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Formal infectious disease surveillance in Ukraine has been disrupted by Russia’s 2022 invasion, leading to challenges with tracking and containing epidemics. To analyze the effects of the war on infectious disease epidemiology, we used open-source data from EPIWATCH, an artificial intelligence early-warning system. We analyzed patterns of infectious diseases and syndromes before (November 1, 2021–February 23, 2022) and during (February 24–July 31, 2022) the conflict. We compared case numbers for the most frequently reported diseases with numbers from formal sources and found increases in overall infectious disease reports and in case numbers of cholera, botulism, tuberculosis, HIV/AIDS, rabies, and salmonellosis during compared with before the invasion. During the conflict, although open-source intelligence captured case numbers for epidemics, such data (except for diphtheria) were unavailable/underestimated by formal surveillance. In the absence of formal surveillance during military conflicts, open-source data provide epidemic intelligence useful for infectious disease control.

Abstract Background Antenatal steroid therapy for fetal lung maturation is routinely administered to women at risk of preterm delivery. There is strong evidence to demonstrate benefit from antenatal steroids in terms of survival and respiratory disease, notably in infants delivered at or below 32 weeks’ gestation. However, dosing remains unoptimized and lung benefits are highly variable. Current treatment regimens generate high-concentration, pulsatile fetal steroid exposures now associated with increased risk of childhood neurodevelopmental diseases. We hypothesized that damage-associated changes in the fetal hippocampal transcriptome would be independent of preterm lung function. Methods Date-mated ewes carrying a single fetus at 122 ± 2dGA (term = 150dGA) were randomized into 4 groups: (i) Saline Control Group, 4×2ml maternal saline intramuscular(IM) injections at 12hr intervals (n = 11); or (ii) Dex High Group, 2×12mg maternal IM dexamethasone phosphate injections at 12hr intervals followed by 2×2ml IM saline injections at 12hr intervals (n = 12; representing a clinical regimen used in Singapore); or (iii) Dex Low Group, 4×1.5mg maternal IM dexamethasone phosphate injections 12hr intervals (n = 12); or (iv) Beta-Acetate Group, 1×0.125mg/kg maternal IM betamethasone acetate injection followed by 3×2ml IM sterile normal saline injections 12hr intervals (n = 8). Lambs were surgically delivered 48hr after first maternal injection at 122–125dGA, ventilated for 30min to establish lung function, and euthanised for necropsy and tissue collection. Results Preterm lambs from the Dex Low and Beta-Acetate Groups had statistically and biologically significant lung function improvements (measured by gas exchange, lung compliance). Compared to the Saline Control Group, hippocampal transcriptomic data identified 879 differentially significant expressed genes (at least 1.5-fold change and FDR

Introduction: The aims of this systematic review and meta-analysis are to synthesise quality of life (QOL) of family caregivers of children and young adults with Down syndrome (DS) and determine factors affecting their QOL. Method: This review was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Key search terms were “quality of life”, “down syndrome” and “trisomy 21”. Meta-analysis using random effect model was conducted where feasible. All studies underwent qualitative synthesis. The study protocol was registered with PROSPERO (CRD42023413532). Results: Eighteen studies with 1956 caregivers were included. Of the 10 studies utilising the World Health Organization Quality of Life Instrument-Brief Version, 5 were included in the meta-analysis. Psychosocial domain had the highest score with mean (95% confidence interval [CI]) of 63.18 (39.10–87.25). Scores were poorer in physical, environmental and social domains: 59.36 (28.24–90.48), 59.82 (19.57–100.07) and 59.83 (44.24–75.41), respectively. Studies were heterogenous with I2 values ranging from 99–100% (P less than 0.01). The remaining 8 studies used 6 other instruments. Qualitative synthesis revealed that caregivers’ QOL was adversely affected by child-related factors, such as level of functional independence, developmental delay, presence of multiple comorbidities, impaired activities of daily living and poor sleep quality. Environmental factors that adversely affected caregivers’ QOL included number of children, housing and support from the family. Personal factors that affected caregivers’ QOL included age, being a single mother, low education and low income. Conclusion: QOL of caregivers of children with DS was lower than population reference data. Understanding the factors that influence family caregivers’ QOL is an essential step towards improving the QOL of caregivers and their children with DS.

Introduction: Down syndrome (DS) negatively impacts the well-being of affected individuals. This study aimed to summarise the evidence on quality of life (QOL) of children and young adults with DS using quantitative measures from caregivers’ perspective and identify factors that affected their QOL. Method: Database search was conducted on PubMed, Embase, Web of Science and CINAHL on 24 April 2024. Meta-analysis using random effects model was conducted where feasible. All studies underwent qualitative synthesis. The study protocol was registered with PROSPERO (CRD42023413532). Results: Seventeen studies involving 3038 children with DS using various QOL measures were included: Pediatric Quality of Life Inventory (PedsQL) (8 studies), KIDSCREEN (4 studies), KidsLife (2 studies), The Netherlands Organization for Applied Scientific Research Academic Medical Center Children’s QOL (2 studies) and Personal Outcome Scale (1 study). Meta-analysis on PedsQL studies compared scores between children with DS and typically developing (TD) children. Total scale score was lower in children with DS (mean 70.28, 95% confidence interval [CI] 64.31–76.24) compared to TD children (mean 88.17, 95% CI 80.50–95.83). All subdomains of PedsQL were also lower in children with DS. Within the domain of psychosocial health, children with DS had statistically significant lower social functioning (standardised mean difference -1.40, 95% CI -2.27 to -0.53) and school functioning (standardised mean difference -1.09, 95% CI -1.55 to -0.62) scores, but similar emotional functioning scores. Qualitative synthesis revealed poorer subdomain QOL compared to TD children, especially in social functioning and cognitive functioning. QOL worsened during adolescent years. Family variables (parental education and occupation) did not affect parental perception of children’s QOL. Children with DS who had higher intelligent quotient had better QOL. Conclusion: Children with DS have lower caregiver-reported QOL than TD children, especially in social functioning and school functioning subdomains.

Abstract In this paper, we apply stochastic differential equations with the Wiener process to investigate the soliton solutions of the Chaffee–Infante (CI) equation. The CI equation, a fundamental model in mathematical physics, explains concepts such as wave propagation and diffusion processes. Exact soliton solutions are obtained through the application of the modified extended tanh (MET) method. The obtained wave figures in 3D, 2D, and contour are highly localized and determine an individual frequency shift under the behavior of sharp peak, periodic wave, and singular soliton. The MET method shows to be a valuable analytical tool for obtaining soliton solutions, essential for understanding the dynamics of nonlinear wave phenomena. Numerical simulations enable us to explore soliton solutions in two and three dimensions, shedding light on their properties over time. Our results have wide applications in various domains, including stochastic processes and nonlinear dynamics, impacting advancements in physics, engineering, finance, biology, and beyond.

Abstract Water contaminated with arsenic presents serious health risks, necessitating effective and sustainable removal methods. This article proposes a method for removing arsenic from water by impregnating biochar with iron oxide (Fe2O3) from brown seaweed (Sargassum polycystum). After the seaweed biomass was pyrolyzed at 400 °C, iron oxide was added to the biochar to increase its adsorptive sites and surface functional groups, which allowed the binding of arsenic ions. Batch studies were conducted to maximize the effects of variables, including pH, contact time, arsenic concentration, and adsorbent dosage, on arsenic adsorption. The maximum arsenic adsorption efficiency of 96.7% was achieved under optimal conditions: pH 6, the adsorbent dosage of 100 mg, the initial arsenic concentration of 0.25 mg/L, and a contact time of 90 min. Langmuir and Freundlich’s isotherms favored the adsorption process, while the kinetics adhered to a pseudo-second-order model, indicating chemisorption as the controlling step. Column studies revealed complete saturation after 200 min, and the adsorption behavior fits both the Adams–Bohart and Thomas models, demonstrating the potential for large-scale application. The primary mechanism underlying the interaction between iron-modified biochar and arsenic ions is surface complexation, enhanced by increased surface area and porosity. This study highlights the significant contribution of iron-modified biochar derived from macroalgae as an effective and sustainable solution for arsenic removal from water.

Abstract Background Equine-assisted services (EAS) involves the use of horses within therapy, learning or horsemanship sessions and has been used with military veterans suffering from post-traumatic stress disorder (PTSD). This study systematically reviewed existing research on the use of EAS in the treatment of PTSD in military veterans and evaluated its effectiveness. Methods A systematic review was performed, in May 2023, with searches and data extraction carried out from three separate databases (PubMed, JSTOR and Science Direct) related to testing the effect of EAS on PTSD outcomes in veterans. A risk of bias assessment of included studies was conducted and meta-analysis of outcomes performed when two or more studies reported the same outcomes. Other effects of EAS on veterans’ health were also discussed. Results A total of 13 studies were identified based on our inclusion and exclusion criteria with 11 originating from the US and the remaining two from Australia and Israel. There were 344 participants amongst all of the studies with a mean age of 47 years and a male:female ratio of 19:6. Eight out of the 13 studies reported PTSD scores, as measured by either PTSD Checklist for DSM-5 (PCL-5) or PCL-Veteran/-Military versions (PCL-V/-M), and results suggested a reduction in PTSD score after EAS treatment of 22.6%. A meta-analysis confirmed that EAS favored a significantly lower PTSD score after treatment, with a mean difference of 12.46, 95% CI [9.03,15.88], p

Introduction: Because of wide heterogeneity in the epidemiology of heart failure among different populations, it is imperative to establish population-specific databases. Aims and Objectives: To describe the clinical profile, treatment patterns, and outcomes of heart failure patients admitted to our tertiary care hospital. Material and Methods: The study was a prospective observational study conducted over two years at our tertiary care hospital. It included patients admitted with acute and acute-on-chronic heart failure. Results: We recruited 264 patients. Mean age of the study population was 57.8 ± 15.14 years. Males were 157 (59.5%). Dilated cardiomyopathy was the most common cause followed by ischemic heart disease. Most common risk factors were hypertension, tobacco use, anemia, and diabetes. Heart failure with reduced ejection fraction was present in 154 (62%) patients. Acute de novo heart failure was present in 91 (34.5%) patients. The most common precipitant for heart failure exacerbation was infection, followed by ischemic causes and non-adherence to drugs. The mean duration of hospital stay was 7.5 ± 3.1 days. The in-hospital mortality was 8.7%, and cumulative six-month and one-year mortality was 23% and 28%, respectively. In multivariate analysis, renal failure, readmission, and not being on guideline-directed medical treatment were significant predictors of mortality. Conclusion: Our patients were younger, predominantly males, with dilated and ischemic cardiomyopathy as commonest etiology. Hypertension and tobacco smoking were most common risk factors, with infections as most common precipitants. Only one-third of patients were on guideline-directed medical therapy. The one-year mortality was 28% and was higher in those without guideline-directed medical therapy.

Abstract Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.

Abstract Clematis graveolens Lindl., an indigenous climbing plant found in the Himalayan areas, is used by local communities for the treatment of neck tumors. The objective of this work is to examine the comprehensive metabolomic profile, antioxidant capability, in vitro and in silico anti-glioma effects on U-87 human glioma cell lines of the crude extract and fractions from C. graveolens. Liquid chromatography coupled with mass spectroscopy (LC–MS/MS) was used to establish detailed metabolite profiling of C. graveolens. The assessment of cell cytotoxicity was conducted using MTT cell viability assay on U-87 and BHK-21. Through molecular docking studies, the mode of inhibition and binding interaction between identified compounds and target proteins were also determined to evaluate the in vitro results. The use of LC–MS/MS-based global natural products social (GNPS) molecular networking analysis resulted in the identification of 27 compounds. The crude extract, ethyl acetate fraction, and chloroform fraction exhibited significant inhibitory activity against the U-87 cell lines, with IC50 values of 112.0, 138.1, and 142.7 µg/mL, respectively. The ethyl acetate fraction exhibited significant inhibitory concentration for 2,2’-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) activity, 2,2-diphenyl-1-picrylhydrazyl (DPPH) activity and the metal chelation activity with IC50 value of 39.50 µg/mL, 32.27 µg/mL, and 53.46 µg/mL, respectively. The crude extract showed maximum total phenolic, and total flavonoid concentration measuring 338.7 µg GAE/mg, and 177.04 µg QE/mg, respectively. The findings of this study indicate that C. graveolens consists of a diverse range of active phytoconstituents that possess antioxidant and anti-glioma properties.

Abstract Background As part of the fight against coronavirus disease, Nigeria received nearly 4 million doses of the COVID-19 vaccine via the COVID-19 Vaccines Global Access (COVAX) Facility, marking a historic step towards equitable global distribution of COVID-19 vaccines. Although evidence exists on COVID-19 hesitancy in Nigeria, yet, we are unaware of any study on the optimization of COVID-19 vaccination from the lenses of the mobile teams. Objective This study seeks to explore the perceptions and experiences of mobile teams in selected communities during the implementation of COVID-19 vaccination in Benue and Niger. Methods An exploratory approach was adopted, and the study was conducted in Niger and Benue states based on poor performance in COVID-19 vaccination. Focus Group Discussions (FDGs) were conducted among 12 mobile vaccination teams from 12 LGAs. The recorded discussions were transcribed and coded (inductively and deductively) using Dedoose software (v9.0). Four themes and seven sub-themes were generated from the participants’ responses. Results Seventy-two (72) health workers including vaccinators, validators, Electronic Management of Immunization Data (EMID) recorders, social mobilizers, and paper recorders participated in this study. Health workers’ perceptions and experiences were thematized using the health building blocks. The mobilization teams in Benue and Niger states perceived that their mobilization efforts contributed to improved coverage, increased accessibility, and reduced hesitancy among the community dwellers. Challenges reported by the teams were vaccine misconceptions, requests for incentives in exchange for vaccine uptake, poor network services, distance to communities, and vaccine stockout. Conclusion This study concluded that social mobilizers play key roles in vaccine uptake, especially at the community level. Their roles in creating awareness, sensitization, and bringing the vaccine closer to hard-to-reach communities contributed to the success attained in the fight against COVID-19 in both states.

Abstract Background This study delves into the intricate landscape of oral cancer, a global concern with a high incidence in Asian countries. We focus on oral squamous cell carcinoma (OSCC), primarily driven by the consumption of betel nut and its derivatives. OSCC often arises from premalignant lesions like oral submucous fibrosis (OSF). In Pakistan, OSCC is prevalent among men due to various addictive substances, including smokeless tobacco and chewing materials. Mutations in tumor suppressor genes, such as TP53 and p21, play crucial roles in this malignancy’s development. We also explore the involvement of TUSC3 gene deletion in OSCC and OSF. Methods In this study we investigated demographics, TUSC3 gene expression, deletion analysis, and TP53 and p21 genetic alterations in OSCC and OSF patients (blood and tissue of 50 samples in each condition) who had tobacco derivates usage history. The association analysis was carried out mainly through PCR based genotyping. Results The study’s patient cohort (OSCC and OSF) displayed a wide age range from 13 to 65 years (Mean = 32.96 years). Both conditions were more prevalent in males, with a male-female ratio of approximately 2.5:1. Chewing habits analysis revealed high frequencies of gutka use in both OSF and OSCC patients. TUSC3 expression analysis in OSCC cell lines indicated significant downregulation. Genotyping showed no TUSC3 deletion in OSF cases, but a deletion rate of over 22% in OSCC tissue samples. Analysis supported a significant association of TUSC3 deletion with OSCC development but not with OSF. Polymorphism in p53 exon 4 and p21 (rs1801270) were significantly associated with both OSCC and OSF, adding to their pathogenesis. Our findings further revealed a strong correlation between TUSC3 deletion and the excessive use of tobacco and related products, shedding light on the genetic underpinnings of OSCC development. Conclusions Notably, our study provides a crucial insight into genetic aspects underlying OSCC and OSF in response of addictive consumption of areca nut, betel quid, and tobacco derivatives. A significant association between TUSC3 deletion and OSCC development, along with polymorphisms in TP53 and p21, underscores the importance of further research into the molecular mechanisms driving oral cancer progression for improved diagnosis and treatment outcomes.

The hybrid nanofluid (Hnf) flow with heat and mass transmission under the magnetic field and activation energy consequences across parallel double-rotating surfaces has been studied. In order to synthesize the Hnf, polymer/CNT matrix nanocomposites (MNCs) are dissolved in water. Polymer/CNT MNCs are highly efficient and have exceptional properties. These MNCs are helpful in various applications, from engineering to biomedical research, because of their incredible thermophysical properties. Keeping in view the significant uses of the polymer/CNT MNC hybrid nanofluid flow, we have formulated the fluid flow in the form of the system of PDEs (partial differential equations), which are reformed into the non-dimensional form of ODEs (ordinary differential equations) and then solved numerically through the Matlab package (bvp4c). The numerical outputs for velocity, heat and mass profiles are compared with another numerical approach ND-solve. It has been determined that the outputs are precisely correct and reliable. Furthermore, the fluid velocity drops with the influence of suction/injection, Reynold number, and polymer/CNT MNC. The increasing quantity of polymer/CNT MNC in water reduces the energy and mass profiles. The energy field enhances with the upshot of the heat source term, whereas the concentration field falloffs with the effect of Schmidt number.

Background and Objectives: “Synchronous videoconference telemedicine in neonatal office-practice” (SyNTOP) has been a routine practice in our center since the start of the COVID-19-related lockdown. We recently reported our experience with the “success” of this practice in terms of removing the need to visit the hospital over the next 48 h after the teleconsult. Methods: Secondary results of this retrospective descriptive study which analyzed 829 consults are presented in this manuscript. Data from electronic medical records of those who availed teleconsultation facility between March 2020 and April 2021 were retrieved. Relevant information about clinical presentation, findings from the video call, demographic information, decisions made by the clinician, and outcomes were collected. Best efforts were made to obtain follow-up information by the clinical team or guest–patient relations officers. Results: Fever (n = 118) and acute diarrheal disease (n = 58) were the common presenting complaints; most (80.5% and 95.5%, respectively) were resolved without physical examination; 265 developmental assessments were completed by video-facilitated checks. Fast-track vaccination visits where queries were resolved and bills paid online, were an innovation where well babies could avoid queues and possible exposure to crowds. One-fourths of SyNTOP were from outside the district, and 1.4% were from foreign countries. Conclusions: Teleconsults were successfully conducted in neonatal office practice for different health-care enquiries. Strategies such as fast-track vaccinations and online developmental follow-up assessments were performed by leveraging technology. We highlight the benefits of these innovations in our center with a view to enhance their uptake elsewhere. Such approaches have the potential to increase health equity and access to specialty health care.

Abstract Diabetic retinopathy (DR) is a multifactorial disease displaying vascular-associated pathologies, including vascular leakage and neovascularization, ultimately leading to visual impairment. However, animal models accurately reflecting these pathologies are lacking. Vascular endothelial growth factor A (VEGF-A) is an important factor in the development of micro- and macro-vascular pathology in DR. In this study, we evaluated the feasibility of using a cumate-inducible lentivirus (LV) mediated expression of vegf-a to understand DR pathology in vitro and in vivo. Retinal pigment epithelial cells (ARPE-19) were transduced with cumate-inducible LV expressing vegf-a, with subsequent analysis of vegf-a expression and its impact on cell proliferation, viability, motility, and permeability. Cumate tolerability in adult Wistar rat eyes was assessed as an initial step towards a potential DR animal model development, by administering cumate via intravitreal injections (IVT) and evaluating consequent effects by spectral domain optical coherence tomography (SD-OCT), flash electroretinography (fERG), ophthalmic examination (OE), and immunohistochemistry. Transduction of ARPE-19 cells with cumate-inducible LV resulted in ~ 2.5-fold increase in vegf-a mRNA and ~ threefold increase in VEGF-A protein secretion. Transduced cells displayed enhanced cell proliferation, viability, permeability, and migration in tube-like structures. However, IVT cumate injections led to apparent retinal toxicity, manifesting as retinal layer abnormalities, haemorrhage, vitreous opacities, and significant reductions in a- and b-wave amplitudes, along with increased microglial activation and reactive gliosis. In summary, while cumate-inducible LV-mediated vegf-a expression is valuable for in vitro mechanistic studies in cellular drug discovery, its use is not a feasible approach to model DR in in vivo studies due to cumate-induced retinal toxicity.

Abstract During the last decade, nanotechnology has attained a significant place among the scientific community for the biosynthesis of plant‐based nanoparticles owing to its effective, safe, and eco‐friendly nature. Hence, keeping in view the significance of nanotechnology, the current study was conducted to develop, characterize (UV–visible spectroscopy, scanning electron microscopy, Fourier‐transform infrared spectroscopy, and energy‐dispersive X‐ray spectroscopy), and assess the antimicrobial (antibacterial and antifungal) properties of Peganum harmala L. Extract‐based Gold (Au) and Silver (Ag) nanoparticles (NPs). Characteristic absorption peaks at 420 and 540 nm revealed the formation of AgNPs and AuNPs, respectively. SEM images revealed that both silver and gold nanoparticles were oval and spherical with average size ranging from 42 to 72 and 12.6 to 35.7 nm, respectively. Similarly, FT‐IR spectra revealed that the functional groups such as hydroxyl, carboxyl, and polyphenolic groups of biomolecules present in the extract are possibly responsible for reducing metallic ions and the formation of nanoparticles. Likewise, the EDX analysis confirmed the presence of silver and gold in synthesized NPs. Furthermore, the AgNPs and AuNPs showed good antibacterial and antifungal activities. The maximum antibacterial and antifungal activity was noticed for P. harmala extract against Pseudomonas aeroginosa (21 mm) and Candida albicon (18 mm), respectively. Whereas, the maximum antibacterial and antifungal activities of synthesized AgNPs were observed against Salmonella typhi (25 mm) and Penicillium notatum (36 mm), respectively. Moreover, in the case of AuNPs, the highest antibacterial and antifungal activity of synthesized AuNPs was noticed against Escherichia coli (25 mm) and C. albicon (31 mm), respectively. Findings of this study revealed that P. harmala extract and biosynthesized NPs (silver and gold) possessed significant antibacterial and antifungal properties against different bacterial (Bacillus subtilis, Staphylococcus aureus, E. coli, P. aeroginosa, and S. typhi) and fungal (C. albicans, Aspergillus Niger, and P. notatum) strains. Further studies must be carried out to assess the probable mechanism of action associated with these antimicrobial properties.

Recent research has shown that there is a link between the trend of cardiovascular disease (CVD), chronic symptoms of SARS-CoV-2 (COVID-19), and medical nutrition therapy. Making positive changes to an individual’s lifestyle can help to reduce the symptoms that follow exposure to CVD and COVID-19. Sustainable nutrition and lifestyle changes can positively impact an individual’s health. Studies have considered the risk factors associated with the disease, medical history, the link between nutrition and peripheral vascular disease (PVD), symptom management, and the interrelationship between nutrition, COVID-19, and PVD. One study has demonstrated that Western Dietary intake can boost the innate immune system while suppressing humoral response, causing chronic inflammation and poor host defense against viruses. However, further investigation is needed to confirm. Patients with PVD and COVID-19 have experienced a reduction in side effects when prescribed a regimen of medical nutrition therapy, heart-healthy diets, and adequate physical activity before and after symptoms of both diseases appear. This approach has proven to be a protective factor during the combination of both illnesses. Our findings indicate that balanced diet and lifestyle are essential in supporting an optimal immune system that can reduce the risk of virus load in individuals at risk of infection and symptoms from COVID-19 and PVD.

IntroductionEndotracheal intubation is an uncommon procedure for children in the emergency department but can be technically difficult and cause significant adverse effects. Videolaryngoscopy (VL) offers improved first-pass success rates over direct laryngoscopy (DL) for both adults and children undergoing elective surgery. This systematic review was designed to evaluate current evidence regarding how the effectiveness and safety of VL compares to DL for intubation of children in emergency departments.MethodsFour databases (MEDLINE, Embase, CENTRAL and Web of Science) were searched on 11th May 2023 for studies comparing first-pass success of VL and DL for children undergoing intubation in the emergency department. Studies including adult patients or where intubation occurred outside of the emergency department were excluded. Quality assessment of included studies was carried out using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken for first-pass success and adverse event rate.ResultsTen studies met the inclusion criteria representing 5,586 intubations. All included studies were observational. Significantly greater first-pass success rate was demonstrated with VL compared to DL (OR 1.64, 95% CI [1.21–2.21], p = 0.001). There was no significant difference in risk of adverse events between VL and DL (OR 0.79, 95% CI [0.52–1.20], p = 0.27). The overall risk of bias was moderate to serious for all included studies.ConclusionVL can offer improved first-pass success rates over DL for children intubated in the emergency department. However, the quality of current evidence is low and further randomised studies are required to clarify which patient groups may benefit most from use of VL.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=415039, Identifier CRD42023415039.

This systematic review seeks to improve the existing framework for developing students’ Computing Identity (CI) by integrating contemporary elements and identifying new dimensions. A meticulous selection of 31 articles followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, ensuring a comprehensive and systematic approach. The findings highlight factors that influence students’ CI and also the constructs defining the frameworks for developing students’ CI. The identified existing constructs are competence/performance, interest, sense of belonging, and recognition in computing, with competence/performance being the most explored and recognition the least. The review proposes a new framework for developing students’ CI that includes the “social context” as it interweaves with existing constructs to shape the multifaceted process of CI formation. The findings underscore a research gap concerning the inclusion of diverse perspectives, which is essential for a richer understanding of CI. Additionally, the study emphasizes the potential to incorporate new elements to enhance the existing frameworks for developing students’ CI, along with its validation in diverse contexts.

Introduction: Antimicrobial resistance (AMR), a transboundary health issue, critically impacting low- and middle-income countries (LMICs) where 80% of antibiotics are used in the community, with 20–50% being inappropriate. Southeast-Asia, including Bangladesh, faces heightened AMR risk due to suboptimal healthcare standard and unregulated antibiotic sales. This study aimed to audit antibiotic dispensing patterns from community pharmacies, identifying factors influencing purchasing behaviors. Methods: A cross-sectional survey of 385 antibiotic customers and structured observations of 1000 pharmacy dispensing events were conducted in four urban and rural areas in Bangladesh. Descriptive analysis defined antibiotic use, while Poisson regression examined how patients' demographics and health symptoms influenced prescription behaviors. Results: Among 1000 observed medicine dispensing events, 25.9% were antibiotics. Commonly purchased antibiotics included macrolides (22.8%), third-generation-cephalosporins (20.8%), and second-generation-cephalosporins (16.9%). Following WHO-AWaRe classifications, 73.5% of antibiotics were categorized as Watch, and 23.1% as Access. From the survey, 56.6% antibiotics were purchased without a prescription from drug-sellers and informal healthcare providers, primarily for “non-severe” health-symptoms such as upper-respiratory-tract infections (37.4%), fever (31.7%), uncomplicated skin infections (20%), gastrointestinal-infections (11.2%), and urinary-tract infections (7.9%). The likelihood of presenting a prescription while purchasing antibiotics was 27% lower for individuals aged 6–59 compared to those ≤5 or ≥ 60. Lower-respiratory-tract infections and enteric-fever had higher prescription rates, with adjusted prevalence ratios of 1.78 (95% CI: 1.04, 3.03) and 1.87 (95% CI: 1.07, 3.29), respectively. After adjusting for confounders, sex, urban-rural locations, income, education, and number of health-symptoms exhibited no significant influence on prescription likelihood. Conclusion: This study underscores unregulated antibiotic sales without prescriptions, urging tailored interventions considering prevailing health-seeking practices in diverse healthcare settings in LMICs. Enforcing prescription-only regulations is hindered by easy access through community pharmacies and conflicts of interest. Future strategies should consider how stewardship impacts the financial interests of pharmacy personnel in settings lacking clear authority to ensure optimal compliance.

Polyethylene microplastics (PEMPs) are widely distributed in environment and exerts deleterious effects on animal as well as human health. Sakuranetin (SKN) is a natural flavonoid that manifests profound therapeutic potential. Albino rats (n = 24) were partitioned into 4 groups i.e., Control, PEMPs 1.5 mg/kg, PEMPs 1.5 mg/kg + SKN 10 mg/kg and SKN 10 mg/kg administered group. After 30 days of treatment, our results revealed that PEMPs exposure reduced nuclear factor erythroid 2–related factor 2 (Nrf-2) and antioxidant genes while enhancing the expression of kelch-like ECH-associated protein 1(Keap-1). Besides, PEMPs intoxication reduced the level of renal biomarkers i.e., creatinine clearance and increased the level of creatinine, urea, neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Additionally, it lessened the activities of glutathione S-transferase (GST), superoxide dismutase (SOD), glutathione reductase (GSR), catalase (CAT), glutathione peroxidase (GPx) and heme oxygenase-1 (HO-1) whereas the levels of malondialdehyde (MDA) and reactive oxygen species (ROS) were increased. Conversely, it increased the levels of nuclear factor-kappa B (NF-kB), tumor necrosis factor-alpha (TNF-a), interleukin-1beta (IL-1b) and IL-6 as well as escalated the activity of cyclooxygenase-2 (COX-2). Furthermore, the expression of bcl-2-associated X protein (Bax) and caspase-3 were elevated, while the expression of B-cell lymphoma 2 (Bcl-2) was lowered. However, SKN treatment significantly (P

STEM education for deaf students aims to engage and include intellectual and experiential learning other than normal classrooms. These programs improve students' critical thinking, problem-solving, creativity, and complex decision-making, which are essential for academic and life success. This study aims to explore several aspects of a STEM based workshop including problem solving skills, STEM skills, subject knowledge, and effectiveness of the workshop for a group of 27 deaf students. The workshop spanned five consecutive days and focused on problem-solving principles within the context of global warming. Moreover, in this study, the Creative Problem-solving approach developed by Osborn and Parnes was implemented to measure improvement of the constructs above, through a post questionnaire. Cronbach's alpha and McDonald's Omega coefficient exceeded .7 for each construct. The data obtained from the questionnaire demonstrated a random distribution of data according to the Shapiro-Wilk test performed (p

Abstract Background and Aims Several studies imply that influenza and other respiratory illnesses could lead to acute myocardial infarction (AMI), but data from low‐income countries are scarce. We investigated the prevalence of recent respiratory illnesses and confirmed influenza in AMI patients, while also exploring their relationship with infarction severity as defined by ST‐elevation MI (STEMI) or high troponin levels. Methods This cross‐sectional study, held at a Dhaka tertiary hospital from May 2017 to October 2018, involved AMI inpatients. The study examined self‐reported clinical respiratory illnesses (CRI) in the week before AMI onset and confirmed influenza using baseline real‐time reverse transcription polymerase chain reaction (qRT‐PCR). Results Of 744 patients, 11.3% reported a recent CRI, most prominently during the 2017 influenza season (35.7%). qRT‐PCR testing found evidence of influenza in 1.5% of 546 patients, with all positives among STEMI cases. Frequencies of CRI were higher in patients with STEMI and in those with high troponin levels, although these relationships were not statistically significant after adjusting for other variables. The risk of STEMI was significantly greater during influenza seasons in the unadjusted analysis (relative risk: 1.09, 95% confidence interval [CI]: 1.02–1.18), however, this relationship was not significant in the adjusted analysis (adjusted relative risk: 1.03, 95% CI: 0.91–1.16). Conclusion In Bangladesh, many AMI patients had a recent respiratory illness history, with some showing evidence of influenza. However, these illnesses showed no significant relationship to AMI severity. Further research is needed to understand these relationships better and to investigate the potential benefits of infection control measures and influenza vaccinations in reducing AMI incidence.

BackgroundImperforate hymen is an uncommon obstructive anomaly of the developing female reproductive tract. There are occasional case reports of imperforate hymen occurring in family clusters, suggesting a plausible familial mode of inheritance. We describe a set of monozygotic premature twins with imperforate hymen noted at birth, whose mother was diagnosed with the same condition as a teenager. We also elucidate the likely underlying mode of inheritance of imperforate hymen.MethodWe utilized the CARE (Case Report) guideline in reporting the cases.Case presentationThese are monozygotic twins born prematurely at 30 weeks of gestation, noted at birth to have bulging cyst-like structures protruding from their vaginas. The twins were not dysmorphic and did not have any other congenital malformations. Over the next few weeks, these cyst-like structures (mucoceles) became less prominent. The genital anomaly was diagnosed as imperforate hymen. Their mother was also diagnosed with an imperforate hymen when she was 12 years old and was treated with hymenectomy.DiscussionThis unique occurrence of imperforate hymen in a set of premature monozygotic twins and their mother suggests a plausible autosomal or X-linked dominant mode of inheritance. Given the role of genetic inheritance in imperforate hymen development, it is important to screen female relatives of an index case for this genital anomaly.

Introduction Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants.Methods and analysis Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions).Ethics and dissemination The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

IntroductionThe aim of the study was to summarize and update clinical features and outcomes of multisystem inflammatory syndrome in neonates (MIS-N).MethodsA systematic literature search was conducted of studies on MIS-N published in PubMed, MEDLINE, EMBASE, CNKI, and WHO COVID-19 databases between 1 December 2019 and 30 June 2023. Reference lists of selected articles, Google Scholar, and pre-print servers were searched for additional studies. The methodological quality of included studies was assessed.ResultsOf 1,572 records screened after the initial search, 35 studies involving a total of 201 neonates with MIS-N were included. One study was retrieved from a pre-print server. For those with available data, 34/47 (78.7%) mothers were infected in the third trimester. Of the 199 mothers (two with twin pregnancies), 183 (92.0%) were from India. The median age of neonates at presentation was 2.0 days (interquartile range 1.0–9.5). Over two-thirds (144/201, 71.6%) presented with respiratory distress, while 112 (55.7%) had cardiac involvement, such as ventricular dysfunctions, involvement of coronary arteries, and atrioventricular blocks. Arrhythmias and thrombosis were reported in 15/201 (7.5%) and 2/201 (3.0%) neonates, respectively. All neonates, except one, required critical care; 64/160 (40.0%) required inotropic support and 105/187 (56.1%) required respiratory support, of whom 59/105 (56.2%) were specified to require intubation. The mortality rate was 5.0% (10/201).Discussion/ConclusionMIS-N should be considered in ill neonates presenting with involvement of two or more organ systems, especially among those neonates with cardiorespiratory dysfunctions, in the presence of proven or suspected maternal COVID-19 infection during pregnancy.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278717, PROSPERO, identifier CRD42021278717.

The production of new pavements involving recycled asphalt pavement (RAP) is beneficial for preserving petroleum asphalt and natural aggregates. However, increasing the RAP content raises performance concerns in new pavement, thus necessitating the use of rejuvenators. This research examined the potential of using petroleum sludge (PS) as a rejuvenator for RAP recycling. Gas chromatography-mass spectrometry (GCMS) detected the PS hydrocarbons involved in rejuvenation. The dynamic shear rheometer (DSR) provided the rheological data of rejuvenated binders. The rheological data were subsequently processed using response surface methodology (RSM) to develop rutting and fatigue models. RSM was also employed to model the Marshall and volumetric properties of the asphalt mixture. Atomic force microscopy (AFM) of PS rejuvenated RAP binder revealed a new microstructure containing protrusions that resembled the morphology of lightweight bitumen fractions. These rejuvenating effects were attributed to lightweight hydrocarbons of PS, which supplement the maltenes fractions in aged asphalt. The multi-objective optimization provided the RAP and bitumen content of 90% and 4.79% to meet the required PWD specifications.

Emulsion systems are extensively used in the food processing sector and the use of natural emulsifiers like proteins for stabilizing emulsion has been in demand from consumers due to increased awareness about the consumption of healthy food. Numerous methods are available for the preparation of emulsion, but ultrasound got more attention among common methods owing to its economical and environment-friendly characteristics. The physical effects caused by to bursting of the cavity bubble, result in reduced droplet size, thus forming an emulsion with appreciable stability. Ultrasound ameliorates the emulsifying characteristics of natural emulsifiers like protein and improves the storage stability of the emulsion by positively boosting the rheological, emulsifying characteristics, improving zeta potential, and reducing average droplet size. The stability of protein-based emulsion is affected by environmental stresses hence conjugate of protein with polysaccharide showed good emulsifying characteristics. However, the data on the effect of ultrasound parameters on emulsifier properties is lacking and there is a need to develop a sonication device that can carry out large-scale emulsification operation. The review covers the principles and mechanisms of ultrasound-assisted formation of protein-based and protein-based conjugate emulsions. Further, the effect of ultrasound on various characteristics of protein-based emulsion is also explored. This review will provide concise data to the researchers to extend their experiments in the area of ultrasound emulsification which will help in commercializing the technology at the industrial scale.

In this study lead free methyl ammonium tin iodide MASnI3 perovskite solar cell was studied and optimized using SCAPS-1D simulator. Different potential materials were assessed to determine their suitability as HTLs and ETLs. Results revealed that among the investigated materials the combination of V2O5 as HTL and IGZO as ETL is most suitable for the performance of MASnI3 solar cell. In an attempt to find the most appropriate material for back contact for further enhancement in performance of solar cell, gold has been found to stand out as the best choice among the examined metals. The wavelength range of 400–900 nm of sun light corresponds to highest quantum efficiency which falls off rapidly beyond this range. Increase in defect density of active layer has been found to have detrimental influence on the performance of solar cell. Above the room temperature cell performance has been found to decline and optimized thickness of active layer has been found to be 0.6 µm at 300 K for which the maximum PCE (30.35%) has been observed. The optimized device Glass/ITO/IGZO/MASnI3/V2O5/Au shows Voc, Isc and FF values of 1.08 V, 33.48 mA/cm2 and 81.53% respectively.

Abstract Background Parent-reported experience measures are part of pediatric Quality of Care (QoC) assessments. However, existing measures were not developed for use across multiple healthcare settings or throughout the illness trajectory of seriously ill children. Formative work involving in-depth interviews with parents of children with serious illnesses generated 66 draft items describing key QoC processes. Our present aim is to develop a comprehensive parent-reported experience measure of QoC for children with serious illnesses and evaluate its content validity and feasibility. Methods For evaluating content validity, we conducted a three-round Delphi expert panel review with 24 multi-disciplinary experts. Next, we pre-tested the items and instructions with 12 parents via cognitive interviews to refine clarity and understandability. Finally, we pilot-tested the full measure with 30 parents using self-administered online surveys to finalize the structure and content. Results The Delphi expert panel review reached consensus on 68 items. Pre-testing with parents of seriously ill children led to consolidation of some items. Pilot-testing supported feasibility of the measure, resulting in a comprehensive measure comprising 56 process assessment items, categorized under ten subthemes and four themes: (1) Professional qualities of healthcare workers, (2) Supporting parent-caregivers, (3) Collaborative and holistic care, and (4) Efficient healthcare structures and standards. We named this measure the PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS). Conclusions PRECIOUS is the first comprehensive measure and has the potential to standardize assessment of QoC for seriously ill children from parental perspectives. PRECIOUS allows for QoC process evaluation across contexts (such as geographic location or care setting), different healthcare workers, and over the illness trajectory for children suffering from a range of serious illnesses.

The study of fluid dynamics in the context of flow across a rotating disk is highly important since it has extensive applications in multiple industries, as well as in engineering and scientific fields. The objective of our current research is to investigate the heat transfer in the vicinity of a Stagnation Point of a Maxwell nanofluid flow passing over a porous rotating disk. A rotating disc is a phenomenon where a circular arc is formed at every point on the disc as it rotates uniformly around an axis. The shear stress at the interface between the disc and the spinning fluid provides information about the amount of power required to overcome friction and move the disc and the heat transfer is influenced by the alterations in the flow field inside the region. The heat and mass movement are studied in the context of a chemical process. Firstly, convert the PDEs into ODEs, suitable self-similarity transformation is used. After applying transformations, for graphical purpose we have used the Bvp4c technique. A variety of graphs (2D, Contour, vector plots, and Stream lines) and tables depict the impact of active parameters on the fluid's capacity to transfer significance. Velocity outline decreases for the greater values of the Deborah number values. The temperature profile improved with an improvement in the Nb parameter, while the opposite trend we noticed on ϕ(ζ). The findings of this study will have advantages in various fields, including transportation operations, architectural design systems, increased oil recovery systems, and medicinal applications that utilize nanofluids.

Abstract Aneurysmal subarachnoid haemorrhage (aSAH) presents a challenge to clinicians because of its multisystem effects. Advancements in computed tomography (CT), endovascular treatments, and neurocritical care have contributed to declining mortality rates. The critical care of aSAH prioritises cerebral perfusion, early aneurysm securement, and the prevention of secondary brain injury and systemic complications. Early interventions to mitigate cardiopulmonary complications, dyselectrolytemia and treatment of culprit aneurysm require a multidisciplinary approach. Standardised neurological assessments, transcranial doppler (TCD), and advanced imaging, along with hypertensive and invasive therapies, are vital in reducing delayed cerebral ischemia and poor outcomes. Health care disparities, particularly in the resource allocation for SAH treatment, affect outcomes significantly, with telemedicine and novel technologies proposed to address this health inequalities. This article underscores the necessity for comprehensive multidisciplinary care and the urgent need for large-scale studies to validate standardised treatment protocols for improved SAH outcomes.

Abstract This article systematically reviews the pedagogies employed in mixed-ability high school biology classrooms to spotlight the most effective educational model, in terms of learning gains. A meta-analysis was performed on 32 eligible studies sorted via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The effect sizes (impacts) were calculated in terms of students’ affective, behavioral, and cognitive gains. The results confirmed that the overall effectiveness of non-traditional models was highly significant when compared to traditional lecture models (p

E-learning has established itself as a new alternative to conventional learning styles to accomplish the goal of education and learning for everyone. The classroom learning style is based on a “one size fits all” approach because, in a typical classroom environment, an instructor has to deal with several students at the same time. A similar problem goes along with the traditional learning management systems in which every student must learn the course devised by the instructor, within a specific timeline and achieve specific objectives, despite students’ preferences and capabilities. The recent global pandemic has pushed educational institutes worldwide to recourse to an “online-only” mode of education and teaching delivery which has raised many challenges that need to be addressed. The existing e-learning systems fail to fulfill the expectations of a learner or an instructor in certain ways including the style of content delivery, mode of teaching, an adaptation of learner style that doesn’t match with the teaching style, the content type, and above all the e-learning lacks to provide the e-mentoring capability to deal with the challenges a learner and an instructor’s face during the learning process. This research aims to develop personalized learning by incorporating an intelligent e-mentor. The proposed e-mentor-based learning model is capable of customizing a course for individuals by automatically adapting it to their unique learning styles, preferences, abilities, existing knowledge, and expectations from the course. The outcome of the proposed model shows that e-mentoring not only increased learner satisfaction but also enhanced the learning process making it a preferred choice.

The adoption of cloud computing has become increasingly widespread across various domains. However, the inherent security vulnerabilities of cloud computing pose significant risks to its overall safety. Consequently, intrusion detection systems (IDS) play a pivotal role in identifying malicious activities within a cloud system. The considerable volume of network traffic data may contain redundant and irrelevant features that can impact the classification performance of the classifier. In addition, the complexity and time consumption increase while processing such a substantial volume of data in the cloud intrusion detection process. To enhance the performance of the IDS, this study proposes a hybrid feature selection approach, combining two bio-inspired algorithms, namely the grasshopper optimization algorithm (GOA) and the genetic algorithm (GA). The combination of these two algorithms ensures a more efficient search for optimal solutions. A random forest (RF) classifier is trained using those optimal features. Moreover, the proposal addresses the challenge of imbalanced data by employing a hybrid approach: over-sampling the minority classes using an adaptive synthetic (ADASYN) algorithm, while implementing random under-sampling (RUS) for the majority class as needed. This integrated strategy significantly influences each category, enhancing the true positive rate (TPR) while minimizing the false positive rate (FPR), thus improving the overall system performance. The proposed approach was evaluated using three datasets: UNSW-NB15, CIC-DDoS2019, and CIC Bell DNS EXF 2021. The recorded accuracies for these datasets were 98%, 99%, and 92%, respectively. The hybrid feature selection-based IDS demonstrated superior performance in multi-class classification, along with exemplary results for individual classes within the datasets. The proposed strategy exhibited a marked superiority with the random forest classifier, especially when compared to other classifiers including SVM, LR, FLN, LSTM, AlexNet, DNN, DBN, DT, and XGBoost. Moreover, this performance remained consistent and commendable even when benchmarked against contemporary state-of-the-art methodologies across multiple evaluation metrics.

Abstract Water stress is an important factor that substantially impacts crop production. As a result, there is a need for various strategies that can mitigate these negative effects. One such strategy is the application of potassium humate (Kh) and cobalt (Co), which have been reported to enhance the resistance of crop plants. Therefore, the present experiment was designed to investigate whether the application of Kh and Co could positively affect proline, chlorophyll and mineral elements contents, and antioxidant defense systems which in turn will mitigate the negative impact of water stress under different irrigation strategies. In 2021 and 2022, an open-field experiments were conducted by using a split-plot design. The main plots were divided to represent different irrigation strategies (ST), with additional control of full irrigation requirements (ST1). Four STs were implemented, with ST1, followed by the application of 75%, 50%, and 25% irrigation strategies in ST2, ST3, and ST4 respectively, in the next irrigation, followed by the full requirements, and so on. In the subplots, peanut plants were treated with tap water (Control), Kh at 2 g l−1 and 3 g l−1, Co, Co + Kh 2 g l−1 and Co + Kh 3 g l−1. The yield was negatively affected by the implementation of ST4, despite the increase in proline contents. Furthermore, there was a decrease in relative water content, chlorophyll content, antioxidant enzymes, protein, and mineral nutrient elements. However, the application of Kh or Co showed better improvements in most of the studied parameters. It is worth noting that there was an antagonistic relationship between Co and iron/manganese, and the intensity of this relationship was found to depend on the STs implemented. The highest mineral nutrient accumulation, chlorophyll content, relative water content, protein content, oil content, seed yield, and water productivity were observed when peanut plants were treated with Kh 3 g l−1 + Co under the ST2 water strategy.

This study examines the complex dynamics of an incompressible, electrically conducting third-grade fluid (TGF) flow through a vertical micro-channel that is filled with porous media. The research utilizes asymmetrical convective cooling, a transverse magnetic field, and exothermic reactions to introduce a comprehensive model. The viscosity of the fluid, which is determined by the Naham-type law, changes significantly with temperature. Additionally, the convective heat transfer rates, which govern the asymmetric convective cooling at the surfaces of the micro-channel, are modeled using Newton's law of cooling, and Modified Darcy law is used to address the porous medium effect. To solve the complex system of nonlinear partial differential equations, we employ computational solutions derived from reliable and efficient finite difference methods (FDM). The method is tested for different time-steps and mesh sizes and it is found that the algorithms reliably produce the same results. Our investigation includes an evaluation of both spatial and temporal convergence of the FDM scheme. The study present qualitative discussions of graphical results, that highlight the impact of various flow parameters integrated into the system. The velocity and temperature profiles increases for higher values of thermal Grashoff number Gr and Reynolds number Re while opposite effect is noticed for increasing values of Hartman number M.

Objective: The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. Methods: This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. Results: A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. Conclusion: After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. Innovation: The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

Polystyrene microplastics (PS-MPs) are raising global concerns as they have tendency to induce adverse effects on organisms. Herbacetin (HBN) is a natural flavone that shows diverse biological activities. Therefore, the current study was designed to evaluate the curative role of HBN against PS-MPs provoked hepatic damage. Forty-eight rats were divided into 4 groups, control, PS-MPs-intoxicated (0.01 mg/kg), PS-MPs + HBN co-treated (0.01 mg/kg + 40 mg/kg) and HBN only treated (40 mg/kg) group. The experiment was conducted for 30 days. PS-MPs administration reduced the expressions of Nrf-2 as well as anti-oxidants genes and increased Keap-1 expression. It also lessened the activities of superoxide dismutase (SOD), glutathione reductase (GSR), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST) and heme oxygenase-1 (HO-1) and glutathione (GSH) level, while elevating the levels of MDA and ROS. Additionally, PS-MPs exposure augmented the levels of alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine transaminase (ALT). Furthermore, there was an upsurge in the levels of inflammatory indices in PS-MPs treated group. PS-MPs also upregulated Caspase-3 and Bax expression whereas, decreased Bcl-2 expression. Nevertheless, HBN treatment recovered all the impairments due to its anti-apoptotic, anti-oxidant and anti-inflammatory and hepatoprotective nature. Therefore, it is deduced that HBN could be used as a potential therapeutic agent to counter PS-MPs induced hepatic toxicity.

The current research was planned to evaluate the ameliorative role of juglanin (Jug) against polyethylene microplastics (PEMP) prompted testicular impairments. 48 rats were allocated in 4 groups: control, PEMP exposed, Jug + PEMP co-administrated and Jug supplemented group. The activities of antioxidant enzyme, inflammatory markers level, hormonal level, the expressions of steroidogenic enzymes, pro-apoptotic and anti-apoptotic protein were assessed after the 56 days of the trial. PEMP intoxication significantly disturbed Nrf-2/Keap-1 pathway and the biochemical profile of rats. However, the administration of Jug markedly increased Nrf-2 and anti-oxidant enzymes expressions, besides decreased the Keap-1 expression. Jug administration also increased Catalase (CAT), super oxide dismutase (SOD) glutathione reductase (GPx), glutathione peroxidase (GSR) and Hemeoxygenase-1 (HO-1) activities. On the other hand, the levels of reactive oxygen species (ROS) and malondialdehyde (MDA) were decreased following Jug administration. Moreover, Jug administration decreased the levels of inflammatory markers. Additionally, Jug administration increased luteinizing hormone (LH), testosterone, follicle-stimulating hormone (FSH) levels and steroidogenic enzymes expression including 17β-hydroxysteroid dehydrogenase (17β-HSD), steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD) expressions. Jug administration decreased Caspase-3 and Bax expressions, while increasing Bcl-2 expression. Therefore, the current findings suggested that Jug can remarkably alleviate PEMP induced testicular damage due to its therapeutical potentials.

Polystyrene microplastics (PSMPs) are noxious environmental pollutants that pose a significant threat to vital body organs including the lungs. Robinetin (ROB) is a flavonoid which demonstrates various pharmacological potentials. This trial was designed to assess the protective ability of ROB to avert PSMPs provoked pulmonary toxicity in rats. Twenty-four rats were divided into four groups i.e., control, PSMPs (0.1 mg/kg), PSMPs (0.1 mg/kg) + ROB (30 mg/kg) and ROB (30 mg/kg) only supplemented group. PSMPs exposure led to a notable reduction in the activities of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione-S-transferase (GST), glutathione reductase (GSR) as well as GSH contents while causing a pronounced elevation in the concentration of MDA and ROS. Furthermore, PSMPs significantly augmented the levels of myeloperoxidase (MPO), macrophages, neutrophils, and lymphocytes in BALF. Moreover, the levels of IL-1β, TNF-α, NF-κB, IL-6 and COX-2 activities were increased following the PSMPs exposure. Nonetheless PSMPs remarkably decreased Bcl-2 levels, coupled with an escalation in Caspase-9, Caspase-3 and Bax levels. Despite this, severe histological alterations were observed in lungs tissues after PSMPs provision. Nevertheless, ROB provision markedly protected the lungs via regulating aforementioned dysregulations. This investigation validated the shielding strength of ROB to counteract PSMPs caused pulmonary toxicity.

In this paper, Bi2ZnxSe3-x with compositions x = 0 and x = 0.25 were synthesized using the melt technique at 850˚C. The crystal structures and surface morphologies of both the samples were investigated with X-ray diffraction (XRD), Raman spectroscopy and field emission scanning electron microscopy (FESEM), respectively. XRD spectra of both the bulk alloys of Bi2ZnxSe3-x (x = 0 and x = 0.25) revealed a polycrystalline nature with a hexagonal structure. UV-Vis absorbance spectra have shown that Zn doping increases the optical band gap while decreasing the absorbance edge. The activation energy (Ea) as calculated using Arrhenius plot revealed that Zn doping in place of Se results in a decrease in Ea. The variation in resistance with temperature highlights the prevalence of phonon-phonon and electron-phonon scattering as the dominant mechanisms. Topological insulators, due to their ability to suppress intrinsic electron backscattering, are viable recommendations for use as counter electrode materials in photovoltaic cells. This approach is poised to create a novel pathway for the future commercialization of flexible photovoltaic applications.

Objectives: The study aimed to assess the outcome of open circumferential soft tissue degloving injuries of lower limbs using a staged protocol by utilizing the stored skin graft harvested from degloved skin flaps. Materials and Methods: This retrospective study included 12 patients with open circumferential lower limb degloving injuries (Arnez types 3 and 4), with a minimum final, follow-up of two years. All the patients were treated using a staged protocol which included harvesting skin graft from the degloved skin followed by refrigerator storage of the graft and stay sutures for the flap. The refrigerator-stored graft was then used to cover the raw areas left after secondary debridement. Results: The mean area of the wound per patient that required skin grafting in the present study was 1082.9±679 cm2 and the mean area of the wound covered by refrigerator-preserved, meshed skin graft per patient was 798.75±350 cm2. One patient needed a latissimus dorsi flap and three patients with whole limb degloving had to undergo skin grafting for the remnant raw area which was harvested from the contralateral thigh. None of the patients landed up with amputation. All the patients had complete graft uptake and healing at the final follow-up. All the patients were satisfied with the final functional outcome and were able to return to their pre-injury working status. The mean hospital stay per patient in the present study was 15.16±4.9 days. Conclusion: Despite being rare, open STDIs are very complex injuries with no definitive guidelines for management, especially Arnez type 3 and 4 injuries. The staged protocol presented in the present series provides a potential answer to the dilemma. However, larger multi-centric trials are needed to compare the various methods of treatment and the outcomes thereof.

Summary: Environmental enteric dysfunction (EED) is a subclinical enteropathy challenging to diagnose due to an overlap of tissue features with other inflammatory enteropathies. EED subjects (n = 52) from Pakistan, controls (n = 25), and a validation EED cohort (n = 30) from Zambia were used to develop a machine-learning-based image analysis classification model. We extracted histologic feature representations from the Pakistan EED model and correlated them to transcriptomics and clinical biomarkers. In-silico metabolic network modeling was used to characterize alterations in metabolic flux between EED and controls and validated using untargeted lipidomics. Genes encoding beta-ureidopropionase, CYP4F3, and epoxide hydrolase 1 correlated to numerous tissue feature representations. Fatty acid and glycerophospholipid metabolism-related reactions showed altered flux. Increased phosphatidylcholine, lysophosphatidylcholine (LPC), and ether-linked LPCs, and decreased ester-linked LPCs were observed in the duodenal lipidome of Pakistan EED subjects, while plasma levels of glycine-conjugated bile acids were significantly increased. Together, these findings elucidate a multi-omic signature of EED.

ABSTRACT Environmental enteric dysfunction (EED) is a subclinical syndrome of altered small intestinal function postulated to be an important contributor to childhood undernutrition. The role of small intestinal bacterial communities in the pathophysiology of EED is poorly defined due to a paucity of studies where there has been a direct collection of small intestinal samples from undernourished children. Sixty-three members of a Pakistani cohort identified as being acutely malnourished between 3 and 6 months of age and whose wasting (weight-for-length Z-score [WLZ]) failed to improve after a 2-month nutritional intervention underwent esophagogastroduodenoscopy (EGD). Paired duodenal luminal aspirates and duodenal mucosal biopsies were obtained from 43 children. Duodenal microbiota composition was characterized by sequencing bacterial 16S rRNA gene amplicons. Levels of bacterial taxa (amplicon sequence variants [ASVs]) were referenced to anthropometric indices, histopathologic severity in biopsies, expression of selected genes in the duodenal mucosa, and fecal levels of an immunoinflammatory biomarker (lipocalin-2). A “core” group of eight bacterial ASVs was present in the duodenal samples of 69% of participants. Streptococcus anginosus was the most prevalent, followed by Streptococcus sp., Gemella haemolysans, Streptococcus australis, Granulicatella elegans, Granulicatella adiacens, and Abiotrophia defectiva. At the time of EGD, none of the core taxa were significantly correlated with WLZ. Statistically significant correlations were documented between the abundances of Granulicatella elegans and Granulicatella adiacens and the expression of duodenal mucosal genes involved in immune responses (dual oxidase maturation factor 2, serum amyloid A, and granzyme H). These results suggest that a potential role for members of the oral microbiota in pathogenesis, notably Streptococcus, Gemella, and Granulicatella species, warrants further investigation.IMPORTANCEUndernutrition among women and children is a pressing global health problem. Environmental enteric dysfunction (EED) is a disease of the small intestine (SI) associated with impaired gut mucosal barrier function and reduced capacity for nutrient absorption. The cause of EED is ill-defined. One emerging hypothesis is that alterations in the SI microbiota contribute to EED. We performed a culture-independent analysis of the SI microbiota of a cohort of Pakistani children with undernutrition who had failed a standard nutritional intervention, underwent upper gastrointestinal tract endoscopy, and had histologic evidence of EED in their duodenal mucosal biopsies. The results revealed a shared group of bacterial taxa in their duodenums whose absolute abundances were correlated with levels of the expression of genes in the duodenal mucosa that are involved in inflammatory responses. A number of these bacterial taxa are more typically found in the oral microbiota, a finding that has potential physiologic and therapeutic implications.

Artificial intelligence (AI) education in K–12 schools is a global initiative, yet planning and executing AI education is challenging. The major frameworks are focused on identifying content and technical knowledge (AI literacy). Most of the current definitions of AI literacy for a non-technical audience are developed from an engineering perspective and may not be appropriate for K–12 education. Teacher perspectives are essential to making sense of this initiative. Literacy is about knowing (knowledge, what skills); competency is about applying the knowledge in a beneficial way (confidence, how well). They are strongly related. This study goes beyond knowledge (AI literacy), and its two main goals are to (i) define AI literacy and competency by adding the aspects of confidence and self-reflective mindsets, and (ii) propose a more comprehensive framework for K–12 AI education. These definitions are needed for this emerging and disruptive technology (e.g., ChatGPT and Sora, generative AI). We used the definitions and the basic curriculum design approaches as the analytical framework and teacher perspectives. Participants included 30 experienced AI teachers from 15 middle schools. We employed an iterative co-design cycle to discuss and revise the framework throughout four cycles. The definition of AI competency has five abilities that take confidence into account, and the proposed framework comprises five key components: technology, impact, ethics, collaboration, and self-reflection. We also identify five effective learning experiences to foster abilities and confidences, and suggest five future research directions: prompt engineering, data literacy, algorithmic literacy, self-reflective mindset, and empirical research.

Background: The prevalence of verbal and physical violence against healthcare workers (HCWs) is reportedly high in Bangladesh. We aimed to determine the prevalence and risk factors associated with violence against HCWs in Bangladesh. Methods: This cross-sectional study was done in May-June 2021 among 378 physicians and nurses working in 19 randomly selected rural government health facilities. A self-administered validated Bangla version of the WHOQOL-BREF questionnaire on workplace violence (WPV) and the quality of life (QoL) was used. Multiple logistic regression analyses were done to find out the independent risk factors of WPV. Results: The prevalence of overall WPV was about 48.0% (psychological 46.6%, physical 5.0%, and sexual harassment 1.9%). However, the WPV reporting rate was very low (27.8%). Being a male (aOR= 2.18; 95% confidence interval: 1.22−3.90) and a physician (aOR = 2.93; 95% CI: 1.56−5.52) had increased the likelihood of experiencing WPV. HCWs who were encouraged to report WPV were less likely to experience WPV (aOR = 0.36; 95% CI: 0.18−0.70). Study participants exposed to WPV had sig-nificantly lower QoL (P