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Background The need of pulmonary rehabilitation (PR) for COVID-19 patients with long-term effects was desperately felt. The study’s objective was to measure the effect of PR on functional capacity and health-related quality of life (HRQOL) in patients with post COVID conditions. Methods Pulmonary medicine department of a teaching hospital conducted this pre-experimental study. The patient underwent a pre and post-assessment, including a six-minute walk test (6MWT) measuring distance, oxygen desaturation, pulse rate, and HRQOL. The intervention had six components; education to patients and caregivers, breathlessness relieving exercises, postural correction, aerobic training, strength training, and stretching exercises. These activities were carried out twice a week for eight weeks, supervised, unsupervised in homes, and a combination. Results The study enrolled 155 post-COVID patients (Males, 102 and female, 53), out of which 28 (18.1%) had mild, 55 (35.5%) had moderate and 72 (46.5%) had severe COVID. Paired t-test showed improvement in resting pulse rate (P = 0.001) and resting oxygen saturation (P < 0.0001). Distance walking for six minutes increased after rehabilitation (P < 0.0001). After eight weeks of pulmonary rehabilitation, there was an improvement (P < 0.001) in all domains of quality of life, that is, mobility, self-care, pain and discomfort, usual activity, sleep, anxiety and depression. Conclusion Pulmonary rehabilitation is beneficial for post-COVID patients in improving their quality of life and six-minute walk test parameters, resulting in improved functional capacity and overall quality of life.

This research focused on synthesizing CuO@NiO nanocomposites using a co-precipitation method to explore their antimicrobial, antioxidant, and melamine-sensing capabilities. Nickel oxide (NiO), known for its stability and optical properties, was doped with copper oxide (CuO) to enhance its performance. The synthesized nanocomposites showed strong antioxidant activity, achieving 72% inhibition for 2% CuO@NiO and 80% inhibition for 5% CuO@NiO, as determined by the DPPH assay. Antimicrobial tests demonstrated significant inhibition of both Gram-positive and Gram-negative bacteria, particularly with the 5% CuO@NiO composite. Electrochemical analysis, including cyclic voltammetry and differential pulse voltammetry, revealed high sensitivity for melamine detection, with a detection limit of 0.01 µM. These results suggest that CuO@NiO nanocomposites hold promise for applications in antioxidant therapies, antimicrobial treatments, and chemical sensing.

Objective: This prospective, double-blind, randomized study aimed to compare the effects of dexmedetomidine and fentanyl on the latency and amplitude of transcranial motor evoked potentials (TcMEPs) under propofol-based total intravenous anaesthesia (TIVA) in spine surgery. Secondarily, intraoperative hemodynamics, total propofol consumption, recovery profile, and surgical field quality were compared. Methods: TcMEP amplitude and latency recordings of bilateral abductor pollicis brevis and abductor hallucis muscles posted for elective lumbar spine surgery under TcMEP monitoring randomly divided into two study groups. Throughout the surgery, TIVA was administered using intravenous propofol (100-150 µg kg-1 min-1) and dexmedetomidine (0.5-0.7 µg kg-1 h-1) in group D and intravenous propofol (100-150 µg kg-1 min-1) and fentanyl (1 µg kg-1 h-1) in group F. TcMEPs were recorded at various time points during the surgery. Immediately after extubation recovery from anaesthesia was noted. Additionally, hemodynamic parameters, total propofol consumption, and surgical field quality were assessed. Results: Latency and amplitude were comparable between the groups. Time to extubation was significantly longer in group D, but the mean (standard deviation) duration of stay in recovery was shorter in group D [47.55 (7.51) 95% confidence interval (CI) (44.863-50.237)] (P=0.046). Total propofol consumption was reduced in group D [220 (38) 95% CI (206.402-233.598)] (P=0.025) and surgical field condition was better in group D. Conclusions: Dexmedetomidine and fentanyl do not have any effect on TcMEP amplitude and latency. However, dexmedetomidine provides the additional advantage of reduced total propofol consumption, shorter stay in recovery, and better surgical field quality.

Background: Retinopathy of prematurity (ROP) is a vaso-proliferative retinal disease which can cause blindness if not diagnosed early. The various risk factors associated with ROP other than pre mature birth and low birth weight are high flow oxygen, sepsis , multiple transfusions, multiple births, respiratory distress syndrome, apnoeic episodes, intraventricular haemorrhage. Poor antenatal care, unavailability, poor access and poorly monitored neonatal care are some of the factors contributing to increase in the number of ROP cases in developing countries. Objective: To study ROP in preterm and high risk neonates in a tertiary care hospital. To assess and record changes of ROP and the associated risk factors in the study population.. To document the staging of ROP. To determine the outcome of Retinopathy of Prematurity and the different modalities of treatment used. Material & Method: This study was conducted on 262 eyes of 131 neonates over a period of 18 months. All Pre term neonates having gestational age of less than or equal to 32 weeks and birth weight less than or equal to 1500gms and other older neonates more than 32 weeks of gestation and more than 1500gms of birth weight with risk factors for developing Retinopathy of prematurity (i.e on oxygen supplementation, Respiratory distress syndrome, Sepsis, Multiple blood transfusions, Apnoeic episodes, Intraventricular haemorrhage) , admitted and referred to our institute within the study period were screened for Retinopathy of Prematurity. Neonates observed having ROP were followed up till complete regression of ROP. Results: In our study ROP was observed in 18.32 % of neonates. There was significant relation of birth weight and gestational age with retinopathy of prematurity. Also risk factors like Respiratory distress syndrome and mechanical ventilation were significantly associated with retinopathy of prematurity. The treatment requiring cases of Retinopathy of Prematurity were 6.11% i.e 8 neonates. All the treatable cases were given ROP Laser therapy while 6 neonates were also given intra- vitreal injections of bevacizumab. Conclusion: Low birth weight, Prematurity, Respiratory distress syndrome, Mechanical ventilation were the risk factors significantly associated with ROP. Prompt screening and early diagnosis of ROP can help in reducing devastating complications and thus prevent blindness.

As the COVID-19 pandemic began spreading worldwide in late 2019 and early 2020, many vaccine candidates were developed to combat the disease. However, new COVID-19 variants such as Omicron and Delta continue to emerge globally despite advancements in vaccine technology, leaving certain countries and variants more vulnerable than others to future outbreaks of these variants. This research aims to analyze the susceptibility of different countries to a COVID-19 outbreak, present the first visualization of the spread of COVID-19, and predict which countries are at greater risk for future outbreaks of new variants based on various factors. We created interactive maps to understand the pandemic’s spread and identify high-risk countries based on their vaccination percentages. Then we employed binary classification, K-nearest neighbors (KNN), and neural network machine learning models to predict each country’s risk factor. The risk factor determines whether a country is safe from a new COVID-19 variant based on vaccine percentage and government stringency. The neural network achieved the highest accuracy, classifying countries as high risk or low risk with 94% accuracy. Inspired by the Albert Barabasi model, we graphed connections between countries based on vaccination percentages. These graphs illustrate the correlation between the two countries and better demonstrate how their vaccination rates relate to the probability of a new COVID-19 outbreak.

Abstract Background Apexification is a procedure that promotes apical closure by forming mineralized tissue in the apex region of a nonvital young permanent tooth. Calcium silicate-based cement like Mineral trioxide aggregate (MTA) and Biodentine are commonly employed as apical barriers to facilitate this process. Microleakage, defined as the leakage along the junction between the canal wall and filling material, is a crucial aspect to assess in MTA and Biodentine applications as apical barriers, as it directly impacts the prevention of bacterial seepage and maintenance of structural integrity. The current study aims to assess the microleakage of MTA and Biodentine when used as apical barriers in simulated young permanent teeth. Methods From a total of 128 extracted teeth, 114 were selected for the study and randomly allocated into three groups: G1 (MTA), G2 (Biodentine), and G3 (Control), with 38 teeth per group. After excluding 5 teeth from each group due to issues such as canal calcification, breakage during sectioning, and procedural errors, 33 teeth were analyzed to ensure equal distribution. To simulate young permanent teeth, samples were instrumented using a person-reamer with a diameter of 1.7 mm. A 4 mm thick apical plug of MTA and Biodentine was placed in G1 and G2, respectively, while G3 was the control group. Apical microleakage in all experimental groups was assessed using a dye penetration method. Specimens were longitudinally sectioned and examined under a stereomicroscope with graded eyepiece. Results The Kruskal-Wallis test revealed variations in mean apical microleakage among the groups: G1 recorded 0.67, G2–0.16, and G3–1.62, with G2 showing the lowest value and G3 group exhibiting the highest. Conclusions Biodentine was found to excel in its ability to create a secure seal and function effectively as an apical barrier in simulated young permanent teeth. These results underscore its potential as a highly efficient material for dental applications, particularly in scenarios requiring reliable sealing and barrier formation in the root canal system of developing permanent teeth.

Background and Aims: Labor pain is consistently ranked high on the various pain rating scales, when compared to other painful life experiences, and the experience of labor during the process of childbirth is both complex and subjective. Though patient-controlled epidural analgesia (PCEA) using dilute concentrations of local anesthetics (LAs) has been a popular method to control labor pain, yet the optimal dose and regimen for PCEA remain ambiguous. So, the present study was undertaken to evaluate the safety and efficacy of three different concentrations of ropivacaine for labor analgesia using PCEA. Materials and Methods: Seventy-five healthy nulliparous women who gave voluntary consent for labor analgesia using PCEA were randomly assigned to three groups to receive three different ropivacaine concentrations (0.0625%, 0.1%, and 0.125%) with adjuvant fentanyl 2 μg/ml, after double-blinding. Analgesic efficacy, neuraxial blockade, vital parameters, neonatal outcomes, maternal satisfaction, and side effects were assessed. Primary outcome was total dose of ropivacaine consumed in milligrams. Results: Number of pain breakthroughs (Visual Analog Score >4) and PCEA demand and rescue boluses were found to be statistically more in group 0.0625% (P < 0.01), followed by group 0.1% and were the least in 0.125%. Still, total drug consumed in milligrams was significantly less in 0.0625% group. Maternal satisfaction was comparable among the three groups (P = 0.33). There was no significant difference in maternal side effects and neonatal APGAR scores among the three groups. Conclusion: When three different concentrations of ropivacaine, that is, 0.0625%, 0.1%, and 0.125%, are used for labor analgesia, the use of 0.125% ropivacaine leads to higher total amount of ropivacaine consumed. Despite the lower efficacy in terms of breakthrough pain episodes observed with a 0.0625% ropivacaine concentration for labor analgesia, maternal satisfaction remained consistent across all three doses of ropivacaine. PCEA demand and rescue boluses for the lowest concentration, that is, 0.0625%; and did not affect maternal satisfaction with the management of labor pain.

Malignant transformation (MCT) of ovary is rare complications affecting elderly, squamous cell carcinoma being the most common. The prognosis worsens with extraovarian spread. We present two cases of MCT-derived SCC. Patients exhibited abdominal lump, pain, bowel symptoms, sometimes with weight loss; imaging revealed MCT. Age (51–60), postmenopausal status, large size (>20 cm), bilaterality, and complex ovarian lesions raised suspicion of malignancy. Elevated tumor markers (e.g., cancer antigen-125 and lactate dehydrogenase) were noted in one case. Intraoperative frozen section confirmed malignancy, guiding staging laparotomy. One case was advanced stage on histopathology. Intraoperative frozen section aids optimal staging.

Background and Aim: Breathing exercise is an exercise intended to promote effective and healthy breathing and breathing control. Virtual reality (VR) is defined as a computer-generated simulation, such as a set of images and sounds that represent a real place or situation that can be interacted within a seemingly real or physical way by a person using special electronic equipment. Breathing exercises with VR have shown benefits over conventional diaphragmatic breathing exercises in normal individuals in many new studies. We propose the use of a novel VR-based approach as a respiratory biofeedback to improve breathing patterns in chronic obstructive pulmonary disease (COPD) patients, decrease their work of breathing, and improve breathing control. Materials and Methods: In a randomized controlled study involving 72 COPD patients divided into two groups of 36 in each, the control and experimental groups performed a short 5 min breathing exercise for 6 consecutive days. In experimental group patients performed breathing exercise with VR goggles while in controls they performed without VR goggles. Results: Both the control and experimental groups showed improved changes in vitals and better quality of life, but not statistically as significant when compared to each other. Conclusion: Future studies need to address the long-term effects and stability of the results with a larger sample size, compare the approach with the existing treatments, and make the required smaller changes to the program for better outcomes.

Abstract Background Neuroblastoma (NB) is a complex disease, and the current understanding of NB biology is limited. Deregulation in genomic imprinting is a common event in malignancy. Since imprinted genes play crucial roles in early fetal growth and development, their role in NB pathogenesis could be suggested. Methods We examined alterations in DNA methylation patterns of 369 NB tumours at 49 imprinted differentially methylated regions (DMRs) and assessed its association with overall survival probabilities and selected clinical and genomic features of the tumours. In addition, an integrated analysis of DNA methylation and allele-specific copy number alterations (CNAs) was performed, to understand the correlation between the two molecular events. Results Several imprinted regions with aberrant methylation patterns in NB were identified. Regions that underwent loss of methylation in > 30% of NB samples were DMRs annotated to the genes NDN, SNRPN, IGF2, MAGEL2 and HTR5A and regions with gain of methylation were NNAT, RB1 and GPR1. Methylation alterations at six of the 49 imprinted DMRs were statistically significantly associated with reduced overall survival: MIR886, RB1, NNAT/BLCAP, MAGEL2, MKRN3 and INPP5F. RB1, NNAT/BLCAP and MKRN3 were further able to stratify low-risk NB tumours i.e. tumours that lacked MYCN amplification and 11q deletion into risk groups. Methylation alterations at NNAT/BLCAP, MAGEL2 and MIR886 predicted risk independently of MYCN amplification or 11q deletion and age at diagnosis. Investigation of the allele-specific CNAs demonstrated that the imprinted regions that displayed most alterations in NB tumours harbor true epigenetic changes and are not result of the underlying CNAs. Conclusions Aberrant methylation in imprinted regions is frequently occurring in NB tumours and several of these regions have independent prognostic value. Thus, these could serve as potentially important clinical epigenetic markers to identify individuals with adverse prognosis. Incorporation of methylation status of these regions together with the established risk predictors may further refine the prognostication of NB patients.

Abstract Tuberculosis (TB) remains a leading cause of death, but antibiotic treatments for tuberculous meningitis, the deadliest form of TB, are based on those developed for pulmonary TB and not optimized for brain penetration. Here, we perform first-in-human dynamic 18F-pretomanid positron emission tomography (PET) in eight human subjects to visualize 18F-pretomanid biodistribution as concentration-time exposures in multiple compartments (NCT05609552), demonstrating preferential brain versus lung tissue partitioning. Preferential, antibiotic-specific partitioning into brain or lung tissues of several antibiotics, active against multidrug resistant (MDR) Mycobacterium tuberculosis strains, are confirmed in experimentally-infected mice and rabbits, using dynamic PET with chemically identical antibiotic radioanalogs, and postmortem mass spectrometry measurements. PET-facilitated pharmacokinetic modeling predicts human dosing necessary to attain therapeutic brain exposures. These data are used to design optimized, pretomanid-based regimens which are evaluated at human equipotent dosing in a mouse model of TB meningitis, demonstrating excellent bactericidal activity without an increase in intracerebral inflammation or brain injury. Importantly, several antibiotic regimens demonstrate discordant activities in brain and lung tissues in the same animal, correlating with tissue antibiotic exposures. These data provide a mechanistic basis for the compartmentalized activities of antibiotic regimens, with important implications for developing treatments for meningitis and other infections in compartments with unique antibiotic penetration.

Globally, diabetes mellitus (DM) and stroke are two common chronic illnesses that have a substantial impact on rates of morbidity and mortality. There is significant evidence linking diabetes to an increased risk of stroke in terms of incidence, severity, and mortality. This extensive review looks at shared risk factors, underlying pathophysiological mechanisms, epidemiological trends, and evidence-based therapy approaches to give a thorough analysis of the causal relationship between diabetes mellitus and stroke. Studies using epidemiological data regularly show that people with diabetes have a higher incidence of stroke than people without the disease. Furthermore, diabetes is linked to a less favorable outcome following a stroke, as well as an elevated chance of stroke recurrence. Determining the pathophysiological pathways that connect diabetes and stroke is essential to understanding their relationship. Key pathophysiological processes associated with these disorders include endothelial dysfunction, inflammation, oxidative stress, hyperglycemia, and dyslipidemia. Due to microvascular complications, these mechanisms raise the risk of hemorrhagic stroke and predispose diabetics to an increased risk of ischemic stroke by creating a prothrombotic and atherosclerotic milieu. Diabetes and stroke are linked due to shared risk factors like smoking, obesity, dyslipidemia, hypertension, and poor glycemic control. Lifestyle changes, blood pressure control, lipid-lowering therapy, antiplatelet medicines, and a nutritious diet are essential for stroke risk reduction. Reducing the risk of stroke in people with diabetes requires the implementation of management techniques that focus on both diabetes control and stroke prevention. Optimizing results and lowering the frequency of stroke-related complications in diabetics requires multidisciplinary care. The intricate interactions between diabetes mellitus and stroke are highlighted in this review’s conclusion, which also highlights the value of patient education, risk factor treatment, the effect of antidiabetic therapy on stroke, and integrated care in lowering the incidence of stroke in people with diabetes.

Objectives: To assess the prevalence of self-medication in urban Indian medical students and explore possible factors associated with this practice. Methods: After obtaining institutional ethics approval, 180 medical students from six medical colleges in Mumbai were recruited to participate via social media. They were administered a pre-validated questionnaire that assessed self-medication as a practice, along with the perceived stress scale (PSS-10) online. Anonymity and confidentiality were maintained Results: The prevalence of self-medication in medical students was found to be 83.9%, with no significant difference between genders or between academic years of medical education. The most used source of information for self-medicating was older prescriptions, and for procuring drugs was pharmacist stores. Common cold was the most cited indication. Anti-pyretics and anti-inflammatory drugs were the most commonly self-medicated drugs. It was found that 73.3% of medical students had self-medicated with non-over-the-counter (OTC) drugs. It was observed that 6.1% of medical students had experienced adverse drug reactions, and alarmingly, 0.6% of medical students continued self-medicating despite experiencing adverse drug reactions Conclusions: Most of the study participants admitted to having practised self-medication. It was alarming to find that an appreciable fraction of the study population had uncontrolled access to non-OTC drugs. Thus, there needs to be a greater emphasis on the education of medical students with respect to the problems encountered by self-medicating and a need to enforce stricter regulations, as well as to establish a more watertight monitoring system, to curb this hazardous practice.

Background Germany has increased its political and financial commitment for global health, but this needs to be backed by a robust global health research ecosystem with strong partnerships in low- and middle-income countries (LMICs). Objective This article suggests pathways for empowering researchers to operate beyond their disciplinary silos and strengthen partnerships across sectors and countries. The authors identify barriers and enablers of operations from a nascent research network in Germany, trusting that this experience can inform other initiatives seeking to stoke interdisciplinary and collaborative global health research. Methods This article represents the culmination of extensive reflections spanning the initial four years of the German Alliance for Global Health Research (GLOHRA). The insights have additionally been informed by an analysis of publicly available reports, internal procedural records, and externally conducted studies based on interviews with researchers and policymakers. Results GLOHRA has developed a toolbox of practices that foster interdisciplinary research and support capacity-building. Insights indicate that highly interdisciplinary and diverse governance structures and seed-funding for interdisciplinary and cross-sector research with appropriate review processes represent a critical step for achieving these aims. Additionally, inclusive training sessions and networking events help to bridge disciplinary boundaries, equipping researchers to envision the broader context of their work. Conclusions Despite achievements, challenges persist. Wider support, especially from universities and research institutions, is necessary to make global health research an attractive career path and to reduce bureaucratic barriers for collaborators in LMICs. Sustained, longer-term federal funding mechanisms will also be essential for ongoing progress.

Prior research has shown that manipulating stimulus energy by changing both stimulus contrast and variability results in confidence-accuracy dissociations in humans. Specifically, even when performance is matched, higher stimulus energy leads to higher confidence. The most common explanation for this effect, derived from cognitive modeling, is the positive evidence heuristic where confidence neglects evidence that disconfirms the choice. However, an alternative explanation is the signal-and-variance-increase hypothesis, according to which these dissociations arise from changes in the separation and variance of perceptual representations. Because artificial neural networks lack built-in confidence heuristics, they can serve as a test for the necessity of confidence heuristics in explaining confidence-accuracy dissociations. Therefore, we tested whether confidence-accuracy dissociations induced by stimulus energy manipulations emerge naturally in convolutional neural networks (CNNs). We found that, across three different energy manipulations, CNNs produced confidence-accuracy dissociations similar to those found in humans. This effect was present for a range of CNN architectures from shallow 4-layer networks to very deep ones, such as VGG-19 and ResNet-50 pretrained on ImageNet. Further, we traced back the reason for the confidence-accuracy dissociations in all CNNs to the same signal-and-variance increase that has been proposed for humans: higher stimulus energy increased the separation and variance of evidence distributions in the CNNs' output layer leading to higher confidence even for matched accuracy. These findings cast doubt on the necessity of the positive evidence heuristic to explain human confidence and establish CNNs as promising models for testing cognitive theories of human behavior.

Background and Aims: Intrathecal morphine (ITM) or erector spinae plane (ESP) block reduces postsurgical pain in patients who underwent kidney transplantation surgeries. We aimed to compare the effectiveness of both modalities in terms of duration and quality of postoperative analgesia along with postoperative fentanyl consumption. Methods: We conducted a randomised study and analysed 60 patients posted for elective live-related kidney transplantation surgery. They were randomised into two groups. Group M patients received ITM, whereas Group E patients received ESP block. We standardised the postoperative analgesia for both groups with intravenous fentanyl-based patient-controlled analgesia. The primary outcome was to compare the quality of analgesia using the numerical rating scale score between the groups. The secondary outcome was to observe the effect of both modalities on the duration of analgesia, postoperative fentanyl consumption, rescue analgesics requirement, catheter-related bladder discomfort and any complications. Results: We found significantly lower pain scores at rest and while coughing in Group M at all time intervals, except at 24 h while coughing. The mean time to first analgesia requirement was significantly longer in Group M than in Group E (P = 0.002). No significant difference was found in postoperative consumption of total fentanyl (P = 0.065) and rescue analgesia in both groups. In Group M, there was significantly more nausea, vomiting and pruritus (P = 0.001). Conclusions: ITM provides long-lasting postoperative analgesia at the cost of higher side effects than ESP block.

Objective: The presence of donor-specific antigens (human leukocyte antigen [HLA] incompatibility) leads to positive T-cell or B-cell crossmatch. Kidney transplant after desensitization protocols not only poses a financial burden on the patients but also there is an increased rate of infections and graft rejection. Paired kidney exchange (PKE) is cost-effective and offers better postoperative graft outcome. Methods: We included six pairs of kidney transplant donors and recipients for 6-way simultaneous PKE transplantation. These patients were ABO incompatible or HLA incompatible or both. Results: All patients underwent transplant in a single day without any perioperative surgical and anesthesia complications except for the need of mechanical ventilation in one patient in the postoperative care unit. The graft function was excellent in all recipients. Conclusion: This is the first 6-way simultaneous kidney exchange transplantation in the northwestern region of India. The inclusion of multiple donors and recipients for a paired exchange kidney transplant, although challenging, increases the donor pool and decreases the waiting time and financial constraints.

Multi-objective transportation problems (MOTPs) are mathematical optimization problems that involve simultaneously considering multiple, often conflicting objectives in transportation planning. Unlike traditional transportation problems, which typically focus on minimizing a single objective such as cost or distance, MOTPs aim to balance multiple objectives to find the optimal solution. These problems appear in various real-world applications such as logistics, supply chain management, and transportation, where decision-makers need to consider multiple criteria when designing transportation networks, routing vehicles, or scheduling deliveries. The primary challenge lies in the uncertainty in real-world transportation scenarios, where logistics involve factors beyond cost and distance. We investigated a multi-choice solid fractional multi-objective transportation problem (MCSF-MOTP) based on supply, demand, and conveyance capacity, where the coefficients of the objective functions were of the multi-choice type due to uncertainty. To address this uncertainty, the proposed model employed the Newton divided difference interpolation polynomial method, and the suitability of this model was validated through a numerical illustration employing a ranking approach.

Background: Development of esophageal varices is one of the major complications of liver cirrhosis, and endoscopy is used to see the presence, grading, and long-term monitoring of esophageal varices which is an invasive and unpleasant procedure. There is no adequate data available showing noninvasive methods can be used for the same. Methods: Seventy patients with liver cirrhosis participated in the study. Factors like portal vein diameter, spleen size, platelet count, serum bilirubin, Child-Pugh score, prothrombin time (PT), and PT INR were observed and correlated endoscopically with the presence and grading of esophageal varices in all patients. Results: The platelet count, portal vein diameter, serum bilirubin, spleen bipolar diameter, and PT had statistically significant correlations with the presence of varices. Among them, platelet count, portal vein diameter, and serum bilirubin also had statistically significant correlations with the grading of varices. Monitoring of these noninvasive parameters can help in monitoring variceal growth. Conclusions: Noninvasive parameters can be used effectively to predict the presence and grading of esophageal varices and at the same time keep the rate of undiagnosed varices acceptably low. By using noninvasive parameters, patients can be benefited by decreasing the requirement of repeated endoscopic evaluation which is an unpleasant procedure and availability is also limited.

Abstract HIV infection has been a global public health threat and overall reported ~ 40 million deaths. Acquired immunodeficiency syndrome (AIDS) is attributed to the retroviruses (HIV-1/2), disseminated through various body fluids. The temporal progression of AIDS is in context to the rate of HIV-1 infection, which is twice as protracted in HIV-2 transmission. Q-PCR is the only available method that requires a well-developed lab infrastructure and trained personnel. Micro-PCR, a portable Q-PCR device, was developed by Bigtec Labs, Bangalore, India. It is simple, accurate, fast, and operationalised in remote places where diagnostic services are inaccessible in developing countries. This novel micro-PCR determines HIV-1 and HIV-2 viral load using a TruePrep™ extractor device for RNA isolation. Five ml blood samples were collected at the blood collection centre at AIIMS, New Delhi, India. Samples were screened for serology, and a comparison of HIV-1/2 RNA was done between qPCR and micro-PCR in the samples. The micro-PCR assay of HIV-RNA has compared well with those from real-time PCR (r = 0.99, i

IntroductionThe prevalence of underweight in women of reproductive age (WRA) in South Asia remains unacceptably high. Underweight women suffer from lowered immunity, infertility, and a risk of developing non-communicable diseases. In pregnancy, undernutrition results in poor neonatal and maternal outcomes. We present the findings and the management strategy of undernutrition in the preconception and pregnancy phase intervention group in the WING study in low- to lower-middle-income neighborhoods of North India.MethodsWe analyzed data from the Women and Infants Integrated Interventions for Growth Study (WINGS) intervention group. In this individually randomized factorial design trial, 13,500 women were enrolled from low to middle-income neighborhoods of Delhi: 6,722 women in the preconception group and 2,640 from the pregnancy group. Food supplements in the form of locally prepared snacks were given to provide necessary calories and protein requirements as per the Body mass index (BMI) during the preconception period and each trimester of pregnancy. The snacks (sweet or savory) and milk or egg as a source of high-quality protein were delivered at home, and intakes were observed. Individual tracking and close monthly monitoring were done for compliance, besides screening and treatment of infections.ResultsThe enrolled women's mean (SD) age was 24.2 (3.1) years. Approximately 35% of women had a height of < 150 cm, and 50% had schooling >12 years. 17% of women in preconception and 14 % in pregnancy intervention groups were Underweight. Approximately two-thirds of underweight women improved 9–12 months after management in the preconception group, and the same proportion improved 4 weeks after management during pregnancy. The proportion of women with inadequate weight gain (IWG) during pregnancy was higher in women who were underweight during preconception.DiscussionA comprehensive approach to managing undernutrition with high-quality energy-dense food supplementation substantially improved weight gain in women during preconception and pregnancy.Clinical trial registrationhttp://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies, identifier: Clinical Trial Registry India #CTRI/2017/06/008908.

Background: Music elicits multifactorial benefits in emotional, social, cognitive, and academic aspects of human life. Music is clinically proven to reduce stress and anxiety, and improve mood and self-expression, particularly after traumatic events. Studies have also demonstrated that music promotes parasympathetic autonomic systems, suppresses hyperactivation of stress responses, and boosts immune functions. However, its ability to promote brain plasticity and signalling are only beginning to be realized. Moreover, its employment as a therapy for the treatment of specific aspects of other neurological disorders, including neurodevelopmental and neurodegenerative conditions and their comorbidities, is fast becoming an interesting field of research. Objective: The aim of this review is to summarize some of the recent studies focused on evaluating the applications of music therapy. For this purpose, we have focused on disorders encompassing both temporal extremities of brain developmental stages, from developmental conditions of autism and attention deficit hyperactivity disorder (ADHD), to ageing-related pathologies of Parkinson's disease and dementias. Results: The findings of the reviewed studies indicate potent utilities of music-based interventions in beneficially affecting multiple spheres of brain functions, such as sensorimotor, auditory, communication/language, psychological/emotional, behavioural, sleep and memory and cognitive attributes of patients diagnosed with diverse neuropathologies. Nevertheless, lack of standardized protocols for music provision as well as absence of information regarding key aspects, such as cultural and musical orientations of subjects and therapists'/caregivers' attitudes, have hindered the complete realization of music's therapeutic potential for neurological conditions. Further, while some studies have undertaken assessments of core neurophysiological mechanisms underlying music therapy, this information is largely lacking for most clinical studies. Conclusion: While this is not an exhaustive review of literature, we do hope that it serves as a platform to promote future research for establishing music therapy as a relevant neurotherapeutic strategy.

This study compared the regeneration status, vegetation diversity, stand structure, and carbon stock of two community-managed forests located in different ecological regions of Nepal. A total of 61 concentric sample plots were investigated by using systematic random sampling with 1 % sampling intensity. The phytosociological parameters of trees and regeneration density were calculated using standard techniques. The aboveground tree carbon was estimated using a non-destructive method. Correlation analysis was performed to assess the variation of carbon stock with biomass, stand density, tree diameter at breast height (DBH), tree height, basal area, and seedling density. Janata community forest had higher regeneration than the Hazare community forest, with a bell-shaped distribution of DBH in Janata and an interrupted curve in Hazare community forest. Both forests were dominated by Shorea robusta. Hazare had higher Shannon diversity index, Simpson's index, and evenness index, while Janata community forest had higher carbon stock. The observed differences in the studied parameters between the two community forests can be attributed to the difference in ecological factors such as temperature, rainfall, soil nutrient availability, and management practices. Future studies focusing on investigating the underlying factors driving the observed patterns and relationships, such as the effects of disturbance, climate, and management practices on forest structure and function are also needed. These findings have important implications for forest management and conservation policies, especially in the context of climate change mitigation and biodiversity conservation.

In public-health crises, members of multilingual communities must be able to access, understand, trust and act upon behaviour-change messaging. The role of translators is therefore critical, not only for the relaying of information but also in the transcreation of texts, understood as adaptation to suit the characteristics of an intended audience. Failure to use transcreation may produce messaging that is culturally inappropriate and thus ineffective. This study analyses healthcare resources created by governments in Australia with a view to identifying formatting and other visual features that would benefit from transcreation. A mixed-method approach combined numerical evaluation of four documents using the Patient Education Materials Assessment Tool (PEMAT) and a bottom-up thematic analysis of the way the same texts were discussed by 58 members of a broad range of ethnocultural and linguistic groups in Victoria, Australia. The findings point to a need to go beyond the linguistic aspects of the translation and take into account the discourse organisation, layout, images and cultural appropriateness of health messaging. The implications of applying the PEMAT criteria are not only that start texts will become more accessible and better able to facilitate understanding-based trust relations, but also that translators are well placed to participate in the transcreations that may be required in the various target languages.

Artificial intelligence (AI), a branch of computer science, involves developing intelligent computer programs to mimic human intelligence and automate various processes [...]

Abstract Hypertension guidelines recommend team‐based care for the treatment of high blood pressure (BP). Clinical pharmacists can help patients get to goal BP with rapid medication titration in conjunction with telehealth visits. We conducted a pharmacist‐led home BP monitoring pilot program from June 2020 to September 2021. Forty‐two patients with a SBP ≥140 despite using ≤2 antihypertensive medications were referred for pharmacist telehealth with expedited medication titration to achieve a BP goal

The You Only Look Once (YOLO) series, renowned for its efficiency and versatility in object detection, has become a fundamental component in diverse fields ranging from autonomous vehicles to robotics and video surveillance. Despite its widespread application, a notable gap exists in the literature concerning selecting YOLO models for specific tasks. Current trends often lean towards the latest models, potentially overlooking crucial factors such as computational complexity, speed, accuracy, model size, adaptability, and generalization. This approach may not always yield the optimal choice for a given application. Therefore, this paper aims to provide an exhaustive comparative analysis of various YOLO models, focusing on emotion recognition. We trained and tested YOLOv5, YOLOv7, YOLOv8, and YOLOv9 along with their respective variants, using a subset of AffectNet dataset, which consists of facial images annotated with one of five emotions, namely angry, happy, sad, neutral, and surprise. The study evaluates the models based on several key parameters: accuracy using metrics like mean Average Precision (mAP), inference time, FPS, model size, adaptability to altered datasets, and generalization capability. Comprehensive results are presented, highlighting the strengths and limitations of each model variant across these parameters. Insights are provided to guide researchers in selecting the most suitable YOLO architecture for their specific emotion recognition requirements, considering factors such as computational constraints, real-time performance needs, and the importance of accuracy vs efficiency tradeoffs. The analysis reveals the exceptional performances of certain models like YOLOv9e for high accuracy and YOLOv8n for balancing speed and accuracy. Overall, this work fills a crucial gap by offering a detailed comparative study to facilitate informed decision-making when deploying YOLO for facial emotion recognition tasks.

This article presents a scientometric and literature analysis of current research on ChatGPT, a conversational AI technology developed by OpenAI. Using various databases, 103 relevant articles were retrieved and analyzed through scientometric, quantitative, and application-based approaches. A Google trend analysis and comparison with other generative AI and chatbot technologies were also carried out. The study provides insights into the distribution of ChatGPT publications across different countries and regions, the network of co-occurring keywords, authorship analysis, article typology, and publishing entities. The findings offer a comprehensive overview of the current state of ChatGPT research, highlighting key directions for future research. The study finds that ChatGPT has gained significant attention and interest in online platforms, particularly in technology, education, and healthcare, and highlights potential ethical and legal concerns related to its use. Its applications extend to several literary and text generation areas. We do note that the sample of extracted publications is lower than anticipated due to the niche area of investigation. The article is relevant to researchers, practitioners, and policymakers interested in the field of AI-powered language models, especially ChatGPT.

Aloe vera is one of the most significant therapeutical plant species that belongs to the family Liliaceae. Aloe vera is composed of a high amount of water, with the remainder being dry matter. The dry matter contains a lot of bioactive compounds like carbohydrates, fats, and enzymes, with various therapeutic and antimicrobial properties. It can enhance the proliferation of cells and prevent cell damage by anti-oxidative properties (stimulating the secretion of superoxide dismutase and peroxidase). Human skin is colonized by microbes like fungi (Candida albicans), bacteria (Propionibacterium acnes, Staphylococcus aureus), and mites. These commensals are responsible for skin characteristics such as acidic pH, the pungent smell of sweat, etc. Human fetuses lack skin microbiota, and their skin is colonized after birth. Commensals present on the skin have a crucial role in training the human immune system against other pathogenic microbes. Propionibacterium acnes act as an opportunistic pathogen when the balance between the commensals is disturbed. We also emphasize the recent progress in identifying the aloe metabolite biosynthesis pathways and the associated enzyme machinery. The hyperproliferation of Propionibacterium acnes causes acne, and acemannan plays a significant role in its cure. Hence, we need to consider a new treatment approach based on the root cause of this dysbiosis.

Tracking microrobots is challenging due to their minute size and high speed. In biomedical applications, this challenge is exacerbated by the dense surrounding environments with feature sizes and shapes comparable to microrobots. Herein, Motion Enhanced Multi‐level Tracker (MEMTrack) is introduced for detecting and tracking microrobots in dense and low‐contrast environments. Informed by the physics of microrobot motion, synthetic motion features for deep learning‐based object detection and a modified Simple Online and Real‐time Tracking (SORT)algorithm with interpolation are used for tracking. MEMTrack is trained and tested using bacterial micromotors in collagen (tissue phantom), achieving precision and recall of 76% and 51%, respectively. Compared to the state‐of‐the‐art baseline models, MEMTrack provides a minimum of 2.6‐fold higher precision with a reasonably high recall. MEMTrack's generalizability to unseen (aqueous) media and its versatility in tracking microrobots of different shapes, sizes, and motion characteristics are shown. Finally, it is shown that MEMTrack localizes objects with a root‐mean‐square error of less than 1.84 μm and quantifies the average speed of all tested systems with no statistically significant difference from the laboriously produced manual tracking data. MEMTrack significantly advances microrobot localization and tracking in dense and low‐contrast settings and can impact fundamental and translational microrobotic research.

The collective migration of keratinocytes during wound healing requires both the generation and transmission of mechanical forces for individual cellular locomotion and the coordination of movement across cells. Leader cells along the wound edge transmit mechanical and biochemical cues to ensuing follower cells, ensuring their coordinated direction of migration across multiple cells. Despite the observed importance of mechanical cues in leader cell formation and in controlling coordinated directionality of cell migration, the underlying biophysical mechanisms remain elusive. The mechanically-activated ion channel PIEZO1 was recently identified to play an inhibitory role during the reepithelialization of wounds. Here, through an integrative experimental and mathematical modeling approach, we elucidate PIEZO1's contributions to collective migration. Time-lapse microscopy reveals that PIEZO1 activity inhibits leader cell formation at the wound edge. To probe the relationship between PIEZO1 activity, leader cell formation and inhibition of reepithelialization, we developed an integrative 2D continuum model of wound closure that links observations at the single cell and collective cell migration scales. Through numerical simulations and subsequent experimental validation, we found that coordinated directionality plays a key role during wound closure and is inhibited by upregulated PIEZO1 activity. We propose that PIEZO1-mediated retraction suppresses leader cell formation which inhibits coordinated directionality between cells during collective migration.

Background: Little is known about the prevalence of cellular senescence among immune cells (i.e., immune cells expressing senescence markers, iSCs) nor is there a gold-standard to efficiently measure iSCs. Major depressive disorder (MDD) in older adults has been associated with many hallmarks of senescence in whole blood, leukocytes, and plasma, supporting a strong connection between iSCs and MDD. Here, we investigated the prevalence and phenotype of iSCs in older adults with MDD. Using a single-cell phenotypic approach, circulating immune cells were examined for iSC biomarkers and their relationship to depression and inflammation.Results: PBMCs from older adults with MDD (aged 69.75 ± 5.23 years) and healthy controls (aged 71.25 ± 8.8 years) were examined for immune subset distribution and senescence biomarkers (i.e., lack of proliferation, senescence-associated heterochromatin foci (SAHF), and DNA damage). Dual-expression of SAHF and DNA damage was categorized by low, intermediate, and high expression. A significant increase in the number of high expressing total PBMCs (p = 0.01), monocytes (p = 0.008), a trending increase in the number of high expressing CD4 T cells (p = 0.06) was observed overall in those with MDD. There was also a significantly lower proportion of intermediate expressing cells in monocytes and CD4 T cells in MDD (p = 0.01 and p = 0.05, respectively). Correlation analysis revealed associations between iSCs and mRNA expression of factors related to SASP and immune cell function.Conclusion: MDD is associated with increased senescent cell biomarkers in immune cell populations delineated by distinct levels of SAHF and DNA damage. Inflammatory markers might serve as potent indicators of iSC burden in MDD.

Amidst uncertainty, decision-making in manufacturing becomes a central focus due to its complexity. This study explores complex transportation constraints and uses novel ways to guide manufacturers. The Multi-objective Stochastic Linear Fractional Transportation Problem (MOSLFTP) is a crucial tool for managing supply chains, manufacturing operations, energy distribution, emergency routes, healthcare logistics, and other related areas. It adeptly addresses uncertainty, transforming efficiency and effectiveness in several domains. Stochastic programming is the process of converting theoretical probabilities into concrete certainties. The artistic compromise programming technique acts as a proficient mediator, reconciling opposing objectives and enabling equitable decision-making. This novel approach also addresses the Multi-objective Stochastic Linear plus Linear Fractional Transportation Problem (MOSLPLFTP), which involves two interconnected issues. The effectiveness of these principles is clearly shown with the help of the LINGO® 18 optimization solver. This study uses a ranking method to compare the similar methods to solve the current problems. A meticulously designed example acts as a significant achievement, shedding light on our method in a practical setting. It serves as a distinctive instrument, leading manufacturers through the maze of uncertainty and assisting them in determining the most advantageous course of action. This journey involves subtle interactions between complexity and simplicity, uncertainty is overcome by decisiveness, and invention is predominant.

Background: Re-emerging scrub typhus is gaining recognition as an important cause of focal or disseminated vasculitis or perivasculitis which is responsible for its various clinical manifestations and complications. Neurological manifestations with varied presentations have been reported in rickettsial diseases with variable prevalence (28%–80%). Methods: A cross-sectional study among admitted children was conducted for 1½ years in a tertiary care hospital with the objective to study the clinical profile and outcome of the patients with neurological manifestations of scrub typhus. Results: Out of 105 scrub typhus cases (immunoglobulin M enzyme-linked immunosorbent assay positive), 32 patients (30.4%) had neurological manifestations with a male: female ratio of 19:13. These children presented with fever (100%), headache (71.8%), vomiting (62.5%), convulsion (53.1%), and altered sensorium (43.7%). Neurological manifestations included meningeal signs (75%), ataxia (6.2%), lateral rectus palsy (9.3%), papilledema (18.7%), stroke (6.2%), and retinal hemorrhage (3.1%). Lumbar puncture was done in 31 cases and the mean cerebrospinal fluid (CSF) white blood cell count, lymphocyte, and neutrophil proportion was 66 cells/cu.mm, 60%, and 27%, respectively, with the mean CSF protein and glucose is 67 mg/dl and 55 mg/dl. Neuroimaging was done in 24 patients and the abnormalities found were cerebral edema (n = 5), basal ganglia infarct (n = 2), and features of cerebellitis (n = 2). Conclusion: Rickettsial disease should be considered an etiological agent in all febrile illnesses with neurological manifestations, especially in endemic areas. Early recognition and treatment of rickettsial infections with neurological manifestations are important to prevent morbidity and mortality of the disease.

Background: Apart from the flexion crease and secondary folds, dermatoglyphics is the scientific study of naturally existing epidermal ridges and their arrangement on the digits, palms, and soles. In medicolegal cases, fingerprints can be used to identify suspects, victims, and other people who touch a surface as well as to diagnose inherited diseases. ABO blood group is divided into A, B, AB, and O. ABO type is determined by two antigens and two antibodies. Due to the presence or absence of the D antigen, it is further divided into Rh-positive and Rh-negative. Aims and Objectives: This study aimed to find correlation between ABO and Rh blood group with dermatoglyphic pattern in human beings. Materials and Methods: The study was conducted among 107 medical students studying at RMCHRC, Kanpur, UP, India. Rubber stamp ink pads were utilized to smear each finger. Imprints were obtained, and each fingerprint pattern was inspected and documented using a strong hand lens on a sturdy white piece of paper. Results: Among 1070 fingerprint patterns studied, the most common pattern observed was whorl. This pattern was present in 226 male’s digits (49.23%) and 233 female’s digits (50.26%), totaling to 459 forming 42.89% of the total patterns observed. B + blood group was the most common blood group present with whorl pattern, seen in 92 males and 99 females. Conclusion: This study shows the association between the distribution of dermatoglyphics, ABO, Rh blood group, and gender.

Over the past decade, the field of solid organ transplantation has undergone significant changes, with some of the most notable advancements occurring in liver transplantation. Recent years have seen substantial progress in preoperative patient optimization protocols, anesthesia monitoring, coagulation management, and fluid management, among other areas. These improvements have led to excellent perioperative outcomes for all surgical patients, including those undergoing liver transplantation. In the last few decades, there have been numerous publications in the field of liver transplantation, but controversies related to perioperative management of liver transplant recipients persist. In this review article, we address the unresolved issues surrounding the anesthetic management of patients scheduled for liver transplantation.

Background: In Bundelkhand region, 15–18% of patients who are attended in the emergency setting comprises poisoning, 60–70% of which are agriculture-based poisons due to its easy accessibility. The chief complication of poisoning is acute kidney injury (AKI). Aims and Objectives: The aim of the study was to find out the proportion of AKI in acute poisoning, the spectrum of clinical features and their complications and outcome. Materials and Methods: The cross-sectional study was performed in patients admitted in Departments of Medicine, MLB Medical College and Hospital, Jhansi over a period of 25 months (December 2020–October 2022). Results: In our study, there were 100 patients, 83% developed pre-renal AKI and 17% landed up into acute tubular necrosis. Maximum patients recovered, but 13 patients deteriorated, in which most presented after a lag time of 12 h of poison exposure, during the course of management, 5 patients required dialysis (3 peritoneal/2 hemodialysis). Out of 13 Patients, 11 expired and 2 improved, most of them consume celphos and insecticide. Conclusion: Our study shows that agriculture-based chemicals are easily available and accessible for poisoning. The time lag in proper treatment and detoxification leads to various complications; an early intervention and appropriate antidote easily reverses complications and end-organ damage, whereas some cases require dialysis or ventilator support. Middle-aged male, low socioeconomic economic groups, and psychiatric issues lay as background for most poisoning cases, where financial deprivement, lack of knowledge, and awareness have major issues.

A substantial number of studies have been published since the Ninth International Workshop on Tropical Cyclones (IWTC-9) in 2018, improving our understanding of the effect of climate change on tropical cyclones (TCs) and associated hazards and risks. These studies have reinforced the robustness of increases in TC intensity and associated TC hazards and risks due to anthropogenic climate change. New modeling and observational studies suggested the potential influence of anthropogenic climate forcings, including greenhouse gases and aerosols, on global and regional TC activity at the decadal and century time scales. However, there are still substantial uncertainties owing to model uncertainty in simulating historical TC decadal variability in the Atlantic, and the limitations of observed TC records. The projected future change in the global number of TCs has become more uncertain since IWTC-9 due to projected increases in TC frequency by a few climate models. A new paradigm, TC seeds, has been proposed, and there is currently a debate on whether seeds can help explain the physical mechanism behind the projected changes in global TC frequency. New studies also highlighted the importance of large-scale environmental fields on TC activity, such as snow cover and air-sea interactions. Future projections on TC translation speed and medicanes are new additional focus topics in our report. Recommendations and future research are proposed relevant to the remaining scientific questions and assisting policymakers.

Introduction: Transsphenoidal resection of pituitary tumours presents challenges for an anaesthesiologist due to haemodynamic fluctuations caused by intense nociceptive stimuli during different surgical stages. This relatively short procedure requires a smooth and rapid emergence for spontaneous airway control and assessment of surgical outcomes. Therefore, the chosen anaesthetic agent should provide effective haemodynamic control and facilitate rapid recovery. Alpha-2 agonists such as dexmedetomidine and clonidine are known to centrally decrease noradrenaline release, thus reducing sympathetic outflow. This could be particularly beneficial in minimising haemodynamic fluctuations during such surgeries. Aim: To compare the effects of preoperative clonidine and perioperative dexmedetomidine in attenuating haemodynamic responses and blood loss in patients undergoing elective Transnasal Transsphenoidal resection (TNTS) of pituitary tumours. Materials and Methods: A randomised, double-blinded study was conducted in the Department of Neuroanesthesiology at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, over a period of one year, from February 2022 to January 2023. Sixty patients of either sex, aged 18-65 years with ASA I or II, scheduled for elective TNTS pituitary surgery, were enrolled and divided into group A and group B. Group A received clonidine tablets (3 mcg/kg) 180 minutes prior to surgery, while group B received intravenous (i.v.) infusion of dexmedetomidine (1 mcg/kg/min) over 10 minutes before induction, followed by 0.5-0.7 mcg/kg/hr. Group A received a placebo of 0.9% Normal Saline (NS) (50 mL). Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were recorded at baseline, intubation, nasal pack insertion, endoscope insertion, and at various time intervals. Data obtained were analysed using unpaired sample t-test for independent groups, and Chi-square test was used for categorical data. A probability value of 0.05 was considered significant for both statistical tests. Results: The mean age of participants was 42±11 years for group A and 43±12 years for group B, with a male: female ratio of 66.6% to 33.3% in group A and 70% to 30% in group B, respectively. The mean Body Mass Index (BMI) was 26.4±3.2 in group A and 25.2±1.7 in group B. HR, SBP, and MAP decreased at various stages in group B compared to group A, and these differences were statistically significant (p-value

Abstract Excitonic states trapped in harmonic moiré wells of twisted heterobilayers is an intriguing testbed for exploring many-body physics. However, the moiré potential is primarily governed by the twist angle, and its dynamic tuning remains a challenge. Here we demonstrate anharmonic tuning of moiré potential in a WS2/WSe2 heterobilayer through gate voltage and optical power. A gate voltage can result in a local in-plane perturbing field with odd parity around the high-symmetry points. This allows us to simultaneously observe the first (linear) and second (parabolic) order Stark shift for the ground state and first excited state, respectively, of the moiré trapped exciton - an effect opposite to conventional quantum-confined Stark shift. Depending on the degree of confinement, these excitons exhibit up to twenty-fold gate-tunability in the lifetime (100 to 5 ns). Also, exciton localization dependent dipolar repulsion leads to an optical power-induced blueshift of ~ 1 meV/μW - a five-fold enhancement over previous reports.

Background:. To address patient health literacy, the American Medical Association recommends that readability of patient education materials should not exceed a sixth grade reading level; the National Institutes of Health recommend no greater than an eigth-grade reading level. However, patient-facing materials in plastic surgery often remain at an above-recommended average reading level. The purpose of this study was to evaluate ChatGPT 3.5 as a tool for optimizing patient-facing craniofacial education materials. Methods:. Eighteen patient-facing craniofacial education materials were evaluated for readability by a traditional calculator and ChatGPT 3.5. The resulting scores were compared. The original excerpts were then inputted to ChatGPT 3.5 and simplified by the artificial intelligence tool. The simplified excerpts were scored by the calculators. Results:. The difference in scores for the original excerpts between the online calculator and ChatGPT 3.5 were not significant (P = 0.441). Additionally, the simplified excerpts’ scores were significantly lower than the originals (P

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives' competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts.

Background. Chronic kidney disease (CKD) is defined by gradual deterioration of renal parenchyma and decline of functioning nephrons. The risk of cardiovascular events is drastically increased in patients with CKD. This complicated link of CKD and cardiovascular disease (CVD) is not well understood till date. Objective. We aim to study the influence of genetic variants of matrix Gla protein (MGP) gene rs1800801, rs1800802, and rs4236 and nitric oxide synthase-3 (NOS3) gene rs1799983 and rs2070744 on the risk of CKD and its associated cardiovascular comorbidity in South Indian Tamils. Methods. One hundred and eighty-five CKD patients and 185 controls were recruited in this research. Flow-mediated dilatation (FMD) of brachial artery was measured ultrasonically. Circulating levels of MGP and nitric oxide (NO) were measured by ELISA. Genotyping was done by real-time PCR. Results. We observed a significant difference in the distribution of TT and CT genotypes of NOS3 (rs2070744), indicating an increase in the risk of CKD. NO level was significantly decreased in CKD cases than controls. We also found a significant difference in the distribution of TTA and CCG haplotypes of MGP polymorphisms (1-rs4236; 2-rs1800801; 3-rs1800802) between the groups, indicating an increase in the risk of CKD. CT genotype of MGP (rs4236) and CT genotype of NOS3 (rs2070744) variants were found to be associated with decreased FMD, indicating endothelial dysfunction, the harbinger of CVD. Conclusion. We conclude that genetic variants of MGP and NOS3 enhance the risk of CKD and its associated cardiovascular comorbidity in South Indian Tamils.

COPD is the second leading cause of death in India. The guidelines for early detection of COPD were released by the Government of India in 2019. However, due to the COVID-19 pandemic, its implementation could not be optimal. Diagnosis of COPD is based on the presence of respiratory symptoms, the presence of exposure to risk factors, and the presence of poorly reversible airflow obstruction as assessed using a spirometer. Spirometers are currently available only at a few district hospitals. The existing guidelines expect the patient to visit the Rural hospital/ Community Health Centre, which does not have a spirometer or a pulmonary medicine specialist. Also, it is not feasible or accessible for patients to visit the district hospital to get diagnosed. The current study will be implemented to determine the prevalence, annual incidence of COPD and asthma, quality of life, and nutritional status of COPD and asthma patients. The novelty of this implementation research, which will be conducted in collaboration with Zilla Parishad (i.e., Government), Pune district, is the empowerment of an Accredited Social Health Activist (ASHA), a peripheral health worker to screen all individuals using a peak flow meter and confirmation of the diagnosis at health and wellness center (HWC). An accredited Social Health Activist (ASHA) will take relevant history to suspect COPD and asthma in 30+-year-old adults, and she will refer the suspected cases to the Community Health Officer (CHO) at the Health and Wellness Center. The CHO/ Medical officer of PHC will initiate the appropriate treatment after confirming the diagnosis using a portable spirometer. The difficult-to-diagnose patients with comorbidity and acute exacerbations will be referred to the nearest higher center, i.e., Primary Health Centre (PHC) or Community Health Centre (CHC), where a primary care physician is available. The ASHA workers will provide two follow-ups to these patients in a year, depending on the severity, to ensure compliance with the treatment. Thus, early diagnosis and appropriate treatment of COPD and asthma at the community level may help to reduce the episodes of acute exacerbations.

Negligible quantitative research evidence exists on standardisation and psychometric validation of questionnaires that measure midwifery educators' confidence in their competence. This study developed a self-assessment of confidence in competence questionnaire in India based on the WHO Midwifery Educator Core Competencies (2014) with an aim to develop and validate a self-assessment tool measuring midwifery tutors' confidence in competence in imparting quality midwifery education. The questionnaire was developed as part of a multi-centre study to identify confident midwifery tutors for further training as educators, supporting India's rollout of professional midwives. The questionnaire underwent rigorous psychometric testing among 2016 midwifery tutors in India. Following exploratory Principal Component Analyses (PCA), the nine core competencies outlined in the WHO document were analysed separately. The results indicate that the questionnaire is psychometrically valid, with an internal consistency range of 0.81-0.93 for the nine domains. This robust testing process ensures the reliability and validity of the questionnaire. The self-assessment questionnaire can potentially be a valuable tool in India and other high-, middle-, and low-income countries. From a programmatic perspective, it can help identify key gaps and prioritise training needs, particularly in low-resource settings, so that limited resources are best utilised to fill the most prominent gaps. Furthermore, it can provide a universal platform for comparing data from different settings, facilitating global collaboration and learning in midwifery education.

ObjectiveDissociation is a conscious state characterized by alterations in sensation and perception and is thought to arise from traumatic life experiences. Previous research has demonstrated that individuals with high levels of dissociation show impairments in cognitive-emotional processes. Therefore, using the Competing Neurobehavioral Decisions System (CNDS) theory, we used statistical modeling to examine whether dissociative experience and trauma symptoms are independently predicted by impulsivity, risk-seeking, affective state (i.e., anxiety, depression, stress, and negative affect), and trauma history.MethodIn this cross-sectional study design, data were collected via Amazon Mechanical Turk from a total of n = 557 English-speaking participants in the United States. Using Qualtrics, participants answered a series of self-reported questionnaires and completed several neurocognitive tasks. Three independent multiple linear regression models were conducted to assess whether impulsivity, risk seeking, affective state, and trauma history predict depersonalization, trauma symptoms, and PTSD symptoms.ResultsAs hypothesized, we found that depersonalization and other trauma symptoms are associated with heightened impulsivity, increased risk-seeking, impaired affective states, and a history of traumatic experiences.ConclusionWe demonstrate that an imbalanced CNDS (i.e., hyperimpulsive/hypoexecutive), as evidenced by decreased future valuation, increased risk seeking, and impaired affective states, predicts heightened depersonalization and other trauma and PTSD symptomatology. This is the first time that dissociation has been connected to delay discounting (i.e., the tendency to place more value on rewards received immediately compared to farther in the future). Interventions that positively impact areas of the CNDS, such as episodic future thinking or mindfulness meditation, may be a target to help decrease dissociative symptoms.