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Late-presenting congenital diaphragmatic hernia (CDH) is an unusual case. It rarely appears apart from the neonate. We report the case of a 3-month-old male infant presented with a history of recurrent chest infections and breathlessness for the past 4 days. Examination revealed the signs of respiratory distress in the form of subtitles and tachypnea; there was no air entry on the left side but bowel sounds were audible better heart sounds could be auscultated to right. A chest X-ray showed a suspicion of left-sided CDH. Subsequently, the patient was transferred to operation theater farminent. Laparotomy surgery was done under general anesthesia. Note intraoperatively bowel and spleen were reduced from the thoracic cavity and delivered through this posterolateral defect. Following insertion of a chest tube and repositioning the herniated organs back into abdominal cavity, closure was performed. The patient recovered uneventfully with an improvement of the postoperative radiograph. With time, he improved and was able to tolerate oral feeds.

In today’s digital age, the Internet has become an integral part of our lives, providing a wealth of information at our fingertips. However, the ease of accessing medical information online has given rise to a new phenomenon known as cyberchondria (CCD). CCD is characterized by the excessive anxiety and worry caused by the information discovered on the internet, leading individuals to believe that they have a serious medical condition. Although it shares similarities with hypochondria or illness anxiety disorder, there is an ongoing debate about whether CCD should be regarded as a separate condition or simply a manifestation of preexisting hypochondria. Those who engage in self-diagnosis and self-management of their health concerns without confirming the accuracy of the published material are presumed to be affected by CCD. No research has yet been undertaken on CCD therapeutic approaches. Psychoeducation is the cornerstone of CCD therapy. There is no specific pharmaceutical therapy. CCD is a developing public mental health concern in India that needs prompt response or might seriously harm the general public.

In paediatric intensive care units (PICUs), advanced medical care meets deeply emotional human experiences. This review examines grief and bereavement support in PICUs, emphasising its significance in extending palliative care beyond end-of-life scenarios. A comprehensive literature search of PubMed and Google Scholar from 2014 to 2023 yielded 50 relevant studies. The findings illustrate the unique challenges in PICUs, such as children’s limited communication abilities, parental distress and emotional burden on healthcare providers. Our review revealed the multifaceted nature of grief in PICUs, including anticipatory and complicated grief, and its profound impact on families and siblings of PICU patients. We identified diverse emotional, psychological, cultural and spiritual support needs that underscored the importance of continuous bereavement care and access to resources. Current support practices, including counselling, support groups, memorial services and interdisciplinary teamwork, are explored. Challenges such as resource limitations, healthcare providers’ emotional toll and communication barriers are discussed. The study also highlights emerging trends such as digital tools, innovative therapies and policy changes to enhance holistic, family-centred care in PICUs.

In the scientific field, there is a critical need for the rapid and timely dissemination of findings to foster collaborations, seek funding, and establish oneself as a growing expert within their chosen domain. Abstracts are essential for conveying research findings and their significance in a concise manner. A well-written abstract is both unbiased and easily understandable, avoiding hype and jargon that might be difficult for readers without background knowledge in the field to understand. Keywords and Medical Subject Headings (MeSH) are important tools for enhancing the accessibility and discoverability of research. While authors prioritize keywords for search engine optimization, MeSH terms, created by the National Library of Medicine, ensure that articles in medical databases are correctly indexed. Properly choosing and strategically placing keywords with optimal density can effectively increase the visibility and impact of an article. This letter emphasizes the importance of a concise, focused abstract that is easy to read and well-organized, using bullet lists to enhance the dissemination and visibility of scientific research and discusses strategies for choosing and improving keywords.

Over the past few decades, society's perception of transgender individuals has significantly transformed, leading to increased recognition and acceptance. However, despite these positive changes, transgender people have historically faced numerous challenges and stigmatization. This article delves into psychiatric perspectives on transgender sexuality and its impact on mental health. It emphasizes the importance of integrating psychiatrists into primary care to enhance engagement in outpatient behavioral health services for transgender and nonbinary adults. Gender identity and sexuality are interconnected aspects of human experience, and understanding transgender sexuality is essential for mental health professionals to provide effective support and care. Gender dysphoria, a psychological condition stemming from incongruence between gender identity and assigned sex, profoundly affects the mental health of transgender individuals, emphasizing the necessity of affirming and comprehensive mental health care. The significance of cultural factors and intersectionality in supporting transgender individuals and mental health professionals play a critical role in identity development by creating safe and supportive environments for exploration and self-acceptance. Affirmative approaches and treatment options, such as hormone replacement therapy and gender confirmation surgery, are discussed, stressing the importance of collaborative care involving medical and mental health professionals. Ultimately, this article underscores mental health professionals' vital role in supporting transgender individuals' mental well-being, fostering inclusivity, and contributing to more affirming society.

Abstract Considering the major source of plant-derived low/non-calorie steviol glycosides (SGs), comprehensive physiological, biochemical, and deep transcriptional investigations were conducted to explicit deeper insight into multiple abiotic stress responses in Stevia rebaudiana. The physiological indicators including photosynthesis, chlorophyll, relative water content, shoot growth, electrolyte leakage, and SG biosynthesis were negatively impacted under drought (DS), followed by salinity (SS) and waterlogging (WS). Global transcriptional analysis revealed significant upregulated expression of the genes encoding for ROS detoxification (GST, SOD, APX, glutathione peroxidase), osmotic adjustment (alpha-trehalose-phosphate and S-adenosylmethionine decarboxylase), ion transporters (CAX, NHX, CNGS, VPPase, VATPase), water channel (PIP1, TIP) and abiotic stress-responsive candidate genes (LEA, HSPs, and Dehydrins) regulating abiotic stress response in S. rebaudiana. These inferences were complemented with predicted interactome network that revealed regulation of energy metabolism by key stress-responsive genes (GST, HKT1, MAPKs, P5CSs, PIP), transcription factors (HSFA2, DREB1A, DREB2A), and abiotic stress responsive pathways (ABA, ethylene, ion stress). This is the first detailed study to comprehend the molecular regulation of stress response and their interplay under DS, SS, and WS. The key genes and regulators can be functionally validated, and will facilitate targeted gene editing for genetic improvement of crop sustainability under changing environmental conditions in S. rebaudiana.

The challenge of performing efficient and reliable crop classification with multisensor multitemporal (MSMT) images in mixed land cover scenarios i.e. presence of small land parcels (area

Introduction. The intensive care unit (ICU) plays a pivotal role in providing specialized care to patients with severe illnesses or injuries. As a critical aspect of healthcare, ICU admissions demand immediate attention and skilled care from healthcare professionals. However, the intricacies involved in this process necessitate analytical solutions to ensure effective management and optimal patient outcomes. Aim. The aim of this review was to highlight the enhancement of the ICUs through the application of analytics, artificial intelligence, and machine learning. Methods. The review approach was carried out through databases such as MEDLINE, Embase, Web of Science, Scopus, Taylor & Francis, Sage, ProQuest, Science Direct, CINAHL, and Google Scholar. These databases were chosen due to their potential to offer pertinent and comprehensive coverage of the topic while reducing the likelihood of overlooking certain publications. The studies for this review involved the period from 2016 to 2023. Results. Artificial intelligence and machine learning have been instrumental in benchmarking and identifying effective practices to enhance ICU care. These advanced technologies have demonstrated significant improvements in various aspects. Conclusions. Artificial intelligence, machine learning, and data analysis techniques significantly improved critical care, patient outcomes, and healthcare delivery.

IntroductionRiverine forests in the Himalaya represent a biodiverse, dynamic, and complex ecosystem that offers numerous ecosystem services to local and downstream communities and also contributes to the regional carbon cycle. However, these forests have not been assessed for their contribution to dry matter dynamics and carbon flux. We studied these parameters along three classes of riverine forests in eastern Uttarakhand, dominated by Macaranga, Alnus, and Quercus-Machilus forest.MethodsUsing volume equations, we assessed tree biomass, carbon storage, and sequestration in the study area.ResultsThe total standing tree biomass in Macaranga, Alnus, and Quercus-Machilus forest ranged from 256.6 to 558.1 Mg ha−1, 460.7 to 485.8 Mg ha−1, and 508.6 to 692.1 Mg ha−1, respectively. A total of 77.6–79.6% of vegetation biomass was stored in the aboveground biomass and 20.4–22.4% in belowground plant parts across the riverine forests. The carbon stock in Macaranga forest ranged from 115.5 to 251.1 Mg ha−1, in Alnus forest from 207.3 to 218.6 Mg ha−1, and in Quercus-Machilus forest from 228.9 to 311.4 Mg ha−1. The mean annual litterfall was accounted maximum for Quercus-Machilus forest (5.94 ± 0.54 Mg ha−1 yr.−1), followed by Alnus (5.57 ± 0.31 Mg ha−1 yr.−1) and Macaranga forest (4.67 ± 0.39 Mg ha−1 yr.−1). The highest value of litterfall was recorded during summer (3.40 ± 0.01 Mg ha−1 yr.−1) and the lowest in winter (0.74 ± 0.01 Mg ha−1 yr.−1). The mean value of net primary productivity and carbon sequestration was estimated to be highest in Quercus-Machilus forest (15.8 ± 0.9 Mg ha−1 yr.−1 and 7.1 ± 0.9 Mg C ha−1 yr.−1, respectively) and lowest in Alnus forest (13.9 ± 0.3 Mg ha−1 yr.−1 and 6.1 ± 0.3 Mg C ha−1 yr.−1, respectively).DiscussionThe results highlight that riverine forests play a critical role in providing a large sink for atmospheric CO2. To improve sustainable ecosystem services and climate change mitigation, riverine forests must be effectively managed and conserved in the region.

Introduction: Hypertension is a form of cardiovascular disorder that results from a wide range of interconnected etiologies. Untreated and uncontrolled hypertension leads to structural and functional abnormalities of the cardiovascular system, ultimately harming the body’s vital organs, e.g., heart, kidneys, and brain. The study aimed to assess the prevalence of medication adherence among hypertensive patients. Materials and Methods: This study was conducted with a quantitative approach and descriptive research design. The study was conducted at the Outpatient Department of Medicine, Prince Bijay Singh Memorial Hospital & Associated Group Hospitals, Sardar Patel Medical College, Bikaner, Rajasthan, India. The population was 615 hypertensive patients. A nonprobability convenient sampling technique selected the participants. Data collection was done with the help of a demographic profile and Modified Morisky Medication adherence 8-scale. Results: In this study, most subjects (53.98%) were male. Approximately half of the participants (49.75%) had an average level of medication adherence, followed by 38.70% poorly adhering to their prescribed hypertensive regimens. The overall mean medication adherence score was 6.122 ± 1.539. In addition, variables such as age, educational status, other illnesses, regular visits to the doctor, and allergy to drugs were statistically (

BACKGROUND: Vaccination is a quick, safe, and effective way to avoid contracting hazardous diseases, but it often causes pain and discomfort. Various pharmacological and non-pharmacological pain management techniques are used to treat pain. This study aimed to compare the effectiveness of breastfeeding, musical therapy, and oral sucrose in infant’s pain relief during pentavalent vaccination. MATERIALS AND METHODS: A quasi-experimental posttest-only research design was used. A total of 150 infants were enrolled using the purposive sampling technique (50 in the breastfeeding, 50 in the musical therapy, and 50 in the oral sucrose groups) coming for the first, second, and third doses of pentavalent vaccination. The data were collected using observation and the Neonatal Infant Pain Scale (NIPS). The results were calculated by descriptive and inferential statistics. RESULTS: The study revealed that half of the infants in the breastfeeding group felt severe pain, whereas the majority of infants in the musical therapy and oral sucrose groups felt severe pain during pentavalent vaccination. The median pain score in breastfeeding, musical therapy, and oral sucrose was 4.50, 6, and 7, respectively. Breastfeeding was significantly different from both musical therapy and oral sucrose in terms of pain scores. However, no significant difference was observed between musical therapy and oral sucrose. Overall, the results indicate that breastfeeding had a distinct impact on pain relief during pentavalent vaccination compared with the other interventions, while musical therapy and oral sucrose did not differ significantly in their effectiveness. CONCLUSION: The study concluded that breastfeeding is a safe, reliable, cost-effective, and easily accessible method to relieve an infant’s pain during pentavalent vaccination. It is a simple method to alleviate pain among infants during vaccination.

India bears a significant portion of the worldwide burden of chronic and terminal illnesses. Nevertheless, there is a dearth of a standardized approach in delivering optimal end-of-life care (EOLC) to a substantial proportion of patients who have reached the terminal phase of their lives. Health-care providers are urged by health-care professionals to be aware of the cultural and spiritual beliefs and practices that can shape patients' and their families' perspectives on EOLC. They should also emphasize the importance of providing support for religious and cultural practices and involving family members in the EOLC process. Holistic care is discussed as an approach that considers the physical, emotional, spiritual, and social aspects of a patient's well-being. Healthcare providers must address ethical and legal issues when delivering EOLC and prioritize personalized care that respects patients' choices. Language and communication barriers in multicultural EOLC are identified as significant challenges. In a nutshell, the authors discuss the importance of incorporating cultural and spiritual practices in bereavement support to help patients and their families process grief and celebrate the patient's life and legacy. Overall, this article provides a comprehensive overview of the importance of cultural and spiritual awareness in EOLC for elderly patients. It emphasizes the necessity for health-care providers to deliver inclusive and culturally sensitive care, ultimately enhancing the quality of life for both individuals and their loved ones. The significance of cultural and spiritual awareness in improving EOLC for older individuals is underscored in this context.

Alarm fatigue has become a significant concern for intensive care unit (ICU) nurses. The incessant flood of alarms can result in desensitization, negatively affecting both nurses and consequently, patient care. This article delves into the struggles ICU nurses encounter due to alarm fatigue, its repercussions, and potential strategies to tackle the problem. By comprehending and addressing alarm fatigue, healthcare professionals can foster a safer and more efficient work environment for ICU nurses.

Amid the Ukrainian War, the heroes of the intensive care unit (ICU) - doctors, nurses, respiratory therapists, and many others - valiantly confront unprecedented challenges, showcasing resilience and dedication in the face of adversity. Despite limited resources and electricity backup issues, these health professionals worked tirelessly to provide life-saving care to critically ill patients, including those with gunshot wounds, shrapnel injuries, burns, and traumatic brain injuries. The article highlights the need to denounce attacks on medical personnel during conflicts, and strategies for supporting ICU health professionals in war zones are suggested, including hazard pay, comprehensive insurance coverage, safety training and equipment, support networks and mental health services, and ongoing education and professional development. The heroic efforts of ICU health professionals during times of war highlight the crucial role they play in healthcare systems worldwide.

The smart grid’s structure is distinctive because it incorporates numerous cutting-edge communication and sensor technologies. It is challenging to manage smart grids using conventional power grids’ unified optimum delivery strategy effectively. This work offers a smart grid power production and maintenance collaborative optimization framework with renewable energy based on power generation and maintenance analysis. The operating costs of conventional units, the price of generating solar or wind power, and the cost of maintaining units are the problems of objective functions; the constraints taken into account are primarily system constraints. The genetic algorithm (GA) is used in this research to examine the optimization solution strategy. Depending on the properties of the system, various loads, power sources, and constraints are considered. The difficulty of adjusting load scheduling is transformed into a control problem by developing an efficient objective function. When uncertain system components are considered, the real-time control system can dynamically alter load scheduling to meet the needs of the actual system. In this study, the real-time algorithm put forward in this research is based on a strategy that satisfies the load optimization requirement and achieves dynamic compensation for unpredictable changes in renewable energy power generation. Moreover, the simulation compares the proposed algorithm capabilities with the existing algorithms/study, demonstrating the effectiveness of the suggested approach.

Abstract Soil respiration (SR), a natural phenomenon, emits ten times more CO2 from land than anthropogenic sources. It is predicted that climate warming would increase SR in most ecosystems and give rise to positive feedback. However, there are uncertainties associated with this prediction primarily due to variability in the relationship of SR with its two significant drivers, soil temperature and moisture. Accounting for the variabilities, we use a climosequence in Himalaya with a temperature gradient of ~ 2.1 °C to understand the variations in the response of SR and its temperature sensitivity to climate change. Results indicate an equilibrium in SR ranging from 1.92 to 2.42 µmol m−2 s−1 across an elevation gradient (3300–3900 m) despite its increased sensitivity to temperature (Q10) from 0.47 to 4.97. Additionally, moisture reduction towards lower elevation weakens the temperature-SR relationship. Finally, soil organic carbon shows similarities at all the elevations, indicating a net-zero CO2 flux across the climosequence. The findings suggest that as the climate warms in this region, the temperature sensitivity of SR reduces drastically due to moisture reduction, limiting any change in SR and soil organic carbon to rising temperature. We introduce an equilibrium mechanism in this study which indicates the resilient nature of SR to climate change and will aid in enhancing the accuracy of climate change impact projections.

Abstract Background Alcohol abuse is a major problem worldwide and it affects people’s health and economy. There is a relapse in alcohol intake due to alcohol withdrawal. Alcohol withdrawal anxiety-like behavior is a symptom that appears 6–24 h after the last alcohol ingestion. Methods The present study was designed to explore the protective effect of a standardized polyherbal preparation POL-6 in ethanol withdrawal anxiety in Wistar rats. POL-6 was prepared by mixing the dried extracts of six plants Bacopa monnieri, Hypericum perforatum, Centella asiatica, Withania somnifera, Camellia sinesis, and Ocimum sanctum in the proportion 2:1:2:2:1:2 respectively. POL-6 was subjected to phytochemical profiling through LC-MS, HPLC, and HPTLC. The effect of POL-6 on alcohol withdrawal anxiety was tested using a two-bottle choice drinking paradigm model giving animals’ free choice between alcohol and water for 15 days. Alcohol was withdrawn on the 16th day and POL-6 (20, 50, and 100 mg/kg, oral), diazepam (2 mg/kg) treatment was given on the withdrawal days. Behavioral parameters were tested using EPM and LDT. On the 18th day blood was collected from the retro-orbital sinus of the rats and alcohol markers ALT, AST, ALP, and GGT were studied. At end of the study, animals were sacrificed and the brain was isolated for exploring the influences of POL-6 on the mRNA expression of GABAA receptor subunits in the amygdala and hippocampus. Results Phytochemical profiling showed that POL-6 contains major phytoconstituents like withaferin A, quercetin, catechin, rutin, caeffic acid, and β-sitosterol. In-vivo studies showed that POL-6 possesses an antianxiety effect in alcohol withdrawal. Gene expression studies on the isolated brain tissues showed that POL-6 normalizes the GABAergic transmission in the amygdala and hippocampus of the rats. Conclusion The study concludes that POL-6 may have therapeutic potential for treating ethanol-type dependence.

Abstract Alpine ecosystems in the Himalaya, despite low primary productivity, store considerable amount of organic carbon. However, these ecosystems are highly vulnerable to climate warming which may stimulate ecosystem carbon efflux leading to carbon-loss and positive feedback. We used open-top chambers to understand warming responses of ecosystem respiration (ER) and soil respiration (SR) in two types of alpine meadows viz., herbaceous meadow (HM) and sedge meadow (SM), in the Western Himalaya. Experimental warming increased ER by 33% and 28% at HM and SM, respectively. No significant effect on SR was observed under warming, suggesting that the increase in ER was primarily due to an increase in above-ground respiration. This was supported by the warming-induced increase in above-ground biomass and decrease in SR/ER ratio. Soil temperature was the dominant controlling factor of respiration rates and temperature sensitivity of both ER and SR increased under warming, indicating an increase in contribution from plant respiration. The findings of the study suggest that climate warming by 1.5–2 °C would promote ER via increase in above-ground respiration during the growing season. Moreover, net C uptake in the alpine meadows may increase due to enhanced plant growth and relatively resistant SR under warming.

Background: Previous research has shown a significant association between psychological distress (PD) and all-cause mortality. However, there is a dearth of studies quantifying the contributions of sociodemographic and behavioral characteristics to group differences in mortality. In this study, we identify factors of mortality differences by PD. Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed mortality differences between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled data from the 1997-2014 National Health Interview Survey prospectively linked to the 1997-2015 National Death Index (N = 263,825). Results: Low educational level, low household income, and high proportions of current smokers, renters, former drinkers, and adults experiencing marital dissolution contributed to high all-cause mortality among adults with SPD. The relative percentage of all-cause mortality disparity explained by socioeconomic and demographic factors was 38.86%. Approximately 47% of the mortality disparity was attributed to both sociodemographic and behavioral risk factors. Lower educational level (21.13%) was the top contributor to higher all-cause mortality among adults with SPD, followed by smoking status (13.51%), poverty status (11.77%), housing tenure (5.11%), alcohol consumption (4.82%), marital status (3.61%), and nativity/immigrant status (1.95%). Age, sex, and body mass index alleviated all-cause mortality risk among adults with SPD. Conclusions and Global Health Implications: Improved education and higher income levels, and reduced smoking among US adults with SPD might eliminate around half of the all-cause mortality disparity by SPD. Such a policy strategy might lead to reductions in mental health disparities and adverse health impacts both in the US and globally. Copyright © 2022 Lee et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Globally, a number of leading countries have adopted biogeographic based protected area planning to conserve their natural resources. India, a mega-diverse country also has conceded with a massive exercise to prepare a biogeography based conservation planning. Undoubtedly, initiating such conservation planning at national or regional level requires a holistic understanding about the landscapes and its habitat features for their long-term management. In the Indian Trans-Himalaya (ITH), quite a few authors have attempted to identify and name various habitat and vegetation classes. However, several terms have been used on adhoc basis and loosely leading to ambiguity and difficulty in mapping landscape elements and conservation planning. In order to overcome this predicament, the current communication proposes a standardized protocol to identify peculiar landscape-habitat-plant physiognomic classes in ITH. Based on an analysis of habitat characteristics in terms of their geo-morphological and vegetation attributes coupled with an extensive review and examination of existing studies, a total of 20 classes comprising 10 landforms and 10 physiognomic units have been proposed. Salient identifying features of different classes with respect to their physical attributes such as elevation, slope, orientation, stratification, rock exposure, soil type; and vegetation attributes along with dominant and representative species and their management are discussed in detail.

Angelica glauca Edgew, which is an endangered medicinal and aromatic herb, is a rich source of numerous industrially important bioactive metabolites, including terpenoids, phenolics, and phthalides. Nevertheless, genomic interventions for the sustainable utilization and restoration of its genetic resources are greatly offset due to the scarcity of the genomic resources and key regulators of the underlying specialized metabolism. To unravel the global atlas of the specialized metabolism, the first spatial transcriptome sequencing of the leaf, stem, and root generated 109 million high-quality paired-end reads, assembled de novo into 81,162 unigenes, which exhibit a 61.53% significant homology with the six public protein databases. The organ-specific clustering grouped 1136 differentially expressed unigenes into four subclusters differentially enriched in the leaf, stem, and root tissues. The prediction of the transcriptional-interactome network by integrating enriched gene ontology (GO) and the KEGG metabolic pathways identified the key regulatory unigenes that correspond to terpenoid, flavonoid, and carotenoid biosynthesis in the leaf tissue, followed by the stem and root tissues. Furthermore, the stem and root-specific significant enrichments of phenylalanine ammonia lyase (PAL), cinnamate-4-hydroxylase (C4H), and caffeic acid 3-O-methyltransferase (COMT) indicate that phenylalanine mediated the ferulic acid biosynthesis in the stem and root. However, the root-specific expressions of NADPH-dependent alkenal/one oxidoreductase (NADPH-AOR), S-adenosyl-L-methionine-dependent methyltransferases (SDMs), polyketide cyclase (PKC), and CYP72A15 suggest the “root” as the primary site of phthalide biosynthesis. Additionally, the GC-MS and UPLC analyses corresponded to the organ-specific gene expressions, with higher contents of limonene and phthalide compounds in the roots, while there was a higher accumulation of ferulic acid in the stem, followed by in the root and leaf tissues. The first comprehensive genomic resource with an array of candidate genes of the key metabolic pathways can be potentially utilized for the targeted upscaling of aromatic and pharmaceutically important bioactive metabolites. This will also expedite genomic-assisted conservation and breeding strategies for the revival of the endangered A. glauca.

Inula racemosa Hook. f. (Pushkarmula), a perennial Himalayan herb known for its aromatic and phytopharmaceutical attributes, is not yet explored at genomic/transcriptomic scale. In this study, efforts were made to unveil the global transcriptional atlas underlying organ-specific specialized metabolite biosynthesis by integrating RNA-Seq analysis of 433 million sequenced reads with the phytochemical analysis of leaf, stem, and root tissues. Overall, 7242 of 83,772 assembled nonredundant unigenes were identified exhibiting spatial expression in leaf (3761), root (2748), and stem (733). Subsequently, integration of the predicted transcriptional interactome network of 2541 unigenes (71,841 edges) with gene ontology and KEGG pathway enrichment analysis revealed isoprenoid, terpenoid, diterpenoid, and gibberellin biosynthesis with antimicrobial activities in root tissue. Interestingly, the root-specific expression of germacrene-mediated alantolactone biosynthesis (GAS, GAO, G8H, IPP, DMAP, and KAO) and antimicrobial activities (BZR1, DEFL, LTP) well-supported with both quantitative expression profiling and phytochemical accumulation of alantolactones (726.08 μg/10 mg) and isoalantolactones (988.59 μg/10 mg), which suggests “roots” as the site of alantolactone biosynthesis. A significant interaction of leaf-specific carbohydrate metabolism with root-specific inulin biosynthesis indicates source (leaf) to sink (root) regulation of inulin. Our findings comprehensively demonstrate the source-sink transcriptional regulation of alantolactone and inulin biosynthesis, which can be further extended for upscaling the targeted specialized metabolites. Nevertheless, the genomic resource created in this study can also be utilized for development of genome-wide functionally relevant molecular markers to expedite the breeding strategies for genetic improvement of I. racemosa.

The Himalayan region is one of the global biodiversity hotspots. However, its biodiversity and ecosystems are threatened due to abiotic and biotic drivers. One of the major biotic threats to biodiversity in this region is the rapid spread of Invasive Alien Species (IAS). Natural forests and grasslands are increasingly getting infested by IAS affecting regeneration of native species and decline in availability of bio-resources. Assessing the current status of IAS and prediction of their future spread would be vital for evolving specific species management interventions. Keeping this in view, we conducted an in-depth study on two IASs, viz., Ageratina adenophora and Lantana camara in the Indian part of Kailash Sacred Landscape (KSL), Western Himalaya. Intensive field surveys were conducted to collect the presence of A. adenophora (n = 567) and L. camara (n = 120) along an altitudinal gradient between 300 and 3000 m a.s.l. We performed Principal Component Analysis to nullify the multi-colinearity effects of the environmental predictors following MaxEnt species distribution model in the current and future climatic scenarios for both the species. All current and future model precision (i.e., Area Under the Curve; AUC) for both species was higher than 0.81. It is predicted that under the current rate of climate change and higher emission (i.e., RCP 8.5 pathway), A. adenophora will spread 45.3% more than its current distribution and is likely to reach up to 3029 m a.s.l., whereas, L. camara will spread 29.8% more than its current distribution range and likely to reach up to 3018 m a.s.l. Our results will help in future conservation planning and participatory management of forests and grasslands in the Kailash Sacred Landscape-India.

Objectives: Socioeconomic disparities in life expectancy in the United States (US) are marked and have widened over time. However, there is limited research using individual-level socioeconomic variables as such information is generally lacking or unreliable in vital records used for life table construction. Using longitudinal cohort data, we computed life expectancy for US adults by social determinants such as education, income/poverty level, occupation, and housing tenure. Methods: We analyzed the 1997-2014 National Health Interview Survey prospectively linked to mortality records in the National Death Index (N=1,146,271). Standard life table methodologies were used to compute life expectancy and other life table functions at various ages according to socioeconomic variables stratified by sex and race/ethnicity. Results: Adults with at least a Master’s degree had 14.7 years higher life expectancy at age 18 than those with less than a high school education and 8.3 years higher life expectancy than those with a high school education. Poverty was inversely related to life expectancy. Individuals living in poverty had 10.5 years lower life expectancy at age 18 than those with incomes ≥400% of the poverty threshold. Laborers and those employed in craft and repair occupations had, respectively, 10.9 years and 8.6 years lower life expectancy at age 18 than those with professional and managerial occupations. Male and female renters had, respectively, 4.0 years and 4.6 years lower life expectancy at age 18 than homeowners. Women in the most advantaged socioeconomic group outlived men in the most disadvantaged group by 23.5 years at age 18. Conclusions and Global Health Implications: Marked socioeconomic gradients in US life expectancy were found across all sex and racial/ethnic groups. Adults with lower education, higher poverty levels, in manual occupations, and with rental housing had substantially lower life expectancy compared to their counterparts with higher socioeconomic position. Copyright © 2021 Singh and Lee. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Background Decreased tumor content (TC) in resection specimens after neoadjuvant therapy is used to predict prognosis. We investigated whether TC assessed in biopsy specimens or the shift in TC from baseline to on-treatment can be used accordingly to predict response in patients with rare tumors who were treated with pembrolizumab.Methods A total of 57 tumors (represented by 173 baseline and 179 on-treatment biopsies) from 57 patients with rare tumors participating in an ongoing phase II clinical trial of pembrolizumab were evaluated. TC was estimated on H&E-stained slides and tumors were dichotomized into low and high TC according to a cut-off of 10%. Necrosis, proliferative fibrosis (PF) and normal tissue were assessed in on-treatment biopsies. TC at baseline and on-treatment, as well as the shift in TC from baseline to on-treatment, was correlated with clinical response defined according to Response Evaluation Criteria in Solid Tumors.Results A decrease in TC was seen in 14% (n=8); no change in TC was seen in 75% (n=43); and an increase in TC from baseline to on-treatment was seen in 11% (n=6). Objective response was significantly associated with decrease in TC from baseline to on-treatment (38%, 3/8) compared with no change/increase in TC (6%, 3/49) (p=0.031). Patients with a decrease in TC had a significantly increased time to progression (TTP) (75% probability) compared with patients with an increase (20% probability) or no change in TC (19% probability) (p=0.0042). Low TC was seen in 23% (13/57) of the tumors at baseline and in 26% (15/57) on-treatment. High TC was seen in 77% (44/57) of tumors at baseline and in 74% (42/57) on-treatment. No significant associations with response were seen for necrosis, PF or normal tissue in on-treatment biopsies.Conclusion Patients with a decrease in TC from baseline to on-treatment had a significant improvement in objective response and a longer TTP. Our data suggest that the shift in TC might be used to predict response to pembrolizumab in rare tumors. However, further investigations in larger cohorts are needed to determine the clinical value of TC, the shift in TC and the cut-off of 10% assessed in biopsies.Trial registration number NCT02721732

The western Himalaya represent an important and distinct botanical sub-region and biogeographic zone in the Himalayan Biodiversity Hotspot. There is a long history of floral exploration in this region as compared to the eastern Himalaya; however, recent additions of several species to western Himalayan flora reveal remote areas yet to be explored intensively. The present reports on Anemone trullifolia and Berberis angulosa from the subalpine-alpine areas of western Himalaya also emphasize the need for further exploration. In this article, a brief description of these species is presented along with distribution, ecology, phytogeographical notes and photographs are provided for easy identification.

Objective: To determine pattern of health care utilization and extent of out-of-pocket healthcare expenditure in rural areas of Punjab in India. Methods: Using multi stage sampling procedure, 660 participants were selected from 110 villages, out of all 22 districts; 440 participants had utilized outpatient care in past 15 days, and 220 had been hospitalized in past one year. Pretested semistructured questionnaires were used to enquire about household and healthcare expenditures. Out-of-pocket (OoP) expenditure included only direct costs of healthcare. Sevety seven 77 (12%) participants could not provide expenditures, hence were excluded from analysis. More than 10% of total household expenditure on healthcare was considered catastrophic. Results: Majority of the participants had used public sector health facilities for outpatient (57%) and inpatient (51.5%) care. Public sector facilities were utilized more often for communicable diseases and gynaecological problems whereas private sector services were used more commonly for accidents and non-communicable diseases. Mean healthcare expenditure on outpatient and inpatient healthcare services was Indian Rupees (INR) 8501 and INR 53889 respectively. Expenditure in private sector was significantly higher compared to the public sector facilities. Catastrophic expenditure was incurred by 7% of the households while seeking outpatient care and by 53% while seeking inpatient care. To pay for outpatient and inpatient care, 23.3% and 61.5% of the participants respectively had to borrow money or sell their assets. Conclusions: Healthcare expenditure places households under considerable financial strain in rural areas of Punjab in India. Improvements of public hospitals may increase their utilization and decrease financial burden.

Background: Several nonlaboratory based cardiovascular disease (CVD) risk scoring tools are available for resource-limited settings, but the performance of these tools remains to be established in Indian population. This study aimed to assess and compare the performance of the World Health Organization (WHO)/International Society for Hypertension (ISH) risk prediction chart and the Framingham Risk Score (FRS) calculator in an Indian setting. Materials and Methods: This cross-sectional study was carried out among 283 participants aged 30–74 years who attended screening camps in the rural area of Punjab from October to December 2015. Nonlaboratory-based WHO/ISH risk prediction chart for South-East Asia Region and FRS calculator was used to assess the 10-year risk of cardiovascular event. Chi-square test for trend and quadratic weighted kappa were used for analysis. Results: Of total participants, 67.1% were female. Mean age of the study participants was 52.1 (standard deviation ± 11.6) years. Using the WHO/ISH risk prediction chart, 11.3% and 4.9% of the participants were found to have high and very high risk, respectively, whereas, FRS calculator predicted high risk in 13.8% and very high risk in 12.0% for developing CVD in next 10 years. Agreement level between two risk prediction tools was good (67.8%). Conclusion: Although the good agreement was seen between WHO/ISH risk prediction chart and FRS calculator, the proportions of participants having a high and very high risk of CVD identified by these risk prediction tools are significantly different. In resource constraint setting like India, CVD risk prediction tools should be validated for local population by prospective cohort studies to ensure judicious use of resources.

Objective: To evaluate the effects of Oscimum sanctum L (O. sanctum), an important medicinal herb, on alcohol withdrawal syndrome in Wistar rats. Methods: Liquid diet with 7.2%, v/v ethanol was administered to the rats for 21 d. Control group animals received sucrose as an isocaloric liquid diet. After alcohol withdrawal, rats were examined at 6th and 24th hour for major withdrawal signs that included anxiety and hyper locomotor activity. Ethanol withdrawal anxiety was tested using elevated plus maze, light and dark model; the hyper locomotor activity using actophotometer. O. sanctum leaf extract (100, 200 and 300 mg/kg, oral) and diazepam (2 mg/kg, i.p) were administered to the treatment group animals 30 min before alcohol withdrawal estimation. Drug treatment was also given 30 min before the second observation at 24th hour. On the last day of the protocol, rats were sacrificed by cervical dislocation liver, kidney and brain were isolated and preserved in formalin for further histopathological examination. Results: Findings from the present study revealed that O. Sanctum leaf extract treatment at doses 100, 200 and 300 mg/kg, oral had a significant protective effect on signs and symptoms of ethanol withdrawal in alcohol-dependent rats. However, no remarkable pathological and microscopic alterations were observed in histopathological examination. Conclusions:O. sanctum seems to be an active drug for the treatment of alcohol abstinence syndrome.

Compositionally controlled, light-emitting, group IV semiconductor nanomaterials have potential to enable on-chip data communications and infrared (IR) imaging devices compatible with the complementary metal−oxide−semiconductor (CMOS) technology. The recent demonstration of a direct band gap laser in Ge-Sn alloys opens avenues to the expansion of Si-photonics. Ge-Sn alloys showed improved effective carrier mobility as well as direct band gap behavior at Sn composition above 6–11%. In this work, Ge1−xSnx alloy nanoparticles with varying Sn compositions from x = 0.124 to 0.178 were prepared via colloidal synthesis using sodium borohydride (NaBH4), a mild and non-hazardous reducing reagent. Successful removal of the synthesized long-alkyl-chain ligands present on nanoparticles’ surfaces, along with the passivation of the Ge-Sn nanoparticle surface, was achieved using aqueous (NH4)2S. The highly reactive surface of the nanoparticles prior to ligand exchange often leads to the formation of germanium oxide (GeO2). This work demonstrates that the (NH4)2S further acts as an etching reagent to remove the oxide layer from the particles’ surfaces. The compositional control and long-term stability will enable the future use of these easily prepared Ge1−xSnx nanoalloys in optoelectronic devices.

Typhoid conjugate vaccines (TCV) are effective in preventing enteric fever caused by Salmonella enterica serovar Typhi in Southeast Asia and Africa. To facilitate vaccination with the Vi capsular polysaccharide–tetanus toxoid conjugate vaccine, Typbar TCV, and allow it to be transported and stored outside a cold chain just prior to administration, an extended controlled-temperature conditions (ECTC) study was performed to confirm the quality of the vaccine at 40 °C for 3 days at the end of its shelf-life (36 months at 2–8 °C). Studies performed in parallel by the vaccine manufacturer, Bharat Biotech International Limited, and an independent national control laboratory (NIBSC) monitored its stability-indicating parameters: O-acetylation of the Vi polysaccharide, integrity of the polysaccharide–protein conjugate, and its molecular size and pH. ECTC samples stored at 40 °C and 45 °C in comparison with control samples stored at 4 °C and 55 or 56 °C, were shown to have stable O-acetylation and pH; only very slight increases in the percentage of free saccharide and corresponding decreases in molecular size were observed. The deoxycholate method for precipitating conjugated polysaccharide was very sensitive to small incremental increases in percentage of free saccharide, in line with storage temperature and duration. This extended ECTC study demonstrated minimal structural changes to the Vi polysaccharide and conjugate vaccine and a stable formulation following extended exposure to elevated temperatures for the desired durations. This outcome supports the manufacturer’s ECTC claim for the vaccine to be allowed to be taken outside the cold chain before its administration.

During recent botanical explorations in the western Himalaya, three interesting species were recorded from the subalpine-alpine areas, which were hitherto unknown from this region. Their occurrence in this region is phytogeographically significant and noteworthy. In this paper a brief description of these species along with phenology, distribution, ecology, photographs and phytogeographical notes are provided.

Introduction: Chronic non communicable diseases in India have increased in magnitude with earlier onset and more likelihood of complications. Much emphasis is given to early diagnosis and timely treatment. Additionally, tertiary prevention through medication adherence is needed to limit disability and prevent early onset of complications. This study was aimed to assess the magnitude of medication and lifestyle adherence among elderly patients suffering from diabetes and hypertension in rural areas of Punjab. Methodology: This was a clinic based study in district Fatehgarh Sahib, Punjab. Patients were subjected to regular blood pressure and blood glucose monitoring. Thereafter they were offered free medications through weekly clinic held at Community Health Center, Bassi Pathana. Along with treatment, Public Health Nurse conducted counselling on diet and lifestyle. Frequency and process of taking medications was explained in local language and records duly maintained during visits. Results: Nearly 70% of study subjects were more than 50 years old. Males constituted 26% of the sample and 60% of subjects were illiterate. Large majority of study subjects did not consumed tobacco (98.08%) or alcohol (89.42%) in past thirty days. In-sufficient physical activity and poor compliance to diet was reported by 10.5% (Males: 7.4%, Females: 11.7%) and 23.5% (Males: 31.5%, Females: 20.8%) subjects. Nearly 46.15% of study subjects reported missing prescribed medications. Nearly 61.54% of study subjects were very sure that they will be able to take medicines as directed by physician. Conclusion: National Program for Control of Diabetes, Cardio-vascular Disease and Stroke relies on early diagnosis and treatment non- communicable diseases. However, with reported levels of adherence to medication and lifestyle interventions, there is an urgent need of exploring innovative ways to ensure compliance and improve treatment outcomes.

We recorded three species of angiosperms viz., Dontostemon glandulosus, Potentilla pamirica and Carex sagaensis for the first time from Nanda Devi Biosphere Reserve in Uttarakhand, Western Himalaya. These species had not been reported from the state of Uttarakhand, Western Himalaya till date. Since these species are restricted in distribution and very little is known about them, we provide diagnostic features of these species along with photographs to aid field identification, phytogeographic and ecological notes.

Tubercular infection of hydatid cyst of the chest wall in an immunocompetent individual is rare. Immune modulation for symbiosis between host cells and the parasite - Echinococcus granulosus favors tubercular infection. In this case report, we describe a case of both these chronic diseases coexisting together, to present as chest wall mass.

Swamp deer (Rucervus duvaucelii duvaucelii) or Barasingha is categorized as vulnerable on the IUCN Red list. With a global population of less than 5,000 the species has a very limited distribution spanning over 2,000 km2 in India and Nepal. A small population of swamp deer was recently rediscovered in Uttarakhand state at Jhilmil Jheel. This population warranted a conservation initiative because the habitat around this Conservation Reserve is heavily fragmented due to expansion of agriculture, habitation and various other land use practices. The reserve provides an area of only 0.009 km2 per animal, which is insufficient in maintaining a viable population of swamp deer. It is therefore important to identify further potential habitat and to begin linkages between existing and potential habitats. A habitat conservation evaluation can play a key role in influencing conservation strategies by conducting detailed research including identification of potential habitat blocks and suggesting linkages between existing and adjacent potential habitat blocks. In this way the initiative can help to increase the number of swamp deer and to maintain a viable population of the species.

All human genes contain a diverse array of cis-acting elements within introns and exons that are required for correct and efficient precursor messenger RNA (pre-mRNA) splicing. Recent computational analyses predict that most human exons contain elements required for splicing coinciding with an appreciation for the high frequency with which mutations that disruption pre-mRNA splicing cause disease. Minigenes provide a means to directly determine whether disease-causing mutations or single nucleotide polymorphisms (SNPs) affect splicing efficiency. Minigenes have also been instrumental in investigations of alternative splicing to identify cis elements required for cell-specific splicing events, demonstrating regulation of individual splicing events by specific RNA binding proteins, and correlating binding of these splicing regulators with splicing regulation. Here we present a versatile minigene plasmid vector designed for rapid cloning and analysis of cis elements and trans-acting factors that influence splicing efficiency or regulate cell-specific splicing. Ubiquitous expression and unique restriction sites allow for straightforward replacement of a variety of gene segments to analyze the effects of nucleotide substitutions on splicing, to identify tissue-specific regulatory elements, or to determine responsiveness to coexpressed proteins or small molecules.

The Himalaya is the largest mountain range in the world, spanning approximately ten degrees of latitude and elevation between 100 m asl to the highest mountain peak on earth. The region varies in plant species richness, being highest in the biodiversity hotspot of Eastern Himalaya and declining to the North-Western parts of the Himalaya. We examined all published floras (31 floras in 42 volumes spanning the years 1903–2014) from the Indian Himalayan region, Nepal, and Bhutan to compile a comprehensive checklist of all gymnosperms and angiosperms. A total of 10,503 species representing 240 families and 2322 genera are reported. We evaluated all the botanical names reported in the floras for their updated taxonomy and excluded >3000 synonyms. Additionally, we identified 1134 species reported in these floras that presently remain taxonomically unresolved and 160 species with missing information in the global plant database (The Plant List, 2013). This is the most comprehensive estimate of plant species diversity in the Himalaya.