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Diffuse low-grade gliomas (LGG) are tumours of the glial tissue, which are generally slow-growing, but have the potential to undergo anaplastic progression into more aggressive tumours. Diffuse low-grade gliomas (LGG) represent a heterogeneous group of primary brain tumour arising from supporting glial cells. The role of surgery in the management of human low- gliomas has been controversial. The current adjuvant therapies have facilitated treatment of patients, and have rendered neurosurgical removal without morbidity or mortality more commonplace than ever before. Here, we investigated the role of neurosurgery in the management of adults with low-grade gliomas. The management of low- grade glioma is one of the most controversial areas in clinical neuro-oncology. The concept of management of low-grade gliomas is not unitary but much more a composite of different challenges depending on the clinical presentation, signs, neuroradiology, perspectives of neurologists, the opinion of the neurosurgeon, and perhaps most importantly, the aspirations of the patient. It is true therefore that in many patients there will be a dilemma about what is considered optimal management since there is no good evidence base to underpin any single management. Even though there is substantial evidence which claims that surgery have a role to play in extending patient survival.

Existing parenteral SARS-CoV-2 vaccines produce only limited mucosal responses, which are essential for reducing transmission and achieving sterilizing immunity. Appropriately designed mucosal boosters could overcome the shortcomings of parenteral vaccines and enhance pre- existing systemic immunity. Here we present a new protein subunit nanovaccine using multiadjuvanted (e.g. RIG-I: PUUC, TLR9: CpG) polysaccharide-amino acid-lipid nanoparticles (PAL-NPs) that can be delivered both intramuscularly (IM) and intranasally (IN) to generate balanced mucosal-systemic SARS-CoV-2 immunity. Mice receiving IM-Prime PUUC+CpG PAL- NPs, followed by an IN-Boost, developed high levels of IgA, IgG, and cellular immunity in the lung, and showed robust systemic humoral immunity. Interestingly, as a purely intranasal vaccine (IN-Prime/IN-Boost), PUUC+CpG PAL-NPs induced stronger lung-specific T cell immunity than IM-Prime/IN-Boost, and a comparable IgA and neutralizing antibodies, although with a lower systemic antibody response, indicating that a fully mucosal delivery route for SARS-CoV-2 vaccination may also be feasible. Our data suggest that PUUC+CpG PAL-NP subunit vaccine is a promising candidate for generating SARS-CoV-2 specific mucosal immunity.

Background and Aims Hepatic Encephalopathy (HE) leads to multiple hospitalizations in liver cirrhosis. This imposes a significant burden on patients caregivers, and the healthcare system. Rifaximin reduces HE recurrence and hospitalizations, but many patients are not able to receive Rifaximin promptly after hospitalizations due to gaps in the prior authorization process and insurance coverage. This study shows the results of the Quality Improvement (QI) project aimed at improving access to Rifaximin by utilization of hospital pharmacy to provide Rifaximin at bedside or soon after hospital discharge with HE. Methods A retrospective analysis of 124 patients admitted to our hospital with recurrent HE was performed. All selected patients had Rifaximin prescribed for the first time during a hospitalization (index hospitalization). Both 30-day and 60-day liver-related hospitalizations were recorded for these patients. 80 patients were included in the intervention group when the hospital pharmacy was notified of the Rifaximin prescription prior to discharge as part of a QI project (Group A). Control (Group-B) group included 44 patients who had admission and were prescribed Rifaximin at discharge, prior to initiation of our QI project. Results The number of patients who had a re-admission after index hospitalization with HE was lower in Group A compared to Group B (48% vs 73%, p=0.002 for re-admission within 30 days; 56% vs 73%, p=0.007 for re-admission within 60 days respectively). Total hospitalizations decreased in Group A (reduced by 32%, and 59% for the 30-day and 60-day time frame, respectively) compared to Group B. The median days to readmission in Group A was 32, compared to 10 in Group B after the index hospitalization. Conclusion Providing Rifaximin to patients with recurrent HE before or soon after discharge from HE-related hospitalization reduced readmission rates for liver-related admissions at our hospital. A significantly higher number of patients did not require early readmission when Rifaximin was provided by the hospital pharmacy. This intervention could lead to lower costs, fewer complications related to frequent hospitalization, and thus reduced healthcare burden.

This work proposes a method utilizing only the submentalis EMG channel for the classification of sleep and wake states among the healthy individuals and patients with various sleep disorders such as sleep apnea hypopnea syndrome, dyssomnia, etc. We extracted autoregressive model parameters, discrete wavelet transform coefficients, Hjorth's complexity and mobility, relative bandpowers, Poincaré plot descriptors and statistical features from the EMG signal. We also used the energy of each epoch as a feature to distinguish between the sleep and wake states. Mutual information based feature selection approach was considered to obtain the top 25 features which provided maximum accuracy. For classification, we employed an ensemble of decision trees with random undersampling and boosting technique to deal with the class-imbalance problem in the sleep data. We achieved an overall accuracy of about 85% for the healthy population and about 70% on an average across different pathological groups. This work shows the potential of EMG chin activity for sleep analysis. Clinical Relevance- Automatic and reliable sleep-wake classification can reduce the burden of sleep experts in analyzing overnight sleep data (~ 8 hours) and also assist them to diagnose various neurological disorders at an early stage. Utilizing EMG channel provides an easier and convenient long-term recording of data without causing much disturbance in sleepunlike EEG which is inconvenient and hampers the natural sleep.

Using a single EOG channel, sleep-wake states of patients with different sleep disorders are accurately classified. We used polysomnography data of 27 patients (mixed apnea, periodic limb movement syndrome, sleep apnea-hypopnea syndrome, and dyssomnia) from DRMS-PAT and 20 healthy subjects from DRMS-SUB databases. We extracted a 67-dimensional feature vector, involving statistical features derived from ensemble empirical mode decomposition, approximate entropy, and relative powers in different frequency bands. Of these, the most relevant features are selected by exploiting mutual information between the features and corresponding labels. RUSBoost classifier is deployed to take care of the unbalanced data distribution. We achieved a high sensitivity of 97.5% and 95.3% as well as high specificity of 96.4% and 93.3% for sleep state in healthy and patients' groups, respectively. Ten-fold crossvalidation accuracies of 91.6% and 95% are achieved for patients and healthy individuals, respectively, using a single EOG channel. Clinical relevance-Accurate detection of sleep-wake states is crucial for the diagnosis of various sleep disorders including apnea-hypopnea syndrome and insomnia. Automated sleep-wake classification using EOG facilitates easy and convenient long-term sleep monitoring of patients without disturbing their sleep, thereby assisting the clinicians to analyze their sleeping patterns.

We examine the effect of testing and social distancing measures on the severity of COVID19 across Indian states during the 68th day nationwide lockdown period. We also explore whether pre-existing socio-economic factors such as quality of health care and the ability to practice social distancing influences the effect of these policy measures across states. Using daily level data between April 1 and May 31 for 18 of the major states, we find that both testing and social distancing have a negative effect on COVID-19 fatalities in India. Further, testing is more helpful in reducing CFR for states with lower per capita health expenditure and weaker medical infrastructure. This highlights how ramping up testing can aid states that have a weak health care system through the detection of infection, contact tracing and isolation. In contrast, social distancing measures are more effective in states that are less populous and have lesser people dwelling in single-room houses. Our results confirm the role of pre-existing institutional factors in shaping the effect of policy actions on health outcomes.

This article estimates the impact of a maternity cash transfer programme, Indira Gandhi Matritva Sahyog Yojana, implemented in India since 2011, on fertility choices. Since the scheme restricts the benefits to the first two births, we ask whether there is an impact on the likelihood of birth post implementation and if this behaviour is driven by son preference. We also test whether the scheme has affected the likelihood of female births. Our results give evidence in support of ‘stopping rule’ and we find that treated households reduce births only when their first two births are sons. However, we do not find any statistically significant impact of the likelihood of a female birth. We further find that post the implementation of the scheme, mothers and children are less likely to get better care for higher order births. JEL Codes: J13, J18

Despite recent success in vaccinating populations against SARS-CoV-2, concerns about immunity duration, continued efficacy against emerging variants, protection from infection and transmission, and worldwide vaccine availability, remain. Although mRNA, pDNA, and viral-vector based vaccines are being administered, no protein subunit-based SARS-CoV-2 vaccine is approved. Molecular adjuvants targeting pathogen-recognition receptors (PRRs) on antigen-presenting cells (APCs) could improve and broaden the efficacy and durability of vaccine responses. Native SARS-CoV-2 infection stimulate various PRRs, including toll-like receptors (TLRs) and retinoic-acid-inducible gene I-like receptors (RIG-I). We hypothesized that targeting the same PRRs using adjuvants on nanoparticles along with a stabilized spike (S) protein antigen could provide broad and efficient immune responses. Formulations targeting TLR4 (MPLA), TLR7/8 (R848), TLR9 (CpG), and RIG-I (PUUC) delivered on degradable polymer-nanoparticles (NPs) were combined with the S1 subunit of S protein and assessed in vitro with isogeneic mixed lymphocyte reactions (iso-MLRs). For in vivo studies, the adjuvanted nanoparticles were combined with stabilized S protein and assessed using intranasal and intramuscular prime-boost vaccination models in mice. Combination NP-adjuvants targeting both TLR and RIG-I (MPLA+PUUC, CpG+PUUC, or R848+PUUC) differentially increased proinflammatory cytokine secretion (IL-1β, IL-12p70, IL-27, IFN-β) by APCs cultured in vitro, and induced differential T cell proliferation. When delivered intranasally, MPLA+PUUC NPs enhanced local CD4+CD44+ activated memory T cell responses while MPLA NPs increased anti-S-protein-specific IgG and IgA in the lung. Following intramuscular delivery, PUUC-carrying NPs induced strong humoral immune responses, characterized by increases in anti-S-protein IgG and neutralizing antibody titers and germinal center B cell populations (GL7+ and BCL6+ B cells). MPLA+PUUC NPs further boosted S-protein-neutralizing antibody titers and T follicular helper cell populations in draining lymph nodes. These results suggest that SARS-CoV-2-mimicking adjuvants and subunit vaccines could lead to robust and unique route-specific adaptive immune responses and may provide additional tools against the pandemic.GRAPHICAL ABSTRACT