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Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. Other specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouses work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sexs impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages.

Abstract Automatic Sign Language Recognition Systems (ASLR) offers smooth communication between hearing-impaired and normal-hearing individuals, enhancing educational opportunities for impaired. However, it struggles with “curse of dimensionality” due to excessive features resulting in prolonged training time and exhaustive computational demand. This paper proposes technique that integrates machine learning and swarm intelligence to effectively address this issue. The proposed technique, initially, extracts features using histrogram of gradient (HOG) approach and then reduces dimensions of extracted features using unsupervised autoencoder and subsequently refining the feature set with an improved GWO algorithm. A handcrafted artificial neural network serves as the classifier within this integrated framework, denoted as AEGWO-Net. Exhaustive experimentations were conducted on six different datasets namely ASL, ASL MNIST, ISL, ArSL, MNIST Digits, and IEEE-ISL containing gestures of different languages to demonstrate the performance of AEGWO-Net. The AEGWO-Net demonstrates superior performance improving accuracy and F1 score by 6% and 4% respectively compared to PCA-IGWO and KPCA-IGWO algorithms. Achieving high accuracy (98.40%), F1-score (96.59%), MCC (97.14%), and AUC (96.21%) indicates the robustness and generalizability of the AEGWO-Net method even with reduced dimensionality. Furthermore, a comparison between AEGWO-Net with other existing swarm intelligence techniques is also made to demonstrate its superiority.

Abstract Background Despite the increasing integration of competency-based education in medicine, there remains a significant gap in effectively assessing educational outcomes, underscoring the urgent need for designed assessment blueprints that accurately reflect both curriculum content and competency standards in Community Medicine for undergraduate students. This study, conducted across the All-India Institute of Medical Sciences (AIIMS) network, develops a summative assessment blueprint aimed at standardizing evaluations in medical education across diverse geographic locations in India. Methods Twenty-five experts from 10 All India Institutes of Medical Science were invited via email and contributed for summative assessment for a theory paper. Each week, the study lead team sent an online form containing 25 topics. A total of 269 topics were selected to be included in the blueprint development. An Impact and Frequency score was obtained for each topic, with a score between 1 and 3 for both its “Impact (I)” and “Frequency” (F). Results The overall response rate was 71%. “Principle of epidemiology” (14.7%) had the most weight, followed by “Epidemiology of communicable disease” (13.4%) and “National Health Program” (10%). These three chapters constituted more than one-third of the total weight of the summative assessment (theory). 20 out of 24 (83%) chapters have moderate-to-good interrater reliability. Conclusions The blueprint developed in this study is intended to serve as a guideline for setting question papers and aims to enhance objectivity, uniformity, and validity in assessment construction. While it provides a structured approach within the AIIMS network, its broader applicability may be limited, suggesting that its effectiveness in other educational contexts remains to be validated. Continued research is encouraged to explore its utility across diverse educational settings.

Abstract An interconnected system employing Kinect Azure and Fitbit Sense for continuous and non-intrusive data collection was used in the PRO-HOME protected discharge program, aiming at monitoring functional and clinical parameters in hospitalized older patients at different risks of frailty. The present study shows the findings on 30 older patients included in the PRO-HOME project. The Fitbit Sense recorded the mean daily and hourly number of steps, mean daily walked distance, and time spent inactive. Moreover, Kinect infrared camera captured gait speed and daily mean latero-lateral (body sway) and antero-posterior oscillations (lean-in). Patients underwent a standard Comprehensive Geriatric Assessment (CGA) to compute the Multidimensional Prognostic Index (MPI), including basic and instrumental activities of daily living (ADL, IADL), cognition (Short Portable Mental Status Questionnaire, SPMSQ) and nutrition, risk of pressure sores (Exton-Smith Scale, ESS), comorbidity, number of drugs and cohabitation status. Significant correlations between the mean hourly number of steps and MPI (p = 0.022), IADL (p = 0.013), SPMSQ (p = 0.006), ESS (p = 0.009), and both mean and maximum automated gait speed (p = 0.046 and p = 0.048) were found. Automated gait speed was also correlated with mean walked distance per day (p = 0.007) and lean-in (p = 0.047). Domotic technological monitoring through Fitbit Sense and Kinect Azure provides information on multidimensional frailty, including mobility and cognitive and functional status, in older people.

Background and Objective: Few studies in adults and none in children have analyzed simultaneously, the correlation of SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) cycle threshold (Ct) value (inversely correlated to viral load) at diagnosis, with subsequent disease severity and antibody responses. A correlation could potentially inform treatment and vaccination decisions in advance. Materials and Methods: This prospective observational study was conducted from February 2021 to January 2022 in children below 16 years who tested RT-PCR test positive for SARS-CoV-2, including multisystem inflammatory syndrome in children. Disease severity was stratified as per standard definitions. Ct values were analyzed at diagnosis; IgG antibodies to S and N2 were quantified using a binding antibody test, 4–6 weeks after diagnosis. Multivariable analyses factored in potential effect modifiers such as age, gender, time from onset of symptoms to RT-PCR testing, time from RT-PCR to antibody testing, and immunocompromised state. Results: Of the 79 (47 male: 32 female) children who completed the study, 23 (29%) were asymptomatic, 47 (59%) had mild-to-moderate disease, 9 (11.4%) had severe disease; and 30/79 (38%) had comorbidities. The mean Ct/standard deviation (SD) value of the study population was 27.94 (±6.8); with mean Ct/SD values of 30.71 (±4.82), 26.25 (±6.82), and 29.69 (±8.5) in asymptomatic, mild-to–moderate, and severe disease, respectively. Although differences were observed between disease groups in mean Ct values and anti-N antibody titers using multiple-comparison correction, multivariable analyses showed no statistically significant correlation between Ct values, disease severity, and antibody titers. Conclusions: In children, SARS-CoV-2 Ct value at diagnosis independently predicts neither subsequent disease course/severity nor antibody response after 4–6 weeks.

Background: Leadership is the behavior of an individual when directing the activities of a group toward a shared goal. In the health-care system, doctors’ responsibilities extend beyond clinical treatment. They should be efficient to lead a team in the patient care setting and within the broader framework of health-care systems. Good medical leadership is vital in delivering high-quality health care. Incorporating leadership skills in medical undergraduates will help them act as leaders and members of the health-care team. Aims and Objectives: The aims and objectives of the study are to enhance leadership skills and to assess the improvement in leadership skills of the participating medical undergraduate students. Materials and Methods: In this prospective study, medical undergraduate students posted in otorhinolaryngology clinics took part in various activities in two subsequent community otorhinolaryngology programs. Students were given different roles and responsibilities in the community programs to improve their leadership skills. Students filled out a pre- and post-activity self-assessment leadership trait questionnaire form for each community program. Results: 88 students participated in the study. The overall percentage leadership score increased significantly from the first pre-activity questionnaire (Q1) to the first post-activity questionnaire (Q2) (P

To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities.

Burn injuries, although largely preventable, continue to pose a significant global health burden and substantially contribute to morbidity and mortality. This study emphasises the pivotal role of timely and effective burn care in mitigating the adverse consequences of these injuries. General physicians often serve as frontline responders to burn incidents, highlighting the importance of proficiency in burn management for accurate diagnosis, prognosis and appropriate referral to specialised burn units. Prompt initiation of acute burn care is paramount, with first-aid interventions playing a crucial role in shaping patient outcomes and reducing morbidity and it highlights the essential principles of burn care that general physicians should apply to enhance patient care outcomes. This emphasises the critical role of general physicians in implementing these principles effectively. In addition, it underscores the necessity of a multidisciplinary approach, advocating collaboration between general physicians and specialised burn care teams to ensure comprehensive patient management and rehabilitation. Ultimately, effective burn care enhances individual patient outcomes and reduces the overall burden of burn injuries on healthcare systems and society.

Introduction Adolescents represent 16% of the world’s population and around 21% of the Indian population. A study was done to assess the double burden of malnutrition, the proportion of inadequate intake of some important macronutrients and micronutrients, and the impact of COVID-19 pandemic on nutrient intakes among adolescents. Methodology Retrospective data analysis of the adolescents presented at the Adolescent Health Clinic at a teaching hospital (tertiary care level) in Andhra Pradesh, India, between September 2022 and December 2022 was done in the current study. Results A total of 800 adolescents were studied with the mean age of the participants as 15.8 (±2.38) years of age. Among the participants, the majority (59%) were immunized with Td vaccination at 10 years and/or 16 years, 21% were not immunized, and the rest 20% did not remember the status. Only 17 participants had a history of COVID-19 infection in the past. The majority (62.75%) of the participants belong to normal nutrition status as per BMI for age WHO growth charts. There is a significant difference in the nutrition status between males and females belonging to overweight and obese subgroups. There is no significant difference in the intake with respect to past COVID-19 status. Almost all the participants take inadequate amounts of carbohydrates (calories), pyridoxine, folate, iron, calcium, vitamin D3, and retinol. Protein intake is inadequate in 63% of participants, and the deficient intake rises with the age with respect to both EAR and RDA guidelines. Conclusion A large proportion of adolescents suffer from the double burden of malnutrition in South India, and almost all the adolescents do not get the recommended intake of most of the macro- and micronutrients in their diet following the lockdown and online schooling due to the COVID-19 pandemic.

Background Hepatitis B virus (HBV) and Hepatitis C virus (HCV) show similarity in the transmission, distribution, hepatotropism, and leading to chronic asymptomatic infection. Coinfection of HBV and HCV can lead to more severe liver disease and an increased risk for progression to hepatocellular carcinoma (HCC). Most of the people with chronic infection are unaware of their HBV and HCV infections, hence facilitating these to go undiagnosed until these viruses have caused serious liver damage and they act as a potential source of infection for the community at large. Therefore, the present study aimed to find the prevalence of HBV and HCV along with incidences of coinfection of HBV and HCV in patients seeking hospital care in central India. Methods A five-year hospital-based study was carried out at the tertiary care hospital in Central India from 2018 to 2022. A total of 72402 patients attending the outdoor patients and admitted indoor patients who were advised for HBV and HCV for screening before any invasive/surgical procedure and patients who presented with symptoms of acute or chronic liver disease were included in this study. Screening was done by immunochromatography-based card test followed by the confirmation of all samples by enzyme immunoassay. Results Seroprevalence of HBV and HCV was found to be 3.71% and 1.91%, respectively. Coinfection with HBV/HCV was seen in 0.13% of the individuals. The overall prevalence of HBV, HCV, and HBV-HCV coinfection was significantly higher in the male population as compared to females. Conclusion The study findings of seroprevalence of HBV and HCV among the hospital-based population will help to get a baseline understanding of the disease burden in central India. The HBV/HCV coinfection rate also raises serious concerns owing to its high prevalence rate among the younger age.

Background Definite history is not always present in children with foreign body aspiration (FBA), hence necessitating a high index of suspicion. Objective To assess the predictive value of clinico-radiological variables among children presenting with features of suspected FBA and to document their course in a tertiary care teaching hospital. Materials and Methods In this retrospective observational study, we included children aged below 15 years presenting with clinical features of suspected FBA. Data was obtained from case records. Multivariable binary logistic regression analysis (MVA) was performed to determine statistically significant predictors of FBA, and Weighted Risk Scores (WRS) were calculated to determine the significance of the model. Results Of the 296 children included in the study and having undergone bronchoscopy, 84.5% were toddlers; 269 (90.87%) had a foreign body (FB) removed. Organic material was commonly found with 64.3% being peanut and right main bronchus, the commonest lodging site (50.6%). Of the 54 (18%) children with symptomatic but unwitnessed FBA, 45 (83.3%) had a FB retrieved. Choking with sudden onset cough, stridor, unilateral decreased breath sounds, abnormal chest radiograph, unilateral hyperinflation and mediastinal shift correlated with FBA (P < 0.05). MVA confirmed statistical significance with choking with sudden onset cough to predict FBA (P = 0.024) with overall sensitivity and specificity of 60.9% and 77.8%, respectively. Total WRS with cut-off >2 showed good power of discrimination with sensitivity, specificity and AUC of 60.2%, 77.8% and 0.704%, respectively. Conclusions The proposed predictive value-based scoring system enhances accuracy in decision-making regarding bronchoscopy in children with suspected FBA.

Abstract The main challenges for utilizing daily evapotranspiration (ET) estimation in the study area revolve around the need for accurate and reliable data inputs, as well as the interpretation of ET dynamics within the context of local agricultural practices and environmental conditions. Factors such as cloud cover, atmospheric aerosols, and variations in land cover pose challenges to the precise estimation of ET from remote sensing data. This research aimed to utilize Landsat 8 and 9 datasets from the 2022–23 period in the Udham Singh Nagar district to apply the modified Priestley-Taylor (MPT) model for estimating ET. An average ET was estimated 1.33, 1.57, 1.70, 2.99, and 3.20 mm day−1 with 0.29, 0.33, 0.41, 0.69, and 1.03 standard deviation for December, January, February, March, and April month, respectively. In the validation phase, a strong correlation was found between the evaporative fraction derived from MPT and that observed by lysimeter, with R2 = 0.71, mean biased error = 0.04 mm day−1, root mean squared error = 0.62 mm day-1 and agreement index of 0.914. These results collectively support the effectiveness of the MPT model in accurately estimating ET across Udham Singh Nagar district. In essence, this research not only confirms the MPT model’s capability in ET estimation but also offers detailed insights into the spatial and temporal fluctuations of energy fluxes and daily ET rates.

Abstract Our study from an ongoing research experiment initiated in Rabi 1967 at the Research Farm of CCS Haryana Agricultural University, Haryana, India, reports that during the 51st wheat cycle in pearl millet-wheat sequence, adding FYM in both seasons significantly impacted various soil parameters at different wheat growth stages compared to the rabi season. The application of 15 t of FYM ha−1 resulted in a considerable increase in dissolved organic carbon content (9.1–11.2%), available P (9.7–12.1%), and available S (12.6–17.1%), DHA levels by 7.3–22.0%, urease activity (10.1 and 17.0%), β-Glucosidase activity (6.2–8.4%), and APA activity (5.2–10.6%), compared to 10 t FYM ha−1. Application of N120 exhibited a considerable improvement in DHA (11.0–23.2%), β-Glucosidase (9.4–19.2%), urease (13.3–28.3%), and APA (3.3–6.2%) activity compared to control (N0). At stage 3, the box plot revealed that 50% of the available N, P, and S values varied from 223.1 to 287.9 kg ha−1, 53.0 to 98.2 kg ha−1, and 50.0 to 97.6 kg ha−1, respectively. Principal component analysis, with PC1 explaining 94.7% and PC2 explaining 3.15% of the overall variability, and SOC had a polynomial relationship with soil characteristics (R2 = 0.89 to 0.99). Applying FYM15 × N120 treatment during both seasons proved beneficial in sustaining the health of sandy loam soil in North-West India.

Background: This study aims to find out the distribution pattern of cavitary lung disease across clinical, radiological, and etiological variables. Methods: This is an observational monocentric retrospective study conducted in Apollo Hospital, Greams Road, Chennai, between August 2022 and May 2023. After excluding cases lacking follow-up and no clinical data, 50 patients with cavitary lung disease who underwent bronchoscopy were included in this study. Data such as demographics, smoking status, clinical presentation, comorbidities, and radiological features were obtained. Results: Of the 50 participants, the majority had tuberculosis (TB), fungal, and bacterial infections. Fungal cavities were common in males with uniform age distribution and had cavities with air crescent signs. Bronchoscopy was inconclusive in most of them and required either computed tomography or video-assisted thoracic surgery (VATS)-guided biopsy to establish a diagnosis. The most common malignancy was squamous cell carcinoma, and autoimmune disease was granulomatous polyangiitis. Conclusion: Our study shows that the presence of cavities points more toward TB. One of the key measures in making TB treatment and control activities a success is identifying patients at high risk of transmission and poor outcomes like patients with cavities. However, it is important to exclude other diagnoses like malignancy where the prognosis can be fatal.

A young man was diagnosed to have pulmonary arteriovenous malformation (PAVM) when he was admitted with COVID infection. He had no respiratory distress but his saturation at room air was 90%. Chest X-ray revealed non-homogenous opacity in left lower lobe (LLL). The heart was structurally normal on 2D echocardiography; the saline bubble study was however positive for extra-cardiac shunt. Computed tomography pulmonary angiography (CTPA) revealed PAVM with well-defined lobulated sac measuring 2.9 × 1.9 × 2.5 cm in lateral basal segment of LLL with segmental branch of left pulmonary artery as feeder vessel and it drained into left pulmonary vein. The patient was managed with percutaneous intervention using Amplatzer Vascular Plug II to occlude the feeder vessel. Post-intervention, patient’s saturation improved to 98% at room air and saline bubble study was negative for extra-cardiac shunt. CTPA at 06 weeks revealed complete thrombosis of the sac.

Abstract Safe and effective brain tumor surgery aims to remove tumor tissue, not non-tumoral brain. This is a challenge since tumor cells are often not visually distinguishable from peritumoral brain during surgery. To address this, we conducted a multicenter study testing whether the Sentry System could distinguish the three most common types of brain tumors from brain tissue in a label-free manner. The Sentry System is a new real time, in situ brain tumor detection device that merges Raman spectroscopy with machine learning tissue classifiers. Nine hundred and seventy-six in situ spectroscopy measurements and colocalized tissue specimens were acquired from 67 patients undergoing surgery for glioblastoma, brain metastases, or meningioma to assess tumor classification. The device achieved diagnostic accuracies of 91% for glioblastoma, 97% for brain metastases, and 96% for meningiomas. These data show that the Sentry System discriminated tumor containing tissue from non-tumoral brain in real time and prior to resection.

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Abstract Background This is an interesting and unexpected thromboembolic event in a hemophiliac patient. Case presentation This is a case of a 33-year-old primigravidarum of Indian Asian origin with Factor V and Factor VIII deficiency who developed a case of pulmonary embolism during the course of her pregnancy after presenting to the emergency department in Leicester, United Kingdom, with hemoptysis, tachycardia, and tachypnea. Patient was subsequently diagnosed with pulmonary embolism after a computed tomography pulmonary angiogram and was treated with therapeutic daltaparin, a low-molecular-weight heparin. Conclusion In conclusion, a thromboembolic event is not an improbable event in a hemophiliac patient and should be considered despite a low Well’s score.

Anaplastic Large Cell Lymphoma (ALCL) is an uncommon type of Non Hodgkin Lymphoma (NHL). It commonly arises in lymph nodes and can also involve extranodal sites such as the skin, soft tissues, lungs, bones, and liver. Here, a case of Anaplastic Lymphoma Kinase (ALK)-positive ALCL in a 17-year-old male patient who presented with swelling in the frontal and occipital bones is presented. The patient was clinically and radiologically diagnosed with Langerhans Cell Histiocytosis (LCH), and excision of the occipital lesion was performed. Preoperatively, lymphoma was not considered a differential diagnosis. Detailed histopathological examination, immunohistochemistry, and Positron Emission Tomography (PET) scan confirmed the diagnosis of primary bone ALK-positive ALCL. This T-cell NHL is composed of large lymphoid cells with abundant cytoplasm and pleomorphic horseshoe or kidney-shaped nuclei, with characteristic ALK and CD30 positivity. An isolated presentation of ALCL as a primary lesion in the bone is extremely rare. Clinicians and pathologists should be aware of this rare presentation, as prompt diagnosis and proper treatment can lead to favourable outcomes.

Chylothorax is the presence of chylus in the pleural cavity and is due to the damage or blockage of the thoracic duct. Surgery or trauma is the most common cause of chylothorax. Malignant lymphoma is the most common cause among nontraumatic etiology. Whenever a chylothorax of unknown etiology occurs, we should rule out underlying malignant lymphoma. Here, we present a case of lymphoma presented with bilateral chylothorax.

Background: Subarachnoid spread of local anesthetics is quite erratic and is determined by several factors. There is a high predictive for the spread of spinal anaesthesia in terms of abdominal girth and vertebral column length. Our study is designed to determine the effect of abdominal girth and vertebral column length with cephalad spread of spinal anaesthesia for a given dose of 0.5% hyperbaric bupivacaine in Nepalese patients. Materials and Methods: In this prospective observational study, a total 100 patients of ASA PS I-II, aged16-65 years and undergoing lower extremity surgery under spinal anesthesia were enrolled. 2.8 mL of 0.5% hyperbaric bupivacaine was injected intrathecally at L3-4 interspace in sitting position. Extent of sensory blockade was assessed for 60 min. Simple linear regression, multiple linear regression and Pearson’s correlation coefficient analysis were performed to determine the correlation between patient variables viz abdominal girth, vertebral column length, height, weight, body mass index and age and maximum sensory block height. Results: Abdominal girth and vertebral column length correlated significantly with the maximal sensory block height after intrathecal administration of a fixed dose of 0.5% hyperbaric bupivacaine by all the three statistical tools used. Conclusion: Abdominal girth and vertebral column lengthcorrelate significantly with the maximal sensory block height in Nepalese patients receiving a fixed dose subarachnoid block with 0.5% hyperbaric bupivacaine

Abstract Forecasting floods encompasses significant complexity due to the nonlinear nature of hydrological systems, which involve intricate interactions among precipitation, landscapes, river systems, and hydrological networks. Recent efforts in hydrology have aimed at predicting water flow, floods, and quality, yet most methodologies overlook the influence of adjacent areas and lack advanced visualization for water level assessment. Our contribution is two-fold: firstly, we introduce a graph neural network model (LocalFLoodNet) equipped with a graph learning module to capture the interconnections of water systems and the connectivity between stations to predict future water levels. Secondly, we develop a simulation prototype offering visual insights for decision-making in disaster prevention and policy-making. This prototype visualizes predicted water levels and facilitates data analysis using decades of historical information. Focusing on the Greater Montreal Area (GMA), particularly Terrebonne, Quebec, Canada, we apply LocalFLoodNet and prototype to demonstrate a comprehensive method for assessing flood impacts. By utilizing a digital twin of Terrebonne, our simulation tool allows users to interactively modify the landscape and simulate various flood scenarios, thereby providing valuable insights into preventive strategies. This research aims to enhance water level prediction and evaluation of preventive measures, setting a benchmark for similar applications across different geographic areas.

Introduction: Hyperbaric Oxygen Therapy (HBOT) consists of administering oxygen at pressures higher than atmospheric pressure. Though HBOT remains one of the safest therapies used today, it is not completely devoid of side effects. Pulmonary oxygen toxicity can result as a result of continuous exposure of elevated levels of oxygen for increased duration and at increased pressures. The main pathological manifestations occur as acute exudative phase followed by subacute proliferative phase. Effects of HBOT on pulmonary functions has not been studied in detail. This study was conducted to ascertain the effects of HBOT on pulmonary functions and determine if these changes are reversible in nature. Material and Method: A prospective observational study was conducted at a tertiary care hospital over a period of 02 years. A total of 72 patients who were undergoing HBOT for any indication normal chest radiograph and normal spirometry/DLCO were included in the study. Spirometry and DLCO was done initially at the time of inclusion and repeated after half of the total planned HBOT sessions and finally at the end of all sessions of HBOT. Spirometry and DLCO was also repeated 6 months post completion of HBOT. The HBOT protocol consisted of breathing 100% oxygen at 2.4 atmospheric absolute (ATA) for 90 minutes which was referred as one session. Total sessions varied from 20-30 based on indication and response of their primary disease to HBO. Results: The mean age score in study population was 47.12 ± 12.88. Among the study population, 12(24%) participants were male and 38(76%) participants were female. The mean BMI was 24.49 ± 5.45. The mean DLCO was 6.67 ± 1.45 ml/min/mm Hg pre intervention, it was 6.38 ± 1.43 ml/min/mm Hg at mid cycle and 6.21 ± 1.41 ml/min/mm Hg post intervention and at 6 months follow up it was 6.43 ± 1.46 ml/min/mm Hg. The difference in the DLCO at mid cycle, post intervention and 6 months follow up period with baseline value were statistically significant (P value 0.005). Conclusion: HBOT although a safe intervention, it is not totally devoid of complications. Although our study did reveal statistically significant changes in pulmonary function in most of the instances, it did not show any clinically significant changes in pulmonary function with use of HBOT protocol at 2.4 ATA. Studies with larger sample size will be required to ensure evidence based safety of HBOT use.

Abstract The present investigation reported that FYM application in different seasons influenced root, shoot, and seedling length, straw K, vigour index-I, nutrient uptake, grain, and stover yield of pearl millet significantly (P kharif > rabi. Applying FYM in both seasons resulted in higher N, P, and K content in pearl millet grain (1.99%, 0.17%, and 0.37%, respectively) followed by kharif season application (1.93, 0.16, and 0.35%, respectively). Applying 15 t FYM ha−1 significantly increased the grain N (13.19%), P (63.16%), K (22.29%), protein (13.56%), stover N (32.76%), P (46.66%) and root length (29.83%) over FYM0. After 50 cropping cycles, continuous application of FYM15, FYM10, and FYM5 significantly improved vigour index-I by 52.85, 39.26, and 23.63% over no FYM, respectively. Applying 120 kg N ha−1 significantly increased N (6.38%), P (15.89%), and protein (6.03%) content, germination (5.91%), and vigour indexes (24.52 to 30.91%) of pearl millet grain over no fertilizer N. The treatment FYM15 × N120 increased the seedling length of pearl millet by 30.54 over N120 and 11.08% over FYM15 alone, respectively. Adding FYM either during both seasons or in the kharif season along with fertilizer N proved superior in improving the quality and yield of pearl millet.

Introduction: Endometrial carcinoma is the second most common female genital tract malignancy in India with a incidence rising globally. Hormone receptors are positive in 35-90% of endometrial carcinomas. Hormone therapy can be given to patients with hormone receptor positive tumours. Aim: To determine whether Progesterone and Oestrogen receptors (PR and ER) are most often expressed in endometrial cancer cases, and to correlate this expression with histopathologic features in these cases. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology, Government Medical College, Thrissur, Kerala, India, on 37 cases of endometrial carcinoma. ER and PR expression were assessed and correlated with histopathologic parameters in carcinoma endometrium. Results: 75.6% of the patients were in the 51-70 age range. Grade I endometrioid cancer accounted for 24 (77.42%) of the 31 cases, grade II for 5 (16.13%) and grade III for 2 (6.45%). 19 (51.4%) of cases had ER positivity and 21 (56.8%) had PR positivity. While all grade III tumours were PR and ER negative, grade I tumours had 70.83% and 79.17% ER and PR positivity, respectively. While ER expression did not correlate negatively with grade (p-value=0.076), PR expression did (p-value=0.043). In 29.73% of patients, lymphocytic infiltrates were seen, and they had a strong correlation with the expression of ER and PR. All cases of papillary serous carcinomas (100%), mucinous carcinomas (100%), and clear cell carcinomas (100%), showed ER negative. Hormone receptor status did not significantly correlate with FIGO (The International Federation of Gynecology and Obstetrics) stage, lymphovascular emboli, or myometrial invasion. Conclusion: Most of the endometrioid endometrial carcinomas showed ER and PR positivity, while all of the non endometrioid endometrial carcinomas were negative for both ER and PR. ER and PR were positive in most of the grade I tumours, whereas in the high-grade tumours, they were often negative. Immunoreactivity for PR had a stronger association with tumour grade, when compared to ER.

Abstract Accurately predicting agricultural commodity prices is crucial for India's economy. Traditional parametric models struggle with stringent assumptions, while machine learning (ML) approaches, though data-driven, lack automatic feature extraction. Deep learning (DL) models, with advanced feature extraction and predictive abilities, offer a promising solution. However, their application to agricultural price data ignored the exogenous factors. Hence, the study explored advanced versions of the well-known univariate models, NBEATSX and TransformerX. The research employed price data for essential crops like Tomato, Onion, and Potato (TOP) from major Indian markets and complemented it with corresponding weather data (precipitation and temperature). To provide a comprehensive analysis, the study also evaluated traditional statistical methods (ARIMAX and MLR) and a suite of ML algorithms (ANN, SVR, RFR, and XGBoost). The performance of these models was rigorously evaluated using error metrics like RMSE, MAE, sMAPE, MASE and QL. The findings were significant indicating DL models, particularly when augmented with exogenous variables, consistently outshone other methods with NBEATSX and TransformerX showing an average RMSE of 110.33 and 135.33, MAE of 60.08 and 74.92, sMAPE of 22.14 and 24.00, MASE of 1.02 and 1.32 and QL of 30.04 and 34.07, respectively. They exhibited lower error metrics, as compare to the statistical and ML models underscoring their effectiveness and potential in agricultural crop price forecasting. This study not only bridged a crucial research gap but also highlighted the robust potential of DL models in enhancing the accuracy of agricultural commodity price predictions in India.

Abstract Here, we explore the application of Raman spectroscopy for the assessment of plant biodiversity. Raman spectra from 11 vascular plant species commonly found in forest ecosystems, specifically angiosperms (both monocots and eudicots) and pteridophytes (ferns), were acquired in vivo and in situ using a Raman leaf-clip. We achieved an overall accuracy of 91% for correct classification of a species within a plant group and identified lignin Raman spectral features as a useful discriminator for classification. The results demonstrate the potential of Raman spectroscopy in contributing to plant biodiversity assessment.

Background: Infographics or image-based teaching-learning methods are innovative student-centered teaching–learning approaches. The objective of our study was to explore medical students’ perception regarding the effectiveness of image-based learning strategy in promoting their lifelong learning skills and evaluate its influence on improving students’ exam grades. Methods: We conducted a prospective single-cohort study on undergraduate medical students enrolled in the academic year 2021–2022. The efficacy of the image-based teaching–learning method was evaluated through the assessment of pretest, posttest, and exam scores. Students’ feedback was obtained using a pre-established questionnaire utilizing a 3-point Likert scale. The questionnaire’s reliability was assessed using Cronbach’s alpha coefficient test. The results of In-Course Exam-4 were compared to those of In-Course Exams 1, 2, and 3. Correlation coefficients were calculated, as appropriate, to determine the influence of the activity on grades. The data were gathered, inputted into Microsoft Excel, and subjected to statistical analysis using SPSS version 22. Results: The study comprised 127 students. The post-test scores of students exhibited a considerable increase (26.82 ± 3.14) in comparison to the pre-test scores (8.42 ± 5.62). Students’ perception of the efficacy of image-based learning in enhancing their lifelong learning skills was highly favorable (Cronbach’s alpha for all questions was 0.756). A majority of students (>80%) expressed that image-based learning was engaging, promoted peer conversation, and facilitated their ability to recognize, investigate, and modify crucial information and enhance their knowledge. Approximately 70% of respondents indicated that image-based learning improved their abilities in critical thinking and problem-solving. Nine out of 10 students endorsed an image-based learning method for future topics. Conclusions: In summary, the utilization of the image-based learning method proved to be successful in attaining the learning outcomes of undergraduate medical students in microbiology. The study’s findings supported the adoption of an image-based learning strategy in microbiology courses. Nevertheless, it is necessary to conduct multicentric studies to validate our study findings.

Introduction The current literature suggests that the frequency and complexity of public health emergencies are rising and this trend will likely continue. From 2000 to 2023, seven events have been declared as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Organisational models such as the Incident Management System, Incident Response System and Incident Command System or country-specific models are essential in managing PHEIC.The review aims to achieve four key objectives. First, identify and describe the organisational models used in the South-East Asia Region (SEAR) nations defined by WHO as Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste and DPR Korea for managing PHEICs. Second, explore the indicators used to gauge the effectiveness of these models. Third, assess how these indicators impact the overall success of organisational models. Finally, the review will delve into the implementation aspects gaining a deeper understanding of how the organisational models are put into practice to manage PHEICs in the SEAR region.Methods and analysis Following Preferred Reporting Items for Systematic review and Meta-Analysis Protocols guidelines, a qualitative evidence synthesis will be conducted. A defined search strategy will be employed to conduct a comprehensive literature search of the following academic databases: PubMed (MEDLINE), Excerpta Medica Database, Cochrane CENTRAL, Cumulative Index to Nursing and Allied Health Literature, WHO Library Database, US Centers for Disease Control and Prevention (CDC), CDC’s Morbidity and Mortality Weekly Report and Web of Science; as well as non-academic databases including Google Scholar, Evidence Aid, Epistemonikos, Shodhganga and ResearchGate. This review will employ the SPIDER-D tool for searching qualitative studies. Two reviewers will check the quality of included studies and will be appraised using standard critical appraisal tools. In case of any difference between the two reviewers, a third reviewer will take the decision.Ethics and dissemination No ethical approval is required. Results will be published in a peer-reviewed journal and disseminated through a workshop for stakeholders and policymakers.PROSPERO registration number CRD42023394418.

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With the discovery of low-density lipoprotein (LDL) receptor in 1980s much of the therapeutic developments have had a robust influence in LDL-c reduction and guidelines globally have documented targets for LDL-c and other lipoproteins. Despite the advances, the risk for atherosclerotic cardiovascular disease (ASCVD) remains high globally and the prevalence of ASCVD has increased since 1990 from 271 million to 523 million in 2019. With time it has become evident that at any level of LDL-c, ASCVD events rate are a 2-3 fold risk higher, when lipoprotein little a Lp(a) level is elevated. Furthermore, the ASCVD risk from elevated Lp(a) has been demonstrated to be similar in magnitude to each of the established major risk factors (hypercholesterolemia, smoking, hypertension, diabetes, etc.). It means unlike other established risk factors, but like homozygous familial hypercholesterolemia, Lp(a) levels influence atherogenicity from birth. Since 24% of the world's population (1.891 billion) is in South Asia (India, Pakistan, Afghanistan, Nepal, Bangladesh, and Sri Lanka) and Indians do tend to elicit ASCVD 5-10 years earlier than other populations; clinicians in this geography may be prudent to consider intervention without waiting given the early incidence of disease and the high burden of illness in this geography. There are no approved medications for lowering Lp(a), but medications have been demonstrated to modulate Lp(a). Except for statins most currently available hypolipidemic agents demonstrate mixed and perhaps ambiguous effects on Lp(a). Emerging nucleic acid-based therapies allow for selective gene silencing, thus preventing the production of proteins that may cause or enhance ASCVD. This review summarise available scientific knowledge and progress made in understanding Lp(a) and the current research that is in works of planned with newer therapeutics.

Introduction: Neonatal sepsis remains a diagnostic burden globally, responsible for about 30-50% of the total neonatal deaths each year in developing countries. Neutrophil CD-64 is found to be a promising marker for the diagnosis of early and late infections in newborns. Human Leukocyte Antigen-DR (HLA-DR) is a glycosylated cell surface transmembrane protein expressed on monocytes, allowing antigen presentation to T-cells and playing a crucial role in initiating the immune cascade during sepsis. Decreased expression of HLA-DR on monocytes has been associated with decreased survival in newborns with sepsis. Aim: To evaluate the role of neutrophil CD-64 and monocyte HLA-DR expression as markers of neonatal sepsis. Materials and Methods: This was a cross-sectional prospective study carried out at the Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between July 2016 and June 2017. Total of 70 full-term neonates with clinical suspicion of sepsis were enrolled. A 2 mL peripheral venous blood sample was collected for flow cytometry, blood culture, and sepsis screening in all patients. The expression of cell surface markers (CD-64 on neutrophils and HLA-DR on monocytes) was measured by an eight-color flow cytometer. A composite parameter was derived by dividing the Mean Fluorescence Intensity (MFI) values of nCD-64 and their respective mHLA-DR, multiplying the ratio by 100, and terming it as the sepsis index (Sepsis Index = nCD-64/mHLA-DR x 100). A region was drawn on monocytes on an SSC/CD14 plot. Gating was performed on ‘not monocytes’ on the SSC/CD45 bivariate dot plot, and regions were drawn on lymphocytes and neutrophils. Data were entered into a Microsoft Excel spreadsheet and analysed using Statistical Package for Social Sciences (SPSS) version 21.0 statistical software. The Chi-square test was applied for proportions, and the Analysis of Variance (ANOVA) test was applied for normally distributed data. Results: In this study, 70 symptomatic neonates clinically suspected to have sepsis were enrolled and categorised into the sepsis group and the no Sepsis group. The sepsis group was further subgrouped into Definite Sepsis (Blood culture positive) and Probable Sepsis (Symptomatic baby with sepsis screen positive but sterile blood culture). nCD-64 positivity was observed in all cases (n=19) of definite sepsis. nCD-64 revealed 100% sensitivity, 87.5% specificity, 86.36% Positive Predictive Value (PPV), 100% Negative Predictive Value (NPV), and 93.02% diagnostic accuracy in culture-positive sepsis. However, downregulation of mHLA-DR observed in the present study alone showed poor diagnostic utility. The Sepsis index showed sensitivity of 94.73%, specificity of 62.50%, PPV of 66.66%, NPV of 93.75%, and accuracy of 76.74% in the definite sepsis group. Conclusion: Flow cytometric assessment of neutrophil CD-64 may be considered a rapid and reliable marker for the diagnosis of bacterial neonatal sepsis. mHLA-DR may be beneficial for monitoring patients at a later point in time for the identification of delayed immuno-suppression in neonatal sepsis.

Abstract Myocarditis is considered a fatal form of foot-and-mouth disease (FMD) in suckling calves. In the present study, a total of 17 calves under 4 months of age and suspected clinically for FMD were examined for clinical lesions, respiratory rate, heart rate, and heart rhythm. Lesion samples, saliva, nasal swabs, and whole blood were collected from suspected calves and subjected to Sandwich ELISA and reverse transcription multiplex polymerase chain reaction (RT-mPCR) for detection and serotyping of FMD virus (FMDV). The samples were found to be positive for FMDV serotype “O”. Myocarditis was suspected in 6 calves based on tachypnoea, tachycardia, and gallop rhythm. Serum aspartate aminotransferase (AST), creatinine kinase myocardial band (CK-MB) and lactate dehydrogenase (LDH), and cardiac troponins (cTnI) were measured. Mean serum AST, cTn-I and LDH were significantly higher (P 2 months 2 months

Abstract The primary objective of Sustainable Development Goal target 2.5 established by the United Nations is to ensure the preservation of genetic diversity in domesticated animals. The ICAR-National Bureau of Animal Genetic Resources in India has been actively engaged in the conservation of cattle and buffalo bull semen for long-term storage. This present study aimed to assess the genetic diversity present in the conserved cattle bull semen, which would aid in determining the most suitable strategy for future conservation management. A total of 192 bull semen belonging to 19 cattle breeds were selected to evaluate genetic diversity using 17 pairs of FAO recommended microsatellite primers. Total 267 alleles were detected across all the samples which indicates substantial amount of allelic variation is being maintained in conserved bulls. Further, all cattle bulls semen conserved showed higher observed heterozygosity than expected heterozygosity which indicates excess genetic diversity in all the populations. The FST, F IT and FIS value across the loci and population is 0.146 ± 0.009, 0.054 ± 0.038, and − 0.105 ± 0.035, respectively, which suggests lack of inbreeding in conserved cattle bull semen. This study has established genetic diversity in conserved cattle semen samples to achieve sustainable development goals. In addition, it provides compelling evidence that the current approach for conserving cattle bull semen is heading in the correct direction.

Abstract Fusarium wilt, caused by (Fusarium udum Butler), is a significant threat to pigeonpea crops worldwide, leading to substantial yield losses. Traditional approaches like fungicides and resistant cultivars are not practical due to the persistent and evolving nature of the pathogen. Therefore, native biocontrol agents are considered to be more sustainable solution, as they adapt well to local soil and climatic conditions. In this study, five isolates of F. udum infecting pigeonpea were isolated from various cultivars and characterized morphologically and molecularly. The isolate from the ICP 8858 cultivar displayed the highest virulence of 90%. Besides, 100 endophytic bacteria, 100 rhizosphere bacteria and three Trichoderma spp. were isolated and tested against F. udum isolated from ICP 8858 under in vitro conditions. Out of the 200 bacteria tested, nine showed highest inhibition, including Rb-4 (Bacillus sp.), Rb-11 (B. subtilis), Rb-14 (B. megaterium), Rb-18 (B. subtilis), Rb-19 (B. velezensis), Eb-8 (Bacillus sp.), Eb-11 (B. subtilis), Eb-13 (P. aeruginosa), and Eb-21 (P. aeruginosa). Similarly, Trichoderma spp. were identified as T. harzianum, T. asperellum and Trichoderma sp. Notably, Rb-18 (B. subtilis) and Eb-21 (P. aeruginosa) exhibited promising characteristics such as the production of hydrogen cyanide (HCN), cellulase, siderophores, ammonia and nutrient solubilization. Furthermore, treating pigeonpea seedlings with these beneficial microorganisms led to increased levels of key enzymes (POD, PPO, and PAL) associated with resistance to Fusarium wilt, compared to untreated controls. In field trials conducted for four seasons, the application of these potential biocontrol agents as seed treatments on the susceptible ICP2376 cultivar led to the lowest disease incidence. Specifically, treatments T2 (33.33) (P. aeruginosa) and T3 (35.41) (T. harzianium) exhibited the lowest disease incidence, followed by T6 (36.5) (Carbendizim), T1 (36.66) (B. subtilis), T4 (52.91) (T. asperellum) and T5 (53.33) (Trichoderma sp.). Results of this study revealed that, P. aeruginosa (Eb-21), B. subtilis (Rb-18) and T. harzianum can be used for plant growth promotion and management of Fusarium wilt of pigeonpea.

Background: India has been classified by the World Health Organization as an endemic country with the highest incidence of rabies-related deaths globally. Therefore, any instance of a dog or wild animal bite is considered a potential exposure to rabies. The National Action Plan for Dog-Mediated Rabies Elimination emphasizes the importance of formulating state and district-level action plans tailored to local circumstances and evidence. A cross-sectional study analyzed the epidemiological traits of animal bites reported at the anti-rabies clinic of a tertiary hospital in Jaipur, Rajasthan, India. Materials and Methods: The research was conducted at Sawai Man Singh Medical Hospital in Jaipur, India, from September to October 2022. A pretested interviewer-administered questionnaire was used to collect data on the socio-demographic and epidemiological features of animal bites from a sample of 328 victims. Descriptive statistics and a spatial map were employed to analyze the results. Results: Among animal bite victims, 73% were males, and 35% fell within the age group of 5–18 years. The majority of cases, accounting for 92%, were categorized as category III exposure, with 61% of the victims being bitten on their lower limbs. Dogs were responsible for 76% of the bites, while monkeys accounted for 21%. Approximately 74% of dog bites were inflicted by stray dogs, and 82% of these incidents were unprovoked. Conclusion: The study highlights a higher prevalence of category III exposure and monkey bites compared to previous research, along with subpar adherence to prior immunizations. Most animal bite incidents were observed in public areas, particularly on streets and tourist destinations. These findings emphasize the importance of customizing district and state action plans to the specific context in Rajasthan to combat rabies effectively.

Aim: To analyze the potential predisposing factors and clinical presentation of mucormycosis in patients with COVID-19. Material and Methods: Medical records of 141 patients with COVID-19-associated mucormycosis (CAM) treated at a tertiary care center in Bihar were reviewed. The predisposing factors, clinical features, and imaging findings of mucormycosis were analyzed. Results: The median age was 48 years (IQR, 43-60). A total of 58 patients developed concurrent CAM and 83 post-CAM. The median interval between COVID-19 and onset of CAM symptoms was 15 days (IQR, 9–16). A total of 80 patients received at-home treatment for COVID-19, and 73 had mild-to-moderate disease. While 61 patients received in-hospital treatment, 57 had severe disease. At presentation, 131 patients had hyperglycemia: 64 type 2 diabetes mellitus (DM) and 67 new-onset DM. The history of glucocorticoid use for COVID-19 was present in 125 patients; 47% were administered at home without monitoring plasma glucose. The common presenting features were toothache, periocular or facial pain, and edema. Rhino-orbital mucormycosis was the most common. Imaging revealed rhinosinusitis in all patients, including pansinusitis (68%), pterygopalatine fossa involvement (21%), cavernous sinus thrombosis (38%), brain abscess (8%), and infarct (4%). All patients received intravenous liposomal amphotericin B, and surgical debridement was performed in 113. Conclusion: COVID-19 patients with hyperglycemia are at risk of developing CAM, irrespective of the severity. Timely recognition of symptoms and prompt initiation of therapy by primary healthcare physicians are imperative for enhancing outcomes. Additionally, glucocorticoid overuse should be avoided, and close monitoring for hyperglycemia development is warranted.

Significant progress has been made in the understanding of many human diseases, especially cancers, which has contributed to improved and increased survival. The Human Genome Project and The Cancer Genome Atlas project brought about a new era, with an understanding of inherited diseases at a molecular level, which subsequently facilitated the option of precision medicine. Precision medicine has helped tailor treatment decisions at an individual level, for instance in terms of surgical treatments or targeted therapies in advanced diseases. Despite the increasing advances in genetic-lead precision medicine, this has not translated into increasing uptake among patients. Reasons for this may be potential knowledge gaps among clinicians; on reasons for poor uptake of genetic testing such as for cultural, religious or personal beliefs; and on financial implications such as lack of support from insurance companies. In this review, we look at the current scenario of genetic screening for common inherited endocrine conditions affecting the thyroid, parathyroid and adrenal glands in Singapore, and the implications associated with it.

The majority of malignant pleural effusions are caused by adenocarcinomas, with the most common primary sites being the lung and breast in men and women, respectively. Metastatic squamous cell carcinoma in serous effusions is rare, accounting for less than 3% of all malignant effusions. The most common primary site of origin for metastatic squamous cell carcinoma involving serous effusions is the lung, followed by the head and neck, oesophagus, and cervix. Well-differentiated squamous cell carcinoma in pleural effusion, characterised by keratinised cells with hyperchromatic nuclei, tadpole cells, and fiber cells, is exceedingly rare. Poorly differentiated squamous cell carcinomas often present a diagnostic challenge and can be mistaken for poorly differentiated adenocarcinoma, malignant mesothelioma, or reactive mesothelial hyperplasia. Immunohistochemistry is often required for a definitive diagnosis. Making an accurate diagnosis is crucial for providing optimal treatment to the patient. In this series, four cases (56 years old male,69 years old male, 60 years old female and 81 years old male) of malignant pleural effusion caused by metastatic squamous cell carcinoma arising from the lung, oropharynx, cervix, and oesophagus were examined. While one of the cases involved a well-differentiated squamous cell carcinoma with characteristic cellular morphology that allowed for a straightforward diagnosis, the other three cases were poorly differentiated squamous cell carcinomas that required cell block preparation and immunohistochemistry for confirmation.

Abstract Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. “Other” specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouse’s work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sex’s impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages.

Abstract The rapid progress that plasma wakefield accelerators are experiencing is now posing the question as to whether they could be included in the design of the next generation of high-energy electron-positron colliders. However, the typical structure of the accelerating wakefields presents challenging complications for positron acceleration. Despite seminal proof-of-principle experiments and theoretical proposals, experimental research in plasma-based acceleration of positrons is currently limited by the scarcity of positron beams suitable to seed a plasma accelerator. Here, we report on the first experimental demonstration of a laser-driven source of ultra-relativistic positrons with sufficient spectral and spatial quality to be injected in a plasma accelerator. Our results indicate, in agreement with numerical simulations, selection and transport of positron beamlets containing $$N_{e+}\ge 10^5$$ N e + ≥ 10 5 positrons in a 5% bandwidth around 600 MeV, with femtosecond-scale duration and micron-scale normalised emittance. Particle-in-cell simulations show that positron beams of this kind can be guided and accelerated in a laser-driven plasma accelerator, with favourable scalings to further increase overall charge and energy using PW-scale lasers. The results presented here demonstrate the possibility of performing experimental studies of positron acceleration in a laser-driven wakefield accelerator.

Abstract Nitrogen (N) and phosphorus (P) are vital for crop growth. However, most agricultural systems have limited inherent ability to supply N and P to crops. Biochars (BCs) are strongly advocated in agrosystems and are known to improve the availability of N and P in crops through different chemical transformations. Herein, a soil-biochar incubation experiment was carried out to investigate the transformations of N and P in two different textured soils, namely clay loam and loamy sand, on mixing with rice straw biochar (RSB) and acacia wood biochar (ACB) at each level (0, 0.5, and 1.0% w/w). Ammonium N (NH4-N) decreased continuously with the increasing incubation period. The ammonium N content disappeared rapidly in both the soils incubated with biochars compared to the unamended soil. RSB increased the nitrate N (NO3–N) content significantly compared to ACB for the entire study period in both texturally divergent soils. The nitrate N content increased with the enhanced biochar addition rate in clay loam soil until 15 days after incubation; however, it was reduced for the biochar addition rate of 1% compared to 0.5% at 30 and 60 days after incubation in loamy sand soil. With ACB, the net increase in nitrate N content with the biochar addition rate of 1% remained higher than the 0.5% rate for 60 days in clay loam and 30 days in loamy sand soil. The phosphorus content remained consistently higher in both the soils amended with two types of biochars till the completion of the experiment.

Objectives: The management of valgus-impacted neck of femur fracture is controversial between operative and conservative treatments. This study aimed to investigate the usefulness of the Clinical frailty Score for predicting the prognosis of patients who underwent non-operative treatment for the valgus-impacted neck of femur fracture (NOF). Methods: A single-centred retrospective review of patients admitted with valgus impacted NOF. Data were collected from patients’ records, including demographics, Clinical Frailty Score (CFS), Nottingham Hip Fracture Score (NHFS) and Abbreviated Mental Test Score (AMTS). Patients were followed up to 24 months postoperatively. Results: Fifty-eight patients who were treated non-operatively with a mean follow-up of 2.6 years met our inclusion criteria. Twenty-nine patients failed the non-operative treatment and required replacement surgeries, while 29 had successful outcomes (50%). There were no differences between the two groups’ mean age and gender distributions (P 0.527 and 0.139, respectively). The successful group had significantly higher CFS (P 0.013), worse AMTS and higher mortality risk based on the NHFS (P 0.006 and P < 0.001, respectively). Conclusion: This study demonstrates that CFS, AMTS and NHFS can be used as predictors when considering non-operative treatment for the valgus-impacted neck of femur fracture. Patients who are frail, demented and high risk based on the NHFS have higher success rates with non-operative treatment.

Abstract The study presented here aims at assessing the effects of hypobaric hypoxia on RAAS pathway and its components along with mitigation of anomalies with quercetin prophylaxis. One hour prior to hypobaric hypoxia exposure, male SD rats were orally supplemented with quercetin (50 mg/kg BW) and acetazolamide (50 mg/kg BW) and exposed them to 25,000 ft. (7,620 m) in a simulated environmental chamber for 12 h at 25 ± 2 °C. Different biochemical parameters like renin activity, aldosterone, angiotensin I, ACE 2 were determined in plasma. As a conventional response to low oxygen conditions, oxidative stress parameters (ROS and MDA) were elevated along with suppressed antioxidant system (GPx and catalase) in plasma of rats. Quercetin prophylaxis significantly down regulated the hypoxia induced oxidative stress by reducing plasma ROS & MDA levels with efficient enhancement of antioxidants (GPx and Catalase). Further, hypoxia mediated regulation of renin and ACE 2 proves the outstanding efficacy of quercetin in repudiating altercations in RAAS cascade due to hypobaric hypoxia. Furthermore, differential protein expression of HIF-1α, NFκB, IL-18 and endothelin-1 analyzed by western blotting approves the biochemical outcomes and showed that quercetin significantly aids in the reduction of inflammation under hypoxia. Studies conducted with Surface Plasmon Resonance demonstrated a binding among quercetin and ACE 2 that indicates that this flavonoid might regulate RAAS pathway via ACE 2. Henceforth, the study promotes the prophylaxis of quercetin for the better adaptability under hypobaric hypoxic conditions via modulating the RAAS pathway.

Abstract Chromium nitride (CrN) spurred enormous interest due to its coupled magnetostructural and unique metal-insulator transition. The underneath electronic structure of CrN remains elusive. Herein, the electronic structure of epitaxial CrN thin film has been explored by employing resonant photoemission spectroscopy (RPES) and X-ray absorption near edge spectroscopy study in combination with the first-principles calculations. The RPES study indicates the presence of a charge-transfer screened 3 $$d ^n{\underline{L}}$$ d n L ̲ ( $$L$$ L : hole in the N-2 $$p$$ p ) and 3 $$d ^{n-1}$$ d n - 1 final-states in the valence band regime. The combined experimental electronic structure along with the orbital resolved electronic density of states from the first-principles calculations reveals the presence of Cr(3 $$d$$ d )-N(2 $$p$$ p ) hybridized (3 $$d ^n{\underline{L}}$$ d n L ̲ ) states between lower Hubbard (3 $$d ^{n-1}$$ d n - 1 ) and upper Hubbard (3 $$d ^{n+1}$$ d n + 1 ) bands with onsite Coulomb repulsion energy (U) and charge-transfer energy ( $$\Delta$$ Δ ) estimated as $$\approx$$ ≈ 4.5 and 3.6 eV, respectively. It verifies the participation of ligand (N-2 $$p$$ p ) states in low energy charge fluctuations and provides concrete evidence for the charge-transfer ( $$\Delta

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Introduction Diabetes is a significant metabolic disorder characterized by high blood glucose levels, leading to various complications if not properly managed. Understanding these factors is crucial for early identification, effective prevention, and management of diabetes within this community. Our study focused on the prevalence and risk factors of diabetes in Puzhakkatiri, a village in Malappuram district, Kerala, aiming to provide insights into local epidemiological patterns and targeted public health interventions. Methodology The community-based cross-sectional study included 582 participants (?18 years) selected via multistage sampling from Puzhakkattiri Panchayath, Northern Kerala, India. Selected participants were invited to a camp that was held at the Government school in collaboration with the panchayath office, where participants had their BMI, waist-to-hip ratio, fasting blood sugar (FBS), and postprandial blood sugar (PPBS) levels measured. Sociodemographic data were collected through interviews, and the data were analyzed using SPSS software, with a p-value of 0.05 or lower indicating statistical significance. Results The study, with participants having a mean age of 39.13 ± 12.56 years, found a diabetes prevalence of 30% and an impaired glucose tolerance prevalence of 47.4%. Higher diabetes rates were observed among individuals over 40 years (37.2%), those divorced/widowed/separated (46.5%), those with lower education levels (40%), those in unskilled occupations (34.4%), and those with overweight BMI (33%) or high waist-to-hip ratios (34.5%). Significant associations (p-value

Key Clinical Message Coronary artery aneurysms and ST‐segment elevation myocardial infarction are rare in clinical practice, presenting a management challenge. To the best of our knowledge, this case appears to be the first successful percutaneous treatment of a completely obstructed aneurysmal left main coronary artery.

Patients with chest wall tumors present diagnostic and therapeutic challenges. The differential diagnosis of these tumors is broad because they can present a heterogeneous spectrum of diseases such as primary benign or malignant tumors, metastasis, local extension of adjacent tumors, and infectious or inflammatory conditions. Among that, primary chest wall tumors are rare.