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The primary mission of the healthcare sector is to protect from various ailments with improved healthcare services and to use advanced diagnostic solutions to promote reliable treatments for complex diseases. However, healthcare is among the significant contributors to the current climate crisis. Therefore, research is underway to identify various measures to reduce the emissions from advanced healthcare systems. Modern healthcare facilities invest significantly in renewable energy, efficient energy solutions, and intelligent climate cooling and control technologies. Furthermore, innovative technologies like artificial intelligence (AI) are proposed to enable automation for patient health monitoring. With the advances in AI, there are green AI goals for potentially reducing emissions through data-driven and well-optimized models for healthcare. Furthermore, novel machine learning and deep learning techniques are continually proposed for improved efficiency to reduce emissions. Therefore, the scope of the research is to review the potential of AI in healthcare for lowering emission rates and its methodologies, current approaches, metrics, challenges, and future trends to attain a straightforward pathway.

Cancer is a life-threatening disease, resulting in nearly 10 million deaths worldwide. There are various causes of cancer, and the prognostic information varies in each patient because of unique molecular signatures in the human body. However, genetic heterogeneity occurs due to different cancer types and changes in the neoplasms, which complicates the diagnosis and treatment. Targeted drug delivery is considered a pivotal contributor to precision medicine for cancer treatments as this method helps deliver medication to patients by systematically increasing the drug concentration on the targeted body parts. In such cases, nanoparticle-mediated drug delivery and the integration of artificial intelligence (AI) can help bridge the gap and enhance localized drug delivery systems capable of biomarker sensing. Diagnostic assays using nanoparticles (NPs) enable biomarker identification by accumulating in the specific cancer sites and ensuring accurate drug delivery planning. Integrating NPs for cancer targeting and AI can help devise sophisticated systems that further classify cancer types and understand complex disease patterns. Advanced AI algorithms can also help in biomarker detection, predicting different NP interactions of the targeted drug, and evaluating drug efficacy. Considering the advantages of the convergence of NPs and AI for targeted drug delivery, there has been significantly limited research focusing on the specific research theme, with most of the research being proposed on AI and drug discovery. Thus, the study's primary objective is to highlight the recent advances in drug delivery using NPs, and their impact on personalized treatment plans for cancer patients. In addition, a focal point of the study is also to highlight how integrating AI, and NPs can help address some of the existing challenges in drug delivery by conducting a collective survey.

Objective: Maturity-onset diabetes of the young (MODY) type 5 is caused by an autosomal dominant mutation in the HNF1B gene. Our objective was to report a case of a young girl with bicornuate uterus and recurrent renal stones with diabetes mellitus (DM) without a family history that was diagnosed to be MODY 5. Case Report: A 12-year-old girl presented with recurrent renal stones that were managed with lithotripsy and double-J stenting at various time points. At the age of 14 years, she was found to have a bicornuate uterus with an absent cervix and vagina. She was diagnosed with DM at the age of 16 years without a preceding history of osmotic symptoms or steatorrhea. Although there was no family history of young-onset diabetes, given her long-standing history of müllerian abnormalities, renal cysts, and pancreatic hypotrophy, she was evaluated for MODY. Using the next-generation sequencing, she was found to be positive for a reported HNF1B gene pathogenic mutation c.494G>A (p.Arg165His), confirming a diagnosis of MODY 5. Discussion: There is a significant overlap in clinical criteria for type 2 DM and MODY in the Asian Indian population. The HNF1B gene mutation is difficult to diagnose as none of the clinical manifestations are pathognomonic and many lack a family history of DM. Diagnostic algorithms with specific clinical and biochemical criteria along with pancreatic imaging can help in case detection and direct toward particular genetic mutation analysis. Conclusion: We suggest that genetic testing be offered to patients with otherwise unexplained DM and such genitourinary anomalies.

Objectives To assess whether the extent of deviation from chronic disease guideline recommendations is more prominent for specific diseases compared with combined-care across multiple conditions among multimorbid patients, and to examine reasons for this deviation.Design A cross-sectional cohort.Setting Multimorbidity care management programme across 11 primary care clinics.Patients Patients aged 45–95 years with at least two common chronic conditions, sampled according to being new (≤6 months) or veteran (≥1 year) to the programme.Main outcome measures Deviation from guideline-recommended care was measured for each patient’s relevant conditions, aggregated and stratified across disease groups, calculated as measures of ‘disease-specific’ guideline deviation and ‘combined-care’ (all conditions) guideline deviation for: atrial fibrillation, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disorder, depression, diabetes, dyslipidaemia, hypertension and ischaemic heart disease. Combined-care deviation was evaluated for its association with specific diseases. Frequencies of previously derived reason types for deviation (biomedical, patient personal and contextual) were reported by nurse care managers, assessed across diseases and evaluated for their association with specific diseases.Results Among 204 patients, disease-specific deviation varied more (from 14.7% to 48.2%) across diseases than combined-care deviation (from 14.7% to 25.6%). Depression and diabetes were significantly associated with more deviation (mean: 6% (95% CI: 2% to 10%) and 5% (95% CI: 2% to 9%), respectively). For some conditions, assessments were among small patient samples. Guideline deviation was often attributed to non-disease-specific reasons, such as physical limitations or care burden, as much as disease-specific reasons, which was reflected in the likelihood for guideline deviation to be due to different types of reasons for some diseases.Conclusions When multimorbid patients are considered in disease groups rather than as ‘whole persons’, as in many quality of care studies, the cross-cutting factors in their care delivery can be missed. The types of reasons more likely to occur for specific diseases may inform improvement strategies.Trial registration number NCT01811173; Pre-results.

Daniel Barthelmes, Jay Chandra Department of Ophthalmology, Westmead Hospital, Westmead, NSW, Australia Purpose: To evaluate outcomes in patients with complex retinal detachments (RD) with proliferative vitreoretinopathy (PVR) requiring retinectomy using a staged approach utilizing perfluoro-n-octane (PFO) as a short-term postoperative intraocular tamponade.Methods: Retrospective analysis. Patients who underwent 23G pars plana vitrectomy for the management of complicated RD where PFO was used as a primary temporary intraocular tamponade. Only eyes with PVR in rhegmatogenous RD or eyes with penetrating injuries or globe ruptures (ocular trauma) and subsequent RD with PVR were included. Analysis of 17 eyes of 17 consecutive patients with a minimum follow-up of 12 months during a period of 5 years. The primary outcome measure was the reattachment rate after at least 12 months of follow-up after the PFO removal. Secondary outcome measures were changes in visual acuity, complications due to PFO use, and necessity for further surgeries.Results: Eight eyes with prior penetrating injuries or globe rupture and nine eyes with rhegmatogenous pathology were included. All eyes had PFO as temporary tamponade for 14 days (median), which was replaced by silicon oil. Sixteen eyes (94%) had complete and one eye partial reattachment. No redetachments occurred. All eyes retained or improved visual acuity. On average, only 2.5 procedures, including silicon oil removal, were performed. Two eyes had long-term intraocular pressure of 5 mmHg and no eye had intraocular pressure of ≥21 mmHg. No long-term inflammation was observed.Conclusion: PFO seems to be beneficial in a staged approach to repair complex detachments when used as short-term tamponade. A median period of 14 days allowed for both sufficient retinal support plus a reduction in side effects seen in long-term endotamponades. Keywords: pars plana vitrectomy, complex retinal detachments, proliferative vitreoretinopathy, trauma

Past earthquake disasters have shown that irregular gravity load designed (GLD) reinforced concrete (RC) frame buildings were very vulnerable to strong ground shaking. Many of them collapsed and caused loss of human lives as well as materials. Hence, in order to prevent future disasters, this type of buildings needs to be strengthened against earthquake. This paper presents a case study of an innovative approach for seismic strengthening of a typical six story residential building with a soft/weak first story using buckling restrained braces (BRBs). The seismic performance of the original GLD building and the retrofitted one are compared using three dimensional nonlinear dynamic time history analysis in OpenSees. The analysis results show that the innovative seismic strengthening approach for irregular GLD RC frame buildings using BRBs can significantly reduce maximum story drifts as well as building damages which benefits in reducing the risk of building’s collapse during earthquake.

AIMS: This study assesses the attributable impact of adherence to oral glucose medications as a risk factor for poor glycemic control in population subgroups of a large general population, using an objective medication adherence measure. METHODS: Using electronic health records data, adherence to diabetes medications over a two-year period was calculated by prescription-based Medication Possession Ratios for adults with diabetes diagnosed before January 1, 2010. Glycemic control was determined by the HbA1c test closest to the last drug prescription during 2010-2012. Poor control was defined as HbA1c>75 mmol/mol (9.0%). Medication adherence was categorized as "good" (>80%), "moderate" (50-80%), or "poor" (

Over the past few decades Special Olympics has been criticized within the academic community for failing to provide inclusive recreational services, reinforcing negative stereotypes, misusing volunteers, and lacking research demonstrating positive impacts for individuals with intellectual disabilities and the larger community (Hourcadde, 1989; Storey 2004, 2008). Following the recent passing of Eunice Kennedy Shriver on August 11, 2009 and her husband, R. Sargent Shriver on January 18, 2011, it seems timely to respond to these critics in defense of Special Olympics and the tremendous accomplishments of the Shrivers. This article presents a brief history of the Special Olympics (SO) movement; summarizes the concerns presented in the literature about the organization; highlights the mission and offerings; and presents counter points in defense of its programs. Within the article we advocate that the impact of Special Olympics on the lives of individuals with significant developmental disabilities far surpasses that of any other organization in the world, and SO's potential for future success is certain should the mission and goals remain so strongly focused. As former Chicago Mayor Richard Daley eloquently stated on the opening day of the first International Special Olympic Games in 1968 "You know, Eunice, the world will never be the same after this".

Faculty teaching courses at the higher education level employ a wide variety of strategies on the first day of class. Little research has been conducted on the efficacy of these practices. This study examines the first-day practices of instructors of higher education classes who have been recognized as outstanding practitioners by their respective institutions. The information obtained is framed within the learning theories of social constructivism, feminist and liberatory pedagogy. The results of this inquiry suggest practices that may be recommended to all instructors at the college/university level and generate hypotheses regarding the efficacy of first class practices in higher education.

This study investigates the current state of inclusion practices in general education classrooms via survey of 71 inclusion teachers currently serving as special educators across the state of New York. Specifically, small group instruction, co-teaching, one-to-one instruction, and planning support are explored in relationship to class size, number of students with disabilities, and severity of disability. The qualifications, strengths, and professional development experiences of inclusion teachers based on their reported years of teaching experience, preparatory course work, and professional development opportunities are examined. Finally, information on common forms of assistance including consultant special education teachers, teacher assistants, and classroom volunteers are documented. Quantitative analysis of survey responses indicate great variability among the inclusion practices employed in general education classrooms. Co-teaching, though frequently cited as the most beneficial model of inclusive practice, emerged as the least documented method of instruction, with the utilization of consultant teacher models emerging as the most prevalent. Endorsement of the use volunteer support was found to be the second most common support mechanism employed within inclusive classrooms. Few differences in the types of supports employed were found across population densities. Findings highlight the heterogeneity of current inclusion practices, and bear implications in terms of future research examining the qualifications of support staff assisting students with special needs, such as volunteers, and the overall efficacy of inclusion practices in general. (Contains 11 tables.)

Reinforced concrete (RC) wall is a critical structural member that resists lateral loadings, such as earthquake and wind. RC wall having moderate height to length ratio, 1.50-2.50, has the altered shearflexure interaction (SFI) behavior, so shear and flexural failure mechanisms occur almost concurrently. Therefore, an experimental study of a moderate RC wall was conducted as a comprehensive study of the wall's coupled nonlinear shear-flexure behavior under cyclic loading. The experimental results show that the RC wall failed in flexure mechanism, indicated by crushing of the flexural compression zone, and followed by immediate shear failure, notified by the occurrence of web crushing. In addition to the experiment, an analytical model using SFI-MVLEM element in OpenSees software was performed to verify the experimental results. The analytical results show that the model is able to simulate reasonably well the coupled nonlinear shearflexure behavior of the RC wall subjected to cyclic loading. [ABSTRACT FROM AUTHOR]