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In the recent past, much nanotechnology research has been done in an effort to increase agricultural productivity. The Green Revolution led to the careless use of pesticides and artificial fertilizers, which reduced soil biodiversity and led to the development of disease and insect resistance. This article highlights the worldwide development and status of precision agriculture. Precision agriculture utilizes technologies and principles to manage spatial and temporal variability in agricultural production to improve crop performance and environmental quality. In precision agriculture (PA), information technology (IT) is used to make sure that crops and soil receive exactly what they require for optimal productivity and health. Precision farming includes the use of hardware i.e., a global positioning system (GPS) and geographic information system (GIS), different software of GIS, and traditional knowledge of agriculture management practices. The benefits of precision agriculture can be seen in both the economic and environmental aspects of agricultural production. Only nanoparticles or nanochips can transport materials to plants in a nanoparticle-mediated manner and create sophisticated biosensors for precision farming. Conventional fertilizers, insecticides, and herbicides can be nano encapsulated to provide exact doses to plants through a gradual, continuous release of nutrients and agrochemicals. The main topics included in this article are the variability of natural resources, variability management; administrative districts; the impact of precision farming technologies on farm profitability and the environment; innovations in sensors, controls, and remote sensing, information management; trends in global application and acceptance of precision farming technologies; potential and possibilities of technology along with challenges in agricultural modernization. Modern equipment and procedures based on nanotechnology have the ability to solve many of the issues in conventional agriculture and might transform this industry. There are many challenges in the implementation of smart agriculture equipment and approaches in the field as this technique uses both hardware and software. The cost of labour for managing IoT devices and the cost-of-service registration are included in the system operational cost. Additionally, there are operating costs related to the use of energy, maintenance, and communication between IoT devices, gateways, and cloud servers. In this review, nanotechnology is explored as a potential tool in precision agriculture, as well as the advantages of nanoparticles in agriculture, such as the use of fertilizers. By using precision agriculture, the food production chain can be monitored and quality and quantity can be managed effectively.

Intensive agriculture practices in India to meet the food demand of the increasing population have led to the use of agrochemicals such as pesticides in higher quantities to increase productivity resulting in contamination of the environment. Pesticides control pests, weeds, and diseases in plants, animals, and humans. Despite bans on pesticides such as organochlorides (OC), organophosphate (OP), or synthetic pyrethroids ranging from minimal to excessive, are detected in soil, surface water, and groundwater often exceeding WHO and BIS safety limits. The predominantly found pesticides were DDT, HCH, Endosulfan, malathion, chlorpyrifos, atrazine, endrin, cypermethrin, dichlorvos, etc. Different ranges of pesticides were detected in different states (Kashmir, UP, Tamil Nadu, Kerala, Rajasthan, Haryana, Assam, Madhya Pradesh, etc.) of India, which demonstrate that pesticides can persist in the environment and later can show bioaccumulation in the food chain. The article explores the consequences of this pollution such as biomagnification, bioaccumulation, and risks to human health and ecological integrity. This article also covers the adverse effects of pesticides such as carcinogenic, teratogenic, mutagenic, and endocrine-disrupting properties along with the importance of developing new policies or strengthening the current policies and regulations to monitor the use of pesticides.

Background Up to 83% of patients with SLE stop taking hydroxychloroquine (HCQ) within the first year due to knowledge gaps regarding the survival benefits of HCQ versus inflated fears of rare toxicity. Thus, there is a need for a shared decision-making tool that highlights HCQ’s significant benefits versus rare harms to improve patients’ understanding and align treatments with their values. The objective of this study was to describe development and piloting of a decision aid (HCQ-SAFE) to facilitate HCQ adherence, and safe, effective use by engaging patients in therapeutic decision-making.Methods HCQ-SAFE was developed via a collaborative process involving patients, clinicians, implementation scientists and health literacy experts. The initial prototype was informed by Agency for Healthcare Research and Quality (AHRQ) low literacy principles and key themes about HCQ use from six prior patient and clinician focus groups, with iterative expert and stakeholder feedback to deliver a final prototype. We implemented HCQ-SAFE in four clinics to examine usability and feasibility on Likert scales (0–7) and net promoter score (0%–100%).Results The final HCQ-SAFE shared decision-making laminated tool organises data using pictograms showing how HCQ use reduces risk of organ damage, early death and blood clots versus low risk of eye toxicity.HCQ-SAFE was reviewed in all eligible patient visits (n=40) across four clinics on an average of ~8 min, including 25% non-English-speaking patients. All patients scored 100% on the knowledge post-test; no decisional conflicts were noted after using HCQ-SAFE. HCQ-SAFE garnered high clinician and patient satisfaction with 100% likelihood to recommend to peers.Conclusions HCQ-SAFE is a stakeholder-informed feasible shared decision-making tool that enhances communication and can potentially improve knowledge, clarify misbeliefs and engage patients in treatment decisions, including those with limited English proficiency.

The challenge of limiting global warming to below 1.5°C requires all industries to implement new technologies and change practices immediately. The aviation industry contributes 2% of human-induced CO2 emissions and 12% of all transport emissions. Decarbonising the aviation industry, which relies heavily on high-density liquid fuels, has been difficult to achieve. The problems are compounded by the continued reliance on so-called sustainable aviation fuels, which use first-generation agricultural feedstocks, creating a trade-off between biomass for food and feed and its use as a feedstock for energy generation. Decarbonising aviation is also challenging because of problems in developing electric aircraft. Alternative feedstocks already exist that provide a more feasible path towards decelerating climate change. One such alternative is to use gas fermentation to convert greenhouse gases (e.g. from food production and food waste) into fuels using microbial acetogens. Acetogens are anaerobic microorganisms capable of producing alcohols from gaseous CO, CO2 and H2. Australia offers feedstock resources for gas fermentation with abundant H2 and CO2 production in proximity to each other. In this review, we put forward the principles, approaches and opportunities offered by gas fermentation technologies to replace our dependency on fossil fuels for aviation fuel production in Australia.

Objective Patients with lupus nephritis (LN) have a 26‐fold higher mortality rate compared with their peers. Kidney biopsy, the gold standard diagnostic method for LN, may have an average wait time of more than 50 days. Other gaps in quality process measures during LN visits have also been reported. A subspecialty multidisciplinary clinic (MDC) can provide better care and quality in LN; therefore, we aimed to examine how an LN MDC impacted time to biopsy, time to treatment, and other quality measures. Methods We included all validated patients with LN who underwent diagnostic kidney biopsies between the 2011 to 2017 pre‐MDC period and the 2018 to 2020 post‐MDC period. We compared time to biopsy and treatment and quality measures between the two periods and examined factors associated with timely LN diagnosis, defined as a biopsy within 21 days. Results During the pre‐ and post‐MDC periods, 53 and 21 patients with LN underwent a diagnostic biopsy, respectively. We found a decrease in the median time to biopsy from 26 days to 16 days after starting the LN clinic (P = 0.014). Beyond clinical factors, the presence of social factors, such as being of a non‐White race and having food insecurity, were associated with 54% lower odds of timely diagnosis (adjusted Hazards Ratio [aHR] = 0.46; 95% confidence interval: 0.22‐0.93; P = 0.031). We found higher odds of quality measure performance during the post‐ versus pre‐MDC period. Conclusion Wait times to diagnose LN decreased by 40% and higher quality measure performance was noted after establishing an LN MDC. Systemic and social barriers predicted delays in diagnosis that may be addressed by MDCs.

An attractive route for carbon-negative synthesis of biochemical products is the reverse β-oxidation pathway coupled to the Wood-Ljungdahl pathway. Here the authors use a high-throughput in vitro prototyping workflow to screen 762 unique pathway combinations using cell-free extracts tailored for r-BOX to identify enzyme sets for enhanced product selectivity.

Objectives: To evaluate if addition of an anti-anaerobic agent to standard drug-cefazolin for antimicrobial prophylaxis would further decrease postoperative infectious morbidity or not. This is relevant as most of the infections in gynecological surgeries are anaerobic but cefazolin does not protect against anaerobes. Materials and Methods: The study design was a parallel randomized controlled trial. Two hundred patients undergoing benign gynecological surgeries were divided into two groups of 100 each. Group A received 2 g cefazolin 30–60 min before incision and Group B received 2 g cefazolin 30–60 min and 1.6 g tinidazole 60–120 min before incision. The patients were followed for any infectious morbidity for 1 month postoperatively. The analysis was done separately for abdominal, laparoscopic, and vaginal surgeries. The analysis was also done for surgeries according to the wound category, i.e. clean and clean-contaminated. Results: The two groups were comparable for age and body mass index (BMI). The two groups were comparable for the factors affecting infectious morbidity such as duration of surgery, blood loss, blood transfusions, duration of hospital stay, and need for additional antibiotics. The postoperative infectious morbidity was analyzed in terms of fever, surgical site infection (SSI), and urinary tract infection (UTI). No patient in vaginal and laparoscopic groups suffered from infectious morbidity. In abdominal surgeries group, postoperative fever occurred in 6/74 (8.1%) and 11/74 patients (14.8%) in Groups A and B, respectively (P = 0.38). SSI occurred in 1/74 (1.3%) and 2/74 (2.7%) patients in Groups A and B, respectively (P = 1.0). UTI occurred in 5/74 patients (6.7%) and 2/74 patients (2.7%) in Groups A and B, respectively (P = 0.44). The data were also analyzed for infectious morbidity for clean and clean-contaminated wound categories, and the results were nonsignificant between both groups for each type of wound category (P > 0.05). Conclusion: Cefazolin alone is a sufficient antibiotic prophylaxis for benign gynecological procedures.

We report a patient with catastrophic antiphospholipid syndrome who had significant improvement after corticosteroids, plasmapheresis, argatroban, rituximab, and sirolimus. Argatroban was used instead of heparin due to a history of heparin-induced thrombocytopenia.

Objective Patients identified as black and from disadvantaged backgrounds have a twofold higher hydroxychloroquine (HCQ) non-adherence, which contributes to worse lupus outcomes and disparities. Yet, most adherence interventions lack tailored strategies for racially and socioeconomically diverse patients who face unique challenges with HCQ. We aimed to examine a broadly representative group of patients with SLE and physician perspectives on HCQ adherence and adherence strategies to redesign an adherence intervention.Methods We conducted four virtual focus groups (90 min each) with 11 racially and socioeconomically diverse patients with SLE recruited from two health systems. Additionally, we hosted two focus group meetings with nine healthcare advisors. In focus groups, patients: (1) shared their perspectives on using HCQ; (2) shared concerns leading to non-adherence; (3) discussed strategies to overcome concerns; (4) prioritised strategies from the most to least valuable to inform an adherence intervention. In two separate focus groups, healthcare advisors gave feedback to optimise an adherence intervention. Using content analysis, we analysed transcripts to redesign our adherence intervention.Results Worry about side effects was the most common barrier phrase mentioned by patients. Key themes among patients’ concerns about HCQ included: information gaps, logistical barriers, misbeliefs and medication burden. Finally, patients suggested adherence strategies and ranked those most valuable including co-pay assistance, personal reminders, etc. Patient and healthcare advisors informed designing a laminate version of an adherence intervention to link each barrier category with four to six patient-recommended adherence strategies.Conclusion We developed a patient stakeholder-informed and healthcare stakeholder-informed tailored intervention that will target non-adherence at the individual patient level.

The increase in pollutants such as hazardous refractory contaminants, organic dyes, pharmaceuticals, and pesticides entering water resources on a large scale due to global population growth and industrialization has become a significant health concern worldwide. The two-dimensional (2D) MXene material is a new type of transition metal carbide or carbonitride material, which has demonstrated the capability to adsorb various heavy contaminants, particularly metals such as chromium, copper, lead, and mercury. In addition, MXenes have a tunable band gap (0.92–1.75 eV) and exhibit good thermal stability and considerable damage resistance, which means that they are well suited as adsorbents for waste removal. In this review article, MXene nanocomposites are introduced for the removal of pollutants from water. The idea of water remediation, the applications of MXene-based nanocomposites, and the effects on the degradation of water and wastewater contaminants are reviewed. Future trends in MXene-based nanocomposites for water treatment and environmental applications will also be discussed.

Abstract Background Systemic lupus erythematous (SLE) disproportionately impacts patients of color and socioeconomically disadvantaged patients. Similar disparities in HIV were reduced through a World Health Organization-endorsed Care Continuum strategy targeting “retention in care,” defined as having at least two annual visits or viral load lab tests. Using similar definitions, this study aimed to examine predictors of lupus retention in care, to develop an SLE Care Continuum and inform interventions to reduce disparities. We hypothesized that Black patients and those residing in disadvantaged neighborhoods would have lower retention in care. Methods Abstractors manually validated 545 potential adult cases with SLE codes in 2013–2014 using 1997 American College of Rheumatology (ACR) or 2012 Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) criteria. We identified 397 SLE patients who met ACR or SLICC criteria for definite lupus, had at least one baseline rheumatology visit, and were alive through 2015. Retention in care was defined as having two ambulatory rheumatology visits or SLE labs (e.g., complement tests) during the outcome year 2015, analogous to HIV retention definitions. Explanatory variables included age, sex, race, ethnicity, smoking status, neighborhood area deprivation index (ADI), number of SLE criteria, and nephritis. We used multivariable logistic regression to test our hypothesis and model predictors of SLE retention in care. Results Among 397 SLE patients, 91% were female, 56% White, 39% Black, and 5% Hispanic. Notably, 51% of Black versus 5% of White SLE patients resided in the most disadvantaged ADI neighborhood quartile. Overall, 60% met visit-defined retention and 27% met complement lab-defined retention in 2015. Retention was 59% lower for patients in the most disadvantaged neighborhood quartile (adjusted OR 0.41, CI 0.18, 0.93). No statistical difference was seen based on age, sex, race, or ethnicity. More SLE criteria and non-smoking predicted greater retention. Conclusions Disadvantaged neighborhood residence was the strongest factor predicting poor SLE retention in care. Future interventions could geo-target disadvantaged neighborhoods and design retention programs with vulnerable populations to improve retention in care and reduce SLE outcome disparities.

Introduction: Atherosclerosis (i.e. hardening and thickening of arteries) causes vascular remodeling, obstruction of lumen, abnormalities of blood flow and reduced oxygenation of target tissues. Manifestation of atherosclerosis in the form of either Myocardial Infarction or Stroke is the major cause of morbidity and mortality. This study evaluated extracranial carotid arteries of patients (>60 years) who presented with risk factors of atherosclerosis and determined the association of risk factors with carotid abnormalities. Aim: To evaluate the prevalence of atherosclerosis, haemodynamic and morphological changes that take place in extra cranial portion of carotid arteries in patients with risk factors of atherosclerosis (Diabetes Mellitus, Hypertension, Smoking, Stroke, Coronary Artery Disease, Hypercholesterolaemia) and determine the association of risk factors with carotid abnormalities. Materials and Methods: The prospective cross-sectional analytical study included the examination of Extracranial carotid arteries of 1043 patients over a period of 2 years (2013-2015) using duplex ultrasound. Assessment of CCA-IMT, ICA-IMT and percent stenosis was done using a linear probe of 8-12 MHz. Statistical Analysis: Correlation between risk factors of atherosclerosis, wall thickness of common carotid (CCA-IMT), internal carotid arteries (ICA-IMT) and stenosis was studied using statistical tools like multiple logistic regression analysis and analysis of variance (p70%) was low while the prevalence of mild stenosis (

Aims: Carbapenems are usually the choice of antimicrobials in infections caused by Enterobacteriaceae bacteria-producing ESBL (extended spectrum β-lactamases) and Amp C. Resistance to carbapenems is mostly due to production of enzymes - Carbapenemases, which are divided into Ambler Classes A, B and D. Phenotypic detection and differentiation of types of Carbapenemases in carbapenem-resistant Enterobacteriaceae (CRE) is important for proper infection control and appropriate patient management. Materials and Methods: The present study done in a tertiary care hospital from North India differentiates Class A (KPC type) and B (MBL type) carbapenemases among Enterobacteriaceae isolates by simple phenotypic method that uses both the inhibitors EDTA and phenylboronic acid. Results: Total of 330 strains of Enterobacteriaceae were included in the study. Out of these 330 strains, 26 strains were resistant to carbapenems. The prevalence of CRE in our Institute is 7.87% (26/330). Conclusions: The prevalence of Enterobacteriaceae strains producing MBL type carbapenemase in our health care setup is 5.75% (19/330). None of the strains among the carbapenem-resistant bacterial isolates showed production of KPC enzyme. The need of the hour is simple, rapid and cost effective tests which will be able to identify and distinguish resistant pathogens for improved patient outcome, facilitating efficient infection control and reducing the escalation of resistance.