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Despite advancing treatment methods, esophageal cancer (EC) maintains a high mortality rate and poor prognosis. Through various mechanisms, aspirin has been suggested to have a chemopreventive effect on EC. However, the long-term impact, particularly regarding the rate of metastasis, needs to be further elucidated. NIS 2016–2020 was used to identify adult patients (age > 18 years) with EC using ICD-10 codes. Patients with missing demographics and mortality were excluded. Patients were stratified into two groups based on aspirin use. Data were collected on patient demographics, Elixhauser Comorbidity Index (ECI), and comorbidities (hypertension, chronic pulmonary disease, coronary artery disease (CAD), chronic kidney disease (CKD), congestive heart failure (CHF), coagulopathy, alcohol use, smoking, and obesity). The outcomes studied were rates of total metastasis, gastrointestinal (GI) metastasis, non-GI metastasis, and lymphoid metastasis. Multivariate logistic regression analysis was performed to evaluate the impact of aspirin use on various metastases after adjusting for patient demographics, comorbidities, and ECI. Out of 190,655 patients, 20,650 (10.8%) patients were aspirin users. Majority of the patients in the aspirin group were aged > 65 years (74.7%), males (82.1%), White race (84%), and had medicare insurance (71%). There was a higher incidence of diabetes, hypertension, chronic pulmonary disease, CAD, CKD, CHF, and smoking in aspirin users than non-aspirin users. Patients with aspirin users had a lower incidence of metastasis (28.9% vs. 38.7%, P  < 0.001), GI metastasis (14.2% vs. 20.6%, P  < 0.001), non-GI metastasis (15.1% vs. 22%, P  < 0.001), and lymphoid metastasis (8.9% vs. 11.3%, P  < 0.001) than non-aspirin users. After adjusting for confounding factors, patients with aspirin use had lower odds of having metastasis (aOR-0.73, 95% CI-0.70-0.77, P  < 0.001). Our study noted that aspirin use is associated with a reduction in the rate of metastasis in patients with EC. These studies support the use of aspirin in patients with EC and suggest the need for further studies to understand the mechanism by which aspirin use reduces metastasis in patients with EC. [ABSTRACT FROM AUTHOR]

Idiopathic intracranial hypertension (IIH) is a cerebrospinal fluid (CSF) disorder defect that is frequently treated with CSF shunts. Shunts utilizing the cisterna magna as a proximal reservoir have been described in literature; however, long-term outcomes are unknown. The present study aims to describe the long-term effectiveness, revision rates, and clinical outcomes of this shunt in 14 patients with IIH and slit ventricles. A single-center retrospective review of 14 IIH patients treated by cisterna magna shunts was performed. Shunt histories, including revision rate and time until first shunt failure for ventricular, lumbar, and cisterna magna shunts were recorded. "Revision rate" was calculated as the total number of shunt revisions over years of total shunt placement. The average follow-up time was 12.08 years. The mean age at first cisterna magna shunt placement was 18.1 years (6.6–43.3 years) and all patients had radiological evidence of slit ventricles. Cisterna magna shunts improved or resolved clinical symptoms for all 14 patients and had a lower rate of revisions (0.42 revision/year) compared to ventricular (0.72 revision/year) and lumbar (1.30 revision/year) shunts. Of the 11 patients still requiring CSF diversion at the end of the study, eight had functioning shunts that utilized the cisterna magna. The cisterna magna shunt may be a suitable option for patients with IIH and slit ventricles. Further study is needed to understand the clinical utility of this shunt for the population in which it is indicated. [ABSTRACT FROM AUTHOR]

Hydroxyapatite crystal deposition disease (HADD) poses diagnostic challenges in the emergency department (ED) as it may clinically present similarly to infection and other musculoskeletal conditions. Misdiagnosis often leads to unnecessary treatments and resource over-utilization. This review article provides an overview of HADD in seven patients who presented to the ED secondary to an acute presentation of this disease process. HADD is a prevalent pathology, which commonly involves the shoulder, followed by the hip, elbow, wrist, and knee. Predisposing risk factors, such as diabetes and certain genetic factors, have also been identified. Clinical history and imaging, particularly radiographs, play a vital role in diagnosing HADD, with characteristic calcification patterns observed in different stages of the disease. Conservative nonsurgical therapy is the mainstay of treatment, providing effective symptom relief in over 90% of cases. By recognizing HADD as a crucial differential diagnosis for patients with acute or chronic pain, healthcare resource utilization can be optimized, leading to improved patient care in the ED. [ABSTRACT FROM AUTHOR]

With the rise of commercial space tourism, the barrier to entry into space lowers. Therefore, passengers with more complex medical conditions are predicted to enter space. This report aims to initiate the development of procedures assessing the safety of space travel for individuals with orthopedic implants. In preparation for the 2023 sounding rocket launch by McGill Rocket Team, the Payload subteam developed a bone model, a human model, a finite element analysis model, and a testing model to determine the safety of orthopedic implants under the harsh conditions of spaceflight. Measuring the dynamic forces of the MRT's Porthos rocket in flight yielded vibrations in the 300-2750 Hz range, which is valuable for creating better models of the loading conditions on orthopedic implants in silico. Three point bending testing revealed high precision but low accuracy in measuring the mechanical strength of the models. Ultimately, the study recommends adjusting the testing models to prevent oversimplification. Future work should analyze bone screw interfaces on a microscopic level to detect small changes in implant stresses. By implementing these changes, procedures can accurately describe the safety of spaceflight for those with orthopedic implants. [ABSTRACT FROM AUTHOR]

Objective: Oral cavity and oropharyngeal cancer (OOPC) is a devastating disease often caught in late stages. People who use tobacco are at higher risk of OOPC. Tobacco cessation discussions and OOPC screenings are important factors in decreasing the risk of OOPC or its late stage diagnosis. As research on sex differences has been increasing—from research on biomedical to psychological and sociological determinants—there is a potential difference, by sex, as to whom is more likely to have a tobacco cessation discussion and OOPC screening. The objective of this study is to determine if there is an association of sex with tobacco cessation discussions and OOPC screenings conducted by dental healthcare professionals among participants who currently use tobacco. Method: Data from 8 years of the National Health and Nutrition Examination Survey (2011–2018) were merged. Data from participants, ages 30 years and above, who self‐reported current use of tobacco, a dental visit within the previous year and responsed to questions about oral cancer screening were analysed for frequency determination and logistic regression analysis. Having the combination of neither OOPC screening nor discussion about the benefits of not using tobacco was the outcome in the analysis. Results: There were 22.1% who had an OOPC screening by a dental professional within the previous year. Of the 41% who reported having had a conversation with a dental professional within the previous year about the benefits of tobacco cessation, 9.8% reported having both the conversation and OOPC screening. Males were less likely than females to have the combination of neither OOPC screening nor advice about tobacco cessation than females (adjusted odds ratio: 0.74; 95%CI: 0.57, 0.96). Conclusion: There is an increased need for OOPC screening and the discussion of tobacco use by dental professionals among their patients who use tobacco, particularly for female patients. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, explores the relationship between spontaneous cerebrospinal fluid (CSF) leaks and idiopathic intracranial hypertension (IIH). The study aims to evaluate the incidence of radiographic and clinical markers associated with IIH in patients with spontaneous CSF leaks. The researchers conducted a review of medical records for patients admitted for spontaneous CSF leaks and collected demographic, radiologic, and clinical data. The results suggest that there is an increased incidence of radiographic markers of IIH in those with spontaneous CSF leaks, and the presence of dilated Meckel's cave volume, dilated optic nerve sheath diameter, and an empty sella may assist in the diagnosis of IIH in these patients. [Extracted from the article]

Ammonium perchlorate (AP) is a commonly used oxidizer in solid propellant compositions. As a result, numerous experimental and theoretical studies have been carried out in order to better understand the behavior of its decomposition in both the liquid and gas phases. In this work, the first step of Ammonium perchlorate (AP) decomposition in the condensed phase has been investigated using quantum mechanics‐based calculations. The process of proton transfer from ammonium ion (NH4+) to perchlorate ion (ClO4−) was investigated in‐depth as it is thought to be the preferred reaction for the initiation of AP decomposition in the condensed phase. The calculations were carried out using density functional theory (DFT) at the B3LYP level in conjunction with the 6‐311G++(d,p) basis set. The current study revealed that proton transfer from ammonium cation to perchlorate anion takes place in two steps. The first step involves the decomposition of ClO4− to ClO2− and O2 followed by the second step which is H+ transfer from NH4+ to ClO2− giving NH3 and HClO2. In order to better understand protonation and deprotonation, it is essential to know the proton affinity (PA) of the involved species. In this study, the CBS‐QB3 method is used to determine the PA of various energetic ionic compounds. These compounds include guanidinium azotetrazolate, triaminoguanidinium azotetrazolate, guanidinium nitrate, ammonium nitrate, and ammonium perchlorate. Based on the results of the calculations, it is concluded that direct proton transfer process does not occur in the condensed phase because the proton affinities of all cations are significantly higher than those of the corresponding anions. In conjunction with experimental studies, this modelling study can help in the development of a better understanding of AP decomposition in the condensed phase. [ABSTRACT FROM AUTHOR]

Background: Lower socioeconomic status (SES) affects health care delivery and is associated with worse outcomes. Integrated healthcare systems (IHS) may help reduce barriers to health care and affect outcomes. Our aim was to compare outcomes of colon cancer cases diagnosed at the largest IHS in California, Kaiser Permanente Southern California (KPSC), to other insured patients (OI) to determine how SES influences mortality. Methods: This retrospective cohort study included insured adults in southern California diagnosed with colon cancer between 2009 and 2014, using data from the California Cancer Registry, and followed through 2017. Main outcome was all-cause mortality. Person-year mortality rates were calculated for two groups, KPSC and OI. Multivariable hazard ratios were calculated for association between SES quintiles and mortality. Results: Total of 15 923 patients were diagnosed with colon cancer, 4195 patients (26.3%) within KPSC and 11 728 patients (73.7%) in OI. The overall mortality rate per 1000 person-years (PY) was lower in KPSC [103.8/1000 PY (95% CI:98.5-109.3)] compared to OI [139.3/1000 PY (95% CI:135.2-143.4)]. Compared to the highest SES group, the lowest SES group did not experience higher mortality risk in the KPSC population, after adjusting for race/ethnicity and other factors (HR, 95% CI = 1.13, .93-1.38). However, in OI patients, lowest and lower-middle SES groups had higher mortality risk compared to the highest SES group (HR, 95% CI = 1.26, 1.13-1.40 and 1.28, 1.16-1.41, respectively). Discussion: Lower SES was associated with higher mortality risk within the OI group; however, within KPSC no such association was observed. Care coordination in IHS settings mitigate SES-related mortality differences. [ABSTRACT FROM AUTHOR]

The major significance of the 2018 gingivitis classification criteria is utilizing a simple, objective, and reliable clinical sign, bleeding on probing score (BOP%), to diagnose gingivitis. However, studies report variations in gingivitis diagnoses with the potential to under- or over-estimating disease occurrence. This study determined the agreement between gingivitis diagnoses generated using the 2018 criteria (BOP%) versus diagnoses using BOP% and other gingival visual assessments. We conducted a retrospective study of 28,908 patients' electronic dental records (EDR) from January-2009 to December-2014, at the Indiana University School of Dentistry. Computational and natural language processing (NLP) approaches were developed to diagnose gingivitis cases from BOP% and retrieve diagnoses from clinical notes. Subsequently, we determined the agreement between BOP%-generated diagnoses and clinician-recorded diagnoses. A thirty-four percent agreement was present between BOP%-generated diagnoses and clinician-recorded diagnoses for disease status (no gingivitis/gingivitis) and a 9% agreement for the disease extent (localized/generalized gingivitis). The computational program and NLP performed excellently with 99.5% and 98% f-1 measures, respectively. Sixty-six percent of patients diagnosed with gingivitis were reclassified as having healthy gingiva based on the 2018 diagnostic classification. The results indicate potential challenges with clinicians adopting the new diagnostic criterion as they transition to using the BOP% alone and not considering the visual signs of inflammation. Periodic training and calibration could facilitate clinicians' and researchers' adoption of the 2018 diagnostic system. The informatics approaches developed could be utilized to automate diagnostic findings from EDR charting and clinical notes. [ABSTRACT FROM AUTHOR]

With the development of fast charging unit for electric vehicles (EVs) battery, it is required to develop a battery pack that can maintain the temperature in the desired range. Hence, some thermal management system is required to enhance performance and safety issues. The objective of the present work is to enhance the performance of phase change material (PCM)‐based battery thermal management system (BTMS) for continuous charging/discharging cycles. The cycle is considered as 3C‐1C as charging‐discharging rates. The PCM‐in‐pack BTMS is effective only for one cycle, and after that, the value of maximum battery temperature (Tmax) and maximum battery temperature difference (ΔTmax) reaches above 60°C and 5°C, respectively. The PCM‐around‐cell BTMS (PCM layer around battery cells) is found effective in maintaining ΔTmax below 5°C for three consecutive cycles but found effective in maintaining Tmax below 60°C for the first cycle only. For further improvement, fins are utilized, and found that fin and PCM‐around‐cell BTMS can effectively maintain Tmax below 60°C for two cycles. Even the addition of fins is found effective after the second cycle; therefore, rest time between charging and discharging is explored for further improvement. With a 10‐min rest time, both Tmax and ΔTmax are found under 60°C and 5°C for four consecutive cycles. However, the value of Tmax increases around 4°C to 5°C after each cycle. This problem of increment in Tmax after each cycle is eliminated by 20‐min rest time and found almost similar Tmax for four consecutive cycles. For 20 min of rest time between charging and discharging, Tmax is found with PCM‐around‐cell with fin based BTMS as 44.98°C, 45.98°C, 46.49°C, and 46.82°C during four consecutive cycles. Hence, PCM‐around‐cell arrangement, fins, and rest time of 20 min can provide desirable results for a large number of consecutive cycles. [ABSTRACT FROM AUTHOR]

Performance of a solar reflector depends upon the topology of the reflector unit. Curved reflector certainly performs better but it has high-cost, high manufacturing complexity and sometimes even requires non-indigenous technology for its production. Besides, the flat plate solar reflecting unit (FSRU) offers low cost, are widely available and are indigenous in nature. The present work attempts to give a simple methodology to test different combinations of a large-scale FSRU under azimuthal sun alignment. The obtained result is validated with corresponding CAD model and previously performed experimental results. The FSRU is a funnel-type solar reflector in the form of an inverted frustum of a square pyramid. The path followed by the in the unit is classified in different categories, based on their interaction with reflectors. The results show that there is a good agreement between path of rays observed during experiment and path of rays predicted by a CAD software. The maximum deviation ( δ max ) in path for optical performance is 2.1%. On other hand the maximum uncertainty (χ) in path is 2.96% considering ± 1° error of manufacturing of FSRU. Thermal efficiency of FSRU is 69% considering reflectivity of 97% for the reflectors. The final output of the present study predicts that (a) amount of errors ( δ max and χ) are under control for large size of FSRU and (b) azimuthal alignment improves the FSRU's thermal performance. [ABSTRACT FROM AUTHOR]

Background: Esophageal inlet patch (IP) with heterotopic gastric mucosa is an incidental finding on esophagogastroduodenoscopy (EGD). Although IP is thought to be embryologic in nature, IP has been associated with Barrett's esophagus (BE). Aims: The aim of this study was to compare prevalence, symptoms, demographic factors, and esophageal testing in patients with IP and BE. Methods: We retrospectively analyzed endoscopic findings of EGDs, high-resolution esophageal manometry and esophageal pH impedance studies from January 2010 to January 2021 at a single academic medical center. Patients were grouped by presence or absence of IP and BE. Results: Of 27,498 patients evaluated, 1.3% had endoscopic evidence of IP and 4.9% had BE. Of 362 patients with IP, 17.1% had BE; of 1356 patients with BE, 4.6% had IP. Both IP and BE patients presented primarily with heartburn and/or regurgitation. Patients with BE and/or IP were older and had higher BMI than those without (p < 0.001). Mean lower esophageal sphincter pressure was lower and mean acid exposure time (AET) was higher in patients with IP and/or BE than those without (p < 0.05). Conclusions: Our study reports an IP prevalence of 1.3%, with 17.1% patients having concomitant BE; and a BE prevalence of 4.9%, with 4.6% also having IP. Patients with IP alone presented with similar symptoms to patients with concomitant BE. Esophageal function testing showed that patients with either IP or BE had decreased LES pressures and increased esophageal AET. During endoscopy, patients found to have one of these findings should be carefully examined for the other. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) significantly contributes to acute ischaemic stroke (AIS), yet its precise influence on clinical outcomes post-intravenous thrombolysis (IVT) and post-endovascular thrombectomy (EVT) has remained elusive. Furthermore, the overall prevalence of AF in AIS patients undergoing reperfusion therapy has not been clearly determined. Employing random-effects meta-analyses, this research aimed to estimate the pooled prevalence of AF among AIS patients undergoing reperfusion therapy, while also examining the association between AF and clinical outcomes such as functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. Studies comparing AF and non-AF patient groups undergoing reperfusion therapy were identified and included following an extensive database search. Forty-nine studies (n = 66,887) were included. Among IVT patients, the prevalence of AF was 31% (Effect Size [ES] 0.31 [95%CI 0.28–0.35], p < 0.01), while in EVT patients, it reached 42% (ES 0.42 [95%CI 0.38–0.46], p < 0.01), and in bridging therapy (BT) patients, it stood at 36% (ES 0.36 [95%CI 0.28–0.43], p < 0.01). AF was associated with significantly lower odds of favourable 90-day functional outcomes post IVT (Odds Ratio [OR] 0.512 [95%CI 0.376–0.696], p < 0.001), but not post EVT (OR 0.826 [95%CI 0.651–1.049], p = 0.117). Our comprehensive meta-analysis highlights the varying prevalence of AF among different reperfusion therapies and its differential impact on patient outcomes. The highest pooled prevalence of AF was observed in EVT patients, followed by BT and IVT patients. Interestingly, our analysis revealed that AF was significantly associated with poorer clinical outcomes following IVT. Such an association was not observed following EVT. [ABSTRACT FROM AUTHOR]

• Our modernized depression intervention used internet and telephonic psychotherapy. • Intervention participants exhibited meaningful improvements in depressive symptoms. • Successful depression treatment did not reduce cardiovascular risk biomarkers. • Depression treatment is not sufficient to lower cardiovascular risk in depression. • Integrated care should harness technology to maximize access/minimize resources. Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, M age = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges' g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results – 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI : 1.93–7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers – i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges' gs = -0.23 to 0.02, p s ≥ 0.09). Our modernized collaborative care intervention – which harnessed technology to maximize access and minimize resources – produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches. Trial Registration: ClinicalTrials.gov Identifier: NCT02458690. [ABSTRACT FROM AUTHOR]

Numerous studies have investigated the efficacy of intralesional immunotherapy for warts, but there are a lack of studies investigating the efficacy of alternative intralesional immunotherapies following failure of initial intralesional immunotherapy. In this retrospective study, we aimed to investigate the efficacy of intralesional measles, mumps, and rubella vaccine for the treatment of pediatric warts following failure of intralesional therapy with Candida antigen. Following intralesional measles, mumps, and rubella vaccine administration, 8/51 (15.5%) patients had complete resolution of their warts, 6/51 (12%) had near complete resolution, 19/51 (37%) had partial improvement, 12/51 (23.5%) had no change, and 6/51 (12%) had worsening. Although limited by retrospective nature and low sample size, our results demonstrate that intralesional immunotherapy with measles, mumps, and rubella vaccine provides an alternative therapeutic option for the treatment of recalcitrant pediatric warts in patients who fail to respond to intralesional Candida antigen. [ABSTRACT FROM AUTHOR]

Guideline-directed medical therapy (GDMT) is the cornerstone of pharmacological therapy for patients with heart failure with reduced ejection fraction (HFrEF) and consists of the four main drug classes: renin-angiotensin system inhibitors, evidence-based β-blockers, mineralocorticoid inhibitors and sodium glucose cotransporter 2 inhibitors. The recommendation for use of GDMT is based on the results of multiple major randomized controlled trials demonstrating improved clinical outcomes in patients with HFrEF who are maintained on this therapy. The effect is most beneficial when medications from the four main drug classes are used in conjunction. Despite this, there is an underutilization of GDMT, partially due to lack of awareness of how to safely and effectively initiate and titrate these medications. In this review article, we describe the different drug classes included in GDMT and offer an approach to initiation and effective titration in both the inpatient as well as outpatient setting. [ABSTRACT FROM AUTHOR]

Doxorubicin (DOX) is a highly effective chemotherapy agent prescribed for cancer treatment. However, the clinical use of DOX is limited due to off-target toxicity in healthy tissues. In this regard, hepatic and renal metabolic clearance results in DOX accumulation within these organ systems. Within the liver and kidneys, DOX causes inflammation and oxidative stress, which promotes cytotoxic cellular signaling. While there is currently no standard of care to treat DOX hepatic- and nephrotoxicity, endurance exercise preconditioning may be an effective intervention to prevent elevations in liver alanine transaminase (ALT) and aspartate aminotransferase (AST) and to improve kidney creatinine clearance. To determine whether exercise preconditioning is sufficient to reduce liver and kidney toxicity resulting from acute exposure to DOX chemotherapy treatment, male and female Sprague–Dawley rats remained sedentary or were exercise trained prior to saline or DOX exposure. Our findings demonstrate that DOX treatment elevated AST and AST/ALT in male rats, with no effects of exercise preconditioning to prevent these increases. We also showed increased plasma markers of renin–angiotensin–aldosterone system (RAAS) activation and urine markers of proteinuria and proximal tubule damage, with male rats revealing greater differences compared to females. Exercise preconditioning showed improved urine creatinine clearance and reduced cystatin c in males, while females had reduced plasma angiotensin II (AngII) levels. Our results demonstrate both tissue- and sex-specific responses related to the effects of exercise preconditioning and DOX treatment on markers of liver and kidney toxicity. [ABSTRACT FROM AUTHOR]

Understanding strategic commitments and policy responses to overcome antimicrobial resistance at the national, regional, and global levels is required to evaluate current progress and direct future planning. National action plans (NAPs) are the primary mechanism for guiding national strategy and action for antimicrobial resistance governance. Although several NAPs have been developed, no comprehensive content analysis of these plans exists. Using a governance framework, we aimed to assess all publicly available NAPs on antimicrobial resistance. We systematically reviewed the contents of NAPs on antimicrobial resistance from 114 countries, applying a governance framework containing 18 domains and 54 indicators in three integral areas: policy design, implementation tools, and monitoring and evaluation. As well as manually searching NAPs and doing online and literature searches that were relevant to specific indicators from repository inception to June 1, 2022, several data sources were used to generate scores, including the Tripartite Antimicrobial Resistance Country Self-Assessment Survey, the Global Antimicrobial Resistance and Use Surveillance System, the Global Antimicrobial Resistance Research and Development Hub, and various WHO datasets. NAPs were included if the country had also submitted the NAP to the Tripartite Antimicrobial Resistance Country Self-Assessment Survey 2020–21, if the NAP was retrievable through a publicly accessible database or website, and if the NAP was either published in English or eligible for machine translation. Three researchers independently reviewed each NAP and were initially blinded to the evaluations of other researchers. They generated a score using a quantification system for each of 54 indicators. The Cochrane protocol for ensuring reliability was followed. The three researchers were then unblinded and met to resolve any disagreements in scoring to reach a consensus agreement. In each case of discrepancy, consensus was reached between the researchers. We developed criteria to standardise the process of quantifying each indicator. We also weighted and collated relevant national data from various sources to generate composite scores concordant with the key governance areas. We transformed these data to a scale of 0 (worst) to 100 (best), ranked countries on the basis of their mean scores, and used descriptive statistics to analyse global and regional trends. 306 NAPs were identified and 114 were eligible for analysis. Between 2020 and 2021, the mean antimicrobial resistance governance score was 51 (SD 14). Norway had the highest governance score (mean 85 [SD 32]), and the Federated States of Micronesia had the lowest governance score (28 [37]). The highest scoring domain was participation (83 [16]), and the lowest scoring domains were accountability (30 [18]) and feedback mechanism (30 [25]). Domains relating to policy design (55 [13]) and implementation tools (54 [17]) scored similarly, whereas monitoring and evaluation (38 [20]) efforts were lower. International efforts to control antimicrobial resistance varied considerably between countries. Monitoring and evaluation efforts need improving for continuous understanding of national and international progress. International response might not be commensurate with the scale and severity of antimicrobial resistance. None. [ABSTRACT FROM AUTHOR]

Nonetheless, these findings reveal inconsistencies between clinical evidence and social media content about the primary sources of blue light that can cause cutaneous effects and best practices for blue light photoprotection. Our aim was to characterize the content contained in popular social media platforms about the sources of blue light likely to have clinical effects and blue light photoprotection strategies recommended on these platforms by different types of content creators. Visible light (400-700 nm), especially blue light, can produce erythema in all skin phototypes and long-lasting changes in skin pigmentation in individuals with darker skin phototypes (SPT IV-VI) when they are exposed to intensities and wavelengths similar to those from natural sun exposure.[[1], [3], [5]] In addition to the sun, electronic screens also emit blue light; however, they emit these wavelengths at much lower intensities - approximately three orders of magnitude lower than the corresponding intensities in sunlight. [Extracted from the article]

Objective: To develop two automated computer algorithms to extract information from clinical notes, and to generate three cohorts of patients (disease improvement, disease progression, and no disease change) to track periodontal disease (PD) change over time using longitudinal electronic dental records (EDR). Methods: We conducted a retrospective study of 28,908 patients who received a comprehensive oral evaluation between 1 January 2009, and 31 December 2014, at Indiana University School of Dentistry (IUSD) clinics. We utilized various Python libraries, such as Pandas, TensorFlow, and PyTorch, and a natural language tool kit to develop and test computer algorithms. We tested the performance through a manual review process by generating a confusion matrix. We calculated precision, recall, sensitivity, specificity, and accuracy to evaluate the performances of the algorithms. Finally, we evaluated the density of longitudinal EDR data for the following follow-up times: (1) None; (2) Up to 5 years; (3) > 5 and ≤ 10 years; and (4) >10 and ≤ 15 years. Results: Thirty-four percent (n = 9954) of the study cohort had up to five years of follow-up visits, with an average of 2.78 visits with periodontal charting information. For clinician-documented diagnoses from clinical notes, 42% of patients (n = 5562) had at least two PD diagnoses to determine their disease change. In this cohort, with clinician-documented diagnoses, 72% percent of patients (n = 3919) did not have a disease status change between their first and last visits, 669 (13%) patients' disease status progressed, and 589 (11%) patients' disease improved. Conclusions: This study demonstrated the feasibility of utilizing longitudinal EDR data to track disease changes over 15 years during the observation study period. We provided detailed steps and computer algorithms to clean and preprocess the EDR data and generated three cohorts of patients. This information can now be utilized for studying clinical courses using artificial intelligence and machine learning methods. [ABSTRACT FROM AUTHOR]

The biologic effects of visible light, particularly blue light, on the skin at doses and irradiances representative of sunlight have been established. Recent research studies investigated the effects of blue light (BL) from electronic screen devices; however, it is unclear if the evidence can be generalized to real life. The aim of this systematic review was to evaluate available evidence regarding clinical effects of BL emitted from electronic devices on human skin using the framework established by the Office of Health Assessment and Translation (OHAT). A systematic literature search was conducted by two librarians in Ovid MEDLINE, Embase.com, and Web of Science for relevant articles published from 1946 to March 2022. In vitro and in vivo studies that investigated the effects of BL from electronic devices on skin were included. From the 87 articles gathered from database searches and 1 article identified from citation search, only 9 met the inclusion criteria (6 in vitro and 3 in vivo studies). Human and animal literature with the highest level of evidence ratings were considered with mechanistic data to form one of five human hazard identifications for each outcome category using the OHAT protocol: (1) known, (2) presumed, (3) suspected, (4) not classifiable, or (5) not identified to be a hazard to humans. Literature-based evidence integration did not identify exposure to BL from electronic devices as a hazard to skin pigmentation, redness, yellowness, or melasma exacerbation. Exposure to BL from electronic devices was not classified as a skin photoaging hazard. Low confidence in representative exposure characterization drove high OHAT risk-of-bias ratings for the majority of included studies. While these conclusions hold true for the limited existing data, a larger number of future studies with high-confidence evidence are needed to verify and strengthen hazard identification conclusions. [ABSTRACT FROM AUTHOR]

Mishri is a form of smokeless tobacco used as a dentifrice in rural areas of central India. Mishri is applied to teeth and gums to clean the oral cavity. Mishri use has ill effects on oral health and periodontal tissues. The present study assessed the ill effect of mishri application periodontal tissues, and its correlation to the duration of use. A total of 300 subjects who used mishri as a dentifrice were considered. The enrolled subjects were categorized into three subgroups depending on the years of mishri usage. Age, gender, education level, socioeconomic status (SES), and body mass index (BMI), were recorded. Periodontal clinical parameters i.e. plaque index, gingival index, clinical attachment loss, and probing pocket depth were assessed. The data were statistically correlated with the duration of mishri usage with the Chi-square test and Analysis of variance. Out of the 300 subjects, 162 (54%) were males and 138 (46%) were females. SES and BMI had no association with mishri use but education level played a significant role in the avoidance of mishri use (P - 0.041). All the periodontal clinical parameters deteriorated with the duration of mishri use (P - 0.0001). It was concluded that mishri use was common in both genders. There was a deterioration of periodontal health and the progressive destruction of periodontal tissues with years of mishri use. The Dentist and community health workers should educate about the ill effects of tobacco use and mishri, as a dentifrice among the rural population. [ABSTRACT FROM AUTHOR]

The present work demonstrates, in-situ generation of Ni(0) nanoparticle stabilized by phosphomolybdic acid during the reaction. Nickel exchanged supported phosphomolybdic acid, Zirconia is use as support, (Ni–PMo 12 /ZrO 2) was synthesized, characterized by various physicochemical methods and its catalytic activity was evaluated for the solvent free aqueous phase hydrogenation of lignocellulosic biomass-derived levulinic acid (LA) using formic acid (FA) as internal hydrogen source. FA is promising green hydrogen storage molecule which is selectively hydrogen removed from its chemical structure and utilized it in a variety of catalytic hydrogenation reaction. FA is unique hydrogen source with high hydrogen content (4.4 wt%), low flammability, low toxicity and ease in handling as compared to other hydrogen source. To achieve outstanding performance of the catalyst, a detailed assessment of vital reaction parameters (mole ratio of FA, catalyst amount, temperature and time) were carried out. The catalyst shows outstanding activity (94% conversion) with a very low amount of Ni(0) (0.00247 mmol) and high TON (1092) for LA hydrogenation. The catalyst was found to be sustainable up to three catalytic cycles without any alteration in activity. The hot filtration test shows true heterogeneous nature of the synthesized catalyst as well as stabilizing nature of PMo 12. In situ formed Ni(0) was confirmed by thoroughly characterizing the regenerated catalyst by XPS, TEM, HR-TEM and STEM. The catalyst exhibits superior activity against reported catalysts. Also a plausible mechanism was proposed based on control experiments. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: An acute coronary syndrome (ACS) needs to be distinguished from a variety of other cardiac and non cardiac diseases that may cause chest pain. The challenge in the ED is not only to identify patients at the highest risk, but also to identify patients with non-urgent diseases. These patients may be discharged immediately with minimal testing or intervention. In addition, this causes the occupation of hospital beds through admission of such patients and associated increase in medical costs. Aims and Objectives: The aim is to identify the elements of the chest pain history and to assess the likelihood ratio of each symptom in predicting ACS. Materials and Methods: This cross sectional study was a conducted in the emergency department of VS hospital after getting approval from Institutional ethical committee. Total 500 patients presenting to the emergency department of VS Hospital with chest pain were included. Information was obtained regarding basic characteristics of chest pain, associated symptoms, past medical history, previous medications. Characteristics of ischemic chest pain and non ischemic chest pain were compared using chi square test. P value less than 0.05 was considered as significance. Results: Of the 500 patients presenting with chest pain to emergency department, 216 patients (43.2%) had ischemic chest pain while the rest 284 patients (56.8%) had non ischemic chest pain. It was found that chest pain is more likely to be due to myocardial ischemia if it is heavy in nature [LR-5.05], retrosternal in location [LR-1.82], radiating to both shoulders [LR-17.09], back [LR-2.007], epigastrium [LR-3.94] or left shoulder +/- left hand [LR-3.39]. Features of chest pain like throbbing in nature [LR- 0.31], burning in nature [LR- 0.39], constricting in nature [LR- 0.41], gnawing in nature [LR- 0.09], pin-pricking in nature [LR- 0.55], stretching in nature [LR- 0.4], right sided chest pain [LR-0.22], epigastric pain [LR-0.4], non radiating chest pain [LR- 0.43], and that associated with local tenderness [LR-0.12], decreases the likelihood of chest pain being ischemic in nature. Conclusion: Thus despite the recent advances & technology (bedside 2D ECHO, bedside troponin I measurements etc.), proper history taking is still the most vital component in evaluating and managing chest pain in emergency department. There is a need for spreading awareness in community about early & appropriate consultation for chest pain. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to examine treatment-related adverse events (TRAEs) for combination of nivolumab (NIVO) and ipilimumab (IPI) compared to NIVO monotherapy among cancer patients. We searched several databases to identify relevant RCTs. Meta-analysis was performed using random-effects model. In fourteen RCTs included in the study, we found that compared to NIVO monotherapy, combination NIVO + IPI increased the risk of any grade (Risk Ratio (RR) = 1.11), and grade 3 or 4 (RR = 1.95) TRAEs. Compared to NIVO, NIVO + IPI had higher risk for any grade colitis (RR = 4.52), pneumonitis (RR = 3.06), and diarrhea (RR = 1.68). [ABSTRACT FROM AUTHOR]

Objective: The pathogenesis of cutaneous lupus erythematosus (CLE) is multifactorial, and CLE is difficult to treat due to the heterogeneity of inflammatory processes among patients. Antimalarials such as hydroxychloroquine (HCQ) and quinacrine (QC) have long been used as first‐line systemic therapy; however, many patients do not respond to treatment with antimalarials and require systemic immunosuppressants that produce undesirable side effects. Given the complexity and the unpredictability of responses to antimalarial treatments in CLE patients, we sought to characterize the immunologic profile of patients with CLE stratified by subsequent treatment outcomes to identify potential biomarkers of inducible response. Methods: We performed mass cytometry imaging of multiple immune cell types and inflammation markers in treatment‐naive skin biopsy samples from 48 patients with CLE to identify baseline immunophenotypes that may predict the response to antimalarial therapy. Patients were stratified according to their response to treatment with antimalarials, as HCQ responders, QC responders, or nonresponders. Results: HCQ responders demonstrated increased CD4+ T cells compared to the QC responder group. Patients in the nonresponder group were found to have decreased Treg cells compared to QC responders and increased central memory T cells compared to HCQ responders. QC responders expressed increased phosphorylated stimulator of interferon genes (pSTING) and interferon‐κ (IFNκ) compared to HCQ responders. Phosphorylated STING and IFNκ were found to be localized to conventional dendritic cells (cDCs), and the intensity of pSTING and IFNκ staining was positively correlated with the number of cDCs on a tissue and cellular level. Neighborhood analysis revealed decreased regulatory cell interactions in nonresponder patients. Hierarchical clustering revealed that nonresponder patients could be further differentiated based on expression of pSTAT2, pSTAT3, pSTAT4, pSTAT5, phosphorylated interferon regulatory factor 3 (pIRF3), granzyme B, pJAK2, interleukin‐4 (IL‐4), IL‐17, and IFNγ. Conclusion: These findings indicate differential immune cell compositions between patients with CLE, offering guidance for future research on precision‐based medicine and treatment response. [ABSTRACT FROM AUTHOR]

In this article, first time we are reporting two steps synthesis of Fe exchanged phosphomolybdic acid supported on zirconia (Fe-PMA/ZrO2) by incipient wet impregnation and ion exchange method. The obtained material was well characterized by EDX mapping, ICP, FT-IR, Raman, 31P MAS NMR, ESR, XPS and powder XRD. The catalytic evaluation was explored for cyclohexene hydrogenation at low temperature using water as a solvent. The obtained results demonstrate remarkable efficiency of the synthesized material as a sustainable heterogeneous catalyst with very low amount of active species (Fe: 0.024 mol%), 90% conversion, high substrate/catalyst ratio (4157/1) as well as TON (3742) for 3 catalytic cycles. The present synthetic approach is highly green as it does not involve use of any noble metal, with no waste generation (E-factor = 0) as well as high reaction mass efficiency (92.20%). [ABSTRACT FROM AUTHOR]

Despite advances in cerebrospinal fluid shunting technology, complications remain a significant concern. There are some contradictions about the effectiveness of proximal catheter entry sites that decrease shunt failures. We aim to compare efficiency of shunts with ventricular frontal, ventricular occipital, and cisterna magna entry sites. The systemic search was conducted in the database from conception to February 16, 2022 following guidelines of PRISMA. Between 2860 identified articles, 24 articles including 6094 patients were used for data synthesis. The aggregated results of all patients showed that "overall shunt failure rate per year" in mixed hydrocephalus with ventricular frontal and occipital shunts, and cisterna magna shunt (CMS) were 9.0%, 12.6%, and 30.7%, respectively. The corresponding values for "shunt failure rate" due to obstruction were 15.3%, 31.5%, and 10.2%, respectively. The similar results for "shunt failure rate" due to infection were 11.3%, 9.1%, and 27.2%, respectively. The related values for "shunt failure rate" due to overdrainage were 2.9%, 3.9%, and 13.6%, respectively. CMS was successful in the immediate resolution of clinical symptoms. Shunting through an occipital entry site had a greater likelihood of inaccurate catheter placement and location. Contrary to possible shunt failure due to overdrainage, the failure likelihood due to obstruction and infection in pediatric patients was higher than that of mixed hydrocephalus patients. In both mixed and pediatric hydrocephalus, obstruction and overdrainage were the most and least common complications of ventricular frontal and occipital shunts, respectively. The most and least common complications of mixed CMS were infection and obstruction, respectively. [ABSTRACT FROM AUTHOR]

Background Spinal cord herniation into a traumatic pseudomeningocele is a rare clinical entity. We present the sixth known case and describe surgical management. Case Presentation A 44-year-old male presented with Brown-Sequard syndrome three decades after a cervical nerve root avulsion injury. Imaging revealed hemicord herniation into a C7/T1 pseudomeningocele in addition to extra-axial cord compression from further pseudomeningoceles. Significant clinical improvement was achieved following surgical repair. The radiological findings and technique for operative repair are described. Conclusion The case highlights this rare pathology and presentation, describes the surgical measures for repair of cord herniation, and provides evidence for the favorable outcome that can be achieved by surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: The effects of recipient body mass index (BMI) on waitlist strategies, waitlist outcomes, and post‐transplant outcomes among adult patients listed for heart transplantation under the updated 2018 allocation system have not been well characterized. Methods: The United Network of Organ Sharing data set between October 2015 and March 2021 was analyzed, and patients were grouped based on recipient BMI and whether listing occurred in the old (pre‐October 2018) or new allocation system. Results: Listing strategies differed by BMI group, but trends of increased use of temporary mechanical support and decreased use of durable support remained among all BMI groups, except those with BMI > 35 kg/m2. Waitlist outcomes improved among all BMI cohorts in the new allocation system, including among patients with BMI 30–34.9 and >35 kg/m2, although patients with higher BMIs continued to have longer waitlist times. Post‐transplant outcomes in the new allocation system are worse for patients with BMI > 30 kg/m2 (hazard ratio: 1.47; confidence interval: 1.19–1.82; p <.001). Conclusions: The 2018 change to the heart transplant allocation system was associated with similar changes in the use of mechanical support for listing strategy across BMI ranges, except in the most obese, and improved waitlist outcomes across all BMI ranges. Post‐transplant outcomes in the new allocation system are worse for patients with BMI > 30 kg/m2 compared to patients with BMI < 30 kg/m2. These findings have important clinical implications for our understanding of the ongoing influence of BMI on waitlist courses and post‐transplant outcomes among patients listed for heart transplantation [ABSTRACT FROM AUTHOR]

Background: Patients with blood group O have historically been disadvantaged in the United Network for Organ Sharing (UNOS) heart transplant allocation system. We sought to determine whether the new UNOS allocation system implemented in 2018 had an impact on waitlist and post‐transplant outcomes among blood groups. Methods: Using the UNOS database we included all adult patients listed and transplanted with first‐time single‐organ heart transplant between 10/17/15 and 10/1/21. For post‐transplant outcomes, we separately evaluated all adult patients transplanted with the same time‐frame. We used exclusion criteria and censoring to limit biases from changing clinical practices around the allocation change (10/18/2018), and from unequal or inadequate follow‐up. We compared clinical characteristics and outcomes before and after the allocation change among each blood group. Fine‐Gray and Cox regression models were used to estimate the effect of the new allocation system on competing waitlist outcomes‐ transplantation, death‐or‐removal from waitlist‐ and post‐transplant survival, respectively. Results: Of the 21,565 patients listed for transplantation 14,000 met criteria for waitlist analysis (7,035 in the old system vs. 6,965 in the new), and 7,657 met criteria for post‐transplant analysis (3,519 in the old system vs. 4,138 in the new). Among each blood group, new allocation change was associated with higher transplantation rates lower waitlist days and lower waitlist mortality (except Group AB). However, despite improvements, Group O was still associated with worse waitlist outcomes for each metric compared to non‐O Groups. The new allocation system did not have a significant impact on post‐transplant survival among any blood groups. Conclusion: Changes in heart transplant allocation have attenuated but not eliminated blood group O disadvantage in access to donor hearts. [ABSTRACT FROM AUTHOR]

Objective: Antisynthetase syndrome (ASyS) and dermatomyositis (DM) are autoimmune disorders that overlap clinically. Given the presence of DM‐like skin lesions in ASyS patients, there is debate about whether ASyS is a distinct disease or a subclassification of DM. Recent studies identified differences in type I interferon (IFN) expression between ASyS and DM muscle and finger eruptions. This study was undertaken to elucidate similarities and differences in the pathogenesis of cutaneous disease in ASyS and DM at the single‐cell level. Methods: Five ASyS patients and 7 DM patients were recruited from a prospectively collected database of well‐characterized DM patients. ASyS patients were clinically confirmed as having ASyS according to the Connors et al criteria and the Solomon et al criteria and the presence of aminoacyl–transfer RNA synthetase antibodies. Immunophenotyping was conducted using immunofluorescence (IF) and imaging mass cytometry (IMC). Results: IF staining for MxA and IFNβ expression revealed up‐regulation of type I IFN in ASyS and DM samples compared to healthy control samples (P < 0.05). IMC showed similar numbers of macrophages, T cells, B cells, and dendritic cells in ASyS and DM samples, with no differences in counts (P > 0.05), but an increase in myeloid dendritic cell percentage in DM samples (P < 0.05). Key type I IFN, cytokine, and JAK/STAT pathways were similarly expressed in both ASyS and DM (P > 0.05). At the single‐cell level, macrophages positive for phosphorylated stimulator of IFN genes in ASyS samples expressed increased levels of tumor necrosis factor, interluekin‐17 (IL‐17), and IFNβ (P < 0.001). Conclusion: IMC is a powerful tool that identifies a role for the type I IFN system in DM‐like skin lesions in ASyS and DM with some differences at the cellular level, but overall significant overlap, supporting similar therapeutic decision making. [ABSTRACT FROM AUTHOR]

Kaposi sarcoma can have a myriad cutaneous presentation, but an underrecognized one is an initial manifestation of simply edema. Herein, we highlight a series of cases where edema was the presenting feature of Kaposi Sarcoma and emphasize the importance of recognizing this finding as a possible sign of KS. [ABSTRACT FROM AUTHOR]

Background: Long‐term care (LTC) providers prescribe anticoagulation (AC) less frequently in residents with atrial fibrillation (AF) and geriatric conditions independent of CHA2DS2‐VASc stroke risk score. Geriatric conditions include recent fall, activities of daily living dependency, mobility impairment, cognitive impairment, low body mass index, and weight loss. Multiple publications have suggested that patients with geriatric conditions are at increased risk for stroke. Understanding better the risk of stroke and bleeding in residents with AF and geriatric conditions would be valuable to LTC providers for AC decision‐making. Methods and results: We measured the association of geriatric conditions with composite of stroke/transient ischemic attack (TIA)/systemic embolism and bleeding in residents with AF and elevated stroke risk (CHA2DS2‐VASc score ≥ 2) living in American LTC facilities in 2015. After merging nursing home assessments (Minimum Data Set) with medication and hospital utilization records, we identified 209,413 eligible residents. Using generalized estimating equations, we found that the incidence of stroke/TIA/systemic embolism ranged from 0.13% to 0.26% over 30 days (1.43%–3.08%/year) in residents off AC with and without geriatric conditions adjusting for other resident characteristics including CHA2DS2‐VASc score and propensity to receive AC. Similarly, the monthly incidence of bleeding on AC ranged from 0.22% to 0.28% (2.61%–3.31%/year) without increased risk with geriatric conditions. Residents with a CHA2DS2‐VASc score of ≥7 had a 2.4‐fold increased risk of stroke compared with those with score of 2–4 (0.30% vs. 0.12%/month). Conclusion: Calculating a CHA2DS2‐VASc score can be helpful in AC decision‐making for residents with and without geriatric conditions. [ABSTRACT FROM AUTHOR]

[Display omitted] • Metal excess or deficiency destabilizes the gut microbiota. • Toxin-mediated intestinal inflammation leads to changes in metal bioavailability. • C. difficile employs multiple mechanisms to overcome host metal sequestration. • Inflammation-derived heme elicits a coordinated response to avoid toxicity. The enteric pathogen Clostridioides difficile overcomes barriers to colonization imposed by the microbiota and host immune response to induce disease. To navigate the dynamic gut environment, C. difficile must respond to dietary and host-mediated fluctuations in transition metal availability. Transition metals are required trace nutrients that foster inter-microbial competition when limited, inhibit bacterial growth through host sequestration, or induce toxicity in excess. This review highlights recent evidence that transition metals influence multiple stages of C. difficile colonization and that C. difficile initiates a coordinated response to maintain metal-dependent homeostasis. Further exploration of the mechanisms of C. difficile metal sensing and nutrient competition with the microbiota will be necessary for the therapeutic manipulation of the gut environment during C. difficile infection. [ABSTRACT FROM AUTHOR]

The era of electric mobility has started, and petrol/diesel vehicles are being replaced by electric vehicles (EVs). The phase change material (PCM) is a trending field of research in its application of energy storage and thermal management. PCM-based thermal management method is found to be quite simple and effective for battery packs. However, its commercialization is difficult due to its low thermal conductivity and extra weight addition to the battery pack. Hence, the present research focuses on the battery performance with PCM. The experimental setup for a 48V, 25Ah battery pack is developed, and its performance is explored with and without PCM. The numerical model for same sized battery pack is developed, and validated with experimental results. The major objective of the present research is to find the optimal gap between two battery cells so that a sufficient amount of PCM can be filled inside the battery pack. Initially, inline and staggered cell arrangements are examined, and no significant difference in thermal performance is found. Further, cell spacing of 5 mm, 3 mm, and 1 mm are examined, and maximum temperature and temperature difference are compared along with the weight and volume of the battery pack. For a single charging process, 1 mm cell spacing is found sufficient, considering the weight of the battery pack and thermal performance. However, with 1 mm cell spacing, temperature increases significantly after each charging and discharging. At the same time, 3 mm and 5 mm are found as feasible solutions considering single and double charging-discharging cycles, respectively. 3 mm cell spacing is better option when weight is a critical issue, while 5 mm cell spacing is better when thermal performance is a critical issue. The current study offers guidance in the advancement of battery packs, particularly in cases where space constraints are a concern. • The research focuses on utilization of optimal amount of PCM. • The battery charging experiments are carried out on 48V, 25Ah battery pack. • PCM OM42 reduced battery temperature by 18 %. • The inline and staggered arrangements are found equally effective. • 3 mm cell spacing is found sufficient with limited weight increment. [ABSTRACT FROM AUTHOR]

Objectives: Financial protection mechanisms are in place to overcome the costs of a few diseases in India. Our objective was to estimate the costs incurred due to Oral Potentially Malignant Disorders (OPMD) and to determine predictors of such costs. Results: We found that the median (Interquartile range IQR) total costs of OPMD was Indian Rupees (INR) 500 (350–750), direct medical costs was INR 0 (0–50), direct non-medical costs was INR 150 (40–200) and indirect costs was INR 350 (250–500). The travel cost to attend the health facilities [INR 100 (40–150)] and the patient's loss of wages [INR 200 (150–400)] mainly accounted for the direct non-medical and indirect costs respectively. The median expenditure on smokeless and smoking forms of tobacco was INR 6000 (5400–7200) and INR 2400 (1800–3600) respectively. On multiple linear regression analysis, rural residence, belonging to below poverty line family, being a sole earner in the family, number of months since diagnosis and first visit at a private provider were found to be the significant predictors of total costs of OPMD. Financial protection mechanisms are needed for covering the direct non-medical and indirect costs. Early management of OPMD might mitigate the costs of OPMD. [ABSTRACT FROM AUTHOR]

Acute abdominal pain is a common presenting symptom that possesses a wide differential. Congenital internal hernias are a rare condition that often presents with abdominal pain and can lead to obstruction. Early diagnosis is often difficult and therefore can present acutely and in an emergent setting. Prompt recognition of symptoms and evaluation are important to prevent poor prognosis. We are presenting a case of a congenital internal hernia in a patient presenting with nonspecific symptoms. Prompt diagnosis and subsequent surgical intervention allowed for appropriate management and resolution of symptoms. [ABSTRACT FROM AUTHOR]

In 2018, the United Network for Organ Sharing (UNOS) adopted a 6‐tier system for heart allocation which shifted patterns in listing strategies. The effects of the change on waitlist survival and transplantation rates have yet to be substantiated by analysis of competing outcomes among various listing strategies. This study included all adult patients listed for first‐time heart transplantation in UNOS between 10/17/15 and 6/12/20. Clinical characteristics were compared before and after allocation change among various listing strategies: no support, inotropes, intra‐aortic balloon pump, durable left ventricular assist device (LVAD), temporary VAD, and extracorporeal membrane oxygenation. Fine‐Gray proportional subhazard models were used to estimate the effect of allocation change on competing waitlist outcomes—transplantation, death, or removal from waitlist—among each strategy. During the study period, there were 17 422 patients listed for heart transplantation. Among each listing strategy, clinical characteristics were similar before and after allocation change. Subhazard models demonstrated reduced risk for waitlist mortality (p <.001) among each strategy except temporary VAD and increased transplantation rates (p <.001) among each strategy except for durable LVAD. These results validate the association of the new allocation system on waitlist outcomes across listing strategies. [ABSTRACT FROM AUTHOR]

Background: Anatomic interventions for pulmonary vein stenosis (PVS) in infants and children have been met with limited success. Sirolimus, a mammalian target of rapamycin inhibitor, has demonstrated promise as a primary medical therapy for PVS, but the impact on patient survival is unknown.Objectives: The authors sought to investigate whether mTOR inhibition with sirolimus as a primary medical therapy would improve outcomes in high-risk infants and children with PVS.Methods: In this single-center study, patients with severe PVS were considered for systemic sirolimus therapy (SST) following a strict protocol while receiving standardized surveillance and anatomic therapies. The SST cohort was compared with a contemporary control group. The primary endpoint for this study was survival. The primary safety endpoint was adverse events (AEs) related to SST.Results: Between 2015 and 2020, our PVS program diagnosed and treated 67 patients with ≥moderate PVS. Of these, 15 patients were treated with sirolimus, whereas the remaining patients represent the control group. There was 100% survival in the SST group compared with 45% survival in the control group (log-rank p = 0.004). A sensitivity analysis was completed to address survival bias using median time from diagnosis of PVS to SST. A survival advantage persisted (log-rank p = 0.027). Two patients on sirolimus developed treatable AEs. Patients in the SST group underwent frequent transcatheter interventions with 3.7 catheterizations per person-year (25th to 75th percentile: 2.7 to 4.4 person-years). Median follow up time was 2.2 years (25th to 75th percentile: 1.2 to 2.9 years) in the SST group versus 0.9 years (25th to 75th percentile: 0.5 to 2.7 years) in the control group.Conclusions: The authors found a survival benefit associated with SST in infants and children with moderate-to-severe PVS. This survival benefit persisted after adjusting the analysis for survival bias. There were 2 mild AEs associated with SST during the study period; both patients were able to resume therapy without recurrence. [ABSTRACT FROM AUTHOR]

Introduction: The presence of ring sideroblasts (RS) and mutation of the SF3B1 gene are diagnostic of lower‐risk (LR) myelodysplastic syndromes (MDS) and are correlated with favorable outcomes. However, information on testing and reporting in community‐based clinical settings is scarce. This study from the Connect® MDS/AML Disease Registry aimed to compare the frequency of RS and SF3B1 reporting for patients with LR‐MDS, before and after publication of the 2016 World Health Organization (WHO) MDS classification criteria. Methods: Ring sideroblasts assessment and molecular testing data were collected from patients with LR‐MDS at enrollment in the Registry. Patients enrolled between December 2013 and the data cutoff of March 2020 were included in this analysis. Results: Among 489 patients with LR‐MDS, 434 (88.8%) underwent RS assessment; 190 were assessed prior to the 2016 WHO guidelines (Cohort A), and 244 after (Cohort B). In Cohort A, 87 (45.8%) patients had RS identified; 29 (33.3%) patients had RS < 15%, none of whom underwent molecular testing for SF3B1. In Cohort B, 96 (39.3%) patients had RS identified; 31 (32.3%) patients had < 15% RS, with 13 undergoing molecular testing of which 10 were assessed for SF3B1. Conclusions: In the Connect® MDS/AML Registry, only 32% of patients with <15% RS underwent SF3B1 testing after the publication of the WHO 2016 classification criteria. There was no change in RS assessment frequency before and after publication, despite the potential impact on diagnostic subtyping and therapy selection, suggesting an unmet need for education to increase testing rates for SF3B1 mutations. [ABSTRACT FROM AUTHOR]

Voltage-gated potassium (Kv) channels regulate the membrane potential and conductance of excitable cells to control the firing rate and waveform of action potentials. Even though Kv channels have been intensely studied for over 70 year, surprisingly little is known about how specific channels expressed in various neurons and their functional properties impact neuronal network activity and behavior in vivo. Although many in vivo genetic manipulations of ion channels have been tried, interpretation of these results is complicated by powerful homeostatic plasticity mechanisms that act to maintain function following perturbations in excitability. To better understand how Kv channels shape network function and behavior, we have developed a novel optogenetic technology to acutely regulate Kv channel expression with light by fusing the light-sensitive LOV domain of Vaucheria frigida Aureochrome 1 to the N-terminus of the Kv1 subunit protein to make an Opto-Kv1 channel. Recording of Opto-Kv1 channels expressed in Xenopus oocytes, mammalian cells, and neurons show that blue light strongly induces the current expression of Opto-Kv1 channels in all systems tested. We also find that an Opto-Kv1 construct containing a dominant-negative pore mutation (Opto-Kv1(V400D)) can be used to down-regulate Kv1 currents in a blue light-dependent manner. Finally, to determine whether Opto-Kv1 channels can elicit light-dependent behavioral effect in vivo, we targeted Opto-Kv1 (V400D) expression to Kv1.3-expressing mitral cells of the olfactory bulb in mice. Exposure of the bulb to blue light for 2–3 hours produced a significant increase in sensitivity to novel odors after initial habituation to a similar odor, comparable to behavioral changes seen in Kv1.3 knockout animals. In summary, we have developed novel photoactivatable Kv channels that provide new ways to interrogate neural circuits in vivo and to examine the roles of normal and disease-causing mutant Kv channels in brain function and behavior. [ABSTRACT FROM AUTHOR]

Partial shading of a solar module can induce a set of cells within the module to operate under reverse bias. Studies have shown that metal halide perovskite solar cells with a wide variety of compositions and contacts exhibit interesting behavior in reverse bias that includes both reversible performance loss and non‐reversible degradation. In this paper, an advanced drift‐diffusion approach incorporating an electrochemical term to explain the short‐circuit, open circuit and fill factor losses that are experimentally measured after prolonged reverse bias is used. It is shown that holes can tunnel into the perovskite due to sharp band bending near the contact, accumulate within the bulk of the perovskite absorber, and trigger the oxidation of halides to form neutral halogens. The density of neutral halogens is much higher in reverse bias because there are hardly any electrons available to reduce the iodine. The resulting halogens act as bulk recombination centers. While the interstitial halogen density does decay when the cell is operated in forward bias, permanent degradation can occur if the iodine diffuses out of the perovskite layer. Finally, the ways in which changing parameters such as the mobile ion density or the series resistance at the contact can influence device performance and stability are discussed. [ABSTRACT FROM AUTHOR]

Corrugations can dramatically change the effective mechanical properties of a thin sheet. Such alternating ridges and grooves are typically fabricated by mechanical processing. Herein, the ability to trigger and tune corrugations within thin (≈300 µm thick) thermoplastic sheets rapidly (≈seconds) using only light is reported. Patterns of black ink on the otherwise transparent, flimsy sheet preferentially adsorb external IR light, inducing localized heating of the underlying polymer. This heating causes localized shrinkage of the polymer, producing folds in the sheets; collectively, these folds result in corrugations of controlled geometry. Depending on orientation, these corrugations dramatically increase stiffness or extensibility, similar to corrugated roofs (stiff) or accordions (extensible). In the direction parallel to the folds, the maximum load‐carrying capacity increases by two orders of magnitude relative to the non‐corrugated sheet; perpendicular to the folds, the effective modulus decreases by four orders of magnitude. In addition to tuning effective mechanical properties, the ability to corrugate flat surfaces using light has implications for assembling 3D objects from substrates printed in 2D (such as lithographically patterned electronics) or 3D structures shipped in a flat state. Herein, the process of forming such structures is discussed and their properties are characterized. [ABSTRACT FROM AUTHOR]

Purpose: Infection following total hip arthroplasty is a challenging and devastating complication. In two-stage revision arthroplasty, antibiotic spacers, although efficacious, can be associated with an unacceptable rate of mechanical complications (e.g., fracture, dislocation). This series describes 15 patients with infected total hip prostheses treated with hybrid cement-screw fixation constrained liner antibiotic spacers to enhance stability and minimize mechanical complications. Materials and Methods: All patients with an infected hip prosthesis undergoing two-stage revision arthroplasty at a single academic medical center were identified and screened for inclusion. Clinical and radiographic data including patient demographics and outcome measures were collected and retrospectively analyzed. Results: Two patients died of unrelated causes at an average of 6-week postoperatively. Infections in the remaining thirteen patients (100%) were successfully eradicated; all underwent uncomplicated revision arthroplasty at a mean duration of 99.5 days after the placement of the antibiotic spacer. No dislocations, fractures, or other mechanical failures of any spacer were observed in this series. Conclusion: The hybrid cement-screw fixation technique for constrained liner antibiotic spacers is a reliable and effective treatment method for eradicating prosthetic joint infections without mechanical complications. [ABSTRACT FROM AUTHOR]

Polymer matrix composites are attractive structural materials in automotive, defense, and aerospace industries due to their high strength to low weight ratios. However, due to their low shear strength, compression dominated failure mechanisms such as plastic microbuckling lead to the development of kink bands, which are a key strength-limiting factor in modern polymer matrix composites. This phenomenon has been studied extensively, particularly for uniaxial compression; however, experimental measurements of the strain fields leading to and developing inside these bands under bending are not well explored. In this study, digital image correlation is used to measure strains inside kink bands developing during three-point bending of cross-plied [0/90] laminated composite Dyneema™ HB80. Measurements indicated large normal and shear strains developed inside the band in a way that suggested systematic increases in ply rotation angle as the band evolved with increased bending deflection. Results also suggested intermittent buckling events involving fiber bundles that correlate with oscillations observed in the load–displacement curve. Optical microscopy of failed samples showed failure resulted from a combination of plastic microbuckling and axial splitting. [ABSTRACT FROM AUTHOR]

The menisci are fibrocartilaginous tissues that are crucial to the load-sharing and stability of the knee, and when injured, these properties are compromised. Meniscus replacement scaffolds have utilized the circumferential alignment of fibers to recapitulate the microstructure of the native meniscus; however, specific consideration of size, shape, and morphology has been largely overlooked. The purpose of this study was to personalize the fiber-reinforcement network of a meniscus reconstruction scaffold. Human cadaveric menisci were measured for a host of tissue (length, width) and subtissue (regional widths, root locations) properties, which all showed considerable variability between donors. Next, the asymmetrical fiber network was optimized to minimize the error between the dimensions of measured menisci and predicted fiber networks, providing a 51.0% decrease (p=0.0091) in root-mean-square (RMS) error. Finally, a separate set of human cadaveric knees was obtained, and donor-specific fiber-reinforced scaffolds were fabricated. Under cyclic loading for load-distribution analysis, in situ implantation of personalized scaffolds following total meniscectomy restored contact area (253.0mm² to 488.9mm², p=0.0060) and decreased contact stress (1.96MPa to 1.03MPa, p=0.0025) to near-native values (597.4mm² and 0.83MPa). Clinical use of personalized meniscus devices that restore physiologic contact stress distributions may prevent the development of post-traumatic osteoarthritis following meniscal injury. [ABSTRACT FROM AUTHOR]