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Hoe Nam Leong,1 Asok Kurup,2 Mak Yong Tan,3 Andrea Lay Hoon Kwa,4,5 Kui Hin Liau,6 Mark H Wilcox7 1Rophi Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore; 2Infectious Diseases Care Private Ltd, Mount Elizabeth Medical Centre, Singapore, Singapore; 3My Orthopaedic Clinic, Gleneagles Medical Centre, Singapore, Singapore; 4Department of Pharmacy, Singapore General Hospital, Singapore, Singapore; 5Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore; 6LIAU KH Specialist Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore; 7Department of Medical Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK Abstract: Complicated skin and soft tissue infections (cSSTIs) represent the severe form of infectious disease that involves deeper soft tissues. Involvement of methicillin-resistant Staphylococcus aureus (MRSA) further complicates cSSTI with increased hospitalization, health care costs, and overall mortality. Various international guidelines provide recommendations on the management of cSSTIs, with the inclusion of newer antibiotics. This literature-based review discusses the overall management of cSSTI, including appropriate use of antibiotics in clinical practice. Successful treatment of cSSTIs starts with early and precise diagnosis, including identification of causative pathogen and its load, determination of infection severity, associated complications, and risk factors. The current standard-of-care for cSSTIs involves incision, drainage, surgical debridement, broad-spectrum antibiotic therapy, and supportive care. In recent years, the emergence of newer antibiotics (eg, ceftaroline, tigecycline, daptomycin, linezolid, etc) has provided clinicians wider options of antimicrobial therapy. Selection of antibiotics should be based on the drug characteristics, effectiveness, safety, and treatment costs, alongside other aspects such as host factors and local multidrug resistance rates. However, larger studies on newer antibiotics are warranted to refine the decision making on the appropriate antimicrobial therapy. Local Antimicrobial Stewardship Program strategies in health care settings could guide clinicians for early initiation of specific treatments to combat region-specific antimicrobial resistance, minimize adverse effects, and to improve outcomes such as reduction in Clostridium difficile infections. These strategies involving iv-to-oral switch, de-escalation to narrow-spectrum antibiotics, and dose optimization have an impact on the overall improvement of cSSTI therapy outcomes, especially in countries like Singapore that has a high disease burden. Keywords: antibiotics, complicated skin and soft tissue infections, methicillin-resistant Staphylococcus aureus, Singapore

Abstract Lassa fever virus (LASV), a member of the Arenavirus family, is the etiological agent of Lassa fever, a severe hemorrhagic disease that causes considerable morbidity and mortality in the endemic areas of West Africa. LASV is a rodent-borne CDC Tier One biological threat agent and is on the World Health Organization’s (WHO) Priority Pathogen list. Currently, no FDA-licensed vaccines or specific therapeutics are available. Here, we describe the efficacy of a deactivated rabies virus (RABV)-based vaccine encoding the glycoprotein precursor (GPC) of LASV (LASSARAB). Nonhuman primates (NHPs) were administered a two-dose regimen of LASSARAB or an irrelevant RABV-based vaccine to serve as a negative control. NHPs immunized with LASSARAB developed strong humoral responses to LASV-GPC. Upon challenge, NHPs vaccinated with LASSARAB survived to the study endpoint, whereas NHPs in the control group did not. This study demonstrates that LASSARAB is a worthy candidate for continued development.

Abstract Myosin1D (Myo1D) has recently emerged as a conserved regulator of animal Left-Right (LR) asymmetry that governs the morphogenesis of the vertebrate central LR Organizer (LRO). In addition to Myo1D, the zebrafish genome encodes the closely related Myo1G. Here we show that while Myo1G also controls LR asymmetry, it does so through an entirely different mechanism. Myo1G promotes the Nodal-mediated transfer of laterality information from the LRO to target tissues. At the cellular level, Myo1G is associated with endosomes positive for the TGFβ signaling adapter SARA. myo1g mutants have fewer SARA-positive Activin receptor endosomes and a reduced responsiveness to Nodal ligands that results in a delay of left-sided Nodal propagation and tissue-specific laterality defects in organs that are most distant from the LRO. Additionally, Myo1G promotes signaling by different Nodal ligands in specific biological contexts. Our findings therefore identify Myo1G as a context-dependent regulator of the Nodal signaling pathway.

Dual-energy or spectral computed tomography (CT) information may be obtained by either sending X-ray beams of different energy spectra through the patient or by discriminating the energy of the X-rays that reach the detector. The spectral signal is then used to generate multiple results: conventional, virtual monoenergetic (MonoE), effective atomic number, electron density, and other material specific (e.g., iodine, calcium, or uric acid). This report demonstrates the potential benefits of spectral CT imaging during percutaneous tumor ablation procedures, specifically regarding visualization of inconspicuous tumors, accurate probe placement, and assessment of treatment efficacy.

The necessity for the development and enhancement of teacher commitment to satisfying students' learning needs in response to the COVID crisis is increasingly highlighted. It is not known, however, how to increase commitment in schoolteachers to boost online teaching in light of the fact that they, too, are struggling to cope with the rapid, unexpected change. A total of 601 teachers from primary and secondary schools across China participated in this study, with an average teaching experience of 15.9 years. Structural equation modelling was used to verify the significance of contextual, cognitive, affective and behavioural factors in boosting teachers' commitment to online teaching. The findings demonstrated that teacher agency played a complete mediating role in the predicting power of other factors to teacher commitment. Therefore, it was recommended that attention be paid to the practice and opportunities for teacher agentic actions, which necessitates real encounters with online teaching, allowing teachers to act meaningfully and initiate a new set of teaching strategies.

Nucleoside and polynucleotide cytidine deaminases (CDAs), such as CDA and APOBEC3, share a similar mechanism of cytosine to uracil conversion. In 1984, phosphapyrimidine riboside was characterised as the most potent inhibitor of human CDA, but the quick degradation in water limited the applicability as a potential therapeutic. To improve stability in water, we synthesised derivatives of phosphapyrimidine nucleoside having a CH2 group instead of the N3 atom in the nucleobase. A charge-neutral phosphinamide and a negatively charged phosphinic acid derivative had excellent stability in water at pH 7.4, but only the charge-neutral compound inhibited human CDA, similar to previously described 2'-deoxyzebularine (Ki = 8.0 ± 1.9 and 10.7 ± 0.5 µM, respectively). However, under basic conditions, the charge-neutral phosphinamide was unstable, which prevented the incorporation into DNA using conventional DNA chemistry. In contrast, the negatively charged phosphinic acid derivative was incorporated into DNA instead of the target 2'-deoxycytidine using an automated DNA synthesiser, but no inhibition of APOBEC3A was observed for modified DNAs. Although this shows that the negative charge is poorly accommodated in the active site of CDA and APOBEC3, the synthetic route reported here provides opportunities for the synthesis of other derivatives of phosphapyrimidine riboside for potential development of more potent CDA and APOBEC3 inhibitors.

Non-invasive tests (NITs) are a potential alternative to screening oesophagogastroduodenoscopy (OGD) for ruling out high-risk varices (HRVs) in patients with compensated advanced chronic liver disease (cACLD). This retrospective study aimed to externally validate and compare various NITs in a multi-centre Australian cohort. Patients with cACLD were enrolled between January 2013 and December 2022. Liver stiffness measurements (LSMs), clinicopathological data, and OGD results were collected. A total of 210 patients were included. The median age was 57 years and 65.7% were male. The main aetiology of cACLD was hepatitis C (41.9%), and 91.9% of patients were Child–Pugh A. HRV prevalence was 12.4%. The Baveno VI criteria (B6C) was the only NIT that could safely reduce the need for OGDs across all aetiologies of cACLD, with a negative predictive value of 98.6 and spared OGD in 33.8%. The FIB-4 would have avoided the most OGDs (71%); however, the HRV miss rate was 6%. The results suggest that the B6C is the best performing NIT in our cohort and reliably excludes HRVs in cACLD patients, regardless of aetiology. This study confirms that the Baveno VI criteria can be applied in an Australian, mixed aetiology cohort to avoid unnecessary screening OGD.

Khaled Saeed Yousef Al Baloushi,1 Annadurai Senthilkumar,1,2 Karthishwaran Kandhan,1 Radhakrishnan Subramanian,1 Jaleel Kizhakkayil,3 Tholkappiyan Ramachandran,4,5 Safa Shehab,6 Shyam Sreedhara Kurup,1 Mohammed Abdul Muhsen Alyafei,1 Ayesha Salem Al Dhaheri,3 Abdul Jaleel1 1Department of Integrative Agriculture, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates; 2PG and Research Department of Botany, Kandaswami Kandar’s College, Velur, TN, India; 3Department of Nutrition & Health Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; 4Department of Physics, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 5Department of Physics, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, TN, India; 6Department of Human Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesCorrespondence: Abdul Jaleel, Tel +971-3-713-4576, Email abdul.jaleel@uaeu.ac.aeIntroduction: The synthesis of nanoparticles using naturally occurring reagents such as vitamins, sugars, plant extracts, biodegradable polymers and microorganisms as reductants and capping agents could be considered attractive for nanotechnology. These syntheses have led to the fabrication of limited number of inorganic nanoparticles. Among the reagents mentioned above, plant-based materials seem to be the best candidates, and they are suitable for large-scale biosynthesis of nanoparticles.Methods: The aqueous extract of Moringa peregrina leaves was used to synthesize silver nanoparticles. The synthesized nanoparticles were characterized by various spectral studies including FT-IR, SEM, HR-TEM and XRD. In addition, the antioxidant activity of the silver nanoparticles was studied viz. DPPH, ABTS, hydroxyl radical scavenging, superoxide radical scavenging, nitric oxide scavenging potential and reducing power with varied concentrations. The anticancer potential of the nanoparticles was also studied against MCF-7 and Caco-2 cancer cell lines.Results: The results showed that silver nanoparticles displayed strong antioxidant activity compared with gallic acid. Furthermore, the anticancer potential of the nanoparticles against MCF-7 and Caco-2 in comparison with the standard Doxorubicin revealed that the silver nanoparticles produced significant toxic effects against the studied cancer cell lines with the IC50 values of 41.59 (Caco-2) and 26.93 (MCF-7) μg/mL.Conclusion: In conclusion, the biosynthesized nanoparticles using M. peregrina leaf aqueous extract as a reducing agent showed good antioxidant and anticancer potential on human cancer cells and can be used in biological applications.Keywords: plant-based nanoparticles, silver nanoparticles, Moringa peregrina, anticancer, antioxidant activity

A shift towards outcome-based education (OBE) is visible in an emerging set of educational policy and regulatory documents and higher education institutions across the country. The article argues for OBE to be approached through the lens of 'travelling theory' to foreground the process of translation across various scales, from the transfer of policy knowledge to negotiations in the classroom. By doing so, the article highlights the process of translation which remains at the core of OBE, as it tends to mobilize both managerial and behaviourist approaches along with a constructivist and constructionist approach. The popularity and acceptance of OBE and the disagreements surrounding it are made possible due to this Janus-faced nature of OBE. It argues for acknowledging the mobilization of multiple, contradictory and divergent epistemological approaches as integral to the process of translation of OBE.

The quality profile, extraction yield, and fermentation chemistry of palm sap depend on various factors such as extraction technique, weather conditions, and preservation methods. This review aims to provide a detailed overview of palm sap extraction techniques and the methods for its preservation. The compositional analysis of palm sap, including physical and chemical parameters such as sugar content, acidity, and mineral composition, is discussed thoroughly. The role of microorganisms in fermentation and the effects of various influencing factors are also critically examined. Additionally, this review evaluates different preservation methods, including thermal processes, refrigeration, and electrical techniques, highlighting their effectiveness in extending the shelf life of palm sap. The review further explores the emerging impact of nanotechnology on palm sap preservation, offering insights into the latest industry challenges, developments, and future prospects. By presenting these findings, this review aims to enhance the scientific understanding of palm sap and stimulate additional research and innovation in the field, paving the way for improved production practices and product quality.

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.

West syndrome is a severe form of epilepsy with onset in infancy and early childhood. The characteristic triad described includes infantile spasms (IS), an abnormal electroencephalogram (EEG) pattern referred to as hypsarrhythmia, and developmental regression. It comprises 2% of childhood epilepsies. Etiologically, West syndrome can be classified into symptomatic with known etiology and cryptogenic with unknown etiology. Hypsarrhythmia is defined as chaotic, asynchronous, disorganized slow background activity with high-voltage spike activity. Burst-suppression pattern is a rarely described pattern of modified hypsarrhythmia, which denotes severe disease. Hereby, we describe the case of a female infant who presented with IS; EEG showed a modified hypsarrhythmia pattern in the form of burst suppression, and magnetic resonance imaging brain showed complete corpus callosal agenesis. She was initiated on injection of adrenocorticotropic hormone and showed marked improvement in epileptic spasms.

Building the capacity of pre-service teachers to work in globalized cross-cultural environments is essential to cope with the challenges of the 21st century. This study establishes the value of internationally paired, authentically collaborative practicums with strong epistemological and positional framing in pursuing such capacity development. It was conducted among 90 pre-service teachers from three different universities in Australia and India who participated in a three-week paired practicum in three schools in India. The practicum included the collaborative production of an integrated Australian and Indian combined theme presented in a whole school forum. Mixed methods and a design-based research approach yielded data affirming that such a model did indeed provide pre-service teachers with the confidence to teach in increasingly diverse classrooms and contexts, while also identifying which aspects of this practicum model were most influential in this regard.

The new paradigm approaches to technology-enhanced feedback (TEF) have piqued the interest of educators seeking to shift away from feedback monologic processing and toward feedback dialogic exchange. The way teachers demonstrate constructive TEF behaviours for their students is essential to the development of students' feedback literacy. However, there is a general lack of multidimensional theoretical conceptualisation for understanding, and instrumentation for measuring teacher TEF literacy. To fill this gap in the literature, this study designed and empirically validated a teacher TEF literacy scale (TTLS) using exploratory factor analysis and confirmatory factor analysis on two distinct samples of teacher participants chosen at random. A total of 632 school teachers from throughout most of China, with a variety of subject backgrounds, participated in this study. The results show that the TTLS' three-factor structure is valid and reliable. To provide supplementary evidence of structural validity, the status quo of TEF literacy among primary and secondary school teachers in China was tested, and a discipline variation in teacher TEF literacy was identified, as hypothesised.

Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality.

Substantial evidence suggests that all types of water, such as drinking water, wastewater, surface water, and groundwater, can be potential sources of Helicobacter pylori (H. pylori) infection. Thus, it is critical to thoroughly investigate all possible preconditioning methods to enhance the recovery of H. pylori, improve the reproducibility of subsequent detection, and optimize the suitability for various water types and different detection purposes. In this study, we proposed and evaluated five distinct preconditioning methods for treating water samples collected from multiple urban water environments, aiming to maximize the quantitative qPCR readouts and achieve effective selective cultivation. According to the experimental results, when using the qPCR technique to examine WWTP influent, effluent, septic tank, and wetland water samples, the significance of having a preliminary cleaning step becomes more evident as it can profoundly influence qPCR detection results. In contrast, the simple, straightforward membrane filtration method could perform best when isolating and culturing H. pylori from all water samples. Upon examining the cultivation and qPCR results obtained from groundwater samples, the presence of infectious H. pylori (potentially other pathogens) in aquifers must represent a pressing environmental emergency demanding immediate attention. Furthermore, we believe groundwater can be used as a medium to reflect the H. pylori prevalence in a highly populated community due to its straightforward analytical matrix, consistent detection performance, and minimal interferences from human activities, temperature, precipitation, and other environmental fluctuations.

Abstract Capacitive pressure sensors based on porous foams have been demonstrated for various biomedical applications (0–10 kPa). Many different methods for fabricating porous foams have been reported. In this work, for the first time, the incorporation of silica nanoparticles are reported into the templating process of porous foams fabricated through a combination of particle and emulsion templating, in order to enhance the formation of smaller microstructures in polydimethylsiloxane foams. The foams are coated with graphene, and pressure sensors developed using these foams showed increased sensitivity, up to 4.08 kPa−1. The incorporation of nanoparticles also improves the linearity of the sensitivity, giving a linear sensitivity for the pressure sensors over a pressure range of 0–6 kPa. Further, these pressure sensors have a low limit of detection of ≈13 Pa. These results indicate that incorporation of suitable nanoparticles in the templating of foams is a promising strategy for developing foam‐based pressure sensors with high and linear sensitivity.