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Author(s): Aditi Sharma [1]; Aditya Singh [1]; Yashik Bansal [2]; Aditi Mohan [1]; Ramya Gnanaraj [3]; Pranita Khulbe [1]; Kavita Pangtey [1]; Kaushiki Tripathi [1]; Mohammad Ali Khan [4]; Akshita [...], Purpose: To evaluate the alterations in the psycho-physical tests, contrast sensitivity (CS) and hue discrimination (total estimation score, TES) in COVID-19 patients. Methods: A prospective case-control study was undertaken in 2021-22 to look at CS and TES among COVID-19 patients and RT-PCR negative normal subjects by a mobile app "smart optometry" and X-Rite's free online version of Farnsworth-Munsell 100 hue test. Strict visual acuity (minimum of 6/9 equivalent on Snellen) and other clinical parameters were used as exclusion criteria to filter potentially confounding pre-receptoral co-morbid conditions. The effect of mismatch in recruiting age and sex matched controls during the pandemic were analyzed by multivariate linear regression. Result: One-way ANOVA ruled out any influence of gender on CS and TES; however, there was significant difference in the TES on Mann Whitney U test (TES- 2.95 +/- 3.8 for cases; 0.30 +/- 1.1 for controls; p Conclusion: The study demonstrates that COVID-19 infection leads to altered TES representing dyschromatopsia -an ocular counterpart of anosmia, with little difference on CS. Keywords: Angiotensin-converting-enzyme 2 receptor, color vision, COVID-19, dyschromatopsia, X-rite color challenge and hue test

Author(s): Ankeeta Satish Khadilkar [1]; Aditi Kapur (corresponding author) [1]; Ashima Goyal [1]; Krishan Gauba [1]; Sanjeev Kumar Singh [1,2] Introduction The goal of pulpectomies is a complete reduction of [...], Background: Chemomechanical debridement is insufficient to disinfect all bacteria from the root canals of primary teeth, and obturation of canals with an appropriate material thus acquires excellent importance and remains a critical step in the ultimate success of pulpectomy. Aim: The aim of the study was to compare and evaluate Endoflas, Metapex, and a mixture of calcium hydroxide (CH) and zinc oxide (ZnO) as obturating materials (OMs) in primary mandibular second molars. Materials and Methods: Seventy-five mandibular second primary molars requiring pulpectomies were identified in children aged 4-8 years. They were randomly allocated to the three treatment groups according to the type of OM received using the block randomization technique. After the completion of chemomechanical debridement, the canals were filled with Endoflas, Metapex, and CH-ZnO mixture, respectively. The intergroup clinical and radiographic comparison was made based on Coll and Sadrian criteria to decipher their clinical performance at 1, 3, and 6 months. Results: No statistically significant differences between the groups were observed at any evaluation time interval (P > 0.05). At 6 months, the clinical success rates were 95.2% in Endoflas, 96% in Metapex, and 95.8% in the CH and ZnO mixture groups, respectively. The materials, however, behaved differently in different clinical situations. Conclusion: Based on the observations, all three OMs showed similar clinical success in maintaining tooth functioning, but their use can be restricted to indications. However, prospective studies with longer follow-ups with more stringent eligibility criteria are required to reach more definitive conclusions. Keywords: Children, obturating material, pediatric endodontics, pulp therapy, pulpectomy

TABLE OF CONTENTS I. DISAGREEMENT ABOUT OBLIGATION II. MORAL AMBIGUITY IN THE CONCEPT OF CONSENT A. Conceptual Ambiguity 1. Revealment 2. Quality 3. Relevance 4. Force B. Four Examples III. [...], Contracts purport to settle rights and obligations between parties. The fact that parties have consented to a given set of terms seems to hold the promise of preempting conflict about those terms after the fact. But contract gives rise to disputes about consent itself. Many disputes about implied conditions, for example, are best understood as disagreements about the scope of consent. This article identifies several moral ambiguities in the concept of consent. We not only disagree about the analytic merits of competing conceptions among ourselves but, even as individuals, we tend not to endorse and consistently apply a single version of the concept. Psychologists use the "availability heuristic" to describe how we rely on salient facts when making quick probabilistic judgments. Similarly, the availability of some facts but not others prompts us to default to the version of an ambiguous moral concept that we are in a position to operationalize. On the flip side, we discount understandings of consent that fail to guide us given the facts we know. The distinct sets of facts available to the giver and receiver of consent, respectively, thus direct them to rely on different conceptions of consent, thereby driving a systematic wedge between how parties to exchange are likely to understand the bindingness of their agreement. Contract law privileges a single, potentially unifying conception of consent; but that conception must compete with the complex understanding of the concept that we each bring from our lives outside of contract. Without the benefit of clear legal rules, consent in other social contexts generates still more frequent and deeper disagreement. Within the domain of contract, we should recognize that the concept of concept does not eradicate either disagreement or its underlying moral ambuity. We should react systemically with contextualized legal rules and, in some cases, flexible application of those rules.

Author(s): Nishi Prasad (corresponding author) [1]; Aditi Dubey [1]; Kavita Kumar [1]; Jyotsna Shrivastava [2] Retinopathy of prematurity (ROP) is a vascular disease affecting primarily the premature retina, which can [...], Purpose: The objective of this study was to find the association between fetal hemoglobin (HbF) concentration and retinopathy of prematurity (ROP) in preterm infants. Methods: In this observational, prospective, longitudinal study, a total of 410 preterm infants with Results: A total of 410 preterm infants were included, out of which 110 infants had ROP (26.8%). Infants with ROP had significantly lower percentage of HbF with gestational age groups and birth weight groups, compared to infants without ROP. Higher percentage of HbF was associated with a lower prevalence of ROP. Higher concentration of HbF was found in the ROP infants who regressed spontaneously without treatment and less concentration was found in those who progressed to a severe disease and those who required treatment. The predictive ability of HbF (%) was 0.976 for ROP. Conclusion: Low fraction of HbF was found to be significantly associated with the development and progression of ROP. Keywords: Fetal hemoglobin, preterm infants, protective, retinopathy of prematurity

Background: Corneal degenerations is an all-inclusive term encompassing a broad spectrum of entities that result from physiological changes secondary to aging, as sequelae to environmental insult, or as an ocular manifestation of systemic diseases or long-standing local inflammation. They are often peripheral and eccentric. They may result in vision loss, ocular pain, and reduced depth perception, and limit patient's ability to focus well. Degenerations are mostly sporadic and manifest late in life, thus highlighting their coexistence when dealing with cataract surgeries in the concomitant settings of corneal degenerations. Purpose: Cataract with coexisting corneal degeneration poses certain unique challenges. Synopsis: In this video, we have highlighted the challenges of cataract surgery in a patient with Terrien's marginal degenerations and Salzman nodular degenerations. Preoperative management, evaluation, intraocular lens power calculation, and postoperative outcome in cases with coexisting diseases along with case-based examples are presented. Highlights: In patients of cataract with coexisting corneal degenerations, the critical point is to ensure that the corneal findings are relatively stable. Any surgical planning is quickly invalidated if the disease is actively progressing. It is important to consider location of wound placement and optimization of surgical view in these patients undergoing cataract surgery. Visual prognosis is good, but regular monitoring is required. These cases highlight the importance of addressing the refractive sequelae of coexisting corneal degenerations when planning cataract surgery, to ensure minimal postoperative astigmatism and achieve favorable outcomes. Video link: https://youtu.be/JONMwZiKxMs Keywords: Cataract, corneal degeneration, IOL, SND, TMD, Author(s): Aditi Jhori [1]; Mona Bhargava (corresponding author) [1]; Debasmita Bera [1] References 1. Couret, D, Boumaza, D, Grisotto, C, Triglia, T, Pellegrini, L, Ocquidant, P, et al. Reliability of [...]

This study examines the relationship between marketing capabilities and re-patronage intentions in the retail sector. Building upon dynamic capability theory, expectation-confirmation theory, and social exchange theory, it also investigates the moderating role of technological advancement between marketing capabilities and customer satisfaction. Further, the mediating role of customer satisfaction has also been examined. Four hundred and seventy-nine shoppers across six shopping malls have responded to the questionnaire. The validity and reliability of the measurements have been confirmed through Confirmatory Factor Analysis. Structural equation modeling has been used for hypothesis testing. The study revealed that marketing capabilities affect customer satisfaction, and customer satisfaction affects both customer trust and re-patronage intentions. Further, technological advancement moderates the relationship between marketing capabilities and customer satisfaction. The study has many implications for academics and practitioners., Author(s): Jeevan Jyoti, Department of Commerce, University of Jammu, India, Ganesh Dash, College of Administrative and Financial Sciences, Saudi Electronic University, Riyadh, Saudi Arabia, Aditi Sharma, Department of Commerce, University [...]

1 | INTRODUCTION Prices are the major driver of health care spending in the United States, prompting state and federal policy makers to develop approaches to control health care prices. [...], Objective: To compare prices paid by commercial insurers for ambulatory services in physician office and hospital outpatient settings. Data Sources: MarketScan Commercial Claims and Encounters database obtained from Truven Health Analytics. Study Design: We examined ambulatory service claims for a sample of privately insured individuals who were continuously enrolled in a health maintenance organization plan, preferred provider organization plan, high-deductible/consumer-driven health plan, or exclusive provider organization plan in 2018. We categorized services into five categories: Evaluation & Management, Medical Services & Procedures, Pathology/Lab, Radiology, and Surgical. We identified services commonly provided in both outpatient and office settings and computed the price differential between out-patient and office services overall and for each service category, controlling for observable patient characteristics and geography. Data Collection: We examined 89 services (defined by Current Procedural Terminology [CPT] code) that were provided in both office and outpatient settings in our sample (102.7 million claims, 8.3 million individuals). Principal Findings: Adjusting for patient and geographic characteristics and across all services, total payment for an ambulatory service was, on average, 145% higher in a hospital outpatient department than the same service in a physician office. Out-of-pocket spending was 109% higher. Price differences between outpatient and office services were highest for pathology/laboratory services. Patients receiving services in outpatient departments had higher mean risk scores and received more services on the date of their visit (in addition to the index CPT being studied) than patients receiving the same index CPT in a physician's office. Conclusions: Payments in hospital outpatient departments were significantly higher than payments for the same services in physician offices among commercially insured patients. Policies such as site-neutral payment would lower costs and could reduce incentives for further consolidation in health care markets. Care must be given to adjusting for patient severity across settings. KEYWORDS access/demand/utilization of services, ambulatory/outpatient care, anti-trust/health care markets/competition, health care costs, health economics, health policy/politics/law/regulation, hospitals What is known on this topic * Documented payment differentials in Medicare have shown that payments are generally higher for services provided in hospital outpatient departments relative to the same services provided in physician offices. * Private insurers pay, on average, double what Medicare pays for the same services, and therefore site-based payment differentials are likely to be larger in private insurance than in Medicare, however, there is little evidence on this topic. * Payment differentials in Medicare have led to policies to institute "site-neutral payments," which could be applied to commercial insurance as well. What this study adds * In 2018, among individuals with employer-sponsored insurance, total payments across five categories of ambulatory care were, on average, 145% higher for services provided in hospital outpatient departments relative to the same services provided in physician offices. * In six states, outpatient prices were over 200% higher than office prices for the same services. * The average patient out-of-pocket payment was 109% higher for outpatient versus office services. The average outpatient patient also received more services during their visit than a patient receiving office-based care, potentially further raising costs.

Poverty and associated health-related social needs can negatively impact child health. As pediatric health systems implement social needs screening programs, they should aim to measure and promote equal rates of screening across demographic groups and to support families in connecting to resources.We describe implementation of the Linking Families to Support (LiFTS) quality improvement initiative, an inpatient social needs screening and support program. Our objectives were to (1) implement screening across inpatient units, (2) promote equal screening rates across demographic groups, and (3) optimize rates of resource connection. LiFTS was implemented at a quaternary care children’s hospital. Families of children admitted to participating units during the study period (September 2022-February 2024) were eligible for screening.Over the 18-month project period, we implemented screening in 9 inpatient units. Of 2582 eligible caregivers, 1741 (67.4%) were offered screening. Of these caregivers, 667 (38.3%) declined screening and 1074 (61.6%) completed screening. A total of 496 families (46.2%) reported 1 or more social needs. In analyses stratified by child race, ethnicity, insurance status, and preferred language, we observed equal rates of screening. Among 233 families reached in follow-up, 183 (78.5%) recalled receiving resources and 133 (57.1%) reported connecting to 1 or more resources.Our interdisciplinary team successfully implemented social needs screening across 9 inpatient units, achieved equal rates of screening, and measured caregiver-reported rates of resource connection. Our approach could guide other health systems as they implement social needs screening programs that meet regulatory requirements, prioritize equality in screening, and support resource connection.

In order to predict streamflow and understand the associated snow dynamics in a data scarce situation for the snow-dominated, wooded, hilly Alaknanda River basin in India's Western Himalayan area, the Soil and Water Assessment Tool (SWAT) model was set up. Measured discharge from 2010 to 2012 and 2013 to 2015 were used as calibration and validation data in the current study, respectively. As a warm-up period, data from the first two years (2008–2009) were used. To incorporate SWAT in the study, ArcSWAT interface was used, and parameter optimization was performed using SWAT-CUP/SUFI2 algorithm (Sequential Uncertainty Fitting version 2). The sensitivity analysis revealed that the streamflow of the region is influenced by 20 parameters, indicating their significant role in shaping the hydrological patterns. The temperature lapse rate (TLAPS) was observed to be the most significant parameter. The values of Nash Sutcliffe Efficiency (NSE), the coefficient of determination (R2) and the Percent Bias (PBIAS) for the calibration period were 0.91, 0.92, and + 5.1%, respectively. The validation (2013–2015) of the streamflow data resulted in the values of the NSE, R2, and PBIAS as 0.84, 0.86, and − 2.9%, respectively. In the Alaknanda River Basin, 58.3% of the total precipitation of the whole year was converted into streamflow/total runoff. About 10.61% of the streamflow/total runoff was contributed by the snowmelt of the region, thereby significantly affecting the discharge of the region.

Alli Abdelal, a bag designer, has created a brand called Ruskin that features handcrafted bags made from Herdwick tweed and Italian leather. Inspired by her childhood love for bags and a conversation with a local farmer in the Lake District, Alli's brand focuses on using natural materials and artisanal workmanship. The brand's designs are practical, timeless, and named after the writer John Ruskin, reflecting a commitment to handcrafted natural materials. Alli's journey from a schoolteacher to a designer has shaped her business, emphasizing the importance of skills gained from previous experiences. [Extracted from the article]

In India, currently, there are no standard guidelines for the management of moderate acute malnutrition (MAM). Previous research in Bangladesh has shown that children with MAM have impaired gut microbiota development, and microbiota-directed complementary foods (MDCF) can potentially repair their gut microbiota.

Intel’s efforts to build a practical quantum computer are focused on developing a scalable spin-qubit platform leveraging industrial high-volume semiconductor manufacturing expertise and 300 mm fabrication infrastructure. Here, we provide an overview of the design, fabrication, and demonstration of a new customized quantum test chip, which contains 12-quantum-dot spin-qubit linear arrays, code named Tunnel Falls. These devices are fabricated using immersion and extreme ultraviolet lithography (EUV), along with other standard high-volume manufacturing (HVM) processes as well as production-level process control. We present key device features and fabrication details as well as qubit characterization results confirming device functionality. These results corroborate our fabrication methods and are a crucial step toward scaling of extensible 2D qubit array schemes.

Molecular conformer generation (MCG) is an important task in cheminformatics and drug discovery. The ability to efficiently generate low-energy 3D structures can avoid expensive quantum mechanical simulations, leading to accelerated virtual screenings and enhanced structural exploration. Several generative models have been developed for MCG, but many struggle to consistently produce high-quality conformers for meaningful downstream applications. To address these issues, we introduce CoarsenConf, which coarse-grains molecular graphs based on torsional angles and integrates them into an SE(3)-equivariant hierarchical variational autoencoder. Through equivariant coarse-graining, we aggregate the fine-grained atomic coordinates of subgraphs connected via rotatable bonds, creating a variable-length coarse-grained latent representation. Our model uses a novel aggregated attention mechanism to restore fine-grained coordinates from the coarse-grained latent representation, enabling efficient generation of accurate conformers. Furthermore, we evaluate the chemical and biochemical quality of our generated conformers on multiple downstream applications, including property prediction and large-scale oracle-based protein docking. Overall, CoarsenConf generates more accurate conformer ensembles compared to prior generative models.

Pre-eclampsia is a placental disorder that affects 3–5% of all pregnancies and is a leading cause of maternal and fetal morbidity worldwide1,2. With no drug available to slow disease progression, engineering ionizable lipid nanoparticles (LNPs) for extrahepatic messenger RNA (mRNA) delivery to the placenta is an attractive therapeutic option for pre-eclampsia. Here we use high-throughput screening to evaluate a library of 98 LNP formulations in vivo and identify a placenta-tropic LNP (LNP 55) that mediates more than 100-fold greater mRNA delivery to the placenta in pregnant mice than a formulation based on the Food and Drug Administration-approved Onpattro LNP (DLin-MC3-DMA)3. We propose an endogenous targeting mechanism based on β2-glycoprotein I adsorption that enables LNP delivery to the placenta. In both inflammation- and hypoxia-induced models of pre-eclampsia, a single administration of LNP 55 encapsulating vascular endothelial growth factor (VEGF) mRNA resolves maternal hypertension until the end of gestation. In addition, with our VEGF mRNA LNP 55 therapeutic, we demonstrate improvements in fetal health and partially restore placental vasculature, the local and systemic immune landscape and serum levels of soluble Fms-like tyrosine kinase-1, a clinical biomarker of pre-eclampsia1. Together, these results demonstrate the potential of this mRNA LNP platform for treating placental disorders such as pre-eclampsia.

Introduction: The current gold standard for imaging to rule out extra-hepatic biliary atresia (EHBA) is hepatobiliary scintigraphy (HBS), which involves visually assessing the tracer appearance in the bowel. However, in cases where hepatic function is impaired, biliary-to-bowel transit may not be observable, even in neonatal hepatitis (NH) cases. This study aims to assess the utility of semi-quantitative parameters on HBS to distinguish biliary atresia (BA) from NH when there is a lack of biliary-to-bowel transit for up to 24 h. Materials and methods: The study involved retrospective analysis of patients with the diagnosis of neonatal cholestasis where HBS failed to differentiate BA and NH. Histopathological examination was taken as the gold standard. Semiquantitative parameters calculated include: Liver: blood pool (LBR) and liver: kidney ratios (LKR) at 5 min, 30 min, 1 h and 24 h. Mean values for the two groups were calculated. Student’s t-test was employed to assess the statistical significance of difference of mean between the two groups. Receiver operating characteristic (ROC) curve was also drawn to determine a cut-off of these ratios to differentiate between the two groups using SPSS v26.0. P-value < 0.05 was considered statistically significant. Results: The study included 53 patients (37 males) with a median age of 3 months (range: 24 days to 10 months). Of these, 32 patients had a histopathological diagnosis of BA, while 21 had NH. Mean LBR and LKR at 24 h were statistically different in the two groups (p-value < 0.05). Receiver operating characteristic (ROC) curve analyses showed highest AUC for LBR at 24 h 0.683 (CI:0.532–0.834, p-value 0.017) and LKR at 24 h − 0.669 (CI: 0.511–0.827, p-value:0.036). For diagnosis of BA a cut-off value of ≤4.18 for LBR at 24 h (sensitivity and specificity of 62.5% and 61.9% respectively) and ≤4.64 for LKR at 24 h (sensitivity and specificity of 68.8% and 66.7% respectively) were found to be pertinent. Conclusion: HBS serves as non-invasive imaging of choice to rule out EHBA. Semi-quantitative indices LBR and LKR at the 24-hour can differentiate between EHBA and NH even in cases with compromised hepatic function where traditional visual interpretation of tracer transit proves inadequate.

IntroductionNevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant disorder classically associated with multiple basal cell carcinomas, odontogenic keratocysts and skeletal anomalies. However, its significant phenotypic heterogeneity often delays the diagnosis. Here, we undertake the first comprehensive characterisation of NBCCS and congenital urinary tract anomalies.MethodsClinical evaluation followed by genetic testing was performed on a proband with congenital hydronephrosis due to ureteropelvic obstruction. Then, a cohort of patients with molecularly confirmed NBCCS evaluated at a single institution was analysed, followed by a comprehensive review of the literature.ResultsThe novel, non-canonical splice-site variant c.349+4 delA in PTCH1was detected in a proband, with RNA analysis confirming exon 2 skipping. Of the additional nine NBCCS cases examined at our institution, a second proband with a nonsense variant in PTCH1was identified with renal agenesis and a bladder diverticulum. A literature review then yielded 11 case reports of patients with congenital urinary tract anomalies, most frequently renal agenesis.DiscussionCongenital urinary tract anomalies are a variable finding in NBCCS. Renal ultrasound may be warranted at the time of initial diagnosis, if not previously performed. Moreover, PTCH1should be included in multigene panels that assess for congenital urinary tract disorders.

Neural stimulation is used routinely to diagnose and treat neurological disorders. The stimulation artifacts are, however, problematic for closed-loop neuromodulation therapy, which dynamically adjusts the electrical stimulation parameters based on real-time feedback from the recorded neural activity because they can cause saturation or prolonged recovery times in traditional recording front ends. This article presents a per-pixel second-order $\Delta \Sigma $ analog-to-digital converter (ADC) for direct digitization of neural signals, which addresses the stimulation artifact recovery time in voltage-controlled oscillator (VCO)-based quantizers with a fast-recovery, overrange-detecting phase quantizer. The ADC uses a pseudo-virtual ground feedforwarding (PVG FF) technique and a complementary input ${G} _{\text {m}}$ -C filter with per-pixel decimation. It supports four recording modes covering 2.5–20 kS/s through a power-efficient, bandwidth-scalable continuous time $\Delta \Sigma $ modulator. Fabricated in a 180-nm CMOS process, this $300\times 300~\mu $ m2 ADC achieves $\gt 250\times $ faster (0.05–0.4 ms) stimulation artifact recovery time, enabling in-stimulation recording. Recording with artifact tolerance was demonstrated through an in vivo whisker barrel rat experiment.

Women are the largest growing population of Veterans within the U.S. Department of Veterans Affairs (VA) Health Care System. Among women Veterans, breast cancer is the most common malignancy (30% of all cancers), yet little is known about the unique needs of women Veterans with cancer and how to provide them with high quality care. The VA health care system has initiated multiple system-wide systemic efforts, including launching the Breast and Gynecologic Cancer System of Excellence (BGSOE) to address this knowledge gap. This report summarizes the outcomes of the inaugural 2023 VA Women’s Cancer Research Conference, which assembled 37 multidisciplinary clinicians, scientists, the VA and civilian partners with a shared goal of advancing VA breast cancer research. Conference objectives were to build a collective vision for improving: (1) referral patterns for breast cancer treatment and patient-level outcomes and (2) molecular and genetic testing patterns across the breast cancer continuum among women Veterans. The meeting hosted 15 speakers at the Houston VA Medical Center. Future research priorities for women Veterans with cancer were identified from discussions and a post-conference survey. We then administered a 13-question post-conference survey to conference attendees. Respondents ranked the research priorities. The survey results show that the cross-cutting cancer research priorities designed to transform cancer care for women Veterans at the VA fit into 5 broad areas of study, including (1) care quality for treatment, (2) improving treatment, (3) care quality of molecular and genetic testing, (4) risk reduction through risk assessment and germline genetic testing, and (5) establishing strategic partnerships. Our data elucidate areas for further investigation to improve the delivery of cancer care.

Bioactive phyto-components are eco-friendly alternatives to harmful synthetic fungicides. Gymnema sylvestrecontains many multifunctional bioactive compounds; however, it is yet to be explored for comprehensive chemical profiling and efficient management of fungal decay in storage. The present study demonstrated optimization of the production of bioactive compounds from G. sylvestreleaves, displaying broad-spectrum efficacy against storage fungi. Ethyl acetate soluble fraction (EAGS) exhibited the highest efficacy against Penicillium expansum2995 (effective concentration for 50% inhibition (EC50) 102.3 µg/ml) followed by Aspergillus flavus8529 (EC50109.5 µg/ml), Penicillium digitatum7910 (EC50201.1 µg/ml), Aspergillus parasiticus6365 (EC50209.6 µg/ml) and Fusarium verticillioides8271 (EC50285.2 µg/ml). Response surface methodology (RSM)-based optimization of ultrasonication-assisted extraction (UAE) of bioactive phyto-compounds revealed a maximum production of EAGS (106.83 mg/g sample) with 50 W amplitude, 10.6 min time and 20 ml solvent/g of sample. Comprehensive phytochemical profiling using UPLC-QToF-MSEgenerated tentative identification of 35 compounds, dominating gymnemic acid VII. Among these, gymnemic acid VII and gymnemagenin were further isolated and characterized using 1H-nuclear magnetic resonance (NMR), 13C-NMR and HRMS. The interaction mechanism of the phyto-components, responsible for fungal growth inhibition, was determined using molecular docking analysis and validated with fungal ergosterol biosynthesis and membrane ionic leakage inhibition. Gymnemic acid I (− 33.7 kJ/mol) and gymnemagenin (− 31.5 kJ/mol) exhibited higher binding affinity with the target-specific protein through conventional hydrogen bonds and hydrophobic pi–alkyl interactions. High-value G. sylvestrephytochemicals could be further exploited to achieve tangible outcomes in managing fungal decay under postharvest storage.

MicroRNAs (miRNAs) associate with Argonaute (AGO) proteins to form complexes that direct mRNA repression. miRNAs are also the subject of regulation. For example, some miRNAs are destabilized through a pathway in which pairing to specialized transcripts recruits the ZSWIM8 E3 ubiquitin ligase, which polyubiquitinates AGO, leading to its degradation and exposure of the miRNA to cellular nucleases. Here, we found that 22 miRNAs in Caenorhabditis elegansare sensitive to loss of EBAX-1, the ZSWIM8 ortholog in nematodes, implying that these 22 miRNAs might be subject to this pathway of target-directed miRNA degradation (TDMD). The impact of EBAX-1 depended on the developmental stage, with the greatest effect on the miRNA pool (14.5%) observed in L1 larvae, and the greatest number of different miRNAs affected (17) observed in germline-depleted adults. The affected miRNAs included the miR-35–42 family, as well as other miRNAs among the least stable in the worm, suggesting that TDMD is a major miRNA-destabilization pathway in the worm. The excess miR-35–42 molecules that accumulated in ebax-1mutants caused increased repression of their predicted target mRNAs and underwent 3′ trimming over time. In general, however, miRNAs sensitive to EBAX-1 loss had no consistent pattern of either trimming or tailing. Replacement of the 3′ region of miR-43 substantially reduced EBAX-1 sensitivity, a result that differed from that observed previously for miR-35. Together, these findings broaden the implied biological scope of TDMD-like regulation of miRNA stability in animals, and indicate that a role for miRNA 3′ sequences is variable in the worm.

Change point detection (CPD) is a valuable technique in time series (TS) analysis, which allows for the automatic detection of abrupt variations within the TS. It is often useful in applications such as fault, anomaly, and intrusion detection systems. However, the inherent unpredictability and fluctuations in many real-time data sources pose a challenge for existing contemporary CPD techniques, leading to inconsistent performance across diverse real-time TS with varying characteristics. To address this challenge, we have developed a novel and robust online CPD algorithm constructed from the principle of discriminant analysis and based upon a newly proposed between-class average and variance evaluation approach, termed B-CAVE. Our B-CAVE algorithm features a unique change point measure, which has only one tunable parameter (i.e. the window size) in its computational process. We have also proposed a new evaluation metric that integrates time delay and the false alarm error towards effectively comparing the performance of different CPD methods in the literature. To validate the effectiveness of our method, we conducted experiments using both synthetic and real datasets, demonstrating the superior performance of the B-CAVE algorithm over other prominent existing techniques.

Background In very low birth weight infants, mother’s own milk (MOM) feeding is an essential part of the bundle of best practices to reduce potentially preventable neonatal morbidities and associated costs. Mothers of preterm infants can have an altered sequence of lactogenesis because of their preterm delivery and mother–infant separation. Healthy mothers with term infants typically experience coming to volume(CTV), that is, MOM volume of ≥ 500 ml/day, by the end of the second week of postpartum. There is paucity of data regarding MOM output in preterm mothers.Objective To assess MOM output and factors influencing MOM volume among mothers delivering <32 weeks during the first two weeks after birth. To determine the proportion of mothers attaining CTV and whether the first two weeks’ MOM volume predicts MOM feeding at discharge and 40 weeks corrected gestational age (CGA).Methodology In this prospective observational study conducted at a tertiary care NICU over a period of 18 months, the milk output of the preterm mothers was quantified, and the proportion of infants fed with MOM at discharge and 40 weeks of corrected age was assessed.Results The median milk output per day at the end of the first and second weeks was 180 IQR (100, 290) ml and 300 IQR (178, 420) ml, respectively. Earlier initiation of kangaroo mother care, higher birth weight of the infant, increase in the frequency of daytime milk expression and non-nutritive suckling (NNS) contributed to increased MOM output per day. The proportion of mothers who came to volume (milk output of ≥500 ml/day) by day 14 was 26 (19%). The proportion of babies on predominant MOM feeding at discharge and at 40 weeks’ follow-up was 96 (72%) and 75 (61.5%) infants, respectively. Mothers who came to volume were more likely to feed MOM at 40 weeks [odds ratio (OR) 5.2 (1.2–23.0)].Conclusion Higher birth weight, more frequency of daytime milk expression, earlier initiation of KMC and NNS and longer duration of KMC are factors improving the MOM output. Mothers who came to volume by the first two weeks after birth sustained feeding with MOM till 40 weeks CGA.

The article discusses the trend of built-in storage units in home decor, highlighting their ability to clear clutter, display collections, and make a statement. Various designers and architects provide insights on the advantages and creative possibilities of built-in wardrobes, shelves, and storage solutions. The text showcases different examples of architecturally rich built-in units, emphasizing the importance of design, color, and functionality in creating visually appealing and practical storage spaces for different areas of the home. [Extracted from the article]

What children who face eyesight, hearing and literacy challenges can decipher may be limited, but what they appreciate and celebrate knows no bounds. In the award-winning Indian picture book ''A [...]

1 | INTRODUCTION Medicare spending on Part B drugs (i.e., clinician-administered injections and infusions) grew 9.6% annually from 2009 to 2017, which is more than double the 4.4% annual increase [...], Objective: Examine whether Medicare Advantage (MA) coverage is associated with more efficient prescribing of Part B drugs than traditional Medicare (TM) coverage. Data Sources: Twenty percent sample of 2016 outpatient and carrier TM claims and MA encounter records and Master Beneficiary Summary File data. Study Design: We analyzed whether MA enrollees compared to TM enrollees more often received the low-cost Part B drug in four clinical scenarios where multiple similarly effective drugs exist: (1) anti-VEGF agents to treat macular degeneration, (2) bone resorption inhibitors for osteoporosis, (3) bone resorption inhibitors for malignant neoplasms, and (4) intravenous iron for iron deficiency anemia. We then estimated differences in spending if TM prescribing aligned with MA prescribing. Finally, using linear probability models, we examined whether differences in MA and TM prescribing patterns were attributable to differences in the hospitals and clinician practices who treat MA and TM enrollees or differences in how these hospitals and clinician practices treat their MA versus TM patients. Data Collection/Extraction Methods: Not applicable. Principal Findings: In all cases, a larger share of MA enrollees received the low-cost drug compared to TM enrollees, ranging from 8 percentage points higher for anemia to 16 percentage points higher for macular degeneration in the unadjusted analysis. Results were similar in regression analyses controlling for enrollee characteristics and market factors (5-13 percentage points). If TM prescribing matched MA prescribing, we estimated savings ranging from 6% to 20% of TM spending for each scenario. Differences in prescribing patterns were driven both by MA enrollees receiving treatment at more efficient hospitals and clinician practices and hospitals and clinician practices more often prescribing low-cost drugs to their MA patients. Conclusions: Our findings show MA enrollees were more likely than TM enrollees to receive low-cost Part B drugs in four clinical scenarios where multiple similarly or equally effective treatment options exist. KEYWORDS drug costs, Medicare, Medicare Part B/economics, Medicare Part C, prescription drugs, reimbursement mechanisms What Is known on this topic * The current traditional Medicare reimbursement system for Part B drugs incentivizes clinician practices and hospital outpatient departments to prescribe more expensive drugs. * Medicare Advantage insurers have a financial incentive to reduce spending on medical services, but it is unknown whether Medicare Advantage coverage reduces wasteful spending on Part B drugs. * There is limited research on whether Medicare Advantage coverage is associated with more efficient or higher quality treatment, and the existing studies have mixed results. What this study adds * Medicare Advantage coverage was associated with more efficient prescribing of Part B drugs in four scenarios where multiple similarly effective treatments were available. * Medicare Advantage enrollees received treatment at hospitals and clinician practices that favored prescribing lower cost Part B drugs. * In addition, within hospitals and clinician practices, Medicare Advantage enrollees more often received low-cost drugs than traditional Medicare enrollees.

1 | INTRODUCTION Older adults with cognitive impairment represent a growing population with unique and significant care needs requiring a costly mix of social and medical services. (1-6) There is [...], Objective: To assess whether home health agencies incur significantly higher care delivery costs for patients with cognitive impairment across three timeframes relevant to home health payment policy. Data Sources: Linked Medicare home health claims and patient assessments, National Health and Aging Trends Study (NHATS), and home health agency cost reports for a nationally representative sample of Medicare beneficiaries receiving home health between 2011 and 2016. Study Design: We modeled care delivery costs incurred by the home health agency as a function of patient cognitive impairment using multivariable, propensity score-adjusted, generalized linear models. Data Collection/Extraction Methods: We identified NHATS participants who experienced an index home health episode between 2011 and 2016 (n = 1214; weighted n = 5,856,333) and linked their NHATS survey data to standardized patient assessment and claims data for the episode, as well as cost report data for the home health agency that provided care. Principal Findings: Across the first 30, 60, and 120 days of caring for a patient with cognitive impairment, we estimate additional costs of care to the home health agency of $186.19 (p = 0.02), $282.46 (p = 0.01), and $740.91 (p = 0.04), respectively. Conclusions: Home health agencies incur significantly higher costs when caring for a patient with cognitive impairment. As patient cognitive function is not considered in the most recent Medicare home health reimbursement model, agencies may be disincentivized from providing care to those with cognitive impairment. Policy makers and researchers should carefully monitor home health access among Medicare beneficiaries with cognitive impairment and further investigate the inclusion of patient cognitive function in future risk adjustment models. KEYWORDS cognitive function, dementia, home care services, home health, Medicare What is known on this topic * An estimated one-third of home health patients have cognitive impairment. * Patients with cognitive impairment receive more intensive care during Medicare-funded home health (including receiving a greater number of visits and longer duration of home health care). * Centers for Medicare and Medicaid Services revised the Medicare home health reimbursement model in 2020; the new model adjusts for patient health status/characteristics but excludes cognitive function. What this study adds * Nationally representative estimates of variation in home health care delivery costs by patient cognitive function. * Home health agencies incurred higher costs when caring for patients with cognitive impairment across all timeframes considered (first 30, 60, or 120 days of care). * Failure to adjust for patient cognitive function in risk adjustment models may financially penalize home health agencies caring for a greater proportion of older adults with cognitive impairment, potentially threatening access and/or care quality.

1 | INTRODUCTION In 2020, over 163 million Americans - 50% of the US population were covered by health insurance provided by an employer, either through their own job or [...]

I can do anything, but my hand always falls short. You say I am loved, but no eyes meet mine. You say I will be more, but my dreams rise [...]

I INTRODUCTION The COVID-19 pandemic presented many contracting parties with new problems. One basic question many parties faced was whether either or both parties were excused from performance, and if [...]

Graphical Abstract:

Ameya is wondering how she is going to communicate with everyone at her cousin's Indian wedding. A celebration of the duality of cultures within every third culture child, this book [...]

•Immunodeficient mice with murine HMOX-1 deletion have persisting hRBCs in their peripheral blood.•Immunodeficient mice with murine HMOX-1 deletion have reduced erythrophagocytic macrophages.

In March 2017, the Uttarakhand High Court granted legal personhood to the Ganga and Yamuna rivers, along with their tributaries, marking a significant development in India’s recognition of nature’s rights. This decision came shortly after New Zealand’s Te Awa Tupua (Whanganui River Settlement Act) 2017, which recognised the Whanganui River as a legal entity. While New Zealand’s legal recognition was the result of decades of negotiations, culminating in statutory enactment for a single river, India’s approach was through judicial conferment, a more expedited process which lacked in-depth deliberation. In contrast to the approaches in India and New Zealand, which focus specifically on the rights of rivers, Ecuador and Bolivia have integrated nature’s rights into their constitutions, elevating environmental protection to a constitutional obligation for all of nature. This framework seeks to balance ecological integrity with human interests but faces significant enforcement challenges due to competing development priorities. Although the Supreme Court of India later overturned the Uttarakhand High Court’s ruling as ‘legally unworkable,’ the Indian discourse on the rights of nature can still draw valuable lessons from New Zealand’s Te Awa Tupua enactment and the constitutional recognition of nature’s rights in Ecuador and Bolivia. These examples highlight both the potential and the challenges of granting legal personhood to nature, offering important insights for shaping future policies in India. By synthesising these experiences, this casenote calls for a deeper societal connection to nature, urging a shift in perspective from conquerors to caretakers, and fostering a sustainable and just coexistence with the natural world.

This paper provides developments in statistical shape analysis of shape graphs, and demonstrates them using such complex objects as Retinal Blood Vessel (RBV) networks and neurons. The shape graphs are represented by sets of nodes and edges (articulated curves) connecting some nodes. The goals are to utilize nodes (locations, connectivity) and edges (edge weights and shapes) to: (1) characterize shapes, (2) quantify shape differences, and (3) model statistical variability. We develop a mathematical representation, elastic Riemannian metrics, and associated tools for shape graphs. Specifically, we derive tools for shape graph registration, geodesics, statistical summaries, shape modeling, and shape synthesis. Geodesics are convenient for visualizing optimal deformations, and PCA helps in dimension reduction and statistical modeling. One key challenge lies in comparing shape graphs with vastly different complexities (in number of nodes and edges). This paper introduces a novel multi-scale representation to handle this challenge. Using the notions of (1) “effective resistance” to cluster nodes and (2) elastic shape averaging of edge curves, it reduces graph complexity while retaining overall structures. This allows shape comparisons by bringing graphs to similar complexities. We demonstrate these ideas on 2D RBV networks from the STARE and DRIVE databases and 3D neurons from the NeuroMorpho database.

This study attempts to unmask the relative importance of partisan alignments vis-à-vis the relevance of individual candidate characteristics for the voters. To facilitate this analysis, our study relies on comparing the election outcomes of incumbent parties against those of incumbent candidates using data from the Indian national elections from 1977 to 2014. The idea hinges on the fact that electoral returns may vary according to the ‘ideological’ alignments of the party (incumbent) vis-a-vis the idiosyncratic factors of the candidates (incumbent). We also analyse the role of political reservation in influencing these voters’ alignments. Our results indicate that while, on average, incumbent parties and candidates are significantly disadvantaged in comparison to their non-incumbent counterparts, the electoral choice of the voters favours parties more than the candidates. However, our analysis of the impact of political reservation shows that an incumbent individual candidate faces far less disadvantages than the incumbent parties in reserved constituencies.

Emotional Artificial Intelligence (Emotional AI), with its advanced capability to detect, analyze, and interpret human emotions, presents a groundbreaking opportunity for enhancing various aspects of policing and criminology. This paper delves into the integration of Emotional AI in these fields, highlighting its potential to revolutionize crime detection, prevention, and the improvement of interactions within the criminal justice system. By categorizing the applications of Emotional AI, from predictive policing to emotional assessments during interrogations, the paper explores how this technology can offer novel insights into criminal behavior and support mental health initiatives. Additionally, it addresses the ethical considerations associated with Emotional AI's deployment, such as privacy, bias, and the accuracy of emotion interpretation. The survey synthesizes current challenges and proposes future research directions, aiming to guide the responsible integration of Emotional AI technologies in law enforcement practices. The paper emphasizes the need for a balanced approach that respects individual rights while harnessing Emotional AI's benefits for justice and public safety.

Perceptual image hashing is a significant and time-effective method for recognizing images within extensive databases, focusing on achieving two key objectives: robustness and discrimination. The right balance between these two aspects remains a significant challenge in contemporary hashing research. Moreover, many image hashing algorithms face limitations when performing satisfactorily against specific image processing attacks, such as rotation. With this in mind, a rotation correction based perceptual image hashing system is designed called as Pyramusing a pyramid histogram of gradients (PHOG). The system exploits the properties of log polar transform for invariance to geometric distortions and then the PHOG in blocks for generating the final hash vector. In computing hash similarity, the correlation is employed as the metric of choice. The trade-off between robustness and discrimination is evaluated on benchmark databases against single and double attacks. Furthermore, the comprehensive experiments further confirm that the PHOG method consistently delivers better accuracy than its state-of-the-art methods.