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Aim To determine stresses generated in the posterior teeth region by two different self-ligating systems, 3M Unitek SmartClip and Damon Q Self-ligating brackets, using the finite element method (FEM). Methodology Computed tomography (CT) scan of maxilla was taken using Mimics software, and the Dicom data were imported into Hypermesh 13.0 software to convert it into a geometric model and then into FEM. Physical models of both the brackets were constructed and positioned on the teeth. Post archwire modeling, contact is defined between the bracket slot and 0.014” NiTi arch wire. The final assembled model was exported to ANSYS 12.1 for analysis, and 60 grams of load was applied at the ends of the arch wire. Results On using 0.014” CuNiTi in both the bracket systems, stresses generated on the root surface were found to be maximum on the first molar region, followed by the first premolar, second molar, canine, and second premolar regions. Comparison between the two bracket systems showed differences in the stresses generated, where higher stresses were generated at all regions in the Damon Q bracket system, except the inter-second premolar region. Conclusion Maximum stresses were observed with the 3M Unitek SmartClip bracket system at the second premolar cervical region when compared to the Damon Q system. In both the cortical bone and cancellous bone, maximum stresses were observed at the second premolar cervical in the Damon Q bracket system region.

Background: Persistent suicidal ideation, self-harm behaviors, and suicide attempts constitute suicidality and are consistent predictors for future suicides. Research on what protects individuals from harming themselves is equivocal. While factors like impulsivity could increase risk of suicide, research is needed on what stops people from acting out on self-harm thoughts/suicidal ideation. Aim: To explore the help-seeking behaviors and other protective factors during periods of suicidality in individuals at risk of suicide. Method: This study aimed to explore help-seeking behavior and other protective factors that prevent or delay self-harm and suicide attempts during suicidality in individuals at risk. We used a qualitative study design and interviewed 15 participants comprising at-risk individuals, caregivers, and mental health professionals (MHPs). We used thematic analysis for deriving themes. Results: Themes in ‘at-risk individuals’ include mental state during suicidality, handling of oneself during suicidality, and seeking help from support systems. Themes from caregivers included handling of crises and the role of informal and formal support systems. Themes from MHPs included phenomenology of suicidality, handling of suicidality, help-seeking, and support systems. Conclusion: At-risk individuals handle suicidality by either managing themselves on their own or seeking help from informal sources and formal health systems. Caregivers appear to be crucial stakeholders in help-seeking during self-harm. The involvement of caregivers – in discussion with the at-risk individual – should be a necessary component of suicide risk management. Suicide prevention policies at institutional, regional, and national levels should include strategies to prevent burnout and other occupational health issues in MHPs.

Abstract Leukemia is a form of cancer that affects the bone marrow and lymphatic system, and it requires complex treatment strategies that vary with each subtype. Due to the subtle morphological differences among these types, monitoring gene expressions is crucial for accurate classification. Manual or pathological testing can be time-consuming and expensive. Therefore, data-driven methods and machine learning algorithms offer an efficient alternative for leukemia classification. This study introduced a novel super learning model that leverages heterogeneous machine learning models to analyze gene expression data and classify leukemia cells. The proposed approach incorporates an entropy-based feature importance technique to identify the gene profiles most significant to the labeling process. The strength of this super learning model lies in its final super learner, Random Forest, which effectively classifies cross-validated data from the candidate learners. Validation on a gene expression monitoring dataset demonstrates that this model outperforms other state-of-the-art models in predictive accuracy. The study contributes to the knowledge regarding the use of advanced machine learning techniques to improve the accuracy and reliability of leukemia classification using gene expression data, addressing the challenges of traditional methods that rely on clinical features and morphological examination.

The COVID-19 pandemic has significantly impacted life globally. The lockdown-imposed restrictions have negatively impacted a host of sectors, specifically with respect to India, but more so among marginalized communities of children with special needs (CSN) and their primary caregivers whose struggles have been left unnoticed. This article attempts to elucidate the numerous challenges that primary caregivers of this overlooked section of society have endured and its repercussions on their mental and emotional well-being. We further propound the experiences from the pandemic necessitates novel guidelines and make recommendations to support CSN and their caregivers in the advent of another massive crisis.

Importance: Ischemic heart disease is the leading cause of death worldwide. In ST-elevation myocardial infarction (STEMI), delaying reperfusion from the onset of chest pain increases the incidence of mortality and morbidity. Prehospital thrombolysis (PHT) has been evaluated in the setting of STEMI. We performed a systematic analysis of studies of PHT in acute STEMI. Objective: The objective of this study was to evaluate the all-cause mortality benefit in STEMI with PHT during short-term and long-term follow-up. Data Sources: In December 2020, the Cochrane search strategy was used to analyze randomized control trials, nonrandomized control studies, and registry studies in PubMed, EMBASE, Cochrane Library, Google Scholar, ClinicalKey, and Clinical Trial Registries. The search was repeated, and the included studies were updated in June 2023 to include more recent literature. We restricted the analysis to full-text publications in English. Study Selection: Studies using any thrombolytic agent in treating acute myocardial infarction in prehospital and inhospital settings with or without percutaneous Coronary intervention (PCI) were included in the analysis. Selection criteria included patient history and symptoms, electrocardiogram findings, and cardiac markers. Data Extraction: We used the Cochrane Handbook for Systematic Reviews of Interventions for assessing bias, the PRISMA flow diagram to show the process of inclusion and exclusion of studies, and RevMan software to perform meta-analysis. Main Outcomes and Measures: Outcomes include all-cause hospital mortality rate of PHT versus inhospital thrombolysis (IHT), influence of ischemic median time on all-cause mortality with PHT, and effect of PHT before PCI. The measures must have been observed for a follow-up period of up to 35 days, 1-year, and 5-years. Results: Data from 63,814 patients from 32 studies were reviewed. Results indicate a reduction in all-cause mortality in patients assigned to PHT (odds ratio [OR] −0.68, P < 0.00001) compared to IHT. There was a significant reduction in mortality when thrombolytics were administered before PCI (OR − 0.78, P = 0.0001). The overall survival was better with an ischemic time of

Abstract Background CD55 deficiency with hyper-activation of complement, angiopathic thrombosis, and protein-losing enteropathy (CHAPLE) disease is ultra-rare (

Modern novels opposed power structures by struggling for personal autonomy, leading to alienation of the individual from society. However, this kind of alienation was insufficient to oppose power structures in postmodernism. It was recognized that power structures sustain on naturalization of language as tool of oppression, and postmodern texts therefore became self-conscious of the act of writing and reading. They began to question their own mediums of expression, and the relationship between fiction and reality. Metafictional writing made this turn inward possible, allowing the resistance to the dominant structures to come from within the text itself. This paper explores the use of metafiction that is characteristic of postmodernism, grounding its arguments in Linda Hutcheon’s theorisation of historiographic metafiction. This understanding of metafictionality and postmodernism itself is then used to closely read Don DeLillo’s novel, White Noise (1984). The motives and effects of metafictionality discussed is exemplified through the textual and formal analysis of the novel. The paper argues that by bringing together the literary, theoretical, and historical through its self-referential attempts, the novel is able to open up a dialogue about and challenge the dominant consumerist, postmodern American society it is situated within.

Background: Although studies often report the prevalence of obesity, community-based studies reporting the incidence of overweight or obesity in India are scarce. Such incidence data are crucial for improving projections about the future burden of obesity. Methods: A non-concurrent follow-up study was done in 2015 in urban Vellore, Tamil Nadu, among two groups of women aged 30-40 years, with body mass index (BMI) 25 kg/m2. The incidence of overweight (BMI ≥25 kg/m2) in three years, was 29.2% (24/82), among women with a normal BMI (

ABSTRACT E.PathDash facilitates re-analysis of gene expression data from pathogens clinically relevant to chronic respiratory diseases, including a total of 48 studies, 548 samples, and 404 unique treatment comparisons. The application enables users to assess broad biological stress responses at the KEGG pathway or gene ontology level and also provides data for individual genes. E.PathDash reduces the time required to gain access to data from multiple hours per data set to seconds. Users can download high-quality images such as volcano plots and boxplots, differential gene expression results, and raw count data, making it fully interoperable with other tools. Importantly, users can rapidly toggle between experimental comparisons and different studies of the same phenomenon, enabling them to judge the extent to which observed responses are reproducible. As a proof of principle, we invited two cystic fibrosis scientists to use the application to explore scientific questions relevant to their specific research areas. Reassuringly, pathway activation analysis recapitulated results reported in original publications, but it also yielded new insights into pathogen responses to changes in their environments, validating the utility of the application. All software and data are freely accessible, and the application is available at scangeo.dartmouth.edu/EPathDash.IMPORTANCEChronic respiratory illnesses impose a high disease burden on our communities and people with respiratory diseases are susceptible to robust bacterial infections from pathogens, including Pseudomonas aeruginosa and Staphylococcus aureus, that contribute to morbidity and mortality. Public gene expression datasets generated from these and other pathogens are abundantly available and an important resource for synthesizing existing pathogenic research, leading to interventions that improve patient outcomes. However, it can take many hours or weeks to render publicly available datasets usable; significant time and skills are needed to clean, standardize, and apply reproducible and robust bioinformatic pipelines to the data. Through collaboration with two microbiologists, we have shown that E.PathDash addresses this problem, enabling them to elucidate pathogen responses to a variety of over 400 experimental conditions and generate mechanistic hypotheses for cell-level behavior in response to disease-relevant exposures, all in a fraction of the time.

Background Street and working children (SWC) and young people (YP) are highly vulnerable to violence, exploitation, hazardous environments and human rights violations. While the UN Committee on the Rights of the Child and the International Labour Organisation provide some guidance, there is limited information on their right to healthcare. This study aims to identify enablers and barriers to healthcare access for SWC and document associated rights violations.Methods From 2000 to the present, we conducted systematic searches for SWC (0–18 years) in databases including MEDLINE, PsycINFO, EBSCO, PUBMED and PROQUEST, using broad search terms related to street children, working children, healthcare access and rights. The searches were supplemented by grey literature and hand searches. Two independent reviewers finalised the included studies, and data were analysed using a rights-based framework with narrative analysis and thematisation.Results The initial search yielded 7346 articles (5972 for street children and 1374 for working children), with 35 studies (18 for street children and 17 for working children) included in the review. Most studies on working children (13/17) focused on trafficking/commercial exploitation. Studies were predominantly from Africa, followed by the USA, Asia, the UK and Canada, with only two employing a rights framework. SWC face barriers such as cost, distance, visibility/accessibility of services, stigma, seclusion, threats of violence, lack of legal documents, crisis-oriented healthcare use and self-medication. Enablers included agency, self-efficacy, positive relationships with adults and proactive healthcare use when accessible. Emergency departments are frequently accessed by SWC, indicating a need for healthcare professionals to be trained and sensitised. Holistic and comprehensive healthcare is essential.Conclusion Significant research gaps exist, with many SWC populations under-represented. SWC share healthcare access barriers with other marginalised groups. Healthcare for SWC must be tailored to their unique needs and strengths and be holistic and trauma-informed.

Introduction The use and value of artificial intelligence (AI)-driven tools and techniques are under investigation in detecting coronary artery disease (CAD). EchoGo Pro is a patented AI-driven stress echocardiography analysis system produced by Ultromics Ltd. (henceforth Ultromics) to support clinicians in detecting cardiac ischaemia and potential CAD. This manuscript presents the research protocol for a field study to independently evaluate the accuracy, acceptability, implementation barriers, users’ experience and willingness to pay, cost-effectiveness and value of EchoGo Pro.Methods and analysis The ‘Evaluating AI-driven stress echocardiography analysis system’ (EASE) study is a mixed-method evaluation, which will be conducted in five work packages (WPs). In WP1, we will examine the diagnostic accuracy by comparing test reports generated by EchoGo Pro and three manual raters. In WP2, we will focus on interviewing clinicians, innovation/transformation staff, and patients within the National Health Service (NHS), and staff within Ultromics, to assess the acceptability of this technology. In this WP, we will determine convergence and divergence between EchoGo Pro recommendations and cardiologists’ interpretations and will assess what profile of cases is linked with convergence and divergence between EchoGo Pro recommendations and cardiologists’ interpretations and how these link to outcomes. In WP4, we will conduct a quantitative cross-sectional survey of trust in AI tools applied to cardiac care settings among clinicians, healthcare commissioners and the general public. Lastly, in WP5, we will estimate the cost of deploying the EchoGo Pro technology, cost-effectiveness and willingness to pay cardiologists, healthcare commissioners and the general public. The results of this evaluation will support evidence-informed decision-making around the widespread adoption of EchoGo Pro and similar technologies in the NHS and other health systems.Ethics approval and dissemination This research has been approved by the NHS Health Research Authority (IRAS No: 315284) and the London South Bank University Ethics Panel (ETH2223-0164). Alongside journal publications, we will disseminate study methods and findings in conferences, seminars and social media. We will produce additional outputs in appropriate forms, for example, research summaries and policy briefs, for diverse audiences in NHS.

The electrocardiogram (ECG) is a fundamental tool in cardiology, providing invaluable insights into cardiac physiology and detecting various abnormalities. This review article presents a comprehensive overview of ECG interpretation, focusing on the procedure, application, and methodology. The placement of electrodes, ECG paper speed, and measurements of intervals and blocks are discussed in detail. The article emphasizes the importance of a systematic approach to ECG interpretation, highlighting six main sections: determination of heart rhythm, calculation of heart rate, assessment of intervals and blocks, analysis of atrial depolarization patterns, assessment of ventricular depolarization complexes, and delving into the intricate characteristics of ST segments and exploration of the electrocardiographic T-wave manifestations. Specific criteria for identifying abnormalities in each section are provided, along with their associated etiologies and clinical implications. Furthermore, the limitations of ECG as a diagnostic tool are acknowledged, emphasizing the need for clinical correlation and consideration of additional tests. The abstract encapsulates the breadth and depth of the review, conveying the relevance and the profound significance of ECG interpretation in the realm of clinical practice and scientific inquiry.

Abstract Introduction The emergence of artificial intelligence (AI) chat programs has opened two distinct paths, one enhancing interaction and another potentially replacing personal understanding. Ethical and legal concerns arise due to the rapid development of these programs. This paper investigates academic discussions on AI in medicine, analyzing the context, frequency, and reasons behind these conversations. Methods The study collected data from the Web of Science database on articles containing the keyword “ChatGPT” published from January to September 2023, resulting in 786 medically related journal articles. The inclusion criteria were peer-reviewed articles in English related to medicine. Results The United States led in publications (38.1%), followed by India (15.5%) and China (7.0%). Keywords such as “patient” (16.7%), “research” (12%), and “performance” (10.6%) were prevalent. The Cureus Journal of Medical Science (11.8%) had the most publications, followed by the Annals of Biomedical Engineering (8.3%). August 2023 had the highest number of publications (29.3%), with significant growth between February to March and April to May. Medical General Internal (21.0%) was the most common category, followed by Surgery (15.4%) and Radiology (7.9%). Discussion The prominence of India in ChatGPT research, despite lower research funding, indicates the platform’s popularity and highlights the importance of monitoring its use for potential medical misinformation. China’s interest in ChatGPT research suggests a focus on Natural Language Processing (NLP) AI applications, despite public bans on the platform. Cureus’ success in publishing ChatGPT articles can be attributed to its open-access, rapid publication model. The study identifies research trends in plastic surgery, radiology, and obstetric gynecology, emphasizing the need for ethical considerations and reliability assessments in the application of ChatGPT in medical practice. Conclusion ChatGPT’s presence in medical literature is growing rapidly across various specialties, but concerns related to safety, privacy, and accuracy persist. More research is needed to assess its suitability for patient care and implications for non-medical use. Skepticism and thorough review of research are essential, as current studies may face retraction as more information emerges.

Background Anxiety has been reported to be one of the most common epidemics in recent years. The present study focused on understanding the association between early menarche and the prevalence of anxiety and anxiety symptoms among adult undergraduate students. Methods This was an observational, case-control study. The sample included 146 young female adults aged more than or equal to 18 years pursuing the Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Sciences (BDS). Using an online questionnaire, participants were asked to recall and enter the age at which they attained menarche. We used the Generalized Anxiety Disorder 7- Item Questionnaire (GAD-7) to measure the severity of their present anxiety symptoms. Results The results showed a significant increase in anxiety symptoms in participants who had early menarche compared to those who did not have early menarche. The mean score on the GAD-7 Questionnaire for the cases was 9.93 and the control group was 6.89. The GAD-7 scores among the cases group were significantly higher in the GAD-7 scores than in the control group. Conclusions This study concluded that early menarche is associated with higher anxiety levels in young adults.

Background There has been increasing emphasis towards adopting strengths-based practice (SBP) within adult social care in England. Whilst there is agreement that SBP is the right approach to discharge adult social care duties, there is limited evidence regarding the implementation of SBP. This paper presents findings from the evaluation of the implementation of SBP in fourteen local authorities in one region in England. Methods We employed a mixed methods research design, drawing on data from a scoping review, 36 interviews with practice leaders and two surveys, one with wider adult social care staff and the other, with external organisations like independent care providers and community and voluntary organisations. Our data collection and analysis were guided by two well established implementation theories: the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). Interviews were analysed deductively, and surveys were analysed descriptively. Results Local authorities are at different stages in their implementation journey. The Care Act 2014 and support for SBP demonstrated by key professional groups were seen as major drivers for implementing SBP. Whilst SBP resonated with the professional principles of social workers and occupational therapists, staff did not always have the confidence and skills to adapt to SBP. Changing paperwork and recording systems, providing training opportunities to develop staff competencies, establishing new care pathways, genuine co-production, and senior management buy-in were key enablers supporting implementation. Conclusions To successfully implement SBP, a whole system approach that meaningfully collaborates with key professionals across sectors is essential. When implemented well, SBP has the potential to empower individuals by focusing on what matters to them.

Background and Objectives: Staphylococcal infections are one of the major infectious diseases affecting globally in spite of advances in development of antimicrobial agents. Knowledge and awareness about the local pattern and prevalence of MRSA infections plays a key role in treatment. The aim of this study was to identify MRSA strains by phenotypic and genotypic methods and to analyze the antibiotic susceptibility pattern of MRSA strains from patients attending a tertiary care hospital. Materials and Methods: This study was conducted over a period of 1 year, where 296 isolates of Staphylococcus aureus were isolated from various clinical specimens. The isolated strains were examined for antibiotic susceptibility by the modified Kirby Bauer disc diffusion method. Methicillin resistance was detected by cefoxitin disk diffusion test. Results: A total of 104 isolates were found to be MRSA and 192 were found to be MSSA. Among the 104 MRSA isolates, 10 strains that were multidrug resistant were subjected to 16S rRNA gene sequencing analysis. All the 10 strains had a 99% match with S. aureus strains that were responsible for causing some serious biofilm mediated clinical manifestations like cystic fibrosis and device mediated infections. The biofilms were quantified using crystal violet staining and their ability to produce biofilms was analyzed using scanning electron microscopy and matched with the Genbank. Conclusion: Hence these phylogenetic analysis aid in treating the patients and combating resistance to antibiotics.

Summary: Tumor cells undergo uncontrolled proliferation driven by enhanced anabolic metabolism including glycolysis and glutaminolysis. Targeting these pathways to inhibit cancer growth is a strategy for cancer treatment. Critically, however, tumor-responsive T cells share metabolic features with cancer cells, making them susceptible to these treatments as well. Here, we assess the impact on anti-tumor T cell immunity and T cell exhaustion by genetic ablation of lactate dehydrogenase A (LDHA) and glutaminase1 (GLS1), key enzymes in aerobic glycolysis and glutaminolysis. Loss of LDHA severely impairs expansion of T cells in response to tumors and chronic infection. In contrast, T cells lacking GLS1 can compensate for impaired glutaminolysis by engaging alternative pathways, including upregulation of asparagine synthetase, and thus efficiently respond to tumor challenge and chronic infection as well as immune checkpoint blockade. Targeting GLS1-dependent glutaminolysis, but not aerobic glycolysis, may therefore be a successful strategy in cancer treatment, particularly in combination with immunotherapy.

IntroductionFew minimally invasive options for sampling the small intestinal (SI) luminal fluid exist to study the SI microbiota in health and disease. To address the lack of tools and methods to study GI regions that are difficult to access, Nimble Science developed a fully autonomous and passive sampling method, the Small Intestine MicroBiome Aspiration (SIMBA™) capsule, for convenient, high-quality, and reliable sampling to study the diet-microbiota interactions in the SI. MethodsThe sealing efficacy and microbial DNA preservation capacity of the SIMBA capsules was first validated through in vitro simulation assays. Then, a clinical study was conducted with 20 healthy participants to validate the in vivo use of SIMBA capsules to reliably capture samples for SI microbiome analysis before and after an intervention (NCT04489329). Briefly, participants ingested the capsules at baseline and 7 days later, with a probiotic capsule containing a blend of L. rhamnosus R0011 and B. longum R0175. Following baseline SIMBA capsule ingestion, multiple low-dosage x-ray scans were performed to track the sampling location. Fecal samples corresponding with the baseline and intervention capsule were analyzed for comparison. ResultsThe SIMBA capsules’ performance in vitro demonstrated the potential for contamination-free sampling with preservation of the microbial communities. Within the clinical study, the capsules performed safely and reliably for collection of SI content. X-ray tracking confirmed that 97.2% of the capsules completed sample collection in the SI regions before reaching the colon. Importantly, our data showed that the capsules sampled in the right area of the intestines and that baseline SIMBA microbiome profile is significantly different from fecal microbiome profile. SIMBA successfully detected a concurrent probiotic intervention in the small intestine, which was not detectable using stool samples. DiscussionsThe high accuracy of sampling location and sealing efficacy of the SIMBA capsules makes them potentially useful research tools in clinical trials for studying diet-microbiota interactions in health and disease, and perhaps eventually for the clinical diagnosis of GI tract conditions affecting the SI such as SIBO.

In the 21st century, impact of social media, particularly Social Networking Sites (SNSs) has been linked to a wide range of human beliefs and expectations. Growing body of research has indicated that body image concerns along with exercise motivation and social comparison are on the rise among young adults. The present study aimed to examine the sex difference in body image, exercise motivation and social comparison among people who use Instagram in the age group 20-30. A total of 212 participants (men=106, women=106) aged 20-30 years, who are users of Instagram completed Body Self Image Questionnaire Short Form as a measure of Body image, Exercise Motivation Inventory – 2 as a measure of Exercise Motivation and Instagram as a Tool for Social Comparison as a measure of Social Comparison. Results showed that a significant difference in body image exist across gender with body image issues higher among females and significant difference in exercise motivation across gender with exercise motivation higher among males. No sex differences were seen in social comparison. It was concluded that body image concerns are higher among females and the drive for exercise is higher among males who used Instagram. It was found that body image concerns were higher among people who exercised regularly as well as among those who followed fitness related pages on Instagram as compared to those who did not. These results provide an insight into the sex differences between the variables and future directions can be aimed at conducting an in-depth analysis using body image, exercise motivation and social comparison.

Introduction: Cannabis is one of the most widely used psychoactive substances globally, with an increasing trend in its legalization for both medical and recreational purposes in various countries. While cannabis offers potential therapeutic benefits, its regular use can lead to the development of Cannabis Use Disorders (CUDs). Understanding the epidemiology of CUDs is crucial in assessing the public health burden associated with cannabis use. Methods: Epidemiological parameters of CUDs were assessed using the Global Burden of Disease (GBD) methodology across different age-groups, years, sexes, and locations worldwide from 1990-2019. Results: Globally, for both sexes combined, prevalent cases of CUDs increased steadily from 17.1 million(95%UI=12.7-22.8million) in 1990 to 23.8-million(95%UI=17.8-30.9 million) in 2019. All age-adjusted highest number of incidence observed in High-Income-North-America(HINA)(121/100,000), followed by Australasia(100/100,000), Oceania(83.97/100,000), Tropical Latin America(69.59/100,000). Globally, age-standardized disability-adjusted life years rate(ASDR) observed higher in HINA, followed by Australasia, and Western-Europe. In male, all-age incidence counts increased from 1.7 million(95%UI=1.3-2.4million) in 1990 to 2.4 million(95%UI=1.8-3.2 million) in 2019. The highest annual percentage of change in age-standardized incidence rate(ASIR) was found in East-Asia (22%) followed by Middle-East and North-Africa(MENA)(15%). The age group of 15-24 years exhibited the highest burden of CUDs. Conclusion: The widespread occurrence of CUDs on a global scale poses a substantial challenge to public health. Understanding the impact of CUDs and implementing evidence-based interventions is crucial in mitigating the associated individual, societal, and economic burdens. Continued research, collaboration, and knowledge dissemination are essential to inform policies, prevention efforts, and treatment strategies aimed at addressing CUDs on a global-scale.

Background: Type 2 Diabetes mellitus (T2DM) may affect the musculoskeletal (MSK) system in a variety of ways. The impacts can be debilitating enough to impair functional ability and quality of life. MSK complications are the most common endocrine arthropathies which are often under-recognized and poorly treated. This study was done to evaluate the prevalence of MSK complications and its correlation with microvascular complications of T2DM given the paucity of similar studies in India particularly South India. Materials and Methods: A cross-sectional study was conducted on 130 diabetic patients at a tertiary care hospital in Bengaluru. The patient's demographic details, clinical profile including history, general physical examination, systemic examination, and relevant investigations were done to record microvascular complications. A thorough MSK system examination along with imaging of bones and joints was also performed. Results: Out of 130 diabetic patients, 21 patients (16.2%) had MSK complications of which 47.6% (n = 10) of them had carpal tunnel syndrome and 42.8% (n = 9) had frozen shoulder and 9.5% (n = 2) had diabetic amyotrophy. It was also noted that patients who were on oral hypoglycemic agents alone were more likely to develop MSK complications (57.14%) than patients solely on insulin (14.2%). Poor glycemic control, existing microvascular complications, and low high-density lipoprotein were found to be associated with increased risk of MSK complications. Conclusion: The prevalence of MSK complications in T2DM patients is quite significant and is also associated with microvascular complications. Improved glycemic control in T2DM was found to reduce the burden of such complications. Early identification of MSK complications can improve the quality of life in diabetic patients and hence demands proper screening and follow-up.

The human gut microbiota forms a biome and acts as a neglected organ, playing vital roles in organ integrity, metabolism, immunity, and homeostasis. Variations in the microbiome can lead to disease initiation. Research using bacterial sequencing of faeces and digestive tissues has focused on understanding the role of gut microbiota in cancer development, particularly Colorectal Cancer (CRC), Dysbiosis and modifications in the intestinal microbiota have been observed in CRC cases. Hypotheses like the alpha bug hypothesis and the driver-passenger model aim to explain the correlation between gut microbiota and CRC pathogenesis. The present article summarise the functions of gut microbiota, mechanisms involved in colorectal carcinogenesis, and discusses the clinical significance of gut microbiota in CRC screening and therapy.

Abstract Background The gastrointestinal microbiome and metabolome vary greatly throughout the different segments of the gastrointestinal tract, however current knowledge of gastrointestinal microbiome and metabolome in health and disease is limited to fecal samples due to ease of sampling. The engineered Small Intestinal MicroBiome Aspiration (SIMBA™) capsule allows specific sampling of the small intestine in humans. We aimed to determine whether administration of SIMBA™ capsules to healthy beagle dogs could reliably and safely sample the small intestinal microbiome and metabolome when compared to their fecal microbiome and metabolome. Results Eleven beagle dogs were used for the study. Median transit time of capsules was 29.93 h (range: 23.83–77.88). Alpha diversity, as measured by the Simpson diversity, was significantly different (P = 0.048). Shannon diversity was not different (P = 0.114). Beta diversity results showed a significant difference between capsule and fecal samples regarding Bray–Curtis, weighted and unweighted unifrac (P = 0.002) and ANOSIM distance metric s (R = 0.59, P = 0.002). In addition to observing a statistically significant difference in the microbial composition of capsules and feces, distinct variation in the metabolite profiles was seen between the sample types. Heat map analysis showed 16 compounds that were significantly different between the 2 sampling modes (adj-P value ranged between 0.004 and 0.036) with 10 metabolites more abundant in the capsule than in the feces and 6 metabolites more abundant in the feces compared to the capsules. Conclusions The engineered Small Intestinal MicroBiome Aspiration (SIMBA™) capsule was easy and safe to administer to dogs. Microbiome and metabolome analysis from the capsule samples were significantly different than that of the fecal samples and were like previously published small intestinal microbiome and metabolome composition. Graphical abstract

Abstract Background The past few decades have seen a marked increase in the macrovascular complications of Type-2 diabetes mellitus (T2DM) such as coronary heart disease, peripheral arterial disease, and cerebrovascular disease. This has been predominantly attributed to the increased atherosclerosis in these patients. Atherosclerosis usually remains an asymptomatic condition and this poses a significant challenge in its early diagnosis and timely intervention. Hence, there is an immediate need for exploring novel tools to aid in the early detection of atherosclerosis, especially in T2DM patients. Osteocalcin (OC), synthesized by osteoblasts, is a protein hormone found in the skeletal system. This protein is considered as a marker for bone density and in recent times has been gaining interest due to its protective role in cerebrovascular diseases(CVD). Methods We conducted a cross-sectional study and evaluated the association between serum OC levels and atherosclerosis in 113 T2DM patients. Carotid intima-media thickness (CC-IMT) was used as an estimate of atherosclerosis and patients were divided into two groups (CC-IMT

Background Rational prescription writing is an important skill to master during internship. This Quality Improvement (QI) project aimed to understand the state of prescription writing among interns posted in the Department of Psychiatry, analyze the causes responsible for errors in prescription writing and bring about a change in the current practice. Methods The MBBS interns are posted in the Department of Psychiatry for 15 days. During day 1 to day 5 of their posting, a pre intervention phase was conducted wherein prescriptions written by interns in the Department of Psychiatry were collected. The prescriptions were scored based on 14 criteria which were selected based on World Health Organization (WHO) guidelines and Medical Council of India (MCI) ideal prescription format. During PDSA (Plan Do Study Act) Cycle 1, an educational handout was distributed to the interns containing the MCI ideal prescription format and WHO guidelines regarding prescription writing. The brochure was also verbally explained to the interns. From day 7 to day 15 of their posting, prescriptions written by the interns were collected. The prescriptions were scored using the same criteria. Results During the pre intervention phase the mean total score of prescriptions was 9.54 ± 1.003. There was a significant improvement in the mean total score to 10.26 ± 0.746. There was a 7.54% improvement. There was also a significant improvement in several individual criteria. Conclusions The first PDSA cycle was successful in improving the quality of prescription writing among interns posted in the Department of Psychiatry. There is a need to implement more PDSA cycles to improve the quality still further.

Abstract The Madden‐Julian Oscillation (MJO) is often used for subseasonal forecasting of tropical cyclone (TC) activity. However, TC activity still has considerable variability even given the state of the MJO. This study evaluates the connection between MJO propagation speed with Atlantic TC activity and possible physical mechanisms guiding this relation. We find the Atlantic sees the highest accumulated cyclone energy (ACE) during MJO phase 2. However, the odds of above average ACE in the Atlantic is greatest during slow MJO propagation. We find that slow propagation of the MJO results in lower vertical wind shear anomalies over the Caribbean and main development region compared with typical MJO propagation. Typical MJO propagation produces an amplified height pattern and lower height anomalies along the region of the tropical upper tropospheric trough which is known to impede Atlantic TC activity. Slow MJO propagation sees weaker height anomalies over the Atlantic.

Effective pain management is essential for optimal surgical outcomes; however, it can be challenging in patients with a history of opioid use disorder (OUD). Buprenorphine, a partial opioid agonist, is a valuable treatment option for patients with OUD. Initiating buprenorphine treatment in patients concurrently taking opioids can be complex due to potential adverse outcomes like precipitated withdrawal. Evolving guidelines suggest there are benefits to continuing buprenorphine for surgical patients throughout the perioperative period, however situations do arise when buprenorphine has been discontinued. Typically, in this scenario patients would be restarted on buprenorphine after they have fully recovered from post-surgical pain and no longer require opioids for pain control. Unfortunately, holding MOUD may expose the patient to risks such as opioid induced respiratory depression or addiction relapse. In this case series, we discuss a novel method to restart buprenorphine in small incremental doses, known as micro-dosing, while the patient is still taking opioids for pain. We will present two complex clinical cases when this method was used successfully at a tertiary care hospital system.

Abstract Focused cardiac ultrasound (FoCUS) is becoming standard practice in a wide spectrum of clinical settings. There is limited data evaluating the real-world use of FoCUS with artificial intelligence (AI). Our objective was to determine the accuracy of FoCUS AI-assisted left ventricular ejection fraction (LVEF) assessment and compare its accuracy between novice and experienced users. In this prospective, multicentre study, participants requiring a transthoracic echocardiogram (TTE) were recruited to have a FoCUS done by a novice or experienced user. The AI-assisted device calculated LVEF at the bedside, which was subsequently compared to TTE. 449 participants were enrolled with 424 studies included in the final analysis. The overall intraclass coefficient was 0.904, and 0.921 in the novice (n = 208) and 0.845 in the experienced (n = 216) cohorts. There was a significant bias of 0.73% towards TTE (p = 0.005) with a level of agreement of 11.2%. Categorical grading of LVEF severity had excellent agreement to TTE (weighted kappa = 0.83). The area under the curve (AUC) was 0.98 for identifying an abnormal LVEF (

microRNA (miRNA)–messenger RNA (mRNA or gene) interactions are pivotal in various biological processes, including the regulation of gene expression, cellular differentiation, proliferation, apoptosis, and development, as well as the maintenance of cellular homeostasis and pathogenesis of numerous diseases, such as cancer, cardiovascular diseases, neurological disorders, and metabolic conditions. Understanding the mechanisms of miRNA–mRNA interactions can provide insights into disease mechanisms and potential therapeutic targets. However, extracting these interactions efficiently from a huge collection of published articles in PubMed is challenging. In the current study, we annotated a miRNA–mRNA Interaction Corpus (MMIC) and used it for evaluating the performance of a variety of machine learning (ML) models, deep learning-based transformer (DLT) models, and large language models (LLMs) in extracting the miRNA–mRNA interactions mentioned in PubMed. We used the genomics approaches for validating the extracted miRNA–mRNA interactions. Among the ML, DLT, and LLM models, PubMedBERT showed the highest precision, recall, and F-score, with all equal to 0.783. Among the LLM models, the performance of Llama-2 is better when compared to others. Llama 2 achieved 0.56 precision, 0.86 recall, and 0.68 F-score in a zero-shot experiment and 0.56 precision, 0.87 recall, and 0.68 F-score in a three-shot experiment. Our study shows that Llama 2 achieves better recall than ML and DLT models and leaves space for further improvement in terms of precision and F-score.

Bromocriptine (BCR) presents poor bioavailability when administered orally because of its low solubility and prolonged first-pass metabolism. This poses a significant challenge in its utilization as an effective treatment for managing Parkinson’s disease (PD). The utilization of lipid nanoparticles can be a promising approach to overcome the limitations of BCR bioavailability. The aim of the research work was to develop and evaluate bromocriptine-loaded solid lipid nanoparticles (BCR-SLN) and bromocriptine-loaded nanostructured lipid carriers (BCR-NLC) employing the Box-Behnken design (BBD). BCR-SLNs and BCR-NLCs were developed using the high-pressure homogenization method. The prepared nanoparticles were characterized for particle size (PS), polydispersity index (PDI), and entrapment efficiency (EE). In vitro drug release, cytotoxicity studies, in vivo plasma pharmacokinetic, and brain distribution studies evaluated the optimized lipid nanoparticles. The optimized BCR-SLN had a PS of 219.21 ± 1.3 nm, PDI of 0.22 ± 0.02, and EE of 72.2 ± 0.5. The PS, PDI, and EE of optimized BCR-NLC formulation were found to be 182.87 ± 2.2, 0.16 ± 0.004, and 83.57 ± 1.8, respectively. The in vitro release profile of BCR-SLN and BCR-NLC showed a biphasic pattern, immediate release, and then trailed due to the sustained release. Furthermore, a pharmacokinetic study indicated that both the optimized BCR-SLN and BCR-NLC formulations improve the plasma and brain bioavailability of the drug compared to the BCR solution. Based on the research findings, it can be concluded that the BCR-loaded lipid nanoparticles could be a promising carrier by enhancing the BBB penetration of the drug and helping in the improvement of the bioavailability and therapeutic efficacy of BCR in the management of PD.

Background: The schools physical environment refers to all school buildings, indoors and outdoors. A healthy school environment can directly improve children’s health and effective learning. Understanding the variations in the physical infrastructure of schools becomes crucial for educators, parents and policy makers. Objective: To assess health promoting physical environment in schools of Raipur City. Methodology: This descriptive cross-sectional study was conducted in schools of Raipur City to assess health promoting physical school environment. Total 132 schools, 66 each from government and private were selected using stratified random sampling. Observation checklist was used for assessing based on the standards set for health promoting schools. Results: Majority, 98% of government and 74% of private schools had play area. Adequate lighting & separate toilets for boys and girls were present in majority schools. Clean drinking water was available only in 30% of government schools and 62% of private schools. Dustbins were provided in 30% of government and 60% of private schools. Toilets were clean only in 38% of government schools and 71% of private schools. Unhealthy food was available to purchase nearby in 45% government and 39% private schools and Outlets for tobacco/ alcohol were present nearby in 4% government schools and 1.5% private schools. Posters against Alcohol/Tobacco were displayed in 7.6% of government schools and none of the private schools. Conclusion: A score of 0-5 was achieved by 61% of government and 39% of private schools, 6-11 score was achieved by only 39% of government and 61% of private schools. Thus the physical school environment score of private schools was found to be higher as compared to that of government schools. However study findings recommended schools to improve their physical environment in order to achieve better health and effective learning among children.

As radio frequency (RF) hardware continues to improve, two-way ranging (TWR) has become a viable approach for high-precision ranging applications. The precision of a TWR system is fundamentally limited by estimates of the time offset T between two platforms and the time delay τ of a signal propagating between them. In previous work, we derived a family of optimal “one-shot” joint delay–offset estimators and demonstrated that they reduce to a system of linear equations under reasonable assumptions. These estimators are simple and computationally efficient but are also susceptible to channel impairments that obstruct one or more measurements. In this work, we formulate an extended Kalman filter (EKF) for this class of estimators that specifically addresses this limitation. Unlike a generic KF approach, the proposed solution specifically integrates the estimation process to minimize the computational complexity. We benchmark the proposed first- and second-order EKF solutions against the existing one-shot estimators in a MATLAB Monte Carlo simulation environment. We demonstrate that the proposed solution achieves comparable estimation performance and, in the case of the second-order solution, reduces the computation time by an order of magnitude.

Sickness behaviour, a set of behavioural changes associated with neuroinflammation, is expressed as decreased mobility and depressed behaviour. Activation of AMP-activated protein kinase (AMPK) is reported to regulate inflammation in conditions such as Alzheimer and traumatic brain injury. Metformin, an antidiabetic agent acting via AMPK activation, possesses anti-inflammatory properties. Similarly, the reported anti-inflammatory activities of berberine could be partially attributed to its ability to activate AMPK. In this study, we investigated the effects of metformin and berberine against lipopolysaccharide (LPS)-induced sickness-like behaviour, associated with neuroinflammation, impaired cognition, and oxidative stress. Swiss albino mice were divided into four groups, normal control, LPS control, metformin treatment, and berberine treatment. The control groups received saline for 7 days. Groups 3 and 4 received metformin (200 mg/kg) and berberine (100 mg/kg), respectively, orally once daily for 7 days. On day 7, 1 h after the treatments, animals received LPS (1.5 mg/kg i.p.) to induce sickness-like behaviour. Open field test (OFT) and forced swim test (FST), were performed within 2 h of LPS administration. Then, proinflammatory cytokines (IL-1β and TNF-α), acetylcholinesterase activity (AChE), and oxidative stress markers were estimated in the brain homogenate. In the LPS control group, immobility state, proinflammatory cytokines, AChE, and lipid peroxidation were significantly increased, whereas the glutathione levels were decreased. Pretreatment with metformin significantly improved immobility in the FST, with reduced IL-1β, oxidative stress markers, and AChE activity. However, no significant changes were observed in OFT. Berberine pretreatment exhibited only an apparent, statistically insignificant, improvement in sickness-like behaviour assessed using FST and OFT, cytokine levels, oxidative markers, and AChE. Several factors affect treatment efficacy, such as treatment duration and administered dose. Considering these, berberine warrants elaborate preclinical evaluation for neuroinflammation. Nevertheless, based on the effects observed, AMPK activators could regulate neuroinflammation, cognition, and oxidative stress linked with sickness-like behaviour.

Clozapine is an antipsychotic medicine used to treat mental illnesses that is resistant to therapy. It can induce dose-dependent adverse effects such as increased susceptibility to infections and hematological irregularities. In this case report, we present a 37-year-old woman with schizoaffective disorder who experienced clozapine side effects following a moderate urinary tract infection (UTI). Her serum clozapine levels and side effects were increased throughout her UTI but resolved once the UTI was managed conservatively. We reviewed clozapine’s pharmacokinetic properties to understand why serum levels rose during infection. While we could not definitely explain the mechanism of elevation, we emphasize the importance of monitoring serum clozapine levels and keeping watchful for adverse effects, as well as heightened scrutiny, evaluation for recent infections, and regular monitoring of patients.

Background The pyramidalis muscle is a tiny triangular-shaped muscle that is located in the anterior abdominal wall, which originates from the body of the pubis and pubic symphysis and is inserted into linea alba. This study aimed to measure the different parameters of the pyramidalis muscle in adult cadavers. Methods This study was carried out on 31 adults (26 males and five females) 10% formalin embalmed cadavers of both sexes from the Department of Anatomy at Kasturba Medical College, Manipal. Results The mean length of the right pyramidalis muscle was 64.44 ± 12.52 mm and the left pyramidalis muscle was 64.73 ± 12.81 mm. The mean width of the muscle was 15 ± 4.18 mm and 15.03 ± 3.52 mm on the right and left sides, respectively. The mean thickness of the muscle was 1.32 ± 0.55 mm and 1.4 ± 0.80 mm on the right and left sides, respectively. The distance between the umbilicus to pubic symphysis ranged from 130–192 mm and their mean was calculated to be 159.77 ± 15.36. The distance between the umbilicus and the apex of the muscle ranged from 72–123 mm. Conclusions The measured parameters like length, width and thickness may help the surgeons to locate the muscle during infra umbilical surgeries.

ABSTRACT Developing software tools that leverage biological data sets to accelerate drug discovery is an important aspect of bioinformatic research. Here, we present a novel example: a web application called Rocket-miR that applies an existing bioinformatic algorithm (IntaRNA) to predict cross-species miRNA-mRNA interactions and identify human miRNAs with potential antimicrobial activity against antibiotic-resistant bacterial infections. Rocket-miR is the logical extension of our prior finding that human miRNA let-7b-5p impairs the ability of the ubiquitous opportunistic pathogen Pseudomonas aeruginosa to form biofilms and resist the bactericidal effect of β-lactam antibiotics. Rocket-miR’s point and click interface enables researchers without programming expertise to predict additional human-miRNA-pathogen interactions. Identified miRNAs can be developed into novel antimicrobials effective against the 24 clinically relevant pathogens, implicated in diseases of the lung, gut, and other organs, that are included in the application. The paper incorporates three case studies contributed by microbiologists that study human pathogens to demonstrate the usefulness and usability of the application. Rocket-miR is accessible at the following link: http://scangeo.dartmouth.edu/RocketmiR/.IMPORTANCEAntimicrobial-resistant infections contribute to millions of deaths worldwide every year. In particular, the group of bacteria collectively known as ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter sp.) pathogens are of considerable medical concern due to their virulence and exceptional ability to develop antibiotic resistance. New kinds of antimicrobial therapies are urgently needed to treat patients for whom existing antibiotics are ineffective. The Rocket-miR application predicts targets of human miRNAs in bacterial and fungal pathogens, rapidly identifying candidate miRNA-based antimicrobials. The application’s target audience are microbiologists that have the laboratory resources to test the application’s predictions. The Rocket-miR application currently supports 24 recognized human pathogens that are relevant to numerous diseases including cystic fibrosis, chronic obstructive pulmonary disease (COPD), urinary tract infections, and pneumonia. Furthermore, the application code was designed to be easily extendible to other human pathogens that commonly cause hospital-acquired infections.

Abstract This observational claims-linked survey study assessed the prevalence of and risk factors for suboptimal asthma control and healthcare utilization in adults with asthma receiving fixed-dose combination (FDC) inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). Commercially insured adults from the Optum Research Database were invited to complete the Asthma Control Test (ACT) and Asthma Control Questionnaire-6 (ACQ-6). Among participants (N = 428), 36.4% (ACT-assessed) and 55.6% (ACQ-6-assessed) had inadequately controlled asthma. Asthma-related quality of life was worse and asthma-related healthcare resource utilization was higher in poorly controlled asthma. Factors associated with ACT-defined suboptimal asthma control in multivariate analysis included: frequent short-acting β2-agonist (SABA) use, asthma-related outpatient visits, lower treatment adherence, and lower education levels. During follow-up, factors associated with asthma exacerbations and/or high SABA use included: inadequately controlled asthma (ACT-assessed), body mass index ≥30 kg/m2, and high-dose ICS/LABA. Approximately 35–55% of adults with asthma were inadequately controlled despite FDC ICS/LABA; poor control was associated with worse disease outcomes.

Briefly (10 min) exposing C2C12 myotubes to low amplitude (1.5 mT) pulsed electromagnetic fields (PEMFs) generated a conditioned media (pCM) that was capable of mitigating breast cancer cell growth, migration, and invasiveness in vitro, whereas the conditioned media harvested from unexposed myotubes, representing constitutively released secretome (cCM), was less effective. Administering pCM to breast cancer microtumors engrafted onto the chorioallantoic membrane of chicken eggs reduced tumor volume and vascularity. Blood serum collected from PEMF-exposed or exercised mice allayed breast cancer cell growth, migration, and invasiveness. A secretome preconditioning methodology is presented that accentuates the graded anticancer potencies of both the cCM and pCM harvested from myotubes, demonstrating an adaptive response to pCM administered during early myogenesis that emulated secretome-based exercise adaptations observed in vivo. HTRA1 was shown to be upregulated in pCM and was demonstrated to be necessary and sufficient for the anticancer potency of the pCM; recombinant HTRA1 added to basal media recapitulated the anticancer effects of pCM and antibody-based absorption of HTRA1 from pCM precluded its anticancer effects. Brief and non-invasive PEMF stimulation may represent a method to commandeer the secretome response of muscle, both in vitro and in vivo, for clinical exploitation in breast and other cancers.

Introduction Ticagrelor use has become more prominent in acute ischemic stroke management in the presence of clopidogrel resistance(1‐2). This study compares the effectiveness of aspirin plus ticagrelor at different doses versus clopidogrel in reducing the risk of recurrent stroke and other thrombotic events without increasing the risk of bleeding. Methods We performed a retrospective chart review of patients diagnosed with acute ischemic stroke at a large academic comprehensive stroke center from September 1, 2020, to July 1, 2022. A total of 3 separate groups, low‐dose ticagrelor (45 mg or 60 mg twice a day), full‐dose ticagrelor (90 mg twice a day) and clopidogrel (75 mg daily) were created. We compared baseline characteristics and completed a one‐way ANOVA to analyze for outcome measures such as in‐hospital mortality, 90‐day mortality, favorable functional outcome defined as modified Rankin Score (mRS) of 0‐2, at 90 days, symptomatic intracranial hemorrhage (sICH) and asymptomatic hemorrhage (aICH) between groups. All data was analyzed via IBM SPSS v28.0. Results A total of 445 patients were included in our study. The mean age was 66.1 ± 12.8 years and the majority of patients were female (52.9%). The most common ethnicity was African American (82.9%). Sixty patients were discharged on low‐dose ticagrelor, 39 on full dose ticagrelor and 351 on clopidogrel. A total of 162/433 (36.0%) had a presumed stroke etiology of intracranial atherosclerotic disease (ICAD). Only 24 patients received intravenous thrombolytics (5.3%) and 47 had stent placement (10.4%). Out of 445 patients, 288 were on aspirin 81 mg at time of discharge. Of that group, 228 were on both aspirin and clopidogrel, 60 were on aspirin and low‐dose ticagrelor and 39 were on aspirin and full‐dose ticagrelor. There was no statistical significance for new or recurrent ischemic stroke between groups (low‐dose vs full‐dose vs clopidogrel) determined by one‐way ANOVA (10.0% vs. 17.9% vs. 7.8%, F(2,103) = 0.01, p=0.99). Symptomatic ICH was also similar between the groups (3.3% vs. 2.6% vs. 1.1%, F(2,101) = 0.68, p=0.51). There was no significance for favorable functional outcomes and mortality as well (26.7% vs. 23.1% vs. 24.2%, F(2,173) = 0.62, p=0.54; 80.0% vs. 79.5% vs. 81.5%, F(2,150) = 1.5, p=0.22). Conclusion These findings suggest that a lower dose of ticagrelor may be a safe and effective alternative to full dose ticagrelor or clopidogrel for the prevention of recurrent ischemic stroke without increasing hemorrhagic complications. Larger randomized trials are necessary to further evaluate these findings.

Background: Both lower and higher estradiol (E2) levels have been associated with increased mortality among women with kidney failure. However, robust data are still lacking. Objective: We investigated the interaction of diabetes and age on linear and nonlinear associations between E2 levels, adverse outcomes, and health-related quality of life (HRQOL) in Canadian women undergoing hemodialysis (HD). Design: Population-based cohort study; data from Canadian Kidney Disease Cohort Study (CKDCS). Setting & patients: A total of 427 women undergoing HD enrolled in the CKDCS. Measurements: Baseline E2 (in pmol/L) and E2 tertiles (95 pmol/L). Methods: Cox-proportional hazards used for all-cause and cardiovascular disease (CVD) mortality. Fine-Gray models used for incident CVD. Mixed models used for Health Utilities Index Mark 3 (HUI3), Kidney Disease Quality of Life Physical Component Scores (KDQOL12-PCS), and Mental Component Scores (KDQOL12-MCS). Results: Over a median follow-up of 3.6 (interquartile range [IQR]: 1.6-7.5) years, 250 (58.6%) participants died; 74 deaths (29.6%) were CV-related. Among 234 participants without prior CV events, 80 (34.2%) had an incident CVD event. There were no significant linear associations between E2 and all-cause mortality, CVD mortality, and incident CVD. However, E2 showed a significant concave association with all-cause mortality, but not with CVD mortality and incident CVD. Among patients aged ≥63 years, higher E2 levels were associated with lower HUI3 scores, mean difference (MD) = –0.062 per 1 – SD pmol/L, 95% confidence interval (CI) = –0.112 to –0.012, but the opposite was observed in younger patients (

BACKGROUND: The volumetric relationship between the tongue and the oral cavity is an important factor in tooth alignment and occlusion. The aim of this study was to evaluate the difference in tongue and airway volume in skeletal Class I and Class II malocclusion. MATERIALS AND METHODS: The CBCT data which comprised of 30 skeletal Class I and 30 skeletal Class II was stored in DICOM format. Tongue volume and airway volume was analyzed with the help of 3D dolphin software. Values obtained were subjected to statistical analysis with help of SPSS. RESULTS: Skeletal Class I pattern had more tongue volume with a mean of 45.32 mm3 than skeletal Class II pattern with mean value of 40.27mm3 with P value of

Abstract Using 42 years of reanalysis data, we investigate regional, storm‐relative characteristics of three groups of Atlantic tropical cyclone intensification: slightly, moderately, and rapidly intensifying. Probability density functions are distinct between these groups for vertical wind shear, sea surface temperature (SST), and radius of maximum winds (RMW), but less so for relative humidity (RH). In the Gulf of Mexico and southern North Atlantic, shear and RMW are good predictors. In the open Atlantic, north of 22°N, shear and SST are the best predictors. In the Caribbean, weaker relationships suggest low statistical predictability in a region where RI cases increased between 1980–2000 and 2001–2021. Of our storm‐relative variables tested, increasing SST appears to be most closely connected to the 36% increase in rapidly intensifying events between the two periods, whereas shear and RH are not significantly more favorable. The variability across regions, periods, and variables motivates further investigation.

Background: The pyramidalis muscle is a tiny triangular-shaped muscle that is located in the anterior abdominal wall, which originates from the body of the pubis and pubic symphysis and is inserted into linea alba. This study aimed to measure the different parameters of the pyramidalis muscle in adult cadavers. Methods: This study was carried out on 31 adults (26 males and five females) 10% formalin embalmed cadavers of both sexes from the Department of Anatomy at Kasturba Medical College, Manipal. Results: The mean length of the right pyramidalis muscle was 64.44 ± 12.52 mm and the left pyramidalis muscle was 64.73 ± 12.81 mm. The mean width of the muscle was 15 ± 4.18 mm and 15.03 ± 3.52 mm on the right and left sides, respectively. The mean thickness of the muscle was 1.32 ± 0.55 mm and 1.4 ± 0.80 mm on the right and left sides, respectively. The distance between the umbilicus to pubic symphysis ranged from 130–192 mm and their mean was calculated to be 159.77 ± 15.36. The distance between the umbilicus and the apex of the muscle ranged from 72–123 mm. Conclusions: The measured parameters like length, width and thickness may help the surgeons to locate the muscle during infra umbilical surgeries.

Critical metals, which mainly include the platinum group of metals, and the rare earth elements, have gained much importance because these elements are essential for economic development. A matter of concern is their availability, which is scarce, and so a constant supply is at risk. Bioleaching is one of the commonly used methods to extract these critical metals from various sources, such as industrial wastewater and mining water. In this study, we have discussed the mechanisms of bioleaching, the factors that affect bioleaching, and a correlation between the extraction of the critical metals using microalgae which has many positive aspects. The review also suggests the future prospects for the use of microalgae in the extraction of critical metals.

Abstract Background The aim of this study is to evaluate the extent and associations with patient‐reported disruptions to cancer treatment and cancer‐related care during the COVID‐19 pandemic utilizing nationally representative data. Methods This analysis uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross‐sectional survey of US adults. Adults (age >18) who reported requiring current cancer treatment or other cancer‐related medical care in the second half of 2020 were included. Estimated proportions of patients with self‐reported changes, delays, or cancelations to cancer treatment or other cancer care due to the COVID‐19 pandemic were calculated using sampling weights and associations with sociodemographic and other health‐related variables were analyzed. Results In total, 574 (sample‐weighted estimate of 2,867,326) adults reported requiring cancer treatment and/or other cancer care since the start of the COVID‐19 pandemic. An estimated 32.1% reported any change, delay, or cancelation. On sample‐weighted univariable analysis, patients who were younger, female, had one or fewer comorbidities, and uninsured were significantly more likely to report disruptions. On sample‐weighted, multivariable analysis, patients who were younger and female remained significant predictors. Nearly 90% of patients included in the study reported virtual appointment use. Patients reporting disruptions were also significantly more likely to report feelings of anxiety. Conclusions An estimated 1/3 of patients experienced disruptions to cancer care due to the COVID‐19 pandemic. Patients experiencing disruptions in care were more likely to be female or younger which may reflect risk stratification strategies in the early stages of the pandemic, and also had higher rates of anxiety. The longitudinal impact of these disruptions on outcomes merits further study.

Abstract Background Extended first‐line therapy (1LT) has improved clinical outcomes in newly diagnosed multiple myeloma (NDMM). This retrospective study of NDMM patients evaluated the relationship between dose‐attenuation of 1LT and duration of therapy (DOT) and DOT on outcomes. Methods Adults with NDMM not undergoing stem cell transplant (SCT) from January 1, 2012 toMarch 31, 2018 from the Integrated Oncology Network were included; 300 were randomly selected for chart review. 1LT DOT, time to next treatment (TTNT), progression‐free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier analysis. Marginal structural models evaluated relationships between DOT and TTNT, PFS, and OS at 2 years accounting for confounders and survival bias from the time‐dependent nature of DOT. Results Of 300 chart‐reviewed patients, 93 were excluded for incomplete data or meeting exclusion criteria. Among 207 NDMM patients, median age was 74 years; 146 (70.5%) did not receive dose‐attenuation during 1LT. Patients with short DOT were older, frailer, with a higher comorbidity burden, and a significantly lower proportion had an Eastern Cooperative Oncology Group PS = 0. As DOT increased, more patients underwent dose‐attenuation (p

Background and Aim: One of the main reasons that patients seek orthodontic treatment is aesthetics. Unfortunately, treatment with fixed orthodontic appliances can at times increase the chances of developing white spot lesions on the surfaces of teeth, thus creating a new aesthetic issue for the patient. The prevalence of white spot lesions (WSL) reported after treatment varies from 2% to 97%, and these lesions can occur despite increased attention to hygiene. Hence the aim of this study was to assess the effect of Amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy. Materials and Methods: Study participants were randomly divided into two groups (Group A – experimental 25 patients and Group B – control 25 patients). The pre-intervention and post-intervention intra-oral digital photographs were analysed by using ImageJ software to assess the percentage of the facial surface affected on the teeth (10 maxillary teeth), which had white spot lesions. Results: The mean value of WSLs showed significant difference between the experimental and control groups. Mean values of WSL in the experimental group decreased from 2 to 1.54 with a mean difference of 0.46 after 6 months of follow-up which indicated that amine fluoride mouthwash was effective in preventing WSLs during fixed orthodontic treatment. Conclusion: WSLs scores were significantly reduced in patients who received the mouthwash when compared to patients who followed standard oral hygiene regimen with fluoridated toothpaste only. In clinical practice, amine fluoride mouthwash is an effective method for the prevention of WSLs during fixed orthodontic treatment.

This research is the first of its kind to leverage the power of Quantum Machine Learning (QML) to perform multi-class classification of Cardiovascular Diseases (CVDs). We propose a novel approach that enables multi-class classification with Pegasos Quantum Support Vector Classifier (QSVC). The QSVC and the Pegasos QSVC significantly outperform the classical SVC by a margin of +10.76% and +9.72%, respectively. The paper further ventures into a quantum deep learning based architecture with a novel Quanvolutional Neural Network (QNN) implementation, outperforming not only its classical CNN counterpart by +3.88% but also the other models by achieving 97.31% accuracy, 97.41% precision, 97.31% recall, 97.30% F1 score, and 99.10% specificity.