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Background: Transgender individuals face significant stigma and discrimination in healthcare, leading to adverse health outcomes. This study investigates the perceptions of dentists in India towards transgender patients. Methods: A cross-sectional study collected data from 143 licensed practicing dentists in India using a 9-item structured questionnaire distributed via online forms from November 2023 to January 2024. The questionnaire assessed dentists’ perceptions, comfort levels, and educational background regarding transgender healthcare. Results: The sample included 62.9% female and 37.1% male dentists, predominantly early-career practitioners. Only 32.2% had treated transgender patients, and 25.2% had received specific training in transgender health issues. Despite limited experience and training, 71.3% of dentists expressed a willingness to treat transgender patients, and 84% recognized the societal benefits of acknowledging transgender identities as natural. Additionally, 87.4% supported the inclusion of LGBTQ patients in healthcare. Significant barriers were noted, with many respondents acknowledging problematic attitudes among healthcare staff towards transgender individuals. Conclusions: The study highlights positive attitudes among dentists towards transgender patients, despite substantial gaps in training and experience. Addressing these gaps through targeted education and sensitization programs is crucial for fostering an inclusive healthcare environment. Future research should focus on longitudinal assessments and the effectiveness of educational interventions to enhance knowledge and attitudes toward transgender healthcare.

In this study, we adapted an HP D100 Single Cell Dispenser – a novel low-cost thermal inkjet (TIJ) platform with impedance-based single cell detection – for dispensing of individual cells and one-pot sample preparation. We repeatedly achieved label-free identification of up to 1,300 proteins from a single cell in a single run using an Orbitrap Fusion Lumos Mass Spectrometer coupled to either an Acquity UPLC M-class system or a Vanquish Neo UHPLC system. The developed sample processing workflow is highly reproducible, robust, and applicable to standardized 384- and 1536-well microplates, as well as glass LC vials. We demonstrate the applicability of the method for proteomics of single cells from multiple cell lines, mixed cell suspensions, and glioblastoma tumor spheroids. As additional proof of robustness, we monitored the results of genetic manipulations and the expression of engineered proteins in individual cells. Our cost-effective and robust single-cell proteomics workflow can be transferred to other labs interested in studying cells at the individual cell level.

Background: Hypertensive disorders of pregnancy (HDP) remain a primary contributor for maternal and perinatal death and results in long-term health risks for both the mother and child. Heterogeneous studies have evaluated the possible benefit of low dose aspirin (50 to 150 mg per day) in pregnancy to minimize the risk of HDP. Objective: To assess the impact of low-dose Aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy. Methodology: This was a non-prespecified secondary analysis of a randomized masked trial of Low-dose Aspirin (LDA). Nulliparous singleton pregnancies between 6 weeks and 0 days and 13 weeks 6 days in 6 low- middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial were included. The incidence of HDP at delivery at three gestational age periods (< 37 weeks) between women who were randomized to Aspirin or Placebo. Women were included if they were randomized and had an outcome at or beyond 20 weeks (Modified Intent to Treat). Results: Amongst the 11,976 pregnancies, LDA did not significantly lower HDP at delivery. Conclusion: In low-risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks. LDA works in part by delaying HDP.

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at

As the pandemic COVID-19 has severely affected the entire world, it became the utmost necessity of careful prioritization and utilization of limited medical resources, especially for the resource-constraint societies. This requirement along with the asymptomatic nature of COVID-19 in a significant proportion of the population, has prompted the need for a risk assessment tool-kit that can provide a rational behind prioritization and allocation of limited available medical resources. The purpose of this study is to compose a scientific-rationale-based ‘COVID-19-Self-Assessment-Test’ (C19SAT) framework, which helps develop a basis for measuring the risk of COVID-19 exposure with self-assessment. The study comprises of two major parts- (1) identification of key components of the C19SAT framework by studying various guidelines (WHO & CDC) and relevant literature, and (2) quantification of those components by assigning weight through the analysis of survey results and opinions from medical physicians and experts. A C19SAT framework is developed to measure the risk of covid-19 exposure, comprising a set of identified components (12 parameters and their corresponding attributes) and their corresponding weights. As the scientific rationale behind such assessment framework has not been reported to date in case of available mobile applications and web-based toolkit, the present study brings the novelty and reports the construction of such a framework. The study opens up untouched research and discussion on the composition of the COVID-19 exposure-measurement framework, which can help in vaccine prioritization and resource allocation. Further studies can be carried out on refining the framework for better understanding and effectiveness towards urban health governance.

Objective Describe the population of babies who do and do not receive postnatal corticosteroids for prevention or treatment of bronchopulmonary dysplasia (BPD).Design Retrospective cohort study using data held in the National Neonatal Research Database.Setting National Health Service neonatal units in England and Wales.Patients Babies born less than 32 weeks gestation and admitted to neonatal units from 1 January 2012 to 31 December 2019.Main outcomes Proportion of babies given postnatal corticosteroid; type of corticosteroid; age at initiation and duration, trends over time.Secondary outcomes Survival to discharge, treatment for retinopathy of prematurity, BPD, brain injury, severe necrotising enterocolitis, gastrointestinal perforation.Results 8% (4713/62019) of babies born

Abstract Sanitation problems faced by the humanity are tightly coupled with the ever-growing water problems. Better sanitation infrastructures ensure sustainable solutions to the health and water issues faced by the majority of the urban population on the planet. In this study, we investigated sanitation status for squatter settlements in Mumbai, a major global megacity. We observe that capacity building in terms of adequate toilet infrastructure alone cannot eliminate open defecation. There is a huge need for more toilet blocks in Mumbai’s wards, even after considering unusable public and community toilets into account, since 71–99% out of 8417 toilets are not in good condition. We contend that the normal perception regarding more toilet infrastructures and its alleviating effect on open defecation is not always directly correlated and is an emerging as well as a complex urban issue. We corroborate the need for addressing associated governance issues along with capacity building, which will help stakeholders to identify the prevailing sanitation scenario towards further policy amendments. Further, effectively identifying the trends and processes entangled in the urban sanitation issues can ensure a more sustainable resource utilization situation and a better standard of living for the urban poor.

Objective To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.Design Retrospective analysis using data extracted from the National Neonatal Research Database.Setting All National Health Service neonatal units in England.Patients Infants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measures Proportion of infants who received iNO; age at initiation and duration of iNO use.Results 4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born 34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: 34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation:

The shift towards capacity building and deteriorating governance, may lead to poor service delivery which is a prime challenge for governing agencies. Different countries follow their own sets of governance parameters and often assess the outcome of policies based on them. In order to compose a uniform good governance framework, we have conducted a comparative analysis among 22 existing governance frameworks across the globe and shortlisted 13 major criteria along with 74 sub-criteria. We explored the method to measure these governance components with the help of various indicators and took expert opinion to distribute weight among these indicators. Finally, the case of Mumbai city is discussed with the examples of direct indicators, which may be used to measure a sub-criteria of any specific criteria. The quantification process is also demonstrated with three specific representative indicators. For example- the contribution towards good-governance has been increased from 0.001218 in 2016 to 0.004466 in 2017, for the indicator “conviction percentage of corruption cases” of sub-criterion “active anti-corruption commission” of criterion “accountability”. Researchers as well as policymakers will be benefitted with the method demonstrated here, which can help in assessing governance of any public service towards further policy amendments. Keywords: Governance, Public, Urban Services, Management, Indicator

Breast Cancer remains a significant health issue, with roughly around 42,000 maternal deaths occurring each year. The relationship between exercise and breast cancer has been widely studied with substantial evidence suggesting that higher exercise can lower breast cancer proliferation. The meta analysis aimed to investigate the relationship between exercise activating the hormones and receptors of dopamine, insulin, and estrogen and breast cancer across different populations. We conducted a comprehensive search of electronic databases and included studies that reported the association between exercise and the hormones and their impact on breast cancer. Through this analysis, we were able to generate novel mechanisms for the hormones and were able to link exercise and breast cancer. Our findings suggest that an increase in exercise increased the levels of dopamine while lowering insulin and estrogen levels. These effects have a strong relationship with lowering breast cancer proliferation. Previous studies focused on generating already researched pathways to a higher degree. Our research incorporates previously researched pathways with the extension of introducing a new pathway that has not been researched thoroughly. Our research employs a meta-analysis of research papers and scientific data, which allows for a more comprehensive and rigorous examination of the research question and can help identify patterns and trends across studies.

Introduction: Different techniques of radiation therapy have been studied to reduce the cardiac dose in left breast cancer. Aim: In this prospective dosimetric study, the doses to heart as well as other organs at risk (OAR) were compared between free-breathing (FB) and deep inspiratory breath hold (DIBH) techniques in intensity modulated radiotherapy (IMRT) and opposed-tangent three-dimensional radiotherapy (3DCRT) plans. Materials and Methods: Fifteen patients with left-sided breast cancer underwent computed tomography simulation and images were obtained in both FB and DIBH. Radiotherapy plans were generated with 3DCRT and IMRT techniques in FB and DIBH images in each patient. Target coverage, conformity index, homogeneity index , and mean dose to heart (Heart Dmean), left lung, left anterior descending artery (LAD) and right breast were compared between the four plans using the Wilcoxon signed rank test. Results: Target coverage was adequate with both 3DCRT and IMRT plans, but IMRT plans showed better conformity and homogeneity. A statistically significant dose reduction of all OARs was found with DIBH. 3DCRTDIBHdecreased the Heart Dmeanby 53.5% (7.1 vs. 3.3 Gy) and mean dose to LAD by 28% compared to 3DCRTFB. IMRT further lowered mean LAD dose by 18%. Heart Dmeanwas lower with 3DCRTDIBHover IMRTDIBH (3.3 vs. 10.2 Gy). Mean dose to the contralateral breast was also lower with 3DCRT over IMRT (0.32 vs. 3.35 Gy). Mean dose and the V20of ipsilateral lung were lower with 3DCRTDIBHover IMRTDIBH (13.78 vs. 18.9 Gy) and (25.16 vs. 32.95%), respectively. Conclusions: 3DCRTDIBHprovided excellent dosimetric results in patients with left-sided breast cancer without the need for IMRT.

Introduction: Oral squamous cell carcinoma (OSCC) are amongst commonest cancer in the Indian sub-continent. After treatment, these patients require frequent followup to look for recurrences/second primary. Mouth Self Examination (MSE) has a great potential in all levels of prevention of oral cancer. However, the compliance to self-examination has been reported as poor. Mobile phone is a cheap and effective way to reach out to people. Short Message Service (SMS) is extremely popular can be a very effective motivational and interactive tool in health care setting. Methodology: We aimed to identify in adequately treated OSCC patients, the influence of health provider initiated SMS on the compliance to the MSE and to establish the efficacy of MSE by comparing patients' MSE interpretation via replies to the SMS with that of the experts' opinion on clinical examination status during follow up. Conclusion: We conclude that MSE can be very useful in adequately treated OSCC patients for evaluating disease status. All treated OSCC patients must be adequately educated for MSE as an integral part of treatment & follow-up protocol by the health provider facility. Health provider generated SMS reminders do improve motivation and compliance towards MSE but don't seem to reduce dropouts in follow up for large and diverse population like that in India.

Lung cancer is one of the most prevalent malignancies worldwide, contributing to over a million cancer-related deaths annually. Despite extensive research investigating the genetic factors associated with lung cancer susceptibility and prognosis, few studies have explored genetic predispositions regarding the immune system. This review discusses the most recent genomic findings related to the susceptibility to or protection against lung cancer, patient survival, and therapeutic responses. The results demonstrated the effect of immunogenetic variations in immune system-related genes associated with innate and adaptive immune responses, cytokine, and chemokine secretions, and signaling pathways. These genetic diversities may affect the crosstalk between tumor and immune cells within the tumor microenvironment, influencing cancer progression, invasion, and prognosis. Given the considerable variability in the individual immunegenomics profiles, future studies should prioritize large-scale analyses to identify potential genetic variations associated with lung cancer using highthroughput technologies across different populations. This approach will provide further information for predicting response to targeted therapy and promotes the development of new measures for individualized cancer treatment.

Purpose: To describe the Quality Assurance (QA) methods of modern Three-dimensional conformal radiotherapy (3DCRT) treatments such as image guided Intensity-modulated radiation therapy (IMRT), RapidArc, Stereotactic radiosurgery (SRS)/ Stereotactic fractionated radiation (SRT) to ensure quality of treatments delivered to cancer patients. Materials and methods: 3D-RFA and Ionisation chambers were used for the machine specific QA. Imatrixx-2D array with locally fabricated phantom and another locally fabricated spherical phantom with ionization chambers is used for relative and absolute QA respectively. Electronic Portal Imaging Devices and Epiqa software is used for the QA with portal dosimetry. Varians Eclipse and Brainlab’s Iplan treatment planning systems were used for treatment plans and dose calculations. For relative dosimetry the planar dose matrices are analysed using global Gamma Index criteria of 3mm distance to agreement (DTA) and 3% dose difference. The QA of Machines and patient treatments were carried out using national and international protocols. Results: The maximum deviations of percentage of dose points in which γ>1 are 1.98 in relative dosimetric QA and 1.5 for absolute QA in the delivery of IMRT, RapidArc and SRS/SRT treatments. The mean deviations and Standard deviation (SD) values are less in portal dosimetry than that of phantom studies in relative dosimetry and all the absolute dose deviations are less than that of relative dose deviations. Conclusion: The results of machine specific QA as well as relative and absolute dosimetric QA of patient treatments are well within the acceptable limits of values mentioned in the national and international protocols. The study ensures the accuracy and quality of the treatments delivered to the patients at our oncology center.