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Abstract Hematological malignancies are associated with an increased risk of complications during SARS-CoV-2 infections. Primary series or monovalent booster vaccines reduce disease severity, hospitalization, and death among multiple myeloma patients. We characterized virus-neutralizing and spike-binding antibody profiles following monovalent (WA1) or bivalent (WA1/BA.5) SARS-CoV-2 booster vaccination in MM patients. Bivalent vaccination improved the breadth of binding antibodies but not neutralization activity against contemporary variants. Hybrid immunity and immune imprinting impact vaccine-elicited immunity.

Abstract Background Hypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health, with substantial mortality and morbidity rates globally, particularly in developing countries. Pre-eclampsia (PE) accounts for a notable portion of maternal morbidity and mortality, with varied prevalence across regions within countries like India. Despite advancements, disparities in healthcare access persist, influencing outcomes. PE not only affects maternal health during pregnancy but also predisposes women to long-term cardiovascular complications, emphasizing the need for early screening and preventive measures. Methods This prospective randomized double-blind clinical trial aims to compare the efficacy and safety of 75 mg versus 150 mg aspirin for preventing preterm pre-eclampsia in high-risk women. Screen-positive women aged 18–45 years with singleton pregnancies between 12 and 16 weeks of gestational age will be enrolled. They will be randomized in a 1:1 ratio to receive either 75 mg or 150 mg of aspirin nightly until 37 weeks of pregnancy or earlier if preterm pre-eclampsia develops. Feto-maternal outcomes, including preterm pre-eclampsia incidence and neonatal and maternal complications, will be assessed. The sample size calculation based on expected proportions of preterm pre-eclampsia in both groups indicates a total of 370 participants (185 per group) accounting for 20% attrition. Discussion This prospective randomized double-blind clinical trial aims to compare the effectiveness and safety of two doses of aspirin (75 mg vs 150 mg) in preventing preterm pre-eclampsia in high-risk women. The potential implications of this study are significant, including the optimization of aspirin prophylaxis, the development of evidence-based guidelines, and comprehensive assessment of maternal and fetal outcomes. In conclusion, the results of this study have the potential to significantly impact clinical practice by enhancing maternal and perinatal health outcomes and contributing to evidence-based obstetric care. Trial registration Clinical Trials Registry-India CTRI/2023/12/060983. Trial was registered prospectively on 29 December 2023. Acknowledgement Number REF/2023/12/076358. https://acrobat.adobe.com/id/urn:aaid:sc:AP:15870322-f1f4-4460-900c-6e056ab83a44 .

Abstract Background Brain volume loss (BVL) has been identified as a predictor of disability progression in relapsing multiple sclerosis (RMS). As many available disease-modifying treatments (DMTs) have shown an effect on slowing BVL, this is becoming an emerging clinical endpoint in RMS clinical trials. Methods In this study, a systematic literature review was conducted to identify BVL results from randomized controlled trials of DMTs in RMS. Indirect treatment comparisons (ITCs) were conducted to estimate the relative efficacy of DMTs on BVL using two approaches: a model-based meta-analysis (MBMA) with adjustment for measurement timepoint and DMT dosage, and a network meta-analysis (NMA). Results In the MBMA, DMTs associated with significantly reduced BVL versus placebo at two years included fingolimod (mean difference [MD] = 0.25; 95% confidence interval [CI] = 0.15 – 0.36), ozanimod (MD = 0.26; 95% CI = 0.12 – 0.41), teriflunomide (MD = 0.38; 95% CI = 0.20 – 0.55), alemtuzumab (MD = 0.38; 95% CI = 0.10 – 0.67) and ponesimod (MD = 0.71; 95% CI = 0.48 – 0.95), whereas interferons and natalizumab performed the most poorly. The results of NMA analysis were generally comparable with those of the MBMA. Conclusions Limitations of these analyses included the potential for confounding due to pseudoatrophy, and a lack of long-term clinical data for BVL. Our findings suggest that important differences in BVL may exist between DMTs. Continued investigation of BVL in studies of RMS is important to complement traditional disability endpoints, and to foster a better understanding of the mechanisms by which DMTs can slow BVL.

Introduction: Reach tests are commonly used outcome measures to assess balance among various populations. The psychometric properties of these outcome measures help in selecting the most effective tests to enhance the credibility of interventions. Aim: To determine the psychometric properties of reach tests among children aged 5 to 17 years. Materials and Methods: A comprehensive search was conducted across databases such as PubMed/MEDLINE, Scopus, and Cochrane from inception to November 2023. Cross-sectional studies involving children that assessed at least one psychometric property of a reach test and were written in English were included. An adapted version of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria were used for quality assessment of the psychometric properties. Results: A total of 944 articles were screened, of which 17 studies were included. Eleven studies recruited typically developing children, while six studies used Functional Reach Test (FRT) and its modifications as the primary outcome measure. Another six studies focused on the Sit-and-Reach Test (SRT) and its modifications. The Paediatric Reach Test (PRT) was also utilised in some studies. Conclusion: The FRT demonstrated excellent methodological quality. Other outcome measures showed limitations in their psychometric properties. Therefore, there is a need to refine reach tests in multiple ways to achieve excellent psychometrics that could be beneficial for children aged 5 to 17 years.

Background: The use of a standardized national chronic noncommunicable disease (CNCD) registry is of immense benefit in addressing the CNCD burden in Trinidad and Tobago (T&T). This study seeks to assess the outcomes of a paper-based CNCD registry implemented in the primary health-care centers in South Trinidad. Methods: At the South-West Regional Health Authority, a standardized paper-based registry was implemented in 2017, at the 33 public primary health-care clinics. Following this, a CNCD Registry Assessment Survey was administered cross-sectionally to 94 end-users to evaluate the implementation outcomes of the registry. The outcome domains – feasibility, penetration, acceptability, sustainability, fidelity, uptake, and costs were analyzed using summary statistics. Results: Fifty-five percent of end-users responded. Most responses came from the primary care physicians 1 (50.0%) of County Caroni. Most respondents were from County Caroni, 19 (36.5%) and St. Patrick, 19 (36.5%). Ninety-one percent of end-users thought that the CNCD registry was easily adopted. For 85.9% of end-users, the registry had fidelity (85.9%); 84.2% thought it was well accepted; feasible (82.7%); easily penetrated (82.7%), and appropriate (76.0%). Forty-two percent thought that the cost of implementation was high, while 30.8% were neutral. Seventy-one percent thought that the paper-based CNCD registry should be sustained, and 94.2% of end-users thought that an electronic CNCD registry should be implemented. Conclusion: It is possible and feasible to implement a standardized paper-based registry. Through this process, we were able to define the prevalence of five CNCDs and two risk factors of overweight/obesity and smoking for the chronic disease clinic population. Subsequently, we would like to implement a digitized CNCD registry.

Abstract The textile industry is witnessing a paradigm shift towards sustainable materials, prompting the exploration of novel natural fibers as alternatives to synthetic fibers to meet environmental standards and address the growing demand for eco-friendly and sustainable products. Different natural fibers possess varied properties and are suitable for numerous applications in conventional and technical textiles. The coloration of these textile materials is an important aspect of conventional textiles, which starts with the pretreatment of the material. This study introduces a novel blend of cotton and Bauhinia vahlii fiber, a lesser-known natural cellulosic fiber with promising textile properties, and evaluates its pretreatment outcomes and dyeability characteristics. The study employs a systematic approach to pretreat the cotton and Bauhinia vahlii fiber blend (cotton: Bauhinia vahlii fiber 70:30) in a single bath using a conventional combined scouring bleaching process. The pretreatment process is carried out two times with varied sodium hydroxide (NaOH) and hydrogen peroxide (H2O2) concentrations for different processing times at 90 °C to assess the component fibers’ whiteness index, union bleaching balance, and weight loss percentage under diverse pretreatment conditions. Each time, 50% of the chemicals were used and continued for half of the processing time. The dyeability of the treated fibers is analyzed by dyeing the same in a single bath using amron bright red HF2R bifunctional reactive dye in varied shade depths (1%, 3%, and 5%) and fiber blend ratios (cotton: Bauhinia vahlii fiber 100:0, 90:10, 80:20, 70:30, and 0:100) to assess the color strength, union dyeing balance, and fastness properties. The maximum whiteness was achieved with 6 g per liter (gpl) of NaOH and H2O2 and at a processing time of 150 min with a whiteness index of 80.46 and 54.34 of cotton and Bauhinia vahlii fiber, respectively, with a union bleaching balance of 1.48. The dyed fibers’ colorimetric results confirm that Bauhinia vahlii fiber gives higher color strength than cotton fiber, irrespective of shade depth and blend ratio. The union dyeing balance of 1.2 was achieved at 5% shade depth with a 70:30 cotton Bauhinia vahlii fiber blend. This research contributes to the conventional textile field by introducing a sustainable fiber blend that reduces reliance on synthetic fiber and opens new avenues for utilizing Bauhinia vahlii fiber in conventional textile manufacturing.

Introduction: Human immunodeficiency virus (HIV) patients may undergo renal damage due to disease or nephrotoxic drugs. Tenofovir has been associated with the development of renal impairment. The aim of this study was to compare trends in creatinine clearance (CrCl) and estimated glomerular filtration rate (eGFR) in patients on highly active antiretroviral therapy (HAART) and to compare the same between patients on tenofovir- and nontenofovir-based regimens. Methods: A prospective observational study was conducted. We followed 244 patients for 2 years. The demographic, clinical, and laboratory parameters of the patients were recorded at baseline, 1 year of therapy, and 2 years of therapy. The data were analyzed using dividing patients into tenofovir- and nontenofovir-based groups. Statistical analysis was performed using the Chi-square test, paired and unpaired t-tests, and Fisher’s exact test. Results: The mean blood urea nitrogen and serum creatinine in both groups were comparable at the start of the therapy. The decline in CrCl and eGFR in all patients on HAART for 2 years was statistically significant, irrespective of tenofovir usage. The mean decrease in eGFR in the tenofovir group was 12.4 mL/min/1.73 m2 and in the nontenofovir group, 9 mL/min/1.73 m2, though the differences between eGFR and CrCl were not significant between the two groups at any point. Conclusion: Even though previous studies have suggested that HAART usage can slow the decline in kidney function in people living with HIV, patients who receive HAART still show a statistically significant decline in renal function parameters, akin to the observations of other such studies in low-resource settings.

Abstract AURKA is predominantly famous as an essential mitotic kinase. Recent findings have also established its critical role in a plethora of other biological processes including ciliogenesis, mitochondrial dynamics, neuronal outgrowth, DNA replication and cell cycle progression. AURKA overexpression in numerous cancers is strongly associated with poor prognosis and survival. Still no AURKA-targeted drug has been approved yet, partially because of the associated collateral toxicity and partly due to its limited efficacy as a single agent in a wide range of tumors. Mechanistically, AURKA overexpression allows it to phosphorylate numerous pathological substrates promoting highly aggressive oncogenic phenotypes. Our review examines the most recent advances in AURKA regulation and focuses on 33 such direct cancer-specific targets of AURKA and their associated oncogenic signaling cascades. One of the common themes that emerge is that AURKA is often involved in a feedback loop with its substrates, which could be the decisive factor causing its sustained upregulation and hyperactivation in cancer cells, an Achilles heel not exploited before. This dynamic interplay between AURKA and its substrates offers potential opportunities for targeted therapeutic interventions. By targeting these substrates, it may be possible to disrupt this feedback loop to effectively reverse AURKA levels, thereby providing a promising avenue for developing safer AURKA-targeted therapeutics. Additionally, exploring the synergistic effects of AURKA inhibition with its other oncogenic and/or tumor-suppressor targets could provide further opportunities for developing effective combination therapies against AURKA-driven cancers, thereby maximizing its potential as a critical drug target.

BackgroundAnkle instability results in sensory and motor impairments. Typically, health professionals recommend conservative treatment as the initial approach for individuals with this condition. One such treatment option is Electrical Stimulation (ES). This systematic review assesses the effects of ES techniques on postural control measures in cases of ankle instability.MethodWe systematically searched five electronic databases: ClinicalTrials.gov, PubMed, Scopus, SPORTDiscus, and Web of Science. To evaluate the quality of the included articles, we utilized the PEDro checklist. We extracted data on population, intervention, and outcomes and synthesized them narratively.ResultES decreased the time needed to stabilize the center of pressure, velocity, displacement, and area, thereby enhancing the performance of clinical tests. While postural stability indexes remained unaffected, the gait inversion angle increased with electrical stimulation.ConclusionThese results suggest that ES interventions are crucial in enhancing postural control in subjects with ankle instability compared to coordination exercises therapy alone. Stochastic resonance reduced A/P and M/L TTS, COP velocity, COP displacement, and COP area, resulting in enhanced postural control.

Psychiatric rehabilitation is to assist disabled people in developing the emotional, social, and cognitive skills required to live, learn, and work in the community with the least amount of professional assistance. The goal of the current case study revealed that support from family, friends, community, treating mental health professionals, and drug compliance contributes to the recovery. Many persons with mental illness will experience disability which becomes a barrier to regular follow-up. The needs of severely disabled people are often neglected or not met adequately by mental health professionals, family, and the community. They do not understand what is happening in the community and the home environment. Therefore, the current case study made an effort to know the actual situation of mentally disabled people in their home environment and evaluated psychiatric rehabilitation needs. A case study was presented in detail with findings of the home visit and the strengths and weaknesses of the home visit from a social work perspective. The case study concludes that community attitude; the economic burden was one of the leading causes of barriers to psychiatric rehabilitation in India.

The aim of this article is to gain a better knowledge of the non-Newtonian features of Casson fluid flow under torsional motion through two concentric cylinders in a porous medium. This study is crucial because it has the ability to control the flow characteristics of Casson fluids in porous media using rotating cylinders for the optimization of industrial processes. The flow-narrating differential equations are converted into a set of nonlinear differential equations. To obtain numerical results to flow problem, a computational model is developed. Numerical solutions are acquired employing the fourth-order exactness programme (Bvp4c), and findings are validated by comparing them to the Runge-Kutta fourth-order approach. Consequences of various distinct parameters for fluid flow and heat transfer are interpreted in graphical and tabular form. It is found that both fluid velocity and temperature increase with growing inputs of outer angular velocity (0.3≤Ω2≤0.9). Skin friction coefficient (CfsTa) is observed to decline in the case when both cylinders are rotating in same direction (Ω1=0.7andΩ2=0.7) with enhanced inputs of Hartmann number (0.5≤Ha≤2.0), while Nusselt number (Nus) profiles are enhanced with rising inputs of the Forchheimer parameter (0.2≤Fr≤0.8) when both cylinders are rotating in opposite direction (Ω1=0.7andΩ2≤−0.7).

Background: Hair symbolizes well-being and self-expression, with graying occurring naturally among different racial groups at varying ages. Premature graying has psychological and societal impacts, influencing self-esteem and quality of life. Gray hair usually advances gradually and is permanent, with occasional reports of natural repigmentation. Premature graying of hair (PMGH) results from a complex interplay of genetic, environmental, and cellular factors. Materials and Methods: Studies exploring links between gray hair and conditions such as osteopenia, hearing loss, smoking, obesity, dyslipidemia, and cardiovascular disease have yielded mixed results. Despite continuous research into the causes of gray hair, effective, evidence-based treatments are lacking and still need to be improved. Conclusion: Herein, we reviewed the causes, mechanisms, risk factors, psychosocial effects, and emerging therapies for PMGH.

Aim: To compare the Subfoveal Choroidal Thickness (SFCT) measured by Enhanced Depth Imaging (EDI) technique of Spectral Domain Optical Coherence Tomography (SD-OCT) in healthy pregnant and preeclamptic women. Methods: Our study was cross-sectional hospital-based study in which healthy pregnant women and women having preeclampsia were selected from Obstetrics and Gynecology department and enrolled in it. The guidelines of the American College of Obstetricians and Gynecologists were used to diagnose the cases of preeclampsia. The study included 100 women (200 eyes) which were grouped into 50 healthy pregnant women (group 1), i.e., n = 100 eyes and 50 preeclamptic women (group 2), i.e., n = 100 eyes. SFCT was measured using the EDI technique of SD-OCT and data were entered in a Microsoft Excel sheet. Statistical analysis was done using Epi Info. Software version 7.2.1.0 (Atlanta, Georgia, US) and the results of both the groups were compared. Results: The mean SFCT in both the eyes of the healthy pregnant group and the preeclamptic group was 318.12 ± 37.12 µm and 209.04 ± 26.73 µm, respectively, with a P-value 0.001 showing a statistically significant difference between both the groups. Conclusion: The SFCT is significantly decreased in preeclamptic pregnant women than in healthy pregnant women.

Abstract Linseed or flaxseed, native to the Indian subcontinent, had undergone domestication, edaphic selection and evolutionary processes that may have resulted in huge genetic variability in Indian genotypes. To understand the hitherto unexplored genetic diversity for sustainable flaxseed production amid challenges of climate fluctuation and identify trait-specific high-yielding genotypes, 2576 unique linseed accessions were comprehensively evaluated for 36 traits for up to six environments representing two major agroecological zones in India. A wide range of variability was recorded for days to initiation of flowering (42.86–114.99), plant height (43.31–122.88 cm), capsules/plant (64.62–375.87), seed size (6.06–14.44 cm2), thousand seed weight (2.80–11.86 g), seed yield (2.93–17.28 g/plant), oil content (30.14–45.96%) and fatty acid profile especially the key constituent omega-3 fatty acid (25.4–65.88%). Most of the traits such as plant height, flowering time, seed yield, seed and capsule size showed a high or moderately high level of variance coupled with high broad sense heritability indicating precise capturing of less heritable quantitative traits. The infraspecific classification of the tested collection revealed the seed/oil type (2498 accessions) as the dominant morphotype over dual-purpose/fiber flax (78 accessions) in the conserved collection. Correlation analysis indicated a significant positive association between flowering time, plant height, days to maturity and oil content. Trait-specific superior genotypes for earliness (50% flowering in 11 g), capsules/plant (> 350), oil content (> 45%) and fatty acid composition (> 65% alpha-linolenic acid) were identified to aid genetic improvement of linseed and to broaden the narrow genetic base.

Abstract Recently, we have reported that extracellular vesicles (EVs) from the bone marrow mesenchymal stromal cells (BM-MSC) of aplastic anemia (AA) patients inhibit hematopoietic stem and progenitor cell (HSPC) proliferative and colony-forming ability and promote apoptosis. One mechanism by which AA BM-MSC EVs might contribute to these altered HSPC functions is through microRNAs (miRNAs) encapsulated in EVs. However, little is known about the role of BM-MSC EVs derived miRNAs in regulating HSPC functions in AA. Therefore, we performed miRNA profiling of EVs from BM-MSC of AA (n = 6) and normal controls (NC) (n = 6) to identify differentially expressed miRNAs. The Integrated DEseq2 analysis revealed 34 significantly altered mature miRNAs, targeting 235 differentially expressed HSPC genes in AA. Hub gene analysis revealed 10 HSPC genes such as IGF-1R, IGF2R, PAK1, PTPN1, etc., which are targeted by EV miRNAs and had an enrichment of chemokine, MAPK, NK cell-mediated cytotoxicity, Rap1, PI3k-Akt, mTOR signalling pathways which are associated with hematopoietic homeostasis. We further showed that miR-139-5p and its target, IGF-1R (hub-gene), might regulate HSPC proliferation and apoptosis, which may serve as potential therapeutic targets in AA. Overall, the study highlights that AA BM-MSC EV miRNAs could contribute to impaired HSPC functions in AA.

Abstract Background Multiple lines of evidence support peripheral organs in the initiation or progression of Lewy body disease (LBD), a spectrum of neurodegenerative diagnoses that include Parkinson’s Disease (PD) without or with dementia (PDD) and dementia with Lewy bodies (DLB). However, the potential contribution of the peripheral immune response to LBD remains unclear. This study aims to characterize peripheral immune responses unique to participants with LBD at single-cell resolution to highlight potential biomarkers and increase mechanistic understanding of LBD pathogenesis in humans. Methods In a case–control study, peripheral mononuclear cell (PBMC) samples from research participants were randomly sampled from multiple sites across the United States. The diagnosis groups comprise healthy controls (HC, n = 159), LBD (n = 110), Alzheimer’s disease dementia (ADD, n = 97), other neurodegenerative disease controls (NDC, n = 19), and immune disease controls (IDC, n = 14). PBMCs were activated with three stimulants (LPS, IL-6, and IFNa) or remained at basal state, stained by 13 surface markers and 7 intracellular signal markers, and analyzed by flow cytometry, which generated 1,184 immune features after gating. Results The model classified LBD from HC with an AUROC of 0.87 ± 0.06 and AUPRC of 0.80 ± 0.06. Without retraining, the same model was able to distinguish LBD from ADD, NDC, and IDC. Model predictions were driven by pPLCγ2, p38, and pSTAT5 signals from specific cell populations under specific activation. The immune responses characteristic for LBD were not associated with other common medical conditions related to the risk of LBD or dementia, such as sleep disorders, hypertension, or diabetes. Conclusions and Relevance Quantification of PBMC immune response from multisite research participants yielded a unique pattern for LBD compared to HC, multiple related neurodegenerative diseases, and autoimmune diseases thereby highlighting potential biomarkers and mechanisms of disease.

Introduction: The maternal and fetal outcomes are poorer in pregnancies associated with obstetric complications. A newly recognized marker of hypoxia, serum ischemia-modified albumin (IMA), which serves as an early predictive marker of myocardial infarction in the emergency department, is now being studied in obstetric complications of pregnancy. Aims and Objectives: (1) To study the levels of maternal serum IMA in the early 2nd trimester (12–20 weeks) to predict the occurrence of uncomplicated and complicated pregnancy post 20 weeks of gestation. (2) To evaluate the IMR ratio (IMAR) (serum IMA-to-human serum albumin ratio) and its significance in the obstetric complications of pregnancy. Methodology: This prospective cohort study was conducted on 150 antenatal women with gestational age from 12 to 20 weeks. A complete detailed history of all participants was taken and they were followed up to the time of delivery for the specific complications (i.e., pregnancy-induced hypertension [PIH], preeclampsia, eclampsia, and gestational diabetes in mother and stillbirth, preterm birth, and fetal growth restriction [FGR] in the fetus) that developed during pregnancy. IMA levels and IMA ratio were obtained and correlated with the development of the defined complications of pregnancy. The data were recorded, tabulated, and subjected to statistical analysis. Results: A significant relationship between IMA value and the incidence of PIH, preeclampsia, and eclampsia and between IMAR value and the incidence of preeclampsia and eclampsia was seen among the study population (P < 0.05). We observed that IMA and IMAR values were higher in women who did not have any fetal complications than in women who had fetal complications, namely, stillbirth, preterm birth, and FGR. However, this difference was not significant (P > 0.05). Conclusion: Serum IMA and IMAR levels were higher in women with PIH, preeclampsia, and eclampsia. The most common pregnancy outcome was small for gestation age. No significant link was found between serum IMA levels or IMAR and the severity of eclampsia, gestational diabetes, stillbirth, preterm, and FGR.

Background: The utilization of a theoretical framework is vital in health promotion research, particularly when endeavoring to modify health behaviors. This systematic review aimed at evaluating and synthesizing evidence through studies conducted using the fourth-generation multi-theory model (MTM) of health behavior change for its effectiveness. Methods: A comprehensive article search was performed across MEDLINE, CINAHL, and Academic Search Premier. The search focused on studies utilizing MTM from 2016 to December 2023, following the PRISMA guidelines for systemic reviews. Results: An initial pool of 7583 articles was narrowed down through screening of titles, abstracts, and full texts. A total of 69 articles met the inclusion criteria. These studies, encompassing a global range of diverse target groups and health behaviors, were categorized as qualitative, cross-sectional, or experimental. The six qualitative studies revealed MTM themes for diverse health behaviors. The fifty-six cross-sectional studies showed MTM constructs effectively predicting behavior change, albeit with varying statistical significance. The seven experiments demonstrated MTM’s role in initiating and sustaining change. For the initiation model, operationalized by 49 studies, the mean adjusted R2 was 38.4% (SD=16.4%). For the sustenance model, operationalized by 45 studies, the mean adjusted R2 was 38.9% (SD=15.5%). Conclusion: This systematic review corroborates the MTM as a potent framework for understanding, predicting, and facilitating health behavior changes. Its universal applicability and effectiveness underscore the model’s potential as a foundational tool in designing future health promotion strategies and interventions aimed at positive and enduring behavior modifications.

Digitalization has transformed dynamics across all fields, and technology has completely changed the customer experience. One prominently utilized technology in offline retail is self-checkout services. The present study intends to investigate the attributes that influence people to use self-checkout services and assess their impact on service quality and customer satisfaction. Drawn from Dabholkar’s attribute-based model, the study employs a positivist approach to test the conceptual framework. After the preliminary survey of 330 respondents, it identified ninety-nine consumers who had used the self-service check-out facility. The data collected were analyzed using a multi-variate technique – Partial Least Squares Structural Equation Modeling (PLS-SEM) – owing to the small sample size requirement. All independent variables taken for the study positively affect the service quality. Customer perception of control, ease of use, reliability, enjoyment, speed, adventure, and openness positively affect service quality. It was noted that ease of use, with a variance value of 2.451, and openness to experience, with a variance value of 2.437, show the importance of determining independent variables with service quality. The study findings reported that service quality is primarily influenced by ease of use, enjoyment, and openness to experience. It underlines that some retail customers will likely feel frustrated rather than enjoy the self-service technology, perceiving it as less reliable. The study suggests incorporating openness to experience and adventure shopping in retail outlets that can enhance consumer satisfaction and loyalty. Adopting an immersive and interactive shopping experience will ultimately improve the perception of service quality and customer happiness.

Abstract Background Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established. Methods This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 h of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 h will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient-reported quality of life measures. Discussion In vitro and in vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms. Trial registration ClinicalTrials.gov NCT04217551. Registered on 30 December 2019.

Introduction: The Mandibular Lingual Canals (MLC), which carry the sublingual artery, are present in the mandible near the genial tubercle. Identification of these canals is important before any dental surgical procedures. Aim: To identify and evaluate the mandibular lingual canal in Cone Beam Computed Tomography (CBCT) of the Western Indian Population. Materials and Methods: The current cross-sectional study was conducted at the Department of Oral Medicine and Radiology, Sumandeep Vidyapeeth, Vadodara, Gujarat, India between October 2022 and June 2023. A total of 100 CBCT volumes showing the mandibular anterior region were evaluated for the presence or absence of a mandibular lingual canal. The canals were further evaluated for their number, diameter, length, thickness of the buccal cortical plate, and the remaining bone above and below the canal. The evaluation was done by two separate investigators. The data were entered into Microsoft Excel and subjected to statistical analysis. Data collected were tested statistically using the Chi-square test. Results: A total of 59 males and 41 females’ mandibular CBCT volumes were evaluated, out of which 93 CBCT volumes showed the mandibular lingual canal. The maximum number (n=57) of individuals showed three canals, followed by two canals (n=26) and one canal (n=10). There was no statistical significance between genders regarding canal number, diameter, length, thickness of the buccal cortical plate, and the remaining bone above and below the canal. Conclusion: Three-canal morphology was the most common anatomical form of MLC found in the Western Indian population.

Abstract Background Cardiac magnetic resonance (CMR) in the four-chamber plane offers comprehensive insight into the volumetrics of the heart. We aimed to develop an artificial intelligence (AI) model of time-resolved segmentation using the four-chamber cine. Methods A fully automated deep learning algorithm was trained using retrospective multicentre and multivendor data of 814 subjects. Validation, reproducibility, and mortality prediction were evaluated on an independent cohort of 101 subjects. Results The mean age of the validation cohort was 54 years, and 66 (65%) were males. Left and right heart parameters demonstrated strong correlations between automated and manual analysis, with a ρ of 0.91−0.98 and 0.89−0.98, respectively, with minimal bias. All AI four-chamber volumetrics in repeatability analysis demonstrated high correlation (ρ = 0.99−1.00) and no bias. Automated four-chamber analysis underestimated both left ventricular (LV) and right ventricular (RV) volumes compared to ground-truth short-axis cine analysis. Two correction factors for LV and RV four-chamber analysis were proposed based on systematic bias. After applying the correction factors, a strong correlation and minimal bias for LV volumetrics were observed. During a mean follow-up period of 6.75 years, 16 patients died. On stepwise multivariable analysis, left atrial ejection fraction demonstrated an independent association with death in both manual (hazard ratio (HR) = 0.96, p = 0.003) and AI analyses (HR = 0.96, p

Abstract Halophiles are one of the classes of extremophilic microorganisms that can flourish in environments with very high salt concentrations. In this study, fifteen bacterial strains isolated from various crop rhizospheric soils of agricultural fields along the Southwest coastline of Saurashtra, Gujarat, and identified by 16S rRNA gene sequencing as Halomonas pacifica, H. stenophila, H. salifodinae, H. binhaiensis, Oceanobacillus oncorhynchi, and Bacillus paralicheniformis were investigated for their potentiality to produce extremozymes and compatible solute. The isolates showed the production of halophilic protease, cellulase, and chitinase enzymes ranging from 6.90 to 35.38, 0.004–0.042, and 0.097–0.550 U ml−1, respectively. The production of ectoine-compatible solute ranged from 0.01 to 3.17 mg l−1. Furthermore, the investigation of the ectoine-compatible solute production at the molecular level by PCR showed the presence of the ectoine synthase gene responsible for its biosynthesis in the isolates. Besides, it also showed the presence of glycine betaine biosynthetic gene betaine aldehyde dehydrogenase in the isolates. The compatible solute production by these isolates may be linked to their ability to produce extremozymes under saline conditions, which could protect them from salt-induced denaturation, potentially enhancing their stability and activity. This correlation warrants further investigation.

Background/Objective: Severe hypocalcemia is common in critically ill patients. There are different mechanisms. To our knowledge, there are no data about the acute presentation of hypocalcemia at the time of diagnosis of aplastic anemia (AA). The objective of this case report was to describe the case of hypoparathyroidism with severe hypocalcemia in a critically ill patient with AA. Case Report: A 60-year-old man presented with severe hypocalcemia with a calcium level of 6.1 mg/dL (reference range, 8.6-10.3 mg/dL) and hypoparathyroidism with a parathyroid hormone level of 11 pg/mL (reference range, 12-88 pg/mL). He developed a critical state caused by newly diagnosed AA and its complications, such as an acute decrease in the platelet value to a critically low level of 2 × 103/cmm, complicated by neutropenic fever and lower gastrointestinal bleeding. After the initiation of immunosuppressive therapy for AA, his parathyroid hormone-calcium metabolism improved and remained stable but did not normalize completely. Discussion: In our patient, hypoparathyroidism with hypocalcemia may have been caused by cytokine-related upregulation of the calcium-sensing receptor in the setting of AA. On the other hand, given the severity of the initial hypocalcemia and only partial improvement in calcium homeostasis with residual mild hypocalcemia after treatment initiation for AA, autoimmune causes cannot be entirely ruled out, nor could a combination of cytokine-mediated and autoimmune causes. Conclusion: It is essential to treat the underlying causes of hypocalcemia, which, in this case, were AA and hypoparathyroidism.

The incidence of spotted fever group (SFG) rickettsioses in the United States has tripled since 2010. Rocky Mountain spotted fever, the most severe SFG rickettsiosis, is caused by Rickettsia rickettsii. The lack of species-specific confirmatory testing obfuscates the relative contribution of R. rickettsii and other SFG Rickettsia to this increase. We report a newly recognized rickettsial pathogen, Rickettsia sp. CA6269, as the cause of severe Rocky Mountain spotted fever–like illness in 2 case-patients residing in northern California. Multilocus sequence typing supported the recognition of this pathogen as a novel Rickettsia genotype most closely related to R. rickettsii. Cross-reactivity observed for an established molecular diagnostic test indicated that Rickettsia sp. CA6269 might be misidentified as R. rickettsii. We developed a Rickettsia sp. CA6269–specific real-time PCR to help resolve this diagnostic challenge and better characterize the spectrum of clinical disease and ecologic epidemiology of this pathogen.

Abstract Centrin1 gene deleted Leishmania donovani parasite (LdCen1 −/− ) was developed and extensively tested experimentally as an intracellular stage-specific attenuated and immunoprotective live parasite vaccine candidate ex vivo using human PBMCs and in vivo in animals. Here we report manufacturing and pre-clinical evaluation of current Good-Laboratory Practice (cGLP) grade LdCen1 −/− parasites, as a prerequisite before proceeding with clinical trials. We screened three batches of LdCen1 −/− parasites manufactured in bioreactors under cGLP conditions, for their consistency in genetic stability, attenuation, and safety. One such batch was preclinically tested using human PBMCs and animals (hamsters and dogs) for its safety and protective immunogenicity. The immunogenicity of the CGLP grade LdCen1 −/− parasites was similar to one grown under laboratory conditions. The cGLP grade LdCen1 −/− parasites were found to be safe and non-toxic in hamsters and dogs even at 3 times the anticipated vaccine dose. When PBMCs from healed visceral leishmaniasis (VL) cases were infected with cGLP LdCen1 −/− , there was a significant increase in the stimulation of cytokines that contribute to protective responses against VL. This effect, measured by multiplex ELISA, was greater than that observed in PBMCs from healthy individuals. These results suggest that cGLP grade LdCen1 −/− manufactured under cGMP complaint conditions can be suitable for future clinical trials.

Abstract Background Childcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population. Methods We conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers. Results Among the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs. Conclusions Childcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.

Abstract Objective Our objectives were to (1) obtain the prevalence and demography of people with multiple sclerosis (MS) in a representative Colorado population, and (2) to assess the utilization of disease‐modifying therapy within this prevalent cohort. Methods This is a retrospective, observational study of patients that had contact with the University of Colorado Health System from 2012 to 2020. We queried Health Data Compass, a data warehouse, for patient data and applied the MS Prevalence Workgroup Algorithm to generate a prevalent cohort. We calculated prevalence as of 31 December 2020, and stratified by age, sex, race, and ethnicity. Payer information and treatment exposure were obtained from linked claims from the Colorado All Payers Claim Database. Disease‐modifying therapies were classified as highly effective and moderately effective based on the clinical trial, TREAT‐MS (NCT03500328). Results From a population of 1,382,821 individuals, 8557 people with MS were captured. Age‐adjusted prevalence of MS as of 31 December 2020 was 572.3 per 100,000 with a mean age of 47.36. Prevalence varied between demographic subgroups, with the lowest prevalence in Hispanic men (215.6) and highest in White (824.1) and Black women (820.1). Overall disease‐modifying therapy exposure was 62.4%, with increased highly effective therapy use and a corresponding decrease in moderately effective therapy use on a yearly basis. Interpretation MS is highly prevalent in a representative Colorado cohort. Overall treatment and proportion of highly effective therapy exposure increased significantly during a critical period of MS therapeutic advances, indicating a shift in disease management driven sharply by the availability of on‐label anti‐CD20 therapy.

Abstract Background Racial and ethnic inequities in palliative care are well-established. The way researchers design and interpret studies investigating race- and ethnicity-based disparities has future implications on the interventions aimed to reduce these inequities. If racism is not discussed when contextualizing findings, it is less likely to be addressed and inequities will persist. Objective To summarize the characteristics of 12 years of academic literature that investigates race- or ethnicity-based disparities in palliative care access, outcomes and experiences, and determine the extent to which racism is discussed when interpreting findings. Methods Following Arksey & O’Malley’s methodology for scoping reviews, we searched bibliographic databases for primary, peer reviewed studies globally, in all languages, that collected race or ethnicity variables in a palliative care context (January 1, 2011 to October 17, 2023). We recorded study characteristics and categorized citations based on their research focus—whether race or ethnicity were examined as a major focus (analyzed as a primary independent variable or population of interest) or minor focus (analyzed as a secondary variable) of the research purpose, and the interpretation of findings—whether authors directly or indirectly discussed racism when contextualizing the study results. Results We identified 3000 citations and included 181 in our review. Of these, most were from the United States (88.95%) and examined race or ethnicity as a major focus (71.27%). When interpreting findings, authors directly named racism in 7.18% of publications. They were more likely to use words closely associated with racism (20.44%) or describe systemic or individual factors (41.44%). Racism was directly named in 33.33% of articles published since 2021 versus 3.92% in the 10 years prior, suggesting it is becoming more common. Conclusion While the focus on race and ethnicity in palliative care research is increasing, there is room for improvement when acknowledging systemic factors – including racism – during data analysis. Researchers must be purposeful when investigating race and ethnicity, and identify how racism shapes palliative care access, outcomes and experiences of racially and ethnically minoritized patients.

Objectives: The present study aims to address the psychological motivations behind social media use, focusing on its under-explored regulatory function in the context of coping strategies and emotional regulation among teachers. This exploratory research explores the relationship between social media engagement and its impact on educators’ stress management and emotional regulation mechanisms. Methods: To investigate this relationship, the study utilized two key instruments: The coping inventory for stressful situations and the Italian version of the difficulties in emotion regulation scale. These tools were administered to a sample of 214 Italian teachers, predominantly female (90.7%), with ages ranging from 25 to 65 years (Mean±SD 47.19±9.02 years). The study employed correlation analysis to assess the associations between social media use in addition to various coping and emotional regulation strategies. Results: The correlation analysis revealed a nuanced relationship between the usage of certain social media platforms and a higher inclination toward a problem-oriented coping style, alongside a decreased sense of a lack of negative emotional control. Accordingly, while social media can serve as a tool for problem-oriented coping, it may also hinder the ability to disengage from negative emotional states. Discussion: The results of this study shed light on the potential of social media as a resource and a challenge in the emotional and professional lives of teachers. By identifying specific coping strategies that are positively and negatively associated with social media use, the research points toward possible interventions that could mitigate the adverse effects of social media. This could include developing targeted support mechanisms to enhance teachers’ ability to manage stress and regulate emotions effectively, thereby optimizing their use of social media in a way that supports their psychological well-being.

Abstract FOXA family proteins act as pioneer factors by remodeling compact chromatin structures. FOXA1 is crucial for the chromatin binding of the androgen receptor (AR) in both normal prostate epithelial cells and the luminal subtype of prostate cancer (PCa). Recent studies have highlighted the emergence of FOXA2 as an adaptive response to AR signaling inhibition treatments. However, the role of the FOXA1 to FOXA2 transition in regulating cancer lineage plasticity remains unclear. Our study demonstrates that FOXA2 binds to distinct classes of developmental enhancers in multiple AR-independent PCa subtypes, with its binding depending on LSD1. Moreover, we reveal that FOXA2 collaborates with JUN at chromatin and promotes transcriptional reprogramming of AP-1 in lineage-plastic cancer cells, thereby facilitating cell state transitions to multiple lineages. Overall, our findings underscore the pivotal role of FOXA2 as a pan-plasticity driver that rewires AP-1 to induce the differential transcriptional reprogramming necessary for cancer cell lineage plasticity.

Abstract Background Preventable newborn deaths are a global tragedy with many of these deaths concentrated in the first week and day of life. A simple low-cost intervention, chlorhexidine cleansing of the umbilical cord, can prevent deaths from omphalitis, an infection of the umbilical cord. Bangladesh and Nepal have national policies promoting chlorhexidine use, as well as routinely collected household survey data, which allows for an assessment of coverage and predictors of the intervention. Methods We used data from the 2017–2018 Bangladesh Demographic and Health Survey and the 2016 Nepal Demographic and Health Survey, two large-scale nationally representative household surveys. We studied coverage of single application of chlorhexidine to the umbilical cord of newborns born in the past year using descriptive, bivariate and multivariable analyses. Key predictors of newborns receiving chlorhexidine cleansing, including socio-economic factors, healthcare related factors and the application of harmful and nonharmful substances, were explored in this study. Results Coverage of chlorhexidine cleansing was 15.0% in Bangladesh and 50.7% in Nepal, while the application of a harmful substance was 16.9% in Bangladesh and 22.6% in Nepal. Results from the multivariable analyses indicated that delivery in a health facility was strongly associated with a newborn’s receipt of chlorhexidine in both countries (Bangladesh: OR = 2.23, p = 0.002; Nepal: OR = 5.01, p = 0.000). In Bangladesh, delivery by Cesarean section and application of another non-harmful substance were significantly and positively associated with the receipt of chlorhexidine. In Nepal antenatal care was significantly and positively associated with chlorhexidine, while application of a harmful substance was significantly and negatively associated with receipt of chlorhexidine. Maternal education, urban/rural residence, religion and sex were not significant in the multivariable analysis. Wealth was not a significant factor in Bangladesh, but in Nepal newborns in the two highest wealth quintiles were significantly less likely to receive chlorhexidine than newborns in the lowest wealth quintile. Conclusion As Bangladesh and Nepal continue to scale-up chlorhexidine for newborn umbilical cord care, additional focus on newborns born in non-facility environments may be warranted. Chlorhexidine cleansing may have the potential to be an equitable intervention, as newborns from the poorest wealth quintiles and whose mothers had less education were not disadvantaged in receiving the intervention in these two settings.

Introduction: Bacterial Meningitis (BM) is a serious health problem worldwide with high mortality and permanent long-term neurological sequelae. Cerebrospinal Fluid (CSF) analysis is the cornerstone for diagnosing BM, but the lack of specificity creates a difficult clinical scenario for initiating proper treatment. Empiric antibiotic use in patients with suspected meningitis at primary care settings decreases the yield of CSF culture and alters CSF cytological and biochemical findings, making it further difficult to diagnose BM. To overcome this difficulty, there is a need for other biochemical markers with higher sensitivity and specificity. Aim: To determine the diagnostic sensitivity and specificity of Procalcitonin (PCT) in serum and CSF in patients with BM and compare its diagnostic accuracy in both sample types. Materials and Methods: A cross-sectional study was conducted in the Department of Internal Medicine at a tertiary care centre in eastern India from September 2018 to August 2020. A total of 82 adult patients with meningitis were recruited as per the protocol, and CSF analysis was done along with estimation of PCT in serum and CSF. Receiver Operating Characteristics (ROC) curve analysis of serum and CSF PCT was used to determine sensitivity and specificity with a 95% confidence interval. Results: Out of the 82 patients recruited, 30 (36.6%) had BM. CSF PCT with a cut-off value of >0.45 ng/mL had a sensitivity of 86.7% and specificity of 92.3%. The sensitivity of serum PCT with a cut-off value of >0.6 ng/mL was 83.3%, and specificity was 86.5%. There was no statistically significant difference in sensitivity and specificity between CSF and serum PCT in patients with BM (p-value=0.7988). Conclusion: Both serum and CSF PCT were found to have high sensitivity and specificity as markers for diagnosing BM without any statistically significant difference between them.

This study addresses the numerical investigation of the steady and two-dimensional flow of magnetohydrodynamic nanofluid containing motile microorganisms over three distinct configurations: a wedge, a plate, and the stagnation point of a flat plate. The impacts of activation energy, melting phenomena, thermophoresis, and Brownian motion are taken into account. The dimensionless form of the governing coupled nonlinear partial differential equations is obtained by using similarity transformations. The system of ordinary differential equations is numerically solved using the “bvp4c” solver in MATLAB, and obtained results are also validated with an analytical approach Optimal Auxiliary Function Method (OAFM). Skin friction, heat, mass and motile microorganisms transfer rates are discussed through graphs and tables. Findings indicate that profile for Nusselt number enhances for higher inputs of melting parameter while Sherwood number lowers with increasing inputs of activation energy parameter. An improving pattern of velocity profiles is magnificent for stagnation point flow [f(η = 1) = 0.943711] compared to wedge [f(η = 1) = 0.915698]and horizontal plate [f(η = 1) = 0.868617]with respect to wedge angle parameter keeping velocity ratio parameter A < 1. For the wedge surface, the temperature profiles decrease [θ(η = 1.5) = 0.933075, 0.895245, 0.858931] for increasing inputs of radiation parameter (2.5 ≤ Nr ≤ 4.5) while motile microorganism profiles enhance [χ(η = 1.3) = 0.532505, 0.621569, 0.690635] with bioconvection Schmidtt number (0.3 ≤ Sb ≤ 0.7) respectively. Furthermore, it was found that, as velocity slip parameter increases then velocity of fluid also improves over a plate, wedge, and stagnation point of a flat plate considering velocity ratio parameter A < 1 .

Background: Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid. Objectives: To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs. Methods: PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE. Results: Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula. Conclusions: There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.

Background: Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative. Objectives: To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns. Methods: PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE. Results: Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33–5.36) but the evidence is very uncertain, and no difference in urine output (SMD −0.17, 95% CI −0.65–0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72–476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8–28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55–1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08–1.09), improved creatinine levels (SMD −3.48, 95% CI −4.69 to −2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38–0.72). Conclusions: Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered.

In the current work, flow of 2-D MHD Walters'B viscoelastic fluid is discussed in the existence of elastic deformation, Cattaneo–Christov Heat Flux Model (CCHFM), heat source, Newtonian heating, viscous dissipation and porous medium. Dimensionless equations that are in charge of the problem's analysis are produced by using the suitable similarity transformation, and Optimal Auxiliary Functions Method (OAFM) is employed to solve them. In the ongoing investigation, the main results are decreasing behavior of temperature profile for the thermal relaxation parameter and elastic deformation parameter, while the reverse effect is noticed while increasing the Weissenberg number and porosity parameter. Our findings reveal significant insights into the fluid dynamics and heat transfer characteristics. Integrating the Cattaneo–Christov heat flux model and elastic deformation analysis in Walters'B viscoelastic fluid flow having its importance in polymer processing, aerospace engineering and waste treatment systems.

Recent strides in understanding the molecular underpinnings of head and neck cancers have sparked considerable interest in identifying precise biomarkers that can enhance prognostication and enable personalized treatment strategies. Immunotherapy has particularly revolutionized the therapeutic landscape for head and neck squamous cell carcinoma, offering new avenues for treatment. This review comprehensively examines the application and limitations of the established and emerging/novel biomarkers for head and neck squamous cell carcinoma. Established biomarkers, including well-characterized genetic mutations, protein expressions, and clinical factors, have been extensively studied and validated in clinical practice. Novel biomarkers identified through molecular analyses, including novel genetic alterations, immune-related markers, and molecular signatures, are currently being investigated and validated in preclinical and clinical settings. Biomarkers hold the potential to deepen our understanding of head and neck squamous cell carcinoma biology and guide therapeutic strategies. The evolving paradigm of predictive biomarkers facilitates the study of individual responses to specific treatments, including targeted therapy and immunotherapy.

ObjectivesVasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants 6 h. Analyses were performed using SAS v9.4, with a priori less than 0.05. A multiple variable logistic regression was employed to assess odds of hyponatremia.ResultsOf the 105 patients included, 57 (54.3%) developed hyponatremia, and 17 (29.8%) were classified as severe hyponatremia. Overall, the median (interquartile range, IQR) gestational and postnatal age at vasopressin initiation were 35.4 (27–38.7) weeks and 2 (1–12) days. There was no difference in vasopressin dose, but duration of treatment was longer in those with hyponatremia. Higher baseline serum sodium was associated with decreased odds of hyponatremia [adjusted odds ratio (OR): 0.90 (95% CI: 0.83–0.99), p = 0.03], and increased vasopressin duration was associated with increased odds of hyponatremia [aOR: 1.02 (95% CI: 1.01–1.03), p

Introduction: Region-specific data on individual factors associated with uptake of breast and cervical cancer screening or early testing in diverse Indian populations are limited. Aim: To assess the prevalence and individual determinants of uptake of breast and/or cervical cancer screening or testing among women aged 30–69 years in regionally representative populations of two large Indian cities: New Delhi and Chennai. Methods: We conducted an analysis of the cross-sectional data (2016–2017) nested within the Centre for Cardiometabolic Risk Reduction in South Asia cohort, established in 2010–2011 with 12,271 participants (5365 in New Delhi; 6906 in Chennai). Among 3310 women participants, we evaluated the associations of demographic, socioeconomic, lifestyle, medical, psychosocial, and reproductive factors with breast and/or cervical cancer screening or testing using multivariable logistic regression models with results expressed as adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: At any point prior to 2016–2017, 193 women self-reported having undergone evaluations for breast and/or cervical cancer. The reasons for evaluation were ‘general examination’ or ‘physician’s advice’ (i.e., screening) or ‘being symptomatic’ (i.e., early testing). The overall prevalence was 5.8% for screening or testing and 2.5% for screening alone. Formal education (OR:1.88; 95% CI:1.12–3.15), high monthly household income (OR:2.27; 95% CI:1.59–3.25) and less ‘fear-of-judgement’ (OR:1.65; 95% CI:1.05–2.58) were positively associated with screening or testing uptake. When screening uptake was analysed separately, the results were generally similar. Conclusion: Our findings may have important implications for interventions at community-level (e.g., reducing ‘fear-of-judgement’, increasing awareness to screening programs and early symptoms) and health-system level (e.g., opportunistic screening).

The decline in performance of sugarcane either due to non-availability of suitable planting material or negligence in nutrient management is increasing at an alarming rate. Therefore, a field experiment was conducted for two consecutive years in Bihar, India to study the effect of different planting material and integrated nutrient management strategies on performance and yield of sugarcane. The experiment was conducted in a factorial randomized block design replicated thrice with four planting materials (single budded sett, double budded sett, three budded sett and tissue culture plantlets) and seven integrated nutrient management strategies [control, recommended dose of fertilizer (RDF), soil test-based RDF, RDF + 25% N through pressmud + ZnSO4, soil test-based RDF+ 25% N through pressmud + ZnSO4, RDF + 25% N through FYM + ZnSO4 and soil test-based RDF+ 25% N through FYM + ZnSO4]. Crop growth attributes viz. leaf area index, plant height, tillers, total chlorophyll content was found maximum with tissue culture plantlets followed by three budded setts while the minimum in single budded sett. During both the years of the study, three budded setts increased the cane yield by 33.9 and 34.5% over single budded sett respectively. Application of soil test-based RDF + 25% N through pressmud + ZnSO4 significantly enhanced physio-agronomic performance and further, the sugar yield by 39.1, 13.3 and 38.7, 11.6 % as compared to RDF and soil test-based RDF in first and second year of the study respectively. Hence, it was concluded that three budded sett along with soil test-based RDF + 25% N through pressmud + ZnSO4 of 25 kg/ha can increase overall growth and productivity of sugarcane.

BackgroundMetal oxide nanoparticle–reinforced polymethyl methacrylate (PMMA) has been shown to improve mechanical properties, such as strength. Different types of metal oxide nanoparticles have been used previously, but the comparative effect on the strength of heat-cured denture base resins remains unclear. ObjectiveThis is a protocol for a systematic review and meta-analysis that will aim to pool evidence to compare and analyze the effects of the addition of different metal oxide nanoparticles, with varied sizes and concentrations, on the strength (flexural, impact, transverse, compressive tensile strength, and fracture toughness) of heat-cured PMMA. In addition, this review aims to analyze methodological factors, such as adherence to testing and sample-making guidelines, and the effects of surface treatments of the nanoparticles on the strength of heat-cured denture base resins. MethodsThe protocol has been registered in the Open Science Framework. Search strategies to identify studies on the effect of metal oxide nanoparticles on the strength of heat-cured PMMA were developed by the subject matter expert in library science. Following this, a systematic search of 5 electronic databases (PubMed [NCBI], Scopus [Elsevier], Cochrane Library [Wiley], CINAHL Plus with Full Text [EBSCO], and Dimensions Free Web App) was conducted to retrieve in vitro studies published in English from January 2012 to October 2023. Along with this citation chasing, other online sources and gray literature were also searched. Furthermore, papers will be screened, and appropriate data elements will be extracted in a standardized manner. A risk-of-bias assessment will be performed using a modified Cochrane Risk of Bias Tool. A meta-analysis will be performed using a random-effects model. ResultsSearch in databases resulted in 1837 papers, of which 1752 were duplicates, leaving 85 records that were screened for titles and abstracts based on the eligibility criteria. A similar search run on other online sources identified 129 papers that will be further analyzed for inclusion. The study was initiated in November 2023 and research questions and search strategies were formulated. The proposed study is expected to be completed by December 2024. ConclusionsThis systematic review will comprehensively analyze the effects of the incorporation of metal oxide nanoparticles in heat-cured denture base resins on the strength of the material. We anticipate gaining a deeper understanding of the effects and method of use of metal oxide nanoparticles to improve the strength of PMMA denture base resins. International Registered Report Identifier (IRRID)PRR1-10.2196/59999

Introduction: ALK-positive lung cancers represent a molecularly diverse disease. With drug exposure, driving selection pressure, and resistance pathways, disease relapse will emerge. There is compelling rationale to investigate novel treatment strategies, informed by dynamic circulating tumor DNA (ctDNA) monitoring. Methods: The single-arm, pilot study ALKTERNATE investigated fixed alternating cycles of lorlatinib intercalated with crizotinib in individuals resistant to second-generation ALK inhibitors. Dynamic ctDNA explored the correlation with disease response and disease recurrence and defined disease resistance. The primary outcome was time-to-treatment failure, a composite of tolerability, feasibility, and efficacy. Secondary outcomes included standard survival measures, toxicity, pharmacokinetic analysis, and patient-reported outcomes. Tertiary outcomes were proteogenomic analyses of tissue and plasma. Results: A total of 15 individuals were enrolled; three encountered primary resistance to lorlatinib induction. There were 12 participants who received alternating therapy, and this approach revealed safety, feasibility, and effectiveness. Patient-reported outcomes were maintained or improved on therapy, and toxicity was consistent with previous reports. The pharmacokinetic measures were similar to the single-arm drug experience. Median time-to-treatment failure was 10 months; overall survival was 23 months. ctDNA profiles indicated inferior survival in those with preexistent TP53 mutations and those without clear or cleared ctDNA at trial induction. The study defined a vastly heterogeneous population with an abundance of ALK coexisting with non-ALK resistance variants. Conclusions: ALKTERNATE revealed feasibility with a novel alternating ALK inhibitor strategy in ALK-positive NSCLC. Results support progressing inquiry into this approach and propose a flexible design with drug(s) selected and alternating time frames, informed by real-time plasma profiling. Moving this concept to treatment naive may also optimize impact.

Objective . Viral hepatitis is a global problem leading to significant morbidity and mortality in adults as well as children. This study explores Hepatitis A among Nepalese children and their water habits. Methods . A prospective observational study was conducted over a period of 10 years among Nepalese children. We included 287 children with hepatitis in our study. Results . Among 287 children studied, 266 had Hepatitis A. There were 33 toddlers (11.5%), 121 pre-school children (42.2%), 102 school children (35.5%), and 31 adolescents (10.8%). Ninety-one (32%) children used filtered water, 55 (19%) used boiled water, 23 (8%) used boiled and filtered water, 53 (18%) used jar water and 65 (23%) used direct tap water. Five children had complications. One child died due to complications. The mortality rate in the study was 0.38%. Conclusion . Hepatitis A affected pre-school and school children most. Boiled and filtered is safest against transmission of Hepatitis A.

Western disturbances (WD) bring moderate to heavy rain in the northern parts of the country as well as heavy snow to the mountain areas of the Indian subcontinent. It is the source of most of the winter and post-monsoon rainfall in northwest India. Spatio-temporal analysis of western disturbances was carried out by using weather data recorded at Ballowal Saunkhri (sub-mountainous region), Ludhiana (central plain region) and Bathinda (south west region). The WD events per month were lowest in November and highest in March month averaged over all the agroclimatic regions. The highest numbers of WD events were found during February month in the Sub-mountainous region and during March in central plain region and south-western region. Winter rainfall quantity and number of rainfall events were higher in the sub-mountainous region followed by the central plain region and lowest in the south-western region. Higher number of WD during wheat growing season along with less and well distributed rainfall resulting in lower maximum temperature conditions were conducive for higher productivity in Punjab. The significantly positive correlation was observed between the number of western disturbances and wheat productivity during April month at central plain region and southwest region, whereas, the seasonal total number of WDs showed significant positive relationship at submontane region and southwest region.