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Ageing is associated with an increased risk of adverse drug reactions. This calls for great care and diligent follow up when prescribing medication to older patients. Yet, this is seldom the case and the proportion of older people taking five or more medications has quadrupled from 12% to 49% in the last 20 years. Certain medications are riskier than others. Those with anticholinergic effects are of particular concern. Adverse effects of anticholinergics include dry mouth, nausea, dizziness, fatigue, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment, such as confusion and agitation. Anticholinergic medication can cause daytime drowsiness and cognitive decline, while increasing the risk of fall and can lead to increased mortality. Although anticholinergic medication should be avoided in older people whenever possible, their use has almost doubled in the last 20 years, and those who are most vulnerable to its adverse effects had the greatest increase in use. This article examines why older people are at increased risk of adverse drug reactions and how medication review can enable older persons to take medications regularly, improve quality of life and minimise medication waste. [ABSTRACT FROM AUTHOR]

Urban regeneration practices create an opportunity to make many different improvements in cities along with earthquake safety. Building renewal at parcel scale, which is seen as a type of urban regeneration practices in Turkey, has an impact on a wide area throughout the city due to the large number of individual projects. The concept of sustainability gains importance in the construction sector, especially because of the high energy, material and water consumption of buildings, and the large share of buildings in waste generation and greenhouse gas emissions. Implementation of urban regeneration practices by using methods that are suitable for local conditions, created in line with legal requirements and providing environmental, economic and social sustainability principles are considered necessary in terms of sustainability in the built environment. The aim of the study is to develop a decision model for the design process of residential building renewal that complies with the conditions of parcel-scale building renewal practices in Turkey, covers the three components of sustainability, and provides sustainability cost-effectively by evaluating the cost. In this context, firstly, an expert panel was formed with the Delphi technique, then an expert questionnaire was applied and a decision-making model was constructed with the analytical network process. The model setup created at the last stage of the study was tested with a case study. As a result of the case study, a design alternative that has a lower thermal permeability value than other alternatives, uses renewable energy, has low-impact materials, and has systems that reduce water use was determined as the most suitable alternative by the participants. [ABSTRACT FROM AUTHOR]

Methods: Web of Science, Cochrane library and PubMed were systematically searched up to January 2024 to identify studies examining the impact of financial incentives on diabetes management in patients. Studies were evaluated based on the robustness of their methodology, participant numbers, and quality scores. The Cochrane risk-of-bias tool was applied for randomized controlled trials, while the Newcastle–Ottawa Scale was used for non-randomized controlled trials to assess study quality. Due to the heterogeneity of the included studies, a narrative synthesis approach was utilized. Results: In the study, we included 12 published research studies. Five studies investigated the influence of financial incentives on patient behavior, all demonstrating a significant positive impact on behaviors such as blood glucose monitoring, medication adherence, and physical activity. 10 studies analyzed the impact of financial incentives on HbA1c levels in diabetes patients. Among them, 5 studies reported that financial incentives could improve HbA1c levels through longitudinal historical comparisons. The other 5 studies did not find significant improvements compared to the control group. Three studies explored long-term effects, two studies targeting the adolescent population had no impact, and one study targeting adults had a positive impact. Conclusions: In summary, this review found that financial incentives can positively influence patient behavior and enhance compliance, but their impact on HbA1c levels is inconsistent. Financial incentives may help adult patients maintain behavior even after the withdrawal of incentives. [ABSTRACT FROM AUTHOR]

This study explores the development and implementation of Shadow, an advanced mobile social robot designed to meet specific functional requirements. Shadow is intended to serve both as a versatile tool and a human companion, assisting in various tasks across different environments. The construction emphasizes cost efficiency and high agility, utilizing 3D printing technology exclusively. The robot features omnidirectional kinematics and a flexible power electronics system, accommodating diverse energy needs with lithium batteries that ensure at least seven hours of autonomous operation. An integrated sensor array continuously monitors the power system, tracks tilt and acceleration, and facilitates self-diagnostic functions. Rapid prototyping allows for swift iteration, testing, and refinement to align with project goals. This paper provides a comprehensive blueprint for designing cost-effective, highly agile robots using advanced manufacturing techniques. Extensive testing, including stability and sensory skills evaluations, demonstrates Shadow's adherence to its design objectives. Shadow has advanced from technology readiness level (TRL) 2 to TRL 7 within a year and is currently undergoing trials with advanced functionalities, offering significant insights into overcoming practical design challenges and optimizing robot functionality. [ABSTRACT FROM AUTHOR]

Objective of this randomized, controlled, multi-site clinical trial was to compare long-term safety and efficacy of mPNS in patients with chronic, intractable, post-traumatic or post-surgical neuropathic pain to comprehensive Conventional Medical Management (CMM). Methods: A total of 65 patients with post-traumatic, post-surgical neuropathy were treated within a multicenter, randomized, clinical trial comparing the safety and effectiveness of mPNS + CMM to CMM alone. Patients were randomized 1:1 and followed through 90 days. The primary endpoint is a proportion of responders, 50% or greater reduction in pain at Day 90. The secondary endpoints included the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) and Patient Global Impression of Change (PGIC). Results: At 3 months, 71% of subjects were considered responders (> 50% pain relief) in the mPNS + CMM group vs 13% of subjects in the CMM group. The mPNS + CMM group had a mean reduction in VAS scores at Day 90 of 3.8 points (> 50% reduction), while CMM showed less than a 1-point (0.7 point) mean reduction or ~10% reduction (p < 0.0001). The EQ-5D-3L score increased in the mPNS + CMM study group, whereas the CMM group showed no improvement in EQ-5D-3L at Day 90. PGIC responder rates were 80.6% and 4.3% at Day 90 for mPNS + CMM and CMM groups, respectively. Conclusion: mPNS + CMM was superior to CMM in a randomized prospective study when used for treatment of post-traumatic, post-surgical neuropathy. Due to the lack of other effective non-invasive treatments for neuropathic pain, mPNS should be considered much earlier in the treatment algorithm. [ABSTRACT FROM AUTHOR]

Abstract Methods Web of Science, Cochrane library and PubMed were systematically searched up to January 2024 to identify studies examining the impact of financial incentives on diabetes management in patients. Studies were evaluated based on the robustness of their methodology, participant numbers, and quality scores. The Cochrane risk-of-bias tool was applied for randomized controlled trials, while the Newcastle–Ottawa Scale was used for non-randomized controlled trials to assess study quality. Due to the heterogeneity of the included studies, a narrative synthesis approach was utilized. Results In the study, we included 12 published research studies. Five studies investigated the influence of financial incentives on patient behavior, all demonstrating a significant positive impact on behaviors such as blood glucose monitoring, medication adherence, and physical activity. 10 studies analyzed the impact of financial incentives on HbA1c levels in diabetes patients. Among them, 5 studies reported that financial incentives could improve HbA1c levels through longitudinal historical comparisons. The other 5 studies did not find significant improvements compared to the control group. Three studies explored long-term effects, two studies targeting the adolescent population had no impact, and one study targeting adults had a positive impact. Conclusions In summary, this review found that financial incentives can positively influence patient behavior and enhance compliance, but their impact on HbA1c levels is inconsistent. Financial incentives may help adult patients maintain behavior even after the withdrawal of incentives.

Background: The diagnosis and treatment monitoring of hepatitis C is quite challenging. The screening test, i.e. antibody assay, is unable to detect acute cases, while the gold standard hepatitis C virus (HCV) reverse transcriptase polymerase chain reaction (RTPCR) assay is not feasible in resource-limited countries such as India due to high cost and infrastructure requirement. European Association for the Study of the Liver and World Health Organization have approved a new marker, i.e. HCV core antigen (HCVcAg) assay, as an alternative to molecular assay. In this study, we have evaluated HCVcAg assay for diagnosis and treatment monitoring follow-up in Indian population infected with hepatitis C. Methods: Blood specimen of 90 clinically suspected cases of acute hepatitis C were tested simultaneously for anti-HCV antibody assay via ELISA (enzyme-linked immunoassay), HCVcAg assay by chemiluminescence immune assay (CLIA) and HCV RTPCR VL (viral load) assay. Thirty-four HCV RTPCR positive patients were further enrolled in treatment monitoring group whose blood samples were tested at the beginning of treatment, two weeks, four weeks and 12 weeks via HCV core Ag assay and HCV RTPCR Viral Load assay. Results: Considering HCV RTPCR as gold standard, diagnostic performance of HCV core Ag assay and anti-HCV antibody assay was evaluated. The sensitivity and specificity of HCV core Ag assay were higher than that of anti-HCV Antibody assay, i.e. 88.3% and 100% vs. 23.3% and 83.3%, respectively. The overall diagnostic accuracy of HCV core Ag assay was 92.20%. Among treatment follow-up group, HCV core Ag levels correlated well with HCV viral load levels, at the beginning of treatment (baseline) till 12 weeks showing highly significant Spearman rank correlation coefficient of > 0.9 with HCV viral load levels. Conclusions: HCV core Ag assay is a cost-effective, practically feasible substitute of HCV RTPCR viral load assay for diagnosis as well as long duration treatment monitoring of hepatitis C infection in resource-limited settings. [ABSTRACT FROM AUTHOR]

Microservices are containerized, loosely coupled, interactive smaller units of the application that can be deployed, reused, and maintained independently. In a microservices-based application, allocating the right computing resources for each containerized microservice is important to meet the specific performance requirements while minimizing the infrastructure cost. Microservices-based applications are easy to scale automatically based on incoming workload and resource demand automatically. However, it is challenging to identify the right amount of resources for containers hosting microservices and then allocate them dynamically during the auto-scaling. Existing auto-scaling solutions for microservices focus on identifying the appropriate time and number of containers to be added/removed dynamically for an application. However, they do not address the issue of selecting the right amount of resources, such as CPU cores, for individual containers during each scaling event. This paper presents a novel approach to dynamically allocate the CPU resources to the containerized microservice during the autoscaling events. Our proposed approach is based on the machine learning method, which can identify the right amount of CPU resources for each container, dynamically spawning for the microservices over time to satisfy the application's response time requirements. The proposed solution is evaluated using a benchmark microservices-based application based on real-world workloads on the Kubernetes cluster. The experimental results show that the proposed solution outperforms by yielding a 40% to 60% reduction in violating the response time requirements with 0.5 × to 1.5 × less cost compared to the state-of-art baseline methods. [ABSTRACT FROM AUTHOR]

The present work is to promote the use of agricultural waste (sugarcane bagasse, banana fibers, and rice husk) in the creation of handcrafted paper. This work alters the manufacturing process by utilizing various cellulose ratios derived from different agricultural residues. Craft papers have been made with the use of a fairly straightforward and environmentally benign process known as the handmade technique, which includes these raw residues in various ratios. The physico-mechanical properties are measured for synthesized sheets with an appropriate basis weight (63-80 g/m²), thickness (20-300 m), burst strength (58.9-105.2 kPa), burst index (1.03-1.67 kPa m²/g), and bulk (1.06 - 3.12 cm³/g), respectively. It is demonstrated that the used ingredients are cost-effective and eco-friendly. In addition, it is found that the quality of the handmade paper sample composition formed with a blend of 20% rice husk, 30% sugarcane bagasse, and 50% banana fiber, is relatively high. This study demonstrates that agricultural waste can provide viable alternatives for the industries that produce handmade paper. [ABSTRACT FROM AUTHOR]

Hypoglycemia in the pediatric population tends to present in the newborn period or during metabolic crisis triggered by prolonged fasting and intercurrent illness. Current recommendations to investigate all children presenting with hypoglycemia for the first time are cumbersome and costly but necessary to identify those with serious conditions who predispose to hypoglycemia. We describe a practical and cost-effective method of evaluating children who present to the emergency department with previously undiagnosed hypoglycemia. Glucose and point-of-care (POC) beta-hydroxybutyrate levels should be measured on all children with a low screening POC glucose level, and a full history and physical examination will identify those requiring further investigation. This approach is suggested to identify patients with serious and life-threatening disease with the same fidelity as the currently recommended approach of performing a critical sample on all children with hypoglycemia. Our streamlined approach will reduce the cost to approximately 10% of the current approach per patient diagnosed with a serious underlying disease. Further, children without underlying hypoglycemia-predisposing disorders will be identified and discharged without unnecessary intervention. [ABSTRACT FROM AUTHOR]

The article discusses the promising synergy between MXenes and polymers in developing advanced nanocomposites with diverse applications in biomedicine domains. MXenes, possessing exceptional properties, are integrated into polymer matrices through various synthesis and fabrication methods. These nanocomposites find applications in drug delivery, imaging, diagnostics, and environmental remediation. They offer improved therapeutic efficacy and reduced side effects in drug delivery, enhanced sensitivity and specificity in imaging and diagnostics, and effectiveness in water purification and pollutant removal. The perspective also addresses challenges like biocompatibility and toxicity, while suggesting future research directions. In totality, it highlights the transformative potential of MXenes-polymer nanocomposites in addressing critical issues across various fields. [ABSTRACT FROM AUTHOR]

Abstract Background Current clinical diagnosis pathway for lysosomal storage disorders (LSDs) involves sequential biochemical enzymatic tests followed by DNA sequencing, which is iterative, has low diagnostic yield and is costly due to overlapping clinical presentations. Here, we describe a novel low-cost and high-throughput sequencing assay using single-molecule molecular inversion probes (smMIPs) to screen for causative single nucleotide variants (SNVs) and copy number variants (CNVs) in genes associated with 29 common LSDs in India. Results 903 smMIPs were designed to target exon and exon–intron boundaries of targeted genes (n = 23; 53.7 kb of the human genome) and were equimolarly pooled to create a sequencing library. After extensive validation in a cohort of 50 patients, we screened 300 patients with either biochemical diagnosis (n = 187) or clinical suspicion (n = 113) of LSDs. A diagnostic yield of 83.4% was observed in patients with prior biochemical diagnosis of LSD. Furthermore, diagnostic yield of 73.9% (n = 54/73) was observed in patients with high clinical suspicion of LSD in contrast with 2.4% (n = 1/40) in patients with low clinical suspicion of LSD. In addition to detecting SNVs, the assay could detect single and multi-exon copy number variants with high confidence. Critically, Niemann-Pick disease type C and neuronal ceroid lipofuscinosis-6 diseases for which biochemical testing is unavailable, could be diagnosed using our assay. Lastly, we observed a non-inferior performance of the assay in DNA extracted from dried blood spots in comparison with whole blood. Conclusion We developed a flexible and scalable assay to reliably detect genetic causes of 29 common LSDs in India. The assay consolidates the detection of multiple variant types in multiple sample types while having improved diagnostic yield at same or lower cost compared to current clinical paradigm.

Background: Current clinical diagnosis pathway for lysosomal storage disorders (LSDs) involves sequential biochemical enzymatic tests followed by DNA sequencing, which is iterative, has low diagnostic yield and is costly due to overlapping clinical presentations. Here, we describe a novel low-cost and high-throughput sequencing assay using single-molecule molecular inversion probes (smMIPs) to screen for causative single nucleotide variants (SNVs) and copy number variants (CNVs) in genes associated with 29 common LSDs in India. Results: 903 smMIPs were designed to target exon and exon–intron boundaries of targeted genes (n = 23; 53.7 kb of the human genome) and were equimolarly pooled to create a sequencing library. After extensive validation in a cohort of 50 patients, we screened 300 patients with either biochemical diagnosis (n = 187) or clinical suspicion (n = 113) of LSDs. A diagnostic yield of 83.4% was observed in patients with prior biochemical diagnosis of LSD. Furthermore, diagnostic yield of 73.9% (n = 54/73) was observed in patients with high clinical suspicion of LSD in contrast with 2.4% (n = 1/40) in patients with low clinical suspicion of LSD. In addition to detecting SNVs, the assay could detect single and multi-exon copy number variants with high confidence. Critically, Niemann-Pick disease type C and neuronal ceroid lipofuscinosis-6 diseases for which biochemical testing is unavailable, could be diagnosed using our assay. Lastly, we observed a non-inferior performance of the assay in DNA extracted from dried blood spots in comparison with whole blood. Conclusion: We developed a flexible and scalable assay to reliably detect genetic causes of 29 common LSDs in India. The assay consolidates the detection of multiple variant types in multiple sample types while having improved diagnostic yield at same or lower cost compared to current clinical paradigm. [ABSTRACT FROM AUTHOR]

Background: Autoimmune encephalitis (AIE) has been ranked as the third most common cause of encephalitis after viral encephalitis and acute disseminated encephalomyelitis. The estimated incidence is 5-8 cases per 100,000 population. The objective of this study was to develop a costeffective test for detection of anti NMDA R antibodies by using in house prepared rodent brain tissue sections which could facilitate timely diagnosis and management of anti NMDA R Encephalitis, which if left undiagnosed may prove fatal. Methods: A total of 500 samples sent for autoimmune encephalitis related antibody testing were included in this cross-sectional study from April 2019 to March 2021 at department of Immunology, Shifa International Hospital (SIH), Islamabad. Rodent brain was dissected to prepare tissue sections on which samples were tested by Indirect Immunofluorescence. Simultaneously samples were tested on cell-based assay (CBA) which is gold standard for testing anti NMDA R antibodies. Sensitivity, specificity, positive and negative predictive values were calculated. Results: Median age of patients who tested positive for anti NMDA encephalitis was 19 years (range: 1 to 57). Out these 76% were female and 24% males. 5% patients tested positive for anti NMDA antibodies out of those suspected to be suffering from autoimmune encephalitis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of rodent brain IF for anti-NMDR antibodies taking CBA as gold standard was 92.6%, 98.5%, 78.1% and 99.6% respectively. The accuracy of the procedure was 98.2%. Conclusion: Indirect immunofluorescence (IF) on rodent brain tissue sections can be useful as a cost-effective alternate for resource constrained laboratories for timely detection of anti NMDA R antibodies facilitating timely diagnosis and management of anti-NMDA receptor encephalitis patients. [ABSTRACT FROM AUTHOR]

: Have you ever been in the trenches of a complicated study only to be interrupted by a not-so urgent phone-call? We were, repeatedly– unfortunately. : To increase productivity of radiologists by quantifying the main source of interruptions (phone-calls) to the workflow of radiologists, and too assess the implemented solution. : To filter calls to the radiology consultant on duty, we introduced an automatic voicemail and custom call redirection system. Thus, instead of directly speaking with radiology consultants, clinicians were to first categorize their request and dial accordingly: 1. Inpatient requests, 2. Outpatient requests, 3. Directly speak with the consultant radiologist. Inpatient requests (1) and outpatient requests (2) were forwarded to MRI technologists or clerks, respectively. Calls were monitored in 15-minute increments continuously for an entire year (March 2022 until and including March 2023). Subsequently, both the frequency and category of requests were assessed. : 4803 calls were recorded in total: 3122 (65 %) were forwarded to a radiologist on duty. 870 (18.11 %) concerned inpatients, 274 (5.70 %) outpatients, 430 (8.95 %) dialed the wrong number, 107 (2.23 %) made no decision. Throughout the entire year the percentage of successfully avoided interruptions was relatively stable and fluctuated between low to high 30 % range (Mean per month 35 %, Median per month 34.45 %). : This is the first analysis of phone-call interruptions to consultant radiologists in an imaging department for 12 continuous months. More than 35 % of requests did not require the input of a specialist trained radiologist. Hence, installing an automated voicemail and custom call redirection system is a sustainable and simple solution to reduce phone-call interruptions by on average 35 % in radiology departments. This solution was well accepted by referring clinicians. The installation required a one-time investment of only 2h and did not cost any money. [ABSTRACT FROM AUTHOR]

Anthropogenic activities have led to a surge in the use of synthetic chemical compounds in agriculture, elevating environmental toxicity levels. As a response to this concern, there is a growing demand for environmentally friendly solutions. In recent times, the focus has shifted towards the development of cost-effective and ecologically sound organic products known as biostimulants. These innovative products play a pivotal role in enhancing agricultural productivity by fostering comprehensive plant growth and development. Biostimulants encompass a diverse range of natural and synthetic substances, categorized into microbial, non-microbial, and waste-derived sources. When judiciously applied to crops, these substances exhibit the remarkable ability to enhance plant metabolism, bolster productivity, and enhance resilience to adverse environmental conditions. Through modulation of molecular mechanisms and epigenetic alterations, biostimulants achieve this by influencing critical signalling molecules, transcription factors, and hormonal levels, which collectively contribute to stress tolerance. This review paper delves into the burgeoning industrial interest surrounding biostimulants. It sheds light on their intricate modes and mechanisms of action, encompassing both physiochemical and molecular aspects. Furthermore, the paper underscores the captivating potential of biostimulants to induce trans-generational plasticity and metabolite accumulation within plants, a phenomenon warranting deeper exploration through metabolomics. This review paper focusses on valuable insights into the transformative influence of biostimulants on agricultural practices, showcasing their capacity to usher in a new era of sustainable and resilient crop cultivation. [ABSTRACT FROM AUTHOR]

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The development of efficient energy management for nanogrid (NG) systems, while reducing both the carbon dioxide (CO2) emissions and power generation cost, is achievable through the effective utilization of available energy sources. This paper proposes a multi-objective optimal energy management strategy for grid-connected NG systems, which incorporates PV arrays and battery storage devices (BSDs), to reduce operating costs and CO2 emission simultaneously over a 24-hour scheduling period. This strategy, which is based on the improved pelican optimization algorithm (IPOA), involves the development of a multi-objective optimization (MOA) equation with several constraints, while taking into account the Malaysian grid purchasing and selling prices. An innovative IPOA-derived technique is developed to facilitate the NG’s optimal energy management operation in multi-objective situations. The proposed algorithm is tested on three distinct scenarios to affirm its efficacy. It is assumed that (a) power exchange between the NG and the main grid is limitless, (b) power interchange between the NG and main grid has a predetermined limit and (c) operating at the maximum capacity of PV array. In order to demonstrate the effectiveness of the proposed algorithm, The outcomes of the simulation are juxtaposed with results obtained from the initial Pelican Optimisation Algorithm (POA), the Bat Algorithm, and the Improved Differential Evolutionary (IDE) Algorithm. The simulation reveals that the suggested IPOA algorithm exhibited the most economical performance and the lowest CO2 emissions. Moreover, in the second scenario, operational costs decreased by 9.5%, and CO2 emissions were reduced by 15%. Conversely, in Scenario 3, there was a 2% decrease in cost and 23% reduction in CO2 emissions as against the first scenario.

Tension-free mesh repair is standard for inguinal hernia in high-income regions despite limitations like chronic pain and costs. This study assessed whether Desarda’s tissue-only repair can offer an affordable yet effective option. 250 inguinal hernia patients underwent Desarda repair during 2015-2020 at an Indian rural hospital. Outcomes like operative duration (mean 47.3 min), recovery (discharge by day 3), pain resolution (VAS declined from 3.8 to 0 over 6 months), return to work (median 6 days), complications (~4%) and recurrence (0% over 30 months) after Desarda repair matched or exceeded mesh repair standards. Our data establishes it as a simplified tension-free physiology-restoring hernia cure that can expand surgical capacity affordably. Guideline-based evaluation via implementation research is warranted before global use recommendations.

Background: The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. Methods: A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis. Results: A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56 GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. Conclusions: A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. We demonstrated that the implementation of a multimodal package of interventions for acute respiratory tract infections in general practice resulted in a reduction of prescriptions and were well received. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. [ABSTRACT FROM AUTHOR]

Background: The timely provision of test results to facilitate early access to treatment is an essential component of sexually transmissible infection (STI) control and contributes to a significant proportion of the workload at sexual health services. We aimed to estimate the time to deliver client results and treatment as well as the health system costs of the nurse-led urgent results management model at the Sydney Sexual Health Centre (SSHC) compared to an alternative 'ordering clinician' model. Methods: We conducted a retrospective analysis of urgent results managed by the results nurse over 2 weeks in 2019 and an observational study over 2 weeks in 2021, where 10 clinicians managed five of their own urgent results. Additional activity data were gathered to determine the annual health system costs for both models. Results: In the nurse-led model 211 of 280 clients required notification; 156 (73.9%) were notified on the day their results became available, and the median time to treatment (n = 137) was 1 day. The annual health system cost for the nurse-led model was A$3 922 143. In the ordering clinician model, 17 (42.5%) clients were notified on the same day, and of the 27 clients treated at SSHC, the median time to treatment increased to 4 days. The annual health system cost for the ordering clinician model was A$4 043 667.28 compared with the nurse-led model, and an additional 33.3 h per week of clinician time was required for the same level of service provision. Conclusions: This study highlights the strengths of the nurse-led results model at SSHC, demonstrating improved client outcomes for STI notification and treatment times and health systems savings. Pathology results management contributes to a significant proportion of the workload at sexual health services. This study estimates the client outcomes and costs of the existing nurse-led urgent results management model at the Sydney Sexual Health Centre compared to an ordering clinician model. The nurse-led model demonstrated improved time to notification and treatment and health system savings of 33 h of staff time per week and A$121 524 annually. Nurse-led models continue to provide value and effectiveness within sexual health services. [ABSTRACT FROM AUTHOR]

An innovative solar-powered tiffin warmer with built-in thermal storage is suggested in this research. Storing food for long periods of time is difficult in many areas of the world due to a lack of electricity, particularly in developing regions. People that depend on pre-packaged meals, such employees, students, and tourists, are especially affected by this problem. sun tiffin warmers, which use sun energy to keep food at a constant temperature, are one answer to this problem. An efficient heating element, thermal storage, a solar reflecting mirror, a phase change material (PCM), and a small, portable tiffin make up the system. In order to maintain a constant temperature regardless of the weather, the system makes use of thermal storage materials to store any surplus heat energy generated during the sun's peak hours. This creative method not only helps the environment by reducing our dependence on traditional energy sources, but it also offers a long-term solution for keeping food warm. The goal of this project is to provide a green, efficient, and cost-effective way to heat meals when traditional energy sources are unavailable. Solar tiffin warmers with thermal storage could help people in off-grid locations live better lives while also decreasing their environmental impact and boosting sustainability. [ABSTRACT FROM AUTHOR]

Owing to environmental and disease issues, the use of high-frequency chest wall oscillation (HFCWO) devices in hospitals is consistently increasing. This study proposes a cost-effective actuator-less HFCWO device that utilizes an external wall port utility in hospitals to generate the positive and negative pneumatic pressures required for HFCWO treatment instead of an embedded mechanical actuator. The manufactured prototype with the no-amplification (NO-AMP) setting contained an electric pressure regulator to enable intensity level adjustment and two solenoid valves to enable vibration frequency adjustment, whereas the prototype with the pre-amplification (PRE-AMP) setting contained an additional air reservoir and an air-pressure booster. The prototype device was tuned to output average local maximum values in the pressure waveform similar to a commercial VEST-205 device at an 8–12 Hz frequency and 2–4 pressure intensity levels. In vitro comparative experiments demonstrated that the prototype device showed similar local maximum pressures to those of the VEST-205 (mean absolute pressure difference, <3 mmH2O); in contrast, the proposed device showed significantly higher local minimum pressures than those of the VEST-205 (mean absolute pressure difference, >8 mmH2O). Additionally, the driving sound of the proposed device was 17.0–17.8 dB higher than that of VEST-205. We conclude that the proposed device has the potential to substitute for conventional HFCWO devices under the limited but most frequently used operating conditions, although more detailed modifications are necessary in future studies to improve its performance and clinical usability. [ABSTRACT FROM AUTHOR]

The effectiveness and cost of a public health intervention is dependent on complex human behaviors, yet health economic models typically make simplified assumptions about behavior, based on little theory or evidence. This paper reviews existing methods across disciplines for incorporating behavior within simulation models, to explore what methods could be used within health economic models and to highlight areas for further research. This may lead to better‐informed model predictions. The most promising methods identified which could be used to improve modeling of the causal pathways of behavior‐change interventions include econometric analyses, structural equation models, data mining and agent‐based modeling; the latter of which has the advantage of being able to incorporate the non‐linear, dynamic influences on behavior, including social and spatial networks. Twenty‐two studies were identified which quantify behavioral theories within simulation models. These studies highlight the importance of combining individual decision making and interactions with the environment and demonstrate the importance of social norms in determining behavior. However, there are many theoretical and practical limitations of quantifying behavioral theory. Further research is needed about the use of agent‐based models for health economic modeling, and the potential use of behavior maintenance theories and data mining. [ABSTRACT FROM AUTHOR]

The article discusses the promising synergy between MXenes and polymers in developing advanced nanocomposites with diverse applications in biomedicine domains. MXenes, possessing exceptional properties, are integrated into polymer matrices through various synthesis and fabrication methods. These nanocomposites find applications in drug delivery, imaging, diagnostics, and environmental remediation. They offer improved therapeutic efficacy and reduced side effects in drug delivery, enhanced sensitivity and specificity in imaging and diagnostics, and effectiveness in water purification and pollutant removal. The perspective also addresses challenges like biocompatibility and toxicity, while suggesting future research directions. In totality, it highlights the transformative potential of MXenes-polymer nanocomposites in addressing critical issues across various fields.

Background: The non-vitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphi-based consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). Methods: We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development. Results: Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options. Conclusion: The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major NOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management.

The quality control of road implementation on the rim and the strengthening of river edges to prevent road collapses need to be studied and developed continuously. In order to carry out maintenance in a cost-effective manner as much as possible, this research aims to provide a way to reach a better understanding of the quality control of riverbank roads. The study conducted an SWOT questionnaire, which is a means of discovering and evaluating the strengths, weaknesses, opportunities, and threats in the field of quality control of river bank roads, and it can help in identifying the optimal path to achieve specific goals and improve the quality of roads in these areas and determine the necessary steps to improve performance and quality in general. It also contributes to enhancing joint cooperation between the concerned parties. The type of questionnaire was closed and included two parts: the first part is the personal information of the respondents, and the second part is related to the subject of the study, which in turn includes four basic axes. It relates to the elements of the SWOT tool and includes questions ranging from 1 to 44. Sixty people from different academic levels in Iraq responded to the questionnaire, and the answers were according to a five-point Likert scale. The Statistical Package for Social Sciences version 26 was used for statistical analysis, and the statistical methods used in this study are Cronbach’s alpha test to measure reliability, validity of the test to measure the validity of the research tool, frequencies, and percentages, or what is known as relative frequencies, arithmetic mean, and standard deviation, relative importance index.

Marshall Bedder,1,2 Lisa Parker1 1Department of Surgery, Pain Medicine Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA, USA; 2Department of Psychiatry and Health Behavior, Addiction Medicine Service, Medical College of Georgia at Augusta University, Augusta, GA, USACorrespondence: Marshall Bedder, FRCPC Chief of Pain Medicine Service, Department of Surgery, Pain Medicine Service, Charlie Norwood Veterans Administration Medical Center, 950 15th Street, Augusta, GA, 30904 4C-125 USA, USA, Tel +1 706-733-0188 extension 33481, Fax +1-706-823-3983, Email marshall.bedder@va.govPurpose: To assess magnetic peripheral nerve stimulation (mPNS) for the treatment of chronic or chronic and intractable neuropathic pain with a retrospective review case series.Patients and methods: Twenty-four patients with predominantly neuropathic post-traumatic or postoperative pain were treated as per protocol and followed for 3 months.Results: Data were analyzed as an observational, one-armed, convenience sample. Graphical evidence backed up by a mixed model for repeated measures statistical analysis showed a highly significant reduction of pain at one month out from initial treatment with mPNS. At one month, there was a 3.8 average reduction in pre-pain scores using a visual analogue scale (VAS), and that relief was generally durable measured out to three months. Two-thirds of patients, deemed responders, showed an 87% reduction in pain. Opioid reduction was seen in 58.3% of responders as well.Conclusion: mPNS appears promising for the treatment of chronic or chronic and intractable neuropathic pain for many of the same indications as traditional electrical peripheral nerve stimulation (PNS). No invasive techniques or implants are needed for mPNS.Keywords: neuropathic pain, noninvasive, cost effective, pain relief, neuropathy

Rat intravenous self-administration is a widely-used animal model in the study of substance use disorders. Rats are tethered to a drug delivery system usually through a port or button that interfaces the drug delivery system with a chronic indwelling jugular vein catheter. These buttons can be purchased commercially but are costly, presenting a significant economic barrier for many researchers. Many researchers manufacture buttons in-house from a combination of individual custom made and commercially available components, resulting in large variation in terms of how the animals are handled and the longevity of catheter patency. We have developed a jugular catheter button that uses a split septum port to provide snap-on entry of a blunt cannula allowing for quick and easy attachment of the i.v. tubing. The port is constructed from commercially available split septum ports, surgical mesh and small metal cannula. The system is “needleless” which decreases the risk of infection and improves safety. The split-septum buttons are easily sterilized in-house adding to the reliability and decreases in the risk of infection. We have used this easily constructed, and inexpensive button for i.v. self-administration experiments in which 80 % of the rats maintained patency for a minimum of 35 days. • Inexpensive method to construct a self-administration backport button. • Utilizes inexpensive components already found in a research laboratory or commercially available. • Can be sterilized in-house without degrading glue or components.

Larvae of the mealworm beetle Tenebrio molitor is commonly used as feed for pets and food for humans due to its rich nutrient contents. The beetle breeds prolifically and are reared in close proximity with their diet; known as substrates. However, the most commonly used substrate, wheat bran, is expensive making the rearing out of reach to many, especially in developing countries. This study evaluated the suitability of six other potential substrates; wheat flour, maize flour, Lucerne pellets, dog food, soya four and oats in comparison to wheat bran in order to explore a cost-effective alternative rearing substrate for mealworms. To achieve this, the mealworms were reared in a climate-controlled chamber and the total numbers, weight and the fecundity were determined for each substrate. Wheat bran and wheat flour produced the most mealworms, had the highest fecundity with wheat bran, Lucerne pellets an oat producing heavier worms than all other substrates. Maize flour, wheat flour and Lucerne, were found to be the most cost-effective alternative substrates for rearing mealworms with the cost per gram at 0.07, 0.05 and 0.04 US$ respectively. Both wheat flour and maize flour are easily accessible, have a long self-life thus ideal for both large-and small-scale production. [ABSTRACT FROM AUTHOR]

Mesenchymal stromal cell (MSC)-derived products, such as trophic factors (MTFs), have anti-inflammatory properties that make them attractive for cell-free treatment. Three-dimensional (3D) culture can enhance these properties, and large-scale expansion using a bioreactor can reduce manufacturing costs. Three lots of MTFs were obtained from umbilical cord MSCs produced by either monolayer culture (Monol MTF) or using a 3D microcarrier in a spinner flask dynamic system (Bioreactor MTF). The resulting MTFs were tested and compared using anti-inflammatory potency assays in two different systems: (1) a phytohemagglutinin-activated peripheral blood mononuclear cell (PBMNC) system and (2) a lipopolysaccharide (LPS)-activated macrophage system. Cytokine expression by macrophages was measured via RT-PCR. The production costs of hypothetical units of anti-inflammatory effects were calculated using the percentage of TNF-α inhibition by MTF exposure. Bioreactor MTFs had a higher inhibitory effect on TNF (p < 0.01) than monolayer MTFs (p < 0.05). The anti-inflammatory effect of Bioreactor MTFs on IL-1β, TNF-α, IL-8, IL-6, and MIP-1 was significantly higher than that of monolayer MTFs. The production cost of 1% inhibition of TNF-α was 11–40% higher using monolayer culture compared to bioreactor-derived MTFs. A 3D dynamic culture was, therefore, able to produce high-quality MTFs, with robust anti-inflammatory properties, more efficiently than monolayer static systems. [ABSTRACT FROM AUTHOR]

Introduction: Rituximab is the recent treatment of choice for primary membranous nephropathy However, dose of rituximab mentioned in literature is high and not economical in middle income countries. Low dose rituximab based on CD 19 cell count can be tried as an alternative for high dose rituximab for inducing clinical remission in appropriate clinical settings. Case Series: Four patients were administered low dose rituximab and initial CD 19 count was monitored for optimal rituximab response. Three males and one female are part of this case series. Renal biopsies showed membranous nephropathy with tissue phospholipase A2 receptor (PLA2R) positivity in two cases. Serum PLA2R was positive for the same two cases. Two patients completely remitted after one year, one male patient required additional rituximab dose based on CD19 count, one patient required single dose of rituximab for partial remission in the background of tacrolimus with steroids. One patient failed to remit on low dose rituximab protocol. Conclusion: Low dose Rituximab can be tried as a favorable alternative for high dose Rituximab in appropriate clinical settings. [ABSTRACT FROM AUTHOR]

The emergence of Wireless Body Area Networks (WBANs) with health monitoring capabilities has revolutionized health care. Implementing fully independent WBAN nodes is important to the long-term viability of this initiative. Regularly recharged and depletable batteries remain a significant impediment in such systems. Energy harvesting (EH) from environmentally clean sources has thus been receiving increasing attention. Nevertheless, the autonomy and optimization of existing WBAN sensor nodes have remained questionable because methods that integrate realistic usage conditions into the design process have been lacking. A plausible method is proposed to establish a framework for designing a sustainable health monitoring node in this work. A Health Monitoring Energy System (HeMeS) tool prototype is consequently developed using comprehensive analytical models and utilized to demonstrate system design space exploration for various patient types, incorporating environmental factors, electronic load activity levels, and system cost/size constraints. It is concluded that the patient-centered system design approach incorporating interactions across transducers, electronics, sensors, user environment and data duty-cycling profiles, is viable, and is in fact appealing in safeguarding truly autonomous and cost-optimal WBANs that are compatible with climate-neutral society.

Background This paper analyses input from global interests in the policy process leading up to the passing of alcohol control legislation in Vietnam in 2019. The global alcohol industry now relies on growth in volume in emerging markets in middle-income countries such as Vietnam, a large, rapidly industrialising country with a youthful population and emerging middle class. The industry’s role in the alcohol policy process is compared with that of global health interests.Methods Document analysis of letters and English language media coverage was supplemented by and triangulated with data from key informants on changes in the content of draft alcohol legislation and participant observation.Results The alcohol legislation was negotiated in the context of active engagement from the global alcohol industry and some input from global public health interests. The global alcohol industry established a partnership relationship with politicians using CSR and funded a local employee in Hanoi over the decade prior to the draft legislation being considered. Direct lobbying took place over the content of the legislation, which went through six published drafts. Trade and investment agreements provided a supportive environment and were referred to by both politicians and industry. In contrast public health resource was limited and lacked the support of a normative global policy to counter the economic imperatives. Vietnamese Ministry of Health proposals for cost effective alcohol policy were not enacted.ConclusionGlobal commercial interests employed their considerable resources to engage in corporate social responsibility (CSR) and build partnerships with policy-makers over a long period, contributing significantly to an environment unsupportive of enacting effective alcohol control policy. The absence of structural support from a global health treaty on alcohol and lack of an equivalent level of long-term sustained input from global health actors contributed to the legislative outcome, which excluded proposed cost-effective policies to reduce alcohol harm.

Background: Laparoscopic inguinal hernia repairs done by totally extra peritoneal (TEP) or trans abdominal preperitoneal techniques require mesh fixation which is commonly done by either tackers or fibrin glue. In this study, we discuss about using cyanoacrylate glue for mesh fixation as a more cost effective but equally suitable alternate. Aims and Objectives: The aim of the study was to evaluation of suitability of using highly economical cyanoacrylate ($ 0.13) with tackers ($ 318.52) and fibrin glue ($ 11.94) for mesh fixation during TEP hernia repair. Materials and Methods: A comparative study was done in the Department of Surgery over a period of 3 years (2018–2021). This study included 210 patients who underwent laparoscopic TEP hernia repair. Cases were randomized into three groups of 70 subjects each: Group A - mesh was fixed with tacker, Group B - mesh was fixed using cyanoacrylate, and Group C - mesh was fixed with fibrin glue. Subjects were followed up for 3 months. Type of presentation, diagnosis, and type of mesh fixation were compared to post-operative complications that included pain, seroma, hematoma, and urinary retention findings were recorded and data were statistically analyzed using “SPSS” software. Results: Decreased incidence of post-operative pain (P=0.01) and hematoma was observed in Group B as compared to Groups A and C. Average hospital stay was significantly less in fibrin glue group (P=0.02) and cyanoacrylate group (P=0.02) as compared to tacker group. There was same incidence of postoperative urinary retention (P=0.520) and seroma (P=0.354) formation between all groups. Patients of Group B started daily activities earlier at 15 days follow-up (P=0.032) as compared to Groups A and C. Conclusion: Cyanoacrylate and fibrin glue fixation of mesh in laparoscopic TEP have better outcomes when compared to tackers. Furthermore, as cyanoacrylate is 300 times cheaper than tacker and 10 times cheaper than fibrin glue, this imparts a huge cost advantage to this technique in developing countries. Therefore, use of cyanoacrylate for mesh fixation in laparoscopic TEP can be safely advocated over tackers and fibrin glue.

Cloud computing plays a significant role in everyone’s lifestyle by snugly linking communities, information, and trades across the globe. Due to its NP-hard nature, recognizing the optimal solution for workflow scheduling in the cloud is a challenging area. We proposed a hybrid meta-heuristic cost-effective load-balanced approach to schedule workflow in a heterogeneous environment. Our model is based on a genetic algorithm integrated with predict earliest finish time (PEFT) to minimize makespan. Instead of assigning the task randomly to a virtual machine, we apply a greedy strategy that assigns the task to the lowest-loaded virtual machine. After completing the mutation operation, we verify the dependency constraint instead of each crossover operation, which yields a better outcome. The proposed model incorporates the virtual machine’s performance variance as well as acquisition delay, which concedes the minimum makespan and computing cost. One of the most astounding aspects of our cost-effective hybrid genetic algorithm (CHGA) is its capacity to anticipate by creating an optimistic cost table (OCT) while maintaining quadratic time complexity. Based on the results of our meticulous experiments on some real-world workflow benchmarks and comprehensive analysis of some recently successful scheduling algorithms, we concluded that the performance of our CHGA is melodious. CHGA is 14.58188%, 11.40224%, 11.75306%, and 9.78841% cheaper than standard Ant Colony Optimization (ACO), Particle Swarm Optimization (PSO), Cost Effective Genetic Algorithm(CEGA), and Cost-Effective Load-balanced Genetic Algorithm (CLGA), respectively.

The molybdenum disulfide (MoS 2) based nanomaterials show outstanding catalytic performance in many electrochemical sensing applications with improved catalytic and electrochemical properties. Novel electrocatalyst developments and their application for food additives monitoring are of significant interest. In this work, we have developed a novel synthesis protocol for graphitic carbon nitride nanotubes decorated MoS 2 composite (g-C 3 N 4 NTs@MoS 2) using the hydrothermal method and evaluated its electrochemical sensing performance towards vanillin (VN) determination. The electrochemical sensor was accomplished at various electrolytes and optimized parameters to get an enhanced current signal for VN detection. Under the optimized conditions, the sensor obtained wide linear ranges (0.005-458.9 µM), low limit of detection (LOD, 4 nM), and excellent sensitivity (3.48 μA μM−1 cm−2) using differential pulse voltammetry (DPV). Moreover, the practical applicability of the developed sensor was also successfully evaluated in food samples with an excellent recovery rate. [Display omitted] • Novel MoS 2 nanosheets assembled on g-C 3 N 4 nanotubes using in-situ hydrothermal method. • The composite electrocatalyst of g-C 3 N 4 NTs@MoS 2 offers a synergistic effect for enhanced electrochemical detection of VN. • The proposed sensor has better electrocatalytic activity with a wide linear range and LOD for VN detection. • The proposed sensor has potential for sensing of VN in real samples. [ABSTRACT FROM AUTHOR]