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AbstractBackgroundObjectivesMaterials and methodsResultsConclusionsVestibular migraine (VM) and Menière’s disease (MD) have numerous overlapping symptoms. Distinguishing the two common recurrent vestibulopathies was challenging.To assess the characteristics of hearing loss and the horizontal semicircular canal function in VM and MD.Various frequency horizontal semicircular canal function tests, including caloric test, video head impulse test (vHIT), and rotatory chair test, as well as multifrequency audiological test with pure-tone average (PTA), were carried out.The hearing threshold of all frequencies in VM is lower than that of MD (p < .05). The phase shift at 0.01 Hz, 0.02 Hz, 0.04 Hz, 0.08 Hz and 0.64 Hz was significantly different in VM and MD patients. The gain at 0.01 Hz differed between VM and MD (p < .05); the time constant (RTc) in VM patients was longer than that of MD patients (p < .05). The incidence of caloric test abnormality was 40% in VM patients and 68.3% in MD patients. The abnormal rate of horizontal semicircular canal vHIT was 3.2% in VM and 5.8% in the MD, and the rates of overt/cover saccades were 9.7% and 17.6%, respectively.The degree and type of hearing loss were conducive to distinguishing between VM and MD, and the rotatory chair test was a necessary supplement. [ABSTRACT FROM AUTHOR]

Wire arc additive manufacturing (WAAM), also known as Arc-DED, possesses great potential for efficient production using various materials and wire types. This study utilized gas metal arc (GMA) and plasma transferred arc (PTA) variants of WAAM to deposit 2.25Cr-1Mo steel employing a metal-cored wire (MCW) and a solid wire counterpart having the same chemical composition for the comparative study. Initially, bead-on-plate trials were conducted with both WAAM processes and different shielding gas combinations in GMA-WAAM using the cored wire. The heat input versus deposition ratio was analysed to assess the heat input and the effects of shielding gases in GMA-WAAM. Arc behaviour was monitored with a process camera, and bead morphologies and dilutions were compared. Furthermore, test walls were deposited under the two WAAM processes and the shielding gas conditions, employing the cored and solid wire. Detailed microstructural study was conducted through optical microscopy, and hardness tests were performed to determine the mechanical properties. Energy dispersive X-ray spectroscopy (EDS) was used to examine the elemental composition and potential segregation in walls deposited with cored and solid wires. Results indicated a lower heat input when using cored wire and variable heat input due to shielding gases. A bainitic/martensitic microstructure was observed in test walls deposited with cored and solid wires with comparable microstructural features. The PTA process produced higher hardness than GMA, and solid wire exhibited slightly higher hardness than cored wire. Selection of shielding gas also influenced the hardness. Finally, the EDS maps and elemental study revealed comparable results for both wires. The results show good performance and outcome for cored wire. [ABSTRACT FROM AUTHOR]

Background: It's known that COVID-19 affects the audio-vestibular system, while its variant is not studied yet. Accordingly, this work was designed to study the effect of COVID-19 and its variant on audio-vestibular system and to compare between symptoms and effects of these two. Methods: A case- control study was conducted, with each case and control group consisting of 75 people who were age and gender matched. Their age ranged from 18 to 45 years. They were splited into three groups as follows: Study group 1 (post-COVID-19), it consisted of 25 post recovery adults, Study group 2 (post- COVID-23) consisted of 25 post recovery adults. Finally, a control group (group 3) consisted of 25 healthy people. PTA and tympanometry were used to evaluate hearing while VNG was used to evaluate vestibular system in all subjects included. Results: Regarding the SNHL there was a statistically significant difference between post-COVID-19 and controls while no statistically significant difference was reported between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding conductive hearing loss there was statistically significant difference between post-COVID-23 and controls with no statistically significant differences between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding the vestibular examination, Statistical analysis revealed significant difference in caloric test results between post-COVID-19 and controls with no statistically significant difference between the post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Conclusions: SNHL was more than CHL in post-COVID 2019. On the other hand, in post COVID-2023 cases CHL was more than SNHL. Also, the severity of symptom decreased from 2019 to 2023. We recommend that COVID patients should proceed with an audio-vestibular evaluation. So that early affection could be detected and managed properly accordingly. [ABSTRACT FROM AUTHOR]

Abstract Background It’s known that COVID-19 affects the audio-vestibular system, while its variant is not studied yet. Accordingly, this work was designed to study the effect of COVID-19 and its variant on audio-vestibular system and to compare between symptoms and effects of these two. Methods A case- control study was conducted, with each case and control group consisting of 75 people who were age and gender matched. Their age ranged from 18 to 45 years. They were splited into three groups as follows: Study group 1 (post-COVID-19), it consisted of 25 post recovery adults, Study group 2 (post- COVID-23) consisted of 25 post recovery adults. Finally, a control group (group 3) consisted of 25 healthy people. PTA and tympanometry were used to evaluate hearing while VNG was used to evaluate vestibular system in all subjects included. Results Regarding the SNHL there was a statistically significant difference between post-COVID-19 and controls while no statistically significant difference was reported between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding conductive hearing loss there was statistically significant difference between post-COVID-23 and controls with no statistically significant differences between post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Regarding the vestibular examination, Statistical analysis revealed significant difference in caloric test results between post-COVID-19 and controls with no statistically significant difference between the post-COVID-19 and post-COVID-23 or between post-COVID-23 and controls. Conclusions SNHL was more than CHL in post-COVID 2019. On the other hand, in post COVID-2023 cases CHL was more than SNHL. Also, the severity of symptom decreased from 2019 to 2023. We recommend that COVID patients should proceed with an audio-vestibular evaluation. So that early affection could be detected and managed properly accordingly.

Abstract Background Stenosis resulting in dysfunctional dialysis access may occur simultaneously on the anastomotic and central venous side. The purpose of this study was to retrospectively evaluate the feasibility of a single sheath inverse technique using the vertical puncture approach to perform bidirectional transvenous percutaneous transluminal angioplasty (PTA) from a single sheath for such dialysis access stenoses. Materials and Methods Twenty patients (26 cases; 13 males; median age, 74 [range: 50–89] years) who underwent PTA using the sheath inverse technique for dysfunctional arteriovenous fistula stenoses between April 2019 and June 2023 were included. All procedures were performed in an outpatient setting. A 4-cm sheath (4Fr, four cases; 5Fr, 19 cases; 6Fr, three cases) was inserted by vertical puncture through a cutaneous vein in the forearm (20 cases) or upper arm (six cases). After treating one side of the lesion, the sheath was reversed to treat the lesion on the opposite side. The vessel diameter at the sheath insertion site, the success rate of sheath inversion, the number of PTA balloon catheters used, the PTA success rate, adverse events, and primary and secondary patency rates up to one year after PTA were evaluated. Results The median diameter at the sheath indwelling site was 5.2 (range: 3.6–9.5) mm, and sheath inversion was successful in all cases, eliminating the need to place an additional sheath at another site for contralateral stricture treatment. The number of balloon catheters used was one and two in 17 (65%) and eight cases (31%), respectively, and three in one case wherein a drug-coated balloon was used. PTA was successful in all cases and major complications were not observed. However, in one case wherein a sheath had to be placed at the arterial needle puncture site, the skin was hard, leading to difficulty in inversion, and transient venous spasm occurred post-inversion. The primary patency rates at 3, 6 and 12 months after the PTA were 87.5%, 41.7%, and 20.8%, respectively. The secondary patency rates at 6 and 12 months were 100% and 75%, respectively. Conclusion The single-sheath inverse technique for arteriovenous fistulas was feasible without sheath withdrawal. Graphical Abstract

Background: Military troops deployed in high altitude areas (HAAs) may suffer from illnesses peculiar to the terrain which are usually due to hypoxia. The physiological dynamics at high altitude (HA) are different from those in the plains and hence environmental factors play an important role at HA. The effect, if any, of hemodynamic changes in terms of raised hemoglobin (Hb) levels in HA on otological disorders is not very well researched and needs to be explored further. This study was undertaken to study the clinical manifestations, if any, of the hemodynamic alterations in the inner ear and their correlation with the Hb levels after 1 year deployment at HA. Methods: A longitudinal descriptive study was conducted over 1 year duration at a Military Hospital located at HAA on 99 soldiers who were

Background: Stenosis resulting in dysfunctional dialysis access may occur simultaneously on the anastomotic and central venous side. The purpose of this study was to retrospectively evaluate the feasibility of a single sheath inverse technique using the vertical puncture approach to perform bidirectional transvenous percutaneous transluminal angioplasty (PTA) from a single sheath for such dialysis access stenoses. Materials and Methods: Twenty patients (26 cases; 13 males; median age, 74 [range: 50–89] years) who underwent PTA using the sheath inverse technique for dysfunctional arteriovenous fistula stenoses between April 2019 and June 2023 were included. All procedures were performed in an outpatient setting. A 4-cm sheath (4Fr, four cases; 5Fr, 19 cases; 6Fr, three cases) was inserted by vertical puncture through a cutaneous vein in the forearm (20 cases) or upper arm (six cases). After treating one side of the lesion, the sheath was reversed to treat the lesion on the opposite side. The vessel diameter at the sheath insertion site, the success rate of sheath inversion, the number of PTA balloon catheters used, the PTA success rate, adverse events, and primary and secondary patency rates up to one year after PTA were evaluated. Results: The median diameter at the sheath indwelling site was 5.2 (range: 3.6–9.5) mm, and sheath inversion was successful in all cases, eliminating the need to place an additional sheath at another site for contralateral stricture treatment. The number of balloon catheters used was one and two in 17 (65%) and eight cases (31%), respectively, and three in one case wherein a drug-coated balloon was used. PTA was successful in all cases and major complications were not observed. However, in one case wherein a sheath had to be placed at the arterial needle puncture site, the skin was hard, leading to difficulty in inversion, and transient venous spasm occurred post-inversion. The primary patency rates at 3, 6 and 12 months after the PTA were 87.5%, 41.7%, and 20.8%, respectively. The secondary patency rates at 6 and 12 months were 100% and 75%, respectively. Conclusion: The single-sheath inverse technique for arteriovenous fistulas was feasible without sheath withdrawal. [ABSTRACT FROM AUTHOR]

Hearing loss is an important health care concern. Pure Tone Audiometry (PTA) is considered Gold Standard for audiometric evaluations though, there exist a huge variance between the demand and the actual services available. As smartphones are mobile, applications are upgradable, results are reproducible, the mobile applications may offer a good screening tool, especially in remote areas. There are many smartphone-based hearing applications which are already in use. However, effectiveness of such applications needs to be validated. To evaluate the reliability of 'Hearing Test' a phone application against PTA for assessment of hearing thresholds in adults. We conducted a diagnostic study on a heterogenous group of 250 individuals irrespective of their hearing levels. The hearing thresholds for both ears were measured by PTA and phone app and then compared statistically. The agreement between the methods were statistically significant with respect to diagnosing hearing loss and the degree of hearing loss. Though, PTA remains Gold Standard for hearing evaluation but freely available, highly reproducible & specific 'Hearing Test' application could be used as a screening tool in remote areas and may help bridging the gap between the requirement and availability of diagnostic audiometric services. [ABSTRACT FROM AUTHOR]

Preferential trade agreements (PTAs) between trading partners are known to have positive impact on the expanding and deepening of global value chain integration due to lower trade and investment barriers. Less is known, however, is if other PTAs of PTA partners have any impact on the value‐added trade linkages of the direct PTA partners concerned. Based on compositive indicators measuring the breadth and depth of PTAs from 2007 to 2018 and using Multiregional Input–Output Table database covering 62 countries and 35 sectors and the Content of Deep Trade Agreements database, this paper estimates the multiplicative form of the constant‐elasticity augmented gravity equation model by a Poisson Pseudo Maximum Likelihood (PPML) estimator. This study shows that indirect impact of the deepening of trade agreements of a country's PTA partner exerts positive, significant impact on value‐added exports of a country. Both backward and forward linkages of a country measured by various decomposition of valued added exports indicate this indirect channel of value chain deepening effect even outweighs the direct impact from the deepening of PTAs between direct trading partners with significant policy implications in formulating PTA strategies. [ABSTRACT FROM AUTHOR]

In recent years, with the miniaturization of high-precision position and orientation systems (POS), precise motion errors during SAR data collection can be calculated based on high-precision POS. However, compensating for these errors remains a significant challenge for multi-rotor UAV-borne SAR systems. Compared with large aircrafts, multi-rotor UAVs are lighter, slower, have more complex flight trajectories, and have larger squint angles, which result in significant differences in motion errors between building targets and ground targets. If the motion compensation is based on ground elevation, the motion error of the ground target will be fully compensated, but the building target will still have a large residual error; as a result, although the ground targets can be well-focused, the building targets may be severely defocused. Therefore, it is necessary to further compensate for the residual motion error of building targets based on the actual elevation on the SAR image. However, uncompensated errors will affect the time–frequency relationship; furthermore, the ω-k algorithm will further change these errors, resulting in errors in SAR images becoming even more complex and difficult to compensate for. To solve this problem, this paper proposes a novel improved precise topography and aperture-dependent (PTA) method that can precisely compensate for motion errors in the UAV-borne SAR system. After motion compensation and imaging processing based on ground elevation, a secondary focus is applied to defocused buildings. The improved PTA fully considers the coupling of the residual error with the time–frequency relationship and ω-k algorithm, and the precise errors in the two-dimensional frequency domain are determined through numerical calculations without any approximations. Simulation and actual data processing verify the effectiveness of the method, and the experimental results show that the proposed method in this paper is better than the traditional method. [ABSTRACT FROM AUTHOR]

The common-spectrum process, characterized by the Hellings–Downs angular correlation and observed by pulsar timing array collaborations, such as NANOGrav, PPTA, EPTA, and CPTA, can be explained by the scalar-induced gravitational waves (SIGWs). The energy density of SIGWs exhibits universal behavior in the infrared regions. Utilizing a broken power law parameterization for the primordial curvature power spectrum, we clarify the PTA signal through the infrared characteristics of the SIGWs, using Bayesian analysis to provide posterior distributions. Bayesian factors emphasize the statistical preference for the SIGW model over explanations involving supermassive black hole binaries. [ABSTRACT FROM AUTHOR]

The stochastic signal observed by collaborations such as NANOGrav, PPTA, EPTA +InPTA, and CPTA may originate from gravitational waves induced by primordial curvature perturbations during inflation. This study investigates small-scale properties of inflation and reheating, assuming a log-normal form for the power spectrum of the primordial curvature and a reheating phase equation of state w = 1 / 9 . Inflation and reheating scenarios are thoroughly examined using Bayesian methods applied to the NANOGrav 15-year dataset. The analysis establishes constraints on the reheating temperature, suggesting T rh ≳ 0.1 Gev , consistent with Big Bang nucleosynthesis constraints. Additionally, the NANOGrav 15-year dataset requires the amplitude (A∼0.1) and width ( Δ ≲ 0.001 ) of the primordial curvature power spectrum to be within specific ranges. A notable turning point in the energy density of scalar-induced gravitational waves occurs due to a change in the equation of state w. This turning point signifies a transition from the reheating epoch to radiation domination. Further observations of scalar-induced gravitational waves could provide insights into the precise timing of this transition, enhancing our understanding of early Universe dynamics. [ABSTRACT FROM AUTHOR]

Kauri (Agathis australis), a tree species endemic to northern New Zealand, is threatened by kauri dieback disease, caused by the plant pathogen Phytophthora agathidicida. Some human and animal activities capable of disturbing and transferring infected soil may facilitate the spread of this pathogen. Feral pigs (Sus scrofa) are thought to be especially important due to their foraging behaviour. Consequently, management of feral pigs has been proposed as a key mitigation strategy for reducing the impacts of kauri dieback disease. We reviewed the evidence for feral pigs facilitating the spread of P. agathidicida. Although feral pigs can spread other plant pathogens, there is scant direct evidence that they act as vectors or transport hosts of P. agathidicida. Whether this is due to the lack of in-depth investigations, limitations in current detection methods, or simply that feral pigs are not playing a substantial role in the spread of kauri dieback disease is currently unknown. If management agencies proceed with a management strategy for feral pigs such as sustained control or eradication, under the assumption that this will mitigate unwanted impacts on kauri, an adaptive management approach should be taken to increase our understanding of the importance of feral pigs in this system. [ABSTRACT FROM AUTHOR]

During veno-venous extracorporeal membrane oxygenation (vv ECMO) therapy, antimicrobial drugs are frequently used, and appropriate dosing is challenging due to there being limited data to support the dosage. Linezolid is effective against multidrug-resistant Gram-positive pathogens frequently isolated in ECMO patients. In total, 53 steady-state linezolid levels were obtained following 600 mg intravenous (IV) injections every 8 h, and these were used to develop a population pharmacokinetic (PopPK) model in patients with COVID-19-associated acute respiratory distress syndrome (CARDS) on vv ECMO. The data were analyzed using a nonlinear mixed-effects modelling approach. Monte Carlo simulation generated 5000 patients' individual PK parameters and corresponding concentration–time profiles using the PopPK model, following the administration of 600 mg/8 h (a higher-than-standard dosing) and 600 mg/12 h (standard). The probabilities of pharmacokinetic/pharmacodynamic (PK/PD) target attainment (PTA) and the cumulative fraction of responses (CFR) for three pathogens were calculated and compared between the two dosing scenarios. Linezolid 600 mg/8 h was predicted to achieve greater than or equal to 85%Tf>MIC in at least 90% of the patients with CARDS on vv ECMO compared to only approximately two thirds of the patients after dosing every 12 h at a minimal inhibitory concentration (MIC) of 2 mg/L. In addition, for the same MIC, fAUC24/MIC ≥ 80 was achieved in almost three times the number of patients following an 8-h versus a 12-h interval. PopPK simulation predicted that a significantly higher proportion of the patients with CARDS on vv ECMO would achieve the PK/PD targets following the 8-h dosing interval compared to standard linezolid dosing. Nevertheless, the safety concern, in particular, for thrombocytopenia, with higher-than-standard linezolid dosage is reasonable, and consequently, monitoring is essential. [ABSTRACT FROM AUTHOR]

Introduction: WHO estimated the prevalence of disabling hearing loss is 5% of the world population (430 million). People with a risk of hearing loss from noise exposure, ototoxic drugs, and comorbidities need regular hearing assessments. It is done by pure tone audiometry (PTA), requiring a skilled audiologist, special equipment, and a soundproof room. Modern technologies can help in overcoming these barriers. This study aimed to fill the lacuna by developing a new android-based application "Shravana Mitra" (Hearing companion) with features of both air conduction (AC) and bone conduction (BC) testing. Objectives: To develop, corroborate and compare smartphone application-based audiometry with PTA. Methodology: This study was done in three phases -(i) development of a mobile application, (ii) app validation in healthy individuals (iii) testing and comparison of results with PTA in individuals visiting OPD. The third phase was done as a cross-sectional observational study including 780 individuals visiting OPD of 10–60 years of age. Results: The mean age of the study population was 32.89 years with female preponderance (57%). In AC testing, 83% of the pure tone average of the mobile application was within 5 dB of PTA thresholds and 99% was within 10 dB and for BC testing, 81% was within 5 dB of PTA thresholds and 98% within 10 dB. Conclusion: Our user-friendly mobile application- Shravana Mitra is the first Indian application available in the google play store with both AC & BC testing, multiple language options and accuracy similar to PTA. Thus, it can be used as the best hearing screening tool in camps, high-risk individuals, or any healthcare setup requiring initial hearing assessment. [ABSTRACT FROM AUTHOR]

Renal transplantation is the treatment of choice for improved survival and quality of life in patients with end-stage renal disease. However, perirenal fluid collections are common surgical complications after renal transplant, with about 0.6 to 18% of patients developing a lymphocele. Conventional treatments include percutaneous aspiration and drainage, laparoscopic fenestration, and open surgical decompression stepwise. Recently, a new image-guided percutaneous transperitoneal balloon fenestration technique has been described as an alternative to the laparoscopic or surgical technique. We present the case of a 25-year-old male patient diagnosed with a lymphocele after 2 months of transplantation and no resolution of the lymphocele with percutaneous aspiration and drainage. We used this new technique under ultrasound and fluoroscopy guidance, which resulted in the resolution of the lymphocele at 1 month postprocedure. This case report highlights this new technique's potential role in successfully managing the posttransplant lymphocele in a minimally invasive manner.

Objective: The objective of this study was to produce a cross-cultural adaptation in Italian of the Agitated Behavior Scale (ABS), originally developed in English, as the first of two stages that also include cross-cultural validation and allow a clinical scale to be used in the proper setting such as rehabilitation units. Methods: In order to adapt the ABS scale to a different cultural environment, five consecutive steps were performed: (1) forward translations (n = 8), (2) synthesis of the 8 forward translations to obtain a first shared italian version (ABS_I_trial), (3) back translations (n = 3), (4) creation of an expert committee to evaluate forward and back translations and finally (5) the cognitive debriefing. Results: After the five steps, including forward translations and back translations, the process of committee verification and judgement and the evaluative step of cognitive debriefing, high comprehensibility of all items was found, resulting in an Italian translation version of ABS suitable for application in a clinical setting. Conclusion: ABS translation was produced by means of a standardized procedure aimed at minimizing cross-cultural gaps. The expert committee evaluated the version produced as highly understandable in Italian. Further steps, such as the subsequent validation of its psychometric properties, are needed to employ this translation in a clinical setting.

Previous research highlights how schools value white, middle-class modes of parental involvement, we know less about Latinx parents' involvement in their children's schools. This article compares the participatory patterns of Latinx and non-Latinx white parents whose children attend a Spanish/English dual-immersion school in Los Angeles. Drawing from 66 interviews and 20 months of participant observation, I find that all parents participate actively but are channeled into racially segregated Parent Teacher Organizations (PTO) based on the reputation, demographic composition and informal culture of each of these organizations. This organizational segregation disadvantages Latinxs – working-class Latinx parent efforts garner less power and recognition and middle-class Latinx are less active in PTOs, as they feel they do not 'fit' in either organization. This article illustrates how school-based parental involvement is stratified in ways that are not fully captured by solely focusing on participation, and demonstrates how parent organizations can function as racialized organizations that perpetuate inequality. [ABSTRACT FROM AUTHOR]

This paper analysis the trends in India's Directional Change in Exports using the time series data for the period 1990-1991 to 2019- 2020.The Government of India introduced economic reforms since 1991 especially in the export import sector mainly concentrating on the trade avenue, therefore, in order to see the impact of economic reforms on export sector particularly in the regions and directional changes witnessed during the post reform period 1990-1991 to 2019- 2020. The period has been divided into seven sub-periods 1990-'91, 1991-'96, and 1996- '01,2001-'06,2006-2011,2011-2016,2016-'20. In order to calculate the growth rate, the regression equation used was Yt = Yo (1+r) t, where, YO=the beginning value of Y, Yt = Y's value at the time t, r=the compound rate of growth of Y. The study showed that the India's Directional Change in Exports during post --reform period improved significantly and there has been a perceptible change in volume and value paved a way for increased quantum of exports,increase in directions, and a change and addition of new regions, However,as it is seen from the study it reveals that India's Global Share of world exports not increased in directions and it is still not up to the planned expectations. [ABSTRACT FROM AUTHOR]

The policy changes effected after 1991-92, went far beyond those accompanying earlier balance of payments crises. Several factors contributed to this greater scopes and depth. First, there was severity of crisis itself and it was estimated that foreign exchange reserves were no more than two weeks imports when initial measures were taken. Second, it was evident that fiscal deficit had been the major factor contributing to the crisis and had to be sharply curtailed. Third, over time, a large number of people expressed their discontent with India's slow growth. Fourth, the disintegration of Soviet Union further altered perceptions and undermined support for state dominance of economic activity. Fifth and most important, the economic policy team lead Finance Minister Dr. Manmohan Singh supported by Prime Minister Narasimha Rao was Convinced that economic reform was essential if India was to improve its economic performance. The crisis provided more than the visual room to change the policy regime. The reform proceeded slowly and gradually structural changes began to take place in 1992. The main areas chosen in the initial phase for reforms were tariffs, exchange rates, non tariff barriers and capital flows. Many of the reforms affected in the capital flows had major impact on domestic monetary system, which was significantly liberalized. In 1991, import licensing on intermediate inputs and capital goods accounting for approximately 30 percent of the tariff lines remained subject to licensing. It was only after a challenge by India's trading partners in the Dispute Settlement Body (DSB) of the WTO that these goods were freed of licensing decade later in 2001. This paper analyzes the trends in India's exports using the time series data for the period 1990-91 to 2019-2020. On study it revealed that the composition of India's foreign trade has undergone substantial changes, particularly, after the liberalization and globalization. Our major exports now includes manufacturing goods such as Engineering Goods, Petroleum Products, chemical and allied products, Gems and Jewelleries, Textile, Electronic Goods and Information Technologies related services sectors etc, which constitute over 80 percent of our expert basket. The study is focusing on the structured changes in the composition of commodities exported from India during last more than three decades since 1990-91(Post reform period). The dominance pattern is Heavy industries, Gems and Jewelleries and Services sector. Over all mobility and turn-over is 12.3 percent per annum on an average basis. The annual compound growth rate (ACGR) of concentration ratio of composition of commodities is positive and statistically significant. Average value of concentration ratio is 0.075. The increasing trend of concentration ratio has been supplemented and complemented to the dominance pattern. India now has significant share in the world trade. India is required to make its commodities more competitive at the world trade level. It is also required to add new commodities and services at competitive price in the export basket for increasing export performance. Hence; India needs a comprehensive and definite policy measure and integrated efforts. This study elaborately analyzed various aspects of commodity composition and Directional changes reflected in India's exports since Post-Liberalization period. [ABSTRACT FROM AUTHOR]

Antibiotic development traditionally involved large Phase 3 programs, preceded by Phase 2 studies. Recognizing the high unmet medical need for new antibiotics and, in some cases, challenges to conducting large clinical trials, regulators created a streamlined clinical development pathway in which a lean clinical efficacy dataset is complemented by nonclinical data as supportive evidence of efficacy. In this context, translational Pharmacokinetic/Pharmacodynamic (PK/PD) plays a key role and is a major contributor to a "robust" nonclinical package. The classical PK/PD index approach, proven successful for established classes of antibiotics, is at the core of recent antibiotic approvals and the current antibacterial PK/PD guidelines by regulators. Nevertheless, in the case of novel antibiotics with a novel Mechanism of Action (MoA), there is no prior experience with the PK/PD index approach as the basis for translating nonclinical efficacy to clinical outcome, and additional nonclinical studies and PK/PD analyses might be considered to increase confidence. In this review, we discuss the value and limitations of the classical PK/PD approach and present potential risk mitigation activities, including the introduction of a semi-mechanism-based PK/PD modeling approach. We propose a general nonclinical PK/PD package from which drug developers might choose the studies most relevant for each individual candidate in order to build up a "robust" nonclinical PK/PD understanding. [ABSTRACT FROM AUTHOR]

Renal transplantation is the treatment of choice for improved survival and quality of life in patients with end-stage renal disease. However, perirenal fluid collections are common surgical complications after renal transplant, with about 0.6 to 18% of patients developing a lymphocele. Conventional treatments include percutaneous aspiration and drainage, laparoscopic fenestration, and open surgical decompression stepwise. Recently, a new image-guided percutaneous transperitoneal balloon fenestration technique has been described as an alternative to the laparoscopic or surgical technique. We present the case of a 25-year-old male patient diagnosed with a lymphocele after 2 months of transplantation and no resolution of the lymphocele with percutaneous aspiration and drainage. We used this new technique under ultrasound and fluoroscopy guidance, which resulted in the resolution of the lymphocele at 1 month postprocedure. This case report highlights this new technique's potential role in successfully managing the posttransplant lymphocele in a minimally invasive manner. [ABSTRACT FROM AUTHOR]

Abstract Background Vertigo and dizziness are frequent clinical symptoms. Peripheral vertigo and central vertigo are two different types of vertigo that result from a disrupted vestibular system. Imbalance and dizziness are frequent initial complaints. It is common for improper diagnosis and subpar treatment to result from a lack of a systematic approach to the examination and laboratory evaluation of the vestibular system. A correct diagnosis can be made with a fundamental knowledge of vestibular physiology and the right examination methods. Objectives The current study was done to evaluate and assess the roles of neuro-otological examinations, vestibular tests, and videonystagmography among patients with dizziness visiting a tertiary care centre. Methodology An analytical cross-sectional study was conducted among patients complaining of vertigo at a tertiary care centre for the duration of 18 months. A total of 64 patients were included according to inclusion and exclusion criteria. Various diagnostic tests were applied and correlated with the complaints of the patients. Result Forty-two percent of patients with dizziness had hearing loss, and 26.5% had tinnitus. 57.8% had the PTA test within the normal limit, and the head shake test (videonystagmography) was positive among 39.1%. Caloric test abnormality was seen in 53.1% of patients with dizziness. Neuro-otological examination of the head shake test was found positive in 29.7% of cases. 79.7% of cases show a positive Fukuda test. SP > AP is seen among 9.4% of cases in EchoG. 67.1% show a positive Romberg test. The Dix-Hallpike test was positive among 31.2% of dizziness patients. Conclusion In conclusion, history and neuro-otological testing can aid in the diagnosis of vertigo, but they cannot be relied on if the vertigo is complex. Only symptomatic history and neuro-otological tests are helpful in cases like a simple unilateral posterior canal BPPV, but in a complex case with tinnitus, aural fullness, Romberg positivity, or Fukuda positivity, we need the assistance of additional investigations such as vestibular tests such as ECochG and VNG.

Background Chronic defects in the lower leg present significant challenges in plastic surgery due to their diverse etiologies and association with impaired peripheral circulation. This study describes the localization of stable perforators and assesses their changing velocities after digital subtraction angiography (DSA) and alterations of flow characteristics.

Secondary autoimmune inner ear disease (AIED) is often bilateral and asymmetric in patients presenting with audiovestibular symptoms due to a systemic autoimmune disease. This systematic review and meta-analysis are aimed at identifying and highlighting patterns in prevalence of vestibular dysfunction, symptom presentation, and diagnostic methods in extant literature by combining clinical context from case reports with quantitative analyses from cohort studies. Screening of articles by title, abstract, and full text was completed by four reviewers (K.Z., A.L., S.C., and S.J.). In this study, we grouped secondary AIED and systemic autoimmune diseases by pathophysiologic mechanism: (1) connective tissue disease (CTD), (2) vasculitides (VAS), (3) systemic inflammatory disorders (SID), and (4) other immune-mediated disorders (OIMD). The search for AIED disease identified 120 articles (cohorts and case reports) that met the final inclusion criteria. All 120 were included in the qualitative review, and 54 articles were included for meta-analysis. Of these 54 articles, 22 included a control group (CwC). Ninety individual cases or patient presentations from 66 articles were included for analysis in addition to the 54 cohort articles. Secondary AIED does not have a diagnostic algorithm for managing vestibular symptoms. The management of audiovestibular symptoms requires close collaboration between otolaryngologists and rheumatologists to preserve end-organ function of the ear. To improve our ability to understand the impact on the vestibular system, vestibular clinicians need to develop a standardized reporting method. Clinical presentation should frequently be paired with vestibular testing to contextually investigate symptom severity and provide higher quality care. [ABSTRACT FROM AUTHOR]

This study used the ARCS approach to investigate the effects of university students' motivation, including attention, relevance, confidence, and satisfaction, to use the Programming Teaching Assistant (PTA) on their Programming Problem-Solving Skills (PPSS). Previous studies have shown that PTA features enhance learners' programming performance, but relevant studies have not empirically evaluated the factors influencing learners' problem-solving skills in PTA-based programming language practice. Thus, the current study used the ARCS model to investigate the effects of its core factors, Attention (A), Relevance (R), Confidence (C), and Satisfaction (S), on the learners' PPSS. A total of 99 students major in computer science and engineering (CSE) participated in this study. Multiple linear regression analysis was conducted and the results indicated that these motivational factors influenced learners' PPSS in PTA-based programming language practice. The PTA has proven to be a motivating platform for programming language practice. Finally, relevant implications are offered. [ABSTRACT FROM AUTHOR]

Purpose: To study effects of chemoradiation therapy on hearing in patients with malignancy of head and neck. Methods and materials: Patients receiving drugs other than cisplatin as well as those with any otology-related pathology or abnormalities were excluded from the study. Patients with primary biopsy-proven malignancy of the Nasopharynx, Oropharynx, Paranasal Sinuses, Oral Cavity, and Parotid with chemoradiation by cisplatin and different radiation modalities were all eligible. Areas of interest and OARs are indicated on CT images. All patients' hearing was assessed using pure tone audiometry at the beginning of treatment, at its conclusion, and six months later. Variations in pure tone thresholds from baseline and CTCAE - Common Terminology Criteria for Adverse Events grading are related to cochlear dose. Results: The study involves 75 patients. At cochlear dosage levels of more than 40 Gy, significant SNHL (>10 dB loss) is seen. Absolute PTA threshold values do not statistically differ from baseline to completion at any frequency. For 4000 and 8000 Hz, the absolute PTA threshold values differed from baseline to follow-up, but only for 8000 Hz was the difference statistically significant after six months of follow-up. Following treatment, 64% of patients had grade I CTCAE scoring and 16% and 12%, respectively, had otitis media with effusion and Eustachian tube dysfunction. Conclusion: The inner ear may be harmed in patients receiving radiation to the head and neck. Radiation-induced SNHL typically goes unreported in routine clinical practise because of its long-term nature. In the group of head and neck tumours with high-risk locations, nearly 90% of patients with SNHL were affected. Therefore, it's critical to reduce cochlear dosage in these patient populations. More investigation is needed to distinguish between cochlear and retro-cochlear types of sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate auditory performance and speech intelligibility of children with Usher syndrome up to 10 years after cochlear implantation. Methods: Thirty-five children with USH were compared to 46 non-syndromic patients regarding age at implantation. Auditory performance and speech intelligibility was assessed with standard tools. Genetic counseling, vestibular tests, imaging studies, and ophthalmological findings were evaluated, depending on the availability. Results: The mean age of implantation in USH children was 6.3 years (SD 4.6, range 0.3–17.6 years). Post-implantation values of the studied parameters were compared between USH and NS children and presented as follows: PTA = 25.0 dB HL vs. 28.4, CAP = 5.3 vs. 5.1, SIR = 4.1 vs. 3.9, MAIS = 82.3% vs. 80.5%, MUSS = 81.8% vs. 76.6%. There were no statistically significant differences between the USH and NS groups (p > 0.005). USH patients reached a higher score ceiling earlier compared to NS patients. Children implanted before 3 years of age achieved significantly higher results than older children in USH and NS groups (p < 0.005). In all patients with USH, the electroretinogram was abnormal. Vestibular examination was abnormal in 29 of 31 patients with USH1. Imaging studies revealed no inner ear or auditory nerve anomalies in patients with USH. Conclusion: Cochlear implantation successfully improves auditory performance and speech intelligibility in patients with USH, especially those implanted under 3 years of age. The electroretinogram is the only reliable test to establish a diagnosis of USH. Logopedic outcomes are associated with early implantation, and early diagnosis of USH contributes to optimizing speech therapy. [ABSTRACT FROM AUTHOR]

The most popular objective physiologic test for detecting hearing loss that is in use today is the ABR, however it is not frequency specific. The frequency specific tool available for evaluation of hearing is ASSR. The study is aimed to assess the ability of ASSR to estimate hearing thresholds and identify the ideal modulation frequency in hearing impaired personnel. All subjects and controls were subjected to PTA to determine presence/absence of hearing loss, and the nature and configuration of the hearing loss if any. The subjects were then subjected to ASSR testing to objectively ascertain hearing thresholds. The PTA thresholds obtained and the hearing thresholds obtained by ASSR were correlated in this study. The study was carried out in 100 subjects under the age of 50 years (50 with normal hearing & 50 with impaired hearing by PTA) after obtaining informed consent. Moderate correlation was found between PTA and ASSR thresholds only in certain frequencies while in other frequencies the correlation though present, was low. This study concluded that ASSR system could be used to estimate hearing thresholds only approximately as no significant linear correlations were found between PTA thresholds and ASSR at the tested frequencies. [ABSTRACT FROM AUTHOR]

A peritonsillar abscess (PTA) is a localized collection of pus in the peritonsillar space, between the palatine tonsillar capsule and the superior pharyngeal constrictor muscle (G. Gupta & R. McDowell, 2022). It is the most commonly occurring abscess in the head and neck region. Patient presentation usually includes odynophagia, unilateral otalgia, trismus, and voice changes. Managing a pediatric patient may be challenging, as children may not be able to describe their history of illness and symptoms. The management of a PTA can also differ between pediatric and adult patients (S. Ahmed Ali et al., 2018). It is important for practitioners to consider all aspects when providing treatment. This article describes the encounter and individualized treatment plan of an 11-year-old nonverbal autistic child who presented with fever, decreased oral intake, and left neck swelling. It also provides a general overview of PTAs and procedural steps to perform drainage through needle aspiration and incision and drainage. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine prognostic factors of limb salvage after iliac angioplasty ± stenting for chronic limbthreatening ischemia patients with iliac artery disease alone or with concomitant other lesion (femoro-popliteal or infrapopliteal disease). Methods: In this prospective interventional study, 32 patients with symptomatic steno-occlusive iliac artery disease treated by balloon angioplasty ± stenting. Patients’ data & comorbidities are collected and they are followed up for 1 month after iliac artery angioplasty ± stenting for above the knee amputation. Results: Comparison of data for final outcomes of limb salvage versus above-the- knee amputation showed that amputation is more likely with the increase in age with p value 0.035. Moreover, medical comorbidities were of no statistical significance regarding amputation however, angiographic characteristics and TASC classification were statistically significant regarding limb salvage. All the patients with total iliac artery occlusion (5 patients) underwent above-the-knee amputation within 1 month following the intervention while the limb was salvaged in patients with iliac artery stenosis with p value < 0.001. In addition, limbs with diseased both CIA and EIA were more prone to above-the-knee amputation than limbs with diseased CIA only with p value 0.009. State of profunda femoris artery was a statistically significant prognostic factor for limb salvage as limbs with diseased PFA were more prone to above-the-knee amputation than limbs with healthy PFA with p value 0.023. Limbs with TASC D were more prone to above-the- knee amputation than TASC A, B, C with p value < 0.001. Limb salvage was more reported in patients who underwent iliac artery angioplasty & stenting than in patients who underwent angioplasty only with p value 0.002. Conclusion: Above-the-knee amputation 30 days post iliac artery angioplasty ± stenting is significantly associated with increasing age, total iliac artery occlusion, concomitant CIA & EIA lesions, diseased PFA, TASC D lesions & in patients who underwent iliac artery angioplasty only than in patients who underwent angioplasty & stenting. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potential significance of the second transurethral resection of a bladder tumor (TURBT) in a population of patients whose primary pathology was high-grade pTa (Ta/HG) and who had received Bacillus Calmette-Guérin (BCG) treatment for at least 12 on oncological outcomes, based on the presence or absence of detrusor muscle. Materials and Methods: Patients with primary Ta/HG tumors (n=207) that met the inclusion criteria were grouped based on the presence of muscle tissue in the first TURBT and whether the secondary TURBT was performed. Progression, recurrence, and disease-free survival rates were compared between the groups. Results: Median follow-up period was 24 (12-205) months. In cases with muscle in the first TURBT, a second TURBT significantly increased the median disease-free survival time compared with those that did not undergo the second TURBT [32 months (12-83) vs 12 months (6-67); p<0.005]. In cases without muscle in the first TURBT, the second TURBT significantly reduced the rate of progression (p<0.05). Regression analysis showed that tumor size >3 cm [95% confidence interval (CI)=1.09-2.96, hazard ratio (HR)=1.79, p=0.021], presence of muscle tissue (95% CI=0.35-0.92, HR=0.57, p=0.022), and multiple tumor (95% CI=1.06-2.90, HR=1.75, p=0.028) were independent factors affecting disease relapse in primary Ta/HG tumor. Conclusions: In patients with primary Ta/HG tumors, if there was no muscle in the first TURBT, a second TURBT should be performed to achieve lower progression rates. If there is muscle in the first TURBT, the second TURBT will only increase the median disease-free survival time. [ABSTRACT FROM AUTHOR]

CoWC composite coatings were produced on AISI 430 steel by the plasma transfer arc cladding. Three different powder mixtures containing WC (90%, 85% and 80%) and Co (10%, 15% and 20%) were used. Phase composition, microstructural characterization and coating properties were investigated by using scanning electron microscope (SEM), energy dispersive spectrometry (EDS), X-ray diffraction (XRD), elemental mapping, hardness and wear test. The wear shape morphology of coatings was determined by SEM. The increased ratio of WC in CoWC powders reduced the degradation of CoWC. The substrate hardness of 180 HV gained a coating hardness value of approximately 462 HV. An increase in the hardness of the coating alloy compared to the substrate was achieved. W2C, WC, CoC and Co6W6C phases were determined on the coating surface. The high levels of WC concentration on the coating surface increased the wear resistance. [ABSTRACT FROM AUTHOR]

Improving the cellulose accessibility and reactivity in an efficient and convenient way has become the focused issue in the field of dissolving pulp manufacturing. We herein demonstrate a simple yet efficient strategy, namely a simultaneous microwave (MW)-assisted phosphotungstic acid (PTA) catalysis (MW-PTA sim). The MW-PTA sim treatment was efficient to improve Fock reactivity from 49.1 % to 85.8 % and decrease viscosity from 561 to 360 mL/g within 10 min, which was superior to the single MW treatment and the sequential MW-PTA seq treatment. Besides, the MW-PTA sim treated fiber had rougher and more fibrillated surfaces with an enhanced fiber accessibility, showing increased specific surface area (SSA) from 1.43 to 6.31 m2/g, mean pore diameter (MPD) from 6.92 to 11.20 nm and water retention value (WRV) from 101 % to 172 %. These positive enhancements are mainly due to a synergy that MW-enhanced rotation of PTA mediums was served as "spinning cutters" to attack the fibers, plus MW-accelerated PTA transfer and catalytic hydrolysis further improved the fiber accessibility. Moreover, PTA also demonstrates a high reusability and chemical stability. This process offers an effective and sustainable alternative for manufacturing a premium dissolving pulp. [Display omitted] • A simultaneous treatment for an enhanced reactivity of dissolving pulp was developed. • The treatment (MW-PTA sim) consisted of microwave radiation and PTA catalysis. • A synergy in the simultaneous treatment contributed to the enhanced pulp reactivity. • The recycled PTA maintained a high catalytic activity after several cycles. [ABSTRACT FROM AUTHOR]

[Display omitted] • The permanent internal electric fields facilitates the separation and migration of photogenerated carriers of PTA. • A transformation of radical–to nonradical-dominated pathway of PMS activation by the photoexcited PTA was confirmed. • The PTA exhibited outstanding photocatalytic activity for bisphenol A removal in presence of PMS under visible light irradiation. As a green, highly efficient, and sustainable technology, photocatalytic peroxymonosulfate (PMS) activation is a promising strategy for wastewater treatment. Moreover, the development of photocatalysts with excellent PMS activation performance is highly desirable for removing refractory organic contaminants from wastewater. Herein, perylenetetracarboxylic acid (PTA) nanosheets obtained using a facile method were explored as a highly efficient photocatalyst with a high PMS activation ability for bisphenol A (BPA) removal. Experimental results indicated that BPA can be removed within 16 min using PTA under optimal conditions. As confirmed through radical quenching, electron paramagnetic resonance spectroscopy, galvanic-oxidation-process experiments, and density functional theory calculations, photoinduced electrons and holes from PTA trigger PMS activation and thereby convert the reaction routes of BPA degradation from radical- to nonradical-dominated. The BPA degradation pathway was also studied using intermediate analysis and Fukui functions. Overall, the findings of this study shed light on organic semiconductor photocatalysts for nonradical-dominated PMS activation with regard to recalcitrant-organic-pollutant removal. [ABSTRACT FROM AUTHOR]

• A 3D multiphase flow model has been established for the plasma transferred arc (PTA) cladding of composite powder (NiCrBSi/50 wt% WC) on a 40CrNi2MoA substrate. • The multiphase flow model simulates both the discrete phase (WC particles) and continuous phase in the melt pool, including the behaviors of heat transfer and particle distribution. • The influences of welding currents and preheating temperatures on the temperature field, the dimensions, and the HAZ depth of the cladding layers have been predicted by the model. • This is the first work of modeling 3D multiphase flow in PTA cladding process of particle-reinforced metal matrix composite (MMCs). In this paper, a 3D multiphase flow model has been established for the plasma transferred arc (PTA) cladding of composite powder (NiCrBSi/50 wt% WC) on a 40CrNi2MoA substrate. The multiphase flow model simulates both the discrete phase (WC particles) and continuous phase in the melt pool, including the behaviors of heat transfer and particle distribution. The buoyancy, arc pressure, surface tension, and electromagnetic force are calculated. The model is then used to predict the influences of welding currents and preheating temperatures on the depth of heat-affected zone (HAZ), the temperature field, and the dimensions of the cladding layers. To validate this model, the dimensions and the HAZ depth are analyzed and compared to experimental data. The results show that the dimensions and HAZ depth obtained by the model simulation are in good agreement with the experiment. The HAZ depth, the melt pool length, and the dimensions of cladding layer would increase with the increasing welding current or preheating temperature. Driven by the inward convection in the melt pool, WC particles tend to distribute around the center line of cladding layers. This is the first work of modeling 3D multiphase flow in PTA cladding process of particle-reinforced metal matrix composite (MMCs). The work can provide theoretical guidance for adjusting process parameters to control HAZ depth and cladding quality in actual production. [ABSTRACT FROM AUTHOR]

Antibiotic development traditionally involved large Phase 3 programs, preceded by Phase 2 studies. Recognizing the high unmet medical need for new antibiotics and, in some cases, challenges to conducting large clinical trials, regulators created a streamlined clinical development pathway in which a lean clinical efficacy dataset is complemented by nonclinical data as supportive evidence of efficacy. In this context, translational Pharmacokinetic/Pharmacodynamic (PK/PD) plays a key role and is a major contributor to a “robust” nonclinical package. The classical PK/PD index approach, proven successful for established classes of antibiotics, is at the core of recent antibiotic approvals and the current antibacterial PK/PD guidelines by regulators. Nevertheless, in the case of novel antibiotics with a novel Mechanism of Action (MoA), there is no prior experience with the PK/PD index approach as the basis for translating nonclinical efficacy to clinical outcome, and additional nonclinical studies and PK/PD analyses might be considered to increase confidence. In this review, we discuss the value and limitations of the classical PK/PD approach and present potential risk mitigation activities, including the introduction of a semi-mechanism-based PK/PD modeling approach. We propose a general nonclinical PK/PD package from which drug developers might choose the studies most relevant for each individual candidate in order to build up a “robust” nonclinical PK/PD understanding.

There are concerns regarding the health effects of electromagnetic fields (EMFs) generated by mobile phones. There are apprehensions regarding the effect of these radiations on auditory system. The objective of this study was to find the effect of mobile phone on hearing in young adults. We studied 75 medical students who were mobile phone users for >1 year. Initial hearing status of subjects was assessed by Pure Tone Audiometry (PTA), Otoacoustic emissions (OAE) and Brainstem evoked response audiometry (BERA) at the time of enrollment in the study and repeat audiological assessment was conducted at 6 months and again at one year and comparison was done. The mean age of the population was 20.13 + 1.33 years. Right, left and no particular preference for any ear was seen in 74.7%, 16% and 9.3%, respectively. Mean PTA at baseline in right ear at baseline, 6 months and 1 year was 12.71 ± 3.51 dB, 13.73 ± 3.69 dB and 14.07 ± 3.25 dB (p value=0.120), respectively and the same values for left ear were 13.28±3.57, 14.32±3.10 and 14.24±3.20 (p = 0.170) at baseline, 6 months and 1 year. No statistically significant difference in hearing thresholds was seen at baseline and at subsequent follow-ups and between dominant ear and non-dominant ear on BERA and OAE. We did not find any short term effect of mobile phones on the hearing in young adults, however, long term effect on hearing with progressing age cannot be ruled out. [ABSTRACT FROM AUTHOR]

Allergic rhinitis is a type-I hypersensitivity reaction of the nasal mucosa, primarily mediated by immunoglobulin E (IgE) with complex etiological factors.Allergic rhinitis may involve the inner ear. The scientific basis for this is poorly understood. However, the inner ear has been found to demonstrate both cellular and humoral immunity, and the seat of immuno-activity appears to reside in the endolymphatic sac and duct. To assess the audiological profile of patients with allergic rhinitis. 100 Study group patients and 50 control group subjects underwent detailed audiological assessment. Present study revealed high frequency sensorineural hearing loss with prolongation of Wave I and shortened wave I–III and Wave I–V interpeak latencies on ABR and abnormal DPOAE findings, compared with controls which indicate inner ear involvement (cochlear pathology). Individuals with allergic rhinitis are more prone to hearing abnormalities which can be detected even before any symptoms of hearing impairment are present. However, the exact pathophysiology of inner ear damage in patients of airway allergy is poorly understood and therefore, additional studies in this area are required with a larger sample population to assess the benefits of hearing assessment in patients of allergic rhinitis for early detection of hearing loss. [ABSTRACT FROM AUTHOR]

The article revisits a cornerstone in preferential rules of origin (ROO) - the principle of territoriality. In essence, the principle requires manufacturing processes for the purpose of acquiring originating status to be carried out without interruption in the territory of one or several contracting parties to a preferential trade agreement (PTA). Territoriality requirements are found to be at odds with recent developments in global trade and production practice, particularly the emergence of global value chains (GVCs) since they hinder the fragmentation of production. Moreover, the requirement of uninterrupted production in one single country also contravenes the objective of liberalizing preferential ROO through the introduction of full cumulation because the notion of counting all working and processing carried out in various eligible countries would prove impossible. In addition, the principle of territoriality may affect the precise determination of origin because it fails to accord equal treatment to conventional and unconventional inputs for production. For trade-facilitating origin regimes to be effective, territoriality requirements need to be revisited and relaxed. [ABSTRACT FROM AUTHOR]

Event-B is a formal method that is used in the development of safety-critical systems; however, these systems may introduce uncertainty and also need to meet real-time requirements, which make the modeling and analysis of such systems a challenging task. While some works exist that try to extend Event-B with probability and over time, they fail to address both in a single framework. Besides, these works mainly addressed extending the language itself, not integrating extended Event-B with verification. In this paper, we aim to represent both probability and time in the Event-B language, and we will show how such a representation can be automatically translated into the probabilistic timed automata (PTA) that are described in the language of the PRISM probabilistic model checker. This transformation approach would allow us to analyze the probabilistic and time-bounded probabilistic reachability properties of probabilistic real-time systems through probabilistic timed CTL (PTCTL) logic. [ABSTRACT FROM AUTHOR]

Salmonella Typhimurium is a Gram-negative facultative pathogen that causes a range of diseases, from mild gastroenteritis to severe systemic infection in a variety of animal hosts. S. Typhimurium regulates virulence gene expression by a silencing mechanism using nucleoid-associated proteins such as Histone-like Nucleoid Structuring protein (H-NS) silencing. We hypothesize that the posttranslational modification, specifically protein acetylation, of proteins in gene silencing systems could affect the pathogenic gene expression of S. Typhimurium. Therefore, we created acetylation-deficient mutant by deleting two genes, pat and pta, which are involved in the protein acetylation pathway. We observed that the pat and pta deletion attenuates mouse virulence and also decreases Salmonella's replication within macrophages. In addition, the Δpat Δpta strain showed a decreased expression of the horizontally-acquired virulence genes, mgtC, pagC, and ugtL, which are highly expressed in low Mg2+. The decreased virulence gene expression is possibly due to higher H-NS occupancy to those promoters because the pat and pta deletion increases H-NS occupancy whereas the same mutation decreases occupancy of RNA polymerase. Our results suggest that Pat- and Pta-mediated protein acetylation system promotes the expression of virulence genes by regulating the binding affinity of H-NS in S. Typhimurium. [ABSTRACT FROM AUTHOR]

A new RuII–ReII complex salt, μ-cyanido-κ2C:N-bis[(η5-cyclopentadienyl)bis(3,5,7-triazaphosphaadamantane-κP)ruthenium(II)] tetrabromido(ethanol/methanol-κO)nitrosylrhenate(II), [Ru(CN)(C5H5)2(C6H12N3P)4][ReBr4(NO)(CH4O)0.5(C2H6O)0.5] or [RuCp(PTA)2–μ-CN–1κC:2κ2N-RuCp(PTA)2][Re(NO)Br4(EtOH)0.5(MeOH)0.5] (PTA = 3,5,7-triazaphosphaadamantane) was obtained and characterized by single-crystal X-ray diffraction, elemental analysis and infrared spectroscopy. The title salt was obtained by liquid–liquid diffusion of methanol/DMSO solutions of (NBu4)[Re(NO)Br4(EtOH)] and [(PTA)2CpRu–μ-CN–1κC:2κ2N-RuCp(PTA)2](CF3SO3). The RuII and ReII independent moieties correspond to a binuclear and mononuclear complex ion, respectively. A deep geometrical parameter analysis was performed, and no significant differences were found with earlier reports containing similar molecules. The magnetic properties were investigated in the temperature range 2.0–300 K, and the complex behaves as a quasi-magnetically isolated spin doublet with weak antiferromagnetic interactions.

Abstract Background Adverse drug reactions (ADRs) are regarded as a major cause of death and a major contributor to public health costs. For the active surveillance of drug safety, the use of real-world data and real-world evidence as part of the overall pharmacovigilance process is important. In this regard, many studies apply the data-driven approaches to support pharmacovigilance. We developed a pharmacovigilance data-processing pipeline (PDP) that utilized electronic health records (EHR) and spontaneous reporting system (SRS) data to explore pharmacovigilance signals. Methods To this end, we integrated two medical data sources: Konyang University Hospital (KYUH) EHR and the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). As part of the presented PDP, we converted EHR data on the Observation Medical Outcomes Partnership (OMOP) data model. To evaluate the ability of using the proposed PDP for pharmacovigilance purposes, we performed a statistical validation using drugs that induce ear disorders. Results To validate the presented PDP, we extracted six drugs from the EHR that were significantly involved in ADRs causing ear disorders: nortriptyline, (hazard ratio [HR] 8.06, 95% CI 2.41–26.91); metoclopramide (HR 3.35, 95% CI 3.01–3.74); doxycycline (HR 1.73, 95% CI 1.14–2.62); digoxin (HR 1.60, 95% CI 1.08–2.38); acetaminophen (HR 1.59, 95% CI 1.47–1.72); and sucralfate (HR 1.21, 95% CI 1.06–1.38). In FAERS, the strongest associations were found for nortriptyline (reporting odds ratio [ROR] 1.94, 95% CI 1.73–2.16), sucralfate (ROR 1.22, 95% CI 1.01–1.45), doxycycline (ROR 1.30, 95% CI 1.20–1.40), and hydroxyzine (ROR 1.17, 95% CI 1.06–1.29). We confirmed the results in a meta-analysis using random and fixed models for doxycycline, hydroxyzine, metoclopramide, nortriptyline, and sucralfate. Conclusions The proposed PDP could support active surveillance and the strengthening of potential ADR signals via real-world data sources. In addition, the PDP was able to generate real-world evidence for drug safety.

Posttraumatic amnesia (PTA) duration is used to predict outcome after traumatic brain injury (TBI): however, no meta-analysis exists. A systematic review was performed following PRISMA reporting guidelines. The databases Scopus-1966, PubMed/MEDLINE, CINAHL, PsycINFO, and Embase were searched for relevant texts. Random effects meta-analysis derived pooled estimates of the odds ratio of outcomes of interest and sensitivity and specificity of PTA at different cutoffs, and subsequently a summary receiver operating curve was derived. PTA prediction of Glasgow Outcome Scale (GOS) and Glasgow Outcome Scale–Extended (GOSE) scores was assessed both qualitatively and quantitatively by pooled odds ratio regarding both a good outcome (GO: GOS-5 or GOSE-7/GOSE-8) and a severe disability outcome (SDO: GOS-3 or a GOSE-3/GOSE-4). Summary receiver operating curve analysis was performed in the prediction of composite of a moderate disability outcome (MDO: GOS-4 or GOSE-5/GOSE-6) and SDO. Twenty-four studies were included in qualitative synthesis, and 9 (12,386 patients; males, 64%–84%) in meta-analysis. The odds of a GO and SDO were significantly different between PTA >56 days and PTA <7 days (P = 0.04 and P = 0.03). PTA <7 days (mild TBI) excluded MDO/SDO and SDO alone with 87% and 90% sensitivity. PTA of 43–86 days (severe TBI) predicted MDO/SDO or SDO with 90%–96% and 80%–90% specificity. However, PTA of 7–42 days (moderate TBI) predicted MDO/SDO or SDO with only 38%–89% and 30%–80% specificity. PTA duration was reliable in predicting outcome when <7 days, and especially when >42 days but was often unreliable between 7 and 42 days duration. [ABSTRACT FROM AUTHOR]

Biofilms and infectious process may alter free antimicrobial concentrations at the site of infection. Tobramycin (TOB), an aminoglycoside used to treat lung infections caused by Pseudomonas aeruginosa, binds to alginate present in biofilm extracellular matrix increasing its minimum inhibitory concentration (MIC). This work aimed to investigate the impact of biofilm-forming P. aeruginosa infection on TOB lung and epithelial lining fluid (ELF) penetration, using microdialysis, and to develop a population pharmacokinetic (popPK) model to evaluate the probability of therapeutic target attainment of current dosing regimens employed in fibrocystic and non-fibrocystic patients. The popPK model developed has three compartments including the lung. The ELF concentrations were described by a penetration factor derived from the lung compartment. Infection was a covariate in lung volume (V3) and only chronic infection was a covariate in central volume (V1) and total clearance (CL). Simulations of the recommended treatments for acute and chronic infection achieved >90% probability of target attainment (PTA) in the lung with 4.5 mg/kg q24h and 11 mg/kg q24h, respectively, for the most prevalent P. aeruginosa MIC (0.5 mg/mL). The popPK model was successfully applied to evaluate the PTA of current TOB dosing regimens used in the clinic, indicating the need to investigate alternative posology. [ABSTRACT FROM AUTHOR]

Susac Syndrome (SS) is a rare unique autoimmune underdiagnosed disorder characterized by the clinical triad of central nervous system (CNS) dysfunction, sensorineural hearing impairment, and branch retinal artery occlusion (BRAO). Objectives The purpose of reporting the case is to succinctly highlight this enigmatic condition with focus on otological and audiological aspect of SS and also to augment awareness of this disease among otolaryngologists neurologists, psychiatrists and ophthalmologists. Additionally we reviewed the otological menifestations and audiological findings related to SS. Methods A case of 38 year old female is presented with bilateral SNHL as the initial symptom of SS. The review of otological and audiological findings of previous 10 year case reports was executed using the PRISMA protocol on 20 cases. Results It was seen that inspite of the ear being one of the main organs involved in the SS very few had undergone detailed audiological assessment. Our review of literature showed that only 40% cases had done audiological assessment other than PTA, out of which only 5% had undergone complete audiological workup. 30% of the patients were having auditory symptoms as presenting chief complaint. Conclusion Otolyryngologists should keep SS in differentials when a case of SNHL of unknown etiology is encountered.We emphasize the use newer noninvasive Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnostic tools like Optical coherence tomography (OCT), MRI and detailed audiological tests for timely diagnosis of SS. Further multidisciplinary assessment protocols should be used to prevent the development of severe sequelae. [ABSTRACT FROM AUTHOR]

Objectives: Resting heart rate has been increasingly identified as a marker of cardiovascular risk and has been extensively studied as a predictor of coronary artery disease progression. In peripheral artery disease, the prognostic impact of resting heart rate remains elusive. Methods: Consecutive patients undergoing invasive peripheral procedures were included. Data included resting heart rate determination by averaging manual radial pulse palpation measurements taken 24 h before and after an invasive peripheral procedure. Results: A total of 1720 patients were included (mean age 70±11 years, 38% were female, 39% had critical limb ischemia). During a median follow-up of 729 days, 364 (21.2%) patients died. Resting heart rate emerged as an independent predictor of mortality, even after adjusting for clinical characteristics, peripheral artery disease manifestation and anatomic extent, traditional risk factors, co-morbidities, and disease-modifying therapies: hazard ratio for heart rate >75 bpm was 1.010 (95% confidence interval 1.001–1.109), with each bpm increase in resting heart rate conferring a 1.1% increase in the risk of all-cause mortality (95% confidence interval 0.1–10.9%, adjusted p = 0.030). Conclusions: Resting heart rate is an independent predictor of mortality in patients with peripheral artery disease; our findings extend heart rate as a possible marker of prognosis to non-coronary atherosclerotic vascular disease. [ABSTRACT FROM AUTHOR]

Considerable calcification and stenosis frequently occur in the radial artery (RA) in diabetic nephropathy. PTA was performed successfully using a balloon to expand and restrictively tear the longitudinal axis of the RA. This approach seems to be a useful measure of promoting the maturation of AVF in diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Abstract Background Endovascular therapy is the gold standard in patients with hemodynamic relevant renal artery stenosis (RAS) resistant to medical therapy. The severity grading of the stenosis as well as the result assessment after endovascular approach is predominantly based on visible estimations of the anatomic appearance. We aim to investigate the application of color-coded DSA parameters to gain hemodynamic information during endovascular renal artery interventions and for the assessment of the procedures´ technical success. Methods We retrospectively evaluated 32 patients who underwent endovascular renal artery revascularization and applied color-coded summation imaging on selected monochromatic DSA images. The differences in time to peak (dTTP) of contrast enhancement in predefined anatomical measuring points were analyzed. Furthermore, differences in systolic blood pressure values (SBP) and serum creatinine were obtained. The value of underlying diabetes mellitus as a predictor for clinical outcome was assessed. Correlation analysis between the patients´ gender as well as the presence of diabetes mellitus and dTTP was performed. Results Endovascular revascularization resulted in statistically significant improvement in 4/7 regions of interest. Highly significant improvement of perfusion in terms of shortened TTP values could be found at the segmental artery level and in the intrastenotical segment (p