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Against medical advice (AMA) discharges are practically and emotionally challenging for both patients and clinicians. Moreover, they are common after admissions for respiratory conditions such as COPD and asthma, and they are associated with poor outcomes. Despite the challenges presented by AMA discharges, clinicians rarely receive formal education and have limited guidance on how to approach these discharges. Often, the approach to AMA discharges prioritizes designating the discharge as "AMA," whereas effective coordination of discharge care receives less attention. Such an approach can lead to stigmatization of patients and low-quality care. Although evidence for best practices in AMA discharges remains lacking, we propose a set of strategies to improve care in AMA discharges by focusing on respect, in which clinicians treat patients as equals and honor differing values. We describe five strategies, including (1) preventing an AMA discharge; (2) conducting a patient-centered and truthful discussion of risk; (3) providing harm-reducing discharge care; (4) minimizing stigma and bias; and (5) educating trainees. Through a case of a patient discharging AMA after a COPD exacerbation, we highlight how these strategies can be applied to common issues in respiratory-related hospitalizations, such as prescribing inhalers and managing oxygen requirements. We argue that, by using these strategies, clinicians can deliver more respectful and higher quality care to an often-marginalized population of patients with respiratory disease. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study are to evaluate how upper limb impairment ratings are affected by updates to the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2024 compared with the AMA Guides Sixth Edition 2008 and to investigate potential correlations with judicial, legislative, and economic factors. Methods: Two expert evaluators reviewed 31 upper limb clinical vignettes from the 2008 and 2024 versions. The impairment ratings for each version were compared. Results: After following the impairment ratings steps in each version, the results for 2024 showed no significant differences when compared with the impairment ratings generated using 2008 methods (Cohen's kappa = 1.00). Conclusions: The updated AMA Guides Sixth Edition 2024 with improved, transparent processes and enhanced diagnosis-based impairment tables provides efficiency while retaining the accuracy, validity, and reliability of past versions of the AMA Guides. [ABSTRACT FROM AUTHOR]

Objective: Describe and evaluate methodological improvements in AMAGuides to the Evaluation of Permanent Impairment (Guides) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008. Methods: Three physician experts and 3 premedical students, respectively, completed 2 rounds of impairment ratings using the AMA Guides Sixth 2008 versus 2024 methods. Impairment values and completion times using eachmethodwere compared for both groups. Results: Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024. Conclusions: The Guides Sixth 2024 allowed more efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility. [ABSTRACT FROM AUTHOR]

The detection of antimitochondrial antibodies (AMA) is the specific diagnostic marker for primary biliary cholangitis. Indeed, it is the most specific autoantibody in clinical autoimmunity, with a high titer directed response to the inner lipoyl domain of PDC-E2. The current international reference for AMA detection is based upon sera samples of PBC patients. In rheumatic diseases, i.e. rheumatoid arthritis, great efforts are placed at development of international standards. In this study, we report the development of a monoclonal chimeric IgG1 antibody as a reference for AMA testing. A monoclonal 4G6 antibody was constructed from a murine monoclonal antibody specific for the inner lipoyl domain (ILD) of PDC-E2, by combining the variable region with the constant region of human IgG1. The 4G6 antibody recognizes all AMA epitopes containing the ILD of PDC-E2, including the classical BPO recombinant antigen in all currently available diagnostic methods. The binding affinity of the 4G6 antibody to PDC-E2 and BPO antigen reaches KD value of 7.22 × 10−11 M and 4.55 × 10−11 M, which is sufficient to use as a quantitative reference for all AMA tests. The unlimited availability of the 4G6 antibody makes it a promising candidate for use as an AMA reference or assay calibrator for the international community.

Visually impaired individuals may encounter some negative situations in their daily lives, both legally and religiously. While laws deal with the legal aspect, Islamic law deals with the religious aspect. In order to minimize the difficulties that visually impaired people may face in their daily lives, Islamic law has made some flexible provisions based on the principle of facilitation. This work, which we are introducing, deals in detail with the information on the provisions for the visually impaired in ibādāt, muāmalāt, munāqahāt - mufārekāt, ukūbāt and some other issues by including the views of the four major madhhabs. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study describes clinical, biochemical, and histological features and long-term outcomes in pediatric patients diagnosed with autoimmune hepatitis (AIH) at King Abdullah University Hospital, Jordan. Design Retrospective, single-center study. Setting King Abdullah University Hospital, Jordan. Participants Inclusion of all pediatric patients with AIH diagnosed at our hospital from 2015 to 2023. Exclusion criteria was patients aged over 18 at time of diagnosis and those diagnosed elsewhere. Outcome measures Understanding clinical, biochemical, and histological AIH features in children, evaluating treatment responses, and reporting short- and long-term complications, including mortality. Results Sixteen pediatric cases were diagnosed, with an average age of 9.84 ± 4.13 years. Females comprised 75% of patients, and 31.3% presented with acute liver failure. Jaundice was the most common symptom, and hepatosplenomegaly was observed in 18% of cases. Most patients had elevated transaminase levels, along with positive anti-smooth muscle antibody (ASMA) and antinuclear antibodies (ANA). Common hematological abnormalities included anemia (56.3%) and thrombocytopenia (37.5%). All patients underwent liver biopsy, with interface hepatitis present in 81.3% of cases. Treatment mainly involved prednisone and azathioprine. Three patients died, one discontinued therapy, two patients were lost to follow-up, and 10 remained on treatment. Conclusion Autoimmune hepatitis affects Jordanian children, primarily female children. Jaundice is the most common presenting symptoms. Only Type I AIH occurred in our cohort. Although of good response to conventional treatment with steroids and immunosuppression, mortality reached 18.8%.

Background: How antimitochondrial antibody (AMA)-positive patients evolve to have primary biliary cholangitis (PBC) in viral hepatitis–endemic areas is unknown. Objectives: We aimed to investigate this evolution in Taiwan. Design/methods: A 16-year medical center-based cohort study of 2,095,628 subjects was conducted in Taiwan, an Asian country endemic to viral hepatitis. AMA-positive subjects were those with positive AMA with alkaline phosphatase (ALP) ⩽1.5 times the upper limit of normal (ULN), and PBC was defined as positive AMA with ALP >1.5 × ULN. Results: AMA-positive subjects had a lower average age- and sex-adjusted prevalence than PBC patients (4.68/105 versus 11.61/105, p = 0.0002), but their incidence was comparable (0.99/105 versus 1.12/105, p = 0.36). The former group had a borderline significantly lower mean age (56.59 years versus 58.10 years, p = 0.06) and a lower female-to-male ratio (2.85:1 versus 5.44:1, p < 0.0001). Both AMA-positive subjects (prevalence change: 20.0%, p < 0.01; incidence change: −9.2%, p < 0.01) and PBC patients (prevalence change: 14.6%, p < 0.01; incidence change: −4.7%, p < 0.01) prevalence rate increased but the incidence rate decreased. Among the 423 AMA-positive subjects, 77 (18.2%) developed PBC, for a mean duration of 1.757 years. Compared with AMA-positive subjects, PBC patients had similar concurrent chronic hepatitis B (CHB) rates (2.7% versus 4.3%, p = 0.197) but lower chronic hepatitis C (CHC) rates (3.69% versus 15.60%, p < 0.01). Conclusion: PBC was more prevalent than AMA-positive subjects, and PBC patients had a higher female-to-male ratio than AMA-positive subjects, of whom 18.2% developed PBC (mean lag: 1.757 years). Upward trends in prevalence rates and downward trends in incidence rates were noted for both AMA-positive subjects and PBC. CHB was rare, CHC was more prevalent among PBC patients than the general population, and CHC was less prevalent among PBC than among AMA-positive subjects. Plain language summary: Evolutionary relationship between AMA positivity and PBC in Taiwan PBC was more prevalent than AMA-positive subjects, and PBC patients had a higher female-to-male ratio than AMA-positive subjects, of whom 18.2% developed PBC (mean lag: 1.757 years). Upward trends in prevalence rates and downward trends in incidence rates were noted for both AMA-positive subjects and PBC. CHB was rare, CHC was more prevalent among PBC patients than the general population, and CHC was less prevalent among PBC than among AMA-positive subjects. [ABSTRACT FROM AUTHOR]

Objectives: This study describes clinical, biochemical, and histological features and long-term outcomes in pediatric patients diagnosed with autoimmune hepatitis (AIH) at King Abdullah University Hospital, Jordan. Design: Retrospective, single-center study. Setting: King Abdullah University Hospital, Jordan. Participants: Inclusion of all pediatric patients with AIH diagnosed at our hospital from 2015 to 2023. Exclusion criteria was patients aged over 18 at time of diagnosis and those diagnosed elsewhere. Outcome measures: Understanding clinical, biochemical, and histological AIH features in children, evaluating treatment responses, and reporting short- and long-term complications, including mortality. Results: Sixteen pediatric cases were diagnosed, with an average age of 9.84 ± 4.13 years. Females comprised 75% of patients, and 31.3% presented with acute liver failure. Jaundice was the most common symptom, and hepatosplenomegaly was observed in 18% of cases. Most patients had elevated transaminase levels, along with positive anti-smooth muscle antibody (ASMA) and antinuclear antibodies (ANA). Common hematological abnormalities included anemia (56.3%) and thrombocytopenia (37.5%). All patients underwent liver biopsy, with interface hepatitis present in 81.3% of cases. Treatment mainly involved prednisone and azathioprine. Three patients died, one discontinued therapy, two patients were lost to follow-up, and 10 remained on treatment. Conclusion: Autoimmune hepatitis affects Jordanian children, primarily female children. Jaundice is the most common presenting symptoms. Only Type I AIH occurred in our cohort. Although of good response to conventional treatment with steroids and immunosuppression, mortality reached 18.8%. [ABSTRACT FROM AUTHOR]

This study discusses two different functions of the coordinating conjunction "ammâ" in the work Misbâhu'l-Envâr written in the last period of Chagatai Turkish. These are the functions of "strengthening the contrast" and "also/as well as" The coordinating conjunction "ammā/but" is used in General Turkish as a coordinating conjunction with the function of contrast in the meanings of "however, however" In other words, it connects two sentences with the function of contrast. The sentence's meaning following the coordinating conjunction "but" contrasts with the first sentence. The word is essential of Arabic origin and is used in Arabic, as in Turkish, with the function of contrast in the meanings of "but, on the other hand, together with this" In Misbâhu'l-Envâr, written in the last period of Chagatai Turkish, the coordinating conjunction is also used in "reinforcing the negative meaning" and "also/as well as this" functions in addition to this basic contrastive function. The function of "also/as well as" occurs especially when it is desired to give additional information that complements or completes the meaning of the sentence preceding the preposition. The preposition "ammā" is used 51 times in Misbā? al-Anwār, 5 of which are in the functions of "beside/in addition to" and one of which is in the functions of "reinforcing the negative meaning" It is observed that the preposition "ammā" is used 45 times in the work in the function of contrast. This shows that the coordinating conjunction is predominantly used with the function of contrast in the work. However, in Misbâhu'l-Envâr, which is written in the Tashkent dialect of Chagatai Turkish, in addition to this basic function, it is also seen that the coordinating conjunction establishes a parallelism relation in the diametrically opposite sense of "also/as well as this" and plays a role in reinforcing the negative meaning. [ABSTRACT FROM AUTHOR]

Copyright of Artuklu Akademi is the property of Artuklu Akademi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We aimed to evaluate the pregnancy outcomes of cleavage-stage embryo transfers (ETs) for the first time and explore optimal number of high-quality cleavage-stage embryos for extended culture to blastocyst-stage in women of advanced maternal age (AMA). We retrospectively identified 1646 AMA women ≥ age 38 years for the first fresh ETs between January 2014 and December 2020 at our hospital. Double ETs were divided into three groups as follows: DET-HH (two high-quality embryos), DET-HL (one high-quality and one low-quality embryo), and DET-LL (two low-quality embryos) groups. We mainly analyzed the pregnancy outcomes of double cleavage-stage ETs with different embryo grades and blastocyst-stage ETs with different number of high-quality cleavage-stage embryos on day 3. Our data indicated that the DET-HH group had significantly higher clinical pregnancy, ongoing pregnancy, and live birth rates than DET-HL and DET-LL groups (p <.05). For extended culture to blastocyst-stage with 2 (D3-2H), 3 (D3-3H), and 4 (D3-≥4H) high-quality cleavage-stage embryos, the D3-≥ 4H group had significantly higher ongoing pregnancy and live birth rates than D3-2H and D3-3H groups (p <.05). We observed that the number of high-quality embryos on day 3 was independently associated with live birth rate for blastocyst transfers (OR: 1.133, 95% CI 1.023–1.256, p =.017). There were no significant differences in the clinical pregnancy, ongoing pregnancy and live birth rates among DET-HH, D3-2H and D3-3H groups (p >.05). Extended culture to blastocyst-stage for transfer was safe and recommended for AMA women with ≥ 4 high-quality embryos on day 3. [ABSTRACT FROM AUTHOR]

Background: Discharging a patient against medical advice (AMA) is used to describe when a patient opts to leave the hospital prior to a physician's recommendation while acknowledging the risks of doing so. There are limited published data that identify risk factors for patients leaving AMA, particularly after trauma. Objective: This study sought to delineate risk factors for AMA discharge after trauma. Methods: Trauma patients who left AMA at our ACS-verified level 1 trauma center were retrospectively included (2021-2022) without exclusions. Demographics, clinical/injury data, and outcomes were collected. The primary outcome was patient-stated reason for leaving AMA. Study variables were summarized with descriptive statistics. Results: During the study period, 262 (8%) of 3218 admitted trauma patients left AMA. Psychiatric disease was present in most patients (n = 197, 75%), including substance abuse (n = 146, 56%), and alcohol abuse (n = 95, 36%). Common patient-stated reasons for leaving AMA were inability/unwillingness to wait for procedure, imaging, or placement (n = 56, 22%); and psychiatric disease other than alcohol/substance abuse (n = 39, 15%). Of the patients who left AMA, 29% (n = 77) returned to the hospital 30 days, and 13% (n = 35) were readmitted. Conclusion: Patients who leave AMA are at elevated risk of returning to the hospital, which incurs additional costs in already resource-constrained systems. These findings provide impetus for early identification of high-risk patients and efforts to decrease wait times for imaging, procedures, and placement. These actions may mitigate AMA discharges and their resultant impact on patients and hospitals. [ABSTRACT FROM AUTHOR]

Purpose: The technique of adjusted mechanical alignment (AMA) in total knee arthroplasty (TKA) has been described to achieve alignment and balancing goals in varus knees in a high percentage, albeit at the price of non-anatomical bone cuts. The purpose of this study was to analyze (1) whether AMA achieves similar alignment and balancing results in different types of deformity and (2) whether they can be achieved without altering the native anatomy. Methods: A series of 1000 patients with hip–knee–ankle (HKA) angles from 165° to 195° were analyzed. All patients were operated using AMA technique. According to the preoperative HKA angle, three groups of knee phenotypes (varus, straight, valgus) were defined. The bone cuts were analyzed for being anatomic (< 2 mm deviation of individual joint surface) or non-anatomic (> 4 mm deviation of individual joint surface). Results: AMA reached the goals for postoperative HKA in over 93% in every group (varus: 636 cases, 94%, straight: 191 cases, 98%, valgus: 123 cases, 98%). In 0° extension, the gaps were balanced in varus knees in 654 cases (96%), in straight knees in 189 cases (97%) and in valgus knees in 117 cases (94%). A balanced flexion gap was found in a similar number of cases (varus: 657 cases, 97%, straight: 191 cases, 98%, valgus: 119 cases, 95%). In the varus group, non-anatomical cuts were performed at the medial tibia (89%) and the lateral posterior femur (59%). The straight group showed similar values and distribution for non-anatomical cuts (medial tibia: 73%; lateral posterior femur 58%). Valgus knees showed a different distribution of values, being non-anatomical at the lateral tibia (74%), distal lateral femur (67%) and posterior lateral femur (43%). Conclusion: In all knee phenotypes, the AMA goals were achieved in a high percentage by altering the patients' native anatomy. In varus knees, the alignment was corrected by non-anatomical cuts at the medial tibia, and in valgus knees at the lateral tibia and the lateral distal femur. All phenotypes showed non-anatomical resections on the posterior lateral condyle in approximately 50% of cases. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Thanks to the use of linguistic comparison and analyses of new inscriptions, Meroitic, the extinct language of the kingdom of Meroe, Sudan, has become increasingly well known. The present article deals with the identification of personal markers and verbal number. It shows how Meroitic, like many other languages, used a former demonstrative, qo, as a 3rd person independent pronoun. An in-depth analysis of the royal chronicles of the kings and princes of Meroe, compared with their Napatan counterparts written in Egyptian, further yields the 1st person singular dependent pronoun e- (later variant ye-), which can be compared with 1st person singular pronoun found in related languages. A stela of Candace Amanishakheto found in Naga is the starting point for identifying the 2nd person singular and plural independent pronouns are and deb. These two morphemes are linked with the most recent reconstructions of Proto-Nubian pronouns and conrm the narrow genetic relation between Nubian and Meroitic. Finally, the reassessment of the so-called “verbal dative” ‐xe/‐bxe shows that this morpheme is simply a former verbal number marker with integrated case endings. This makes it a rare instance of transcategorisation in the cross-linguistic typology of verbal number.

Ama verbs are comparable with Nubian and other related languages in their clause-final syntax, CVC root shape, and some affixes. However, there is also considerable innovation in adjoined relative clauses, a shift from number to aspect marking traced by T/K morphology, and other changes in the order and meaning of affixes. These developments show a unique trend of concretization of core clause constituents, and internal growth in the complexity of verbs in isolation from other languages. On the other hand, Ama’s stable distributive pluractional represents a wider Eastern Sudanic category. The late loss of pronominal subject marking supports a hypothesis that the Ama language was used for inter-group communication with Kordofan Nubians.

Introduction: baseball has been constantly under the threat of doping, and currently there are criteria issued by some experts that suggest the possibility that many successes achieved by famous baseball players who nowadays appear as the main big stars of this sport in the ballroom fame, have been related to the consumption of prohibited substances. Objective: the objective of this study was to explore the data published in the specialized world bibliography that reveal how doping, as well as other forms of fraud, have affected baseball in both the major and minor categories. Materials and methods: this bibliographic review work is carried out as a suggestion from baseball fans and the sports press interested in knowing how the problem of doping and the use of prohibited substances has influenced this sport since its origins. Results: Currently, doping control tests are carried out on amateur and professional players in the sport's leagues around the world. The tests, measures and sanctions that are applied conform to the prohibitions and standards issued by the World Anti-Doping Agency and the World Anti-Doping Code. The substances used most frequently have been anabolic steroids, stimulants, Growth Hormone and narcotics. Conclusions: once the competitive stage is over and with the passage to retirement, many baseball players begin to consume tobacco, alcohol and other drugs that significantly affect their health and quality of life.

We examine Van Wynsberghe and Robbins (JAMA 25:719-735, 2019) critique of the need for Artificial Moral Agents (AMAs) and its rebuttal by Formosa and Ryan (JAMA 10.1007/s00146-020-01089-6, 2020) set against a neo-Aristotelian ethical background. Neither Van Wynsberghe and Robbins (JAMA 25:719-735, 2019) essay nor Formosa and Ryan's (JAMA 10.1007/s00146-020-01089-6, 2020) is explicitly framed within the teachings of a specific ethical school. The former appeals to the lack of "both empirical and intuitive support" (Van Wynsberghe and Robbins 2019, p. 721) for AMAs, and the latter opts for "argumentative breadth over depth", meaning to provide "the essential groundwork for making an all things considered judgment regarding the moral case for building AMAs" (Formosa and Ryan 2019, pp. 1–2). Although this strategy may benefit their acceptability, it may also detract from their ethical rootedness, coherence, and persuasiveness, characteristics often associated with consolidated ethical traditions. Neo-Aristotelian ethics, backed by a distinctive philosophical anthropology and worldview, is summoned to fill this gap as a standard to test these two opposing claims. It provides a substantive account of moral agency through the theory of voluntary action; it explains how voluntary action is tied to intelligent and autonomous human life; and it distinguishes machine operations from voluntary actions through the categories of poiesis and praxis respectively. This standpoint reveals that while Van Wynsberghe and Robbins may be right in rejecting the need for AMAs, there are deeper, more fundamental reasons. In addition, despite disagreeing with Formosa and Ryan's defense of AMAs, their call for a more nuanced and context-dependent approach, similar to neo-Aristotelian practical wisdom, becomes expedient. [ABSTRACT FROM AUTHOR]

Integration of Ayurveda into our current health care research programs is critical to making progress in global wellness and in disease prevention and control, especially for cancer. Ayurveda promotes restoration of the innate healing mechanisms existing in the body for optimal immunity, resilience, and health. Ayurveda also has an abundant resource of botanical products containing diverse pharmaco-active ingredients and millennia of experience of clinical applications for health benefits. But there is a lack of evidence–based research to demonstrate its efficacy and potential. This 2-part review is written from the perspective of a western-trained biomedical scientist and student of Ayurveda. It aims to educate research scientist peers about the opportunities and challenges for scientific validation of Ayurvedic herbal compounds, protocols, and modalities and inspire more research in this area. Part 1 will review several aspects of Ayurveda including principles of body constitution (Prakriti), digestion (Agni and Ama) and mind-body health, in relation to cancer. Part 2 [1] will focus on Ayurvedic botanical resources used for cancer and research studies will be discussed on selected herbal compounds. Research gaps and opportunities will be identified to guide development of research programs to validate safety and efficacy of these therapies. Importantly, the use of Ayurvedic modalities is not intended to substitute for allopathic treatments for cancer but as an integrative component for prevention and restoration of strength and immunity post treatment.

Background: COVID-19 may require hospitalization in an intensive care unit (ICU) and is often associated with the onset of critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Due to the spread of the disease around the world, the identification of new rehabilitation strategies for patients facing this sequence of events is of increasing importance. Case presentation: We report the clinical presentation and the beneficial effects of a prolonged, supervised adapted motor activity (AMA) program in a highly deconditioned 61-year-old male COVID-19 patient discharged from the ICU and complicated by residual CIP and CIM. The program included aerobic, strength, gait, and balance training (1 h, 2 sessions per week). Measures: Pulmonary (spirometry), metabolic (indirect calorimetry and bioimpedance), and neuromuscular functions (electromyography) were evaluated at baseline and after 1 year of training. Results: Relative to baseline, an amelioration of several spirometric parameters such as vital capacity (VC, +40%), total lung capacity (TLC, +25%), and forced expiratory volume in 1 s (FEV1, +28%) was appreciable. Metabolic parameters such as body water (60%--46%), phase angle (3.6°--5.9°), and respiratory quotient (0.92--0.8) returned to the physiological range. Electromyographic parameters were substantially unchanged. The overall amelioration in clinical parameters resulted in a significant improvement of patient autonomy and the quality of life. Conclusion: Our results highlight the importance of AMA for counteracting respiratory, metabolic, and functional but not neuromuscular impairments in COVID-19 patients with residual CIM and CIP. [ABSTRACT FROM AUTHOR]

Backgroud: Jala-Nimajjan Purisha Pariksha is an ancient method that has been described in all most all the Samhitas, which was done to assess the presence of Ama (undigested substance) in the stool. Ama is an important factor which is considered generally as the root cause of all the diseases. So, this technique was considered as an important tool to ascertain the presence of Ama in the stool. This is a simple method in which stool mass is dropped on water and observation is being made whether stool floats or sinks. If stool sinks, then it is associated with Ama or otherwise if it floats, then it is Nirama (digested substance). Aim: The aim of the study was to standardize the procedure of Jal-Nimajjan Purisha Pariksha. Materials and Methods: The present study is broadly divided into two parts: Part-I a pilot study for standardization of Jala-Nimajjan Purisha Pariksha in terms of physical parameters And Part-II: study on features of Jala-Nimajjan Purisha Pariksha in apparently healthy volunteers along with routine and microscopic examination of stool. Thirty apparently healthy volunteers were selected from BHU campus. Results: This study showed a significant result in correlation with textual descriptions of Ayurveda regarding Agni and Purisha Pariksha. Statistically, Chi-square test was applied to obtained data and analyzed by SPSS software version 6. Conclusion: This method is more important because it can detect the Ama before its manifestation of symptoms in the whole body. Whenever there is abnormality of Agni in the body, it has a direct effect on digestion. If Agni does not work properly, then Ama is produced in the intestine. Stool is the first excretory substance produced as a result of digestion. If any changes occur in the bowel, it will be seen first in stool and can be detected by Jala-Nimajjan Purisha Pariksha.

Background: COVID-19 may require hospitalization in an intensive care unit (ICU) and is often associated with the onset of critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Due to the spread of the disease around the world, the identification of new rehabilitation strategies for patients facing this sequence of events is of increasing importance.Case presentation: We report the clinical presentation and the beneficial effects of a prolonged, supervised adapted motor activity (AMA) program in a highly deconditioned 61-year-old male COVID-19 patient discharged from the ICU and complicated by residual CIP and CIM. The program included aerobic, strength, gait, and balance training (1 h, 2 sessions per week).Measures: Pulmonary (spirometry), metabolic (indirect calorimetry and bioimpedance), and neuromuscular functions (electromyography) were evaluated at baseline and after 1 year of training.Results: Relative to baseline, an amelioration of several spirometric parameters such as vital capacity (VC, +40%), total lung capacity (TLC, +25%), and forced expiratory volume in 1 s (FEV1, +28%) was appreciable. Metabolic parameters such as body water (60%–46%), phase angle (3.6°–5.9°), and respiratory quotient (0.92–0.8) returned to the physiological range. Electromyographic parameters were substantially unchanged. The overall amelioration in clinical parameters resulted in a significant improvement of patient autonomy and the quality of life.Conclusion: Our results highlight the importance of AMA for counteracting respiratory, metabolic, and functional but not neuromuscular impairments in COVID-19 patients with residual CIM and CIP.

Copyright of PODIUM- Revista de Ciencia y Tecnologia en la Cultura Física is the property of Universidad de Pinar del Rio and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Normal tables of development are essential for studies of embryogenesis, serving as an important resource for model organisms, including the frog Xenopus laevis. Xenopus has long been used to study developmental and cell biology, and is an increasingly important model for human birth defects and disease, genomics, proteomics and toxicology. Scientists utilize Nieuwkoop and Faber's classic 'Normal Table of Xenopus laevis (Daudin)' and accompanying illustrations to enable experimental reproducibility and reuse the illustrations in new publications and teaching. However, it is no longer possible to obtain permission for these copyrighted illustrations. We present 133 new, high-quality illustrations of X. laevis development from fertilization to metamorphosis, with additional views that were not available in the original collection. All the images are available on Xenbase, the Xenopus knowledgebase (http://www.xenbase.org/entry/zahn.do), for download and reuse under an attributable, non-commercial creative commons license. Additionally, we have compiled a 'Landmarks Table' of key morphological features and marker gene expression that can be used to distinguish stages quickly and reliably (https://www.xenbase. org/entry/landmarks-table.do). This new open-access resource will facilitate Xenopus research and teaching in the decades to come. [ABSTRACT FROM AUTHOR]

Backgroud: Jala-Nimajjan Purisha Pariksha is an ancient method that has been described in all most all the Samhitas, which was done to assess the presence of Ama (undigested substance) in the stool. Ama is an important factor which is considered generally as the root cause of all the diseases. So, this technique was considered as an important tool to ascertain the presence of Ama in the stool. This is a simple method in which stool mass is dropped on water and observation is being made whether stool floats or sinks. If stool sinks, then it is associated with Ama or otherwise if it floats, then it is Nirama (digested substance). Aim: The aim of the study was to standardize the procedure of Jal-Nimajjan Purisha Pariksha. Materials and Methods: The present study is broadly divided into two parts: Part-I a pilot study for standardization of Jala-Nimajjan Purisha Pariksha in terms of physical parameters And Part-II: study on features of Jala-Nimajjan Purisha Pariksha in apparently healthy volunteers along with routine and microscopic examination of stool. Thirty apparently healthy volunteers were selected from BHU campus. Results: This study showed a significant result in correlation with textual descriptions of Ayurveda regarding Agni and Purisha Pariksha. Statistically, Chi-square test was applied to obtained data and analyzed by SPSS software version 6. Conclusion: This method is more important because it can detect the Ama before its manifestation of symptoms in the whole body. Whenever there is abnormality of Agni in the body, it has a direct effect on digestion. If Agni does not work properly, then Ama is produced in the intestine. Stool is the first excretory substance produced as a result of digestion. If any changes occur in the bowel, it will be seen first in stool and can be detected by Jala-Nimajjan Purisha Pariksha. [ABSTRACT FROM AUTHOR]

Ryan Tonkens (2009) has issued a seemingly impossible challenge, to articulate a comprehensive ethical framework within which artificial moral agents (AMAs) satisfy a Kantian inspired recipe—"rational" and "free"—while also satisfying perceived prerogatives of machine ethicists to facilitate the creation of AMAs that are perfectly and not merely reliably ethical. This series of papers meets this challenge by landscaping traditional moral theory in resolution of a comprehensive account of moral agency. The first paper established the challenge and set out autonomy in Aristotelian terms. The present paper interprets Kantian moral theory on the basis of the preceding introduction, argues contra Tonkens that an engineer does not violate the categorical imperative in creating Kantian AMAs, and proposes that a Kantian AMA is not only a possible goal for Machine ethics research, but a necessary one. [ABSTRACT FROM AUTHOR]

Tonkens (Mind Mach, 19, 3, 421–438, 2009) has issued a seemingly impossible challenge, to articulate a comprehensive ethical framework within which artificial moral agents (AMAs) satisfy a Kantian inspired recipe—"rational" and "free"—while also satisfying perceived prerogatives of machine ethicists to facilitate the creation of AMAs that are perfectly and not merely reliably ethical. Challenges for machine ethicists have also been presented by Anthony Beavers and Wendell Wallach. Beavers pushes for the reinvention of traditional ethics to avoid "ethical nihilism" due to the reduction of morality to mechanical causation. Wallach pushes for redoubled efforts toward a comprehensive account of ethics to guide machine ethicists on the issue of artificial moral agency. Options, thus, present themselves: reinterpret traditional ethics in a way that affords a comprehensive account of moral agency inclusive of both artificial and natural agents, or give up on the possibility and "muddle through" regardless. This series of papers pursues the first option, meets Tonkens' "challenge" and pursues Wallach's ends through Beavers' proposed means, by "landscaping" traditional moral theory in resolution of a comprehensive account of moral agency. This first paper sets out the challenge and establishes the tradition that Kant had inherited from Aristotle, briefly entertains an Aristotelian AMA, fields objections, and ends with unanswered questions. The next paper in this series responds to the challenge in Kantian terms, and argues that a Kantian AMA is not only a possibility for Machine ethics research, but a necessary one. [ABSTRACT FROM AUTHOR]

As emergency medicine physicians, we engage in informed consent, have conversations with patients leaving against medical advice, and screen them daily. Better understanding these concepts and processes can improve patient care., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Most of the people experience digestive problems like constipation, diarrhoea, acid eructations, loss of appetite etc. at some stage of life. These are the acute conditions that appear due to Agnimandya (reduced power of digestion, assimilation and metabolism). Conditions that may cause Agnimandya includes changes in diet and lifestyle and chronic diseased conditions. When the Agnimandya or the conditions that may cause Agnimandya persist for longer duration it turns into a life threatening disease. When Doshas (body humours) get aggravated, they affect the Agni (Power of digestion, assimilation and metabolism) and thus the food taken is not digested properly forming the Ama (morbid material). Ama when formed is accumulated in the body over the period of time, forming roots of many diseases.In the present case study the patient has Agnimandya, because of the chronic metabolic conditions. The Agnimandya and consequent nutritional deficiencies are addressed, while preparing the treatment protocol. The central focus of Ayurvedic treatment is the management of Agni and the Ama. The diet was advised on the line of Samsarjana Krama (Sequential administration of liquid diet to normal diet to kindle the Agni or digestive power) and the effect of treatment was analysed after 1 month. The symptoms of the diseases were reduced along with the improvement in the Agni and the nutritional status.

In this essay, I detail commitments that some of the major health organizations—the American Medical Association, the American Public Health Association, and the Centers for Disease Control and Prevention—have made to addressing anti‐Black racism and discuss their policies meant to curtail racism's effects on health equity. Although these organizations' historical lack of action has contributed to a culture of anti‐Black racism in health care and public health and many Black people have suffered because of it, progress has to begin somewhere, and outlining their future actions is a good start. Now, bioethicists, with our expertise in how historic policies connect to contemporary disparate health outcomes and access to health care, are in a position to hold these organizations accountable for fulfilling their commitments. [ABSTRACT FROM AUTHOR]

The study has been conducted at Agartala Municipal area (AMA) of Tripura, which exhibits rapid population growth and faster land use land cover changes. The major purpose of the study is to understand the dynamics of land use and Land surface temperature (LST) in the city of Agartala. The study incorporated satellite data such as Landsat TM (Thematic Mapper) and OLI (Operational Land Imager)/TIRS (Thermal Infra-Red Sensors) data along with LandScan datasets of the years from 2008 to 2018. The results revealed a drastic change of land use land cover specifically built up land with net change of 15.63 sq km. While during the same epoch, population portrayed a net growth of 250,017 in the city. The population induced change of land use land cover have accelerated the mean LST of the city from 25.71 ºC to 26.29 ºC in summer and 21.48 ºC to 26.05 ºC in winter season, respectively. The increasing strength of correlation between NDBI (Normalized Difference Built-up Index) &NDVI (Normalized Difference Vegetation Index), NDBI&LST, NDVI&LST and finally Population density and LST with changing 'r' value from -0.46 to -0.89, 0.75 to 0.90,-0.76 to -0.81 and 0.34 and 0.67 in summer (2008–2018) whereas -0.34 to -0.83, 0.66 to 0.85, -0.56 to -0.78 and 0.35 to 0.50 in winter, respectively, signify the active role of population growth and built up land development on the intensification of the process of LST in the study area. [ABSTRACT FROM AUTHOR]

Agni is a Sanskrit word. Vedas and Upanishads have given much importance to Agni. Agni is also worshiped as deity. Agni is equivalent to fire. Fire is one of the panchmahabhutas. Agni is a unique concept in Ayurveda. There are total 13 types of Agni. Normal and healthy agni can give robust health and very strong immunity. Bad Eating food habits can cause impairment of Agni. Ayurved has described Asthavidhaharavisehsayatan that is the rules and regulations for Ahara. Different seasons have different actions on Agni. In the rainy season Agni becomes weak. Out of13 types Jatharagni play important role in the digestion of food and the formation of Ahara rasa. This Ahara rasa is the primary constituent in the formation of further dhatus. Each Dhatus have its agnis and they nourish their dhatus and form the primary constituent of the next succeeding dhatus. Panchmahabhuta Agni play important role in the digestion of panchbhautik food and the formation of the main elements of doshas. Vitiation of agni results in Ama a toxic product formed due to impaired digestion. [ABSTRACT FROM AUTHOR]

Some authors have recently suggested that it is time to consider rights for robots. These suggestions are based on the claim that the question of robot rights should not depend on a standard set of conditions for 'moral status'; but instead, the question is to be framed in a new way, by rejecting the is/ought distinction, making a relational turn, or assuming a methodological behaviourism. We try to clarify these suggestions and to show their highly problematic consequences. While we find the suggestions ultimately unmotivated, the discussion shows that our epistemic condition with respect to the moral status of others does raise problems, and that the human tendency to empathise with things that do not have moral status should be taken seriously—we suggest that it produces a "derived moral status". Finally, it turns out that there is typically no individual in real AI that could even be said to be the bearer of moral status. Overall, there is no reason to think that robot rights are an issue now. [ABSTRACT FROM AUTHOR]

Nitrogen (N2) accumulation in the blood and tissues can occur due to breath-hold (BH) diving. Post-dive venous gas emboli have been documented in commercial BH divers (Ama) after repetitive dives with short surface intervals. Hence, BH diving can theoretically cause decompression illness (DCI). “Taravana,” the diving syndrome described in Polynesian pearl divers by Cross in the 1960s, is likely DCI. It manifests mainly with cerebral involvements, especially stroke-like brain attacks with the spinal cord spared. Neuroradiological studies on Ama divers showed symptomatic and asymptomatic ischemic lesions in the cerebral cortex, subcortex, basal ganglia, brainstem, and cerebellum. These lesions localized in the external watershed areas and deep perforating arteries are compatible with cerebral arterial gas embolism. The underlying mechanisms remain to be elucidated. We consider that the most plausible mechanisms are arterialized venous gas bubbles passing through the lungs, bubbles mixed with thrombi occlude cerebral arteries and then expand from N2 influx from the occluded arteries and the brain. The first aid normobaric oxygen appears beneficial. DCI prevention strategy includes avoiding long-lasting repetitive dives for more than several hours, prolonging the surface intervals. This article provides an overview of clinical manifestations of DCI following repetitive BH dives and discusses possible mechanisms based on clinical and neuroimaging studies.

Nitrogen (N2) accumulation in the blood and tissues can occur due to breath-hold (BH) diving. Post-dive venous gas emboli have been documented in commercial BH divers (Ama) after repetitive dives with short surface intervals. Hence, BH diving can theoretically cause decompression illness (DCI). "Taravana," the diving syndrome described in Polynesian pearl divers by Cross in the 1960s, is likely DCI. It manifests mainly with cerebral involvements, especially stroke-like brain attacks with the spinal cord spared. Neuroradiological studies on Ama divers showed symptomatic and asymptomatic ischemic lesions in the cerebral cortex, subcortex, basal ganglia, brainstem, and cerebellum. These lesions localized in the external watershed areas and deep perforating arteries are compatible with cerebral arterial gas embolism. The underlying mechanisms remain to be elucidated. We consider that the most plausible mechanisms are arterialized venous gas bubbles passing through the lungs, bubbles mixed with thrombi occlude cerebral arteries and then expand from N2 influx from the occluded arteries and the brain. The first aid normobaric oxygen appears beneficial. DCI prevention strategy includes avoiding long-lasting repetitive dives for more than several hours, prolonging the surface intervals. This article provides an overview of clinical manifestations of DCI following repetitive BH dives and discusses possible mechanisms based on clinical and neuroimaging studies. [ABSTRACT FROM AUTHOR]

Current literature regarding systemic autoimmune diseases in X‐chromosome aneuploidies is scarce and limited to case reports. Our aim was to evaluate the frequency of anti‐nuclear (ANAs), extractable nuclear (ENA), anti‐double‐stranded DNA (dsDNAs), anti‐smooth muscle (ASMAs) and anti‐mitochondrial (AMAs) antibodies in a large cohort of adults with Klinefelter's syndrome (KS, 47,XXY) and rare higher‐grade sex chromosome aneuploidies (HGAs) for the first time. Sera from 138 X‐chromosome aneuploid patients [124 adult patients with 47,XXY KS and 14 patients with HGA (six children, eight adults)] and 50 age‐matched 46,XY controls were recruited from the Sapienza University of Rome (2007–17) and tested for ANAs, ENAs, anti‐dsDNAs, ASMAs and AMAs. Non‐organ‐specific immunoreactivity was found to be significantly higher in patients with 47,XXY KS (14%) than in the controls (2%, p = 0.002). Among all the antibodies investigated, only ANAs were observed significantly more frequently in patients with 47,XXY KS (12.1%) than in the controls (2%, p = 0.004). No anti‐dsDNA immunoreactivity was found. Stratifying by testosterone replacement therapy (TRT), non‐organ‐specific autoantibody frequencies were higher in TRT‐naive (p = 0.01) and TRT‐treated groups than in controls. No patients with HGA were found positive for the various autoantibodies. Non‐organ‐specific autoantibodies were significantly present in 47,XXY adult patients. Conversely, HGAs did not appear to be target of non‐organ‐specific immunoreactivity, suggesting that KS and HGAs should be considered as two distinct conditions. The classification and diagnosis of systemic autoimmune diseases is frequently difficult. To support a correct clinical evaluation of KS disease and to prevent eventual secondary irreversible immune‐mediated damages, we highlight the importance of screening for non‐organ‐specific autoimmunity in Klinefelter's syndrome. [ABSTRACT FROM AUTHOR]

Objective: To describe the rationale for, and benefits of, trainees and psychiatrists to be involved in medico-political volunteering. Conclusions: Volunteering for professional organisations and other bodies may be considered as an important advocacy role for psychiatrists. Such volunteering is meaningful through shared goals and achievements, as well as developing a sense of mastery and significance as part of a larger quest. Volunteering is also a professional developmental process that both enhances individual skills/career development as well as organisational efficacy. [ABSTRACT FROM AUTHOR]

Abstract Background & Aims Anti-mitochondrial-autoantibodies (AMA) remain a hallmark of Primary Biliary Cholangitis (PBC) however approximately 10% of patients test negative for these antibodies. They do not differ in terms of biochemistry or clinical presentation from AMA positive ones. Epigenetics play a key role in immune signalling. Two microRNAs (miRs), namely, miR-21 and miR-150 are known to be involved in liver inflammation and fibrosis. The expression of those two microRNAs and their downstream targets were analyze in the context of AMA-status and the stage of liver fibrosis. Methods The relative levels of miR-21 and miR-150 and their target genes: cMyb, RAS-guanyl-releasing protein-1(RASGRP1), and DNA-methyltransferase-1(DNMT1) were determined by Real-Time PCR in serum, liver tissue and peripheral blood mononuclear cells (PBMCs) of patients with PBC. Results Serum expressions of miR-21 and miR-150 were significantly enhanced in AMA-negative patients, and they inversely correlated with disease-specific AMA titers in PBS patients. In PBMCs, an increased expression of miR-21 correlated with decreased levels of RASGRP1 and DNMT1 mRNAs whereas, the level of miR-150 remained comparable to controls; and cMyb mRNA was downregulated. In cirrhotic livers, the level of miR-21 was unchanged while miR-150 expression was increased. Conclusion This study convincingly report, that AMA-negative PBC is characterized by notable alternations of miR-21 and miR-150 and their downstream targets compared to AMA-positive patients underlining their possible importance in the induction of the disease and its progression to fibrosis.

Identification of changes in biochemical parameters of liver functional activity during screening studies requires additional examination of the patient in order to determine the genesis of the disease. In recent years, in routine practice, the most frequently used is an isolated definition of the level of transaminases (ALT, AST), which does not allow timely detection of latent cholestasis syndrome. Primary biliary cholangitis (PBC), previously referred to as primary biliary cirrhosis, is a relatively rare chronic autoimmune cholesthetic liver disease, predominantly affecting middle-aged women and prone to progressing liver cirrhosis. The recommendations of AASLD and EASL note the need for long-term monitoring of patients with ongoing UDCA therapy and regular diagnostic studies to identify signs of disease progression. A clinical example of successful treatment of a patient with PBC with the Russian drug Exhol® is described.