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Summary: Malignant gliomas are the most common and aggressive primary brain tumor in adults, and high mitotic rates are associated with their malignancy. Gliomas were modeled in mice using the Sleeping Beauty system to encode genetic lesions recapitulating the human disease. The presented workflow allows the study of the proliferation of glioma cells in vivo, enabling the identification of different phases of the cell cycle, with the advantage that 5-ethynyl-2′-deoxyuridine staining does not involve denaturation steps and samples do not require histological processing.For complete details on the use and execution of this protocol, please refer to Núñez et al. (2019).

Background: Gender stereotyping and assumptions about men and women shape everyday personal interactions and attitudes on gender norms. Adolescents forming the future society would be playing an essential role in practising gender equality norms and inculcating it in future generations. Hence the study was undertaken to know the adolescent's attitude towards gender equality norms and to explore its determinants. Objectives: To assess the attitude of adolescents towards gender equality in Urban, Rural, and Tribal areas of Mysuru district. To determine the association of socio-demographic variables, interpersonal influences of family, friends, and experiences of gender bias with adolescent’s attitude towards gender equality. Methods: A cross-sectional study was conducted in the urban, rural, and tribal areas of Mysuru district using multistage sampling. Data was collected from 500 adolescents by a pre-structured and pre-tested, validated questionnaire and analysis was done using SPSS V.24. Results: 50.5% of adolescents had negative attitude scores towards gender equality, and 79.3 % of adolescent girls had reported the personal experience of gender bias. Age, Sex, Residence, interpersonal influence of family and friends and personal experience of gender bias among adolescent girls showed significant association with their attitude towards gender equality. Conclusion: Nearly, half of the adolescents have a negative attitude towards gender equality, and more than three fourth of adolescent girls had personally experienced gender bias. The influence of family and friends was significant in determining the attitude of adolescents towards gender equality norms.

Summary:. Abdominal wall–vascularized composite allotransplantation (AW-VCA) has evolved as a technically feasible but challenging option in the rare event of abdominal wall reconstruction in patients whose abdomen cannot be closed by applying conventional methods. The authors conducted the first synchronous child-to-adult recipient AW-VCA using an arteriovenous loop technique. This article presents a 1-year follow-up of the patient’s postoperative course. Frequent skin biopsies were performed in accordance with Duke Institutional Review Board protocol, with 3 episodes of rejection treated with high-dose steroids and Thymoglobulin (Genzyme Corp, Cambridge, Mass.). The patient developed an opportunistic fungal brain abscess secondary to immunosuppression, which led to temporary upper extremity weakness. Future considerations for AW-VCA include a modified surgical technique involving utilization of donor vein graft for arteriovenous loop formation. In addition, reduction in postoperative biopsy schedule and changes in immunosuppression regimen may lead to improved outcomes and prevent unnecessary high-dose immunosuppression.

A multitude of psychiatric disorders have been described in classification systems like the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM V). Diagnosing a specific mental disorder requires memorising specific symptom criteria, and their improper recall may result in misdiagnosis. Clinicians may use mnemonics, considering them as narratives or anecdotes of the diagnostic criteria. A scoping review of previously described mnemonics for DSM diagnostic criteria was carried out. An electronic search was done in PubMed, Google Scholar, Google Books and Google Search engine using a prespecified search strategy. Reference lists of relevant articles and chapters were hand searched to identify original and additional articles. Mnemonics retrieved from websites were manually searched in Google to identify published journal articles or chapters for the same mnemonics. Additionally, some mnemonics were developed, modified or added based on the author’s knowledge. The comprehensive search identified 93 records (44 journal articles, 45 books and 4 websites) eligible for the review. Most of the mnemonics retrieved were related in some way to the disorder itself. They were listed under the heading of their respective disorders and indexed in the same order as in DSM V. The mnemonics that reflect a facet of their respective disorders were elaborated in detail.

The Outerbridge-Kashiwagi (O-K) procedure has conventionally been used for the treatment of osteoarthritis of the elbow and to treat posttraumatic sequelae including posttraumatic arthritis, stiffness, contracture, and ulnar neuritis. The procedure involves exposure of the posterior elbow joint as well creating a window posteriorly through the olecranon fossa to target anterior aspects of the elbow. Several case series have shown the O-K procedure to have good functional outcomes with minimal complications. Used mostly for the surgical treatment of adult osteoarthritis, the O-K procedure has not been previously described for the treatment of a pediatric supracondylar humerus fracture malunion. This article and accompanying video will present the pearls and discuss the technique of the O-K procedure used to treat the loss of elbow flexion as a sequelae of supracondylar humerus fracture malunion.

IntroductionUndernutrition rates remain high in rural, low-income settings, where large, gender-based inequities persist. We hypothesised that increasing gender equity in agriculture could improve nutrition.MethodsWe conducted a systematic review to assess the associations between gender-based inequities (in income, land, livestock, and workloads) and nutrition, diets and food security outcomes in agricultural contexts of low-income and middle-income countries. Between 9 March and 7 August 2018, we searched 18 databases and 14 journals, and contacted 27 experts. We included quantitative and qualitative literature from agricultural contexts in low-income and middle-income countries, with no date restriction. Outcomes were women’s and children’s anthropometric status, dietary quality and household food security. We conducted meta-analyses using random-effects models.ResultsWe identified 19 820 records, of which 34 studies (42 809 households) met the inclusion criteria. Most (22/25) quantitative studies had a high risk of bias, and qualitative evidence was of mixed quality. Income, land and livestock equity had heterogeneous associations with household food security and child anthropometric outcomes. Meta-analyses showed women’s share of household income earned (0.32, 95% CI −4.22 to 4.86; six results) and women’s share of land owned (2.72, 95% CI -0.52 to 5.96; three results) did not increase the percentage of household budget spent on food. Higher-quality studies showed more consistently positive associations between income equity and food security. Evidence is limited on other exposure–outcome pairings.ConclusionsWe find heterogeneous associations between gender equity and household-level food security. High-quality research is needed to establish the impact of gender equity on nutrition outcomes across contexts.PROSPERO registration numberCRD42018093987.

Non-communicable diseases, such as cardiovascular diseases (CVDs), diabetes and cancer account for more than half of the global disease burden, and 75% of related deaths occur in low- and middle-income countries (LMICs). Despite large regional variations in CVD incidence and prevalence, CVDs remain the leading causes of death worldwide. With urbanisation, developing nations are undergoing unprecedented labour-force transitions out of agriculture and into types of non-agricultural employment, mainly in the industry and service sectors. There are few studies on the effect of these transitions on CVDs and CVD risk factors in LMICs. We systematically searched MEDLINE, PubMed, EMBASE and the Cochrane Library from January 1950 to January 2017 to assess the association of engaging in agriculture compared to types of non-agricultural employment (e.g. services and manufacturing) with CVD incidence, prevalence and risk factors. Studies were included if they: included participants who engaged in agriculture and participants who did not engage in agriculture; measured atherosclerotic CVDs or their modifiable risk factors; and involved adults from LMICs. We assessed the quality of evidence in seven domains of each study. Prevalence ratios with 95% confidence intervals were calculated and compared in forest plots across studies. Study heterogeneity did not permit formal meta-analyses with pooled results. There was a lack of publications on the primary outcomes, atherosclerotic CVDs (n = 2). Limited evidence of varying consistency from 13 studies in five countries reported that compared with non-agricultural workers, mainly living in urban areas, rural agriculture workers had a lower prevalence of hypertension, overweight and obesity; and a higher prevalence of underweight and smoking. High quality evidence is lacking on the associations of engaging in and transitioning out of agriculture with atherosclerotic CVDs and their modifiable risk factors in LMICs. There is a need for interdisciplinary longitudinal studies to understand associations of types of employment and labour-force transitions with CVD burdens in LMICs.

In this study, we assessed the possible impacts of climate variability and change on growth and performance of maize using multi-climate, multi-crop model approaches built on Agricultural Model Intercomparison and Improvement Project (AgMIP) protocols in five different agro-ecological zones (AEZs) of Embu County in Kenya and under different management systems. Adaptation strategies were developed that are locally relevant by identifying a set of technologies that help to offset potential impacts of climate change on maize yields. Impacts and adaptation options were evaluated using projections by 20 Coupled Model Intercomparison Project-Phase 5 (CMIP5) climate models under two representative concentration pathways (RCPs) 4.5 and 8.5. Two widely used crop simulation models, Agricultural Production Systems Simulator (APSIM) and Decision Support System for Agrotechnology Transfer (DSSAT) was used to simulate the potential impacts of climate change on maize. Results showed that 20 CMIP5 models are consistent in their projections of increased surface temperatures with different magnitude. Projections by HadGEM2-CC, HadGEM2-ES, and MIROC-ESM tend to be higher than the rest of 17 CMIP5 climate models under both emission scenarios. The projected increase in minimum temperature (Tmin) which ranged between 2.7 and 5.8°C is higher than the increase in maximum temperature (Tmax) that varied between 2.2 and 4.8°C by end century under RCP 8.5. Future projections in rainfall are less certain with high variability projections by GFDL-ESM2G, MIROC5, and NorESM1-M suggest 8 to 25% decline in rainfall, while CanESM2, IPSL-CM5A-MR and BNU-ESM suggested more than 85% increase in rainfall under RCP 8.5 by end of 21st century. Impacts of current and future climatic conditions on maize yields varied depending on the AEZs, soil type, crop management and climate change scenario. Impacts are largely negative in the low potential AEZs such as Lower Midlands (LM4 and LM5) compared with the high potential AEZs Upper Midlands (UM2 and UM3). However, impacts of climate change are largely positive across all AEZs and management conditions when CO2 fertilization is included. Using the differential impacts of climate change, a strategy to adapt maize cultivation to climate change in all the five AEZs was identified by consolidating those practices that contributed to increased yields under climate change. We consider this approach as more appropriate to identify operational adaptation strategies using readily available technologies that contribute positively under both current and future climatic conditions. This approach when adopted in strategic manner will also contribute to further strengthen the development of adaptation strategies at national and local levels. The methods and tools validated and applied in this assessment allowed estimating possible impacts of climate change and adaptation strategies which can provide valuable insights and guidance for adaptation planning.

Sustainability evaluation of wastewater treatment helps to reduce greenhouse gas emissions, as it emphasizes the development of green technologies and optimum resource use rather than the end-of-pipe treatment. The conventional approaches for treating acid mine drainages (AMDs) are efficient; however, they need enormous amounts of energy, making them less sustainable and causing greater environmental concern. We recently demonstrated the potential of immobilized acid-adapted microalgal technology for AMD remediation. Here, this novel approach has been evaluated following emergy and carbon footprint analysis for its sustainability in AMD treatment. Our results showed that imported energy inputs contributed significantly (>90%) to the overall emergy and were much lower than in passive and active treatment systems. The microalgal treatment required 2–15 times more renewable inputs than the other two treatment systems. Additionally, the emergy indices indicated higher environmental loading ratio and lower per cent renewability, suggesting the need for adequate renewable inputs in the immobilized microalgal system. The emergy yield ratio for biodiesel production from the microalgal biomass after AMD treatment was >1.0, which indicates a better emergy return on total emergy spent. Based on greenhouse gas emissions, carbon footprint analysis (CFA), was performed using default emission factors, in accordance with the IPCC standards and the National Greenhouse Energy Reporting (NGER) program of Australia. Interestingly, CFA of acid-adapted microalgal technology revealed significant greenhouse gas emissions due to usage of various construction materials as per IPCC, while SCOPE 2 emissions from purchased electricity were evident as per NGER. Our findings indicate that the immobilized microalgal technology is highly sustainable in AMD treatment, and its potential could be realized further by including solar energy into the overall treatment system.

Left atrial (LA) mural endocarditis is exceedingly rare, and carries an increased risk of embolization. Ours was a case of rheumatic mitral regurgitation and infective endocarditis due to Staphylococcus hominis, with vegetations over the mitral valve and the posterior LA wall which embolized widely. This case is presented for its rarity and to highlight the plethora of events after septic embolization.

Urinary tract infections (UTIs) caused by fungi, frequently associated with medical devices, have increased and caused great morbidity and mortality among hospitalized patients. Difficulties on different species identification as well as the lack of standardized sensitivity tests in vitro, contribute to the limited information available on epidemiology, diagnosis, and therapeutics of Trichosporon infections. There are only sporadic reports of UTI caused by Trichosporon asahii reported from India. We report six cases of UTI caused by T. asahii in severely ill patients in a tertiary care setup. Among six positive T. asahii UTI, four were found in female patients with a mean age of 60 years. We observed that all patients were on indwelling urinary catheter, broad-spectrum antibiotics, and with other comorbid conditions. With regard to the antifungal susceptibility testing, all the isolates were resistant to amphotericin B and sensitive to voriconazole. Majority of them were sensitive to Itraconazole, half of them were sensitive to fluconazole. The ubiquity and biofilm formation poses difficulty in establishing pathogenicity and delineating environmental or nosocomial infections. Risk factors such as use of antibiotics, indwelling catheter, and comorbidities such as hypertension, diabetes, anemia, and chronic kidney disease predispose for the development of UTI by T. asahii. Isolation of the same yeast in three consecutive urine samples with significant counts, along with significant number of pus cells establishes T. asahii as an etiological agent of UTI. Furthermore, the clearance of the fungus from the urinary tract with the recovery of the patient following catheter removal and antifungal therapy further confirms T. asahii as the cause of UTI.

ABSTRACT: Objective: Succinate dehydrogenase complex, subunit D (SDHD) gene mutations are most commonly associated with head and neck paragangliomas. We describe a pair of cases with early-onset, bilateral pheochromocytoma (PCC) and paraganglioma (PGL) syndrome associated with SDHD mutation.Methods: We describe 2 cases of hereditary, early-onset, bilateral PCC/PGL syndrome associated with SDHD mutation.Results: Both cases presented under the age of 30 with bilateral PCC and PGL with SDHD mutations. Case 1 is a female who was initially diagnosed with hypertension and later work-up revealed elevated norepinephrine levels. Positron emission tomography coupled with computed tomography showed avid uptake of fluorodeoxyglucose by the right adrenal gland, the organ of Zuckerkandl, and the left carotid bifurcation. Surgical resection was performed and resulted in normalization of her catecholamines. Case 2 is a male who similarly presented with hypertension and elevated norepinephrine levels. Imaging revealed head, neck, and abdominal PGL. He underwent staged adrenal-ectomies and abdominal PGL resection. Gene sequencing and deletion/duplication analysis revealed that case 1 had an exon 2 deletion in her SDHD gene and case 2 had a frameshift mutation resulting in a stop codon in exon 3 in his SDHD gene.Conclusion: While SDHD mutations are primarily thought to result in silent head and neck tumors, our cases indicate that they should also be considered in the evaluation of functional, bilateral adrenal PCC in young patients.Abbreviations: FDG fluorodeoxyglucose PCC pheochromocytoma PGL paraganglioma SDHD succinate dehydrogenase complex, subunit D gene VHL von Hippel-Lindau

Abstract Background Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. ‘Nutrition-sensitive’ agriculture programs could tackle the underlying causes of undernutrition. Methods/design This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women’s groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women’s groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women’s groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6–23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0–23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children’s weight-for-height z-score 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions. Discussion This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts. Trial registration ISRCTN , ISRCTN65922679. Registered on 21 December 2016.

Aim: The aim of the study is to identify the prevalence of metabolic abnormalities in children with urolithiasis. Materials and Methods: This is a prospective study; all children below 15 years who are found to have urolithiasis were prospectively evaluated with relevant history, clinical examination, and urine and serum testing. Metabolic workup includes complete urine examination, urine culture and sensitivity, and 24-h urinary analysis (lithorisk profile). Results: A total of 55 patients are included in the study. Forty-two are boys and 13 are girls aged between from 8 months to 15 years. Thirty-three patients underwent stone analysis, primary composition of calcium oxalate stones in 19 (58%), ammonium urate in 4, dahlite in 3 and uric acid in 3, silicon oxide in 2, and struvite in 2 cases. Lithorisk profile was performed in 40 cases (72.7%). The pH range is 5.6–6.2. We noted hypercalciuria in 20 patients (50%), hyperuricosuria in 23 (57.5%), hyperoxaluria in 20 (50%), hypernatriuria in 26 (65%), hypocitraturia in 9 (23%), and hypomagnesuria in 3 (7.5%). Urine calcium-to-creatinine ratio >0.2 was found in 22 (55%) patients. Statistically significant association between hyperoxaluria and hyperuricosuria (P < 0.04, r = 0.32) and hypercalciuria and hyperuricosuria (P < 0.001, r = 0.51) found in this study. Hyperuricosuria is seen in 75% and 73% of patients with hypercalciuria and hyperoxaluria, respectively. Twenty-five children have both lithorisk profile and stone analysis. Hypercalciuria and hyperoxaluria were noted in 60% of calcium oxalate stone formers each. Elevated urinary calcium/creatinine ratio (>0.2) was seen in 73% of calcium oxalate stone formers. Conclusion: Because of high prevalence of metabolic risk factors and the significant risk of lifelong recurrence, all children with urolithiasis need complete evaluation with metabolic workup.

Context: A major determinant of the prognosis of oral cancer is the risk of cervical lymph node metastasis. Several factors have been assessed preoperatively to predict the risk of lymph node metastasis; among them, tumor thickness is proved to be a significant predictor of lymph node metastasis. Ultrasonography (US) is a noninvasive, rapid, easily repeatable, and economical examination to measure tumor thickness. This study is undertaken for evaluating the usefulness of US to predict neck metastasis. Aim: To measure tumor thickness in oral cancer with preoperative US and to predict occult cervical lymph node metastasis. Materials and Methods: In all, 43 patients with biopsy-proven squamous cell carcinoma of tongue/buccal mucosa underwent preoperative US to measure tumor thickness. Statistical Analysis: Tumor thickness from histolopathology and US was analyzed using Pearson's product moment correlation. Fisher's exact test was used to assess the relationship between tumor thickness and the risk of cervical lymph node metastasis. Results: There was a significant correlation between preoperative US and histological measures of tumor thickness (correlation coefficient 0.961, P < 0.001). The overall rate of lymph node metastasis was 25.5% (11/43). In the group with tumors 0.05. Conclusion: Preoperative US is an accurate measure of maximal tumor thickness. Tumor thickness ≥5 mm can be considered as a risk factor for cervical lymph nodal metastasis.

As a result of the limited resources available in IoT local devices, the large scale cloud consumer’s data that are produced by IoT related machines are contracted out to the cloud. Cloud computing is unreliable, using it can compromise user privacy, and data may be leaked. Because cloud-data and grid infrastructure are both growing exponentially, there is an urgent need to explore computational sources and cloud large-data protection. Numerous cloud service categories are assimilated into numerous fields, such as defense systems and pharmaceutical databases, to compute information space and allocation of resources. Attribute Based Encryption (ABE) is a sophisticated approach which can permit employees to specify a higher level of security for data stored in cloud storage facilities. Numerous obsolete ABE techniques are practical when applied to small data sets to generate cryptograms with restricted computational properties; their properties are used to generate the key, encrypt it, and decrypt it. To address the current concerns, a dynamic non-linear polynomial chaotic quantum hash technique on top of secure block chain model can be used for enhancing cloud data security while maintaining user privacy. In the proposed method, customer attributes are guaranteed by using a dynamic non- polynomial chaotic map function for the key initialization, encryption, and decryption. In the proposed model, both organized and unorganized massive clinical data are considered to be inputs for reliable corroboration and encoding. Compared to existing models, the real-time simulation results demonstrate that the stated standard is more precise than 90% in terms of bit change and more precise than 95% in terms of dynamic key generation, encipherment, and decipherment time.

Under-water sensing and image processing play major roles in oceanic scientific studies. One of the related challenges is that the absorption and scattering of light in underwater settings degrades the quality of the imaging. The major drawbacks of underwater imaging are color distortion, low contrast, and loss of detail (especially edge information). The paper proposes a method to address these issues by de-noising and increasing the resolution of the image using a model network trained on similar data. The network extracts frames from a video and filters them with a trigonometric–Gaussian filter to eliminate the noise in the image. It then applies contrast limited adaptive histogram equalization (CLAHE) to improvise the image contrast, and finally enhances the image resolution. Experimental results show that the proposed method could effectively produce enhanced images from degraded underwater images.

Abstract Purpose The study evaluates and provides an overview of the nutritional importance of 19 selected food wastes as aids in human/livestock/soil/plant health. Methods Nitric acid-digested extracts of food wastes belonging to four different classes (fruits, vegetables, oilseeds and beverages) were analysed for different elements in an inductively coupled plasma mass spectrometer. Results Our study recommends spent coffee grounds, tea leaves, radish peel, watermelon rind and pineapple skin that contain substantially high concentrations of essential elements such as N, P, K, S and Fe for their use as: (a) substrates for composting, (b) biofertilizers, (c) soil amendments, and (d) bioadsorbents of toxins. Although these food wastes are rich in essential nutrients, we do not suggest them for the preparation of food supplements as they contain non-essential elements in concentrations beyond the human safety limits. However, food wastes like banana peel, plum pomace and pistachio shell that contain low and permissible concentrations of toxic elements can be recommended as dietary supplements for oral intake in spite of their lesser essential elemental composition than the other residues examined. Conclusions Our study confirms that food wastes are rich sources of essential nutrients and there is need to harness their real industrial systems.

Epilepsy has many causes and comorbidities affecting as many as 4% of people in their lifetime. Both idiopathic and symptomatic epilepsies are highly heritable, but genetic factors are difficult to characterize among humans due to complex disease etiologies. Rodent genetic studies have been critical to the discovery of seizure susceptibility loci, including Kcnj10 mutations identified in both mouse and human cohorts. However, genetic analyses of epilepsy phenotypes in mice to date have been carried out as acute studies in seizure-naive animals or in Mendelian models of epilepsy, while humans with epilepsy have a history of recurrent seizures that also modify brain physiology. We have applied a repeated seizure model to a genetic reference population, following seizure susceptibility over a 36-d period. Initial differences in generalized seizure threshold among the Hybrid Mouse Diversity Panel (HMDP) were associated with a well-characterized seizure susceptibility locus found in mice: Seizure susceptibility 1. Remarkably, Szs1 influence diminished as subsequent induced seizures had diminishing latencies in certain HMDP strains. Administration of eight seizures, followed by an incubation period and an induced retest seizure, revealed novel associations within the calmodulin-binding transcription activator 1, Camta1. Using systems genetics, we have identified four candidate genes that are differentially expressed between seizure-sensitive and -resistant strains close to our novel Epileptogenesis susceptibility factor 1 (Esf1) locus that may act individually or as a coordinated response to the neuronal stress of seizures.

Abstract Background Convergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs – Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery. Methods Semi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers. Results Close collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities. Conclusions Congruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes.

Background: The Society of Radiologists in Ultrasound (SRU) recommendations on thyroid nodules are intended to ”diagnose thyroid cancers that have reached clinical significance,while avoiding unnecessary tests and surgery in patients with benign nodules.” Methods: This prospective observational study was conducted on 193 consecutive patients undergoing ultrasonography (USG) guided thyroid FNA. Nodules were categorized as “SRU-positive”and “SRU-negative” based on USG features. The sensitivity and specificity of the SRU recommendations and of various US features for thyroid malignancy were calculated. Results: Of 193 patients subjected to FNA, 83 patients of Bethesda class I, III, IV, V were excluded. Among 110 nodules subjected to FNA, 79 were SRU positive and 31 were SRU negative. There were 24 malignancies in 110 FNA (22% malignancy prevelance). There was significant difference between the malignancy rates of SRU positive and negative groups (p=0.0192). The sensitivity, specificity, PPV, NPV of thyroid malignancy in our cohort was 91.6%,33.7%, 27.8% and 93.5% respectively. Conclusions: The application of SRU recommendations reduces the number of benign nodules that undergo workup. Potentially missed malignancies in SRU negative nodules are less aggressive by histologic type and stage compared to SRU-positive malignancies.

Hepatoid adenocarcinoma is a rare histological form of gastric cancer with a poor prognosis. We describe a 53-year-old woman who presented to the surgical gastroenterology outpatient department with a history of abdominal pain, vomiting and loss of appetite for one month. Laboratory investigations revealed anaemia (haemoglobin 5.6 g/dL). On gastrointestinal endoscopy, an ulceroproliferative growth was seen in the pylorus with gastric outlet obstruction. Endoscopic biopsy was suggestive of a well differentiated adenocarcinoma. Computed tomography of abdomen revealedirregular circumferential thickening of pylorus with perigastric and common hepatic nodes without distant metastasis. Patient underwent radical subtotal gastrectomy. The final histopathology was reported as hepatoid adenocarcinoma. Further immunohistochemistry with alpha-foetoprotein showed intense cytoplasmic positivity. She was treated with adjuvant Macdonald regimen. She developed liver metastasis eight months after surgery and received palliative chemotherapy. She died 13 months after surgery. Our experience and previous reports suggest that hepatoid adenocarcinoma is an aggressive cancer. Radical surgery and chemotherapy still remain the main stay of treatment.

Background: Good implant stability is the prime concern for successful prosthetic rehabilitation. Many methods and different types of implants have been used to achieve primary and secondary stability with varying success rates. The evolution continued with the use of biological materials for early osseointegration. The present study was aimed to compare and evaluate the effect of platelet rich plasma (PRP) on the early osseointegration and secondary stability of dental implants using implant stability values. Materials and Methods: A total of 18 dental implants were randomly placed among 10 patients in the mandibular posterior region using split mouth design. In the control group, implants were placed following standard surgical protocol. In the study group, autologous PRP was used to moisten the implants before placement. Implant stability was observed and compared using Osstel Implant stability meter at 0, 30, 60, and 90 days. All the cases were followed-up over period of 18 months. Statistical analysis was carried using one-way analysis of variance and paired and unpaired t-test. Results: Significant difference in stability values were observed in the study group following 30 days after implant placement. Control group showed no statistically significant difference at all time intervals. Implant stability values were higher in the early phase of osseointegration in the PRP group. However, at the end of the study period, both groups showed similar stability. Conclusion: Good primary implant stability is beneficial for early loading and rehabilitation. PRP can be successfully used as an adjunct for better and early function. It is safe due to its autologous origin, thus eliminating the risk of disease transmission and immunogenic reactions.

Background: Assessment is a crucial step in the educational process and is the driving force behind learning. Formative assessment (FA) is a relatively new concept in assessment methods. By applying Blooms taxonomy (BT), which describes developmental progression for knowledge in FA, we can drive deeper learning. We were interested to know if by framing multiple choice questions (MCQ) using BT model and using it as a tool for FA will help to reinforce learning among first year MBBS students. Materials and Methods: All 150 MBBS students taking biochemistry classes were subjected to MCQ tests at the end of series of lectures and an internal exam (T3). MCQ s were framed by applying BT testing at all levels of cognition domain. Pearson's correlation coefficient of marks before and after the intervention was calculated. Mean scores were analyzed using students paired t-test. Feedback was analyzed for students' perception regarding the assessment method. Results: Comparison of mean scores in T3 with average of T1 and T2 showed P value of> 0.0001. Only 28.7% students got

Congenital absence of the left circumflex artery is a rare anomaly of the coronary circulation with a prevalence ranging from 0.6% to 1.3%. We report a 33-year-old male who presented with recent anterior wall myocardial infarction, in whom coronary angiography revealed absent left circumflex artery and stenosed left anterior descending artery. The left circumflex territory was being perfused by the superdominant right coronary artery. Although the absence of an artery is mostly considered as a benign condition, atherosclerotic lesions may diminish the compensatory mechanisms and worsen the outcome.

Abstract The multiple burdens of persistent undernutrition and micronutrient deficiencies, along with the rapidly growing rates of overweight, obesity, and associated chronic diseases, are major challenges globally. The role of agriculture and the food system in meeting these challenges is very poorly understood. Achieving food security and addressing malnutrition in all its forms, a Sustainable Development Goal, requires an understanding of how changing food systems affect health outcomes and the development of new tools to design and evaluate interventions. An interinstitutional programme to address this interdisciplinary research challenge is described. Over the past seven years, the Leverhulme Centre for Integrative Research on Agriculture and Health has built a portfolio of successful and innovative research, trained a new cadre of interdisciplinary researchers in “Agri‐Health,” and built an international research community with a particular focus on strengthening research capacity in low‐ and middle‐income countries. The evolution of this programme is described, and key factors contributing to its success are discussed that may be of general value in designing interdisciplinary research programmes directed at supporting global development goals.

Despite progress in fighting undernutrition, Africa has the highest rates of undernutrition globally, exacerbated by drought and conflict. Mobile phones are emerging as a tool for rapid, cost effective data collection at scale in Africa, as mobile phone subscriptions and phone ownership increase at the highest rates globally. To assess the feasibility and biases of collecting nutrition data via computer assisted telephone interviews (CATI) to mobile phones, we measured Minimum Dietary Diversity for Women (MDD-W) and Minimum Acceptable Diet for Infants and Young Children (MAD) using a one-week test-retest study on 1,821 households in Kenya. Accuracy and bias were assessed by comparing individual scores and population prevalence of undernutrition collected via CATI with data collected via traditional face-to-face (F2F) surveys. We were able to reach 75% (n = 1366) of study participants via CATI. Women's reported nutrition scores did not change with mode for MDD-W, but children's nutrition scores were significantly higher when measured via CATI for both the dietary diversity (mean increase of 0.45 food groups, 95% confidence interval 0.34-0.56) and meal frequency (mean increase of 0.75 meals per day, 95% confidence interval 0.53-0.96) components of MAD. This resulted in a 17% higher inferred prevalence of adequate diets for infants and young children via CATI. Women without mobile-phone access were younger and had fewer assets than women with access, but only marginally lower dietary diversity, resulting in a small non-coverage bias of 1-7% due to exclusion of participants without mobile phones. Thus, collecting nutrition data from rural women in Africa with mobile phones may result in 0% (no change) to as much as 25% higher nutrition estimates than collecting that information in face-to-face interviews.

BackgroundHilar cholangiocarcinoma (hCCA) is a rare and aggressive malignancy with R0 resection being currently the only option for long-term survival. With the improvement in the outcomes of liver transplantation (LT), the indications for LT have expanded to include other malignant tumors, such as hCCA. The aim of the present analysis is to demonstrate and critically evaluate the outcomes of LT compared to resection with curative intent in patients with hCCA.MethodsWe systematically searched the literature for articles published up to May 2018. The following algorithm was applied ((hilar cholangiocarcinoma) OR (perihilar cholangiocarcinoma) OR klatskin$ OR (bile duct neoplasm) OR cholangiocarcinoma) AND (transplant$ OR graft$).ResultsNeoadjuvant treatment with chemotherapy and radiation therapy was far more common in the LT group, with very few patients having received preoperative therapy in the resection group (p = 0.0005). Moreover, length of hospital stay was shorter after LT than after resection (pConclusionsIn non-disseminated unresectable tumors, LT seems to have a non-inferior survival. In the same patients, neoadjuvant chemoradiotherapy and/or strict selection criteria may contribute to superior survival outcomes compared to curative-intent resection. Due to the scarcity of level 1 evidence, it remains unclear whether LT should be increasingly considered for technically resectable early stage hCCA.

Introduction: Infections are the most important and leading cause of morbidity and mortality among the patients admitted in Intensive Care Units (ICU). The formation of biofilm around the Endotracheal Tubes (ET) by the micro organisms and their subsequent dislodgement following ET suction and repeated incubations contributes to lung colonisation and may lead ultimately to ventilator-associated pneumonia. The study also analysed common micro organisms associated with these infections and their antibiotic sensitivity profile. Aim: To study the time/trends of bacterial colonisation and sensitivity profile in tracheal tubes, in mechanically ventilated patients, in a tertiary care hospital ICU. Materials and Methods: A total of 109 consecutive patients admitted in the intensive care unit who were on mechanical ventilation for more than seven days were chosen. The study period was for one year. The ET suction catheter tip was cultured at 24 hours and at 48 hours post-incubation and ET tube tip culture was done on 7th day of incubation. Sensitivity of bacterial isolates from ET tip and suction tip cultures to commonly used antibiotics was also tested. All data were recorded in a predesigned study proforma and entered in Microsoft Excel (Microsoft Corporation, Redmond). All entries were double checked for any possible errors. Categorical variables were summarised as percentages. Results: A total of 109 subjects were enrolled in the study. Fifteen patients were excluded from the study. Bacterial colonisation was present in 60 patients at 24 hours, in 76 patients at 48 hours, and in 82 patients on 7th day of incubation. Three most common colonising organisms isolated at 24 hours, 48 hours and on the 7th day of incubation were Non-Fermentative Gram Negative Bacilli (NFGNB) including Acinetobacter, Pseudomonas aeruginosa and Klebsiella pneumonia. At 24 hours of incubation, 47.06% of NFGNB including Acinetobacter and 87.5% of Pseudomonas were sensitive to Cephaperazone-Sulbactam and with Imipenem the sensitivity was 35.29% for NFGNB including Acinetobacter and 93.57% for Pseudomonas. Almost similar trends were found in 48 hours post incubation culture and on 7th day culture. Among ventilator-associated pneumonia patients, Klebsiella pneumonia was the most common isolate. Conclusion: Most commonly isolated organisms were NFGNB including Acinetobacter, Pseudomonas aeruginosa and Klebsiella pneumoniae. Most of isolated organisms were sensitive to Cefaperazone-sulbactam and Imipenem antibiotics.

Note: This paper has been published in the "International Review of Finance." It is published in: Vol 3, No.1, March 2002,pp. 27-52 of the journal.

Coronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment. A retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years. Based on logistic regression, age (OR 1.039, 95% CI [1.020–1.058], p ​< ​0.001), diabetes mellitus (OR 2.192, 95% CI [1.307–3.676], p ​< ​0.003), tobacco use (OR 1.748, 95% CI [1.157–2.643], p ​< ​0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003–1.015], p ​< ​0.002), and hypertension (OR 1.613, 95% CI [1.024–2.540], p ​< ​0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p ​< ​0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26–128.26], p ​< ​0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025–4.627], p ​< ​0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension. NCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study is to assess the effect of dentin conditioners and luting cements on the retention of full metal crowns. Materials and Methods: Sixty recently extracted caries free molar teeth were prepared using airotor hand piece mounted to a surveyor with a custom made jig, to obtain a standardized 26° total convergence and 4 mm of axial height. Individual crowns were fabricated using base metal alloy. Thus prepared specimens were divided into six groups: 1) Two groups with no dentin conditioning (Control groups A and B), 2) Two groups, dentin conditioned with 10% polyacrylic acid conditioner (First test groups C and D), and 3) Two groups, dentin conditioned with 17% Ethylenediaminetetraacetic acid (EDTA) (Second test groups E and F). Groups A, C, and E were cemented with conventional glass ionomer whereas Groups B, D, and F were cemented with resin-modified glass ionomer. De-cementation was done using universal testing machine at a cross head speed of 1 mm/min after 48 hours of cementation. The obtained results were analysed using One-way analysis of variance (ANOVA) and Post hoc test. Results: The mean retentive (tensile) strength of Group A specimens was 2.26 ± 0.15 MPa, Group B specimens was 2.71 ± 0.15 MPa, Group C specimens was 12.26 ± 0.67 MPa, Group D specimens was 14.28 ± 1.47 MPa. Similarly, Group E specimens was 5.23 ± 0.62 MPa, and Group F specimens was 7.36 ± 0.51 MPa. Conclusion: Within the limitations of the study, retentive (tensile) strength required to dislodge the metal crowns was higher with the combination of resin-modified glass ionomer luting cement and 10% polyacrylic acid dentin conditioner.