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Introduction: Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions. Objective: Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop. Methods: We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop. Results: Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice. Conclusions: This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs. Disclosure: No. [ABSTRACT FROM AUTHOR]

Supercapacitors are considered as newly developed auxiliary and clean supplies of power and energy for the next generation energy storage devices with significant impact in many fields. In the present investigation, Ag nanoparticles decorated over TiO2-ZrO2 films are used as the material for energy storage applications. The cyclic voltammograms of the proposed material show better specific capacitance values and robust cyclic stability. The results of the electrochemical measurements further show a strong double-layer electrical capacitance of ternary mixed oxides. The synergetic interaction among the components in the hierarchical nanostructured porous Ag@TiO 2-ZrO2 film guaranteed the good capacitive performance. The comparison between the TiO2-ZrO2 films and Ag decorated TiO 2-ZrO2 films bring out the strong interconnection between the constitution and composition of both systems and their properties. These results underline the exceptional electrical double layer capacitive behavior that is seen in porous ternary composite films with better surface area. Furthermore, such a simple and low-cost layer by layer assembly method with self-cleaning property can be used for the large-scale fabrication of diverse functional architectures for energy storage and conversions.

Background: The prime concern for an individual with disability is independence. Self-help groups (SHGs) provide opportunities for those with such needs. Objectives: The objectives of the study were (i) to assess the impact of SHGs on the livelihood, social inclusion, and community participation of those with disability and (ii) to evaluate the self-esteem and assess the role of such SHGs among those with disability. Materials and Methods: This was a community-based, cross-sectional study. An interview schedule captured responses to standardized questionnaires (community-based rehabilitation assessment tool, Rosenberg's self-esteem score, and Social Inclusion Scale). Responses were scored and compared among the two groups of those with disability (member or nonmember of SHGs). Results: The median scores for all our outcome variables were found to be more among those with disabilities enrolled in SHGs than those who were not with a significant association in the component of empowerment, sociocommunity participation, social inclusion, and self-esteem. Conclusion: SHGs improve social and community participation of individuals with disability. It empowers them to lead independent lives and also contributes to social inclusion.

'Urine dipstick', the commonly used point-of-care test, is an extremely sensitive investigation. Results of this test affected by numerous factors, if not meticulously linked with detailed history and examination, can lead a well-meaning clinician down the wrong clinical pathway. The aim of this article is to provide an overview of this every day test, touching on the physiological and technological basis initially, but mainly focusing on common questions like when to request the dipstick test, the correlation of dipstick results with urine specimen collected by different method and complexities of interpretation of dipstick results in everyday clinical scenarios. [ABSTRACT FROM AUTHOR]

Despite the fact that metal oxides have gained a foothold into a range of structural applications over the last decade, their investigation in the field of sensors, supercapacitors, has been limited. Novel sol-gel derived TiO2-ZrO2 composite coatings have recently found lots of applications in industrial as well as scientific world. The present article reviews, scrutinizes and highlights various types of applications of TiO2-ZrO2 coatings, functioning mechanisms and synthesis techniques used globally. Herein, particular emphasis is firstly given to the challenges faced by metal oxides in their performance for different applications. The different synthesis methods for the metal oxide composites and deposition techniques for obtaining corresponding coatings were examined in-depth from the aspects of its merits and demerits. Their distinct characteristics, underlying mechanisms, and possible applications in a variety of fields are highlighted. The literature work also enumerates studies of the surface property towards water and organic dirt may jointly conclude its self-cleaning nature. The review provides an up-to-date account on the different applications such as electrochemical storage, antibacterial effect and photocatalysis for TiO2-ZrO2 coatings. An insightful viewpoint for rational design of binary metal oxide TiO2-ZrO2 towards sensing and capacitance is also provided. The functionalities include better surface area and porosity which facilitates the charge transport and prevention of charge recombination of the synthesized TiO2-ZrO2 composite coatings are thoroughly reviewed. Finally, the prospective uses and future perspectives, along with their scaling capabilities and potential advances of these nanocomposite coatings are examined.

We have studied the kinetics and elucidated the mechanism by DFT calculation of the reaction between ethanolamine (EOA) and 1‐fluoro‐2,4‐dinitrobenzene (DNFB) in acetonitrile and toluene. To determine the contribution of the nitro group, the activation energy of the reaction between ethanolamine and 1‐fluoro‐2‐nitrobenzene (MNFB) vs. DNFB was determined in acetonitrile and calculated by DFT method. Kinetic measurements reveal that the reaction is faster in acetonitrile than in toluene. The reaction follows overall second‐order kinetics: first order with respect to both EOA and DNFB which is similar to the results reported for reaction between other primary amines and 1‐substituted‐2,4‐dinitrobenzenes. The calculations by using DFT methods reveal that the mechanism of the reaction involves the formation and decomposition of a Meisenheimer complex (MC). DFT calculations also reveal that the activation energy of the reaction is highest in vacuum and decreases with increasing polarity of the solvent reaching a minimum in acetonitrile. In addition, activation energies obtained by both DFT calculations and experiments show that the reactivity of MNFB is less than that of DNFB showing the effect of the 4‐nitro group. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Single crystals of Sm3+ doped cerium oxalate decahydrate were synthesized using single diffusion gel technique and the conditions influencing the size, morphology, nucleation density and quality of the crystals were optimized. Highly transparent single crystals of average size 3 mm × 2 mm × 1 mm with well-defined hexagonal morphology were grown during a time period of two weeks. X-ray powder diffraction analysis revealed that the grown crystals crystallize in the monoclinic system with space group P21/c as identical with the pure cerium oxalate. The various functional groups of the oxalate ligand and the water of crystallization were identified by Fourier transform infrared spectroscopy. The photoluminescence spectrum of the Sm3+ doped cerium oxalate indicated that the Sm3+ ions are optically active in the cerium oxalate matrix. The crystal has a strong and efficient orange red emission with a wavelength peak at 595 nm and hence can be effectively used for optical amplification. Microhardness measurements of the crystal revealed that they belong to the soft material category.

A combined sol–gel and electrospinning process was employed to synthesize one-dimensional nanofibers of samarium molybdate (Sm2MoO6). X-ray diffraction (XRD), scanning electron microscopy (SEM), photoluminescence (PL) and CIE chromaticity studies were used to characterize the resulting samples. XRD studies revealed the formation of crystalline phase of nanofibers on annealing. SEM analyses indicate that the fibers were of uniform size with length of 10–100 μm. Due to the efficient energy transfer from host molybdate groups to Sm3+, Sm2MoO6 phosphors show their strong characteristic emission on exciting the molybdate group. The emission colors of Sm2MoO6 nanofibers are in the orange red region hence suggests its potential applications in fluorescent lamps and field emission displays (FEDs).

Traffic analysis and anomaly detection have been extensively used to characterize network utilization as well as to identify abnormal network traffic such as malicious attacks. However, so far, techniques for traffic analysis and anomaly detection have been carried out independently, relying on mechanisms and algorithms either in edge or in core networks alone. In this paper we propose the notion of multi-level network resilience, in order to provide a more robust traffic analysis and anomaly detection architecture, combining mechanisms and algorithms operating in a coordinated fashion both in the edge and in the core networks. This work is motivated by the potential complementarities between the research being developed at IIT Madras and Lancaster University. In this paper we describe the current work being developed at IIT Madras and Lancaster on traffic analysis and anomaly detection, and outline the principles of a multi-level resilience architecture.

This study was conducted to determine the effect of reducing ruminally degradable protein (RDP) with constant ruminally undegradable protein in mid-lactation dairy cow diets on feed intake, milk production, milk composition, feed efficiency and body condition score. Forty mid-lactation Holstein (36) and Jersey by Holstein cross-bred (4) cows were randomly assigned to one of four dietary treatments. Diets were fed as total mixed rations. A common diet of 18.4% crude protein (CP) was fed from day 1 to 28. From day 29 through 47, cows were fed diets with formulated CP contents of 18, 16.8, 15.7, or 14.5% with formulated RDP contents of 11.3, 10.4, 8.5 and 7.6% of dry matter, respectively. Cows were transitioned to lower CP diets over a period of 3 d. Feed intake, milk yield and body weight were measured daily. Milk composition was measured for 3 d in each of weeks 3 and 7. Body condition was scored by two individuals at the end of the 3rd and 7th weeks. Blood was collected from the coccygeal vessel on two days in weeks 3 and 7 for metabolite analyses. Individual forage samples, grain mixtures and total mixed rations were sampled weekly. The Proc Mixed procedure of SAS was used to analyze the data using a repeated measures model. Second period milk yields were observed to be 41.2, 42.1, 40.3, and 36.6 kg/d as dietary CP decreased from 18 to 14.5% with the lowest CP diet trending towards significance. No treatment effects were observed for body weight or milk fat, protein, or lactose content. Milk urea nitrogen decreased linearly as the CP content of the diets declined averaging 20.2, 17.6, 14.3, and 12.4 mg/dl, respectively, for diets of 18 to 14.5% CP. These results suggest that mid-lactation dairy cows can be fed diets with RDP contents as low as 8.5% of dry matter, which is less than that recommended by NRC (2001). This indicates that current NRC RDP requirements may be overstated. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary transit time (PTT) is the time it takes blood to pass from the right ventricle to the left ventricle via the pulmonary circulation, making it a potentially useful marker for heart failure. We assessed the association of PTT with diastolic dysfunction (DD) and mitral valve regurgitation (MVR). Methods: We evaluated routine stress perfusion cardiovascular magnetic resonance (CMR) scans in 83 patients including assessment of PTT with simultaneously available echocardiographic assessment. Relevant DD and MVR were defined as exceeding Grade I (impaired relaxation and mild regurgitation). PTT was determined from CMR rest perfusion scans. Normalized PTT (nPTT), adjusted for heart rate, was calculated using Bazett's formula. Results: Higher PTT and nPTT values were associated with higher grade DD and MVR. The diagnostic accuracy for the prediction of DD as quantified by the area under the ROC curve (AUC) was 0.73 (CI 0.61-0.85; p = 0.001) for PTT and 0.81 (CI 0.71-0.89; p < 0.001) for nPTT. For MVR, the diagnostic performance amounted to an AUC of 0.80 (CI 0.68-0.92; p < 0.001) for PTT and 0.78 (CI 0.65-0.90; p < 0.001) for nPTT. PTT values < 8 s rule out the presence of DD and MVR with a probability of 70% (negative predictive value 78%). Conclusion: CMR-derived PTT is a readily obtainable hemodynamic parameter. It is elevated in patients with DD and moderate to severe MVR. Low PTT values make the presence of DD and MVR-as assessed by echocardiography-unlikely., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Martin Segeroth et al.)

Background Report writing skills are a core competency to be acquired during residency, yet objective tools for tracking performance are lacking. Purpose To investigate whether the Jaccard index, derived from report comparison, can objectively illustrate learning curves in report writing performance throughout radiology residency. Materials and Methods Retrospective data from 246 984 radiology reports written from September 2017 to November 2022 in a tertiary care radiology department were included. Reports were scored using the Jaccard similarity coefficient (ie, a quantitative expression of the amount of edits performed; range, 0-1) of residents' draft (unsupervised initial attempt at a complete report) or preliminary reports (following joint readout with attending physicians) and faculty-reviewed final reports. Weighted mean Jaccard similarity was compared between years of experience using Welch analysis of variance with post hoc testing overall, per imaging division, and per modality. Relationships with years and quarters of resident experience were assessed using Spearman correlation. Results This study included 53 residents (mean report count, 4660 ± 3546; 1-5 years of experience). Mean Jaccard similarity of preliminary reports increased by 6% from 1st-year to 5th-year residents (0.86 ± 0.22 to 0.92 ± 0.15; P < .001). Spearman correlation demonstrated a strong relationship between residents' experience and higher report similarity when aggregated for years ( r s = 0.99 [95% CI: 0.85, 1.00]; P < .001) or quarters of experience ( r s = 0.90 [95% CI: 0.73, 0.96]; P < .001). For residents' draft reports, Jaccard similarity increased by 14% over the course of the 5-year residency program (0.68 ± 0.27 to 0.82 ± 0.23; P < .001). Subgroup analysis confirmed similar trends for all imaging divisions and modalities (eg, in musculoskeletal imaging, from 0.77 ± 0.31 to 0.91 ± 0.16 [ P < .001]; r s = 0.98 [95% CI: 0.72, 1.00] [ P < .001]). Conclusion Residents' report writing performance increases with experience. Trends can be quantified with the Jaccard index, with a 6% improvement from 1st- to 5th-year residents, indicating its effectiveness as a tool for evaluating training progress and guiding education over the course of residency. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Bruno in this issue.

Competing Interests: There are no conflicts of interest.

This study is to examine zinc exchanged montmorillonite (Zn-MMT) as a potential slow release nanofertilizer for rice crop. The effective intercalation of zinc within the montmorillonite inter layers was firmly established via analytical techniques including Zeta potential, FE-SEM (Field Emission Scanning Electron Microscopy) with Energy Dispersive X-ray Analysis (EDAX), Transmission Electron Microscope (TEM), X-Ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FT-IR). The efficacy of Zn-MMT was examined by evaluating its ability to facilitate controlled zinc release, as confirmed through an incubation study. Subsequently, the kinetics of zinc release was analyzed by different mathematical models such as Zero-order kinetics, First-order kinetics, the Higuchi model, and the Korsmeyer-Peppas model. From the pot culture study spanning 90 days the results indicated that Zn-MMT had significantly high plant height, Leaf Area Index (LAI), Dry Matter Production (DMP), number of tillers per hill, panicles length, increased grain and straw yield, in comparison with conventional zinc sulphate (ZnSO 4 ). Total phenol, total protein and total chlorophyll content were significantly at higher levels with Zn-MMT treated rice crops as compared to conventional fertilizers and control. A similar trend was seen with phytochemicals such as Indole Acetic Acid (IAA), Superoxide Dismutase (SOD) and Carbonic Anhydrase (CA). Notably, rice grains harvested from Zn-MMTtreated crops exhibited significantly higher zinc content than those using other treatments. This Zn-MMT can be confirmed as a better alternative to conventional zinc sulphate fertilizers owing to its slow-release of nutrient into the soil and thus increased zinc use efficiency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Rationale: Microbubble ( MB ) contrast agents combined with ultrasound targeted microbubble cavitation ( UTMC ) are a promising platform for site-specific therapeutic oligonucleotide delivery. We investigated UTMC-mediated delivery of siRNA directed against epidermal growth factor receptor ( EGFR ), to squamous cell carcinoma ( SCC ) via a novel MB-liposome complex ( LPX ). Methods: LPXs were constructed by conjugation of cationic liposomes to the surface of C 4 F 10 gas-filled lipid MBs using biotin/avidin chemistry, then loaded with siRNA via electrostatic interaction. Luciferase-expressing SCC-VII cells ( SCC-VII-Luc ) were cultured in Petri dishes. The Petri dishes were filled with media in which LPXs loaded with siRNA against firefly luciferase ( Luc siRNA ) were suspended. Ultrasound ( US ) (1 MHz, 100-µs pulse, 10% duty cycle) was delivered to the dishes for 10 sec at varying acoustic pressures and luciferase assay was performed 24 hr later. In vivo siRNA delivery was studied in SCC-VII tumor-bearing mice intravenously infused with a 0.5 mL saline suspension of EGFR siRNA LPX (7×10 8 LPX, ~30 µg siRNA) for 20 min during concurrent US (1 MHz, 0.5 MPa spatial peak temporal peak negative pressure, five 100-µs pulses every 1 ms; each pulse train repeated every 2 sec to allow reperfusion of LPX into the tumor). Mice were sacrificed 2 days post treatment and tumor EGFR expression was measured (Western blot). Other mice ( n =23) received either EGFR siRNA-loaded LPX + UTMC or negative control ( NC ) siRNA-loaded LPX + UTMC on days 0 and 3, or no treatment ("sham"). Tumor volume was serially measured by high-resolution 3D US imaging. Results: Luc siRNA LPX + UTMC caused significant luciferase knockdown vs. no treatment control, p <0.05) in SCC-VII-Luc cells at acoustic pressures 0.25 MPa to 0.9 MPa, while no significant silencing effect was seen at lower pressure (0.125 MPa). In vivo, EGFR siRNA LPX + UTMC reduced tumor EGFR expression by ~30% and significantly inhibited tumor growth by day 9 (~40% decrease in tumor volume vs. NC siRNA LPX + UTMC, p <0.05). Conclusions: Luc siRNA LPXs + UTMC achieved functional delivery of Luc siRNA to SCC-VII-Luc cells in vitro . EGFR siRNA LPX + UTMC inhibited tumor growth and suppressed EGFR expression in vivo , suggesting that this platform holds promise for non-invasive, image-guided targeted delivery of therapeutic siRNA for cancer treatment., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)