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In India, stubble burning is frequently practiced in the dominant rice-growing states of the Indo-Gangetic Plains, primarily in Punjab, Haryana and Uttar Pradesh. We attempted monitoring and mapping of the active fire events in real time for all the 3 states by acquiring thermal datasets from 3 different sensors i.e. Visible Infrared Imaging Radiometer Suite (VIIRS) at 375 m aboard Sumo-NPP, Moderate-Resolution Imaging Spectro-Radiometer (MODIS) at 1000 m aboard Terra & Aqua, and Advanced Very High Resolution Radiometer (AVHRR) at 1,100 m aboard NOAA 18/19 & MetOp 1/2, made available by IARI Satellite Ground Station during Kharif crop harvest season (October–November) 2018. The standard algorithm of detection of the temperature of a pixel at (4.0 µm and/or 10 to 12 µm) and its difference from the temperature of surrounding pixels was employed for day and night passes. Analysis of active fire locations detected from VIIRS, MODIS and AVHRR between 01st October and 30th November 2018 suggests continuing practice of stubble burning with a total of 75563 burning events distributed as 59695, 9232 and 6636 in Punjab, Haryana and Uttar Pradesh, respectively. District-wise monitoring showed a significant upsurge of fire events during the study period in the south-western and eastern districts of Punjab. Intense fire was witnessed in northern districts of Haryana and western districts of Uttar Pradesh. Comparative analysis shows that the burning events in the current year up till 30th November 2018 are 85% of the events detected in 2017 and about 59.10% of the events detected in 2016. It implies that the burning of rice stubble in the current year has reduced significantly over the past years due to various scheme implemented by the State and Central government.

Urinary tract infections (UTIs) are counted among serious health problems affecting large number of people each year. UTIs are the second most common infections. This paper reports the synthesis of a novel nitrosyl complex of Ru(II) that has been found effective against some selected gram negative bacteria, E. coli and Pseudomonas. It has been found that the activity was pronounced more against Pseudomonas than E. coli. Hence, the complex may be seen effective agent against UTI. On characterizing the complex by virtue of combined experimental-DFT scope, a suitable octahedral structure has been suggested. Molecular specification under B3LYP functional, LanL2DZ basis set for Ru atom and 6–31g(d,p) for all other atoms were employed. Electron density plots and geometrical optimization were the main theoretical insights. Elemental analysis, mass spectrometry, NMR, FT-IR, UV-vis, cyclic voltammetry and TGA were the characterization techniques made comparable to computed data. From overall study it may be culminated that both the experimental and theoretical outcomes have been found in good agreement with each other. Keywords: DFT, Ru(II), NO, UTI

Background: Invasive melanoma, a lethal form of skin cancer, is the seventh most common cancer in women. Factors such as a history of indoor tanning or sunburn and a personal or family history of skin cancer increase a woman’s risk of developing a melanoma. Objective: Because the majority of melanomas occur in patients age 40 years or older, which is the age that is recommended for women to begin screening mammograms, the mammogram experience could be used to promote early detection of melanoma by introducing skin self-examinations (SSE) to a population of women who are already invested in preventive health. Methods: This was a pilot and feasibility study that was designed to promote the early detection of melanoma among women who undergo a mammogram at the Lynn Sage Breast Center at the Northwestern Medicine/Prentice Women’s Hospital in Chicago, Illinois. The study was conducted in three phases: development of the materials, delivery of the program, and assessment of the program effectiveness. Results: Eighty six percent of women with scheduled mammogram appointments participated in the study (n = 560). Among these women, 68% noticed the SSE information in the changing rooms, 78% thought the information applied to them, and 68% identified with at least one of the risk factors for melanoma. Twenty percent of the patients checked their skin in the changing room, 13% noticed a concerning mole, and 60% of those women who noted a concerning lesion stated their intent to see a dermatologist for further evaluation. Conclusion: A large proportion of the women in our study had risk factors for developing a melanoma and noticed the SSE information in the screening center. Placing an intervention to encourage methods for the early detection of melanoma in an outpatient mammography environment is an effective strategy to increase awareness in a large proportion of at-risk women. Keywords: melanoma, skin self-examination, skin cancer screening, mammogram

This paper presents the first evidence of a new and unique feature of spontaneous reconnection at multiple sites in electron current sheet, viz. a "nested quadrupole" structure of the Hall field at electron scales, in Cluster observations. The new nested quadrupole is a consequence of electron-scale processes in reconnection. Whistler response of the upstream plasma to the interaction of electron flows from neighboring reconnection sites produces a large-scale quadrupole Hall field enclosing the quadrupole fields of the multiple sites, thus forming a nested structure. Electron-magnetohydrodynamic simulations of an electron current sheet yields a mechanism of the formation of a nested quadrupole.

The present paper reports the synthesis and characterization of some new sulfa drug based Schiff base oxovanadium(IV) complexes of composition, [VO(sal-sdz)2(H2O)]·H2O, [VO(sal-sgn)2(H2O)]·H2O, [VO(sal-snm)(H2O)]·H2O, [VO(sal-smr)2(H2O)]·H2O and [VO(dadps)(H2O)]2·2H2O, where sal-sdzH = N-(salicylidene)sulfadizine, sal-sgnH = N-(salicylidene)sulfaguanidine, sal-snmH = N-(salicylidene)sulfanilamide, sal-smrH = N-(salicylidene)sulfamerizine, sal-dadpsH2 = N,N′-bis(salicylidene)-4,4′-diaminodiphenylsulfone, respectively. Complexes, (1)–(4) were prepared by the reaction of VOSO4·5H2O with the Schiff bases in 1:2 metal-ligand ratio while complex (5) in 2:2 metal-ligand ratio in DMF-ethanol medium. The compounds so obtained were characterized by different physico-chemical studies, such as, elemental analysis, molar conductance and magnetic measurements, infrared, ESR, thermogravimetric studies, mass and electronic spectral studies. The overall IR studies conclude that the ligand in complex (1)–(4) behave as monobasic bidentate ON donor, while the ligand in the complex (5) behaves as dibasic tetradentate O2N2 donor. The 3D-molecular modeling and analysis for bond lengths and bond angles have also been carried out for two representative compounds, [VO(sal-snm)2(H2O)]·H2O (3) and [VO(dadps)(H2O)]2·2H2O (5) to substantiate the proposed structures. Based on these studies suitable octahedral structures have been proposed for these complexes.

In this paper, design of linear phase second order recursive digital integrators and differentiators is discussed. New second order integrators have been designed by using Genetic Algorithm (GA) optimization method. Thereafter, by modifying the transfer function of these integrators appropriately, new digital differentiators have been obtained. The proposed digital integrators and differentiators accurately approximate the ideal ones and have linear phase response over almost entire Nyquist frequency range. The proposed operators also outperform the existing operators in terms of both magnitude and phase response.

An electron-magnetohydrodynamic model is used to simulate the structure of an electron scale current sheet during early phase of collisionless magnetic reconnection. The current sheet develops structures, viz. bifurcated, filamented and triple-peak structures at different locations in the current sheet. The reversal of the net out-of-plane electric field seen by electrons bifurcates the current sheet in the outflow regions, the individual peaks having scale sizes of a few electron skin depths. Secondary instabilities of the bifurcated CS lead to its filamentation in the outflow and separatrix regions while triple-peak structures form at reconnection sites. These structures have implications for the forthcoming NASA/MMS mission designed to resolve electron space and time scales in the magnetosphere.

AI has emerged as a revolutionary technology in the pharmaceutical and biomedical fields. This review explores its transformative role, particularly in drug development, the discovery of future interventions in the pharmaceutical sector. By leveraging AI, these processes have become more efficient, cost-effective, and capable of delivering personalized medicine to individual patients. Moreover, AI’s potential in disease prevention and outbreak prediction is promising, as it can analyze vast datasets to identify crucial patterns and trends, leading to targeted interventions for combating diseases. In biomedical research, AI has proven highly beneficial, especially in genomics, proteomics, and metabolomics, where it enables researchers to comprehensively analyze complex biological data, uncovering new insights and accelerating scientific discoveries. The impact of AI is also evident in the patient-physician interface, as it enhances diagnostic accuracy and treatment efficiency, ultimately improving patient care.

Abstract Background Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between endothelial dysfunction markers among children with and without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, and develop prediction models to identify those at highest risk of SA-AKI. Methods Secondary analyses of prospective observational cohort of pediatric septic shock. Primary outcome of interest was the presence of ≥ Stage II KDIGO SA-AKI on day 3 based on serum creatinine (D3 SA-AKI SCr). Biomarkers including those prospectively validated to predict pediatric sepsis mortality (PERSEVERE-II) were measured in Day 1 (D1) serum. Multivariable regression was used to test the independent association between endothelial markers and D3 SA-AKI SCr. We conducted risk-stratified analyses and developed prediction models using Classification and Regression Tree (CART), to estimate risk of D3 SA-AKI among prespecified subgroups based on PERSEVERE-II risk. Results A total of 414 patients were included in the derivation cohort. Patients with D3 SA-AKI SCr had worse clinical outcomes including 28-day mortality and need for CRRT. Serum soluble thrombomodulin (sTM), Angiopoietin-2 (Angpt-2), and Tie-2 were independently associated with D3 SA-AKI SCr. Further, Tie-2 and Angpt-2/Tie-2 ratios were influenced by the interaction between D3 SA-AKI SCr and risk strata. Logistic regression demonstrated models predictive of D3 SA-AKI risk performed optimally among patients with high- or intermediate-PERSEVERE-II risk strata. A 6 terminal node CART model restricted to this subgroup of patients had an area under the receiver operating characteristic curve (AUROC) 0.90 and 0.77 upon tenfold cross-validation in the derivation cohort to distinguish those with and without D3 SA-AKI SCr and high specificity. The newly derived model performed modestly in a unique set of patients (n = 224), 84 of whom were deemed high- or intermediate-PERSEVERE-II risk, to distinguish those patients with high versus low risk of D3 SA-AKI SCr. Conclusions Endothelial dysfunction biomarkers are independently associated with risk of severe SA-AKI. Pending validation, incorporation of endothelial biomarkers may facilitate prognostic and predictive enrichment for selection of therapeutics in future clinical trials among critically ill children. Graphical abstract

Abstract Background Sepsis is associated with significant mortality. Yet, there are no efficacious therapies beyond antibiotics. PCSK9 loss-of-function (LOF) and inhibition, through enhanced low-density lipoprotein receptor (LDLR) mediated endotoxin clearance, holds promise as a potential therapeutic approach among adults. In contrast, we have previously demonstrated higher mortality in the juvenile host. Given the potential pleiotropic effects of PCSK9 on the endothelium, beyond canonical effects on serum lipoproteins, both of which may influence sepsis outcomes, we sought to test the influence of PCSK9 LOF genotype on endothelial dysfunction. Methods Secondary analyses of a prospective observational cohort of pediatric septic shock. Genetic variants of PCSK9 and LDLR genes, serum PCSK9, and lipoprotein concentrations were determined previously. Endothelial dysfunction markers were measured in day 1 serum. We conducted multivariable linear regression to test the influence of PCSK9 LOF genotype on endothelial markers, adjusted for age, complicated course, and low- and high-density lipoproteins (LDL and HDL). Causal mediation analyses to test impact of select endothelial markers on the association between PCSK9 LOF genotype and mortality. Juvenile Pcsk9 null and wildtype mice were subject to cecal slurry sepsis and endothelial markers were quantified. Results A total of 474 patients were included. PCSK9 LOF was associated with several markers of endothelial dysfunction, with strengthening of associations after exclusion of those homozygous for the rs688 LDLR variant that renders it insensitive to PCSK9. Serum PCSK9 was not correlated with endothelial dysfunction. PCSK9 LOF influenced concentrations of Angiopoietin-1 (Angpt-1) upon adjusting for potential confounders including lipoprotein concentrations, with false discovery adjusted p value of 0.042 and 0.013 for models that included LDL and HDL, respectively. Causal mediation analysis demonstrated that the effect of PCSK9 LOF on mortality was mediated by Angpt-1 (p = 0.0008). Murine data corroborated these results with lower Angpt-1 and higher soluble thrombomodulin among knockout mice with sepsis relative to the wildtype. Conclusions We present genetic and biomarker association data that suggest a potential direct role of the PCSK9-LDLR pathway on Angpt-1 in the developing host with septic shock and warrant external validation. Further, mechanistic studies on the role of PCSK9-LDLR pathway on vascular homeostasis may lead to the development of pediatric-specific sepsis therapies. Graphical abstract

Summary: Background: Multiple organ dysfunction syndrome (MODS) disproportionately drives morbidity and mortality among critically ill patients. However, we lack a comprehensive understanding of its pathobiology. Identification of genes associated with a persistent MODS trajectory may shed light on underlying biology and allow for accurate prediction of those at-risk. Methods: Secondary analyses of publicly available gene-expression datasets. Supervised machine learning (ML) was used to identify a parsimonious set of genes associated with a persistent MODS trajectory in a training set of pediatric septic shock. We optimized model parameters and tested risk-prediction capabilities in independent validation and test datasets, respectively. We compared model performance relative to an established gene-set predictive of sepsis mortality. Findings: Patients with a persistent MODS trajectory had 568 differentially expressed genes and characterized by a dysregulated innate immune response. Supervised ML identified 111 genes associated with the outcome of interest on repeated cross-validation, with an AUROC of 0.87 (95% CI: 0.85–0.88) in the training set. The optimized model, limited to 20 genes, achieved AUROCs ranging from 0.74 to 0.79 in the validation and test sets to predict those with persistent MODS, regardless of host age and cause of organ dysfunction. Our classifier demonstrated reproducibility in identifying those with persistent MODS in comparison with a published gene-set predictive of sepsis mortality. Interpretation: We demonstrate the utility of supervised ML driven identification of the genes associated with persistent MODS. Pending validation in enriched cohorts with a high burden of organ dysfunction, such an approach may inform targeted delivery of interventions among at-risk patients. Funding: H.R.W.′s NIH R35GM126943 award supported the work detailed in this manuscript. Upon his death, the award was transferred to M.N.A. M.R.A., N.S.P, and R.K were supported by NIH R21GM151703. R.K. was supported by R01GM139967.

OBJECTIVES:. Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based risk strata upon adjusting for illness severity, presence of severe acute kidney injury (acute kidney injury), and use of continuous renal replacement therapy (CRRT) in pediatric septic shock. DESIGN:. Ongoing multicenter prospective observational cohort. SETTING:. Thirteen PICUs in the United States (2003–2023). PATIENTS:. Six hundred and eighty-one children with septic shock. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Cumulative percent PFB between days 1 and 7 (days 1–7 %PFB) was determined. Primary outcome of interest was complicated course defined as death or persistence of greater than or equal to two organ dysfunctions by day 7. Pediatric Sepsis Biomarker Risk Model (PERSEVERE)-II biomarkers were used to assign mortality probability and categorize patients into high mortality (n = 91), intermediate mortality (n = 134), and low mortality (n = 456) risk strata. Cox proportional hazard regression models with adjustment for PERSEVERE-II mortality probability, presence of sepsis-associated acute kidney injury on day 3, and use of CRRT, demonstrated that time-dependent variable days 1–7%PFB was independently associated with an increased hazard of complicated course. Risk-stratified analyses revealed that each 10% increase in days 1–7 %PFB was associated with increased hazard of complicated course only among patients with high mortality risk strata (adjusted hazard ratio 1.24 (95% CI, 1.08–1.43), p = 0.003). However, this association was not causally mediated by PERSEVERE-II biomarkers. CONCLUSIONS:. Our data demonstrate the influence of cumulative %PFB on the risk of complicated course in pediatric septic shock. Contrary to our previous report, this risk was largely driven by patients categorized as having a high mortality risk based on PERSEVERE-II biomarkers. Incorporation of such prognostic enrichment tools in randomized trials of restrictive fluid management or early initiation of de-escalation strategies may inform targeted application of such interventions among at-risk patients.

Plain abdominal radiographs and gastrointestinal contrast studies remain the first line of investigation for the evaluation of several conditions due to their easy availability and ease of use in pediatric patients. A systematic approach to evaluating the plain radiograph for pediatric abdomen can lead the radiologist to a relevant differential diagnosis in most cases. In other cases, it leads the radiologist to the next line of investigation. The plain radiograph of the abdomen is requested for several conditions ranging from abdominal pain, vomiting, failure to pass meconium, abdominal distension, perforation, mass or for suspected obstruction. The radiation dose involved in abdominal radiography, although significant, the diagnostic information provided outweighs the risk. Dose reduction techniques should be employed to reduce the radiation dose to infants and children. Spectrum of atresias and stenosis from the esophagus up to the rectum, Hirschsprung disease, small left colon syndrome, and anorectal malformations can be identified with a detailed and systematic contrast study. They act as an adjunct in the diagnosis of conditions such as intussusception and hypertrophic pyloric stenosis. Inflammatory conditions such as acute appendicitis, necrotizing enterocolitis, and acute conditions such as pneumoperitoneum are also well appreciated on plain abdominal radiographs.

Background. COVID‐19 disease, a pandemic for more than two years, has major morbidity and mortality related to pulmonary involvement. Chest radiography is the main imaging tool for critically-ill patients. As the availability of arterial blood gas analysis is limited in the Level I and II healthcare centres, major partners in providing healthcare in resource‐limited times, we planned the present study. Objective. To assess the role of chest radiography in predicting the need for oxygen/ventilator support in critically ill COVID‐19 patients. Methods. This hospital‐based, retrospective study included 135 patients who needed oxygen/ventilator support and had optimal‐quality chest radiographs at admission. All the chest X‐rays were evaluated and a severity score was calculated on a predesigned pro forma. Statistical evaluation of the data obtained was done using appropriate tools and methods. Results. Males outnumbered females, with a mean age of 54.35 ± 14.49 years. More than 72% of patients included in our study needed ventilator support while the rest needed oxygen support. There was a significant statistical correlation between the chest radiograph severity score and SPO2/PaO2 levels in our study. Using a cut‐off value >8 for the chest radiograph severity score in predicting the need for ventilator support in a Covid‐19 patient, the sensitivity, specificity and accuracy was 85.7%, 92.5% and 89.5%, respectively. Conclusions. Chest radiography remains the mainstay of imaging in critically ill COVID‐19 patients when they are on multiple life‐support systems. Though arterial blood gas analysis is the gold standard tool for assessing the need for oxygen/ventilator support in these patients, the severity score obtained from the initial chest radiograph at the time of admission may also be used as a screening tool. Chest radiography may predict the need for oxygen/ventilator support, allowing time for patients to be moved to an appropriate‐level healthcare centre, thus limiting morbidity and mortality.

Space weather refers to conditions around a star, like our Sun, and its interplanetary space that may affect space- and ground-based assets as well as human life. Space weather can manifest as many different phenomena, often simultaneously, and can create complex and sometimes dangerous conditions. The study of space weather is inherently trans-disciplinary, including subfields of solar, magnetospheric, ionospheric, and atmospheric research communities, but benefiting from collaborations with policymakers, industry, astrophysics, software engineering, and many more. Effective communication is required between scientists, the end-user community, and government organizations to ensure that we are prepared for any adverse space weather effects. With the rapid growth of the field in recent years, the upcoming Solar Cycle 25 maximum, and the evolution of research-ready technologies, we believe that space weather deserves a reexamination in terms of a “risk and resiliency” framework. By utilizing open data science, cross-disciplinary collaborations, information systems, and citizen science, we can forge stronger partnerships between science and industry and improve our readiness as a society to mitigate space weather impacts. The objective of this manuscript is to raise awareness of these concepts as we approach a solar maximum that coincides with an increasingly technology-dependent society, and introduce a unique way of approaching space weather through the lens of a risk and resiliency framework that can be used to further assess areas of improvement in the field.

The WHO analgesic ladder (1986) has recommended certain oral analgesics vis-a-vis intensity of cancer pain for optimum relief as a practical doctrine, easy to implement, and taught extensively to healthcare professionals globally. However, the WHO approach despite been implemented appropriately and aggressively in the last three decades, 10%–20% of patients may not achieve acceptable pain relief. There is a refractory group of patients which is considered for interventional pain management; however, reserving this modality as a last resort is questioned by interventional protagonists. It is anticipated that the general understanding of interventional approach on cancer pain relief may not only expedite pain relief but should also consider all potential therapeutic options. Interventional physicians, mainly anesthesiologists, have a well-defined and beneficial role in the treatment of cancer pain, if patients are appropriately selected with various cancer pain syndromes. Pain physicians should successfully optimize outcomes depends on timely referral with adequate assessment and patient selection. Pain physicians have a complex role. Managing expectations of referring physicians, of patients, and family members, assuring adequacy of interventional care is not an easy task. An experienced, skilled interventionist who is well versed in not only techniques of procedure but side effects management, if any, will assume full responsibility for pre- and postintervention evaluation and follow-up care as indicated by the circumstances of each patient to be managed.

Respiratory distress is one of the leading causes of neonatal morbidity and mortality. Factors such as gestational age at birth, pulmonary maturity, and congenital factors are peculiar to this demographic. Clinical evaluation accompanied by chest radiography is the standard protocol for evaluating the underlying causative factors. Knowledge of the radiographic appearances of various pathologies and associations with certain congenital factors is quintessential for radiologists and primary neonatal care providers to steer the management in the right direction.

Objectives COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.Design Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.Setting UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.Participants The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measures Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.Results The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.Conclusions Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration number The study is registered with ClinicalTrials.Gov (NCT04572438).

Patients in the intensive care units suffer from a myriad of cardiopulmonary processes for which portable chest radiography is the most utilized imaging modality. A pragmatic approach toward evaluating the nearly similar radiographic findings seen in most of the pathologies with comparative review and strong clinical acumen can help the radiologists and clinicians achieve a rapid and precise diagnosis.

This paper provides insights pertaining to the validity of a regional travel demand model in mimicking real-world travel times. The estimated travel times from the regional travel demand model, for the base year 2015, for Mecklenburg County in the city of Charlotte, North Carolina (NC) were compared with travel time statistics from a private data source, for the same year. The results indicate that the estimated travel times from the regional travel demand model are typically lower than the 85th percentile travel times, irrespective of the link speed limit. The estimated travel times for the Central Business District (CBD) area type are moderately correlated with the travel time statistics from the private data source, irrespective of the time of the day. For all the other area types, stronger correlations were observed when the estimated travel times from the regional travel demand model are compared with 10th to 50th percentile travel times. The calculated Pearson correlation coefficients are low for morning and evening peak periods compared to mid-day and night-time period, indicating the inability of the regional travel demand model in mimicking congested traffic conditions accurately.