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This paper presents a comprehensive study of the impacts of three governing factors: Alkaline concentration, curing temperature and curing period on the mechanical properties of a geopolymer that include the uniaxial compressive strength, Poisson’s ratio, and Young’s modulus of elasticity. As literature review indicates, most of the previous research studies were focused on the effect of single factor, while there is a lack of comprehensive studies to simultaneously investigate the combined effects of all these factors, especially in a systematic experimental setup. Acknowledging this rarely exploited area of geopolymer research, this work developed a sequential experimental setup to perform a detailed study to understand the mechanical behaviors of the geopolymer as a function of alkaline concentration, curing temperature and curing period. The test results show that the compressive strength of geopolymer is mostly governed by the curing temperature as compared to alkaline concentration and curing period. Geopolymer samples cured at 60 °C and 80 °C give a competitive compressive strength of about 30 MPa even when prepared with less alkaline activator and cured for a shorter period. This observation is justified by the microscopic analysis of samples at each curing temperature that explains the formation of microcracks, amount of unreacted fly ash, sodium-aluminosilicate hydrate crystals (NASH), calcium-silicate hydrate (CSH) crystals and efflorescence.

The Savage-Hutter (SH) equations of granular avalanche flows are a hyperbolic system of equations determining the distribution of depth and depth-averaged velocity components tangential to the sliding bed. We review the equations and point out the geometrical complexities to which these equations have been generalized. Because of the hyperbolicity of the equations, successful numerical modelling is challenging, particularly when large gradients of the physical variables occur, e.g. for a moving front or possibly formed shock waves in avalanche flows if velocities change from supercritical to subcritical e.g. during the deposition. Numerical schemes solving these free surface flows must be able to cope with smooth as well as non-smooth solutions. In this paper several numerical methods are applied to solve the SH equations and compared, including traditional difference schemes, e.g. central and upstream difference schemes, as well as high-resolution NOC (Non-Oscillatory Central Differencing) schemes, in which several second-order TVD (Total Variation Diminishing) limiters and a third-order ENO (Essentially Non-Oscillatory) cell reconstruction scheme are used. Results show that the high-resolution schemes, particularly the NOC scheme with the Minmod TVD limiter or the van Leer limiter, provide excellent performances. In the SH theory the material response is expressed by only two phenomenological parameters – the internal and the bed friction angles. Parameter investigations show that avalanche flows are much more sensitive against variations of the bed friction angle than that of the internal angle of friction. Effects due to a pressure dependence of the bed friction angle and lateral variations of the basal topography are therefore also numerically examined. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccines are well tolerated and effective but may have adverse effects on the cardiovascular system. Vaccine-associated myocardial injury was analysed by measuring high-sensitive troponin T (hsTnT); mid-regional pro-adrenomedullin (MR-proADM) levels were evaluated to assess endothelial dysfunction., Methods: This was a prospective study with a vulnerable population of healthcare workers (HCWs) and elderly patients (>70 years) who were vaccinated with either one dose of ChAdOx1 nCov-19 adenoviral vector vaccine (AZ) followed by one dose of the BNT162b2 messenger RNA vaccine (BNT), or with two doses of BNT (12th of January - 30th of November 2021). HsTnT and MR-proADM were measured in blood samples at three visits (V 1 : 1st immediately before vaccination; V 2, 3 : 3-4 weeks after 1st and 2nd vaccination). HsTnT of HCWs was compared to a healthy reference population., Results: N  = 162 volunteers were included (V 1  = 161; V 2 , V 3  = 162 each). N  = 74 (45.7%) received AZ/BNT and n  = 88 (54.3%) received BNT/BNT [elderly: n  = 20 (12.3%), HCWs: n  = 68 (42.0%)]. Median hsTnT levels were 4 ng/L, 5 ng/L and 4 ng/L (V 1 -V 3 ) for AZ/BNT and at 5 ng/L, 6 ng/L and 6 ng/L (V 1 -V 3 ) for BNT/BNT. Compared to the reference population ( n  = 300), hsTnT was significantly higher at all visits for both vaccination groups ( p  < 0.01), without differences between the AZ/BNT and BNT/BNT cohort. Median MR-proADM values were 0.43 nmol/L, 0.45 nmol/L, 0.44 nmol/L (V 1 -V 3 ) in the AZ/BNT cohort and 0.49 nmol/L, 0.44 nmol/L, 0.47 nmol/L for BNT/BNT, respectively. Change of median hsTnT and MR-proADM between visits did not show significant increases. One HCW experienced a permanent and three a transient hsTnT increase ≥14 ng/L., Conclusion: No overall subtle, persistent cardiovascular involvement was observed after the 2nd COVID-19 vaccination. Elevated cardiovascular biomarkers in clinically asymptomatic individuals need further investigations., Competing Interests: Independent of this work, MM received speakers and consulting fees from Bayer Healthcare, BMS, Boehringer Ingelheim, Daiichi Sankyo, Astra Zeneca, Sanofi, BRAHMS GmbH and Roche Diagnostics. He received research funding from German public funding authorities for Health Care Research and Roche Diagnostics. SP receives research funding from Roche Diagnostics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Pudasaini, Le, Huscher, Holert, Hillus, Tober-Lau, Kurth, Sander and Möckel.)

The European Society of Cardiology issued updated syncope guidelines in 2018 which included recommendations for managing syncope in the emergency department (ED) setting. However, these guidelines lack detailed process-oriented instructions regarding the fact that ED syncope patients initially present with a transient loss of consciousness (TLOC), which can have a broad spectrum of causes. This study aims to establish a European consensus on the general process of the workup and care for patients with suspected syncope and provides rules for sufficient and systematic management of the broad group of syncope (initially presenting as TLOC) patients in the ED. A variety of European diagnostic and therapeutic standards for syncope patients were reviewed and summarized in three rounds of a modified Delphi process by the European Society for Emergency Medicine syncope group. Based on a consensus statement, a detailed process pathway is created. The primary outcome of this work is the presentation of a universal process pathway for the structured management of syncope patients in European EDs. The here presented extended event process chain (eEPC) summarizes and homogenizes the process management of European ED syncope patients. Additionally, an exemplary translation of the eEPC into a practice-based flowchart algorithm, which can be used as an example for practical use in the ED, is provided in this work. Syncope patients, initially presenting with TLOC, are common and pose challenges in the ED. Despite variations in process management across Europe, the development of a universally applicable syncope eEPC in the ED was successfully achieved. Key features of the consensus and eEPC include ruling out life-threatening causes, distinguishing syncope from nonsyncopal TLOCs, employing syncope risk stratification categories and based on this, making informed decisions regarding admission or discharge., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Children are at greatest risk for severe illness from Respiratory Syncytial Virus (RSV). The aim of the study was to find out the knowledge of RSV, practice and knowledge about vaccination during pregnancy and the willingness to accept vaccines against RSV during pregnancy in the future among mothers needs to be understood which would add up information for stakeholder and policy makers., Methods: A preformed Performa was used for face-to-face interview was conducted among 340 pregnant women who visited the Antenatal clinic from 15-Oct-2023 to 30-Nov-2023 in their second and third trimester. Socio-demographic characteristics, knowledge and the attitude concerning antenatal vaccination affecting the acceptance of RSV vaccine were evaluated from the interview., Results: The mean age was 28.4 years, with 310 (91.18%) already having at least one child. Six (1.76%) participants had previously heard about RSV, and 325 (95.59%) were aware of the problem caused by RSV after they were briefly explained about it in their local language. A total of 246 (72.35%) of the mothers expressed willingness to be vaccinated themselves rather than vaccinating their children if such an option existed. Only 2 (0.59%) participants were familiar with nasal vaccines, and only 18 (5.29%) believed in such vaccines being effective. Despite this, almost all participants 339 (99.71%) in the study demonstrated willingness to receive additional antenatal vaccines if approved for use in future., Conclusions: The study showed a limited understanding of RSV in children among pregnant women in Nepal. However, they are aware of the impact of bronchiolitis and expressed a strong willingness to undergo maternal vaccination against RSV.

Background: This nationwide routine data analysis evaluates if oral anticoagulant (OAC) use in patients with heart failure (HF) and atrial fibrillation (AF) leads to a lower mortality and reduced readmission rate. Superiority of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), was analyzed for these endpoints., Methods: Anonymous data of patients with a health insurance at the Allgemeine Ortskrankenkasse and a claims record for hospitalization with the main diagnosis of HF and secondary diagnosis of AF (2017-2019) were included. A hospital stay in the previous year was an exclusion criterion. Mortality and readmission for all-cause and stroke/intracranial bleeding (ICB) were analyzed 91-365 days after the index hospitalization. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome., Results: 180,316 cases were included [81 years (IQR 76-86), 55.6% female, CHA 2 DS 2 -VASc score ≥ 2 (96.81%)]. In 80.6%, OACs were prescribed (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%; with multiple prescriptions per patient included). Mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9%. Risk of death was lower with any OAC (HR 0.77, 95% CI [0.75-0.79]) but without significant differences in OAC type (VKA: HR 0.73, [0.71-0.76]; FXaI: HR 0.77, [0.75-0.78]; DTI: HR 0.71, [0.66-0.77]). The total readmission rate (HR 0.97, [0.94 to 0.99]) and readmission for stroke/ICB (HR 0.71, [0.65-0.77]) was lower with OAC., Conclusions: Nationwide data confirm a reduction in mortality and readmission rate in HF-AF patients taking OACs, without NOAC superiority., Competing Interests: Declaration of Competing Interest M.M. received speakers and consulting fees from Bayer Healthcare, BMS, Boehringer Ingelheim, Daiichi Sankyo, Astra Zeneca, Sanofi, BRAHMS GmbH and Roche Diagnostics as well as research funding from German public funding authorities for Health Care Research and Roche Diagnostics; G.M. received speaker fees from Getinge, Orion Pharma and AOP Orphan Pharmaceuticals Germany GmbH; no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Prolapse is among the most common indication for gynaecological surgery. It is difficult to estimate prevalence of pelvic organ prolapse even in developed countries due to lack of epidemiological studies. This study was done to find the prevalence, risk factors and common presenting complaints of women with pelvic organ prolapse., Methods: Women with pelvic organ prolapse visiting Paropakar Maternity and Women's Hospital during 4 months duration in 2021 were approached and after obtaining an informed consent, all the patient information on various risk factors and clinical profile(age,parity,body mass index,smoking etc.) for pelvic organ prolpase were collected in a pre-developed proforma. Pelvic Organ Prolapse was classified by Pelvic Organ Prolapse Quantification system. Data analysis was done using statistical package for the social sciences-25. Ethical approval was taken from Institutional Review Committee- National Academy of Medical Sciences., Results: Out of 58 cases enrolled in the study, prevalence of pelvic organ prolapse was found to be 1.28%. Women belonging to age group ≥ 49 years was 91.4%. Bulge symptom was the most common presenting complain among the women, 98.3%. 50% of women (n=29) were grand multipara. 53.4% (n=31) of women had delivered their first baby before 20 years of age. Multiparity,vaginal birth and menopausal age were the common risk factors., Conclusions: Menopausal age, multi-parity, vaginal births, age at first vaginal delivery of less than 20 years were significant risk factors for development of prolapse. Bulge symptom was the most common presenting complaint. However,Smoking habit, overweight were not related to pelvic organ prolapse.

Cauda equina syndrome is a rare but severe neuro-spinal disorder commonly caused due to lumbar disc herniation, which occurs mostly at lower levels of L4-S1. We report a case of 38-year-old male soldier deployed on a foreign mission who presented to a level 1 military hospital 4 months back with complaints of decreased movement of bilateral lower limbs and severe low back pain radiating to the right lower limb for 2 hours. He was referred to a higher centre and diagnosed with cauda equina syndrome due to massive disc herniation at levels L2-L3. He underwent laminotomy and discectomy of the extruded intervertebral disc after 48 hours. On subsequent follow-up, his bladder and lower limbs sensations were normal however, he had bowel incontinence, hypotonia, hyporeflexia, and no significant improvement in power. Hence, early diagnosis, referral, and timely intervention affect the outcomes in a cauda equina syndrome patient., Keywords: case reports; cauda equina syndrome; disc herniation; low back pain; military personnel.

Antimicrobial resistance (AMR) is a global public health threat. Surveillance of AMR requires affordable, rapid, and user-friendly diagnostic methods. Our aim was to develop a low-cost thermocycler to perform polymerase chain reaction (PCR). We developed a smartphone-operated PCR thermal cycler using locally available recycled materials. The thermal cycler was used for the amplification for three bacterial genes-bla-TEM, bla-CTXM and 16s rRNA in human urine samples. The performance of custom-built thermal cycler was compared with commercial thermal cycler. The thermal cycler was portable (<1kg weight), required 12 V power supply, 25 μL of solution, and cost only USD50.0. Temperature and time conditions were instructed using a custom-built smartphone application. The ramping rate of was 0.23°C for heating and 0.43°C for cooling. The reported temperatures were within ± 0.5°C of set temperature. The human urine samples were highly resistance and multi-resistant. Nearly 46% (n = 54) E. coli isolates were positive in ESBL screening test. The custom-built thermocycler was able to accurately predict the presence of bla-TEM, bla-CTXM genes, and 16s rRNA (n = 6). We developed and demonstrated a portable, low-cost, easy-to-use, and smartphone-operated PCR thermal cycler. Since it is portable, it can be used in remote location and field settings, including places without stable power supply. The use of the thermal cycler system can be extended, beyond the detection of AMR genes, e.g., in clinical diagnosis, genetics, forensic analysis, and environmental protection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Pudasaini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

By applying an explorative approach, we aimed to identify a wide set of challenges and opportunities for the compatibility of the work and life domains in emergency department (ED) physicians as well as their suggestions for practical approaches to improve work-life balance. Four focus groups with 14 physicians of differing hierarchical position and family status were carried out at two EDs of one major university hospital. Data analysis was based on qualitative content analysis. Discussed themes within main categories included ED work conditions, aspects of residency training, physician's mentality and behaviors as well as context factors of university medicine. Working in an ED is associated with a comparatively high work-life-interference, mostly due to the unpredictable nature of ED work. Based on our context-specific findings, further research might address factors influencing work-life balance in ED physicians with a mixed-methods approach for identification of relevant associations and intervention approaches in this field., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Pudasaini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The current COVID-19 pandemic, despite the availability of rapid tests and the start of the vaccination campaign, continues to pose major challenges to emergency departments (ED). Structured collection of demographic, clinical, as well as treatment-related data provides the basis for establishing evidence-based processes and treatment concepts., Aim of the Work: To present the systematic collection of clinical parameters in patients with suspected COVID-19 in the Registry for COVID-19 in the Emergency Room (ReCovER) and descriptive presentation of the first 1000 patients., Materials and Methods: Data from patients with suspected COVID-19, regardless of evidence of SARS-CoV‑2 infection, are continuously entered into a web-based, anonymized registry in ED at six university hospitals., Results: Between 19 May 2020 and 13 January 2021, 1000 patients were entered into the registry, of whom 594 patients (59.4%) were in the SARS-CoV‑2 positive group (PG) and 406 patients (40.6%) were in the negative group (NG). Patients of the PG had significantly fewer pre-existing conditions and a significantly longer latency between symptom onset and presentation to the ED (median 5 vs. 3 days), were more likely to suffer from cough, myalgia, fatigue, and loss of smell/taste and had significantly higher oxygen requirements than NG patients. The rate of severe disease progression was significantly higher in the PG, and persistent symptoms were more common after discharge (11.1 vs. 4.6%)., Conclusions: The multicenter collection of comprehensive clinical data on COVID-19 suspected cases in the ED allows analysis of aspects specific to the situation in Germany in particular. This is essential for a targeted review and adaptation of internationally published strategies., (© 2021. The Author(s).)

Introduction: Aging brings progressive changes in the physiology of the musculoskeletal system that leads to postural changes and degenerative diseases in elderly. The most common postural change is hyperkyphosis which decreases physical performance, ability to perform daily activities, overall quality of life, and increases the risk of falls in elderly. The aim of the study was to find out the prevalence of hyperkyphosis among the elderly in a community., Methods: A descriptive cross-sectional study was done in a local community from 26 May 2019 to 8 June 2019 after obtaining ethical approval from the Institutional Review Committee (Protocol approval number: 138/19). Participants above 60 years of age were included in the study. Convenience sampling was done. A bubble inclinometer was used to measure the degree of kyphosis. Point estimate and 95% Confidence Interval were calculated., Results: Among 144 elderly participants, hyperkyphosis was present in 90 (62.50%) (54.59-70.41, 95% Confidence Interval) with the mean hyperkyphosis being 47.07±4.83˚. The elderly in the age group of 70-75 years had a higher degree of hyperkyphosis with a mean value of 47.77±4.92˚. The mean hyperkyphosis was 48.18±5.30˚ and 45.31±3.36˚ in female and male participants respectively., Conclusions: The prevalence of hyperkyphosis was found to be higher in our study compared to other studies conducted in similar settings. Early identification and interventions of hyperkyphosis are thus warranted to prevent the detrimental consequences in the later stages of life., Keywords: aging; hyperkyphosis; posture.

Paper analytical devices (PADs) are a class of low-cost, portable, and easy-to-use platform for several analytical tests in clinical diagnostics, environmental pollution monitoring, and food and drug safety screening. These devices are primarily made from cellulosic paper. Considering the importance of eco-friendly and local or distributed manufacturing of devices realized during the COVID-19 pandemic, we systematically studied the potential of handmade Nepali paper to be used in fabricating PADs in this work. We characterized five different handmade papers made from locally available plant fibers using an eco-friendly method and used them to fabricate PADs for determining the drug quality. The thickness, grammage, and apparent density of the paper samples ranged from 198.6 to 314.8 μm, 49.1 to 117.8 g/m 2 , and 0.23 to 0.43 g/cm 3 , respectively. The moisture content, water filtration, and wicking speed ranged from 5.8 to 7.1%, 35.7 to 156.7, and 0.062 to 0.124 mms -1 , respectively. Furthermore, the water contact angle and porosity ranged from 76.6 to 112.1° and 79 to 83%, respectively. The best paper sample (P5) was chosen to fabricate PADs for the determination of metformin, an antidiabetic drug. The metformin assay on PADs followed a linear range from 0.0625 to 0.5 mg/mL. The assay had a limit of detection and limit of quantitation of 0.05 and 0.18 mg/mL, respectively. The average amount of metformin concentration in samples collected from local pharmacies ( n = 20) was 465.6 ± 15.1 mg/tablet. When compared with the spectrophotometric method, PAD assay correctly predicted the concentration of 90% samples. The PAD assay on handmade paper may provide a low-cost and easy-to-use system for screening the quality of drugs and other point-of-need applications., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Myelination of axons in the neonatal brain is a highly complex process primarily achieved by oligodendroglial cells (OLs). OLs express receptors for γ-aminobutyric acid (GABA) which is released from cortical interneurons on a basal level, while glial cells can be a source of GABA, too. We investigated GABA-induced oligodendroglial maturation, proliferation, apoptosis, and myelin production after pharmacological inhibition of GABA A and GABA B in the neonatal rat brain. Daily injections of the reverse GABA A receptor agonist (DMCM) and the GABA B receptor antagonist (CGP35348) were performed from postnatal day 6 (P6) to P11. MBP expression was examined by Western blots and immunohistochemistry. Furthermore, we determined the number of CC1 + OLIG2 + and CNP + OLIG2 + cells to assess maturation, the number of PCNA + OLIG2 + oligodendrocytes to assess proliferation, the number of oligodendrocyte precursor cells (PDGFRα + OLIG2 + ), and apoptosis of OLs (CASP3A + OLIG2 + ) as well as apoptotic cells in total (CASP3A + DAPI + ) at P11 and P15. In addition, we analyzed the expression Pdgfrα and CNP. MBP expression was significantly reduced after CGP treatment at P15. In the same animal group, CNP expression and CNP + OLIG2 + cells decreased temporarily at P11. At P15, the proliferation of PCNA + OLIG2 + cells and the number of PDGFRα + OLIG2 + cells increased after GABA B receptor antagonization whereas no significant differences were visible in the Pdgfrα gene expression. No changes in apoptotic cell death were observed. CGP treatment induced a transient maturational delay at P11 and deficits in myelin expression at P15 with increased oligodendroglial proliferation. Our in vivo study indicates GABA B receptor activity as a potential modulator of oligodendroglial development., (© 2021 The Authors. Developmental Neurobiology published by Wiley Periodicals LLC.)

Electroporation is a promising method to inactivate cells and it has wide applications in medical science, biology and environmental health. Here, we investigate the bacteria inactivation performance of two different microfluidic electroporation devices with rhombus and circular micropillars used for generating locally enhanced electric field strength. Experiments are carried out to characterize the inactivation performance (i.e., the log removal efficiency) of two types of bacteria: Escherichia coli (E. coli, gram-negative) and Enterococcus faecalis (E. faecalis, gram-positive) in these two microfluidic devices. We find that under the same applied electric field, the device with rhombus micropillars performs better than the device with circular micropillars for both E. coli and E. faecalis. Numerical simulations show that due to the corner-induced singularity effect, the maximum electric field enhancement is higher in the device with rhombus micropillars than that in the device with circular micropillars. We also study the effects of DC and AC electric fields and flowrate. Our experiments demonstrate that the use of the DC field achieves higher log removal efficiencies than the use of AC field., (© 2021 Wiley-VCH GmbH.)