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Long-segment chronic total occlusion in femoropoplitial segment can be effectively treated with self-expandable stent especially when there are flow-limiting dissections created either while wiring the lesion or while predilating the lesions. Distortion of a self-expandable stent can during the procedure; hence, proper care should be taken in Plaque modification before stent deployment. Distortion can cause retention of the stent markers. Understanding the problem, the hardware we are using can guide us in bailing out the situation and also improving the long-term outcomes of the extremities.

Introduction: Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines for management of agitation among pediatric patients in the ED, including non-pharmacologic methods and the use of immediate and as-needed medications. Methods: Using the Delphi method of consensus, a workgroup comprised of 17 experts in emergency child and adolescent psychiatry and psychopharmacology from the the American Association for Emergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency Child Psychiatry Committee sought to create consensus guidelines for the management of acute agitation in children and adolescents in the ED.Results: Consensus found that there should be a multimodal approach to managing agitation in the ED, and that etiology of agitation should drive choice of treatment. We describe general and specific recommendations for medication use. Conclusion: These guidelines describing child and adolescent psychiatry expert consensus for the management of agitation in the ED may be of use to pediatricians and emergency physicians who are without immediate access to psychiatry consultation.

Introduction: Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines for management of agitation among pediatric patients in the ED, including non-pharmacologic methods and the use of immediate and as-needed medications.Methods: Using the Delphi method of consensus, a workgroup comprised of 17 experts in emergency child and adolescent psychiatry and psychopharmacology from the the American Association for Emergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency Child Psychiatry Committee sought to create consensus guidelines for the management of acute agitation in children and adolescents in the ED.Results: Consensus found that there should be a multimodal approach to managing agitation in the ED, and that etiology of agitation should drive choice of treatment. We describe general and specific recommendations for medication use.Conclusion: These guidelines describing child and adolescent psychiatry expert consensus for the management of agitation in the ED may be of use to pediatricians and emergency physicians who are without immediate access to psychiatry consultation.

Introduction: Agitation in children and adolescents in the emergency department (ED) can be dangerousand distressing for patients, family and staff. We present consensus guidelines for management ofagitation among pediatric patients in the ED, including non-pharmacologic methods and the use ofimmediate and as-needed medications.Methods: Using the Delphi method of consensus, a workgroup comprised of 17 experts in emergencychild and adolescent psychiatry and psychopharmacology from the the American Association forEmergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency ChildPsychiatry Committee sought to create consensus guidelines for the management of acute agitation inchildren and adolescents in the ED.Results: Consensus found that there should be a multimodal approach to managing agitation in theED, and that etiology of agitation should drive choice of treatment. We describe general and specificrecommendations for medication use.Conclusion: These guidelines describing child and adolescent psychiatry expert consensus for themanagement of agitation in the ED may be of use to pediatricians and emergency physicians who arewithout immediate access to psychiatry consultation.

Abstract Background The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate of 3–5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunction. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccination, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reducing risk for immune dysfunction and impaired mental health. Methods We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed journals were searched for relevance by two independent review authors. A third review author checked the excluded records. All disagreements were resolved through discussion amongst review authors or through adjudication by a fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded. Observations Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranayama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga’s ability to bolster innate immunity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and cardiac injury. Conclusion and relevance This review paves the path for further research on yoga as a potential intervention for enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.

Abstract Background A major goal in the discovery of cellular signaling networks is to identify regulated phosphorylation sites (“phosphosites”) and map them to the responsible protein kinases. The V2 vasopressin receptor is a G-protein coupled receptor (GPCR) that is responsible for regulation of renal water excretion through control of aquaporin-2-mediated osmotic water transport in kidney collecting duct cells. Genome editing experiments have demonstrated that virtually all vasopressin-triggered phosphorylation changes are dependent on protein kinase A (PKA), but events downstream from PKA are still obscure. Methods Here, we used: 1) Tandem mass tag-based quantitative phosphoproteomics to experimentally track phosphorylation changes over time in native collecting ducts isolated from rat kidneys; 2) a clustering algorithm to classify time course data based on abundance changes and the amino acid sequences surrounding the phosphosites; and 3) Bayes’ Theorem to integrate the dynamic phosphorylation data with multiple prior “omic” data sets covering expression, subcellular location, known kinase activity, and characteristic surrounding sequences to identify a set of protein kinases that are regulated secondary to PKA activation. Results Phosphoproteomic studies revealed 185 phosphosites regulated by vasopressin over 15 min. The resulting groups from the cluster algorithm were integrated with Bayes’ Theorem to produce corresponding ranked lists of kinases likely responsible for each group. The top kinases establish three PKA-dependent protein kinase modules whose regulation mediate the physiological effects of vasopressin at a cellular level. The three modules are 1) a pathway involving several Rho/Rac/Cdc42-dependent protein kinases that control actin cytoskeleton dynamics; 2) mitogen-activated protein kinase and cyclin-dependent kinase pathways that control cell proliferation; and 3) calcium/calmodulin-dependent signaling. Conclusions Our findings identify a novel set of downstream small GTPase effectors and calcium/calmodulin-dependent kinases with potential roles in the regulation of water permeability through actin cytoskeleton rearrangement and aquaporin-2 trafficking. The proposed signaling network provides a stronger hypothesis for the kinases mediating V2 vasopressin receptor responses, encouraging future targeted examination via reductionist approaches. Furthermore, the Bayesian analysis described here provides a template for investigating signaling via other biological systems and GPCRs. Video abstract

Vehicular emissions have many impacts on human health and travel behaviour. A lot of evidence on the health effects of vehicular emissions is available but very few studies have looked at the impacts on travel behaviour. The current study attempts to fill this research gap by analysing the factors that influence pedestrian travel behaviour concerning vehicle emissions based on travellers’ perceptions in the Indian context. For this, a stated preference questionnaire survey was conducted and a factor-based regression followed by a mediation analysis was used to analyse the responses. Results showed that a person’s perceived impacts about vehicular emissions had a greater impact on their travel behaviour. Public concern and environmental attitude lead to direct changes in travel behaviour whereas vehicle technology and negligent attitude had significant indirect effects. The present study findings are useful to the urban planning policymakers in reducing the impact of vehicular emissions on pedestrians by implementing strategies that lessen human exposure to transport emissions.

Background: Lack of understanding regarding labour pain has long been shown to be a burden on both health care providers and expectant mothers. Labor analgesia is still not well established and is undermining in underdeveloped nations. Therefore, the aim of this study was to explore final year medical students' knowledge and attitudes towards pain relief during labor. Methods: A cross-sectional study was conducted among final year undergraduate medical students of a tertiary care medical college hospital for 2 months. A Structured, and self-administered questionnaire was used (N = 97). Data was analyzed by using coGuide software, V.1.0.3. Results: No statistical significance found in awareness parameters before learning about labour analgesia (P Value >0.05). There was no statistically significant difference between self-grading. However, there was statistically significant difference in different awareness related parameters before and after learning labour analgesia and many showed the improvement in post class response compared to before class response. (P value

Legged robots can have a unique role in manipulating objects in dynamic, human-centric, or otherwise inaccessible environments. Although most legged robotics research to date typically focuses on traversing these challenging environments, many legged platform demonstrations have also included “moving an object” as a way of doing tangible work. Legged robots can be designed to manipulate a particular type of object (e.g., a cardboard box, a soccer ball, or a larger piece of furniture), by themselves or collaboratively. The objective of this review is to collect and learn from these examples, to both organize the work done so far in the community and highlight interesting open avenues for future work. This review categorizes existing works into four main manipulation methods: object interactions without grasping, manipulation with walking legs, dedicated non-locomotive arms, and legged teams. Each method has different design and autonomy features, which are illustrated by available examples in the literature. Based on a few simplifying assumptions, we further provide quantitative comparisons for the range of possible relative sizes of the manipulated object with respect to the robot. Taken together, these examples suggest new directions for research in legged robot manipulation, such as multifunctional limbs, terrain modeling, or learning-based control, to support a number of new deployments in challenging indoor/outdoor scenarios in warehouses/construction sites, preserved natural areas, and especially for home robotics.

Introduction The severity of internal carotid artery (ICA) atherosclerosis is assessed through measurements of degree of stenosis. This approach does not factor in mechanisms compensating for reduced distal perfusion, such as collateral circulation. An alternative approach is evaluating severity of carotid stenosis based on downstream changes in ocular perfusion. Laser speckle flowgraphy (LSFG) is a non‐invasive tool that quantifies intraocular blood flow. This pilot study investigated whether LSFG metrics could be surrogates for degree of stenosis. Additionally, we quantified changes in flow through the stenosed vessel before and after stenting usingsyngoiFlow (iFlow). Methods Fourteen patients had stents placed to treat symptomatic carotid stenosis. LSFG metrics were obtained before and after stenting. Mean blur rate (MBR), an index of ocular blood velocity, and associated waveform parameters were extracted from the optic nerve head (ONH) region of the eye. iFlow quantified time to peak (TTP), an index of peak cerebral contrast flow, by transforming digital subtraction angiography (DSA) images into perfusion heat maps.TTPswere extracted for seven regions of interest (ROIs) by two raters. Results Two LSFG waveform parameters were significantly negatively correlated with degree of stenosis. These parameters, flow acceleration index (FAI) and rising rate (RR), also increased significantly after stenting. Intraclass correlation coefficients calculated for TTPs showed substantial agreement across all ROIs. Significant decreases in TTP after stenting were observed in ROIs placed in the high cervical ICA, cavernous segment of the ICA, and brain parenchyma. Conclusions LSFG provides biometrics that can accurately measure the impact of ICA stenosis by quantifying distal perfusion. Indices of ocular blood flow acceleration may serve as surrogate metrics for degree of stenosis. iFlow is a sensitive tool to quantify changes in flow after stenting. Non‐invasive flow‐dependent methods are promising in the assessment of patients with ICA stenosis.

IntroductionTransgender persons in India, who are one of the most vulnerable groups, were particularly impacted by the COVID-19 pandemic. Increased risk of COVID-19, challenges with continuing livelihood, uncertainty, and anxiety around the pandemic over pre-existing social discrimination and exclusion pose risk of a mental health impact as well. To investigate this further, this component of a larger study on experiences in healthcare of transgender persons in India during COVID-19 and looks into the question “How did the COVID-19 pandemic impact the mental health of transgender persons in India”.Methods22 In-depth interviews (IDI) and 6 focus group discussions (FGD) were conducted virtually and in-person with persons self-identifying as transgender or belonging to ethnocultural transgender communities from different parts of India. Community based participatory research approach was used by ensuring representation from the community in the research team and through a series of consultative workshops. Purposive sampling with snowballing was used. The IDIs and FGDs were recorded, transcribed verbatim and analyzed using an inductive thematic analysis.ResultsMental health of transgender persons were affected in the following ways. Firstly, COVID-19, its associated fear and suffering combined with pre-existing inaccessibility of healthcare and reduced access to mental health care affected their mental health. Secondly, unique social support needs of transgender persons were disrupted by pandemic linked restrictions. Thirdly, pre-existing vulnerabilities such as precarious employment and underlying stigma were exacerbated. Finally, gender dysphoria was a key mediating factor in the impact of COVID-19 on mental health with a negative and positive impact.ConclusionsThe study reiterates the need to make systemic changes to make mental healthcare and general healthcare services trans-inclusive while also recognizing the essential nature of gender affirmative services and the need to continue them even during emergencies and disaster situations. While this brings out how public health emergencies can exacerbate vulnerabilities, it also shows how the lived mental health experience of transgender person is intricately linked to the way work, travel and housing is structured in our society and therefore points to the structural nature of the linkage between mental health and gender.

BackgroundThe initial insights from the studies on COVID-19 had been disappointing, indicating the necessity of an aggravated search for alternative strategies. In this regard, the adjunct potential of yoga has been proposed for enhancing the effectiveness of the standard of care with respect to COVID-19 management. We tested whether a telemodel of yoga intervention could aid in better clinical management for hospitalized patients with mild-to-moderate COVID-19 when complemented with the standard of care.MethodsThis was a randomized controlled trial conducted at the Narayana Hrudyalaya, Bengaluru, India, on hospitalized patients with mild-to-moderate COVID-19 infection enrolled between 31 May and 22 July 2021. The patients (n = 225) were randomized in a 1:1 ratio [adjunct tele-yoga (n = 113) or standard of care]. The adjunct yoga group received intervention in tele-mode within 4-h post-randomization until 14 days along with the standard of care. The primary outcome was the clinical status on day 14 post-randomization, assessed with a seven-category ordinal scale. The secondary outcome set included scores on the COVID Outcomes Scale on day 7, follow-up for clinical status and all-cause mortality on day 28, post-randomization, duration of days at the hospital, 5th-day changes post-randomization for viral load expressed as cyclic threshold (Ct), and inflammatory markers and perceived stress scores on day 14.ResultsAs compared with the standard of care alone, the proportional odds of having a higher score on the 7-point ordinal scale on day 14 were ~1.8 for the adjunct tele-yoga group (OR = 1.83, 95% CI, 1.11–3.03). On day 5, there were significant reductions in CRP (P = 0.001) and LDH levels (P = 0.029) in the adjunct yoga group compared to the standard of care alone. CRP reduction was also observed as a potential mediator for the yoga-induced improvement of clinical outcomes. The Kaplan–Meier estimate of all-cause mortality on day 28 was the adjusted hazard ratio (HR) of 0.26 (95% CI, 0.05–1.30).ConclusionThe observed 1.8-fold improvement in the clinical status on day 14 of patients of COVID-19 with adjunct use of tele-yoga contests its use as a complementary treatment in hospital settings.