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Purpose The purpose of this study was to validate the use of a semiautomated software for liver volumetry preoperatively by comparing it with the volume of resected specimen in patients undergoing hepatic resections. Materials and Methods This is a single-center retrospective study of patients who underwent estimation of future liver remnant (FLR) using Myrian XP-Liver which is a semiautomated software for hepatectomy. The estimated resection volume, which is the sum of volume of normal liver to be resected and tumor volume, was compared with actual specimen weight to calculate the accuracy of the software. The statistical analysis was performed with SPSS software version 24. Results Data on FLR estimation using the semiautomated software was available for 200 out of 388 patients who underwent formal hepatic resections. The median resected volume of surgical specimen was 650 mL (interquartile range [IQR] 364–950), while the median estimated volume using the Myrian software was 617 mL (IQR 362–979). There was significant correlation between estimated resection volume calculated using the semiautomated method and actual specimen weight (p-value < 0.0001) with the Spearman’s correlation value of 0.956. Conclusion The estimated volume of liver to be resected as calculated by the semiautomated software was accurate and correlated significantly with the volume of resected specimen, and hence, the estimation of FLR volume may likely correlate with the true postoperative residual liver volume. In addition, the software-based liver segmentation, FLR estimation, and color-coded three-dimensional images provide a clear road map to the surgeon to facilitate safe resection.

Cone-beam computed tomography is a relatively new three-dimensional imaging technology, which has been specifically developed for imaging of the teeth and jaws. This article gives an overview of the subject and discusses some of the implications for dental practitioners. An understanding of the underlying principles will allow the users of this technology to tailor the imaging protocol to the patient′s individual needs to achieve appropriate imaging at the lowest radiation dose.

Since 2004, the US Food and Drug Administration (FDA) has had the authority to allow access to unapproved medical products via the Emergency Use Authorization (EUA) pathway during times of emergency. It was rarely used until the COVID-19 pandemic, when concerns arose regarding the role of political pressure in the FDA's issuance of some EUAs, such as for hydroxychloroquine. Although US government officials should be responsive to the public, democratic accountability must be balanced against the need for thoughtful science-based decision-making. Inadequate agency independence can diminish public confidence in government leaders and the FDA. To consider whether reform of the EUA process might be appropriate, we considered three possible sources of inspiration for balancing independence and accountability in government scientific decision-making: models in other countries, models in other US agencies, and models within the FDA itself. Strategies used in these settings include: (1) expanding the role of advisory committees, (2) increasing transparency of the agency's decision-making process and supporting rationale, and (3) improving management of internal agency disagreement. Such reforms could improve public trust in public health regulation both related to and separate from future emergencies. [ABSTRACT FROM AUTHOR]

Background: Thyroid dysfunction evaluation during pregnancy is important for the mother’s health, obstetric outcomes, and the child’s cognitive development. This study is conducted to know various thyroid disorders that can occur during antenatal and their impact on mother and fetus outcomes. Materials and Methods: This observational research was conducted over two years at a tertiary center in Western Rajasthan, India. Seven hundred and seventy-two low-risk singleton pregnant patients who met the inclusive criteria were recruited. The estimation of T3, T4, and TSH was done along with a routine investigation in antenatal women. Antenatal having abnormal thyroid profiles were then analyzed for mother and fetus problems. Results: The prevalence of thyroid dysfunction in antenatal women is 16.5%. Subclinical hypothyroidism (SCH) was seen in 12.5% of cases, overt hypothyroidism in 3.36%, and subclinical hyperthyroidism in only 0.51% of cases. Anti-TPO was positive in 46 (41.44%) women with hypothyroidism and 1 (25%) with hyperthyroidism. Compared to euthyroid women, women with overt hypothyroid (19.23% vs 3.1%, P = 0.002) and subclinical hypothyroid (9.27% vs 3.1%, P = 0.003) were found to be associated with a higher risk of hypertensive disease. Concerning fetal outcomes. There was a high risk for preterm (12.37% v/s 4.9%, P = 0.004) and fetal growth retardation (FGR) in patients with SCH (7.21% v/s 3.1%, P = 0.04). Conclusion: Considering the significant influence of thyroid disorders on mother and fetus outcomes, the screening for thyroid during pregnancy should be considered universally, particularly in developing countries with high prevalent rates, such as India.

Abstract Multiple myeloma management requires a balance between maximizing survival, minimizing adverse events to therapy, and monitoring disease progression. While previous work has proposed data-driven models for individual tasks, these approaches fail to provide a holistic view of a patient’s disease state, limiting their utility to assist physician decision-making. To address this limitation, we developed a transformer-based machine learning model that jointly (1) predicts progression-free survival (PFS), overall survival (OS), and adverse events (AE), (2) forecasts key disease biomarkers, and (3) assesses the effect of different treatment strategies, e.g., ixazomib, lenalidomide, dexamethasone (IRd) vs lenalidomide, dexamethasone (Rd). Using TOURMALINE trial data, we trained and internally validated our model on newly diagnosed myeloma patients (N = 703) and externally validated it on relapsed and refractory myeloma patients (N = 720). Our model achieved superior performance to a risk model based on the multiple myeloma international staging system (ISS) (p

Abstract This study investigates the potential of platinum (Pt) decorated single-layer WSe2 (Pt-WSe2) monolayers as high-performance gas sensors for NO2, CO2, SO2, and H2 using first-principles calculations. We quantify the impact of Pt placement (basal plane vs. vertical edge) on WSe2’s electronic properties, focusing on changes in bandgap (ΔEg). Pt decoration significantly alters the bandgap, with vertical edge sites (TV-WSe2) exhibiting a drastic reduction (0.062 eV) compared to pristine WSe2 and basal plane decorated structures (TBH: 0.720 eV, TBM: 1.237 eV). This substantial ΔEg reduction in TV-WSe2 suggests a potential enhancement in sensor response. Furthermore, TV-WSe2 displays the strongest binding capacity for all target gases due to a Pt-induced “spillover effect” that elongates adsorbed molecules. Specifically, TV-WSe2 exhibits adsorption energies of − 0.5243 eV (NO2), − 0.5777 eV (CO2), − 0.8391 eV (SO2), and − 0.1261 eV (H2), indicating its enhanced sensitivity. Notably, H2 adsorption on TV-WSe2 shows the highest conductivity modulation, suggesting exceptional H2 sensing capabilities. These findings demonstrate that Pt decoration, particularly along WSe2 vertical edges, significantly enhances gas sensing performance. This paves the way for Pt-WSe2 monolayers as highly selective and sensitive gas sensors for various applications, including environmental monitoring, leak detection, and breath analysis.

Diffuse alveolar hemorrhage (DAH) is characterized by a syndrome of alveolar bleeding, a fall in hemoglobin, and respiratory failure. It can occur because of various immunologic and non-immunologic conditions. The etiology of DAH is important, as treatment varies with the etiology. This retrospective observational study evaluates the diverse etiologies, time to diagnosis from symptom onset, management strategies, and outcome of DAH in a span of 12 months at our tertiary care center. A total of 8 patients were identified with 8 different etiologies. 6/8 (75%) patients had immunologic causes, and 2/8 (25%) had non-immunologic causes of DAH. 6/8 (75%) patients were females, the mean time to DAH diagnosis was 4.25 months from symptom onset, 6/8 (75%) patients improved, and 2/8 (25%) died due to complications. It is necessary to differentiate between the etiologies of DAH and establish an early diagnosis to plan management and improve outcomes.

Introduction: Artificial intelligence (AI) is becoming an important part of our lives owing to increased data availability and improved power of computing. One of the recently launched modalities of AI, ChatGPT, is being enormously used worldwide for different types of tasks. In medical context, its use is being explored for clinical queries, academia, research help, etc. Further, literature suggests that parents seek information about health of their children using different Internet resources and would surely turn toward ChatGPT for the same, as this chatbot model is easy to use, generates “one” response, and is available without any subscription. ChatGPT generates a response using text cues and applying different algorithms on prepublished literature but is still in its naïve state; hence, it is imperative to validate the generated responses. Accordingly, we planned this study to determine the clarity, correctness, and completeness of some Frequently asked questions (FAQs) about child’s oral health, from a mother’s perspective. Methods: The study design was a vignette-based survey and included a set of 23 questions, for which ChatGPT was interviewed from the perspective of an imaginary parent. The answers responded by ChatGPT were copied “verbatim,” and a Google survey form was designed. The survey form was validated and then sent to 15 pediatric dentists, and the responses were mainly collected on the Likert’s scale with a provision of one open-ended question aiming to determine “what they would have added” to this generated response as an expert in the field. Results: The responses on Likert’s scale were condensed and values ≥4 were considered ‘adequate and acceptable’ while scores ≤3, were considered ‘inadequate’. The generated responses and comments mentioned by different respondents in the open-ended question were critiqued in reference to the existing literature. Conclusion: Overall, the responses were found to be complete and logical and in clear language, with only some inadequacies being reported in few of the answers.

Background: We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care. Methods: Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared. Results: 29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % p

Abstract Brigatinib is an oral anaplastic lymphoma kinase (ALK) inhibitor approved for the treatment of ALK‐positive metastatic non‐small cell lung cancer. In vitro studies indicated that brigatinib is primarily metabolized by CYP2C8 and CYP3A4 and inhibits P‐gp, BCRP, OCT1, MATE1, and MATE2K. Clinical drug–drug interaction (DDI) studies with the strong CYP3A inhibitor itraconazole or the strong CYP3A inducer rifampin demonstrated that CYP3A‐mediated metabolism was the primary contributor to overall brigatinib clearance in humans. A physiologically‐based pharmacokinetic (PBPK) model for brigatinib was developed to predict potential DDIs, including the effect of moderate CYP3A inhibitors or inducers on brigatinib pharmacokinetics (PK) and the effect of brigatinib on the PK of transporter substrates. The developed model was able to predict clinical DDIs with itraconazole (area under the plasma concentration–time curve from time 0 to infinity [AUC∞] ratio [with/without itraconazole]: predicted 1.86; observed 2.01) and rifampin (AUC∞ ratio [with/without rifampin]: predicted 0.16; observed 0.20). Simulations using the developed model predicted that moderate CYP3A inhibitors (e.g., verapamil and diltiazem) may increase brigatinib AUC∞ by ~40%, whereas moderate CYP3A inducers (e.g., efavirenz) may decrease brigatinib AUC∞ by ~50%. Simulations of potential transporter‐mediated DDIs predicted that brigatinib may increase systemic exposures (AUC∞) of P‐gp substrates (e.g., digoxin and dabigatran) by 15%–43% and MATE1 substrates (e.g., metformin) by up to 29%; however, negligible effects were predicted on BCRP‐mediated efflux and OCT1‐mediated uptake. The PBPK analysis results informed dosing recommendations for patients receiving moderate CYP3A inhibitors (40% brigatinib dose reduction) or inducers (up to 100% increase in brigatinib dose) during treatment, as reflected in the brigatinib prescribing information.

In the original publication [...]

Background: There is paucity of reliable epidemiological data regarding the burden of food allergy in most developing countries, including India. Objective: To provide current estimates of the prevalence and distribution of food allergy among urban and rural school children aged 6–14 years in Delhi and the National Capital Region (NCR) of Khekra in India. Methods: A cross-sectional study was conducted from January 2022 to February 2023 to enroll school children, 6–14 years, from select urban and rural schools in Delhi and NCR. A questionnaire consisting of questions focused on household environment, early life factors, and pediatric food allergy characteristics was administered by a trained medical researcher to collect parent-proxy data. Univariate statistics were used to describe frequencies, percentages, and 95% confidence intervals for survey items. Results: The estimated prevalence of parent-reported food allergy was 0.8% (95% CI: 0.4–1.5; urban: 0.4%, 95% CI: 0.1–1.1; rural: 1.7%, 95% CI: 0.7–3.5). Fruits such as mango (0.3%, 95% CI: 0.1–0.9), strawberry (0.1%, 95% CI: 0.0–0.7), orange (0.1%, 95% CI: 0.0–0.7), and custard apple (0.1%, 95% CI: 0.0–0.7) were reported only by urban children, while rural children reported yogurt (0.6%, 95% CI: 0.1–1.8) and wheat (0.3%, 95% CI: 0.0–1.3). Both groups reported brinjal (also known as eggplant) and banana, 0.1% (95% CI: 0.0–0.7) of urban and 0.3% (95% CI: 0.0–1.3) of rural, respectively. Overall, commonly reported clinical symptoms were diarrhea and/or vomiting (100%, 95% CI: 76.2–100), abdominal pain (88.9%, 95% CI: 58.6–98.8), and rash/itchy skin (66.7%, 95% CI: 34.8–89.6). Among children with parent reported food allergy, 66.7% (95% CI: 34.8–89.6) of food allergies were physician diagnosed, of which 33.3% were diagnosed via history alone (95% CI:7.7–71.4) while 66.7% (95% CI: 28.6–92.3) were confirmed via skin prick test and/or blood test. Conclusion: The overall prevalence of food allergy is very low in Delhi and Khekra, India. Future work should focus on elucidating the complex interplay of early-life, environmental, genetic, and lifestyle factors to understand the reasons for India's low food allergy burden and improve epidemiological clues to prevention for the nations with higher disease burden.

Persistent air leaks in patients with pneumothorax can lead to significant morbidity. If a patient with persistent air leak is medically unfit for thoracic surgery, medical pleurodesis via chest tube or thoracoscopy is either an option. Thoracoscopy offers the advantage of visualizing the site of the air leak and enabling direct instillation of the pleurodesis agent or glue at that location. Autologous blood patch instillation via chest tube has been reported to be a cheap and very effective technique for the management of persistent air leaks. However, thoracoscopic blood patch instillation has not been reported in the literature. We report two cases of secondary spontaneous pneumothorax in which patients had persistent air leaks for more than seven days and were subjected to thoracoscopy to locate the site of the leak. In the same sitting, 50 mL of autologous blood patch was instilled directly at the leak site. Post-procedure, the air leak subsided in both patients, and the chest tube was removed with complete lung expansion. We also conducted a systematic review of the use of medical thoracoscopic interventions for treating persistent air leaks.

Abstract Epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations represent ~6%–12% of all EGFR‐mutated non‐small cell lung cancer (NSCLC) cases. First‐, second‐, and third‐generation tyrosine kinase inhibitors (TKIs) have limited clinical activity against EGFR ex20ins mutations. Mobocertinib is a first‐in‐class oral EGFR TKI that selectively targets in‐frame EGFR ex20ins mutations in NSCLC; accelerated approval in the United States was granted for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR ex20ins mutations whose disease has progressed on or after platinum‐based chemotherapy. Accelerated approval was based on the results from the three‐part, open‐label, multicenter, pivotal phase I/II nonrandomized clinical trial (NCT02716116) that enrolled 114 patients with locally advanced or metastatic EGFR ex20ins mutation–positive NSCLC who were previously treated with platinum‐based chemotherapy and received mobocertinib at the recommended dosage of 160 mg once daily. At the November 1, 2021, data cutoff date, the confirmed objective response rate per independent review committee (IRC) was 28%, median duration of response was 15.8 months, median progression‐free survival per IRC was 7.3 months, and median overall survival was 20.2 months. The most common treatment‐emergent adverse events were gastrointestinal‐ and skin‐related. The phase III EXCLAIM‐2 study evaluated mobocertinib versus chemotherapy as first‐line therapy for locally advanced or metastatic EGFR ex20ins–positive NSCLC; however, the primary end point was not met, resulting in initiating voluntary withdrawal of mobocertinib worldwide. This mini‐review article summarizes the mechanism of action, pharmacokinetic characteristics, key clinical trials, and clinical efficacy and safety data for mobocertinib.

Background Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO's QualityRights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare. Aims We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO's approach to eliminate coercion and the WPA's goal to implement alternatives to coercion. Method We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes. Results Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors. Conclusions We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.

Background: The data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment.

Institutions persisting from colonial rule affect the spatial structure and conditions under which 100s of millions of people live in Sub-saharan African cities. In a sample of 318 cities, Francophone cities have more compact development than Anglophone, overall, in older colonial sections, and at clear extensive margins long after the colonial era. Compactness covers intensity of land use, gridiron road structures and leapfrogging of new developments. Why the difference? Under British indirect and dual mandate rule, colonial and native sections developed without coordination. In contrast, integrated city planning and land allocation were featured in French direct rule. These differences in planning traditions persist. 1 [ABSTRACT FROM AUTHOR]

The integration of renewable energy resources into the power system has led to growing interest in the field of microgrids. These microgrids can operate in grid-connected or islanded modes.Load flow analysis is an important step for the operation and planning of the power system. The traditional load flow techniques, which use the concept of a reference bus, are not valid in microgrids, particularly when operating in islanded mode. Thus, in this study, a modified Gauss-Seidel method has been implemented in which to find the optimum values for droop coefficients, different optimisation techniques have been used. The value of droop gain impacts the load distribution among various DGs, as the fast action of droop is indicated by a higher value of droop gain. But the inappropriate value of droop gain affects the stability of the system, so typically the values are kept low due to steady state stability concerns. The optimum droop gain helps to keep the voltage and frequency within the permissible limits. The voltage profile has been improved with optimal gains for the droop coefficients, and about 4% loss reduction has been reported, proving the effectiveness of the proposed method. The method has been tested on 6-bus, 38-bus, and 40-bus islanded microgrid systems.

AbstractThe study examined the relationship between board characteristics and firm performance and the moderating effects of firm size, the board size, and firm age between board characteristics and firm performance. This study considers the legal reforms implemented after the Indian Companies Act 2013. Data from 113 firms with 904 observations from 2012–13 to 2019–20 were analyzed using the fixed panel data estimation approach. A subsample analysis is employed, dividing the data by firm size, the board size, and firm age to test the robustness of the results. The results show that the board size, female director, Promoter CEOs, meeting frequencies, and attendance rate positively affect firm performance. At the same time, the impact of the independent directors and busy CEO has a negative impact on performance. Male CEOs are beneficial for firm performance. The study adds to the literature by identifying critical board characteristics in light of ongoing regulatory reform in emerging economies like India. It has implications for regulators and policymakers who are entrusted with the framing of corporate governance policies.

Background: The data on incidence of recovered Left Ventricular Ejection Fraction (LVEF) and outcome in patients with non ischemic systolic heart failure is limited. We report the incidence, determinants and mortality in patients with recovered LVEF. Methods: The 369 patients with HFrEF with LVEF of less than 40% of non ischemic etiology with available follow up echocardiography study at one year were enrolled. The baseline data of clinical characteristics and treatment was recorded prospectively and were followed up annually for mean of 3.6 years (range 2 to 5 years) to record all cause death and LVEF measured echocardiographically. The recovered, partially recovered and no recovery of LVEF was defined based on increase in LVEF to 50% and more, 41% to 49% and to persistently depressed LVEF to 40% or lower respectively. Results: The LVEF recovered in 36.5%% of the cohort at 5 years. The rate of recovery of LVEF was slower in patients with no recovery of LVEF at one year compared to cohort with partially recovered LVEF (18% vs.53%) at five year. The Baseline LVEF was significantly associated with recovered LVEF, odd ratio (95% C.I.) 1.09(1.04, 1.14). The cumulative mortality at five years was significantly lower in cohort with recovered LVEF (18.1% vs. 57.1%). Conclusions: One third of the patients had recovered LVEF and was significantly associated with baseline LVEF and lower mortality rate.

Introduction: Due to the advancement of medical technology, it is difficult to monitor the vast inventory in hospitals. Thirty-three percentage of the hospital operating budget are spent on buying materials and supplies. Out of all the inventory control measures, Always better control (ABC) and Vital, essential, and desirable (VED) are the most used inventory control techniques. The present study was conducted at a tertiary care specialty hospital to study drug management through the application of inventory control techniques. Aim and Objectives: The present study aimed at studying the drug management system by application of ABC and VED analysis and to give recommendations for an efficient inventory management system. Materials and Methods: It was an observational study conducted at the dispensary of a tertiary care teaching hospital. The data of annual consumption and expenditure incurred on each item of the dispensary for the fiscal year 2021–2022 were collected. The annual expenditure of individual items was arranged in descending order. The cumulative cost percentage and the cumulative percentage of number of items were calculated, and the list was then categorized into three subdivisions: A, B, and C categories. For classifying drugs into VED, inputs from the concerned clinicians were sought. Data were analyzed using statistical tools of MS Excel. ABC-VED matrix was formed to couple the items into various categories and groups so that managers can efficiently monitor them. Results: Of the 291 items used, 15% of the items were A items which need strict monitoring by the top-level management as they are the costliest. VED analysis revealed 37% of the items as vital which should be present at all times in the hospital and are inescapable requirements. ABC-VED matrix analysis showed 10% of the items as A items from ABC and vital items from VED (AV) items which are costly and should be present at all times at the hospital, thereby demanding strict managerial control. Conclusion: Using inventory control techniques, substantial improvement could be brought about in patient care by ensuring the uninterrupted availability of vital and essential medicines all the time. It can also be used to identify drugs that require stringent control for the optimal use of financial resources and the elimination of out-of-stock conditions at the dispensary.

INTRODUCTION: Asthma and allergic rhinitis (AR) are among the most prevalent diseases worldwide and they frequently persist throughout the life. These have significant effect on physical, financial, and mental wellbeing of patients and caregivers. There have been few attempts previously, assessing the quality of life (QOL) in affected families suffering from these diseases. However, the data from developing countries are scarce. QOL assessment in children and caregivers of patients suffering can help in symptomatic management and provide inputs for the better utilization of resources to achieve optimal treatment. MATERIALS AND METHODS: Patient and caregiver QOLs were ascertained using Mini Pediatric Asthma QOL Questionnaire and Pediatric Asthma Caregiver's QOL Questionnaire, respectively, in the study and correlated with disease severity and chronicity using the parametric and nonparametric statistical tools. RESULTS: There were 246 pairs of children diagnosed with asthma and/or AR and their caregivers attending the pediatric allergy and asthma clinic. Symptom score, emotional domain, and activity limitation in children did not validate a statistically significant difference in QOL in the various grades of AR/asthma/AR with asthma (P = 0.632) (P = 0.772) (P = 0.496) (P = 0.918) (P = 0.384) and (P = 0.561), respectively. In addition, there was no significant correlation between the severity of asthma and caregiver emotional disturbance (P = 0.594) or caregiver activity limitation (P = 0.446). CONCLUSIONS: QOL in children and caregivers where children are suffering from either AR or asthma, or both has not shown any significant difference as per the disease severity or chronicity in various domains. There was no significant difference in QOL noted as per the change in age group, gender of patients, or education status of caregivers.

Summary: Background: The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016–22. Methods: Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness. Suspected CRS cases underwent detailed systemic examination, including echocardiography and serological investigation for rubella. Cardiac defects were categorized as ‘Simple’ or ‘Complex’ as per the National Heart, Lung, and Blood Institute classification. We compared the distribution of cardiac defects among laboratory confirmed CRS cases and seronegative discarded cases. Findings: Of the 4578 suspected CRS cases enrolled by 14 sites, 558 (12.2%) were laboratory confirmed. 419 (75.1%) laboratory confirmed cases had structural heart defects (simple defects: n = 273, 65.2%, complex defects: n = 144, 34.4%), with ventricular septal defect (42.7%), atrial septal defect (39.4%), patent ductus arteriosus (36.5%), and tetralogy of Fallot as the commonest defects (4.5%). Laboratory confirmed CRS cases had higher odds of left to right shunt lesions (OR = 1.58, 95% CI: 1.15–2.17). This was mainly on account of a significant association of PDA with CRS (OR = 1.77, 95% CI: 1.42–2.21). Mortality was higher among CRS patients with complex heart defects (HR = 2.04, 95% CI: 1.26–3.30). Interpretation: Three-fourths of the laboratory confirmed CRS cases had structural heart defects. CRS patients with complex cardiac defects had higher mortality. Detecting CRS infection early and providing timely intervention for cardiovascular defects is critical for the management of CRS patients. Funding: Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance.

Here, we synthesized a MoS _2 /Si heterojunction device using a scalable approach involving DC sputtering coupled with sulfurization. The observed current–voltage characteristics unequivocally indicate a rectifying behavior at MoS _2 /Si heterointerface. To quantitatively assess the carrier dynamics, a comprehensive analysis utilizing thermionic emission and Landauer transport formalism model was employed. The spatial variation in current across the MoS _2 /Si devices suggests a potential influence of MoS _2 ’s in-plane series resistance. Furthermore, the electrical behavior of the device is found to be temperature-dependent, with higher temperatures resulting in enhanced conductivity attributed to an increase in thermally generated charge carriers. As temperature rises, the Landauer current model observes an increased ratio of density of states to carrier injection rate, along with other temperature-dependent terms. Meanwhile, the thermionic current model maintains a fixed effective value for its material-dependent term, the Richardson constant, irrespective of temperature changes. Therefore, a comparative analysis between thermionic emission and Landauer transport formalism reveals that the conventional thermionic emission model better aligns with experimentally observed leakage current in reverse bias, showcasing a minimal barrier height at the heterojunction. This comprehensive investigation provides valuable insights into the charge transfer mechanisms at the MoS _2 /Si interface, opening avenues for its potential innovative applications in electronic devices.

Nitrogen-rich carbon nanotubes NCNT700 and NCNT800 were prepared using the chemical vapor deposition method (CVD). The catalysts were characterized via high-resolution transmission electron microscopy (HRTEM) and X-ray photoelectron spectroscopy (XPS) analysis. Both the catalysts were found to have an inverted cup-stack-like morphology. The XPS analysis revealed that the catalysts are rich in pyridinic sites with variable amounts of nitrogen on their surface. The NCTN700, with a higher nitrogen content and more pyridinic sites on its surface, was found to be a good catalyst for the oxidation of benzyl and veratryl alcohols into respective aldehydes. It was observed that toluene and 4-methyl veratrole were also produced in this reaction. The amount of toluene produced was as high as 21%, with 99% conversion of benzaldehyde in the presence of NCNTs-700. The mechanistic pathway was revealed through DFT studies, where the unusual product formation of aromatic alkanes such as toluene and 4-methyl veratrole was explained during the reaction. It was astonishing to observe the reduced product in the reaction that proceeds in the forward direction in presence of a peroxide (tert-butyl hydroperoxide, TBHP). During the computational analysis, it was revealed that the reduced product observed in the reaction did not appear to proceed through a direct disproportionation reaction. Rather, the benzyl alcohol (the reactant) used in the reaction may undergo oxidation by releasing the hydrogen radicals. The hydrogen atoms released during the oxidation reaction appear to have been trapped on pyrrolic sites on the surface of catalyst and later transferred to the reactant molecules to produce toluene as a side product.

The extension of intuitionistic fuzzy sets (IFS) to Pythagorean fuzzy sets (PFS) is a significant advancement, addressing the inherent limitations of IFS. This study introduces a novel entropy measure specifically designed for Pythagorean fuzzy sets, establishing its axiomatic definition and presenting key properties. Decision making guided by entropy is advantageous, as it effectively mitigates ambiguity with increasing entropy values. Furthermore, a numerical example is provided to facilitate a comparative assessment of our newly introduced entropy measure in contrast to existing PFS entropy measures. The validation of our findings is achieved through the application of the COPRAS method, which determines decision outcomes based on a multitude of influencing factors. Notably, the determination of weights in this method is underpinned by the utilization of our innovative entropy measure.

The ever-increasing demand for high-quality solutions drives research toward more sophisticated decision-making solutions. In the field of decision making, the ability to solve complex real-world problems is of paramount importance. To this end, fuzzy sets are used, which offer the possibility of incorporating uncertainty into the values describing decision options. This study focuses on Pythagorean fuzzy sets, an extension of classical fuzzy sets, providing even more tools for modeling real-world problems by presenting a distance measure for these specific sets. A verification of the characteristics of the proposed distance measure has been carried out, proving its validity. The proposed measure is characterized by a more straightforward formula and thus simplifies the calculations. Furthermore, to confirm its usability, a multi-criteria decision-making methodology is presented, the results of which are compared with two multi-criteria decision-making methods, namely, PF-TOPSIS and PF-VIKOR, and another distance measure previously presented in the literature. The comparative analysis highlights lower variability in terms of preference values calculated using the proposed distance measure, which confirms the stability and reliability of the newly proposed distance measure while maintaining low computational complexity. Moreover, a high correlation with rankings calculated using PF-TOPSIS ensures its utility in terms of decision making.

Abstract Ixazomib is an oral proteasome inhibitor approved in combination with lenalidomide and dexamethasone for the treatment of relapsed/refractory multiple myeloma (MM). Approval in the United States, Europe, and additional countries was based on results from the phase III TOURMALINE‐MM1 (C16010) study. Here, joint population pharmacokinetic/pharmacodynamic time‐to‐event (TTE) and discrete time Markov models were developed to describe key safety (rash and diarrhea events, and platelet counts) and efficacy (myeloma protein [M‐protein] and progression‐free survival [PFS]) outcomes observed in TOURMALINE‐MM1. Models reliably described observed safety and efficacy results; prior immunomodulatory drug therapy and race were significant covariates for diarrhea and rash events, respectively, whereas M‐protein dynamics were sufficiently characterized using TTE models of relapse and dropout. Moreover, baseline M‐protein was identified as a significant covariate for observed PFS. The developed framework represents an integrated approach to describing safety and efficacy with MM therapy, enabling the simulation of prospective trials and potential alternate dosing regimens.