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The current study examines the role of constraints in well-defined problem-solving in ill-defined problem-solving. We chose variants of Raven’s advanced progressive matrices(APM) for well-defined problem-solving and creative reasoning tasks (CRT) for ill-defined problem-solving. Using traditional APM, we created a novel version of APM withcomparatively lesser constraints available to solve the puzzle, called creative APM(cAPM). The cAPM task was designed to induce divergent thinking along with convergent thinking. It is assumed that the difference in constraints changes the nature of the problem space in solving APM and cAPM and may differently affect the following creative reasoning task. We randomly assigned 50 participants to perform APM or cAPM, followed by the CRT, in a fixed order. We observed a significant effect of constraints available to solve well-defined problems on ill-defined problem-solving. The current result shows higher CRT scores when CRT preceded cAPM (Median = 79.25) than APM (Median = 53.00). The result suggests that the flexibility in constraints to solve a well-defined problem induces more divergent thinking alongside convergent thinking and facilitates creative thinking required in ill-defined problem-solving.

Objectives: To validate the reproducibility and inter/intra‐observer variability of the Pink Esthetic Score/White Esthetic Score (PES/WES) of single tooth‐supported prostheses in the maxillary esthetic zone (13–23). Materials and Methods: Forty‐five patients were randomly assigned to one of the three treatment options (15 patients per group) receiving each one a different crown type: Porcelain fused to metal (PFM), monolithic zirconia, and lithium disilicate. Eight observers from each of four different specialties (Prosthodontists, Orthodontists, Periodontists, and Oral Surgeons) were recruited and assessed twice and four weeks apart (i.e., T1 and T2) 45 photographs of the single tooth‐supported prosthesis using PES/WES and compared them with contralateral teeth. Results: According to the ANOVA and post hoc tests, the zirconia crown type obtained the highest mean score by all observers, with a mean value of 16.70 ± 2.94. The prosthodontists and oral surgeons assigned the lowest mean score to PFM crowns, 13.03 ± 3.47 and 13.80 ± 3.17, respectively. Notably, the prosthodontists awarded the highest scores, specifically 17.50 ± 2.81 for the zirconia crowns. Intraobserver agreement was calculated utilizing the paired t‐test. Pairwise comparisons between observers of different specialties revealed significant intraobserver agreement. Interclass correlation coefficient (ICC) scores were statistically significant among four specialties. No difference was detected concerning the interobserver agreement. Conclusions: The PES/WES index remains consistent across various observers from different specializations, yielding uniform results in the overall esthetic evaluation. Consequently, in light of the presented preliminary positive results, its use might also be considered for the esthetic assessment of single‐tooth‐supported prostheses. Clinical Significance: The PES/WES index may be employed clinically to evaluate single tooth‐supported prostheses as it emerged as a reproducible esthetic scoring system. [ABSTRACT FROM AUTHOR]

Background: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. Objective: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. Methods: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. Results: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI.29 to.28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI.11 to.99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03–1.18, 573 participants; P value = 0.006). Conclusion: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the effect of utilization of treatment for insomnia symptoms on the prevalence of major depressive disorder among older adults in India. We used the data from the Longitudinal Ageing Study in India (LASI), 2017–18. The sample included 10,911 older individuals who reported insomnia symptoms. The propensity score matching (PSM) approach was used to compare the depressive disorder among those who received vs. not received treatment. Only 5.7% of older adults reporting insomnia symptoms received treatment. On average, prevalence of depressive disorder among men and women who received treatment for insomnia symptoms was lesser by 0.79 and 0.33 points, respectively, than those who did not receive treatment. In the matched sample, treatment for insomnia symptoms was significantly associated with lesser prevalence of depression for both older men (β= −0.68, p <.001) and older women (β= −0.62, p <.001). The current findings suggest that treatment for insomnia symptoms can reduce the risk of depressive disorder among older adults and the effects are higher among older men than women. [ABSTRACT FROM AUTHOR]

Background: Several observational studies have reported the prevalence of cerebral microbleeds (CMBs) and their risk factors in an elderly population. Any information in this regard is currently lacking from India. Aim of this study was to estimate the prevalence, risk factors of CMBs, and association with cognition in an Indian urban population aged 50 years and above. Methods: Household surveys were conducted as part of ongoing Longitudinal Cognition and Aging Research on Population of the National Capital Region (LoCARPoN) study in areas of urban Delhi. Magnetic resonance imaging of the brain was performed in 2599 participants. Using standard neuropsychological battery, mean Z-scores for each domain (memory, executive, information) were derived. Binary and stepwise logistic regression models were used to determine associated risk factors for the presence of CMB and its association with cognitive domains. Results: The prevalence of CMBs was 14.42% (95% confidence interval [CI]: 13.06-15.73). Of these, 203 (7.81%) participants had single CMBs and 172 (6.61%) had multiple microbleeds (≥2). Higher prevalence was observed in older age (6070 years: odds ratio [OR]: 1.25 [95% CI: 0.93-1.67]; 70-80 years: OR: 2.05 [95% CI: 1.48-2.84]; ≥80 years: OR: 3.27 [95% CI: 1.97-5.44]) compared to individuals in the age group 50-60 years. History of stroke (OR: 2.97 [95% CI: 1.56-5.66]), hypertension (OR: 1.36 [95% CI: 1.05-1.75]), and smoking (OR: 1.43 [95% CI: 1.11-1.85]) was associated with at least one CMB. Multiple CMBs were associated with worse scores in memory and executive domains. Conclusion: Older age, hypertension, history of stroke, and history of smoking emerged as important risk factors for the presence of multiple CMBs. Follow-up study is required to determine implications of CMBs. [ABSTRACT FROM AUTHOR]

Purpose: To develop, analyze, and optimize a dental implant by considering square threads and varying the thread dimensions to obtain an optimal shape. Materials and Methods: For this study, finite element analysis (FEA) and numerical optimization method were integrated to develop a mathematical model. The critical parameters of dental implants were studied, and an optimized shape was obtained using response surface method (RSM) and design of experiment (DOE). The simulated results were then compared to the predicted values under optimal conditions. Results: Using the one-factor RSM design model for the dental implant and a vertical compressive load of 450 N for testing, the optimal depth to width ratio for the thread was 0.7 in order to achieve the minimum von Mises and shear stress. Conclusion: The buttress thread was found to be the optimal shape for achieving the lowest von Mises and shear stress compared to square threads, and the thread parameters were calculated accordingly, with a thread depth 0.45 times the pitch, a width 0.3 times the pitch, and a thread angle of 17 degrees. Also, due to the constant diameter of the implant, common 4-mm diameter abutments can be used interchangeably. [ABSTRACT FROM AUTHOR]

Background and Objective: The most frequently seen intra-oral soft tissue is the gingiva. Most often, it is seen as coral-pink tissue that surrounds the neck of the teeth. Gingiva that encircles the tooth necks and covers the alveolar processes of the jaws is an intra-oral tissue that exhibits biomimetic features. The wide range of colors of the gingiva depends on the configuration of gingival vascularity, the degree of epithelial cornification, level of melanogenesis, and the depth of epithelialization. However, the color of the gingiva varies depending on the degree of melanin pigmentation. The current study aimed to identify the different distribution patterns of gingival color and determine the correlation between skin color, gender, and geographical area of origin. Materials and methods: A total of 839 subjects were involved in the study where the gingival color and skin tone were measured using the Dummett-Gupta Oral pigmentation Index (DOPI) combined with VITA VMK MASTER and skin shade method developed by Revlon (USA) and L'Oreal (France) for makeup foundation shades. One investigator was calibrated for the examination of the colors after being tested for normal color vision and color aptitude using the line test. Results: A significant association was found between skin color and gingival pigmentation (χ2 value (6) = 114.48; P = 0.001). It was also found that females (67.1%) significantly had darker gingiva than males (58.3%). The study statistics display that location of the individual was also statistically associated with melanin pigmentation of the gingiva (χ2 value (57) = 559.33; P = 0.001). Conclusion: The study concluded that gender, skin color, and individual location are significantly associated with gingival melanin pigmentation. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Initially, some 80% of all patients with stroke experience motor impairments of the contralateral limb, i.e hemiparesis. Mirror therapy is relatively new therapeutic intervention that focuses on moving the unimpaired limb. Likewise, another technique called Mental imagery is the cognitive rehearsal of a task in the absence of movement. Aim and Objectives: To compare mirror therapy and mental imagery in improving ankle motor recovery in acute stroke patients. Methodology: 30 stroke patients were selected in the study, and were randomly assigned into two groups. Group A i.e. Mirror Therapy group (n=15) or the Group B i.e. Mental Imagery group (n=15). Both the groups received 30 minutes of their respective therapy that is mirror therapy and mental imagery and in addition to 30 minutes of conventional therapy which included neuro developmental facilitation technique, stretching, gait training that is a total of 1 hour per day for 5 days a week for 4 weeks. Modified Ashworth Scale, 10 Meter Walk test (10MWT), Fugl-Meyer assessment Lower extremity (FMA-LE) scale were administered pre and post intervention to assess the ankle motor function. Results: Only Fugl Meyer Assessment scores on comparison between Group A (Mirror Therapy) and Group B (Mental Imagery) revealed that statistically significant improvement was found in Group B (Mental Imagery) (t-value: 2.140; p-value: .041*). Conclusion: The present study concluded that Mental Imagery proved to be more effective than Mirror Therapy in improving ankle motor recovery in acute stroke patients. [ABSTRACT FROM AUTHOR]

Mastectomy serves as the main surgical treatment for both invasive and in situ breast carcinoma and large phyllodes tumors. It is associated with skin necrosis, seroma, and surgical site infection in up to 30% of patients. In the present trial, we compared the complications in patients undergoing skin flap elevation by one of the 4 techniques: thick skin flap raised by scalpel(group1), thin skin flap raised with scalpel (group 2), thick skin flap raised with diathermy (group 3), and thin skin flap raised with diathermy (group 4). A randomized trial with superiority hypothesis and 2 × 2 factorial design was conducted at All India Institute of Medical Sciences New Delhi. Mastectomy skin flap necrosis (MSN) was recorded as the main outcome of interest. MSN was noted in 2.5% in group1, 10% in group 2, 7.5% in group 3, and 30% in group 4. MSN was observed in 5% cases with thick flap compared to 20% cases with a thin skin flap (p = 0.007). Raising the flap with scalpel was associated with MSN in 6.25% compared to 18.75% in the diathermy group (p = 0.029). We conclude that raising a thick flap with scalpel is associated with lowest risk of skin flap necrosis. Trial Registration: Clinical Trial Registry- India CTRI/2014/09/004978 [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic resulted in a national lockdown and physical contact was avoided that substantially changed people's lives. The overall impact of lockdown during COVID-19 was negative on the general & mental health of adolescents. During the COVID-19 pandemic, there is a 25% massive increase in the global prevalence of anxiety and depression. Aims & Objectives: To assess anxiety & depression and their association with socio-demographic factors during the COVID-19 pandemic among school-going adolescents. Methodology: Using two simple random sampling, a cross-sectional study was conducted among 690 school-age adolescents (14 to 19 years) in four Nagar Palikas of the district of Dehradun. The questionnaire includes sociodemographic section, GAD-7, PHQ-2, Modified version of CoPaQ and coping strategies. Result: In study it's been found that more than half of the participants were facing symptoms of anxiety and 58.7% of participants had a major depressive disorder likely. 78% participants used phone and internet f/b watching TV (73.8%) and sleeping (68.1%). Conclusion: In order to combat adolescents' mental illness, we advise the creation of support groups at the family and school levels as well as prompt intervention through the revision of current strategies or formulation of new legislation [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of fixed-dose combinations (FDC) of triple-drug dapagliflozin, sitagliptin, and metformin (DSM) compared with FDC of two-drug sitagliptin and metformin (SM), in Indian adult patients with type 2 diabetes (T2D). Methods: A multicentric, randomized, double-blind, active-controlled, Phase 3 study (CTRI/2021/10/037461) was conducted on 274 Indian adult patients with T2D. Patients were randomized (1:1) to receive either an FDC of triple-drug (n = 137) dapagliflozin propanediol 10 mg, sitagliptin phosphate 100 mg, and metformin hydrochloride 1000 mg extended-release (DSM) or FDC of two-drug (n = 137) sitagliptin phosphate 100 mg and metformin hydrochloride 1000 mg sustained-release (SM), for 16 weeks. The primary endpoint was a change in HbA1c, while the secondary endpoints were changes in fasting plasma glucose (FPG), postprandial glucose (PPG), body weight, and safety. Results: Both DSM and SM FDCs reduced HbA1c significantly (-1.45% and -1.00%, respectively, both p < 0.0001), however, HbA1c lowering was superior with DSM (∆ -0.45%; p = 0.0005) compared to SM, at week 16. Similarly, both DSM and SM FDCs reduced FPG and PPG significantly, however, FPG (∆ -12.4 mg/dl; p = 0.003) and PPG reduction (∆ -18.45 mg/dl; p = 0.01) were significantly superior to DSM compared to SM, respectively. No significant reduction in body weight was observed between the two arms. Both FDCs were well tolerated. Conclusion: FDC of DSM was superior to SM in reducing HbA1c, FPG, and PPG in Indian adults with T2D. Both triple and dual FDCs had optimal safety profiles. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate Cancer represents a significant health risk for men, especially African American men, despite the availability of PSA testing. Although PSA testing is the current gold-standard test for identifying at-risk men, an increased PSA level may arise from Benign Prostatic Hyperplasia instead of Prostate Cancer. For men with BPH, PSA testing may lead them to undergo unnecessary biopsies. As an alternative to PSA, we have previously described a Filamin-A and prostate volume based biomarker test with superior performance. To simplify this test, we removed the requirement of prostate volume measurement. Herein, we present results of this updated test utilizing Filamin-A alone in Caucasian and African American men. Filamin-A demonstrates superior predictive power compared to PSA in both patient populations. By reliably separating benign conditions from aggressive prostate cancer, this test would reduce the health care burden resulting from unnecessary prostate biopsies. Prostate cancer represents a significant health risk to aging men, in which diagnostic challenges to the identification of aggressive cancers remain unmet. Prostate cancer screening is driven by the prostate-specific antigen (PSA); however, in men with benign prostatic hyperplasia (BPH) due to an enlarged prostate and elevated PSA, PSA's screening utility is diminished, resulting in many unnecessary biopsies. To address this issue, we previously identified a cleaved fragment of Filamin A (FLNA) protein (as measured with IP-MRM mass spectrometry assessment as a prognostic biomarker for stratifying BPH from prostate cancer and subsequently evaluated its expanded utility in Caucasian (CA) and African American (AA) men. All men had a negative digital rectal examination (DRE) and PSA between 4 and 10 ng/mL and underwent prostate biopsy. In AA men, FLNA serum levels exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.71 AUC and 12.2 OR in 48 men with BPH and 60 men with PCa) and outperformed PSA (0.50 AUC, 2.2 OR). In CA men, FLNA serum levels also exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.74 AUC and 19.4 OR in 191 men with BPH and 109 men with PCa) and outperformed PSA (0.46 AUC, 0.32 OR). Herein, we established FLNA alone as a serum biomarker for stratifying men with BPH vs. those with high Gleason (7–10) prostate cancers compared to the current diagnostic paradigm of using PSA. This approach demonstrates clinical actionability of FLNA alone without the requirement of prostate volume measurement as a test with utility in AA and CA men and represents a significant opportunity to decrease the number of unnecessary biopsies in aggressive prostate cancer diagnoses. [ABSTRACT FROM AUTHOR]

Fractals are a common characteristic of many artificial and natural networks having topological patterns of a self-similar nature. For example, the Mandelbrot set has been investigated and extended in several ways since it was first introduced, whereas some authors characterized it using various complex functions or polynomials, others generalized it using iterations from fixed-point theory. In this paper, we generate Mandelbrot sets using the hybrid Picard S-iterations. Therefore, an escape criterion involving complex functions is proved and used to provide numerical and graphical examples. We produce a wide range of intriguing fractal patterns with the suggested method, and we compare our findings with the classical S-iteration. It became evident that the newly proposed iteration method produces novel images that are more spontaneous and fascinating than those produced by the S-iteration. Therefore, the generated sets behave differently based on the parameters involved in different iteration schemes. [ABSTRACT FROM AUTHOR]

In the present work we have perform a comparative study of structural and elastic properties of some inorganic and organic molecular crystals viz. Realgar As4S4, As4S3, C14H10 (anthracene), C10H8 (naphthalene). For theoretical prediction, four different EOSs have been used viz. modified Lenard-Jones EOS (M-L Jones EOS), Brennan-Stacey EOS, Hamma—Suito EOS and Thomsen EOS. Further, we have checked the applicability of these EOSs for calculation of Grüneisen parameter at different compressions. Experimental data and theoretical facts give the validity of our work. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Our goal is to describe the association between total quantitative blood loss (QBL) and risk of obstetric haemorrhage‐related morbidity (OBH‐M) to assess the utility of the current definition of obstetric haemorrhage (OBH). Methods: This was a retrospective cohort study completed of all patients who had a live delivery at the only urban safety‐net hospital over a 2‐year period from 2018 to 2019. We categorized deliveries into 10 equally sized deciles based on QBL and compared the proportion with OBH‐M in each. Among the two deciles with the highest proportions of OBH‐M, we stratified deliveries into seven groups of ascending intervals of 250cc QBL. Finally, we compared the positive predictive value (PPV) of the standard definition of OBH (QBL ≥ 1000cc) to a definition extrapolated from our stratified analysis. The primary outcome was proportion of deliveries within each QBL decile affected by OBH‐M. The secondary outcome was PPV. Results: We found a significant increase in OBH‐M from decile 9 (895–1201cc QBL) to decile 10 (1205–8325cc QBL) (p < 0.001). In our stratified analysis, we found QBL of 1500cc to be an inflection point for an increased proportion of OBH‐M. Our secondary analysis showed an increased PPV for OBH‐M using QBL of 1500cc (20.5%) compared with that of QBL 1000cc (9.8%). Conclusions: Our findings suggest that a higher QBL threshold than the currently accepted definition of OBH is more predictive of OBH‐M. [ABSTRACT FROM AUTHOR]

Background: Childbirth is a transformative process. Modern healthcare offers pharmacological and non-pharmacological interventions for safe and improved childbirth experience. Studies have found that maternal mobility during the first stage of labour has a significant effect on maternal and child outcomes. A pilot study was done to find the effect of mobility during the first stage of labour on maternal satisfaction and foetal outcome. Method: An experimental study was done with 60 primigravida women with uncomplicated antenatal history reporting to the labour room of a tertiary care government hospital in Delhi chosen as study participants. Validated and reliable tools were used to measure labour, maternal and neonatal outcomes within 24 h post-delivery. Results: The results showed that there was an impact on mobility intervention during the first stage of labour on parturition (p =.03) and significant maternal satisfaction (p =.001). However, the neonatal outcome of both groups was not significant. Conclusion: Mobility was an effective non-pharmacological intervention for enhancing parturition and maternal satisfaction. Mobility during the first stage of labour can be recommended for practice guidelines for all midwives in the labour room as a protocol. [ABSTRACT FROM AUTHOR]

Background: Asthma is defined as a chronic inflammatory disorder of airways characterized by reversible air- flow obstruction causing cough, wheeze, chest tightness and shortness of breath Crompton et al7Asthmatic attacks are set up by exposure to specific allergens such as house dust mite, pollen and animal dander. Some other factors are exercise particularly running, dyes, air pollution, infection, cigarette smoke, dry inhaled air, certain foods such as fish, eggs, yeast, and wheat which presumably reach the bronchi via blood stream. There is notice- able increase in healthcare burden from asthma in several areas of world .The most frequently mentioned aims of breathing exercises are to 'normalize' breathing pattern by adopting a slower respiratory rate with longer expiration and reduction of hyperventilation and hyperinflation. Training also frequently involves encouraging nasal breathing and a diaphragmatic breathing pattern.AQLQ AND SF36 questionnaire was used as outcome measure. Methods: The sample size of this study was 30 subjects with 15 subjects in each group. The group A was given breathing exercises interventions and group B was given aerobic exercises intervention. A written consent was taken from each before their participation into the study. Asthma Quality of Life Questionnaire (AQLQ) and SF-36 quality of life Questionnaire of both the groups were taken in 0 week and both groups were assigned treatment interventions and after 3 weeks the AQLQ and SF-36 quality of life questionnaire has been repeated. The independent variables in the study were Aerobic Exercises and Breathing Exercises. Conclusion: The breathing exercise intervention was effective in improving the quality of life in asthmatic patients. The aerobic exercise intervention was also effective in improving the quality of life in asthmatic patients. However, the quantum of reduction in lung obstruction and therefore, the overall improvement in quality of life found to be more significant with the aerobic exercise intervention than breathing exercise intervention. Thus, a combination of the breathing exercises and aerobic exercise should be incorporated into the pulmonary reha- bilitation program of the asthmatic patients. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to evaluate the synergistic role and advantages of integrating noncontrast computed tomography (NCCT) and magnetic resonance cholangiopancreatography (MRCP) in disorders of the pancreatobiliary (PB) system. Methods In this cross-sectional and retrospective record-based study, radiological (NCCT and MRCP) data were collected retrospectively for a period of 3 years (June 2018–August 2020) from 52 patients. The results were compared to the final diagnosis on endoscopic retrograde cholangiopancreatography (ERCP) findings (gold standard). The data collected were analyzed by measuring the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and p -value for NCCT, MRCP, and integrated NCCT plus MRCP at different cutoff points. Subsequently, a receiver operating characteristic (ROC) curve was plotted to analyze different thresholds for NCCT, MRCP, and integrated NCCT plus MRCP. Results The most common pathologies identified were biliary dilations (18.4%), common bile duct (CBD) calculi (13.6%), and biliary strictures (12.0%). Overall, MRCP provided a higher percentage of correct diagnoses (81.6%) compared to CT (56.0%). Integrating NCCT with MRCP showed a significant increase in sensitivities and specificities when compared to NCCT or MRCP alone. Integrated NCCT plus MRCP showed excellent performance with an area under the curve (AUC) of ROC analysis of 0.937. Conclusion Our study showed that integrating NCCT and MRCP can prove to be an excellent tool in establishing a detailed diagnosis of PB disorders, better than either NCCT or MRCP alone. Due to the concurrent nature of PB disorders, it may be worth considering integrating NCCT and MRCP, given that there is an absence of contraindications to either modality. [ABSTRACT FROM AUTHOR]

Background: All women with hyperglycemia in pregnancy (HIP) require optimal care. With western Uttarakhand alone recording a HIP prevalence of 9.7%, the successful implementation of HIP guidelines pan-India at primary healthcare level becomes paramount. Aim and objective: The present cross-sectional study aimed to assess the baseline awareness of medical undergraduates regarding HIP management protocols assuming higher their knowledge better the successful implementation of these guidelines within the community. Methodology: A descriptive study was carried out among 309 medical undergraduates at a private teaching institute in Uttarakhand. Data was collected using a selfadministered, pre-tested questionnaire. Based on individual knowledge scores, participants were subdivided into: good (score≥24), moderate (score 12-24), and poor (score<12) knowledge categories. Data were analyzed using Statistical Package for Social Sciences. Results: Most subjects (92.2%) reported reading Indian textbooks on obstetrics; despite this, only 3.6% of subjects had good awareness of the protocols. Sub-domain analysis showed while 90.0% of respondents had a fair understanding of the disease basics, more than two-thirds lagged in recollecting its standard diagnostic and management protocols including the role of health workers. Conclusion: Most medical undergraduates have overall poor-to-moderate awareness of HIP management especially the diagnostic and management protocols including the role of health workers. [ABSTRACT FROM AUTHOR]

Purpose: A locking plate (LP) or non-locking plate (NLP) can be used for distal fibula fracture fixation. However, the advantages of LP over NLP in patients with distal fibula fractures are not clear. In terms of indications, the role of the two plates probably differs; however, to draw comparative conclusions, we conceptualized this systematic review and meta-analysis of studies that directly compared the two plates, wherein both groups' indications and baseline parameters were similar. Methods: An electronic literature search was performed using PubMed/Medline, Embase, Scopus, and Cochrane Library databases for studies comparing the LP versus NLP fixation for the lateral malleolus fracture. A total of 18 studies were included in qualitative and quantitative analysis. A subgroup analysis was performed for patients aged < 55 years and patients aged > 55 years. The statistical analysis was performed by Review Manager Software version 5.4.1. Results: A meta-analysis of 4243 fractures was performed across 18 studies. The rate of fracture union and overall complication rates did not differ between the two fixation groups with an OR of 0.71 (95% CI 0.26, 1.96, p = 0.51 and 1.11 (95% CI 0.84, 1.47, p = 0.47, respectively. There is no difference in the reoperation rate due to minor or major complications between the two groups. There was no difference in functional outcome (MD −0.85, with 95% CI −5.63, 3.93, p = 0.73), but NLP has a shorter surgical duration (MD 3.0, with 95% CI 0.26, 5.75, p = 0.03). A leave-one-out sensitivity analysis performed for overall complications affected the final outcome of the meta-analysis. Conclusion: This meta-analysis demonstrates no clear benefit in selecting LP over NLP for the fixation of lateral malleolus fractures. [ABSTRACT FROM AUTHOR]

Rathor, Richa, Sukanya Srivastava, and Geetha Suryakumar. A comparative biochemical study between L-carnosine and β-alanine in amelioration of hypobaric hypoxia-induced skeletal muscle protein loss. High Alt Med Biol. 24:302–311, 2023. Background: Carnosine (CAR; β-alanyl-L-histidine), a biologically active dipeptide is known for its unique pH-buffering capacity, metal chelating activity, and antioxidant and antiglycation property. β-Alanine (ALA) is a nonessential amino acid and used to enhance performance and cognitive functions. Hypobaric hypoxia (HH)-induced muscle protein loss is regulated by multifaceted signaling pathways. The present study investigated the beneficial effects of CAR and ALA against HH-associated muscle loss. Methodology: Simulated HH exposure was performed in an animal decompression chamber. Gastric oral administration of CAR (50 mg·kg−1) and ALA (450 mg·kg−1) were given daily for 3 days and at the end of the treatment, hindlimb skeletal muscle tissue was excised for western blot and biochemical assays. Results: Cosupplementation of CAR and ALA alone was able to ameliorate the hypoxia-induced inflammation, oxidative stress (FOXO), ER stress (GRP-78), and atrophic signaling (MuRF-1) in the skeletal muscles. Creatinine phospho kinase activity and apoptosis were also decreased in CAR- and ALA-supplemented rats. However, CAR showed enhanced protection in HH-induced muscle loss as CAR supplementation was able to enhance protein concentration, body weight, and decreased the protein oxidation and ALA administration was not able to restore the same. Conclusions: Hence, the present comprehensive study supports the fact that CAR (50 mg·kg−1) is more beneficial as compared with ALA (450 mg·kg−1) in ameliorating the hypoxia-induced skeletal muscle loss. [ABSTRACT FROM AUTHOR]

Software-Defined Networking (SDN) outperforms conventional networks in terms of programmability, management, flexibility, and efficiency. This is because SDN separates the control and data planes. The centralised control of devices aids in the prevention of Distributed Denial of Service (DDoS) attacks. The controller has a larger network perspective and has the ability to filter network traffic in order to detect harmful flows. The separation of the control and data planes provided benefits, but it is vulnerable to DDoS attacks. DDoS assaults are difficult to detect and resist in real-time. This is only possible if appropriate features for attack detection are chosen. We intend to employ feature selection methods such as BORUTA, IRelief, Random Forest, Information Gain and Chi-Square Test to obtain the most relevant features for DDoS detection. Moreover, we have devised a strategy to detect and mitigate DDoS attack using tracebacking approach through ONOS Flood Defender (OFD) Application. The application effectively detects different DDoS attack traffic using XGBoost and Multilayer Perceptron algorithms with 99% accuracy and least testing times without adding unnecessary load to the system and mitigates the attack in approximately 3.2 s using tracebacking approach. We have performed our experiment on four benchmark datasets CIC-DoS 2017, CIC-DDoS 2019, CIC-IDS 2018 and InSDN. We have evaluated the trade-off between detection accuracy and testing time in order to determine the most effective detection model for addressing DDoS attacks on SDN networks. [ABSTRACT FROM AUTHOR]

Background: Myofascial pain is one of the most common facial region pains, presenting itself with various signs and symptoms like tenderness of masticatory muscles and difficulty in mouth opening. Considering its multifactorial aetiology various treatment modalities are present. Objective: The aim of this study is to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS)and low‐level laser therapy (LLLT) for the patients of temporomandibular disorders (TMDS). Methods: The study was conducted with 20 patients diagnosed with TMDS. Group A received LLLT at 660 nm, 6 J/point, two sessions/week for 4 weeks and group B received TENS at 2–250 Hz, two sessions/week for 4 weeks. Results: Pain Score decreased and mouth opening increased in both groups with time, however, the difference between the two groups was not statistically significant. Right and left lateral excursions showed improvement at different intervals in both groups. However, the LLLT group showed significant improvement. Conclusion: Clinical trial showed improvement in visual analogue scale (VAS), maximum mouth opening (MMO) and lateral excursion in the different time intervals in both the groups with LLLT showed more improvement with lateral excursions movements. [ABSTRACT FROM AUTHOR]

Background: One of the sustainable development goals' (SDGs) primary goals (Goal 3) is to ensure healthy lives and promote well‐being for persons of all ages. While extensive literature documents the link between physical frailty and low life satisfaction (LLS) among older adults, research of this nature is limited within low and middle‐income countries including India. The purpose of this study was to examine the association between physical frailty and life satisfaction among community‐dwelling older men and women in India. Methods: Data come from the 2017–18 wave 1 of the Longitudinal Ageing Study in India (LASI), with a sample of 30 390 individuals aged 60 and above (14 559 men and 15 831 women). Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. Ordered logistic regression models are employed to examine the association between physical frailty and life satisfaction. Results: The prevalence of frailty was higher in older women than men (32.2% vs. 27.5%). Nearly 30.4% of men and 33.8% of women reported having LLS. However, after adjusting for the selected confounders, women were less likely (adjusted odds ratio [aOR]: 0.92; CI: 0.87–0.97) to report LLS compared to men. The physically frail older adults were more likely (aOR: 1.40; CI: 1.27–1.55) to report LLS relative to their physically stronger counterparts. Moreover, we found that frail older men had higher odds of reporting LLS than non‐frail older men (aOR: 1.25; CI: 1.09–1.43). Also, non‐frail older women had lower odds of reporting LLS than non‐frail older men (aOR: 0.80; CI: 0.67–0.95). Conclusions: Findings of our study suggest that policies and programs to address later life well‐being need to consider gender differences. Doing so would not only help identify older adults most at risk of LLS, but gender differentiated policies would help streamline health expenditures and costs typically relegated to assist all older adults without proper focus on the uniqueness of their social location. [ABSTRACT FROM AUTHOR]

Research of lead-free perovskite solar cells (PSCs) has gained attention with an urgent intent to eliminate toxic lead in perovskite materials. The prime intention of this research is to supplement the current research progress with a comparative analysis of various lead-free PSCs through numerical simulation analysis using solar cell capacitance simulator (SCAPS)-1D software. Lead-based toxicity and instability have been one of the major hurdles in restricting perovskite solar cells from being commercialized. This study caters in substituting the need for toxic lead (Pb)-based PSCs with more efficient Pb-free PSCs. The device simulation is carried out in the n-i-p configuration of FTO/[6,6]- phenyl-C61-butyric acid methyl ester/perovskite layer/poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine/Au using six distinct Pb-free perovskites. The impact of various active layers, including hole and electron transport thicknesses and the concentration of doping on solar device performances, has been minutely probed and optimized. CsSnI3 based PSC shows the best power conversion efficiency of 28.97% among all Pb-free devices. This makes very evident its probability to achieve high-performance Pb-free solar devices experimentally at par with lead-based perovskite solar cells in future research. [ABSTRACT FROM AUTHOR]

Indian population is ageing at a higher pace coupled with the increase in life expectancy, and the prevalence of cognitive impairment, dementia, and comorbidities increase dramatically with age. Such cognitive and physical changes are intimately linked with declines in everyday functioning that include loss of decision-making skills. The present study explored the relationship between socioeconomic and health status of older adults and their role in household decision making. The study used data from the "Building a Knowledge Base of Population Ageing in India" (BKPAI) survey conducted in 2011 (n = 9181). Descriptive statistics along with multivariate negative binomial and binary logistic regression analyses were conducted. A proportion of 29.7% of older adults had no or partial involvement in household decision making and 26.5% of older adults reported that they had witnessed a decline in their role as decision-maker. The involvement of older adults in household decision making was 1.51 times lower among those who did not contribute money in household expenditure (incidence rate tatio (IRR):1.51; 95% confidence interval (CI): 1.24, 1.84) than those who contributed. Respondents who had low cognitive ability (IRR: 1.22; 95% CI: 1.09, 1.37) or had more than one disability (IRR: 1.27; 95%CI: 1.09, 1.47) were significantly 1.22 and 1.27 times less likely to have involvement in household decision making, respecctively. Older adults who reported low self-rated health (adjusted odds rati (aOR): 1.4; 95% CI: 1.21, 1.61), low general health (aOR: 2.85; 95% CI: 2.46, 3.31), low subjective wellbeing (aOR: 2.29; 95% CI: 1.99, 2.64) and low IADL (aOR: 1.49; 95% CI: 1.31, 1.69) were significantly more likely to report a decline in the role as a decision maker compared to their healthy counterparts. Along with the poor socioeconomic characteristics, the negative effects of cognitive and health markers of ageing further diminish the role of older adults in household decision making. Further research in the field of familial role and importance of older adults in different family settings is required in tackling a wide range of issues related to the wellbeing of the aged population. [ABSTRACT FROM AUTHOR]

Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25; N = 32), group with overweight (OW-BN; BMI ≥25 and <30; N = 66), and group with obesity (O-BN; BMI ≥30; N = 54). We compared the groups on demographics, diet and weight histories, body esteem, BN symptoms, and depression using chi square, analysis of variance, analysis of covariance, and Poisson regression models. The O-BN group was older (d = 0.57) and OW-BN and O-BN groups had greater proportions of race/ethnic minorities than NOW-BN group. The O-BN group was significantly younger at first diet (d = 0.41) and demonstrated significantly higher cognitive dietary restraint (d = 0.31). Compared to NOW-BN, O-BN participants had lower incidence of objective binge eating (incidence rate ratio [IRR] = 4.86) and driven exercise (IRR = 7.13), and greater incidence of vomiting (IRR = 9.30), laxative misuse (IRR = 4.01), and diuretic misuse (d = 2.08). O-BN participants also experienced higher shape (d = 0.41) and weight (d = 0.42) concerns than NOW-BN and OW-BN, although NOW-BN experienced higher shape (d = 0.44) and weight (d = 0.39) concerns than OW-BN. Groups did not differ on depression scores. These results were replicated when examining BMI as a continuous predictor across the full sample, with the exception of objective binge eating and driven exercise, which were not significantly associated with BMI. Individuals with BN and comorbid obesity have distinct clinical characteristics. Existing interventions may need to be adapted to meet clinical needs of these individuals. [ABSTRACT FROM AUTHOR]

Glasgow Coma Scale-Pupils (GCS-P) score has been found to be strongly related to in-hospital mortality in retrospective studies. We hypothesized that GCS-P would be better prognosticator than Glasgow Coma Scale (GCS) in patients with traumatic brain injury (TBI). In this prospective, multicentric, observational study, GCS and GCS-P scores were noted in adult TBI patients at ICU admission. Demographic variables, relevant clinical history, clinical/radiological findings and ICU complications were also noted. Extended Glasgow Outcome scale was noted at hospital discharge and at 6 months post-injury. Logistic regression analysis was carried out to estimate the odds for poor outcome adjusted for covariates. Sensitivity, specificity, area under curve (AUC) and odds ratio are reported for poor outcome at estimated cutoff point. A total of 573 patients were included in this study. The predictive power for mortality, shown by the AUC, was 0.81 [95% CI: 0.77–0.85] for GCS and 0.81 [95% CI: 0.77–0.86] for GCS-P score, both being comparable. Similarly, the predictive ability for outcome at discharge and 6 months, the AUC-ROC for both GCS and GCS-P were comparable. GCS-P is a good predictor of mortality and poor outcome. However, the predictive performance of GCS and GCS-P for in-hospital mortality and functional outcome at discharge and at 6 months remains comparable. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is an inflammatory systemic disease with a chronic relapsing course. Methotrexate, a dihydrofolate reductase inhibitor, and Apremilast, an oral phosphodiesterase type 4 inhibitor, are currently the mainstay drugs in the treatment of psoriasis. Aims and Objectives: To compare the efficacy of Methotrexate with a combination of Methotrexate and Apremilast in treating chronic plaque psoriasis. Materials and Methods: The present study was a prospective comparative study conducted among 40 patients, aged above 18 years, with clinically diagnosed psoriasis attending Dermatology OPD of a tertiary care hospital in North India. The study utilised a pre-structured proforma to record a detailed demographic profile and clinical examination related to chronic plaque psoriasis. The patients were divided into two groups of 20 each. Group A was treated with oral Methotrexate, while Group B was treated with oral Apremilast and Methotrexate, and they were evaluated every 4 weeks for 12 weeks. Necessary investigations were done wherever indicated. Results: The male-to-female ratio was 1.35, and the majority (55.0%) of patients belonged to the age group of 31-50 years. 27.5% of patients had comorbidities like diabetes, hypertension, etc., The mean PASI score of group A at the first, second and third follow-ups was higher than that of group B. The reduction in mean PASI score was statistically significant in group B at successive follow-ups, with a percentage improvement of 89.4% at the end of 12 weeks. Conclusions: When comparing monotherapy with methotrexate and multidrug therapy with Methotrexate and Apremilast, multidrug therapy had better efficacy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the effectiveness of various disinfectants for extracting human teeth. The objectives were to assess the effectiveness of 5% vinegar, 3% hydrogen peroxide, 70% alcohol, and 5.25% sodium hypochlorite for disinfection of extracted human teeth. Methods: The teeth were divided into one of the following four groups consisting of 10 teeth in each group. All teeth were immersed in separate bottles containing 10 ml of the disinfectant for 7 days at 25°C. No visible growth in the broth was considered effective disinfection. The Institutional Ethics Committee (IEC) Number is SVIEC/ON/DENT/SRP/15186, and the IEC Clearance number is SVIEC/ON/DENT/SRP/15040. Results: Vinegar was most effective for bacterial disinfection, and 5.25% sodium hypochlorite was most effective for fungal disinfection. The result was statistically significant with Chi-square values of 0.015 and 0.057, respectively, and P < 0.001. Conclusions: Extracted teeth should be handled with extreme care as these are a potential source of infection. The present study documented the role of various disinfectants. Vinegar can be used as an effective disinfectant medium for extracting human teeth. Sterilisation and autoclaving are superior options while vinegar is cheap, readily available, and relatively non-toxic. All these qualities plus the fact that it has given encouraging results as an antibacterial disinfectant should necessitate its usage on a more regular basis than it is used at present. [ABSTRACT FROM AUTHOR]

This investigation examined two propolis samples from the Garhwal region of Uttarakhand. The various hues of the propolis samples were a result of their distinct botanical origins and geographic locations. The results of physicochemical analysis (moisture, soluble and insoluble solids content, pH, conductivity, ash content, wax, total phenolic content, flavonoids content, protein, DPPH and reducing power) used to classify the sample according to its botanical/geographic origin. The physicochemical properties of propolis from an Apis mellifera L. hive in Pantnagar were as follows: average moisture content (8.51±0.04%), average insoluble substance (42.06±0.35%), soluble substance (56.36±0.12%), pH (4.18± 0.021), EC (1.67±0.003 ms/cm), ash percentage (1.82 ±0.005%), amount of wax (6±0.17 %)), total phenol content (19.02±0.58 mg/ml), flavonoid content (65.23±0.42 mg/ml) and protein content (1.12±0.002 mg/g) were detected especially in the Pantnagar propolis sample indicating that it holds good antioxidant properties in comparison to Pauri district sample. It appears that total phenolic and flavonoid compositions have a significant impact on the antioxidant activity of propolis extracts. There was a strong correlation between phenolics, flavonoids, DPPH, protein and reducing power, suggesting that in addition to the total phenolic content, flavonoid and protein concentrations are excellent indicators of the antioxidant potential of propolis. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, and transgender (LGBT) individuals have a high prevalence of substance use disorders (SUDs) and experience unique barriers to treatment. Little is known about the characteristics of SUD treatment facilities providing LGBT-tailored programs at the outpatient and residential levels of care. The purpose of this study is to examine the availability of LGBT-tailored programs in outpatient and residential SUD treatment facilities. Using the National Survey of Substance Abuse Treatment Services 2020, we conducted logistic regression to examine facility characteristics, including ownership, pay assistance, region, outreach, and telehealth services, associated with having an LGBT-tailored program among SUD treatment facilities. Outpatient facilities that were for-profit, had pay assistance, had community outreach services, and provided telemedicine/telehealth were more likely to have an LGBT-tailored program. Those that were government-owned, in the Midwest, and that accepted Medicaid were less likely to have an LGBT-tailored program. Residential facilities that were in the West, for-profit, and had community outreach services were more likely to have an LGBT-tailored program. This study offers a national examination of the availability of LGBT-tailored programs in SUD treatment facilities. Differences in availability based on ownership, region, pay assistance, and outreach highlight potential gaps in treatment availability. [ABSTRACT FROM AUTHOR]

Cyclical mastalgia of moderate to severe degree requires systemic drug therapy. Tamoxifen is the drug of choice worldwide. A novel molecule, centchroman/Ormeloxifene, developed in India, was found to be equally effective in previous studies. However, its optimal dose regimen is uncertain. We conducted three-arm randomized controlled trial to compare the effectiveness in relieving breast pain. Group 1 received tamoxifen 10 mg daily, and groups 2 and 3 received centchroman 30 mg twice and 30 mg thrice a week, respectively, for 3 months with a follow-up of 3 more months. Breast pain score, nodularity score, sonographic evaluation of the breasts and ovaries, quality of life scores, and adverse events were recorded. The number of patients enrolled was 32, 31, and 30 in group 1, group 2, and group 3, respectively. All three groups had significant improvement in breast pain scores [group 1 (5 → 2), group 2 (5 → 2), group 3 (6 → 2), p < 0.001)], nodularity scores [group1 (1 → 0), group 2 (1 → 0), group 3 (1 → 0), p < 0.001)] and in the quality of life scores over time. However, no significant differences were observed in-between the groups. Transient ovarian cyst formation and menstrual irregularities were more common with a higher dose of centchroman. Centchroman in the dosages of 30 mg twice or thrice a week is as effective as a daily dose of tamoxifen 10 mg in relieving pain, nodularity, and improving quality of life scores. The dose of centchroman 30 mg twice a week for 12 weeks has the least adverse effects and should be accepted as the optimal dosage regimen. There is a need of further study with a greater number of participants and longer follow-up. Trial registration number: CTRI/2018/02/012043 (Registered on: 21/02/2018). [ABSTRACT FROM AUTHOR]

In this study, we have carried out a comparative analysis of a fixed bed reactor (FBR) and reverse flow chromatographic reactor (RFCR) for a series reaction. This comparison has been carried out using mathematical model based single and multi-objective optimization. In addition, since the model merely approximates the actual process, there is an inherent presence of uncertainty in it. To account for the uncertainty, optimization is done considering the uncertainty in the key model parameters. Three objective functions are used in this work for the comparative study, namely yield, selectivity, and conversion. The decision variables used in the optimization problem are the inlet concentration, Damkohler number, and dimensionless switching time. The multi-objective optimization results have been analysed in terms of optimal Pareto fronts for three bi-objective and one tri-objective optimization problems. A detailed analysis of the Pareto fronts for both the reactors is presented for five distinct representative Pareto points. The results of the work indicated the superiority of RFCR over FBR. In particular, a representative Pareto point solution of 3-objective problem in RFCR corresponds to 51.36% higher yield, 27.06% higher selectivity and 19.15% higher conversion as compared to FBR. [Display omitted] • Multi-objective optimization study of reverse flow chromatographic reactor and fixed bed reactor. • Process criteria for the multi-objective study include the maximization of yield, selectivity, and conversion. • Optimization variables include switching time, Damkohler number and inlet concentration. • RFCR shows 51.39%, 27.06%, and 19.15% improvement in yield, selectivity, and conversion, respectively as compared to FBR. [ABSTRACT FROM AUTHOR]

Determine the temporal and spatial characteristics of stairs versus elevator use in a university residence hall to inform future physical activity promotion efforts. All residents and visitors for a single, four-story residence hall dormitory building located on a college campus in Orange, CA. Smart mat systems capable of detecting pedestrian traffic were placed in front of the stairs and elevators on each floor plus a basement. Generalized additive mixed models (GAMMs) were used to compare stair versus elevator usage at different times of the day and on different floors. Stair versus elevator use varied much more throughout the day on floors nearest to the ground floor, with stair use most common in the morning. Overall, the elevator was used more frequently on higher floors, with less variation throughout the day. To be most effective, future stair promotion interventions should target residents on higher floors and in the morning. [ABSTRACT FROM AUTHOR]

Background: Alcohol dependence is a wide and extending social and physical problem in the world. It affects a person at the individual, family, and society levels. The aim is to study and compare the influence of motivational enhancement therapy (MET) and behavioral couple therapy on the level of motivation in a person with alcohol dependence. Methodology: Pre- and post-test with control group design was used. A total number of 60 subjects were selected using a purposive sampling method. The sample comprised twenty subjects in the behavioral couple therapy treatment as usual (Behavioral couple therapy BCT + TAU) group, twenty subjects in the control (TAU) group, and twenty subjects in the (MET + TAU) group, respectively. The subjects recruited were in the age range of 21-60 years, educated up to primary level and above, with no comorbid psychiatric, neurological disorder, physical problem, multiple substance use coming to outpatient department and inpatient department Department of Psychiatry IMS, BHU, Varanasi, and wife having age above 18 years, married for at least 1 year, educated up to primary level and above. Tools: sociodemographic datasheets, alcohol use disorder identification test, general health questionnaire-12, and stages of change readiness and treatment eagerness scale were utilized. Results: Psychotherapeutic intervention such as MET and behavioral couple therapy plays an effective role in raising motivation to change in alcohol-dependent person to quit alcohol, which is indicated by the significant rise in motivation for the change of alcohol-dependent person's recognition (F = 4.42, P < 0.05) and taking steps (F==3.78, P < 0.05). Conclusion: The present study suggests that combining pharmacological treatment with appropriate psychosocial therapies give fruitful result in the form of a desire to quit alcohol dependence. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) is also called Osteoarthrosis or degenerative joint diseases; it represents a vital cause of dejection and defects. With the help of Muscle Energy Technique (MET) claimed to be effective for improvement in flexibility and strength along with cellular nutrition and conservative treatment in knee Joint. Methods: According to the inclusion and exclusion criteria; 60 unilateral participation OA knee patients were randomly placed into two groups, pre and post-test calculation of KOOS scale and knee extension and flexion were done. Group A had MET with conservative treatment along with cellular nutrition. Conclusion: Both Group A and B improves the strength and flexibility of knee joint but in Group A was shown more improvement than Group B. [ABSTRACT FROM AUTHOR]

Background: The Stanford Youth Diabetes Coaching Program (SYDCP) is an evidence-based program led by health care professionals to teach healthy youth who then coach family members with diabetes or other chronic conditions. This purpose of this study is to evaluate a Community Health Worker (CHW)-led implementation of the SYDCP for low-income Latinx students from underserved agricultural communities. Method: CHWs were trained and virtually led 10 training sessions virtually during the COVID-19 for Latinx students who were recruited from high schools in agricultural regions of Washington state. Feasibility measures include recruitment, retention, class attendance, and successful coaching of a family member or friend. Acceptability was measured by responses on the post-training survey. Effectiveness was evaluated by pre-post changes in measures used in prior studies of the SYDCP such as level of activation and diabetes knowledge. Results: Thirty-four students were recruited, 28 completed the training and 23 returned both pre- and post-surveys. Over 80% of students attended 7 or more classes. All met with a family or friend and 74% met with them weekly. Approximately 80% of the students rated the program's usefulness as "very good" or "excellent." Pre-post increases in diabetes knowledge, nutrition-related behaviors, resilience, and activation were significant and similar to those observed in prior published studies of the SYDCP. Conclusions: Findings support the feasibility, acceptability, and effectiveness of a CHW-led implementation of the SYDCP in underserved Latinx communities using a virtual remote model. [ABSTRACT FROM AUTHOR]

This investigation purports to study if gratitude interventions lead to an increase in overall wellbeing among Indian youth during the coronavirus lockdown. Second, to examine if a cumulative effect of two gratitude interventions on wellbeing is greater than a single gratitude intervention. Participants (N = 80) were randomly allocated to the experimental and control groups (n = 40 each). It was found that after administering a single gratitude intervention there was a significant increase in mental health, happiness, and gratitude and a decrease in depression, anxiety, and stress in the experimental group. Moreover, after administering two gratitude interventions together, a greater increase was seen in these variables as compared to the administration of a single gratitude intervention. There was no significant change in the control group in both cases. In summary, online gratitude interventions lead to increase in happiness and mental health and decrease in depression, anxiety, and stress even during crises such as the coronavirus pandemic. Moreover, the cumulative effect of two gratitude interventions is more than a single gratitude intervention. It is suggested that these gratitude interventions should be included in providing mental health care even when clients are not able to meet counselors in physical settings. [ABSTRACT FROM AUTHOR]

In the modern era of dentistry, role modeling/roleplaying is one of the most prevalent and recommended methods of dental education. Working on video production projects and using student-centred learning also help students create feelings of ownership and self-esteem. This study aimed to compare students' perceptions of roleplay videos among genders, different disciplines of dentistry, and different levels of dental students. This study included 180 third- and fourth-year dental students registered in courses such as 'Introduction to Dental Practice' and 'Surgical management of oral and maxillofacial diseases', respectively, at the College of Dentistry at Jouf University. Four groups of recruited participants were pre-tested using a questionnaire about their clinical and communication skills. The students were tested again using the same questionnaire at the end of the workshop to evaluate improvements in their skills. The students were then assigned to create roleplay videos with respect to demonstrated skills related to all three disciplines (Periodontics, Oral Surgery, and Oral Radiology) in a week's time. Students' perceptions of the roleplay video assignments were collected through a questionnaire survey. The Kruskal–Wallis test was used to compare responses for each section of the questionnaire (p < 0.05). Improvements in problem-solving and project management skills during video production were reported by 90% of the participants. No significant difference (p > 0.05) in the mean scores of the responses was found with respect to the type of discipline involved in the process. There was a significant difference in the mean scores of the responses between male and female students (p < 0.05). The fourth year participants demonstrated increased mean scores and significantly higher (p < 0.05) mean scores than third-year participants. Students' perceptions of roleplay videos differed by gender and the level of the students, but not by the type of discipline. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is more prevalent in middle- and higher-income groups and is spreading at an alarming rate. Drug therapy is compulsory because of the chronic and progressive nature of the disease. With such multifactorial background of high prevalence, progressive nature of the disease leading to various complications, increased healthcare cost, and availability of multiple therapeutic regimens prescribed, this study has been done to evaluate the cost-effective analysis of oral hypoglycemic agents. Materials and Methods: This is a prospective, parallel group, and comparative observational study conducted by the Department of Pharmacology in collaboration with the Department of Endocrinology at Kalinga Institute of Medical Sciences, Bhubaneswar. The duration of the study was of 2 years. A total number of 220 patients were selected and based on body mass index, patients were categorized into preobese (new and old diabetic patients) and obese (new and old diabetic patients) categories. In this study, cost-effectiveness analysis (CEA) was done to evaluate the cost differences between two or more medication groups, with a similar clinical effect. Results of CEA are expressed as an average cost-effectiveness ratio or as an incremental cost-effectiveness ratio. Results: From this study, it is observed that in terms of benefit, dual therapy of Metformin and Dapagliflozin was most efficacious followed by Metformin and Sitagliptin as well as Metformin and Glimepiride combinations. If cost is considered, Metformin montherapy and metformin and Glimepiride dual therapy was most cost-effective. In triple regimen, MET+VOG+GLIM combination was seen to be more cost effective than gliptin combination, both in terms of control of FBS as well as PPBS. The cost of treatment goes parallel with duration of disease, being higher in the old cases of long-standing duration. Conclusion: The present study shows that SGLT2 inhibitors are better class of oral hypoglycemics in terms of longterm benefits and this group is prescribed as dual therapy more frequently but cost of therapy is the greatest barrier. Metformin and Sulfonylureas remain the most beneficial combination, both in terms of efficacy and cost. The cost of treatment was varying, depending on the duration of disease, being higher in old cases and lower in new cases. [ABSTRACT FROM AUTHOR]

Background: Transgender women in India face unique stressors associated with minority experiences, such as experiences of gender transition and participation in sex work. However, the relationship between sex work, transition and mental health outcomes is understudied in this population. Aims: This article aims to examine the association between gender transition status, sex work, family rejection and depressive symptoms among transgender women in India. Methods: Data comes from a cross-sectional epidemiological study with transgender women from three states of India; Karnataka, Maharashtra and Tamil Nadu (N = 1366). Multivariate regressions were used to examine the association between sex work status and gender transition and how gender transition, and sex work are associated with depressive symptoms. Results: 70% of the sample reported being in sex work and over 82% endorsed taking some form of gender transition service. Those who reported being in sex work were significantly more likely to have undergone breast augmentation, hormonal therapy and gender affirming surgery. Those who reported ever being married were less likely to report gender affirming surgery and were more likely to report hormonal therapy. Additionally, being in sex work, undergoing transition, leaving home because of sexual orientation, and being married were significantly associated with depressive symptoms. Discussion: Community-led organizations and other service agencies must incorporate intersectional experiences and identities, including sex work and gender transition, in their programs to further social and health justice for transgender women in India. Policy and programmatic implications are discussed. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1939220 [ABSTRACT FROM AUTHOR]

Background and Aims: The success of labour analgesia is significantly influenced by the patient's position during the insertion of the epidural catheter. In this study, we contrasted how simple it was to implant the epidural catheter in the crossed-legged sitting position (CLP) against the traditional sitting position (TSP) (CLSP). The main goal was to compare how many of the groups' initial epidural placement attempts were successful. The patient's comfort, the simplicity of landmark palpation, and the quantity of needle-to-bone contacts were secondary goals. Methods: 50 parturients with uncomplicated pregnancies participated in the prospective, non-blinded, randomised control study while in active labour. Using the closed envelope technique, patients were divided into two groups at random using a computer-generated random sequence of integers. While group CLSP received an epidural while sitting with their legs crossed and their knees and hips flexed, group TSP received an epidural while doing the same. Results: The distribution of age, height, weight, and parity among the parturient in the two groups was comparable. The VAS values at 15 minutes and the baseline VAS were comparable between groups. In comparison to the TSP group, the CLSP group had a larger percentage of parturients who had successful epidural placement on the first try (88% versus 44%, P = 0.004). Both groups experienced similar levels of comfort during positioning and landmark, needle, and bone contact. Conclusion: The typical sitting position is preferable than the cross-legged position for labour epidural catheter implantation. [ABSTRACT FROM AUTHOR]

Background and Purpose: There is an unmet need for a more effective thrombolytic agent in acute ischemic stroke (AIS) management. Various studies and meta-analysis suggest tenecteplase (TNK) as non-inferior over alteplase (rTPA). The present single-center study compares biosimilar TNK and rTPA in a tertiary care setting. Methods: Data of patients who presented with AIS and underwent intravenous thrombolysis (FVT) were recruited retrospectively from January 2018 to July 2021. Primary efficacy outcome was a modified Rankin score (mRS) at 90 days dichotomized at < = 2. Qualitative and quantitative variables were assessed using Chi-square test and Student's t-test, respectively. Results: A total of 160 patients, 103 in the rTPA and 57 in TNK group, were analyzed. The baseline characteristics were well matched apart from hypertension. Large artery atherosclerosis was the most frequent subtype of stroke among the two groups. Good functional outcome was seen in 47.92% of patients TNK and 64.77% of patients in rTPA group (p = 0.069). No difference was seen in the rates of any ICH (p = 0.29) and mortality at 3 months (p = 0.32) among the two groups. Conclusion: This present study observed no difference in the efficacy and safety between biosimilar TNK and rTPA. Our findings are in concordance with published trials showing equivalence between the two molecules. [ABSTRACT FROM AUTHOR]

The proportion of older adults are increasing at a much higher rate than ever expected in both developing and developed countries, and India is no exception. High health care expenditure is attributed to deteriorating health condition among older adult following disability in later life stages and also due to the presence of chronic diseases, and multi-morbidity among them as life expectancy has substantially increased in last few decades. Data for the analysis was used from the National Sample Survey Organization conducted during the 71st (2014) and 75th round (2017-18). Descriptive statistics, bivariate analysis, and linear regression were used for the study. It was found that mean OOPE for older adults was high if the household head was an older adult in case of both men and women. Older adults from higher socio-economic status incurred high OOPE. Moreover, older adults who were financially independent incurred high OOPE compared to those who were partially or fully economically dependent. More interestingly, financially independent women incur higher OOPE than financially independent men. In most states, it was observed that mean OOPE was high for men compared to women, which depicts clear gender differentials. The findings of this study are significant and provide new information on discrepancies between older men and women in health-care spending. Older men were found to have slightly higher health care costs relative to women in this nationally representative survey, after adjusting for confounding factors. [ABSTRACT FROM AUTHOR]

A three-dimensional (3D) plane wave incident at a functionally graded triclinic medium (FGTM) under two different types of boundary (viz. stress free (Case I) and rigid (Case II)) has been modelled. The constitutive equations of the functionally graded triclinic medium are used to deduce the Christoffel matrix of order 3. By using Cardano's method, we derive the expressions for the phase velocities of the reflected waves (qP, qSV and qSH waves). The expressions of the reflection coefficients (amplitude ratios) are obtained for the present geometry with the help of the generalized Snell's law and Cramer's rule. The obtained mathematical expressions are perfectly matched with pre-established results. Further, the slowness surface and energy ratios have been also completed to prove the correctness of the presented problem. The effect of anisotropy and functionally graded parameter on the reflection coefficients has been traced out remarkably through a comparative study by numerical modelling. The comparative analysis reveals that the functionally graded parameter and anisotropy have significant impact on the amplitude ratios and both these attributes contribute simultaneously to simulate a realistic elastodynamic model and predict the response of the medium (geo-medium) with better accuracy. [ABSTRACT FROM AUTHOR]

In this paper, a detailed qualitative & quantitative comparative analysis of measurement based centralized voltage stability monitoring approaches using Thevenin equivalent is presented. These methods typically utilize the state estimation output, making them easily implementable at the control centers. The metrics for comparison are defined in terms of computation resources required, accuracy of identifying the critical loading point, critical contingency screening, and robustness to noise. These performance metrics are relevant for practical implementation and are presented on the IEEE 300 bus system and the MATPOWER 2383-bus system. To the best of our knowledge, this is the first systematic qualitative & quantitative comparison between various measurement based voltage stability methods using these performance metrics. The results will guide the utilities and operators about possible trade-offs between the various methods for large systems, enabling them to make an informed decision on the specific method to use for their needs. [ABSTRACT FROM AUTHOR]