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Abstract Objective To evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States. Methods We used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use. Results The decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16–2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Conclusion When patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making. Trial registration ClinicalTrials.gov NCT03985449; registered 6 June 2019.

The present study aims to investigate the palaeoenvironmental changes around Sattal Lake, Kumaun Lesser Himalaya spanning the last 1670 years. Based on multi proxy analysis (i.e., grain size, mineral magnetism, clay mineralogy, Total Organic Carbon (TOC) and carbon isotopes), supported by a robust radiocarbon chronology, three major environmental phases were identified. Warm, wet phases occurred between 1,150–650 cal yr BP and 260 cal yr BP to the present. These phases coincide closely with the Medieval Climatic Anomaly (MCA) and modern warming, respectively. These warm/wet events were due to elevated precipitation, resulting in high lake levels and an expansion of the lake margin, which were marked by lower δ13C values, comparatively higher sand concentration, TOC values and magnetic susceptibility (χlf). The inference of a modern warm phase is supported by high resolution instrumental data. The MCA, which is marked by elevated amounts of coarse grained (sand) detrital material, is inferred to be an interval of strengthened of monsoonal intensity, which correlates with available monsoon records from various continental paleoclimate archives. Following the MCA a cold and dry phase was observed to occur between 610 and 260 cal yr BP, corresponding to the Little Ice Age (LIA). The LIA, which was characterized by high silt and clay concentration, high δ13C, low TOC and reduced magnetic susceptibility (χlf), is inferred to represent an interval of low lake levels, likely reflecting an episode of weakened monsoonal intensity.

Abstract This research employs Kirkpatrick’s model, to assess the efficacy of training programmes for managerial and non-managerial employees in the banking sector using all the four components i.e., Reaction, Learning, Behavior and Results. Data were collected from 402 respondents from public, private and foreign sector banks. SEM-PLS was used to determine the relationship between the levels of the Kirkpatrick’s model for the evaluation of the training programs of the baking sector. The results suggest that all the four levels are interlinked and Kirkpatrick model was effective to evaluate the impact of training programs on employee motivation and bank performance. Reactions of employees (stage 1) have enhanced knowledge, and skills and has a positive and significant influence on learning (stage 2) and Behavior through job performance (stage 3) has a positive impact on results (stage 4). The results reflected that the adjusted R 2 = 0.732 of the managerial level is more than that of the non-managerial level (R 2 = 0.571). This indicates that the training is more effective on the Managerial level than the Non-Managerial level and that the managerial employees are more skilled and experienced in their jobs. The study is novel and one of the initial contributions to apply Kirkpatrick’s model to banking sector in India.

Caspase 3 activation is a hallmark of cell death and there is a strong correlation between elevated protease activity and evolving pathology in neurodegenerative disease, such as amyotrophic lateral sclerosis (ALS). At the cellular level, ALS is characterized by protein aggregates and inclusions, comprising the RNA binding protein TDP-43, which are hypothesized to trigger pathogenic activation of caspase 3. However, a growing body of evidence indicates this protease is essential for ensuring cell viability during growth, differentiation and adaptation to stress. Here, we explored whether caspase 3 acts to disperse toxic protein aggregates, a proteostasis activity first ascribed to the distantly related yeast metacaspase ScMCA1. We demonstrate that human caspase 3 can functionally substitute for the ScMCA1 and limit protein aggregation in yeast, including TDP-43 inclusions. Proteomic analysis revealed that disrupting caspase 3 in the same yeast substitution model resulted in detrimental TDP-43/mitochondrial protein associations. Similarly, suppression of caspase 3, in either murine or human skeletal muscle cells, led to accumulation of TDP-43 aggregates and impaired mitochondrial function. These results suggest that caspase 3 is not inherently pathogenic, but may act as a compensatory proteostasis factor, to limit TDP-43 protein inclusions and protect organelle function in aggregation related degenerative disease.

Surface functionalization of iron oxide nanoparticles (Fe2O3 NPs) with antibiotics is a novel approach that opens the door to drug delivery applications. In the present work, we report iron oxide nanoparticles synthesized by chemical co-precipitation method. As-synthesized nanoparticles were characterized using field emission scanning electron microscopy (FESEM) , energy dispersive X-ray (EDX), X-ray diffraction (XRD), ultraviolet (UV)–visible (Vis) spectroscopy, Fourier transform infrared (FTIR), and vibrating sample magnetometer (VSM). The poly-shaped Fe2O3 NPs of size (34 ± 10) nm with hematite (α-Fe2O3) phase were synthesized. The antibacterial activity of chloramphenicol and gentamicin and their formulation with encapsulated iron oxide nanoparticles was investigated by the agar well diffusion technique. Drug-encapsulated Fe2O3 NPs showed antibacterial activity against Escherichia coli and Staphylococcus aureus strains, possibly in a dose-dependent manner. Significant effectiveness was confirmed by the increase in the single range of inhibition against the tested microorganisms. Furthermore, the effect of iron oxide nanoparticle concentrations ranging from 1 to 9 μg/μL on bacterial growth was examined.

Beaches form one of the most contaminated sedimentary environments by a myriad variety of anthropogenic activities, including tourism and recreational activities. The concentrations of metals and their pollution levels were studied for four tropical tourist beaches in Kerala state, Southern India. Bulk geochemical and mineralogical analyses of 16 sediment samples were performed to determine the environmental status and the environmental risk level using various geochemical indices. Based on the enrichment of TiO2 and SiO2 concentrations, the samples were grouped into ilmenite-rich samples (IRS) and quartz-rich samples (QRS) respectively and the geochemical signatures are significantly different. Mineralogically, the IRS group is dominated by ilmenite, quartz, sillimanite, zircon and rutile while the QRS group consists of quartz, spinel and calcite and garnets are common in both groups of sediments. Despite the variation in the trends of pollution indices, it has been found that Kovalam beach sediments are enriched with W, Th and U where, IRS with enrichment of W, U and Th while QRS only enriched with W and Th and not U. The mineralogical affinity of W with secondary tungsten-bearing minerals has been documented by the XRD analysis and these metals are mainly controlled by the geogenic sourced minerals. However, in terms of ecological risk, Pb, As and Cu have a considerable to moderate risk in both groups of sediments. Overall, both group of sediments shows a moderate risk. Based on the biological effect assessment the elements of concern are Pb and Zn in IRS and possible effect by the Cr, Cu and As in IRS and only by Cu in QRS. Though the prevalence of geogenic and anthropogenic processes and influences of metal enrichments are documented by the study, their relative influences, mobility and bioavailability need to be systematically studied.

Limited evidence is available on the vulnerability of Adolescent Girls and Young Women (AGYW) to sexual risk behaviour and STI/HIV. Though there are almost no statistics available on vulnerability, related literature suggests that AGYW have low awareness about sexual risk behaviour/ transmission and the prevalence of STI/HIV, making them vulnerable. We conducted a rapid review of peer-reviewed studies addressing transmission network, prevalence, incidence awareness, common determinants of sexual risk behaviour/STI/HIV, health-seeking behaviour and existing interventions addressing the situation among AGYW (age 15-24) to inform the evidence gap in this crucial area of research. We registered the study in PROSPERO (CRD42023403713). We developed detailed inclusion/exclusion criteria, searched JSTOR, PubMed, Google Scholar, Science Direct and Population Council Knowledge Commons databases and followed the guidance from Cochrane Rapid Review to develop the rapid review. We also searched the bibliography of the included studies. We included the English language peer-reviewed quantitative, qualitative, mixed method studies published from Jan 1 2000 to Mar 31 2023. Six reviewers extracted data, and the seventh reviewer independently assessed the quality. Ninety-six studies met the inclusion criteria. We used descriptive statistics and narrative synthesis methods for data analysis. We also conducted a Risk of Bias Assessment (RoB) to check the quality of the included studies. Inadequate literature was found on the transmission network. Prevalence and awareness of STI/HIV are low among AGYW. However, Female Sex Workers, sex-trafficked women or drug users in this age group suffer more. Age, education, income, relationship dynamics with spouses/partners, multiple partners, and substance use are crucial in determining STI/HIV. Traditional sources of health seeking are more popular than formal sources because of social stigma. Mass media campaigns, community mobilization programs, and life skills training programs increase awareness about HIV, condom use and self-efficacy. The inclusion of only English language studies and not conducting meta-analysis because of high heterogeneity are some of the limitations of the study.

Introduction: The most prevalent endocrine cancer in the world is thyroid cancer, and its incidence is on the rise. The distinction between benign and malignant thyroid nodules must be made, which is why fine needle aspiration cytology of thyroid lesion is necessary and required. This study aimed to find out the prevalence of thyroid malignancy among fine needle aspiration cytology of thyroid lesions in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among fine needle aspiration cytology of thyroid lesions in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data from 13 April 2020 to 13 April 2023 was collected between 19 May 2023 to 19 June 2023. All the patients with complete hospital record data were included in this study. However, repetitive fine needle aspiration cytology of thyroid lesion were excluded from the study. Fine needle aspiration cytology diagnoses were categorized in this study as per the Bethesda system for reporting thyroid cytopathology. The point estimate was calculated at a 95% Confidence Interval. Results: Among 398 fine needle aspiration cytology of thyroid lesions, thyroid malignancy was seen in 12 (3.02%) (1.34-4.70, 95% Confidence Interval) patients. Conclusions: The prevalence of thyroid malignancy was found to be lower than other studies done in similar settings.

We present results of our investigations on 7.65 m long core sediments from the Khajjiar lake, Himachal Pradesh, aimed at reconstructing palaeoclimate variability in the climatically sensitive region affected by both ISM (Indian Summer Monsoon) and IWM (Indian Winter Monsoon). Based on the multi-proxy approach, including organic geochemistry (carbon isotopes), magnetic susceptibility as primary proxies and inorganic geochemistry (major oxides) with grain size analysis as secondary proxies, climate of the mid-late Holocene (∼4600 yr) has been established on centennial to millennial scale. The chronology of the sediments is constrained by five AMS radiocarbon dates. The sedimentological data reveal variations in sediment grain size related to palaeo-precipitation. The first high resolution multi-proxy record from the Khajjiar lake core indicates less humid conditions during ∼4600–4185 cal yr BP except an extreme peak of dry and arid climate at around ∼4370 cal yr BP. Intensified monsoon with more wet and humid conditions has been interpreted during ∼4185–3790 cal yr BP. ∼3790–3300 cal yr BP, ∼2845–2115 and ∼1555–405 cal yr BP, and ∼2990–2845 cal yr BP and fluctuations are observed from ∼2115 to 1555 cal yr BP. The results suggest two major climatic phases corresponding with the 4.2 ka and Roman Warm Period (RWP). A regional comparison of mid-late Holocene climate records reveals a broad synchronicity, but with considerable spatial variation. The timing and duration of climate events varied across regions.

Background: The aim of this study was to compare the fracture resistance of endodontically treated teeth using epoxy resin-based sealer and bioceramic sealer. Materials and Methods: Twenty-eight single-rooted, single-canal mandibular premolars extracted for orthodontic purposes were used in this in vitro study. The teeth were decoronated using a wheel diamond bur to a standard length of 14 mm under water lubrication. The canals were irrigated between successive filings. All teeth were instrumented (biomechanical preparation) by ProTaper rotary files up to F2. These teeth were then divided into two groups based on the type of root canal sealer used. Gutta-percha was used for all the samples: Group I: Bio-C root canal sealer and Group II: AH Plus root canal sealer. The teeth were embedded in acrylic resin blocks, and fracture force was measured using a universal testing machine. Independent sample t-test/unpaired t-test was performed to assess significant differences between the two groups. This comparison showed statistically significant differences between the two groups (P < 0.05). Results: Group I, i.e., Bio-C (bioceramic based) sealer, showed higher resistance to fracture than Group II, i.e., AH Plus (resin based) sealer. Conclusion: Based on this in vitro study, the Bio-C sealer was more effective as compared to the resin-based AH Plus sealer.

Background: Despite of several guidelines metformin and glimepiride remains the first prescribed drug in most people with diabetes. Very often canagliflozin and teneligliptin remain the third prescribed OHA. Efficacy of teneligliptin and canagliflozin as solo drug or in combination with other single OHA’s on glycaemic parameters, lipid profiles & blood pressure is already established. But their efficacy on above parameters when used as third drug next to metformin and sulfonylurea is still not investigated. Aims and objectives: Aim of this study is to compare glycaemic and non-glycemic effects of canagliflozin and teneligliptin as third line drug. Objective is to establish their multiple pleotropic effects at this position. Methods: Subjects with uncontrolled glycaemic parameters with hypertension and diabetic dyslipidaemia already on half maximal doses of metformin and glimepiride were enrolled in the study. Out of 87 selections, 45 were prescribed canagliflozin 100 mg/d and to 42 subjects, teneligliptin 20mg/d, each for 24 weeks. Effects over HbA1c, fasting and post prandial plasma glucose, systolic and diastolic blood pressures, HDL’c and triglycerides were observed pre and post intervention. Results: As a third drug both canagliflozin and teneligliptin show significant reduction in HbA1c (1.5 versus 1.6%), fasting (-20.2 versus -28.8 mg %), and post prandial (-39.9 versus – 58.5mg %). Effects over systolic (4 mmHg versus 1.1 mmHg) and diastolic BP (3.1 mmHg versus 0.2 mmHg) was clinically and statistically significant (p = 0.3 and 0.1) respectively in both groups. A statistically insignificant (9.6 versus 4.1 mg%; p =) reduction in Triglycerides but significant (7.6 versus 1.2; p

The challenge of dealing with synthetic dye pollution in waste from the leather industry requires continual research and development. Although numerous dyes used in the textile, food, and other industries have been found to be degraded by photocatalyst based on zinc oxide nanoparticles (ZnO NPs), no thorough studies on the degradation of leather dye from dye-containing wastewaters from tanneries have been reported to date. Hence, this study investigates the efficient photocatalytic destruction of leather dye using ZnO NPs produced by chemical precipitation method. The influence of calcination temperatures ranging from 400 to 600 °C on the structural and optical characteristics of ZnO NPs was investigated. XRD examination revealed an increase in crystallite size as the calcination temperature increased, presumably due to the merger of smaller crystallites into larger ones. Meanwhile, the polycrystalline and wurtzite structure of the synthesized ZnO NPs was observed, with particle diameters ranging from 40 to 90 nm and an average size of around 62 nm. UV–vis spectra revealed a decrease in energy band gap (3.15 to 3.05 eV), which was ascribed to an increase in crystallite size produced by higher calcination temperature from 400 to 600 °C. The photocatalytic degradation of leather dye was studied further. It has been demonstrated that ZnO NPs synthesized at a calcination temperature of 400 °C can remove 90% of the leather dye in 30 min. The dynamics of deterioration were also studied. It was discovered that the degradation of leather dyes best fitted the pseudo-first-order kinetics, with superoxide ions being the most likely species.

Application of drug conjugated iron oxide hematite ( α -Fe _2 O _3 ) nanoparticles are of tremendous interest in biomedicine nowadays. Meanwhile, green production of iron oxide nanoparticles is gaining favour due to its sustainability, ease of usage, and biocompatibility. Therefore, this work reports on the use of hexahydrate ferric chloride and nerium oleander flower extract to synthesize nanoscaled hematite ( α -Fe _2 O _3 ) iron oxide particles conjugated with various drugs for antibacterial agents. Diverse morphological, physicochemical, structural, optical, and magnetic characteristics have been characterized using FESEM, EDX, XRD, UV–vis, FTIR, Raman and vibrating sample magnetometer. The synthesis of the polyshaped iron oxide nanoparticles, with average sizes ranging from 47.2 ± 20 nm, was accomplished. Furthermore, temperature-dependent variations in magnetic behavior were observed during calcination. The XRD and Raman spectra revealed hematite ( α -Fe _2 O _3 ) type formation of iron oxide nanoparticles. Only calcinated IO-NPs at high temperatures (700 °C) demonstrated low coercivity and residual magnetism, which revealed weak ferromagnetic ordering; other calcinated samples, including nascent ones, showed incredibly weak ferromagnetic ordering. Besides, the effectiveness of drug-encapsulated iron oxide nanoparticles against bacteria in vitro was examined. It was interesting to observe that gentamycin-coated IO-NPs tended to be more susceptible to S. aureus than E. coli bacteria, but streptomycin-conjugated IO-NPs showed the reverse trend. However, as compared to the nascent sample and the high temperature (700 °C) calcinated sample, both antibiotic-loaded IO-NPs displayed better inhibitory abilities.

ABSTRACT Biofilm and hypha formation are central to virulence of the fungal pathogen Candida albicans. The G1 cyclin gene HGC1 is required for hypha formation under diverse in vitro and in vivo growth conditions. Hgc1 is required for disseminated infection and is a linchpin in the argument that hyphal morphogenesis itself is required for pathogenicity. We report here that HGC1 is dispensable for hypha formation during biofilm formation both in vitro, under strong inducing conditions, and in vivo, in a mouse oropharyngeal candidiasis model. These findings are validated with two or more C. albicans isolates. Systematic screening of overexpressed cyclin genes indicates that CCN1 and CLN3 can compensate partially for Hgc1 function during biofilm growth. This conclusion is also supported by the severity of the hgc1Δ/Δ ccn1Δ/Δ double mutant biofilm defect. Our results suggest that hypha formation in biofilm is accomplished by combined action of multiple cyclins, not solely by Hgc1. IMPORTANCE The HGC1 gene encodes a cyclin that is required for virulence of the fungal pathogen Candida albicans. It is required to produce the elongated hyphal filaments of free-living planktonic cells that are associated with virulence. Here, we show that HGC1 is not required to produce hyphae in the alternative growth form of a biofilm community. We observe Hgc1-independent hyphae in two infection-relevant situations, biofilm growth in vitro and biofilm-like oropharyngeal infection. Our analysis suggests that hypha formation in the biofilm state reflects combined action of multiple cyclins.

ABSTRACT Engineered conditional gene expression is used in appraisal of gene function and pathway relationships. For pathogens like the fungus Candida albicans, conditional expression systems are most useful if they are active in the infection environment and if they can be utilized in multiple clinical isolates. Here, we describe such a system. It employs the RBT5 promoter and can be implemented with a few PCRs. We validated the system with RBT5 promoter fusions to two genes that promote filamentation and polarized growth, UME6 and HGC1, and with efg1Δ/Δ mutants, which are defective in an activator of filamentous growth. An RBT5 promoter fusion to either gene enabled filamentous growth of an efg1Δ/Δ mutant of strain SC5314 in iron-limited media, including RPMI with serum and yeast extract-peptone-dextrose with bathophenanthrolinedisulfonic acid. The RBT5-UME6 fusion promoted filamentation of efg1Δ/Δ mutants in RPMI with serum of four other clinical C. albicans isolates as well. In a mouse model of disseminated candidiasis, the RBT5-UME6 fusion promoted filamentation of the SC5314 efg1Δ/Δ mutant in kidney tissue, an indication that the RBT5 promoter is active in the iron-limited host environment. The RBT5 promoter expands the conditional expression toolkit for C. albicans genetics. IMPORTANCE Genetic strategies have been vital for mechanistic analysis of biological processes. Here, we describe a genetic tool for the fungal pathogen Candida albicans.

Boron (B) and Tungsten (W) are often found enriched in high-temperature geothermal waters associated with the development of subduction-related mafic to felsic arc magma. However, knowledge about the sourcing and transportation of these elements from such hydrothermal systems is sparse and ambiguous. Being the only active continental collision site in the world, the Trans-Himalaya offers a unique chance to study how continental collision sources the high boron and tungsten concentrations in geothermal fluids. This study investigated the distribution of trace elements, major cations, and anions in three physicochemically distinct hotspring sites in the Ladakh region. The results were integrated with the existing geochemical and isotopic data to address the research problem more effectively. This study exhibits that the extreme concentrations of boron, sodium, chlorine, potassium, and tungsten in the hotspring waters were primarily governed by magmatic fluid inputs. In addition, this study recorded the highest-ever chlorine and boron concentrations for the Trans-Himalayan hotspring waters. The highest-ever boron and chlorine concentrations in the hotspring waters probably represented an increase in magmatic activity in the deeper source zone.

This paper examines the impact of the drivers of change, that is, digitalization, demonetization, and consolidation of banks as factors affecting training and development. Banking institutions are the real contributors of the GDP in today’s world. The study is based on the data collected from senior bank officers, middle and lower level officers from India. The balanced scorecard is used to determine the performance of the banks with the help of four perspectives, that is, financial, customer, innovative, and growth perspective. Job enrichment helps in adding value to an employee through various techniques and programs. Partial Least Square-Structured Equation Modeling (PLS-SEM) was applied for examining the relation among the drivers of change and job enrichment with Banking Sector Performance. It also examines the mediating role of training between drivers of change and banking sector performance. The results suggest that training along with selected drivers and job enrichment influenced bank performance and value of adjusted R 2 is .668. The current research suggests that the role of digitalization, demonetization, and consolidation of banks on banking performance improved with mediation effect of training. This research also highlights that in types of training, special training has higher loading, which implies the need to focus on training and specifically of special training to enhance banking performance.

Minimal change disease is an important cause of nephrotic syndrome in children, however, few cases are seen among adults. There is very little literature regarding the occurrence of minimal change disease in adults. We reported a case of a 63-year-old male who presented with the complaint of swelling around the eyes mostly during the morning for 18 days and frothing of urine for 7 days. On examination, the patient was ill-looking and had edema around the eyes and over the ankles. After preliminary investigations, renal biopsy was performed and electron microscopy revealed diffuse effacement of foot processes of visceral epithelial cells suggesting minimal change disease (podocytopathy). The patient has been treated with tablet prednisolone 60 mg per oral once daily, tablet ramipril 2.5 mg per oral once daily, and tablet torsemide 20 mg per oral twice daily. Hence, minimal change disease should also be considered as a differential diagnosis in adults presenting with the features of nephrotic syndrome.

The primary objective is to compare the difference in preschool teachers’ understanding of the five competencies of social-emotional learning (SEL) in India. The purpose is to assist teachers in reflecting on their emotions and knowledge about SEL, which is important for their personal and professional development. However, the research on preschool teachers’ own SEL is very limited in the state of Punjab in India. Therefore, this study examined 90 teachers’ understanding of SEL via a survey and a self-reported questionnaire. The data were analyzed using descriptive statistics (mean and standard deviation) and parametric t -test in SPSS. The results revealed that private preschool teachers of the Ludhiana and Patiala districts of Punjab have better knowledge about the competencies of SEL than public preschool teachers. The findings highlight the need to improve the SEL of both public and private preschool teachers, focusing on public preschool teachers through continuous and effective training interventions.

Background and Aims: Height and weight-based formulae are used for calculation of dose of medications for caudal analgesia but these have not been compared. We compared spinal column height-based Spiegel and weight-based Takasaki and Armitage formulae for achieving maximum height of sensory neuraxial block after caudal epidural analgesia in paediatric patients. Methods: In this double-blind randomised study, children aged between 1 and 6 years and planned for infra-umbilical surgery were randomly allocated to receive caudal epidural block (targeting T10level block) with 0.25% bupivacaine, using a volume calculated by modified Spiegel formula (group I), Takasaki formula (group II), and Armitage formula (group III). The Institute ethics committee reviewed and approved the study protocol. The primary endpoint of the study was the difference in the number of spinal segments blocked as assessed by pinprick method. The secondary endpoint was the difference in volume of 0.25% bupivacaine used among the groups. The groups were compared using one-way ANOVA. Results: Seventy-five patients (25 in each group) completed the study as per protocol. The mean number of spinal segments blocked was significantly different among groups (P < 0.001) with patients in group I (13.8 ± 0.83) showing significantly lower number of spinal segments blocked as compared to that in group II (15.8 ± 1.06; P < 0.001), and group III (16.8 ± 1.28; P < 0.001). The mean volume of 0.25% bupivacaine used in group I was significantly lower (P < 0.001) than that in group II and group III. Conclusion: Dose calculation in caudal epidural analgesia as per spinal column height-based modified Spiegel formula was more precise than bodyweight-based Takasaki and Armitage formulae.

Acute postoperative pancreatitis is an uncommon complication following laparoscopic cholecystectomy. The common complications in the early postoperative period are usually attributable to a bile duct injury or a bleeding vessel. Pancreatitis in such a setting usually resolves by conservative management unless there is an active obstruction at the lower common bile duct. Very few cases have been documented in the literature in this contention. In this case report, a case of acute pancreatitis following laparoscopic cholecystectomy is described in terms of the clinical presentation, laboratory parameters, management strategy, and a short review of the literature.

The primary objective of this article is to create a conceptual Early Childhood Care and Education (ECCE) happiness framework for preschool children in India. Although happiness is regarded as one of the key elements that influence early childhood development, an effective happiness framework does not exist for preschools in rural and socio-economically disadvantaged areas in the state of Punjab in India. Therefore, based on research gaps and existing literature, a conceptual framework has been developed to promote social and emotional competence among preschool children through the happiness intervention. The article also discusses (a) the concepts of happiness, and social and emotional competence; (b) the importance of happiness in preschool; (c) the association between happiness and social-emotional competence of preschool children; and (d) the role of preschool teachers in implementing the framework. Future implementation of this framework in the preschools of India will help overcome the limitation that exists in regard to its validation.

Clathrin is a major coat protein involved in vesicle formation during endocytosis and transport in the endosomal/trans Golgi system. Clathrin is required for normal growth of yeast (Saccharomyces cerevisiae) and in some genetic backgrounds deletion of the clathrin heavy chain gene (CHC1) is lethal. Our lab defined a locus referred to as “suppressor of clathrin deficiency” (SCD1). In the presence of the scd1-v allele (“v” – viable), yeast cells lacking clathrin heavy chain survive but grow slowly, are morphologically abnormal and have many membrane trafficking defects. In the presence of scd1-i (“i”- inviable), chc1∆ causes lethality. As a strategy to identify SCD1, we used pooled linkage analysis and whole genome sequencing. Here, we report that PAL2 (YHR097C) is the SCD1 locus. pal2∆ is synthetic lethal with chc1∆; whereas a deletion of its paralog, PAL1, is not synthetic lethal with clathrin deficiency. Like Pal1, Pal2 has two NPF motifs that are potential binding sites for EH domain proteins such as the early endocytic factor Ede1, and Pal2 associates with Ede1. Also, GFP-tagged Pal2p localizes to cortical patches containing other immobile phase endocytic coat factors. Overall, our data show that PAL2 is the SCD1 locus and the Pal2 protein has characteristics of an early factor involved in clathrin-mediated endocytosis.

Fludioxonil belongs to the phenylpyrrole group of fungicides with a broad antifungal spectrum that has been widely used in agricultural practices for the past thirty years. Although fludioxonil is known to exert its fungicidal action through group III hybrid histidine kinases, the downstream effector of its cytotoxicity is poorly understood. In this study, we utilized a S. cerevisiae model to decipher the cytotoxic effect of fludioxonil. Through genome wide transposon mutagenesis, we have identified Bem2, a Rho GTPase activating protein, which is involved in this process. The deletion of BEM2 resulted in fludioxonil resistance. Our results showed that both the GAP and morphogenesis checkpoint activities of Bem2 were important for this. We also provided the genetic evidence that the role of Bem2 in the cell wall integrity (CWI) pathway and cell cycle regulation could contribute to the fludioxonil resistance phenotype.

Rock varnishes are known to be fine, dark, glossy submicron films found in deserts bare rock surfaces. The oxides and hydroxides of manganese and iron bind together the clay minerals present in the varnish layer. The processes of oxide-hydroxide accumulation at varnish sites are due to iron and manganese oxidizing bacteria which may require clay minerals for additional nutrition. Quantification and identification of clay minerals in this biofilm is needed to understand its formation. Past attempts to analyze the mineralogical composition of rock varnish have led to inconclusive results as varnish is a submicron thin layer composed of a complex mineral matrix. The elimination of non-crystalline cementing groups comprising of free iron oxides is a key step in the identification of many types of clay minerals, particularly in soil/sediment mineral studies. • The Fe-Mn oxide-hydroxide coatings, acting as cementing materials, can be easily removed using a one-step reduction method employing Na2S2O4 at 70 °C, leading to separation of clay minerals. • We have taken the lead from earlier reported Jackson (1958) method, wherein a combination of reagents was used such as sodium acetate, sodium citrate, hydrogen peroxide, sodium bicarbonate, and sodium dithionite for removing carbonate, organic carbon and Fe-Mn oxy-hydroxide coatings respectively from sediment grains to segregate individual grains from each other. • Our modification helps in the unveiling of clay minerals from a solid substrate and reports the X-ray diffraction peaks, which are elsewise hard to detect and therefore earlier studies are inconclusive.

Introduction: ABO Blood group system was discovered by Karl Landsteiner in the year 1900 who classified the blood groups into A,B,AB and O on the basis of the presence or absence of the antigens A and B on the cell surface of Red blood cells.Further ,in the year 1911, Von Dungern and Hirszfeld divided the group A into A1 and A2 hence total of six blood groups A1,A2,B,A1B,A2B,O. Aim of the study is to find out the frequency of subgroups of A and AB Blood groups and its importance in transfusion practice. Methods: A total of 5594 blood donors’ samples were collected in a one-year period who came to donate blood. Blood grouping was done by the conventional tube method both forward and reverse grouping. Sub grouping of A and AB was done by using the commercially available Lectin Anti A1 (Tulip diagnostics, Goa ,India) .Group A red blood cells which agglutinate with Anti A1 lectin are classified as subgroup A1,whereas which do not agglutinate are classified as A2. Result: Out of total 5594 blood donors, 1354 belonged to group A and 413 constituted group AB. The percentage of A1 amongst the A blood group is 93.94% (1272) and A2 is 6.056 (82). The percentage of A1 amongst the AB blood group is 91.04% (376) and A2 is 8.95% (37) Conclusion: The frequency of A1 subgroup is more in comparison to A2 in both A and AB blood groups amongst the blood donors. Identification and recording of subgroups is important in blood bank in respect to blood group discrepancy, blood transfusion reactions as well as Organ transplantation.

In this paper we approximate common fixed points of nearly asymptotically nonexpansive mappings under modified S P-iteration process in the setting of CAT(k) spaces and establish strong and Δ-convergence theorems. Our results generalize and improve the corresponding known results of the existing literature. Keywords: Δ-convergence, Modified SP-iteration process, Nearly asymptotically nonexpansive mapping, Common fixed point, CAT(k) space, Mathematics Subject Classification: 47H09, 47H10

A brief literature review on the breccias of contrasting origin, their diagnostic signatures along with related terminologies is presented here. The importance of individual breccia types and their geological implication has also been reviewed. The present study suggests that breccia is formed either by igneous, sedimentary and tectonic processes or a combination of these. This review is mainly focused on the most common seven sub-classes, (i.e., volcanic, igneous-hydrothermal, chert, collapse, fault, impact and seismic) and the specification of the processes involved in their formation, which subsequently brings more clarity in its classification and characterization. Keywords: Breccia, Volcanic, Fragmentation, Tectonic, Ore deposits

Ebstein's anomaly is an uncommon cardiac malformation affecting tricuspid valve and right ventricle. We report a case of inferior wall myocardial infarction which was haemodynamically decompensated due to presence of previously undiagnosed Ebstein anomaly.Following aspects of this case makes it a rare presentation. Firstly, presentation of Ebstein anomaly as inferior wall myocardial infarction in a young female with previous two successful pregnancies is uncommon. Paradoxical embolism through a patent foramen ovale could be the most probable aetiology which led to thrombotic right coronary artery occlusion leading to inferior wall and right ventricular myocardial infarction. And, the presence of Ebstein anomaly led to cyanosis and further worsening of haemodynamic status. So, this highlights the importance of early revascularization to salvage myocardium in already congenitally thin and fibrosed ventricles in Ebstein anomaly.

The purpose of this paper is to prove some even tupled coincidence theorems for mappings with one variable in ordered complete metric spaces by using the concept of C-class functions. Our results generalize and improve several results in the literature.

The trans-Himalayan region of NW India including the western part of Tibet, Karakoram, and Hindukush range host thousands of glaciers ensuring perennial freshwater supply to the Indian subcontinent and supports a large fraction of the global population. The peculiar physiography not only limits the entry of water enriched Indian Summer Monsoon winds to this region but also give passage to dry winds of barren desert of the Taklamakan, the Aksai Chin, and western Tibet, to qualify it as a cold desert. The Himalayan Orogen linked structural elements and the Quaternary glacial, and interglacial phases define the geomorphological setup of the region, which subsequently modified by the fluvial-lacustrine-aeolian processes. Over the years, our understanding in drawing climatic inferences from the sedimentary archives has improved significantly but the discrepancy in chronology, among and within different dating techniques, poses a serious challenge and therefore requires more work to address the issues. Similarly, till recently, it was argued that the major source of moisture to the Ladakh region is contributed from the Mediterranean Sea because the region falls under the rain shadow zone for the water-laden Indian summer monsoon winds. Our recent water isotopic study of upper Indus River Basin, however, emphasized that Indian summer monsoon source is also an equally important supplier. The present review highlights that the disturbed chronology and inadequate data support on moisture sources are two gap areas for further research.

Daily maximum and minimum temperatures of 4 stations and rainfall of 22 stations of Himachal Pradesh for the period of 1970 to 2014 have been used to work out extreme climate indices and trends. The temperature and rainfall indices for different stations studied showed no uniform trend. The results indicated the increasing trend in minimum of maximum and minimum of minimum temperature. The increased frequency of warm nights and warm spell but decrease in the number of hot days and hot nights were observed at Bajaura and Shimla. The maximum one day rainfall amount, maximum 5-day rainfall during the month and very wet days were found to decrease at most of the stations in the state. Consecutive wet days (CWD) and annual total rainy days (PRCPTOT) showed statistically mixed trends at various stations in the state.

Oxidative stress is one of the key factors that contributes to the pathogenesis of keratoconus (KC). Macroautophagy is a vital cellular mechanism that is activated in response to oxidative stress. The aim of this study was to understand the role of the autophagic lysosomal pathway in the oxidative damage of KC corneal epithelium and the human corneal epithelial cell line (HCE).The corneal epithelium was collected from 78 KC patients undergoing corneal cross-linking or topography guided photorefractive keratectomy. We performed microarray, qPCR and western blot analysis for the expression of autophagy markers on this epithelium from patients with different clinical grades of KC. A differential expression pattern of autophagy related markers was observed in the diseased corneal cone-specific epithelium compared to matched peripheral epithelium from KC patients with increasing clinical severity. Human corneal epithelial cells exposed to oxidative stress were analyzed for the expression of key proteins associated with KC pathogenesis and the autophagic pathway. Oxidative stress led to an increase in reactive oxygen species and an imbalanced expression of autophagy markers in the HCE cells. Further, reduced levels of Akt/p70S6 Kinase, which is a known target of the mTOR pathway was observed in HCE cells under oxidative stress as well as in KC epithelium. Our results suggest that an altered expression of proteins suggestive of defective autophagy and is a consequence of oxidative damage. This could play a possible role in the pathogenesis of KC.

The notion of n-tupled fixed point is introduced by Imdad, Soliman, Choudhury and Das, Jour. of Operators, Vol. 2013, Article ID 532867. In this manuscript, we prove some n-tupled fixed point theorems (for even n) for mappings having mixed monotone property in partially ordered complete asymptotically regular metric spaces. Our main theorem improves the corresponding results of Imdad, Sharma and Rao (M. Imdad, A. Sharma, K.P.R. Rao, Generalized n-tupled fixed point theorems for nonlinear contractions, preprint).

Background: Despite significant advances in understanding and management of neuropsychiatric disorders during past few decades, anxiety and depression, still remains the leading cause of deaths, primarily for want of effective and safe treatment of these ailments. Approximately, two third of the anxious or depressed patients respond to the currently available treatment but the magnitude of improvement is still disappointingPurpose of Study: The aim of the present study was to investigate the antianxiety activity of Gelsemium sempervirens (Linn.) Ait. Various doses (50,100, 150, 200mg/kg) of plant extracts viz., of petroleum ether, chloroform, methanol and water were administered orally to Swiss Albino Mice before evaluating their behavioural pattern. Diazepam (2.5 mg/kg) was used as standard drug.Result: The methanol extract of G. sempervirens (150 mg/kg) increased the mean time spent, mean number of arms entries in the open arms of elevated plus maze (EPM) and decreased the mean time spent in the closed arms. The locomotor activity of methanol extract was not affected to the same extent as observed for diazepam.Conclusion: The results suggested that methanol extract of G. sempervirens possess anxiolytic effects with no sedative activity when compared to diazepam.

The objective of this paper is to numerically investigate the effects of the atmospheric boundary layer on the aerodynamic performance and loads of a novel dual-rotor wind turbine (DRWT). Large eddy simulations are carried out with the turbines operating in the atmospheric boundary layer (ABL) and in a uniform inflow. Two stability conditions corresponding to neutral and slightly stable atmospheres are investigated. The turbines are modeled using the actuator line method where the rotor blades are modeled as body forces. Comparisons are drawn between the DRWT and a comparable conventional single-rotor wind turbine (SRWT) to assess changes in aerodynamic efficiency and loads, as well as wake mixing and momentum and kinetic energy entrainment into the turbine wake layer. The results show that the DRWT improves isolated turbine aerodynamic performance by about 5%–6%. The DRWT also enhances turbulent axial momentum entrainment by about 3.3 %. The highest entrainment is observed in the neutral stability case when the turbulence in the ABL is moderately high. Aerodynamic loads for the DRWT, measured as out-of-plane blade root bending moment, are marginally reduced. Spectral analyses of ABL cases show peaks in unsteady loads at the rotor passing frequency and its harmonics for both rotors of the DRWT.