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The diagnosis and prognosis of cardiovascular disease are crucial medical tasks to ensure correct classification, which helps cardiologists provide proper treatment to the patient. Machine learning applications in the medical niche have increased as they can recognize patterns from data. Using machine learning to classify cardiovascular disease occurrence can help diagnosticians reduce misdiagnosis. This research develops a model that can correctly predict cardiovascular diseases to reduce the fatality caused by cardiovascular diseases. This paper proposes a method of k-modes clustering with Huang starting that can improve classification accuracy. Models such as random forest (RF), decision tree classifier (DT), multilayer perceptron (MP), and XGBoost (XGB) are used. GridSearchCV was used to hypertune the parameters of the applied model to optimize the result. The proposed model is applied to a real-world dataset of 70,000 instances from Kaggle. Models were trained on data that were split in 80:20 and achieved accuracy as follows: decision tree: 86.37% (with cross-validation) and 86.53% (without cross-validation), XGBoost: 86.87% (with cross-validation) and 87.02% (without cross-validation), random forest: 87.05% (with cross-validation) and 86.92% (without cross-validation), multilayer perceptron: 87.28% (with cross-validation) and 86.94% (without cross-validation). The proposed models have AUC (area under the curve) values: decision tree: 0.94, XGBoost: 0.95, random forest: 0.95, multilayer perceptron: 0.95. The conclusion drawn from this underlying research is that multilayer perceptron with cross-validation has outperformed all other algorithms in terms of accuracy. It achieved the highest accuracy of 87.28%.

Background: Respiratory protective equipment recommended in the UK for healthcare workers (HCWs) caring for patients with COVID-19 comprises a fluid-resistant surgical mask (FRSM), except in the context of aerosol generating procedures (AGPs). We previously demonstrated frequent pauci- and asymptomatic severe acute respiratory syndrome coronavirus 2 infection HCWs during the first wave of the COVID-19 pandemic in the UK, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Methods: Here, we use observational data and mathematical modelling to analyse infection rates amongst HCWs working on ‘red’ (coronavirus disease 2019, COVID-19) and ‘green’ (non-COVID-19) wards during the second wave of the pandemic, before and after the substitution of filtering face piece 3 (FFP3) respirators for FRSMs. Results: Whilst using FRSMs, HCWs working on red wards faced an approximately 31-fold (and at least fivefold) increased risk of direct, ward-based infection. Conversely, after changing to FFP3 respirators, this risk was significantly reduced (52–100% protection). Conclusions: FFP3 respirators may therefore provide more effective protection than FRSMs for HCWs caring for patients with COVID-19, whether or not AGPs are undertaken. Funding: Wellcome Trust, Medical Research Council, Addenbrooke’s Charitable Trust, NIHR Cambridge Biomedical Research Centre, NHS Blood and Transfusion, UKRI.

Introduction: In‐hospital stroke (IHS) is defined as stroke that occurs during hospitalization for non‐stroke conditions. We aimed to understand the timing of symptom recognition for patients who experienced IHS and its impact on the care they receive. Methods: A prospective, single center registry of adult patients (9/20/19‐2/28/21) was queried for acute anterior circulation IHS. Indications for hospitalization, delays from last known well (LKW) to symptom recognition, imaging, and treatment were explored. Results: Of 928 consecutively evaluated adults with acute stroke, 85 (9%) developed an anterior circulation IHS, 39 (46%) of whom were female, with a median age of 67 years (IQR 60–76) and median NIHSS of 15 (IQR 4–22). Sixty‐eight (80%) had a >1 hour delay from last known well to symptom recognition. Two patients (2%) received IV thrombolysis, although another 38 (45%) would have been eligible if not for a delay in symptom recognition. An ICA, M1, or M2 occlusion was observed in 18 patients (21%), 7 of whom were treated at a median of 174 minutes after LKW (IQR 65–219). Compared to the 11 patients who did not undergo thrombectomy with large vessel occlusion, those who underwent thrombectomy had non‐significantly shorter delays from LKW until neuroimaging (median 85 [IQR 65‐162] vs. 216 [IQR 133‐507], p = 0.12). Conclusions: While uncommon, patients with IHS experience delays in symptom recognition and treatment, which lead to exclusion from acute care treatment such as thrombolysis and thrombectomy. Earlier detection with more frequent nursing assessments or advanced neuromonitoring devices in at‐risk patients may reduce delays in care.

Introduction: Increased transmissibility of B.1.1.7 variant of concern (VOC) in the UK may explain its rapid emergence and global spread. We analysed data from putative household infector - infectee pairs in the Virus Watch Community cohort study to assess the serial interval of COVID-19 and whether this was affected by emergence of the B.1.1.7 variant. Methods: The Virus Watch study is an online, prospective, community cohort study following up entire households in England and Wales during the COVID-19 pandemic. Putative household infector-infectee pairs were identified where more than one person in the household had a positive swab matched to an illness episode. Data on whether or not individual infections were caused by the B.1.1.7 variant were not available. We therefore developed a classification system based on the percentage of cases estimated to be due to B.1.1.7 in national surveillance data for different English regions and study weeks. Results: Out of 24,887 illnesses reported, 915 tested positive for SARS-CoV-2 and 186 likely ‘infector-infectee’ pairs in 186 households amongst 372 individuals were identified. The mean COVID-19 serial interval was 3.18 (95%CI: 2.55 - 3.81) days. There was no significant difference (p=0.267) between the mean serial interval for VOC hotspots (mean = 3.64 days, (95%CI: 2.55 – 4.73)) days and non-VOC hotspots, (mean = 2.72 days, (95%CI: 1.48 – 3.96)). Conclusions: Our estimates of the average serial interval of COVID-19 are broadly similar to estimates from previous studies and we find no evidence that B.1.1.7 is associated with a change in serial intervals. Alternative explanations such as increased viral load, longer period of viral shedding or improved receptor binding may instead explain the increased transmissibility and rapid spread and should undergo further investigation.

Berberine is a quaternary ammonium salt and naturally occurring benzylisoquinoline alkaloid, present in numerous medicinal herbs’ roots and stem bark as an active constituent, especially in the genus Berberis. It contains many pharmacological properties such as antioxidant, antiviral, antidiabetic, antidepressant, antidiarrheal, antibacterial any many more. Since nature is the best healer, it has been traditionally used in Ayurvedic and Chinese medicine to mitigate several disease conditions. Besides the beneficial effects of berberine, some drawbacks such as its poor aqueous solubility and low oral bioavailability hinder its applications. Although it has been used for dietary supplements, despite its vast potential to evolve as a drug candidate, there are no approved pure berberine formulations available in market for any particular disease. Therefore, this review provides an overview to the reader by incorporating recent studies on berberine's sources, extraction techniques, chemistry, different Nano carriers and bioavailability enhancers for enhancing bioavailability, versatile applications, toxicological aspects and recent patents along with future perspectives. The accumulated evidence may broaden the horizon of drug designers, scientists, academicians, and researchers on berberine and help design and develop effective berberine formulations on a large scale for treating several diseases.

Introduction The coronavirus (COVID-19) pandemic has caused significant global mortality and impacted lives around the world. Virus Watch aims to provide evidence on which public health approaches are most likely to be effective in reducing transmission and impact of the virus, and will investigate community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviours.Methods and analysis Virus Watch is a household community cohort study of acute respiratory infections in England and Wales and will run from June 2020 to August 2021. The study aims to recruit 50 000 people, including 12 500 from minority ethnic backgrounds, for an online survey cohort and monthly antibody testing using home fingerprick test kits. Nested within this larger study will be a subcohort of 10 000 individuals, including 3000 people from minority ethnic backgrounds. This cohort of 10 000 people will have full blood serology taken between October 2020 and January 2021 and repeat serology between May 2021 and August 2021. Participants will also post self-administered nasal swabs for PCR assays of SARS-CoV-2 and will follow one of three different PCR testing schedules based on symptoms.Ethics and dissemination This study has been approved by the Hampstead National Health Service (NHS) Health Research Authority Ethics Committee (ethics approval number 20/HRA/2320). We are monitoring participant queries and using these to refine methodology where necessary, and are providing summaries and policy briefings of our preliminary findings to inform public health action by working through our partnerships with our study advisory group, Public Health England, NHS and government scientific advisory panels.

Herbal teas are nutrient, antioxidant, and hydration rich brews made from herbs and spices and taken for various purposes. The objective of this study was to formulate tea from clove (Syzygium aromaticum), leaves of lemongrass (Cymbopogon citratus), guava (Psidium guajava), and moringa (Moringa oleifera), as well as compared with Chinese and yellow Lipton Tea. The samples were analyzed for comparative sensory analysis using the 7 points hedonic scale. The sensory evaluation result demonstrated that the color of the clove tea sample (5.87) was most acceptable by participants, while the lemongrass tea (4.46) sample was least acceptable amongst all the tea samples. The clove remained the most accepted tea for aroma (6.07), taste (5.92), texture (5.76), general appearance (5.74), and general acceptability (5.93), in 7 points hedonic scale. However, all tea samples were had significant acceptable scores above average (p

Background: One in seven people living in the United Kingdom (UK) is an international migrant, rendering migrants an important population group with diverse and dynamic health and healthcare needs. However, there has been no attempt to map contemporary trends within migration health research conducted in the UK. The aim of this scoping review was to describe trends within migration health research and identify gaps for future research agendas. Methods: PubMed and Embase were systematically searched for empirical research with a primary focus on the concepts “health” and “migrants” published between 2001 and 2019. Findings were analysed using the UCL-Lancet Commission on Migration and Health Conceptual Framework for Migration and Health. Results: In total, 399 studies were included, with almost half (41.1%; 164/399) published in the last five years of the study period between 2015 and 2019 and a third (34.1%; 136/399) conducted in London. Studies included asylum seekers (14.8%; 59/399), refugees (12.3%; 49/399), and undocumented migrants or migrants with insecure status (3.5%; 14/399), but most articles (74.9%; 299/399) did not specify a migrant sub-group. The most studied health topics were specific disease outcomes such as infectious diseases (24.1% of studies) and mental health (19.1%) compared to examining systems or structures that impact health (27.8%), access to healthcare (26.3%), or specific exposures or behaviours (35.3%). Conclusions: There has been a growing interest in migration health. Ensuring a diverse geographic distribution of research conducted in the UK and disaggregation by migrant sub-group is required for a nuanced and region-specific understanding of specific health needs, interventions and appropriate service delivery for different migrant populations. More research is needed to understand how migration policy and legislation intersect with both the social determinants of health and access to healthcare to shape the health of migrants in the UK.

24-nt phased siRNA (phasiRNA) regulate reproduction in grasses, yet are absent from Arabidopsis, and were thought to be monocot-specific. Here, Xia et al. show that 24-nt phasiRNAs are in fact broadly distributed among eudicots and are consistently enriched during meiosis, despite possibly arising from distinct biogenesis pathways.

Introduction: Canadians are living longer than before, and a large proportion of them are living with obesity. The present study sought to describe how older participants in the Canadian Longitudinal Study on Aging (CLSA) who are living with obesity are aging, through an examination of measures of social, functional and mental well-being. Methods: We used data from the first wave of the CLSA for people aged 55 to 85 years in this study. We used descriptive statistics to describe characteristics of this population and adjusted generalized logistic models to assess measures of social, functional and mental well-being among obese participants (body mass index ≥ 30 kg/m2) relative to non-obese participants. Findings are presented separately for females and males. Results: More than half of the participants reported living with a low personal income (less than $50 000); females were particularly affected. Less than half of the participants were obese; those who were had higher odds of multimorbidity than those who were not living with obesity (among those aged 55–64 years: odds ratio [OR] 2.7, 95% CI: 2.0–3.5 males; OR 2.8, 95% CI: 2.2–2.5 females). Low social participation was associated with obesity among older female participants, but not males. Physical functioning issues and impairments in activities of daily living were strongly associated with obesity for both females and males. While happiness and life satisfaction were not associated with obesity status, older females living with obesity reported negative impressions of whether their aging was healthy. Conclusion: The odds of multimorbidity were higher among participants who were obese, relative to those who were not. Obese female participants tended to have a negative perception of whether they were aging healthily and had lower odds of involvement in social activities, while both sexes reported impairments in functional health. The associations we observed, independent of multimorbidity in older age, highlight areas where healthy aging initiatives may be merited.

Abstract Background Pore-forming proteins released from bacteria or formed as result of complement activation are known to produce severe cell damage. Inhibition of purinergic P2X receptors markedly reduces damage inflicted by cytolytic bacterial toxin and after complement activation in both erythrocytes and monocytes. P2X expression generally shows variation throughout the population. Here, we investigate correlation between P2X receptor abundance in blood cell plasma membranes and haematocrit during sepsis, in patients admitted to the emergency department (ED) or intensive care unit (ICU). Method Patients admitted to the ED and successively transferred to ICU with the diagnosis sepsis (

Introduction. Si les Canadiens vivent plus longtemps qu’avant, bon nombre d’entre eux souffrent cependant d’obésité. Cette étude vise à décrire, par un examen de mesures du bien-être social, fonctionnel et mental, le vieillissement des personnes âgées souffrant d’obésité ayant participé à l’Étude longitudinale canadienne sur le vieillissement (ELCV). Méthodologie. Nous avons extrait des données du premier cycle de l’ELCV portant sur les personnes de 55 à 85 ans. Nous avons utilisé des statistiques descriptives pour caractériser cette population et ajusté des modèles logistiques généralisés pour comparer les mesures du bien-être social, fonctionnel et mental chez les participants souffrant d'obésité (indice de masse corporelle de 30 kg/m2 et plus) et chez les participants n'en souffrant pas. Nos résultats sont présentés en fonction du sexe. Résultats. Plus de la moitié des participants ont déclaré avoir un revenu personnel relativement faible (moins de 50 000 $), les femmes étant particulièrement affectées. Moins de la moitié des participants souffraient d'obésité et la multimorbidité était plus fréquente parmi ceux souffrant d'obésité que parmi ceux n'en souffrant pas (participants de 55 à 64 ans; rapport de cotes [RC] : 2,7; intervalle de confiance [IC] à 95 % : 2,0 à 3,5 chez les hommes; RC : 2,8; IC à 95 % : 2,2 à 2,5 chez les femmes). La faible participation sociale était associée à l’obésité chez les femmes plus âgées mais pas chez les hommes plus âgés. La présence de problèmes de fonctionnement physique et de limitations dans la vie quotidienne était fortement associée à l’obésité tant chez les femmes que chez les hommes. Bien que le bonheur et la satisfaction à l’égard de la vie ne soient pas associés à l'obésité, les femmes âgées souffrant d’obésité ont déclaré avoir une perception défavorable de leur état de santé. Conclusion. La multimorbidité était plus fréquente chez les participants souffrant d'obésité que chez ceux n'en souffrant pas. Les femmes souffrant d'obésité étaient plus nombreuses que les hommes à avoir une perception défavorable de leur état de santé et à ne pas prendre part à des activités sociales. Les participants des deux sexes ont fait état de problèmes de santé fonctionnelle. Les associations observées, qui sont indépendantes de la multimorbidité chez les personnes âgées, mettent en relief les secteurs où des actions en faveur d'un vieillissement en santé pourraient être bénéfiques.

Purpose: The aim is to evaluate the bacterial contamination in dental unit waterlines (DUWLs) before and after the use of the disinfectant 1% (Lysoformin 3000) for its efficacy also assess the awareness about the same among the practicing dental surgeons of Vadodara city. Methodology: A volume of 20 ml water samples from the DUWLs from the clinics of the practicing dental surgeons of Vadodara city was collected. And were asked to answer a validated questionnaire in private. Disinfection of the waterlines was performed twice a week for 2 weeks with 1% disinfectant (Lysoformin 3000) and the samples were again collected. Qualitative and quantitative microbiological analysis was performed for both the predisinfected and postdisinfected samples. Results: Predisinfection samples showed a mean colony count of 670.35 colony forming unit (CFU)/ml which was reduced to 63.90 CFU/ml (P < 0.001) postdisinfection. Questionnaire assessment showed that 70% awareness of the participants about DUWL infections and the microorganisms associated. However, only 20% practiced any type of DUWL disinfection. Conclusion: Lysoformin 3000 can be promising to be used a DUWL disinfection solution as an easy to use and readily available solution with great antibacterial properties. However, still more long-term studies are required to check for its efficacy in anaerobic bacteria as well as resistant species of microorganisms.

The unique properties of chitosan make it a useful choice for various nanoparticulate drug delivery applications. Although chitosan is biocompatible and enables cellular uptake, its interactions at cellular and systemic levels need to be studied in more depth. This review focuses on the various physical and chemical properties of chitosan that affect its performance in biological systems. We aim to analyze recent research studying interactions of chitosan nanoparticles (NPs) upon their cellular uptake and their journey through the various compartments of the cell. The positive charge of chitosan enables it to efficiently attach to cells, increasing the probability of cellular uptake. Chitosan NPs are taken up by cells via different pathways and escape endosomal degradation due to the proton sponge effect. Furthermore, we have reviewed the interaction of chitosan NPs upon in vivo administration. Chitosan NPs are immediately surrounded by a serum protein corona in systemic circulation upon intravenous administration, and their biodistribution is mainly to the liver and spleen indicating RES uptake. However, the evasion of RES system as well as the targeting ability and bioavailability of chitosan NPs can be improved by utilizing specific routes of administration and covalent modifications of surface properties. Ongoing clinical trials of chitosan formulations for therapeutic applications are paving the way for the introduction of chitosan into the pharmaceutical market and for their toxicological evaluation. Chitosan provides specific biophysical properties for effective and tunable cellular uptake and systemic delivery for a wide range of applications.

Background and Objectives: While the impact of maternal factors on birth outcomes are widely reported, the extent to which paternal involvement and varying cultural family dynamics influence birth outcomes particularly in an international context, remain understudied. The purpose of this study was to assess the relationship between paternal involvement and adverse birth outcomes in South Gujarat, India. Methods: An in-person questionnaire was administered to adult women at delivery or during the one-month postpartum visit at New Civil Hospital, in South Gujarat, India between May and June 2016 to assess level of paternal support and attendance at prenatal appointments and household structure. Pregnancy variables including birthweight and gestational age at delivery were collected from maternal and newborn record/chart review. Chi-square and t-test were used to assess demographics, as appropriate. Logistic regression was used to examine the association between paternal involvement and pregnancy birth outcomes. Results: Of the 404 infants born during the study period, 26.7% were premature (

The increasing prevalence of carbon nanotubes (CNTs) as components of new functional materials has the unintended consequence of causing increases in CNT concentrations in aqueous environments. Aqueous systems are reservoirs for bacteria, including human and animal pathogens, that can form biofilms. At high concentrations, CNTs have been shown to display biocidal effects; however, at low concentrations, the interaction between CNTs and bacteria is more complicated, and antimicrobial action is highly dependent upon the properties of the CNTs in suspension. Here, impact of low concentrations of multiwalled CNTs (MWCNTs) on the biofilm-forming opportunistic human pathogen Pseudomonas aeruginosa is studied. Using phase contrast and confocal microscopy, flow cytometry, and antibiotic tolerance assays, it is found that sub-lethal concentrations (2 mg/L) of MWCNTs promote aggregation of P. aeruginosa into multicellular clusters. However, the antibiotic tolerance of these "young" bacterial-CNT aggregates is similar to that of CNT-free cultures. Overall, our results indicate that the co-occurrence of MWCNTs and P. aeruginosa in aqueous systems, which promotes the increased number and size of bacterial aggregates, could increase the dose to which humans or animals are exposed.

Scrub typhus or Tsutsugamushi disease is a febrile illness caused by bacteria of the family Rickettsiaceae and named Orientia Tsutsugamushi. Severe complications such as acute respiratory distress syndrome (ARDS), encephalitis, interstitial pneumonia, acute renal failure, acute hepatic failure and acute myocarditis may manifest. Fulminant scrub typhus myocarditis can lead to cardiogenic shock and cardiac arrest. Though myocarditis has been described as one of the rare manifestations of this infection, early detection of scrub typhus myocarditis is crucial before patients develop cardiogenic shock. Recovery depends on the prompt administration of hemodynamic support and appropriate antibiotics. We are presenting a case of acute fulminant myocarditis in complicated scrub typhus in a young female known case of atrial septal defect who was previously asymptomatic and not on any therapy for the same prior to admission. She was diagnosed by Enzyme-linked immunosorbent assay scrub typhus serology and 2D Echocardiography (mild mitral and tricuspid regurgitation with right ventricle systolic pressure = 25 mmHg + right atrial pressure and global hypokinesia of left ventricle with an ejection fraction of 25%) and responded very well to the administration of Doxycycline and other supportive treatments.

Background: Cumulative data on radiation monotherapy for Merkel cell carcinoma (MCC) is lacking. Objective: We sought to synthesize all available data on treatment outcomes for radiation monotherapy for inoperable stage I-III MCC. Methods: We performed a systematic review of the current literature. Articles published in English in the PUBMED database up to July 29, 2016 were evaluated. Results: Eight case reports, 4 case series, and 6 retrospective studies, yielding 68 patients, were included in our analysis. Of the 24 stage I/II patients treated with local irradiation, 6 (25%) relapsed and 1 (4%) died from MCC. Of the 24 stage I/II patients treated with local and regional nodal irradiation, 5 (21%) relapsed and 2 (8%) died from MCC. Of the 20 stage III patients treated with local and regional nodal irradiation, 12 (60%) relapsed and 7 (35%) died from MCC. Conclusions: Radiation monotherapy appears to be a reasonable treatment modality for patients with inoperable stage I-III MCC. Further investigation with prospective studies is needed to draw definitive conclusions.

Introduction: The major proportion of the population suffering from nutritional deficiency and continues to grow worldwide, especially in developing countries like India, and it is the most common cause of morbidity and mortality. Aim: To evaluate the oral health-related quality of life (OHRQOL) and nutrition status and association between nutritional status, and OHRQOL in the elderly. Materials and Methods: A cross-sectional study was conducted among the elderly of Karad city. The elderly were subjected to type 3 oral examination. Data regarding the nutritional status and OHRQOL were obtained using Geriatric Oral Health Assessment Index (GOHAI) and mini nutritional assessment (MNA) index. Descriptive statistics was used to analyze data using SPSS version 21. Results: The sample included 200 elderly, of which 59% consisted of males, and 41% are females. The majority of study subjects (46%) were between age group 61 and 70 years. Among the assessed subjects, nearly 95% of them had total scores of GOHAI between 12 and 57 which require "needed dental care." As per MNA, 3.5% had adequate nutrition, 60% were at risk of malnutrition, and remaining 36.5% of subjects were malnourished. There was a significant correlation between GOHAI and MNA scores. Conclusion: Nutritional status was associated with the poor OHRQOL among the elderly. A strong association was found between mean GOHAI and MNA scores and nutrition status and OHRQOL.

Background: Inadequate dermoscopy training represents a major barrier to proper dermoscopy use. Objective: To better understand the status of dermoscopy training in US residency programs. Methods: A survey was sent to 417 dermatology residents and 118 program directors of dermatology residency programs. Results: Comparing different training times for the same training type, residents with 1-10 hours of dedicated training had similar confidence using dermoscopy in general (p = 1.000) and satisfaction with training (p = .3224) than residents with >10 hours of dedicated training. Comparing similar training times for different training types, residents with 1-10 hours of dedicated training had significantly increased confidence using dermoscopy in general (p = .0105) and satisfaction with training (p = .0066) than residents with 1-10 hours of only bedside training. Lastly, residents with 1-10 hours of dedicated training and >10 hours of dedicated training had significantly increased confidence using dermoscopy in general (p = .0002, p = .2471) and satisfaction with training (p

While cutaneous metastases are already extremely rare in primary metastatic prostatic adenocarcinoma, cutaneous manifestations in recurrent prostate cancer have rarely been described prior to this report. Here we present the case report of a 93-year-old male who underwent radical prostatectomy but eventually suffered from a previously undescribed recurrence of prostatic adenocarcinoma with distant cutaneous metastases to proximal right lower leg.

Penile gangrene is a rare but unfortunate complication of surgical intervention and priapism shunts. The literature regarding penile gangrene following surgical correction of priapism is sparse, the majority of which dates back to thirty to forty years. Here, we present the case of a 60-year-old man who presented with priapism that required operative management with a modified Al-Ghorab shunt and eventually suffered from complete necrosis of the penis with abscess formation in both corpora cavernosa.