Search

Abstract The family of pro-inflammatory and pro-angiogenic chemokines including Interleukin-8 (IL-8, aka CXCL8) and its homologues (CXCL1,2,3,5,6, and 7) exhibit promiscuous binding and activation of several G-protein-coupled receptors (i.e., CXCR2, CXCR1, and the atypical chemokine receptor (ACKR1)). A high proportion of their biological activity is attributed to CXCR2 activation, thus many CXCR2 inhibitors are in clinical trials for several chronic diseases. However, CXCR2 inhibition is often only investigated acutely in these trials or in Cxcr2 −/− mice grown in gnotobiotic conditions. Since humans do not live in germ-free environments, our first goal is to highlight novel retinal and systemic observations in Cxcr2 −/− mice grown in non-gnotobiotic conditions that suggest potential harmful consequences of long-term CXCR2 deficiency or blockade. Beyond confirmation of circulating blood/immune cell-related phenotypes, we report novel findings in Cxcr2 −/− mice including: (1) delayed dye transit to the retinal vasculature, (2) alterations in the density and distribution of retinal vessels, astrocytes and microglia, (3) decreased electroretinogram a- and b-wave amplitudes, (4) reduced visual acuity, and (5) increased polymorphonuclear cell accumulation in vascular lumina abutting venular walls in the retina and in vital non-ocular tissues (lung and liver). Furthermore, PheWAS of CXCR2 CXCR1, and ACKR1 gene variants using data from UK Biobank participants suggest clinical associations with both retinal and vascular disease phenotypes. We conclude that chronic CXCR2 deficiency in mice contributes to functional damage to the retina and that the long-term safety of CXCR1/2 inhibitors designed for chronic use in humans should be explored before clinical adoption to safeguard sight and overall vascular health.

Since the discovery of graphene in 2004, the unique properties of two-dimensional materials have sparked intense research interest regarding their use as alternative materials in various photonic applications. Transition metal dichalcogenide monolayers have been proposed as transport layers in photovoltaic cells, but the promising characteristics of group IV–VI dichalcogenides are yet to be thoroughly investigated. This manuscript reports on monolayer Ge2Se2 (a group IV–VI dichalcogenide), its optoelectronic behavior, and its potential application in photovoltaics. When employed as a hole transport layer, the material fosters an astonishing device performance. We use ab initio modeling for the material prediction, while classical drift–diffusion drives the device simulations. Hybrid functionals calculate electronic and optical properties to maintain high accuracy. The structural stability has been verified using phonon spectra. The E–k dispersion reveals the investigated material’s key electronic properties. The calculations reveal a direct bandgap of 1.12 eV for monolayer Ge2Se2. We further extract critical optical parameters using the Kubo–Greenwood formalism and Kramers–Kronig relations. A significantly large absorption coefficient and a high dielectric constant inspired the design of a monolayer Ge2Se2-based solar cell, exhibiting a high open circuit voltage of Voc = 1.11 V, a fill factor of 87.66%, and more than 28% power conversion efficiency at room temperature. Our findings advocate monolayer Ge2Se2 for various optoelectronic devices, including next-generation solar cells. The hybrid quantum-to-macroscopic methodology presented here applies to broader classes of 2D and 3D materials and structures, showing a path to the computational design of future photovoltaic materials.

This article explores the onomastic necessity of renaming gender-derogatory toponyms in the South African landscape. It contends that there is a need to interrogate the reasons behind gender-derogatory names and how society relates to these names. Four theories: Critical Discourse Analysis (CDA), Critical Toponymic, Socio-onomastic and Feminism theories guided, shaped and informed the authors’ argument. Qualitative in nature, the article employed content analysis for data collection and analysis purposes. A database of over twenty-five (25) toponyms that are considered gender-derogatory was purposively collected and analysed. These toponyms were further grouped into different categories for easy presentation and analysis. It was found that there are gender-derogatory toponyms among South African geographical features, many of which were named using African languages. Furthermore, there is an existing intersectionality between gender-derogatory toponyms with toxic masculinity and feminism. For these reasons, the article postulated that there should be synergy, resonance and constructive alignment among toponyms, renaming, transformation agenda and identity construction. The article further recommends renaming gender-derogatory toponyms and raising awareness about the renaming process and its approach. It emphasises that renaming should be guided by semantics and linguistic ideology rather than race, language, or political power and its influence.

Abstract Background The healthcare system in India is tiered and has primary, secondary and tertiary levels of facilities depending on the complexity and severity of health challenges at these facilities. Evidence suggests that emergency services in the country is fragmented. This study aims to identify the barriers and facilitators of emergency care delivery for patients with time-sensitive conditions, and develop and implement a contextually relevant model, and measure its impact using implementation research outcomes. Methods We will study 85 healthcare facilities across five zones of the country and focus on emergency care delivery for 11 time-sensitive conditions. This implementation research will include seven phases: the preparatory phase, formative assessment, co-design of Model “Zero”, co-implementation, model optimization, end-line evaluation and consolidation phase. The “preparatory phase” will involve stakeholder meetings, approval from health authorities and the establishment of a research ecosystem. The “formative assessment” will include quantitative and qualitative evaluations of the existing healthcare facilities and personnel to identify gaps, barriers and facilitators of emergency care services for time-sensitive conditions. On the basis of the results of the formative assessment, context-specific implementation strategies will be developed through meetings with stakeholders, providers and experts. The “co-design of Model ‘Zero’” phase will help develop the initial Model “Zero”, which will be pilot tested on a small scale (co-implementation). In the “model optimization” phase, iterative feedback loops of meetings and testing various strategies will help develop and implement the final context-specific model. End-line evaluation will assess implementation research outcomes such as acceptability, adoption, fidelity and penetration. The consolidation phase will include planning for the sustenance of the interventions. Discussion In a country such as India, where resources are scarce, this study will identify the barriers and facilitators to delivering emergency care services for time-sensitive conditions across five varied zones of the country. Stakeholder and provider participation in developing consensus-based implementation strategies, along with iterative cycles of meetings and testing, will help adapt these strategies to local needs. This approach will ensure that the developed models are practical, feasible and tailored to the specific challenges and requirements of each region.

Introduction: Gerotranscendence represents a shift in meta-perspective, transitioning from a materialistic and rational outlook to a more cosmic and transcendent one. This phase fosters resilience in older individuals, enabling them to overcome the challenges and despondency associated with ageing, thereby promoting a positive embrace of the ageing process. Remarkably, individuals with high levels of gerotranscendence, even in the presence of poor oral health, demonstrate the capacity to cope and adapt to their circumstances. This adaptive capability may contribute to an enhancement in their self-reported Oral Health-Related Quality of Life (OHRQoL). Aim: To evaluate the relationship between gerotranscendence and OHRQoL among the elderly population in the Vidarbha region. Materials and Methods: This cross-sectional study was conducted over a 6-month period from March 2023 to August 2023 in collaboration with the Department of Prosthodontics and the Department of Public Health Dentistry at the Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra on 350 participants. The study included volunteers aged ≥70 years, residing in homes or old age homes, and those visiting tertiary healthcare centers. Methodologically, data collection employed a self-made organised proforma. Oral examinations were conducted using Type III inspections with a mouth mirror. Gerotranscendence was assessed using the Gerotranscendence Scale Type 2 (GST2), which was validated and translated into Marathi. The Geriatric OHRQoL was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), also translated into Marathi. The study used Chi-square tests for categorical variables and Pearson’s and Spearman’s tests for correlation analyses. Results: The average gerotranscendence score was 23.45 (95% confidence interval [CI]: 22.96, 23.94), reflecting a mid-level of gerotranscendence, indicating that the gerotranscendence score was neither low nor high. According to Pearson’s and Spearman’s correlation tests, the gerotranscendence score was significantly positively correlated with age and self-perceived need for treatment. The mean GOHAI score was 40.16 (95% CI: 39.55, 40.76). A substantial positive association between the GOHAI and self-perceived need for treatment was found using Pearson’s and Spearman’s correlation tests. When comparing gerotranscendence and GOHAI, Pearson and Spearman correlation tests revealed a significant positive association (p

Paved roads are a solution for communication between human societies, but at the same time, their expansion is detrimental to wildlife. In this work, vertebrate mortality events due to traffic collisions on National Route N° 5, in a 50 km stretch from the town of Pozo Colorado to the east, are evaluated. Vehicle journeys were carried out at a constant speed of 40 km/h every two months, from November 2020 to May 2022. All findings of roadkill were recorded by photograph. To analyse spatial patterns, the Kernel density was estimated, assessing the randomness of Ripley's K collisions and standardised roadkill rates were assessed for each species. A total of 272 individuals were recorded, corresponding to 87 amphibians, 38 birds and 35 mammals. In terms of the number of species, the composition was as follows: reptiles with 20 species, birds with 13 species, mammals with 11 and amphibians with at least 12 species. The species with the highest number of dead individuals was the common toad (Rhinella diptycha), followed by snakes. According to the standardised roadkill rates, the most affected animals are Cerdocyon thous, Rhinella diptycha, Caiman yacare and Dryophylax hypoconia with more than 200 individuals per kilometre per year. A bat, Lasiurus ega, was identified for the first time for Paraguay. Climatic conditions seems to have no strong effect on the occurrence pattern of the different taxa, with the exception of birds that decrease with stronger winds. The greatest coincidences occurred in three sections: km 5–5.5, km 33.5–34.5 and km 40–43. There was a correlation with crossroads areas, watercourses and forest islands. In view of the road development policy in the region, it is necessary to carry out studies of its impacts in the longer term.

A current-perpendicular-to-plane giant magnetoresistive (CPP-GMR) device with a half-metallic electrode is one of the most promising candidates of next-generation read head for hard disk drive. In this study, we fabricate [001]-oriented polycrystalline CPP-GMR devices with the normal ferromagnet (NFM) CoFe/half-metallic ferromagnet (HMFM) Co2FeGa0.5Ge0.5 (CFGG) bilayer electrodes to enhance the magnetoresistance (MR) ratio by large interfacial spin-dependent scattering at the NFM/HMFM interface. The CoFe/CFGG bilayer electrode provides the additional large interfacial spin-dependent scattering and achieves high MR ratio of 22.7% with the CoFe(4.5 nm)/CFGG(2.5 nm) bilayer electrodes, which is almost three(two) times larger than the MR ratio with the single CoFe(CFGG) (7 nm) electrodes. The bias voltage dependent study revealed an additional advantage of increasing the output voltage |ΔV| by using the CoFe/CFGG bilayer due to the improvement of the endurance against spin-transfer torque under high bias current. A maximum output voltage [Formula: see text] of 6.5 mV was obtained with the CoFe(5.5 nm)/CFGG(1.5 nm) electrodes, which is the highest ever reported in the CPP-GMR devices with a uniform metallic spacer including high-quality epitaxial devices.

The development and characterization of bioactive surfaces based on chitosan-polyethylene glycol coatings modified with hydroxyapatite on Ti6Al4V alloy were conducted to enhance bioactivity. Characterization techniques such as scanning electron microscopy, X-ray diffraction, infrared spectroscopy, atomic absorption spectroscopy, and electrochemical impedance spectroscopy were used to evaluate coating properties, apatite formation after immersion in simulated body fluid, and electrochemical stability. Results demonstrated apatite deposition due to the bioactivity of the polymer-ceramic composite, with calcium accumulation observed on the substrate surface after 5 days of immersion. Electrochemical impedance spectroscopy revealed a highly capacitive layer in the 50:50 chitosan-polyethylene glycol coating with 0.05% w/v hydroxyapatite, indicating increased interaction with the biological medium while preserving the protective resistive properties of the Ti6Al4V alloy. These findings suggest that this coating composition is a promising material for bone tissue regeneration applications.

Introduction: Drymaria cordata is used traditionally against hyperglycemia. In this research the methanol (DCM), hexane (DCH), and water (DCW) extracts of D. cordata were investigated for their metabolite profiling, antioxidant, antibacterial, and carbohydrate hydrolyzing enzyme inhibitory activities. Methods: The antidiabetic activities of the extracts were investigated using the α-amylase and α-glucosidase (carbohydrate-hydrolyzing enzymes) inhibition assays and yeast glucose uptake assays. Antibacterial investigation of D. cordata extracts was done against methicillin-resistant Staphylococcus aureus (MRSA) and β-lactam-resistant Escherichia coli. The zone of inhibition and minimum inhibitory concentration (MIC) were observed. Results: GC-MS metabolite profiling revealed the presence of stearyl aldehyde, henicosanal, glycidyl palmitate, eicosane, phytol, octacosanal, and neophytadiene. The DCM extract had a higher phenolic (168.19 ± 3.34 mg gallic acid equivalent/g), flavonoid (843 ±11.55 mg rutin equivalents/g), and ferric reducing potential (556.083 ± 6.51 mg ascorbic acid equivalent/g) than the DCH and DCW extracts. Also, DCM showed its greatest scavenging activity with a minimum IC50 value using the ABTS assay. DCM extract had the highest zone of inhibition and lowest MIC value against E. coli and S. aureus. Carbohydrate-hydrolyzing enzymes were inhibited, with DCM extract having minimum IC50 values of 714.66 µg/ml and 508.94 µg/ml. Yeast glucose uptake assays confirmed the highest efficacy of DCM extract for glucose uptake by yeast cells. Conclusion: Drymaria cordata, especially DCM, has the potential to be considered an effective phytopharmaceutical drug for the treatment of oxidative stress, bacterial infections, and type 2 diabetes.

Abstract Background People with severe mental illness (SMI) such as schizophrenia and bipolar disorder are at a substantially higher risk of premature death in that they die between 10 and 20 years earlier than the general population. Cardiovascular disease (CVD) and diabetes are the main potentially avoidable contributors to early death. Research that explores the experiences of people with SMI highlights their struggles in engaging with health professionals and accessing effective and timely interventions for physical health conditions. A consequence of such struggles to navigate and access physical healthcare results in many people with SMI relying heavily on support provided by informal carers (e.g., family members, close friends). Despite this, the experiences of informal carers, and the roles they undertake in relation to supporting the physical health and psychotropic medication use of people with SMI, remains under-researched. Aims To explore the impacts of providing care for physical health in severe mental illness on informal carers. Method Thematic analysis of semi-structured interviews with eight informal carers of people with SMI in United Kingdom (UK) national health services. Results Informal carers played an active part in the management of the patient’s conditions and shared their illness experience. Involvement of informal carers was both emotional and practical and informal carers’ own lives were affected in ways that were sometimes deeply profound. Informal carers were involved in both ‘looking after’ the patient from the perspective of doing practical tasks such as collecting dispensed medication from a community pharmacy (caring for) and managing feelings and emotions (caring about). Conclusions Providing care for the physical health of someone with SMI can be understood as having two dimensions - ‘caring for’ and ‘caring about’. The findings suggest a bidirectional relationship between these two dimensions, and both have a cost for the informal carer. With appropriate support informal carers could be more actively involved at all stages of care without increasing their burden. This should be with an awareness that carers may minimise the information they share about their own needs and impacts of their role to spare the person they care and themselves any distress.

Technology and information systems are high-speed in their application in helping community activities in the digital era. People's desire to access the Internet has increased to provide opportunities for companies to provide technology services, namely the Internet. One of the latest platforms to gain popularity among young users is Threads, which Instagram launched. X is an online social networking and microblogging service that allows users to send and receive text-based messages or posts. To determine whether Threads and X can be used to the best of their ability to access information, an analysis of the performance of the applications was conducted. This study uses the PIECES method to determine user satisfaction with the Threads and X applications. This research uses the PIECES analysis method, which consists of several assessment indicators (Performance, Information and Data, Economics, Control, Security, Efficiency, and Service) by distributing questionnaires to active users of Threads and X from various regions to get 1002 respondents. The results of this study show that Threads receives an average score of 3.61, indicating that users are satisfied, while X gets an average score of 4.37, indicating that users are satisfied. So, the results of this study show that the average level of satisfaction of X users is more significant than Threads. This shows that X's average level of user satisfaction is superior to that of Threads.

This article presents the results of a series of experiments conducted in a virtual space, which is part of Computer Environments for Human Learning (CEHL). The experiments take place in a 2D virtual world, created on the GatherTown platform to develop a space conducive to immersion and interactions between learners. The article examines the hypothesis that the freedom of movement and exploration of space offered by this space encourage interactions and stimulate learning and collaboration between learners. The experiments consist of a series of tests of pedagogical escape games that were created by students from the master didactique des langues. These tests were recorded and the screen recordings enabled the analysis of interactions with and within space. The results highlight the impact of the spatial layout of the virtual world on participants' interactions, and highlight the benefits of gamification in terms of foreign language learning and collaboration.

Postpartum maternal sepsis is a leading cause of maternal mortality and morbidity. A single dose of prophylactic antibiotics following assisted vaginal births has been shown to significantly reduce postpartum maternal infection in a landmark multicentre randomised controlled trial, which led to its national recommendation. This project aimed to improve the local implementation of prophylactic antibiotics following assisted vaginal births to reduce postnatal maternal infections.Using a prospectively collated birth register, data were collected retrospectively on prophylactic antibiotics administration and postnatal maternal infection rates after assisted vaginal births at the Sandwell and West Birmingham Hospitals National Health Service Trust in North-West Birmingham of the UK. The data were collected from routinely used electronic health records over three audit cycles (n=287) between 2020 and 2023.A mixed-method approach was used to improve the use of prophylactic antibiotics: (1) evidence-based journal clubs targeting doctors in training, (2) presentations of results after all three audit cycles at our and (3) expedited a formal change of local guidelines to support prophylactic antibiotics use.Prophylactic antibiotic administration increased from 13.2% (December 2021) to 90.7% (July 2023), associated with a reduction in maternal infection rates (18.2% when prophylaxis was given vs 22.2% when no prophylaxis was given). However, we observed a gradual increase in the overall postnatal maternal infection rates during the project period.Our repeat audit identified prophylactic antibiotics were regularly omitted after deliveries in labour ward rooms (59.3%), compared with 100% of those achieved in theatre. After further interventions, prophylactic antibiotics administration rates were comparable between these clinical areas (>90%) in 2023.Together, we have demonstrated a simple set of interventions that induced sustainable changes in practice. Further evaluation of other modifiable risk factors and infection rates following all deliveries is warranted in view of the gradual increase in the overall postnatal maternal infection rates.

This paper focuses on the speed regulation of permanent magnet synchronous motors (PMSM) in electric vehicle application using sliding mode control (SMC). Harris hawks optimizations (HHO) based sliding mode controller is adopted to increase the dynamic response of the PMSM motor, thereby enhancing vehicle performance. For the independent control of torque and flux, field oriented-control (FOC) is used to drive the PMSM. In this work, the speed reference provided for the controller is based on an electric car driving cycle that replicates real-world driving conditions. The optimal selection of sliding mode controller parameter enhances the dynamic characteristics of the speed regulation in electric vehicles, which is validated using the hardware in the loop (HIL-402) device. The HHO based sliding mode controller has superior performance in terms of robustness against load disturbances, fast convergence, and tracking accuracy.

Environmental exposures and gene-exposure interactions are the major causes of some diseases. Early-life exposome studies are needed to elucidate the role of environmental exposures and their complex interactions with biological mechanisms involved in childhood health. This study aimed to determine the contribution of early-life exposome to DNA damage and the modifying effect of genetic polymorphisms involved in air pollutants metabolism, antioxidant defense, and DNA repair. We conducted a cohort study in 416 Colombian children under five years. Blood samples at baseline were collected to measure DNA damage by the Comet assay and to determine GSTT1, GSTM1, CYP1A1, H2AX, OGG1, and SOD2 genetic polymorphisms. The exposome was estimated using geographic information systems, remote sensing, LUR models, and questionnaires. The association exposome-DNA damage was estimated using the Elastic Net linear regression with log link. Our results suggest that exposure to PM2.5 one year before the blood draw (BBD) (0.83, 95 %CI: 0.76; 0.91), soft drinks consumption (0.94, 0.89; 0.98), and GSTM1 null genotype (0.05, 0.01; 0.36) diminished the DNA damage, whereas exposure to PM2.5 one-week BBD (1.18, 1.06; 1.32), NO2 lag-5 days BBD (1.27, 1.18; 1.36), in-house cockroaches (1.10, 1.00; 1.21) at the recruitment, crowding at home (1.34, 1.08; 1.67) at the recruitment, cereal consumption (1.11, 1.04; 1.19) and H2AX (AG/GG vs. AA) (1.44, 1.11; 1.88) increased the DNA damage. The interactions between H2AX (AG/GG vs. AA) genotypes with crowding and PM2.5 one week BBD, GSTM1 (null vs. present) with humidity at the first year of life, and OGG1 (SC/CC vs. SS) with walkability at the first year of life were significant. The early-life exposome contributes to elucidating the effect of environmental exposures on DNA damage in Colombian children under five years old. The exposome-DNA damage effect appears to be modulated by genetic variants in DNA repair and antioxidant defense enzymes.

Background: Bone marrow edema (BME) refers to the accumulation of excess fluid in the bone marrow, often indicative of injury or inflammation. Some studies suggest that incorporating plant-based therapies, rich in anti-inflammatory compounds and nutrients, may contribute to alleviating BME and promoting overall bone health. Aims and Objective: The study aims to evaluate the effect of Cissus quadrangularis and Dalbergia sissoo therapy on BME and knee pain associated with degenerative medial compartment knee osteoarthritis (OA). Materials and Methods: This retrospective study examined seven individuals with medial tibial condyle BME associated with medial compartment OA. These patients were treated with initial 10 days of non-steroidal anti-inflammatory drugs along with once-a-day tablet containing C. quadrangularis (500 mg) and D. sissoo (400 mg). Visual analogue scores (VAS) and Oxford knee score (OKS) were noted at the beginning of the therapy and at 12 weeks of completion of therapy. Before treatment, BME (percentage of the medial tibial condyle) and presence/absence of subtle subchondral fracture were diagnosed with T2-weighted magnetic resonance imaging (MRI) images, and subsequently, its resolution was confirmed with a repeat MRI scan at 12 weeks. Results: At the end of 12 weeks of therapy, there was a statistically significant improvement in the mean VAS score (baseline 8.14±0.90 improved to 2.00±0.58 at 12 weeks, [P

Abstract Background: Epistaxis is the most common case in ORL-HNS emergencies. One of the risk factors of recurrent epistaxis is hypertension. Epistaxis in hypertension usually originates from the posterior vessels. This requires more invasive procedures such as sphenopalatine artery ligation. Case Report: A 58-year-old woman with complaints of recurrent epistaxis from the right nose. The results of the blood pressure examination showed the results of 190/120 mmHg. The patient underwent sphenopalatine artery ligation to prevent recurrence. Conclusion: One of the factors for recurrent epistaxis is hypertension. Initial management of epistaxis with recurrent hypertension can be done in a conservative way followed by surgery and keeping blood pressure stable. Endoscopic sphenopalatine artery ligation is the definitive treatment according to the epistaxis management algorithm. Endoscopic sphenopalatine artery ligation provides satisfactory results and minimal complications.Keywords: Recurrent epistaxis, hypertension, sphenopalatine artery ligation

Pesantren Mizanul Ulum mempunyai permasalahan dalam kegiatan pendidikan yaitu model pembelajaran yang diberikan guru kepada para santri bersifat konvensional dan belum memanfaatkan teknologi komputer. Pengabdian yang kami lakukan bertujuan agar mitra mendapat pengetahuan tentang manfaat informasi dan teknologi komunikasi dengan cara melakukan sosialisasi dan pelatihan kepada para guru. Sosialisasi dan pelatihan modul pembelajaran terdiri dari pembelajaran Word, Excel, Power Point dan penggunaan Google Forms. Untuk mengetahui hasil dari sosialisasi ini, kami melakukan evaluasi terhadap guru melalui pretest dan posttest dengan jumlah soal sebanyak 30 soal dengan skor maksimal 30. Peserta yang terlibat dalam sosialisasi sebanyak 16 orang guru. Berdasarkan hasil evaluasi diketahui bahwa skor pretest adalah 334 dan skor posttest adalah 414. Rata-rata skor pretest adalah 20,875 dan posttest adalah 25,875 sedangkan skor pretest maksimum adalah 26 dan posttest adalah 28, skor minimum untuk pretest adalah 15 dan posttest adalah 23. Kegiatan sosialisasi yang kami lakukan ini pada Pesantren Mizanul Ulum Sanrobone Kabupaten Takalar mampu meningkatkan pengetahuan para guru.

Abstract Background The ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations. Methods We systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in harvest plots. Results The Depth framework identifies three constructs influencing agentic demand: exposure — initial contact with intervention (two levels), mechanism of action — how the intervention enables or discourages behaviour (five levels) and engagement — recipient response (two levels). When combined, these constructs form a matrix of 20 possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness. Conclusions This framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis.

Background: Research on medicines access and use is heterogeneous and can be challenging for decision- makers to interpret. Pharmaceutical policy is an additional component for study and is the foundation for the promotion of access and use of medicines. This systematic review summarizes findings from the literature on medicines policy, access and use over the past two decades in Mexico and identifies research gaps that should be addressed. Methods: A systematic review of the literature published between 2000 and 2022 was conducted to identify publications on medicines policy, access and use in Mexico. The study followed PRISMA Statement guidelines 2020. A narrative review including content analysis was conducted. Results: A total of 5057 articles were reviewed, of which 77 fit the inclusion criteria. Studies described the lack of an explicit national policy, a misalignment between the legal framework and reinforcement incentives, deficient policy documentation at the national level, and the absence of necessary medicines regulation and transparency. In terms of access to medicines, challenges related to supply, selection, acquisition, distribution and expenditure were noted. Regarding medicine use, key study findings included a lack of adherence to standard treatment guidelines, dispensing, lack of reliable information on medicines, lack of treatment adherence and harmful self-medication. Conclusion: The appropriate use of medicines and adequate access to them are priority topics for the formulation of Mexican pharmaceutical policy. It is critical that further research includes longitudinal studies of medicine access and use, and the consideration of studying the private sector as well as new methodological approaches. Many reported challenges related to access to and use of medicines have persisted across decades, suggesting a lack of effective research-to-practice knowledge transfer and policy implementation. This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/

Introduction: Cancer is a leading cause of death in the Americas. Colorectal cancer is the third most common cancer, while stomach cancer is the sixth most common cancer worldwide. Tobacco and alcohol consumption, unhealthy diet, physical inactivity and air pollution are risk factors for these cancers. This study aimed to identify the association between dietary patterns and gastric and colorectal cancer. Methodology: A multi-cluster ecological study, using as secondary sources two national databases, the HIGIA (High-Cost Account) and the ENSIN 2015 (National Survey of Nutritional Status of Colombia 2015), was carried out. The population consisted of 2585 people over 50 years of age, distributed in six regions of Colombia: Atlántica, Central, Oriental, Pacífica, Amazonía-Orinoquía, and Bogotá. Multiple linear regression was performed using R2 to measure goodness of fit to estimate the effect between colorectal cancer incidence rate/gastric cancer incidence rate and exposure factors. Results: A positive association was observed between colorectal cancer and non-compliance with the recommendation of vigorous physical activity (p = 0.00) and consumption of beverages/grilled food pattern (p = 0.001). Conversely, it decreased incidence by enjoying some specific health insurance and following a conservative dietary pattern (p = 0.05). Gastric cancer incidence was found to increase with age (p = 0.000), sex (p = 0.001), and consumption of the beverages/grilled food pattern (p = 0.006). However, being in the first wealth quartile decreased the incidence (p = 0.002). Conclusion: There is evidence of an association between diet, physical activity and wealth quartile with colorectal and gastric cancer. This information should be considered for preventive interventions in the population.

Durante a realização da cintilografia de perfusão miocárdica (CPM) de estresse e repouso, é medida a carga de trabalho alcançada, definida pelos equivalentes metabólicos (METs), e verificada a presença de alterações isquêmicas nos exames eletrocardiográficos. O objetivo deste estudo foi avaliar essas variáveis e identificar quais seriam úteis na identificação dos pacientes com isquemia miocárdica severa. Para tanto, foi realizado um estudo do tipo transversal, observacional e retrospectivo, com amostragem do tipo não probabilístico por conveniência, feito por meio da análise de 2.388 prontuários cujos pacientes haviam sido encaminhados para realização de CPM. Os pacientes foram divididos em dois grupos de acordo com os METs alcançados, e foram comparadas as prevalências de isquemia severa aferida pelo software Wackers-Liu. Dos 2.388 prontuários, 506 atingiram 10 METs sem alterações eletrocardiográficas do segmento ST no estresse, os quais foram enquadrados no grupo B; desses, 0,4% (2/506) apresentou isquemia severa. Os 515 pacientes do grupo A não alcançaram 10 METs e apresentaram, simultaneamente, alterações eletrocardiográficas isquêmicas do segmento ST; 3,6% (19/515) deles evidenciaram isquemia severa, diferença estatisticamente significante (p < 0,0002). Com base nesses achados, conclui-se que, na presença de alterações eletrocardiográficas isquêmicas na fase de estresse com carga de trabalho < 10 METs, a probabilidade de isquemia miocárdica severa é nove vezes maior em comparação aos que alcançaram ≥ 10 METs sem alterações eletrocardiográficas isquêmicas. Desse modo, uma carga de trabalho que alcança ≥ 10 METs sem alterações eletrocardiográficas compatíveis com isquemia pode ser um bom preditor para ausência de isquemia severa na CPM.

The primary goal of the KIDS4ALLL project was to empower educators to foster a flexible, innovative, and collaborative learning environment within their classrooms. This article delves into teachers’ experiences with implementing collaborative learning during the KIDS4ALLL project. Additionally, it explores how teachers perceived the implementation of the KIDS4ALLL pilot in learning environments across different national educational settings, specifically in Israel and Turkey. Given that both Israel and Turkey have centralized education systems and adhere to a traditional teaching approach, the two research questions offer insights into how the national education context of both countries influences the implementation of the collaborative learning approach of KIDS4ALLL and the experiences of educators. The methodology employed in this study involved semi-structured interviews with 16 educators and participant observation during the two pilots. The findings highlight a sense of fear and uncertainty among educators regarding their ability to conduct lessons in an unfamiliar yet innovative and flexible learning environment. These feelings were accompanied by challenges such as technological and language barriers, sociocultural diversities, and occasional behavioral issues. The results also underscore similarities between the two countries, emphasizing that centralized education systems, teachers’ previous training, curriculum, and available physical space posed challenges to the pilot program’s implementation.

Summary: The mechanical environment generated through the adhesive interaction of endothelial cells (ECs) with the matrix controls nuclear tension, preventing aberrant gene synthesis and the transition from restrictive to leaky endothelium, a hallmark of acute lung injury (ALI). However, the mechanisms controlling tension transmission to the nucleus and EC-restrictive fate remain elusive. Here, we demonstrate that, in a kinase-independent manner, focal adhesion kinase (FAK) safeguards tension transmission to the nucleus to maintain EC-restrictive fate. In FAK-depleted ECs, robust activation of the RhoA-Rho-kinase pathway increased EC tension and phosphorylation of the nuclear envelope protein, emerin, activating DNMT3a. Activated DNMT3a methylates the KLF2 promoter, impairing the synthesis of KLF2 and its target S1PR1 to induce the leaky EC transcriptome. Repleting FAK (wild type or kinase dead) or inhibiting RhoA-emerin-DNMT3a activities in damaged lung ECs restored KLF2 transcription of the restrictive EC transcriptome. Thus, FAK sensing and control of tension transmission to the nucleus govern restrictive endothelium to maintain lung homeostasis.

Background Problems: Due to the intricate nature of the game and the requirement for proficiency in core skills like dribbling, passing, shooting, and defensive positioning, basketball players frequently have difficulties developing their technical abilities. Traditional training approaches may not focus enough on these skills, leaving room for growth. Research Objective: This study investigates how well basketball players' technical skills may be improved through game-based instruction, particularly small-sided basketball games. The study aims to address the need for a more focused approach to technical elements by highlighting the value of focused practice in pertinent game scenarios. Methods: The type of research used was quantitative research with a sample of 12 amateur athletes. The instrument used is the game performance evaluation tool (GPET). Quantitative data from pre- and post-assessments were examined using the appropriate statistical techniques, such as paired t-tests or analysis of variance (ANOVA). For the study, basketball players with various skill levels were listed. Small groups of participants received specialised training to develop their technical abilities. Findings and Results: Participants' technical proficiency significantly improved after strategically focused practice using small-sided basketball games. The outcomes show that this game-based method works well for improving basic abilities, including passing, dribbling, shooting, and positioning defensively. The results highlight how effective it is to use small-sided games to help basketball players enhance their skills. Conclusion: The study concludes that small-sided basketball games are an effective strategy for improving basketball players' technical proficiency. Notwithstanding several constraints, such as a comparatively limited sample size and consistency in participant skill levels, the findings indicate that focused practice in pertinent gaming environments produces notable enhancements. To better understand the potential of this strategy for players of different skill levels, future studies should include additional variables like training amounts and differences in small-sided game structures.

Primary meningeal melanomatosis is an extremely rare tumor with very few documented responses to treatment. A 3-year-old male with a complex past medical history, including prematurity and shunted hydrocephalus, was diagnosed with primary meningeal melanomatosis with peritoneal implants. Molecular testing revealed an NRAS Q61R mutation. The patient received proton craniospinal radiation followed by immunotherapy with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) IV every 3 weeks and, upon progression, he was switched to a higher dose of nivolumab (3 mg/kg IV every 2 weeks) and binimetinib (24 mg/m2/dose, twice a day). The patient had significant improvement of CNS disease with radiation therapy and initial immunotherapy but progression of extracranial metastatic peritoneal and abdominal disease. Radiation was not administered to the whole abdomen. After two cycles of nivolumab and treatment with the MEK inhibitor binimetinib, he had radiographic and clinical improvement in abdominal metastasis and ascitis. He ultimately died from RSV infection, Klebsiella sepsis, and subdural hemorrhage without evidence of tumor progression. This is the first report of a child with primary meningeal melanomatosis with extracranial metastatic disease with response to a combination of radiation, immunotherapy and MEK inhibitor therapy.

Pendahuluan: Limfoma Non Hodgkin (LNH) sinonasal merupakan tumor ganas ekstranodal yang jarang terjadi. Lokasi paling sering adalah sinus maksilaris, sinus ethmoid dan rongga hidung. Diagnosis pasti imfoma ditegakkan berdasarkan hasil pemeriksaan histopatologi dan imunohistokimia. Tatalaksana kasus berdasarkan stadium dengan menggunakan stagging Ann Arbor. Laporan Kasus: Dilaporkan satu kasus LNH sinonasal pada laki–laki usia 56 tahun dengan keluhan hidung kanan tersumbat dan keluar darah dari hidung kanan. Pemeriksaan kavum nasal dekstra ditemukan adanya massa yang memenuhi kavum nasal disertai sekret mukopurulen. Kemudian dilakukan tindakan medial maksiektomi dengan pendekatan endoskopik dan didapatkan hasil histopatologi limfoma maligna tipe sel sedang serta imunohistokimia (IHK) dengan hasil limfoma maligna tipe sel B. Kesimpulan: Dilaporkan satu kasus LNH sinonasal pada laki–laki usia 56 tahun dengan keluhan hidung kanan tersumbat dan keluar darah dari hidung kanan. Pemeriksaan kavum nasal dekstra ditemukan adanya massa yang memenuhi kavum nasal disertai sekret mukopurulen. Kemudian dilakukan tindakan medial maksiektomi dengan pendekatan endoskopik dan didapatkan hasil histopatologi limfoma maligna tipe sel sedang serta imunohistokimia (IHK) dengan hasil limfoma maligna tipe sel B. Kata kunci: Limfoma Non Hodgkin sinonasal, Limfoma tipe Sel B, Kemoterapi.

Latar Belakang: Teknik operasi bedah basis kranii dengan pendekatan endoskopi transfenoid memberikan kualitas visualisasi lapang pandang operasi lebih baik dibanding menggunakan mikroskop dan morbiditas lebih rendah dibanding teknik lainnya. Selama dua dekade terakhir bedah endoskopik telah mendapatkan dukungan sebagai pendekatan utama untuk lesi sellar dan parasellar termasuk adenoma hipofisis. Laporan Kasus: Dilaporkan satu kasus seorang laki-laki 34 tahun dengan keluhan penurunan penglihatan dan didiagnosis dengan adenoma hipofisis. Pada pasien dilakukan tindakan reseksi tumor oleh ahli bedah saraf dengan pendekatan endoskopi transfenoid berkolaborasi dengan ahli THT-KL. Kesimpulan: Bedah basis kranii pendekatan endoskopi transfenoid adalah tindakan bedah yang menjadi pilihan utama untuk lesi basis kranii. Tindakan ini memberikan visualisasi struktur anatomi yang baik, lapang pandang operasi yang lebih luas, manipulasi struktur neurovaskular minimal, meminimalisir morbiditas dan meningkatkan kualitas hidup pasien, memiliki tingkat keberhasilan yang cukup tinggi dan memberikan hasil yang memuaskan.

The classrooms in Israel are very diverse, with students differing in learning styles, their handling of literacy tasks, personal and socioeconomic backgrounds, and more. These differences significantly impact the curriculum aimed at promoting literacy resilience, explicit teaching processes in the classroom, and imparting metacognitive strategies and actions to overcome learning difficulties. This qualitative-interpretative study reveals the pedagogical perceptions, challenges, and coping strategies of fourteen Hebrew teachers in five elementary schools in central Israel regarding integrating home literacy in language lessons and cultivating literacy resilience among their students. The research data were collected through in-depth interviews with the teachers. The analysis of the teachers’ reports reveals two main perceptions regarding literacy resilience: (1) Literacy resilience is a tool for life; (2) Home literacy significantly contributes to fostering literacy resilience. Furthermore, cultivating literacy resilience presents three significant challenges for the teachers: (1) Teaching in a heterogeneous classroom, (2) Encouraging parental involvement, and (3) Fostering independent learners. To cultivate literacy resilience in a heterogeneous classroom, teachers must be sensitive to each student’s unique needs and plan teaching-learning processes based on principles of self-directed learning and peer dialogue. They must establish a personal-emotional connection that is a significant anchor for the students and outlines a path for integrating and strengthening the sense of competence in handling literacy tasks. It was also found that parental involvement is a significant factor influencing the cultivation of literacy resilience, and teachers undertake various actions to increase their level of involvement. This study adds an essential layer to the body of knowledge regarding the understanding of the factors affecting the development of pedagogical literacy perceptions that promote the integration of home literacy in the classroom. These perceptions may promote the nurturing process of literacy resilience among students from various cultures, accepting and understanding them. In this way, we can attempt to address literacy and language challenges in Israel.

Various global-scale proposals exist to reduce the loss of biological diversity. These include the Half-Earth and Whole-Earth visions that respectively seek to set aside half the planet for wildlife conservation or to diversify conservation practices fundamentally and change the economic systems that determine environmental harm. Here we assess these visions in the specific context of Bornean orangutans Pongo pygmaeus and their conservation. Using an expert-led process we explored three scenarios over a 10-year time frame: continuation of Current Conditions, a Half-Earth approach and a Whole-Earth approach. In addition, we examined a 100-year population recovery scenario assuming 0% offtake of Bornean orangutans. Current Conditions were predicted to result in a population c. 73% of its current size by 2032. Half-Earth was judged comparatively easy to achieve and predicted to result in an orangutan population of c. 87% of its current size by 2032. Whole-Earth was anticipated to lead to greater forest loss and ape killing, resulting in a prediction of c. 44% of the current orangutan population for 2032. Finally, under the recovery scenario, populations could be c. 148% of their current size by 2122. Although we acknowledge uncertainties in all of these predictions, we conclude that the Half-Earth and Whole-Earth visions operate along different timelines, with the implementation of Whole-Earth requiring too much time to benefit orangutans. None of the theorized proposals provided a complete solution, so drawing elements from each will be required. We provide recommendations for equitable outcomes.

Indonesian Sign Language (BISINDO) is one of the sign languages used in Indonesia. The process of classifying BISINDO can be done by utilizing advances in computer technology such as deep learning. The use of the BISINDO letter classification system with the application of the MobileNet V2 FPNLite SSD model using the TensorFlow object detection API. The purpose of this study is to classify BISINDO letters A-Z and measure the accuracy, precision, recall, and cross-validation performance of the model. The dataset used was 4054 images with a size of consisting of 26 letter classes, which were taken by researchers by applying several research scenarios and limitations. The steps carried out are: dividing the ratio of the simulation dataset 80:20, and applying cross-validation (k-fold = 5). In this study, a real time testing using 2 scenarios was conducted, namely testing with bright light conditions of 500 lux and dim light of 50 lux with an average processing time of 30 frames per second (fps). With a simulation data set ratio of 80:20, 5 iterations were performed, the first iteration yielded a precision result of 0.758 and a recall result of 0.790, and the second iteration yielded a precision result of 0.635 and a recall result of 0.77, then obtained an accuracy score of 0.712, the third iteration provides a recall score of 0.746, the fourth iteration obtains a precision score of 0.713 and a recall score of 0.751, the fifth iteration gives a precision score of 0.742 for a fit score case and the recall score is 0.773. So, the overall average precision score is 0.712 and the overall average recall score is 0.747, indicating that the model built performs very well.

Introduction: Labour, especially in primiparas, is associated with intense pain. Patients labouring without analgesia may experience longer durations in all stages, along with the suffering associated with labour pains. The study was conducted to determine whether a programmed labour regime provided adequate pain relief and accelerated the labour process. Aim: To compare the maternal and perinatal outcomes in patients who underwent conventional labour with those who received programmed labour analgesia. Materials and Methods: This prospective interventional study was conducted in the Department of Obstetrics and Gynecology at Netaji Subhash Chandra Bose Medical College and Hospital in Jabalpur, Madhya Pradesh, India. The study duration was one year and five months, from March 2021 to August 2022. A total of 100 patients, including 50 low-risk primiparas in each group with cervical dilatation of 3 to 4 cm, were randomly allocated to the case and control groups. The case group received a programmed labour regime, which involved administering small doses of various drugs such as pentazocine, drotaverine, diazepam, and tramadol. No analgesia was given to the control group. Pain relief assessment was conducted using a Visual Analogue Scale (VAS). The duration of the various stages of labour and the rate of cervical dilatation were assessed in both groups. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study subjects in the control group was 24.14±2.39 years, and in the case group, it was 24.26±2.49 years. Compared to the control group, 29 (58%) cases experienced mild pain, and 21 (42%) experienced moderate pain. The rate of cervical dilatation was 2.57±1.41 cm/hour in the case group compared to 1.41±0.36 cm/hour in the control group (p-value

Background: Cancer of the cervix is the second most common cancer among women worldwide. Although pap test has successfully reduced the incidence of cervical cancer, it is associated with high false positive and high false negative test results. In order to improve the efficacy of screening program, United States cervical cancer screening guidelines recommend use of combined testing (cytology + HPV-DNA) in women above 30-65 years of age. However, due to application of current HPV vaccines, cervical screening will face challenges due to declining trends in the prevalence of HPV genotypes covered by vaccines. Aim: The study is aimed at finding out the role of immunomarkers (P16 and Ki67) in identifying pre-malignant and malignant lesion of carcinoma cervix and their comparison with the co-testing (cytology + HPV-DNA) method of screening. Methods: A cross-sectional observational study was conducted on 32 cases after consent. The tests done were cytology + HPV-DNA, cytology+p16, cytology+ Ki-67 and were compared in terms of their sensitivity, specificity, positive predictive value and negative predictive value against the gold standard, histopathology. Result: Majority of cases were in 30-40 years of age group. The sensitivity, specificity, positive predictive value and negative predictive value of cytology + HPV-DNA testing was 94.44%, 50%, 77.27%, 83.33% while that of cytology + P16 was 88.88%, 60%, 80%, 75% and cytology + Ki-67 was 88.88%, 100%, 100%, 91.66% respectively. Conclusion: Ki67 immunomarker is a better screening tool in terms of specificity, positive predictive value and negative predictive value when compared to cytology + HPV/p16. Ki-67 can be considered as a potential screening tool in future for both vaccinated and unvaccinated population.

Background: Suction evacuation is the most common surgical method of first-trimester pregnancy termination and cervical dilatation is the most critical step. Misoprostol is increasingly being used as a cervical priming agent before suction evacuation although the ideal dosage and route of administration is not yet agreed upon. Objective: The present study aimed to compare the efficacy, side effects and acceptability of the sublingual vs. vaginal route of administration of misoprostol. Methodology: 120 women seeking first-trimester termination of pregnancy between 6 to 12 weeks of gestation were randomized to receive 400mcg of misoprostol either sublingually or vaginally. Women in the two groups were comparatively evaluated for cervical dilatation before a surgical abortion, operative blood loss, time duration of surgery, adverse effects and overall satisfaction with the route of administration. Result: Successful dilatation of more than 8mm was achieved in 41(68.3%) women in the sublingual group and 23(38 %) in the vaginal group (p

Marine macroalgae are the habitat of epiphytic bacteria and provide several conditions for a beneficial biological interaction to thrive. Although Bacillus is one of the most abundant epiphytic genera, genomic information on marine macroalgae-associated Bacillus species remains scarce. In this study, we further investigated our previously published genome of the epiphytic strain Bacillus altitudinis 19_A to find features that could be translated to potential metabolites produced by this microorganism, as well as genes that play a role in its interaction with its macroalgal host. To achieve this goal, we performed a pan-genome analysis of Bacillus sp. and a codon bias assessment, including the genome of the strain Bacillus altitudinis 19_A and 29 complete genome sequences of closely related Bacillus strains isolated from soil, marine environments, plants, extreme environments, air, and food. This genomic analysis revealed that Bacillus altitudinis 19_A possessed unique genes encoding proteins involved in horizontal gene transfer, DNA repair, transcriptional regulation, and bacteriocin biosynthesis. In this comparative analysis, codon bias was not associated with the habitat of the strains studied. Some accessory genes were identified in the Bacillus altitudinis 19_A genome that could be related to its epiphytic lifestyle, as well as gene clusters for the biosynthesis of a sporulation-killing factor and a bacteriocin, showing their potential as a source of antimicrobial peptides. Our results provide a comprehensive view of the Bacillus altitudinis 19_A genome to understand its adaptation to the marine environment and its potential as a producer of bioactive compounds.

The plants on earth are a blessing to both humans and animals. Both humans and animals depend on them, to survive in many ways. The plants help us in meeting our food demands while also aiding the treatment of numerous illnesses like alzheimer, cancer, asthma, and others. Among the numerous plants, the safflower leaves are used as vegetables in India and many Asian countries. Along with veggies, safflower leaves have a variety of health benefits for treating ailments. In this regard, the major goal of this study was to examine the multitargeted anti-alzheimer's activity of eight phytoconstituents identified in safflower leaves. Molecular docking study has been performed on each of the eight molecules with the targets linked to alzheimer's disease. The compounds were docked with beta-secretase 1, beta-secretase 2, and butyrylcholinesterase by using the autodock vina algorithm inbuilt in the PyRx software. Four FDA-approved drugs were selected for the comparative analysis along with these eight compounds. The analysis showed that almost all compounds have stronger affinity for the selected targets than FDA-approved drugs. Finally, Quercetin-7-O-(6''-O-acetyl)-β-d-glucopyranoside was selected as best based on binding energy (−8.4 to −10.2) and the interactions for all the selected targets. The toxicity analysis was also performed for best bioactive and FDA-approved drug. Finally, molecular dynamics analysis was performed to analyse the complexes stability. Overall, this study will help the scientific community and society to find a novel drug candidate for the treatment of Alzheimer's disease.

Digital image processing is a field of study that focuses on how an image can be formed, processed, and analyzed to generate useful information for humans. In this research, the utilization of digital images is implemented to classify BISINDO (Indonesian Sign Language) letters from A to Z using the Random Forest classification method. The initial stage in the classification of BISINDO letter images involves pre-processing, which includes converting RGB images to grayscale and performing segmentation through three stages: thresholding, morphology, and edge detection using the Prewitt operator. Subsequently, features such as HSV color extraction and metric shape features, as well as eccentricity, are extracted. These extracted feature values are then utilized in the classification stage of BISINDO letter images from A to Z using the Random Forest method. In this study, three data comparison scenarios were employed for testing purposes. The first scenario involved an 80:20 data ratio, which achieved a testing accuracy of 94.2%. The second scenario with a 70:30 data ratio achieved a testing accuracy of 93.6%, while the third scenario with a 60:40 data ratio had a lower accuracy of only 77.9%. Based on the results of our testing, the system developed is capable of effectively classifying BISINDO letters from A to Z using color and shape feature extraction, along with the Random Forest classification method. The best results were obtained in the data comparison scenario of 80:20, achieving an accuracy rate of 94.2%. Keywords – BISINDO, HSV, Metric, Eccentricity, Random Forest.

Digital image processing juga dikenal sebagai pengolahan citra digital merupakan suatu metode yang digunakan untuk memproses atau manipulasi citra digital. Pengolahan citra digital dapat menyelesaikan berbagai bidang permasalahan, salah satunya adalah pengenalan huruf Bahasa Isyarat Indonesia (BISINDO) yang digunakan penyandang tunarungu dan tunawicara dalam berkomunikasi. Adapaun tujuan kami melakukan penelitian ini adalah membangun aplikasi berbasis citra digital yang dapat mengenali huruf BISINDO dari huruf A sampai Z dengan tingkat akurasi kemiripan huruf yang baik. Data huruf BISINDO yang digunakan sebanyak 260 citra dengan pembagian dataset 80% atau 208 citra untuk data latih dan 20% atau 52 citra untuk data uji. Tahapan dalam pengenalan huruf ini diawali dengan melakukan pre-processing dengan menkonversi citra RGB ke grayscale, segmentasi menggunakan thresholding, morfologi opening dan deteksi tepi sobel, peroleh nilai ekstraksi fitur bentuk menggunakan Chain Code Contour. Nilai yang didapatkan dari ekstraksi fitur tersebut akan digunakan pada tahap akhir, yaitu tahap pengenalan citra huruf BISINDO menggunakan metode klasifikasi Naive Bayes. Penelitian ini menggunakan 2 skenario pengujian yaitu skenario database dan skenario diluar database, dimana setiap skenario menggunakan 3 pembagian dataset yaitu 80: 20, 70:30, dan 60:40. Hasil pengujian pada skenario database dengan pembagian dataset 80:20 memperoleh akurasi mencapai 100%, pada pembagian dataset 70:30 akurasi mencapai 92.3%, dan pada pembagian dataset 60:40 akurasi mencapai 88.4%. Untuk skenario diluar database pada pembagian dataset 80:20 memperoleh akurasi mencapai 80.7%, pada pembagian dataset 70:30 akurasi mencapai 73.07%, dan pada pembagian dataset 60:40 akurasi mencapai 75.9%. Berdasarkan hasil pengujian yang telah dilakukan diperoleh akurasi terbaik pada pembagian dataset 80:20, dengan tingkat akurasi pengujian pada skenario database mencapai 100% dan pada skenario diluar database akurasi mencapai 80.7%. Hal ini menunjukkan bahwa metode ekstraksi fitur bentuk Chain Code Contour dan klasifikasi Naive Bayes mampu mengenali huruf BISINDO dengan baik.

The relationship between gut microbiota and its metabolites with cardiovascular disease (CVD) has been proven. In this review, we aim to conclude the potential mechanism of gut microbiota and its metabolites on inducing the formation of vulnerable atherosclerotic plaque, and to discuss the effect of intestinal metabolites, including trimethylamine-N-oxide (TMAO), lipopolysaccharide (LPS), phenylacetylglutamine (PAG), short-chain fatty acids (SCFAs) on plaque stability. Finally, we include the impact of gut microbiota and its metabolites on plaque stability, to propose a new therapeutic direction for coronary heart disease. Gut microbiota regulation intervenes the progress of arteriosclerosis, especially on coronary atherosclerosis, by avoiding or reducing the formation of vulnerable plaque, to lower the morbidity rate of myocardial infarction.

El objetivo de la revisión documental se basó en sintetizar los hallazgos encontrados en América Latina sobre la espiritualidad dentro de contextos pedagógicos de los últimos diez años hasta la fecha actual. Se incluyeron un total de 62 trabajos en esta revisión. Se destaca que la gran mayoría de estudios enfatizan los aspectos positivos de la espiritualidad, adoptando una postura innovadora sobre esta temática. Además, se observó que las investigaciones con un paradigma cualitativo fueron las más relevantes en este campo, puesto que se da mayor prioridad a la comprensión exhaustiva de la espiritualidad en entornos educativos, y no netamente cuantificarla. Finalmente, se propone profundizar en la creación de modelos estadísticos y de acción participativa para generar conocimiento a partir de la vinculación de dicha variable en las instituciones educativas.

Introduction: Periodontal medicine indicates a strong relationship between Periodontal Health (PH) or disease and ‘systemic health.’ Although Periodontal Disease (PD) is quite distant from the area affected by endometriosis, both conditions share a similar pathogenesis. Both endometriosis and PD are chronic inflammatory diseases that occur more commonly in patients with systemic disorders. Moreover, significant alterations in immune modulators have been shown to occur in both diseases. Need for the Study: The research is to evaluate the correlation between endometriosis and PH for early diagnosis, treatment planning, and prevention of long-term sequelae. Aim: To evaluate the PH status in female patients with endometriosis. Materials and Methods: A cross-sectional study will be carried out in the Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India from September 2023 to March 2024, involving 384 participants (192 patients diagnosed with endometriosis and 192 controls). Assessment of oral hygiene, plaque accumulation, gingival status, Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (GR), and other factors will be measured to evaluate the PH of the patients.

A 64-year-old female presented with complaints of multiple episodes of palpitations, pedal edema, and abnormal neck pulsations for the past 6 months. Pulse was regular and jugular venous pulse elevated with a prominent V wave and sharp Y descent. Cardiovascular examination revealed grade II left parasternal heave, epigastric pulsations, right ventricle S3, and a grade III high-pitched blowing pansystolic murmur at the left lower sternal border. Electrocardiogram, chest X-ray, and 24-h Holter monitoring were normal. We clinically diagnosed isolated right heart failure with nonhypertensive tricuspid regurgitation. Transthoracic echocardiography showed a huge right atrial tumor prolapsing into the right ventricle and right ventricular outflow tract along with significant tricuspid regurgitation. The tumor was removed surgically. Histopathological examination confirmed the diagnosis of right atrial myxoma. Right atrial myxoma presenting as pure tricuspid regurgitation and right heart failure is rarely reported in the literature.

Chronic rhinosinusitis (CRS) is defined as chronic inflammation of the nose and paranasal sinuses with two or more symptoms, one of which can be nasal congestion/obstruction/congestion or rhinorrhea (anterior/postnasal drip), and/or with facial pain, reduced or loss of smell. Elongated uncinate is one of the anatomical variants of the uncinate process where the uncinate process is curved or bent, which causes sinus problems and is one of the risk factors for CRS. It has been reported a 19-year-old man with the diagnosis of chronic rhinosinusitis with third-grade bilateral nasal polyp from computed tomography of the paranasal sinusitis. There was an impression of the sinonasal polyp with inverted papilloma as a differential diagnosis. The patient was treated through microdebrider-assisted functional endoscopic sinus surgery. This was chronic rhinosinusitis with grade III bilateral nasal polyps, and microdebrider-assisted fungsional endoscopic sinus surgery was performed with great results. Keywords: chronic rhinosinusitis, elongated unsinatus, functional endoscopic sinus surgery, nasal polyp

Abstract Background In 2019, our interdisciplinary team of researchers, family members, and youth co-designed four simulation training videos and accompanying facilitation resources to prepare youth, family members, trainees, and researchers to build the knowledge and skills to engage in patient-oriented research (POR) authentically and meaningfully. Videos covered challenges in aspects of the research process including (1) forming a project team; (2) identifying project objectives and priorities; (3) agreeing on results; and (4) carrying out knowledge translation. Methods The purpose of the study was to deliver four simulation training videos across 2 two-hour facilitated workshops with researchers, trainees, and family partners. We evaluated whether the training videos and facilitated discussion of the simulations helped to improve knowledge and attitudes about authentic and meaningful partnership in research and self-perceived ability to engage in POR. An explanatory sequential two-phase mixed methods design was used. Phase 1 (quantitative) included two training workshops and a pre/post-training survey. Phase 2 (qualitative) included two qualitative focus groups. Results of each phase were analyzed separately and then combined during interpretation. Results Sixteen individuals (including researchers/research staff, trainees, family members, clinicians) took part in this research study. Overall, participants were highly receptive to the training, providing high scores on measures of acceptability, appropriateness, and feasibility. While the training videos and facilitated discussion of the simulations were found to increase participants’ knowledge and ability to engage in authentic and meaningful POR, we found no significant change in attitude or intent. Recommendations about the simulation content and delivery were provided to inform for future use. Conclusions The simulations were found to be a positive and impactful way for collaborative research teams to build knowledge and ability to engage in authentic and meaningful POR. Recommendations for future work include covering different content areas with varying levels of nuance; and offering the training to stakeholders in a variety of roles, such as those higher-ranked academic positions.

Abstract Background Policymakers and program developers in low-and lower-middle-income countries (LLMICs) are increasingly seeking evidence-based information and guidance on how to successfully develop and implement continuing professional development (CPD) systems. We conducted a rapid scoping review to map and synthesize what is known regarding the development, implementation, evaluation and sustainability of CPD systems for healthcare professionals in LLMICs. Methods We searched MEDLINE, CINAHL and Web of Science. Reference lists were screened and a cited reference search of included articles was conducted. Supplementary information on the CPD systems identified in the articles was also identified via an online targeted grey literature search. English, French and Spanish literature published from 2011 to 2021 were considered. Data were extracted and combined and summarized according to country/region and healthcare profession via tables and narrative text. Results We included 15 articles and 23 grey literature sources. Africa was the region most represented followed by South and Southeast Asia and the Middle East. The literature most often referred to CPD systems for nurses and midwives; CPD systems for physicians were frequently referred to as well. Findings show that leadership and buy-in from key stakeholders, including government bodies and healthcare professional organizations, and a framework are essential for the development, implementation and sustainability of a CPD system in a LLMIC. The guiding framework should incorporate a regulatory perspective, as well as a conceptual lens (that informs CPD objectives and methods), and should consider contextual factors (support for CPD, healthcare context and population health needs). In terms of important steps to undertake, these include: a needs assessment; drafting of a policy, which details the regulations (laws/norms), the CPD requirements and an approach for monitoring, including an accreditation mechanism; a financing plan; identification and production of appropriate CPD materials and activities; a communication strategy; and an evaluation process. Conclusion Leadership, a framework and a clearly delineated plan that is responsive to the needs and context of the setting, are essential for the development, implementation and sustainability of a CPD system for healthcare professionals in a LLMIC.

Abstract Objective To compute penetrance and recurrence risk using a genome‐wide PRS (including and excluding the APOE region) in families with Alzheimer's disease. Methods Genotypes from the National Institute on Aging Late‐Onset Alzheimer's Disease Family‐Based Study and a study of familial Alzheimer's disease in Caribbean Hispanics were used to compute PRS with and without variants in the 2 MB region flanking APOE. PRS was calculated in using clumping/thresholding and Bayesian methods and was assessed for association with Alzheimer's disease and age at onset. Penetrance and recurrence risk for carriers in highest and lowest PRS quintiles were compared separately within APOE‐ε4 carriers and non‐carriers. Results PRS excluding the APOE region was strongly associated with clinical and neuropathological diagnosis of AD. PRS association with AD was similar in participants who did not carry an APOE‐ε4 allele (OR = 1.74 [1.53–1.91]) compared with APOE‐ε4 carriers (1.53 [1.4–1.68]). Compared to the lowest quintile, the highest PRS quintile had a 10% higher penetrance at age 70 (p = 0.0006) and a 20% higher penetrance at age 80 (p