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Mohammed Abdul Shafi, Mohamed Rimzy Mohamed Riza, Muhammed Shaan RiazFaculty of Medicine, St George’s Hospital Medical School, London, UKWe have read with great interest the article by Kumar et al,1 which correlates the performance of physician associates in a multiple mini-interview (MMI) to performances in objective structured clinical examinations (OSCEs). As senior medical students, we share many similarities with physician associate students as we were assessed through MMIs for entrance into medical school and are constantly assessed via OSCEs throughout our training. We would therefore like to share our perspective on the topic.Authors' responseWe thank Shafi et al for their interest in our recently published paper1 and for sharing their perspective as medical students who have gone through multiple mini-interview (MMI) and objective structured clinical examinations (OSCE). Having read their response in detail, we feel it warrants several clarifications.View the original paper by Kumar and colleagues.

Muhammed Shaan Riaz, Mohamed Rimzy Mohamed Riza, Mohammed Abdul ShafiFaculty of Medicine, St George’s Hospital Medical School, London, UKWe note with great interest the article by Aldosari et al,1 which investigated the learning style preferences of dental students at a single institution in Riyadh. Although the original article focuses on a single institution in Riyadh, we believe that the approach to improve student learning is critically important on a global level. We appreciate the authors’ efforts in understanding different learning styles to improve the effectiveness of teaching.View the original paper by Aldosari and colleagues.

This paper aims at studying the association between university students' English learning anxiety and their academic performance. The study selected 380 students from universities of the capital of Pakistan, using purposive sampling technique. It utilized the following two instruments to collect the relevant information: Foreign Language Classroom Anxiety Scale poll (FLCAS) in order to decide the students' level of uneasiness on a Likert scale which had five-point; and the academic performance which was managed at the completion of the final exams (CGPA). The quantifiable assessments showed a significant association between the students' academic performance and their Anxiety in their English Classes, the anxiety scale test, and the scale of communication anxiety and the fear of negative assessment. The study concludes that with the increase in the students' anxiety level their academic performance decreases. The research recommends that educational counselor need to intervene regularly to help students in reducing English learning anxiety and thus enhancing their academic performance. [ABSTRACT FROM AUTHOR]

We present a fabrication process for hierarchical (Ni,Co) 0.85 Se sheets, achieving efficient oxygen evolution reaction (OER) activity with a 10 mA cm -2 current density at an overpotential of 290 mV. Porous architecture and doping improve kinetics, supported by DFT calculations. This approach offers insights into designing stable, high-performance OER catalysts.

Background/aims: To describe the role of ustekinumab in inducing remission and endoscopic healing in anti-tumor necrosis factor α nonresponsive pediatric ulcerative colitis patients at a tertiary care inflammatory bowel disease center., Methods: A retrospective chart review was performed on patients with ulcerative colitis receiving ustekinumab. Primary outcome was steroidfree clinical remission at follow-up. Secondary outcomes were biochemical remission and endoscopic healing., Results: Ten children were analyzed; 7 (70%) had ulcerative colitis, and 3 (30%) had inflammatory bowel disease unspecified with colitis. Median follow-up period was 56 weeks. Nine patients (90%) achieved steroid-free clinical remission and biochemical remission. Seven patients had follow-up colonoscopies, out of which 6 (86%) achieved endoscopic remission, while 1 (14%) underwent colectomy. Out of the 3 patients without a follow-up colonoscopy, fecal calprotectin levels downtrended to < 150 mg/kg in 2 patients and < 400 mg/kg in 1 patient from baseline level of > 2,000 mg/kg., Conclusions: Ustekinumab appears efficacious in achieving not only clinical and biochemical remission but also has promising role in inducing endoscopic healing end point in patients who fail other biologics.

The Covid-19 pandemic has highlighted an era in hearing health care that necessitates a comprehensive rethinking of audiology service delivery. There has been a significant increase in the number of individuals with hearing loss who seek information online. An estimated 430 million individuals worldwide suffer from hearing loss, including 11 million in the United Kingdom. The objective of this study was to identify National Health Service (NHS) audiology service social media posts and understand how they were used to communicate service changes within audiology departments at the onset of the Covid-19 pandemic. Facebook and Twitter posts relating to audiology were extracted over a six week period (March 23 to April 30 2020) from the United Kingdom. We manually filtered the posts to remove those not directly linked to NHS audiology service communication. The extracted data was then geospatially mapped, and themes of interest were identified via a manual review. We also calculated interactions (likes, shares, comments) per post to determine the posts' efficacy. A total of 981 Facebook and 291 Twitter posts were initially mined using our keywords, and following filtration, 174 posts related to NHS audiology change of service were included for analysis. The results were then analysed geographically, along with an assessment of the interactions and sentiment analysis within the included posts. NHS Trusts and Boards should consider incorporating and promoting social media to communicate service changes. Users would be notified of service modifications in real-time, and different modalities could be used (e.g. videos), resulting in a more efficient service., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hussain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Infliximab (IFX) is commonly used to treat children with inflammatory bowel disease (IBD). We previously reported that patients with extensive disease started on IFX at a dose of 10 mg/kg had greater treatment durability at year one. The aim of this follow-up study is to assess the long-term safety and durability of this dosing strategy in pediatric IBD., Methods: We performed a retrospective single-center study of pediatric IBD patients started on IFX over a 10-year period., Results: Two hundred ninety-one patients were included (mean age = 12.61, 38% female) with a follow-up range of 0.1-9.7 years from IFX induction. One hundred fifty-five (53%) were started at a dose of 10 mg/kg. Only 35 patients (12%) discontinued IFX. The median duration of treatment was 2.9 years. Patients with ulcerative colitis ( P ≤ 0.01) and patients with extensive disease ( P = 0.01) had lower durability, despite a higher starting dose of IFX ( P = 0.03). Adverse events (AEs) were observed to occur at a rate of 234 per 1000 patient-years. Patients with a higher serum IFX trough level (≥20 µg/mL) had a higher rate of AEs ( P = 0.01). Use of combination therapy had no impact on risk of AEs ( P = 0.78)., Conclusions: We observed an excellent IFX treatment durability, with only 12% of patients discontinuing therapy over the observed timeframe. The overall rate of AEs was low, the majority being infusion reactions and dermatologic conditions. Higher IFX dose and serum trough level> 20 µg/mL were associated with higher risk of AEs, the majority being mild and not resulting in cessation of therapy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral zoonosis carried and transmitted by infected rodents through urine, droppings, or saliva. The etiology of HFRS is complex due to the involvement of viral factors and host immune and genetic factors which hinder the development of potential therapeutic solutions for HFRS. Hantaan virus (HTNV), Dobrava-Belgrade virus (DOBV), Seoul virus (SEOV), and Puumala virus (PUUV) are predominantly found in hantaviral species that cause HFRS in patients. Despite ongoing prevention and control efforts, HFRS remains a serious economic burden worldwide. Furthermore, recent studies reported that the hantavirus nucleocapsid protein is a multi-functional protein and plays a major role in the replication cycle of the hantavirus. However, the precise mechanism of the nucleoproteins in viral pathogenesis is not completely understood. In the framework of the current study, various in silico approaches were employed to identify the factors influencing the codon usage pattern of hantaviral nucleoproteins. Based on the relative synonymous codon usage (RSCU) values, a comparative analysis was performed between HFRS-causing hantavirus and their hosts, suggesting that HTNV, DOBV, SEOV, and PUUV, were inclined to evolve their codon usage patterns that were comparable to those of their hosts. The results indicated that most of the overrepresented codons had AU-endings, which revealed that mutational pressure is the major force shaping codon usage patterns. However, the influence of natural selection and geographical factors cannot be ignored on viral codon usage bias. Further analysis also demonstrated that HFRS causing hantaviruses adapted host-specific codon usage patterns to sustain successful replication and transmission chains within hosts. To our knowledge, no study to date reported the factors influencing the codon usage pattern within hantaviral nucleoproteins. Thus, the proposed computational scheme can help in understanding the underlying mechanism of codon usage patterns in HFRS-causing hantaviruses which lend a helping hand in designing effective anti-HFRS treatments in future. This study, although comprehensive, relies on in silico methods and thus necessitates experimental validation for more solid outcomes. Beyond the identified factors influencing viral behavior, there could be other yet undiscovered influences. These potential factors should be targets for further research to improve HFRS therapeutic strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Noor, Ashfaq, Bakar, Qasim, Masoud, Alshammari, Alharbi and Riaz.)

Background: In 2016, ESPGHAN/NASPGHAN issued revised guidelines for the management of Helicobacter pylori (H. pylori) infection in children and adolescents. Recommendations include performing antibiotic susceptibility testing to tailor therapy. The aim of our study was to evaluate the H. pylori treatment landscape in pediatric patients at our institution., Methods: We performed a retrospective study of patients diagnosed with H. pylori infection at a single academic children's hospital from 2015 to 2021. The frequency of each treatment regimen and their respective eradication rates were calculated. We compared trends in antibiotic prescriptions and eradication rates before and after 2016., Results: One hundred and ninety-six patients were included. Triple therapy with amoxicillin, clarithromycin, and a proton pump inhibiter (PPI) was the most often prescribed regimen (46.5%), followed by amoxicillin, metronidazole, and PPI (33%). Eradication rates were 70% for amoxicillin, clarithromycin, and PPI and 64% for amoxicillin, metronidazole, and PPI., Conclusion: Our results show eradication rates for both regimens were comparable but suboptimal, highlighting the need to incorporate resistance testing into broader practice.

Flexible piezosensing electronic skins (e-skins) have attracted considerable interest owing to their applications in real-time human-health monitoring, human-machine interactions, and soft bionic robot perception. However, the fabrication of piezosensing e-skins with high sensitivity, biological affinity, and good permeability at the same time is challenging. Herein, we designed and synthesized Mo 2 S 3 nanowires by inserting ∞ 1 [Mo 2+ S] chains between MoS 2 interlayers. The resulting Mo 2 S 3 nanowires feature high conductivity (4.9 × 10 4 S m -1 ) and a high aspect ratio (∼200). An ultrathin (∼500 nm) Mo 2 S 3 nanowire network was fabricated using a simple liquid/liquid interface self-assembly method, showing high piezoresistive sensitivity (5.65 kPa -1 ), a considerably low pressure detection limit (0.08 Pa), and gratifying air permeability. Moreover, this nanowire network can be directly attached to human skin for real-time human pulse detection, finger movement monitoring, and sign language recognition, exhibiting excellent potential for health monitoring and human-machine interactions.

Highly reversible plating/stripping in aqueous electrolytes is one of the critical processes determining the performance of Zn-ion batteries, but it is severely impeded by the parasitic side reaction and dendrite growth. Herein, a novel electrolyte engineering strategy is first proposed based on the usage of 100 mM xylitol additive, which inhibits hydrogen evolution reaction and accelerates cations migration by expelling active H 2 O molecules and weakening electrostatic interaction through oriented reconstruction of hydrogen bonds. Concomitantly, xylitol molecules are preferentially adsorbed by Zn surface, which provides a shielding buffer layer to retard the sedimentation and suppress the planar diffusion of Zn 2+ ions. Zn 2+ transference number and cycling lifespan of Zn∥Zn cells have been significantly elevated, overwhelmingly larger than bare ZnSO 4 . The cell coupled with a NaV 3 O 8 cathode still behaves much better than the additive-free device in terms of capacity retention., (© 2023 Wiley-VCH GmbH.)

Tenofovir alafenamide (TAF) is an antiretroviral (ARV) drug that is used for the management and prevention of human immunodeficiency virus (HIV). The clinical availability of ARV delivery systems that provide long-lasting protection against HIV transmission is lacking. There is a dire need to formulate nanocarrier systems that can help in revolutionizing the way to fight against HIV/AIDS. Here, we aimed to synthesize a polymer using chitosan and polyethylene glycol (PEG) by the PEGylation of chitosan at the hydroxyl group. After successful modification and confirmation by FTIR, XRD, and SEM, TAF-loaded PEGylated chitosan nanoparticles were prepared and analyzed for their particle size, zeta potential, morphology, crystallinity, chemical interactions, entrapment efficacy, drug loading, in vitro drug release, and release kinetic modeling. The fabricated nanoparticles were found to be in a nanosized range (219.6 nm), with ~90% entrapment efficacy, ~14% drug loading, and a spherical uniform distribution. The FTIR analysis confirmed the successful synthesis of PEGylated chitosan and nanoparticles. The in vitro analysis showed ~60% of the drug was released from the PEGylated polymeric reservoir system within 48 h at pH 7.4. The drug release kinetics were depicted by the Korsmeyer-Peppas release model with thermodynamically nonspontaneous drug release. Conclusively, PEGylated chitosan has the potential to deliver TAF from a nanocarrier system, and in the future, cytotoxicity and in vivo studies can be performed to further authenticate the synthesized polymer.

This paper addresses the issues in making wood-concrete composites more resilient to environmental conditions and to improve their compressive strength. Tests were carried out on cubic specimens of 10 × 10 × 10 cm 3 composed of ordinary concrete with a 2% redwood- and hardwood-chip dosage. Superficial treatments of cement and lime were applied to the wood chips. All specimens were kept for 28 days in the open air and for 12 months in: the open air, drinking water, seawater, and an oven. Consequently, the compressive strength of ordinary concrete is approximately 37.1 MPa. After 365 days of exposure to the open air, drinking water, seawater, and the oven, a resistance loss of 35.84, 36.06, 42.85, and 52.30% were observed, respectively. In all environments investigated, the untreated wood composite concrete's resistance decreased significantly, while the cement/lime treatment of the wood enhanced them. However, only 15.5 MPa and 14.6 MPa were attained after the first 28 days in the cases of the redwood and the hardwood treated with lime. These findings indicate that the resistance of wood-concrete composites depends on the type of wood used. Treating wood chips with cement is a potential method for making these materials resistant in conservation situations determined by the cement's chemical composition. The current study has implications for researchers and practitioners for further understanding the impact of these eco-friendly concretes in the construction industry.

Zeolite is a characteristic material for removing heavy metals exhibiting by low tolerance quantities. It is particularly desirable although challenging to cultivate an unmodified and reusable zeolite for eradicating heavy metals with great capacity. Herein, we sought out and firstly synthesized the uniform octahedral zeolite Na 6 Al 6 Si 10 O 32 ·12H 2 O for heavy metal ions trap, proven extraordinarily effective decontamination of M 2+ (Pb 2+ , Cd 2+ , Cu 2+ , and Zn 2+ ). The maximum capacities of Pb 2+ , Cd 2+ , Cu 2+ , and Zn 2+ were 649, 210, 90 and 88 mg/g, and the distribution coefficients (K d ) was ~10 8  mL/g for Pb 2+ which emphasized the superior effectiveness of Na 6 Al 6 Si 10 O 32 ·12H 2 O contrasted with other zeolites. Rapid adsorption was observed that Pb 2+ concentration (7.5 ppm) was reduced to 0.6 ppb in 2 min. The removal mechanism was ascribed to the ion exchange and hydroxyl groups thereby affording high adsorption capacity. We also investigated the heavy metal removal of zeolite 13X and 4A for comparison and concluded the determining factor affecting absorption capacity. The removal rate of Pb remained at 97% even after five regeneration recycles. The zeolite was therefore promising for practical water purification and industrialization., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in the paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Mycobacterium tuberculosis ( M.tb ) infection results in approximately 1.3 million human deaths each year. M.tb resides primarily inside macrophages, and maintains persistent infection. In response to infection and inflammation, platelet activating factor C-16 (PAF C-16), a phospholipid compound, is released by various cells including neutophils and monocytes. We have recently shown that PAF C-16 can directly inhibit the growth of two representative non-pathogenic mycobacteria, Mycobacterium bovis BCG and Mycobacterium smegmatis ( M. smegmatis ), by damaging the bacterial cell membrane. Here, we have examined the effect of PAF C-16 on M. smegmatis residing within macrophages, and identified mechanisms involved in their growth inhibitory function. Our results demonstrated that exogenous PAF C-16 inhibited the growth of M. smegmatis inside phagocytic cells of monocytic cell line, THP-1; this effect was partially blocked by PAF receptor antagonists, suggesting the involvement of PAF receptor-mediated signaling pathways. Arachidonic acid, a downstream metabolite of PAF C-16 signaling pathway, directly inhibited the growth of M. smegmatis in vitro . Moreover, the inhibition of phospholipase C and phospholipase A 2 activities, involved in PAF C-16 signaling pathway, increased survival of intracellular M. smegmatis . Interestingly, we also observed that inhibition of inducible nitric oxide synthase (iNOS) enzyme and antibody-mediated neutralization of TNF-α partially mitigated the intracellular growth inhibitory effect of PAF C-16. Use of a number of PAF C-16 structural analogs, including Lyso-PAF, 2-O-methyl PAF, PAF C-18 and Hexanolamino PAF, revealed that the presence of acetyl group (CH 3 CO) at sn -2 position of the glycerol backbone of PAF is important for the intracellular growth inhibition activity against M. smegmatis . Taken together, these results suggest that exogenous PAF C-16 treatment inhibits intracellular M. smegmatis growth, at least partially, in a nitric oxide and TNF-α dependent manner., (Copyright © 2020 Riaz, Kaur, Shwayat, Behboudi, Kishore and Pathan.)

Oxygen electrocatalysis is of remarkable significance for electrochemical energy storage and conversion technologies, together with fuel cells, metal-air batteries, and water splitting devices. Substituting noble metal-based electrocatalysts by decidedly effective and low-cost metal-based oxygen electrocatalysts is imperative for the commercial application of these technologies. Herein, a novel strategy is presented to fabricate selenized and phosphorized porous cobalt-nickel oxide microcubes by using a sacrificial ZnO spherical template and the resulting microcubes are employed as an oxygen evolution reaction (OER) electrocatalyst. The selenized samples manifest desirable and robust OER performance, with comparable overpotential at 10 mA cm -2 (312 mV) as RuO 2 (308 mV) and better activity when the current reaches 13.7 mA cm -2 . The phosphorized samples exhibit core-shell structure with low-crystalline oxides inside amorphous phosphides, which ensures superior activity than RuO 2 with the same overpotential (at 10 mA cm -2 ) yet lower Tafel slope. Such a surface doping method possibly will provide inspiration for engineering electrocatalysts applied in water oxidation., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: The inability to test at scale has become humanity's Achille's heel in the ongoing war against the COVID-19 pandemic. A scalable screening tool would be a game changer. Building on the prior work on cough-based diagnosis of respiratory diseases, we propose, develop and test an Artificial Intelligence (AI)-powered screening solution for COVID-19 infection that is deployable via a smartphone app. The app, named AI4COVID-19 records and sends three 3-s cough sounds to an AI engine running in the cloud, and returns a result within 2 min., Methods: Cough is a symptom of over thirty non-COVID-19 related medical conditions. This makes the diagnosis of a COVID-19 infection by cough alone an extremely challenging multidisciplinary problem. We address this problem by investigating the distinctness of pathomorphological alterations in the respiratory system induced by COVID-19 infection when compared to other respiratory infections. To overcome the COVID-19 cough training data shortage we exploit transfer learning. To reduce the misdiagnosis risk stemming from the complex dimensionality of the problem, we leverage a multi-pronged mediator centered risk-averse AI architecture., Results: Results show AI4COVID-19 can distinguish among COVID-19 coughs and several types of non-COVID-19 coughs. The accuracy is promising enough to encourage a large-scale collection of labeled cough data to gauge the generalization capability of AI4COVID-19. AI4COVID-19 is not a clinical grade testing tool. Instead, it offers a screening tool deployable anytime, anywhere, by anyone. It can also be a clinical decision assistance tool used to channel clinical-testing and treatment to those who need it the most, thereby saving more lives., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors.)

Objectives: The main objective of study was to investigate the effect of psycho-social predictors on acculturative stress and adjustment in Pakistani institutions., Methods: The study was carried out from November 15, 2016 to January 18, 2019. For this purpose data was collected from 450 international students who were studying in public and private sector universities of Pakistan and who experienced acculturative stress. The instruments include Relationship Assessment Scale, Acculturative Stress Scale for International, Psychological Adaptation Scale, and Revised Socio Cultural Adaptation Scale. The proposed model was tested by using SPSS (Version-23) and AMOS (Version-9)., Results: Findings of the study revealed that relationship satisfaction (p<0.05), length of stay (p<0.05), and financial support (p<0.05) significantly negatively predicted acculturative stress. Financial support significantly positively predicted psychological adjustment (p<0.05). Employment status did not predict acculturative stress, psychological and socio-cultural adjustment (p>0.05). Moreover, all psycho-social predictors did not show effect on socio-cultural adjustment among international students (p>0.05)., Conclusion: It can be concluded that general relationship satisfaction, more length of stay in host country, and financial support are very important for international students to manage their acculturative stress and to adjust better in a new cultural environment.

Behavioural observation studies in road safety research collect naturalistic data of road users that are not informed (beforehand) of their participation in a research project. It enables the observation of behavioural and situational processes that contribute to unsafe traffic events, while possible behavioural adaptations due to the road users' recognition of being observed are minimized. The literature in this field is vast and diverse, with studies dating back to the 1930s. The aim of this paper is to summarize the research efforts in the domain of road user behavioural observation research to examine trends and developments of this type of research, using a scoping review. After the definition of certain selection criteria, 600 journal articles found in three major online databases were retrieved and included in this review. The number of publications regarding road user behavioural observation studies has increased rapidly during recent years, indicating the importance of behavioural observation studies to study traffic safety. Most studies collected data on car drivers (81%), while vulnerable road users have been observed in 32% of all studies, with pedestrians and (motor)cyclists as the most common road user types. The results showed that the main goal of behavioural observation is to monitor (51%), followed by the evaluation of a specific safety improving measure (38%) and the development of behavioural models (10%). Most topics relate to traffic events where interactions with other road users are necessary, indicating that the examination of behavioural processes underlying single-vehicle crashes has received little attention. The ongoing developments of automated video analysis software tools can be the next methodological step forward in video-based behavioural observation studies, since it enables a more objective data collection and data analysis process., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To determine the need of contemporary immersive approaches (Virtual Reality) in teaching and training at medical sector. The main objective of this study was to explore the effects of text, video and immersive technologies learning methodologies for participants' learning in public and private medical colleges and universities of Pakistan., Methods: In this quantitative research 87 medical students of 4 th year from three public and five private medical colleges and universities participated. A laparoscopy operation was selected in consultation with senior medical consultants for this experiment. The experimental material was arranged in virtual reality, video and text based learning. At completion of each of which, participants completed a questionnaire about learning motivation and learning competency through the different mediums., Results: Statistical t-test was selected for the analysis of this study. By comparing the mean values of virtual reality, video, and text based learning methodologies in medical academics; result of virtual reality is at top of others. All performed model are statistically significant (P=0.000) and results can be applied at all population., Conclusion: Through this research, we contribute to medical students learning methodologies. In medical studies, both theoretical and practical expertise has a vital role, while repetition of hands-on practice can improve young doctors' professional competency. Virtual reality was found best for medical students in both learning motivation and learning competency. Medical students and educationist may select virtual reality as new learning methodology for curriculum learning.

Hybridization of nanostructured cobalt oxides with carbon nanotubes (CNTs) is considered to be an operative approach to harvest high-performance anode material for lithium-ion batteries (LIBs). On the other hand, there are numerous related works, most of which adopted a "post-combination" strategy, which is not only complicated but also ecologically unpromising for using toxic acid for surface modification of CNTs. Herein, we productively fabricate Co@Co 3 O 4 /CNTs nanocomposite with excellent conductivity through arc discharge following low-temperature oxidation in air. As the anode material for LIBs, this nanocomposite shows an exceedingly high reversible capacity of 820 mA h g -1 at a current density of 0.2 A g -1 after 250 cycles, much higher than its theoretical capacity. The rate performance of the material is also outstanding, with a capacity of 760 mA h g -1 after 350 cycles at 1 A g -1 (103% of the initial capacity) and 529 mA h g -1 after 600 cycles at 2 A g -1 . X-ray photoelectron spectroscopy tests are accomplished to disclose the true cause of extra capacity. And for the first time, we propose an "electron-sharing" storage mode, where extra electrons and Li + can separate and be stored at the interface of cobalt metal/Li 2 O. This not only gives a reasonable revelation for this unusual capacity exceeding the theoretical value but also directs the capacitor-like electrochemical behavior extra capacity.

Mycobacterium tuberculosis , the causative agent of tuberculosis, is one of the leading causes of human deaths due to a single infectious agent. M. tuberculosis infection of the host initiates a local inflammatory response, resulting in the production of a range of inflammatory factors at the site of infection. These inflammatory factors may come in direct contact with M. tuberculosis and immune cells to activate different signaling pathways. One such factor produced in excess during inflammation is a phospholipid compound, Platelet Activating Factor C-16 (PAF C-16). In this study, PAF C-16 was shown to have a direct inhibitory effect on the growth of Mycobacterium bovis BCG ( M. bovis BCG) and Mycobacterium smegmatis ( M. smegmatis ) in a dose- and time-dependent manner. Use of a range of PAF C-16 structural analogs, including the precursor form Lyso-PAF, revealed that small modifications in the structure of PAF C-16 did not alter its mycobacterial growth inhibitory properties. Subsequent experiments suggested that the attachment of aliphatic carbon tail via ether bond to the glycerol backbone of PAF C-16 was likely to play a vital role in its growth inhibition ability against mycobacteria. Fluorescence microscopy and flow cytometry using Propidium iodide (PI) indicated that PAF C-16 treatment had a damaging effect on the cell membrane of M. bovis BCG and M. smegmatis . Furthermore, the growth inhibitory effect of PAF C-16 was partially mitigated by treatment with membrane-stabilizing agents, α-tocopherol and Tween-80, which further suggests that the growth inhibitory effect of PAF C-16 was mediated through bacterial cell membrane damage.

Human surfactant protein-D (SP-D), an innate immune pattern recognition soluble factor, is known to modulate a range of cytokines and chemokines, such as TNF-α and TGF-β at mucosal surfaces during infection, allergy, and inflammation. A recent study has shown that treatment with a recombinant fragment of human SP-D (rfhSP-D) for 48 h induces apoptosis in pancreatic cancer cells. Our hypothesis is that at earlier time points, SP-D can also influence key cytokines as a part of its putative role in the immune surveillance against pancreatic cancer, where the inflammatory tumor microenvironment contributes to the epithelial-to-mesenchymal transition (EMT), invasion, and metastasis. Here, we provide the first evidence that rfhSP-D can suppress the invasive-mesenchymal properties of highly aggressive pancreatic cancer cells. Mechanistically, rfhSP-D inhibited TGF-β expression in a range of pancreatic cancer cell lines, Panc-1, MiaPaCa-2, and Capan-2, thereby reducing their invasive potential. Smad2/3 expression diminished in the cytoplasm of rfhSP-D-treated cells as compared to the untreated control, suggesting that an interrupted signal transduction negatively affected the transcription of key mesenchymal genes. Thus, expressions of Vimentin, Zeb1, and Snail were found to be downregulated upon rfhSP-D treatment in the pancreatic cancer cell lines. Furthermore, blocking TGF-β with neutralizing antibody showed similar downregulation of mesenchymal markers as seen with rfhSP-D treatment. This study highlights yet another novel innate immune surveillance role of SP-D where it interferes with EMT induction by attenuating TGF-β pathway in pancreatic cancer.

Human surfactant protein D (SP-D) is a potent innate immune molecule, which is emerging as a key molecule in the recognition and clearance of altered and non-self targets. Previous studies have shown that a recombinant fragment of human SP-D (rfhSP-D) induced apoptosis via p53-mediated apoptosis pathway in an eosinophilic leukemic cell line, AML14.3D10. Here, we report the ability of rfhSP-D to induce apoptosis via TNF-α/Fas-mediated pathway regardless of the p53 status in human pancreatic adenocarcinoma using Panc-1 (p53 mt ), MiaPaCa-2 (p53 mt ), and Capan-2 (p53 wt ) cell lines. Treatment of these cell lines with rfhSP-D for 24 h caused growth arrest in G1 cell cycle phase and triggered transcriptional upregulation of pro-apoptotic factors such as TNF-α and NF-κB. Translocation of NF-κB from the cytoplasm into the nucleus of pancreatic cancer cell lines was observed via immunofluorescence microscopy following treatment with rfhSP-D as compared to the untreated cells. The rfhSP-D treatment caused upregulation of pro-apoptotic marker Fas, as analyzed via qPCR and western blot, which then triggered caspase cascade, as evident from cleavage of caspase 8 and 3 analyzed via western blot at 48 h. The cell number following the rfhSP-D treatment was reduced in the order of Panc-1 (~67%) > MiaPaCa-2 (~60%) > Capan-2 (~35%). This study appears to suggest that rfhSP-D can potentially be used to therapeutically target pancreatic cancer cells irrespective of their p53 phenotype.

Co@Co 9 S 8 nanochains with core-shell structures are prepared by a direct-current arc-discharge technique and followed sulfurization at 200 °C. The nanochains, which consist of uniform nanospheres connecting each other, can range up to several micrometers. The thickness of Co 9 S 8 shell can be changed by regulating the sulfurization time. In this heterostructure of Co@Co 9 S 8 , Co nanochains function as a conductive network and can inject electrons into Co 9 S 8 , which manipulates the work function of Co 9 S 8 and makes it more apposite for catalysis. The density functional theory calculation also reveals that coupling with Co can significantly reduce the overpotential needed to drive the oxygen evolution process. On the basis of the exclusive structure, Co@Co 9 S 8 nanochains have shown high catalytic activity in the oxygen evolution reaction. Co@Co 9 S 8 reaches an overpotential of 285 mv at 10 mA cm -2 , which is much lower than that of Co nanochains (408 mV) and Co 9 S 8 (418 mV). Co@Co 9 S 8 also shows higher catalytic activity and robustness compared to state-of-the-art noble-metal catalyst RuO 2 .

Metal alloy nanoparticles have shown promising applications in electrocatalysis. However, the nanoparticles usually suffer from limited charge-transfer efficiency, which can be solved by preparing one-dimensional materials. Herein, Co-Ni alloy nanochains are prepared by a direct-current arc-discharge method. The nanochains, comprised of mutually coupled uniform nanospheres, can range up to several micrometers in size. When the alloy is exposed to air or under the electro-oxidation process, a metal-metal-oxide heterostructure is obtained. The alloy can inject electrons into the oxide, which makes it more suitable for electrocatalysis. The composition of the samples can be changed by varying the ratio of Ni/Co (i.e., Co, Co 7 Ni 3 , Co 5 Ni 5 , Co 3 Ni 7 , Ni) in the synthesis process. The nanochains show good oxygen evolution performance that correlates with the Ni/Co ratio. Co 7 Ni 3 demonstrates optimal activity with an onset point of 1.50 V vs. reversible hydrogen electrode (RHE) and overpotential of 350 mV at 10 mA cm -2 . The alloy nanochains also show excellent durability with 95.0 % current retention after a long-term test for 12 h., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The effects of weightlessness on enteric microorganisms have been extensively studied, but have mainly been focused on pathogens. As a major component of the microbiome of the human intestinal tract, probiotics are important to keep the host healthy. Accordingly, understanding their changes under weightlessness conditions has substantial value. This study was carried out to investigate the characteristics of Lactobacillus acidophilus, a typical probiotic for humans, under simulated microgravity (SMG) conditions. The results revealed that SMG had no significant impact on the morphology of L. acidophilus, but markedly shortened its lag phase, enhanced its growth rate, acid tolerance ability up to pH < 2.5, and the bile resistance at the bile concentration of <0.05%. SMG also decreased the sensitivity of L. acidophilus to cefalexin, sulfur gentamicin, and sodium penicillin. No obvious effect of SMG was observed on the adhesion ability of L. acidophilus to Caco-2 cells. Moreover, after SMG treatment, both the culture of L. acidophilus and its liquid phase exhibited higher antibacterial activity against S. typhimurium and S. aureus in a time-dependent manner. The SMG treatment also increased the in vitro cholesterol-lowering ability of L. acidophilus by regulating the expression of the key cholesterol metabolism genes CYP7A1, ABCB11, LDLR, and HMGCR in the HepG2 cell line. Thus, the SMG treatment did have considerable influence on some biological activities and characteristics of L. acidophilus related to human health. These findings provided valuable information for understanding the influence of probiotics on human health under simulated microgravity conditions, at least.

With increased access to high-speed Internet and smartphone devices, patients have started to use mobile applications (apps) for various health needs. These mobile apps are now increasingly used in integration with telemedicine and wearables to support fitness, health education, symptom tracking, and collaborative disease management and care coordination. More recently, evidence (especially around remote patient monitoring) has started to build in some chronic diseases, and some of the digital health technologies have received approval from the Food and Drug Administration. With the changing healthcare landscape and push for value-based care, adoption of these digital health initiatives among providers is bound to increase. Although so far there is a dearth of published evidence about effectiveness of these apps in gastroenterology care, there are ongoing trials to determine whether remote patient monitoring can lead to improvement in process metrics or outcome metrics for patients with chronic gastrointestinal diseases., Competing Interests: The authors disclose no conflicts. The authors disclose that they are part of the innovation team at Sinai Applab that has developed 2 of the mobile apps references in the article: “HealthPROMISE” and “HepCure”., (Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. We wanted to highlight this case of myxoedema coma occurring in the context of a hyperglycaemic hyperosmolar state (HHS), as the former condition is normally associated with hypoglycaemia, hyponatraemia and hypo-osmolality. Decompensated hypothyroidism should be considered in presentations of HHS as well as with other metabolic derangements, as delays in thyroid hormone replacement are associated with poorer outcomes. It has multisystem effects challenging its recognition and we discuss potential complications and their management., (2016 BMJ Publishing Group Ltd.)

Crimean-Congo hemorrhagic fever (CCHF) is a vector-borne viral disease, widely distributed in different regions of the world. The fever is caused by the CCHF virus (CCHFV), which belongs to the Nairovirus genus and Bunyaviridae family. The virus is clustered in seven genotypes, which are Africa-1, Africa-2, Africa-3, Europe-1, Europe-2, Asia-1 and Asia-2. The virus is highly pathogenic in nature, easily transmissible and has a high case fatality rate of 10-40%. The reservoir and vector of CCHFV are the ticks of the Hyalomma genus. Therefore, the circulation of this virus depends upon the distribution of the ticks. The virus can be transmitted from tick to animal, animal to human and human to human. The major symptoms include headache, high fever, abdominal pain, myalgia, hypotension and flushed face. As the disease progresses, severe symptoms start appearing, which include petechiae, ecchymosis, epistaxis, bleeding gums and emesis. Enzyme-linked immunosorbent assay, quantitative polymerase chain reaction, antigen detection, serum neutralization and isolation of the virus by cell culture are the diagnostic techniques used for this viral infection. There is no specific antiviral therapy available thus far. However, ribavirin has been approved by the World Health Organization for the treatment of CCHFV infection. Awareness campaigns regarding the risk factors and control measures can aid in reducing the spread of this disease to a greater extent, particularly in developing countries.

Aims: In order to develop an application that addresses the most significant challenges facing IBD patients, this qualitative study explored the major hurdles of living with IBD, the information needs of IBD patients, and how application technology may be used to improve quality of life., Methods: 15 IBD patients participated in two focus groups of 120 minutes each. Data collection was achieved by combining focus groups with surveys and direct observation of patients looking at a patient-engaged app (HealthPROMISE) screenshots. The survey elicited information on demographics, health literacy and quality of life through the Short IBD Questionnaire (SIBDQ)., Results: The needs of IBD patients center around communication as it relates to both patient information needs and navigating the social impacts of IBD on patients' lives: Communication Challenges regarding Information Needs: Patients cited a doctor-patient communication divide where there is a continued lack of goal setting when discussing treatments and a lack of objectivity in disease control. When objectively compared with the SIBDQ, nearly half of the patients in the focus groups wrongly estimated their IBD control.Communication Challenges regarding Social Impacts of IBD: Patients strongly felt that while IBD disrupts routines, adds significant stress, and contributes to a sense of isolation, the impact of these issues would be significantly alleviated through more conversation and better support.Implication for Mobile Health Solutions: Patients want a tool that improves tracking of symptoms, medication adherence and provides education. Physician feedback to patient input on an application is required for long-term sustainability., Conclusions: IBD patients need mobile health technologies that evaluate disease control and the goals of care. Patients feel an objective assessment of their disease control, goal setting and physician feedback will greatly enhance utilization of all mobile health applications., Competing Interests: COMPETING INTERESTS Authors have declared that no competing interests exist.

Exposure to unpredictable chronic mild stress (CUS) is a commonly used protocol in rats that is reported to evoke antidepressant-reversible behaviors such as loss of preference for a sweetened water solution which is taken as an analog of the anhedonia seen in major depression. However, the induction of anhedonic-like behavior by chronic mild stress, gauged by an animal's preference for sucrose solution, is not fully reproducible and consistent across laboratories. In this study, we compared a widely used behavioral marker of anhedonia - the sucrose preference test, with another phenotypic marker of emotional valence, social interaction-associated ultrasonic vocalizations as well as a marker of an anxiety-like phenotype, novelty-suppressed feeding, and cognitive performance in the eight arm radial maze task in adult male Sprague-Dawley rats. Chronic four-week exposure to unpredictable mild stressors resulted in 1) attenuation of social interaction-associated ultrasonic vocalizations 2) attenuation of spatial memory performance on the radial arm maze 3) attenuation of body weight gain and 4) increased latency to feed in a novelty-suppressed feeding task. However, chronic exposure to CUS did not result in any significant change in sucrose preference at one-week and three-week intervals. Our results argue for the utility of ultrasonic vocalizations in a social interaction context as a comparable alternative or adjunct to the sucrose preference test in determining the efficacy of CUS to generate an anhedonic-like phenotypic state., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Thalassemia major is one of the most common genetic disorders in Pakistan and over five thousand new patients are added in the pool annually. This familial disease has both medical and social implications, and therefore there is a need to assess the magnitude of beta-Thalassemia trait amongst family members of Thalassemia major patients., Methods: This cross-sectional descriptive study enrolled 674 blood samples from first degree relatives of registered patients of Thalassemia major at Sir Ganga Ram Hospital, Lahore. Peripheral blood smears were studied for abnormal morphology findings of microcytosis, hypochromia, poikilocytosis (tear drops, target cells) and Erythrocyte indices (haemoglobin, RBCs, mean corpuscular haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin concentration) and Hb electrophoretic (HbA, HbA2, & HbF)., Results: Hb electrophoresis showed 61% of the study subjects had haemoglobinopathies. Frequency of beta-Thalassemia trait was highest followed by beta-Thalassemia major, HbE trait, HbD Punjab and Hb intermedia., Conclusion: Findings strongly suggest screening for beta-Thalassemia trait in families of Thalassemia major patients.

The global availability of a therapeutically effective influenza virus vaccine during a pandemic remains a major challenge for the biopharmaceutical industry. Long production time, coupled with decreased supply of embryonated chicken eggs (ECE), significantly affects the conventional vaccine production. Transformed cell lines have attained regulatory approvals for vaccine production. Based on the fact that the avian influenza virus would infect the cells derived from its natural host, the viral growth characteristics were studied on chicken embryo-derived primary cell cultures. The viral propagation was determined on avian origin primary cell cultures, transformed mammalian cell lines, and in ECE. A comparison was made between these systems by utilizing various cell culture-based assays. In-vitro substrate susceptibility and viral infection characteristics were evaluated by performing hemagglutination assay (HA), 50 % tissue culture infectious dose (TCID₅₀) and monitoring of cytopathic effects (CPE) caused by the virus. The primary cell culture developed from chicken embryos showed stable growth characteristics with no contamination. HA, TCID₅₀, and CPE exhibited that these cell systems were permissive to viral infection, yielding 2-10 times higher viral titer as compared to mammalian cell lines. Though the viral output from the ECE was equivalent to the chicken cell culture, the time period for achieving it was decreased to half. Some of the prerequisites of inactivated influenza virus vaccine production include generation of higher vial titer, independence from exogenous sources, and decrease in the production time lines. Based on the tests, it can be concluded that chicken embryo primary cell culture addresses these issues and can serve as a potential alternative for influenza virus vaccine production.

Background: Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios., Methods: A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women)., Results: A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases., Conclusions: We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.