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Abstract Background The occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature. Case presentation A young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma. Conclusion Intracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical. Learning Points Intracranial aneurysms are rare complications of cardiac myxoma that may present before, concurrent or many years after diagnosis of the myxoma. Special attention must be given to nonspecific neurological complaints with a low threshold for neuroimaging in those with a prior history of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-up including conventional angiography and/or magnetic resonance imaging is critical.

Abstract Unmet needs for contraception in India have declined over time but the rate has not been uniform among women across geographies and socio-economic strata. Identifying the characteristics of women in communities where unmet need is still high is important to devise appropriate strategies to ensure access and uptake of modern contraceptive methods. The current study examined whether there was a national decline in unmet need over time and if regional disparities exist in unmet need. Demographic variations in unmet need based on factors such as maternal age, education, religion, caste, wealth index quintile, family size, and access to antenatal care (ANC) were also documented. Our approach was to document the prevalence of total unmet need for family planning and unmet need for spacing among married Indian women and quantify variability based on socio-economic and demographic drivers within a hierarchal framework, thus providing both macro and micro perspectives. We used data from the fourth and fifth rounds of the National Family Health Survey (NFHS) collected from all the States and Union Territories (UTs) in India. Quantile regression analysis and multilevel regression techniques were used to understand the predictors for the total unmet need for family planning and the unmet need for spacing. Results show a considerable decline in the prevalence of unmet need for family planning in India from NFHS-4 to 5 (from 12.9 to 9.3%) in the last six6 years. The north-eastern states show a significant reduction in unmet need for family planning in Manipur (17.8%), Nagaland (13.5%), and followed by Sikkim (9.1%). The predictors such as years of schooling, place of residence, caste, religion, wealth quintile, number of antenatal care (ANC) visits, and children ever born have a significant association with unmet needs for family planning and spacing among married women in India. There is a significant association between years of schooling with the total unmet needs for family planning at (q25) quantiles and the unmet need for spacing at (q25, q50) quantiles. Results reveal that the demand for unmet need for spacing and limiting was the highest among the women in the age categories 15–19 (17.8%) and 20–24 (17.3%). The demand for limiting was the highest (6.8%) among Muslim women. Across wealth quantile categories, the overall unmet demand (11.4%) for spacing and limiting was the highest among the women in the lowest socioeconomic groups. We conclude that greater access to frontline health workers among young wives, and significant investment in education in general, will continue to reduce the unmet needs for family planning in India.

Coronary involvement in Kawasaki disease is not uncommon; however, giant coronary aneurysm exceeding 50 mm is extremely rare. In this article, we presented a case of giant coronary aneurysm involving right coronary artery with associated asymptomatic myocardial ischemia as evident by multimodality imaging.

Advancements in light engineering have led to the creation of pulsed laser sources capable of delivering high-repetition-rate, high-power few-cycle laser pulses across a wide spectral range, enabling exploration of many fascinating nonlinear processes occurring in all states of matter. High-harmonic generation, one such process, which converts the low-frequency photons of the driver laser field into soft x-rays, has revolutionized atomic, molecular, and optical physics, leading to progress in attosecond science and ultrafast optoelectronics. The Extreme Light Infrastructure, Attosecond Light Pulse Source (ELI ALPS) facility pioneers state-of-the-art tools for research in these areas. This paper outlines the design rationale, capabilities, and applications of plasma- and gas-based high-repetition-rate (1 kHz to 100 kHz) attosecond extreme ultraviolet (XUV) beamlines developed at ELI ALPS, highlighting their potential for advancing various research fields.

Pristine and nitrogen (N) doped zinc oxide (ZnNxO1-x, x = 0, 0.005, 0.01, and 0.02) nanoparticles (NPs) were successfully synthesized using chemical co-precipitation approach. The formation of pure crystalline wurtzite ZnO phase without any second phase during N-doping was confirmed by X-ray diffraction (XRD) analysis of N-doped ZnO samples. X-ray photoelectron spectroscopic (XPS) analysis ensured the effective inclusion of nitrogen into ZnO matrix. The morphological analysis revealed the formation of nanorods as a result of N-doping. The optical band gap calculated from UV–vis spectroscopy was observed to decrease up to 1 mol.% N doping followed by a subtle increase. Photoluminescence (PL) spectra revealed that electron-hole recombination was the least for 1 mol.% N doped ZnO NPs. ZnN0.01O0.99 NPs showed superior photocatalytic activity among all samples due to rod-shaped NPs and reduced electron-hole recombination, which was accessed by the photodegradation of Rhodamine B (RhB).

A controlled transition between two different ion acceleration mechanisms would pave the way to achieving different ion energies and spectral features within the same experimental set up, depending on the region of operation. Based on numerical simulations conducted over a wide range of experimentally achievable parameter space, reported here is a comprehensive investigation of the different facets of ion acceleration by relativistically intense circularly polarized laser pulses interacting with thin near-critical-density plasma targets. The results show that the plasma thickness, exponential density gradient, and laser frequency chirp can be controlled to switch the interaction from the transparent operating regime to the opaque one, thereby enabling the choice of a Maxwellian-like ion energy distribution with a cutoff energy in the relativistically transparent regime or a quasi-monoenergetic spectrum in the opaque regime. Next, it is established that a multispecies target configuration can be used effectively for optimal generation of quasi-monoenergetic ion bunches of a desired species. Finally, the feasibility is demonstrated for generating monoenergetic proton beams with energy peak at E≈20–40 MeV and a narrow energy spread of ΔE/E≈18%–28.6% confined within a divergence angle of ∼175 mrad at a reasonable laser peak intensity of I0 ≃ 5.4 × 1020 W/cm2.

This article aims to communicate insights from a collaboration between human-centered designers and social science researchers. We report the insights from Project RISE (Rituals to Improve Service-delivery and Empower health workers), which employed a complex systems approach to understanding Accredited Social Health Activists’ motivations and performance in Bihar, India. We describe the process of interdisciplinary integration between human-centered design and mixed-method social science research. We describe insights from each phase of Project RISE. In the Discover phase, we engaged in an expansive and inclusive ideation process informing the formulation of research questions and mixed methodology. Design-led synthesis transformed research findings into actionable, context-specific insights. In the Define phase, we integrated mixed methods rigor with the design process to identify opportunities instrumental in shaping the development of design drivers and solution concepts. We engaged in inclusive prototyping and open-source collaboration to prototype productive solutions in the Create phase. We detail the challenges encountered and the strategies to address them in each phase. Integrating human-centered design and social science research can tackle community health workers’ complex challenges and create more productive public health solutions.

Abstract Ultrafast plasma dynamics play a pivotal role in the relativistic high harmonic generation, a phenomenon that can give rise to intense light fields of attosecond duration. Controlling such plasma dynamics holds key to optimize the relevant sub-cycle processes in the high-intensity regime. Here, we demonstrate that the optimal coherent combination of two intense ultrashort pulses centered at two-colors (fundamental frequency, $$\omega$$ ω and second harmonic, $$2\omega$$ 2 ω ) can lead to an optimal shape in relativistic intensity driver field that yields such an extraordinarily sensitive control. Conducting a series of two-dimensional (2D) relativistic particle-in-cell (PIC) simulations carried out for currently achievable laser parameters and realistic experimental conditions, we demonstrate that an appropriate combination of $$\omega -2\omega$$ ω - 2 ω along with a precise delay control can lead to more than three times enhancement in the resulting high harmonic flux. Finally, the two-color multi-cycle field synthesized with appropriate delay and polarization can all-optically suppress several attosecond bursts while favourably allowing one burst to occur, leading to the generation of intense isolated attosecond pulses without the need of any sophisticated gating techniques.

Adolescence phase has high intrinsic and instrumental relevance. The Transformative Action for Rural Adolescents intervention delivered PACE++ curriculum with innovations to introduce a) health and nutrition sessions and b) delivery of the content in community settings of rural Bihar. This paper examines impact of the intervention showcasing establishment of intergenerational community connect for empowering and invigorating adolescent girls on gender attitude, empowerment and adolescent health and nutrition. The impact evaluation is based on a two-arm (intervention and comparison groups) cluster randomized controlled design with two rounds of representative cross-sectional surveys. The baseline and endline sample comprised of 2327 and 2033 adolescent girls (15-19 years), respectively. Descriptive statistical, difference-in-differences and propensity score matching methods are used to confirm the program impact. The DID and PSM analyses confirm high significance of impact on gender equity norms, diets and nutritional knowledge and understanding of employee related rights and responsibilities. School-going adolescent girls performed better than those who have discontinued formal education. The intervention showcases the importance of delivering the modified PACE curriculum in rural settings through leveraging community platforms. The findings call for greater policy attention on scaling up of similar initiatives for empowerment and social capital development of adolescent girls.

ObjectivesChild dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups.MethodsThe study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6-23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase.ResultsDuring the pre-intervention phase, 19% of the children (6-23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events.ConclusionBCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.

Chain-length-specific subsets of diacylglycerol (DAG) lipids are proposed to regulate differential physiological responses ranging from signal transduction to modulation of the membrane properties. However, the mechanism or molecular players regulating the subsets of DAG species remain unknown. Here, we uncover the role of a conserved eukaryotic protein family, DISCO-interacting protein 2 (DIP2) as a homeostatic regulator of a chemically distinct subset of DAGs using yeast, fly, and mouse models. Genetic and chemical screens along with lipidomics analysis in yeast reveal that DIP2 prevents the toxic accumulation of specific DAGs in the logarithmic growth phase, which otherwise leads to endoplasmic reticulum stress. We also show that the fatty acyl-AMP ligase-like domains of DIP2 are essential for the redirection of the flux of DAG subspecies to storage lipid, triacylglycerols. DIP2 is associated with vacuoles through mitochondria–vacuole contact sites and such modulation of selective DAG abundance by DIP2 is found to be crucial for optimal vacuole membrane fusion and consequently osmoadaptation in yeast. Thus, the study illuminates an unprecedented DAG metabolism route and provides new insights on how cell fine-tunes DAG subspecies for cellular homeostasis and environmental adaptation.

Community health worker (CHW) programs are essential for expanding health services to many areas of the world and improving uptake of recommended behaviors. One of these programs, called Accredited Social Health Activists (ASHA), was initiated by the government of India in 2005 and now has a workforce of about 1 million. ASHAs primarily focus on improving maternal and child health but also support other health initiatives. Evaluations of ASHA efficacy have found a range of results, from negative, to mixed, to positive. Clarity in forming a general impression of ASHA efficacy is hindered by the use of a wide range of evaluation criteria across studies, a lack of comparison to other sources of behavioral influence, and a focus on a small number of behaviors per study. We analyze survey data for 1,166 mothers from Bihar, India, to assess the influence of ASHAs and eight other health influencers on the uptake of 12 perinatal health behaviors. We find that ASHAs are highly effective at increasing the probability that women self-report having practiced biomedically-recommended behaviors. The ASHA's overall positive effect is larger than any of the nine health influencer categories in our study (covering public, private, and community sources), but their reach needs to be more widely extended to mothers who lack sufficient contact with ASHAs. We conclude that interactions between ASHAs and mothers positively impact the uptake of recommended perinatal health behaviors. ASHA training and program evaluation need to distinguish between individual-level and program-level factors in seeking ways to remove barriers that affect the reach of ASHA services.

Fatty acyl-AMP ligases (FAALs) channelize fatty acids towards biosynthesis of virulent lipids in mycobacteria and other pharmaceutically or ecologically important polyketides and lipopeptides in other microbes. They do so by bypassing the ubiquitous coenzyme A-dependent activation and rely on the acyl carrier protein-tethered 4′-phosphopantetheine (holo-ACP). The molecular basis of how FAALs strictly reject chemically identical and abundant acceptors like coenzyme A (CoA) and accept holo-ACP unlike other members of the ANL superfamily remains elusive. We show that FAALs have plugged the promiscuous canonical CoA-binding pockets and utilize highly selective alternative binding sites. These alternative pockets can distinguish adenosine 3′,5′-bisphosphate-containing CoA from holo-ACP and thus FAALs can distinguish between CoA and holo-ACP. These exclusive features helped identify the omnipresence of FAAL-like proteins and their emergence in plants, fungi, and animals with unconventional domain organizations. The universal distribution of FAALs suggests that they are parallelly evolved with FACLs for ensuring a CoA-independent activation and redirection of fatty acids towards lipidic metabolites.

Emulsifiers are used in the pharmaceutical, food, cosmetic, and biomedical industry. Here the authors fabricate rigid helical peptides that can perform as emulsifiers and thickeners, which typically requires synergistic effects of surfactants and polysaccharides.

The interpretation of experimental data from novel mid-infrared few-cycle laser sources requires an understanding of ionization mechanisms and knowledge about related ion yields. Experimental studies have indicated sequential double ionization as the dominant process above 10 ^14 W cm ^−2 . These results contradict a recent prediction that in this spectral region, non-sequential processes dominate the double ionization of xenon up to intensities of about 10 ^15 W cm ^−2 . In either case, the ratio of doubly to singly charged xenon yield reported in previous studies has been limited to a few percent, indicating a regime well below the onset of saturation of the double ionization process. We present an experimental study of double ionization of xenon and krypton atoms exposed to intense near four-cycle pulses at 3.2 μ m. Our experiments rely on the ion microscopy technique, which facilitates the detection of ions originating from a restricted region within the interaction volume, thereby reducing the impact of focal averaging. Our measurements suggest that at intensities of close to 1.2 × 10 ^14 W cm ^−2 , double ionization of xenon and krypton is already significantly saturated. In particular, we find a doubly to singly charged yield ratio of about 75 percent for xenon and 25 percent for krypton. We compare our results with the predictions of different models accounting for the effects of volume averaging and focal geometry. We find that in the deeply saturated regime of our experiment, the Perelomov–Popov–Terentyev theory significantly underestimates the observed double ionization yield.

Peptide-based self-assembly offers a unique entry into the construction of soft structures with interesting material properties and functions. Aromatic amino acid-containing peptides are commonly employed as they exhibit high propensity to aggregate due to increased hydrophobic content, promotion of favorable secondary structures, planarity and the possibility of ?–? interactions. Incorporation of covalent scaffolds, stimuli-responsive handles and carbohydrate moieties augment beneficial characteristics to the resulting peptide conjugates. These modifications were shown to enforce self-association, elicit stimuli response and achieve improved hydrophilic properties, to name but a few.

Takayasu arteritis (TA) is a form of large vessel vasculitis that may lead to fibrosis, stenosis, or aneurysm formation of vessels. Its presentation varies depending on the arterial beds involved. We report 3 cases out of around 150 cases of TA with rare initial presentations of brachial plexopathy caused by an axillary artery aneurysm, complicated type A intramural hematoma, and renal artery aneurysms along with abdominothoracic TA presenting as a pulsatile abdominal mass.

Background Maternal malnutrition is a major source of regional health inequity and contributes to maternal and infant morbidity and mortality. Bihar, a state in eastern India adjacent to Jharkhand and West Bengal, has relatively high neonatal mortality rates because a large portion of infants are born to young mothers. Bihar has the second-highest proportion of underweight children under 3 in India, with infant mortality rates of 48 per 1000 live births. Maternal malnutrition remains a major threat to perinatal health in Bihar, where 58.3% of pregnant women are anaemic.Methods We examined dietary beliefs and practices among mothers, mothers-in-law and community members, including Accredited Social Health Activists (ASHAs), using focus group discussions (n=40 groups, 213 participants), key informant interviews (n=50 participants) and quantitative surveys (n=1200 recent mothers and 400 community health workers). We report foods that are added/avoided during the perinatal period, along with stated reasons underlying food choice. We summarise the content of the diet based on responses to the quantitative survey and identify influencers of food choice and stated explanations for adding and avoiding foods.Key findings Analyses for all methodologies included gathering frequency counts and running descriptive statistics by food item, recommendation to eat or avoid, pregnancy or post partum, food group and health promoting or risk avoiding. During pregnancy, commonly added foods were generally nutritious (milk, pulses) with explanations for consuming these foods related to promoting health. Commonly avoided foods during pregnancy were also nutritious (wood apples, eggplant) with explanations for avoiding these foods related to miscarriage, newborn appearance and issues with digestion. Post partum, commonly added foods included sweets because they ease digestion whereas commonly avoided foods included eggplants and oily or spicy foods. Family, friends, relatives or neighbours influenced food choice for both mothers and ASHAs more than ASHAs and other health workers.Perinatal dietary beliefs and behaviours are shaped by local gastroecologies or systems of knowledge and practice that surround and inform dietary choices, as well as how those choices are explained and influenced. Our data provide novel insight into how health influencers operating within traditional and biomedical health systems shape the perinatal dietary beliefs of both mothers and community health workers.