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Introduction/Objective: PEG-Asparaginase (PEG-ASNase) is critical in treating pediatric acute lymphoblastic leukemia (ALL). However, hypersensitivity reactions and inactivations associated with ASNase are major patient challenges. The detection of single nucleotide polymorphisms (SNPs), which recognize, in advance, patients who will develop hypersensitivity to ASNase, would help to optimize treatment. To describe pharmacogenetic variations influencing hypersensitivity to PEG-ASNase and their correlation with our patient population. Material and methods: We conducted a prospective multicenter study involving ALL patients under 18 years old receiving PEG-ASNase. Genotyping was carried out for 6 SNPs, which are more frequently related to hypersensitivity in other populations, including GRIA1 rs4958351, NFACT2 rs6021191, MYBBP1A rs3809849, CNOT3 rs73062673, GR1A1 rs6890057 and HLA-DQB1 rs1694129. The tests were performed using custom TaqMan® SNP genotyping assays. Results: A total of 305 patients were included, with 10.8% experiencing clinical allergic reactions and (14.1%) patients with inactivation (ASNase activity < 0.1 IU/mL). Genotypic distribution and Hardy-Weinberg equilibrium (HWE) for studied SNPs were as follows: GRIA1 rs4958351 (GG 59.1%, GA 32.6%, AA 8.3%, HWE = 0.06); NFACT2 rs6021191 (AA 89.8%, AT 9.8%, TT 4%, HWE = 0.74); MYBBP1A rs3809849 (GG 60.7%, GC 35.3%, CC 4%, HWE = 0.55); CNOT3 rs73062673 (TT 69.8%, TC 26.4%, CC 3.7%, HWE = 0.34); GR1A1 rs6890057 (CC 70.6%, CT 25.5%, TT 3.9%, HWE = 0.22); HLA-DQB1 rs1694129 (GG 83%, GT 16.5%, TT 4%, HWE = 0.55). No correlation was found between clinical allergic reactions and inactivation with SNPs (p > 0.01). Discussion: Our analysis characterized the pharmacogenetic polymorphisms in our population, reflecting diversity similar to the general population. Despite the lack of correlation between the studied SNPs and allergic reactions observed in our sample, we encourage further exploration to identify additional SNPs associated with hypersensitivity. Conclusion: These findings lay the groundwork for future research to uncover new genetic predictors of hypersensitivity, which could contribute to the development of personalized treatment approaches and the prevention of allergic reactions.

Introduction: PEG asparaginase (PEG-ASNase) is an essential drug in the treatment of acute lymphoblastic leukemia (ALL). However, asparaginase-related hypersensitivity and silent inactivation continue to represent clinical challenges. Objective: Describe the incidence of hypersensitivity reactions and inactivations associated with PEG-ASNase in Brazilian children undergoing first-line treatment for ALL. Material and methods: Prospective, multicenter and randomized trial. Patients younger than 18 years with ALL who received PEG-ASNase between February 2021 and February 2024 in eigth differents hospitals were included. ASNase activity was monitored in all patients 7 days and 14 days after each PEG-ASNase. Results: 305 patients were included. 33 (10.8%) patients had clinical allergic reactions and 43 (14.1%) patients had inactivation (asparaginase activity < 0.1 IU/mL). Among those who had allergic reactions, 45.5% also inactivated the drug. There was a significant association between clinical allergic reaction and inactivation (p < 0.001). However, among those who inactivated, 65% did not have an allergic reaction. The silent inactivation rate was 9.2% (n = 28). Conclusions: Our findings are consistent with the literature, underscoring the importance of therapeutic monitoring of asparaginase for all patients. We aim to further contribute to the treatment of children with ALL by investigating the influence of pre-medication on inactivation and hypersensitivity reactions.

Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12–18 months of a child’s life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia.

This study aims to address the problem of porosity preservation in the Mangahewa Formation of five main hydrocarbon fields covering onshore and offshore of the Taranaki Basin. An integrated reservoir characterization of the Middle to Late Eocene Mangahewa Formation is achieved through petrophysical evaluation, sedimentological and petrographical descriptions, and well log analysis methods. Petrophysical parameters (porosity and permeability) were acquired from the available core analysis and using mathematical equations to obtain other petrophysical matrices such as normalized porosity index (NPI) and reservoir quality index (RQI). Factors that affected Mangahewa reservoir were studied through thin-section microscopy and well-log analysis helped to measure the reservoir and hydrocarbon potentiality in the Mangahewa Formation. The Mangahewa Formation is dominated by sandstone and a range of marginal to shallow marine facies with varying hydraulic flow units (HFU). The Mangahewa Formation has a high positive correlation in porosity-permeability relationship and has a maximum of 4.67 μm RQI and 20.08 μm FZI (Well Kapuni-14) which reflect potential reservoir. The Mangahewa Formation observed from Wells Kapuni-14, Maui-A1G, McKee-16A, and Mokau-1 are dominated with 59.6%, 56.4%, 79.3%, and 68% of macro- and megapores, respectively. The presence of authigenic clay and calcite cement has greatly reduced the reservoir quality; however, primary and secondary pores are still observed within the Mangahewa sands. Moreover, well log analysis was carried out on four wells in Taranaki Basin, to run a qualitative and quantitative analysis of the Mangahewa reservoir. Eight potential reservoir zones were examined, revealing that the Mangahewa Formation has a very low shale volume of less than 6%, good effective porosity ranging between 11.0% and 13.3%, up to 36.2% of average water saturation and maximum of 69.8% average hydrocarbon saturation. In conclusion, from this comprehensive study, it can be deduced that the Mangahewa Formation possesses fair to good reservoir quality and hydrocarbon potentiality.

Introduction: Serum cystatin C has been proposed as a sensitive marker for detecting renal impairment. Renal impairment can often co-exist with liver cirrhosis, as decreased blood flow through the cirrhotic liver can lead to kidney dysfunction. However, its role in patients with liver cirrhosis has not been extensively studied, especially in the detection of early renal impairment. Aim: To investigate whether serum cystatin C could serve as a potential marker for detecting early renal dysfunction in patients with liver cirrhosis. Materials and Methods: This hospital-based cross-sectional study was conducted on 60 patients with liver cirrhosis at Assam Medical College and Hospital, Dibrugarh, Assam, India, from June 2019 to May 2020. All patients were assessed for clinical symptoms and laboratory parameters, focusing on renal function tests, measurement of serum cystatin C levels, and Glomerular Filtration Rate (GFR). A two-tailed p-value

The Mangahewa Formation is the primary reservoir target in the Mangahewa Field in the Taranaki Basin, New Zealand. This formation is distinguished by its marginal marine substantial tight-sand reservoir, having thickness exceeding 800 m. The aim of this study is to assess the reservoir properties of the Mangahewa Formation through 3D reservoir modeling, employing 3D seismic data, core data, and well data from the Mangahewa Field. Utilizing variance attributes, the faults and horizons have been identified successfully within the field. The majority of the interpreted faults exhibit dip angles exceeding 60°, with a maximum displacement of 118 m. To detect direct hydrocarbon indicators, root-mean-square amplitude seismic attribute, envelope, and generalized spectral decomposition techniques have been employed. Subsequently, four lithofacies, comprising 78.3% sandstone, 9.2% siltstone, 9.5% claystone, and 3.0% coal have been established by utilizing the Sequential Indicator Simulation (SIS) algorithm to create a lithofacies model. A property model has been generated using the Sequential Gaussian Simulation (SGS) algorithm. Petrophysical evaluation indicates that the Mangahewa Formation exhibits reservoir qualities ranging from fair to good, with porosity levels between 8% and 11%, permeability averaging up to 10 mD, variable shale volumes, and hydrocarbon saturation in the range of 40%–50%. This study's methodologies and findings can serve as a valuable foundation for similar investigations in other tight-sand gas fields located in different regions.

Latar belakang. Leukemia merupakan keganasan yang sering terjadi pada anak dan kemoterapi merupakan terapi kuratif penting pada pasien leukemia limfablastik akut. Penggunaan kemoterapi pada awal diagnosis dapat memicu terbentuknya radikal bebas yang mengganggu homeostasis sel. Malondialdehid merupakan produk sekunder dari peroksida lipid yang dihasilkan oleh reaksi radikal bebas lemak tak jenuh dalam membran sel dan dapat digunakan sebagai penanda stress oksidatif. Protokol kemoterapi sebelumnya tidak konsisten. Protokol kemoterapi di Indonesia saat ini menggunakan protokol LLA 2018 yang berbeda dari protokol sebelumnya. Tujuan. Penelitian ini bertujuan mengetahui perbedaan kadar malondialdehid sebelum dan sesudah kemoterapi fase induksi pada anak dengan limfoblastik leukemia akut. Metode. Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian anak berusia >1 bulan hingga 18 tahun dengan LLA yang mendapat pengobatan di Rumah Sakit Umum Pusat Prof. dr. IGN Gde Ngoerah dari bulan Juli 2021 hingga September 2022. Uji Wilcoxon digunakan untuk menilai perbedaan kadar malondialdehid sebelum dan sesudah kemoterapi fase induksi. Tingkat signifikansi ditentukan dengan nilai p

Background: Labor pain is among the foremost severe pain that ladies experience in their lifespan, if inadequately treated can lead to certain complications in labor. Relieving this pain with medical interventions is also full of misconceptions and disagreement among people. Different traditional and pharmacological methods for labor pain relief are utilized by obstetric care providers. Aims and Objectives: The aim of the study was to obtain perception, attitude, and practice of labor analgesia among obstetric care providers in Eastern Uttar Pradesh. Materials and Methods: A cross-sectional online survey was conducted among obstetric care providers practicing in eastern Uttar Pradesh to access the perception, attitude, and practice of labor analgesia. Results: A total of 152 valid responses were obtained from the 250 participants contacted (response rate of 60.8%). The majority (98%) of them were in favor of utilizing some or the other technique of labor pain relief, and 80.3% of the participants were utilizing some of the available methods solely or in combination. Non-pharmacological methods were the most frequently used technique (77.9%). Epidural analgesia was used by only 9.8% of participants. Less awareness among pregnant women, fear of harm to the baby, lack of dedicated supporting staff, and non-availability of anesthesiologists were among the most commonly pointed out as barriers to utilizing labor epidural analgesia. Conclusion: The majority of obstetric care providers were in favor of using some or the other technique of labor analgesia, but there was a large gap between the practice and attitude among health-care service providers regarding labor analgesia. Epidural analgesia was practiced very less due to some myths and scarcity of workforce.

Educational stakeholders in Brunei are not exempted from the search for innovative instructional approaches as a tool to stem the tide of poor performance of students in mathematics. This study was designed to contribute to this national project by examining the impact of a digital escape game intervention on students’ mathematics performance and affective constructs. Using a mixed methods approach, we generated both quantitative and qualitative data from 32 secondary school students who took part in the intervention study. The comparison between the pre-test and post-test scores of students shows a substantial improvement in the performance of students with different ability levels. Further analysis of the generated interview and questionnaire data reveals that the digital escape game reinforces students’ interest in and enjoyment of mathematics, provides an avenue for students’ collaborative learning and enhances students’ communication skills while working together on mathematics tasks. These findings highlight the potential of the digital escape game in not only stemming the tide of poor performance in mathematics but also in enhancing students’ motivational and social skills. In addition to students’ positive perceptions of the digital escape game, there are some reservations about the clarity of instruction and the duration of the intervention. We discuss the implications of these findings for the teaching and learning of mathematics within and outside the Bruneian borders.

Introduction/Objective: Platelets play an essential role in hemostasis, for their characterization, several platelet surface glycoproteins (GP) were identified as GPIIb, evaluated by the expression of CD41, and non-covalently binds to GPIIIa, recognized by the CD61 marker, making up the GPIIb-GPIIIa complex (CD41/CD61). GPIX is identified by CD42a and GPIb by CD42b that interacts together with GPV (CD42d), forming the other complex, GPIb-IX-V. Flow Cytometry (FC) is one of the techniques which allows the identification and characterization of platelets. The detection of absent or reduced expression of the glycoproteins is the main objective of this technique. Abnormalities of glycoproteins lead to hemorrhagic syndromes. Among the main diseases, Bernard Soulier (BS) and Glanzmann's Thrombasthenia (GT) stand out. BS is an disease caused by several molecular changes that produce altered proteins that would have a fundamental role in the stability of the expression of the von Willebrand receptor GPIb/IX/V complex (CD42a/CD42b/CD42d). GT is an thrombocytopathy caused by deficiency or decrease in the fibrinogen receptor GPIIb-GPIIIa (CD41/CD61). We aimed to show a FC based platelet assessment test for diagnostic use, which measures the expression of markers in normal patients, and evaluate these markers in patients with platelet disorders. Materials and methods: We examined a control group of 41 healthy adults to establish reference values and assess the variability of the relative expression of platelet markers and compare to 30 patients with suspected platelet dysfunctions. Were determined the MFI of the expressed parameters by FC using CD41, CD42a, CD42b and CD61, and SSC/FSC platelet gated cells. Results: We determined our baseline panel of markers and compared them with suspected platelet dysfunctions. Patients with suspected BS presented increased levels of MFI for GPIIIa (CD61) and GPIIb (CD41). They showed significantly reduced levels of GPIb (CD42b) and GPIX (CD42a). Patients with suspected GT showed normal expression of GPIX (CD42a), increased expression of GPIb (CD42b) and reduced levels of GPIIIa (CD61), showing expression patterns like those described in the literature, which characterizes GT as deficiency or decrease of one of the markers of the GPIIb/GPIIIa complex (CD41/CD61). Discussion: We describe the FC assay to support the diagnosis of different platelet disorders. We standardized and implemented the technique in which the expression profile of platelet-associated immunophenotypic markers was determined in a population of hematological normal individuals. It was possible to incorporate the test into laboratory research, to assist in the study of various pathologies associated with platelet dysfunction through the evaluation of the expression of these markers. With the analyzes in our laboratory, it was possible to evaluate 30 patients with suspected platelet dysfunction and contribute to diagnostic elucidation. Conclusions: Our study made it possible to implement a technique that brought benefits to care. These analyzes can be implemented in clinical practice to improve diagnosis for patients with suspected platelet disorders.

Background and Aim: Conjoined twins, due to their rarity and complex anatomy, pose not only a technical, but also a physiological challenge for their separation, with each case being uniquely distinct. The aim of the present article is to describe the surgical approach and management strategy for two cases of pyopagus conjoined twins operated at our center. Case Report: Case 1: Antenatally detected conjoined twin girls presented postnatally to our centre. They were found to have a common vestibule with single anal opening facing partially away from each other. On evaluation they were found to have a single sacrum and fused conus and filum terminale. They were taken up for separation at 2years of age & the 24hour long surgery, culminated in successful separation. The children had good post-operative outcome at 10months post separation. Case 2: Conjoined pyopagus twin girls presented postnatally, and were found to have fused cords, having a terminal syrinx and partially separate sacrum. They were separated at 2.5 years of age, with a multi-departmental effort and coordination. They are doing well 2 months post-operatively. Conclusion: A multidisciplinary team support with thorough preoperative planning significantly aids in improving the outcome of surgical separation. This has been possible by using modern technology. Each reported case contributes significantly to literature.

Background and Aim: A developing odontogenic cyst known as odontogenic keratocyst (OKC) originates from the remains of dental lamina. Its aggressive pattern of expansion and high recurrence rate differentiate it from other odontogenic cysts. Herein, we describe a large OKC in the mandibular ramus, close to the condyle, in a juvenile patient with a third molar crypt. Age and sex of patient, and size, location, and fast development of this lesion were different compared with previously reported OKCs. Our management strategy aimed to maintain the mandible's natural dentition, form, function, and continuity. Case Presentation: The conservative strategy of marsupialization and decompression, which results in final total clearance of the cystic lesion, is one of the treatment strategies for OKC. Segmental resection, en bloc, and complex procedures are other treatment options. Surgical enucleation of the lesion and subsequent marsupialization were conducted effectively in this case. After a lengthy follow-up, there was no recurrence. Conclusion: A detailed comprehension of the nature of the lesion supported by a strong clinical history and cutting-edge radiography may greatly aid the physician in making the appropriate treatment decision for patient's long-term interests.

The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed “pre-burst suppression” (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3–35 Hz power (dB) during the 1-s preceding BSup relative to the average 3–35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman’s ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: −0.10 [−0.19, −0.01], p = 0.024; −0.04 [−0.06, −0.01], p = 0.009; −0.04 [−0.06, −0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk.

Adult green turtles are known to display either preference in their foraging habits or fidelity to their foraging sites which, in turn, influences their migrations and the availability of forage. With an abundant supply of seagrass and algae, the lagoons of the Lakshadweep Archipelago off the Indian west coast serve as significant feeding grounds for green turtles. In the last 2 decades, the numbers of foraging green turtles have varied across islands, leading to speculation about their foraging patterns and movements. We collated secondary data and conducted periodic surveys between 2013 and 2019 to record trends in green turtle abundance and seagrass characteristics and investigate relationships between them. Over the last decade, green turtle abundances have fluctuated widely with increases followed by sharp declines within different lagoons. Our results also show that a reduction in seagrass density, particularly Thalassia sp. and Cymodocea sp., coincided with the decline in green turtle abundance. Moreover, turtle presence was observed at sites with higher seagrass density and canopy height. Our findings indicate that green turtles appeared to forage in particular lagoons until their preferred resources declined, before moving to other islands within the Archipelago or other unknown locations. Therefore, to devise effective management strategies, it is crucial to understand how this green turtle population will adapt to the decline in foraging resources. The declining seagrass populations also suggest the need for an ecosystem approach towards green turtle conservation.

This work presents a design and testing of a prototype 27 MHz radio frequency controlled mobile dummy LASER gun system utilizing off-the-shelf components. The work is intended to serve as a proof of concept subsequent to implementing a real system. The system employed a pair of TX6/RX6 data encoder and decoder. Four onboard motors control the motion direction, steering, gun elevation and gun trigger lever. The model could cover 0.345m/s and accelerate to 60m/s2 in a 1m dash under laboratory conditions. The maximum distance from which the model can be controlled is limited to 25m. This limitation is inherent in the off-the-shelf materials used for building it. The mounted dummy LASER gun could be fired at up to 84 times per second, limited by the human operator with a maximum elevation of 40o.

Effective school leadership is critical for school success. Teachers as leaders have extraordinary influences not only in their classrooms but also in the general school framework. The aspect of teacher leadership provides self-knowledge and the courage to act on that knowledge. However, there is no consensus on what defines teacher leaders and the specific qualities that characterise them. In this study, the insights of twelve conveniently sampled graduate teacher candidates in one of the teacher training institutions in Brunei Darussalam were explored. They were asked to describe the ideal leadership qualities that a secondary school mathematics teacher leader should possess. There were many variations in their responses. However, the overarching finding was that mathematics teacher leaders should have ideal qualities that make them functional within and outside of the classroom. Key attributes such as effective classroom management, content and pedagogical knowledge, effective communication and problem-solving skills, and the ability to contribute to maintaining a healthy school-community partnership were mentioned. This study concluded that in defining teacher leadership, it is essential to define the concept based on teachers’ ability to influence others to achieve set goals within and outside of the classroom.

The current research has come from the deep concern for the sustainability of the environment in terms of waste disposal and producing bio-based materials. In this way, the developed composite materials made from flax fiber reinforced with expanded polystyrene wastes are low-cost, lightweight, eco-friendly and will be reduced environmental pollution. In this paper, alkali-treated short flax fiber reinforced expanded polystyrene (FFEPS) composites were developed to characterize mechanical and water absorption properties. The expanded polystyrene wastes from packages were dissolved in gasoline to prepare the matrix. Short flax fibers extracted from the plants were treated in 5% NaOH solution to improve fiber/matrix bond. The tests were accompanied by a fiber weight of 20, 30 and 40%. The influence of fiber content on various properties such as tensile strength, tensile modulus, flexural, impact strengths and water absorption properties of the composites were evaluated. Samples are prepared as per respective ASTM standards. The result revealed that both tensile, bending, and impact strength were maximum at 30% of fiber weight fraction. The maximum tensile strength, tensile modulus, flexural and impact strengths were noted as 25.28 MPa, 3.105 GPa, 41.27Mpa and 8.33 J/cm2 and respectively at 30% of FFEPS composite. The composite with 30% fiber content gave higher results and the developed composite can be used for automobile interior panels and for housing panels, etc. Also, the FFEPS composite was prepared from expanded polystyrene waste and available flax fibers thus the material is recycled at the end of its life.

This research aims to reveal the financial inclusion occurs in zakat institutions within zakat distribution and empowerment program in Indonesia and Brunei Darussalam. This study will deliver zakat distribution and empowerment program held by zakat institutions in two countries and then analyze how are financial inclusion process happened to mustahiq in both institutions. The object of this research are the government zakat institution in two countries, namely Indonesia (BAZNAS) and Brunei Darussalam (BAKAZ). This study uses a qualitative method within multiple case strategy. Data collection in this study was carried out through in-depth interviews with several expert informants of BAZNAS and BAKAZ and also mustahiq of each institutions. This study shows that there are mustahiq financial inclusion process on empowerment program held by BAZNAS and BAKAZ by distribution of zakat for consumption and production needs. Financial inclusion happened in zakat institution are transferring zakat fund, financing mustahiq business within capital loan, and channeling to financial institutions, so that mustahiq can transform gradually to be bankable and have financial access to scale up their business

Introduction Chronic rhinosinusitis (CRS) with or without nasal polyps is a significant public health burden worldwide and owing to its multifactorial etiology, it is often encountered across various medical and surgical specialities. Role of fungus in etiology of CRS has been debated for decades altogether and there is plethora of researches on cellular, molecular and biochemical aspects of fungal presence in nasal cavity and paranasal sinuses and how it affects. Although, there is denial at large on fungal effects on development of CRS, but the question, that whether concomitant and demonstrable presence of fungus in cases of CRS aggravates classic symptoms and signs, largely remains unanswered. Material and Methods This cohort study includes 121 subjects, which were divided in CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) on basis of rigid nasal endoscopic findings. Severity of disease symptoms, among these groups was corelated with Lund – Mackay (LM) symptom scores and extent of disease with LM endoscopic staging scores and LM radiology scores. Histopathology samples for demonstrating presence of fungus were taken and cohort was further subdivided into Fungi positive CRS and Fungi negative CRS, and, LM scores were compared. Results In fungi positive CRS group, mean LM symptoms score was 7.09 with standard deviation (SD) ±1.07; mean LM endoscopy score was 6.64 with SD ±1.94 and LM radiological score was 14.58 with SD ±2.96. In Fungi negative group, mean LM symptoms score was 3.58 with SD ±1.30; mean LM endoscopy score was 4.47 with SD ±1.57 and LM radiological score was 12.20 with SD ±2.98. Conclusion Results of this study were statistically significant that fungi positive group was found to have more severe symptoms and larger extent of disease as compared to fungi negative group which indicate that fungal presence may have a role in escalation of symptoms, signs and radiological scores and it may aggravate pre-existing CRS.

Introduction: Ventilator Associated Pneumonia (VAP) is the second most common nosocomial infection. Aspiration of bacteria from the upper digestive tract is important in the pathogenesis of this infection. Oral decontamination using antiseptic like chlorhexidine reduces the incidence of VAP but not mortality. There is conflicting results about oral decontamination with antibiotics in preventing VAP, some suggesting benefit and others showing no benefit. Aim: To use two different prophylactic oral decontaminant, gentamicin and chlorhexidine, to compare the incidence of VAP, prevalence of bacterial flora, duration of Intensive Care Unit (ICU) stay, and mortality. Materials and Methods: This double-blind, randomised, clinical study was conducted at Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from January 2017 to December 2018. Patients intubated within 24 hours of admission and who needed mechanical ventilation with an expected duration of more than 48 hours were included. All the adult patients between age group 18-50 years were studied. Patients were randomised to receive either Topical Antimicrobial Prophylaxis (TAP) with 2% gentamicin (Group G) or 2% chlorhexidine (Group C). Patients were followed until extubation or death. Sequential cultures from endotracheal tube were sent on days 3,7,14, and 21, and for oropharyngeal swab culture were sent on days 0, 3,7,14 and 21. VAP was diagnosed with the help of Clinical Pulmonary Infection Score (CPIS). Results: Out of 151 patients, 82 patients were in group G (2% gentamicin) and 69 in group C (2% chlorhexidine). On follow-up of various interval among both the groups, CPIS increased with ICU stay but incidence of VAP was comparable between the groups (50% vs 71%, p-value=0.009). Pseudomonas was found to be most prevalent bacteria among both the groups. Discharge rate from ICU was higher in group G (54.9%) than group C (52.2%) (p-value=0.744). The mortality rate was higher in the group C (43.9%) than group G (44.9%) (p-value=0.744). Conclusion: Prophylactic oral-decontamination with gentamicin or chlorhexidine does not reduce incidence of VAP and outcome among ICU patients. Gentamicin could be a better option for patients on ventilator because it may lead to less colonisation of Pseudomonas in oral cavity along with lower CPIS in the later stages of VAP.

Salmon lice Lepeophtheirus salmonis infestation of sea trout Salmo trutta results in both additional marine mortality and behavioral changes which may contribute to sea trout population decline. For effective management of activities that increase exposure to salmon lice, such as salmon aquaculture, it is necessary to have a full understanding of how salmon lice may affect sea trout populations. An individual-based model (IBTRUTTA) was therefore developed to investigate the potential effects of salmon lice infestation on sea trout population abundance and dynamics based on data from the River Halselva and Altafjord system in northern Norway. This model allowed investigation of the effect of lice-induced mortality and also the compensatory salmonid behavioral mechanisms of premature return to freshwater, either persistent for overwintering or transitory after which sea trout could go back to sea. It was found that, in the absence of compensatory mechanisms, even low rates of lice infestation could lead to marked declines in sea trout abundance. Compensatory behavioral mechanisms had the potential to reduce these declines, but persistent premature return resulted in reduced body mass of returning adults. The shape of the stock-recruitment relationship was also shown to strongly affect how lice-induced mortality impacted the population.

Background: Hand hygiene is documented as one of the foremost techniques to prevent cross-transmission of germs. Objectives: This paper aims to assess the knowledge of hand cleanliness among medical students and working nurses. Methods: It was a cross-sectional descriptive study, carried over a sample selected by non-probability convenient sampling technique. The questionnaire used here to assess the knowledge and practice on hand hygiene was adapted from the World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care. The data thus collected were presented in terms of counts and percentages. Chi-square test was used to test the significance of the differences, and a p-value of less than 0.05 was considered as statistically significant. Results: Overall, 92.08% of participants have received training in handwashing. Twenty-five (41.60%) medical students believed that the microbes already present with the patient were responsible for hospital-acquired infection (HAI). Medical students had significantly higher knowledge than working nurses regarding dryness of skin due to hand rubbing over handwashing (p

The need for large-scale production of highly accurate simulated event samples for the extensive physics programme of the ATLAS experiment at the Large Hadron Collider motivates the development of new simulation techniques. Building on the recent success of deep learning algorithms, variational autoencoders and generative adversarial networks are investigated for modelling the response of the central region of the ATLAS electromagnetic calorimeter to photons of various energies. The properties of synthesised showers are compared with showers from a full detector simulation using geant4. Both variational autoencoders and generative adversarial networks are capable of quickly simulating electromagnetic showers with correct total energies and stochasticity, though the modelling of some shower shape distributions requires more refinement. This feasibility study demonstrates the potential of using such algorithms for ATLAS fast calorimeter simulation in the future and shows a possible way to complement current simulation techniques.

The ^{244}Pu(^{50}Ti,xn)^{294-x}Lv reaction was investigated at Lawrence Berkeley National Laboratory's 88-Inch Cyclotron. The experiment was aimed at the production of a superheavy element with Z≥114 by irradiating an actinide target with a beam heavier than ^{48}Ca. Produced Lv ions were separated from the unwanted beam and nuclear reaction products using the Berkeley Gas-filled Separator and implanted into a newly commissioned focal-plane detector system. Two decay chains were observed and assigned to the decay of ^{290}Lv. The production cross section was measured to be σ_{prod}=0.44(_{-0.28}^{+0.58})  pb at a center-of-target center-of-mass energy of 220(3) MeV. This represents the first published measurement of the production of a superheavy element near the "island of stability," with a beam of ^{50}Ti and is an essential precursor in the pursuit of searching for new elements beyond Z=118.

This project rethinks architectural work in the context of waste. Fourth-year students designed and built a mobile maker-space at the Repurpose Project, a last stop for cast-off materials before the landfill. This essay argues that the material ecologies found in such places provide a critical context for understanding architectural work as a collective body of knowledge and practical know-how. The rejected and scrapped materials themselves had agency, carrying legacies and future potentialities, not just for the project but also for the larger collaborative project of evaluating and addressing work and waste in and out of academia and the architectural profession. Building the maker-space recast the process of making as a series of critical ecological acts and explored the Repurpose Project model as a knowledge commons for alternative architectural practices.

Although molybdenum-containing enzymes are well-established as having a key role in bacterial respiration, it is increasingly recognized that some may also support bacterial virulence. Here, we show that DmsABC, a putative dimethylsulfoxide (DMSO) reductase, is required for fitness of the respiratory pathogen Haemophilus influenzae (Hi) in different models of infection. Expression of the dmsABC operon increased with decreasing oxygen availability, but despite this, a Hi2019ΔdmsA strain did not show any defects in anaerobic growth on chemically defined medium (CDM), and viability was also unaffected. Although Hi2019ΔdmsA exhibited increased biofilm formation in vitro and greater resistance to hypochlorite killing compared to the isogenic wild-type strain, its survival in contact with primary human neutrophils, in infections of cultured tissue cells, or in a mouse model of lung infection was reduced compared to Hi2019WT. The tissue cell infection model revealed a two-fold decrease in intracellular survival, while in the mouse model of lung infection Hi2019ΔdmsA was strongly attenuated and below detection levels at 48 h post-inoculation. While Hi2019WT was recovered in approximately equal numbers from bronchoalveolar lavage fluid (BALF) and lung tissue, survival of Hi2019ΔdmsA was reduced in lung tissue compared to BALF samples, indicating that Hi2019ΔdmsA had reduced access to or survival in the intracellular niche. Our data clearly indicate for the first time a role for DmsABC in H. influenzae infection and that the conditions under which DmsABC is required in this bacterium are closely linked to interactions with the host.

Aims and Objectives: The sequence of contacts with individuals and organizations prompted by the distressed person's efforts, and those of his or her significant others, to seek help is known as the pathways to care. The study of the pathways to care provides the relevant information regarding the individual's health seeking and illness behaviour. A wide range of professionals including psychiatrists, psychologists, other doctors, faith-healers and religious healers cater to the needs of mentally ill patients. This study was carried out to identify the pathway to care of patients up to psychiatric care with no prior psychiatric treatment at GMCTH. Methodology: It is a cross-sectional, descriptive study conducted in GMCTH, Pokhara from Jan 2015 to Dec 2016. After ethical consideration, all new patients and those newly referred to the psychiatric services and agreed to participate were interviewed until the target 100 participants were recruited. ICD-10 was used for diagnosis. Data were computed and analyzed by using Microsoft excel and SPSS. Parametric & non parametric statistical technique was applied wherever appropriate. Results: Total of 100 patients (56 females, 44 males) was included in the study. Mean age of the entire study cohort was 37.17 years (SD 15.45). The mean no. of months to seek first help from a psychiatrist was 53.03 months (SD: 81.70). Conclusion: All the patients here eventually made treatment contact with psychiatrists. However, delay was pervasive. Delay in treatment has negative effect in the treatment outcome. The knowledge and recognition of psychological disorders by the traditional healers as well as other treatment providers in the community are crucial for early treatment of psychiatric patients.

Captive rearing represents a vital component of many conservation and research programs. However, captive animals can exhibit unnatural behaviors and experience high predation following release, which can limit reintroduction success and the inferential value of studies that use released animals. Soft-release measures (e.g. penning) can acclimate individuals and limit interactions with predators but can also require considerable resources. We reared hatchling gopher tortoises Gopherus polyphemus in the laboratory for physiology experiments and subsequently hard-released them as yearlings to assess the efficacy of this low-cost release method and to explore possible captivity effects on tortoise behavior, growth, and survivorship. Hard-released yearlings exhibited limited dispersal; most constructed burrows soon after release, and, like wild juveniles, exhibited a preference for burrowing under deadwood. Video observations at burrows indicated natural behavior, including overnighting in burrows, extensive basking directly in front of burrows, and limited time away from these important refugia. Basking tortoises responded to simulated predator approach by rapidly entering burrows, with flight initiation distances and hiding times equivalent or similar to those of wild individuals. Survivorship was comparable to that of soft-released juveniles, but growth was slightly lower than expected based on observations of wild tortoises at the site, possibly reflecting performance immediately following release. Our findings indicate that captive-reared juvenile gopher tortoises respond well to hard release and exhibit natural attributes required to thrive in the wild. Moreover, studies of released juveniles can yield valuable insights into the ecology of a life stage that is poorly understood in most chelonians.

This White Paper presents an overview of the current status and future perspective of QCD research, based on the community inputs and scientific conclusions from the 2022 Hot and Cold QCD Town Meeting. We present the progress made in the last decade toward a deep understanding of both the fundamental structure of the sub-atomic matter of nucleon and nucleus in cold QCD, and the hot QCD matter in heavy ion collisions. We identify key questions of QCD research and plausible paths to obtaining answers to those questions in the near future, hence defining priorities of our research over the coming decades.

Introduction: There are several described techniques for ventral hernia mesh repair in both laparoscopic and open approach. Both approaches have their own pros and cons. Ventralex patch repair is an open technique using dual mesh in the intraperitoneal plane for ventral hernia repair. Aim: To describe an open technique with the use of ventalex patch in the repair of selected ventral hernias and to compare the open technique in terms of cost, operating time, complications and duration of hospital stay using Ventral patch and available literature for open and laparoscopic repair. Materials and Methods: This retrospective study was conducted on 248 patients over a period of seven years who underwent open ventral hernia repair with the Ventralex Patch, at a tertiary care hospital. A retrospective chart review and telephonic interview was conducted postoperatively and at the end of atleast 24 months to assess for outcomes, particularly recurrence. Descriptive statistics reported using frequency and percentage for categorical variables. Continuous variables were reported using mean±Standard Deviation (SD). Results: A total of 248 patients underwent hernioplasty with ventralex patch. The mean age was 50.57 years and mean BMI was 28.37 kg/m2 . The average duration of operation was 27.5 minutes and hospital stay was 2.275 days. The most common defect size was 2 cm (47.2%). The cost analysis of this technique revealed an average cost of INR 35,142 as opposed to an average cost of INR 88,601 for laparoscopic repair (including disposables) and INR 30,174 for open traditional sublay repair. Twenty-one patients developed surgical site infection (8.5%), and 27 patients (10.9%) developed seroma formation. A total of six patients developed superficial skin necrosis. The cumulative hernia recurrence rate at the end of 24 months was in 16 patients (6.5%). Conclusion: Ventralex patch repair is very efficient and effective in the treatment of selective umbilical, periumbilical, epigastric and incisional hernias with a comparable complication profile in terms of short term complications and recurrence rate compared to available literature.

Trelegy Ellipta (GlaxoSmithKlineTM) is the first single inhaler triple combination therapy comprising of umeclidinium, vilanterol and fluticasone approved by the United States Food and Drug Administration (US FDA) for patients with severe COPD in 2019. Clinical trials comparing this triple combination with dual therapy including a Long Acting b2-Agonist/Long Acting Muscarinic Antagonist (LABA/LAMA) or Long Acting b2-Agonist/Inhaled Corticosteroids (LABA/ICS) were evaluated. Triple combination did show improvement through the mean Forced Expiratory Volume per second (FEV1), St. George questionnaire, and reduced hospitalisation due to acute exacerbation of COPD. This medication should be prescribed cautiously for certain populations. Although this triple combination is used only in patients with the most advanced forms of disease who have frequent exacerbations and remain uncontrolled, there are certain additional indications that may be explored in future trials. The convenience associated with using a single device for three different classes of drugs could be its biggest trump card and it will not be surprising to see its preference among patients avoiding the need for multiple dosing. Nevertheless, it remains to be seen if this improved adherence would translate into improved outcomes such as reduced mortality in real world practice among patients with severe COPD. The availability of a single inhaler device for delivering a triple combination of LABA/LAMA/ICS is a small success story in the quest to identify better therapies for patients with severe COPD, who are so prone to repeat acute exacerbations which could eventually turn fatal.

Introduction: Contact tracing is a central public health response to infectious disease outbreaks, especially in the early stages of an outbreak when specific treatments are limited. Current clinical and epidemiological data are insufficient to understand the full extent of the transmission potential of the COVID pandemic. The main advantages are that it can identify potentially infected individuals before severe symptoms emerge, and if conducted sufficiently quickly can prevent onward transmission from the secondary cases. Hence the study was undertaken. Methodology: It was a cross-sectional study conducted by the Department of Community Medicine, Bhopal from 9th May to 30th June 2020. Results: Out of 426 COVID positive patients, 54.93% were asymptomatic and 45.07% symptomatic. Fever was the most common presentation reported by the COVID positive patients. Mean incubation period was 4.68 ±2.63 days. Contact with COVID-19 positive cases was major source of infection identified. Only 9.86% patients had co-morbidity. Out of 10512 contacts traced, 66.65% i.e., 6902 samples were collected. Overall Positivity rate was found to be 4.30%. The positivity of the advanced contact tracing is 2.42%. Conclusion: Contact tracing is a highly effective and robust strategy if given sufficient resources.

Introduction: Miniaturisation of the instruments in Percutaneous Nephrolithotomy (PCNL) is advantageous over standard PCNL procedure in patients with renal stone 18 years and renal stones ≤2 cm in size. Patients were equally randomised to standard PCNL and mini-Perc group. The primary outcomes included operative time, stone clearance, postoperative analgesic requirement, and associated complications. Association between qualitative variables were evaluated using Chi-square test and Fisher-exact test; while, comparison of quantitative data was performed using unpaired t-test or Mann-Whitney U test. Results: A total of 100 patients (standard PCNL, n=50; mini-Perc, n=50) were enrolled. The mean age (years) of patients in standard PCNL and mini-Perc were 40.78 and 39.79, respectively. The complete stone clearance rate was comparable between miniPerc and standard PCNL (92% vs 94%). The mean operative time (minutes) was significantly more with mini-Perc than standard PCNL (78.86 vs 73.72; p

Background: Cerebral metabolic rate of oxygen (CMRO2), a measure of global oxygen metabolism, reflects resting cellular activity. The mechanisms underlying fatigue and cognitive dysfunction in multiple sclerosis (MS) remain unknown. If fatigue indeed reflects ongoing autoimmune activity and cortical reorganization, and cognitive decline is the result of gray matter atrophy and white matter degeneration, we postulate that changes in CMRO2 should reflect disease activity and predict these symptoms. Objective: We sought to utilize T2-Relaxation-Under-Spin-Tagging (TRUST) and phase-contrast (PC) MRI to measure global CMRO2 to understand its relationships to white matter microstructure, fatigue and cognitive dysfunction. Methods: We measured venous oxygenation (TRUST) and cerebral blood flow (PC-MRI) in superior sagittal sinus to calculate global CMRO2 and diffusion tensor imaging (DTI) to evaluate white matter microstructure in healthy controls (HC) and MS patients. Participants underwent neuropsychological examinations including Modified Fatigue Impact Scale (MFIS) and Symbol-Digit-Modalities Test (SDMT). Results: We observed lower CMRO2 in MS patients compared to HC. After controlling for demographic and disease characteristics (i.e., age, education, disability, lesion volume), CMRO2 predicted increased fatigue (MFIS) and reduced cognitive performance (SDMT) in MS patients. Finally, MS patients with higher CMRO2 have reduced FA in normal-appearing white-matter. Conclusion: Altogether, these results suggest that increased CMRO2 reflects ongoing demyelination and autoimmune activity which plays an important role in both fatigue and cognitive dysfunction.

A search for high-mass resonances decaying into a Formula Presented-lepton and a neutrino using proton-proton collisions at a center-of-mass energy of Formula Presented is presented. The full run 2 data sample corresponding to an integrated luminosity of Formula Presented recorded by the ATLAS experiment in the years 2015-2018 is analyzed. The Formula Presented-lepton is reconstructed in its hadronic decay modes and the total transverse momentum carried out by neutrinos is inferred from the reconstructed missing transverse momentum. The search for new physics is performed on the transverse mass between the Formula Presented-lepton and the missing transverse momentum. No excess of events above the Standard Model expectation is observed and upper exclusion limits are set on the Formula Presented production cross section. Heavy Formula Presented vector bosons with masses up to 5.0 TeV are excluded at 95% confidence level, assuming that they have the same couplings as the Standard Model Formula Presented boson. For nonuniversal couplings, Formula Presented bosons are excluded for masses less than 3.5-5.0 TeV, depending on the model parameters. In addition, model-independent limits on the visible cross section times branching ratio are determined as a function of the lower threshold on the transverse mass of the Formula Presented-lepton and missing transverse momentum.

Summary: Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. Funding: Medical Research Council of South Africa.

Abstract Background Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth. Method One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups. Result Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145. Conclusion Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers. Trial registration Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012 (retrospectively registered one week after enrolment of first participant).

This paper studies the behaviour of circular tunnel subjected to dynamic excitation. Tunnels with three different diameters were selected to perform the shake table test at three different covers. The dry sandy soil was used for testing. The mechanical properties like Young’s modulus and shear modulus of sand was calculated from bender element test. The soil–tunnel interface coefficient was calculated from the direct shear test. The soil pressure generated due to dynamic loading were measured by soil pressure transducers. The actual motion of shake table was captured by hand-held vibration analyser. The tunnel was placed parallel and perpendicular to the direction of shaking. The three-dimensional finite-element model was developed for tunnel with both the orientations. The tunnel was assumed to be elastic. Dry sand was assumed to follow non-linear elasto-plastic material using Mohr–Coulomb failure criterion with non-associated flow rule. The results obtained from numerical analysis are compared with experimental results and are expressed in the form of peak dynamic stresses. The time history and fast Fourier transform results of dynamic stresses are also compared. It shows reasonable agreement with both values. Finally, the seismic design guidelines for tunnel are suggested.

Meckle’s Diverticulum (MD) is the most common congenital Gastro-Intestinal Tract (GIT) anomaly. Intestinal obstruction is the common presenting symptom in the adult population, due to complications like intussusception, incarceration, adhesion, stricture and torsion around a fibrous band. MD can present with similar symptoms of acute appendicitis or can present with painless lower GIT bleeding. Axial torsion of gangrenous MD can cause acute small bowel obstruction. The correct diagnosis of complicated MD before surgery is often difficult. This article is about a young boy who had signs and symptoms of acute small bowel obstruction for 15 days duration. He had MD which was adherent to umbilical region causing gangrenous small bowel obstruction. Initially, the patient was treated conservatively for suspected appendicitis in a peripheral Hospital at his native place and later he was referred for further management. He underwent surgery successfully and discharged after a week. As the acute small bowel obstruction in paediatric patients can also have associated MD with initial presentation as acute appendicitis we should have a high index of suspicion while treating such cases. Early diagnosis and surgical intervention can avoid major bowel resection and overall morbidity.

To determine relationship between BCS, ramp fat thickness, body measurements and milk yield, a total of 44 Jersey crossbred cows were observed from calving to 120 days post-partum. The ultrasonography images were recorded from rump region during entire experimental period. Statistically analyzed data revealed that BCS, HG, THT were significantly (P

A search for quantum black holes in electron + jet and muon + jet invariant mass spectra is performed with 140 fb-1 of data collected by the ATLAS detector in proton-proton collisions at √s = 13 TeV at the Large Hadron Collider. The observed invariant mass spectrum of lepton + jet pairs is consistent with Standard Model expectations. Upper limits are set at 95% confidence level on the production cross section times branching fractions for quantum black holes decaying into a lepton and a quark in a search region with invariant mass above 2.0 TeV. The resulting quantum black hole lower mass threshold limit is 9.2 TeV in the Arkani-Hamed-Dimopoulos-Dvali model, and 6.8 TeV in the Randall-Sundrum model.

Johannes Harlan Saing,1 Dina Keumala Sari,2 Supriatmo,1 Aida Fitri,3 Muhammad Arief Pratama4 1Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia; 2Department of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia; 3Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia; 4Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, IndonesiaCorrespondence: Dina Keumala Sari, Department of Clinical Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Jl. Dr. Mansur, No. 5, Kampus USU, Padang Bulan, Medan, Indonesia, Tel +6281397177693, Email dina@usu.ac.idBackground: Epilepsy is highly prevalent among children worldwide, making it one of the most common neurological disorders. Drug-Resistant Epilepsy (DRE) significantly impacts the quality of life (QoL) of affected children, attributed to factors such as seizure frequency and severity, low vitamin D levels, comorbidities, radiological abnormalities, and elevated IL-1β levels.Objective: This study aims to identify the factors most significantly affecting the QoL in children with DRE.Methods: This cross-sectional study at Adam Malik Hospital involved children with DRE. Participants’ QoL was assessed with the QOLCE-55 score, while epilepsy severity was measured using the HASS score. Vitamin D status was quantified by serum 25-hydroxy vitamin D (25(OH)D) levels, and IL-1β levels were measured using the ELISA method. Multivariate logistic regression analysis using Pearson and Spearman test was conducted to evaluate risk factors that significantly impact the QoL of children with DRE.Results: The findings revealed several factors significantly influencing QoL in children with DRE. Comorbidities (OR = 24.98, p = 0.004, 95% CI) and high IL-1β levels (OR = 8.36, p = 0.022, 95% CI) were strongly correlated and significant factors in determining QoL, indicating 24.98- and 8.36-times higher likelihood of decreased QoL, respectively. Vitamin D levels had no statistically significant effect on QoL.Conclusion: Vitamin D levels have no substantial impact on QoL in children with DRE. IL-1β levels and comorbidities are crucial components affecting QoL in these patients. These findings highlight the importance of considering these factors in the management of children with DRE.Keywords: vitamin D, interleukin-1 beta, comorbidities, quality of life, drug-resistant epilepsy

Cello bowing techniques are classified by applying supervised machine learning methods to sensor data from two inertial sensors called the Orient specks – one worn on the playing wrist and the other attached to the frog of the bow. Twelve different bowing techniques were considered, including variants on a single string and across multiple strings. Results are presented for the classification of these twelve techniques when played singly, and in combination during improvisational play. The results demonstrated that even when limited to two sensors, classification accuracy in excess of 95% was obtained for the individual bowing styles, with the added advantages of a minimalist approach.

The past two cycles of PISA have reflected the demands of the skills and competencies that many countries desire their future generations to possess. Among these competencies, students’ financial literacy, problem solving, and communication skills have emerged to be as important as their reading and quantitative literacy (OECD, 2013). Problem-solving, along with other 21st century skills can be inculcated in the students by using the problem-solving pedagogy. However, teachers who are not used to teaching mathematics via problem solving need to experience the pedagogy themselves and this can be best achieved by implementing Lesson Study. A Lesson Study research study was conducted to look at collaborative problem solving in the teaching of the topic on “rate” to year 5 students. Results showed that students benefited from their lesson in terms of increased knowledge of the problem context and the ability to apply knowledge of rates in finding the best solution that the problem posed. Consequently, Lesson Study was found to help enhance teachers’ pedagogical content knowledge. It helped them produce effective lesson plans that incorporated student-centred authentic lessons that also integrated values, use of technology and students’ creativity in problem solving.

Rapid distinguishing of mycobacterial species and knowledge about their susceptibility is vital for the management of patients with pulmonary disease who are not responding to initial treatment as the mycobacteria have a spectrum of virulence and different susceptibilities to antibiotics. Most biochemical techniques used for species differentiation are laborious and time consuming. Hence molecular techniques are becoming an alternative to existing conventional testing. This study demonstrates the utility of molecular diagnostics for patients with mycobacterial infections who are not responding to initial anti TB therapy.

The protection of biodiversity is one of the most important goals in terrestrial and marine conservation. Marine conservation approaches have traditionally followed the example of terrestrial initiatives. However, patterns, processes, habitats, and threats differ greatly between the 2 systems—and even within the marine environment. As a result, there is still a lack of congruence as to how to best identify and prioritize conservation approaches moving from the static terrestrial and nearshore realm into a more fluid, 3-dimensional pelagic realm. To address this problem, we investigate how the conservation science literature has been used to inform and guide management strategies in the marine system from coastal to pelagic environments. As cumulative impacts on the health of the oceans continue to increase, conservation priorities have shifted to include highly dynamic areas of the pelagic marine system. By evaluating whether priorities match science with current place-based management approaches (i.e. marine protected areas, MPAs), we identify important gaps that must be considered in current conservation schemes. Effective pelagic MPA design requires monitoring and evaluation across multiple physical, biological, and human dimensions. Because many threatened and exploited marine species move through an ephemeral and ever-changing environment, our results highlight the need to move beyond traditional, 2-dimensional approaches to marine conservation, and into dynamic management approaches that incorporate metrics of biodiversity as well as oceanographic features known to promote multilevel, trophic productivity.

Introduction : Le lupus érythémateux systémique est une connectivite fréquente chez les femmes en activité génitale. Au cours du lupus érythémateux systémique, la pseudo-obstruction intestinale est l'une des graves complications rares. Ainsi l'objectif de cet article est de présenter un cas clinique d'atteinte urinaire et pseudo-obstruction intestinale révélatrice d'un lupus érythémateux systémique. Observation : Une patiente âgée de 28 ans mariée, de Nationalité Guinéenne admise pour une diarrhée fébrile, asthénie, météorisme, associée à des douleurs articulaire et abdominale nécessitant une consultation et des bilans sans succès.Une échographie abdominale qui objective un épaississement diffus de la paroi colique et des anses grêles ainsi qu'une ascite de moyenne abondance. La coloscopie révèle un aspect inflammatoire spécifique de la muqueuse iléale. Conclusion : La pseudo-obstruction intestinale peut être inaugurale ou concomitante du lupus érythémateux systémique.

Manual muscle testing and its variants have a long history of use for classifying muscle strengths. For the first time, inexpensive wearable wireless sensors combined with machine learning techniques are used to classify different levels of muscle strength, which addresses some limitations of the manual method. A mean accuracy of 93% was obtained across ten subjects using gyroscope and accelerometer data in classifying four distinct levels of strengths of the biceps brachii muscle when performing muscle contraction under appropriate load. This was reduced by 2% for accelerometer-only data, thus offering a potentially inexpensive and viable solution for testing muscle strength.

Objective To study the common symptoms and outcome of surgical treatment of Eagle’s syndrome Methods A total of 22 cases were studied prospectively in both sexes from January 2008 to December 2010, in Department of ENT-HNS College Of Medical Sciences-Teaching Hospital, Bharatpur, Nepal. Patients with symptomatic styloid process were clinically palpated at tonsillar fossa and finally sent for X-ray styloid process. Patients underwent intra-oral tonsillectomy with styloidectomy. Post-operative improvement was analysed by follow up at one three and six months interval. Results Most common age group was 30-40 years (63.63%) with female dominance (M:F=1:4.5). The most frequent symptoms were pain in throat (29.62%), referred pain in ear (20.37%), pain in anterior triangle in neck (24.07%), foreign body sensation in throat (14.81%) and difficulty in swallowing (11.11%). Fifty nine percent of patients were having symptoms for last two to four years and 50% were on medication for last one to two years. All the patients underwent styloidectomy through intra-oral route. (63.63%) patients became symptom free and 13.63% didn’t show improvement even after operation. Conclusion Eagle’s syndrome is common in young females with various atypical presentations. Dull/throbbing or radiationg throat pain and pain in anterior triangle of the neck are common presentations. Diagnosis is done simply by palpating the tonsillar fossa. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12761 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 5-10

The Am 5d-5f resonant inelastic x-ray scattering (RIXS) data of americium sesquioxide were measured at incident photon energies throughout the Am O4,5 edges. The experiment was supported by calculations using several model approaches. While the experimental Am O4,5 x-ray absorption spectrum of Am2O3 is compared with the spectra calculated in the framework of atomic multiplet and crystal-field multiplet theories and Anderson impurity model (AIM) for the Am(III) system, the recorded Am 5d-5f RIXS data are essentially reproduced by the crystal-field multiplet calculations. A combination of the experimental scattering geometry and theoretical analysis of the character of the electronic states probed during the RIXS process confirms that the ground state of Am2O3 is singlet Γ1. An appearance of the low-intense charge-transfer satellite in the Am 5d-5f RIXS spectra at an energy loss of ∼5.5eV suggests weak Am 5f-O 2p hybridization which is in agreement with AIM estimations of the 5f occupancy from spectroscopic data in Am2O3 as being 6.05 electrons.