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Abstract Background Brain volume loss (BVL) has been identified as a predictor of disability progression in relapsing multiple sclerosis (RMS). As many available disease-modifying treatments (DMTs) have shown an effect on slowing BVL, this is becoming an emerging clinical endpoint in RMS clinical trials. Methods In this study, a systematic literature review was conducted to identify BVL results from randomized controlled trials of DMTs in RMS. Indirect treatment comparisons (ITCs) were conducted to estimate the relative efficacy of DMTs on BVL using two approaches: a model-based meta-analysis (MBMA) with adjustment for measurement timepoint and DMT dosage, and a network meta-analysis (NMA). Results In the MBMA, DMTs associated with significantly reduced BVL versus placebo at two years included fingolimod (mean difference [MD] = 0.25; 95% confidence interval [CI] = 0.15 – 0.36), ozanimod (MD = 0.26; 95% CI = 0.12 – 0.41), teriflunomide (MD = 0.38; 95% CI = 0.20 – 0.55), alemtuzumab (MD = 0.38; 95% CI = 0.10 – 0.67) and ponesimod (MD = 0.71; 95% CI = 0.48 – 0.95), whereas interferons and natalizumab performed the most poorly. The results of NMA analysis were generally comparable with those of the MBMA. Conclusions Limitations of these analyses included the potential for confounding due to pseudoatrophy, and a lack of long-term clinical data for BVL. Our findings suggest that important differences in BVL may exist between DMTs. Continued investigation of BVL in studies of RMS is important to complement traditional disability endpoints, and to foster a better understanding of the mechanisms by which DMTs can slow BVL.

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by SARS-CoV-2. Dengue is one of the most common tropical diseases in India caused by dengue virus (DENV). COVID-19 and tropical diseases such as dengue and leptospirosis have a similar spectrum of clinical manifestations; therefore, it becomes very difficult to diagnosis. The present study describes five cases of coinfection of COVID-19 and dengue. A case series of patients reported to the flu clinic with fever and myalgia were tested, and diagnosed with SARS-CoV-2 and DENV as well as epidemiological and entomological investigations were also done for the identification of the source of infection. Laboratory reports were obtained from hospital laboratory data. Data were analyzed using Microsoft Excel. All patients were younger adult age group and were found to be residents of the same locality. The most common symptom found was fever associated with myalgia. Every patient had a history of contact with laboratory-confirmed COVID-19 cases and was fully vaccinated. Thrombocytopenia was seen in two patients. However, only one patient found immunoglobulin M or immunoglobulin G positive for DENV after discharge. No systemic complications were observed throughout the course of illness in patients. We described a case series of five patients with COVID-19 breakthrough and cases of dengue. Clinicians should have a suspicion of multiple infections while managing the cases.

Introduction: Most adolescent women face many restrictions, which become much more severe during menstruation. In India, millions of adolescent girls drop out of school every year due to menstruation-related problems and restrictions. Despite extensive research, a paucity of literature was observed on the level of knowledge, attitude, and practices of adolescent girls regarding menstruation. Hence, we proceeded to undertake the present study, to have a deeper understanding of the menstrual hygiene management of adolescents. Aims: To describe the menstrual hygiene management among adolescent school girls. Objectives: (a) To examine the association, if any, between menstrual hygiene management and school absenteeism during menstruation in adolescent school girls. Materials And Methods: We conducted a school-based cross-sectional analytical study in an urban area in north India. The study population comprised adolescent school girls of all the high schools in the urban area. With a 95% confidence interval, and 5% margin of error, the sample size was calculated to be 369. However, an even larger sample size of 600 was actually studied. The probability proportional to size sampling approach was followed based on the number of adolescent girls in each school class/section. Participants were selected through a stratified proportionate sampling method. Ethical approval was obtained from the ethical committee of the district director of education of the urban area where the study was conducted before the commencement of the study. Confidentiality of the information collected was ensured. The data collected was quantitative in nature, using a pretested self-administered questionnaire consisting of both open-ended and close-ended questions. Data was checked for its completeness, coded, and entered into Microsoft Excel 2021 Spreadsheet. Subsequently, the data was imported into IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. for data analysis. Standard statistical methods were utilized for data analysis. Results: The mean age (standard deviation [SD]) of the study participants was 13.68 (1.29). The mean age (SD) at menarche was 13.29 (0.96). Based on the overall menstrual hygiene management score, 377 (62.83%) of the study participants were engaged in good menstrual hygiene management, while 223 (37.17%) were engaged in poor menstrual hygiene management. The mean score (SD) was 7.80 (±0.43). Compared to those aged 17–19 years, those aged 10–13 years had a 0.36 (95% CI 0.17–0.75) decreased odds of good menstrual hygiene, while those aged 14–16 years had a 0.29 (95% CI 0.14–0.59) decreased odds of good menstrual hygiene. The adjusted odds ratios were 0.32 (95% CI 0.19–0.65) and 0.25 (95% CI 0.12–0.41) respectively. Out of 600 study participants, 229 (38.17%) reported school absenteeism at least once in the last 1 year because of menstruation. The mean (standard deviation) duration of school absenteeism was 2.4 (0.78) days per menstrual cycle. The commonest reason for menstruation-related school absenteeism was pain, wherein 105 (45.85%) study participants reported this reason. Conclusion: In our study, we observed that over two-thirds of the study participants were engaged in good menstrual hygiene practices, while ~40% of them reported menstrual-related school absenteeism. Our study also found evidence that the age of the school girls was associated with their menstrual hygiene management practices. We recommend further research on the impact of menstruation and its management on the academic performance of adolescent school girls. Efforts are also required to develop the capacity of teachers to teach menstrual hygiene education.

Abstract Background Hospital-based clinicians infrequently initiate medications for opioid use disorder (MOUD) for hospitalized patients. Our objective was to understand hospital-based clinicians’ knowledge, comfort, attitudes, and motivations regarding MOUD initiation to target quality improvement initiatives. Methods General medicine attending physicians and physician assistants at an academic medical center completed questionnaires eliciting barriers to MOUD initiation, including knowledge, comfort, attitudes and motivations regarding MOUD. We explored whether clinicians who had initiated MOUD in the prior 12 months differed in knowledge, comfort, attitudes, and motivations from those who had not. Results One-hundred forty-three clinicians completed the survey with 55% reporting having initiated MOUD for a hospitalized patient during the prior 12 months. Common barriers to MOUD initiation were: (1) Not enough experience (86%); (2) Not enough training (82%); (3) Need for more addiction specialist support (76%). Overall, knowledge of and comfort with MOUD was low, but motivation to address OUD was high. Compared to MOUD non-initiators, a greater proportion of MOUD initiators answered knowledge questions correctly, agreed or strongly agreed that they wanted to treat OUD (86% vs. 68%, p = 0.009), and agreed or strongly agreed that treatment of OUD with medication was more effective than without medication (90% vs. 75%, p = 0.022). Conclusions Hospital-based clinicians had favorable attitudes toward MOUD and are motivated to initiate MOUD, but they lacked knowledge of and comfort with MOUD initiation. To increase MOUD initiation for hospitalized patients, clinicians will need additional training and specialist support.

Therapeutic Area: ASCVD/CVD Risk Factors Background: Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Despite practice guidelines recommending routine Lp(a) testing, uptake of screening has been low and variable. We sought to understand differences in Lp(a) testing and levels by race, ethnicity, and ASCVD risk across a large, integrated healthcare system. Methods: We conducted a retrospective cohort study of patients from a large California healthcare system from 2010 to 2021. Eligible individuals were ≥18 years old, with ≥2 primary care visits, and complete race and ethnicity data who underwent Lp(a) testing. Baseline variables were extracted prior to Lp(a) testing. Race/ethnicity was self-reported and stratified as follows: Non-Hispanic White, Non-Hispanic Black, Hispanic (Mexican, Puerto Rican, Other), Non-Hispanic Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other). T-tests were used to test differences among groups for normally distributed data, Wilcoxon tests for skewed data, and chi-square test for categorical data. Results: Among 1,484,410 patients who met the inclusion criteria, 13,689 (0.9%) underwent Lp(a) testing—mean age 54.6±13.8y, 49% female, 59% Non-Hispanic (NH) White. Average Lp(a) values differed significantly by race and ethnicity ranging from 55mg/dL ±63.3 among NH-Asian participants to 99.8mg/dL ±95.3 for NH-Black individuals. 37.3% of tested patients had Lp(a) levels above 50mg/dL with significant variation among subgroups, ranging from 30.7% of Mexican patients to 62.6% of NH Black patients. Estimated ASCVD risk and clinical ASCVD prevalence varied among tested patients. Asian Indian individuals had the lowest overall risk and NH-Black individuals had the highest overall risk (Panel A). There was an increasing trend of elevated Lp(a) by ASCVD risk—40.6% of those with ≥20% 10-Year ASCVD risk and 43.1% of those with a history of ASCVD across had Lp(a) ≥50mg/dL, compared with 36.2% of those with

Abstract Background Within the United States (US), because racial/ethnic disparities in cannabis arrests continue, and cannabis legalization is expanding, understanding disparities in availability of legal cannabis services is important. Few studies report mixed findings regarding disparities in availability of legal cannabis services; none examined New York. We examined disparities in availability of medical cannabis services in New York. We hypothesized that New York census tracts with few Black or Hispanic residents, high incomes, high education levels, and greater urbanicity would have more medical cannabis services. Methods In this cross-sectional study, we used data from the 2018 US Census Bureau 5-year American Community Survey and New York Medical Marijuana Program. Main exposures were census tract characteristics, including urban–rural classification, percentage of Black and Hispanic residents, percentage of residents with bachelor’s degrees or higher, and median household income. Main outcomes were presence of at least one medical cannabis certifying provider and dispensary in each census tract. To compare census tracts’ characteristics with (vs. without) certifying providers and dispensaries, we used chi-square tests and t-tests. To examine characteristics independently associated with (vs. without) certifying providers, we used multivariable logistic regression. Results Of 4858 New York census tracts, 1073 (22.1%) had medical cannabis certifying providers and 37 (0.8%) had dispensaries. Compared to urban census tracts, suburban census tracts were 62% less likely to have at least one certifying provider (aOR = 0.38; 95% CI = 0.25–0.57). For every 10% increase in the proportion of Black residents, a census tract was 5% less likely to have at least one certifying provider (aOR = 0.95; 95% CI = 0.92–0.99). For every 10% increase in the proportion of residents with bachelor’s degrees or higher, a census tract was 30% more likely to have at least one certifying provider (aOR = 1.30; 95% CI = 1.21–1.38). Census tracts with (vs. without) dispensaries were more likely to have a higher percentage of residents with bachelor’s degrees or higher (43.7% vs. 34.1%, p

Abstract Background Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS). Methods Systematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data. Results The search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records. Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS. Conclusion Fatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.

Introduction: Demographic indices known as the age-heaping indexes were used to explore the patterns of age misreporting in a multicentric survey. Methods: The data of 3252 individuals were analyzed, and measurement of errors in age for the sampled data has been evaluated by Whipple's Index (WI), Myer's Blended Index, and United Nations Age–Sex Accuracy Score which comprises Sex Ratio Score, Male Age Ratio Score (ARS), and Female ARS. Results: Out of total 3252 participants, 828 (25.5%) were female. The mean statistical division age of our population was 34 (8.5) years and ranged from 15 to 65 years. The percentage of female ages ending with digits 0 or 5 is 23.55% and percentage of male ages ending with digits 0 or 5 is 23.28%. The calculated WI was 117.75 and 116.34 for males and females, respectively. The calculated Myer's Index for females and males is 10.53 and 25, respectively. Conclusion: The study provides evidence that probably age-heaping bias is less of problem in the conducted study.

Background. Dry eye disease (DED) is a multifactorial and one of the most common problems treated in an ophthalmic outpatient clinic. Due to the variability in presentation, diagnosis of DED consists of a combination of subjective and objective clinical tests. The purpose of this study was to assess the effectiveness of a handheld smartphone-based infrared thermal (IRT) camera for screening symptomatic evaporative DED. Methods. This observational sex-matched control study assessed IRT images of 184 right eyes (46 normal and 138 DED) of 184 participants. Evaporative DED was assessed using noninvasive tear breakup time, fluorescein staining, and the Chinese version of the ocular surface disease index (C-OSDI) questionnaire and categorized into their respective dry eye symptomology group (none, mild, moderate, or severe). The ocular surface temperature (OST) at 8 anatomical regions of interest (ROI) (nasal conjunctiva, nasal limbus, nasal cornea, central cornea, inferior cornea, temporal limbus, temporal cornea, and temporal conjunctiva) were measured and compared using a handheld smartphone-based IRT camera. The effectiveness of these 8 ROIs OST in detecting varying severity of DED was evaluated in terms of correlations with severity of DED and their area under the curve (AUC). Results. OST at the 8 anatomical ROI was significantly higher in DED participants than in the non-DED group (p0.05). Analyzing 8 anatomical ROIs revealed that the nasal limbus had the highest Pearson correlation with the severity of DED (0.64, p

Abstract Reduced lightweight microstrip patch antennas have attracted considerable attention in ultra‐wideband (UWB) applications. In this article, a novel modified circular ultra‐wideband monopole antenna with dual‐band notch characteristics is proposed. A circular split‐ring slot and a mushroom‐electromagnetic bandgap‐type structure are employed to realize the dual‐band notch characteristics. The proposed antenna exhibits the bandwidth of 2.0‐12 GHz with a Voltage Standing Wave Ratio

Introduction: Girl child continues to be insecure and vulnerable in South-East Asia particularly in India despite various legal measures. Only law cannot be a solution, identifying the social factors and working on their improvements are also essential. Aims and Objectives: (1) To assess the present child sex ratio (0-6 child sex ratio [CSR]) in defined study population. (2) To assess the attitude of the women of the reproductive age group toward the girl child and relate it to the status of sex ratio. Methodology: A cross-sectional descriptive study was conducted in a sub locality of 283 households out of which 147 households having children in age group of 0-6 years were selected and mothers of children were interviewed with a prestructured pretested questionnaire containing a rating scale of 40 items in vernacular language to determine the attitude of the mother toward girl child. Results: Total no. of children in the age group of 0-6 years were found to be 241, with CSR of 709 but had a sharp contrast in children

The paper highlights post-production customer connectivity processes in an automobile manufacturing set-up. Identity of post-production processes has been established as a unique in company service operations or pseudo-manufacturing activities. Consequently this research observes that handling these activities purely with a manufacturing focus or with a pure service focus would not be that effective. This paper in-turn proposes a new approach to powering the customer connectivity process in the last mile of a product’s journey from manufacturing to market. The scenario has been addressed in three domains, viz., Post-Production pre-market functions, Product Installation, and Product Liabilities. Through a composite process map of the post-production situations it captures the order winning elements to pick up opportunities for the possible reinforcement of adding value for money in the last mile activities on the product from company to customer.

Bilateral thalamic infarction is rarely seen in cases with artery of Percheron embolization. Artery of Percheron is a rare variant of arterial supply to both thalamus and midbrain. Occlusion of this artery following trauma and causing bilateral thalamic infarction is rare and very few cases are reported in world literature.

Multijunction solar cells designed from silicon (Si)-germanium (Ge) alloy based semiconductor materials exhibit high theoretical efficiencies (19.6%) compared to the single junction one. The modeling calculations for all solar cells are done by AMPS 1D simulator. The structure of multi-junction i-layer is designed using heterolayers, starting from pure crystalline Si and increase of Ge mole fraction by 25% until pure Ge layer is reached. The top layer has the largest band gap, while the bottom layer has the smallest bandgap. This design allows less energetic photons to pass through the upper layer(s) and be absorbed by the layer below, which increases the overall efficiency of the solar cell. Material parameters required to model the absorber layers are calculated and incorporated in the AMPS 1D simulator for optimizing of solar cell parameter values. Simulation results show that considerable efficiency enhancement can be obtained from the addition of the multi-junction layer.

The purpose of this paper is to examine service quality constructs which leads to student satisfaction in the setting of Indian higher management education institutes. In this study, researchers made an attempt to investigate the moderating effect of perceived trust on the relationship between service quality and student satisfaction. The findings of the study suggested that teaching skills of teacher, staff competence, reputation and access have significant impact on student satisfaction whereas generic skills of teachers and staff attitude does not influence student satisfaction significantly. Results of the study also suggested the moderating effect of perceived trust on student satisfaction. This study is a sole attempt to identify various academic and non-academic aspects of service quality which influence student satisfaction. The findings of the study suggest that it is important for management of HEI's to recruit not only good instructors but also the competent staff.