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Background: Chronic insomnia, affecting 15.9% of the population, is characterized by sustained hyperarousal and heightened somatic, cognitive, and cortical activity. Despite its prevalence, the precise impact of chronic insomnia on cognitive domains, particularly attention, working memory, and executive function, remains inadequately understood. Aim: This study aims to systematically investigate the cognitive functioning of adults with chronic insomnia. Methodology: A meticulously matched cohort of 80 participants, comprising 40 with chronic insomnia and 40 controls, participated in this cross-sectional study. The diagnosis followed strict criteria outlined in the International Classification of Sleep Disorders-3. Neuropsychological assessments, including the Digit Span Test, Stroop Test, and Trail Making Test, were employed to scrutinize attention, working memory, and executive function. Robust metrics, such as the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), supported the investigative approach. Results: Analysis revealed notable deficits in backward digit span, digit symbol substitution test, and Stroop Test (cards B and C) among chronic insomnia subjects compared to non-insomniac counterparts. Trail Making Test B indicated prolonged completion times in the chronic insomnia cohort. Despite comparable levels of anxiety and depressive symptoms, the chronic insomnia group exhibited higher ISI and PSQI scores, indicating the severity of their sleep disturbances. Conclusion: This cross-sectional analysis reveals cognitive deficits associated with chronic insomnia, specifically impacting attention, working memory, and executive function. Even with meticulous demographic controls, chronic insomnia leaves a discernible impact on cognitive functions. The study underscores the need for precise cognitive evaluations to reveal the latent impact of chronic insomnia, offering insights for targeted interventions.

Abstract Background Tuberculosis remains a global health challenge, with central nervous system tuberculosis (CNSTB) affecting 5–10% of extrapulmonary tuberculosis cases, leading to severe complications in children aged 2 to 4 years. Despite timely diagnosis and intervention, management of CNSTB is a challenge. Thalidomide, a TNF-α inhibitor, is a potential therapeutic option in cases resistant to adjuvant corticosteroid therapy. This case report describes the management of complicated CNSTB utilising thalidomide, a less commonly used drug, with a favourable outcome. Clinical presentation A 3-year-old boy diagnosed with CNSTB and having a ventriculoperitoneal shunt presented with left-sided hemiparesis. He was previously diagnosed with tubercular meningitis at 2.5 years of age. On anti-tubercular treatment and corticosteroid, he had a complicated course with drug-induced liver injury (DILI) and paradoxical reaction. Despite a year of anti-tubercular therapy, there was a deterioration in neurological symptoms, accompanied by an increase in the number of tuberculomas observed on MRI. Adjuvant treatment with thalidomide proved effective in suppressing immunological activation, leading to a reduction in tuberculomas. Conclusion This case highlights the intricacies of CNSTB, including complications and refractory tuberculomas. Thalidomide was effective in managing these challenges, offering a potential therapeutic option in challenging CNSTB cases. Positive clinical and radiological responses underscore the need to further explore thalidomide as an adjunctive therapy in similar paediatric cases.

ABSTRACTPancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy that is refractory to immune checkpoint inhibitor therapy. However, intratumoral T-cell infiltration correlates with improved overall survival (OS). Herein, we characterized the diversity and antigen specificity of the PDAC T-cell receptor (TCR) repertoire to identify novel immune-relevant biomarkers. Demographic, clinical, and TCR-beta sequencing data were collated from 353 patients across three cohorts that underwent surgical resection for PDAC. TCR diversity was calculated using Shannon Wiener index, Inverse Simpson index, and “True entropy.” Patients were clustered by shared repertoire specificity. TCRs predictive of OS were identified and their associated transcriptional states were characterized by single-cell RNAseq. In multivariate Cox regression models controlling for relevant covariates, high intratumoral TCR diversity predicted OS across multiple cohorts. Conversely, in peripheral blood, high abundance of T-cells, but not high diversity, predicted OS. Clustering patients based on TCR specificity revealed a subset of TCRs that predicts OS. Interestingly, these TCR sequences were more likely to encode CD8+ effector memory and CD4+ T-regulatory (Tregs) T-cells, all with the capacity to recognize beta islet-derived autoantigens. As opposed to T-cell abundance, intratumoral TCR diversity was predictive of OS in multiple PDAC cohorts, and a subset of TCRs enriched in high-diversity patients independently correlated with OS. These findings emphasize the importance of evaluating peripheral and intratumoral TCR repertoires as distinct and relevant biomarkers in PDAC.

In India, the Trans-Himalayan zone lies in the rain shadow of the main Himalayan region and is usually described as a “high-altitude cold desert”. These regions are represented by sparse but unique vegetation composition. The present study is an attempt to investigate the vegetation composition in the alpine ecosystem of the cold desert landscape of the Nelang Valley in Western Himalayas (Uttarakhand), India. The result of the study reveals the existence of a total of 68 taxa of higher plants (56 genera and 28 families). These include herbs (51 species), shrubs (13 species), climbers (one species), and trees (three species). Herbaceous species (52 species) contributed the maximum species richness; Artemisia, Astragalus, and Juniperus were the dominant genera, followed by Aster, Lonicera, Oxytropis, Poa, and Salix. The valley showed irregular distribution of plant species richness along the altitudinal gradient, and maximum taxa exhibited between 3,500 m and 3,600 m of altitude band. In the Nelang Valley, the total number of phytodiversity individuals exhibited a significant linear decline with increasing altitude (3,100–4,300 m). Further, the study recorded 33 important medicinal plants used in the traditional system of herbal medicine in the Himalayan region. Juniperus semiglobosa shows dominance with a maximum important value index (IVI) (31.77), followed by Pinus wallichiana (29.19) and Cedrus deodara (10.72) in the treeline ecotone of the valley. Rapid Threat Assessment shows that Artemisia dubia and Artemisia roxburghiana were the most vulnerable herb species in the region. The information thus generated will be useful for suggesting ecological management and conservation planning.

Abstract Background Dengue fever (DF) is a viral illness caused by the dengue virus transmitted by Aedes aegypti mosquitoe. It manifests with a range of symptoms, from mild DF to severe forms like dengue hemorrhagic fever and dengue shock syndrome. Common symptoms include fever, headache, rash, muscle and joint pain, and itching. The relationship between itching and clinical improvement in dengue patients remains unclear. Case presentation A retrospective analysis was conducted on hospital data from a tertiary care centre in South India from April 2021 to April 2023. Patients diagnosed with dengue fever (confirmed by Immunoglobulin (Ig) M and Non-Structural protein (NS) 1 positivity) who experienced itching were included. Clinical details, age, sex, and laboratory findings were collected. A total of 261 patients were examined. Itching typically occurred around day eight from fever onset and was associated with improved platelet count and hematocrit levels. Conclusions Dengue fever, caused by the dengue virus, presents with various symptoms, including itching during the recovery phase. Studies suggest a correlation between itching and clinical improvement in dengue patients, indicating itching as a potential prognostic marker. Possible mechanisms for itching include direct viral infection of skin cells and cytokine release. However, further research is needed to understand this association fully. Despite limitations such as retrospective analysis, these findings highlight the significance of itching in dengue prognosis and emphasise the need for large-scale studies.

Background: The primary purpose of this study was to evaluate how utilization, physician reimbursement, and patient populations have changed for primary total knee arthroplasty (TKA) from 2013 to 2021 at both a regional and national level within the Medicare population. Methods: The Medicare Physician and Other Practitioners database was queried for all episodes of primary TKA between years 2013 and 2021. TKA utilization per 10,000 beneficiaries, inflation-adjusted physician reimbursement per TKA, and patient demographics of each TKA surgeon were extracted each year. Data were stratified geographically, and Kruskal-Wallis tests were utilized. Results: Between 2013 and 2021, TKA utilization per 10,000 beneficiaries increased at the greatest rate in the Northeast (+15.1%). In 2021, TKA utilization was highest in the Midwest (97.6/10,000; P < .001). The Midwest had the greatest decline in average physician reimbursement per TKA between 2013 and 2021 (−26.3%) and the lowest average reimbursement ($988.70, P < .001) in 2021. Alternatively, the Northeast had the smallest decline in average TKA reimbursement (−22.6%). Nationally, the average number of beneficiaries per TKA surgeon declined (−6.8%), while the average number of TKAs per surgeon (+5.7%) and average services per beneficiary (+24.3%) both increased. The average number of patient comorbidities and proportion of patients with dual Medicare-Medicaid eligibility decreased over time across all regions. Conclusions: This study demonstrates that TKA utilization is increasing and average physician reimbursement per TKA is declining at varying rates across the country, with the Northeast and Midwest most affected. These findings should be addressed in policy discussions to ensure equitable arthroplasty care.

Abstract The trapped-ion quantum charge-coupled device (QCCD) architecture is a leading candidate for advanced quantum information processing. In current QCCD implementations, imperfect ion transport and anomalous heating can excite ion motion during a calculation. To counteract this, intermediate cooling is necessary to maintain high-fidelity gate performance. Cooling the computational ions sympathetically with ions of another species, a commonly employed strategy, creates a significant runtime bottleneck. Here, we demonstrate a different approach we call exchange cooling. Unlike sympathetic cooling, exchange cooling does not require trapping two different atomic species. The protocol introduces a bank of “coolant" ions which are repeatedly laser cooled. A computational ion can then be cooled by transporting a coolant ion into its proximity. We test this concept experimentally with two 40Ca+ ions, executing the necessary transport in 107 μs, an order of magnitude faster than typical sympathetic cooling durations. We remove over 96%, and as many as 102(5) quanta, of axial motional energy from the computational ion. We verify that re-cooling the coolant ion does not decohere the computational ion. This approach validates the feasibility of a single-species QCCD processor, capable of fast quantum simulation and computation.

This study investigates the temporal changes in species richness, composition, and diversity in forest stands spanning a 36-year period in the Western Himalaya. Four forest stands (subtropical Sal-forest, subtropical Chir-pine forest, temperate Banj-oak forest, and temperate Mixed-oak Forest) studied in 1980–1981 were resurveyed using similar methods. Over the past 36 years, 19 new species have been recorded in the four stands; eight species planted and eleven species naturally introduced. Dominant species continue to dominate in the forest stands. However, their contribution to the total tree density has decreased over the year. Species diversity, richness, and evenness increased in all forests except the Sal stand. Three species were newly introduced in the Sal stand, seven in the Chir-pine stand, eight in the Banj-oak stand, and seven in the Mixed-oak stand. The highest similarity in species composition was observed in the Sal stand (59 %), followed by the mixed-oak stand (57 %), Chir-pine stand (50 %), and Banj-oak stand (47 %). The results indicate an increase in tree density across all sites, with the Mixed-oak forest exhibiting the highest increase in tree density due to least biotic pressure. The findings of this study, based on two-time composition datasets, provide valuable insights into forest dynamics, supporting biodiversity conservation and management planning.

Background: Social determinants of health are implicated in the experience of knee osteoarthritis, a key component of which is access to care and healthcare utilization. The objective of this study was to describe difficulties in access to care and healthcare utilization in the United States knee osteoarthritis population. Methods: The publicly available All of Us Database was utilized to conduct a retrospective cohort study. Patients with a diagnosis of knee osteoarthritis were included and matched to a control group who did not have knee osteoarthritis. The association of knee osteoarthritis and patient-specific demographic features with self-reported domains of access to care was analyzed. Results: Among 15,718 patients with knee osteoarthritis, 27.6% reported delayed care (n = 4343), 25.6% reported inability to afford care (n = 4015), 12.8% reported skipped medications (n = 2011), and 1.6% reported not seeing a healthcare provider in over 1 year (n = 247). Patients with knee osteoarthritis were more likely to be unable to afford care (odds ratio 1.21, P < .001) or skip medications (odds ratio 1.12, P = .004) in comparison to matched patients without knee osteoarthritis. Among the knee osteoarthritis cohort, low income and nonheterosexual orientation were both associated with increased rates of delayed care and an inability to afford care. Conclusions: Patients with knee osteoarthritis report significant challenges with delayed care, affordability of care, and medication adherence. Among patients with knee osteoarthritis, patients who are younger age, female sex, low-income, low-education, nonheterosexual orientation, or have poor physical and mental health are at increased risk of having decreased access to treatment.

Background: Carpal Tunnel Syndrome (CTS) is associated with a significant personal and societal burden. Evaluating access to care can identify barriers, limitations, and disparities in the delivery of healthcare services in this population. The purpose of this study was to evaluate access to overall healthcare and healthcare utilization among patients with CTS. Methods: This is a retrospective cohort study conducted with the All of Us database. Patients diagnosed with CTS that completed the access to care survey were included and matched to a control group. The primary outcomes were access to care across 4 domains: (1) delayed care, (2) could not afford care, (3) skipped medications, and (4) over 1 year since seeing provider. Secondary analysis was then performed to identify patient-specific factors associated with reduced access to care. Results: In total, 7649 patients with CTS were included and control matched to 7649 patients without CTS. In the CTS group, 33.7% (n = 2577) had delayed care, 30.4% (n = 2323) could not afford care, 15.4% (n = 1180) skipped medications, and 1.6% (n = 123) had not seen a provider in more than 1 year. Within the CTS cohort, low-income, worse physical health, and worse mental health were associated with poor access to care. Conclusion: Patients experience notable challenges with delayed care, affordability of care, and medication adherence regardless of having a diagnosis of CTS. Targeted interventions on modifiable risk factors such as low income, poor mental health, and poor physical health are important opportunities to improve access to care in this population.

The present study describes how vegetation (the tree layer) is shaped along the elevation gradients in the eastern part of the Indian Himalayan Region. Various vegetation attributes, distribution, population structure, and regeneration patterns of 75 tree species belonging to 31 families were studied. Tree species richness shows a low plateau (peaked between 1,300–1,500 m) with a linearly decreasing pattern above 1,500 m asl. Ericaceae was found as the dominant family, followed by Lauraceae and Rosaceae. The distributional pattern of species-to-genera ratio (S/G) did not follow any particular trends, while β-diversity increased along the elevation gradient. The Margalef index of species richness, the Menheink index of species richness, and the Fisher alpha were found to be highest at lower altitudes (1,000–1,500 m), while the Simpson index was highest at middle altitudes (2,600–3,000 m). Random distribution was shown by maximum tree species (47.3%), followed by a contagious distribution (42.9%), and regular distribution (10.8%). The regeneration of tree species was found to be good with a healthier number of seedlings (10.2%), fair (43.5%), poor (30.3%), while 16% were observed not regenerating. Acer laevigatum (1,500 m), Prunus nepalensis (3,300 m), Viburnum sympodiale (3,400 m) were among the new regenerating species at the respective altitudes. The population structure of tree species in terms of proportion of individuals in seedlings, saplings, and the adult class varied in all the elevation transects. Species with better regeneration on upper distribution limits have been recognized as probable for upward movement.

Abstract Our assessments of effort are critically shaped by experiences of exertion. However, it is unclear how the nervous system transforms physical exertion into assessments of effort. Availability of the neuromodulator dopamine influences features of motor performance and effort-based decision-making. To test dopamine’s role in the translation of effortful exertion into assessments of effort, we had participants with Parkinson’s disease, in dopamine depleted (OFF dopaminergic medication) and elevated (ON dopaminergic medication) states, exert levels of physical exertion and retrospectively assess how much effort they exerted. In a dopamine-depleted state, participants exhibited increased exertion variability and over-reported their levels of exertion, compared to the dopamine-supplemented state. Increased exertion variability was associated with less accurate effort assessment and dopamine had a protective influence on this effect, reducing the extent to which exertion variability corrupted assessments of effort. Our findings provide an account of dopamine’s role in the translation of features of motor performance into judgments of effort, and a potential therapeutic target for the increased sense of effort observed across a range of neurologic and psychiatric conditions.

Abstract We report the first experimental observations of a single-mode Kelvin-Helmholtz instability in a flowing dusty plasma in which the flow is compressible in nature. The experiments are performed in an inverted $$\Pi$$ Π -shaped dusty plasma experimental device in a DC glow discharge Argon plasma environment. A gas pulse valve is installed in the experimental chamber to initiate directional motion to a particular dust layer. The shear generated at the interface of the moving and stationary layers leads to the excitation of the Kelvin-Helmholtz instability giving rise to a vortex structure at the interface. The growth rate of the instability is seen to decrease with an increase in the gas flow velocity in the valve and the concomitant increase in the compressibility of the dust flow. The shear velocity is further increased by making the stationary layer to flow in an opposite direction. The magnitude of the vorticity is seen to become stronger while the vortex becomes smaller with such an increase of the shear velocity. A molecular dynamics simulation provides good theoretical support to the experimental findings.

Background and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. Methods We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. Results Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). Conclusions Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.

The growth of Li dendrites in a solid electrolyte is commonly idealized by a pressure‐filled crack. Recent observations in both garnet and sulfide electrolytes show that sparsely filled cracks exist prior to shorting of the cell, thereby invalidating this assumption. Herein, a variational principle that uses the Onsager formalism to couple Li deposition into the crack, elastic deformation of the electrolyte, and cracking of the electrolyte with the electrochemical driving forces and dissipation within the electrolyte and interfaces is developed. Consistent with observations, it is shown that Li ingress and cracking occur together for garnet electrolytes, but the cracks are sparsely filled. This sparse filling is a direct consequence of the mismatch between the elastic opening of the cracks and the deposition of Li into the cracks across the crack flanks. An increase in the resistance of Li ingress into the tips of Li filaments results in crack propagating ahead of the Li filaments, as observed for sulfide electrolytes. In such cases, the cracks are largely dry. The results provide a framework to model Li ingress into solid electrolytes and explain why the observations are qualitatively so different from dendrites in liquid electrolytes.

The companion to PSR J1622-0315, one of the most compact known redback millisecond pulsars, shows extremely low irradiation despite its short orbital period. We model this system to determine the binary parameters, combining optical observations from the New Technology Telescope in 2017 and the Nordic Optical Telescope in 2022 with the binary modeling code ICARUS . We find a best-fit neutron star mass of 2.3 ± 0.4 M _⊙ , and a companion mass of 0.15 ± 0.02 M _⊙ . We detect for the first time low-level irradiation from asymmetry in the minima as well as a change in the asymmetry of the maxima of its light curves over five years. Using starspot models, we find better fits than those from symmetric direct heating models, with consistent orbital parameters. We discuss an alternative scenario where the changing asymmetry is produced by a variable intrabinary shock. In summary, we find that PSR J1622-0315 combines low irradiation with variable light-curve asymmetry and a relatively high neutron star mass.

Abstract Neuronal stimulation induced by the brain‐derived neurotrophic factor (BDNF) triggers gene expression, which is crucial for neuronal survival, differentiation, synaptic plasticity, memory formation, and neurocognitive health. However, its role in chromatin regulation is unclear. Here, using temporal profiling of chromatin accessibility and transcription in mouse primary cortical neurons upon either BDNF stimulation or depolarization (KCl), we identify features that define BDNF‐specific chromatin‐to‐gene expression programs. Enhancer activation is an early event in the regulatory control of BDNF‐treated neurons, where the bZIP motif‐binding Fos protein pioneered chromatin opening and cooperated with co‐regulatory transcription factors (Homeobox, EGRs, and CTCF) to induce transcription. Deleting cis‐regulatory sequences affect BDNF‐mediated Arc expression, a regulator of synaptic plasticity. BDNF‐induced accessible regions are linked to preferential exon usage by neurodevelopmental disorder‐related genes and the heritability of neuronal complex traits, which were validated in human iPSC‐derived neurons. Thus, we provide a comprehensive view of BDNF‐mediated genome regulatory features using comparative genomic approaches to dissect mammalian neuronal stimulation.

Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. In late-stage AMD, geographic atrophy (GA) of dry AMD or choroidal neovascularization (CNV) of neovascular AMD eventually results in macular atrophy (MA), leading to significant visual loss. Despite the development of innovative therapies, there are currently no established effective treatments for MA. As a result, early detection of MA is critical in identifying later central macular involvement throughout time. Accurate and early diagnosis is achieved through a combination of clinical examination and imaging techniques. Our review of the literature depicts advances in retinal imaging to identify biomarkers of progression and risk factors for late AMD. Imaging methods like fundus photography; dye-based angiography; fundus autofluorescence (FAF); near-infrared reflectance (NIR); optical coherence tomography (OCT); and optical coherence tomography angiography (OCTA) can be used to detect and monitor the progression of retinal atrophy. These evolving diverse imaging modalities optimize detection of pathologic anatomy and measurement of visual function; they may also contribute to the understanding of underlying mechanistic pathways, particularly the underlying MA changes in late AMD.

Abstract Fabricating flexible electronics on plastic is often limited by the poor dimensional stability of polymer substrates. To mitigate, glass carriers are used during fabrication, but removing the plastic substrate from a carrier without damaging the electronics remains challenging. Here we utilize a large-area, high-throughput photonic lift-off (PLO) process to rapidly separate polymer films from rigid carriers. PLO uses a 150 µs pulse of broadband light from flashlamps to lift-off functional thin films from glass carrier substrates coated with a light absorber layer (LAL). Modeling indicates that the polymer/LAL interface reaches above 800 °C during PLO, but the top surface of the PI remains below 120 °C. An array of indium zinc oxide (IZO) thin-film transistors (TFTs) was fabricated on a polyimide substrate and photonically lifted off from the glass carrier. The TFT mobility was unchanged by PLO. The flexible TFTs were mechanically robust, with no reduction in mobility while flexed.

Context: Irrational use of medications for acute diarrhea in children is rampant. We conducted this survey to analyze prescription practices among pediatricians for acute diarrhea and their deviation from standard treatment guidelines. Subjects and Methods: A self-administered online questionnaire regarding prescription practices was circulated among pediatricians in Maharashtra, India, through various academic groups on WhatsApp, during the World Oral Rehydration Salt (ORS) Week, 2021. The questionnaire was anonymous and consisted of 15 compulsory close-ended multiple-choice questions. Results: Two hundred and eighty-seven pediatricians participated. Among which, 88.9% of the participants said that they prescribed ORS in acute diarrhea, 26.8% preferred zinc supplementation only in the case of watery diarrhea, 62% used probiotics or probiotics plus zinc combinations, and 60% said that they prescribe antisecretory drugs such as racecadotril. Forty percentage of the participants admitted that they occasionally use antibiotics for the management of acute diarrhea, while 5% said that they frequently do so. Most pediatricians advise appropriate ORS substitutes. Large number of pediatricians perceived probiotics (51.2%), dietary restriction (15.7%), racecadotril (10.5%), and antibiotics (6.3%) to be an important part in managing acute diarrhea. Only 25.4% of the pediatricians answered correctly and said parental counseling along with zinc and ORS work best as treatment. Conclusions: This study demonstrates low adherence by pediatricians to standard treatment guidelines for the management of acute diarrhea. Misuse of antibiotics and unscientific use of drugs were evidenced from this study. Awareness regarding the advantages of ORS among pediatricians is high. At present, there is a need to focus on appropriate feeding practices, emphasizing on the role of zinc and discouraging use of antibiotics, probiotics, antisecretory drugs, and irrational combinations.

Introduction: Eosinophilic meningitis is diagnosed by the presence of at least 10% eosinophils in CSF (Cerebrospinal fluid). Aetiological factors may be the use of collagen based dural substitutes, floseal, bioglue, silastic reservoir, or parasitic or fungal infections. Case report: A 37 year-old female with a posterior fossa mass, presented with herniation. She underwent emergency surgery and complete removal of the meningioma. An Ommaya reservoir was placed in the occipital region for emergency CSF access, should the need arise. She was discharged 10 days after the surgery.On post-operative day 10, she had a pseudomeningocoele and surgical site CSF discharge. CSF showed no evidence of infection. No growth of any organism was seen on culture. No fever. Moderate leukocytosis and reduced glucose was seen in lumbar CSF. Examination of CSF from ommaya had similar findings. Broad spectrum antibiotic cover was given and serial CSF examinations were done to look for the response. No hydrocephalus was seen on CT scan (post operative).CSF re-examinations in view of persistence of pseudomeningocoele showed eosinophilic pleocytosis (over 80 %). Peripheral blood microscopy revealed eosinophilia. She responded to steroids initially; however on tapering there was a recurrence of the pseudomeningocele with worsening of the CSF picture. The Ommaya reservoir was then removed and steroids were reintroduced. The pseudomeningocoele subsided within a week and has not recurred till date. Conclusion: Eosinophilic meningities is a diagnosis of exclusion. Silastic reservoirs can cause allergic reactions. Possibility of such reactions should be kept in mind while treating patients with resistant postoperative meningitis with pseudomeningocoele.

Elevational gradient, slope, and aspect offer a unique opportunity to explore the response of plant species under changing environmental conditions. The present study aimed to analyze the species diversity and distribution patterns with respect to altitude, aspect, and habitat types in the Kashmir Himalayas. Considering major aspects and habitats, a total of 123 representative sites were selected along the elevational gradients for the present study. The plant species composition of each selected site was studied by organized sampling following the standard ecological methods. During the present study, a total of 361 vascular plant species belonging to 71 families and 214 genera were identified in the study area. At the lower altitudes, the southern aspect and drier habitats showed the highest diversity. Moreover, a significant amount of compositional dissimilarity was observed between the studied aspects, habitats, and elevation belts and was mainly due to species turnover rather than the nestedness component. Further, among the studied variables, altitude was the most important contributing variable, explaining the greatest variation in the species composition. The paired effects of altitude and habitat explained the maximum variation in plant species composition. It may be concluded that floristic diversity should be studied not only with reference to elevational gradients but should also include aspects and habitats. The current study will act as a reference in this direction. A similar study must be replicated in other parts of the Himalayan region in the future to improve our understanding of the distribution and preferences of plant species in mountainous zones. This, in turn, will be immensely helpful in the conservation and sustainable utilization of resources in these ecologically fragile regions.

BackgroundAdvances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. ObjectiveThe goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). MethodsWe conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. ResultsThe CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. ConclusionsAlthough perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial RegistrationClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066

Analyzing plant species richness across a broad geographic gradient is critical for understanding the patterns and processes of biodiversity. In view of this, a species richness map was developed by stacking the ranges of 51 tree species along an elevational gradient in the Western Himalaya using stacked species distribution models (SSDMs). Among modeling algorithms available in SSDMs, random forest and artificial neural networks exhibited the best performance (r = 0.81, p < 0.001). The predicted tree species richness distribution pattern revealed a mid-elevation peak at around 2,000 m asl, which is in concordance with the observed richness pattern (R2 = 0.94, p < 0.001). Additionally, structural equation models (SEMs) were used to confirm the key factors that influence tree richness. The results based on SEMs confirm that the elevational pattern of predicted tree species richness is explained by mutual effects of water–energy availability, climate, and habitat heterogeneity. This study also validates that the impact of moisture on tree species richness coincides geographically with climate factors. The results have revealed that water–energy-related variables are likely to impact the species richness directly at higher elevations, whereas the effect is more likely to be tied to moisture at lower elevations. SSDMs provide a good tool to predict a species richness pattern and could help in the conservation and management of high biodiverse areas at different spatial scales. However, more investigation is needed to validate the SSDMs in other parts of the Himalayan region to provide a comprehensive synoptic perspective of Himalayan biodiversity at a larger scale.

The present study is an attempt to evaluate the Conservation Priority Index (CPI) of species, habitats, and communities for their conservation and management planning in the Kashmir Himalayas in India. The present study is an attempt to prioritize 361 plant species, 18 plant communities (10 within the forest zone and 08 within the alpine zone), and 07 habitats for conservation planning. Out of the total plant species recorded, 06 species were categorized as critically endangered, 20 endangered, 28 vulnerable, and 98 species to be near threatened. Amongst the forest and alpine communities, Abies pindrow community and Juniperus squamata-Rhododendron anthopogon mixed community showed the maximum CPI values. Amongst the habitats, dry habitats showed the maximum CPI in the sanctuary. The study found that the threatened species positively correlated with the native and endemic species indicating that these species were rigorously affected due to biotic and abiotic stresses. Based on the results of the present study, we propose a practical method for biodiversity conservation and management of protected areas. The approach employs a variety of qualitative and quantitative features to compute CPI in conjunction with phytosociological data. This kind of study will be immensely helpful to forest officials, policy makers, conservators, and researchers for planning better strategies to conserve and manage particular species, communities, and even habitats in protected areas.

Abstract Crystallization of granular assemblies has broad implications for rapid and scalable creation of architected materials with applications ranging from structural materials to microarchitected battery electrodes. While significant advances have been made in understanding colloidal self‐assembly at nano to micro scale, the governing mechanisms for organization of dry assemblies of hard spheres remain unclear. Here, we investigate crystallization of mono‐size hard spheres with and without imposed vibration. Using X‐ray computed tomographic analysis coupled with discrete‐element simulations, we unravel the roles of gravity and imposed vibration on the three‐dimensional self‐assembly of the dry spheres. We use these insights to introduce gravity‐mediated epitaxial crystal growth with slow pouring of balls on seeding templates. Contrary to vibration‐induced crystallization, this method can form large single crystals with both close‐packed and rather surprisingly, nonclose‐packed metastable particle arrangements. Our results provide insight for the scalable manufacture of defect‐free granular assemblies that can be used as space‐holding templates to manufacture cellular materials, such as inverse opals and other related topologies. Key points Self‐assembly of hard spheres is a critical step for the scalable manufacture of micro‐architected solids. Via a combination of vibration experiments, 3D X‐ray tomographic observations, and simulations, we elucidate the critical role of gravity in the self‐assembly of hard spheres. We design seeding templates that can not only induce the self‐assembly into stable close‐packed crystal structures but also rather counterintuitively into metastable single crystal structures.

Abstract Photonic curing has shown great promise in maintaining the integrity of flexible thin polymer substrates without structural degradation due to shrinkage, charring or decomposition during the sintering of printed functional ink films in milliseconds at high temperatures. In this paper, single-step photonic curing of screen-printed nickel (Ni) electrodes is reported for sensor, interconnector and printed electronics applications. Solid bleached sulphate paperboard (SBS) and polyethylene terephthalate polymer (PET) substrates are employed to investigate the electrical performance, ink transfer and ink spreading that directly affect the fabrication of homogeneous ink films. Ni flake ink is selected, particularly since its effects on sintering and rheology have not yet been examined. The viscosity of Ni flake ink yields shear-thinning behavior that is distinct from that of screen printing. The porous SBS substrate is allowed approximately 20% less ink usage. With one-step photonic curing, the electrodes on SBS and PET exhibited electrical performances of a minimum of 4 Ω/sq and 16 Ω/sq, respectively, at a pulse length of 1.6 ms, which is comparable to conventional thermal heating at 130 °C for 5 min. The results emphasize the suitability of Ni flake ink to fabricate electronic devices on flexible substrates by photonic curing.

Background: Polypharmacy and the use of potentially inappropriate medications (PIMs) are important issues in older patients with cancer. Objectives: We aimed to study the prevalence of polypharmacy, and the use of PIMs, including the peri-chemotherapy supportive care regimens in older Indian patients with cancer. Materials and Methods: This was an analysis of a prospective observational study of patients aged 60 years and over with a diagnosis of malignancy who were assessed in the geriatric oncology clinic at the Tata Memorial Hospital (Mumbai, India). Patients on five or more medications were considered to have polypharmacy; excessive polypharmacy was defined as ten or more medications and PIMs were defined and categorized according to the Beers criteria. Results: Between June 2018 and October 2020, 285 patients were enrolled in the study. Polypharmacy was noted in 55% of the patients and excessive polypharmacy in 13%. Polypharmacy was noted in 70% of the patients with lung cancer, compared to 45% for other malignancies, P < 0.001. Unindicated medications such as vitamins and calcium were being taken by 20% of the patients and 23% were taking alternative medications (ayurvedic/homeopathic/naturopathic). Eighty percent of the patients were taking PIMs, commonly proton-pump inhibitors (33%) and tramadol (30%). The median number of PIMs was 2 (interquartile range, 1–2). Of the peri-chemotherapy supportive care medications, 53% were potentially inappropriate, commonly intravenous antihistamines in 39%, histamine H2 blockers in 15%, and steroids in 12%. Conclusions: Polypharmacy and PIM use are common problems in older Indian patients with cancer. Recognizing the problem and taking steps to ensure safe medication prescription practices should be a priority.

More than just a health crisis, COVID-19 pandemic has stressed across social, economical and emotional dimensions of human well being and health. The sudden enforcement although willful and honest, perpetuated a sense of insecurity and uncertainty as a result of livelihood loss, especially for the people employed in unorganized and private sectors across different urban centers of the country. The unexpected scenario not only caused widespread joblessness but also created varied conditions of psychological stresses foreseeing the less likelihood of returning of pre-COVID conditions. As an outcome of the pandemic, the involuntarily return of youth was seen as a boon for reversing the undesirable and unprecedented trends impacting the traditional rural dynamics. Present study is an attempt to highlights impacts, challenges and opportunities under and after COVID-19 on rural populace of Kailash Sacred Landscape (KSL) amid the sudden halt of remittances and jobless aspiring youth. A systematic approach was followed, where 16 villages in eight Blocks of KSL were assessed and migrants (n=815) were interviewed for compiling the information. Results revealed that COVID-19 has impacted (both positively and negatively) various sectors such as agriculture, tourism, overall family income, etc., as perceived by the respondents. Sectors like restaurants/shops, tourism, and agriculture emerged as potential cash generating avenues, with 30 %, 21 %, and 20 % respondent's perception, respectively. It is also revealed that in the absence of immediate alternatives, and policy intervention, villagers engaged themselves in the time tested traditional sectors of livelihoods or created their own niche by integrating traditional wisdom and acquired skills.

Fatigue influences our choices to engage in physical activity. Here, the authors investigate the underlying cognitive and neuronal mechanisms by which fatigue influences decisions to exert, and show that information about motor cortical state modulates decisions to engage in physical activity.

Background: A concerted effort has been made by the Government of India and the Armed Forces to train all health-care workers (HCWs) in various aspects of the prevention and management of COVID-19. This study was conducted to evaluate the efforts by assessing their knowledge, attitudes, practice, and behavior regarding COVID-19. Materials and Methods: A quick online survey, using a web portal and social media platform with a pretested questionnaire, was conducted. Responses were collected for 3 days and analyzed. Results: A total of 988 HCWs participated, including 61 (6.17%) specialist officers, 98 (9.91%) medical officers, 17 (1.72%) dental officers, 135 (13.66%) nursing officers, 518 (52.4%) paramedical staff, and 159 (16.09%) supporting staff. There was a high prevalence (>90%) of knowledge related to symptoms and transmission of the disease with no statistically significant difference in knowledge based on the category of HCW except for bleaching powder requirement (0.001) and chemoprophylaxis (0.001). The majority of the participants (>95%) agreed that lockdown, infection control programs, and repeated training of HCWs are good measures to control COVID-19 spread. Observing full precaution while handling personal protective equipment was the only practice which demonstrated a significant association with increasing qualification of the participant (P < 0.001). Conclusions: Levels of knowledge, positive attitude, and good practices are high among HCWs in the Armed Forces, however, feeling of anxiousness and worry prevail being frontline workers with maximum proximity toward patients. Aggressive, continuous, relevant target population-oriented information, education, and communication is the need of the hour, with structured and programmed interventions for positive mental health during course of the pandemic.

In the present study we compared the community composition, structure, regeneration status and carbon stock of a human managed arboretum (restoration site) during three decades with a natural forest in western Himalaya. Results reveal that ecological restoration activities in the arboretum enhanced the species richness of woody plants by 66.4% with a total of 125 species as compared to 42 species in natural forest. Similarly, above ground carbon stock in the arboretum was ∼38% higher (49.5 Mg/ha) as compared to the natural forest (30.8 Mg/ha). Plantation success in the arboretum was ∼52% with a higher survival rate for temperate and Himalayan native species. Tree density in the arboretum was 322.6/ha with 50% higher density of small girth trees (

Abstract Introduction Due to loss of brain buoyancy, spontaneous spinal cerebrospinal fluid (CSF) leaks cause orthostatic headaches but also can cause symptoms indistinguishable from behavioral variant frontotemporal dementia (bvFTD) due to severe brain sagging (including the frontal and temporal lobes), as visualized on brain magnetic resonance imaging. However, the detection of these CSF leaks may require specialized spinal imaging techniques, such as digital subtraction myelography (DSM). Methods We performed DSM in the lateral decubitus position under general anesthesia in 21 consecutive patients with frontotemporal dementia brain sagging syndrome (4 women and 17 men; mean age 56.2 years [range: 31–70 years]). Results Nine patients (42.8%) were found to have a CSF‐venous fistula, a recently discovered type of CSF leak that cannot be detected on conventional spinal imaging. All nine patients underwent uneventful surgical ligation of the fistula. Complete or near‐complete and sustained resolution of bvFTD symptoms was obtained by all nine patients, accompanied by reversal of brain sagging, but in only three (25.0%) of the twelve patients in whom no CSF‐venous fistula could be detected (P = 0.0011), and who were treated with non‐targeted therapies. Discussion Concerns about a spinal CSF leak should not be dismissed in patients with frontotemporal brain sagging syndrome, even when conventional spinal imaging is normal. However, even with this specialized imaging the source of the loss of spinal CSF remains elusive in more than half of patients.

Forests are the world's largest carbon sink and play a vital role in climate change mitigation through carbon sequestration; thus the assessment of carbon stock in the forests is important for policy prescription and management planning. In view of this, present study is an attempt to assess the biomass and carbon stock of tree species in selected subtropical and temperate forest stands along the vertical elevation gradient (300 m to 2250 m) in the Central Himalaya. Volumetric equations (allometric method) were used for various tree species along with field sampling/ assessment (quadrat method) for biomass and carbon sequestration potentials. The total tree biomass and carbon stock of dominant forest stands varied from 227.23 to 577.16 Mg ha−1 (megagram per hectare), and 107.93 to 274.15 Mg C ha−1 respectively; it was found maximum for Sal (Shorea robusta) dominated forest and minimum for mixed Oak forest (Quercus floribunda, Q. lanuginosa, Q. leucotrichophora etc.). The carbon sequestration was recorded maximum (4.83 Mg C ha−1 yr−1) for Chir-pine stand (Pinus roxburghii) followed by Sal (4.63 Mg C ha−1 yr−1), mixed Oak (4.47 Mg C ha−1 yr−1), and minimum (3.99 Mg C ha−1 yr−1) for temperate Banj-oak forest (Quercus leucotrichophora). The contribution of above and below ground biomass among different forest stands was recorded 82% and 18% respectively. The dominant species contributed maximum biomass and carbon stock (70–82%) in pure Sal, Chir-pine and Banj-oak stand, while the contribution of dominant and co-dominant species in the mixed forest varied depending on forest composition. The results reveal higher carbon stock for subtropical forest as compared to temperate forest; however, it is interesting that there is no significant difference in carbon sequestration among the different forest stands. The study recommended for the assessing biomass and carbon stock of different forests for long-term management of forests and climate change mitigation.

The present study synthesizes existing literature on Forest Ecosystem Vulnerability (FEV) assessments across the world's mountain regions. The synthesis reveals a globally substantial number of studies are available on FEV assessment. However, such studies are limited in the mountain regions. Of the total 75 peer-reviewed research papers considered for synthesis, there are 61 (81.32%) studies specific to the country, 6 (8%) to continental, 4 (5.34%) to global scales, and the remaining 4 (5.34%) to local. The study results reveal that most assessments are model-based projections, where complex topography of mountains creates uncertainty for climate projections in limited analyses of socio-ecological indicators. Only a few studies (12%) have considered socio-ecological and ground-based data, which are primarily required for adaptation and management planning at the local level. Overall synthesis of literature provided vital information on climate change impacts and suggested management and adaptation plans but was far from a broad reality for the future of the mountain ecosystem under the paradox of climate change. Scales, targets, indicators, and assessment approaches varied widely and focused on only a subset of resources. We recommend forest managers should critically examine the scale, indicators, methods, and targets when planning forest vulnerability assessments. This synthesis of FEV assessment will help suggest the best approaches and indicators given the limited number of model studies in the mountain area for decision and policy making for forest resource management.

The distribution and dynamics of forest resources provide basis for management and conservation planning. Long-term data and information is important to improve our understanding on spatial and temporal variations of a particular ecosystem. In view of this, distribution and dynamics of temperate forests was assessed for last three decade in the western Himalaya (Uttarakhand). Comparative assessment of existing data and information on Oak species (Quercus leucotrichophora) found in Uttarakhand is performed with present status of forest to provide the consequence of climate change and anthropogenic disturbances. Results of the study reveals a significant increase in tree density of majority of the species studied. Total Basal Area (TBA) of targeted Oak forests has significantly increased (p

We report the energy absorption and piezoresistive self-sensing performance of 3D printed discontinuous carbon fiber (CF)-reinforced polyetheretherketone (PEEK) cellular composites. Experiments conducted on three different 2D lattices with hexagonal, chiral and re-entrant topologies of the same relative density (33%) and CF loading (30 wt%) reveal that the CF/PEEK hexagonal lattice (HL), due its relatively brittle response, shows about 40% and 9% decrease in specific energy absorption (SEA) under in-plane and out-of-plane compression, respectively, compared with PEEK HL. While the collapse response of PEEK HL is nearly insensitive to the strain-rate over 43 ≤ ε̇ ≤ 106 s−1, we observe a twenty-fold increase in peak stress and a five-fold increase in SEA under in-plane impact loading over the same range of strain-rates for the CF/PEEK HL. The CF/PEEK lattices exhibit pronounced piezoresistive response under both in-plane and out-of-plane compression with maximum sensitivity of 3.1 and 5.2, respectively, for the re-entrant lattice, offering insight into the damage-state. Higher damage sensitivity indicates faster percolation of new contacts due to folds forming between the cell walls within the lattice under compression. The energy-absorbing and strain- and damage-sensing nature of 3D printed CF/PEEK lattices demonstrated here offers insight into the design of lightweight, high-performance multifunctional lattices.

Etched fiber Bragg grating (eFBG) sensors have shown to be highly sensitive with the capability of giving accurate real‐time response to a variety of measurands such as pressure, gas, biomolecules, to name a few. These sensors have not shown their mettle as competitive products mainly due to nonreproducibility in results and inefficiency in upscaling for large‐scale production; the main reason being nonuniform and complicated coating procedures. Herein, the enhancement in refractive index (RI) sensitivity (≈4 times) obtained with electrospinning of polyvinyl alcohol–reduced graphene oxide (PVA–rGO) nanofibers onto eFBG sensor using a customized target and a unique sandwich arrangement is demonstrated. The enhancement in RI sensitivity has led to a lower detection limit and increased sensitivity and linear range for a case study using myoglobin (Mb), an early‐stage cardiac biomarker with high reproducible results (standard error ≤±2.3%). rGO embedded PVA nanofiber electrospun onto an eFBG sensor (PVA–rGO sensor) is the first of its kind and has significant importance in developing cost‐effective, label‐free, multianalyte, portable, real‐time, point‐of‐care (POC) kits at ambient conditions.

Abstract Alternating electric fields have been successfully applied to cancer cells in-vitro to disrupt malignant progression and this antimitotic therapy has now been proven to be efficacious in Phase II and Phase III randomized clinical trials of patients with glioblastoma. With additional clinical trials ongoing in a number of other malignancies, there is a crucial need for a better understanding of the radiographic predictors of response and standardization of surveillance imaging interpretation. However, many radiologists have yet to become familiarized with this emerging cancer therapy and there is little active investigation to develop prognostic or predictive imaging biomarkers. This article provides an overview of the pre-clinical data that elucidate the biologic mechanisms of alternating electric fields as a cancer therapy. Results from clinical trials in patients with glioblastoma are then reviewed while elaborating on the several limitations to adoption of this promising line of treatment. Finally, a proposal for the development of imaging markers as a means of overcoming some of these limitations is made, which may improve treatment utilization by augmenting patient selection not only in glioblastoma, but also other malignant conditions for which this therapy is currently being evaluated.