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Introduction Paediatric anxiety disorders (AD) are prevalent and persistent mental health conditions worldwide affecting between 10% and 20% of children and adolescents. Despite the high prevalence of paediatric AD, there is limited understanding of which treatments work best. Outcome heterogeneity across paediatric mental health trials has been a significant factor in hindering the ability to compare results and assess the efficacy of such trials. This scoping review will help to identify and synthesise the outcomes reported in paediatric AD trials to date.Methods and analysis Following the Joanna Briggs Institute scoping review methodology, a comprehensive electronic bibliographic database search (MEDLINE, APA PsycINFO, Embase, CINAHL) strategy will be applied to identify articles examining interventions for children diagnosed with an AD. Articles will be eligible for inclusion if they assess at least one AD intervention (eg, psychological), in children 4–18 years of age inclusive. Initial title and abstract screening will be completed by two trained reviewers independently and in duplicate. Full-text screening of each included article will be completed independently and in duplicate by two of three trained reviewers. Identified outcomes will be mapped to a standard outcome taxonomy developed for core outcome sets. Trial and outcome characteristics will be synthesised using quantitative metrics (counts and frequencies).Ethics and dissemination As this is a scoping review of the literature and patient information or records were not accessed, institutional ethics approval was not required. Results of this scoping review will be disseminated to clinicians, researchers inclusive of trialists and other stakeholders invested in outcome selection, measurement and reporting in paediatric AD trials. In addition, scoping review results will inform the development of a Core Outcome Set for paediatric AD trials—a minimum set of outcomes that should be measured across trials in an area of health, without precluding the inclusion of other outcomes.

Instant Controlled Pressure Drop Technology (DIC) was first introduced as a drying technology but later applied to other processes such as developing puffed snacks, texture enhancing, deodorizing, etc. DIC can replace multiple conventional drying methods to obtain higher quality dried products with improved sensory and texture properties. It can also be used as a pretreatment or in conjunction with different drying processes. This review focuses on the DIC parameters which affect the product quality, working equipment, and types of DIC equipment illustrated, followed by combining DIC with the other technologies, including dehydro-freezing, freezing, freeze-drying, and osmotic pretreatments moisture equilibration process (MEP). Additionally, deodorization by DIC is also discussed. The importance of DIC in extraction, quality variations produced by DIC, and DIC's usage of waste products are all explored.

The present study was initiated with the purpose to evaluate possible health risks associated with pesticide residues through consumption of vegetables and fruits by general population of Gujarat, India. A total of 1075 samples comprising of twelve different varieties of commonly consumed food commodities were collected from twenty-five divergent locations in Gujarat. The collected samples were extracted using QuEChERS method and analyzed for the presence of organophosphorus (OPs), organochlorine (OCs) and synthetic pyrethroids (SPs) pesticides using UHPLC-HR/MS, GC-μECD and GC-MS/SIM. The results indicated that 2.3% of vegetable and fruit samples showed the presence of pesticide residues exceeding maximum residue limits (MRLs). The results suggested that, detected residue levels in samples were within safe limits and their consumption will not pose any significant health risk to human. The outcomes present significant information regarding the status of vegetable and fruit contamination and pointed out the prerequisite for further studies with reference to monitoring of pesticides and other toxic contaminants in different samples for assessing cumulative health risk.

Abstract Measuring partial discharges in DC insulation systems is an issue due to the lack of a reference relating the voltage waveform to the physics of discharge phenomena. Also, DC is not always steady state, due to voltage and load transients that generate electric field profile variations inside an insulation system, which can affect partial discharge inception likelihood and characteristics. Partial discharge measurement technology must be able to separate discharge pulses from noise and identify the type of sources generating partial discharge, which is related to condition assessment and maintenance. Eventually, measurement and analysis should be automatic and unsupervised, in order to get rid, partially or totally, of expert support. This study addresses a new approach to partial discharge measurements in DC insulation systems, presenting algorithms for separation, recognition and identification, which are effective both in DC steady state and during voltage (and load) transients. These algorithms are automatic and do not require expert support. Various cases of algorithm application on test objects consisting of multilayer polymeric specimens with an internal cavity and defective cable models are presented and discussed. Their effectiveness is proved, at least at a laboratory level, with effective noise separation and identification of discharge typology.

Abstract Sepsis is a major cause of mortality among hospitalized patients worldwide. Shorter time to administration of broad‐spectrum antibiotics is associated with improved outcomes, but early recognition of sepsis remains a major challenge. In a two‐center cohort study with prospective sample collection from 1400 adult patients in emergency departments suspected of sepsis, we sought to determine the diagnostic and prognostic capabilities of a machine‐learning algorithm based on clinical data and a set of uncommonly measured biomarkers. Specifically, we demonstrate that a machine‐learning model developed using this dataset outputs a score with not only diagnostic capability but also prognostic power with respect to hospital length of stay (LOS), 30‐day mortality, and 3‐day inpatient re‐admission both in our entire testing cohort and various subpopulations. The area under the receiver operating curve (AUROC) for diagnosis of sepsis was 0.83. Predicted risk scores for patients with septic shock were higher compared with patients with sepsis but without shock (p

Abstract Epilepsy is a common but a complex neurological disorder with limited practices for successful management due to the complicated neuronal network and lack of knowledge of epileptic pathophysiology. Theranostic systems such as implantable devices and biodegradable nanomaterials offer better tailor‐made methods for the detection and treatment using nanotechnology‐based approaches for patients with epilepsy. Miniaturized nano‐implantable devices and biosensors equipped with operations to mimic neurostimulation demonstrate excellent opportunities in profiling the disease and assist in comprehension of the relationship between the disease and host. This strategy is developed for diagnoses and mapping brain activities to integrate and target therapeutic nanosystems in epilepsy. Non‐invasive class of nanotheranostics such as biodegradable and stimuli‐responsive polymers includes nanomaterials that utilize bio‐physico‐chemical processes or stimuli as a source for detecting the state and progress of the disease. The superior form of nanotheranostics encompasses in‐situ diagnostics with triggered release at the specific site. This review article focuses on the nanotheranostic strategies for epilepsy, their implications, challenges and new potentials for detection and therapy in personalized medicine. The concept of “on‐demand” release of drugs at the site of action using bio‐responsive theranostic approach reveals a potential for developing a point of primary care for epilepsy in the future.

Cobalt-copper-zinc ferrite (CoCuZnF) nanoparticles were synthesized using the precipitation method. The characterization of CoCuZnF was carried out using powder XRD, Raman, IR, UV–vis, and FEG-SEM. The TG-DSC data of NTO, and nNTO containing the catalyst was used to study the thermal decomposition behavior. Three non-isothermal methods were used to evaluate the kinetic parameters. The kinetics data suggests that incorporation of CoCuZnF additive can effectively decrease the high activation energy of NTO by ∼83–88 kJ mol−1 and nNTO (∼205–216 kJ mol−1). The decomposition of both NTO and nNTO was faster in the presence of CoCuZnF, suggesting its plausible use in the high explosive munitions containing NTO.

Introduction: Bloodstream Infections (BSI) are defined as the presence of living microorganisms in the blood. It is a systemic condition that can result in life-threatening sepsis, thus leading to high morbidity and mortality. Blood cultures have become critically important. Positive blood culture results can help a clinician’s early diagnosis and start empirical antimicrobial at the correct time. Today many laboratories use modern, automated, continuous-monitoring blood culture systems for the detection of bacterial growth for blood culture. At our hospital, blood culture is done by using automated detection in BacT/Alert instrument (Biomerieux, France). Aim: To determine the effect of number of blood cultures and volume of blood on positivity rates, contamination rate in blood cultures, and rate of false-positive blood cultures. Materials and Methods: The present study was a cross-sectional observational study conducted from 1st May 2019 to 31st July 2019. Blood culture requests of all patients were included in the study. All blood culture bottles were processed as per standard laboratory protocols. The effect of number of blood cultures and amount of blood volume on positivity rate, contamination rate, and false-positive blood cultures were studied in detail. The patient’s details and microbiological result parameters were extracted from Laboratory Information System (LIS). All the data was analysed in Microsoft Excel 2010. Results: A total of 761 blood culture bottles were received at the Microbiology laboratory from 604 patients. Maximum (30%) blood cultures were received from 0-10 years of age group. A total of 31% (236/761) of blood cultures were positive. The true pathogen positivity rate was 41.1% and the contamination rate was 58.9%. Single (74.4%) blood culture requests were more than two (25.3%) or three (0.3%) blood cultures. True pathogens were isolated in 9% (41/449) of single blood cultures and in 18% (56/306) of two blood cultures. Overall, 42% of blood cultures had adequate volume and 58% of blood cultures had inadequate volume. However, the true pathogen positivity rate was 14% (61/444) from bottles with inadequate volume and 11% (36/317) from bottles with adequate volume. Out of 236 positive blood cultures, 139 (59%) were identified as contaminants. A total of 5/761 (0.7%) blood cultures were identified as false positive blood cultures. Conclusion: Based on the study findings, a step should be taken to discourage single blood culture and to encourage multiple blood cultures for the diagnosis and better patient care. Although, volume of blood is important, inadequate volume did not affect true pathogen positivity rate in present study. Contamination rate of blood cultures is a major concern and regular training of the concerned staff regarding strict asepsis should be implemented.

Background: Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older. Methods: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses. Results: Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ 2 = 26.99; P

“Brain-predicted age” quantifies apparent brain age compared to normative neuroimaging trajectories. Advanced brain-predicted age has been well established in symptomatic Alzheimer disease (AD), but is underexplored in preclinical AD. Prior brain-predicted age studies have typically used structural MRI, but resting-state functional connectivity (FC) remains underexplored. Our model predicted age from FC in 391 cognitively normal, amyloid-negative controls (ages 18–89). We applied the trained model to 145 amyloid-negative, 151 preclinical AD, and 156 symptomatic AD participants to test group differences. The model accurately predicted age in the training set. FC-predicted brain age gaps (FC-BAG) were significantly older in symptomatic AD and significantly younger in preclinical AD compared to controls. There was minimal correspondence between networks predictive of age and AD. Elevated FC-BAG may reflect network disruption during symptomatic AD. Reduced FC-BAG in preclinical AD was opposite to the expected direction, and may reflect a biphasic response to preclinical AD pathology or may be driven by inconsistency between age-related vs. AD-related networks. Overall, FC-predicted brain age may be a sensitive AD biomarker.

Background: Premenstrual Syndromes (PMS) are major public health issues that have a significant impact on one's mental health. Additional healthcare costs, absenteeism from work, and activity restrictions all add to the economic burden of such a disorder. Yoga as a therapeutic regimen has been shown to be useful to individuals with mental health and premenstrual syndrome. Aim of the study: The present study was conducted to assess the effect of Yogic intervention on Premenstrual syndrome among Adolescence. Methodology: 30 students were selected from the Government Girls Higher secondary school with ages ranging from 14 to 17 years (group average age±SD 38.37±5.52 years). They all filled Modified Moos menstrual Distress questionnaire before and after the yogic intervention. They were randomly divided into Control and Experimental group. The participants in experimental group did Yoga for 45 minutes each day for 10 weeks under supervision of a female yoga therapist whereas those in control group did not do any such specific activity. Results: Data were analyzed using paired sample t-test. There was a statistically significant reduction in the pain, water retention, autonomic reactions, negative effect, impaired concentration, behavior change, arousal, Control in yoga group as compared to control group. Computed t-value for all participants (i.e., 6.31) has been found significant for df = 28, P

Yolk sac tumors (YST) (or endodermal sinus tumors) are rare neoplasms of germ cell origin that have been reported in gonadal sites (testis and ovary). Extragonadal YST are uncommon and are extremely rare in the extracranial head-and-neck regions. Here, we present a rare case of a 1-year-old male with isolated YST of the right parotid gland initially diagnosed as malignant epithelial neoplasm with possibilities of mucoepidermoid carcinoma and epithelial–myoepithelial carcinoma.

Patient prescriber agreements, also known as opioid contracts or opioid treatment agreements, have been recommended as a strategy for mitigating non-medical opioid use (NMOU). The purpose of our study was to characterize the proportion of patients with PPAs, the rate of non-adherence, and clinical predictors for PPA completion and non-adherence. This retrospective study covered consecutive cancer patients seen at a palliative care clinic at a safety net hospital between 1 September 2015 and 31 December 2019. We included patients 18 years or older with cancer diagnoses who received opioids. We collected patient characteristics at consultation and information regarding PPA. The primary purpose was to determine the frequency and predictors of patients with a PPA and non-adherence to PPAs. Descriptive statistics and multivariable logistic regression models were used for the analysis. The survey covered 905 patients having a mean age of 55 (range 18–93), of whom 474 (52%) were female, 423 (47%) were Hispanic, 603 (67%) were single, and 814 (90%) had advanced cancer. Of patients surveyed, 484 (54%) had a PPA, and 50 (10%) of these did not adhere to their PPA. In multivariable analysis, PPAs were associated with younger age (odds ratio [OR] 1.44; p = 0.02) and alcohol use (OR 1.72; p = 0.01). Non-adherence was associated with males (OR 3.66; p = 0.007), being single (OR 12.23; p = 0.003), tobacco (OR 3.34; p = 0.03) and alcohol use (OR 0.29; p = 0.02), contact with persons involved in criminal activity (OR 9.87; p < 0.001), use for non-malignant pain (OR 7.45; p = 0.006), and higher pain score (OR 1.2; p = 0.01). In summary, we found that PPA non-adherence occurred in a substantial minority of patients and was more likely in patients with known NMOU risk factors. These findings underscore the potential role of universal PPAs and systematic screening of NMOU risk factors to streamline care.

Mechanical ventilation often results in hyperoxia, a condition characterized by excess SpO2 levels (>96%). Hyperoxia results in changes in the physiological parameters, severe cardiac remodeling, arrhythmia development, and alteration of cardiac ion channels, all of which can point toward a gradual increase in the risk of developing cardiovascular disease (CVD). This study extends the analysis of our prior work in young Akita mice, which demonstrated that exposure to hyperoxia worsens cardiac outcomes in a type 1 diabetic murine model as compared to wild-type (WT) mice. Age is an independent risk factor, and when present with a major comorbidity, such as type 1 diabetes (T1D), it can further exacerbate cardiac outcomes. Thus, this research subjected aged T1D Akita mice to clinical hyperoxia and analyzed the cardiac outcomes. Overall, aged Akita mice (60 to 68 weeks) had preexisting cardiac challenges compared to young Akita mice. Aged mice were overweight, had an increased cardiac cross-sectional area, and showed prolonged QTc and JT intervals, which are proposed as major risk factors for CVD like intraventricular arrhythmias. Additionally, exposure to hyperoxia resulted in severe cardiac remodeling and a decrease in Kv 4.2 and KChIP2 cardiac potassium channels in these rodents. Based on sex-specific differences, aged male Akita mice had a higher risk of poor cardiac outcomes than aged females. Aged male Akita mice had prolonged RR, QTc, and JT intervals even at baseline normoxic exposure. Moreover, they were not protected against hyperoxic stress through adaptive cardiac hypertrophy, which, at least to some extent, is due to reduced cardiac androgen receptors. This study in aged Akita mice aims to draw attention to the clinically important yet understudied subject of the effect of hyperoxia on cardiac parameters in the presence of preexisting comorbidities. The findings would help revise the provision of care for older T1D patients admitted to ICUs.

Introduction: Persistent coronary microcirculatory dysfunction (CMD) and elevated trimethylamine N-oxide (TMAO) levels after ST-elevation myocardial infarction (STEMI) may drive negative structural and electrical cardiac remodeling, resulting in new-onset atrial fibrillation (AF) and a decrease in left ventricular ejection fraction (LVEF). Aims: TMAO and CMD are investigated as potential predictors of new-onset AF and left ventricular remodeling following STEMI. Methods: This prospective study included STEMI patients who had primary percutaneous coronary intervention (PCI) followed by staged PCI three months later. Cardiac ultrasound images were obtained at baseline and after 12 months to assess LVEF. Coronary flow reserve (CFR), and index of microvascular resistance (IMR) were assessed using the coronary pressure wire during the staged PCI. Microcirculatory dysfunction was defined as having an IMR value ≥25 U and CFR value p < 0.001. Similarly, CMD patients had a much higher prevalence of diabetes than those without CMD (45.7% vs. 18.2%; p < 0.001). At the one-year follow-up, the LVEF in the CMD group had decreased to significantly lower levels than those in the non-CMD group (40% vs. 50%; p < 0.001), whereas it had been higher in the CMD group at baseline (45% vs. 40%; p = 0.019). Similarly, during the follow-up, the CMD group had a greater incidence of AF (32.6% vs. 4.5%; p < 0.001). In the adjusted multivariable analysis, the IMR and TMAO were associated with increased odds of AF development (OR: 1.066, 95% CI: 1.018–1.117, p = 0.007), and (OR: 1.290, 95% CI: 1.002–1.660, p = 0.048), respectively. Similarly, elevated levels of IMR and TMAO were linked with decreased odds of LVEF improvement, while higher CFR values are related to a greater likelihood of LVEF improvement. Conclusions: CMD and elevated TMAO levels were highly prevalent three months after STEMI. Patients with CMD had an increased incidence of AF and a lower LVEF 12 months after STEMI.

Abstract ID proteins are helix-loop-helix (HLH) transcriptional regulators frequently overexpressed in cancer. ID proteins inhibit basic-HLH transcription factors often blocking differentiation and sustaining proliferation. A small-molecule, AGX51, targets ID proteins for degradation and impairs ocular neovascularization in mouse models. Here we show that AGX51 treatment of cancer cell lines impairs cell growth and viability that results from an increase in reactive oxygen species (ROS) production upon ID degradation. In mouse models, AGX51 treatment suppresses breast cancer colonization in the lung, regresses the growth of paclitaxel-resistant breast tumors when combined with paclitaxel and reduces tumor burden in sporadic colorectal neoplasia. Furthermore, in cells and mice, we fail to observe acquired resistance to AGX51 likely the result of the inability to mutate the binding pocket without loss of ID function and efficient degradation of the ID proteins. Thus, AGX51 is a first-in-class compound that antagonizes ID proteins, shows strong anti-tumor effects and may be further developed for the management of multiple cancers.

Objective: The primary objective was to evaluate the efficacy of a weekly palliative care-guided, case-based discussion of high-risk infants on Neonatal Intensive Care Unit (NICU) physician (MD) and Advanced Practice Provider (APP) perceptions of pediatric palliative care (PPC). Study Design: The study setting was a level IV academic NICU in a United States midwestern children?s hospital. A pre/post design was used to evaluate the effects of a weekly palliative care-guided, case-based discussion of high-risk infants on neonatology providers? (MD and APP) perspectives of palliative and end-of-life care in the NICU using a previously published survey instrument. Surveys were completed at baseline and after 12 months of implementation. Data was analyzed with a Wilcoxon Signed Rank test with significance set at p?0.05. Results: Thirty-one providers (13 APPs and 18 MDs) completed both pre- and post-intervention surveys. Post-intervention, providers were more likely to endorse that they ?are comfortable with PPC?, ?feel comfortable teaching PPC to trainees?, ?feel confident handling end-of-life care?, ?have time to discuss PPC?, and ?were satisfied with the transition to end-of-life care for their most recent patient?. They also were more likely to report, ?families' perception of burden is relevant when making ethical decisions?, that ?parents are involved in decisions regarding palliative care?, and that their ?institution is supportive of palliative care.? (p-values

Mishra, Huang et al. identify 29 linear SARS-CoV-2 epitopes that are immunoreactive with the plasma from individuals who had asymptomatic, mild, or severe SARS-CoV-2 infections. This study suggests the possibility of using these peptides to discriminate the exposure to SARS-CoV-2 and other human coronaviruses.

Abstract Quality control, commissioning and diagnostic tests on insulation systems of electrical apparatus are necessary to reduce the failure risk under operation, eliminate infant mortality failures and reduce the impact of ageing on insulation system reliability. This study tries to establish a path which, based on the statistical–phenomenological modelling of the hazard rate, or bathtub curve, drives in the choice of test overvoltage and procedures. The choice of the test voltage and its waveform should be made carefully to improve reliability (reduce failure hazard) in any section of the bathtub curve. This may require, however, different choices depending on the section which corresponds to the planned test. For example, large overvoltages could be acceptable to remove the infant mortality to ensure the highest reliability of newly commissioned apparatus, but they can incept highly energetic, and, thus, fast degradation mechanisms on apparatus operating on the field for a period of time, that can worsen, rather than improving, the insulation system reliability. Resorting to partial discharge measurement during any overvoltage test seems to be the optimal solution to find the most appropriate overvoltage for any type of testing need, leveraging the Latin concept that ‘in medio stat virtus’.

Background: Pain assessment plays a major role in guiding treatment decisions in rheumatoid arthritis (RA). The long-form McGill Pain Questionnaire (LF-MPQ) is a valid and reliable tool for multidimensional pain assessment. However, a validated Hindi version of the LF-MPQ is not available for use in India. The objective was to develop an equivalent version of the LF-MPQ in native Hindi language that is cross-culturally adapted to suit Indian patients. Methodology: After acquiring permission from the University Ethics Board, guidelines given by the Mapi Research Trust were followed and LF-MPQ was translated to culturally appropriate Hindi version. After translation, the questionnaire was subjected to testing of clinimetric properties in fifty patients with RA. Results: The Hindi version of the LF-MPQ demonstrated high levels of internal consistency (Cronbach's alpha range: 0.74–0.80) and reliability (intraclass correlation coefficient range: 0.76–0.84). The Hindi version of LF-MPQ also demonstrated moderate construct and concurrent validity when tested with Visual Analog Scale (Pearson r: 0.78) and Disease Activity Score in 28 joints (Pearson r: 0.77), respectively. Conclusion: The Hindi version of the LF-MPQ was found to be reproducible and valid for the assessment of pain in patients with RA.

Background: Although flap-based laser refractive surgeries are being extensively performed worldwide, complications due to the flap may occur years after the procedure leading to severe vision-threatening complications. Purpose: To describe the management of a case of traumatic displacement of a LASIK flap performed 8 years earlier. Synopsis: A 42-year-old male presented to us with complaints of decreased vision in his left eye following trauma with a toy gun sustained a day earlier. His best-corrected visual acuity was Counting fingers @ 2 m, and a slit-lamp evaluation revealed a LASIK flap with its temporal edge folded inwards. Flap repositioning was planned. The final surgical plan was interface irrigation with mechanical debridement, alcohol epitheliectomy, fibrin glue application, and bandage contact lens. His uncorrected visual acuity improved to 6/6, N6 at 5 weeks postoperatively, which was maintained at 8 months postoperatively along with a clear interface. Highlights: Traumatic displacement of LASIK flap years after the procedure is a known complication. However, simple flap repositioning may lead to various complications like epithelial ingrowth, DLK, astigmatism, etc., This video describes how to achieve anatomical and visual rehabilitation in such eyes without any long-term complications. Video link: https://youtu.be/QtWG9hEMsXM

An important aspect of energy dissipation in weakly collisional plasmas is that of energy partitioning between different species (e.g., protons and electrons) and between different energy channels. Here we analyse pressure–strain interaction to quantify the fractions of isotropic compressive, gyrotropic, and nongyrotropic heating for each species. An analysis of kinetic turbulence simulations is compared and contrasted with corresponding observational results from Magnetospheric Multiscale Mission data in the magnetosheath. In assessing how protons and electrons respond to different ingredients of the pressure–strain interaction, we find that compressive heating is stronger than incompressive heating in the magnetosheath for both electrons and protons, while incompressive heating is stronger in kinetic plasma turbulence simulations. Concerning incompressive heating, the gyrotropic contribution for electrons is dominant over the nongyrotropic contribution, while for protons nongyrotropic heating is enhanced in both simulations and observations. Variations with plasma β are also discussed, and protons tend to gain more heating with increasing β .

Central nervous system (CNS) disorders represent one of the leading causes of global health burden. Nonetheless, new therapies approved against these disorders are among the lowest compared to their counterparts. The absence of reliable and efficient in vitro blood–brain barrier (BBB) models resembling in vivo barrier properties stands out as a significant roadblock in developing successful therapy for CNS disorders. Therefore, advancement in the creation of robust and sensitive in vitro BBB models for drug screening might allow us to expedite neurological drug development. This review discusses the major in vitro BBB models developed as of now for exploring the barrier properties of the cerebral vasculature. Our main focus is describing existing in vitro models, including the 2D transwell models covering both single-layer and co-culture models, 3D organoid models, and microfluidic models with their construction, permeability measurement, applications, and limitations. Although microfluidic models are better at recapitulating the in vivo properties of BBB than other models, significant gaps still exist for their use in predicting the performance of neurotherapeutics. However, this comprehensive account of in vitro BBB models can be useful for researchers to create improved models in the future.

Abstract Background The second largest Ebola virus disease (EVD) outbreak began in the Democratic Republic of Congo in July 2018 in North Kivu Province. Data suggest the outbreak is not epidemiologically linked to the 2018 outbreak in Equateur Province, and that independent introduction of Ebola virus (EBOV) into humans occurred. We tested for antibodies to ebolaviruses in febrile patients seeking care in North Kivu Province prior to the EVD outbreak. Methods Patients were enrolled between May 2017 and April 2018, before the declared start of the outbreak in eastern DRC. Questionnaires were administered to collect demographic and behavioural information to identify risk factors for exposure. Biological samples were evaluated for ebolavirus nucleic acid, and for antibodies to ebolaviruses. Prevalence of exposure was calculated, and demographic factors evaluated for associations with ebolavirus serostatus. Results Samples were collected and tested from 272 people seeking care in the Rutshuru Health Zone in North Kivu Province. All patients were negative for filoviruses by PCR. Intial screening by indirect ELISA found that 30 people were reactive to EBOV-rGP. Results were supported by detection of ebolavirus reactive linear peptides using the Serochip platform. Differential screening of all reactive serum samples against the rGP of all six ebolaviruses and Marburg virus (MARV) showed that 29 people exhibited the strongest reactivity to EBOV and one to Bombali virus (BOMV), and western blotting confirmed results. Titers ranged from 1:100 to 1:12,800. Although both sexes and all ages tested positive for antibodies, women were significantly more likely to be positive and the majority of positives were in February 2018. Conclusions We provide the first documented evidence of exposure to Ebola virus in people in eastern DRC. We detected antibodies to EBOV in 10% of febrile patients seeking healthcare prior to the declaration of the 2018–2020 outbreak, suggesting early cases may have been missed or exposure ocurred without associated illness. We also report the first known detection of antibodies to BOMV, previously detected in bats in West and East Africa, and show that human exposure to BOMV has occurred. Our data suggest human exposure to ebolaviruses may be more frequent and geographically widespread.

Diminished motivation to pursue and obtain primary and secondary rewards has been demonstrated in anorexia nervosa (AN). However, the neurobehavioral mechanisms underlying the behavioral activation component of aberrant reward motivation remains incompletely understood. This work aims to explore this underexplored facet of reward motivation in AN. We recruited female adolescents with AN, restricting type (n = 32) and a healthy control group (n = 28). All participants underwent functional magnetic resonance imaging (fMRI) while performing a monetary reward task. Diffusion MRI data was also collected to examine the reward motivation circuit's structural connectivity. Behavioral results demonstrated slower speed of reward-seeking behavior in those with AN compared with controls. Accompanying this was lower functional connectivity and reduced white matter structural integrity of the connection between the ventral tegmental area/substantia nigra pars compacta and the nucleus accumbens within the mesolimbic circuit. Further, there was evidence of neurobehavioral decoupling in AN between reward-seeking behavior and mesolimbic regional activation and functional connectivity. Aberrant activity of the bed nucleus of the stria terminalis (BNST) and its connectivity with the mesolimbic system was also evident in AN during the reward motivation period. Our findings suggest functional and structural dysconnectivity within a mesolimbic reward circuit, neurofunctional decoupling from reward-seeking behavior, and abnormal BNST function and circuit interaction with the mesolimbic system. These results show behavioral indicators of aberrant reward motivation in AN, particularly in its activational component. This is mediated neuronally by mesolimbic reward circuit functional and structural dysconnectivity as well as neurobehavioral decoupling. Based on these findings, we suggest a novel circuit-based mechanism of impaired reward processing in AN, with the potential for translation to developing more targeted and effective treatments in this difficult-to-treat psychiatric condition.

IntroductionCryopreservation of immature-testicular-tissue (ITT) prior to gonadotoxic treatment, while experimental, is the only recommended option for fertility preservation in prepubertal boys. The handling and manipulation of ITT prior to banking could influence the functionality, genetic and epigenetic integrity of cells.ObjectivesTo investigate the impact of length of hypothermic holding of mouse ITT on the relative mRNA expression of the DNA methyltransferases (DNMTs) and global DNA methylation, post 14-days of organotypic culture.MethodsITT from 6-day old mice were handled at hypothermic temperature (4 °C) for 6 and 24 h prior to 14-days organotypic culture. Relative mRNA expression of Dnmt1, Dnmt3a, and Dnmt3b along with global DNA methylation was measured from the cultured ITT.ResultsNo significant variation in the expression of Dnmt1, Dnmt3a, and Dnmt3b was observed in relation to varying holding time periods used. Further, global DNA methylation was comparable between 0, 6 and 24 h holding groups.ConclusionsShort-term holding of ITT at 4 °C does not affect the DNA methylation process post organotypic culture. While fully acknowledging the limitations of this approach in the mouse model, the results we presented in this report will be of significant interest to the field.

Introduction: Dental anxiety is of prime concern for the paediatric dentist as it can prevent a child from seeking effective dental care by creating conditions that are challenging to the paediatric dentists and thereby not allowing to render the highest quality care. The dental application (apps) can be a useful tool in alleviating the anxiety in children, but these apps have not yet been evaluated for its use by paediatric dentists. Aim: To assess knowledge, attitude and practices about paediatric dental apps among paediatric dentists in India. Materials and Methods: This cross-sectional questionnaire-based study was conducted among 450 paediatric dentists in India. The study was conducted over a span of one month. A 16-item validated questionnaire with Cronbach’s alpha coefficient value of 0.82, containing professional demographic data, knowledge, attitude, and practices about dental apps were distributed among the participants. The collected data was subjected to descriptive analysis was done using IBM Statistical Package for the Social Sciences (SPSS) software (version 20.0 Chicago IL, USA). Results: The study included (N=370) out of which 159 (42.97%) were female respondents and 211 (57.03%) were male respondents. The mean age of the surveyed professionals was 34.14±9.11 years. The results showed that the correlation between knowledge and attitude was found to be highly statistically significant (p=0.0001) however, no statistically significant results were found when a comparison was made between knowledge and practices (p-value=0.7684) and also attitude and practices (p-value=0.0930). Conclusion: The study concludes that, there is a need for creating awareness about the use of dental apps as an adjunct with conventional behaviour modification techniques among paediatric dentists in our country.

Clinical and Translational Science Award (CTSA) hub websites are a critical communication gateway to assist the clinical and translational science community and promote CTSA hub offerings. The objective of this funded pilot project was to create a website and online database for the CTSA consortium that allows users to conduct structured searches among the 50 + CTSA hub websites. The result is CTSA Search Solutions, an online, searchable database that includes access to 50 + CTSA hub websites with 80+ structured search term options and over 800 links collected, organized, and published. Hubs can be searched by name and filtered by a specific CTSA topic, state, region, or even number of years funded to make detailed comparisons with the data identified. The home page for each hub can be accessed directly from the search page. The CTSA Search Solutions online database will allow for a wide breadth of CTSA personnel (core leads, researchers, administrators, communicators, and evaluators) to find consolidated information to learn about specific CTSA hub program highlights, as well as conduct research into program hub outputs and best practices across the nationwide CTSA consortium.

The catalytic impact of nickel-zinc-copper ferrite (NiZnCuF) on the thermal decomposition of micron and naosize NTO was investigated in this work. NiZnCuF was produced utilising a wet chemical technique with metal nitrate salts as a precursor. Raman, UV–vis, Powder-X-ray diffraction patterns, and Fourier-Transform Infrared Spectroscopy (FT-IR) was employed to characterise NiZnCuF. The synthesized NiZnCuF was incorporated in NTO, and nanosize NTO (nNTO) as a 5 % by mass additive. TG-DSC analysis was used to examine the thermal decomposition of NTO and nNTO samples with and without NiZnCuF. To investigate the catalytic activity of NiZnCuF, kinetic parameters were computed using isoonversional techniques. The results indicated that NiZnCuF can successfully lower the high activation energy and pre-exponential factor of NTO and nNTO (27–34 %), implying a quicker decomposition of NTO and nNTO in the presence of NiZnCuF. The present work provides significant improvement in the thermal decomposition behaviour of NTO using a simple catalyst as an additive. NTO + NiZnCuF composition can be better substitute to NTO in the high energetic explosive formulations for the better thermal performance.

BackgroundSuicides and opioid overdose deaths are among the most pressing public health concerns in the US. However direct evidence for the association between opioid use and suicidal behavior is limited. The objective of this article is to examine the association between frequency and dose of prescription opioid use and subsequent suicide attempts.Methods and findingsThis retrospective cohort study analyzed 4 years of statewide medical claims data from the Connecticut All-Payer Claims Database. Commercially insured adult patients in Connecticut (n = 842,773) who had any medical claims beginning in January 2012 were followed through December 2015. The primary outcome was suicide attempt identified using International Classification of Diseases (ICD 9) diagnosis codes. Primary predictor variables included frequency of opioid use, which was defined as the number of months with claims for prescription opioids per year, and strength of opioid dose, which was standardized using morphine milligram equivalent (MME) units. We also controlled for psychiatric and medical comorbidities using ICD 9 codes. We used Cox proportional hazards regression to examine the association between frequency, dose, and suicide attempts, adjusting for medical and psychiatric comorbid conditions. Interactions among measures of opioid use and comorbid conditions were analyzed. In this cohort study with follow-up time up to 4 years (range = 2-48 months, median = 46 months), the hazard ratios (HR) from the time-to-event analysis indicated that patients prescribed opioid medications for at least 6 months during the past year and at 20-50 MME levels or higher had 4.44 (95% CI: [3.71, 5.32]) to 7.23 (95% CI: [6.22, 8.41]) times the risk of attempted suicide compared to those not prescribed opioids. Risk of suicide attempt was sharply elevated among patients with psychiatric conditions other than anxiety who were prescribed more frequent and higher opioid doses. In contrast, more frequent and higher doses of prescription opioids were associated with lower risk of suicide attempts among patients with medical conditions necessitating pain management. This study is limited by its exclusive focus on commercially insured patients and does not include patients covered by public insurance. It is also limited to patients' receipt of prescription opioids and does not take into account opioids obtained through other means, nor does it include measures of actual patient opioid use.ConclusionsThis analysis provides evidence of a complex relationship among prescription opioids, mental health, pain and other medical comorbidities, and suicide risk. Findings indicate the need for proactive suicide surveillance among individuals diagnosed with affective or psychotic disorders who are receiving frequent and high doses of opioids. However, appropriate opioid treatment may have significant value in reducing suicide risk for those without psychiatric comorbidities.

ObjectivesHypoglycemia unawareness (HUA) in patients with FCPD is common with an unclear etiology. We evaluated the prevalence, characteristics of HUA, glycemic variability (GV), its possible association with pancreatic glucagon secretion & cardiac autonomic function in patients with FCPD.MethodsA two-week ambulatory glucose profile (AGP) and cardiac autonomic function test was done in patients with FCPD (n = 60), and categorized into UNAWARE (n = 44) and AWARE (n = 16) groups based on the Hypoglycemia Unawareness Index (HUI) score. Glycaemic variability was assessed from the AGP data using Easy GV 9.0.2 software. A subset of patients from both the groups (n = 11) underwent a mixed-meal challenge test and were compared with healthy individuals (controls; n = 11).ResultsHUA was evidenced in 73% (44/60) of patients with FCPD. Significant hypoglycemia, nocturnal hypoglycemia, duration of hypoglycemia and poor cardiac autonomic functions (p = 0.01) were prominent in the UNAWARE group. The overall GV was greater in the UNAWARE group. In the UNAWARE group, significantly reduced fasting and post prandial glucagon levels negatively correlated with HUI (r = -0.74, p < 0.05) and GV-hypoglycemia indices (p < 0.05) In contrast, significantly higher post prandial glucagon levels in the AWARE group positively correlated with post prandial hyperglycemia (r = 0.61, p < 0.05).ConclusionHeterogeneity in patterns of glucagon secretion were significantly associated with HUA and GV. Reduced glucagon levels contribute to greater risks of HUA, nocturnal hypoglycemia and greater GV, while hyperglucagonemia predisposes to postprandial hyperglycemia and hypoglycemia awareness in patients with FCPD.

A new artificial intelligence (AI) supported T-Ray imaging system designed and implemented for non-invasive and non-ionizing screening for coronavirus-affected patients. The new system has the potential to replace the standard conventional X-Ray based imaging modality of virus detection. This research article reports the development of solid state room temperature terahertz source for thermograph study. Exposure time and radiation energy are optimized through several real-time experiments. During its incubation period, Coronavirus stays within the cell of the upper respiratory tract and its presence often causes an increased level of blood supply to the virus-affected cells/inter-cellular region that results in a localized increase of water content in those cells & tissues in comparison to its neighbouring normal cells. Under THz-radiation exposure, the incident energy gets absorbed more in virus-affected cells/inter-cellular region and gets heated; thus, the sharp temperature gradient is observed in the corresponding thermograph study. Additionally, structural changes in virus-affected zones make a significant contribution in getting better contrast in thermographs. Considering the effectiveness of the Artificial Intelligence (AI) analysis tool in various medical diagnoses, the authors have employed an explainable AI-assisted methodology to correctly identify and mark the affected pulmonary region for the developed imaging technique and thus validate the model. This AI-enabled non-ionizing THz-thermography method is expected to address the voids in early COVID diagnosis, at the onset of infection.

Abstract Objectives To examine the relationship between duration of the cognitive symptoms, from the earliest reported symptom to death, and hippocampal sclerosis (HS) and TAR‐DNA binding protein of 43kDA (TDP‐43) in Alzheimer’s disease (AD) patients. Methods The study was conducted in 359 cognitively impaired patients who met the pathological criteria for AD (NIA‐Reagan intermediate or high). The mean age at onset was 69.5 ± 8.8 years (range 37‐95) and the mean duration of the symptoms was 10.5 ± 4.2 years. The association between symptoms duration and HS and TDP‐43 was examined with logistic regression analyses controlling for age at death, atherosclerosis in the Circle of Willis (CW), cerebral infarcts, gender, baseline Mini Mental State Examination scores, APOE‐4 allele, and presence of Lewy bodies (LB). Results HS was present in 18% (n = 64) and TDP‐43 in 51.5% (n = 185) of the patients. HS and TDP‐43 were more frequent in patients whose symptoms lasted more than 10 years. LBs were present in 72% of the patients with HS and in 64% of the patients with TDP‐43. Age at onset was not associated with TDP‐43 or HS. HS was associated with duration of symptoms and LB, TDP‐43, and atherosclerosis in the CW. TDP‐43 was associated with duration of symptoms, LB, and HS. Interpretation HS and TDP‐43 are present in early and late onset AD. However, their presence is mainly driven by the duration of symptoms and the presence of LB. This suggests that HS and TDP‐43 are part of the later neuropathological changes in AD.

Introduction: Glass-ionomer cement (GIC) have been indispensable to pediatric dentistry. Along with these, newer materials like bulk-fill alkasite cement (Cention N) are popularizing. In spite of this, the search is still on for the “ideal” bioactive material which could provide a therapeutic edge. In light of this, incorporation of antibiotics in GIC or newer materials like bulk-fill alkasite cement (Cention N) would provide a novel alternative material to the dentists. Aim: The study was aimed at comparing the antibacterial efficacy of conventional glass-ionomer cement (CGIC) and bulk-fill alkasite cement (Cention N) with doxycycline (DOX) and double antibiotic paste (DAP) containing metronidazole and ciprofloxacin (1.5% w/w) on Streptococcus mutans and Lactobacillus. Materials and Methods: Agar well diffusion method was followed, in which material discs of 10 mm were made and inserted into the wells. Inhibition zones were calculated after incubation for 24 h at 37°C with zone interpretation scale. Results: A highly significant statistical correlation was found between antibacterial efficacy of the control groups (CGIC and bulk-fill alkasite cement [Cention N]) without antibiotics as compared to the experimental group (CGIC and bulk-fill alkasite cement [Cention N] with DOX and DAP), P = 0.0001 and P = 0.0006 for the CGIC group and P = 0.0147 and P = 0.0080 for the Cention N group (P < 0.05). Conclusion: Incorporation of antibiotics significantly enhanced the antibacterial efficacy of CGIC and bulk-fill alkasite cement (Cention N).

Introduction: Surgical removal of mandibular third molars is the most frequently performed minor oral surgical procedure. Aims: This study aims to evaluate its effect on periodontal status of second molars at 3 and 6 months' follow-up comparing extractions done by three different flap techniques. Settings and Design: Prospective randomized control clinical study. Subjects and Methods: Ninety medically healthy controls of both gender, aged between 18 and 50 years who underwent surgical removal of impacted mandibular third molars were divided into Group A, Group B and Group C wherein Bayonet flap, modified envelope flap and envelope flap was raised, respectively. Pocket depth at distobuccal and distolingual aspect of adjacent second molar was measured and compared for each group at preoperative as well as 3 and 6 months' follow-up. Statistical Analysis Used: ANOVA, paired t-test, and Tukey post hoc test using SPSS software. Results: There was no statistically significant difference found between pocket depths distal to second molars following impacted third molar extraction between three different flap groups. However, a significant reduction of pocket depth was noted from 3 to 6 months' follow-up for all three flap groups. Conclusions: Flap designs used for impacted third molar extractions do not contribute toward the alteration of periodontal health of second molars.

INTRODUCTION: Dental caries can occur in an individual irrespective of age, which makes preventing the incidence of dental caries vital. The prevention of dental caries includes various types of oral hygiene measures. One such modality is the use of mouthwash. As chlorhexidine mouthwash causes several adverse effects, there is a need for herbal alternative. Green coffee bean extract is one such herbal alternative. AIM: The aim of this study is to compare and evaluate the antibacterial efficacy of green coffee bean extract mouthwash and chlorhexidine mouthwash against Streptococcus mutans and Lactobacilli spp. MATERIALS AND METHODS: The ethanolic extract of green coffee bean was obtained by treating it with cellulase and 30% ethanol. Minimum inhibitory concentration and minimum bactericidal concentration were obtained by the broth dilution method and culture plating method, respectively. Based on these values, 3% green coffee bean extract mouthwash was prepared, and the antibacterial efficacy against S. mutans and Lactobacilli spp. was tested using the direct contact test. The obtained data were analyzed using the Mann–Whitney U-test and Wilcoxon matched-pair test. RESULTS: Intergroup comparison using Mann–Whitney U-test showed that green coffee bean extract mouthwash is equally effective against S. mutans and Lactobacilli spp. as compared to chlorhexidine mouthwash. Wilcoxon matched-pairs test showed that the efficacy of green coffee bean extract mouthwash reduced over a period of 10, 30, and 60 min time intervals. CONCLUSION: Therefore, green coffee bean extract can be used as an alternative to chlorhexidine as mouthwash.

Background and Aims: Host immune response is altered by a series of physiologic and pathologic factors like age, gender, inflammation, surgery, medication etc., The present study was conducted to evaluate differences in salivary IgA (S-IgA) levels among pedodontic subjects undergoing active orthodontic treatment with fixed and removable appliance. The levels of S- IgA were determined before 3 months and 6 months post active orthodontic treatment. Methods: A total of 40 healthy pedodontic subjects (aged 8-15 years) were recruited in the present study. They were equally divided into Group A (fixed orthodontic group) and Group B (removable orthodontic group) with 20 subjects each. 1.5 mL of saliva per subject was obtained before 3 and 6 months after treatment. Enzyme Linked Immunosorbent Assay (ELISA) technique was used for measurement of Salivary IgA levels. Results: Group A and B both showed significant rise in S-IgA levels 3 months and 6 months post active orthodontic treatment. Mean value of S-IgA 3 months post treatment in the saliva of children in group B and group A were (144.27 ± 5.32) and (164.0 ± 3.23) μg/ml respectively. While mean value of S-IgA after 6 months of treatment in group B and group A were (149.8 ± 6.02) and (166.4 ± 3.65) μg/ml respectively. Conclusion: Salivary Immunoglobulin A level values were significantly higher statistically in both group A and group B post active orthodontic treatment than before. The results however, showed that Group A (fixed orthodontic group) showed statistically significant higher levels of S-IgA than Group B (removable orthodontic group). Active orthodontic treatment triggered a stronger stimulus for oral secretory immunity, hence the increase in levels were detected. There is a significant positive correlation between S-IgA and active fixed as well as removable orthodontic treatment. Orthodontic treatment is hence a local immunogenic factor.

Interstitial lung diseases (ILDs) are an intriguing group of pulmonary disorders, which still require the study of epidemiological, genetic, pathophysiological, clinical, and radiological parameters. Pulmonary hypertension (PH) is an underreported complication in interstitial lung diseases which is associated with worse outcome. In our study, we have reported the spectrum of ILDs and estimated the prevalence of pulmonary hypertension among these subjects at a tertiary care centre. A cross-sectional study was performed in which demographical, clinical, radiological, and histological data of subjects with ILD, attending the department of Respiratory Medicine in the University was collected from 1st September 2018 to 31st August 2019. Serological tests were done wherever indicated. Standard criteria along with multidisciplinary opinion were needed to arrive at the final diagnosis. All subjects were screened for pulmonary hypertension via 2-D echocardiography. Mean pulmonary artery pressure ≥20 mmHg was used to define PH. In the defined period, 239 subjects were enrolled (58% females, n=141; mean age 52.38±13.40 years). A tissue diagnosis was obtained in 34% cases. The most common ILD was hypersensitivity pneumonitis (32.2%), followed by autoimmune-ILD (31.4%), idiopathic pulmonary fibrosis (IPF) (15.9%) and sarcoidosis (12.6%), non-IPF idiopathic interstitial pneumonitis (2.1%) and rest 21 (5.9%) subjects were diagnosed as other types of ILD. Pulmonary hypertension was seen in 46.0% of subjects.

Objective: To compare the effect of Maleic acid and Irritrol (combination of Chlorhexidine & Ethylenediaminetetraacetic acid) irrigation on the sealing ability of Biodentine when used as root-end filling material. Material and Methods: Thirty single-rooted human premolars were subjected to standardized root canal instrumentation and were irrigated with 2.5% Sodium Hypochlorite (NaOCl) after each instrument change. Apical root resections were done by removing 3 mm of the apex at a 90° angle to the long axis of the root with a diamond bur. The root end cavity preparation was done using ultrasonic tips at a low power setting under water coolant. They were randomly divided into 3 groups (n=10). Group 1 was irrigated with 7% Maleic acid, Group 2 was irrigated with Irritrol, and Group 3 was irrigated with 0.9% Saline (Control). Then, the root end cavities of all the samples were restored with Biodentine and were subjected to leakage analysis using a glucose filtration test. The mean values for each group were calculated and the obtained data was statistically analysed using ANOVA with post-hoc Tukey’s test, ANOVA with post-hoc Games-Howell test and repeated measures ANOVA with post-hoc Bonferroni test. Results: The specimens irrigated with Irritrol showed least microleakage as compared to 7% Maleic acid and 0.9% Saline. Conclusion: A regimen involving irrigation of the root-end cavity with Irritrol followed by root-end filling with Biodentine can improve the apical seal.