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Abstract Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs. Methods In our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs. Results The mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB

Siva Raman Bala Murugan,1 Srinivasan Sanjay,2 Anjana Somanath,3 Padmamalini Mahendradas,4 Aditya Patil,4 Kirandeep Kaur,5 Bharat Gurnani6 1Department of Uveitis and Ocular Inflammation Uveitis Clinic, Aravind Eye Hospital, Pondicherry, 605007, India; 2Department of Clinical Services, Singapore National Eye Centre, Third Hospital Ave, Singapore City, 168751, Singapore; 3Department of Uveitis and Ocular Inflammation, Aravind Eye Hospital, Madurai, Tamil Nadu; 4Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, 560010, India; 5Department of Cataract, Pediatric Ophthalmology and Strabismus, Gomabai Netralaya and Research Centre, Neemuch, Madhya Pradesh, 458441, India; 6Department of Cataract, Cornea and Refractive Surgery, Gomabai Netralaya and Research Centre, Neemuch, Madhya Pradesh, 458441, IndiaCorrespondence: Siva Raman Bala Murugan, Consultant- Uveitis Services, Aravind Eye Hospital, Pondicherry, 605007, India, Email drbalamuruganms@gmail.comAbstract: In the dynamic field of ophthalmology, artificial intelligence (AI) is emerging as a transformative tool in managing complex conditions like uveitis. Characterized by diverse inflammatory responses, uveitis presents significant diagnostic and therapeutic challenges. This systematic review explores the role of AI in advancing diagnostic precision, optimizing therapeutic approaches, and improving patient outcomes in uveitis care. A comprehensive search of PubMed, Scopus, Google Scholar, Web of Science, and Embase identified over 10,000 articles using primary and secondary keywords related to AI and uveitis. Rigorous screening based on predefined criteria reduced the pool to 52 high-quality studies, categorized into six themes: diagnostic support algorithms, screening algorithms, standardization of Uveitis Nomenclature (SUN), AI applications in management, systemic implications of AI, and limitations with future directions. AI technologies, including machine learning (ML) and deep learning (DL), demonstrated proficiency in anterior chamber inflammation detection, vitreous haze grading, and screening for conditions like ocular toxoplasmosis. Despite these advancements, challenges such as dataset quality, algorithmic transparency, and ethical concerns persist. Future research should focus on developing robust, multimodal AI systems and fostering collaboration among academia and industry to ensure equitable, ethical, and effective AI applications. The integration of AI heralds a new era in uveitis management, emphasizing precision medicine and enhanced care delivery.Keywords: artificial intelligence, uveitis management, machine learning, deep learning, optical coherence tomography, AI, ML, DL, OCT

Abstract Objective To describe four cases of Responsive Neurostimulation (RNS) in the bilateral pulvinar nuclei (PUL) in individuals with drug resistant epilepsy (DRE). This will show that due to widespread PUL connectivity, bilateral PUL RNS may be an option for some individuals with bilateral multifocal epilepsy. Methods This study comprises two centers' experience with bilateral PUL RNS for DRE. Patients treated with bilateral PUL RNS at Westchester Medical Center (Valhalla, NY) and Corewell Health (Grand Rapids, MI) between the years 2019 and 2022 were analyzed and described. Presented here are methods for target selection, device programming, and clinical outcomes. Results Two patients with Lennox–Gastaut phenotype (aged 13 and 21 years) with posteriorly dominant discharges were implanted with bilateral PUL electrodes. Additionally, two patients (aged 20 and 31 years) with independent left and right occipital bilateral multifocal seizure onsets were implanted with bilateral RNS devices targeting the ipsilateral PUL and ipsilateral occipital cortex. Subclinical and clinical seizures were captured by RNS electrocorticography (ECoG) in all patients. RNS implantation and treatment was well‐tolerated without adverse effects in all patients. Relative to baseline, two patients had 25% and 50% reduction in disabling seizures, and two patients had 71% and 100% reduction in disabling seizures. Stimulation paradigms utilized high frequency stimulation in both Lennox–Gastaut phenotype patients. Low frequency (individualized to the terminal ictal frequencies) stimulation was effective in the two bioccipital patients. Significance RNS with electrode placement targeting bilateral PUL is safe, and no adverse effects have been attributable to the pulvinar electrode placement. PUL responsive neurostimulation is potentially effective for patients with bilateral multifocal, posteriorly dominant DRE. Both high and low frequency responsive stimulation are treatment options. Longer follow‐up will shed light on the ultimate reduction of seizure burden. Plain Language Summary We describe four cases where stimulation devices were placed in the Pulvinar area of the thalamus (central sensory area in the brain). This is very unique and different location than where these devices are typically placed. These patients all had great outcomes with marked seizure reduction, demonstrating that this placement is both safe and effective.

Abstract Objective To assess whether the antiseizure medication levetiracetam may improve cognition in individuals with Alzheimer's disease who have not previously experienced a seizure. Methods We performed a randomized, double‐blind, placebo‐controlled crossover pilot study in individuals with mild‐to‐moderate Alzheimer's disease. Electroencephalography was performed at baseline and those with active epileptiform discharges were excluded. Eligible participants were randomized to placebo for 12 weeks or an active arm of oral levetiracetam (4 weeks up‐titration to levetiracetam 500 mg twice daily, 4 weeks maintained on this dose followed by 4 weeks down‐titration to nil). Participants then crossed over to the other arm. The primary outcome was change in cognitive function assessed by the Oxford Memory Task, a task sensitive to hippocampal memory binding. Secondary outcomes included tolerability, other neuropsychological scales, and general questionnaires. Results Recruitment numbers were severely limited owing to restrictions from the COVID‐19 pandemic at the time of the study. Eight participants completed both arms of the study (mean age 68.4 years [SD = 9.2]; 5 females [62.5%]). No participants withdrew from the study and there was no significant difference between reported side effects in the active levetiracetam or placebo arm. Measures of mood and quality of life were also not significantly different between the two arms based on participant or carer reports. In limited data analysis, there was no statistically significant difference between participants in the active levetiracetam and placebo arm on the memory task. Significance This pilot study demonstrates that levetiracetam was well tolerated in individuals with Alzheimer's disease who do not have a history of seizures and has no detrimental effect on mood or quality of life. Larger studies are needed to assess whether levetiracetam may have a positive effect on cognitive function in subsets of individuals with Alzheimer's disease. Plain Language Summary Abnormal electrical activity within the brain, such as is seen in seizures, might contribute to memory problems in people with dementia. We completed a clinical trial to see if an antiseizure medication, levetiracetam, could help with memory difficulties in people with Alzheimer's disease (the most common cause of dementia). In this pilot study, we could not prove whether levetiracetam helped memory function. We did show that the drug is safe and well tolerated in people with dementia who have not had a seizure. This work, therefore, offers a platform for future research exploring antiseizure medications in people with dementia.

An arsenic-resistant bacteria (strain PKA 200) was isolated from the Hindon River (Ghaziabad) after analyzing its water sample. Strain PKA 200 belongs to the Pseudomonas genus and can convert harmful arsenite [As (III)] into less harmful arsenate [As(V)]. Strain PKA 200 exhibits a remarkable ability to sense and move towards arsenite. Strain PKA 200 is a promising candidate for studying how bacteria sense and transform arsenic. Here, we report a novel circular plate assay to demonstrate both chemotaxis and biotransformation of arsenite by Pseudomonas sp. PKA 200.

In this article, we have a tendency to embrace a novel framework for learning morphological operations using counter-harmonic mean. It combines the conception of morphology with convolutional neural networks. Similarly, the elemental morphological operators of dilation and erosion, opening and closing, as well as the more refined top-hat transform, for which we disclose a real-world application from the steel industry, are all subjected to a rigorous experimental validation. Our system learns about the structuring element and the operator's composition via online learning and stochastic gradient descent. It works effectively with massive datasets and in online environments.

Abstract Cypermethrin (Cyp), a persistent synthetic pyrethroid insecticide widely used for insect control. The persistence of Cyp creates toxicity to both humans and the environment This study investigates biochar and Bacillus cereus distinct and collective effects on Cyp -contaminated soil during a 90-day incubation. This study also investigates the effects of different concentrations of Cyp (50, 100, ,500 to 1000 mg kg−1) on soil physicochemical and biological activities during a 90-day incubation period. Microbial biomass carbon and soil respiration rates decreased significantly across all cypermethrin concentrations, with the most substantial reductions observed at 1000 mg kg−1. However noticeable variations in soil enzymes and MBC over time during the entire incubation period. On 1st day, the GMean Enz and MBC rate for Cyp treatments (50, 100, ,500 to 1000 mg kg−1) ranged from 0.98 to 0.63, and 9.06, to 5.03, respectively. Under Cyp pollution, microbial biomass carbon exhibited significant decreases, with the highest inhibition (86.2%) at 1000 mg kg−1 on 1st day of incubation. Soil respiration rates dropped 77%, at 1000 mg kg−1, and Integrated biomarker response (IBR) values peaked on day 30, indicating environmental stress. Biochar and Bacillus cereus effectively facilitated the degradation of Cyp, achieving approximately 85% degradation within the first 45 days of the experiment. The combined application of biochar and Bacillus cereus increased soil pH to a neutral level from 5.9, to 7.1, reduced electrical conductivity from 1.41 µS cm− 1 to 1.20 µS cm−1, and elevated cation exchange capacity from 1.54 ± 0.04 to 6.18 C mol kg−1, while also improving organic carbon content to 3.135%. However, the dehydrogenase activity was decresed upto 47% in the combined application and all other enzymes including urasese catlayse and phostasese enzymes with Gmean enzymeatic activities were significantly improved. These findings suggest biochar and bacterial interaction for soil management to enhance soil resilience against pesticide stress.

Rectal thermometers are commonly used to assess animal health, but non-invasive methods like thermal imaging are gaining popularity for their ease. This study explores using infra-red thermography to measure eye temperatures as a proxy for body temperature in buffaloes. Among 280 adult female buffaloes, rectal temperature averaged 38.26 ± 0.38 °C, while eye temperature averaged 36.99 ± 0.47 °C. Statistical analysis showed a significant positive correlation (0.674, p

Introduction This paper summarizes the safety and immunogenicity data of Influvac Tetra across all age groups starting from 6 months of age, obtained during its clinical development program.Areas covered The article covers the clinical development program of Influvac Tetra based on five registration studies that included different age groups, different comparators, and participants from Europe and Asia. Safety and immunogenicity were assessed in all studies and in one study, the efficacy of Influvac Tetra was assessed.Expert opinion Seasonal influenza is a vaccine-preventable disease that can cause serious complications. Several types of influenza vaccines are available, including egg-based (standard dose, high dose, and adjuvanted), cell-based, and recombinant. The COVID-19 pandemic has stimulated innovation in the development such as mRNA vaccines. However, these vaccines are still in development and the true value still has to be proven. Regardless of the type of vaccine, it is also important to increase overall vaccination coverage. ECDC recommends that EU Member States implement action plans and policies aimed at reaching 75% coverage in at-risk groups and healthcare workers. Even so, vaccine coverage is still far from recommended.

Background: Pain is a significant health problem, and it is estimated that 1 in 5 adults suffers from pain, and even more alarmingly, 1 in 10 adults is diagnosed annually with chronic pain. Pharmacological treatments remain a core element of pain management for acute and chronic conditions, and more so for chronic painful conditions. In India, the major pharmacological options include paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) or combination therapies. Aims and Objectives: The cross-sectional study aimed to understand the practices for prescribing analgesics in either mono-or combination -therapy in management of chronic painful conditions. Materials and Methods: The KAP, was designed for dentists and orthopaedicians. A carefully crafted questionnaire was developed comprising 5 multiple-choice questions with subsets in orthopaedics and 7 multiple-choice questions in dentistry. Results: The survey included general dentists and specialists (n = 200) and orthpaedicians (n = 300). Most of the dentists (97.92%) agreed that their choice of analgesics prescribed depended on the severity of dental pain. While choosing NSAIDs as monotherapy, Diclofenac was the choice of drug for 72.4% of the participants. Dentists favoured combination therapies, with more than 50% preferring, either Diclofenac with Paracetamol and Serratiopeptidase. For management of acute low back pain and osteoarthritis most of the orthopaedicians preferred using Etoricoxib. A combination therapy was preferred with muscle relaxant. Conclusion: The (KAP) survey provided further insight into the selection of NSAIDs as analgesics in dentistry and orthopedic practices in India. There was a notable inclination toward COX-2 inhibitors.

Background: About a third of the world’s population is estimated to suffer from anaemia, and iron deficiency is expected to account for about half of all anaemia cases. This study was designed to get an estimate of the proportion of patients with iron deficiency anaemia (IDA) who have a significant gastrointestinal (GI) pathology, in particular a GI malignancy, and to identify any risk factors or predictors for the same. Methods: This cross-sectional study was conducted at a hospital in Eastern India. The study population comprised males above the age of 18 and postmenopausal females with IDA, excluding those haemodynamically unstable or with chronic diseases. Data collection included a detailed history, sociodemographic details, dietary habits, GI symptoms, and severity of anaemia. Faecal occult blood tests (OBTs) were conducted, and patients were referred for upper and lower GI endoscopy with biopsies. Results: Out of the 257 patients, 50.97% (n = 131) had a significant GI pathology, and 25.68% (n = 66) had a GI malignancy. Male gender (AOR: 5.203, 95% CI: 1.725–15.698) and a positive stool OBT (AOR: 6.516, 95% CI: 2.255–18.828) were found to be independent risk factors for any GI pathology. Age 40 years or above (AOR: 11.376, 95% CI: 1.199–107.946), loss of appetite (AOR: 15.548, 95% CI: 1.416–170.735), pain abdomen (AOR: 5.566, 95% CI: 1.149–26.953), dysphagia (AOR: 7.945, 95% CI: 1.036–60.915), family history of malignancy (AOR: 46.726, 95% CI: 4.076–535.645), and positive OBT (AOR: 22.430, 95% CI: 3.933–127.915) were found to be independent risk factors of GI malignancy. Conclusions: This study shows that a large proportion of adult males and postmenopausal females presenting with IDA in India have significant GI pathology. Furthermore, a significant proportion of them have GI malignancies. Thus, bidirectional endoscopy should be considered for these patients. Male patients, age >40, those with history of loss of appetite or weight, pain abdomen or dysphagia, positive family history, and positive OBT should be prioritised for the investigation.

Background: Many public health topics in the subject of Community Medicine have a psycho sociocultural aspect to them, and these are taught by traditional methods like didactic lectures with little or no interaction of faculty and students. This limits the comprehensive understanding of the students regarding sensitive issues. There is a felt need to improve the knowledge and understanding of many of these competencies among students through available cinema movies addressing these concepts. Objectives: 1. To assess effectiveness of “Cinemeducation” as a tool to teach identified competencies in Community Medicine subject. 2. To assess perception of students for “Cinemeducation” to enhance learning and communication skills. Methodology: Study Design: Nonrandomized intervention study. Setting: Department of Community Medicine, Government Medical College, Pali, Rajasthan. Participants: Year 2 from 2020 Batch. Sample Size: 159 students. Sampling: Complete enumeration. Intervention: All 159 students were divided into two groups and alternately shown movies, Toilet–Ek Prem Katha, Padman, Outbreak, and Steel Magnolias, or exposed to didactic lecture and were assessed using pre- and post-tests and student satisfaction and self-confidence in learning scale. Results: The post-test scores of cinemeducation showed an improvement by a mean of 1.88 ± 0.7 points. The self-confidence and learning scale showed that 86% of students agreed that cinemeducation was better than didactic lectures. The mean satisfaction index of cinemeducation as a teaching–learning method was 97.6. Three out of the four movies addressed the competency well, and the difference between the pre- and post-test scores was statistically significant following cinemeducation as compared to lectures. Conclusions: As the student correlates real-life situations in movies like Toilet–Ek Prem Katha, Outbreak, and Padman, they definitely understood the topic better with cognitive scores showing an increase.

Takotsubo cardiomyopathy (TCM) is a transient and reversible cardiomyopathy which exhibits regional wall motion abnormalities in the absence of obstructive coronary artery disease. While TCM is a rare condition (incidence

The case series outlines two cases of borderline phyllodes tumor which later on transformed into malignant phyllodes with metastasis. Malignant phyllodes tumors, although rare, exhibit unique clinicopathological features that necessitate prompt and accurate diagnosis to mitigate their higher recurrence rates. The current lack of consensus on optimal surgical techniques and the appropriate application of radiation and chemotherapy underscores the critical need for a standardized treatment protocol. This is particularly crucial in palliative care settings, where a standardized approach will play a vital role in reducing tumor recurrence and improving patient outcomes.

Obesity is a heterogeneous, complex, and chronic disease that has a detrimental impact on disability-adjusted life years across the globe. Recent advancements in our understanding of gut-brain communication at the molecular level have driven the development of next-generation anti-obesity medications (AOMs). Glucagon-like peptide-1 receptor agonists (GLP1RAs) remain the front-runners in this rapidly evolving landscape of hormone-based AOMs. Two GLP1RAs, namely Liraglutide and Semaglutide, have been approved by the Food and Drug Administration (FDA) and European Medicine Agency (EMA) for use in clinical practice for weight loss. Three oral GLP1RAs, namely Semaglutide, Danuglipron, and Orforglipron, are undergoing advanced clinical trials in individuals with obesity. Amylin receptor agonist (AMYRA) Cagrilintide, when used alone or in combination with Semaglutide, has demonstrated substantial weight reduction in clinical trials. Tirzepatide, a dual agonist for the glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors, has been observed to be associated with a significant placebo-subtracted weight reduction of 17.8% in a 72-week randomized controlled trial. Novel approaches targeting glucagon signalling have also yielded promising preliminary results. Three long-acting GLP1R/glucagon receptor (GCGR) dual agonists, namely Survodutide, Mazdutide, and Pemvidutide, exhibited significant weight loss in clinical trials. Retatrutide, a GLP1R/GCGR/GIPR tri-agonist, has been associated with a placebo-subtracted weight reduction of -22.1% in a 48-week phase-II trial. As a note of caution, long-term data on such medications’ safety and cardiovascular benefits is yet to be ascertained. Our review provides a comprehensive overview of the approved and emerging hormone-based AOMs, highlighting the diversity of options that might become available in the near future.

Introduction: Effective wound care is crucial in managing diabetic foot ulcers (DFU), with practices such as wound cleaning and maintaining moisture being essential. The total-contact cast (TCC) is a recognized and effective method for off-loading plantar ulcers. This study compares the effectiveness of platelet-rich plasma (PRP) and normal saline (NS) dressings, both combined with TCC, in the treatment of DFUs. Methods: A total of 108 patients with diabetic foot ulcers were randomly divided into three groups: PRP, NS, and TCC, with 36 patients in each group. The PRP group received autologous PRP followed by TCC application, the NS group received wet NS dressings followed by TCC application, and the TCC group had TCC alone. Patients were followed every 15 days for 90 days, with wound measurements taken and TCC reapplied at each visit. Wound healing was assessed based on the time to heal and the PUSH score. Results: Baseline wound sizes were similar across groups, but by day 90, the PRP group showed a greater reduction in wound size (0.61±1.20) compared to the NS (1.58±1.55) and TCC groups (1.22±1.34). The PRP group also had the most significant improvement in PUSH scores, indicating superior wound healing. Conclusion: PRP, NS, and TCC are all effective in DFU treatment, but PRP combined with TCC is statistically superior in enhancing wound healing and reducing the frequency of hospital visit.

Abstract We systematically reviewed the evidence from animal studies assessing the effects of pentoxifylline on neonatal hypoxic-ischemic encephalopathy (HIE). The PubMed, EMBASE, EMCARE, MEDLINE, Cochrane Library, and Google Scholar databases were searched for randomized and quasi randomized controlled trials (RCTs) in December 2023 to determine the effects of pentoxifylline in animal models of HIE. The quality of the included studies was assessed via the SYRCLE risk of bias (ROB) tool. The certainty of evidence was assessed via the GRADE methodology. All seven included studies (n = 248) involved a rat HIE model in which pentoxifylline (25–150 mg/kg) was administered intraperitoneally. The majority had unclear ROB. All the studies reported a protective effect of pentoxifylline on HIE-induced organ injury. Mortality was comparable at pentoxifylline doses between 25 and 75 mg/kg but higher at 150 mg/kg than in the control group. Three studies reported macroscopic changes in HIE-affected organs. There was a significant reduction in cerebral infarction (40 and 75 mg/kg), hippocampal atrophy, and visible gut injury (60 mg/kg). A significantly lower number of Caspase 3 immunoreactive cells and necrotic cells were observed at the 60 mg/kg dose, whereas the 100 mg/kg dose had a deleterious effect. Three other studies reported significantly reduced levels of proinflammatory markers including IL-6 and TNF-alpha. Current evidence (with low uncertainty) from a rat model suggests that pentoxifylline has the potential to improve mortality and attenuate organ injury following HIE. Adequately powered, well-designed human RCTs are needed to confirm our findings.

Abstract Background This study will be the first scoping review dedicated to investigating screening strategies for eating disorders specifically performed in the primary health care setting, as no comprehensive examination has been performed to date. Our primary aim is to explore the available literature and assess and identify validated screening strategies for eating disorders in adolescents and adults within the primary care context. Methods The study protocol was developed following the guidance outlined by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols and the Joanna Briggs Institute methodology for scoping reviews. This study will adhere to the PRISMA extension for scoping reviews to report review data. The protocol was registered on the Open Science Framework. The review will include studies that involve validated screening strategies for eating disorders in adolescents and adults utilising primary health care services. Experimental, quasiexperimental, observational, qualitative, and mixed-methods study designs and reviews will be eligible without language or publication year restrictions. Six databases (MEDLINE-PubMed, Embase, LILACS, CINAHL, Web of Science, PsycINFO) and grey literature will be searched. Studies will be selected and extracted by two independent reviewers via online Covidence. The results will be presented in narrative form and through tables and graphs. When possible, descriptive qualitative content analysis will be conducted. Discussion The expected results of this scoping review will shed light on validated strategies for screening for eating disorders in primary health care. This will equip health care professionals with well-substantiated empirical evidence. Moreover, it is anticipated to uncover research gaps, nurturing the ongoing development and refinement of screening strategies for eating disorders in primary health care. The results will be widely disseminated to the scientific community, policy-makers, service providers, and the general public. Systematic review registration This protocol has been registered on the Open Science Framework ( https://osf.io/pybvf ).

Abstract Alzheimer’s disease (AD), a prevalent neurodegenerative disorder, leads to progressive dementia, which impairs decision-making, problem-solving, and communication. While there is no cure, early detection can facilitate treatments to slow its progression. Deep learning (DL) significantly enhances AD detection by analyzing brain imaging data to identify early biomarkers, improving diagnostic accuracy and predicting disease progression more precisely than traditional methods. In this article, we propose an ensemble methodology for DL models to detect AD from brain MRIs. We trained an enhanced Xception architecture once to produce multiple snapshots, providing diverse insights into MRI features. A decision-level fusion strategy was employed, combining decision scores with a RF meta-learner using a blending algorithm. The efficacy of our ensemble technique is confirmed by the experimental findings, which categorize Alzheimer’s into four groups with 99.14% accuracy. This methodology may help medical practitioners provide patients with Alzheimer’s with individualized care. Subsequent efforts will concentrate on enhancing the model’s efficacy via its generalization to a variety of datasets.

Abstract Background Mirror hand is a rare congenital anomaly. Most of these cases are sporadic and associated with defective sonic hedgehog during embryogenesis. In this report, we present the case of a child with this rare congenital anomaly and its management. Case presentation A 2.5-year-old Asian female child presented with left-sided Al Qattan type 1A ulnar dimelia with restriction of wrist and elbow range of motion. Radiological examination revealed duplication of ulna with polydactyly. Management of mirror hand is a great surgical challenge, so preoperative planning and staged management is essential for the functional outcome of this condition. We successfully achieved fine and gross motor skills of the hand with acceptable cosmetic results at 2 years of follow-up. Conclusion It is crucial to remember that early intervention, ideally between 18 and 24 months of age, is key for optimal functional outcomes. Meticulous preoperative planning and surgical technique are essential. Long-term follow-up and parental counseling about the need for supervised physical therapy are important for managing secondary deformities. Additionally, digital subtraction angiography should be performed to rule out any associated neurovascular malformations.

Abstract Background IOM piloted the use of Ag RDTs for COVID-19 in Iraq, in collaboration with FIND, the Global Alliance for Diagnostics, to facilitate access to testing and understand barriers and opportunities for testing in a displacement context. The purpose was to (i) evaluate the performance metrics of the Sure Status COVID-19 Antigen Card Test in this population; (ii) compare Ag RDT results across high- and low-probability cases, vaccination status, and symptom severity; and (iii) report participant perspectives on Ag RDT use for COVID-19 and other diseases. Methods Secondary analysis was conducted using de-identified cross-sectional data collected from November 2022-March 2023 in four IDP camps in the Kurdistan region of Iraq. Data was collected during the recording, reporting, and monitoring processes of the pilot project using Ag RDTs for COVID-19 among displaced populations. Descriptive statistics and bivariate analyses were conducted in Stata (version 17). Results 9,346 Sure Status Ag RDTs were performed from November 2022-March 2023. Observed performance metrics were as follows: sensitivity = 72.73% (95% CI: 69.56–75.80%); specificity = 99.74% (95% CI: 99.39–100%), PPV = 92.31% (95% CI: 92.31–94.15%), and NPV = 98.85% (95% CI: 98.11–99.58%). Ag RDT uptake was higher among women and symptomatic individuals, and preference for Ag RDTs was especially strong among illiterate respondents. The overall positivity of Ag RDTs and PCR results in this population remained lower than national averages. Concerningly, 23.39% of respondents declined an Ag RDT because they did not believe in COVID-19. Conclusions This pilot program was among the first to explore Ag RDT use in Iraqi Kurdistan. Over 99% of respondents reported satisfaction with their experience, and over 90% wanted to see Ag RDTs available for other diseases. Findings can inform implementation of RDTs and screening protocols for other infectious diseases, and patient perspectives on Ag RDTs for testing and screening of COVID-19 among displaced populations can inform health programming within Iraq and globally.

Abstract AI techniques for cybersecurity are advancing, but AI-based classifiers are suspectable of adversarial attacks. It is challenging to quantify the efforts required of an adversary to manipulate a system and quantify this resilience such that different systems can be compared using standard metrics. The study intends to quantify the actions required when an attacker abuses an AI-based system and propose a model to assess the attacker’s cybersecurity resilience. The study proposes an Egyptian Vulture Optimized Adaptive Elman Recurrent Neural Networks (EVO-AERNN) model to assess cybersecurity resilience and compare it with machine learning and deep learning-based classifiers. It illustrates the potential of using adversary-aware feature sampling to build more robust classifiers and use an optimized algorithm to maintain inherent resilience. The proposed model is achieved with an accuracy of 0.995, an F1 score of 0.9932, a precision of 0.9921, a recall (before an attack) of 0.987, a recall (after an attack) of 0.632, and a severity score of 0.363. The proposed model is further validated with a secondary dataset. This study paves the way for a more comprehensive knowledge of adversarial attack scenarios on network systems and offers valuable insights, inspiring further research on advancing cybersecurity studies.

Dermoid cysts originate from embryonic tissues trapped in the cranial fusion lines and typically manifest extra-axially. However, intradiploic dermoid cysts are rare among cranial tumors, and their rupture has been sparsely documented. We present a case showcasing a remarkable phenomenon—the spontaneous rupture of an intradiploic dermoid cyst into the subarachnoid space, displaying a distinct “volcano-like” appearance on CT and MRI scans. This case represents the first documented instance of spontaneous intracranial rupture of an intradiploic dermoid cyst into the subarachnoid space. Although uncommon, this rupture poses a risk of severe complications, such as chemical meningitis and vasospasm. This extraordinary presentation of an uncommon lesion at an atypical location may contribute to a better understanding of the potential mechanisms of rupture, thereby emphasizing the importance of recognition and exploration.

Congenital Dermoid Fistula of the Anterior Chest Region (CDFACR) is a subcutaneous fistula that ends caudally in the subcutaneous tissue close to the sternoclavicular joint, originating from the skin at the anterior border of the sternocleidomastoid. The fistulous track is lined by keratinised stratified squamous epithelium with hair follicles, sebaceous glands and sweat glands. It presents clinically as a cutaneous pit, sinus, or infected mass. It is rare and can be complicated by recurrent infection and abscess formation. Before surgery, imaging the complete extent of the sinus is essential to prevent recurrence. Authors hereby, report a case of a 20-year-old male presenting with discharge from the anterior chest wall. On radiological and histopathological examination, it was diagnosed as a congenital dermoid fistula. In the present report, authors present a case of CDFACR confirmed through comprehensive evaluation, including sonography, Computed Tomography (CT) sinography, Magnetic Resonance Imaging (MRI) and histopathology. The present case also represents the first documented instance of CDFACR from India, highlighting the importance of multimodal imaging in the diagnosis and management of this rare congenital anomaly.

Abstract Background The COVID-19 pandemic has significantly impacted public health, with emerging evidence suggesting substantial effects on maternal and neonatal health. This systematic review and meta-analysis aimed to quantify the prevalence and risk of respiratory distress syndrome (RDS) in newborns born to mothers infected with SARS-CoV-2, the virus responsible for COVID-19. Methods We conducted a literature search in Embase, PubMed, and Web of Science up to April 20, without language or date restrictions. Observational studies reporting on the prevalence or risk of RDS among newborns from mothers with confirmed SARS-CoV-2 infection were included. Quality assessment was performed using the JBI tool. Statistical analysis was performed by using R software version 4.3. Results Twenty-two studies met the inclusion criteria. The pooled prevalence of RDS among newborns born to COVID-19-infected mothers was 11.5% (95% CI: 7.4–17.3%), with significant heterogeneity (I² = 93%). Newborns from infected mothers had a significantly higher risk of developing RDS, with a pooled risk ratio (RR) of 2.69 (95% CI: 1.77 to 4.17). Conclusion Newborns born to mothers with COVID-19 have a substantially increased risk of developing RDS. These findings emphasize the need for vigilant monitoring and appropriate management of pregnant women with COVID-19 to mitigate adverse neonatal outcomes.

Abstract Detecting glucose levels is crucial for diabetes patients as it enables timely and effective management, preventing complications and promoting overall health. In this endeavor, we have designed a novel, affordable point-of-care diagnostic device utilizing microfluidic principles, a smartphone camera, and established laboratory colorimetric methods for accurate glucose estimation. Our proposed microfluidic device comprises layers of adhesive poly-vinyl films stacked on a poly methyl methacrylate (PMMA) base sheet, with micro-channel contours precision-cut using a cutting printer. Employing the gold standard glucose-oxidase/peroxidase reaction on this microfluidic platform, we achieve enzymatic glucose determination. The resulting colored complex, formed by phenol and 4-aminoantipyrine in the presence of hydrogen peroxide generated during glucose oxidation, is captured at various glucose concentrations using a smartphone camera. Raw images are processed and utilized as input data for a 2-D convolutional neural network (CNN) deep learning classifier, demonstrating an impressive 95% overall accuracy against new images. The glucose predictions done by CNN are compared with ISO 15197:2013/2015 gold standard norms. Furthermore, the classifier exhibits outstanding precision, recall, and F1 score of 94%, 93%, and 93%, respectively, as validated through our study, showcasing its exceptional predictive capability. Next, a user-friendly smartphone application named “GLUCOLENS AI” was developed to capture images, perform image processing, and communicate with cloud server containing the CNN classifier. The developed CNN model can be successfully used as a pre-trained model for future glucose concentration predictions.

Abstract Analyzing root exudates during drought poses a serious challenge; sampling root exudates in soil is destructive to roots and leads to biased molecular analysis, along with microbial decomposition and exudate sorption to soil components. Hydroponic approaches are useful to overcome these problems but lack the utility to induce drought. Nondestructive sampling techniques are thus needed to analyze root exudates from the same plants over time in combination with highly controlled variable water/nutrient stress. The proposed aeroponic approach demonstrated that cotton could be grown to maturity in the aeroponic system, then a progressive drought treatment applied while simultaneously collecting root exudates from the same plants over time. Treatments of varying irrigation rates consisted of well-watered cotton (control) that was compared to cotton given progressive water stress (drought) and subsequent drought recovery for two weeks. Plants were entering flowering as drought treatment was applied. Nondestructive morphological measurements of plant productivity were made. Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) was employed to analyze the molecular profile of exudates, whereas gas chromatography-mass spectroscopy (GC-MS) was used to quantify abscisic acid (ABA). Plant development was highly responsive to reduced irrigation intervals with decreased canopy height, number of green leaves, biomass, and water content. As revealed by FT-ICR MS, the complexity and connectivity of unique biochemical transformation networks in response to drought was greatest at 9 days after treatment, where severe visual symptoms were observed. Overall, the aeroponic approach is a promising technology to simulate drought while sampling root exudates nondestructively, advancing root system research and plant-stress response mechanisms.

Abstract Population health initiatives often rely on cold outreach to close gaps in preventive care, such as overdue screenings or immunizations. Tailoring messages to diverse patient populations remains challenging, as traditional A/B testing requires large sample sizes to test only two alternative messages. With increasing availability of large language models (LLMs), programs can utilize tiered testing among both LLM and manual human agents, presenting the dilemma of identifying which patients need different levels of human support to cost-effectively engage large populations. Using microsimulations, we compared both the statistical power and false positive rates of A/B testing and Sequential Multiple Assignment Randomized Trials (SMART) for developing personalized communications across multiple effect sizes and sample sizes. SMART showed better cost-effectiveness and net benefit across all scenarios, but superior power for detecting heterogeneous treatment effects (HTEs) only in later randomization stages, when populations were more homogeneous and subtle differences drove engagement differences.

Economic progress, urban expansion, and enhanced quality of life in India have led to the formation of densely populated megacities and a significant increase in municipal solid waste generation. Such waste consists of a substantial volume of residues from food waste, kitchen waste originating from residential complexes, restaurants, and remnants of agricultural activities. Consequently, handling municipal solid waste has become a critical issue. Though composting is being practiced as an eco-friendly means of recycling organic waste, it is laborious and time-consuming. In the recent past, researchers have suggested the use of black soldier fly larvae (BSFL) as an effective solution for solid waste management. This study aims to assess the degradation potential of BSFL, which is gaining attention in recycling technology due to its composting capabilities, and its ability to produce soil amendments suitable for agricultural purposes. To evaluate the ability of BSFL to degrade different types of organic wastes, with a focus on cooked food waste, the compost formed after 14 days of degradation was analyzed based on elemental composition and other parameters. Comparative examinations were made with different vermicompost samples and hermicompost produced using BSFL to check the effect on plant growth. The analysis showed a higher percentage of nitrogen (4.21%), and phosphorus (0.5%) in hermicompost. The C:N ratio was 12:1 which is suitable for agronomical purposes. This study concludes that, BSFL are useful as versatile bioconversion agents of cooked food waste and provide a promising organic recycling strategy for sustainable waste management.

Abstract Background The global COVID-19 vaccination campaign, with 13.53 billion doses administered by early 2024, has significantly reduced severe illness and mortality. However, potential adverse effects, such as Postural Orthostatic Tachycardia Syndrome (POTS), have raised concerns. This systematic review evaluates the incidence, mechanisms, and clinical implications of POTS following COVID-19 vaccination. Methods A systematic search of PubMed, EMBASE, and Web of Science was conducted up to June 7, 2024, following PRISMA guidelines to identify studies related to COVID-19 vaccines and POTS. Eligible studies included randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports. Screening, data extraction, and quality assessment were independently performed by two reviewers using the Joanna Briggs Institute Checklists and the Newcastle-Ottawa Scale. Results Of the 1,531 articles identified, 10 met the inclusion criteria, encompassing a total of 284,678 participants. These studies included five case reports, two case series, one cross-sectional study, one prospective observational study, and one cohort study. The cohort study reported that the odds of new POTS diagnoses post-vaccination were 1.33 (95% CI: 1.25–1.41) compared to the 90 days prior. In contrast, the post-infection odds were 2.11 (95% CI: 1.70–2.63), and the risk of POTS was 5.35 times higher (95% CI: 5.05–5.68) post-infection compared to post-vaccination. Diagnostic findings across studies included elevated norepinephrine levels and reduced heart rate variability. Reported management strategies involved ivabradine, intravenous therapies, and lifestyle modifications. Conclusion The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. Further research is needed to clarify the incidence, mechanisms, and long-term outcomes of vaccine-related POTS to inform effective clinical management strategies.

Abstract Asenapine maleate (ASPM) is a second-generation atypical antipsychotic that is approved for treating acute schizophrenia and bipolar disorder in adults by the US FDA. The major downside of ASPM therapy is rapid, extensive first-pass hepatic metabolism following its oral administration with a very low oral bioavailability of

Abstract Working memory (WM) and reinforcement learning (RL) both influence decision-making, but how they interact to affect behaviour remains unclear. We assessed whether RL is influenced by the format of visual stimuli held in WM, either feature-based or unified, object-based representations. In a pre-registered paradigm, participants learned stimulus-action combinations that provided reward through 80% probabilistic feedback. In parallel, participants retained the RL stimulus in WM and were asked to recall this stimulus after each RL choice. Crucially, the format of representation probed in WM was manipulated, with blocks encouraging either separate features or bound objects to be remembered. Incentivising a feature-based WM representation facilitated feature-based learning, shown by an improved choice strategy. This reveals a role of WM in providing sustained internal representations that are harnessed by RL, providing a framework by which these two cognitive processes cooperate.

Abstract Electrochemical CO2 reduction has emerged as a promising CO2 utilization technology, with Gas Diffusion Electrodes becoming the predominant architecture to maximize performance. Such electrodes must maintain robust hydrophobicity to prevent flooding, while also ensuring high conductivity to minimize ohmic losses. Intrinsic material tradeoffs have led to two main architectures: carbon paper is highly conductive but floods easily; while expanded Polytetrafluoroethylene is flooding resistant but non-conductive, limiting electrode sizes to just 5 cm2. Here we demonstrate a hierarchically conductive electrode architecture which overcomes these scaling limitations by employing inter-woven microscale conductors within a hydrophobic expanded Polytetrafluoroethylene membrane. We develop a model which captures the spatial variability in voltage and product distribution on electrodes due to ohmic losses and use it to rationally design the hierarchical architecture which can be applied independent of catalyst chemistry or morphology. We demonstrate C2+ Faradaic efficiencies of ~75% and reduce cell voltage by as much as 0.9 V for electrodes as large as 50 cm2 by employing our hierarchically conductive electrode architecture.

Abstract The survival of modern medicine depends heavily on the effective prevention and treatment of bacterial infections, are threatened by antibacterial resistance. The increasing use of antibiotics and lack of stewardship have led to an increase in antibiotic-resistant pathogens, so the growing issue of resistance can be resolved by emphasizing chemically synthesized antibiotics. This study discovered SMJ-2, a synthetic indole derivative, is effective against all multidrug-resistant gram-positive bacteria. SMJ-2 has multiple targets of action, but the primary mechanism inhibits respiratory metabolism and membrane potential disruption. SMJ-2 was discovered to interfere with the mevalonate pathway, ultimately preventing the synthesis of farnesyl diphosphate, a precursor to the antioxidant staphyloxanthin, eventually releasing reactive oxygen species, and leading phagocytic cells to destroy pathogens. Additionally, no discernible biochemical and histopathological alterations were found in the mouse acute toxicity model. This study emphasizes mechanistic insights into SMJ-2 as a potential antibacterial with an unusual method of action.

Abstract Background Bronchopulmonary dysplasia (BPD) affects up to half of extremely preterm infants, and is associated with adverse long-term respiratory, neurodevelopmental, and educational sequelae and costly health service and family economic outcomes. The NICHD Neonatal Research Network Hydrocortisone for Bronchopulmonary Dysplasia (BPD) Trial evaluated the efficacy and safety of hydrocortisone treatment to prevent BPD in high-risk infants. The trial enrolled 800 very preterm infants with respiratory failure and followed the participants until 2 years corrected age to assess safety of the trial intervention. Longer-term impacts of hydrocortisone exposure and severity of BPD on functional outcomes of high-risk infants remain unknown. The HYdrocortisone for BPD Respiratory and Developmental (HYBRiD) Outcomes Study extends follow-up of all surviving children enrolled in the Hydrocortisone for BPD Trial until early school age. It aims to characterize the childhood functional motor, cognitive, academic, and pulmonary outcomes of this large, well-phenotyped trial cohort. Methods Parents of surviving trial participants complete telephone questionnaires when their children are 3 and 4 years corrected age. A single in-person study visit takes place at early school age (5 years, 0 months to 7 years, 11 months corrected age). Children undergo a multidimensional assessment of functional outcomes and parents complete a battery of questionnaires. In 5 of 19 participating centers, respiratory mechanics are evaluated with impulse oscillometry. Discussion The HYBRiD Outcomes Study will be the largest and most comprehensive evaluation to date of the functional early school age outcomes of children with a history of severe neonatal lung disease and of children exposed to HC during infancy. This will substantially improve understanding of the longer-term implications of severe neonatal lung disease; provide data to facilitate the development of future randomized intervention trials in this population; and inform public policy by enhancing knowledge about school age resource requirements in children with a history of prematurity and lung disease. Trial registration clinicaltrials.gov ID NCT01353313. Primary trial registration 5/11/11 modified to include followup through school age 12/13/17. This manuscript reflects version 3 of the trial manuscript, dated 10/12/2020.

Introduction: Endotracheal intubation often triggers a sympathetic response, leading to an increase in Heart Rate (HR) and blood pressure. Dexmedetomidine (DEX) and lignocaine have shown the potential to mitigate cardiovascular changes secondary to intubation. Aim: To compare the efficacy of 0.25 mcg/kg and 0.5 mcg/kg DEX with 1.5 mg/kg lignocaine in attenuating haemodynamic responses during the peri-intubation period. Materials and Methods: This randomised double-blind study included 90 patients classified as American Society of Anaesthesiologists (ASA) I and II, aged 16-65 years. Patients were divided into three groups: Group A received lignocaine (1.5 mg/kg); Group B received DEX (0.25 mcg/kg); and Group C received DEX (0.5 mcg/kg). Haemodynamic parameters were recorded at various intervals before and after laryngoscopy. Data were checked for normality before statistical analysis using the Shapiro-Wilk test. Normally distributed continuous variables were compared using Analysis of Variance (ANOVA), while categorical variables were analysed using the Chi-square test. For all statistical tests, a p-value of less than 0.05 was considered indicative of a significant difference. Results: All groups were found to be comparable in terms of age, weight, and gender distribution. The mean age in Group A was 36.10±12.60 years, in Group B was 36.10±13.47 years, and in Group C was 37.37±11.49 years. Inter-group comparisons between Group A and Group C showed statistically significant lower HR values in Group C (79.23±10.37 vs. 90.7±17.68) at T0 as well as T1 (90.07±14.65 vs. 99.93±17.02, p-value 0.019). The comparison between Groups A and C revealed significantly lower Systolic Blood Pressure (SBP) values in Group C at T0, T1, T3, and T5. Inter-group comparisons between Groups A and B showed that Diastolic Blood Pressure (DBP) values were significantly lower at T5 in Group B (69.33±10.09 vs. 62.33±9.11, p-value 0.006). Between Groups A and C, significant differences were noted at T0, T1, T3, and T5 in Mean Arterial Pressure (MAP). Conclusion: DEX at a dose of 0.5 mcg/kg appears to be a more effective option for managing haemodynamic responses compared to lignocaine. Nevertheless, the haemodynamic stability achieved with 0.25 mcg/kg of DEX is nearly equivalent to that observed with both 0.5 mcg/kg of DEX and 1.5 mg/kg of lignocaine.

Abstract The transcription repressor REST in the dorsal root ganglion (DRG) is upregulated by peripheral nerve injury and promotes the development of chronic pain. However, the genes targeted by REST in neuropathic pain development remain unclear. The expression levels of four opioid receptor genes (Oprm1, Oprd1, Oprl1 and Oprk1) and the cannabinoid CB1 receptor (Cnr1) gene in the DRG regulate nociception. In this study, we determined the role of REST in controlling their expression in the DRG induced by spared nerve injury (SNI). SNI induced chronic pain hypersensitivity in wild-type mice and was accompanied by increased levels of Rest transcript and protein. Transcriptomic analyses of wild-type mouse DRGs suggested that SNI upregulates the expression of Rest transcripts and downregulates the transcripts of all four opioid receptor genes and the Cnr1 gene. Quantitative reverse transcription polymerase chain reaction analyses of these tissues validated these results. Analysis of publicly available bioinformatic data suggested that REST binds to the promoter regions of Oprm1 and Cnr1. Chromatin immunoprecipitation analyses indicated the presence of REST at these promoters. Full-length Rest conditional knockout in primary sensory neurons reduced SNI-induced pain hypersensitivity and rescued the SNI-induced reduction in the expression of Oprd1 and Cnr1 in mouse DRG. Our results suggest that nerve injury represses the transcription of at least the Oprd1 and Cnr1 genes via REST in primary sensory neurons and that REST is a potential therapeutic target for neuropathic pain. Thus, inhibiting REST activity could potentially reduce chronic neuropathic pain and augment opioid/cannabinoid analgesic actions by increasing the transcription of Oprd1 and Cnr1 genes in DRG neurons.

Abstract Studies have used extensive clinical information to predict time-to-heart failure (HF) in patients with and without diabetes mellitus (DM). We aimed to determine a screening method using only computed tomography calcium scoring (CTCS) to assess HF risk. We analyzed CTCS scans from 1,998 patients (336 with type 2 diabetes) from a no-charge coronary artery calcium score registry (CLARIFY Study, Clinicaltrials.gov NCT04075162). We used deep learning to segment epicardial adipose tissue (EAT) and engineered radiomic features of calcifications (“calcium-omics”) and EAT (“fat-omics”). We developed models incorporating radiomics to predict risk of incident HF in patients with and without type 2 diabetes. At a median follow-up of 1.7 years, 5% had incident HF. In the overall cohort, fat-omics (C-index: 77.3) outperformed models using clinical factors, EAT volume, Agatston score, calcium-omics, and calcium-and-fat-omics to predict HF. For DM patients, the calcium-omics model (C-index: 81.8) outperformed other models. In conclusion, CTCS-based models combining calcium and fat-omics can predict incident HF, outperforming prediction scores based on clinical factors.Please check article title if captured correctly.YesPlease check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Yes

Abstract Access to electricity is a key indicator of a country’s development. In developing nations like Ethiopia, this metric is particularly crucial for assessing progress. Currently, about 45.8% of Ethiopia’s population lacks access to electricity, with rural areas experiencing even higher rates, reaching 57.2%. The Southern Nations, Nationalities, and People’s (SNNP) region faces the greatest challenge, with 62.1% of its population lacking electricity. Ethiopia aims to achieve universal electricity access by 2030, and microgrid (MG) development is expected to play a pivotal role in meeting this goal. This study employs a multi-tier framework (MTF) to categorize village households based on electricity access, considering factors like income level and willingness to pay, to support the MG development process. Three villages—Toba, Koza, and Womba—in the SNNP region were selected for optimal MG sizing. Sensitivity variables such as global horizontal irradiance (GHI) variation, photovoltaic (PV) and battery prices, battery usage limits, and capacity shortage levels were analyzed for their impact on net present cost (NPC), initial capital cost, and cost of energy (COE) using HOMER Pro software. For example, in the Toba MG, increasing the capacity shortage from 0 to 10% reduced the COE from 0.1195 $/kWh to 0.09104 $/kWh, a 23.82% decrease. Additionally, fluctuations in PV and battery prices had a direct impact on the system’s NPC. The study also explored the impact of clustering the microgrids by interconnecting the three individual systems and conducting a techno-economic analysis. The comparison between standalone MG operation and clustered microgrids revealed that, despite the added cost of interconnection, the benefits in terms of technological, economic, and reliable operation of the clustered system were comparable to standalone microgrids. Finally, a feasibility study was conducted for the potential grid extension of the Toba MG, which is located 130 km from the nearest substation in Sawla.

Abstract Prioritizing field practices according to their contribution to regenerative efforts, in a structured and standardized manner, can enable efficient resource allocation and higher adoption rates. However, it is remarkably hampered by the diversity of production environments and their respective best management practices. This paper proposes prioritizing regenerative practices using a multicriteria assessment method informed by expert knowledge. To develop it, we mined and synthesized knowledge from eleven experts for three diverse cropping systems, showing that the prioritization of practices varies greatly across production environments. By integrating the multicriteria approach with a multi-indicator sustainability framework, we demonstrate how practice weights can be used to monitor sustainability efforts and outcomes of thirty vineyard farms in Maharashtra, India. The suggested prioritization approach can be used to standardize the assessment of the importance of regenerative practices in different cropping systems and be adopted in sustainable sourcing schemes of the agro-food industry.

Abstract Objective To identify the most commonly reviewed behaviour change techniques (BCTs) and their effectiveness based on consistency across reviews for lifestyle interventions of non-communicable diseases. Design Umbrella review of systematic reviews. Data sources PubMed, Embase, PsycINFO, Cochrane CENTRAL, Global Health. Data extraction and synthesis A narrative synthesis of extracted findings was conducted. The Behaviour Change Technique v1 Taxonomy was used to identify and code behaviour change techniques (e.g., goal setting) in a standardised manner, which were independently assessed by two reviewers. Study quality was independently assessed by two reviewers using the assessment of multiple systematic review tools. Results 26 reviews were included with a total of 72 BCT labels evaluated across the different lifestyle interventions and non-communicable diseases. A total of 13 BCT clusters were identified to be reported as effective. The most commonly reviewed BCTs and their effectiveness/ineffectiveness were as follows: ‘Goals and Planning’ (12 effective/1 ineffective), ‘Feedback and monitoring’ (9 effective/3 ineffective), ‘Social support’ (9 effective/1 ineffective), ‘Shaping knowledge’ (11 effective/1 ineffective), and ‘Natural consequences’ (6 effectiveness/ 2 ineffective). The vast majority of the studies were conducted in high-income and a few in upper middle-income countries, with hardly any studies from lower middle-income and lower income studies. Conclusion The most common BCTs were ‘Goals and Planning’, ‘Feedback and Monitoring’, ‘Shaping Knowledge’, ‘Social Support’, and ‘Natural Consequence’. Based on consistency across reviews, several BCTs such as ‘Goals and Planning’, Feedback and Monitoring’, ‘Shaping Knowledge’, and ‘Social Support’ have demonstrated effectiveness (Recommendation Grade A) in improving health behaviours across a limited range of NCDs. The evidence is less clear for other BCT techniques. It is also likely that not all BCTs will be transferable across different settings. There is a need for more research in this area, especially in low-middle-income countries. Protocol registration Registered on the International Prospective Register of Systematic Reviews; PROSPERO (CRD42020222832).

Background: Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are connective tissue disorders characterized by increased joint laxity, affecting musculoskeletal health and quality of life. In this study, we explored recent trends in surgical treatment of shoulder instability among patients with these disorders. Methods: We searched the PearlDiver Mariner database, which includes deidentified US all-payer claims data from 2010 to 2020. We used procedure and diagnostic codes for EDS and JHS to select patients. The primary outcome was the yearly trend in relative utilization of the following 4 shoulder instability procedures: arthroscopic stabilization, Latarjet coracoid transfer, open capsulolabral repair, and open capsulolabral shift. Results: Among 109,274 patients with EDS and 453,885 with JHS, 3.4% and 0.8% underwent shoulder instability procedures, respectively. Arthroscopic stabilization was the predominant treatment, with a mean utilization rate of 78% for EDS and 83% for JHS. Notably, the age at surgery increased for EDS patients but decreased for JHS patients. Female patients represented large proportions of those undergoing procedures in both the EDS group (83%) and the JHS group (77%). Conclusions: Our findings indicate a consistent preference for arthroscopic stabilization in treating shoulder instability in patients with EDS and JHS. The trends in age suggest shifts in treatment strategies, possibly influenced by advancements in nonoperative interventions or varying symptom severity. The higher proportion of female patients aligns with the known prevalence of connective tissue disorders in women. Future research should explore outcomes, complications, and specific EDS subtypes to guide optimal treatment strategies for these challenging connective tissue disorders.

The present work was focused on an alternative method for the preparation of clay bricks by the mediation of sodium hydroxide solution as an efficient activator. The traditional brick preparation requires a firing process, but the present innovation avoids it by the use of commercially viable alkali as an activator. Various brick specimens were prepared by the addition of sodium hydroxide solution having different molarities to clay samples. This was done to optimize the process and contribute to process cost reduction. The blends obtained were molded as per the standard brick dimension (19X9X9 cm) and exposed to the ambient atmosphere in a well-ventilated room for curing (14-28 days). The clay samples and the brick specimens were subjected to some critical qualitative tests. Based on the results it was established that increasing the alkali addition to clay had gradually reduced the brick quality. Moreover, the inclusion of fine sand in the blend enhanced the brick quality. In this work, we emphasized optimizing the alkali input, the impact of reduced curing duration, avoiding brick firing, and the fine sand impact on the brick quality.

Background The present study aims to evaluate the etiological spectrum with clinicopathological parameters and adverse outcomes of acute kidney injury (AKI). Methods A hospital-based prospective observational study was conducted for a spectrum of AKI in 103 AKI patients and their AKI-associated adverse outcomes. The AKI patients were included as per the KDIGO definition. The patients with a known chronic kidney disease (CKD) were excluded from the study population. A clinicopathological association with AKI was observed. Adverse outcomes and the need for renal biopsy were recorded in 3 weeks followed up to 6 months. Results A single-center study recorded that the incidence of AKI was 8.6% with a mean age of 34 ± 16 years. The cause of AKI due to medical reasons was maximum (70.8%), followed by obstetric (21.3%) and surgery (7.7%). The AKI mortality rate was 16% (P < 0.05). Renal biopsy in 34 cases showed that acute tubular necrosis was higher (38%), followed by acute cortical necrosis (23%). The spectrum of AKI was very diverse. In the 6-month follow-up, the adverse outcome was observed in 27.2% of patients, where the mortality rate was 16.5% and 10.7% of patients progressed to CKD. Conclusion The spectrum of AKI was diverse among the population, and most of the etiologies are preventable. This alarms the need for better preventive strategies with a better referral system. The obstetric population with AKI, which majorly leads to either mortality or progression to CKD, is the section that seeks more attention.

Introduction Diabetes mellitus (DM) poses a significant health burden globally, impacting millions due to its metabolic disruptions. Among its complications, diabetic peripheral neuropathy (DPN) is a prevalent concern, affecting sensory and motor nerves. While various diagnostic methods exist, discrepancies persist in prevalence estimates of DPN among diabetic populations. Objective This meta-analysis aimed to assess the prevalence of DPN in individuals with DM, focusing on sural nerve conduction velocity (NCV) measurements. Additionally, the study explored how different evaluation techniques influenced prevalence estimates. Methods A systematic literature search was conducted following PRISMA guidelines across multiple databases. Studies reporting sural nerve NCV measurements in diabetic patients were included. Data extraction, quality assessment, and statistical analyses were performed to synthesize findings. Results Twenty-six studies met the inclusion criteria, providing insights into sural nerve NCV among diabetic individuals. Pooled analysis revealed a mean sural nerve NCV of 42.12 m/s (95% CI: 39.87-44.36), indicative of reduced conduction velocity in diabetic populations. Furthermore, sural nerve amplitude was significantly lower in diabetic individuals, with a pooled mean of 4.68 μV (95% CI: 3.11-6.25). Conclusion Individuals with type 2 DM exhibit impaired sural nerve function, as evidenced by reduced NCV and amplitude measurements. Timely NCV assessment, alongside glycemic monitoring, is crucial for identifying and managing DPN to prevent further complications. Interventions addressing glycemic control, dietary regulation, and lifestyle modifications are recommended to mitigate the progression of neuropathy in diabetic populations.

Background and purpose: To compare the efficacy, safety, and immunogenicity of recombinant insulin aspart 100 U/mL manufactured by BioGenomics Limited (BGL-ASP) with innovator NovoRapid® in type 2 diabetes mellitus patients (T2 DM). Experimental approach: This was a multicenter, open-label, randomized, parallel-group study in T2 DM patients, on premix human insulin therapy ± oral anti-diabetics. Besides self-monitored plasma glucose, fasting and post-prandial plasma glucose (FPG and PPG) were tested at baseline, week 12, and week 24. Anti-insulin aspart antibodies measured immunogenicity at 12 and 24 weeks. Findings/Results: 160 patients out of 320 patients randomly received BGL-ASP and the remaining patients received NovoRapid®. The changes in glycated hemoglobin (HbA1c) from baseline to weeks 12 and 24 for the BGL-ASP group were -0.8 ± 0.83 and -0.8 ± 0.81, respectively, while for the NovoRapid®group was -0.8 ± 1.01 and -0.9 ± 0.89, respectively. Changes in FPG and PPG were comparable between the treatment groups after 12 weeks and 24 weeks. The incidence of detectable antibodies at baseline, weeks 12, and 24 were comparable between treatment groups. Eighteen (11.3%) patients in the BGL-ASP group and 23 (14.4%) in the NovoRapid®group reported adverse events. Conclusion and implications: BGL-ASP and NovoRapid®were comparable and equally effective in lowering HbA1c, FPG, and PPG levels, with similar immunogenicity and safety profiles.

Background: The incidence of acute poststernotomy pain after cardiac surgery is 80%1. Pecto-intercostal fascial plane block (PIFB) adjacent to the sternum anesthetizes the anterior cutaneous branches of the intercostal nerves and may provide effective analgesia after sternotomy. Methodology: A randomized controlled, double-blinded, prospective comparative trial was conducted at a tertiary care center on patients of midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open cardiac surgery with the primary aim to evaluate analgesia on deep breathing after 3 hours of PIFB block bilaterally. A total of 60 patients were enrolled and randomly divided into three groups. PIFB was administered bilaterally before extubation, with 15 ml 0.125% bupivacaine plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group C did not receive any intervention. All patients received acetaminophen 1 gram three times a day and injectable tramadol 1 mg/kg as a rescue analgesic. Results: Baseline characteristics were similar among all the groups. The Numeric Rating Scale (NRS) for pain was statistically lower (P < 0.05) in Groups B and B+C compared to Group C at rest, deep breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours, (2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5, 3.6)} at 24 hours after extubation. The peak expiratory flow rate was the highest in Group B. Rescue analgesia was not required in Group B. Conclusion: PIFB reduces sternotomy pain compared to the control group on deep breathing at 3 hours after block, with delayed requirement of rescue analgesia and improved respiratory mechanics in terms of peak expiratory flow rate at all time points. There is no benefit from adding clonidine.

Background: India is home to 14 million survivors of human trafficking, with most being trafficked for sexual exploitation. Trafficking constitutes crimes that violate the rights of survivors, and despite its psychological consequences, there is little evidence-based guidance to meet the needs of these individuals. Aim: The current study aimed to examine the outcome of narrative exposure therapy (KIDNET) among adolescent survivors of sex trafficking in improving trauma-related symptoms, along with psychological distress, dissociation, depression, and anxiety. Methods: A pre-post study design was used with 20 adolescent female survivors of trafficking aged 13 to 17 years, with ten participants in the KIDNET group and ten participants in a waitlist control group. Trafficking Victim Identification Tool and Standard Progressive Matrices were administered as screening measures. The Clinician-Administered PTSD Scale for Children and Adolescents, Kessler’s Psychological Distress Scale, Shutdown Dissociation Scale, Patient Health Questionnaire, and Beck Anxiety Inventory were administered as outcome measures. Fourteen sessions of KIDNET were conducted for the clinical group, while sessions were conducted for the control group post delivery of intervention for the clinical group. Results: Findings suggest an overall improvement in the severity of trauma-related symptoms in the KIDNET group, with significant improvement in psychological distress, depression, and anxiety. Conclusion: Results indicate that KIDNET may be a promising and acceptable treatment for adolescent survivors of sex trafficking, and this intervention module may be safely delivered in further randomised controlled trials to ensure that the holistic needs of this vulnerable group are appropriately addressed.