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Abstract Background Aortic regurgitation with dilated annulus presents a technical challenge for conventional transcatheter aortic valve implantation (TAVI) procedures. Case presentation We report a case of an 84-year-old frail patient with a history of breathlessness found to have severe aortic regurgitation and moderately impaired left ventricular systolic function. The patient underwent a successful TAVI procedure using the XL-Myval 32 mm transcatheter heart valve (THV) via an anterior right mini-thoracotomy with a direct aortic approach. The patient recovered well post-operatively with good hemodynamic resolution. Conclusions This first in human case highlights the efficacy and potential of applying innovative approaches, such as the new sizes of Myval THV and direct aortic access via anterior right mini thoracotomy, in addressing challenging anatomical variations in TAVI procedures with good outcome.

The treatment of diverticulitis is experiencing a shift in management due to a number of large scale clinical trials. For instance, clinicians are beginning to recognize that avoidance of antibiotics in uncomplicated diverticulitis is not associated with worse outcomes. Additionally, while the decision to proceed with elective surgical resection for recurrent uncomplicated disease is less conclusive and favors a patient-centric approach, complicated disease with a large abscess denotes more aggressive disease and would likely benefit from elective surgical resection. Lastly, in patient with acutely perforated diverticulitis who require urgent surgical intervention, laparoscopic lavage is generally not recommended due to high re-intervention rates and the preferred surgical procedure is primary anastomosis with or without diversion due to high morbidity and low rates of Hartmann reversal.

This article explores the performance of interconnected queueing systems and queueing-inventory systems (IQSQIS) in stochastic modeling. IQSQIS features two types of service facilities with dual service stations: one providing non-commodity service with a multi-server, and another handling commodity sales with a single server. As directed, a customer type i,i=1,2 can approach the station i,i=1,2 whose arrival pattern follows the marked Markovian arrival process (MMAP) since we assume that both service stations have an equal arrival phase. The IQSQIS gives an offer to the type-2 customer to choose type-1 service at the end of their service completion. Numerical results suggest that this option reduces customer wait times, orbit size, and overall system costs. The comparative analysis of heterogeneous and homogeneous servers in station-1 and queue-dependent and non-queue-dependent service facilities in station-2 is presented and investigated using the numerical outputs.

Abstract Introduction The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women. Methods A household survey was conducted by using a multi-stage sample with 407 married women aged 18–45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services. Results Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth. Conclusion This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth.

Environmental pollution control in the growing world is a challenging task for all the countries in order to keep the environmental sustainability. Biochar, a processed carbon material, draws a significant attention in the field of environmental remediation, as of its active functional groups that help remove environmental pollutants to a level insignificant to cause hazardous effects. As such, there is an increasing interest developed to promote highly productive biochar for exploring environmental engineering aspects. There is limited comprehensive literature available for understanding biochar science and its potential applications under an umbrella. This review was set to fill this knowledge gap by discussing key points related to biochar, its novel engineering aspects and potential environmental applications. Therefore, this overview tends to summarize and discuss biochar, its fundamentals, engineering aspects commonly used modifications and the potential applications of biochar in water treatment with an intention of addressing the importance of biochar for environmental remediation process. This overview will be useful for researchers, policy-makers and stakeholders to plan and review relevant scientific works in order to produce customized biochar for future environmental applications. HIGHLIGHTS Comprehensive summary of new methods used for engineered biochar production.; Discussion about the functional properties of engineered biochar.; New insights into the use of engineered biochar for the removal of pollutants.; Mechanism of pollutant removal by engineered biochar.;

Background The purpose of the study was to compare the effectiveness of yoga as a form of Vestibular Rehabilitation (VR) to standard VR for managing patients with symptoms such as dizziness, disequilibrium and gait instability. Methods 150 participants based on 18-point difference in the DHI score were randomly assigned to group 1- Yoga, group 2- VR and group 3- control group using block randomization. The intervention was provided for 12 weeks. The participants were assessed for Dizziness Handicap Inventory (DHI) at baseline, 4 th, 8 th and 12 th week. Results The mean DHI for group 1(41.12±7.13) group 2 (42.96±10.54) group 3 (50.84±10.78), p Conclusions In addition to VR, Yoga and medications administered concurrently can provide effective therapeutic effects. Yoga has an advantage over VR since it offers a customized cure for giddiness in addition to symptom relief. Yoga might be a great alternative to the conventional VR because along with enhancing overall body relaxation, it is affordable and is easy to learn.

ABSTRACTVaricella vaccine was first licensed in Japan and South Korea in 1989 for use in healthy children and was introduced in US in 1995. So far, 29 countries have adopted varicella vaccine in their universal immunization program (UIP). No Asian country, India included, has adopted the varicella vaccine as part of their UIP. The extra-cutaneous sites for VZV diseases are central nervous system and gastrointestinal tract, the expanded disease spectrum includes vasculopathy, myelitis, inflammatory bowel disease, perforated ulcers, and gastritis. The actual disease burden of varicella is not known as most of the infected individuals may not visit the physician. The amplifiable VZV DNA will not always be detectable in cerebrospinal fluid (CSF) samples in protracted illnesses such as vasculopathies, but demonstrable anti-VZV IgG in CSF has diagnostic value. The World Health Organization (WHO) position paper 2014 recommends two doses of varicella and zoster vaccines in targeted population. In India, varicella vaccine is not included in the UIP due to the cost and the belief that lifelong immunity occurs following primary infection. The expanded spectrum of VZV disease and the mounting body of evidence, however, suggest the need for both varicella and zoster vaccines in routine immunization schedule.

Background The purpose of the study was to compare the effectiveness of yoga as a form of Vestibular Rehabilitation (VR) to standard VR for managing patients with symptoms such as dizziness, disequilibrium and gait instability. Methods 150 participants based on 18-point difference in the DHI score were randomly assigned to group 1- Yoga, group 2- VR and group 3- control group using block randomization. The intervention was provided for 12 weeks. The participants were assessed for Dizziness Handicap Inventory (DHI) at baseline, 4th, 8th and 12th week. Results The mean DHI for group 1(41.12±7.13) group 2 (42.96±10.54) group 3 (50.84±10.78), p

Time series studies of microbiome interventions provide valuable data about microbial ecosystem structure. Unfortunately, existing models of microbial community dynamics have limited temporal memory and expressivity, relying on Markov or linearity assumptions. To address this, we introduce a new class of models based on transfer functions. These models learn impulse responses, capturing the potentially delayed effects of environmental changes on the microbial community. This allows us to simulate trajectories under hypothetical interventions and select significantly perturbed taxa with False Discovery Rate guarantees. Through simulations, we show that our approach effectively reduces forecasting errors compared to strong baselines and accurately pinpoints taxa of interest. Our case studies highlight the interpretability of the resulting differential response trajectories. An R package, mbtransfer, and notebooks to replicate the simulation and case studies are provided.

BackgroundMultimorbidity, defined as the coexistence of multiple chronic conditions, poses significant challenges to health care systems on a global scale. It is associated with increased mortality, reduced quality of life, and increased health care costs. The burden of multimorbidity is expected to worsen if no effective intervention is taken. Machine learning has the potential to assist in addressing these challenges since it offers advanced analysis and decision-making capabilities, such as disease prediction, treatment development, and clinical strategies. ObjectiveThis paper represents the protocol of a scoping review that aims to identify and explore the current literature concerning the use of machine learning for patients with multimorbidity. More precisely, the objective is to recognize various machine learning models, the patient groups involved, features considered, types of input data, the maturity of the machine learning algorithms, and the outcomes from these machine learning models. MethodsThe scoping review will be based on the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Five databases (PubMed, Embase, IEEE, Web of Science, and Scopus) are chosen to conduct a literature search. Two reviewers will independently screen the titles, abstracts, and full texts of identified studies based on predefined eligibility criteria. Covidence (Veritas Health Innovation Ltd) will be used as a tool for managing and screening papers. Only studies that examine more than 1 chronic disease or individuals with a single chronic condition at risk of developing another will be included in the scoping review. Data from the included studies will be collected using Microsoft Excel (Microsoft Corp). The focus of the data extraction will be on bibliographical information, objectives, study populations, types of input data, types of algorithm, performance, maturity of the algorithms, and outcome. ResultsThe screening process will be presented in a PRISMA-ScR flow diagram. The findings of the scoping review will be conveyed through a narrative synthesis. Additionally, data extracted from the studies will be presented in more comprehensive formats, such as charts or tables. The results will be presented in a forthcoming scoping review, which will be published in a peer-reviewed journal. ConclusionsTo our knowledge, this may be the first scoping review to investigate the use of machine learning in multimorbidity research. The goal of the scoping review is to summarize the field of literature on machine learning in patients with multiple chronic conditions, highlight different approaches, and potentially discover research gaps. The results will offer insights for future research within this field, contributing to developments that can enhance patient outcomes. International Registered Report Identifier (IRRID)PRR1-10.2196/53761

Abstract Internet‐of‐things is an enabling technology in the fourth‐generation industrial revolution. The freshness of the data sent by a sensor node (SN) is an important parameter in the Internet‐of‐things, unlike the throughput in cellular communications. A relatively new performance metric named age of information (AoI) is used in this paper to quantify the freshness of the data. The SN, located in the transport infrastructure, harvests energy from radio frequency signals transmitted by the FD‐UAV. This is used to transmit real‐time sensor observations to the data sink via FD‐UAV. The SN generates an update after replenishing the battery and transmits it by using the harvested energy. A closed‐form expression for average AoI is derived as a function of time allocated for energy harvesting. The optimal time allocation for energy harvesting that maximizes the freshness of data update is identified. A deep learning technique namely long‐short term memory is used to predict the average AoI. Simulation results demonstrate the usefulness of the performance bounds in terms of the freshness of data updates.

Schizophrenia is a disorder with a highly heterogeneous clinical picture. Depressive symptoms occur in schizophrenia, and they increase the disease burden and distress. There are very few studies on this topic in India. This study aims to estimate the prevalence of depressive symptoms in schizophrenia and its correlation with socio-demographic factors as well as symptom domains such as positive, negative and general psychopathology. This cross-sectional study was conducted in a tertiary care hospital with consecutive sampling. Persons diagnosed with schizophrenia were administered a semi-structured proforma to collect socio-demographic data. Positive and Negative Symptom Scale (PANSS) was administered to assess symptom domains, and The Calgary Depression Scale for schizophrenia (CDSS) was used to measure depressive symptoms. The cut-off score to determine clinically significant depression was fixed at a score >7. This study found that 28.6 % of persons with schizophrenia had clinically significant depression. It was found that there were no significant differences in age, education, marital status, residence, occupation, or socio-economic class between the depressed and non-depressed groups. 40% of the depressed patients had a positive history of previous suicide attempts, while in the non-depressed group, only 14% had a positive history of prior suicide attempts. In this study, the psychopathology of schizophrenia measured by the PANSS positive scale, negative scale, general psychopathology scale, and the PANSS total score did not have any statistically significant correlation with the depressive symptoms assessed by the Calgary depression scale for schizophrenia. The multidimensional model of schizophrenia gives a valid explanation for the absence of any correlation between depressive symptoms and other psychopathological entities. The clinically significant depression in schizophrenia is probably an independent component rather than a consequence of the psychotic symptomatology. The depressive symptoms should be addressed while treating schizophrenia, and appropriate therapeutic interventions are required to decrease the disease burden and improve the quality of life.