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Abstract Oral cancer, the most prevalent cancer worldwide, is far more likely to occur after the age of forty-five, according to the World Health Organization. Although many biomarkers have been discovered over the years using non-invasive saliva samples, biopsies, and human blood, these biomarkers have not been incorporated into standard clinical practice. Investigating the function of microRNAs (miRNAs) in the diagnosis, aetiology, prognosis, and treatment of oral cancer has drawn more attention in recent years. Though salivary microRNA can act as a window into the molecular environment of the tumour, there are challenges due to the heterogeneity of oral squamous cell carcinoma (OSCC), diversity in sample collection, processing techniques, and storage conditions. The up and downregulation of miRNAs has been found to have a profound role in OSCC as it regulates tumour stages by targeting many genes. As a result, the regulatory functions of miRNAs in OSCC underscore their significance in the field of cancer biology. Salivary miRNAs are useful diagnostic and prognostic indicators because their abnormal expression profiles shed light on tumour behaviour and patient prognosis. In addition to their diagnostic and prognostic value, miRNAs hold promise as therapeutic targets for oral cancer intervention. The current review sheds light on the challenges and potentials of microRNA studies that could lead to a better understanding of oral cancer prognosis, diagnosis, and therapeutic intervention. Furthermore, the clinical translation of OSCC biomarkers requires cooperation between investigators, physicians, regulatory bodies, and business partners. There is much potential for improving early identification, tracking therapy response, and forecasting outcomes in OSCC patients by including saliva-based miRNAs as biomarkers.

Abstract In the intensive care unit (ICU), acute kidney injury (AKI) is the most common cause of morbidity and mortality. Hospital-acquired acute kidney injury (HAAKI) is AKI developing after 48 h. We aimed to study the development of AKI and its associated risk factors. We conducted a longitudinal observational study. Inclusion criteria were patients > 18 years of age admitted to ICU. The primary outcome was the development of AKI as defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. A total of 273 patients were included in the study. Out of 273, 44(16.11%) patients developed AKI. The mean age was 45.80(17.39) years, and 60.81% were males. The median acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 12(8–18) and 5(3–7), respectively. Diabetes mellitus (23.44%) and hypertension (23.81%) were predominant comorbidities. The risk factors associated with AKI were serum chloride level, colistin, invasive ventilation, positive end-expiratory pressure (PEEP), and fluid balance. The hospital mortality was significantly higher in patients with AKI (43.18%) as compared with no AKI (14.41%). Among the secondary outcomes, 7 (15.90%) patients required renal replacement therapy (RRT) during hospitalisation. The length of ICU stay was higher in patients with AKI 8(5–13) compared to no AKI 5(3–8). A total of 16.11% developed HAAKI, and mortality was 43.18%. Post 6 months follow-up of AKI patients, mortality was 23%. Among survivors none of the patients were on RRT.Patients admitted with normal kidney function can develop AKI. Hence, careful monitoring of ICU patients is necessary.

Abstract Chili fruits are a potential source of phytochemicals and nutrients for food and reconstituted products. Due to its high nutritional and bioactive components, the current study focused on developing chili instant food products employing hot-air drying method. The effect of the hot-air drying method on physicochemical properties, microbiological quality, retention of bioactive components, phytochemicals, antioxidant properties, and sensory quality of green and red chilies reconstitution products were investigated. HPLC quantification unveiled that fresh red chili product had retained the highest capsaicin (2703.14 µg/g) and dihydrocapsaicin (1518 µg/g) content on the 0th day. Furthermore, UPLC-MS confirmed the presence of eleven phenolic compounds such as gallic acid, chlorogenic acid, caffeic acid, syringic acid, p-coumaric acid, protocatechuic acid, trans-cinnamic acid, ferulic acid, catechin, rutin, and quercetin. Among all, ferulic acid (382.91 µg/g) was the most abundant phenolic compound in fresh green chili products, followed by trans-cinnamic acid (73.19 µg/g) in green chili reconstituted and catechin (65.66 µg/g) in green and red chili reconstituted products. The chili products retained reasonable amounts of bioactive components and antioxidants during storage without microbial growth. The correlation analysis revealed a significant correlation between capsaicinoids, phenolic compounds, and antioxidant properties, which are linearly related in green chili products. This study offers manufacturers a cost-effective technology for producing high-quality chili-reconstituted products rich in essential nutrients and health benefits. Graphical Abstract

Abstract Abnormal cytoplasmic localization and accumulation of pathological transactive response DNA binding protein of 43 kDa (TDP-43) underlies several devastating diseases such as amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration with TDP-43 pathology (FTLD-TDP). A key element is the correlation between disease progression and spatio-temporal propagation of TDP-43-mediated pathology in the central nervous system. Several lines of evidence support the concept of templated aggregation and cell to cell spreading of pathological TDP-43. To further investigate this mechanism in vivo, we explored the efficacy of capturing and masking the seeding-competent region of extracellular TDP-43 species. For this, we generated a novel monoclonal antibody (mAb), ACI-6677, that targets the pathogenic protease-resistant amyloid core of TDP-43. ACI-6677 has a picomolar binding affinity for TDP-43 and is capable of binding to all C-terminal TDP-43 fragments. In vitro, ACI-6677 inhibited TDP-43 aggregation and boosted removal of pathological TDP-43 aggregates by phagocytosis. When injecting FTLD-TDP brain extracts unilaterally in the CamKIIa-hTDP-43NLSm mouse model, ACI-6677 significantly limited the induction of phosphorylated TDP-43 (pTDP-43) inclusions. Strikingly, on the contralateral side, the mAb significantly prevented pTDP-43 inclusion appearance exemplifying blocking of the spreading process. Taken together, these data demonstrate for the first time that an immunotherapy targeting the protease-resistant amyloid core of TDP-43 has the potential to restrict spreading, substantially slowing or stopping progression of disease.

Abstract Heterotopic ossification (HO) is a pathological process that commonly arises following severe polytrauma, characterized by the anomalous differentiation of mesenchymal progenitor cells and resulting in the formation of ectopic bone in non-skeletal tissues. This abnormal bone growth contributes to pain and reduced mobility, especially when adjacent to a joint. Our prior observations suggested an essential role of NGF (Nerve Growth Factor)-responsive TrkA (Tropomyosin Receptor Kinase A)-expressing peripheral nerves in regulating abnormal osteochondral differentiation following tendon injury. Here, we utilized a recently developed mouse model of hip arthroplasty-induced HO to further validate the role of peripheral nerve regulation of traumatic HO. Nerve ingrowth was either modulated using a knockin transgenic animals with point mutation in TrkA, or local treatment with an FDA-approved formulation of long acting Bupivacaine which prevents peripheral nerve growth. Results demonstrate exuberant sensory and sympathetic nerve growth within the peri-articular HO site, and that both methods to reduce local innervation significantly reduced heterotopic bone formation. TrkA inhibition led to a 34% reduction in bone volume, while bupivacaine treatment resulted in a 50% decrease. Mechanistically, alterations in TGFβ and FGF signaling activation accompanied both methods of local denervation, and a shift in macrophages from M1 to M2 phenotypes was observed. In sum, these studies reinforce the observations that peripheral nerves play a role in the etiopathogenesis of HO, and that targeting local nerves represents a potential therapeutic approach for disease prevention.

Abstract Background Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. Methods Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. Results Five hundred and seventy unique clients were seen between November 1–30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada’s official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. Conclusions The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

The global burden of skin diseases affects over 3 billion individuals, posing important public health challenges worldwide, with profound impacts in both high-income and low-income and middle-income countries. These challenges are exacerbated by widespread disparities in access to dermatologic care and the prevalence of misinformation. This article, derived from the Skin and Digital Summit at the International Master Course on Aging Science critically evaluates how digital technologies such as artificial intelligence, teledermatology, and large language models can bridge these access gaps. It explores practical applications and case studies demonstrating the impact of these technologies in various settings, with a particular focus on adapting solutions to meet the diverse needs of low-income and middle-income countries. In addition, the narrative highlights the ongoing conversation within the dermatologic community about the role of digital advances in health care, emphasizing that this discussion is dynamic and the one that is continuously evolving. Dermatologists play an essential role in this transition, integrating digital tools into mainstream care to complement a patient-centered, culturally sensitive approach. The article advocates for a globally coordinated digital response that not only addresses current disparities in skin health care but also promotes equitable access to digital health resources, making dermatologic care more representative of all skin types and accessible worldwide.

Background and Objective: Clove (Syzygium aromaticum) extract has antimicrobial and antioxidant potential. The objective was to assess and compare the salivary Streptococcus mutans counts on Mitis Salivarius Bacterium agar plates after 1 h of mouth rinsing with 30 mL solutions containing S. aromaticum and 0.2% chlorhexidine among 18–30-year-old adults in a clinical setting. Methodology: Sixteen participants fulfilling the eligibility criteria were randomized into two groups. Group A: rinsed with 0.16% S. aromaticum extract mouth rinse and Group B: rinsed with 0.2% chlorhexidine mouthwash. Saliva samples of the participants were collected before and 1 h after mouth rinsing with 30 mL of interventional mouth rinse, for S. mutans count analysis. IBM SPSS Statistics for Windows version 20 (IBM Corp., Armonk, N.Y., USA) was used for statistical analysis. The significance level was fixed at P < 0.05. Intra and Intergroup comparison of microbial counts was done using the Wilcoxon signed–rank test and Mann–Whitney U-test, respectively. Results: The results of the study showed that there was a significant reduction in salivary S. mutans counts in both the groups postmouth rinsing with interventional solutions (P < 0.05). However, the intergroup comparison revealed that, in the chlorhexidine group, there was significantly more reduction in salivary S. mutans counts compared to S. aromaticum mouth rinsing group (P = 0.02). Conclusion: There was a reduction in salivary S. mutans counts after mouth rinsing with a solution containing S. aromaticum. Hence, clove mouth rinse could be an effective aid for the prevention and control of dental caries since it is safe and culturally acceptable.

Introduction: Visual perception plays a pivotal role in a child’s overall development and learning. Occupational therapists often employ interventions to support children in enhancing their visual perception skills, with technology-based approaches gaining prominence in recent years. This review intends to highlight the significance of visual perception interventions, especially those involving technology. Aim: To systematically synthesise the literature on the effectiveness of technology-based interventions on visual perception in children with disabilities aged 4-12 years. Materials and Methods: A comprehensive search of studies was conducted using electronic databases (Scopus, PubMed, ProQuest, and OTseeker). Additionally, studies were also considered through manual searches from printed journals (American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and the Australian Journal of Occupational Therapy) to identify existing technology-based visual perception interventions in children aged 4-12 years. Risk of Bias was conducted through guidelines for systematic review by the American Occupational Therapy Association (AOTA). Data extraction was reported by tabulating author(s) and year, sample characteristics, outcome measures used, study design, intervention details (experimental, comparator, study setting, duration), and outcomes of the studies. Results: In the present review of 13 studies, two studies used iPad interventions, while 11 used computer-based interventions, targeting various clinical groups like developmental delays, dyslexia, cerebral palsy, hearing impairment, down syndrome, hydrocephalus, and special needs. Occupational therapists led most studies, with some involving physiotherapists, educators, and multidisciplinary teams. iPad interventions focused on visual skills with structured apps, while computer methods included games and software like Microsoft Office and Computerised Visual Perception Training (CVPT) for visual training. Positive effects were seen on visual perception and motor skills across different conditions with these technology-based interventions. Conclusion: Visual perception interventions, particularly those incorporating technology, have become invaluable in the field of paediatric occupational therapy. As technology continues to evolve, occupational therapists must remain adaptive and innovative in their strategies to provide the best possible support for children with visual perception difficulties.

Abstract High-altitude (HA) environment presents immense physiological adversities for humans that have been overcome by supplementing bio-active phytochemicals from functional foods that support and accelerate acclimatization under these extreme environmental conditions. Several agricultural interventions have been investigated to enhance the phytochemical content in vegetables however; these studies have been limited to low-altitude (LA) regions only. In view of an existing knowledge gap, current work is designed to compare the phytochemical compositions of HA and LA-grown Brassicaceae vegetables (cabbage, cauliflower, knol-khol, and radish) using organic treatments via farm yard manure (FYM) and Azotobacter. The open field study was conducted as a two-factorial randomized block design. The first factor was treatment (T1-FYM, T2-Azotobacter, T3-FYM + Azotobacter, and T4-control) while the second was locations (HA and LA). Among all these treatments, the application of treatment T3 in HA-grown cabbage showed the highest total phenolic content (TPC; 9.56 μg/mg), total flavonoids content (TFC; 14.48 μg/mg), and antioxidant potential using 2,2-diphenyl-1-picrylhydrazyl (DPPH; 85.97%) and ferric reducing antioxidant power (FRAP; 30.77 μg/mg) compared to LA grown samples. Reverse Phase high performance liquid chromatography (RP-HPLC) analysis showed that treatment T3 at HA led to significantly high kaempferol (0.92 μg/mg) and sulforaphane (8.94 μg/mg) contents in cabbage whereas, indole-3-carbinol (1.31 μg/mg) was higher in HA grown cauliflower. The present study provides scientific evidence for the enrichment of health-promoting phytochemical compounds in Brassicaceae vegetables grown with T3 treatment specifically at HA.

Abstract The unprecedented surge in the demand for personal protective equipment (PPE) worldwide during the covid pandemic resulted in a significant increase in PPE consumption and subsequent waste generation. Despite the importance of PPE, its widespread usage and disposal have sparked worries about the environmental impact and its long-term sustainability. The increasing awareness of environmental challenges, resource scarcity, and the urgent need to mitigate climate change necessitates a paradigm shift in the product design, manufacturing process, and waste management of PPE. To address these challenges and have a sustainable PPE future, the development of degradable polymers and natural fibers offers a promising alternative to traditional plastics. Additionally, recycling and upcycling methods can convert the waste into valuable alternate products or energy sources, thereby reducing their environmental impact. Better waste management systems, comprehensive policy frameworks, and international collaborations are essential for the effective PPE waste management and the promotion of sustainable practices. Despite the challenges, collaborative efforts across governments, manufacturers, research institutions, and waste management authorities are crucial for transitioning to a more sustainable PPE industry and a circular economy, ultimately benefiting both the environment and society.

Abstract Background In Kenya, 65% of sexually active unmarried women use modern contraceptives, a population at increased risk of HIV acquisition compared to other populations. Anchoring HIV prevention services, including pre-exposure prophylaxis (PrEP), to trusted contraceptive delivery settings offers opportunities to efficiently reach this important population. In Kenya, almost half (40%) of women accessing contraception services do so outside traditional healthcare facilities, such as retail pharmacies. Thus, integrating PrEP services into retail pharmacies may increase options for reaching adolescent girls and young women (AGYW) who could benefit from PrEP. Efforts are underway to define care pathways for pharmacy-delivered PrEP services in Kenya, including unsupported and supported models with nurse navigators. Methods The AGYW Pharmacy PrEP study is an unblinded 2-arm cluster-randomized controlled trial in Kisumu, Kenya. The objective is to determine the effect that unsupported versus supported pharmacy-delivered PrEP services has on PrEP initiation, persistence, and adherence among AGYW seeking contraception. Twenty retail pharmacies offering pharmacy provider-led PrEP delivery will be randomized 1:1 to either receive or not receive a nurse navigator to support PrEP delivery. Eligible AGYW (n = 1900 total, n = 950/arm) will be ≥ 15 years old, purchasing a method of contraception at the pharmacy. Trained pharmacy provider will offer eligible AGYW either daily oral PrEP or the monthly DPV vaginal ring. The primary trial outcomes are PrEP initiation (use of PrEP at 1 month), persistence (use of PrEP at 10 months), and adherence (quantified by levels of TFV or DPV in hair samples). Additionally, several secondary (STI incidence, PrEP method selection, predictors of PrEP adherence) and exploratory outcomes (HIV incidence, quality of care, contraceptive method mix) will be explored. Discussion We hypothesize pharmacy-delivered PrEP services supported with nurse navigator, versus delivered by pharmacy providers alone, will improve PrEP outcomes among AGYW seeking contraception. Our results will help policy makers better understand how to potentially implement this novel differentiated service model for PrEP and prime pharmacies for the delivery of new PrEP agents in the pipeline (e.g., long-acting injectables and multi-purpose technologies). The study was initiated on May 13, 2023, and is expected to be completed by February 2025. Trial Registration ClinicalTrials.gov (NCT05467306), with registration on July 20, 2022.

Introduction: A major challenge in stroke rehabilitation is the paresis of the Upper Extremity (UE), resulting in limited functional performance. Recently, motor imagery and Mirror Therapy (MT) have been recommended as an additional rehabilitation strategies that could be beneficial for motor rehabilitation after a stroke. Aim: To determine the effectiveness of mirror visual feedback through Telerehabilitation (TR) on UE functional performance in hemiparetic stroke patients. Materials and Methods: An experimental pretest, post-test study design was conducted at SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, India from January 2021 to June 2021. Total of 60 patients diagnosed with hemiparetic stroke were included in the study through convenience sampling and divided into two groups. The experimental group (n=30) received TR, and the control group (n=30) received face-to-face MT for 12 weeks. A pretest and post-test evaluation were administered using the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for the Upper Extremity (FMA-UE). Within-group analysis was performed using the Wilcoxon Signed-Rank Test, while intergroup analysis was conducted using the Mann-Whitney U Test. Results: The study revealed statistical significance between the pretest and post-test scores of the WMFT-FAS (Functional Ability Score), WMFT-Time (Performance Time), and FMA-UE in the control and experimental groups. The results showed no statistically significant difference between the post-test scores of the control and experimental groups in the FMA and WMFT-FAS. However, there was a statistically significant distinction in the post-test scores between the control and experimental groups in WMFT-Time. Conclusion: The study concluded that mirror visual feedback through TR was an effective treatment method to improve UE functional performance among hemiparetic stroke patients by offering an alternative service delivery model for occupational therapy.

Background: Cervical cancer has led to unprecedented mortality in developing countries, including India. Socio-demographic factors are known to influence knowledge of cervical cancer, screening practices, and HPV vaccination. This study aims to assess cervical cancer awareness and vaccination willingness among women in Uttar Pradesh, India, and identify key socio-demographic determinants. Methods: A clinical and community-based survey in northern India was conducted with a total of 666 women of ≥20 years of age. The survey, developed and verified through expert consultation and pilot testing, covered socio-demographics, cervical cancer knowledge, symptoms, HPV awareness, and vaccine attitudes. Online, offline, and targeted outreach distributed the questionnaire randomly to the general public. Data was analyzed using SPSS 16.0 descriptive statistics, cross-tabulation, and chi-square testing. Results: Among the 666 participants involved in this survey, 516 women (77.5 %) were acquainted with the word “cervical cancer”. Only 235 (45.57 %) of the female participators had sound understanding with regard to cervical cancer symptoms (mean score: 7.7); however, it was less in women dwelling in rural areas (p

Abstract Introduction Oral pre‐exposure prophylaxis (PrEP) is highly effective, but coverage remains low in high HIV prevalence settings. Initiating and continuing PrEP remotely via online pharmacies is a promising strategy to expand PrEP uptake, but little is known about potential users’ preferences. Methods We conducted a discrete choice experiment (DCE) to assess preferences for online pharmacy PrEP services. We partnered with MYDAWA, an online pharmacy in Nairobi, Kenya. Eligibility criteria were: ≥18 years, not known HIV positive, interested in PrEP. The DCE contained four attributes: PrEP eligibility assessment (online self‐assessed, guided), HIV test type (provider administered, oral HIV self‐test [HIVST], blood‐based HIVST), clinical consultation (remote, in‐person) and user support options (text messages, phone/video call, email). Additionally, participants indicated whether they were willing to uptake their selected service. The survey was advertised on MYDAWA's website; interested participants met staff in‐person at a convenient location to complete the survey from 1 June to 20 November 2022. We used conditional logit modelling with an interaction by current PrEP use to estimate overall preferences and latent class analysis (LCA) to assess preference heterogeneity. Results Overall, 772 participants completed the DCE; the mean age was 25 years and 54% were female. Most participants indicated a willingness to acquire online PrEP services, with particularly high demand among PrEP‐naive individuals. Overall, participants preferred remote clinical consultation, HIV self‐testing, online self‐assessment and phone call user support. The LCA identified three subgroups: the “prefer online PrEP with remote components” group (60.3% of the sample) whose preferences aligned with the main analysis, the “prefer online PrEP with in‐person components” group (20.7%), who preferred in‐person consultation, provider‐administered HIV testing, and guided assessment, and the “prefer remote PrEP (18.9%)” group who preferred online PrEP services only if they were remote. Conclusions Online pharmacy PrEP is highly acceptable and may expand PrEP coverage to those interested in PrEP but not accessing services. Most participants valued privacy and autonomy, preferring HIVST and remote provider interactions. However, when needing support for questions regarding PrEP, participants preferred phone/SMS contact with a provider. One‐fifth of participants preferred online PrEP with in‐person components, suggesting that providing multiple options can increase uptake.

Objectives: Mutations in Tissue Inhibitor of Metalloproteinases 3 (TIMP3) cause Sorsby's Fundus Dystrophy (SFD), a dominantly inherited, rare form of macular degeneration that results in vision loss. TIMP3 is synthesized primarily by retinal pigment epithelial (RPE) cells, which constitute the outer blood-retinal barrier. One major function of RPE is the synthesis and transport of vital nutrients, such as glucose, to the retina. Recently, metabolic dysfunction in RPE cells has emerged as an important contributing factor in retinal degenerations. We set out to determine if RPE metabolic dysfunction was contributing to SFD pathogenesis. Methods: Quantitative proteomics was conducted on RPE of mice expressing the S179C variant of TIMP3, known to be causative of SFD in humans. Proteins found to be differentially expressed (P

Objectives: Captopril is a commonly used therapeutic agent in the management of renovascular hypertension (high blood pressure), congestive heart failure, left ventricular dysfunction following myocardial infarction, and nephropathy. Captopril has been found to interact with proteins that are significantly associated with bladder cancer (BLCA), suggesting that it could be a potential medication for BLCA patients with concurrent hypertension. Methods: DrugBank 5.0 was utilized to identify the direct protein targets (DPTs) of captopril. STRING was used to analyze the multiple protein interactions. TNMPlot was used for comparing gene expression in normal, tumor, and metastatic tissue. Then, docking with target proteins was done using Autodock. Molecular dynamics simulations were applied for estimate the diffusion coefficients and mean-square displacements in materials. Results: Among all these proteins, MMP9 is observed to be an overexpressed gene in BLCA and its increased expression is linked to reduced survival in patients. Our findings indicate that captopril effectively inhibits both the wild type and common mutated forms of MMP9 in BLCA. Furthermore, the LCN2 gene, which is also overexpressed in BLCA, interacts with captopril-associated proteins. The overexpression of LCN2 is similarly associated with reduced survival in BLCA. Through molecular docking analysis, we have identified specific amino acid residues (Tyr179, Pro421, Tyr423, and Lys603) at the active pocket of MMP9, as well as Tyr78, Tyr106, Phe145, Lys147, and Lys156 at the active pocket of LCN2, with which captopril interacts. Thus, our data provide compelling evidence for the inhibitory potential of captopril against human proteins MMP9 and LCN2, both of which play crucial roles in BLCA. Conclusion: These discoveries present promising prospects for conducting subsequent validation studies both in vitro and in vivo, with the aim of assessing the suitability of captopril for treating BLCA patients, irrespective of their hypertension status, who exhibit elevated levels of MMP9 and LCN2 expression.

Abstract Vitamin D (VitD) is a naturally occurring, fat-soluble vitamin which regulates calcium and phosphate homeostasis in the human body and is also known to have a neuroprotective role. VitD deficiency has often been associated with impaired cognition and a higher risk of dementia. In this study, we aimed to explore the relationship between levels of VitD and cognitive functioning in adult individuals. 982 cognitively healthy adults (≥ 45 years) were recruited as part of the CBR-Tata Longitudinal Study for Aging (TLSA). Addenbrooke’s cognitive examination-III (ACE-III) and Hindi mental status examination (HMSE) were used to measure cognitive functioning. 25-hydroxyvitamin D [25(OH)D] levels were measured from the collected serum sample and classified into three groups— deficient (

Introduction: Individuals with Parkinson’s Disease commonly experience both physical and psychological effects, which subsequently affect their ability to perform daily activities and overall wellbeing. MusicGlove is an emerging adjunct proposed to address the motor issues but also the psychological ones with references to improving motivation and participation in individuals with Parkinson’s Disease. Aim: To determine the effectiveness of the MusicGlove on hand dexterity and the psychological response in individuals with Parkinson’s disease. Materials and Methods: A quasi-experimental study was performed on 40 individuals with Parkinson disease January 2021 to June 2021 from local community settings in Chengalpattu district, Tamil Nadu, India. They were recruited and divided into a control group (n=20) and experimental group (n=20). Hand dexterity and psychological responses were assessed using the Box and Block Test (BBT), Beck’s Depression Inventory (BDI), and Apathy Inventory (AI) as pre and post-test measures. Both groups received conventional occupational therapy for three weeks in total, and in addition to this, the experimental group received the MusicGlove. The control group included muscle stretching and strengthening activities with therapeutic putty and using activities such as connecting circles where the subject is given a sheet of paper with 25 circles, each containing 25 numbers or letters. They were asked to connect these in ascending, alternating numerical, and alphabetical order. Sessions were conducted for 30 minutes with two sets of repetitions. Descriptive statistics were used to examine data using the Statistical Package for Social Sciences (SPSS) version 24.0. Results: The study results revealed that there was no statistically significant difference found between the groups but clinically significant differences were found between the groups with post-test scores on motor symptoms that were measured by BBT: μ=-1.2534, p=0.211 (BBT Dominant); μ=-0.9400, p-value=0.3472 (BBT Non Dominant), and psychological symptoms that were measured by BDI; (μ=-1.0445, p-value=0.2983) and AI; (μ=-1.0445, p-value=0.9203). Conclusion: The study concluded that conventional occupational therapy along with MusicGlove was effective in improving hand dexterity and psychological responses in Parkinson’s disease patients. Also, further study needs to be conducted to warrant its long-term impact of intervention on hand dexterity and psychological responses.

Abstract Epilepsy is a chronic neurological disease, characterized by spontaneous, unprovoked, recurrent seizures that may lead to long-term disability and premature death. Despite significant efforts made to improve epilepsy detection clinically and pre-clinically, the pervasive presence of noise in EEG signals continues to pose substantial challenges to their effective application. In addition, discriminant features for epilepsy detection have not been investigated yet. The objective of this study is to develop a hybrid model for epilepsy detection from noisy and fragmented EEG signals. We hypothesized that a hybrid model could surpass existing single models in epilepsy detection. Our approach involves manual noise rejection and a novel statistical channel selection technique to detect epilepsy even from noisy EEG signals. Our proposed Base-2-Meta stacking classifier achieved notable accuracy (0.98 ± 0.05), precision (0.98 ± 0.07), recall (0.98 ± 0.05), and F1 score (0.98 ± 0.04) even with noisy 5-s segmented EEG signals. Application of our approach to the specific problem like detection of epilepsy from noisy and fragmented EEG data reveals a performance that is not only superior to others, but also is translationally relevant, highlighting its potential application in a clinic setting, where EEG signals are often noisy or scanty. Our proposed metric DF-A (Discriminant feature-accuracy), for the first time, identified the most discriminant feature with models that give A accuracy or above (A = 95 used in this study). This groundbreaking approach allows for detecting discriminant features and can be used as potential electrographic biomarkers in epilepsy detection research. Moreover, our study introduces innovative insights into the understanding of these features, epilepsy detection, and cross-validation, markedly improving epilepsy detection in ways previously unavailable.

Background: Knowledge of basic life support (BLS) is one of the life-saving measures that every medical undergraduate student must possess. Aims and Objectives: This study focused on knowing the level of knowledge in fresh medical undergraduate entrants (knowledge A [KA]) and 3rdyear students with clinical exposure but no BLS training (knowledge B [KB]). We also assessed the knowledge in 1st-year students (retention A [RA]) soon after foundation course and compared it with retained knowledge after 6 months (retention B [RB]). Materials and Methods: This non-randomized multigroup cross-sectional study was done on medical undergraduate students in a tertiary care hospital attached to a medical school in South India. A validated questionnaire with 25 questions assessing knowledge of BLS was formulated and administered to 508 medical students. Results: After analyzing data in SPSS V24, the mean scores in KA and KB were 11.03±4.33 and 13.95±5.43, respectively, with a P50%, clinical exposure had some effect on mean scores in medical undergraduates. Mean scores in RA and RB were 23.16±5.09 and 16.17±6.97, respectively, with P

Abstract Auditory working memory (AWM) is the process by which information is held in the brain for a brief duration of time until either it is employed to complete a task, deleted after a short period, or transferred to long-term memory. AWM deficits have been noticed even in children with milder hearing impairments. It is essential to incorporate AWM assessment as a part of the standard audiological battery to minimize the detrimental effects of working memory deficits. The present study systematically reviews the articles published between 2011–2021 regarding test tools available to assess AWM in children with hearing impairment and the efficiency of the same. An overview of the auditory working measures such as the forward and backward digit span test; digit span subtests of Wechsler Intelligence Scale for Children-III; non-word repetition; Illinois test of Psycholinguistic Skills-Forward Digit Span; Numbers reversed subtest from Woodcock-Johnson III Tests of Cognitive Abilities; and Word and non-word recall subtests of Working Memory Test Battery-Children; Number recall, and Word order task from Kaufman Assessment Battery for Children II are provided in detail. The present systematic review also provides an overview of the efficiency of the assessment tools by discussing the correlation between the findings obtained in memory tasks with other auditory, verbal, and visual measures. The working memory performance in children with hearing impairment using a hearing aid or cochlear implant has been found to be affected but varies in nature depending on the degree of hearing loss.

This research developed a novel chitosan nanoemulsion infused with Cymbopogon khasianus essential oil (CKEO-ChNe) and characterized through Dynamic light scattering, Atomic force microscopy, scanning electron microscopy, fourier transform infrared spectroscopy, and x-ray diffractometry analyses followed by its efficacy testing against fungi and aflatoxin B1 contamination in Syzygium cumini seeds. The CKEO-ChNe inhibited Aspergillus flavus and aflatoxin B1 (AFB1) production at 0.32 and 0.28 µL/mL with enhanced antioxidant activity and controlled delivery strategies. The inhibition of methylglyoxal and ergosterol biosynthesis, leakage of ions and molecular interaction of geraniol with Ver-1 (Versicolorin A dehydrogenase) and Omt-A (O-methyl transferase) proteins suggested the antifungal and anti-AFB1 mechanism of action. Further, the in situ protection of Syzygium cumini seeds against fungi, AFB1 contamination and lipid peroxidation (p

BackgroundDischarge instructions are a key form of documentation and patient communication in the time of transition from the emergency department (ED) to home. Discharge instructions are time-consuming and often underprioritized, especially in the ED, leading to discharge delays and possibly impersonal patient instructions. Generative artificial intelligence and large language models (LLMs) offer promising methods of creating high-quality and personalized discharge instructions; however, there exists a gap in understanding patient perspectives of LLM-generated discharge instructions. ObjectiveWe aimed to assess the use of LLMs such as ChatGPT in synthesizing accurate and patient-accessible discharge instructions in the ED. MethodsWe synthesized 5 unique, fictional ED encounters to emulate real ED encounters that included a diverse set of clinician history, physical notes, and nursing notes. These were passed to GPT-4 in Azure OpenAI Service (Microsoft) to generate LLM-generated discharge instructions. Standard discharge instructions were also generated for each of the 5 unique ED encounters. All GPT-generated and standard discharge instructions were then formatted into standardized after-visit summary documents. These after-visit summaries containing either GPT-generated or standard discharge instructions were randomly and blindly administered to Amazon MTurk respondents representing patient populations through Amazon MTurk Survey Distribution. Discharge instructions were assessed based on metrics of interpretability of significance, understandability, and satisfaction. ResultsOur findings revealed that survey respondents’ perspectives regarding GPT-generated and standard discharge instructions were significantly (P=.01) more favorable toward GPT-generated return precautions, and all other sections were considered noninferior to standard discharge instructions. Of the 156 survey respondents, GPT-generated discharge instructions were assigned favorable ratings, “agree” and “strongly agree,” more frequently along the metric of interpretability of significance in discharge instruction subsections regarding diagnosis, procedures, treatment, post-ED medications or any changes to medications, and return precautions. Survey respondents found GPT-generated instructions to be more understandable when rating procedures, treatment, post-ED medications or medication changes, post-ED follow-up, and return precautions. Satisfaction with GPT-generated discharge instruction subsections was the most favorable in procedures, treatment, post-ED medications or medication changes, and return precautions. Wilcoxon rank-sum test of Likert responses revealed significant differences (P=.01) in the interpretability of significant return precautions in GPT-generated discharge instructions compared to standard discharge instructions but not for other evaluation metrics and discharge instruction subsections. ConclusionsThis study demonstrates the potential for LLMs such as ChatGPT to act as a method of augmenting current documentation workflows in the ED to reduce the documentation burden of physicians. The ability of LLMs to provide tailored instructions for patients by improving readability and making instructions more applicable to patients could improve upon the methods of communication that currently exist.

Summary: There is increasing evidence of the clinical utility of genetic and genomic testing (GT); however, factors influencing personal utility of GT, especially in diverse, multilingual populations, remain unclear. We explored these factors in a diverse cohort of parents/guardians (participants) whose children received clinical GT through the NYCKidSeq program. A total of 847 participants completed surveys at baseline, post-results disclosure, and 6 months (6m) post-results. The largest population groups were Hispanic/Latino(a) (48%), White/European American (24%), and Black/African American (16%). Personal utility was assessed using the Personal Utility (PrU) scale, adapted for pediatric populations and included on the surveys. Three PrU subscales were identified using factor analysis: practical, educational, and parental psychological utility. Overall personal utility summary score and the three subscales significantly decreased after receiving results and over time. Hispanic/Latino(a) participants identified greater overall personal utility than European American and African American participants at all time points (p

Abstract Introduction Assisted partner services (APS) is an effective strategy for increasing HIV testing, new diagnosis, and linkage to care among sexual partners of people living with HIV (PLWH). APS can be resource intensive as it requires community tracing to locate each partner named and offer them testing. There is limited evidence for the effectiveness of offering HIV self‐testing (HIVST) as an option for partner testing within APS. Methods We conducted a cluster randomized controlled trial comparing provider‐delivered HIV testing (Standard APS) versus offering partners the option of provider‐delivered testing or HIVST (APS+HIVST) at 24 health facilities in Western Kenya. Facilities were randomized 1:1 and we conducted intent‐to‐treat analyses using Poisson generalized linear mixed models to estimate intervention impact on HIV testing, new HIV diagnoses, and linkage to care. All models accounted for clustering at the clinic level and new diagnoses and linkage models were adjusted for individual‐level age, sex, and income a priori. Results From March to December 2021, 755 index clients received APS and named 5054 unique partners. Among these, 1408 partners reporting a prior HIV diagnosis were not eligible for HIV testing and were excluded from analyses. Of the remaining 3646 partners, 96.9% were successfully contacted for APS and tested for HIV: 2111 (97.9%) of 2157 in the APS+HIVST arm and 1422 (95.5%) of 1489 in the Standard APS arm. In the APS+HIVST arm, 84.6% (1785/2111) tested via HIVST and 15.4% (326/2111) received provider‐delivered testing. Overall, 16.7% of the 3533 who tested were newly diagnosed with HIV (APS+HIVST = 357/2111 [16.9%]; Standard APS = 232/1422 [16.3%]). Of the 589 partners who were newly diagnosed, 90.7% were linked to care (APS+HIVST = 309/357 [86.6%]; Standard APS = 225/232 [97.0%]). There were no significant differences between the two arms in HIV testing (relative risk [RR]: 1.02, 95% CI: 0.96–1.10), new HIV diagnoses (adjusted RR [aRR]: 1.03, 95% CI: 0.76–1.39) or linkage to care (aRR: 0.88, 95% CI: 0.74–1.06). Conclusions There were no differences between APS+HIVST and Standard APS, demonstrating that integrating HIVST into APS continues to be an effective strategy for identifying PLWH by successfully reaching and HIV testing >95% of elicited partners, newly diagnosing with HIV one in six of those tested, >90% of whom were linked to care. Clinical Trial Number NCT04774835

Abstract Introduction Assisted partner services (APS), or exposure notification and HIV testing for sexual partners of persons diagnosed HIV positive (index clients), is recommended by the World Health Organization. Most APS literature focuses on outcomes among index clients and their partners. There is little data on the benefits of providing APS to partners of partners diagnosed with HIV. Methods We utilized data from a large‐scale APS implementation project across 31 facilities in western Kenya from 2018 to 2022. Females testing HIV positive at facilities were offered APS; those who consented provided contact information for all male sexual partners in the last 3 years. Male partners were notified of their potential HIV exposure and offered HIV testing services (HTS). Males newly testing positive were also offered APS and asked to provide contact information for their female partners in the last 3 years. Female partners of male partners (FPPs) were provided exposure notification and HTS. All participants with HIV were followed up at 12 months post‐enrolment to assess linkage‐to antiretroviral treatment (ART) and viral suppression. We compared HIV positivity, demographics and linkage outcomes among female index clients and FPPs. Results Overall, 5708 FPPs were elicited from male partners, of whom 4951 received HTS through APS (87% coverage); 291 FPPs newly tested HIV positive (6% yield), an additional 1743 (35.2%) reported a prior HIV diagnosis, of whom 99% were on ART at baseline. At 12 months follow‐up, most FPPs were taking ART (92%) with very few adverse events:

Introduction Quality sleep is essential to our health and well-being. Summertime temperatures in the bedrooms of homes in temperate climates are increasing, especially in city apartments. There is very little empirical evidence of the effect of temperature on sleep when people are sleeping in their own bedroom. The Homes Heat Health project seeks to develop a measurable definition of temperature-related sleep disturbance and the effects on health, and so produce a credible criterion for identifying overheating in new and existing homes.Methods and analysis A cohort of at least 95 people that live in London apartments and who are free of significant personal and health factors that could affect sleep are being recruited for an ongoing observational cohort study. A baseline questionnaire determines their customary sleep patterns and health. The geometrical form and thermal characteristics of their apartments is being recorded along with temperature, relative humidity and in some apartments CO2 levels, throughout one summer. Actigraphy records nightly sleep disturbance and every morning an app-based diary captures perceived sleep quality. Questionnaires following spells of hot weather capture changes in sleep pattern, sleep quality, and consequential health and well-being.Ethics and dissemination The study protocol was approved by the Loughborough University ethics committee. The participants will receive both verbal and written information explaining the purpose of the study, what is expected of them, the incentives for participating and the feedback that will be provided. The results will be reported bi-annually to a project advisory board. Presentations will be made at conferences and the methods, intermediary and final results, in academic journals. Informing government bodies, professional organisations, construction industry representatives and housing providers is of particular importance.

Constrictive pericarditis (CP) presents as a pathophysiological state where the pericardium becomes inelastic due to fibrotic changes, most commonly secondary to a protracted inflammatory process. The disease is characterized by compromised diastolic cardiac function due to loss of pericardial compliance. Immunoglobulin G4 (IgG4)-related disease, an entity marked by the insidious proliferation of IgG4-positive plasma cells and subsequent fibrosis within various organs, is an infrequent but recognized cause of CP. A case of a 55-year-old male patient with clinical manifestations of dyspnea and edema in the lower extremities elucidates the diagnostic complexity inherent to CP. Echocardiography revealed a constellation of signs, including annulus reversus, septal bounce, and a congested inferior vena cava; cardiac magnetic resonance imaging (MRI) demonstrated diffuse pericardial thickening with delayed gadolinium enhancement, suggestive of a long-term inflammatory state; and right heart catheterization confirmed the hemodynamic hallmark of CP—equalization of diastolic pressures across the cardiac chambers. The serological analysis elicited elevated serum levels of IgG4 and IgE, pointing to the differential diagnosis of IgG4-related disease. Given the nonspecific clinical presentation of IgG4-related CP, a heightened index of suspicion combined with a systematic approach to imaging and serological evaluation is paramount.

The exploitation of drought-tolerant plant-associated bacteria in sustainable agriculture is considered potential for boosting plant growth and development under adverse environments featured by low water potentials. Herein, the present study aimed to decode the drought-tolerant root-associated bacteria from little millet (Panicum sumatrense L.). A sum of 25 bacterial isolates was obtained from roots of little millet (Var. ATL1) grown under induced drought conditions (-10 bars). They were initially assessed for their capacity to tolerate the drought up to – 36.6 bars (-3.6 MPa) on PEG (PEG 6000) infused agar plates and of which, 9 isolates (LRS1, LRS2, LRS6, LRS9, LRS14, LRS17, LRS22, LRS23, LRS25) were selected. Further, the cultures were assessed for their plant growth-promoting (PGP) traits such as the production of 1-aminocyclopropane-1-carboxylate deaminase (ACCd), exopolysaccharide (EPS), siderophore, indole acetic acid (IAA), ammonia, and hydrogen cyanide (HCN) and plant nutrition properties including phosphorous, potassium, and zinc. Of three isolates, LRS2 produced the highest ACCd (147 mol α- ketobutyrate mg protein–1h–1), IAA (15.89 μg mL–1), siderophore (54.85 % ) and P solubilization compared to other isolates. Further, the potential isolates LRS2, LRS22 and LRS23 were identified as Bacillus albus, Bacillus amyloliquefaciens and Enterobacter sp. respectively based on 16S rRNA sequence analysis. Biotization of little millet seeds (ATL1) with these strains showed that the inoculation of B. albus LRS2 elevated the plant germination (33 %), shoot length (13.5 %), and root length (25.2 %) followed by LRS23 with plant germination (22 %), shoot length (12.2 %) and root length (13.2 %) under induced drought stress (-0.45 MPa). Besides, metabolite profiling of B. albus LRS2 under induced stress analyzed in GC–MS yielded several drought-tolerant metabolites belonging to the class viz., organic acids, fatty acids, amino acid and its derivatives, organoheterocyclic compounds, and benzenoids. The compounds responsible for drought tolerance such as phenol, proline, fumaric acid, ascorbic acid, and gibberellic acid are more pronounced under induced drought stress (PEG 6000) which would aid in drought stress tolerance and facilitate plant health and fitness. These results implied that B. albus LRS2, a root-associated drought-tolerant endophytic bacteria, would enhance plant growth under drought stress, and lay a foundation for developing a novel bioinoculant for mitigating abiotic stress and promoting sustainable little millet production.

University ranking is a technique of measuring the performance of Higher Education Institutions (HEIs) by evaluating them on various criteria like student satisfaction, expenditure, research and teaching quality, citation count, grants, and enrolment. Ranking has been determined as a vital factor that helps students decide which institution to attend. Hence, universities seek to increase their overall rank and use these measures of success in their marketing communications and prominently place their ranked status on their institution's websites. Despite decades of research on ranking methods, a limited number of studies have leveraged predictive analytics and machine learning to rank universities. In this article, we collected 49 Canadian universities’ data for 2017–2021 and divided them based on Maclean's categories into Primarily Undergraduate, Comprehensive, and Medical/Doctoral Universities. After identifying the input and output components, we leveraged various feature engineering and machine learning techniques to predict the universities’ ranks. We used Pearson Correlation, Feature Importance, and Chi-Square as the feature engineering methods, and the results show that “student to faculty ratio,” “total number of citations”, and “total number of Grants” are the most important factors in ranking Canadian universities. Also, the Random Forest machine learning model for the “primarily undergraduate category,” the Voting classifier model for the “comprehensive category” and the Gradient Boosting model for the “medical/doctoral category” performed the best. The selected machine learning models were evaluated based on accuracy, precision, F1 score, and recall.

The antibacterial effects of bio-inspired silver nanoparticles from Azadirachta indica bark were explored in this research work. Herein, the AgNPs were synthesized using aqueous extract of A. indica bark. The optimization of parameters was carried out using Box-Behnken Design using response surface methodology. The physicochemical characterizations of AgNPs were done by DLS, SEM, Zeta potential and FTIR. The DLS and SEM data revealed the average size of particles to be 76.35 nm and 30.6 nm, respectively. FTIR analysis has shown the involvement of conjugated alkenes in the biosynthesis and capping process. The antimicrobial activity was found to be increased in a dose dependent manner. Exploration of the mechanistic aspect of antibacterial activity suggested of cellular damages caused by AgNPs treatment due to membrane leakage. The binding of AgNPs with bacterial cell and cellular leakage were visualized by SEM. Further, in silico docking studies suggested of strong binding of BamA and PBP4 proteins found in E. coli and S. aureus, respectively, with β-sitosterol, salannin, nimbin etc. biomolecules found in the A. indica bark extract. The work can lead to further manufacturing innovation in the future.

The major aim is to synthesize a creatininium hydrogen bromide (CRBr) single crystal through a slow evaporation technique, and its antibacterial activity. According to Single Crystal X-ray Diffraction (SXRD) analysis, the generated crystal belongs to monoclinic structure and centrosymmetric space group P21/n. The optimized structural parameters explain the structural stability with NH…O, CH…O, and OH…O interactions. To verify the existence of intermolecular interactions, Hirshfeld surface analysis of a grown-up single crystal was carried out and that shows the stable nature of the molecule. Intermolecular and intramolecular hydrogen bonding, intermolecular charge transfer and delocalization of electron density can all be studied effectively by Natural Bond Orbital (NBO) analysis. In addition to examining the functional groups, the vibrational analysis gives the absorption peaks and bands associated with the formed crystal. The generated crystal has thermal stability up to 200 °C according to TG/DTA analysis. The material's electronic transition was determined by analyzing the UV–visible absorbance spectrum, showing an optical band gap of 4.2 eV and a lower cut-off wavelength of 265 nm. The charge transfer within the molecule has been elucidated using frontier molecular orbital analysis that shows its antibacterial properties. Molecular electrostatic surface analysis shows that excellent ICT interactions exist in the crystal lattice, where the positive potential is scattered throughout the creatinine portion and the negative region is dispersed on the bromine atom. Molecular docking has been used to examine the compound's antibacterial properties. In addition, the generated compound is tested for its in vitro antibacterial activity against several bacterial strains, including Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, Bacillus cereus, and Staphylococcus aureus. The above findings demonstrated the remarkable antibacterial effectiveness of the compound under study.

Abstract Background Preeclampsia, a condition very frequently linked to maternal and fetal deaths worldwide, remains a pressing concern due to delays in recognition and response. Effective screening tests for early detection of high-risk cases and appropriate preventive measures are currently lacking. Well planned prenatal care, timely detection, monitoring, and appropriate management are vital to prevent preeclampsia-related fatalities. Methods This prospective study evaluated the use of shear wave elastography (SWE) in identifying placental structural issues caused by preeclampsia in high-risk pregnancies. A total of 143 high-risk pregnant women with singleton pregnancies and an anterior placental position were included in the study. Results Women with preeclampsia exhibited significantly elevated SWE values in both center (27.98 ± 16.12 vs. 4.57 ± 6.57 kPa) and peripheral areas of the placenta (29.14 ± 16.12 vs. 4.80 ± 7.70 kPa) when compared to non-preeclampsia women (p = 0.000). Cutoff values of 8.70 kPa and 8.15 kPa at the Center and edge of the placenta respectively, accurately predicted preeclampsia in second-trimester pregnancies, with 84.62% sensitivity and 94% specificity. However no significant difference was observed between elastography values obtained from the center and edge of the placenta. Conclusions In conclusion, shear wave elastography can help diagnose preeclampsia early by assessing placental stiffness.

Respiratory Syncytial Virus (RSV) is a highly contagious seasonal virus that is the leading cause of acute Lower Respiratory Tract Infections (LRTI) in the paediatric age group and is one of the leading causes of death in children under five in developing countries. There is evidence that severe RSV infection and hospitalisation in early life increase the risk of recurrent wheezing, childhood asthma, and allergic sensitisation. Even though RSV being a major global health concern, very few papers concentrate on the neonatal period in India. The present case series presents four cases (three females and one male baby) highlighting the impact of RSV in neonatal and post-neonatal infants in India. The cases highlight the diversity of presentation; one infant required prolonged High-flow Nasal Cannula (HFNC) support, while two needed just symptomatic care. The importance of Polymerase Chain Reaction (PCR) in resource-constrained situations is highlighted as diagnostic issues are examined. Treatment focuses on supportive care; oxygen and respiratory support are provided in more severe cases. The present study emphasises the need for early detection and preventative measures, such as using novel treatments like nirsevimab. The present case series advocates for focused therapies and additional research in the Indian paediatric environment, adding insightful perspectives to the expanding body of knowledge on RSV.

Due to the scarcity of wireless spectrum, it entails the utilization of dynamic shared spectrum solutions, which can be availed with an intelligent wireless communication technology called Cognitive Radio (CR). Wireless sensor nodes equipped with CR reconfigure dynamically to utilize the vacant spectrum holes, forming a Cognitive Radio Sensor Network (CRSN), which has high demand in Internet of Things (IoT) applications. Despite of attaining high spectrum utilization via CR capabilities, CR based sensor networks require energy efficient solutions due to their resource-constrained behavior. Therefore, a clustered architecture becomes suitable for maintaining opportunistically available radio resources and energy efficiency in CRSNs. In this paper, a trust-based secure clustering scheme is introduced for routing in CRSNs, where both direct and indirect/recommended trust are considered, along with an aging method for updating trust. This scheme accumulates the history of trust values to detect and eliminate malicious nodes from the network. Additionally, during cluster formation, two parameters weight value and neighbor set of each node are taken into consideration. These parameters are obtained through the suggested neighbor selection scheme. The neighbor selection approach considers the neighbor’s requirements in terms of transmission time and the availability of a common channel between the Cognitive Sensor (CS) node and the associated neighbor set. Thereafter, the proposed secure clustering approach will incorporate cluster head rotation to ensure an even distribution of energy consumption among the nodes in a cluster. Simulation based study demonstrates that the proposed scheme enhances detection efficiency, detection ratio, the network’s relative average packet delivery ratio, relative average packet drop ratio, average end-to-end delay, and average energy consumption of the network for selective forwarding, blackhole, and ON-OFF attacks in comparison with an existing method. Moreover, the correctness of the proposed scheme is evaluated in terms of precision and F1-Score.

Dapsone, once a fabric dye, is a versatile pharmaceutical for treating diseases like leprosy, malaria, and HIV-AIDS-related pneumonia. Discovered in 1908 but not utilized for its antimicrobial properties until the 1930s, dapsone faced initial setbacks due to toxicity, prompting the development of a safer derivative, Promin. Chemically, dapsone's lipid-soluble nature allows for extensive distribution throughout the body and involves complex metabolism, with a variable elimination half-life. Its clinical efficacy is due to its bacteriostatic action, inhibiting dihydrofolic acid synthesis, and its anti-inflammatory effects on neutrophils. Dapsone's dosing is tailored to the individual's condition and is approved for various dermatological conditions. However, its use is limited by contraindications in certain anemic conditions and potential side effects such as hemolytic anemia and methemoglobinemia, necessitating careful monitoring and management strategies to mitigate risks. Despite these challenges, dapsone's broad therapeutic utility and ongoing research into its mechanisms maintain its status as a significant medical therapy.

Unlicensed cellular networks and spectrum-sharing standards assist operators in meeting the ever-increasing demand for mobile data. However, several incumbents are already operational in these frequencies, rendering the wireless environment extremely dynamic and unpredictable. The challenges associated with unlicensed Licensed Assisted Access (LAA) operations in the 5 GHz band and New Radio in Unlicensed (NR-U) in the 6 GHz band are best addressed through a data-driven approach. This requires operator data from current cellular deployments. Further, from an operator’s perspective, the precision and reliability of predictive models must be analyzed before deployment. Counterfactual machine learning is ideal for quantifying causal impact in a dynamic, unlicensed cellular environment. However, the literature lacks a framework that combines data-driven solutions, counterfactual analysis, and conventional optimization. This work contributes a dataset from the LAA networks of three major cellular operators in Chicago consisting of 15 features and 9676 samples. Additionally, it proposes a framework for analyzing the performance of unlicensed networks that leverages machine learning for predictive modeling, employs counterfactual analysis for model explainability and network performance enhancement, and utilizes optimization for validation. We show that operator data is necessary to build reliable prediction models for network throughput, and signal strength, among others. Further, the impact of network parameters is shown to differ in unlicensed and licensed cellular network models. Next, a counterfactual machine learning framework is proposed to explain and analyze the predictive models. The framework proposes counterfactual policies to enhance unlicensed cellular network performance. Finally, we validate the suggested counterfactual policies through joint network optimization.

The upper mid-band – approximately from 7 to 24 GHz — has recently attracted considerable interest for new cellular services. This frequency range has vastly more spectrum than the highly congested bands below 7 GHz while offering more favorable propagation and coverage than the millimeter wave (mmWave) frequencies. In this regard, the upper mid-band has the potential to provide a powerful and complementary frequency range that balances coverage and capacity. Realizing cellular networks that exploit the full range of these bands, however, presents significant technical challenges. Most importantly, spectrum will likely need to be shared with incumbents including communication satellites, military RADAR, and radio astronomy. Also, the upper mid-band is simply a vast frequency range. Due to this wide bandwidth, combined with the directional nature of transmission and intermittent occupancy of incumbents, cellular systems will likely need to be agile to sense and intelligently use large spatial and frequency degrees of freedom. This paper attempts to provide an initial assessment of the feasibility and potential gains of such adaptive wideband cellular systems operating across the upper mid-band. The study includes: (1) a detailed ray tracing simulation to assess potential gains of multi-band systems in a representative dense urban environment and illustrate the value of a wideband system with dynamic frequency selectivity; (2) an evaluation of potential cross-interference between satellites and terrestrial cellular services and interference nulling to reduce that interference; and (3) design and evaluation of a compact multi-band antenna array structure. Leveraging these preliminary results, we identify potential future research directions to realize next-generation systems in these frequencies.

Abstract The most common denture material used for dentistry is poly-methyl-methacrylate (PMMA). Usually, the polymeric PMMA material has numerous biological, mechanical and cost-effective shortcomings. Hence, to resolve such types of drawbacks, attempts have been made to investigate fillers of the PMMA like alumina (Al2O3), silica (SiO2), zirconia (ZrO2) etc. For the enhancement of the PMMA properties a suitable additive is required for its orthopedic applications. Herein, the main motive of this study was to synthesize a magnesium oxide (MgO) reinforced polymer-based hybrid nano-composites by using heat cure method with superior optical, biological and mechanical characteristics. For the structural and vibrational studies of the composites, XRD and FT-IR were carried out. Herein, the percentage of crystallinity for all the fabricated composites were also calculated and found to be 14.79–30.31. Various physical and optical parameters such as density, band gap, Urbach energy, cutoff energy, cutoff wavelength, steepness parameter, electron–phonon interaction, refractive index, and optical dielectric constant were also studied and their values are found to be in the range of 1.21–1.394 g/cm3, 5.44–5.48 eV, 0.167–0.027 eV, 5.68 eV, 218 nm, 0.156–0.962, 4.273–0.693, 1.937–1.932, and 3.752–3.731 respectively. To evaluate the mechanical properties like compressive strength, flexural strength, and fracture toughness of the composites a Universal Testing Machine (UTM) was used and their values were 60.3 and 101 MPa, 78 and 40.3 MPa, 5.85 and 9.8 MPa-m1/2 respectively. Tribological tests of the composites were also carried out. In order to check the toxicity, MTT assay was also carried out for the PM0 and PM15 [(x)MgO + (100 − x) (C5O2H8)n] (x = 0 and 15) composites. This study provides a comprehensive insight into the structural, physical, optical, and biological features of the fabricated PMMA-MgO composites, highlighting the potential of the PM15 composite with its enhanced density, mechanical strength, and excellent biocompatibility for denture applications.

Abstract Background Several reports discussed a connection between CD36 genotypes associated with obesity, influencing the development of Type 2 diabetes mellitus (T2DM). Therefore, this study examines the prognostic value of CD36 polymorphism rs1761667 (G/A) in individuals with obese T2DM. The investigation also explores the correlation between this genetic variation and the clinical/biochemical parameters of the subjects. Methods Blood samples of a total of 475 subjects from north India were collected from the outpatient unit (OPD), Department of Medicine, KGMU, Lucknow as per inclusion/exclusion criteria. Anthropometric details of study subjects were recorded and biochemical parameters were estimated in 250 T2DM cases, 75 obese T2DM cases, and 150 controls. The CD36 gene variant rs1761667 (G/A) was subject to genotypic analysis using the polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) method, utilizing specific primers and HhaI enzyme. All statistical analysis was done using SPSS (ver. 21.0) and Prism (5.01) software. Results Fasting plasma glucose (FPG), systolic blood pressure (SBP), post-prandial glucose (PPG) were significant in T2DM subjects. Lipid profile such as Total Cholesterol (TC), Low-Density Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL) were also found significantly associated with obese T2DM cases. GA and AA genotypes of rs1761667 (G/A) showed significant associations in obese T2DM cases. The GA genotype demonstrated a considerable association (P

This article investigates the complementary frequency selective surface based metasurface structure that operates at 0.82 THz frequency. Various metasurface structures with single and multi-layered substrates have been reported in literature for sixth generation systems. Here, we review various potential metasurface structures for THz communication. Moreover, a dual complementary loop integrated three-legged structure and related loop integrated metasurface has been studied. The complementary loop integrated is embossed on a polydimethylsiloxane substrate to achieve better angular stability over 0° to 85° with a maximum frequency deviation of 0.05%. The choice of substrate is also investigated with their flexibility and suitability for THz frequency. The equivalent circuit model we analyzed for complementary loop integrated and conventional approaches. The results depict that the complementary structure can achieve better angular stability over the incident angle of 0° to 85° for both TE and TM modes.

Cutaneous metastases (CM) account for 2% of all skin tumors, with an incidence of ~2%–10% in patients with internal malignancy. It has a broad morphological spectrum and histologically mimics the primary tumor. Its advent portends a poor prognosis. The clinical manifestations, diagnostic histopathology, and clinical course of five patients with CM were analyzed, of which 2 were female and 3 were male, ranging in age from 43 to 70 years. Illustrating the indolent behavior of this entity, four out of the five patients developed CM despite adequate treatment of the primary malignancies. The histology of the CM and primary malignancy were in agreement. Out of the five patients, four opted for palliative therapy and one patient succumbed to the illness during the course of treatment. CM usually signifies recurrence or progression of malignancy, rarely it may be the initial presentation of an underlying malignancy. It uniformly upstages the malignancy and gravely impacts survival. Regular follow-up and a high degree of suspicion of seemingly benign progressive skin lesions in patients with internal malignancies are crucial for the timely detection of CM. Early identification can lead to a better understanding of disease progression and potentially assist in optimizing treatment strategies, even though options may be limited at this advanced stage.

Introduction: Memory deficits are one of the common indications of cognitive aging, and they are an essential component for completing day-to-day activities in an effective, timely, and safe manner. Disturbances in memory can have a major impact on an individual’s performance in all areas of occupation. Memory alterations have a substantial influence on numerous elements of everyday living, including sentiments and conceptions of self, connections with others, participation in Activities of Daily Living (ADL), and engagement in leisure activities. Aim: To determine the effectiveness of an occupational therapy Memory Strategy Education Group (MSEG) intervention on memory difficulties and its impact on ADL performance among the geriatric population. Materials and Methods: The present quasi-experimental pre-post-test pilot study was conducted at Department of Occupational Therapy, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India. A total of 10 participants aged 60 years and above were recruited from a community setting through convenience sampling and were divided into an experimental group (n=5) and a control group (n=5). The experimental group participants received MSEG intervention, while the control group participants received conventional occupational therapy memory intervention for three weeks. The Canadian Occupational Performance Measure (COPM), Contextual Memory Test (CMT), and Functional Independence Measure (FIM) were used to measure occupational performance, memory, and ADL. The outcome measure scores within groups were analysed using the Wilcoxon signed-rank test, and the comparison of outcome measures between the groups was analysed using the MannWhitney U test. An alpha level of p=0.05 was considered to be statistically significant. Statistical Package for Social Sciences (SPSS) 24.0 version was used to analyse the data. Results: In the present study, a total of 10 participants from the age group of 60-75 years (mean age=67.4 years) were included, and each group (control and experimental) consisted of five participants (3 males and 2 females). The results showed that there was a significant difference (p0.05) in the post-test scores of the experimental and control groups in FIM (p=0.347). Further analysis revealed a clinically significant difference between the control and experimental groups in post-test scores. Conclusion: The results of the study concluded that the MSEG intervention is effective in improving memory difficulties in the geriatric population but had a lesser effect on improving ADL performance.

Introduction: Challenging behaviours are frequently observed in children diagnosed with Autism Spectrum Disorder (ASD), potentially hindering their daily functioning. As the prevalence of autism continues to rise, the array of challenging behaviours, including repetitive patterns, stereotypes, and self-harm, emphasizes the importance of developing effective interventions in occupational therapy. These interventions aim to manage these challenging behaviours and enhance the overall wellbeing and functionality of these children. Aim: To compare the effectiveness of Functional Communication Training (FCT), Sensory Integration Therapy (SIT), and Behavioural Interventions (BI) on challenging behaviours in children with ASD. Materials and Methods: An experimental study with prepost test design was conducted in the Paediatric Unit of the Department of Occupational Therapy, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India. The duration of the study was nine months, from September 2020 to May 2021. A total of six (N=6) children selected through convenience sampling. The SIT took place at the paediatric unit of the occupational therapy department at SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu, India. Due to Coronavirus Disaese-2019 (COVID-19) restrictions, FCT and BI were conducted simultaneously at the participants’ homes. Outcomes were measured using Functional Behavioural Assessment (FBA) and the Repetitive Behaviour Scale-Revised (RBS-R). Within-group analysis involved utilising the Wilcoxon signed-rank test, while between-group analysis entailed the application of the Kruskal-Wallis and one way Analysis of Variance (ANOVA) test. Results: The mean age of the study participants was 7.83±1.83 years. A significant reduction in challenging behaviours was seen in all six children in the three intervention groups when outcomes were measured using FBA (p

Mitral regurgitation (MR) is the systolic retrograde flow from the left ventricle (LV) to the left atrium. Despite the recognized importance of hemodynamic force (HDF) in cardiology, its exploration in MR has been limited. Therefore, we aimed to explore non-invasively assessed HDF as a novel biomarker for evaluating MR utilizing 4D-flow MRI. The study cohort comprised 15 healthy controls (19–61 years, 53% men) and 26 MR patients with preserved ejection fraction (EF) (33–75 years, trivial–severe, 54% men). The HDF analysis involved the semi-automatic calculation of systolic–diastolic root mean square (RMS), average, and transverse/longitudinal ratio across three directions (S-L: septal–lateral, I-A: inferior–anterior, and B-A: basal–apical) using Segment, v2.2 R6410 (Lund, Sweden, Medviso). A noticeable trend shift emerged in HDF as the MR severity increased (p-value < 0.05). The MR severity demonstrated a noteworthy correlation with systolic RMS B-A, average B-A, diastolic average B-A, systolic average S-L, B-A, and systolic–diastolic ratio (rho = 0.621, 0.457, 0.317, 0.318, 0.555, −0.543, −0.35, respectively; p-value < 0.05). HDF significantly correlated with LV function (end-diastolic volume, end-systolic volume, EF, and mass; p-value < 0.05). Systolic RMS B-A and diastolic RMS S-L emerged as significant predictors of MR (Beta, 95% CI [3.253, 1.204–5.301], [5.413, 0.227–10.6], p-value < 0.05). This study emphasizes HDF as a potential hemodynamic biomarker for evaluating MR.

Background: Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Methods: Within the APS-HIVST study conducted in western Kenya (2021–2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. Results: The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of Conclusions: Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies.