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Objective: The length of the cervix in mid-pregnancy relates to the chance of preterm delivery; and preterm labor and birth cause a major burden to society in view of high perinatal morbidities and mortality with long-term implications. With this background, we aim to measure the implications of cervical length (CL) in mid-trimester for predicting preterm birth. Materials and Methods: A prospective observational study was conducted to compare the CL measurement at 18–22 weeks of gestation, to correlate the measurements with gestational age at delivery, and to compare the predictive value of the same for preterm delivery over 18 months on 100 cases. Results: The mean CL was 38.4 ± 9.1 (22.6–54.4) mm. No significant association of transvaginal CL was found with age. Most patients experienced term vaginal birth with significant association of CL was found with pregnancy outcome. Among preterm deliveries, the CL was shorter, but no significant association of CL was found with the type of delivery. Moreover, optimum cutoff CL (35.55 mm) had very high predictive values with a sensitivity of 100%, specificity of 62.8%, and diagnostic accuracy of 65.0%. Conclusion: Our study has added more evidence that shorter CL at 18–22 weeks of gestation was a direct predictor of spontaneous preterm birth and risky outcomes of pregnancy.

Abstract The Himalayan region is one of the most seismically active areas in the world due to its tectonic setting. This vulnerability poses significant risks to buildings, resulting in substantial loss of life, property, and infrastructure. This study investigates the seismic performance of a reinforced concrete (RC) low-rise building using the seismic codes of countries situated along the Himalayan belt: China, India, Nepal, and Pakistan. These countries, despite sharing a common geological seismic threat, have developed a distinct code and standards for construction. This inconsistency concerns the effectiveness and suitability of seismic design practices in this region, hence prompting a comparative study. This study begins by reviewing the development of seismic codes in these countries. Subsequently, a prototype RC low-rise building was modeled and analyzed using finite element software, employing the linear static method of analysis according to each country's seismic codes. This study focused on key seismic responses, including the fundamental period, base shear, displacement, and story drift. The analysis revealed significant differences in seismic responses among the codes. Notably, the Chinese seismic code resulted in the highest values for the parameters studied, followed by the Nepalese, Pakistani, and Indian codes. The comparison revealed that the base shear from the Chinese code was the highest, being 3.10 times greater than the Indian code, 1.66 times greater than the Nepalese code, and 1.86 times greater than the Pakistani code. Similar ratios for displacements and story drifts were found in the study.

Abstract The goal of this mixed-methods study was to identify and compare the key capacity considerations regarding public health system resilience before and after the 2023 Türkiye-Syria earthquakes. Public health system resilience was assessed through online and face-to-face workshops using the United Nations Public Health System Resilience Scorecard. The pre-earthquake evaluation was conducted in Istanbul and Trabzon in 2021; the post-earthquake evaluation took place in Hatay and Kahramanmaraş in 2023, with a total of 41 participants each. The online workshops lasted approximately four days, while the face-to-face workshops lasted one day. The study found a significant decrease in the scores for most scorecard resilience indicators in the post-earthquake assessment. Qualitative analysis showed that this decline was largely due to infrastructure collapse. Additionally, defining the roles of health disciplines in disaster management and having data transmission procedures between public health system stakeholders in disasters were among the main capacity considerations in both the pre-and post-earthquake assessments. The post-earthquake evaluation revealed several capacity gaps that had not been addressed in pre-earthquake assessments in areas such as disaster preparedness of vulnerable populations and logistics. The findings highlight the critical importance of strengthening building stock and infrastructure to establish a disaster-resilient public health system.

Travelers’ diarrhea has a high incidence rate among deployed US military personnel and can hinder operational readiness. The Global Travelers’ Diarrhea study is a US Department of Defense­–funded multisite surveillance effort to investigate the etiology and epidemiology of travelers’ diarrhea. During 2018–2023, we enrolled 512 participants at partner institutions in 6 countries: Djibouti, Georgia, Egypt, Honduras, Nepal, and Peru. Harmonized laboratory methods conducted at each partner institution identified >1 pathogens, including Escherichia coli (67%–82%), norovirus (4%–29%), and Campylobacter jejuni (2%–20%), in 403 (79%) cases. Among cases, 79.7% were single infections, 19.6% were double infections, and 0.7% were triple infections. The most common enterotoxigenic E. coli colonization factors identified were CS3 (25%) and CS21 (25%), followed by CS2 (18%) and CS6 (15%). These data can inform best treatment practices for travelers’ diarrhea and support US military health readiness.

Objective The objective of the study was to evaluate the efficacy of outpatient MyoSure procedures and their cost-effectiveness. Design A retrospective analysis of patients who had outpatient MyoSure procedures from November 2019 to November 2020. Subjects and Methods Data were collected retrospectively from electronic patient records (hysteroscopy reports, clinic notes, clinic letters, and histopathology results) from November 2019 to November 2020 and analyzed using Microsoft Excel and SPSS software. Results Fifty-eight outpatient MyoSure procedures were performed from November 2019 to November 2020. The mean age was 53.13 years (22–81 years) and the mean body mass index was 29.65 kg/m2 (18–51 kg/m2). We found that our service has a success rate of 93.1% (54/58), a completion rate of 92.59% (50/58), and a discharge rate of 82.75% (48/58). The complete resection rate for polyps was 100% and for fibroids, it was 76.47%. When compared to the same procedure performed under general or regional anesthesia in a day surgery setting, an outpatient MyoSure procedure saves around 1117 GBP per procedure, for the Trust. We have compared data for the first 6 months to the following 6-month period. There were significant improvements in the success rate, completion rate, and discharge rate, also accompanied by a reduced complication rate. This is likely due to improved operators’ experience in performing the procedure, and also the increased use of local anesthetic injection and cervical dilatation. Conclusions Outpatient MyoSure procedures are feasible, efficacious, safe, acceptable, and cost-effective. The use of local anesthetic and cervical dilation has been associated with improved success rates.

Abstract Background Vitamin B12 deficiency is a recognised cause of neurological manifestations, including peripheral neuropathy, behavioural changes, and seizures. However, developmental and epileptic encephalopathy due to vitamin B12 deficiency is very rare. Here, we report an infant with vitamin B12-responsive developmental and epileptic encephalopathy due to a novel mutation in the fucosyltransferase 2 (FUT2) gene responsible for vitamin B12 absorption. Case presentation An 11-month-old girl of non-consanguineous parents presented with recurrent episodes of seizures since four months. Her seizures started as flexor epileptic spasms occurring in clusters resembling infantile epileptic spasms syndrome with hypsarrhythmia in the electroencephalogram. She was treated with multiple drugs, including high-dose prednisolone, vigabatrin, sodium valproate, levetiracetam and clobazam, without any response, and she continued to have seizures at 11 months. She had an early developmental delay with maximally achieving partial head control and responsive smile at four months. Her development regressed with the onset of seizure; at 11 months, her developmental age was below six weeks. On examination, she was pale and had generalised hypotonia with normal muscle power and reflexes. Her full blood count and blood picture revealed macrocytic anaemia with oval and round macrocytes. Bone marrow aspiration showed hypercellular marrow erythropoiesis with normoblastic and megaloblastic maturation. Due to the unusual association of refractory epilepsy and megaloblastic anaemia, a rare genetic disease of the vitamin B12 or folate pathways was suspected. The whole exome sequencing revealed a homozygous missense variant in exon 2 of the FUT2 gene associated with reduced vitamin B12 absorption and low plasma vitamin B12 levels, confirming the diagnosis of vitamin B12 deficiency related developmental and epileptic encephalopathy. She was started on intramuscular hydroxocobalamin, for which she showed a marked response with reduced seizure frequency. Conclusion We report a novel variant in the FUT2 gene associated with vitamin B12-responsive developmental and epileptic encephalopathy and megaloblastic anaemia. This case report highlights the importance of timely genetic testing in children with refractory developmental and epileptic encephalopathy to identify treatable causes.

Abstract Background Methotrexate is an essential medicine used to treat childhood malignancies including acute lymphoblastic leukemia. Neurotoxicity manifesting as leukoencephalopathy is an important adverse effect of methotrexate. Methotrexate-induced leukoencephalopathy classically demonstrates sub-acute-onset neurological manifestations that include learning disability, progressive dementia, drowsiness, seizures, ataxia, and hemiparesis. These are rare in children and are generally reported following intrathecal or intravenous use of methotrexate. In contrast, acute onset neurotoxicity with oral use of methotrexate is very rare. We report a 10-year-old boy presenting with acute onset limb weakness and neurological signs due to methotrexate-induced leukoencephalopathy following oral methotrexate. Case presentation A 10-year-old Sri Lankan boy presented with fever and headache for 5 days and difficulty in walking for 2 days. He was unable to stand unaided on admission, and his parents complained of repetitive, involuntary extension movements involving the right upper limb. He is a child diagnosed with acute lymphoblastic leukemia who was on treatment for a relapse with daily oral dexamethasone and mercaptopurine, weekly oral methotrexate and folinic acid, and once every two weeks intrathecal vincristine. On examination, he had dystonic movements of the right upper limb and hypotonia and reduced muscle power (grade 3/5) of the left upper and lower limbs proximally and distally. The muscle power of the right side was grade 4 (out of 5). Tendon reflexes were diminished in all four limbs, and the plantar response was flexor bilaterally. The child had dysmetria and intension tremors on both sides. T2-weighted magnetic resonance imaging of the brain revealed symmetrical high signal intensities with diffusion restriction involving bilateral putamen, subcortical areas, and deep white matter, suggesting treatment-related neurotoxicity due to methotrexate-induced leukoencephalopathy. Oral methotrexate was discontinued. He showed gradual improvement in limb weakness and other neurological signs following treatment with intravenous folinic acid, aminophylline, dexamethasone, and oral dextromethorphan. Conclusion This case report describes a patient with rapidly progressing methotrexate-induced leukoencephalopathy following oral methotrexate. It highlights that the risk of neurotoxicity persists even with the oral use of methotrexate; therefore, the prescribers should be vigilant of this uncommon side effect.

Hypertrophic cardiomyopathy (HCM) affects 1 in 200–500 of the general population, with about 10%–20% identified clinically. The primary goal of imaging for a cardiologist is to provide an accurate diagnosis and add prognostic value. Multiplanar electrocardiogram-gated cardiac magnetic resonance (CMR) imaging can evaluate all phases of the cardiac cycle. CMR excels in the accurate and reproducible evaluation of cardiac morphology, particularly in determining wall thickness and the distribution of hypertrophy. It can also assess the mitral valvular apparatus. Functional evaluation includes assessing contractility, accurate ejection fraction quantification, and visualizing and quantifying dynamic flow, particularly in the subaortic region. CMR strain imaging with feature tracking software evaluates segmental contractility. Late gadolinium enhancement (delayed enhancement), T1, and extracellular volume mapping add to the prognostic ability of CMR magnetic resonance imaging in predicting outcome by evaluating the myocardial fibrosis. CMR also adds value by evaluating the left atrium and right ventricle. A combination of the above helps accurately differentiate between phenotypes of HCM, suggest genetic forms of HCM, and monitor patients after treatment to track disease progression or changes. This review aims to describe the multiparametric strengths of CMR in the diagnosis and prognosis of HCM.

Warehouse layout optimization is critical to inventory and logistics management in organizations. In many instances, limited warehouse space is a constraint and a barrier to expanding operations and increasing demand. We present a multi-step solution using mixed integer programming to improve space utilization and increase order retrieval and fulfillment efficiency. We present a real-world case study to demonstrate the applicability and efficiency of the proposed mixed integer programming heuristics at a large distribution center.

The development, use, and timely promotion of Open Education (OE) has been effective in addressing myriad educational concerns, including inclusivity, accessibility and learning achievement, among many others. However, limited information exists in the literature concerning how OE could enhance Generative Artificial Intelligence (GenAI), which is receiving extensive interest and criticism at this time. To address this research gap, this study relies on the Open Educational Practices (OEP) framework of Huang et al. (2020) to provide various OEP scenarios that could help to promote and facilitate the effective and safe adoption of GenAI in education. The findings of this study could provide guidelines on how relying on OEP when adopting GenAI could help in ensuring quality education which is the sustainable development goal (SDG 4) of the United Nations (UN).

Perlindungan ini meliputi berbagai aspek, mulai dari hak kreditur untuk memperoleh informasi yang akurat tentang kondisi keuangan debitur, hak untuk menuntut pembayaran utang melalui pengadilan, hingga hak untuk memperoleh bagian dari aset debitur dalam proses kepailitan. Tujuan dari penelitian Guna Mengetahui Kreditur Dan Debitur Dalam Sengketa Hutang Piutang Yang Berakhir Dengan Kepailitan Di Kota Medan, Guna Mengetahui Sanksi Hukum Bagi Debitur Dalam Sengketa Hutang Piutang Yang Berakhir Dengan Kepailitan Di Kota Medan dan Guna Mengetahui Perlindungan Hukum Bagi Kreditur Dalam Sengketa Hutang Piutang Yang Berakhir Dengan Kepailitan Menurut UndangUndang No. 37 Tahun 2004 tentang Kepailitan dan Penundaan Kewajiban Pembayaran Utang. Metode Penelitian Desain penelitian ini adalah suatu usulan untuk memecahkan masalah dan merupakan rencana kegiatan yang dibuat peneliti untuk memecahkan masalah, sehingga akan diperoleh data yang valid sesuai dengan tujuan penelitian. Metode penelitian ini bersifat yuridis normatif yang akan menggali dari berbagai literatur sekunder terdiri dari perundang-undangan, peraturan-peraturan, buku-buku, jurnal dan makalah yang berkaitan dengan Paten. Metode pengumpulan data adalah teknik atau cara-cara yang dapat digunakan oleh peneliti untuk pengumpulan data. Teknik dalam menunjuk suatu kata yang abstrak dan tidak diwujudkan dalam benda, tetapi hanya dapat dilihat penggunaannya melalui: angket, wawancara, pengamatan, ujian (tes), dokumentasi, dan lain-lain. Berdasarkan hasil penelitian Penyelesaian utang debitur pailit terhadap para krediturnya melaui perdamaian (accoord) dapat terjadi apabila paling lambat 8 (delapan) hari sebelum rapat pencocokan piutang debitur pailit mengajukan rencana perdamaian dan diumumkan dengan jalan diletakkan di Kepaniteraan Pengadilan Niaga (Pasal 145 Undang-Undang Nomor 37 tahun 2004 tentang kepailitan dan Penundaan Kewajiban Pembayaran Utang). Rencana perdamaian tersebut wajib dibicarakan dan segera diambil keputusan setelah pencocokan piutang berakhir, apabila rencana perdamaian disetujui oleh kreditur menurut prosedur yang berlaku serta memperoleh pengesahan dari Pengadilan Niaga dan telah berkekuatan hukum tetap, maka kepailitan berakhir. Berdasarkan hasil kesimpulan bahwa ketentuan pasal di atas menunjukan bahwa baik debitur maupun kreditur mempunyai hak asasi manusia dimana hak ini melekat pada hakikat dan keberadaan manusia sebagai anugerah Tuhan Yang Maha Esa harus dilindungi oleh negara, pemerintah, dan hukum. Atas dasar ini maka Undangundang Kepailitan harus memberikan perlindungan seimbang bagi debitur dan kreditur sebagai perwujudan pemenuhan perlindungan hak asasi manusia.

Background: Wilms' tumor is the most common kidney malignancy in the pediatric population. Wilms' tumor can spread to other organs, pressing on surrounding organs, and causing kidney damage and high blood pressure. This case report aims to report on neonatal patients with Wilms' tumor which complicate into obstructive ileus. This study aims to explore the effect of wilm’s tumor on causing obstructive ileus which can be detrimental to a newborn. Methods: A 21-day-old baby boy was brought in with complaints of a lump in the left abdomen that had been felt since birth. The lump was felt to be growing rapidly and feels hard. Physical examination revealed sunken eyes, dry lips, holosystolic murmur on parasternal line intercostal II-IV, and a solid mass sized 5x4 cm in the left hypochondrium up to left iliac region. Abdominal ultrasound and CT scan confirmed a renal mass. Results: The patient was diagnosed with partial obstructive ileus due to left kidney tumor suppression, suspected Wilms tumor and low intake malnutrition with moderate to severe dehydration. The patient was managed with laparotomy and left nephrectomy. The procedure alleviated all symptoms and upon 1 month follow up, the patient was healthy with good nutrition status. Conclusion: The presence of large abdominal mass in neonates can be a sign of Wilms tumor. This disease can lead to obstructive ileus and can be treated with laparotomy and nephrectomy.

Abstract Environmental parameters along elevational gradients affect the number of butterflies and the variety of species. However, which variables play significant roles and how they operate can be difficult to untangle. Here, we examine the relationships between observed butterfly richness (overall and subgroups) at different elevation gradients and remotely sensed environmental variables (vegetation productivity, surface temperature, landscape heterogeneity, and moisture stress) using generalized linear models. We surveyed butterflies with a fixed‐point count method in 19 elevation bands within 1600–5200 m above sea level in Manang district, trans‐Himalayan region, north‐central Nepal. The number of butterflies in each elevation band was studied and estimated, then interpolated across the lowest and highest elevation to estimate butterfly species richness. Then, the selection of models was performed on butterfly richness and elevations to test the best model support based on the lowest value of the Akaike information criterion and a multimodel averaging for other environmental variables. Altogether, 94 butterfly species, representing 20 subfamilies and six families, were recorded throughout the study periods. We obtained cubic model support for overall species richness, Papilionidae, and Hesperiidae, quadratic to Nymphalidae and Pieridae, and the linear model to Lycaenidae. In our study, vegetation productivity was found to have a significant positive impact on butterfly communities. Our study further suggests species richness of Papilionidae and Hesperiidae has a strong positive correlation with surface temperature and landscape heterogeneity and negative associations with moisture stress but other subgroups of butterfly communities including overall species richness showed insignificant relationships with these variables. This study provides significant information related to the responses of montane butterflies to environmental variables along elevational gradients from the Himalayas Nepal. However, further detailed studies on the functional behaviors of butterflies potentially offer more insights into their distribution patterns and ecological relationship in the montane environment.

This study investigated the pH of four popular Nepalese tea brands such as Tokla, Ridhisidhi, Suman, and Muna, under different conditions to assess their acidity and potential health implications. The teas were prepared using standardized brewing methods, and pH measurements were taken at room temperature and after chilling to observe any temperature-related variations. Freshly brewed teas tended to be more alkaline, while those with added sugar and lemon were more acidic. Temperature changes had minimal impact on pH, indicating that acidity remains stable whether the tea is consumed hot or cold. While the pH range of these teas is generally safe for consumption, it may cause discomfort for those with acid sensitivity. These findings provide insights into the acidity of Nepalese teas and its potential effects on sensory and health attributes.

Electric vehicles are widely regarded as pivotal in driving the sustainability of transportation networks forward, thanks to their capacity to diminish carbon emissions, enhance air quality, and bolster the robustness of electricity grids. The accessibility of charging infrastructure and the subjective norms that endorse electric mobility actively shape the electric vehicles acceptance. In this study, Our main goal is to provide off-grid electric vehicle charging infrastructures and the data communication protocols that connect to servers. We analyze the specifications of the OCPP (Open Charge Point Protocol) with an emphasis on its applicabillity for electric charging stations for vehicles. Our research concludes that off-grid electric vehicle charging systems can be effectively applied to small electric vehicles such as electric motorcycles, scooters, and bicycles. The OCPP data communication protocol can also support interactions between small electric vehicle charging stations and central server management systems (CSMS). Furthermore, we tested the electric vehicle charging process for a duration of two hours, and the charging station consistently produced stable voltage, current, and power output, matching the inverter outputs and fulfilling the specifications required by electric vehicle charging adapters. Analysis of throughput data indicates a positive correlation between the number of operational ports at a charging station and the volume of data processed by the server. However, beyond a certain threshold a decline in data transactions was observed, attributable to data loss.

Foreign body ingestion and its natural elimination are common in children. However, this is uncommon for long foreign bodies. Here, we report the spontaneous removal of an ingested pencil in an asymptomatic child. To our knowledge, this is the first case report of asymptomatic spontaneous elimination of a normally-sized ingested pencil. A 7-year-old male child presented with a history of ingestion of a pencil 4 hours back, without any complaints. Immediate abdominal radiography revealed a pencil in the stomach with an estimated length of approximately 10 cm and no signs of complications. He was conservatively treated under a semi-solid diet, presumably due to lack of available endoscopic option. Subsequently, he passed the pencil in stool within 24 hours of ingestion. He was asymptomatic and playful during the course and at discharge. Conservative management of a quickly moving long foreign body initially located below the esophagus in an asymptomatic child is possible with the help of imaging guidance, particularly in settings lacking an endoscopy. Although, this should not be considered a norm. However, this suggests that the treatment of ingested foreign bodies must be individualized. Thus, multiple factors related to the child and the foreign body must be assessed before committing to invasive procedures like laparotomy. Similarly, plain X-rays can be helpful even for radiolucent foreign bodies, for diagnosis and ruling out complications. All of these are vital in underdeveloped countries, where endoscopy and computed tomography facilities might be either lacking or unaffordable by patients.

Introduction: Sacral nerves emerge through sacral foramina and traverse below the multifidus muscle. Hence, blocking this myofascial plane can provide postoperative analgesia in the perianal region by blocking the sacral nerves supplying it. Aim: To study the effect of Sacral Erector Spinae Plane Block (SESPB) on postoperative pain and postoperative analgesic requirement in perianal surgeries. Materials and Methods: A randomised controlled trial was done with 60 patients who were randomly allocated into two groups (30 in each group). Group 1 patients received no intervention, whereas Group 2 received bilateral SESPB. The Visual Analogue Scale (VAS), opioid requirement, first analgesic demand, and additional analgesic requirement were compared between the two groups. The qualitative data was analysed by Student’s t-test, whereas the quantitative data was analysed using the Chi-square test. A p-value of

Introduction: Emergency departments serve as the initial point of contact for patients with a wide range of conditions. Not all patients visiting get admitted to the hospital. The admission rate varies from 20% in the United States to 40.83% in Nepal. Given the variability in these results across different regions, there is a need to better understand the admission rates from the Emergency Department. Methods: A descriptive cross-sectional study was conducted after obtaining ethical approval( Reference Number: 58 (6-11)E2 081/082) in the Emergency Department of a tertiary health care center. Retrospective data was collected from the data register. The data from April 2023 to April 2024 was collected. A sample size of 222 was calculated and convenience sampling was done. Demographic details like age, sex, and data regarding admission status were collected. Data was collected in MS Excel and was analyzed using JASP software. Results: Out of 222 patients that presented to the emergency department, 53 (23.87%)(18.26-29.47,95 % Confidence Interval) were admitted to the ward or intensive care unit of the hospital, whereas 167 (75.23) got discharged, 1 (0.45%) was brought dead and 1 (0.45%) expired. The median age of patients was 43 (IQR: 26-62). The admission rate of females was 20 (17.24%), whereas for males it was 33 (31.13%). Conclusions: The prevalence of admission of patients visiting the emergency department was higher than similar US based studies. There was a higher percentage of female patients presenting to theemergency department, while those being admitted were mostly males.

Lomba Nasional Kreativitas Mahasiswa (LO Kreatif) merupakan ajang tahunan yang diadakan oleh APTISI 7 Jatim untuk mahasiswa perguruan tinggi swasta di Indonesia. Meskipun proses pendaftaran lomba telah beralih ke platform digital, penelitian terbaru menunjukkan keterbatasan performa website LO Kreatif saat menghadapi lebih dari 1000 pengguna secara bersamaan. Evaluasi performansi menggunakan metode load testing mengidentifikasi dua faktor utama yang berkontribusi pada penurunan performa, yaitu penggunaan file load pada halaman web dan penggunaan data gambar, proses query yang kompleks, serta penggunaan library. Penelitian ini mengusulkan solusi dengan merancang arsitektur microservice sebagai alternatif terhadap arsitektur monolitik yang digunakan saat ini. Analisis terhadap penelitian sebelumnya menunjukkan bahwa arsitektur monolitik lebih cocok untuk aplikasi dengan jumlah pengguna kecil, sedangkan arsitektur microservice menawarkan skalabilitas dan reliabilitas yang lebih baik. Melalui Design Science Research Methodology (DSRM), penelitian ini melibatkan enam tahapan, mulai dari identifikasi permasalahan hingga komunikasi hasil kepada pemangku kepentingan. Hasil evaluasi menunjukkan bahwa arsitektur microservice berhasil meningkatkan throughput tanpa mengalami penurunan, meskipun rata-rata error rate sebesar 8.52% masih memerlukan perbaikan. Dengan demikian, arsitektur microservice dapat menjadi solusi untuk meningkatkan performansi website LO Kreatif, namun perhatian terhadap aspek perangkat keras juga krusial untuk mendapatkan performansi optimal.

Abstract The COVID-19 pandemic highlighted the urgent need to strengthen public health systems. In response, the United Nations Disaster Risk Reduction (UNDRR) Public Health System Resilience Scorecard (Scorecard) was applied in workshops across multiple countries. The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience. We conducted a workshop from 14 to 16 March 2023, at the UNDRR Global Education and Training Institute in Incheon, Republic of Korea. A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies. These were drawn from 70 strategies identified from 13 distinct workshops in eight countries. After two surveys, 23 strategies were finalized. Ten received ratings of “High” or “Very High” from 89% of participants. These related to the inclusion of public health risks in emergency plans, integrating multidisciplinary teams into public health, enabling local transport mechanisms, and improving the ability to manage an influx of patients. The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience. By leveraging this methodology, our study demonstrated how resilience strategies could inform disaster risk reduction funding, policies, and actions.

I Made Adi Parmana,1 Cindy Elfira Boom,1 Herdono Poernomo,1 Chairil Gani,1 Budi Nugroho,1 Riza Cintyandy,1 Lisa Sanjaya,1 Yudi Hadinata,1 Dian Raseka Parna,1 Mefri Yulia,1 Dudy Arman Hanafy2 1Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia; 2Department of Cardiothoracic and Vascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, IndonesiaCorrespondence: I Made Adi Parmana, Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia, Email adiparmana13@gmail.comPurpose: On-pump coronary artery bypass grafting (CABG) is one of the most common revascularization surgical therapies for coronary artery disease (CAD). However, owing to the use of cardiopulmonary bypass (“on-pump”), the body develops systemic inflammatory response syndrome, which leads to the risk of morbidity and mortality. This study aimed to determine the perioperative outcomes of patients who underwent on-pump CABG surgery using the systemic immune-inflammation index (SII).Patients and methods: This single-center retrospective study used secondary data from patients’ electronic medical records and medical records archives at the National Cardiovascular Center Harapan Kita, who underwent on-pump CABG from January 2019 to December 2022. A total of 1056 on-pump CABG procedures were performed after exclusion. Lymphocyte, segmental neutrophil, and platelet counts from the preoperative data were used to calculate the SII values. An SII cutoff value of 528.715 × 103/mm3 divided the patients into two groups.Results: The SII value of 1056 patients were calculated, among which 490 (46%) patients had a preoperative SII value of ≥ 528.715 × 103/mm3. Multivariate analysis showed that a high SII significantly prolonged the duration of surgery (OR 1.005, 95% CI 1.003– 1.006) and cardiopulmonary bypass (CPB) time (OR 1.007, 95% CI 1.005– 1.009). High SII values significantly predicted prolonged mechanical ventilation (OR 6.154, 95% CL 3.938– 9.617), intensive care unit (ICU) stay (OR 6.332, 95% CL 4.232– 9.474), and hospital stay (OR 3.517, 95% CL 2.711– 4.562). Regarding other perioperative outcomes, a high SII significantly predicted the risk of postoperative atrial AF, cardiac arrest, acute myocardial infarction, and mortality.Conclusion: A high preoperative SII value can predict morbidity and mortality in patients undergoing on-pump CABG surgery.Keywords: systemic immune-inflammation index, on-pump coronary artery bypass graft, systemic inflammation, morbidity, mortality

Caseous calcification of the mitral annulus, an uncommon kind of intracardiac mass, is a form of degenerative disease that afflicts the mitral valve causing liquefactive or caseous necrosis. Caseous calcification of mitral annulus is rarely encountered in practice; however, it should be on the list of differential diagnosis of any intracardiac masses located close to the mitral annulus.

A domain is commonly defined as a set of system resources, e.g., computers, to which certain users have prescribed access rights as governed by some security policies. The access (viewing) and transfer of data between distinct domains facilitates a wide range of information technology applications. A Cross-Domain Solution (CDS) can provide the security mechanisms that are required to properly restrict the access and exchange of sensitive information between different domains. This article provides a comprehensive up-to-date survey of CDS. This survey is organized according to a CDS taxonomy with access, transfer, and Multi-Level Security (MLS) as the main CDS categories. An access solution helps a client to view the data present in a server (which is in a different domain, other than the client’s domain); thus an access solution effectively provides isolation between domains by allowing data access (without data transfer capabilities) between these domains. A transfer solution secures the transfer of data between domains to avoid leaks of data to unauthorized entities. Thereby, a transfer solution effectively connects domains in either a unidirectional or bidirectional manner. An MLS solution handles data with multiple levels of security (sensitivity of the data), such as top-secret, secret, or unclassified data. Aside from the fundamental conceptual approaches from the existing CDS research, this survey gives a comprehensive overview of the existing commercial CDS products. We identify the limitations of the existing CDS concepts and products and outline directions for future research and development to address these limitations and advance the overall CDS research area.

The merger of the galaxies serves as a trigger for the increase in the galaxy’s star formation rate (SFR), which can be quantified by observing the column density of the Hα line. Our findings report the presence of various gas and metal emission lines, strongly indicating that the galaxy hosts very young stars and is currently undergoing active star formation processes. Notably, we report a relatively high SFR of ∼ 0.0055 M⊙ yr-1 for a dwarf galaxy, alongside a metallicity level of 12 + log(O/H) ∼ 8.88 dex. Our photometric analysis reinforces the notion that the galaxy is in the midst of a merger phase. Additionally, the analysis indicates that the galaxy has a relatively flat shape (Sérsic index ∼ 0.8), with stars distributed more broadly and less concentrated toward its center. This provides further evidence of the ongoing merger and its impact on the galaxy’s structure. The half-life radius of the galaxy is estimated to be 2.73 arcsec by using the Petrosian method.

Background: Globally, rotavirus A (RV) is a leading cause of acute gastroenteritis (AGE) in young children under 5 years. The main aim of this study was to describe the prevalence of RV in children with and without diarrhea whose age ranged from 3 months to 5 years from two different hospitals of Nepal. We also described the diversity of rotavirus circulating during the pre-vaccination period in Nepal between 2006–2009. Materials and methods: A total of 2400 stool samples collected from children's years with diarrhea (cases, N = 1200) and without diarrhea (controls, N = 1200) were tested for the presence of RV by both enzyme-linked immunosorbent assay and real-time reverse transcription polymerase chain reaction (RT-PCR). All samples positive for RT PCR and/or ELISA were further characterized for G and P genotypes by conventional RT-PCR. Results: In total, 500 of the 2398 (20.8 %) samples (424 cases and 76 controls), were positive for RV. The most frequently detected G-types were G12, G1, and G9 and P-types were P[8] and P[6]. The predominant genotypes G12P[6], G12P[8], G1P[8] and G9P[8] were identified in 27.8 %, 24.2 %, 11.8 % and 10.8 % of the samples, respectively. Conclusion: This study observed high prevalence of G12P[6] rotavirus circulating in Nepal before vaccine introduction and they may pose an emerging challenge to current and future vaccine. Therefore, continuous molecular surveillance of circulating genotypes and emerging rotavirus strain should be carried out to better understand the effectiveness of vaccination program.

IntroductionCataract is the leading cause of blindness among the elderly worldwide. Twin and family studies support an important role for genetic factors in cataract susceptibility with heritability estimates up to 58%. To date, 55 loci for cataract have been identified by genome-wide association studies (GWAS), however, much work remains to identify the causal genes. Here, we conducted a transcriptome-wide association study (TWAS) of cataract to prioritize causal genes and identify novel ones, and examine the impact of their expression.MethodsWe performed tissue-specific and multi-tissue TWAS analyses to assess associations between imputed gene expression from 54 tissues (including 49 from the Genotype Tissue Expression (GTEx) Project v8) with cataract using FUSION software. Meta-analyzed GWAS summary statistics from 59,944 cataract cases and 478,571 controls, all of European ancestry and from two cohorts (GERA and UK Biobank) were used. We then examined the expression of the novel genes in the lens tissue using the iSyTE database.ResultsAcross tissue-specific and multi-tissue analyses, we identified 99 genes for which genetically predicted gene expression was associated with cataract after correcting for multiple testing. Of these 99 genes, 20 (AC007773.1, ANKH, ASIP, ATP13A2, CAPZB, CEP95, COQ6, CREB1, CROCC, DDX5, EFEMP1, EIF2S2, ESRRB, GOSR2, HERC4, INSRR, NIPSNAP2, PICALM, SENP3, and SH3YL1) did not overlap with previously reported cataract-associated loci. Tissue-specific analysis identified 202 significant gene-tissue associations for cataract, of which 166 (82.2%), representing 9 unique genes, were attributed to the previously reported 11q13.3 locus. Tissue-enrichment analysis revealed that gastrointestinal tissues represented one of the highest proportions of the Bonferroni-significant gene-tissue associations (21.3%). Moreover, this gastrointestinal tissue type was the only anatomical category significantly enriched in our results, after correcting for the number of tissue donors and imputable genes for each reference panel. Finally, most of the novel cataract genes (e.g., Capzb) were robustly expressed in iSyTE lens data.DiscussionOur results provide evidence of the utility of imputation-based TWAS approaches to characterize known GWAS risk loci and identify novel candidate genes that may increase our understanding of cataract etiology. Our findings also highlight the fact that expression of genes associated with cataract susceptibility is not necessarily restricted to lens tissue.

It is widely acknowledged that the relationship between education, security, and stability is bidirectional. In times of war, access to quality education becomes compromised, and conversely, the absence of proper education constrains individuals to a life under constant threat, disrupting education provision. War, viewed as a “lifetime and life-wide status,” evolves into a self-fulfilling prophecy, both at an individual and collective level, making it challenging to break free from, particularly within the broader context of education provision. Although, scant information exists about how education is maintained during wars, hindering the right to education in such contexts. This study therefore addresses this gap by synthesizing the literature to identify and present 14 educational scenarios and teaching strategies on how education was maintained from different war contexts over time. The findings reveal that education during wars can be digital-based (i.e., facilitated by technology) and non-digital based (without technology). Additionally, various teaching strategies are applied during wars, including inspirational, hands-on and practical, fun-based, among others. Finally, teaching during wars is not limited to teachers only, but it could also involve parents, neighbors, etc. The findings of the literature can help to ensure the right to education in crises like wars and reveal the importance of open education in such crises. They can also contribute to enriching the ongoing theoretical and practical debate on how to maintain education in crises like wars. This can help to better be prepared for future education in crises, which is the focus of several international organizations.

Abstract Internet‐of‐things is an enabling technology in the fourth‐generation industrial revolution. The freshness of the data sent by a sensor node (SN) is an important parameter in the Internet‐of‐things, unlike the throughput in cellular communications. A relatively new performance metric named age of information (AoI) is used in this paper to quantify the freshness of the data. The SN, located in the transport infrastructure, harvests energy from radio frequency signals transmitted by the FD‐UAV. This is used to transmit real‐time sensor observations to the data sink via FD‐UAV. The SN generates an update after replenishing the battery and transmits it by using the harvested energy. A closed‐form expression for average AoI is derived as a function of time allocated for energy harvesting. The optimal time allocation for energy harvesting that maximizes the freshness of data update is identified. A deep learning technique namely long‐short term memory is used to predict the average AoI. Simulation results demonstrate the usefulness of the performance bounds in terms of the freshness of data updates.

Abstract Background and Aim Managing gastric variceal (GV) hemorrhage is more complicated than managing esophageal variceal (EV) bleeding, resulting in significantly higher morbidity and mortality. We aim to compare the outcomes of endoscopic variceal ligation (EVL), transhepatic intrahepatic portosystemic shunt (TIPS), and balloon‐occluded retrograde transvenous obliteration (BRTO) in the management of GV bleeding. Methods We utilized the National Inpatient Sample (NIS) database from January 2016 to December 2019 to include adult patients with GV hemorrhage. Results Our study identified 7160 hospitalizations with a primary diagnosis of GV hemorrhage who underwent the interventions of interest. EVL was performed in 69.83%, TIPS in 8.72%, and BRTO in 4.88%. Patients with liver cirrhosis had a higher frequency of undergoing BRTO (68.6%), followed by TIPS (64.0%) and esophagogastroduodenoscopy (EGD) + TIPS (63.7%) (P

Background: Road traffic accidents (RTAs) are a leading and disproportionately prevalent cause of mortality and disability, particularly burdening Nepal, primarily within the Kathmandu Valley. Methods: This cross-sectional study was conducted between March 22nd and April 24th, 2021, involving 185 victims admitted to the emergency department of a private hospital. Respondents were selected using purposive sampling, and data were collected through face-to-face interviews. Socio-demographic characteristics, human factors, and environmental factors data were analyzed using descriptive statistics, and all statistical tests were conducted using SPSS version 20. Results: Among the 185 RTA victims, the majority (36.8%) fell within the 21-30 age groups. Male victims (55.7%) outnumbered females (44.3%). Students (36.8%) experienced the highest accident rates, with most incidents (21.1%) occurring on Saturdays and 38.4% taking place between 12:00pm and 6:00pm. Human Factors and RTA: Of the total victims, 80 (43.2%) were drivers, with 43.75% of them reporting the use of emergency brakes. Furthermore, 77.61% indicated that accidents were caused by pedestrians not using zebra crossings when crossing the road. Environmental Factors and RTA: Rainy weather was associated with the highest number of accidents, accounting for 36.2% of cases. Additionally, narrow routes (28.6%) and slippery roads (25.9%) contributed to a significant number of accidents. Conclusion: Nepal faces a high rate of road traffic accidents, with critical factors including victim age, vehicle types, speed, road and weather conditions, and traffic rule violations. Authorities must consider these factors to effectively control and prevent RTAs. Corresponding Author: Rajesh Karki View Orcid in Profile You can search for this author in PubMed & Google Scholar Profile

Abstract Background The use of regorafenib in the treatment of hepatocellular carcinoma (HCC) is widespread. Albumin-Bilirubin (ALBI) has been shown to be a potential prognostic marker for regorafenib treatment, but its prognostic value remains controversial. Therefore, we conducted a meta-analysis to investigate the value of the baseline ALBI grade in predicting the efficacy and survival outcomes of HCC patients after regorafenib treatment. Methods PubMed, Embase, Cochrane library, Web of Science, CNKI, Wan Fang Data, and Vip Database were searched from January 2010 to October 2022. Studies treating HCC patients with regorafenib and with ALBI as a categorical variable, overall survival (OS) and progression-free survival (PFS) as outcome indicators were included. After applying Newcastle–Ottawa Scale (NOS) to evaluate the quality of the included studies, Review Manager 5.4 was used to statistically analyze. Chi-square Q test and I2 statistics were used to detect heterogeneity. Funnel plot asymmetry, Egger’s and Begg’s test were used to evaluate publication bias. Results A total of 12 studies, comprising 1,918 patients, were included in the meta-analysis. The included studies were all evaluated as high quality. Compared to the high-grade baseline ALBI group, patients in the low-grade group had a longer survival time after receiving regorafenib and also more suitable for regorafenib treatment [odds ratio (OR) = 6.50, 95% confidence interval (CI): 2.22–18.96, P

Prior to the devastating earthquake in Nepal in 2015, scrub typhus was not recognized as a highly endemic disease in the country. This contrasted with neighboring India, where scrub typhus is endemic and there have been sporadic outbreaks of severe forms. This discrepancy underscores the limitations in our comprehensive understanding of the scrub typhus epidemiological patterns in Nepal, especially before 2015. To better understand the dynamic and current status of scrub typhus, this study investigated its prevalence among patients with acute febrile illness in two hospitals located in Pokhara city, Kaski district and Bharatpur city, Chitwan district during 2009–2010. Our findings revealed that 31.5% (239 of 759 patients) of the cases were positives for scrub typhus based on serological and pathogen detection assays. These results provide crucial insights into the pre-earthquake endemicity of scrub typhus in Nepal, implying its long-standing presence in the region prior to the significant environmental transformations caused by the 2015 earthquake. This study also emphasizes the need for heightened awareness and improved diagnostic capabilities to effectively manage and control scrub typhus, which remains a significant public health concern in Nepal.

Abstract Objective The study aims to identify the optimal 4Kscore thresholds to determine the need for a prostate biopsy when multiparametric magnetic resonance imaging (MRI) (mpMRI) is negative or indeterminate. Materials and methods We analysed retrospective data from men in eight different institutions who underwent an mpMRI, 4Kscore and prostate biopsy for evaluation of prostate cancer. We selected men with a negative (PIRADS ≤2) or indeterminate (PIRADS 3) mpMRI. 4Kscore values were categorized into ranges of 1–7, 8–19, 20–32 and greater than 32. We evaluated the proportion of men with grade group 2 or higher (GG2+) cancer in groups defined by PIRADS and 4Kscore. We also evaluated the number of biopsies avoided and GG2+ cancer missed in each group reported depend on 4Kscore cutoff points. Results Among 1111 men who had an mpMRI, 4Kscore and biopsy, 625 of them had PIRADS ≤3 on mpMRI: 374 negative (PIRADS ≤2) and 251 indeterminate (PIRADS 3). In men with a negative mpMRI, we found a 4Kscore cut‐point of 33 resulted in an increased risk of GG2+ cancer on biopsy. In patients with an equivocal lesion on mpMRI, men with a 4Kscore cutoff ≥8 had a greater risk of GG2+ cancer on biopsy. Decision curve analysis supported the proposed cut‐points in each mpMRI group. Conclusions In men with negative and indeterminate mpMRI, we found the best 4Kscore threshold to determine the need for biopsy to be 33 and 8 respectively. Future prospective studies in independent populations are needed to confirm these findings.

We describe a case in Australia of human neural larva migrans caused by the ascarid Ophidascaris robertsi, for which Australian carpet pythons are definitive hosts. We made the diagnosis after a live nematode was removed from the brain of a 64-year-old woman who was immunosuppressed for a hypereosinophilic syndrome diagnosed 12 months earlier.

Introduction: Brachial plexus blocks have become useful alternatives to general anaesthesia for forearm surgeries. When used as a sole agent, Local Anaesthetics (LA) do not provide adequate pain relief. Tramadol and Butorphanol are synthetic opioid analogues that, when added to Bupivacaine, improve the quality of the block and reduce the need for supplementary postoperative opioids. Aim: To evaluate the effect of Tramadol and Butorphanol as adjuvants to Bupivacaine for supraclavicular brachial plexus block on sensory and motor block characteristics. Materials and Methods: This double-blinded randomised clinical study was conducted in the Department of Anaesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from January 2021 to June 2022. The patients were randomly allocated into two groups of 30 each: group T received 0.5% Bupivacaine 25 mL with 50 mg Tramadol, and group B received 0.5% Bupivacaine 25 mL with 1 mg Butorphanol. The primary objective was to study the onset and duration of sensory and motor blockade. The secondary objectives were to study the duration of postoperative analgesia, requirements of rescue analgesia, and drug-related adverse effects in supraclavicular brachial plexus block. Fisher’s exact test and the Chi-square tests were used to compare categorical variables. Results: Demographic data were comparable in both groups. A faster onset of sensory block and motor block was seen with Tramadol than with Butorphanol (p-value

Acute gastroenteritis (AGE) has a major impact on morbidity and mortality worldwide. The viral aetiology of diarrhoeal diseases may remain unknown due to limited diagnostic facilities. Non-polio enteroviruses (NPEVs) are the third most frequent pathogen detected in stool specimens from AGE cases, yet their potential role in AGE is uncertain. In Nepal, limited data are available on NPEVs, due to both the lack of an adequate surveillance program and the availability of tests. The global polio eradication initiative effort of the WHO has eradicated the incidence of poliomyelitis and acute flaccid paralysis (AFP) from many parts of the world, including Nepal. However, cases of AFP associated with NPEVs have been reported in different countries, including the neighbouring India. This study aims to investigate the diarrhoeal stool samples from a birth cohort until the age of 36 months for NPEVs and the genotype diversity of NPEV in community children with diarrhoea. A total of 280 longitudinal diarrhoeal stool samples that were negative for other enteric pathogens were tested using RT-PCRs. NPEVs was detected in 97 stool specimens (34.6%) and were significantly more frequent in infants up to one year of age. This study identified 17 various NPEV types, with the dominating species being Enterovirus B (EV-B). Ten different types of echoviruses were recorded in this study, with the two rare NPEVs B74 and A120. Based on prevalence, seasonality, and diversity, further studies are warranted to investigate the role of enterovirus in diarrhoeal disease.

Introduction: Waardenburg Syndrome (WS) type IV or Waardenburg-Shah Syndrome (WSS) is a genetic disorder characterized by sensorineural hearing loss, pigmentary defects of the hair and skin, heterochromia of the eyes, and Hirschsprung Disease (HD). There are three other forms of WS, none of which include HD. Case presentation: A 7-year-old female born to non-consanguineous parents presented to our clinic with a history of chronic constipation. She had a white forelock on the frontal aspect of the head and multiple depigmented macules on the chest and lower extremities. She also had sensorineural hearing loss. On the physical exam, her abdomen was distended but soft and non-tender. The digital rectal exam was unremarkable. Plain film of the abdomen showed dilated bowel loops. She underwent a contrast enema that showed a narrow rectum and a dilated sigmoid colon. She subsequently underwent a rectal biopsy, which confirmed the diagnosis of HD. The combination of all the features confirmed the diagnosis of WSS. She underwent a laparotomy-assisted trans-anal pull-through, from which she recovered uneventfully. Conclusion: The possibility of WSS must be considered when a patient with HD presents depigmented lesions in the body and hearing loss.

We report the discovery of a rare isolated group of five dwarf galaxies located at z = 0.0086 ( D = 36 Mpc). All member galaxies are star forming, blue, and gas rich, with g − r indices ranging from 0.2 to 0.6 mag, and two of them show signs of ongoing mutual interaction. The most massive member of the group has a stellar mass that is half of the Small Magellanic Cloud stellar mass, and the median stellar mass of the group members is 7.87 × 10 ^7 M _☉ . The derived total dynamical mass of the group is M _dyn = 6.02 × 10 ^10 M _☉ , whereas its total baryonic mass (stellar + H i ) is 2.6 × 10 ^9 M _☉ , which gives us the dynamical to baryonic mass ratio of 23. Interestingly, all galaxies found in the group are aligned along a straight line in the plane of the sky. The observed spatial extent of the member galaxies is 154 kpc, and their relative line-of-sight velocity span is within 75 km s ^−1 . Using the spatially resolved optical spectra provided by the Dark Energy Spectroscopic Instrument early data release, we find that three group members share a common rotational direction. With these unique properties of the group and its member galaxies, we discuss the possible importance of such a system in the formation and evolution of dwarf galaxy groups and in testing the theory of large-scale structure formation.

The COVID-19 pandemic in the later phase showed the presence of the B.1.1.529 variant of the SARS-CoV-2 designated as Omicron. AYUSH-64 a poly herbal drug developed by Central Council for Research in Ayurvedic Sciences (CCRAS) has been recommended by Ministry of Ayush in asymptomatic, mild to moderate COVID-19 patients. One of the earlier, in-silico study has shown the binding of the constituents of AYUSH-64 to the main protease (Mpro) of the SARS-CoV-2. This study enlisted four phytochemicals of AYUSH-64, which were found to have significant binding with the Mpro. In continuation to the same, the current study proposes to understand the binding of these four phytochemicals to main protease (Mpro) and receptor binding domain (RBD) of spike protein of the Omicron variant. An enhanced molecular docking methodology, namely, ensemble docking has been used to find the most efficiently binding phytochemical. Using molecular dynamics (MD) simulations and clustering approach it was observed that the Mpro and RBD Spike of Omicron variant of SARS-CoV-2 in complex with human ACE2 tends to attain 4 and 8 conformational respectively. Based on the docking studies, the best binding phytochemical of the AYUSH-64, akummicine N-oxide was selected for MD simulations. MD simulations of akummicine N-oxide bound to omicron variant of Mpro and RBD Spike-ACE complex was performed. The conformational, interaction and binding energy analysis suggested that the akummicine N-oxide binds well with Mpro and RBD Spike-ACE2 complex. The interaction between RBD Spike and ACE2 was observed to weaken in the presence of akummicine N-oxide. Hence, it can be inferred that, these phytochemicals from AYUSH-64 formulation may have the potential to act against the Omicron variant of SARS-CoV-2.

Designing policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a country's epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. The OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. We developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. The OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.

Abstract We investigated the effectiveness of using methylboronic acid MIDA ester (ADM) as an additive in an electrolyte to enhance the overall electrochemical and material properties of an LNCAO (LiNi0.8Co0.15Al0.05O2) cathode. The cyclic stability of the cathode material measured at 40 °C (@ 0.2 C) showed an enhanced capacity of 144.28 mAh g−1 (@ 100 cycles), a capacity retention of 80%, and a high coulombic efficiency (99.5%), in contrast to these same properties without the electrolyte additive (37.5 mAh g−1, ~ 20%, and 90.4%), thus confirming the effectiveness of the additive. A Fourier transform infrared spectroscopy (FTIR) analysis distinctly showed that the ADM additive suppressed the EC-Li+ ion coordination (1197 cm−1 and 728 cm−1) in the electrolyte, thereby improving the cyclic performance of the LNCAO cathode. The cathode after 100 charge/discharge cycles revealed that the ADM-containing system exhibited better surface stability of the grains in the LNCAO cathode, whereas distinct cracks were observed in the system without the ADM in the electrolyte. A transmission electron microscopy (TEM) analysis revealed the presence of a thin, uniform and dense cathode electrolyte interface (CEI) film on the surface of LNCAO cathode. An operando synchrotron X-ray diffraction (XRD) test identified the high structural reversibility of the LNCAO cathode with a CEI layer formed by the ADM, which effectively maintained the structural stability of the layered material. The additive effectively inhibited the decomposition of electrolyte compositions, as confirmed by X-ray photoelectron spectroscopy (XPS).

I Made Adi Parmana,1 Cindy Elfira Boom,1 Herdono Poernomo,1 Chairil Gani,1 Budi Nugroho,1 Riza Cintyandy,1 Lisa Sanjaya,1 Yudi Hadinata,1 Dian Raseka Parna,1 Dudy Arman Hanafy2 1Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia; 2Department of Cardiothoracic and Vascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, IndonesiaCorrespondence: I Made Adi Parmana, Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Letjen S. Parman St No. Kav. 87, West Jakarta, Jakarta, Indonesia, Email adiparmana13@gmail.comPurpose: Coronary artery disease (CAD) is the primary cause of mortality in developing countries. Off-pump coronary artery bypass grafting (OPCAB) offers more upside in revascularization by preventing cardiopulmonary bypass trauma and minimizing aortic manipulation. Even though cardiopulmonary bypass is not involved, OPCAB still causes a significant systemic inflammatory response. This study determines the prognostic values of the systemic immune-inflammation index (SII) towards perioperative outcomes in patients who underwent OPCAB surgery.Patients and methods: This was a single-center retrospective study at the National Cardiovascular Center Harapan Kita, Jakarta, using secondary data from electronic medical records and medical record archives of all patients who underwent OPCAB from January 2019 through December 2021. A total of 418 medical records were obtained, and 47 patients were excluded based on the exclusion criteria. The values of SII were calculated from preoperative laboratory data of segmental neutrophil count, lymphocyte count, and platelet count. Patients were divided into two groups based on the SII cutoff value of 878.056 x 103/mm3.Results: The baseline SII values of 371 patients were calculated, among which 63 (17%) patients had preoperative SII values of ≥ 878.057 x 103/mm3. High SII values were a significant predictor of prolonged ventilation (RR 1.141, 95% CI 1.001– 1.301) and prolonged ICU stay (RR 1.218, 95% CI 1.021– 1.452) after OPCAB surgery. A positive correlation was observed between SII and hospital length of stay after OPCAB surgery. From the receiver operating characteristic curve analysis, SII predicted prolonged ventilation duration, with an area under the curve of 0.658 (95% CI 0.575– 0.741, p = 0.001).Conclusion: High preoperative SII values are capable of predicting prolonged mechanical ventilation and intensive care unit stay after OPCAB surgery.Keywords: systemic immune-inflammation index, off-pump coronary artery bypass graft, systemic inflammation, mechanical ventilation, intensive care unit stay

In this investigation, a different form of extended generalized G′G2-expansion technique with variable coefficient is proposed. The advantage of the extended generalized G′G2–expansion technique is that it can be used to solve nonlinear evolution equations with both constant and variable coefficients, whereas the basic G′G2 method can only be used with constant coefficients. The proposed technique is used to solve the Bogoyavlensky–Konopelchenko (BK) equation with variable coefficients, which depicts the interaction of a Riemann wave propagating along the y-axis and a long wave propagating along the x-axis in a fluid. Further, the BK equation with variable coefficients is applied for stratified internal waves, shallow-water waves, ion-acoustic waves, and water propagation in a liquid. The hyperbolic, trigonometric, and rational form solutions of the BK equation are dynamically represented as the annihilation of three-dimensional kink waves, multi-soliton waves, single solitons, and so on. Furthermore, the derived solutions of the considered equation, which comprise arbitrary functional parameters and other constant parameters, can be used to enhance the advanced behaviours of physical situations.

Abstract Rapid construction of buildings in urban area is creating lack of space available for new construction. This problem enforced to construct building on slope in hilly regions. However, the engineers and designers are concerned with the stability analysis of structures built on soil slopes, as it is difficult to achieve a uniform structural level on mountainous terrain. Also, it cannot be reduced to the same level of structural forms and part of base member may not be bound by an identical horizontal plane. The fundamental stability of the structure built on hill slope depends upon on its slope stability. Slope failure has been identified as one of the frequent devastating natural disasters that have claimed huge loss of property and lives. Therefore, in this research, “Phase 2 (2002)”, a Rocscience Finite Element (FE) program and “Slide”, a Rocscience limit equilibrium program were used to simulate and analyze a complex multi-staged model with RCC pile, Anchor Bolt and Geogrid for the stability analysis of slope. Bishop’s method was used to evaluate and analyze the factor of safety. Analysis of the two section (Section 1-1 and 2-2) of slope was taken into consideration for slope stability analysis. As per the analysis using the limit equilibrium approach, the factor of safety for existing slope at Section 1-1 and Section 1-1 was found to be 0.579 and 0.70 respectively. Moreover, it was found that the factor of safety of slope was increased significantly from 0.579 to 1.593 in Sections 1-1 and 0.70 to 1.319 in Section 2-2. In addition, the factor of safety of slope with strength reduction method is 1.408 and 1.05 for Sections 1 and 2 respectively after slope stabilization work in seismic condition. This shows that, the construction of buildings in slope terrain is possible, but it needs specialized excavation and slope protection work. RCC pile with anchor bolt and geogrid is one of the sustainable solutions for construction of structure in slope area.

Abstract Antimicrobial resistance is an urgent threat to human health, and new antibacterial drugs are desperately needed, as are research tools to aid in their discovery and development. Vancomycin is a glycopeptide antibiotic that is widely used for the treatment of Gram-positive infections, such as life-threatening systemic diseases caused by methicillin-resistant Staphylococcus aureus (MRSA). Here we demonstrate that modification of vancomycin by introduction of an azide substituent provides a versatile intermediate that can undergo copper-catalysed azide−alkyne cycloaddition (CuAAC) reaction with various alkynes to readily prepare vancomycin fluorescent probes. We describe the facile synthesis of three probes that retain similar antibacterial profiles to the parent vancomycin antibiotic. We demonstrate the versatility of these probes for the detection and visualisation of Gram-positive bacteria by a range of methods, including plate reader quantification, flow cytometry analysis, high-resolution microscopy imaging, and single cell microfluidics analysis. In parallel, we demonstrate their utility in measuring outer-membrane permeabilisation of Gram-negative bacteria. The probes are useful tools that may facilitate detection of infections and development of new antibiotics.