DNA extracted from skin biopsies of 136 leprosy patients (treatment-naive = 67, with persistent skin lesions = 35, with recurrence = 34) were analysed by polymerase chain reaction followed by Sanger sequencing. Wild-type strain (Thai-53) was used as a reference strain. Results: Resistance mutations were identified in a total of 23 patients, constituting 16.9% of the cohort. Within this subset of 23 cases, resistance to ofloxacin was observed in 17 individuals (12.5%), while resistance to both dapsone and rifampicin was detected in three patients each (2.2% for both). The occurrence of ofloxacin resistance showed minimal disparity between recurrent and treatment-naive cases, at 17.6% and 16.4%, respectively. Dapsone resistance emerged in two treatment-naive cases and one case with persistent skin lesions. Notably, none of the treatment-naive cases or those with recurrence/relapse exhibited rifampicin resistance. Subsequently, no statistically significant correlation was identified between other clinical variables and the presence of antimicrobial resistance. Conclusions: The occurrence of resistance to the current multidrug therapy regimen (specifically dapsone and rifampicin) and to ofloxacin, a secondary antileprosy medication in M. leprae, represents a concerning scenario. This calls for an expansion towards bactericidal drug options and the establishment of robust surveillance for drug resistance in countries burdened with high leprosy rates. Moreover, the introduction of stringent antimicrobial stewardship initiatives is imperative. As a single centre study, it represents a limited, cross-sectional view of the real situation in the field.

Nicholas Kerry, Ria Chhabra, Jeremy DW Clifton Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Nicholas Kerry, Positive Psychology Center, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, USA, Tel +1 215-898-7300, Email nickerry@sas.upenn.eduBackground: Many studies suggest a link between gratitude and life satisfaction, including experimental tests of gratitude interventions. This paper presents a systematic review of recent literature on the influence of gratitude on life satisfaction. The aim of this research is to better understand the nature of the relationship between gratitude and life satisfaction and to evaluate the state of literature.Methodology: A systematic search was conducted using four databases (APA PsycInfo, Scopus, Web of Science, and EBSCO), targeting articles published since 2010. Correlational studies were included if they used the GQ6 measure of gratitude and the Satisfaction With Life Scale (SWLS). Intervention studies were included if they reported effects of a gratitude manipulation on SWLS scores. Forty-four articles (N = 16,529) focusing on gratitude and life satisfaction were ultimately selected. Among the selected studies, 18 employed experimental designs and 26 were cross-sectional studies. Five studies also presented cross-lagged analyses from two or more timepoints.Results: The review indicated a substantial positive correlation between gratitude and life satisfaction. Various potential mediators were also identified, including meaning in life, social support, and self-esteem. Some experimental research suggested that gratitude interventions may increase life satisfaction compared to neutral control conditions, although evidence was mixed. There was stronger evidence for these effects in people from Western countries. However, there is no strong evidence that gratitude interventions outperform positively valenced control conditions. Thus, it is possible that the effects of intervention could be caused by demand- or placebo effects.Conclusion and Recommendation: While it is clear that there is a link between gratitude and life satisfaction, the extent to which gratitude causes life satisfaction and the mechanism underlying that link require further exploration. We suggest that experimental work test effects of changes in gratitude that cannot be explained by placebo- or demand effects. We also encourage more interactive interventions as well as research that investigates third variables that could underlie both gratitude and life satisfaction.Plain Language Summary: People who feel more gratitude tend to be more satisfied with their lives and sometimes report feeling more satisfied after performing gratitude-related tasks such as listing things they are grateful for. However, not all studies find these effects, and there is little evidence that these tasks work better than simply asking people to engage in other positive thoughts. It is also possible that people respond more positively to life satisfaction surveys after these interventions because of expectations, rather than real changes in life satisfaction.Keywords: gratitude, life satisfaction, positive psychology interventions, subjective well-being

It is now known that early government interventions in pandemic management helps in slowing down the pandemic in the initial phase, during which a conservative basic reproduction number can be maintained. There have been several ways to evaluate these early response strategies for COVID-19 during its outbreak globally in 2020. As a novelty, we evaluate them through the lens of patient recovery logistics. Here, we use a data-driven approach of recovery analysis in a case study of Singapore during January 22–April 01, 2020, which is effectively the analysis of length-of-stay in the government healthcare facility, National Center for Infectious Diseases. We propose the use of a data-driven method involving periodization, statistical analysis, regression models, and epidemiological models. We demonstrate that the estimates of reproduction number in Singapore shows variation in different age groups and periods, indicating the success of early intervention strategy in the initial transmission stages of the pandemic.

Abstract Neuronal transmission relies on the regulated secretion of neurotransmitters, which are packed in synaptic vesicles (SVs). Hundreds of SVs accumulate at synaptic boutons. Despite being held together, SVs are highly mobile, so that they can be recruited to the plasma membrane for their rapid release during neuronal activity. However, how such confinement of SVs corroborates with their motility remains unclear. To bridge this gap, we employ ultrafast single-molecule tracking (SMT) in the reconstituted system of native SVs and in living neurons. SVs and synapsin 1, the most highly abundant synaptic protein, form condensates with liquid-like properties. In these condensates, synapsin 1 movement is slowed in both at short (i.e., 60-nm) and long (i.e., several hundred-nm) ranges, suggesting that the SV-synapsin 1 interaction raises the overall packing of the condensate. Furthermore, two-color SMT and super-resolution imaging in living axons demonstrate that synapsin 1 drives the accumulation of SVs in boutons. Even the short intrinsically-disordered fragment of synapsin 1 was sufficient to restore the native SV motility pattern in synapsin triple knock-out animals. Thus, synapsin 1 condensation is sufficient to guarantee reliable confinement and motility of SVs, allowing for the formation of mesoscale domains of SVs at synapses in vivo.

Abstract Background Splenogonadal fusion (SGF) is a rare developmental choristoma in which ectopic splenic tissue is aberrantly attached to the gonads, mostly in the scrotum. It is a great clinical masquerader, and accurate preoperative diagnosis is often difficult due to the rarity of this entity. Many patients tend to undergo unnecessary surgical explorations and also orchiectomy. Accordingly, this article aims to review the latest literature regarding SGF and a description of the radiological features of this rare entity. Multiple systematic methods were used to find the latest publications on splenogonadal fusion by searching the Scopus, PubMed, and Google Scholar databases online since 2013. The latest comprehensive review of this rare entity was of 61 cases by Malik et al. in 2013. We reviewed all the cases of SGF reported in the literature in the last 10 years between 2013 and 2022 with an emphasis on diverse clinical presentations and radiologic findings. Along with this, a surgical and pathological proved case of SGF will be presented with emphasis on imaging findings. Splenogondal fusion is an uncommon differential diagnosis in patients with scrotal swelling. The current literature review showed the discontinuous type (63%) of SGF to be more common than the continuous (37%) type in contradiction to the previous literature review. Orchiectomy was done in 36% of cases as compared to 24% as described in the latest review by Malik et al. Conclusions Knowledge of this entity along with familiarization with its imaging features among radiologists is essential for surgical prognostication and avoiding unnecessary orchiectomy. We suggest that the addition of colour Doppler and elastography to routine grey-scale ultrasound can increase diagnostic confidence. Subsequent cross-sectional imaging with magnetic resonance imaging (MRI) helps categorize the subtype and pre-operative planning.