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Our most recent findings on multi-hop LoRa networks imply that earlier developed multi-hop routing methods, such as our previously suggested Extended-DRESG scheme, had overlooked some essential information. Although the researchers employed uniform node distributions for their multi-hop models, a full capacity LoRa network may be treated as a Gaussian distribution. Extended-DRESG performs better with a Gaussian distribution than with a uniform distribution of nodes. In contrast to optimal ring-hop combinations created earlier, this observation led to the suggested algorithm for optimal ring positioning and ring-hop combinations in Extended-DRESG. The Extended-DRESG cluster developing technique, which may produce much superior performance in terms of energy efficiency when uniform node distribution is encountered, is further suggested in light of the observations made in this research. Future multi-hop models can benefit from the current observations in two ways: (i) a better understanding of the packet forwarding structure, and (ii) a good cluster formation technique when clusters are established based on their distances from the gateway.

This article seeks to investigate the impact of the volatility of the external debt burden on the economic growth of India. The MS (Markov - Switching) - GARCH model is the cornerstone in studying the effects of external debt on the economic growth that is simulated herein. This article applies a MS - GARCH model that allows not only unobserved variables within an observed model but also uses a robust algorithm to reach strong optimization (convergence) through iteration in a dynamic system in the estimation procedure. This article considers the period from Q2 2004 to Q4 2022 with 74 sample observations. Considering various crises like the global financial crisis, the Euro crisis, and the COVID-19 pandemic that occurred during the study period, the results identify two regimes based on conditional volatility. One is the global financial recession period (regime-1) and another is the post-global financial recession period (regime-2). The findings show that the conditional volatility as well as the variance in the volatility of economic growth due to the external debt of India is much stronger in the global financial recession period (regime-1) than in the post-global financial recession period (regime-2). It implies that the Euro crisis and the COVID-19 pandemic are having less impact on external debts in India. The transition matrix indicates the greater probability of the economic growth rate settling down in regime 2 when it is already in regime 2, as it is considered to be a much calmer period. Finally, the results of the stable probabilities suggest that the economic growth rate of India is much more stable in regime 2 than in regime 1. This article puts forward relevant policy implications for coming out from the debt overhang scenario in India.

BackgroundIn order for low and middle income countries (LMIC) to transition to Human Papilloma Virus (HPV) test based cervical cancer screening, a greater understanding of how to implement these evidence based interventions (EBI) among vulnerable populations is needed. This paper documents outcomes of an implementation research on HPV screening among women from tribal, rural, urban slum settings in India.MethodsA mixed-method, pragmatic, quasi-experimental trial design was used. HPV screening on self-collected cervical samples was offered to women aged 30-60 years. Implementation strategies were 1) Assessment of contextual factors using both qualitative and quantitative methods like key informant interviews (KII), focus group discussions (FGDs), pre-post population sample surveys, capacity assessment of participating departments 2) enhancing provider capacity through training workshops, access to HPV testing facility, colposcopy, thermal ablation/cryotherapy at the primary health care centers 3) community engagement, counselling for self-sampling and triage process by frontline health care workers (HCWs). Outcomes were assessed using the RE-AIM (Reach, Effectiveness, adoption, implementation, maintenance) framework.ResultsScreening rate in 8 months' of study was 31.0%, 26.7%, 32.9%, prevalence of oncogenic HPV was 12.1%, 3.1%, 5.5%, compliance to triage was 53.6%, 45.5%, 84.6% in tribal, urban slum, rural sites respectively. Pre-cancer among triage compliant HPV positive women was 13.6% in tribal, 4% in rural and 0% among urban slum women. Unique challenges faced in the tribal setting led to programme adaptations like increasing honoraria of community health workers for late-evening work and recalling HPV positive women for colposcopy by nurses, thermal ablation by gynaecologist at the outreach camp site.ConclusionsSelf-collection of samples combined with HCW led community engagement activities, flexible triage processes and strengthening of health system showed an acceptable screening rate and better compliance to triage, highlighting the importance of identifying the barriers and developing strategies suitable for the setting.Trial registrationCTRI/2021/09/036130.

Although LoRa (radio) technology offers customization of different physical layer transmission parameters such as bandwidth, spreading factor (SF), transmission power, and coding rate to obtain the desired data rate and coverage, the currently preferred single-hop transmission mode cannot simultaneously achieve both. The LoRaWAN community is therefore focusing on multi-hop networks to increase network longevity while extending coverage. In this paper, a detailed mathematical model for a multi-hop network that modifies the Distance Ring Exponential Stations Generator (DRESG) framework is presented. The relay operation is carried out through intermediate gateways, and a distance-based adaptive transmission configuration approach is used. On the basis of the performance metrics, i.e., packet delivery ratio (PDR) and energy usage of end nodes, we compare and contrast the performance characteristics of several routing schemes, including single-hop (SH), next-ring-hop (NRH), and variable-hop (VH) routing. The research covers some core issues, including interference, environmental conditions, and transceiver power constraints, and sets the stage for evaluating various multi-hop LoRa solutions as well as optimizing several implementation factors.

Abstract Background Health behaviour can change outcomes in both healthy and unhealthy populations and are particularly useful in promoting compliance to treatment and maintaining fidelity to care seeking and follow-up options in chronic diseases. Interventions to change health behaviour based on psychological theory are more often successful than those without any underlying theory. The theory of planned behaviour (TPB) is one such psychological theory which had been found to predict human behaviour with respect to disease prevention and when applied to interventions can change the outcomes of diseases. Most of the research evidence of TPB-based interventions have been from developed world. Evidence is required whether TPB-based interventions can be applied and works in low-resource, low health-literacy settings of low- and middle-income countries (LMICs). Methods The protocol has been developed as per PRISMA-P guidelines and incorporates PICO (population, intervention, comparison, outcomes) framework for describing the methodology. Population above 18 years of age and having any chronic disease (as defined for this systematic review) will be selected, while any health or educational intervention based on constructs of TPB will be included. Comparison will be with non-TPB-based interventions or treatment as usual without any intervention, and the primary outcome will be the behaviour change effected by the TPB-based intervention. Intervention studies will be considered, and relevant databases like MEDLINE, Embase, Cochrane Library and ProQuest will be explored. Data extraction will done in a standardised form, and risk-of-bias assessment will be done using the Cochrane Collaboration’s tools for such assessment. Narrative synthesis of the selected studies will be done to draw the conclusions, and meta-analysis will be done to calculate the effect estimates with I-squared statistics to describe the heterogeneity. Discussion This systematic review will provide new evidence on fidelity and effectiveness of the TPB-based interventions among chronic disease patients from low health literacy, resource-poor background. It will inform of how to plan and use such interventions to change health behaviour in chronic disease patients, particularly in LMIC settings. Systematic review registration PROSPERO CRD42018104890 .

Abstract Theories with higher derivatives involve linear instabilities in the Hamiltonian commonly known as Ostrogradski ghosts and can be viewed as a very serious problem during quantization. To cure this, we have considered the properties of antilinearity that can be found inherently in the non-Hermitian Hamiltonians. Owing to the existence of antilinearity, we can construct an operator, called the V-operator, which acts as an intertwining operator between the Hamiltonian and its Hermitian conjugate. We have used this V-operator to remove the linear momentum term from the higher derivative Hamiltonian by making it non-Hermitian in the first place via an isospectral similarity transformation. The final form of the Hamiltonian is free from the Ostrogradski ghosts under some restriction on the mass term.

Winds of massive stars are suspected to be inhomogeneous (or clumpy), which biases the measures of their mass-loss rates. In high-mass X-ray binaries (HMXBs), the compact object can be used as an orbiting X-ray point source to probe the wind and constrain its clumpiness. We perform a spectrotiming analysis of the HMXB OAO 1657–415 with nonsimultaneous NuSTAR and NICER observations. We compute the hardness ratio from the energy-resolved light curves, and, using an adaptive rebinning technique, we thus select appropriate time segments to search for rapid spectral variations on timescales of a few hundred to thousands of seconds. The column density and intensity of the iron K α line were strongly correlated, and the recorded spectral variations were consistent with accretion from a clumpy wind. We also illustrate a novel framework to measure clump sizes and masses in HMXBs more accurately based on the absorption measurements and orbital parameters of the source. We then discuss the limitations posed by current X-ray spacecraft in such measurements and present prospects with future X-ray missions. We find that the source pulse profiles show a moderate dependence on energy. We identify a previously undetected dip in the pulse profile visible throughout the NuSTAR observation near spin phase 0.15 possibly caused by intrinsic changes in accretion geometry close to the neutron star. We do not find any evidence for the debated cyclotron line at ∼36 keV in the time-averaged or phase-resolved spectra with NuSTAR.

BackgroundChronic respiratory diseases (CRDs) are major causes of mortality and morbidity worldwide with a substantial burden of the disease being borne by the low and middle income countries (LMICs). Interventions to change health behaviour which aim to improve the quality of life and reduce disease burden due to CRD require knowledge of the problem and factors influencing such behaviour. Our study sought to appreciate the lived experiences of people with CRD, their understanding of the disease and its risk factors, and usual practice of health behaviour in a rural low-literate community in southern India.MethodsQualitative data were collected between September and December 2018 through eight focus group discussions (FGDs), five in-depth interviews and four key-informant interviews from patients and community members. Community engagement was undertaken prior to the study and all interviews and discussions were recorded with permission. Inductive coding was used to thematically analyse the results.ResultsMajor themes included understanding of chronic lung disease, health behaviours, lived experiences with the disease and social norms, attitudes and other factors influencing health behaviour.DiscussionPoor understanding of CRDs and their risk factors affect health seeking behaviour and/or health practices. Stigma associated with the disease and related health behaviours (e.g. inhaler use) creates emotional challenges and mental health problems, besides influencing health behaviour. However barriers can be circumvented by increasing community awareness; communication and connection with the community through community based health care providers can turn challenges into opportunities for better health care.

Ghost fields in quantum field theory have been a long standing problem. Specifically, theories with higher derivatives involve ghosts that appear in the Hamiltonian in the form of linear momenta term, which is commonly known as the Ostrogradski ghost. Higher derivative theories may involve both types of constraints i.e. first class and second class. Interestingly, these higher derivative theories may have non-Hermitian Hamiltonian respecting PT-symmetries. In this paper, we have considered the PT-symmetric nature of the extended Maxwell-Chern-Simon's theory and employed the second class constraints to remove the linear momenta terms causing the instabilities. We found that the removal is not complete rather conditions arise among the coefficients of the operator Q.

Targeted gene therapy strategies utilizing homology-driven repair (HDR) allow for greater control over transgene integration site, copy number, and expression—significant advantages over traditional vector-mediated gene therapy with random genome integration. However, the relatively low efficiency of HDR-based strategies limits their clinical application. Here, we used HDR to knock in a mutant dihydrofolate reductase (mDHFR) selection gene at the gene-edited CCR5 locus in primary human CD4+ T cells and selected for mDHFR-modified cells in the presence of methotrexate (MTX). Cells were transfected with CCR5-megaTAL nuclease mRNA and transduced with adeno-associated virus containing an mDHFR donor template flanked by CCR5 homology arms, leading to up to 40% targeted gene insertion. Clinically relevant concentrations of MTX led to a greater than 5-fold enrichment for mDHFR-modified cells, which maintained a diverse TCR repertoire over the course of expansion and drug selection. Our results demonstrate that mDHFR/MTX-based selection can be used to enrich for gene-modified T cells ex vivo, paving the way for analogous approaches to increase the percentage of HIV-resistant, autologous CD4+ T cells infused into HIV+ patients, and/or for in vivo selection of gene-edited T cells for the treatment of cancer. Keywords: gene editing, chemoselection, T cell gene therapy, lentiviral vectors, homology-directed repair, methotrexate, dihydrofolate reductase, adeno-associated viruses, HIV, cancer

A naturally occurring 32-base pair deletion of the HIV-1 co-receptor CCR5 has demonstrated protection against HIV infection of human CD4+ T cells. Recent genetic engineering approaches using engineered nucleases to disrupt the gene and mimic this mutation show promise for HIV therapy. We developed a megaTAL nuclease targeting the third extracellular loop of CCR5 that we delivered to primary human T cells by mRNA transfection. The CCR5 megaTAL nuclease established resistance to HIV in cell lines and disrupted the expression of CCR5 on primary human CD4+ T cells with a high efficiency, achieving up to 80% modification of the locus in primary cells as measured by molecular analysis. Gene-modified cells engrafted at levels equivalent to unmodified cells when transplanted into immunodeficient mice. Furthermore, genetically modified CD4+ cells were preferentially expanded during HIV-1 infection in vivo in an immunodeficient mouse model. Our results demonstrate the feasibility of targeting CCR5 in primary T cells using an engineered megaTAL nuclease, and the potential to use gene-modified cells to reconstitute a patient's immune system and provide protection from HIV infection.

Background: Maternal mortality is a reflection of the care given to women by its society. It is tragic that deaths occur during the natural process of child birth and most of them are preventable. Objectives: The present study was undertaken to find out the causes and contributing factors of maternal deaths. Materials and Methods: All maternal deaths occurring in a year in the medical college and hospital were traced and interviews were taken from the relatives as well as the health care providers who were present at the time of death of the woman. Results: Out of the total maternal deaths, 72% belonged to 20-30 yrs age group, also 46.5% were illiterate, and majority deaths (60.5%) were from low socio-economics status. Direct causes were responsible for 76.7% of maternal deaths. Hypertensive disorders of pregnancy were most common (32.6%) cause of direct deaths, while malaria (9.3%) and anemia (7%) were most common indirect causes. Most of the women had to use their own resources to travel to health care facilities. Delays at different levels, often in combination, contributed to the maternal deaths. Conclusions: The study will serve as an eye-opener to the bottlenecks present in the community as well as in the health facility so as to take appropriate measures to prevent maternal deaths.