Search

Objective Clinical Considerations Conclusion Clinical Significance The present clinical report describes a long‐term temporary restorative approach using injectable composite to reshape a canine into a central incisor, within the context of an ongoing orthodontic treatment. This treatment protocol describes a fully‐digital workflow, incorporating digital designed and 3D printed diagnostic wax up, reduction guides and resin‐injection index.Effective planning is important when aiming to deliver a comprehensive and multidisciplinary workflow, and digital tools serve as invaluable aids.The use of a fully digital workflow in a comprehensive dental treatment resulted in a predictable and successful outcome for a restoration of a canine that was transformed into a central incisor.This approach highlights the efficacy of digital technology in achieving precise and successful dental restorations, emphasizing its significance in modern dental practice. [ABSTRACT FROM AUTHOR]

We develop a simulation framework for studying misinformation spread within online social networks that blends agent-based modeling and natural language processing techniques. While many other agent-based simulations exist in this space, questions over their fidelity and generalization to existing networks in part hinder their ability to drive policy-relevant decision making. To partially address these concerns, we create a 'digital clone' of a known misinformation sharing network by downloading social media histories for over ten thousand of its users. We parse these histories to both extract the structure of the network and model the nuanced ways in which information is shared and spread among its members. Unlike many other agent-based methods in this space, information sharing between users in our framework is sensitive to topic of discussion, user preferences, and online community dynamics. To evaluate the fidelity of our method, we seed our cloned network with a set of posts recorded in the base network and compare propagation dynamics between the two, observing reasonable agreement across the twin networks over a variety of metrics. Lastly, we explore how the cloned network may serve as a flexible, low-cost testbed for misinformation countermeasure evaluation and red teaming analysis. We hope the tools explored here augment existing efforts in the space and unlock new opportunities for misinformation countermeasure evaluation, a field that may become increasingly important to consider with the anticipated rise of misinformation campaigns fueled by generative artificial intelligence. [ABSTRACT FROM AUTHOR]

The mammalian brain implements sophisticated sensory processing algorithms along multilayered ("deep") neural networks. Strategies that insects use to meet similar computational demands, while relying on smaller nervous systems with shallow architectures, remain elusive. Using Drosophila as a model, we uncover the algorithmic role of odor preprocessing by a shallow network of compartmentalized olfactory receptor neurons. Each compartment operates as a ratiometric unit for specific odormixtures. This computation arises from a simple mechanism: electrical coupling between two differently sized neurons. We demonstrate that downstream synaptic connectivity is shaped to optimally leverage amplification of a hedonic value signal in the periphery. Furthermore, peripheral preprocessing is shown to markedly improve novel odor classification in a higher brain center. Together, our work highlights a far-reaching functional role of the sensory periphery for downstream processing. By elucidating the implementation of powerful computations by a shallow network, we provide insights into general principles of efficient sensory processing algorithms. [ABSTRACT FROM AUTHOR]

Preeclampsia is an important cause of heart failure during pregnancy and the postpartum period. The aim of this review is to elucidate the pathophysiology and clinical features of preeclamptic heart failure and describe the medical and anesthetic management of these high-risk parturients. This article reviews the current evidence base regarding preeclamptic heart failure and its pathophysiology, types, and clinical features. We also describe the medical and anesthetic management of these patients during the peripartum period. Heart failure due to preeclampsia can present as either systolic or diastolic dysfunction. The management strategies of systolic heart failure include dietary salt restriction, diuresis, and cautious use of beta-blockers and vasodilators. Diuretics are the mainstay in the treatment of diastolic heart failure. In the absence of obstetric indications, vaginal delivery is the safest mode of delivery in these high-risk patients, and the use of an early labor epidural for analgesia is recommended. These patients would require increased invasive monitoring during labor and vaginal delivery. Neuraxial and general anesthesia have been used successfully for cesarean section in these patients but require crucial modifications of the standard technique. Uterotonic drugs have significant cardiovascular and pulmonary effects, and a clear understanding of these is essential during the management of these patients. Preeclamptics with heart failure require individualized peripartum care, as cardiac decompensation is an important risk factor for maternal and neonatal morbidity and mortality. These high-risk parturients benefit from timely multidisciplinary team inputs and collaborated management. [ABSTRACT FROM AUTHOR]

Vascularized Composite Tissue Allotransplantation (VCA) allows replacement of lost body parts from brain-dead donors. These surgeries are laborious, time-intensive, and require vast planning. With the advent of better immunosuppressants, VCA will increasingly play an important role in the reconstructive field. In this paper, the authors share their standard operating protocol created after much deliberation. [ABSTRACT FROM AUTHOR]

Pre-proenkephalin 1 (Penk1) is a pro-neuropeptide that belongs to the typical opioid peptide's family, having analgesic properties. We previously found Penk1 to be the most downregulated gene in a whole gene profiling analysis performed in osteoblasts subjected to microgravity as a model of mechanical unloading. In this work, Penk1 downregulation was confirmed in the bones of two in vivo models of mechanical unloading: tail-suspended and botulinum toxin A (botox)-injected mice. Consistently, in the sera from healthy volunteers subjected to bed rest, we observed an inverse correlation between PENK1 and bed rest duration. These results prompted us to investigate a role for this factor in bone. Penk1 was highly expressed in mouse bone, but its global deletion failed to impact bone metabolism in vivo. Indeed, Penk1 knock out (Penk1−/−) mice did not show an overt bone phenotype compared to the WT littermates. Conversely, in vitro Penk1 gene expression progressively increased during osteoblast differentiation and its transient silencing in mature osteoblasts by siRNAs upregulated the transcription of the Sost1 gene encoding sclerostin, and decreased Wnt3a and Col1a1 mRNAs, suggesting an altered osteoblast activity due to an impairment of the Wnt pathway. In line with this, osteoblasts treated with the Penk1 encoded peptide, Met-enkephalin, showed an increase of Osx and Col1a1 mRNAs and enhanced nodule mineralization. Interestingly, primary osteoblasts isolated from Penk1−/− mice showed lower metabolic activity, ALP activity, and nodule mineralization, as well as a lower number of CFU-F compared to osteoblasts isolated from WT mice, suggesting that, unlike the transient inhibition, the chronic Penk1 deletion affects both osteoblast differentiation and activity. Taken together, these results highlight a role for Penk1 in the regulation of the response of the bone to mechanical unloading, potentially acting on osteoblast differentiation and activity in a cell-autonomous manner. [ABSTRACT FROM AUTHOR]

Nutraceuticals, that include food ingredients and bioactives from natural products, confer physiological health benefits and protection against chronic diseases. Annatto is a tropical shrub grown in Central and South America and parts of India. Its seeds are rich in the edible carotenoid-derived apocarotenoid pigment, bixin, which is used as a natural colorant in food, textiles, and cosmetics, and is now gaining attention for its potential health-promoting attributes. Here, we compared a green solvent (ethyl lactate) based extraction of bixin and associated metabolites in annatto seeds (crushed and seed coat) with two other conventional solvents (acetone and acid-base). Bixin was characterized in the extracts using UV--visible- and FTIR-spectroscopy and thin-layer chromatography. The bixin-containing solvent extracts were then profiled for other co-existing metabolites using GC-MS analysis, which were found to be sesquiterpenes, terpenes, terpenoids, phytosterols, and tocotrienols. Their bioactivity was evaluated based on antioxidant and wound-healing efficacies and compared with pure bixin, using NIH-3T3 fibroblast cells in-vitro. Pure bixin, as well as the annatto solvent extracts, showed strong antioxidant and wound healing properties, wherein pure bixin and green solvent extract (ethyl lactate coat) exhibited higher levels of antioxidant activity, achieving 46.00% and 44.60% reduction in MDA levels, respectively, as well as enhanced wound-healing activity, with 54.09% and 53.60% wound closure within 24 h. The green solvent extracts of annatto seeds revealed: (a) differential bioactive profiles in annatto seeds (crushed and seed coat) in comparison with other solvents, and (b) strong antioxidant and wound healing properties. Thus, ethyl lactate extraction shows strong potential for sustainable environmental friendly production of functional foods/nutraceuticals from annatto seeds. [ABSTRACT FROM AUTHOR]

The novelty of this study is the combined experimental and statistical approach, which is showcased to predict and optimise bamboo–mortar bond strength, incorporating the effects of various material factors. The design of experiments method was used to quantify the impact of multiple factors affecting the bond strength. Firstly, different experimental pull-out tests were conducted in the laboratory to determine the effect of various factors (water/cement ratio, curing duration, cement/sand ratio, fly ash content and bamboo treatment) on bond strength development. Three failure patterns were observed – bamboo failure, bond failure and mortar failure. Secondly, using a two-level full factorial design method, different statistical models were formulated. These models were developed based on the surface treatment of the bamboo (model M1 (untreated) and model M2 (treated and untreated)). The effects of single factors and their interactions on bond strength development were quantified. The developed models were validated for the prediction of bond strength based on different factors. The developed statistical models were found to predict and simulate the experimental behaviour of bond strength with sufficient accuracy. [ABSTRACT FROM AUTHOR]

Epoxy resin, 15.0 wt.% of 5.0 wt.% N-[3-(Trimethoxysilyl) propyl]-ethylene diamine treated plant fibers (banana or coir fiber with length of 5–15 mm) and triethylene tetramine (TETA) mixed in (0.1 wt.%, 0.3 wt.% and 0.5 wt.% individual concentration) of graphite nanoplatelets (GnP) were stirred separately to form GnP filled epoxy-silanated banana fiber (ESBF) and GnP filled epoxy-silanated coir fiber (ESCF) nanocomposites, respectively. Hand layup method was used to pour these nanocomposites on the mold followed by curing for 24 h at room temperature and post-curing for 8 h at 50 °C. Not only the amino group of silane creates bonding of epoxy resin with plant fibers but also the amino group of TETA makes good interaction of GnP with the epoxy resin responsible for enriched mechanical properties. The highest tensile strength of 93 MPa, flexural strength of 318 MPa and impact strength of 224 J/m were recorded for 0.5 wt. % GnP filled ESCF nanocomposite as compared to 87 MPa, 222 MPa and 192 J/m for 0.5 wt.% GnP filled ESBF nanocomposite. The greater improvement in ESCF nanocomposites was due to lower cellulose content, higher lignin content and higher % fiber volume fraction. [ABSTRACT FROM AUTHOR]

Hypospadias is a common congenital anomaly in males and frequently the patient undergoes multiple surgeries and may have complications. The treatment of severe "iatrogenic strictures" presenting in adulthood resulting from childhood hypospadias surgeries continues to be a challenge. The complexity of these cases is increased manifold due to the reasons of delayed presentation of many decades, varying lengths of the stricture, as well as poor healing capacity due to scarred territory from previous surgical attempts and associated complicating factors of renal failure and fistulae. In this paper, a case of reconstruction of a severe urethral stricture in a hypospadias cripple using a pedicled anterolateral thigh flap is reported. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is an absolute necessary intervention for childhood survival. WHO/UNICEF have given utmost emphasis on first 1000 days of life comprising of 270 days in-utero and the first two years post birth as most vital period for nutritional interventions. [1] Infant and Young Child Feeding (IYCF) is a set of renowned and usual recommendations for appropriate feeding of new-born and children below two years of age. Aims & Objectives: To assess the awareness, perception and practices, regarding breast-feeding and IYCF practices among mothers of children up to 2 years, in two districts of Central India. Settings and Design: Cross Sectional Study. Materials and Methods: This Cross-sectional study was carried out in two districts of Central India from January 2021 to December 2021. The study subjects included 400 mothers of babies less than two years old, who had given consent. Interpersonal interview using a pre-designed semi-structured questionnaire was carried out. Data was collected, compiled and analysed using SPSS 25.0 (Trial Version). Result: Only (58.60%) of respondents were completely knowledgeable about exclusive breastfeeding, the value of colostrum feeding, the advantages of breastfeeding (81.69%), and its early onset (64.75%), duration (71.25%), and frequency (74.50%). However, 50.25% of women lacked understanding about the ideal positioning and attachment of the infant to the breast. Conclusion: All beneficiaries should be shown demonstrations of all IYCF practices. Family members should also be counselled and encouraged to support IYCF practices. [ABSTRACT FROM AUTHOR]

Simple Summary: The diagnosis and management of testicular germ cell tumors (TGCTs) currently relies on the use of unreliable biomarkers—conventional serum tumor markers (STMs). Variable levels of elevation in serum samples among patients and cancer types make the use of conventional STMs unfavorable for dependable diagnosis and clinical management of TGCTs. This review of recent studies suggests germ cell tumor associated miRNAs, such as miR-371a-3p, can be utilized as not only a reliable but cost-effective and convenient blood-based biomarker. However, before widespread clinical implementation, the development of a protocol for sample collection, analysis, and interpretation is necessary to prevent overtreatment and guide the management of patients. MicroRNAs, short non-protein coding RNAs, are overexpressed in GCTs. Circulating levels of germ cell tumor (GCT)-associated miRNAs, such as miR-371a-3p, can be utilized as efficient and cost-effective alternatives in diagnosing and managing patients presenting with GCTs. This quality of miRNAs has demonstrated favorable performance characteristics as a reliable blood-based biomarker with high diagnostic accuracy compared to current serum tumor markers (STMs), including α-fetoprotein (AFP), beta human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH). The conventional STMs exhibit limited specificity and sensitivity. Potential clinical implications of miRNAs include impact on de-escalating or intensifying treatment, detecting recurrence at earlier stages, and lessening the necessity of cross-sectional imaging or invasive tissue biopsy for non-teratomatous GCTs. Here, we also highlight the outstanding issues that must be addressed prior to clinical implementation. Standards for measuring circulating miRNAs and determining ideal cutoff values are essential for integration into current clinical guidelines. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease, a leading cause of morbidity and mortality in both the genders, needs noninvasive predicting factors to identify the risk at early stage. Second and fourth digit ratio (2D:4D) of hand has been associated with coronary artery disease among males but literature lacks such data in relation to female population. Aim: To establish any association between 2D:4D ratio and coronary artery disease and with family history related to risk of coronary artery disease so as to assess the predictive value of digit ratio. Material and Methods: The study was conducted on 200 adult female subjects of North India under two groups: 1. Control group-subjects with no known history of coronary artery disease, 2 Patient group-subjects with known history of coronary artery disease (CAD). Family history of CAD, hypertension (HT) and diabetes mellites (DM) was noted. The index finger (2D) and the ring finger (4D) lengths were measured to calculate 2D:4D ratio. Results: Mean right and left 2D:4D ratio was significantly higher group 2. With medium effect size and Odd's ratio (1.83), Right 2D:4D ratio is a better risk predictor. The prevalence of high right 2D:4D ratio was significantly more among subjects having positive family history reflecting risk of CAD in both groups. Conclusion: Association of high right 2D:4D ratio with coronary artery disease and relevant family history shows risk prediction for coronary artery disease among females. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS Cervical cancer associated with human papillomavirus has the highest cancer incidence and mortality for women in Botswana because of a high HIV prevalence and limited screening. This study investigates the significance of HIV on the overall survival (OS) of patients with locally advanced cervical cancer by various treatment categories (curative chemoradiation, definitive radiation [RT] alone, or palliative RT alone).This study included patients diagnosed with cervical cancer between 2013 and 2020, prospectively enrolled in the Botswana Prospective Cancer Cohort. OS based on HIV status and completion of planned treatment regimen was estimated by the Kaplan–Meier method. Comparisons of 2‐year OS by HIV status was performed by the log‐rank test, univariate and multivariable Cox analyses adjusting for cancer stage, RT dose, number of chemotherapy cycles, and baseline hemoglobin levels.Of 1131 patients diagnosed with stage IB‐IVB cervical cancer, 69.8% were women living with HIV (n = 789). For patients receiving curative chemoradiation, HIV status was not significantly associated with OS in unadjusted (p = .987) and adjusted (p = .578) analyses. For RT only treatment and definitive (high‐dose) RT alone, HIV status was significantly associated with OS in unadjusted analysis (HR = 1.77, p = .002; HR = 1.95, p = .014), but not in adjusted analysis (p = .227, p = .73). For patients receiving palliative (low‐dose) RT, HIV status was not associated with OS in unadjusted (p = .835) or adjusted analysis (p = .359).In Botswana, a resource‐limited setting, HIV status had no significant effect on 2‐year OS in patients with cervical cancer with well‐managed HIV receiving chemoradiation, RT alone, or palliative RT. This demonstrates that patients living with HIV receiving antiretroviral treatment can receive clinically appropriate treatment with no evidence that HIV may lead to poorer outcomes. [ABSTRACT FROM AUTHOR]

Wounds, which are becoming more common as a result of traumas, surgery, burns, and chronic illnesses like diabetes, remain a critical medical problem. Infectious bacteria impact the healing process, particularly if its biofilm (biological films) leads to a prolonged effect. Nanomaterials have emerged as promising candidates in the field of wound healing due to their unique properties and versatile applications. New insights into the interactions between nanomaterials and wound microenvironments have shed light on the mechanisms underlying their therapeutic effects. However, a significantly minimal amount of research has been carried out to see if these nanomaterials significantly promote the wound healing process. In this review, we provided an outline of the various types of nanomaterials that have been studied for healing wounds and infection prevention. Overall, the utilization of nanomaterials in wound healing holds great promise and continues to evolve, providing new opportunities for the development of effective and efficient wound care therapies. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a frequently encountered chronic disorder. AD patients suffer from various cognitive dysfunctions. The traditional methods fail to identify AD in the early stage. The presence of AD results in significant changes in electroencephalogram (EEG) signals, including a slowing effect and less synchronization. The important information in EEG is available in low-frequency bands. These bands can be obtained using various wavelet filter banks. This work proposes new, less complex Rational Dyadic Biorthogonal Wavelet Filter Banks (RDBWFBs) with maximum vanishing moments for the decomposition of EEG signals from normal controlled (NC) subjects, mild cognitive impairment (MCI), and AD patients into desired EEG bands. Novel design approaches have been introduced to decrease the complexity associated with current irrational biorthogonal wavelet filter banks. Three different features were calculated from each EEG subband. The importance of these features was determined through the utilization of Kruskal–Walli's test. The present model achieved an AD detection accuracy of 98.85 % for NC vs. AD using RDBWFB-5 and 96.30 % for NC vs. MCI vs. AD classifications using the RDBWFBs-4 with a support vector machine, respectively. New RDBWFBs are more effective and less complex than existing wavelet filter banks. [ABSTRACT FROM AUTHOR]

The nuclear structure effects of correlated pairs of fission fragments in the mass distribution spectrum of the fissioning nucleus are investigated using the fragmentation theory based on the asymmetric two-centre shell model. The model is applied to explain the observed structure in relative mass distribution yields of even Z–even N correlated fission fragment pairs in the low-energy heavy-ion induced fusion–fission reactions 208 Pb (18 O,f) and 238 U (18 O,f). In each of these reactions, the respective fused system is considered to utilise its excitation energy in 0–14 neutron evaporation channels before proceeding to decay. The fissioning isotopes ( 226 - 212 Th and 256 - 242 Fm) resulted after neutron evaporation (in the step of Δ n = 2 ) contribute to the observed even–even individual fission fragments mass distribution spectra. It is shown that the most probable decay channel consisting of correlated pair of magic and deformed shell fission fragments always has a larger mass distribution yield than that containing both magic shell structure fission fragments. The pear-shaped structure that emerges from the combined magic plus deformed shell fission fragments might have relevance to an occurrence of stable octupole deformation of a fissioning nucleus before saddle configuration, which was first noticed by Johansson (S A E Johansson, Nucl. Phys. 22 , 529 (1961)) and more recently, authenticated by Scamps and Simenel (G Scamps and C Simenel, Nature 564 , 382 (2018)). Thus, the combined quantum shell effects of magic and deformed fission fragments both in potential and the cranking mass parameters decide the most probable decay modes (i.e., the correlated pairs of fission fragments with maximum yields) in fusion–fission reactions ( 208 Pb (18 O,f) and 238 U (18 O,f)). [ABSTRACT FROM AUTHOR]

Introduction: This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country. Materials and Methods: Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented. Results: About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels. Conclusion: While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization. [ABSTRACT FROM AUTHOR]

Per-oral endoscopic myotomy (POEM) is one of the main modalities of treatment of achalasia cardia today across subtypes and we are increasingly seeing patients persistent or recurrent symptoms after POEM. An accurate high-resolution esophageal manometry (HREM) is one of the most important tests that can help us guide the treatment in cases of failure of POEM. HREM can help us direct the therapy. The therapy can be lower esophageal sphincter-directed therapy or esophageal body-directed therapy that can be ascertained using HREM. With this review, we detail the factors associated with failure of POEM, tests that can be utilized for its evaluation, and case-based analysis using HREM in patients of post-POEM failure. [ABSTRACT FROM AUTHOR]

Dissolved oxygen (DO) is an important parameter in assessing water quality. The reduction in DO concentration is the result of eutrophication, which degrades the quality of water. Aeration is the best way to enhance the DO concentration. In the current study, the aeration efficiency (E20) of various numbers of circular jets in an open channel was experimentally investigated for different channel angle of inclination (θ), discharge (Q), number of jets (Jn), Froude number (Fr), and hydraulic radius of each jet (HRJn). The statistical results show that jets from 8 to 64 significantly provide aeration in the open channel. The aeration efficiency and input parameters are modelled into a linear relationship. Additionally, utilizing WEKA software, three soft computing models for predicting aeration efficiency were created with Artificial Neural Network (ANN), M5P, and Random Forest (RF). Performance evaluation results and box plot have shown that ANN is the outperforming model with correlation coefficient (CC) = 0.9823, mean absolute error (MAE) = 0.0098, and root mean square error (RMSE) = 0.0123 during the testing stage. In order to assess the influence of different input factors on the E20 of jets, a sensitivity analysis was conducted using the most effective model, i.e., ANN. The sensitivity analysis results indicate that the angle of inclination is the most influential input variable in predicting E20, followed by discharge and the number of jets. [ABSTRACT FROM AUTHOR]

Despite growing cardiogenic shock (CS) research in adults, the epidemiology, clinical features, and outcomes of children with CS are lacking. This study sought to describe the epidemiology, clinical presentation, hospital course, risk factors, and outcomes of CS among children hospitalized for acute decompensated heart failure (ADHF). We examined consecutive ADHF hospitalizations (<21 years of age) from a large single-center retrospective cohort. Patients with CS at presentation were analyzed and risk factors for CS and for the primary outcome of in-hospital mortality were identified. A modified Society for Cardiovascular Angiography and Interventions shock classification was created and patients were staged accordingly. A total of 803 hospitalizations for ADHF were identified in 591 unique patients (median age 7.6 years). CS occurred in 207 (26%) hospitalizations. ADHF hospitalizations with CS were characterized by worse systolic function (P = 0.040), higher B-type natriuretic peptide concentration (P = 0.032), and more frequent early severe renal (P = 0.023) and liver (P < 0.001) injury than those without CS. Children presenting in CS received mechanical ventilation (87% vs 26%) and mechanical circulatory support (45% vs 16%) more frequently (both P < 0.001). Analyzing only the most recent ADHF hospitalization, children with CS were at increased risk of in-hospital mortality compared with children without CS (28% vs 11%; OR: 1.91; 95% CI: 1.05-3.45; P = 0.033). Each higher CS stage was associated with greater inpatient mortality (OR: 2.40-8.90; all P < 0.001). CS occurs in 26% of pediatric hospitalizations for ADHF and is independently associated with hospital mortality. A modified Society for Cardiovascular Angiography and Interventions classification for CS severity showed robust association with increasing mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

Mitigating human–wildlife conflicts by altering human behaviors is critical to urban wildlife conservation. We investigated what actions urban residents are willing to take to mitigate human–wildlife conflicts in metropolitan Atlanta, one of the fastest growing metropolises in the United States (~6.1 million people, 21,690 km2). In 2022, we administered online surveys to 1006 residents of metropolitan Atlanta to determine which measures they had adopted to mitigate conflicts with urban wildlife, elicit their stated willingness to adopt additional conflict mitigation measures, and identify determinants of current or potential implementation of mitigation measures. Respondents most frequently reported watching urban wildlife (63.0% of respondents). The most frequently reported conflicts were wildlife raiding trash cans (14.8%) and damaging landscaping (20.8%). In total, 342 respondents (34.0%) had not taken any action to mitigate conflicts with wildlife. Respondents who had taken action to prevent conflicts most often secured their trash by keeping cans indoors or locking the lid of the can (28.7%), kept pets (20.5%) and pet food (20.3%) indoors, and took trash out on the morning of collection (19.6%). Respondents who had not adopted conflict mitigation measures stated that they were likely to secure their trash or keep pets and pet food indoors if they considered these measures to be necessary. Prior conflicts with wildlife influenced both respondents' current efforts to mitigate conflicts with wildlife, and their stated willingness to adopt additional measures to mitigate human–wildlife conflicts. Risk sensitivity to zoonotic pathogen transmission increased both actual and intended adoption of conflict mitigation measures. Respondents' self‐efficacy, beliefs about wildlife, and age also influenced their willingness to adopt conflict mitigation measures. Our results suggest that education and outreach about the need for conflict mitigation measures should highlight the importance and effectiveness of these measures in conserving wildlife, while also securing the well‐being of humans and pets. [ABSTRACT FROM AUTHOR]

How would what we know about war change if we took seriously the 'embodied experience' of its violences? How do we write 'war' and 'violence' in such a way that we can capture the complexity of what Bousquet, Grove and Shah refer to as 'war's incessant becoming'? How do we, as Sylvester puts it, 'pull the bodies and experiences of war out of entombments created by [international relations] theories... into the open as crucial elements of war'? In other words, how do we write 'war' as if people, lives, suffering, pain, anger, cruelty, hope, resilience, survival and the creativity of it all – the embodied experience – mattered in international relations? In this essay, I wrestle with these questions by re-creating my encounter with Omar Imam, a Syrian artist whose conceptual photography forms the backbone of this piece, and by fleshing out a conceptual framework through which to explore this 'embodied experience': Syrialism. Here, Syrialism, imagined as a 'machine' (borrowing from Deleuze and Guattari) declares that war is experienced as an embodied process that is consistently, though not constantly, partially connected to other violence/violent processes, and this refiguration brings the actual machinations of the injuries of war and the particulars of how it is sensed and made sensible into focus. [ABSTRACT FROM AUTHOR]

Introduction: Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. Materials and Methods: Thirty patients (or 60 sites) with age ranging from 15 to 45 years with mild-to-moderate acne vulgaris were included in the study. Assessment at baseline was done by the global acne grading system score for including mild and moderate acne patients. Results: On grading the improvement according to the 5-point Global Assessment Scale (GAS), it was found that in area A (black peel), 6.7% of patients showed excellent improvement, 86.7% of patients showed good improvement, and 6.7% of patients showed fair improvement. In area B (25%TCA peel), 6.7% of patients showed excellent improvement, 80% of patients showed good improvement, and 13.3% of patients showed fair improvement. Discussion: None of the patients showed poor or worse outcomes in any of the areas. The difference between the groups was not significant (P = 0.688). Conclusion: There is a paucity of data in the literature regarding the comparison of black peel with other conventional peels in the treatment of acne vulgaris. To the best of our knowledge, this is the first study comparing black peel with TCA peel in the treatment of acne vulgaris. [ABSTRACT FROM AUTHOR]

Background: In India, anaemia prevalence is more than 40% so it is a severe public health problem. National Family Health Survey V indicates that prevalence of anaemia in pregnant women in Maharashtra's rural areas is 46.5%. As the pregnant women have high prevalence of anaemia, it highlights the need to conduct research to find out the determinants and its preventive measures. Aim: To determine prevalence of anaemia and to assess its determinants amongst pregnant women in a rural area Methods: Three eighty-four pregnant women in a rural area of Thane district were selected for a community based descriptive cross-sectional study. Association between anaemia and variables in the study was established using Pearson's Chi- square test. For studying association between anaemia as dependent variable and various determinants as independent variables, binary logistic regression analysis was used. Results: Prevalence of anaemia was found to be 62.5%. 29.2% participants were mildly anaemic, 33.0% were moderately anaemic, 0.3% were severely anaemic and 37.5% were non-anaemic. Occurrence of anaemia was significantly associated with age, religion, gravida status, trimester, gestational age at first ANC visit, no consumption of IFA tablets, no consumption of dark green leafy vegetables and dietary habits. Conclusions: High prevalence of anaemia amongst pregnant women reflects poor utilization of health care services, lack of awareness about adequate dietary patterns and poor nutritional status. Anaemia is still a severe public health issue amongst pregnant women of rural areas. [ABSTRACT FROM AUTHOR]

Introduction: In hospital settings, awareness of, and responsiveness to, COVID-19 are crucial to reducing the risk of transmission among healthcare workers and protecting them from infection. Healthcare professionals can offer insights into the practicalities of infection prevention and control (IPC) measures and on how the guideline aimed to ensure adherence to IPC, including use of personal protective equipment (PPE), could best be delivered during the pandemic. To inform future development of such guideline, this study examined the perspectives of healthcare professionals working in a large hospital during the pandemic regarding their infection risks, the barriers or facilitators to implementing their tasks and the IPC measures to protect their safety and health and of their patients. Method: In-depth interviews were conducted with 23 hospital staff coming into contact with possible or confirmed cases of COVID-19, or were at potential risk of contracting the disease, including medical doctors, nurses, virology laboratory staff, and non-medical workers. This qualitative study was carried out as part of a knowledge, attitudes and practice survey to prevent COVID-19 transmission at Ramathibodi Hospital in Thailand. We used content analysis to categorize and code transcribed interview data. Existing IPC guideline and evidence synthesis of organisational, environmental, and individual factors to IPC adherence among healthcare workers were used to guide the development of the interview questions and analysis. Finding: Factors identified as influencing the use of, and adherence to, prevention measures among healthcare workers included knowledge, perceived risk and concerns about the infection. The extent to which these factors were influential varied based on the medical procedures, among other features, that individuals were assigned to perform in the hospital setting. Beyond availability of PPE and physical safety, ease of and readiness to utilize the equipment and implement IPC measures were crucial to motivate hospital staff to follow the practice guideline. Having a ventilated outdoor space for screening and testing, and interaction through mobile technology, facilitated the performance of healthcare workers while reducing the transmission risk for staff and patients. Adequate training, demonstration of guided practices, and streamlined communications are crucial organisational and management support factors to encourage appropriate use of, and adherence to, implementation of infection prevention and control measures among healthcare workers. Conclusion: This finding could help inform the development of recommendations to optimise compliance with appropriate use of these measures, and to improve guidance to reduce HCW's risk of disease in hospital settings. Further study should explore the perceptions and experiences of health professionals in smaller health facilities and community-based workers during the pandemic, particularly in resource-limited settings. [ABSTRACT FROM AUTHOR]

Detecting hypermethylation of tumour suppressor genes could provide an alternative to liquid-based cytology (LBC) triage within HPV primary cervical screening. The impact of using the QIAsure® FAM19A4/mir124-2 DNA Methylation Test (QIAGEN, N.V, Hilden, Germany) on CIN3+ diagnoses, retention, unnecessary colposcopies, and programme costs is unknown. A decision-tree model was developed to compare LBC with the QIAsure Methylation testing to guide colposcopy referral. Incorporating clinician- and self-sampling pathways the model was informed by the Dutch cervical cancer screening programme, published studies, and manufacturer data. Clinical and cost outcomes were assessed using two scenarios for DNA methylation testing and LBC relative performance. Sensitivity analyses (deterministic and probabilistic) were performed to assess model and parameter uncertainty. A range of self-sampling uptake was assessed in scenario analyses. For the screening cohort (n = 807,269) where 22.1% self-sampled, the number of unnecessary colposcopies and CIN3+ diagnoses varied according to the relative performance of methylation testing and LBC. Irrespective of relative performance, the cost per complete screen was lower and fewer people were lost to follow-up when using DNA methylation testing. The results indicate that, within an HPV primary screening programme that incorporates self-sampling, using the QIAsure Methylation Test for triage reduces the cost per screen compared to LBC. [ABSTRACT FROM AUTHOR]

Introduction: This study attempts to generate preliminary data regarding post-COVID pulmonary fungal infections, namely, COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated pulmonary mucormycosis (CAPM), and mixed infections from the Himalayas and compares the micro-radio-clinical profile and outcomes of the affected patients. Materials and Methods: A retrospective data analysis was conducted, where clinical profiles, microbiological and radiological reports, and outcomes of n = 16 patients of post-COVID pulmonary infections were compared. Results: Of n = 16 patients, n = 7 had CAPA (n = 5 Aspergillus fumigatus, n = 1 Aspergillus flavus, and n = 1 Aspergillus niger), n = 5 CAPM (Rhizopus arrhizus), and n = 4 with mixed infections (n = 3 infected with Aspergillus fumigatus and Rhizopus spp. and n = 1 with Aspergillus flavus and Rhizopus arrhizus). Thick-walled cavitary lesions, air–fluid levels, and multiple centrilobular nodules were some of the common radiological findings reported among these patients. Conclusion: The immuno-compromised state following COVID-19 infection and treatment might be responsible for the progression of regular exposure to the dense Himalayan vegetation into an invasive pulmonary fungal infection. Suspecting post-COVID pulmonary fungal infection is necessary for primary care physicians to ensure timely referral to higher centers. Mixed pulmonary fungal infections (coinfection with Aspergillus spp. and Rhizopus spp.) are also emerging as important sequelae of COVID-19. [ABSTRACT FROM AUTHOR]

The word endo-hepatology evokes many perceptions. Some believe it to be the emerging new interventional branch and some believe it to be an extension of endoscopy. Nonetheless, it has continued to evolve into an exciting area of active work. With the advent of endoscopic ultrasound (EUS) based procedures, new vistas have opened up. EUS-guided liver biopsies, portal hypertension management, and multiple new procedures are being described. EUS also plays a large role in the management of patients in the peritransplant period. With this review, we present an overview of the role of EUS in the field of hepatology as well as during the peritransplant period and its applications. [ABSTRACT FROM AUTHOR]

The impact of paternal obesity and metabolic disease on semen quality and fertility outcomes is not fully appreciated. With increasing obesity rates, researchers have studied the intricate relationship between paternal body mass index, metabolic health, and male fertility. This systematic review identified 112 articles in the MEDLINE database between 2013 and 2023 that investigated the effects of body mass index, diabetes, metabolic syndrome, exercise, weight loss medication, or bariatric surgery on semen parameters, sperm quality, or fertility outcomes. This review suggests that obesity, diabetes, and metabolic syndrome have a negative impact on various parameters of male fertility, from semen quality to sperm deoxyribonucleic acid integrity. There is also mounting evidence that male obesity is correlated negatively with live births via both natural conception and assisted reproductive technologies. Lifestyle interventions, such as physical exercise, generally appear to improve male fertility markers; however, the type and intensity of exercise may play a crucial role. Pharmacologic treatments for weight loss, such as metformin and glucagon-like peptide 1 agonists, present a more complex picture, with studies suggesting both beneficial and detrimental effects on male reproductive health. Similarly, surgical interventions, such as gastric bypass surgery, show promise in improving hormonal imbalances but have mixed effects on semen parameters. Future research is needed to clarify these associations and inform clinical guidelines. In the interim, health practitioners should incorporate these insights into clinical practices, encouraging proactive lifestyle changes and providing targeted treatments to improve male reproductive health. [ABSTRACT FROM AUTHOR]

Aims: Neonatal surgical mortality continues to be high in developing countries. A better understanding of perioperative events and optimization of causative factors can help in achieving a favorable outcome. The present study was designed to evaluate the perioperative course of surgical neonates and find out potential factors contributing to postoperative mortality. Methods: This prospective observational study enrolled neonates, undergoing emergency surgical procedures in a tertiary care institute. Primary outcome was 6 weeks postsurgical mortality. The babies were observed till discharge and subsequently followed up telephonically for 6 weeks after surgery. Multivariable logistic regression analysis of various parameters was performed. Results: Out of the 324 neonates who met inclusion criteria, 278 could be enrolled. The median age was 4 days. Sixty‐two (27.7%) neonates were born before 37 weeks period of gestation (POG), and 94 (41.8%) neonates weighed below 2.5 kg. The most common diagnoses was trachea‐esophageal fistula (29.9%) and anorectal malformation (14.3%). The median duration of hospital stay for survivors was 14 days. The in‐hospital mortality was 34.8%. Mortality at 6 weeks following surgery was 36.2%. Five independent risk factors identified were POG < 34 weeks, preoperative oxygen therapy, postoperative inotropic support postoperative mechanical ventilation, and postoperative leukopenia. In neonates where invasive ventilation was followed by non‐invasive positive pressure ventilation in the postoperative period, risk of postoperative surgical mortality was significantly reduced. Conclusion: Present study identified preterm birth, preoperative oxygen therapy, postoperative positive pressure ventilation, requirement of inotropes, and postoperative leukopenia as independent predictors of 6‐week mortality. The possibility of early switch to noninvasive positive pressure ventilation was associated with a reduction in neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Agricultural activities in 2020 have resulted in 5.5 billion tons of CO2 equivalent globally, which is expected to rise because the food system would have to grow 70% more food for the population in 2050. Research suggests that agricultural productivity in South Asian countries, will increase food security; however, the role of their food crops and livestock products in environmental imprints is uncertain. This review aimed to assess the environmental impacts resulting from pre‐ and post‐production agricultural activities related to edible food crops and livestock products consumed in eight South Asian countries. Methods: Studies were retrieved using three databases (PubMed, Google Scholar and Science Direct) from 2011 to 2022. The protocol for this scoping review was not registered. Results: Twenty‐seven studies met the inclusion criteria. Most studies were conducted in India. Twenty‐four articles assessed greenhouse gases (GHG) emissions, followed by water footprints (n = 5), nitrogen and phosphorus (N&P) emissions (n = 4), and land requirements (n = 4). The production of rice and wheat was identified as a significant contributor to GHG emissions. In India, Bangladesh and Sri Lanka, the production of livestock (meat/bovine/shrimp and milk) was reported to be harmful to the environment. Inconclusive data were retrieved for other environment variables. Conclusions: Diversification in food production and cultivating additional coarse cereals (millets) offer opportunities for GHG reduction. Nevertheless, more comprehensive and longitudinal studies for South Asian countries are essential to make precise conclusions and validate the present review. Key points: The present study explored the role of South Asian food crops and livestock in environmental degradation.Most studies assessed green house gas (GHG) emissions.Production of wheat, rice and livestock products contributed significantly to GHG emissions.Diversification in food production, cultivating coarse cereals such as millets is desirable. [ABSTRACT FROM AUTHOR]

Liver transplantation (LT) is a life-saving therapeutic modality for patients with various advanced liver diseases. It is crucial to identify that the patient's illness is sufficiently advanced and unlikely to improve with medical management to justify the need for transplantation. At the same time, it is crucial to identify patients with comorbidities and far advanced disease that would result in an unacceptable outcome after LT. Specific care also is required before deciding on LT in the elderly, acute on chronic liver disease, patients with comorbidities, and hepatocellular carcinoma. Transplantation needs to be timed appropriately to avoid unnecessary LT and ensure that the decision is not left too late to avoid losing the patient without a transplant. Also, important is the decision as to when not to transplant. The current review explores some of these issues of contraindications and ineligibility for LT. [ABSTRACT FROM AUTHOR]

Background: Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The performance of supraglottic devices versus tracheal tubes in children undergoing laparoscopic surgery is uncertain. Methods: A systematic review and meta‐analysis of randomized controlled trials that compared supraglottic devices versus tracheal tubes in patients ≤18 years undergoing laparoscopic surgery under general anesthesia was conducted. The outcomes were peak airway pressures (cm H2O), end‐tidal carbon dioxide during pneumoperitoneum (mm Hg), recovery time (min), postoperative sore throat and adverse events. Mean difference and odds ratio, with 95% confidence intervals were reported using a random effect model. Results: Eight trials (n = 591) were included in the final meta‐analysis. There was no statistically significant difference in the peak airway pressures (MD 0.58, 95% CI: −0.65 to 1.8; p =.36) and end‐tidal carbon dioxide (MD −0.60, 95% CI: −2.00 to 0.80; p =.40) during pneumoperitoneum in the supraglottic device and the tracheal tube group. The tracheal tube group had higher odds of sore throat (OR 3.30, 95% CI: 1.69–6.45; p =.0005) and the supraglottic airway group had faster recovery time (MD 4.21, 95% CI: 3.12–5.31; p <.0001), which were statistically significant. The certainty of evidence is graded low. Conclusion: There is low quality evidence to suggest that for pediatric laparoscopic surgeries of short duration, supraglottic devices could provide comparable intraoperative ventilation in terms of peak airway pressures and end tidal carbon dioxide, with lower odds of postoperative sore throat and faster recovery time when compared to tracheal tubes. [ABSTRACT FROM AUTHOR]

Background: There are many therapeutic effects of medicinal plants that are used in treating and preventing a variety of diseases. Recently medicinal plants contain many bioactive compounds which are playing an important role in the health sector. The use of herbal medicine is based on the fact that herbal medicines are safe without any ill effects on human health and are easily accessible at minimum cost. However, there is an urgent need to assure the quality and efficacy of the product. Objectives: The main objective of current study directed to characterize possible the phytochemical compounds and mineral elements present in the methanolic leaves extract of the Thalictrum foliolosum plant by using GC-MS, FTIR, and ICP-MS analysis to ensure quality of this medicinally important herb and for a better understanding of its pharmacological claim. Materials and Methods: Thalictrum foliolosum was collected in July and August from the Hatu peak at an elevation of 3400 m in the Shimla district of Himachal Pradesh, India. The fine powder of the plant leaf was extracted with methanol at room temperature for 8 hr. The chemical analysis of bioactive compounds of Thalictrum foliolosum has been evaluated using GC-MS, FTIR and ICP-MS. Results: GC-MS analysis disclosed the presence of 48 compounds which shows various medicinal activities. The major phytoconstituents were Octacosanol (22.37%), Diethyl Phthalate (22.32%), Hexanoic acid, 2-ethyl-, ethyl ester (6.14%), n-Hexadecanoic acid (4.11%) and many more which exhibited antioxidant, antidiabetic, antimicrobial, anti-inflammatory and anticancer activities. The compounds found in the extract were compared with mass spectra from the National Institute of Standards and Technology (NIST). The crude extract was analyzed in a spectrometer Perkin Elmer Spectrum 400 and characteristic peaks were recorded indicating various functional groups such as phenol, alkanes, alcohol, amides, and amines are present. The ICP-MS technique was simultaneously used to trace the mineral element and the result revealed the presence of important micronutrients including manganese (1,770.517 ppb), ferrous (22,604.753ppb), zinc (4,322.423 ppb), chromium (491.231), copper (7,048.321ppb) and potassium (450,067.837ppb). These mineral element acts as cofactors for more than 3000 enzymes that regulate various metabolic pathways in the living system. Hence our study provides a huge platform to screen out these bioactive compounds and mineral elements which are used to treat various lethal and lifestyle diseases. Conclusion: The current study reveals that the methanolic leaves extract of Thalictrum foliolosum contains various phytoconstituents which were responsible for various biological activities. The relative concentration of bioactive compounds and mineral elements is reasonable and can be considered for medical purposes. [ABSTRACT FROM AUTHOR]

Background: DM is a complicated condition that impacts the handling of sugar, fat, and protein metabolism in our bodies. Medicinal herbs play a significant role in diabetes care. As a result, we focused on the plant components traditionally employed by regional medical professionals. Objectives: The current research was carried out to check if Sorbaria tomentosa (Lindley) Reh. (ST) the ethanolic root extracts anti-diabetic potential. ST is a member of the Rosaceae family commonly known by the common name "false spirae." The root extract of ST is used by the locals in the Kinnaur district of Himachal Pradesh to effectively treat diabetes. Materials and Methods: Plant ethanolic extracts were evaluated for their potential on alloxan-induced diabetic rats for 14 days. The animals were put into one of four treatment groups at random: a normal control group, not treated diabetic control group (150 mg/kg bw), a drug control group that got glibenclamide (5 mg/kg bw), and the last treatment group medicated with ST root extract (50 mg/kg BW). Liver, pancreas, and kidney histopathology were analyzed to correlate biochemical findings with histological changes. Results: Our results showed that the extract and medication-treated diabetic groups gained statistically significant weight (p≤0.001) and that their BGL went back to normal. Along with more common biological markers such as SGOT, SGPT, ALP, TC, TG, HDL, LDL, VLDL, creatinine level, uric acid, urea, and uric acid were measured. After the extract treated hyperglycaemic rats, all biochemical markers came under the normal range (p≤0.001). Improvement of the damaged structure of the liver, pancreas, and kidneys was observed after treatment with standard medication and root extracts of ST. Conclusion: Based on the data gathered from the tribal research area, to the best of our capacity, we have uncovered for the very first time the anti-diabetic efficacy of the plant parts. The empirical knowledge of previous generations is typically the basis for the traditional utilization of medicinal plants for controlling diabetes. Nevertheless, in vivo, research has assisted to discover the anti-diabetic potential of ST's ethanolic root extract and provides scientific proof to back up these claims. The plant component may also be used to create natural antidiabetic drugs that are effective. [ABSTRACT FROM AUTHOR]

Surgical intervention for gastroesophageal reflux disease (GERD) has historically been limited to fundoplication. Magnetic sphincter augmentation (MSA) is a less invasive alternative that was introduced 15 years ago, and it may have a superior side-effect profile. To date, however, there has been just a single published study reporting outcomes in a UK population. This study reports quality-of-life (QOL) outcomes and antacid use in patients undergoing MSA, with a particular focus on postoperative symptoms and those with severe reflux. A single-center cohort study was carried out to assess the QOL outcomes and report long-term safety outcomes in patients undergoing MSA. GERD-health-related quality of life (GERD-HRQL) and Reflux Symptom Index (RSI) scores were collected preoperatively, and immediately postoperatively, at 1-, 2-, 3-, and 5-year follow-up time points. All patients underwent preoperative esophagogastroduodenoscopy, impedance, and manometry. Two hundred and two patients underwent laparoscopic MSA over 9 years. The median preoperative GERD-HRQL score was 31, and the median RSI score was 17. There was a reduction in all scores from preoperative values to each time point, which was sustained at 5-year follow-up; 13% of patients had a preoperative DeMeester score of >50, and their median preoperative GERD-HRQL and RSI scores were 32 and 15.5, respectively. These were reduced to 0 at the most recent follow-up. There was a significant reduction in antacid use at all postoperative time points. Postoperative dilatation was necessary in 7.4% of patients, and the device was removed in 1.4%. Erosion occurred in no patients. MSA is safe and effective at reducing symptom burden and improving QOL scores in patients with both esophageal and laryngopharyngeal symptoms, including those with severe reflux. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the safety and efficacy of neoadjuvant chemoradiation (NACRT) with dose-escalated image-guided intensity modulated radiation therapy (IG-IMRT) in locally advanced (T3/4; T1-4N1-2) rectal cancers (LARCs). Materials and methods: Twenty patients with the diagnosis of LARC were recruited in this prospective interventional single-arm study treated by IG-IMRT with 45 Gray (Gy) in 25 fractions to elective nodal volumes and 55 Gy in 25 fractions to the gross primary and nodal disease with concurrent capecitabine 825 mg/m2 twice daily on radiotherapy days. Patients underwent total mesorectal excision 6-8 weeks post completion of NACRT followed by adjuvant chemotherapy (Capecitabine and oxaliplatin every 3 weekly for 6-8 cycles). Primary end point was acute toxicity assessment and secondary end points were pathological complete response (pCR) and loco-regional control (LRC). Results: Clinical T stage was T3:T4 in 19:1 and clinical N0:N1: N2 in 2:7:11 patients, respectively. With a median follow up of 21.2 months (13.8-25.6 months), 18 of 20 (90%) patients received the full course of treatment. Tumour and nodal downstaging was achieved in 78% and 84% of patients, respectively. pCR and overall complete response (defined as pCR and near CR) was achieved in 22.2% and 44.4% of patients, respectively. 2 (10%) patients completed NACRT, and achieved complete clinical response but refused surgery. Adjuvant chemotherapy course was completed by 17/18 (94.5%) patients. Grade 3 toxicities were observed in 2 (10%) patients during NACRT. All patients were disease-free at the time of the last follow up. Conclusion: Dose-escalation of NACRT therapy with IG-IMRT in LARC patients offers decent rates of pCR and overall response with excellent LRC and acceptable toxicities. [ABSTRACT FROM AUTHOR]

Traditionally, clinician educators are tasked with the responsibility of training future physician workforce. However, there is limited identification of skills required to fulfill this responsibility and a lack of consensus on effective faculty development for career growth as a clinician educator. The newly released Accreditation Council of Graduate Medical Education (ACGME) Clinician Educator (CE) Milestones framework outlines important skills for clinician educators and provides the opportunity to create robust faculty development. In this paper, members of the Society of General Internal Medicine Education Committee discuss the importance of these CE Milestones, outline the novel themes highlighted in the project, and provide recommendations for proper application on both the individual and institutional levels to optimize faculty development. The paper discusses strategies for how to apply the CE Milestones as a tool to create a culture of professional growth and self-directed learning. Using a reflective approach, CE faculty and mentors can identify areas of proficiency and opportunities for growth, thereby creating individualized professional development plans for career success. Institutions should use aggregate CE Milestones data as a needs assessment of their faculty "population" to create targeted faculty development. Most importantly, institutions should not use CE Milestones for high-stakes assessments but rather encourage reflection by CE faculty and create subsequent robust faculty development programs. The ACGME CE Milestones present an exciting opportunity and lay an important foundation for future CE faculty development. [ABSTRACT FROM AUTHOR]

Context: Adjuvant radiation therapy plays an important role in the management of high-risk cervical cancer after radical hysterectomy or inadvertent hysterectomy. The prime concern with the use of dual modality is steep decline in sexual well-being in cervical cancer survivors. Intravaginal brachytherapy (IVBT) delivered by vaginal cylinder or ovoids is essential for local control but at the cost of impairment of sexual function. Aim: The purpose of this study was to assess the sexual well-being of cervical cancer survivors, who underwent surgery followed by adjuvant radiation and compare the subgroups of ovoids with sorbo brachytherapy. Settings and Design: This was an observational, cross-sectional, and analytical study, whereby we evaluated sexual function of cervical cancer survivors by the Female Sexual Function Index (FSFI) instrument. Subjects and Methods: Seventy-five women, identified as cervical cancer survivors who had received adjuvant radiation and IVBT, were administered FSFI questionnaire in face-to-face interviews. Results: The mean age of 75 interviewed women was 48.64 years. Fifty survivors had received IVBT with a sorbo applicator and twenty-five with ovoids. FSFI full score ranged from 4.4 to 32.40. The mean full score for the whole group was 11.3. The mean FSFI full score was 24.91 (± standard deviation [SD] 5.71) in the ovoid group versus 4.49 (± SD 0.35) in the sorbo group. On Pearson's correlation analysis, age and type of brachytherapy were significantly correlated with FSFI full score (P = 0.006) with correlation coefficient of − 0.312 and − 0.948, respectively. Conclusions: Sexual dysfunction was found prevalent in 83% of cervical cancer survivors. The patients treated with IVBT with sorbo had worse sexual functioning than those treated with ovoids. [ABSTRACT FROM AUTHOR]