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Zain S Hussain,1,2 Asher Khan,2,3 Asad Loya,4 Kaushal Shah,5 Fasika A Woreta,6 Kamran M Riaz2 1University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis; 2Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA; 3College of Medicine, University of Oklahoma, Oklahoma City, OK, USA; 4Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA; 5Department of Psychiatry and Behavioral Sciences, Oklahoma State University, Tulsa, OK, USA; 6Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USACorrespondence: Kamran M Riaz, Dean McGee Eye Institute/University of Oklahoma, 608 Stanton L Young Blvd, Suite 313, Oklahoma City, OK, 73104, USA, Tel +1-405-271-1095, Fax +1-405-271-3680, Email Kamran-Riaz@dmei.orgPurpose: To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level.Methods: National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease.Results: 55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451– 2.949, p< 0.001; OR 1.352, CI 1.227– 1.489, p< 0.001); OR 1.211, CI 1.086– 1.352, p< 0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12– 1.344, p< 0.001; OR 1.363, CI 1.243– 1.495, p< 0.001; OR 1.418, CI 1.134– 1.774; OR 1.388, CI 1.27– 1.518, p< 0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors.Conclusion: Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.Keywords: substance use, ophthalmology, vision loss

The argument whether the well renowned composition – the golden section, a number approximate equal to 0.618 – holds the key to the secret of beauty, is an enigma which has existed from the time of ancient Greeks with Fechner being one of the first to conduct study on golden proportion in the 1980s. The normal human face was considered by Ricketts to be the most beautifully perfect structure in all of the animal kingdom. In an attempt to study the face, the “divine proportion” was explored in relation to the Dentofacial complex, claiming that a number of golden relationships existed in the faces, Cephalogram, and study casts of those considered having outstanding beauty. There has to be set protocols to assess facial profile analysis based on different criteria. Here, we have taken a call to review for assessment of craniofacial morphology in relation golden proportion.

In this article we present a website that offers snippets that we used for our web development project. The snippets are created using HTML, CSS and JavaScript. When creating complex designs like skeuomorphism, flat design, glass morphism, Bauhaus style and neomorphism, these strategies prove useful for web designers. The snippets are responsive and work on both large and small devices, including desktop computers. Skeuomorphism-specific code snippets are also considered, highlighting how well they work to incorporate skeuomorphic aspects into web designs. These code snippets foster a sense of familiarity and improve user engagement by accurately reproducing textures, shadows, fonts, backgrounds, and 3D effects that mimic real things. This endeavor can help designers create intricate designs that are both aesthetically pleasing and useful. &nbsp

Adverse childhood experiences (ACEs) before the age of 18 years are pervasive and noteworthy public health concerns. The ACEs are associated with sleep disorders in later life. In this study, we conduct a systematic review to explore the effects of ACEs on sleep in adulthood. Using Medical Subject Headings keywords, we searched Medline, PubMed, PubMed Central, the American Psychological Association PsycArticles, and PsychInfo databases to evaluate the association between ACEs and sleep disturbances. ACEs increase the odds of developing chronic short sleep duration, that is,6 hours of sleep per night compared with optimal sleep duration of 7-9 hours per night during adulthood. The ACEs are positively associated with poor sleep characteristics such as short sleep duration and long-term sleep problems. Clinicians should pay close attention to developmental trauma care, access community health programs, and help develop better coping skills, resiliency, and good sleep habits in their patients.

Digital assets backed up by blockchain technology are termed Non-Fungible Tokens (NFTs). Every NFT is uniquely identified by its metadata, stored in the smart contract. This metadata can consist of associated images, descriptions , attributes, and other relevant details in a JavaScript Object Notation (JSON) object. Most of these NFTs are static; therefore, their metadata remains immutable. Due to rising blockchain use cases like real-world token regulation and blockchain-based ticketing platforms, a need arises to modify the existing metadata and require interaction for community engagement. Here, Dynamic NFTs (DNFTs) bring the notion of adding upgradeability and interactivity to existing NFTs. We propose a DNFT generation system built on top of decentralized oracle networks and utilizing on-chain metadata using smart contracts, which could be used as a base for future dynamic NFT generation models. Furthermore , we are bringing the web2 equivalent experience to viewable content, which can be used for ad spaces and real-time messaging in the form of NFTs. Henceforth, we are augmenting NFTs for versatile use cases, such that they are more than just static assets.

Background Most COVID-19 infections result in a viral syndrome characterized by fever, cough, shortness of breath, and myalgias. A small but significant proportion of patients develop severe COVID-19 resulting in respiratory failure. Many of these patients also develop multi-organ dysfunction as a byproduct of their critical illness. Although heart failure can be a part of this, there also appears to be a subset of patients who have primary cardiac collapse from COVID-19. Objective Conduct a systematic review of COVID-19-associated myocarditis, including clinical presentation, risk factors, and prognosis. Discussion Our review demonstrates two distinct etiologies of primary acute heart failure in surprisingly equal incidence in patients with COVID-19: viral myocarditis and Takotsubo cardiomyopathy. COVID myocarditis, Takotsubo cardiomyopathy, and severe COVID-19 can be clinically indistinguishable. All can present with dyspnea and evidence of cardiac injury, although in myocarditis and Takotsubo this is due to primary cardiac dysfunction as compared to respiratory failure in severe COVID-19. Conclusion COVID-19-associated myocarditis differs from COVID-19 respiratory failure by an early shock state. However, not all heart failure from COVID-19 is from direct viral infection; some patient's develop takotsubo cardiomyopathy. Regardless of etiology, steroids may be a beneficial treatment, similar to other critically ill COVID-19 patients. Evidence of cardiac injury in the form of ECG changes or elevated troponin in patients with COVID-19 should prompt providers to consider concurrent myocarditis.

With the rise of powerful computational technologies, healthcare systems are going through a paradigm shift to the era of healthcare 5.0, also known as" smart healthcare". This new-age healthcare system not only enhances the life of patients but also aims to reduce healthcare costs significantly. People's health data collected through various means, including various Internet of Things (IoT) devices, is too sensitive to be regulated by particular organisations owing to increasing privacy and security threats. The sheer size of data makes it difficult for centralised bodies to regulate, due to which third-party involvement is introduced, which again poses threats to the privacy of the data holder. Motivated by the abovementioned gaps, we propose a decentralised approach using Ethereum blockchain technology and Oasis protocol. The patient-driven solution approach effectively solves the privacy problem by providing complete control of data to the owner. Along with this, byproducts such as fine-grained access control and on-chain data processing capabilities are also obtained.

Background Pneumothorax (PTX) is defined as air in the pleural space and is classified as spontaneous or nonspontaneous (traumatic). Traumatic PTX is a common pathology identified in the emergency department. Traditional management calls for chest x-ray (CXR) diagnosis and large-bore tube thoracostomy, although recent literature supports the efficacy of lung ultrasound (US) and more conservative approaches. There is a paucity of cohesive literature on how to best manage the traumatic PTX. Objective of the Review This review aimed to describe current practices and future directions of traumatic PTX management. Discussion Lung US has proven to be a potentially more useful tool in the detection of PTX in the trauma bay compared with CXR, and has the potential to become the new gold standard for diagnosing traumatic PTX. Computed tomography remains the ultimate gold standard, although in the setting of trauma, its utility lies more in confirming the presence and measuring the size of a PTX. The traditional mantra calling for large-bore chest tubes as first-line approaches to traumatic PTX is challenged by recent literature demonstrating pigtail catheters as equally efficacious alternatives. In patients with small or occult PTXs, even observation may be reasonable. Conclusions Modern management of the traumatic PTX is shifting toward use of US for diagnosis and more conservative management practices (smaller catheters or observation). Ultimately, this shift is favorable in reducing length of stay, development of complications, and pain in the trauma patient.

Medical records are transmitted between medical institutions using cloud-based Electronic Health Record (EHR) systems, which are intended to improve various medical services. Due to the potential of data breaches and the resultant loss of patient data, medical organizations find it challenging to employ cloud-based electronic medical record systems. EHR systems frequently necessitate high transmission costs, energy use, and time loss for physicians and patients. Furthermore, EHR security is a critical concern that jeopardizes patient privacy. Compared to a single system, cloud-based EHR solutions may bring extra security concerns as the system architecture gets more intricate. Access control strategies and the development of efficient security mechanisms for cloud-based EHR data are critical. For privacy reasons, the Dynamic Constrained Message Authentication (DCMA) technique is used in the proposed system to encrypt the outsource medical data by using symmetric key cryptography which uses the Seagull Optimization Algorithm (SOA) for choosing the best random keys for encryption and then resultant data is hashed using the SHA-256 technique. The system is developed in Python language, and the results are assessed using performance metrics including delay time, security rate, false error rate (FER), storage time, retrieval time, throughput ratio, encryption and decryption time, accuracy rate, key generation time, and security. The implemented system is superior in terms of security because it adopts the advance random secret keys generation which adds more security to the system of about 94% with less delay and loss ratio.

Introduction Ashwagandha has been around for about two thousand years. It is known as Indian Ginseng, winter cherry, and poison gooseberry. In recent years, the benefits of Ashwagandha tohave been explored in various studies due to the popularity of alternative therapeutic options in masses worldwide. Sleep is vital to the rejuvenation of the mind and body by replenishing the energy to carry on life activities. Sleep disorder is a major limitation in living life to full potential and Ashwagandha, known as beneficial for reducing stress and anxiety, is proven to improve the quality of sleep in individuals. In this systematic review, we study the efficacy of Ashwagandha in improving sleep and its safety for its users. Methods A literature search was conducted using relevant MeSH keywords, “Withania” and “Aswagandha” in the context of “Sleep,” “Sleep-Wake Disorders,” or “Sleepiness” in PubMed, PubMed Central, Medline, Web of Science, Biosis, and SciELO databases. We identified all published relevant articles from inception until 11/20/2021 and included 8 studies in our final qualitative synthesis review. Results Ashwagandha has been shown to have beneficial effects in decreasing time to fallasleep, improving duration, quality of sleep, and mood upon awakening. Many studies demonstrated these beneficial effects with clinical significance using multiple rating scales of assessment. Most studies explored the safety profile of Ashwagandha for the subjects. In most studies, there were no adverse events reported, and its use is termed safe and beneficial. Few studies reported some minor side effects, such as in a randomized clinical trial, RCT, by Deshpande A. et al. (2020), headaches, fever, acid reflux, and allergic dermatitis were reported.1A randomized clinical trial by Langade D. et al. in 2019 showed that Ashwagandha shortens the sleep onset latency significantly (p,0.019) after 10 weeks of with test [29.00(7.14)] compared to placebo [33.94(7.65)]. There was a significant improvement in sleep efficiency, SE scores at 83.48 (2.83) after 10 weeks 75.63(2.70) for the test at the baseline compared to placebo.2 In another pilot study by Sharma H. et al. (2007), there was a significant improvement in sleep duration, sleep quality (91.67%, p Conclusion The findings support the efficacy of Ashwagandha for improving sleep quality. Due to the limited availability of data and well-designed studies warrants further research through cohort studies and clinical trials to determine the exact mechanism of action and benefits for sleep. Support (If Any) References:1. Deshpande, A., Irani, N., Balkrishnan, R., & Benny, I. R. (2020). A randomized, double-blind, placebo-controlled study to evaluate the effects of Ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep medicine, 72, 28–36. https://doi.org/10.1016/j.sleep.2020.03.0122. Langade, D., Kanchi, S., Salve, J., Debnath, K., & Ambegaokar, D. (2019). Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. Cureus, 11(9), e5797. https://doi.org/10.7759/cureus.57973. Sharma, H., Chandola, H. M., Singh, G., & Basisht, G. (2007). Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Part 2--Ayurveda in primary health care. Journal of alternative and complementary medicine (New York, N.Y.), 13(10), 1135–1150. https://doi.org/10.1089/acm.2007.7017-B

Securities and Exchange Board of India (SEBI) keeps on improving the securities market regulations to improve investors' protection. To revive the primary market, in 2009, SEBI ICDR (Issue of Capital and Disclosure Requirements) Regulations, 2009 was amended with revised guidelines. The advantage of group affiliation and reputation on IPO performance differs with time and varied business groups. Grouped IPOs evidenced mixed outcomes based on theories developed under tunnelling, propping, network and certification hypothesis. We examine how the business group affiliation impact the underpricing, liquidity and volatility performance of IPOs. Using database of 259 IPOs issued in Indian market from 2009 to 2019, we find less underpricing, liquidity and volatility for group affiliated IPOs. The present study supports certification, network and propping hypothesis. We find underpricing extent is reduced than earlier period, average security return 12 percent while underpricing 11.79 percent is evidenced. Liquidity and volatility reported a declining trend from listing day to 1-month post listing.

To systematically review studies evaluating pharmacological treatment intervention of the atypical antipsychotic induced weight gain in the pediatric population and summarize the current evidence of the pharmacological treatment. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we searched the various databases Medline, PubMed, PubMed central (PMC), CINAHL, and clinicaltrial.gov. until Jan 30th, 2022 for relevant clinical studies. Medical subject heading (MeSH) terms or keywords were used, "Body Weight," "Weight Gain," "Weight Loss," "Body Weight Maintenance," "Pediatric Obesity" in "Pediatrics," "Adolescent," "Child" in context of "Antipsychotic Agents" and "Drug Therapy," "Therapeutics," "Treatment Outcome," "Early Medical Intervention." We used the PICO algorithm for our search (Population, Intervention, Comparison, Outcomes, and Study Design) framework. The initial search included 746 articles, nine studies were ultimately selected in the final qualitative review. We included relevant clinical reviews, case series, and randomized clinical trials that evaluated pharmacological intervention for antipsychotic-induced weight gain in the pediatric population. Non-peer-reviewed, non-human, non-English languages article was excluded. Metformin is the most studied medication for antipsychotic-induced weight gain in children. Three studies have shown that adding Metformin to the antipsychotics can significantly reduce the body weight and body mass index with mild transient side effects. Other adjunct medications like topiramate, amantadine, betahistine, or melatonin vary greatly in mitigating weight with various side effects. Lifestyle modification is the first step in dealing with AIWG, but the result is inconsistent. Avoiding the use of antipsychotic in children is preferred. Adding an adjuvant medication to the antipsychotic could prevent or mitigate their negative metabolic effect on the body weight and body mass index. Metformin has the most evidence, topiramate, betahistine, amantadine, and melatonin is possible alternatives in the pediatric patient without changing their antipsychotic medication. Other viable options show some benefits but need further clinical studies to establish efficacy and safety.

With the ongoing evolution in genetics, recent evidence highlights the role of circulatory microRNA (miRNA) for schizophrenia. The objective of this article is to explore the role of blood/serum miRNA expression in schizophrenia management and to review the expression of different miRNAs before and after treatment with antipsychotics. miRNAs can help increase the accuracy of diagnosis, identify patients at risk of developing schizophrenia, and possibly predict drug response. The collective evidence from this review showed that several miRNAs are promising candidates for schizophrenia diagnosis, management, and prognosis.

Background Multisystem inflammatory syndrome in children is a phenomenon that has emerged during the coronavirus disease 2019 (COVID-19) pandemic. There are, however, few reported cases of a similar disease in adults. Case Report We describe a 25-year-old man who presented with prolonged fever and conjunctivitis and was found to have a post-COVID inflammatory syndrome. His symptoms improved with colchicine, steroids, and a truncated course of intravenous immunoglobulin. Why Should an Emergency Physician Be Aware of This? Post-COVID inflammatory syndrome has the potential to lead to dangerous complications. In addition, the identification of occult COVID infections could have public health implications.

Objective To determine whether a checklist of possible etiologies for syncope provided alongside ECGs helps Emergency Medicine (EM) residents identify ECG patterns more accurately than with ECGs alone. Methods We developed a test of ten ECGs with syncope-related pathology from ECG Wave-Maven. We reviewed the literature and used expert consensus to develop a checklist of syncope-related pathologies commonly seen and diagnosed on ECGs. We randomized residents from three New York EM residency programs to interpret ECGs with or without a checklist embedded into the test. Results We randomized 165 residents and received completed tests from 100 (60%). Of those who responded, 39% were interns, 23% PGY2s, and 38% were PGY3s or PGY4s. We found no significant difference in overall test scores between those who read ECGs with a checklist and those who read ECGs alone. In post-hoc analysis, residents given a checklist of syncoperelated etiologies were significantly more likely to recognize Brugada (96% vs. 78%, p = 0.007), long QT (86% vs. 68%, p = 0.03) and heart block (100% vs 78%, p = 0.003) as compared to those without a checklist. Those with a checklist were more likely to overread normal ECGs (72% vs 35%, p = 0.0001) compared to those without a checklist, finding pathology where there was none. Conclusion Using a checklist with common syncope-related pathology when interpreting an ECG for a patient with clinical scenario of syncope may improve residents' ability to recognize some clinically important pathologies; however it could lead to increased interpretation and suspicion of pathology that is not present.

Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. Findings associated with pneumothorax include dyspnea, chest pain, tachypnea, and absent breath sounds on lung auscultation. Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. Patients with traumatic pneumothorax are typically treated with needle decompression or tube thoracostomy. However, recent literature has found that many patients can be managed conservatively via observation, or with a smaller thoracostomy such as a percutaneous pigtail catheter rather than a larger chest tube.

Program evaluation is an “essential responsibility” but is often not seen as a scholarly pursuit. While Boyer expanded what qualifies as educational scholarship, many still need to engage in processes that are rigorous and of a requisite academic standard to be labelled as scholarly. Many medical educators may feel that scholarly program evaluation is a daunting task due to the competing interests of curricular change, remediation, and clinical care. This paper explores how educators can take their questions around outcomes and efficacy of our programs and efficiently engage in education scholarship. The authors outline how educators can examine whether training programs have a desired impact and outcomes, and then how they might leverage this process into education scholarship.

The demand of cloud computing and 5G networks has increased in the current scenario due to their attractive features and also the security related to the data over the cloud. In the context of cloud security, there is a number of computationally hard methods available. One of the most popular methods used to secure data over the cloud is the identity-based encryption (IBE). It is an access policy that allows only authorized users to access legible data in order to avoid a malicious attack. IBE comprises of four stages, namely, setup, key generation or extract, encryption, and decryption. Key generation is one of the important and time-consuming phases in which a security key is generated. It is a computational and decisional hard problem for generating unbreakable and nonderivable secure keys. This paper proposes an enhanced identity-based encryption approach where a secure key is generated using part of an identity bit string in order to avoid leakage of users’ identity even if an adversary or attacker decodes the key or encrypted data. Experiment results show that the prosed algorithm takes less time in the encryption and decryption as compared to the competitive approach named efficient selective-ID secure identity-based encryption approach. One of the most important features of the proposed approach is that it hides the user’s identity by using the Lagrange coefficient, which consists of a polynomial interpolation function. The security of the system depends on the hardness of computing the bilinear Diffie-Hellman problem.