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Abstract Background Agitation is common in the early stages of recovery from traumatic brain injury (TBI), when patients are in post-traumatic amnesia (PTA). Agitation is associated with risk of harm to patients and caregivers. Recent guidelines recommend that agitation during PTA is managed using environmental modifications. Agitation is also frequently treated pharmacologically, with the use of atypical antipsychotics such as olanzapine among the most common. This is despite a lack of well-designed studies to support the use of antipsychotics within this context. This study will be a double-blind, placebo-controlled randomised controlled trial. We will examine the efficacy, safety, cost-effectiveness and outcomes associated with the use of olanzapine for reducing agitation in patients in PTA following TBI over and above recommended environmental management. Methods Fifty-eight TBI rehabilitation inpatients who are in PTA and are agitated will receive olanzapine or placebo for the duration of PTA. All participants will additionally receive optimal environmental management for agitation. Measures of agitation, PTA and health will be undertaken at baseline. Treatment administration will begin at a dose of 5 mg daily and may be escalated to a maximum dose of 20 mg per day. Throughout the treatment period, agitation and PTA will be measured daily, and adverse events monitored weekly. Efficacy will be assessed by treatment group comparison of average Agitated Behaviour Scale scores during PTA. Participants will cease treatment upon emergence from PTA. Agitation levels will continue to be monitored for a further 2 weeks, post-treatment measures of health will be undertaken and cognitive and functional status will be assessed. Level of agitation and functional health will be assessed at hospital discharge. At 3 months post-discharge, functional outcomes and health service utilisation will be measured. Discussion This trial will provide crucial evidence to inform the management of agitation in patients in PTA following TBI. It will provide guidance as to whether olanzapine reduces agitation over and above recommended environmental management or conversely whether it increases or prolongs agitation and PTA, increases length of inpatient hospitalisation and impacts longer term cognitive and functional outcomes. It will also speak to the safety and cost-effectiveness of olanzapine use in this population. Trial registration ANZCTR ACTRN12619000284167 . Registered on 25 February 2019

The aim of this study is to evaluate the capability of femtosecond Laser Induced Breakdown Spectroscopy (fsLIBS) to discriminate between normal and cancerous bone, with implications to femtosecond laser surgery procedures. The main advantage of using femtosecond lasers for surgery is that the same laser that is being used to ablate can also be used for a feedback system to prevent ablation of certain tissues. For bone tumor removal, this technique has the potential to reduce the number of repeat surgeries that currently must be performed due to incomplete removal of the tumor mass. In this paper, we performed fsLIBS on primary bone tumor, secondary tumor in bone, and normal bone. These tissues were excised from consenting patients and processed through the UC Davis Cancer Center Biorepository. For comparison, each tumor sample had a matched normal bone sample. fsLIBS was performed to characterize the spectral signatures of each tissue type. A minimum of 20 spectra were acquired for each sample. We did not detect significant differences between the fsLIBS spectra of secondary bone tumors and their matched normal bone samples, likely due to the heterogeneous nature of secondary bone tumors, with normal and cancerous tissue intermingling. However, we did observe an increase in the fsLIBS magnesium peak intensity relative to the calcium peak intensity for the primary bone tumor samples compared to the normal bone samples. These results show the potential of using femtosecond lasers for both ablation and a real-time feedback control system for treatment of primary bone tumors.

Abstract The escalating challenge of antimicrobial resistance necessitates the development of novel antibacterial agents. In this study, a series of five vanillin Schiff bases (SB-1 to SB-5) were synthesized from vanillin and various aromatic amines. The chemical structures of these compounds were characterized using Thin Layer Chromatography (TLC), Fourier Transform Infrared Spectroscopy (FT-IR), proton nuclear magnetic resonance ( $$^{1}\text {H}$$ 1 H -NMR), carbon-13 NMR ( $$^{13}\text {C}$$ 13 C -NMR), and mass spectrometry techniques. Antibacterial efficacy was evaluated against strains of bacteria producing extended-spectrum beta-lactamases (ESBL), including Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae using the disc diffusion method. Cytotoxic effects were assessed through haemocompatibility and brine shrimp lethality assays. The Schiff bases demonstrated notable antibacterial activities, with SB-1, SB-2, SB-4, and SB-5 exhibiting zones of inhibition up to 16.0, 16.5, 16.6, and 15.5 mm against ESBL E. coli, respectively. SB-3 showed a maximum inhibition zone of 15.0 mm against ESBL K. pneumoniae. In cytotoxicity assays, the compounds exhibited IC $$_{50}$$ 50 values against red blood cells (RBCs) greater than 200 μg/mL and ranging from 45.7 to 50.5 μg/mL for the brine shrimp assay. While demonstrating potent antibacterial properties, the toxicity towards human RBCs suggests that further toxicity evaluations and structural modifications are essential for developing safer therapeutic agents based on vanillin Schiff bases.

Background To gauge the impact of an interventional workshop conducted to measure the observation skills of 34 postgraduates during induction into an ophthalmology fellowship. Methods A seven-hour workshop was conducted with the ophthalmology trainees. Trainees from the 2022 batch of ophthalmology fellowships (21 females and 13 males) were included in the study. The pre-workshop assessment comprised two non-clinical images to spot the difference and five clinical images from various subspecialties of ophthalmology. This was followed by workshop and Post workshop assessment. The pre- and post-observation grades of participants were then compared by masked ophthalmologists. The Wilcoxon signed-rank test was used to compare scores at two time points, with a p-value < 0.05 for statistical significance. Results Statistical analysis revealed that the observation skill score was significantly higher after the workshop intervention (Md = 4.00, n = 34) compared to the pre-workshop score (Md = 1.85, n = 34), p-value = 0.000. Conclusions Workshops on specific/selected foundational skills, such as observation skills and communication skills, must be integrated into the curricula of basic medical degree and specialty medicine to equip medical professionals with attentive observation and deep learning.

Abstract Dynamic models of sugar kelp (Saccharina latissima) growth are used to estimate the production potential of seaweed aquaculture in many regions around the world. These models do not currently account for the existence of S. latissima ecotypes that are adapted to regional environmental conditions, particularly temperature. We tested the hypothesis that recalibrating the temperature parameters of a dynamic energy budget model using literature data for S. latissima from regions with a similar climate to the region of interest would result in more accurate predictions than using a general species‐wide temperature response curve. Calibrating the model using data from warm regions significantly improved model accuracy for kelp cultivation at the southern end of the species range (Rhode Island, USA) in cases where the original parameters underestimated growth but resulted in drastic overestimates when heavy frond erosion occurred. In Trømso, Norway, a cold parameterization produced extremely accurate predictions: the model predicted a final frond length of 88.2 cm, compared with the observed length of 87.5 (±4.70) cm. Our results demonstrate that recalibrating temperature response curves allows one model to be applied to kelp aquaculture in different regions, an important step toward the prediction of S. latissima productivity over large areas.

IntroductionThis study aimed to evaluate the prevalence of Klebsiella pneumoniae contamination in raw lettuce from Risalpur, Pakistan, and to analyze the antibiotic susceptibility profiles of the isolated strains. The presence of foodborne pathogens such as K. pneumoniae poses significant public health risks, particularly in regions with suboptimal hygiene practices and improper food handling.MethodsLettuce samples were collected from various sources in Risalpur and screened for K. pneumoniae. Antimicrobial susceptibility testing was performed to evaluate the effectiveness of various antibiotics against the isolated strains. Statistical analyses, including ANOVA and linear regression, were conducted to assess differences in inhibition zones and to predict antibiotic effectiveness based on concentration.ResultsThe results revealed a significant prevalence of K. pneumoniae in the lettuce samples, highlighting the risks associated with poor hygiene, transportation, storage, and contaminated irrigation water. The isolated strains exhibited high susceptibility to gentamicin but demonstrated notable resistance to doxycycline, vancomycin, and ticarcillin. Multidrug-resistant (MDR) strains were identified. ANOVA showed significant differences in inhibition zones, and the linear regression model predicted a Zone of Inhibition based on antibiotic concentration (β0 = 10.6667, β1 = 0.4556).DiscussionThe identification of MDR strains of K. pneumoniae underscores the urgent need for enhanced antibiotic stewardship and food safety protocols to manage foodborne pathogens. Improved hygiene practices throughout the food production and supply chain are critical to mitigate health risks and address the challenge of growing antibiotic resistance.

In this special section, various authors (in separate articles) discuss the new face of school segregation; socioeconomic integration--a plan to mix poor and middle-class students; and ways to bridge the minority achievement gap, teach linguistically diverse students, and identify and nurture the gifted poor. (MLH)

Background: Between 25% and 50% of pregnant women and almost half of nonpregnant women suffer from anemia, a common health problem, especially in developing and poor countries. Anemia is one of the most common diseases in women during pregnancy. Aim: Of this study was to investigate the prevalence of anemia in pregnant women, its morphological characterization, and associated sociodemographic characteristics. Materials and Methods: This was a cross-sectional study conducted on 290 pregnant women from Lucknow, Uttar Pradesh, India. The demographic data of the participants (age, place of residence, religion, education, employment status, type of housing, socioeconomic status, and source of drinking water) were collected. A general and physical examination was performed. They were assessed for anemia and its severity. Statistical Analysis: The Chi-square test, independent-samples t-test, and analysis of variance were used for statistical analysis. Results: A total of 290 pregnant women aged 18–38 years were included in the study. A total of 161 individuals (55.5%) were diagnosed with anemia. The prevalence and severity of anemia largely correlated with maternal age ( 30 years), lower body mass index, higher education level, employment status, medication use, and lack of iron supplementation. Employment status, Kachcha residence, lower intake of nonvegetarian diet, lower intake of green leafy vegetables, nonuse of oral contraceptives in the past 3 months, and iron supplementation were found to be significantly associated with anemia severity. Conclusions: A high prevalence of anemia during pregnancy was found in this community. Higher prevalence and severity of anemia were closely related to increasing maternal age, low socioeconomic position, and lack of iron supplementation.

Abstract Background We developed models for tumor segmentation to automate the assessment of total tumor volume (TTV) in patients with colorectal liver metastases (CRLM). Methods In this prospective cohort study, pre- and post-systemic treatment computed tomography (CT) scans of 259 patients with initially unresectable CRLM of the CAIRO5 trial (NCT02162563) were included. In total, 595 CT scans comprising 8,959 CRLM were divided into training (73%), validation (6.5%), and test sets (21%). Deep learning models were trained with ground truth segmentations of the liver and CRLM. TTV was calculated based on the CRLM segmentations. An external validation cohort was included, comprising 72 preoperative CT scans of patients with 112 resectable CRLM. Image segmentation evaluation metrics and intraclass correlation coefficient (ICC) were calculated. Results In the test set (122 CT scans), the autosegmentation models showed a global Dice similarity coefficient (DSC) of 0.96 (liver) and 0.86 (CRLM). The corresponding median per-case DSC was 0.96 (interquartile range [IQR] 0.95–0.96) and 0.80 (IQR 0.67–0.87). For tumor segmentation, the intersection-over-union, precision, and recall were 0.75, 0.89, and 0.84, respectively. An excellent agreement was observed between the reference and automatically computed TTV for the test set (ICC 0.98) and external validation cohort (ICC 0.98). In the external validation, the global DSC was 0.82 and the median per-case DSC was 0.60 (IQR 0.29–0.76) for tumor segmentation. Conclusions Deep learning autosegmentation models were able to segment the liver and CRLM automatically and accurately in patients with initially unresectable CRLM, enabling automatic TTV assessment in such patients. Relevance statement Automatic segmentation enables the assessment of total tumor volume in patients with colorectal liver metastases, with a high potential of decreasing radiologist’s workload and increasing accuracy and consistency. Key points • Tumor response evaluation is time-consuming, manually performed, and ignores total tumor volume. • Automatic models can accurately segment tumors in patients with colorectal liver metastases. • Total tumor volume can be accurately calculated based on automatic segmentations. Graphical Abstract

In the field of railroad safety, the effective detection of surface cracks is critical, necessitating reliable, high-speed, non-destructive testing (NDT) methods. This study introduces a hybrid Eddy Current Testing (ECT) probe, specifically engineered for railroad inspection, to address the common issue of “lift-off noise” due to varying distances between the probe and the test material. Unlike traditional ECT methods, this probe integrates transmit and differential receiver (Tx-dRx) coils, aiming to enhance detection sensitivity and minimise the lift-off impact. The study optimises ECT probes employing different transmitter coils, emphasising three main objectives: (a) quantitatively evaluating each probe using signal-to-noise ratio (SNR) and outlining a real-time data-processing algorithm based on SNR methodology; (b) exploring the frequency range proximal to the electrical resonance of the receiver coil; and (c) examining sensitivity variations across varying lift-off distances. The experimental outcomes indicate that the newly designed probe with a figure-8 shaped transmitter coil significantly improves sensitivity in detecting surface cracks on railroads. It achieves an impressive SNR exceeding 100 for defects with minimal dimensions of 1 mm in width and depth. The simulation results closely align with experimental findings, validating the investigation of the optimal operational frequency and lift-off distance for selected probe performance, which are determined to be 0.3 MHz and 1 mm, respectively. The realisation of this project would lead to notable advancements in enhancing railroad safety by improving the efficiency of crack detection.

Background The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows in training. Methods A 10-hour workshop on presentation skills was conducted for ophthalmology fellows in the 2022 cohort at a single institution. An email was sent to the 2022 cohort to recruit participants. A total of 29 fellows (19 females, 10 males) volunteered to participate in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at four different time points of the workshop. The self-rating questionnaire utilized a ten-point rating scale (1–10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05. Results Both properties & content (PC) and soft skills (SS) showed significant difference (p < 0.001) post workshop compared to earlier stages. The higher self-rating (PC4 and SS4) highlights increased awareness towards the scope of improving the presentation after the workshop intervention. Conclusions Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.

Klebsiella pneumoniae, a Gram-negative pathogen, poses a significant threat as a cause of community- and hospital-acquired infections worldwide. The emergence of multidrug-resistant strains, particularly in nosocomial settings, has further complicated the management of these infections. This study aimed to investigate the culture identification and antibiogram of K. pneumoniae isolated from sputum samples collected in various districts in Mardan, Khyber Pakhtunkhwa, Pakistan. A total of 16 sputum samples were collected from patients at the Mardan Medical Complex. Standard microbiological techniques were employed to identify K. pneumoniae, and the antibiotic susceptibility testing was performed using the Kirby–Bauer disc diffusion method, following CLSI guidelines. Among the confirmed K. pneumoniae isolates, approximately 50% were found to be multidrug-resistant. The results indicated resistance to several antibiotics, including vancomycin (30 g), amikacin (30 g), chloramphenicol (30 g), amoxicillin (30 g), and ticarcillin (75 g), while being susceptible to meropenem (10 g), piperacillin (100 g), and tazobactam (110 g). A bioinformatics analysis was also conducted to gain deeper insights into the resistance patterns and potential clustering of isolates. This comprehensive study provides valuable information on the epidemiological trends and antimicrobial susceptibility profile of K. pneumoniae in the region. The findings of this study highlight the urgent need for antimicrobial stewardship programs to combat the rising challenge of antibiotic resistance. Understanding the resistance landscape of K. pneumoniae can guide healthcare professionals in selecting appropriate antibiotics and improving patient outcomes. These data can contribute to the formulation of local antibiotic policies and assist clinicians in making rational choices for antibiotic therapy.