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Abstract Communities respond to flooding events based upon risk perceptions and available adaptive behaviors (e.g., emigrating, purchasing insurance, constructing levees). Across the United States, sea level rise, intensifying storm-surges, and extreme rainfall may alter human-flood dynamics. Here, we use calibrated Socio-Environmental models of contiguous US coastal census tracts and two shared socio-economic pathways (SSP245 and SSP585). We project that by 2100, total flood insurance claims will increase by +25% to +130% under low (SSP245) and high (SSP585) emissions scenarios, respectively. The increase in flood insurance claims will impact mainly socially vulnerable communities. Further, we project that active NFIP policies will increase from +30% under low emission scenario to +60% under high emission scenario. Our finding also suggests the growing debt of the National Flood Insurance Program under higher emissions. Raising the water elevation threshold for coastal flooding by +1 meter via levees may reduce future surge-related losses by 95% and 40% under low and high emission scenarios and stabilize housing markets. Our future projections of flood insurance claims, policy coverage, and the impact of water elevation serve as credible hypotheses for the evolution of human flood dynamics under climate change. They can inform national flood policy and future research.

Introduction: Road Traffic Accidents (RTAs) can develop Post-Traumatic Stress Disorder (PTSD) due to emotional trauma, which significantly affects the quality of life. Despite satisfactory psychological recovery for many RTA victims, a notable percentage of survivors continue to live with PTSD without diagnosis or treatment. In India, the rising number of RTAs necessitates research into their psychological impacts to inform healthcare strategies and interventions. Aim: To assess the prevalence of PTSD symptoms among RTA survivors and explore the association between PTSD and socio-demographic and clinical variables. Materials and Methods: A cross-sectional descriptive study was conducted and data was collected from selected trauma centres in Gujarat state, India, from April to May 2024. The study involved 380 participants who had experienced RTAs within 30-40 days prior to data collection. Data collection employed an interviewer-administered questionnaire with two sections: a demographic and clinical questionnaire and the PTSD Checklist (PCL-5) for PTSD symptom assessment. The PCL-5 is a 20-item tool, with scores ranging from 0 to 80, where a score of ≥33 indicates PTSD symptoms. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0, employing descriptive statistics, Chi-square tests, and Confidence Intervals (CI) to determine the significance of associations at a p-value

Abstract Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches.

Background. People living with HIV (PWH) frequently have co-morbid substance use disorders that may have been impacted by the COVID-19 pandemic. This study examined associations between COVID-related stress and increased substance use among PWH in Washington State. Methods. Between August 2020 and March 2021, we conducted an online survey of 397 PWH in western Washington. Logistic regression was used to analyze associations between a COVID-19 stress score and four self-reported outcomes: increased alcohol use, increased cigarette smoking, increased marijuana use, and increased use of illicit substances. Results. Thirty-five (38.0%) of 92 participants who smoked, 61 (23.4%) of 261 participants who used alcohol, 15 (14.6%) of 103 participants who used marijuana, and 35 (33.0%) of 102 participants who used illicit substances reported increased use of these substances. Higher COVID-19 stress scores were associated with higher odds of increased cigarette smoking (adjusted odds ratio [aOR] = 1.15, 95% confidence interval [CI]: 1.04–1.27), even after adjustment for anxiety and depressive symptoms (aOR 1.14, 95%CI: 1.03–1.27). COVID-19 stress was not associated with an increased use of alcohol, marijuana, or illicit substances. Conclusions. COVID-19-related stress was associated with self-reported increased cigarette smoking among PWH in western Washington during the pandemic.

Introduction: Latent tuberculosis infection presents with no symptoms. All nursing staff who work closely with patients must possess the appropriate knowledge and follow the right preventive practices to avoid latent tuberculosis infection. This study was carried out to assess knowledge and preventive practices on latent TB which will help in making recommendations for the control of TB infection among nursing staffs. Objective: To assess knowledge and preventive practices regarding latent Tuberculosis infection and to assess infection controlpractices among the nursing staff. Method: This was a facility based cross sectional study conducted among nurses who works in Outpatient departments and wards of tertiary care centre. A complete list of the participants was made, and data from all nurses employed in every ward and outpatient department of the hospital was collected using a semi-structured self-administered questionnaire. A sample size of 384 nurses was calculated using Cochrane formula with p=50% and simple random sampling was used. Results: Out of 384 nurses, 376 (97.9%) were females and 8 (2.1%) were males. Regarding prevention of latent tuberculosis, 327 (85.1%) nurses answered wearing of mask, followed by regular sterilisation of hospitals which was 281 (73.1%) nurses. Out of 384 nurses, 298 (77.6%) of them wear a mask while dealing with coughing patients. In this, 242 (81.3%) reported usage of a surgical mask while N95 mask is only used by 56 (18.7%) of them. Conclusion: Overall knowledge regarding latent tuberculosis was satisfactory among the nurses. Practice on infection control was not satisfactory.

In conventional opencast mining, blasting plays a significant role in mining activity. Basically, blasting is done in mining activity to create fragmentation. In the process of fragmentation via blasting, a lot of side effects arise. The prominent side effects include flyrock, airblast, and ground vibration. Also, the fragmentation size desired by mine owners differs for different minerals. So, usage of the type of explosive and quantity of explosive should be optimum, as it results in an increased magnitude of side effects such as flyrock, airblast, and ground vibrations. Like how space, burden, stemming material type, and stemming column height do affect all of the aforementioned negative effects. In this article, a case study of Indian mines measures the unfriendly impacts of blasting in opencast mining.

Alpha-1 adrenergic receptor (α1-AR) antagonists are commonly used for management of benign prostatic hyperplasia or hypertension. Some studies have shown a potential link between α1-AR antagonist use and cognitive impairment. Given the conflicting data surrounding α1-AR antagonists association with cognitive dysfunction, we aim to systematically review the association of cognitive dysfunction with α1-AR antagonist use to aid clinician decision both with medication initiation and continuation. A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched Ovid Cochrane, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science on March 7, 2023, with an update run on January 22, 2024. The primary outcome was cognitive dysfunction. We used Cochrane risk of bias for randomized controlled trials (RCTs) and MINORS (Methodological Index for Non-Randomized Studies) criteria for non-RCTs to evaluate study quality. This study was registered with PROSPERO (CRD42024505751). We identified 7 studies for our systematic review (3 RCTs, 4 non-RCTs). Tamsulosin was the most studied medication (6 of 7 studies). Tamsulosin was associated with no cognitive dysfunction in 2 RCTs, increased risk for dementia in 2 non-RCTs, no change in cognition in 1 non-RCT, and decreased risk for dementia in 1 non-RCT. Among 3 non-RCTs analyzing alfuzosin, it was associated with decreased risk of or no association with dementia in 2 studies and increased risk for dementia in 1 study. Doxazosin, prazosin, and terazosin were neutral or showed a negative risk for dementia. Our systematic review did not show a convincing causal association between α1-AR antagonists, including tamsulosin, and cognitive dysfunction. Considering the existing literature, it is appropriate to use α1-AR antagonists without concern for cognitive dysfunction. Future research, through robust study designs considering the multifactorial nature of cognitive dysfunction, is required to further evaluate this association.

Western Disturbances (WD) are significantly important weather systems causing precipitation in the Western Himalayan region during Indian Winter months. WDs have two major components-the eastward propagating upper-level trough originating in the mid-latitudes and the low-level Induced Circulation (IC) prevailing over the Northern Indo-Pak region. The present work aims to study the genesis and movement of these upper-level systems using composite analysis of 10 WD events during the Indian winter season that caused extreme precipitation over the western Himalayan region with emphasize on associative mechanisms leading to the IC. Further, we find that the Meridional Temperature Gradient (MTG) is responsible for the development of extra-tropical storms initiated by frontal genesis over the mid-latitude regions. The frontal genesis occurs due to the polar cold air outbreak (CAO) over higher latitudes, causing meandering of the jet stream and leading to the development of the upper-level perturbation that intensifies into a trough. Prior to the IC intensification, the upper-level moisture transport dominates, and during the intensification process, the combined effect of the upper-level trough and IC facilitates a drastic increase in moisture flux from the Arabian Sea at the lower levels. The moisture transport from the Arabian Sea is, therefore, a primary precursor to heavy precipitation in the Himalayan vicinity due to rapid vertical ascent and intense cloud formation because of orographic effects.

Abstract The mitochondrial permeability transition pore (mPTP) is a supramolecular channel that regulates exchange of solutes across cristae membranes, with executive roles in mitochondrial function and cell death. The contribution of the mPTP to normal physiology remains debated, although evidence implicates the mPTP in mitochondrial inner membrane remodeling in differentiating progenitor cells. Here, we demonstrate that strict control over mPTP conductance shapes metabolic machinery as cells transit toward hematopoietic identity. Cells undergoing the endothelial-to-hematopoietic transition (EHT) tightly control chief regulatory elements of the mPTP. During EHT, maturing arterial endothelium restricts mPTP activity just prior to hematopoietic commitment. After transition in cellular identity, mPTP conductance is restored. In utero treatment with NIM811, a molecule that blocks sensitization of the mPTP to opening by Cyclophilin D (CypD), amplifies oxidative phosphorylation (OXPHOS) in hematopoietic precursors and increases hematopoiesis in the embryo. Additionally, differentiating pluripotent stem cells (PSCs) acquire greater organization of mitochondrial cristae and hematopoietic activity following knockdown of the CypD gene, Ppif. Conversely, knockdown of Opa1, a GTPase critical for proper cristae architecture, induces cristae irregularity and impairs hematopoiesis. These data elucidate a mechanism that regulates mitochondrial maturation in hematopoietic precursors and underscore a role for the mPTP in the acquisition of hematopoietic fate.

Introduction Nurses in intensive care units (ICUs) are vulnerable to sick building syndrome (SBS), which can affect their health, performance, and patient safety. Understanding SBS is crucial in healthcare to protect both staff and patients. However, many ICU nurses lack knowledge about this condition and the necessary detection tools. Objectives This study aimed to describe ICU nurses’ knowledge about SBS and the need of an instrument to detect the signs and symptoms of SBS. Methods A cross-sectional study was conducted with a sample of 100 ICU nurses, recruited through simple random sampling from the Critical Care Indonesia Nurse Association. The study focused on nurses’ knowledge of SBS and the need for an instrument to detect it. Research instruments included basic respondent characteristics, nurses’ knowledge, and the need for an SBS detection tool. Data were analyzed using descriptive statistics. Results The majority of respondents exhibited a good level of knowledge (66%), yet many answered questions incorrectly regarding SBS etiology, symptoms, and effects. This was exemplified by incorrect responses attributing noise and chemicals as causes of SBS, overlooking fatigue as a symptom, and inaccurately assessing the physical effects of SBS. Notably, nurses demonstrated strong knowledge regarding SBS prevention (71%) and treatment (94%). Respondents unanimously supported the necessity of an instrument capable of detecting SBS among ICU nurses (71%), with an electronic instrument being the preferred option over other forms. Conclusion ICU nurses possess a good level of knowledge about SBS. It is recommended to develop and investigate an electronic-based instrument for detecting SBS. Additionally, implementing an e-learning educational program could further enhance the knowledge and management of SBS among healthcare professionals.

Agriculture provides basic livelihood for a large section of world's population. It is the oldest economic activity in India, with two third of Indian population involved in crop production. India is second largest producer of rice and biggest exporter globally, with rice which is most common staple crop consumed in country. However, there are several challenges for paddy production including small production yield, soil quality, seed quality, huge volume of water needed and biotic stress. Of these, biotic stress drastically affects yield and susceptibility to other diseases in paddy production. It is caused by pathogens such as bacteria, viruses, fungi, nematodes, all of which severely affect growth and productivity of paddy crop. To mitigate these challenges, infected crops are identified, detected, classified, categorized, and prevented according to their respective suffering disease by using conventional methods which are not effective and efficient for growth of paddy crop. Thus, use of artificial intelligence (AI) and a smart agriculture-based Internet of Things (IoT) platform could be effective for detecting the biotic stresses in very less time or online mode. For this, deep learning, and convolutional neural networks (CNN) multi-structured layer approach were used for diagnosing disease in rice plants. Different models and classifiers of CNN were used for detecting disease by processing high-spectral images and using logistic and mathematical formulation methods for classification of biotic paddy crop stresses. Continuous monitoring of stages of infection in paddy crop can be achieved using real-time data. Thus, use of AI has made diagnosing paddy crop diseases much easier and more efficient.

Porous-activated carbons (PAC) show a lot of applications in various fields due to their large surface area and appropriate pore volume, along with decent thermal, chemical, and mechanical stability. Because of these characteristics, PACs are the best choice as an electrode material in supercapacitors (SCs). Due to the utility of PACs, this work reports the transformation of polyvinyl chloride (PVC) into PAC with a surface area of 162.40 m2/g. The synthesized PAC exhibits a maximum specific capacitance (CSP) of 40 F/g at five mV/s in 1-ethyl-3- methylimidazolium thiocyanate ionic liquid (EMIM SCN-IL) electrolyte. Also, no degradation was recorded in the initial Csp of the fabricated SC, even after 9000 cycles at room temperature. Additionally, using the same PAC in counter electrode dye-sensitized solar cell (DSSC) was also fabricated, and the cell was tested at 1 sun condition, which shows a fill factor of 59.37 % and an efficiency of 1.42 %.

PURPOSEGene fusions are critical oncogenic mutations that drive cancer development and serve as diagnostic and prognostic biomarkers. Despite the increasing cancer burden in India, large-scale analyses of molecular landscapes, particularly gene fusions, have been relatively scarce.MATERIALS AND METHODSThis retrospective study used RNA-exome data from 1,392 Indian patients with cancer across 15 major cancer types to explore gene fusions. The study used a comprehensive framework that integrated open-source and proprietary tools to detect gene fusions from formalin-fixed paraffin-embedded tumor samples. The process involved RNA extraction, RNA-exome library preparation, and analysis using tools such as FastQC, DRAGEN RNA Pipeline, STAR-Fusion, and FusionInspector. We validated and filtered potential false-positive fusion calls using AGFusion and FusionAnnotator to annotate fusion breakpoints and their functional impact through various in silico tools.RESULTSThe study found a notable prevalence of FGFR fusions across cancer types, especially FGFR3, with FGFR3::TACC3 as the most recurrent. Kinase fusions were prevalent in the cohort accounting for 37% of incidence in the patients. We also identified 91 novel potential driver fusions, including those involving FGFR2, MET, ESR1, and PDGFRA.CONCLUSIONThis study underscores the critical role of gene fusions as biomarkers in cancer, extending beyond fusion-driven malignancies to encompass all cancer types. Gene fusions serve as both diagnostic markers and tumor-agnostic therapeutic targets within the current cancer treatment paradigm. Our insights into the prevalence of oncogenic drivers and novel targets expand the understanding of gene fusions, shedding new light on their mechanisms and clinical implications.

Lacrimal sac and nasolacrimal duct tumors are extremely rare, and most of them are malignant tumors, which are often misdiagnosed as chronic dacryocystitis. We herein report a rare case of a 29-year-old female, presented with a history of watering in the right eye associated with a rapidly progressive mass for 4 months near the medial canthus. Further clinical examination revealed firm, non-tender mass occupying the lacrimal sac fossa extending above the medial canthus. The systemic examination was unremarkable, with a palpable right submandibular lymph node palpable. Contrast-enhanced computerized tomography (CECT) orbit revealed a well-defined mass at the medial canthus extending into the osseous nasolacrimal canal. An excision biopsy was performed, and histopathology revealed a poorly differentiated sebaceous carcinoma of the lacrimal sac. The oncologist advised CECT chest, face, and neck post-surgery, which revealed malignant neoplastic changes at the right lacrimal sac region and lacrimal duct with metastasis at right nodes I b, II, V, and left nodes I b and II. Five-month follow-up showed no signs of recurrence.

Background This study investigated the determinants of community preventive behavior in complying with the Indonesian regulations to prevent COVID-19 local transmission. Methods A cross-sectional study used to collect the data via an online cross using a form created from a google questionnaire forms. A total of 1,802 respondents were gathered at a single point in time. The authors used the Health Belief Model (HBM) approach to measure and create a model for the prevention of local transmission of COVID-19. Results This study found that more than half of the respondents still had low perceived susceptibility (16%) and severity (43%). There were only 3% respondents with perceived barriers and 19% with strong self-efficacy. The findings showed that self-efficacy and perceived barriers had statistically significant relationships with preventive behavior (p-value 0.950, AGFI>0.950, SRMR

Aim: The aim of this study was to find the correlation between different anthropometric parameters of the patient on the length and diameter of the hamstring graft harvested during anterior cruciate ligament (ACL) reconstruction. Materials and Methods: A total of 50 consecutive patients (33 males and 17 females) with ACL deficiency scheduled for reconstruction using hamstring autograft were evaluated prospectively at our institution during the study. Preoperatively, we recorded age, gender, height, weight, and body mass index (BMI). Intraoperative measurements of the final diameter of the graft using sizing tubes calibrated to 1 mm and length of tendon harvested were taken. Correlation coefficient (Pearson’s r) analysis was used. Results: As per the study, height of the patients correlated to graft diameter and length in both Indian men and women (P < 0.001). Although there was no correlation between age, sex, weight, and BMI with graft length and diameter. Conclusion: Anthropometric measurements such as weight, gender, and BMI cannot be used as definitive predictors for the hamstring graft diameter during harvest, but the height of the patients can be taken as a good predictor.

Background: In Retzius-sparing robot-assisted radical prostatectomy (RARP), lymphocele formation is a troublesome complication. The use of peritoneal flaps has emerged as a promising novel technique to tackle this complication. We explored this technique by suturing both the medial peritoneal flaps to each other and keeping them distracted so that the lymphadenectomy beds are left wide open. Objective: To assess the efficacy of our peritoneal distraction technique on lymphocele rates following Retzius-sparing RARP. Materials and Methods: This retrospective study included patients with localized prostate carcinoma who underwent Retzius-sparing RARP with standard pelvic lymph node dissection between May 2014 and September 2022 at Aster Medcity, Kochi, India. Based on the use of the technique, patients were divided into two groups: peritoneal distraction and closed groups. Both groups were matched using the propensity scoring method in a 1:1 ratio. Results: A total of 272 patients were included, of which 89 (32.7%) belonged to the peritoneal distraction group. Although the overall incidence of lymphocele between the two groups were comparable, none of the patients in the peritoneal distraction group required any intervention for lymphocele management, as opposed to 7 patients from the closed group (3.9%; P = 0.015). No significant association was found between lymphocele formation and serum prostate-specific antigen level, Gleason score, and the number of lymph nodes harvested. Conclusions: This study found that peritoneal distraction stitch is a simple and effective technique to reduce the incidence of symptomatic lymphocele that require intervention after Retzius-sparing RARP.

Abstract Introduction The study aimed to evaluate comparability in terms of efficacy, safety and immunogenicity of Sun’s ranibizumab biosimilar with reference ranibizumab in patients with neovascular age-related macular degeneration (nAMD). Methods This prospective, randomised, double-blind, two-group, parallel-arm, multicentre, phase 3 comparative study included patients with nAMD ≥ 50 years, randomised (in a 2:1 ratio) in a double-blind manner to receive 0.5 mg (0.05 mL) intravitreal injection of either Sun’s ranibizumab or reference ranibizumab in the study eye every 4 weeks until week 16 (total of four doses). Results Primary endpoint results demonstrated equivalence in the proportion of patients who lost fewer than 15 letters from baseline best-corrected visual acuity (BCVA) to the end of week 16 (99% of patients in Sun’s ranibizumab and 100% in reference ranibizumab; p > 0.9999), with the proportional difference (90% confidence interval) at −1% (−2.51, +0.61) lying within a pre-specified equivalence margin. Visual acuity improved by 15 or more letters in 43% of Sun’s ranibizumab group and 37% of the reference ranibizumab group (p = 0.4267). The mean increase in BCVA was 15.7 letters in Sun’s ranibizumab group and 14.6 letters in the reference ranibizumab group (p

Introduction Tuberculosis (TB) continues to be one of the deadliest infectious diseases over the centuries, killing more people worldwide than any other single infectious disease. There is an urgent need for additional strategies which can expedite efforts to combat TB including a preventive vaccine. In this endeavour, we have developed a protocol for a multisite, double-blind, placebo-controlled clinical trial in India that aims to evaluate the efficacy and safety of two TB vaccines; namely, VPM1002 and Immuvac (M.w) (Mycobacterium Indicus Pranii) (MIP) among healthy household contacts (HHCs) of sputum smear-positive pulmonary TB (PTB) patients.Methods and analysis In the three-arm randomised double-blind placebo-controlled trial study protocol, a total of 12 000 HHCs (aged 6−99 years) of sputum smear-positive PTB patients will be randomised to receive either of the two vaccine candidates VPM1002 and MIP or placebo. The primary efficacy endpoint is the prevention of microbiologically confirmed TB. Secondary endpoints will include (1) prevention against Latent TB infection, (2) incidence of adverse events and serious adverse events in study participants, (3) efficacy of vaccine in prevention of PTB/extra PTB in different age groups (6–18 years, 19–35 years, 36–60 years and above 60 years) and (4) immunogenicity of VPM1002 and MIP at month 2 and month 6 after first vaccination in terms of flow cytometric analysis of M.Tb specific CD4+ and CD8+ T cells secreting cytokines and Luminex assays for the presence of different cytokines in the sera and supernatants of peripheral blood mononuclear cells cultures stimulated with whole cell lysates of M.Tb and subsequently similar analysis for the cases who develop TB postvaccination during the follow-up period.Ethics and dissemination Ethics committees’ approvals have been granted by the Institutional Human Ethics Committees of all participating centres in this study and the names of the ethics committees and approvals are as follows: (1) National Institute for Research in Tuberculosis (NIRT)-Chennai (including subsites): ECR/135/Inst/TN/2013/RR-19, Approval No. 390/NIRT-Institutional Ethics Committee (IEC)/2018 dated 5 December 2018 (NIRT-Madurai-ECR/1365/Inst/TN/2020; approval dated 8 June 2020; NIRT, Vellore: ECR/1215/Inst/TN/2019; approval dated 26 September 2020); (2) All India Institute of Medical Sciences (AIIMS), Delhi (including subsites)-Institute Ethics Committee, ECR/547/Inst/DL/2014/RR-17 ECR/538/Inst/DL/2014/RR-20; approval No.IEC-385/06-07-2018, approval OP-28/05.04.2019 and SFH- ECR/593/Inst/DL/2014/RR-20 IEC/VMMC/SJH/project/2019-05/25 ; 23 May 2019; (3) National Institute of Tuberculosis and Respiratory Diseases (NITRD), Delhi: ECR/315/Inst/DL/2013/RR-19; approval IEC-No-NITRD/EC/2019/9004; 8 January 2019; (4) Pune-National AIDS Research Institute (NARI) and subsite-ECR/23/Inst/MH/2013/RR-19; IEC-NARI/EC/approval/2018/196; 29 May 2018; (5) Regional Medical Research Centre-Bhubaneshwar-ECR/911/Inst/OR-2017/RR-21; approval, dated 25 April 2018; Subsites- AIIMS, Bhubaneshwar ECR/534/Inst/OD/2014/RR-17 and 20 approval No. T/EMF/Pulm. Med/19/01 dated 13 May 2019; SCB, Cuttack No. No.ECR/84/Inst/OR/2013/RR-20; approval no.186 dated 7 February 2020; (6) NTI-Bengaluru: Ethics Committee-No-ECR/1819/Inst/KA/2019; approval No NTI-IEC/1.2019/principal investigator, dated 31 January 2019; (7) BMMRC, Hyderabad- ECR/450/Inst/AP/2013/RR-16 approval No. 779/BMMRC/2018/IEC, dated 11 June 2018 (Subsite Share India- Mediciti Ethics Committee-ECR/283/Inst/AP/2013/RR-20; Approval no. EC/11/VII/2K20(1) dated 11 July 2020) and (8) SJMC-Bengaluru: ECR/238/Inst/KA/2013/RR-19; approval IEC/1/491/2020; 7 August 2020.The trial findings will be published in accordance with the Consolidated Standards of Reporting Trials guidance. The results of this clinical trial will be presented at scientific conferences and disseminated through publications in peer-reviewed journals, conference presentations and shared with Ministry of Health and Family Welfare, policy-makers and other stakeholders.Trial registration number CTRI/2019/01/017026.

Abstract Halide perovskite single crystals (SCs) have attracted much attention for their application in high‐performance x‐ray detectors owing to their desirable properties, including low defect density, high mobility–lifetime product (μτ), and long carrier diffusion length. However, suppressing the inherent defects in perovskites and overcoming the ion migration primarily caused by these defects remains a challenge. This study proposes a facile process for dipping Cs0.05FA0.9MA0.05PbI3 SCs synthesized by a solution‐based inverse temperature crystallization method into a 2‐phenylethylammonium iodide (PEAI) solution to reduce the number of defects, inhibit ion migration, and increase x‐ray sensitivity. Compared to conventional spin coating, this simple dipping process forms a two‐dimensional PEA2PbI4 layer on all SC surfaces without further treatment, effectively passivating all surfaces of the inherently defective SCs and minimizing ion migration. As a result, the PEAI‐treated perovskite SC‐based x‐ray detector achieves a record x‐ray sensitivity of 1.3 × 105 μC Gyair−1 cm−2 with a bias voltage of 30 V at realistic clinical dose rates of 1–5 mGy s−1 (peak potential of 110 kVp), which is 6 times more sensitive than an untreated SC‐based detector and 3 orders of magnitude more sensitive than a commercial α‐Se‐based detector. Furthermore, the PEAI‐treated‐perovskite SC‐based x‐ray detector exhibits a low detection limit (73 nGy s−1), improved x‐ray response, and clear x‐ray images by a scanning method, highlighting the effectiveness of the PEAI dipping approach for fabricating next‐generation x‐ray detectors.

In the context of developing countries like Nepal, enhancing road traffic safety (RTS) requires prioritizing aspects such as road safety management, infrastructure improvement, vehicle safety, and promoting safer road user behavior. Importantly, establishing a conducive legal framework and ensuring effective enforcement are crucial for improving RTS. This study aims to analyze the enforcement status of road traffic regulatory factors and provide suggestions for improvement. A set of structured questionnaires comprising thirty items measuring six dimensions of road traffic regulation was developed to gather data from 396 Nepal traffic police officers. Confirmatory Factor Analysis (CFA) was employed to construct the measurement model. The statistical analysis revealed that road traffic regulatory factors such as seatbelt, helmet, and license laws, along with insufficient penalties for violations related to drunk and distracted driving, speeding, and mobile phone use contribute to road traffic accidents. The findings highlight the pressing need for effective implementation of traffic regulations. To improve road safety in Nepal stricter penalties for drunk driving, speeding, and mobile phone use, advancing vehicle safety technology, formulating transportation safety policies, accrediting pre-hospital care providers, and safety auditing in road planning, construction, and operation are vital. The model developed herein provides valuable insights to policymakers to reinforce prevailing regulations for reducing traffic-related fatalities not only for Nepal but also for other countries encountering similar road safety challenges.

Background: Oral Submucous Fibrosis, OSF is an inflammatory mucosal disorder prevalent in areca nut chewing belts of the world. Although various treatments are available for its management, none provide complete resolution.Curcumin, an indigenous product, improves burning sensation, mouth opening along with other clinical signs of OSF and is potentially viable therapeutic option for its management. Objectives: To assess the available evidence for employing curcumin in improving symptoms in patients with OSF. Methods: Systematic search was carried out in e-databases from January 2010 until July 2023 to identify relevant clinical trials comparing curcumin to active and/or nonactive controls (placebo) for the management of OSF. Results: A total of 20 studies were used for qualitative analysis out of which 11 studies were considered for quantitative synthesis.Curcumin was found to be highly effective in alleviating pain/burning sensation, improving mouth opening (MO), cheek flexibility, tongue protrusion and induces positive histological changes in patients with OSF.The standardized mean difference in mouth opening between both the Curcumin and Multivitamin group showed a statistically significant difference favouring the Curcumin group (SMD, 0.37, 95% CI = 0.18–0.56, p - 0.0001, I2- 0%). Conclusion: Statistically curcumin was noted to be as effective as Aloe vera, lycopene and steroids in relieving symptoms of OSF in stages 1 and 2 and improving MO. It is seen to improve histopathological picture of lesions thereby suggesting its active role in preventing malignant transformation. Its found to be more effective than multivitamins in improving mouth opening of patients in OSF.

Introduction Brace treatment is common to address radiological dysplasia in infants with developmental dysplasia of the hip (DDH); however, it is unclear whether bracing provides significant benefit above careful observation by ultrasound. If observation alone is non-inferior to bracing for radiological dysplasia, unnecessary treatment may be avoided. Therefore, the purpose of this study is to determine whether observation is non-inferior to bracing for infants with radiological dysplasia.Methods and analysis This will be a multicentre, global, randomised, non-inferiority trial performed under the auspices of a global prospective registry for infants and children diagnosed with DDH. Patients will be included if they present with radiological dysplasia (centred hip, alpha angle 43–60°, percent femoral head coverage greater than 35% measured on ultrasound) of a clinically stable hip under 3 months old. Patients will be excluded if they present with clinical hip instability, have received prior treatment or have known/suspected neuromuscular, collagen, chromosomal or lower-extremity congenital abnormalities or syndromic-associated hip abnormalities. Patients will be enrolled and randomised to undergo observation alone or brace treatment with a Pavlik harness for a minimum of 6 weeks. Follow-up visits will occur at 6 weeks, 1 year and 2 years post-enrolment. The primary outcome will be the norm-referenced acetabular index measured on the 2-year radiograph with a 3° non-inferiority margin. A total of 514 patients will be included.The study is anticipated to start in April 2024 and end in September 2028.The primary outcome will be compared between arms with a mixed-effects model with a random intercept for study centre, and a single covariate for the treatment group. If the lower bound of the 95% CI lies within 3° of the mean, we will treat this as evidence for non-inferiority.Ethics and dissemination Ethics approval has been obtained from the lead site’s ethics board (University of British Columbia, Children’s and Women’s Research Ethics Board). Ethics approval will be obtained from the local ethics committees or institutional review boards at each institution prior to patient enrolment. It is intended that the results of this study shall be published in peer-reviewed journals and presented at suitable conferences.Trial registration number NCT05869851.

Introduction: Brucellosis is a disease that can have severe consequences for both humans and animals, resulting in considerable economic losses due to its impact on human health and animal productivity. To prevent the transmission of this disease from animals to humans, it is essential to improve the community’s knowledge, attitude, and practice (KAP). This study aimed to evaluate the KAP and associated risk factors for human brucellosis among rural populations in Nagpur, Maharashtra, India. Materials and Methods: Using closed-ended questionnaires, a cross-sectional study was conducted to collect data on demographics and risk exposure variables from 382 participants. The collected data were entered into Microsoft Excel and analyzed using SPSS. Descriptive statistics were used to evaluate demographic features and KAP. Results: 78.5% were male, and 21.5% were female. Their ages ranged from 18 to 90 years, and 92.1% were married. Only 4.5% of respondents had heard of brucellosis, 21.5% consumed unpasteurized milk, 3.9% used protective gloves while assisting during calving, and 15.4% milked the animal. Furthermore, 21.2% buried animal birth products, 10.9% burned animal birth products, and 13.6% threw animal birth products in the dustbin. Overall, the respondents’ attitude was average to poor. Conclusion: This study revealed that the rural population has poor knowledge and high-risk self-reported practices and behaviors for brucellosis. Therefore, enhancing public health education and local organizational involvement is imperative to increase the community’s capacity to prevent brucellosis as an integral part of the National Control Program on Brucellosis in India.

Background Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. Methods A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Results Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74–19.76 minutes; P

Abstract Acute Myeloid Leukemia (AML) is caused by multiple mutations which dysregulate growth and differentiation of myeloid cells. Cells adopt different gene regulatory networks specific to individual mutations, maintaining a rapidly proliferating blast cell population with fatal consequences for the patient if not treated. The most common treatment option is still chemotherapy which targets such cells. However, patients harbour a population of quiescent leukemic stem cells (LSCs) which can emerge from quiescence to trigger relapse after therapy. The processes that allow such cells to re-grow remain unknown. Here, we examine the well characterised t(8;21) AML sub-type as a model to address this question. Using four primary AML samples and a novel t(8;21) patient-derived xenograft model, we show that t(8;21) LSCs aberrantly activate the VEGF and IL-5 signalling pathways. Both pathways operate within a regulatory circuit consisting of the driver oncoprotein RUNX1::ETO and an AP-1/GATA2 axis allowing LSCs to re-enter the cell cycle while preserving self-renewal capacity.

Introduction: Cysticercosis is a parasitic infestation caused by Taenia solium, which is a pork tape worm. Humans are the definitive host, and pigs are the intermediate host. It is more prevalent in low socioeconomic regions with poor hygiene and among populations where undercooked pork is consumed. Case Presentation: We hereby report an uncommon site of cyst lodgment and duration of presentation in a 24-year-old male who presented with a firm, non-tender mass over the superomedial aspect of the right orbital rim, superior to the medial canthal tendon for the last 9 years. Chronic presentation and location of the mass led to the tentative diagnosis of a dermoid cyst. Hence, a CECT orbit was advised to assess the extent and attachment of the mass. Unexpectedly, a cystic lesion with hyperdense nidus, suggestive of cysticercosis, was identified. Histopathology of the excised mass confirmed the diagnosis of cysticercosis. Conclusion: Our case emphasizes the importance of an uncommon site and chronic presentation in cases of cysticercosis.

This article proposes a method for the automatic generation of a plant model and monitoring using process mining algorithms based on recorded event logs. The behavioral traces of the system are captured by recording event logs during plant operation in either manual control mode or with an automatic controller. Process discovery algorithms are then applied to extract the logic of the process behavior properties from the recorded event logs. The result is represented as a Petri net, which is used to construct the state machine of the plant model and monitor and is in accordance with the IEC 61499 Standard. The monitor is implemented as a function block and can be deployed in real time to trigger an error signal whenever there is a deviation from the actual process scenario. The plant model and controller are connected in a closed loop and are used for the formal verification of the system with the help of the “fb2smv” converter and symbolic model checking tool NuSMV.

Dear Editor, We are truly obliged to be able to read articles in your esteemed journal. We recently read an article published in your prestigious Journal of Clinical and Diagnostic Research under the Physiotherapy Section in 2023;17(5):YC01-YC06 by Bali NK et al., titled “Correlation between BMI and Static Biomechanical Lower Extremity Kinetic Chain Variables in Overweight Young Adults: A Cross-sectional Study” [1]. The authors’ meticulous work is extremely beneficial in evaluating variables related to the lower extremity kinetic chain, including pronated feet, femoral anteversion, Q-angle, tibial torsion, plantar arch index, angle of the toe, and pelvic inclination. However, we would like to draw the attention of the authors to a few concerns.

Extreme rainfall events (ERE) during the summer monsoon season have been occurring over most parts of India resulting in flooding and immense socio-economic loss. These extremes are becoming a frequent norm in the hilly and mountainous regions of the country such as Assam. Assam received one of the most historical EREs from 14–June 17, 2022. The present study analyses the performance of a suite of high-resolution ensemble model forecasts for this extreme event in terms of its intensity, and distribution with a lead time of up to 96 h. Furthermore, the 36 numerical experiments are carried out using two different land use and land cover (LULC) data sets (i.e. ISRO and USGS) and three different sets of parameterization schemes (i.e. planetary boundary layer, cumulus, and microphysics).Rainfall distributions in the case of USGS LULC are relatively less coherent and underestimated (60–260 mm/day) against IMD (80–300 mm/day) including the rainfall categories heavy (HR), very heavy (VHR), and extremely heavy (EHR) rainfall throughout the day-1 to day-4. Among all the ensembles (E1-E10), USGS (E6 - E10) has underestimated rainfall (140–260 mm/day) compared to ISRO (150–280 mm/day), specifically in MR and HR categories over the upper Assam (UAD) and lower Assam (LAD) divisions. Further, the Bias Correction Ensemble (BCE) technique is applied to minimize the forecast errors. A rigorous statistical analysis in terms of frequency distribution, Taylor diagram, and benchmark skill scores is carried out to elucidate the model biases. The set of the model ensembles using ISRO (E1- E5) and USGS (E6- E10) reasonably captured the HR, VHR, and EHR. In addition, throughout the forecast hour, BCE E5 (E10) is noted with the distinct realistic (underestimated) representation of model bias (5–20 %) (10–30 %) over all the subdivisions of Assam. Our results suggest that the combined efforts of ensembles of physical parameterization schemes, along with proper LULC, and the BCE approach are required to overcome challenges to improve the skills of rainfall events, particularly over complex terrains such as Assam.

T-cell acute lymphoblastic leukemia (T-ALL) is a cancer of the immune system. Approximately 20% of paediatric and 50% of adult T-ALL patients have refractory disease or relapse and die from the disease. To improve patient outcome new therapeutics are needed. With the aim to identify new therapeutic targets, we combined the analysis of T-ALL gene expression and metabolism to identify the metabolic adaptations that T-ALL cells exhibit. We found that glutamine uptake is essential for T-ALL proliferation. Isotope tracing experiments showed that glutamine fuels aspartate synthesis through the TCA cycle and that glutamine and glutamine-derived aspartate together supply three nitrogen atoms in purines and all but one atom in pyrimidine rings. We show that the glutamate-aspartate transporter EAAT1 (SLC1A3), which is normally expressed in the central nervous system, is crucial for glutamine conversion to aspartate and nucleotides and that T-ALL cell proliferation depends on EAAT1 function. Through this work, we identify EAAT1 as a novel therapeutic target for T-ALL treatment.

Advanced graphene-based materials have been proficiently incorporated into next-generation solar cells and supercapacitors because of their high electrical conductivity, large surface area, excellent charge-transport ability, and exceptional optical properties. Herein, we report the synthesis of graphene nanosheets (GNs) from waste cardboard via pyrolysis, with ethyl alcohol as the growth initiator. Additionally, we demonstrated the use of GNs in energy conversion and storage applications. Using the GN electrode in perovskite solar cells resulted in an excellent power conversion efficiency of ∼10.41 % for an active area of 1 cm2, indicating an enhancement of approximately 27 % compared to conventional electrodes. Furthermore, the GNs were used as active electrode materials in supercapacitors with excellent electrochemical performance and a high gravimetric specific capacitance of 167.5 F/g at a scan rate of 2 mV/s. The developed GNs can be efficiently used for energy storage, conversion, and electrochemical sensing applications.

Introduction Nasal anthropometry is a useful clinical parameter recognized in medicine and surgical management of nasal abnormalities. Nasal index is the most common nasal parameter, and may be determined by regional and climatic differences. Understanding baseline nasal parameters could make measurements of nasal index a useful tool for researchers, clinicians, rhinoplastic and facial reconstructive surgeons, forensic experts and others in related fields. The aim of this study was to establish normative data for nasal anthropometric parameters and distribution of basic nose types in the South Indian population that could be useful in future forensic and anthropological studies. Methods The study was conducted on 109 skulls available in the Department of Anatomy of a medical college in Southern India. The nasal index was calculated as the percentage nasal width divided by nasal height. The results were tabulated and analyzed to determine nasal types. Results The mean nasal width was 49mm, the mean nasal height was 91mm and the mean nasal index was 54mm. The standard deviation of nasal index was 5mm with a standard error of 0.5mm. Conclusion The study was conducted using a novel anthropometric method that used routine digital photographs of South Indian skulls. Hence the results can be recommended to forensic experts, plastic surgeons and anthropologists.

Restriction modification (RM) systems are one of the ubiquitous yet primitive defense responses employed by bacteria and archaea with the primary role of safeguarding themselves against invading bacteriophages. Protection of the host occurs by the cleavage of the invading foreign DNA via restriction endonucleases with concomitant methylation of host DNA with the aid of a methyltransferase counterpart. RM systems have been extensively studied in bacteria, however, in the case of archaea there are limited reports of RM enzymes that are investigated to date owing to their inhospitable growth demands. This review aims to broaden the knowledge about what is known about the diversity of RM systems in archaea and encapsulate the current knowledge on restriction and modification enzymes characterized in archaea so far and the role of RM systems in the milieu of archaeal biology.

Hepatitis B is a serious threat to public health on a global scale. The Hepatitis B virus (HBV), which spreads both vertically and horizontally, is easily contracted by anyone. In 2020, the World Health Organization estimates that 257 million people worldwide have hepatitis B, and 900,000 people die from it each year. According to the World Health Organization (2021), there are approximately 39.4 million people in Southeast Asia living with chronic hepatitis B mortality, with 410,000 deaths caused by the disease. HBV can spread through injections, horizontal transmission, blood transfusions, and organ transplants. Cochrane, Science Direct, PubMed, Elsevier, Sage, Willey, DOAJ, and Google Scholar database sources were used to search for supported research on how to prevent hepatitis virus transmission in urban communities. 15 publications address the primary and secondary prevention of hepatitis B transmission in urban settings. Prevention keeps a person in good health and prevents them from progressing to a later, worse stage. Given that the hepatitis B virus can infect anyone, regardless of age, and that it affects people's health worldwide, as well as their families, communities, and families within them. In order to eradicate the hepatitis B virus, society must be aware of the importance of implementing preventive measures on a continuous and long-term basis through health advocacy activities, hepatitis B virus screening campaigns, health education, counseling, hepatitis B vaccination with community-based activities, and secondary prevention through combination therapy treatment in post-liver transplant patients.

Summary: AML is characterized by mutations in genes associated with growth regulation such as internal tandem duplications (ITD) in the receptor kinase FLT3. Inhibitors targeting FLT3 (FLT3i) are being used to treat patients with FLT3-ITD+ but most relapse and become resistant. To elucidate the resistance mechanism, we compared the gene regulatory networks (GRNs) of leukemic cells from patients before and after relapse, which revealed that the GRNs of drug-responsive patients were altered by rewiring their AP-1-RUNX1 axis. Moreover, FLT3i induces the upregulation of signaling genes, and we show that multiple cytokines, including interleukin-3 (IL-3), can overcome FLT3 inhibition and send cells back into cycle. FLT3i leads to loss of AP-1 and RUNX1 chromatin binding, which is counteracted by IL-3. However, cytokine-mediated drug resistance can be overcome by a pan-RAS inhibitor. We show that cytokines instruct AML growth via the transcriptional regulators AP-1 and RUNX1 and that pan-RAS drugs bypass this barrier.

Abstract Emerging as a food of the future, cultured meat is created by growing animal cells outside the organism instead of relying on traditional animal rearing and slaughtering practices. This innovative approach shows great promise in addressing challenges associated with resource utilization, environmental pollution, and public health concerns often encountered in conventional livestock production. In the past decade, popularity of cultured meat has grown enough to be considered as a novel food in regions like Europe, the United Kingdom, and China. This paper discusses the recent advancements in technologies for sustainable cultured meat production. It examines the latest developments in cell sources, cell culture media optimization, bioreactor design, 3D printing, and tissue engineering approaches, which have greatly enhanced the efficiency and scalability of cultured meat production. This food can have a tremendous application as a novel functional food. This review explores the future possibility of applying cultured meat matrix for delivery of hydrophobic nutraceuticals, prebiotics, and probiotics (Bacillus sp).

Background: Shoulder adhesive capsulitis (AC) is a common musculoskeletal condition causing pain, loss of range of motion (ROM) in the shoulder, and a decrease in its functionality, yet poorly defined and understood since its identification. Kaltenborn mobilization technique (KMT) and muscle energy technique (MET) are commonly used physiotherapeutic techniques for their treatment. To the best of our understanding, there was no study found to compare the effectiveness of one technique over another. Objective: The objective of this study was to compare the effectiveness of KMT and MET on the ROM, pain and function in subjects with chronic shoulder AC. Methods: In this single-centred, single-blinded quasi-experimental study with a pretest–posttest design 35 subjects were randomized into two groups: Group A ([Formula: see text]) received KMT and Group B ([Formula: see text]) received MET along with the moist hot pack (MHP), supervised exercises and home exercises common to both the groups. A total of 32 subjects completed the study with three dropouts. Subjects were evaluated before and after 10 treatment sessions for the outcomes, shoulder external rotation passive range of motion (ER-PROM) and abduction passive range of motion (ABD-PROM) using the universal goniometer, intensity of pain using the numeric pain rating scale (NPRS) and functional disability using the shoulder pain and disability index (SPADI). Results: Analysis of 32 subjects showed that both groups were homogenous at baseline. The within-group analysis showed significant improvement ([Formula: see text]) in both groups related to all the outcomes. But when we compared the groups, Group B showed significant ([Formula: see text]) improvement in NPRS and SPADI in comparison to Group A. However, there was non-significant ([Formula: see text]) difference found in ER-PROM and ABD-PROM. Conclusion: Both KMT and MET are effective in improving ROM, pain and function but MET showed a significant reduction of pain and improvement in function in subjects with chronic shoulder AC, thus supporting its use as a physiotherapeutic treatment technique.

Abstract Background The opioid epidemic in the United States has had devastating consequences, with many opioid-related deaths and a significant economic toll. Opioids have a significant role in postoperative pain management. Here we aim to analyze differences in postoperative opioid and non-opioid pain medications regimens following common otolaryngological surgeries between two large tertiary care medical centers: the Milton S. Hershey Medical Center, USA (HMC) and The Chaim Sheba Medical center, Israel (SMC). Methods A retrospective chart review of patients undergoing common otolaryngological procedures during the years 2017–2019 was conducted at two tertiary care centers, one in the U.S. and the other in Israel. Types and doses of postoperative pain medications ordered and administered during admission were analyzed. Average doses ordered and administered in 24 h were calculated. Opioid medications were converted to a standardized unit of morphine milliequivalents (MME). Chi-square test and Wilcoxon rank-sum test were used to compare the groups. Results The study included 204 patients (103 U.S., 101 Israel). Patient demographics were similar except for a longer length of stay in Israel (p

Direct or type A CCFs are the direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus. While most direct CCFs are caused by trauma, spontaneous direct CCFs are extremely rare in infants. In this report, we describe a 6-month-old child with bulges in the right eye that had been present since 20 days after birth. On examination, there was a right eye abduction limitation with no deviation associated with proptosis. Bruit was present during auscultation. CEMRI showed an enlarged right cavernous sinus with dilatation of the superior ophthalmic vein, suggesting a carotid-cavernous fistula. The patient was referred to an advanced center where he was advised patch therapy to prevent amblyopia. He was kept under observation by a neurosurgeon until 3 years, after which he was scheduled to undergo transarterial coiling.

Background The COVID-19 pandemic has increased the need for mask production which has caused the problem of mask waste generating in the environment without being managed. This research was conducted to determine the relationship between knowledge, attitudes, and sociodemographic factors with college student behaviours in managing household mask waste in Daerah Khusus Ibukota (DKI) Jakarta Province. Methods This study used a quantitative approach and cross-sectional study design. Data collection was carried out using an online questionnaire consisting of the respondents’ sociodemographic, knowledge, attitudes, and behaviours. Results The majority of students had high knowledge (63.3%), positive attitudes (52.5%), and good behaviours (50.6%). Statistically, there was a significant relationship between knowledge and behaviours (p = 0.022), but there was no significant relationship between attitudes and behaviours (p = 0.269). In addition, the sociodemographic factor variables showed a significant relationship between place of residence and behaviours (p = 0.008). However, there was no significant relationship between age, gender, education, and study program groups and behaviours (p > 0.05). Multivariate analysis showed that living with family was a dominant factor for bad behaviours (OR 1.664, 95% CI=1.124-2.464), and the second risk factor was the low level of knowledge has a significant relationship with the behaviours of mask waste management at home (OR=1.559, 95% CI=1.044-2.330). Conclusions Students who live alone also show better behaviour compared to students who live with their families. The place of residence variable has the greatest influence on the behaviour of mask waste management at the household, followed by the knowledge variable.

This study develops a mathematical link between pharmacokinetics and fractional calculus, emphasizing on metformin’s complex metabolic activities in diverse body areas. Our study proposes and evaluates a metformin kinetics model that incorporates homogenous dimensionality in the Caputo sense. To explore the uniqueness and existence of solutions, we adopt the Banach and Schauder fixed point theorems. The study includes equilibrium points, asymptotic stability in respect to certain parameters, and Lyapunov stable solutions. In addition, we investigate Ulam-type stability for the generalized model. The research finishes with a thorough theoretical analysis based on the generalized Adam–Bashforth–Moulton (A-B-M) technique, laying the groundwork for future empirical validation.

PURPOSEFebrile neutropenia (FN) is a serious complication in hematologic malignancies, and lung infiltrates (LIs) remain a significant concern. An accurate microbiological diagnosis is crucial but difficult to establish. To address this, we analyzed the utility of a standardized method for performing bronchoalveolar lavage (BAL) along with a two-step strategy for the analysis of BAL fluid.PATIENTS AND METHODSThis prospective observational study was conducted at a tertiary cancer center from November 2018 to June 2020. Patients age 15 years and older with confirmed leukemia or lymphomas undergoing chemotherapy, with presence of FN, and LIs observed on imaging were enrolled.RESULTSAmong the 122 enrolled patients, successful BAL was performed in 83.6% of cases. The study used a two-step analysis of BAL fluid, resulting in a diagnostic yield of 74.5%. Furthermore, antimicrobial therapy was modified in 63.9% of patients on the basis of BAL reports, and this population demonstrated a higher response rate (63% v 45%; P = .063).CONCLUSIONOur study demonstrates that a two-step BAL fluid analysis is safe and clinically beneficial to establish an accurate microbiological diagnosis. Given the crucial impact of diagnostic delays on mortality in hematologic malignancy patients with FN, early BAL studies should be performed to enable prompt and specific diagnosis, allowing for appropriate treatment modifications.

Plastic waste has become one of the biggest problems due to their excessive use. Decomposition of bioplastics is very difficult as a result its causes lot of negative impact to landfill and water pollution. The most possible solution to overcome this problem is to substitute synthetic polymeric materials with biodegradable materials suchas bioplastics. Food wastes can be transformed into environment friendly bioplastics, which will not only reduce environmental pollution due to natural fermentation of these wastes, but also generate National revenue besides generating employment potentials. These polymers can be degraded environmentally by microorganisms and water in compost piles. Application of Bioplastics has several advantages over conventional plastics such as lower carbon footprint and greenhouse gases (GHG) emissions, lower energy cost in manufacturing, reduction of permanent litter, and much safer to the environment. In food Industries, the need for high-standard storage features and the urge for packaging with high economic, low ecological impact, ease of customization, and low encumbrance can be answered by compostable or degradable bioplastics where kitchen waste may take essential role. Advancements in biomedical applications of bioplastics lead to the development of drug delivery systems and therapeutic devices for tissue engineering. Nanocellulose and its composites, which may be obtained from the processing of kitchen wastes, may result in potential and economical sources for green plastic studies about the fabrication of medical implants, either in dental, orthopedic, or biomedical fields.

Background This study investigated the determinants of community preventive behavior in complying with the Indonesian regulations to prevent COVID-19 local transmission. Methods A cross-sectional study used to collect the data via an online cross using a form created from a google questionnaire forms. A total of 1,802 respondents were gathered at a single point in time. The authors used the Health Belief Model (HBM) approach to measure and create a model for the prevention of local transmission of COVID-19. Results This study found that more than half of the respondents still had low perceived susceptibility (16%) and severity (43%). There were only 3% respondents with perceived barriers and 19% with strong self-efficacy. The findings showed that self-efficacy and perceived barriers had statistically significant relationships with preventive behavior (p-value 0.950, AGFI>0.950, SRMR

Category: Trauma; Hindfoot Introduction/Purpose: Malunion is a disabling complication of talar neck fractures and is prevalent in approximately 17% of cases. The impact of talar neck malunions (TNM) on foot biomechanics and functional outcomes is not well established. The available evidence is primarily derived from cadaveric studies which have demonstrated that TNMs result in reduced motion and significant alterations in contact characteristics of the subtalar joint. Owing to the paucity of literature on this subject, we conducted this study to evaluate the kinematic and pedobarographic changes and functional outcomes associated with TNMs. Methods: In this study, adult patients with talar neck malunions (TNM) without ankle arthrosis were prospectively enrolled over a 5-year period. The Rammelt and Zwipp classification was utilized to categorize the deformities. Demographic data and ankle and subtalar range of motion were assessed. Weight-bearing anteroposterior (AP), lateral, and long axial radiographs, as well as CT scans of both feet, were obtained. Dynamic pedobarography was performed to evaluate gait kinematics and plantar pressure distribution. Functional outcomes were evaluated using the Manchester Oxford Foot Questionnaire (MOxFQ), Visual Analog Score, and the EQ5D questionnaire. The t-test was utilized to compare the range of motion, pedobarographic and kinematic parameters between the normal and pathologic foot. Furthermore, correlation coefficients were calculated to determine the strength of the association between changes in talar neck geometry, plantar pressures, kinematics, and functional outcomes. Results: A total of 10 patients, 6 males, and 4 females, with a mean age of 32.4 years were enrolled. On the TNM side, significant increases were observed in step length and step time, while significant decreases were noted in the single limb support time and single limb support center of pressure line. Moreover, midfoot forces were significantly increased, whereas the forefoot and hindfoot forces were significantly decreased on the TNM side. A strong positive correlation was found between midfoot force and the talar torsion angle, and a moderate negative correlation was observed between hindfoot and midfoot forces and the inclination angle. A strong positive correlation was also noted between high midfoot pressures and VAS Scores, MOxFQ scores, and the EQ5D walking and usual activities domains. Conclusion: This study demonstrates that TNMs are associated with decreased single limb support time, increased step length and time, increased midfoot pressures, and decreased forefoot and hindfoot pressures. Additionally, an increase in talar neck torsion after TNM is linked with higher midfoot pressures, which can lead to higher levels of pain and poorer function. Our findings provide valuable insights into the altered foot biomechanics after TNMs, which can assist surgeons in offering optimal management strategies for these patients.

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis injury can be of a varying magnitude; little information exists about the influence of degree of initial syndesmotic injury/instability on functional outcomes in ankle fractures, nor is there any correlation of this with follow up radiological parameters. Aims and Objectives: To identify and define morphological patterns of syndesmotic injury in ankle fractures according to a zone based evaluation, and correlate initial degree of instability with mid-term functional and radiological outcomes using validated scores Design: Retrospective cohort study, to review a prospective question. Methods: 40 complex ankle fractures out of 120 ankle fractures in our ankle registry met the inclusion criteria ie significant documented syndesmosis involvement needing stabilization, with all initial clinical and radiological records available. The patients were followed up between January 2020 to July 2021. Injury characteristics, fracture morphology of posterior malleolus, medial malleolus and fibula were noted and classified by validated classification systems based on x-rays and CT scan. The syndesmosis was analyzed on axial CT scan; it was divided into 3 zones, A,B,C from anterior to posterior, and degree of displacement and morphology was noted. Immediate post-operative radiographs were evaluated for fracture and syndesmosis reduction. The patients were evaluated at final follow up with both ankle specific scores (Olerud Molander score, Ankle-Hindfoot scale, Manchester-Oxford Foot questionnaire) and quality of life score (SF-12). Ankle Osteoarthritis grade was used to evaluate radiological outcomes. Results: Mean follow-up was 19 months. 22(55%) patients had syndesmotic widening on plain radiographs; however in pre- operative CT scan evaluation 40(100%) patients had syndesmotic injury based on the Zone evaluation of the syndesmosis. 22 patients had Zone A injury (widening, AITFL, Chaput, Wagstaff). 22 patients had widening of Zone B. Zone C was involved in 30 patients (PM fracture,PITFL involvement). At final follow up; the mean OMAS was 83.38±16.35, mean Ankle-Hindfoot scale= 88±9.98, mean Mox-FQ score=27.15±13.35 & mean SF-12 were (MCS=56.59±8.24, PCS=51.18±8.48). There was no significant difference in outcome scores based on fracture types, Posterior malleolus morphology, or based on zones of syndesmosis injury. Syndesmosis malreduction contributed to significantly poorer outcomes (SF-12, OMAS, MoxFQ) Conclusion: Despite a zonal classification of syndesmotic injury on CT and more clarity of injury patterns, we could not corelate the site and extent of syndesmotic injury with final functional and radiological outcomes. The one factor that has significant influence is initial accurate reduction of both the malleolar fractures and syndesmosis injury. In this the CT based axial classification may play a role.

Category: Ankle; Trauma Introduction/Purpose: Approximately 10-15% of posterior malleolar fractures (PMFs) are "small shell," extra-articular fragments. Current classification systems present difficulties to perform a uniform typification of PMFs and contain no consensus on whether they should be fixed. Anatomical studies have identified two distinct components of the posterior inferior tibiofibular ligament (PITFL); the superficial band is thought to be more important than its deep counterpart in imparting syndesmotic stability. However, the involvement of one or both bands of the PITFL by small shell PMFs has not been evaluated so far. Hence, we conducted this study to perform 3D mapping of small shell PMFs and to determine whether surgeons should fix these routinely. Methods: Ankle fracture patients with a ‘small shell’ PMF (Haraguchi 3/Mason 1/Bartoníček 1 or 2) were included. Demographics, radiological features, treatment, and outcomes were recorded. 3D models of the fractured tibiae were generated from CT scans and superimposed on a statistical shape model of the right tibia, which served as a template. Fracture lines along with footprints of superficial and deep PITFL were marked on the template. 3D fracture heat maps were generated. Size of the fracture fragments and involvement of the superficial and deep PITFL footprints were quantified using a custom MATLAB script (Figure 1). Sparing of the footprint was defined as an overlap of < 1% between the fracture line and the footprint areas. Odds ratios (OR) with 95% confidence intervals (CI) were determined to determine which variables correlated with sparing of the PITFL footprint; P-values of < 0.05 were considered significant. Results: Thirty-nine patients were included. The superficial PITFL footprint was spared in 15 (38%), deep PITFL in 10 (26%), and both in 4 cases (10%). Males and Weber C fractures had a higher likelihood of sparing the superficial and deep PITFL footprints, respectively (P = 0.04). Supination external rotation (SER) patterns were less likely to demonstrate syndesmotic widening if either PITFL footprint was spared. Direct fixation of the PMF was done in 1 case; syndesmotic fixation in 25 cases and in 14 cases, no syndesmotic fixation was done. Of these, 11 were SER injuries where stability was achieved after fixation of medial and lateral malleoli. In 1 SER and pronation external rotation (PER) injury case, the syndesmosis was stable after fixation of a large Chaput fragment. Conclusion: This study demonstrated that 48% of small shell PMFs spare either the superficial or deep footprint of the PITFL; in 10% both PITFL footprints were spared. Hence, 58 % of small-shell PMFs may not benefit from direct fixation. Additionally, SER injuries with small shell PMFs that spare either PITFL footprint may not demonstrate radiographic instability and may not need direct or indirect fixation after addressing other components of the ankle fracture. However, given the fact that syndesmotic stability is not dictated by the PITFL alone, it remains prudent to stress the syndesmosis per-operatively to determine if syndesmotic fixation is needed.

Summary: Acute myeloid leukemia (AML) is a heterogeneous disease caused by different mutations. Previously, we showed that each mutational subtype develops its specific gene regulatory network (GRN) with transcription factors interacting within multiple gene modules, many of which are transcription factor genes themselves. Here, we hypothesize that highly connected nodes within such networks comprise crucial regulators of AML maintenance. We test this hypothesis using FLT3-ITD-mutated AML as a model and conduct an shRNA drop-out screen informed by this analysis. We show that AML-specific GRNs predict crucial regulatory modules required for AML growth. Furthermore, our work shows that all modules are highly connected and regulate each other. The careful multi-omic analysis of the role of one (RUNX1) module by shRNA and chemical inhibition shows that this transcription factor and its target genes stabilize the GRN of FLT3-ITD+ AML and that its removal leads to GRN collapse and cell death.

Background Dengue fever (DF) is a common viral disease, clinical manifestations of which vary from influenza-like illness (DF) to life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The aim of this article was to study the clinical profile of DF in young adults.