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BackgroundMalignancies are the leading cause of disease burden in Australia, comprising 19% of total diseases. Approximately 1 in 4 men and 1 in 6 women die from malignancies by 85 years of age, with patients aged 65 years and older contributing to 58% of diagnoses and 76% of cancer mortality. In the context of malignancy-related disease and age-related degeneration, there is a need for comprehensive assessment of older patients to plan for appropriate management and predict prognosis. The utility of available comprehensive geriatric assessment tools has been limited in routine practice because of their time-consuming nature, despite their informing clearer understanding of patients’ functional status, better clinical decision making, prevention of unpredictable admissions and emergency department overload, and support services planning. Though there are several promising tools available, there is a lack of literature on tools that can comprehensively assess functional status in an expedited fashion. ObjectiveThis study aimed to document functional status and comorbidities among a geriatric oncology patient cohort attending a regionally located, dedicated cancer care facility, using the completed Adelaide tool assessments. This study documents cohort characteristics, including sociodemographics, malignancy type, and comorbidities. Secondarily, we observed the utility of an abridged functional assessment in the multidisciplinary team (MDT) management of older cancer patients. MethodsThe study comprised a facility-based cross-sectional audit of results obtained from a screening tool administered to patients aged 65 years and older and attending an outpatient medical oncology clinic for management of cancer from late 2015 to 2017. Data relating to five domains were collected, including instrumental activities of daily living, activities of daily living, performance status, unintended weight loss, and exhaustion. Sociodemographic and disease-related factors were summarized as frequencies with percentages or mean with SD. Distribution of functional status based on sociodemographic characteristics, living status, disease-related factors, and comorbidities was analyzed using a chi-square test. Cumulative dependencies in the five domains were identified, and patients were classified as fit, vulnerable, or frail. Supplementary review of presentation notes for cases discussed at MDT meetings was undertaken to identify discrepancies. ResultsA majority of the study population showed poor functional status, with 88.7% (243/274) categorized as vulnerable and 8.4% (23/274) as frail. Exhaustion and unintended weight loss were identified as the most common contributors to dependency. Polypharmacy was strongly associated with decreased functional status. ConclusionsThe outcomes of this study are congruent with the existence of dependency in various domains, and with similar research in geriatric oncology. The Adelaide tool provided a useful basis for MDT discussion and management, where cases were referred to the MDT. We recommend further examination of the tool’s utility and impact in clinical decision making, and the distribution of dependencies in a rural cohort compared with metropolitan patients.

Multiple-choice questions (MCQs) are widely used in educational assessments and professional certification exams. Managing large repositories of MCQs, however, poses several challenges due to the high volume of questions and the need to maintain their quality and relevance over time. One of these challenges is the presence of questions that duplicate concepts but are formulated differently. Such questions can indeed elude syntactic controls but provide no added value to the repository. In this paper, we focus on this specific challenge and propose a workflow for the discovery and management of potential duplicate questions in large MCQ repositories. Overall, the workflow comprises three main steps: MCQ preprocessing, similarity computation, and finally a graph-based exploration and analysis of the obtained similarity values. For the preprocessing phase, we consider three main strategies: (i) removing the list of candidate answers from each question, (ii) augmenting each question with the correct answer, or (iii) augmenting each question with all candidate answers. Then, we use deep learning-based natural language processing (NLP) techniques, based on the Transformers architecture, to compute similarities between MCQs based on semantics. Finally, we propose a new approach to graph exploration based on graph communities to analyze the similarities and relationships between MCQs in the graph. We illustrate the approach with a case study of the Competenze Digitali program, a large-scale assessment project by the Italian government.

In retail transactions, mobile payment services (MPS) can potentially replace cash, particularly in developing nations that lack card-swipe machines. Due to the concern that currency notes could spread diseases during the COVID-19 outbreak, digital payments saw a rise in popularity as a practical payment alternative. The extended period of the pandemic resulted in an extended period of continued usage, even for new users. Despite having a lengthy trial period, user-friendly interfaces, and greater fungibility than cash, MPS did not find widespread acceptance, and cash still predominates in retail transactions. There is a lot of research on technology adoption, however there is considerably less on usage retention. While there is some literature on continued use of technology, the main factor for discontinuation or reduction of usage is the lack of satisfaction. With MPS, satisfaction is rarely an issue, yet users limit the extent of their usage. In the context of retail transactions, this research explicitly examines continued usage following extensive initial use. The Gioia method of grounded theory was used to investigate the factors preventing continued use of MPS for retail transactions. The qualitative interviews were carried out among users in an emerging economy that is a leader in MPS adoption and use. To explain the barriers to the continued use of beneficial technology, this study proposes a conceptualization of consumer decision inertia with three dimensions categorized as deep-rooted habits, vicarious indifference, and kairotic uncertainty. This insight would be beneficial to MPS organizations not just in developing countries but even for developed economies. The conceptualization of consumer decision inertia also offers insights that can be applied in the context of sustained usage of other consumer-facing technologies.

Abstract As a nascent class of high‐entropy materials (HEMs), high‐entropy metal–organic frameworks (HE‐MOFs) have garnered significant attention in the fields of catalysis and renewable energy technology owing to their intriguing features, including abundant active sites, stable framework structure, and adjustable chemical properties. This review offers a comprehensive summary of the latest developments in HE‐MOFs, focusing on functional design, synthesis strategies, and practical applications. This work begins by presenting the design principles for the synthesis strategies of HE‐MOFs, along with a detailed description of commonly employed methods based on existing reports. Subsequently, an elaborate discussion of recent advancements achieved by HE‐MOFs in diverse catalytic systems and energy storage technologies is provided. Benefiting from the application of the high‐entropy strategy, HE‐MOFs, and their derivatives demonstrate exceptional catalytic activity and impressive electrochemical energy storage performance. Finally, this review identifies the prevailing challenges in current HE‐MOFs research and proposes corresponding solutions to provide valuable guidance for the future design of advanced HE‐MOFs with desired properties.

Introduction: X-rays, a crucial diagnostic tool, are known for their cytotoxic and mutagenic effects, capable of inducing gene mutations and chromosomal aberrations. Despite this, the risks, especially from dental X-ray machines, are often overlooked. Digital X-ray imaging, particularly cone-beam computed tomography (CBCT), is now common in dental practice due to its reduced radiation dose, high accuracy, and rapid scanning. However, no radiation dose is entirely safe, and biological effects accumulate over time. A significant drawback of CBCT is its emission of scattered X-rays. Biomonitoring studies, such as the micronucleus (MN) assay on buccal mucosal cells, are essential for evaluating genotoxic risk from diagnostic radiation. To evaluate and compare the genotoxic and cytotoxic damage in exfoliated cells, using the buccal cytome assay following exposure to x-ray radiation during partial CBCT exposure between the field of direct and scatter radiation. Materials and methods: To establish the genotoxic and cytotoxic impacts of CBCT radiation on the mucosa and its effects on the basal cell layer of the epithelium, the research enlisted 35 subjects aged 18 to 60 years. Before and after CBCT exposure, samples of exfoliated oral mucosa were stained with Feulgen. Nuclear anomalies were then graded using image analysis software, and 500 intact exfoliated epithelial cells were checked for micronuclei and other nuclear anomalies according to 1992 criteria set by Tolbert et al. Result: The results showed that cytotoxic anomalies, such as karyorrhexis and karyolysis, were significant with a P-value of

Background: Asymptomatic left ventricular systolic dysfunction (ALVSD) affects 7 million globally, leading to delayed diagnosis and treatment, high mortality, and substantial downstream health care costs. Current detection methods for ALVSD are inadequate, necessitating the development of improved diagnostic tools. Recently, electrocardiogram-based algorithms have shown promise in detecting ALVSD. Objectives: The authors developed and validated a convolutional neural network (CNN) model using single-lead electrocardiogram and phonocardiogram inputs captured by a digital stethoscope to assess its utility in detecting individuals with actionably low ejection fractions (EF) in a large cohort of patients. Methods: 2,960 adults undergoing echocardiography from 4 U.S. health care networks were enrolled in this multicenter observational study. Patient data were captured using a digital stethoscope, and echocardiograms were performed within 1 week of data collection. The algorithm's performance was compared against echocardiographic EF (EF measurements, categorizing EF as normal and mildly reduced [>40%] or moderate and severely reduced [≤40%]). Results: The CNN model demonstrated an area under the receiver operating characteristic curve of 0.85, with a sensitivity of 77.5%, specificity of 78.3%, positive predictive value of 20.3%, and negative predictive value of 98.0%. Among those with an abnormal artificial intelligence screen but EF >40% (false positives), 25% had an EF between 41%-49% and 63% had conduction/rhythm abnormalities. Subgroup analyses indicated consistent performance across various demographics and comorbidities. Conclusions: The CNN model, utilizing a digital stethoscope, offers a noninvasive and scalable method for early detection of individuals with EF ≤40%. This technology has the potential to facilitate early diagnosis and treatment of heart failure, thereby improving patient outcomes.

Abstract Background Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period. Methods/design This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions. Discussion This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars. Trial registration ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Abstract The characterization of phospholipid membrane permeability for small molecules is crucial for many applications in drug discovery and biomedical research in general. Here, chemosensor‐laden vesicles offer an attractive platform for permeability assays. In this work, the stability of immobilized chemosensor‐filled vesicles is explored on anti‐fouling polymer brush surfaces for potential use in monitoring small molecule membrane permeability. The study focuses on the development of a method for immobilizing sensor‐loaded vesicles into arbitrary patterns on surfaces and characterizing their stability under changing temperatures and compositions. As substrate to enable intact, long‐term stable vesicle immobilization reactive polymer brushes with anti‐fouling properties are used. Utilizing microchannel cantilever spotting, biotin moieties are introduced on the polymer brush surface, enabling stable tethering of vesicles through streptavidin‐biotin interactions. The immobilized vesicles are monitored through fluorescence microscopy for their response to analytes under changing environmental parameters and vesicle composition. A higher stability of immobilized vesicles compared to free‐floating ones is observed, with permeability only at elevated temperatures. By tuning vesicle compositions, permeability at lower temperatures can be raised again. Overall, the study provides insights into a novel approach for vesicle immobilization, showcasing the potential of surface‐bound vesicles for applications in microfluidic systems and as biosensors in various assays.

Background Late effects of adjuvant radiation therapy (RT) on soft tissues can lead to hair loss, pigmentary changes, loss of tissue volume, and fibrosis, which appear months to years after the treatment. These changes are often progressive and are because of tissue hypoxia due to radiation-induced capillary endothelial damage. Tissue hypoxia may be compounded by subclinical infection following minor trauma, exposed hardware, or associated osteoradionecrosis. The combined effect of these factors causes significant deformities in soft tissue, affecting both function and appearance. Such changes are also seen in primarily transferred flaps, which have been radiated, resulting in severe, progressive soft tissue fibrosis, compromising function and aesthetics. In selected cases, a second flap may be needed to restore function and volume.

Uterine tumor resembling ovarian sex-cord tumor is a rare group of uterine neoplasms with unknown histogenesis and differentiation towards ovarian sex-cord elements. They are benign in nature with low malignancy potential. Diagnosis is based on immunohistochemistry and morphological features, and the distinction from other more malignant differentials is paramount to correctly individualizing treatment. A 47-year-old patient was admitted to the hospital complaining of abdominal pain and abnormal uterine bleeding. Subsequent detection of multiple uterine fibroids by ultrasound study and CT scans lead to a robot-assisted total hysterectomy. Histological studies revealed that one of the fibroids in the myometrium had a morphology resembling an ovarian sex-cord tumor with low Ki-67 proliferative activity. After 12 months of follow-up, no additional treatment was required, and no signs of recurrence or progression were observed. Uterine tumor resembling ovarian sex-cord tumor is a rare gynecological entity with no established treatment protocol. Differentiation between benign and malignant behavior is based on structural features and immunohistochemical expression assessment. This highlights the importance of immunohistochemical staining and morphological analysis to determine the degree of surgical radicality. Minimally invasive approach is feasible and safe, but more experience is needed for further conclusions.

Political conflict has plagued Kashmir, a Muslim-majority region of Hindu-majority India, ever since the partition. The crisis worsened by the end of the 1980s and has continued to disrupt peace in the valley to date. The conflict arguably entered a new phase as the Hindu nationalist Bharatiya Janata Party (BJP) was elected to power in 2014, which also joined the ruling coalition of the Jammu and Kashmir state in 2015 for the first time. Over this period, Kashmir’s resistance evolved into subtler forms, including cultural expressions like memoirs. Published in 2021, Farah Bashir’s debut work, Rumours of Spring, is a deeply personal yet undeniably political exploration of the crisis in Kashmir from its aggravated phase in the beginning of the 1990s. This paper argues that the nuanced depiction of the crisis in the memoir demands an intersectional reading of the traumatising impact of militarisation and militarism on Kashmir’s everyday life, especially given the subject position of the narrator as a Muslim woman. The works on militarisation by Jacklyn Cock, as employed by Samreen Mushtaq to analyse the situation in Kashmir, provide theoretical insights for this reading. Set in Kashmir’s identitarian conflict, the Muslim identity is central to the narrative. We argue that in Bashir’s memoir, religion finds a complex representation, with the Qur’an and Kashmiri folklore serving as respites in times of crisis, even as the fundamentalist factions contribute to their oppressive reality. Bashir’s work openly engages with the experience of being a Muslim in Hindu India. The paper also attempts to place the work in a larger corpus of life-writing by women in conflict zones, comparing the work with Sharon and My Mother-in-Law: Ramallah Diaries (2003), a Palestinian memoir by Suad Amiry.

Aim: In paediatric dentistry, pain is adversely influenced by a child's level of anxiety. Ironically, the most common form of pain control used in dentistry, local anaesthesia, can itself produce anxiety. One of the techniques to overcome a child's anxiety is using distraction. The aim of the present study was to evaluate the effectiveness of distraction techniques, i.e. audio distraction (AD) and audio-visual distraction (AVD) by measuring salivary stress biomarker (salivary cortisol and salivary alpha-amylase) levels in 3–5 year-old children. Materials and Methods: Forty children aged 3–5 years were divided randomly into two groups; (Group I = AD, Group II = AVD). Cotton pellets were placed in the lingual vestibule to collect a sample of saliva. Children were then asked to wear overhead phones in the AD group, connected to a phone, and rhymes were played. In AVD, a cartoon movie was shown to the children using AV glasses. Simultaneously, local anaesthesia was administrated to children, after which another saliva sample was collected. Biomarker estimation was done using ELISA. Fisher's exact test was used for statistical analysis. Results: Statistically significant results were seen with Group II compared to Group I (cortisol-P = 0.009; salivary alpha-amylase-P = 0.03). Conclusion: Both distraction techniques are effective in reducing stress but compared to AD, AVD is more efficacious.

A facile method to prepare activated ZnFe2O4 nanoparticles through novel metal ion doping using Bi3+ is demonstrated. The enhanced activity of the Bi3+-doped ZnFe2O4 nanoparticle was evaluated through Cr(VI) ions adsorption capability analysis from aqueous samples since industrial effluents have the metal ion as a major source of concern. ZnFe2-xBixO4 (x = 0.0, 0.05, 0.10, 0.15, 0.2) were synthesized using sol gel method, and a comparative adsorption efficiency study of Bi3+-doped and undoped ZnFe2O4 was performed. To understand the variation in adsorption efficiency and mechanism of adsorption on the Bi3+-doped ZnFe2O4, the adsorption study was conducted under varying adsorption conditions including pH, adsorbent dosage, contact time, initial ion concentration, and temperature. All the quantification studies regarding the adsorption were done using atomic adsorption spectroscopy (AAS). The studies suggested enhanced adsorption capability via Bi3+ doping as it can enhance the effective surface area and electrostatic charge density on the surface. Adsorption equilibrium information from this study was modeled using prominent adsorption kinetics and isotherm models, for extracting information regarding the performance of the adsorbent, rate of the adsorption and adsorption mechanism, which are imperative in the design and operation of adsorption systems. Scope of regeneration and reusability of the spent adsorbents in water treatment, which is also investigated in this work, addresses the ecological and economic demands for sustainability and also makes the wastewater treatment process cost effective. [ABSTRACT FROM AUTHOR]

"The Glass Menagerie" is one of the Tennessee Williams' most famous plays which won the New York Drama Critics' Circle award. It elevated him to be one of the greatest playwrights of his generation. As a playwright, he is skilful to make the readers conscious of the unconscious habits and attitudes in everyday life. In "The Glass Menagerie," Tennessee Williams (1911-1983) portrayed family relationships and struggles against hopelessness that threaten their lives. The present study made a discourse analysis of Tennessee Williams' "The Glass Menagerie". This discourse analysis of the dialogic language was based on dialogic principles outlined by Weigand (2009). The researchers applied these principles to uncover conventional and unconventional elements embedded in the structures of the language. The study also analyzed the discourse contexts and their impact on the meaning of the given different situations that the main characters, i.e., Amanda, Laura, Tom Wingfield, encounter during the ongoing actions of the play. This research, furthermore, presented insights on how Tennessee Williams achieved the intended dramatic effect in the discourse of the characters. The introductory part of the research paper presented the features of a dramatic discourse in relation to language of "The Glass Menagerie". A review of literature related to the play gives a summary of the literary and linguistic research carried out by different researchers to understand the play from various aspects. A detailed linguistic analysis unravels the functional aspects of dialogic discourse that are embedded in the lines of the text. The findings unfold the logics concealed in the dialogues and kind of structures used for dramatic effect.