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Hepatocellular Carcinoma (HCC) is one of the most aggressive malignant tumours, frequently inducing macrovascular invasion. Tumoural Thrombus (TT) production in mature HCC stages is prevalent and typically affects the hepatic or portal veins. Hereby, the authors present a case report of two cases, firstly, 68-year-old male who presented to the Emergency Department with bilateral pedal oedema and a lack of appetite; secondly, 62-year-old female who reported with weakness and giddiness for two months, abdominal distention for one month, black-coloured stools for one month, and a two-month history of weight loss. Abdominal Computed Tomography (CT) scans for both patients revealed multiple ill-defined solid lesions with necrotic foci in the liver in the former case, and multiple heterogeneously enhancing lesions with a few calcific foci and haemorrhages in the liver in the latter patient, consistent with HCC and tumoural thrombus extending from the hepatic vein into the Right Atrium (RA) via the Inferior Vena Cava (IVC). HCC with TT spreading into the RA is a serious and challenging condition with a poor prognosis. Early detection and aggressive treatment are critical, but they are typically insufficient to prevent rapid disease progression and high mortality.

Abstract This study aims to reach a sustainable solution for waste management of medical plastics through value-added product extraction. It uses the DOE technique to examine the effect of natural zeolite and synthetic Al2O3 and SiO2 as catalysts. A small lab-scale pyrolysis setup was used for medical plastic waste management treatment. Pyrolysis of medical plastics with temperature range (350–450 °C), three catalysts, and wt.% are examined. This process is designed for 3 factors and 3 levels, such as type of catalyst, catalyst wt.%, and temperature, to create an L9 orthogonal array. At the same time, the heating rate and residence time are maintained constant at 5 °C/min and 75 minutes, respectively. Furthermore, this study analyzed the input variables in catalytic pyrolysis using response surface methodology. As a result of the study, generating the regression equation for oil yield, F and P values assure the model is significant. Optimization result shows the type of catalyst, temperature, and catalyst concentration values are found as aluminum oxide, 376 °C, and 6.6 wt.%, respectively. HDPE and LDPE oil yield a value of 58.3648 and 61.2051 wt%, respectively, under the optimum variables condition. For oil yield prediction, HDPE and LDPE’s correlation coefficient (R2) were 0.9949 and 0.9943, respectively. Authentication of the model response using a regression equation validated with the experimental result shows good agreement. The produced medical plastic oil has a density, viscosity, flash & fire point, carbon residue, and cetane number 904 kg/m3, 2.3 cSt, 42 & 45 °C, 7.1 wt.% and 51 respectively. Finally, this study concludes that plastic oil extraction from medical waste through catalytic pyrolysis can be a potential source of alternative fuels in IC engines. Priority to optimization and low-cost catalysts highlights medical plastics waste management under the socio-economic model.

Abstract The Kochen–Specker (KS) theorem is a cornerstone result in quantum foundations, establishing that quantum correlations in Hilbert spaces of dimension d ≥ 3 cannot be explained by (consistent) hidden variable theories that assign a single deterministic outcome to each measurement. Specifically, there exist finite sets of vectors in these dimensions such that no non-contextual deterministic ({0, 1}) outcome assignment is possible obeying the rules of exclusivity and completeness—that the sum of assignments to every set of mutually orthogonal vectors be ≤1 and the sum of value assignments to any d mutually orthogonal vectors be equal to 1. Another central result in quantum foundations is Gleason’s theorem that justifies the Born rule as a mathematical consequence of the quantum formalism. The KS theorem can be seen as a consequence of Gleason’s theorem and the logical compactness theorem. In a similar vein, Gleason’s theorem also indicates the existence of KS-type finite vector constructions to rule out other finite-alphabet outcome assignments beyond the {0, 1} case. Here, we propose a generalisation of the KS theorem that rules out hidden variable theories with outcome assignments in the set {0, p, 1 − p, 1} for p ∈ [0, 1/d) ∪ (1/d, 1/2]. The case p = 1/2 is especially physically significant. We show that in this case the result rules out (consistent) hidden variable theories that are fundamentally binary, i.e., theories where each measurement has fundamentally at most two outcomes (in contrast to the single deterministic outcome per measurement ruled out by KS). We present a device-independent application of this generalised KS theorem by constructing a two-player non-local game for which a perfect quantum winning strategy exists (a Pseudo-telepathy game) while no perfect classical strategy exists even if the players are provided with additional no-signaling resources of PR-box type (with marginals in {0, 1/2, 1}).

Fahr's disease is a rare neurological disorder which is characterized by the presence of abnormal, symmetrical, and bilateral calcifications within the basal ganglia and other cerebral areas. Seizures are 1 of the symptoms that may aid in its diagnosis. Fahr's disease is diagnosed in adults mostly. In this account, we describe the case of a male in his late 20s who was diagnosed with Fahr's disease. The patient experienced multiple seizures and severe headaches for the past 5 months. His medical history was not significant. Upon his admission to the emergency department, imaging studies (Computed Tomography and Magnetic Resonance Imaging) revealed the presence of bilateral and symmetrical calcifications situated within the bilateral corona radiata, bilateral centrum semiovale, bilateral gangliocapsular region, bilateral thalamus and bilateral dentate nucleus. Laboratory investigations ruled out alternative causes for secondary intracranial calcification. Moreover, the patient had no significant familial history. Considering the clinical, biological, and radiological evaluations, the diagnosis was concluded to align with a sporadic form of Fahr's disease.Although seizures are less common symptoms associated with Fahr's disease, the identification of bilateral and symmetrical calcifications in the basal ganglia and other regions on radiological imaging in a patient presenting with seizures should warrant consideration of this neurologic disorder, following the exclusion of other potential causes of intracranial calcification.

Introduction: Intolerance frequently limits the use of intragastric balloons (IGBs) in the treatment of obesity. This includes refractory nausea, vomiting and abdominal discomfort. Our study aims to identify predictors of balloon intolerance and early removal, which will help to guide patient selection for this intervention and peri-procedure care. Method: We conducted a retrospective cohort study of 54 consecutive patients who underwent IGB insertion from July 2017 to July 2022 in a single tertiary institution in Singapore. Forty-seven (87.0%) patients completed therapy, while 7 patients (13.0%) had early removal of the balloon due to intolerance. Characteristics of both groups were compared. Results: Multivariate analysis revealed significant associations between early balloon removal and both depression (P=0.012) and anxiety (P=0.001) after adjusting for age, sex, ethnicity, height, nulliparity, balloon type and volume. Univariate analysis revealed that anxiety was the main risk factor (P=0.004, odds ratio 9.111, 95% confidence interval 1.624–51.124), while depression was no longer a significant predictor. Conclusion: Identifying predictors of balloon intolerance and early removal can enhance patient selection and improve peri-procedural care. In patients with a history of depression or anxiety, it is important to ensure adequate counselling and preparation prior to balloon insertion.

The growth of cities is very fast and is often very difficult for urban development. Pedestrian dynamics in this context are very important when designing a facility in terms of the safety, economics, and level of service to its users. The present study focuses on analysing the effect of density and width of a bottleneck on the behaviour of a crowd under emergency conditions. The inclusion of a buffer space for the dispersion of a crowd through a bottleneck is analysed. A relationship is established between total times, the flow and, a specific flow versus the width of a bottleneck. The formation of a dynamic layer was observed during capacity conditions due to the zipper effect. Among the five types of distributions, a semi-random distribution was the better fit for the headway data observed. It was observed that capacity increases in a stepwise manner as the width of a bottleneck increases, which can be attributed to the formation of dynamic lanes. The distance between these lanes is independent of the width of the bottleneck.

Regarding a simple graph $ \Gamma $ possessing $ \nu $ vertices ($ \nu $-vertex graph) and $ m $ edges, the vertex-weight and weight of an edge $ e = uv $ are defined as $ w(v_{i}) = d_{ \Gamma}(v_{i}) $ and $ w(e) = d_{ \Gamma}(u)+d_{ \Gamma}(v)-2 $, where $ d_{ \Gamma}(v) $ is the degree of $ v $. This paper puts forward a novel graphical matrix named the edge-weighted adjacency matrix (adjacency of the vertices) $ A_{w}(\Gamma) $ of a graph $ \Gamma $ and is defined in such a way that, for any $ v_{i} $ that is adjacent to $ v_{j} $, its $ (i, j) $-entry equals $ w(e) = d_{ \Gamma}(v_{i})+d_{ \Gamma}(v_{j})-2 $; otherwise, it equals 0. The eigenvalues $ \lambda_{1}^{w}\ge \lambda_{2}^{w}\ge\ldots\ge \lambda_{\nu}^{w} $ of $ A_w $ are called the edge-weighted eigenvalues of $ \Gamma $. We investigate the mathematical properties of $ A_{w}(\Gamma) $'s spectral radius $ \lambda_{1}^{w} $ and energy $ E_{w}(\Gamma) = \sum_{i = 1}^{\nu}|\lambda_{i}^{w}| $. Sharp lower and upper bounds are obtained for $ \lambda_{1}^{w} $ and $ E_{w}(\Gamma) $, and the respective extremal graphs are characterized. Further, we employ these spectral descriptors in structure-property modeling of the physicochemical properties of polycyclic aromatic hydrocarbons for a set of benzenoid hydrocarbons (BHs). Detailed regression analysis showcases that edge-weighted energy outperforms classical adjacency energy in structure-property modeling of the physicochemical properties of BHs.

Abstract Topological materials confined in 1D can transform computing technologies, such as 1D topological semimetals for nanoscale interconnects and 1D topological superconductors for fault-tolerant quantum computing. As such, understanding crystallization of 1D-confined topological materials is critical. Here, we demonstrate 1D template-assisted nanowire synthesis where we observe diameter-dependent phase selectivity for tungsten phosphides. A phase bifurcation occurs to produce tungsten monophosphide and tungsten diphosphide at the cross-over nanowire diameter regime of 35–70 nm. Four-dimensional scanning transmission electron microscopy is used to identify the two phases and to map crystallographic orientations of grains at a few nm resolution. The 1D-confined phase selectivity is attributed to the minimization of the total surface energy, which depends on the nanowire diameter and chemical potentials of precursors. Theoretical calculations are carried out to construct the diameter-dependent phase diagram, which agrees with experimental observations. Our findings suggest a crystallization route to stabilize topological materials confined in 1D.

We show that a quantum correlation p is in a face of the nonsignaling polytope with no local points if and only if p has nonlocal content 1, if and only if p allows for a Greenberger-Horne-Zeilinger-like proof, and if and only if p provides a perfect strategy for a nonlocal game. That is, face nonsignaling (FNS) correlations, full nonlocality (FN), all-versus-nothing (AVN) proofs, and pseudotelepathy (PT) are equivalent. This shows that different resources behind a wide variety of fundamental results are in fact the same resource. We demonstrate that quantum correlations with FNS = FN = AVN = PT do not need to maximally violate a tight Bell inequality. We introduce a method for identifying quantum FNS = FN = AVN = PT correlations and use it to prove quantum mechanics does not allow for FNS = FN = AVN = PT neither in the (3,3;3,2) nor in the (3,2;3,4) Bell scenarios. This solves an open problem that, because of the FNS = FN = AVN = PT equivalence, has implications in several fields.

Introduction: While detecting active TB is central to public health efforts, modelling indicates that reducing latent TB through preventive therapy is crucial. Current regimens mitigate risk but are lengthy and have side effects, necessitating support for uninterrupted treatment. This paper presents the development and evaluation of a digital health platform designed to enhance adherence among LTBI patients. Methods: A Quasi-experimental study was conducted among LTBI patients in Delhi. A total of 163 participants were allocated to intervention (n=82) and control (n=81) groups. Participants were followed up for 6 months post recruitment. Effectiveness of mobile application was evaluated through quantitative tools. Results: Intervention group participants showed slightly higher treatment completion rates (65.91%), in comparison to participants in control group (63%). The analysis demonstrated no co-relation of gender, age, education and employment with treatment completion rates in intervention group. While text and video-based interventions have shown success, there remains a need for more user-centric digital health interventions in this area, given the limited number of studies to date. Conclusion: The mobile health applications can be useful for LTBI care. However, there is a need of involving users during development so that continued interest of users can be ensured.

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

This study experimentally investigates the inclined solar still (ISS) with the incorporation of fins and natural bio-jute cloth under dynamic flow. Experiments are conducted on bright sunny summer days in Coimbatore, Tamil Nadu, India. The newly developed ISS features greatly support passive solar desalination. An increase in mass flow rate (Mf) increases heat transfer meticulously pointing out 0.65, 0.8, and 1 kg/min case absorber, and the water temperature difference is within 3°C. An Mf of 0.285 kg/min is secure for the maximum water temperature reach and clean water yield of 70°C and 4.1 kg/m2, respectively, along with jute cloth, it was 1.6 kg/m2 more against without jute cloth. The presence of a jute cloth cumulative water yield of 2.5 kg/m2 at 0.635 kg/min is very close to the absence of a wick cumulative yield of 2.3 kg/m2 during 0.285 kg/min. From these results, the authors conclude higher Mf is feasible to increase the still performance and clean water yield. The implementation of a fully renewable passive solar still is strongly recommended to attain renewable and sustainable desalination. HIGHLIGHTS The proposed modification of the still and wick substantially increases the water yield and reinforces the passive solar still desalination.; The presence of jute cloth has multiple benefits, such as porosity, and the height of the capillary effect enhance the evaporative rate by effective contact-making to absorber fin–wick–water.; A higher mass flow rate makes it possible to increase the still performance and clean water yield.;

Abstract Background POR or POI poses a significant challenge to fertility treatment with different ovarian stimulation strategies. Intra-ovarian injection of platelet-rich plasma (PRP) has been hypothesised to improve ovarian reserve and pregnancies in POI or POR. However, its effectiveness on pregnancy, embryology and ovarian reserve outcomes need to be established. Therefore, we systematically searched databases based on PRISMA guidelines that reported on the effects of intra-ovarian autologous PRP injections in sub-fertile women with POI and POR. The following outcome effects were analysed by random model and included in the meta-analysis in pre- and post-PRP injection groups of POI & POR: (a) pregnancy rates, rate of oocyte & embryo formation (b) ovarian reserve markers (Antral follicular count, Anti-Mullerian Hormone, Follicle Stimulating Hormone). A separate analysis of pregnancies, AFC and AMH was done in POI and POR groups and in age groups 35 years. A total of 12 studies were included. The estimated overall effects size of the log odds ratio (log OR = 2.03; 95% CI = 0.13 to 3.92; P = 0.04; I2 = 0.42) favoured post-PRP with a moderate level of evidence. There are no significant differences in POI/POR and those with 35 years. The pooled standard difference of means favoured the post-PRP injection group significantly with regards to rates of embryo formation (1.39; 95% CI = 0.56 to 2.21; P = 0.02; I2 = 46%.), Oocyte (0.84; 95% CI = -1.3 to 3.0; P = 0.24; I 2 93%), Antral follicle count (1.78; 95% CI = 0.73 to 2.84; P = 0.01. I2 = 97%) with a low level of evidence and Anti-Mullerian Hormone (1.11; 95% CI = 0.16 to 2.05; P = 0.03; I2 = 96%) with low level of evidence. Conclusion Our study shows that intraovarian PRP injection was associated with no significant increase in the rates of pregnancy, in the rates of pregnancy, oocyte, embryo formation, Anti-Mullerian Hormone and antral follicle count. Live birth rates were not calculated. There was no statistical difference between POR/POI and those with 35 years. Further randomized studies are warranted to confirm our findings.

Abstract Protected surface states arising from non-trivial bandstructure topology in semimetals can potentially enable advanced device functionalities in compute, memory, interconnect, sensing, and communication. This necessitates a fundamental understanding of surface-state transport in nanoscale topological semimetals. Here, we investigate quantum transport in a prototypical topological semimetal NbAs to evaluate the potential of this class of materials for beyond-Cu interconnects in highly-scaled integrated circuits. Using density functional theory (DFT) coupled with non-equilibrium Green’s function (NEGF) calculations, we show that the resistance-area R A product in NbAs films decreases with decreasing thickness at the nanometer scale, in contrast to a nearly constant R A product in ideal Cu films. This anomalous scaling originates from the disproportionately large number of surface conduction states which dominate the ballistic conductance by up to 70% in NbAs thin films. We also show that this favorable R A scaling persists even in the presence of surface defects, in contrast to R A sharply increasing with reducing thickness for films of conventional metals, such as Cu, in the presence of surface defects. These results underscore the potential of topological semimetals as future back-end-of-line (BEOL) interconnect metals.

Abstract Luminescence constitutes a unique source of insight into hot carrier processes in metals, including those in plasmonic nanostructures used for sensing and energy applications. However, being weak in nature, metal luminescence remains poorly understood, its microscopic origin strongly debated, and its potential for unraveling nanoscale carrier dynamics largely unexploited. Here, we reveal quantum-mechanical effects in the luminescence emanating from thin monocrystalline gold flakes. Specifically, we present experimental evidence, supported by first-principles simulations, to demonstrate its photoluminescence origin (i.e., radiative emission from electron/hole recombination) when exciting in the interband regime. Our model allows us to identify changes to the measured gold luminescence due to quantum-mechanical effects as the gold film thickness is reduced. Excitingly, such effects are observable in the luminescence signal from flakes up to 40 nm in thickness, associated with the out-of-plane discreteness of the electronic band structure near the Fermi level. We qualitatively reproduce the observations with first-principles modeling, thus establishing a unified description of luminescence in gold monocrystalline flakes and enabling its widespread application as a probe of carrier dynamics and light-matter interactions in this material. Our study paves the way for future explorations of hot carriers and charge-transfer dynamics in a multitude of material systems.

High performing hemodialyzers membranes such as high flux membranes, high cut-off membranes and medium cut-off membranes are always at research interest due to their better efficiency than conventional membranes. These membranes provide greater toxin clearance, however retention of essential solutes in a preferable way are still under study. This paper aims at the design of high performing membrane to study the role of its parameters in solute removal and its capability of holding back important molecules. One of the most effective design of experiments (DOE) tool, namely Taguchi Algorithm was used for the formation of fractional factorial design of parameters. The simulation results were benchmarked with that of experimental data from literature and with manufacturers data sheets. Once the benchmarking was done, the error quantification and significance of each design were analysed using statistical method, Analysis of Variance (ANOVA) testing. The most relevant parameters that helped in better clearance in these membranes were thus identified and substantial conclusions were drawn which can be used in the future for designing optimal dialyzer designs. Results shows that clinically used dialyzer membranes such as RevaclearMax and FxCorDiax series on modelling using COMSOL Multiphysics with a blood flow rate of 400 ml/min and dialysate flow of 500 ml/min showed better urea clearance rate of above 300 indicating that the membranes thus designed was superior to the conventional high flux membranes that have a clearance rate of 297 of less for the exact same functional, geometrical, and parametric conditions. The model replication and thus validation of the design helped in understanding the influence of various parameters in toxin clearance. These parameters can be further investigated, and optimal models can be delivered with more of clinical examinations and trials.

Background: T2DM is a common metabolic disease with enormous effects on health worldwide; moreover, the use of phytochemicals as therapeutic compounds has drawn increasing attention. Therefore, the objective of this study was to assess the effectiveness of these phytochemicals in combating diabetes through a comprehensive evaluation of their interactions with biological networks through network pharmacology, molecular docking, and molecular dynamics simulations. Objectives: The first goal of this study was to search and screen potential phytochemicals for binding with key proteins involved in T2DM, with special emphasis on AKT1 kinase, an integral component of the insulin signaling pathway. Methods: Network pharmacology analysis was carried out, and the interaction network of targets associated with T2DM was generated using KEGG, STRING and Cytoscape 3.9.1 software's. To determine the specific metabolic processes, cellular compartments, and molecular functions involved in T2DM, we performed Gene Ontology and KEGG analyses. An initial and short molecular docking study was conducted to analyze the binding modes, while the molecular dynamics simulations provided insights into the binding energy and stability of phytochemicals at target sites, with emphasis on rutin engaged with AKT1. Results: In total, 10 hub genes were proposed to be involved in T2DM and can be considered candidate therapeutic targets, namely MTOR, CASP3, CCND1, TNF, MMP9, ALB, MDM2, AKT1, and HSP90AA1. Rutin was found to have the highest binding score for AKT1 in docking studies, while MD simulations identified the structural stability and persistence of the compound's activity at the target enzyme loci. Conclusions: This study identified rutin and flavonoids as potential anti-diabetes phytochemicals. Based on these observations, an opportunity for other in vitro experiments and additional in vivo studies to confirm these buildings as multi-target drugs in T2DM patients is provided.

Background: The complexity of the subject content, and its 3D orientation in anatomy makes students difficult to learn, assimilate, and recapitulate the topics. There is a need for innovative teaching methods in anatomy for better understanding of the subject and improved performance of students. In this context, an attempt is made to use concept maps as a tool for learning anatomy. Material and methods: After obtaining ethical committee approval and informed consent, 128 first-term MBBS students were divided into 2 groups, 64 in the study and the control group. After the lecture on each topic from anatomy (radial nerve, median nerve, and ulnar nerve), a pre-test was conducted on 128 MBBS students. Post-test multiple-choice questions-based assessment was conducted for both groups after 1 week of each lecture. Difference in knowledge by comparing the assessment scores of the study group and control group. A feedback form with a 5-point Likert scale was administered to all students at the end of 3 sessions. Mann–Whitney U-test and Wilcoxon signed-rank test were applied to check the significance (p≤.01) of the results. Results: There was a statistically significant difference between the 2 groups during the pre-test for cognition, and total scores and the post-test for recall, cognition, and total scores. 98% of students perceived that the concept map-based approach helped better retain the topic. Conclusions: Concept maps promote comprehensive learning and applying knowledge in new situations. From this study, we recommend that concept mapping can be a pedagogical tool in Anatomy. Resumen: Antecedentes: La complejidad del contenido de la asignatura y su orientación 3D en Anatomía dificulta que los estudiantes aprendan, asimilen y recapitulen los temas. Existe la necesidad de métodos de enseñanza innovadores en Anatomía para una mejor comprensión de la materia y un mejor rendimiento de los estudiantes. En este contexto, se intenta utilizar los mapas conceptuales como herramienta para el aprendizaje de Anatomía. Material y métodos: Después de obtener la aprobación del comité ético y el consentimiento informado, 128 estudiantes de primer semestre de MBBS se dividieron en 2 grupos, 64 en el estudio y el grupo control. Después de la conferencia sobre cada tema de Anatomía (nervio radial, nervio mediano y nervio cubital), se realizó una prueba previa a 128 estudiantes de MBBS. Se realizó una evaluación posterior a la prueba basada en MCQ para ambos grupos después de una semana de cada conferencia. Diferencia en el conocimiento al comparar las puntuaciones de evaluación entre el grupo de estudio y el grupo de control. Se administró a todos los estudiantes un formulario de retroalimentación con una escala Likert de cinco puntos al final de 3 sesiones. Se aplicaron la prueba U de Mann Whitney y la prueba de rangos con signo de Wilcoxon para comprobar la significancia (p ≤ 0,01) de los resultados. Resultados: Hubo una diferencia estadísticamente significativa entre los dos grupos durante la prueba previa de cognición y puntuaciones totales y la prueba posterior de memoria, cognición y puntuaciones totales. El 98% de los estudiantes percibió que el enfoque basado en mapas conceptuales ayudó a retener mejor el tema. Conclusiones: Los mapas conceptuales promueven el aprendizaje integral y la aplicación del conocimiento en situaciones nuevas. A partir de este estudio, recomendamos que los mapas conceptuales pueden ser una herramienta pedagógica en Anatomía.

Background: Mental health, when compared to physical health and wellbeing, is the most neglected area. The health status of the tribal population is in pitiable condition and is heavily influenced by its socio-cultural factors and poor health care delivery system. The study aimed to assess the knowledge, attitude, mental help seeking intention for common mental health problems and factors associated with the study variables among the tribal population. Method: ology: House-to-house survey was done between January to April 2022. Data was collected using standardized tools like Mental Health Knowledge Questionnaire (MHKQ), Community Attitude towards Mentally Ill scale (CAMIS), and Mental Help Seeking Intention scale (MHSIS). Results: Only six participants out of 400 reported that they are aware of someone in their community suffering from mental health problems. The majority (80 %) of the participants had fairly good knowledge regarding mental health, and 68 % of them had a favorable attitude towards mentally ill. It was also found that 79.2 % of the participants hold favorable attitude with an OR = 1.40 (0.50,3.90) suggesting that there is a statistically difference in the odds of favorable attitude being present among illiterate people (p = 0.003). When comparing the odds ratio between the groups, keeping females as reference for comparison, it is evident that males OR = 0.44 (0.21,0.94) are less likely to have good knowledge. Moderately strong (statistically significant at p = .05) relationship was seen between the subscales of attitude towards mentally ill and knowledge regarding mental health among the Koraga population. Conclusion: It has been found that awareness regarding common mental disorders is increasing among the tribals, but it is not accompanied by a favorable attitude. The study concluded that interventional research is needed to reduce the stigma and the treatment gap in mental illness.

Renewable lignocellulosic biomass is a favorable energy resource since its co-pyrolysis with hydrogen-rich plastics can produce high-yield and high-quality biofuel. In contrast to earlier co-pyrolysis research that concentrated on increasing product yield, this study comprehends the synergistic effects of two distinct feedstocks that were not considered earlier. This work focuses on co-pyrolyzing wheat straw (WS) with non-reusable polyethylene terephthalate (PET) for the production of pyrolysis oil. WS and PET were blended in different ratios (100/0, 80/20, 60/40, 40/60, 20/80, and 0/100), and pyrolysis experiments were conducted in a fixed-bed reactor under different temperatures to assess their synergistic effect on oil yield. Synergy rates of up to 7.78 % were achieved on yield for the blends of plastic and biomass at a temperature of 500 °C. In comparison to individual biomass or plastics, co-pyrolyzing PET-biomass blends demonstrated good process interaction and promoted the yields of value-added products. The heating value of the pyrolysis oils was in the range of 16.45–28.64 MJ/kg, which depends on the amount of plastic present in the feedstock. The physical analysis of the oils shows that they can be used for heat production by direct combustion in boilers or furnaces. The correlation between WS and PET was validated with the aid of Fourier transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry (GC-MS) analysis. The GC-MS result demonstrated the presence of different compounds such as O-H compounds, esters, carbonyl group elements, acids, hydrocarbons, aromatics, and nitrogenated compounds in the pyrolysis oil, which differed based on the proportions of PET in the feedstock. The increased hydrocarbon and reduced oxygen percentages in the pyrolysis oil were implicitly caused by enhanced hydrocarbon pool mechanisms, in which the breakdown of PET may be supplied as a hydrogen donor. Overall, waste lignocellulosic biomass and plastics can be used to produce biofuels, which helps reduce the amount of solid waste that ends up in landfills. This study also revealed that future research should be focused on the reaction mechanisms of WS and PET co-pyrolysis in order to examine the synergistic interactions.

ABSTRACT The global increase in the aging population has raised concerns over various age-related conditions like dementia and mild cognitive impairment (MCI) and their consequences on the affected persons. People with MCI exhibit cognitive deficits more significantly than expected for their age and literacy level. Though the nature of this condition is considered "mild", studies have reported that even more subtle deficits can influence the quality of life (QOL). Objective: The present work aimed at exploring and comparing QOL in older adults with and without MCI through a systematic review and meta-analysis. Methods: After a detailed search of articles till May 2021 in the relevant electronic databases (PubMed Central, PubMed, Scopus, CINAHL Plus, Web of Science, ProQuest, and Cochrane) using the keywords "mild cognitive impairment", "quality of life", "old", "old aged", "aged", "older adult", "geriatrics", "healthy controls", "healthy participants", and "normal controls", we included 23 articles in the systematic review and 12 in the meta-analysis. Results: The quality of all the included articles were assessed using the Modified Downs and Black tool. Most of the studies in the systematic review demonstrated differences in QOL scores in older adults with MCI compared to healthy older adults. However, meta-analysis findings suggest that older adults with MCI had statistically non-significant yet lower differences in QOL compared to their healthy counterparts. Conclusion: Future research should focus on developing QOL assessment tools specifically for older adults with MCI and follow-up studies that could provide better knowledge of their changing cognitive profile and life quality.

Background: This study provides us an opportunity to discuss about the development of a smartphone enabled Home based Self-management application for Chronic Obstructive Pulmonary Disease. Objective: To summarize the baseline characteristics of the Chronic Obstructive Pulmonary Disease patients recruited in present study. Methods: A single centered prospective non-randomized study has been conducted to implement the self-management application among 166 patients. Patients were matched based on gender and Global Initiative for Obstructive Lung Disease criteria. Smartphone application was provided to the intervention group and instructions were given to them. Results: The mean age of participants was 58.02 years in which more than half were male, more than 80% were married, almost one-third were educated up to class 10th, more than 65% have disease duration between 3 to 8 years, equally distributed for Grade 2 and 3 and two third were ex-smokers. The St. George's Respiratory Questionnaire score was 40.20 and 39.74, Clinical COPD Questionnaire score was 3.89 and 3.86, COPD Assessment Test score was 23.65 and 22.74 in intervention and control group respectively. There is no statistically significant difference between the group. Conclusion: The findings of present study provide a vital context for the follow-up results of the evaluation study.

Abstract Background Saraca asoca (Asoka) is reported to possess phytoestrogenic components with anticancer properties. The phytoestrogens are recognized as natural agonists for ERβ, which acts as an antagonist to ERα. Despite the absence of ERα, studies have identified ERβ in 50–80% of triple negative breast cancers (TNBC). Thus, the present study is intended to reveal the role of phytoestrogens of Asoka on TNBC. The cytotoxic effect of Asoka methanol bark extract was analyzed on different breast cancer cell lines by MTT assay. Estrogen-screen assay was employed to determine the proliferative/antiproliferative effect. Identification of phytoestrogens in Asoka was accomplished using LC-MS analysis and in silico docking studies were performed to investigate possible interactions of phytoestrogens with ERα and β. Results The extract of Asoka was found to be cytotoxic against TNBC cell line, MDAMB-231 with IC50 of 70.22 ± 1.89 μg/mL and towards HER+ breast cancer cell line, SKBR3 with IC50 of 98.41 ± 2.31 μg/mL, respectively. Whereas the extract did not show any cytotoxicity towards ERα cell line, MCF-7 even up to the concentration 300 μg/mL. Estrogen-screen assay emphasized an estrogenic effect of the extract on MCF-7 and an anti-estrogenic/antiproliferative effect on MDAMB-231 cells. LC–MS analysis identified phytoestrogens such as β-sitosterol, quercetin, kaempferol and others. The docking results revealed good binding efficacy of phytoestrogens with ERβ than ERα and quercetin shows more affinity with the highest docking score of − 9.220. Strikingly, it was found that the S. asoca methanol extract was preferentially cytotoxic to TNBC cells. Conclusion The study demonstrates selective anticancer properties of S. asoca methanol extract on TNBC, which indicates a selective impact on ER subtypes. The identification of phytoestrogens, such as β-sitosterol, quercetin and kaempferol, in the Asoka methanol bark extract provides a molecular basis for its observed effects. In silico studies further support the view that these phytoestrogens may preferentially interact with ERβ rather than ERα. Quercetin, in particular, demonstrated the highest binding efficacy with ERβ, suggesting its potential role in mediating the anticancer effects observed in TNBC cells. Further research is warranted to explore the full therapeutic potential of phytoestrogens in breast cancer treatment.

Uterine perforation is a major but rare complication of surgical abortion, with some of the dreaded complications being bowel herniation, strangulation, gangrene, and sepsis. With the legalisation of medical termination of pregnancy, such life-threatening complications have become a rarity in recent times. Usually, the patient presents with lower abdominal pain, and a history of surgical abortion may not being forthcoming at most of the time. A high index of suspicion should be kept while imaging the patient in an emergency setting, since early diagnosis is key to survival, especially if an unsafe abortion has been performed. Hereby, the authors present a case of a 30-year-old female patient presenting with non specific complaints of abdominal pain. Upon vaginal examination, a structure protruding out of the internal os (admitting the tip of a finger) was noted, and a boggy mass was felt in the pouch of Douglas. Ultrasonography and Contrast-enhanced Computed Tomography scan (CECT) performed in an emergency setting revealed uterine rupture with a rent, intra-abdominal foetal extrusion, and bowel loop herniation through the vagina. A delayed CT scan provided additional information about right ureteral injury, which was helpful in proper urological preoperative planning. In conclusion, ultrasonography and CECT imaging are useful in cases with lower abdominal pain having recent history of abortion to rule out uterine perforation and other obvious and occult associated complications for proper patient management.

Person identification using ear images has gained significant attention recently. Transfer learning provides an effective platform for image classification, utilizing CNNs like AlexNet, ResNet, VGG16, and VGG19, which are fine-tuned for specific applications. Combining transfer learning with support vector machines (SVM) enhances people recognition via ear images. This paper integrates a hybrid transfer learning model with an ensemble technique to improve recognition accuracy. We use pre-trained CNN models, VGG16 and VGG19, for feature extraction and replace the fully connected layer with an SVM classifier. Using the SoftMax activation function, each model generates a probabilistic output, which is averaged for classification. The proposed ensemble model was validated on two datasets with variations in pose, illumination, and rotation. Simulation results show that the ensemble-based transfer learning approach outperforms its two anchor models and competes with state-of-the-art ear recognition techniques.

Abstract Spintronics in halide perovskites has drawn significant attention in recent years, due to their highly tunable spin-orbit fields and intriguing interplay with lattice symmetry. Here, we perform first-principles calculations to determine the spin relaxation time (T 1) and ensemble spin dephasing time ( $${T}_{2}^{*}$$ T 2 * ) in a prototype halide perovskite, CsPbBr3. To accurately capture spin dephasing in external magnetic fields we determine the Landé g-factor from first principles and take it into account in our calculations. These allow us to predict intrinsic spin lifetimes as an upper bound for experiments, identify the dominant spin relaxation pathways, and evaluate the dependence on temperature, external fields, carrier density, and impurities. We find that the Fröhlich interaction that dominates carrier relaxation contributes negligibly to spin relaxation, consistent with the spin-conserving nature of this interaction. Our theoretical approach may lead to new strategies to optimize spin and carrier transport properties.

Background/Aim: Paragangliomas are rare neuroendocrine tumours arising from paraganglia of the autonomic nervous system. Computed to-mography (CT) imaging plays a crucial role in the evaluation and character-isation of neck paragangliomas. This retrospective study aimed to analyse the CT imaging features of neck paragangliomas to enhance diagnostic accuracy and delineate the radiological characteristics associated with these tumours. Methods: A retrospective review of CT imaging studies of patients diagnosed with neck paragangliomas from March 2021 to October 2023 was conducted. Imaging characteristics including tumour location, size, enhancement pattern, vascularity, calcifications, adjacent tissue involvement and relationship with surrounding structures were analysed. Results: A total of 87 patients with histologically confirmed neck paragangliomas were included in the study. CT imaging revealed typical findings of neck paragangliomas ie well-defined hyper-vascular masses with avid contrast enhancement, commonly located at the carotid bifurcation or along the carotid sheath. In addition, characteristic flow voids and the presence of feeding vessels were observed on CT angiography in a significant number of cases. The imaging analysis also identified calcifications and encasement of adjacent structures as frequent features of advanced stage paragangliomas. Conclusions: CT imaging of neck paragangliomas demonstrated consistent radiological features, including hypervascularity, contrast enhancement and distinct anatomic locations. Knowledge of these imaging characteristics is essential for accurate diagnosis and preoperative planning. Recognition of these features on CT imaging can aid in differentiating paragangliomas from other neck masses and facilitate appropriate management strategies.

The selection of a sustainable packaging circular model approach entails numerous obstacles under rapidly developing circumstances, such as environmental factors, market competition, and advancing technology, impacting decision-making processes. We have considered Z-number-based decision-making methods as an alternative to the conventional method. This study presents a selection of circular sustainable packaging models, considering significant challenges from five primary objectives: economic, environmental, social responsibility, sustainability, and time-based, with three circular models: biodegradable, compostable, and recycling. The ZF-DEMATEL-TOPSIS method is used in an integrated manner to address the packaging circular model selection problem. The study results indicate that the mass-customized recyclable packaging circular model is the most highly sustainable among the three models. At the same time, the most significant challenges are production cost, energy efficiency, and makespan. The proposed method was validated using the sensitivity analysis with an 90% consistency ratio. We conducted this study to aid in analyzing and developing a highly sustainable mass-customized circular packaging model.

Investigations of the boundary of the quantum correlation set have gained increased attention in recent years. This is done through the derivation of quantum Bell inequalities, which are related to Tsirelson's problem and have significant applications in device-independent (DI) information processing. However, determining quantum Bell inequalities is a notoriously difficult task and only isolated examples are known. In this paper, we present families of (almost-)quantum Bell inequalities and highlight four foundational and DI applications. Firstly, it is known that quantum correlations on the non-signaling boundary are of crucial importance in the task of DI randomness extraction from weak sources. In the practical Bell scenario of two players with two $k$-outcome measurements, we derive quantum Bell inequalities that demonstrate a separation between the quantum boundary and certain portions of the boundaries of the no-signaling polytope of dimension up to $4k-8$, extending previous results from nonlocality distillation and the collapse of communication complexity. Secondly as an immediate by-product, we give a general proof of Aumann’s Agreement theorem for quantum systems as well as the almost-quantum correlations, which implies Aumann’s agreement theorem is a reasonable physical principle in the context of epistemics to pick out both quantum theory and almost-quantum correlations from general no-signaling theories. Thirdly, we present a family of quantum Bell inequalities in the two players with $m$ binary measurements scenarios, that we prove serve to self-test the two-qubit singlet and the corresponding $2m$ measurements. Interestingly, this claim generalizes the result for $m=2$ discovered by Tsirelson-Landau-Masanes and shows an improvement over the state-of-the-art Device-Independent Randomness-Amplification (DIRA). Lastly, we use our quantum Bell inequalities to derive the general form of the principle of no advantage in nonlocal computation, which is an information-theoretic principle that serves to characterize the quantum correlation set.

A 62-year-old female presented to the Surgery Outpatient Department with a four-month history of a wound on the lateral aspect of her right thigh, with an underlying history of trauma a few days prior. She had suffered a flame burn injury 50 years ago. There was a progressive increase in the size of the wound over the past four months, with an associated pricking type of pain. The patient denied other symptoms such as fever or discharge. Local examination revealed a 14×12 cm solitary ulcer on the posterolateral aspect of the right thigh with irregular margins and rolled-out edges [Table/Fig-1]. The base was formed by muscle induration, associated with slough and an absence of any discharge or bleeding. Multiple wedge biopsies from the wound margins and base were performed, revealing moderately differentiated Squamous Cell Carcinoma (SCC).

Purpose: To determine normal anatomical variation of abdominal wall musculature.Methods: A retrospective analysis of CT scans was performed on adults (>18 years) with normal abdominal wall muscles. Two radiologists analysed the images independently. Distances from three fixed points in the midline were measured. The fixed points were; P1, mid-way between xiphoid and umbilicus, P2, at the umbilicus, and P3, mid-way between umbilicus and pubic symphysis. From these three fixed points the following measurements were recorded; midline to lateral innermost border of the abdominal wall musculature, midline to lateral edge of rectus abdominis muscle, and midline to medial edges of all three lateral abdominal wall muscles. To obtain aponeurotic width, rectus abdominis width was subtracted from the distance to medial edge of lateral abdominal wall muscle.Results: Fifty normal CT scan were evaluated from between March 2023 to August 2023. Mean width of external oblique aponeurosis at P1 was 16.2 mm (IQR 9.2 mm to 20.7 mm), at P2 was 23.5 mm (IQR 14 mm to 33 mm), and at P3 no external oblique muscle was visible. Mean width of the internal oblique aponeurosis at P1 was 32.1 mm (IQR 17.5 mm to 45 mm), at P2 was 10.13 (IQR 1 mm to 17.5 mm), and at P3 was 9.2 mm (IQR 3.0 mm to 13.7 mm). Mean width of the transversus abdominis aponeurosis at P1 was −25.1 mm (IQR 37.8 mm to −15.0 mm), at P2 was 29.4 mm (IQR 20 mm to 39.8 mm), and at P3 was 20.3 mm (IQR 12 mm to 29 mm).Conclusion: In this study we describe normal anatomical variation of the abdominal wall muscles. Assessing this variability on the pre-operative CT scans of ventral hernia patients allows for detailed operative planning and decision making.

The world population is expected to reach 9.8 billion by 2050 according to a report by the United Nations. The global demand for alternative proteins from different sources, such as microalgae, mycoproteins, insects, cell-based, cultured meat, meat substitutes, dairy alternatives, and fungi-based proteins, is projected to reach USD 290 billion by 2035. Due to their similar characteristics, offered at a relatively more affordable cost than animal proteins, alternative plant-based proteins are experiencing significant global demand. In recent years, industrial production of microalgal biomass has received attention due to its rich content of quality proteins, lipids, fatty acids, and pigments, whose products are of commercial interest in the field of food technology and engineering. Microalgae can be grown easily in open and closed systems for biomass and high-value products. Spirulina and Chlorella have the outstanding ability to accumulate protein and have already been used in meat substitutes, food products, feed, nutraceuticals, and pharmaceuticals. Here, we review the current literature, including new insights into the patent landscape about algal protein wholistically for its quality, culture conditions, recovery, and potential applications for food uses, and discuss its potential to find alternative protein sources for global needs.

The novel coronavirus disease 2019 (COVID-19) pandemic outbreak caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has garnered unprecedented global attention. It caused over 2.47 million deaths through various syndromes such as acute respiratory distress, hypercoagulability, and multiple organ failure. The viral invasion proceeds through the ACE2 receptor, expressed in multiple cell types, and in some patients caused serious damage to tissues, organs, immune cells, and the microbes that colonize the gastrointestinal tract (GIT). Some patients who survived the SARS-CoV-2 infection have developed months of persistent long-COVID-19 symptoms or post-acute sequelae of COVID-19 (PASC). Diagnosis of these patients has revealed multiple biological effects, none of which are mutually exclusive. However, the severity of COVID-19 also depends on numerous comorbidities such as obesity, age, diabetes, and hypertension and care must be taken with respect to other multiple morbidities, such as host immunity. Gut microbiota in relation to SARS-CoV-2 immunopathology is considered to evolve COVID-19 progression via mechanisms of biochemical metabolism, exacerbation of inflammation, intestinal mucosal secretion, cytokine storm, and immunity regulation. Therefore, modulation of gut microbiome equilibrium through food supplements and probiotics remains a hot topic of current research and debate. In this review, we discuss the biological complications of the physio-pathological effects of COVID-19 infection, GIT immune response, and therapeutic pharmacological strategies. We also summarize the therapeutic targets of probiotics, their limitations, and the efficacy of preclinical and clinical drugs to effectively inhibit the spread of SARS-CoV-2.

Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications.Aim The current study aims to study the efficacy and safety of long-term DAPT (up to 12 months) in patients with ICAD.Sample size Using 80% power and an alpha error of 5 %, presuming a 10%–15% drop-out rate, a total of 2200 patients will be recruited for the study.Methodology This is a prospective, randomised, double-blind, placebo controlled trial.Study outcomes The primary outcomes include recurrent ischaemic stroke (IS) or transient ischaemic attack and any intracranial haemorrhage (ICH), major or minor systemic bleeding at the end of 12 months. Secondary outcomes include composite of any stroke, myocardial infarction or death at the end of 12 months. The safety outcomes include any ICH, major or minor bleeding as defined using GUSTO (Global Use of Streptokinase and tPA for occluded Coronary Arteries) classification at the end of 12 months and 1 month after completion of the drug treatment phase.Discussion The study will provide level I evidence on the duration of DAPT among patients with IS due to ICAD of more than or equal to 50%.

Abstract Introduction Our simulation‐based mastery learning (SBML) curriculum, delivered in person, has been shown to successfully train novices in structured esophagogastroduodenoscopy (EGD). SBML with virtual coaching (VC) has the potential to improve the effectiveness and efficiency of endoscopy training and expand access to trainees from around the world. We share our observations conducting an EGD training course using SBML with VC. Methods We conducted a 1‐week virtual SBML course for novice trainees across seven academic centers in the USA and Asia. The cognitive component was delivered using an online learning platform. For technical skills, a virtual coach supervised hands‐on training and local coaches provided assistance when needed. At the end of training, an independent rater assessed simulation‐based performance using a validated assessment tool. We assessed the clinical performance of 30 EGDs using the ASGE Assessment of Competency in Endoscopy tool. We compared the trainees’ scores to our cohort trained using in‐person SBML training using non‐inferiority t‐tests. Results We enrolled 21 novice trainees (mean age: 30.8 ± 3.6 years; female: 52%). For tip deflection, the trainees reached the minimum passing standard after 31 ± 29 runs and mastery after 52 ± 37 runs. For structured EGD, the average score for the overall exam was 4.6 ± 0.6, similar to the in‐person cohort (4.7 ± 0.5, p = 0.49). The knowledge‐based assessment was also comparable (virtual coaching: 81.9 ± 0.1; direct coaching: 78.3 ± 0.1; p = 0.385). Over time, our novice trainees reached clinical competence at a similar rate to our historical in‐person control. Conclusions VC appears feasible and effective for training novice gastroenterology trainees. VC allowed us to scale our SBML course, expand access to experts, and administer SBML simultaneously across different sites at the highest standards.

The application of blockchain beyond cryptocurrencies has received increasing attention from industry and scholars alike. Given predicted looming food crises, some of the most impactful deployments of blockchains are likely to concern food supply chains. This study outlined how blockchain adoption can result in positive affordances in the food supply chain. Using Q- methodology, this study explored the current status of the agri-food supply chain and how blockchain technology could be useful in addressing existing challenges. This theorization leads to the proposition of the 3TIC value-driver framework for determining the enabling affordances of blockchain that would increase shared value for stakeholders. First, we propose a framework based on the most promising features of blockchain technology to overcome current challenges in the agri-food industry. Our value-driver framework is driven by the Q-study findings of respondents closely associated with the agri-food supply chain. This framework can provide supply chain stakeholders with a clear perception of blockchain affordances and serve as a guideline for utilizing appropriate features of technology that match organizations’ capabilities, core competencies, goals, and limitations. Therefore, it could assist top-level decision-makers in systematically evaluating parts of the organization to focus on and improve the infrastructure for successful blockchain implementation along the agri-food supply chain. We conclude by noting certain significant challenges that must be carefully addressed to successfully adopt blockchain technology.

Abstract The present study aims to improve the palatable water production from the hemispherical cover solar distiller (HSD). To augment the palatable water produced from the hemispherical cover, a black sponge was utilized as a porous medium using different thicknesses, which augments the interfacial evaporation through the capillary effect of the water through the sponge. The rate of condensation of the hemispherical cover depends on the higher interaction of air from the ambient through wind velocity as the exposure area of the hemispherical cover is relatively higher as compared to the other traditional distillers. The rate of evaporation from the distillers depends on the interfacial materials used in the distillation unit, and this is achieved by using a highly porous black sponge to attain a higher evaporation rate. The thickness of the black porous sponge was optimized (1 to 4 cm), which was the operating parameter for better interfacial evaporation through the sponge, and the same has been compared to the conventional HSD without a porous sponge medium. Results showed a significant improvement in the evaporation rate using a porous medium as the palatable water produced from the HSD was improved by 72.29% using 3 cm as sponge thickness inside compared to the conventional HSD without the porous medium. The cumulative palatable water produced from the HSD using 3 cm as sponge thickness was found as 7150 mL/m2, whereas the conventional HSD without sponge, it was found as 4150 mL/m2. Moreover, using a porous sponge layer as an interfacial evaporation medium, the exergy and energy efficiencies were improved by about 512.87 and 70.53%, respectively. Similarly, with the influence of a porous sponge as an interfacial evaporation medium, the distilled water cost decreased by 41.67% more than the conventional HSD.

Background: Dengue-induced thrombocytopenia can be life-threatening. However, supportive and symptomatic treatment is the current management protocol. The leaf extract of papaya has shown promising results in improving the platelet count. There are many varieties of Carica papaya such as Washington, Honeydew, Coorg honeydew, Solo, Surya, Red lady, C0-1, CO-3, CO-5, C0-6. Aims and Objectives: The aim is to evaluate the efficacy and safety of two varieties (“Red Lady” and “Solo”) of C. papaya fresh leaf extract in patients diagnosed with dengue-induced thrombocytopenia. Materials and Methods: The study was conducted for 2 months, and 18 dengue-confirmed inpatients with thrombocytopenia (platelet count

Abstract Background Hospitals account for approximately 6% of United States’ gross domestic product. We examined the association between hospital competition and outcomes in elderly with localized prostate cancer (PCa). We also assessed if race moderated this association. Methods Retrospective study using Surveillance, Epidemiology, and End Results (SEER) – Medicare database. Cohort included fee-for-service, African American and white men aged ≥ 66, diagnosed with localized PCa between 1998 and 2011 and their claims between 1997 and 2016. We used Hirschman-Herfindahl index (HHI) to measure of hospital competition. Outcomes were emergency room (ER) visits, hospitalizations, Medicare expenditure and mortality assessed in acute survivorship phase (two years post-PCa diagnosis), and long-term mortality. We used Generalized Linear Models for analyzing expenditure, Poisson models for ER visits and hospitalizations, and Cox models for mortality. We used propensity score to minimize bias. Results Among 253,176 patients, percent change in incident rate of ER visit was 17% higher for one unit increase in HHI (IRR: 1.17, 95% CI: 1.15–1.19). Incident rate of ER was 24% higher for whites and 48% higher for African Americans. For one unit increase in HHI, hazard of short-term all-cause mortality was 7% higher for whites and 11% lower for African Americans. The hazard of long-term all-cause mortality was 10% higher for whites and 13% higher for African Americans. Conclusions Lower hospital competition was associated with impaired outcomes of localized PCa care. Magnitude of impairment was higher for African Americans, compared to whites. Future research will explore process through which competition affects outcomes and racial disparity.

Background: Tobacco is one of the leading risk factors for many respiratory infections and is linked to the clinical severity of the disease. COVID-19 primarily infects the lungs and causes severe pneumonia-like illness. Tobacco consumption may thus, increase the risk for developing COVID-19. However, this study was planned to assess the tobacco consumption among COVID-19 patients and determine the relationship between SARS CoV-2 and tobacco use among COVID-19 patients.Methods: Lists of laboratory-confirmed COVID-19 positive patients aged 18-70 years were obtained from District Government Hospital on November 2020 and were interviewed telephonically after taking informed consent. A total of 470 patients under home isolation for the past one month after getting diagnosed with SARS CoV-2 were recruited in this study. Data was entered in MS Excel 2019 (Microsoft Corp.) and analysis was done using SPSS 25 (IBM Inc.). Chi-square and Fisher’s exact test were used and significance level was set 0.05 with 95% confidence interval.Results: In the present study, the mean (standard deviation) age of participants was 37.8 (12.1) years. Among the COVID-19 patients, 21% of participants were tobacco users. Clinical symptoms such as fever, severe acute respiratory illness (SARI), acute respiratory illness (ARI), loss of taste/smell, and other symptoms such as body-ache, myalgia, nasal secretion and flue like symptoms were presented; of which most common symptoms were fever (26.8%) followed by SARI or ARI (11.5%) and significantly presented more among tobacco users (66.3%) than non-tobacco users (55.6%) (P = 0.036). Nonetheless smokers, these symptoms also affected significantly SLT users (64.8%) (P = 0.029) and dual tobacco users (100%) (P = 0.010).Conclusion: Tobacco use may worsen COVID-19 disease symptoms among COVID-19 patients.

Introduction:Mandibular involvement in mucormycosis is rare, and only a few cases of post covid-19 mandibular mucormycosis have been reported to date. Materials & methods: This is a retrospective descriptive case series study conducted at a tertiary care centre.We report the clinico-epidemiological profile and management of 5 cases of post covid mandibular mucormycosis. All patients received intravenous antifungals at the earliest and underwent surgical debridement of the infected bone. Results: 4 patients were managed satisfactorily. 1 patient succumbed to the disease. Extent of debridement was based on the clinical, radiological and intraoperative assessment of the mandible. Conclusion: Mandibular mucormycosis is rare and early recognition of symptoms and treatment is imperative in reducing the spread of disease, decreasing the extent of resection and postoperative reconstruction.

Key Clinical Message We are reporting a case of hypothyroidism presenting as fissured tongue, demonstrating significant resolution of fissure tongue upon thyroid hormone replacement therapy.

Background Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances. Methods A search for RCT’s was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL. Results Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT’s studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = −0.50 [−0.87, −0.13], p = 0.008), wake after sleep onset (WASO) (SMD = −0.29 [−0.53, −0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = −0.09 (95% CI [−0.13 to −0.06]) mg/dL, p

Key Clinical Message Abdominal obesity is common in clinical practice. However, it is important to rule out other causes of abdominal distension. We are reporting a case of giant hydronephrosis misdiagnosed as abdominal obesity for a long time.

Background Magnesium has several actions on bronchial airways including relaxation of airway smooth muscle, bronchodilation, anticholinergic effects, and stabilization of mast cells. The present study aimed to measure the level of serum magnesium and assess the relationship of hypomagnesaemia with severity of asthma.

Introduction/Objectives: The fecal immunochemical test (FIT) helps triage primary care patients at risk of colorectal cancer (CRC). Improving FIT returns has received recent attention, however uncertainty exists regarding the accurate completion of samples provided for laboratory analysis. This study aims to identify the rejection rate of returned FIT samples and determine rejection causes. Methods: FIT samples from symptomatic patients within South Yorkshire, Bassetlaw, and North Derbyshire are processed at a central laboratory. Tests requests are made from 225 GP practices, which serve an estimated 2 million population. This study describes a retrospective review of FIT samples received in the central laboratory between 01/09/19 and 31/12/22. Locally held data was interrogated in March 2023 to determine the number of FIT samples received and rejected during the study period. Documented reasons for rejection were explored to identify common themes. Results: Total FIT specimens received during the study period was 126 422. Of these, 5190 (4.1%) were rejected. Monthly rejection rates fell from 17.4% in September 2019 to 1.3% in December 2022 ( P