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Lasers are based on the principle of light amplification by empowering atoms to store and emit light in a coherent form. Through their effect on tissues, lasers reduce hemorrhage allowing the surgeon to work in a clear field with precise removal of the tissues. Irradiation of the soft tissues by lasers produces thermal effects on the surrounding healthy tissues which can make histopathological examination difficult. Hence this study was done to find a correlation between adjustable parameters of CO2 laser and the extent of collateral thermal damage in the excised vocal cord lesions on histopathological examination and diagnosis. In this study, we enrolled 80 patients who were divided into 4 groups with different combinations of laser power and mode, used during transoral laser micro laryngeal surgery for the excision of vocal cord lesions and subsequent histopathological analysis to objectively measure the extent of thermal damage zone and subjectively assess histo-morphological effects of thermal damage in terms of grade of carbonization. The extent of the thermal damage zone is directly related to the power of the laser, but the mode of the laser had no relation with the thermal damage zone in our study. On subjective histo-morphological examination of excised lesions showed that both power and mode of laser have significant effects on tissue morphology. Continuous mode causes a significantly higher grade of carbonization as compared to the superpulsed mode of the laser. However, in our study it was seen that charring in no way affected the diagnosis in any of the biopsies examined whatever the power or mode of the laser used. The depth and width of the tissue thermal damage zone are mainly dependent upon the laser parameters (power and mode). Although considering the limitations of this study carried out in terms of sample size, it would be pertinent to mention here that further studies with larger cohorts need to be done to authenticate these results. [ABSTRACT FROM AUTHOR]

Mechanistic models of hepatic clearance have been evaluated for more than 50 years, with the first author of this mini-review serving as a co-author of the first paper proposing such a model. However, published quality experimental data are only consistent with the first of these models, designated as the well-stirred model, despite the universal recognition that this model is physiologically unrepresentative of what occurs with respect to liver metabolism and transport. Within the last 3 years, our laboratory has recognized that it is possible to derive clearance equations employing the concepts of Kirchhoff's Laws from physics, independent of the differential equation approach that has been utilized to derive reaction rates in chemistry. Here we review our published studies showing that the equation previously believed to be the well-stirred model, when hepatic basolateral transporters are not clinically relevant, is in fact the general equation for hepatic clearance when only systemic drug concentrations are measured, explaining why all experimental data fit this equation. To demonstrate that the equations deriving the mechanistic models of hepatic elimination for the past 50 years are not valid, we show that when calculating Kpuu, the ratio of unbound drug concentration in the liver to the unbound concentration of drug in the systemic circulation, for the well-stirred, parallel tube and dispersion models, Kpuu surprisingly can never exceed 1 and is a function of FH, the hepatic bioavailability following oral dosing. We believe that knowledgeable drug metabolism scientist and clinical pharmacologist will agree that this outcome is nonsensical. [ABSTRACT FROM AUTHOR]

Neovascular age-related macular degeneration (nvAMD) is the leading cause of severe vision loss in the elderly in the developed world. While the introduction of therapies targeting vascular endothelial growth factor (VEGF) has provided the first opportunity to significantly improve vision in patients with nvAMD, many patients respond inadequately to current anti-VEGF therapies. It was recently demonstrated that expression of a second angiogenic mediator, angiopoietin-like 4 (ANGPTL4), synergizes with VEGF to promote choroidal neovascularization (CNV) in mice and correlates with reduced response to anti-VEGF therapy in patients with nvAMD. Here, we report that expression of ANGPTL4 in patients with nvAMD increases following treatment with anti-VEGF therapy and that this increase is dependent on accumulation of hypoxia-inducible factor (HIF)-1a in response to inhibition of VEGF/KDR signaling in the retinal pigment epithelium (RPE). We therefore explored HIF-1 inhibition with 32-134D, a recently developed pharmacologic HIF-inhibitor, for the treatment of nvAMD. 32-134D prevented the expression of both VEGF and ANGPTL4 and was at least as effective as aflibercept in treating CNV in mice. Moreover, by preventing the increase in HIF-1a accumulation in the RPE in response to anti-VEGF therapy, combining 32-134D with aflibercept was more effective than either drug alone for the treatment of CNV. Collectively, these results help explain why many patients with nvAMD respond inadequately to anti-VEGF therapy and suggest that the HIF inhibitor 32-134D will be an effective drug--alone or in combination with current anti-VEGF therapies--for the treatment of patients with this blinding disease. [ABSTRACT FROM AUTHOR]

Objective: Representation of women and minority groups is traditionally low in Otolaryngology–Head & Neck Surgery (OHNS). This cross‐sectional study aims to assess the difference in gender and racial/ethnic representation within Academic North American pediatric OHNS. Study Design: Cross‐sectional study of North American pediatric OHNS faculty websites. Setting: North America. Methods: Canadian and American residency program registries were searched for accredited OHNS programs. Pediatric OHNS faculty were identified through program websites. Information regarding gender, race/ethnicity, time in practice, research productivity, academic title, and leadership positions was extracted from public profiles and Scopus. Demographic and academic data was also extracted for OHNS and pediatric OHNS department/division chairs. Results: North American academic pediatric OHNS websites listed 516 surgeons, of whom 39.9% were women. Most surgeons were perceived as White (69.0%), followed by Asian (24.0%), Hispanic (3.7%), and Black (3.3%). Women surgeons had lower h‐indices, less publications, and less citations than men (P <.001). Despite women surgeons having fewer years in practice (median 8.0 vs 13.0, P <.001), gender‐differences in h‐index persisted when controlling for years in practice (P <.05). Men surgeons had higher academic titles (P <.001), but there was no gender difference in leadership roles while accounting for years in practice (P =.559). White surgeons had higher academic titles than non‐White surgeons (P =.018). There was no racial/ethnic difference in leadership roles (P =.392). Conclusion: Most pediatric OHNS surgeons are men and/or White. Significant gender‐differences in research productivity and academic title exist, however surgeons of racial/ethnic minority have similar research productivity as their racial/ethnic majority counterparts. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) has emerged as an essential bedside tool for clinicians, but lack of access to ultrasound equipment has been a top barrier to POCUS use. Recently, several handheld ultrasound devices ("handhelds") have become available, and clinicians are seeking data to guide purchasing decisions. Few comparative studies of different handhelds have been done. We conducted a cross-sectional study comparing 6 handhelds readily available in the United States (Butterfly iQ + ™ by Butterfly Network Inc.; Clarius™ by Clarius Mobile Health; Kosmos™ by EchoNous; TE Air™ by Mindray; Vscan Air™ SL and CL by General Electric; and Lumify™ by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed. Results: Thirty-five POCUS experts specializing in internal medicine/hospital medicine, critical care, emergency medicine, and nephrology acquired and rated right upper quadrant, apical 4-chamber, and superficial neck and lung views with 6 different handhelds. For image quality, the highest-rated handhelds were Vscan Air™ for the right upper quadrant view, Mindray TE Air™ for the cardiac apical 4-chamber view, and Lumify™ for superficial views of the neck and lung. Overall satisfaction with image quality was highest with Vscan Air™, Lumify™, and Mindray, while overall satisfaction with ease of use was highest with Vscan Air™. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features. Conclusions: The overall satisfaction with image quality was rated highest with Vscan Air™, Lumify™, and Mindray TE Air™when acquiring right upper quadrant, apical 4-chamber, and superficial neck and lung views. No single handheld was perceived to be superior in image quality for all views. Vscan Air™ was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts. [ABSTRACT FROM AUTHOR]

Background The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PC&PNDT Act), 1994 was enacted to prevent sex determination and female feticide. As a mandatory statutory requirement, All India Institute of Medical Sciences, New Delhi, India has to renew its PC&PNDT license after every 5 years. Aim The current study was undertaken with an objective to delineate in detail, the process of PC&PNDT license renewal, and the challenges dealt with while submitting the renewal application. Methods and Material An observational descriptive study was conducted from February to July 2022. The renewal process was categorized into preapplication, application, and postapplication phases. The requisite documents and data were collected from the Hospital Establishment Section and Medical Records Department. Results The preapplication phase involved obtaining details from 24 departments, with 20 responding initially. Challenges included incomplete documents and deficient details. The application phase required consolidation, affidavits, form filling, and fee payment. Postapplication, an inspection was conducted, and the renewal certification was obtained. Conclusion The study highlights the complexities of renewal of PC&PNDT license of a large multispecialty tertiary care teaching hospital. Planning leads obtained during various phases could serve as a guiding template for other similar teaching hospitals. The study suggests the need for digitalization and streamlining of documentation process to ease out the renewal process and hence contribute to better patient care at large. [ABSTRACT FROM AUTHOR]

Dysphagia is a significant health concern especially amongst the old age population. It is an ailment brought on by the weakening of the swallowing muscles. To reduce the risk of choking in dysphagia patients, the food is usually diluted to suit their swallowing ability. But dilution results in reducing the nutritional density of the foods thus causing undernutrition and malnutrition in patients. In this study, functional liquid diets were formulated under International Dysphagia Diet Standardization Initiative (IDDSI) levels 0–2. The developed diets were analysed for their proximate composition, colour, antioxidant and sensory properties. Antioxidant activities were determined using 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS+), 2,2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP) and total phenolic content (TPC) methods. The highest ABTS+ value was observed in pumpkin puree (level-2) i.e. 98.59%. Black carrot juice (level-1) showed the highest DPPH free radical scavenging activity and FRAP value viz. 88.43% and 689.33 µM TE/g, respectively. Electromyography (EMG) is an upcoming technique of food texture evaluation which provides real-time information about food oral processing. In this study, an EMG was conducted to measure the myoelectrical activity of human suprahyoid and masseter muscles by placing electrodes on the skin's surface during the oral processing of liquid. The EMG parameters correlated significantly with viscosity, ease of swallowing and IDDSI levels of the formulated diets. Hence EMG can be used as a tool for design and development of textured-modified diets for dysphagia patients. The sensory scores of formulated diets in this study were high indicating that these liquid diets may be incorporated into the diet plans of dysphagia patients. [ABSTRACT FROM AUTHOR]

In the 21st century, data privacy, data protection and cybersecurity have become challenging issues with increasing cases of data breaches and data disasters. Data privacy has emerged as one of the challenging issues after numerous cases of data breaches and manipulations in many departments, agencies, bodies and organisations in every country. A well-designed data framework may enable not just secure data privacy/protection but also enable users' control over data through a protective and safe system to share data across organisations, leading to individual empowerment and well-being. In India, privacy still remains a complex area, which has affected data safety and protection. A number of government websites clearly mention that data will not be shared with anyone until and unless for the purpose enshrined so far. In India, there have been various policies, guidelines, strategies and initiatives for cybersecurity, data privacy, data protection and data measures, including the Digital Personal Data Protection Act, 2023; the National Cyber Security Policy, 2013; the Information Technology Act 2000; the Information Technology (Amendment) Act, 2008; the Information Technology Rules, 2011 and so on. This article tries to examine policies/regulations for data privacy, data protection and data safety in South Indian states. [ABSTRACT FROM AUTHOR]

Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) is an excellent solution for patients suffering from single-compartment knee arthritis. While outcomes tend to be favorable for UKAs, revision operations, commonly due to component malpositioning and malalignment resulting in accelerated wear, are a major concern. Intraoperative technologies, such as robotic assistance, can help better ensure that implants are positioned based on a patient's specific anatomy and mechanical physiology. However, long-term survivorship and patient-reported satisfaction with robotic-assisted UKAs are limited. Therefore, the purpose of this study was to assess the 10-year outcomes of patients who underwent robotic-arm-assisted unicompartmental knee arthroplasty. Specifically, we evaluated: 1) 10-year survivorships; 2) patient satisfaction scores; and 3) re-operations. From a single surgeon and single institution, 185 patients who had a mean age of 65 years (range, 39 to 92) and a mean body mass index of 31.6 (range, 22.4 to 39) at a mean of 10 years follow-up were evaluated (range, 9 to 11). For all patients, the same robotic-assistive device was utilized intraoperatively, and all patients underwent standardized physical therapy and received standardized pain control management. Then 10-year survivorships with Kaplan-Meir curves, patient satisfaction evaluations with a 5-point Likert scale, and re-operations were assessed as primary outcomes. Overall implant survivorship was 99%, with only two patients requiring revision surgery. There was one patient who was converted to a total knee arthroplasty, while the other patient underwent polyethylene exchange at 5 weeks for an acute infection with successful implant retention. Overall, 97% of the patients were satisfied with their postoperative outcomes, with 81% of patients reporting being very satisfied. There were two other patients who required arthroscopic intervention: one to remove a cement loose body, the other to remove adhered scar from the fat pad and the anterior cruciate ligament. This study is one of the first to provide longer-term (mean 10-year) survivorship and patient-reported satisfaction outcomes for robotic-assisted UKA patients. These data show strong support for utilizing this surgical technique, as nearly all patients maintained their original prostheses and reported being satisfied after a mean of 10 years. Therefore, based on these results, we recommend the use of robotic assistance when performing UKAs. [ABSTRACT FROM AUTHOR]

We empirically advocate for UK regulators to increase the volume limit of 15% outstanding shares on open market repurchases. Our main framework initially tests the determinants of share repurchases based on their size, Small, Medium and Large. The findings reveal that consistent with extant literature, the payout is primarily determined by its capability of distributing excess cash to shareholders and signaling undervaluation. We then check the viability of increasing the volume limit by testing new levels at 2.50% increments, up to 30%. The results indicate that any increase does not broadly change the determinants' relationship with the payout, rather increased efficiency is realized at every interval, with the 20% and 30% levels being the most favorable. [ABSTRACT FROM AUTHOR]

Background/Objective: To utilize ultra‐widefield multimodal imaging (Optos PLC) to describe novel findings in degenerative retinoschisis. Methods: This retrospective, non‐comparative case series of degenerative retinoschisis received a waiver of consent from Advarra IRB, Protocol 00066379. Initial ultra‐widefield pseudocolour, colour‐separated, autofluorescence, and peripheral OCT imaging were analysed for characterizing features. Results: In total, 139 eyes were included. A hyporeflective reticular pattern associated with retinoschisis was seen on pseudocolour images in 39% of cases, but visible in 53% on green‐separated images. Fine hyper‐reflective foci were observed in 49%. In 27%, retinoschisis was confirmed with OCT. Conclusions: Ultra‐widefield pseudocolour and green‐separated images are valuable for the diagnosis and characterization of degenerative retinoschisis. The findings described may prompt the evaluation of subtle retinoschisis with peripheral OCT. [ABSTRACT FROM AUTHOR]

Owing to globalization, the popular indigenous products from various ethnical backgrounds are increasingly making their presence felt all over the world. This opens up a new arena for food technologists to conduct intensive research and developmental activities on the indigenous products. In this study, six popular Indian rice products viz. plain rice, pulao, kheer, idli, khichdi and pakoda were formulated and evaluated for their proximate composition, sensory attributes and textural parameters. Out of these, kheer with semi-fluid consistency had the highest moisture content and the lowest protein and fiber contents. Kheer is similar to rice pudding consumed in the U.S.A. and Europe. Fat content was the highest in pakoda being a crispy fried product. Khichdi being a cereal pulse combination product had the highest protein content. Khichdi is also the national dish of India. The overall acceptability scores were high for pakoda, pulao and kheer which were 8.60, 7.90 and 7.30, respectively. Electromyographic analysis was conducted for in vivo textural evaluation of formulated rice products. The analysis showed reproducible masticatory behavior of human subjects within an EMG session. Twenty-five masticatory parameters, which could establish significant (p < 0.05) differences between textural perceptions among the formulated rice products, were used for cluster analysis followed by principal component analysis (PCA). The PCA resulted in one principal component which could explain data variance of up to 93%. Further, significant positive correlations were found between EMG parameters and sensory textural attributes indicating applicability of electromyography for comprehensive textural evaluation of formulated rice products. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic severely tested the resilience and robustness of supply chains for medically critical items and various common household goods. Severe and prolonged shortages of personal protective equipment (PPE) and ventilators in the United States have revealed vulnerabilities in the supply chains of such essential products in a time of need. Consequently, corporations have felt public pressure to rethink their supply chains. We begin this paper by examining the underlying causes of the prolonged shortages of critical products in the US as well as government’s and some companies’ initial response. Drawing from the lessons learned from the COVID pandemic, we propose a research agenda and opportunities to develop responsive supply chains to fight future pandemics. These opportunities revolve around measures that are intended to improve the supply chain responsiveness of essential products to combat future pandemics and other major public health emergencies. [ABSTRACT FROM AUTHOR]

Background and purpose: Weaning from a mechanical ventilator is a milestone in the recovery of seriously ill patients in Intensive care. Failure to wean and re-intubation adversely affects the outcome. The method of mechanical ventilation (MV) varies between different ICUs and so does the practice of weaning. Therefore, updated guidelines based on contemporary literature are designed to guide intensivists in modern ICUs. This is the first ISCCM Consensus Statement on weaning complied by a committee on weaning. The recommendations are intended to be used by all the members of the ICU (Intensivists, Registrars, Nurses, and Respiratory Therapists). Methods: A Committee on weaning from MV, formed by the Indian Society of Critical Care Medicine (ISCCM) has formulated this statement on weaning from mechanical ventilators in intensive care units (ICUs) after a review of the literature. Literature was first circulated among expert committee members and allotted sections to each member. Sections of the statement written by sectional authors were peer-reviewed on multiple occasions through virtual meetings. After the final manuscript is accepted by all the committee members, it is submitted for peer review by central guideline committee of ISCCM. Once approved it has passed through review by the Editorial Board of IJCCM before it is published here as "ISCCM consensus statement on weaning from mechanical ventilator". As per the standard accepted for all its guidelines of ISCCM, we followed the modified grading of recommendations assessment, development and evaluation (GRADE) system to classify the quality of evidence and strength of recommendation. Cost-benefit, risk-benefit analysis, and feasibility of implementation in Indian ICUs are considered by the committee along with the strength of evidence. Type of ventilators and their modes, ICU staffing pattern, availability of critical care nurses, Respiratory therapists, and day vs night time staffing are aspects considered while recommending for or against any aspect of weaning. Result: This document makes recommendation on various aspects of weaning, namely, definition, timing, weaning criteria, method of weaning, diagnosis of failure to wean, defining difficult to wean, Use of NIV, HFOV as adjunct to weaning, role of tracheostomy in weaning, weaning in of long term ventilated patients, role of physiotherapy, mobilization in weaning, Role of nutrition in weaning, role of diaphragmatic ultrasound in weaning prediction etc. Out of 42 questions addressed; the committee provided 39 recommendations and refrained from 3 questions. Of these 39; 32 are based on evidence and 7 are based on expert opinion of the committee members. It provides 27 strong recommendations and 12 weak recommendations (suggestions). Conclusion: This guideline gives extensive review on weaning from mechanical ventilator and provides various recommendations on weaning from mechanical ventilator. Though all efforts are made to make is as updated as possible one needs to review any guideline periodically to keep it in line with upcoming concepts and standards. [ABSTRACT FROM AUTHOR]

This position statement reviews the evidence and rationale for the management of severe peripartum infections with a special focus on tropical infections and is tailored for resource-limited settings. [ABSTRACT FROM AUTHOR]

Sepsis poses a significant global health challenge in low- and middle-income countries (LMICs). Several aspects of sepsis management recommended in international guidelines are often difficult or impossible to implement in resource-limited settings (RLS) due to issues related to cost, infrastructure, or lack of trained healthcare workers. The Indian Society of Critical Care Medicine (ISCCM) drafted a position statement for the management of sepsis in RLS focusing on India, facilitated by a task force of 18 intensivists using a Delphi process, to achieve consensus on various aspects of sepsis management which are challenging to implement in RLS. The process involved a comprehensive literature review, controlled feedback, and four iterative surveys conducted between 21 August 2023 and 21 September 2023. The domains addressed in the Delphi process included the need for a position statement, challenges in sepsis management, considerations for diagnosis, patient management while awaiting an intensive care unit (ICU) bed, and treatment of sepsis and septic shock in RLS. Consensus was achieved when 70% or more of the task force members voted either for or against statements using a Likert scale or a multiple-choice question (MCQ). The Delphi process with 100% participation of Task Force members in all rounds, generated consensus in 32 statements (91%) from which 20 clinical practice statements were drafted for the management of sepsis in RLS. The clinical practice statements will complement the existing international guidelines for the management of sepsis and provide valuable insights into tailoring sepsis interventions in the context of RLS, contributing to the global discourse on sepsis management. Future international guidelines should address the management of sepsis in RLS. [ABSTRACT FROM AUTHOR]

The acute manifestations of coronavirus disease 2019 (COVID-19) exhibit the hallmarks of sepsis-associated complications that reflect multiple organ failure. The inflammatory cytokine storm accompanied by an imbalance in the pro-inflammatory and anti-inflammatory host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to severe and critical septic shock. The sepsis signature in severely afflicted COVID-19 patients includes cellular reprogramming and organ dysfunction that leads to high mortality rates, emphasizing the importance of improved clinical care and advanced therapeutic interventions for sepsis associated with COVID-19. Phytochemicals of functional foods and nutraceutical importance have an incredible impact on the healthcare system, which includes the prevention and/or treatment of chronic diseases. Hence, in the present review, we aim to explore the pathogenesis of sepsis associated with COVID-19 that disrupts the physiological homeostasis of the body, resulting in severe organ damage. Furthermore, we have summarized the diverse pharmacological properties of some potent phytochemicals, which can be used as functional foods as well as nutraceuticals against sepsis-associated complications of SARS-CoV-2 infection. The phytochemicals explored in this article include quercetin, curcumin, luteolin, apigenin, resveratrol, and naringenin, which are the major phytoconstituents of our daily food intake. We have compiled the findings from various studies, including clinical trials in humans, to explore more into the therapeutic potential of each phytochemical against sepsis and COVID-19, which highlights their possible importance in sepsis-associated COVID-19 pathogenesis. We conclude that our review will open a new research avenue for exploring phytochemical-derived therapeutic agents for preventing or treating the life-threatening complications of sepsis associated with COVID-19. [ABSTRACT FROM AUTHOR]

The present study was conducted to understand transcriptional response of skin fibroblast of yak (Bos grunniens) and cows of Bos indicus origin to hypoxia stress. Six primary fibroblast cell lines derived from three individuals each of Ladakhi yak (Bos grunniens) and Sahiwal cows (Bos indicus) were exposed to low oxygen concentration for a period of 24 h, 48 h and 72 h. The expression of 10 important genes known to regulate hypoxia response such as HIF1A, VEGFA, EPAS1, ATP1A1, GLUT1, HMOX1, ECE1, TNF-A, GPx and SOD were evaluated in fibroblast cells of Ladakhi yak (LAY-Fb) and Sahiwal cows (SAC-Fb) during pre- and post-hypoxia stress. A panel of 10 reference genes (GAPDH, RPL4, EEF1A1, RPS9, HPRT1, UXT, RPS23, B2M, RPS15, ACTB) were also evaluated for their expression stability to perform accurate normalization. The expression of HIF1A was significantly (p < 0.05) induced in both LAY-Fb (2.29-fold) and SAC-Fb (2.07-fold) after 24 h of hypoxia stress. The angiogenic (VEGFA), metabolic (GLUT1) and antioxidant genes (SOD and GPx) were also induced after 24 h of hypoxia stress. However, EPAS1 and ATP1A1 induced significantly (p < 0.05) after 48 h whereas, ECE1 expression induced significantly (p < 0.05) at 72 h after exposure to hypoxia. The TNF-alpha which is a pro-inflammatory gene induced significantly (p < 0.05) at 24 h in SAC-Fb and at 72 h in LAY-Fb. The induction of hypoxia associated genes indicated the utility of skin derived fibroblast as cellular model to evaluate transcriptome signatures post hypoxia stress in populations adapted to diverse altitudes. [ABSTRACT FROM AUTHOR]

Activist groups debate the complex connection between climate change and migration but generally agree on the normative value of describing those migrants as "environmental refugees." They argue that using such a term, even though unrecognized under international law, might increase the urgency of this issue in the eyes of the public. Does the term do the normative work that has been assumed? To our knowledge, the idea has not been subject to empirical confirmation. In this research note, we present data from two experimental surveys conducted in the UK and the Netherlands (N = 2261) directly addressing that question. The findings significantly undermine the assumption that "environmental refugee" is normatively persuasive outside activists and academic circles. We demonstrate that using "environmental refugees" frames compared to "environmental migrants" does not increase the urgency of the climate migration problem in the eyes of the public, and as our results show, such frames may slightly lower perceptions of urgency. Yet, this result is rather negligible. [ABSTRACT FROM AUTHOR]

In this study, a detailed analysis of the direct piezo-response of AlN nanowire-based vertically integrated nanogenerators (VINGs) is undertaken as a function of mechanical excitation frequency. We show that the piezo-charge, piezo-voltage, and impedance measured at the same position of the devices can be directly correlated through an equivalent circuit model in the whole frequency range of investigation. Our presented results are utilized to determine the performance figures of merit (FoM) of nanowire-based VINGs, namely, the piezoelectric voltage constant (g) for sensing and the product d · g for energy harvesting, where d is the piezoelectric charge constant. By comparison of these metrics with those of freestanding single-crystal GaN and quartz substrates as well as sputtered AlN thin films, we suggest that the nanowires can outperform their rigid counterparts in terms of mechanical sensing and energy generation. This work provides experimental guidelines for understanding the direct piezo-characteristics of VINGs and facilitates a quantitative comparison between nanostructured piezoelectric devices fabricated by using different materials or architectures. [ABSTRACT FROM AUTHOR]

Background: In Retzius-sparing robot-assisted radical prostatectomy (RARP), lymphocele formation is a troublesome complication. The use of peritoneal flaps has emerged as a promising novel technique to tackle this complication. We explored this technique by suturing both the medial peritoneal flaps to each other and keeping them distracted so that the lymphadenectomy beds are left wide open. Objective: To assess the efficacy of our peritoneal distraction technique on lymphocele rates following Retzius-sparing RARP. Materials and Methods: This retrospective study included patients with localized prostate carcinoma who underwent Retzius-sparing RARP with standard pelvic lymph node dissection between May 2014 and September 2022 at Aster Medcity, Kochi, India. Based on the use of the technique, patients were divided into two groups: peritoneal distraction and closed groups. Both groups were matched using the propensity scoring method in a 1:1 ratio. Results: A total of 272 patients were included, of which 89 (32.7%) belonged to the peritoneal distraction group. Although the overall incidence of lymphocele between the two groups were comparable, none of the patients in the peritoneal distraction group required any intervention for lymphocele management, as opposed to 7 patients from the closed group (3.9%; P = 0.015). No significant association was found between lymphocele formation and serum prostate-specific antigen level, Gleason score, and the number of lymph nodes harvested. Conclusions: This study found that peritoneal distraction stitch is a simple and effective technique to reduce the incidence of symptomatic lymphocele that require intervention after Retzius-sparing RARP. [ABSTRACT FROM AUTHOR]

Background: Angiopoietin‐like 4 is a molecular hallmark that correlates with the growth and metastasis of head and neck squamous cell carcinoma, one of the most prevalent cancers worldwide. However, the molecular mechanisms by which angiopoietin‐like 4 promotes head and neck squamous cell carcinoma tumorigenesis are unclear. Methods: Using well‐characterized cell lines of head and neck squamous cell carcinoma development, including human normal oral keratinocytes, dysplastic oral keratinocytes, oral leukoplakia‐derived oral keratinocytes, and head and neck squamous cell carcinoma cell lines, HN13, HN6, HN4, HN12, and CAL27, we investigated the signaling pathways upstream and downstream of angiopoietin‐like 4‐induced head and neck squamous cell carcinoma tumorigenesis. Results: We found that both epidermal growth factor receptor ligands, epithelial growth factor, and amphiregulin led to angiopoietin‐like 4 upregulation in normal oral keratinocytes and dysplastic oral keratinocytes and cooperated with the activation of hypoxia‐inducible factor‐1 in this effect. Interestingly, amphiregulin and angiopoietin‐like 4 were increased in dysplastic oral keratinocytes and head and neck squamous cell carcinoma cell lines, and amphiregulin‐induced activation of cell proliferation was dependent on angiopoietin‐like 4. Although both p38 mitogen‐activated protein kinases (p38 MAPK) and protein kinase B (AKT) were activated by angiopoietin‐like 4, only pharmacological inhibition of p38 MAPK was sufficient to prevent head and neck squamous cell carcinoma cell proliferation and migration. We further observed that angiopoietin‐like 4 promoted the secretion of interleukin 11 (IL‐11), interleukin 12 (IL‐12), interleukin‐1 alpha (IL‐1α), vascular endothelial growth factor, platelet‐derived growth factor (PDGF), and tumour necrosis factor alpha (TNF‐α), cytokines and chemokines previously implicated in head and neck squamous cell carcinoma pathogenesis. Conclusion: Our results demonstrate that angiopoietin‐like 4 is a downstream effector of amphiregulin and promotes head and neck squamous cell carcinoma development both through direct activation of p38 kinase as well as paracrine mechanisms. [ABSTRACT FROM AUTHOR]

This paper presents a competition-based active learning approach that prepares undergraduate students for careers in the drone industry. The competition-based learning (CBL) approach focuses on preparing students for three key drone industry requirements (1) drone assembly, testing, and validation using commercial off-the-shelf (COTS) parts, (2) simulation of drone flight missions and (3) manual and semi-autonomous drone piloting. The CBL curricular modules were developed using the Interactive-Constructive-Active-Passive (ICAP) framework of cognitive engagement. These modules immersed students in the technical challenges corresponding to the three essential drone industry requirements. The approach was implemented through fourteen (14) drone workshops that culminated in a final drone piloting competition at a STEM research university in the United States. Ninety-seven (97) students from various backgrounds with little to no prior experience in building drones participated in the competition as part of 22 teams in total. Multiple assessment methods were used to evaluate the students' progress and the perceived drone-related skills gained by the end of the workshops. Assessment methods included data from direct formative (weekly or biweekly curricular milestones), direct summative (drone piloting for multiple flight tests), indirect quantitative (Likert-style feedback survey about student perceptions), and indirect qualitative (descriptive feedback comments) tools. Direct quantitative assessments indicated that most students successfully reached the technical milestones of the workshop sessions and gained practical drone piloting skills. The indirect quantitative assessment revealed that students perceived the workshops to be a valuable experience in their drone industry skills and knowledge. Indirect qualitative analysis of the feedback comments revealed that students perceived CBL as an engaging and effective method of introducing drone technology. [ABSTRACT FROM AUTHOR]

Skeletal dysplasias (SKDs) are a heterogeneous group of more than 750 genetic disorders characterized by abnormal development, growth, and maintenance of bones or cartilage in the human skeleton. SKDs are often caused by variants in early patterning genes and in many cases part of multiple malformation syndromes and occur in combination with non‐skeletal phenotypes. The aim of this study was to investigate the underlying genetic cause of congenital SKDs in highly consanguineous Pakistani families, as well as in sporadic and familial SKD cases from India using multigene panel sequencing analysis. Therefore, we performed panel sequencing of 386 bone‐related genes in 7 highly consanguineous families from Pakistan and 27 cases from India affected with SKDs. In the highly consanguineous families, we were able to identify the underlying genetic cause in five out of seven families, resulting in a diagnostic yield of 71%. Whereas, in the sporadic and familial SKD cases, we identified 12 causative variants, corresponding to a diagnostic yield of 44%. The genetic heterogeneity in our cohorts was very high and we were able to detect various types of variants, including missense, nonsense, and frameshift variants, across multiple genes known to cause different types of SKDs. In conclusion, panel sequencing proved to be a highly effective way to decipher the genetic basis of SKDs in highly consanguineous families as well as sporadic and or familial cases from South Asia. Furthermore, our findings expand the allelic spectrum of skeletal dysplasias. [ABSTRACT FROM AUTHOR]

The menace caused by antibiotic resistance in bacteria is acknowledged on a global scale. Concerns over the same are increasing because of the selection pressure exerted by a huge number of different antimicrobial agents, including heavy metals. Heavy metals are non-metabolizable and recalcitrant to degradation, therefore the bacteria can expel the pollutants out of the system and make it less harmful via different mechanisms. The selection of antibiotic-resistant bacteria may be influenced by heavy metals present in environmental reservoirs. Through co-resistance and cross-resistance processes, the presence of heavy metals in the environment can act as co-selecting agents, hence increasing resistance to both heavy metals and antibiotics. The horizontal gene transfer or mutation assists in the selection of mutant bacteria resistant to the polluted environment. Hence, bioremediation and biodegradation are sustainable methods for the natural clean-up of pollutants. This review sheds light on the occurrence of metal and antibiotic resistance in the environment via the co-resistance and cross-resistance mechanisms underpinning co-selection emphasizing the dearth of studies that specifically examine the method of co-selection in clinical settings. Furthermore, it is advised that future research incorporate both culture- and molecular-based methodologies to further our comprehension of the mechanisms underlying bacterial co- and cross-resistance to antibiotics and heavy metals. [ABSTRACT FROM AUTHOR]

Background and purpose: The transition to adult services, and subsequent glucocorticoid management, is critical in adults with Duchenne muscular dystrophy. This study aims (1) to describe treatment, functional abilities, respiratory and cardiac status during transition to adulthood and adult stages; and (2) to explore the association between glucocorticoid treatment after loss of ambulation (LOA) and late‐stage clinical outcomes. Methods: This was a retrospective single‐centre study on individuals with Duchenne muscular dystrophy (≥16 years old) between 1986 and 2022. Logistic regression, Cox proportional hazards models and survival analyses were conducted utilizing data from clinical records. Results: In all, 112 individuals were included. Mean age was 23.4 ± 5.2 years and mean follow‐up was 18.5 ± 5.5 years. At last assessment, 47.2% were on glucocorticoids; the mean dose of prednisone was 0.38 ± 0.13 mg/kg/day and of deflazacort 0.43 ± 0.16 mg/kg/day. At age 16 years, motor function limitations included using a manual wheelchair (89.7%), standing (87.9%), transferring from a wheelchair (86.2%) and turning in bed (53.4%); 77.5% had a peak cough flow <270 L/min, 53.3% a forced vital capacity percentage of predicted <50% and 40.3% a left ventricular ejection fraction <50%. Glucocorticoids after LOA reduced the risk and delayed the time to difficulties balancing in the wheelchair, loss of hand to mouth function, forced vital capacity percentage of predicted <30% and forced vital capacity <1 L and were associated with lower frequency of left ventricular ejection fraction <50%, without differences between prednisone and deflazacort. Glucocorticoid dose did not differ by functional, respiratory or cardiac status. Conclusion: Glucocorticoids after LOA preserve late‐stage functional abilities, respiratory and cardiac function. It is suggested using functional abilities, respiratory and cardiac status at transition stages for adult services planning. [ABSTRACT FROM AUTHOR]

Background: Though the use of Hepatitis B viremic (HBV) donor kidneys may be a safe alternative to improve access to transplantation, there has not been wide acceptance of this practice. In this study, we determined the safety and effectiveness of HBV NAT (+) donor kidneys in a protocolized manner in an older adult population. Methods: Over a 3‐year period, 16 decreased donor kidney transplants were performed with HBV NAT+ kidneys. Recipients of HBV NAT+ kidneys were treated with entecavir started pre‐operatively and continued for 52 weeks. Results: HBV NAT+ kidneys were preferentially used in older (68 ± 5 vs. 64 ± 9 years; p =.01) recipients with less dialysis time (93.8% < 5 years vs. 67% <5 years; p =.03). In this cohort, 3/16 had detectable HBV PCR 1‐week post‐transplant, but all were negative at 9‐ and 12‐months. Calculated estimated glomerular filtration rate (eGFR) was slightly decreased 12‐months post‐transplant. Post‐transplant outcomes in an age‐matched cohort showed no difference in rates of delayed graft function, readmission within 30 days, and graft loss or death within 6 months of transplant (p >.05). Conclusion: Transplants with HBV NAT+ donor kidneys in a pre‐emptive treatment protocol allow for increased safe access to transplantation in older adult recipients with little or no dialysis time. [ABSTRACT FROM AUTHOR]

Operation of radio-genetic 'Inherited sterility technique' (IS), proposed for suppression of a serious tropical pest, Spodoptera litura (Fabr.) requires reproductively competitive moths as a prerequisite. Insects harbor microbes, which might be associated with their reproductive viability. The present study was attempted to assess the gut bacterial diversity of the F1 sixth instar (L6) progeny derived from irradiated (100Gy, 130Gy), sub-sterilized male parent moths in comparison with control, using Next Generation Sequencing (NGS) analysis of 16 S rRNA of the bacterial community of larval gut. Irradiated S.litura showed an increased bacterial load than control. Irradiation could stimulate the abundance of some groups of bacteria in the gut, whereas overall species richness and evenness were affected by irradiation. Phylum Firmicutes was the most abundant phylum in the irradiated larvae (both in the 100Gy F1L6 and 130Gy F1L6); whereas in control larval gut, the Proteobacteria, Bacteroidetes, Chlorofexi, and Cyanobacteria were found to be abundant as compared to the irradiated regimens. Lactobacillus, Bacillus, Paenibacillus, the genera belonging to the phylum Firmicutes were relatively more abundant in the irradiated larvae (100Gy F1L6 and 130Gy F1L6), whereas genera Pseudomonas, Neisseria, and Stenotrophomonas belonging to the phylum Proteobacteria were more abundant in control. The functional pathways involved in the oxidation and reduction of sulfate and nitrate were found to be enriched in the control larval gut whereas the streptomycin production, chloramphenicol degradation pathways were enriched in the irradiated larval gut. Irradiation could significantly alter the structure of S. litura bacteriome, which might be correlated with the degree of inherited sterility in this nuclear tactic, IS. [ABSTRACT FROM AUTHOR]

The optimization of the new generation of piezoelectric nanogenerators based on 1D nanostructures requires a fundamental understanding of the different physical mechanisms at play, especially those that become predominant at the nanoscale regime. One such phenomenon is the surface charge effect (SCE), which is very pronounced in GaN NWs with sub-100 nm diameters. With an advanced nano-characterization tool derived from AFM, the influence of SCE on the piezo generation capacity of GaN NWs is investigated by modifying their immediate environment. As-grown GaN NWs are analysed and compared to their post-treated counterparts featuring an Al2O3 shell. We establish that the output voltages systematically decrease by the Al2O3 shell. This phenomenon is directly related to the decrease of the surface trap density in the presence of Al2O3 and the corresponding reduction of the surface Fermi level pinning. This leads to a stronger screening of the piezoelectric charges by the free carriers. These experimental results demonstrate and confirm that the piezo-conversion capacity of GaN NWs is favoured by the presence of the surface charges. [ABSTRACT FROM AUTHOR]

Muffin is a baked product, relished by all age groups, mainly formulated from refined wheat flour, sugar and butter thus has high carbohydrate and fat content. Considering the ever-rising demand of the functional foods, the objective of this study was to formulate muffins fortified with beetroot and ethylene-primed sprouted soybean flour (ESF) to enhance their nutritional, physico-chemical and textural properties. The various formulations of beetroot muffins (BM) were BM0, BM1, BM2, BM3, BM4 and BM5 having a corresponding ESF content of 0%, 20%, 40%, 60%, 80% and 100%, respectively. As expected, the protein, ash, fat and fiber contents increased with the increase in ESF content and were the highest in BM5 viz. 21.12%, 0.94%, 22.77% and 16.03%, respectively. The lightness (L*) of the muffins decreased whereas redness (a*) and yellowness (b*) increased with the increase in the ESF content. The texture profile analysis (TPA) results showed that the hardness, cohesiveness, springiness, chewiness and adhesiveness decreased with the increase in ESF content in beetroot muffins. The BM0, BM1 and BM2 muffins received higher scores for all sensory parameters on 9-point hedonic scale having overall acceptability of 8.10, 7.90 and 7.7, respectively. Notably, as the ESF content in BM increased the muffins became softer, developed more pale-color and bitter after-taste. Electromyography (EMG), an in vivo texture evaluation technique, was used to obtain real-time information about the chewing and swallowing patterns of the formulated muffins. Further, significant correlations were observed between EMG variables, sensory textural parameters and TPA parameters. The addition of ESF in beetroot muffins significantly increased the nutritional content of the muffins but had a negative effect on textural and sensory properties. It can be concluded that the ESF incorporation can successfully be done up to a level of 40%. [ABSTRACT FROM AUTHOR]

The removal of tuberosity post extraction of the maxillary third molar is a very rare complication and there has not been ample discussion in the literature. Forceful extraction of a maxillary third molar can lead to soft and hard tissue loss. Various techniques have been used for the management of such defects such as local flaps, free soft tissue flaps, free bone flaps, and even tissue engineering. We present a case report of a large post-traumatic defect of maxillary tuberosity caused by forceful extraction of the maxillary third molar, which was managed conservatively by secondary healing, and the patient is on regular follow-up. [ABSTRACT FROM AUTHOR]

A mucocele is a prevalent benign oral lesion distinguished by the extravasation or retention of mucous within submucosal tissue originating from minor salivary glands. Mucoceles predominantly manifest on the lower lip, followed by occurrences on the floor of the mouth and the buccal mucosa. Trauma and lip biting habits are one of the main causes of lesions. Mucoceles are rarely observed in infants. This paper highlights an atypical case of mucocele located within the floor of the mouth in the first year of life (9 months old) in a child who was treated successfully with complete surgical excision, and the patient is on regular postoperative follow-up. [ABSTRACT FROM AUTHOR]

A letter published in the journal Techniques in Coloproctology discusses the use of cutting seton (CS) in the management of anal fistulas. The letter highlights that CS is associated with higher postoperative pain and longer healing time compared to other treatment modalities, while having similar recurrence and incontinence rates. The authors argue that there is a lack of evidence to support the assumption that CS preserves the sphincter muscle and prevents incontinence. They also note that CS is commonly used in South Asian countries, where sphincter loss is frequently observed. The authors suggest that further research, including randomized controlled trials, is needed to evaluate the impact of CS in high fistulas and to dispel the belief that CS is safe in all anal fistulas. [Extracted from the article]