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Background: Comatose is a perilous state that is contemplated as a medical emergency. Coma impacts the primary caregiver’s daily living that has debilitating effects. Informal caregivers of comatose patients experience emotional symptoms or grief due to the prolonged illness of an individual. As there is a lack or deficient awareness and knowledge regarding the condition, the attitude toward the condition or grief could be a contributory factor. Considering these factors, the knowledge, attitude, awareness-comatose caregiver questionnaire (KAA-CCQ) was developed for evaluation. Methodology: The KAA-CCQ was developed in two stages. Stage 1 - Development of the questionnaire included conceptualization and item generation. Stage 2: - Expert review, content validity, and item modification. Content validity index (CVI) was analyzed using Microsoft Excel sheet 2013. Results: The computed CVI final score for the questionnaire was 0.91. Conclusion: The KAA-CCQ developed to assess the knowledge, attitude, and awareness regarding coma in informal caregivers of comatose patients achieved a statistically satisfactory content validity.

Background: Sleep deprivation and cognitive impairment represent significant issues among cancer patients undergoing chemotherapy, significantly impacting their daily activities and treatment journeys. The side effects of chemotherapy frequently contribute to disturbances in sleep and cognitive functions in these individuals. Recognizing the scope of these difficulties is essential for developing tailored interventions that cater to the specific requirements of cancer patients, ultimately improving their quality of life and treatment results. Materials and Methods: The research took place at a tertiary cancer care hospital, where 83 eligible chemotherapy patients were enlisted and assessed for sleep quality using the PSQI questionnaire and cognition using MoCA. Each questionnaire was administered only once. A PSQI total score of ≤5 indicated good sleep quality, while a score exceeding 5 indicated poor sleep quality. Similarly, a MoCA score below 26 suggested impaired cognition. Results: Among the entire sample, sleep deprivation was observed in 80.7% of chemotherapy patients, while cognitive impairment was identified in 44.6% of chemotherapy patients. Conclusion: The study deduces that sleep deprivation and cognitive impairment are exceedingly prevalent among cancer patients undergoing chemotherapy.

BACKGROUND: Disorders of consciousness (DOC) incorporate stages of awareness and arousal. Through coma arousal therapy sensory deprivation experienced by patients with DOC can be mitigated. Nevertheless, consensus concerning its effectiveness on these patients is still fractional. PURPOSE: This review aims to investigate the effectiveness of coma arousal therapies on patients with DOC. METHODS: A meta-analysis was performed by searching electronic databases using search terms, the studies investigating the effect of coma arousal therapy in patients with DOC using the Coma Recovery Scale-Revised and Glasgow Coma Scale as outcome measures were included. The risk of bias was assessed, using Cochrane and Joanna Briggs Institute critical appraisal tools. Further, analysis was conducted for the included studies. RESULTS: Out of 260 studies, 45 trials were reviewed and assessed for bias, with 31 studies included for analysis. The analysis demonstrates a significant difference in pre- and post - sensory stimulation, vagus nerve stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation. Sensory stimulation showed the greatest mean difference of −4.96; 95% CI = -5.76 to - 4.15. The patients who underwent intervention after 3 months of illness showed significant improvement. CONCLUSION: The result shows that sensory stimulation, transcranial magnetic stimulation, and transcranial direct stimulation can improve behavioral outcomes of patients with DOC, wherein sensory stimulation is found to be more effective.

Abstract Subseasonal prediction fills the gap between weather forecasts and seasonal outlooks. There is evidence that predictability on subseasonal timescales comes from a combination of atmosphere, land, and ocean initial conditions. Predictability from the land is often attributed to slowly varying changes in soil moisture and snowpack, while predictability from the ocean is attributed to sources such as the El Niño Southern Oscillation. Here we use a set of subseasonal reforecast experiments with CESM2 to quantify the respective roles of atmosphere, land, and ocean initial conditions on subseasonal prediction skill over land. These reveal that the majority of prediction skill for global surface temperature in weeks 3–4 comes from the atmosphere, while ocean initial conditions become important after week 4, especially in the Tropics. In the CESM2 subseasonal prediction system, the land initial state does not contribute to surface temperature prediction skill in weeks 3–6 and climatological land conditions lead to higher skill, disagreeing with our current understanding. However, land-atmosphere coupling is important in week 1. Subseasonal precipitation prediction skill also comes primarily from the atmospheric initial condition, except for the Tropics, where after week 4 the ocean state is more important.

PLNC8 αβ is a cationic antimicrobial peptide that previously has been reported to express both antibacterial and antiviral properties. This study aimed to further elucidate the antiviral effects of PLNC8 αβ and its impact on virus-induced cytotoxicity and inflammatory signaling in human alveolar epithelial cells (A549) infected with the flavivirus Kunjin. Complementary in silico analyses using molecular dynamics (MD) simulation were conducted to investigate the mechanism of action of PLNC8 αβ by studying the interaction of PLNC8 α and β with models of a flavivirus membrane and a eukaryotic plasma membrane, respectively. Our findings demonstrated that PLNC8 αβ significantly reduces both extracellular and intracellular viral loads, as confirmed by plaque reduction assays and RT-PCR. The peptide also mitigated virus-induced cytotoxicity and inflammation. Notably, PLNC8 αβ modulated the virus-induced dysregulation of key signaling and inflammatory genes, such as TLR9, TLR3, NOD2, FOS, JUN, IL6, and CXCL8. MD simulation revealed that PLNC8 αβ exhibits higher binding affinity for a flavivirus membrane model compared to a model of the plasma membrane, likely due to stronger electrostatic interactions with anionic phospholipids. This selective interaction possibly accounts for a potent antiviral activity of PLNC8 αβ combined with a minimal cytotoxicity toward human cells. Overall, PLNC8 αβ shows significant promise as an antiviral agent against flavivirus infections and warrants further exploration for peptide-based antiviral therapies.

Introduction Menopause is a challenging stage of a woman’s life, with increased occurrences of musculoskeletal issues and obesity that need to be tackled early and effectively. Less is known about the effect of HIIT & hatha yoga on musculoskeletal parameters in post-menopausal females. Both exercise approaches differ and are comparable in many ways. Thus, the objective of the study is to determine and compare the effects of 12 weeks of HIIT and yoga training protocols in postmenopausal females with central adiposity, sarcopenia, dynapenia, and knee alignment. The present research article presents a study protocol comparing yoga and HIIT protocols prescribed for postmenopausal females. Methods This is an open-label, randomised, parallel-armed, assessor-blinded clinical trial that will be conducted on 160 postmenopausal females between 46 and 70 years randomly assigned to either the HIIT or yoga group. The intervention will be in the form of group therapy for 5 sessions per week for 12 weeks. The outcomes include sarcopenia by lean muscle mass using a bioelectric impedance analyser, a radiological measure of the Hip-Knee-Ankle angle, and the perceived stress scale and 36-item short form questionnaires assessed twice (pre & post). The outcomes, including gait speed, hand grip strength, waist circumference, and body mass index, will be assessed at pre, post-4th week, post-8th week, and post-12th week. Discussion The study outcomes will provide confirmatory evidence on the effects of Hatha yoga and HIIT exercise training protocols in managing menopausal weight gain, musculoskeletal issues (sarcopenia and knee malalignment), physical and functional capacity, as well as mental health in postmenopausal females. Conclusions

Introduction: The Total Hip Replacement (THR) procedure is indicated to the treatment of choice in chronic refractory joint pain and some types of proximal femoral fractures. Component malalignment is a major cause of THR failure, making it crucial to position the components anatomically for long-term joint survival. Aim: To assess the radiological parameters of uncemented THR surgery. Materials and Methods: This retrospective cohort study was conducted in the Department of Orthopaedic Surgery, King’s George Medical University (KGMU), Lucknow, Uttar Pradesh, India, from June 2017 to May 2021. It included 72 patients who underwent unilateral uncemented THR for isolated hip diseases. Data was collected over the first two years and analysed. Demographic information and radiographic characteristics such as acetabular cup inclination and anteversion, femoral stem placement, vertical and horizontal centers of rotation, and limb length discrepancy were determined. Data was entered into Microsoft Excel 2018-19, and Statistical Package for the Social Sciences (SPSS) software version 28.0 was used for statistical analysis. Results: The average age of the patients was 50.75±9.1 years. Comparison of acetabular cup inclination (preoperative 41.4±3.9° and postoperative 42.2±5.1°) and anteversion (preoperative 13.1±2.96° and postoperative 14.5±3.75°) showed non significant differences following treatment with a normal hip. However, there was a significant difference in the horizontal and vertical Centers Of Rotation (COR) following treatment with a normal hip. Conclusion: Preoperative radiological characteristics of the damaged hip were significantly restored to normal anatomy and alignment following surgery.

This study aims to comprehend the use of Environmental Socio-scientific issues (ESSI) contexts in science education. This qualitative study has used systematic literature review techniques to answer the research questions. The review comprised 61 studies. The research questions focused on the type of methodology used, nature of studies and participants, skills developed through ESSIs, issues taught as ESSI, geographical spread and implication mentioned for student learning, teacher preparation, and suggestions for curriculum. Findings claim that qualitative methods are mainly used; argumentation and decision-making are the most targeted skills. Climate change, followed by nuclear power, is the most reported ESSI. Further, the United States of America and Turkey are the two leading countries where most of the research in this field has occurred, while South Asian countries and the African continent lag. The influence of cultural values in understanding such issues by students, teaching the integration of local socioscientific issues (SSIs) in lesson plans to pre-service and in-service teachers, and evaluation of science textbook curriculum on the frameworks of scientific literacy are some of the unexplored aspects in the domain.

Cancer is a leading cause of mortality worldwide, and conventional cancer therapies such as chemotherapy and radiotherapy often result in undesirable and adverse effects. Natural products have emerged as a promising alternative for cancer treatment, with comparatively fewer side effects reported. Opuntia ficus-indica (L.) Mill., a member of the Cactaceae family, contains a diverse array of phytochemicals, including flavonoids, polyphenols, betalains, and tannins, which have been shown to exhibit potent anticancer properties. Various parts of the Opuntia plant, including the fruits, stems/cladodes, and roots, have demonstrated cytotoxic effects against malignant cell lines in numerous studies. This review comprehensively summarizes the anticancer attributes of the phytochemicals found in Opuntia ficus-indica (L.) Mill., highlighting their potential as natural cancer prevention and treatment agents. Bibliometric metric analysis of PubMed and Scopus-retrieved data using VOSviewer as well as QDA analysis provide further insights and niche to be explored. Most anticancer studies on Opuntia ficus-indica and its purified metabolites are related to colorectal/colon cancer, followed by melanoma and breast cancer. Very little attention has been paid to leukemia, thyroid, endometrial, liver, and prostate cancer, and it could be considered an opportunity for researchers to explore O. ficus-indica and its metabolites against these cancers. The most notable mechanisms expressed and validated in those studies are apoptosis, cell cycle arrest (G0/G1 and G2/M), Bcl-2 modulation, antiproliferative, oxidative stress-mediated mechanisms, and cytochrome c. We have also observed that cladodes and fruits of O. ficus-indica have been more studied than other plant parts, which again opens the opportunity for the researchers to explore. Further, cell line-based studies dominated, and very few studies were related to animal-based experiments. The Zebrafish model is another platform to explore. However, it seems like more in-depth studies are required to ascertain clinical utility of this biosustainable resource O. ficus-indica.

Purpose: The aim of the study was to evaluate and compare the effects of Rhythmic Stabilization and a combination of isotonic technique on grip strength, pinch strength, and dexterity of hand among middle aged healthy individuals. Methods Forty middle aged healthy individuals were selected on the basis of inclusion and exclusion criteria. Participants were randomly allocated to two groups, with 20 in group A (Rhythmic Stabilization) and 20 in group B (Combination of Isotonic Technique). Treatment was given for 4 weeks, thrice a week. Outcome measures: grip strength, pinch strength, and dexterity were assessed by the Jamar hand dynamometer, the Pinch gauge, and the Perdue peg board, respectively. Outcome measures were assessed at baseline and after 4 weeks of treatment. Results Notably, Group A participants showed a significant improvement in all outcome measures compared to Group B (p

In this study, an attempt is made to investigate how the operational parameters such as capacitance, voltage, feed rate, and rotating speed affect the material removal rate, tool wear, overcut, and taper angle for micro-EDM drilling of aluminium 6061 utilizing brass C360 electrode. A novel Taguchi-GRA-CRITIC hybrid optimization methodology is used to obtain the optimal combination of micro-EDM drilling process parameters. The experiment was designed using the Taguchi L18 orthogonal array, and responses were recorded for each experiment. Grey Relational Analysis (GRA) is applied to improve the multi-response of the planned experiment. The weighting values corresponding to various responses are determined using CRITIC (criterion importance through intercriteria correlation) analysis. The hybrid methodology determines the best combination of process parameters for different responses. ANOVA was used to discover the most critical parameters. Finally, confirmation experiments were conducted with optimal parameters to identify improvement in grey relational grade over the initial parameters. The study's findings indicate that, compared to the initial process parameter setting, the grey relational grade (GRG) increased by 92.36% with the optimal parameter setting.

Background and Aim: Two-point discrimination (TPD) is a useful test for assessing cutaneous sensation. Sensory testing devices for testing TPD values have shown to be valid and reliable in the measurement of the functional sensitivity of the hand and its relativity to touch perception. Evaluation of TPD in the lower extremities is debatable because of dearth of information available in the literature about normative values. The aim of this study is to identify the normative values of TPD of lower limb dermatomes in young, healthy individuals and analyze its relationship with body mass index (BMI) and gender. Materials and Methods: A total of 150 participants of the age group 18–25 undergoing graduation program were included in this study. They underwent TPD test for lower limb (L1 to S2) dermatomes, using a baseline esthesiometer. The Spearman's ratio test was used to find the relationship between BMI and TPD values. The Mann–Whitney U-test was used to compare TPD values according to gender. Results: The normative value ranged from 1.46 ± 1.27 to 2.61 ± 1.45 in lower limb dermatomes. The minimum value noted was at the S1 dermatome (left) and the maximum at the L2 dermatome (left). In the sidewise analysis of TPD, the median values of both sides were approximately the same. There was a definite correlation (P < 0.05) between female gender and TPD; however, there was no significant correlation between BMI and TPD. Conclusion: This study suggested that women are more perceptive in appreciating TPD values than men. Moreover, TPD values do not vary according to BMI or right and left sides.

PURPOSE: Stroke lies among the most disabling diseases and is world-wide a leading cause of death. Most of the stroke patients experience cognitive deficits associated with executive dysfunction (decision making, problem solving, working memory, and cognitive flexibility). Executive dysfunction in stroke makes the patients vulnerable to depression, anxiety as their daily activities like personal, social, cultural and occupational are severely affected. Thus, the dependency increases and their quality of life decreases. Problem solving is one such important executive function required in day-to-day life. Puzzle solving reflects onto ones problem-solving ability that requires understanding, conceptual knowledge recruitment, novel and insightful thinking, and processing a solution. The purpose of this study was to determine if noninvasive brain stimulation has any effect on puzzle-solving ability of stroke patients and to assess their performance on the same. METHOD: A 3-week interventional study on 11 stroke participants was done. The samples were assessed at baseline for cognitive impairment using Montreal Cognitive Assessment Scale. Participants with scores

Today the patients and their families are 'powerless' recipients of healthcare services. The healthcare services are siloed and fragmented and getting worse with an increasing array of specialists and subspecialists who “patch up” patients and send them back home. It is important for healthcare providers to become involved in the process of health promotion, prevention, and recovery. For successful implementation of this family-level care needs to be recognized and integrated into all policies, guidelines of the government, and healthcare providers reoriented through in-service and basic training.

Abstract Cloud computing is an extremely important infrastructure used to perform tasks over processing units. Despite its numerous benefits, a cloud platform has several challenges preventing it from carrying out an efficient workflow submission. One of these is linked to task scheduling. An optimization problem related to this is the maximal determination of cloud computing scheduling criteria. Existing methods have been unable to find the quality of service (QoS) limits of users- like meeting the economic restrictions and reduction of the makespan. Of all these methods, the Heterogeneous Earliest Finish Time (HEFT) algorithm produces the maximum outcomes for scheduling tasks in a heterogeneous environment in a reduced time. Reviewed literature proves that HEFT is efficient in terms of execution time and quality of schedule. The HEFT algorithm makes use of average communication and computation costs as weights in the DAG. In some cases, however, the average cost of computation and selecting the first empty slot may not be enough for a good solution to be produced. In this paper, we propose different HEFT algorithm versions altered to produce improved results. In the first stage (rank generation), we execute several methodologies to calculate the ranks, and in the second stage, we alter how the empty slots are selected for the task scheduling. These alterations do not add any cost to the primary HEFT algorithm, and reduce the makespan of the virtual machines’ workflow submissions. Our findings suggest that the altered versions of the HEFT algorithm have a better performance than the basic HEFT algorithm regarding decreased schedule length of the workflow problems.

The signal-to-noise ratio paradox is interpreted as the climate model’s ability to predict observations better than the model itself. This view is counterintuitive, given that climate models are simplified numerical representations of complex earth system dynamics. A revised interpretation is provided here: the signal-to-noise ratio paradox represents excessive noise in climate predictions and projections. Noise is potentially reducible, providing a scientific basis for improving the signal in regional climate projections. The signal-to-noise ratio paradox was assessed in long-term climate projections using single-model and multi-model large ensemble climate data. A null hypothesis was constructed by performing bootstrap resampling of climate model ensembles to test its ability to predict the 20th-century temperature and precipitation trends locally and compare it with the observations. The rejection of the null hypothesis indicates the existence of a paradox. The multi-model large ensemble does not reject the null hypothesis in most places globally. The rejection rate in the single-model large ensemble is related to the model’s fidelity to simulate internal climate variability rather than its ensemble size. For regions where the null hypothesis is rejected in the multi-model large ensemble, for example, India, the paradox is caused by a smaller signal strength in the climate model’s ensemble. The signal strength was improved by 100% through ensemble selection and based on past performance, which reduced uncertainty in India’s 30-year temperature projections by 25%. Consistent with previous studies, precipitation projections are noisier, leading to a paradox metric value 2–3 times higher than that of the temperature projections. The application of ensemble selection methodology significantly decreased uncertainty in precipitation projections for the United Kingdom, Western Australia, and Northeastern America by 47%, 36%, and 20%, respectively. Overall, this study makes a unique contribution by reducing uncertainty at the temporal scale, specifically in estimating trends using the signal-to-noise ratio paradox metric.

Background: Chronic Achilles tendon ruptures are defined as tears that occur 4–6 weeks after injury and also those that fail to heal at 6–12 weeks. Reduced plantar flexion, discomfort, trouble walking, chronic pain, poor wound healing, and rerupture are all problems of chronic tears. The V-Y flap, turndown flap, peroneus tendon graft, flexor digitorum graft, and flexor hallucis longus (FHL) graft are just a few of the operations proposed and claimed to have great post-operative clinical results. Aims and Objectives: This study aims to evaluate the functional outcome of tendon debridement, gastrocnemius turndown flap, and augmentation with FHL tendon to reconstruct a chronic Achilles tendon tear. Materials and Methods: This study included 12 patients with chronic Achilles tendon rupture. The gastrocnemius turndown flap, which was augmented with FHL tendon, was used to treat all of the patients in the study. The American Orthopaedic Foot and Ankle Society (AOFAS) score, Achilles Tendon Total Rupture Score (ATRS) score, and ability to do repetitive single affected side heel raises were the outcomes evaluated in this study. Results: After a year of follow-up, the mean AOFAS score increased from 61.17 points preoperatively to 86.67 points. The mean ATRS improved significantly from 41.91 points preoperatively to 84.41 points at the most recent follow-up (P

Abstract Cloud technology is not immune to bugs and issue tracking. A dedicated system is required that will extremely error prone and less cumbersome and must command a high degree of collaboration, flexibility of operations and smart decision making. One of the primary goals of software engineering is to provide high-quality software within a specified budget and period for cloud-based technology. However, defects found in Cloud-Based Bug Tracking software’s can result in quality reduction as well as delay in the delivery process. Therefore, software testing plays a vital role in ensuring the quality of software in the cloud, but software testing requires higher time and cost with the increase of complexity of user requirements. This issue is even cumbersome in the embedded software design. Early detection of defect-prone components in general and embedded software helps to recognize which components require higher attention during testing and thereby allocate the available resources effectively and efficiently. This research was motivated by the demand of minimizing the time and cost required for Cloud-Based Bug Tracking Software testing for both embedded and general-purpose software while ensuring the delivery of high-quality software products without any delays emanating from the cloud. Not withstanding that several machine learning techniques have been widely applied for building software defect prediction models in general, achieving higher prediction accuracy is still a challenging task. Thus, the primary aim of this research is to investigate how deep learning methods can be used for Cloud-Based Bug Tracking Software defect detection with a higher accuracy. The research conducted an experiment with four different configurations of Multi-Layer Perceptron neural network using five publicly available software defect datasets. Results of the experiments show that the best possible network configuration for software defect detection model using Multi-Layer Perceptron can be the prediction model with two hidden layers having 25 neurons in the first hidden layer and 5 neurons in the second hidden layer.

Abstract Blockchain is the latest boon in the world which handles mainly banking and finance. The blockchain is also used in the healthcare management system for effective maintenance of electronic health and medical records. The technology ensures security, privacy, and immutability. Federated Learning is a revolutionary learning technique in deep learning, which supports learning from the distributed environment. This work proposes a framework by integrating the blockchain and Federated Deep Learning in order to provide a tailored recommendation system. The work focuses on two modules of blockchain-based storage for electronic health records, where the blockchain uses a Hyperledger fabric and is capable of continuously monitoring and tracking the updates in the Electronic Health Records in the cloud server. In the second module, LightGBM and N-Gram models are used in the collaborative learning module to recommend a tailored treatment for the patient’s cloud-based database after analyzing the EHR. The work shows good accuracy. Several metrics like precision, recall, and F1 scores are measured showing its effective utilization in the cloud database security.

Background Alcoholic liver disease (ALD) is a major source of alcohol-related morbidity and mortality. Heavy drinkers and alcoholics may progress from fatty liver to alcoholic hepatitis to cirrhosis. The enzyme γ-glutamyltranspeptidase (GGT) is a membrane-bound glycoprotein which catalyzes the transfer of the γ-glutamyl group from γ-glutamyl peptides to other peptides, amino acids, and water. Serum GGT activity mainly attributed to hepatobiliary system and thus is an important marker of ALD. Hence the present study is conducted to estimate and correlate the levels of GGT and osteopontin (OPN) in ALD. Aims and Objectives The objective of this study is to estimate and correlate the levels of GGT and OPN in ALD. Materials and Methods Sixty clinically diagnosed cases of ALD and sixty age- and gender-matched healthy controls were recruited for the study. Blood samples were collected from them and serum aspartate aminotransferase, serum alanine transaminases (ALTs), serum ALP levels, and plasma OPN levels were measured. Estimation of serum aspartate transaminases (AST), ALTs, and alkaline phosphatase (ALP) was assayed by standard photometric methods in autoanalyzer ERBA-XL (EM-200) using commercially available kits. OPN was estimated by using commercial kit based on enzyme-linked immunosorbent assay. Results The parameters of the liver function tests such as AST, ALT, and ALP were significantly increased in patients with ALD (p

Abstract Distillery industry is amidst the top source of surface water pollution owing to its very high content of recalcitrant organics, inorganics, and persistent turbidity contents. Melanoidins are the chief dark brown-colored complex contaminant existing in the distillery generated effluent with a very high organic load. The present investigation examined the melanoidin elimination from a model wastewater system utilizing Cu-impregnated activated carbon derived from waste leaves of Mangifera indica. With the initial surface characterization utilizing SEM equipped with EDX and FTIR, the Box-Behnken design of experiments was engaged for determining the influence of different factors for the melanoidin removal from the aqueous system. Adsorbent dose, initial melanoidin concentration, and contact time have imposed the maximum effect on to the melanoidin removal (73%) using the synthesized activated carbon, clearly showing its ability for the melanoidin removal from the aqueous contaminated system.

Pectin methylesterases (PMEs) are a class of carbohydrate-active enzymes that act on the O6-methyl ester groups of the homogalacturonan component of pectins, resulting in de-esterification of the substrate polymers and formation of pectate and methanol. PMEs occur in higher plants and microorganisms, including fungi, oomycetes, bacteria, and archaea. Microbial PMEs play a crucial role in pathogens’ invasion of plant tissues. Here, we have determined the structural and functional properties of Pi-PME, a PME from the oomycete plant pathogen Phytophthora infestans. This enzyme exhibits maximum activity at alkaline pH (8.5) and is active over a wide temperature range (25–50 °C). In silico determination of the structure of Pi-PME reveals that the protein consists essentially of three parallel β-sheets interconnected by loops that adopt an overall β-helix organization. The loop regions in the vicinity of the active site are extended compared to plant and fungal PMEs, but they are shorter than the corresponding bacterial and insect regions. Molecular dynamic simulations revealed that Pi-PME interacts most strongly with partially de-methylated homogalacturonans, suggesting that it preferentially uses this type of substrates. The results are compared and discussed with other known PMEs from different organisms, highlighting the specific features of Pi-PME.

Objectives: To determine the prevalence and predictors of Retinopathy of prematurity (ROP) and severe ROP. Methods: A prospective observational study (April 2019–May 2020) was conducted at a tertiary care center in preterm newborns with; 1) birth-weight

This study reassesses the dynamic relationship between stock, oil, foreign exchange markets, and COVID-19-induced uncertainty. For estimation, we utilize the monthly data from January 2020 to December 2021 and utilize panel vector autoregression econometric techniques in emerging market economies. The empirical findings reveal that heightened uncertainty during the pandemic had a negative impact on stock and oil, and foreign exchange markets. Findings further suggest that uncertainty during the pandemic slanted the relationship between oil and stock and foreign exchange markets due to the precautionary approach followed by economic agents. • COVID-19 uncertainty negatively impacted the oil, stock, and foreign exchange markets. • Uncertainty had a non-linear impact on stock and oil prices. • During the initial period of COVID-19, uncertainty distorted the relationship between oil, stock and exchange markets.

This paper re-examines the causality between stock returns and foreign portfolio investment (FPI) flows in the Indian context during the COVID-19 pandemic. Using the Covid-19 index constructed by Narayan et al. [19] and the Toda and Yamamoto Granger causality test, the study reveals that bi-directional causality runs from FPI flows to stock returns in the early period of the Covid-19 pandemic. Whereas after the peak of the pandemic, there is a unidirectional causality that runs from FPI flows to stock returns. • Bi-directional causality runs from FPI flows to stock return during the initial period of COVID. • In the second period, unidirectional causality runs from FPI flows to stock returns

Abstract Epithelial ovarian cancer has become the most frequent cause of deaths among gynecologic malignancies. Our study elucidates the diagnostic performance of Risk of Ovarian Malignancy Algorithm (ROMA), Human epididymis secretory protein 4 (HE4) and cancer antigen (CA125). To compare the diagnostic accuracy of ROMA, HE-4 and CA125 in the early diagnosis and screening of Epithelial Ovarian Cancer. Literature search in electronic databases such as Medicine: MEDLINE (through PUBMED interface), EMBASE, Google Scholar, Science Direct and Cochrane library from January 2011 to August 2020. Studies that evaluated the diagnostic measures of ROMA, HE4 and CA125 by using Chemilumincence immunoassay or electrochemiluminescence immunoassay (CLIA or ECLIA) as index tests. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We included 32 studies in our meta-analysis. We calculated AUC by SROC, pooled estimated like sensitivity, specificity, likelihood ratio, diagnostic odds ratio (DOR), Tau square, Cochran Q through random effect analysis and meta-regression. Data was retrieved from 32 studies. The number of studies included for HE4, CA125 and ROMA tests was 25, 26 and 22 respectively. The patients with EOC were taken as cases, and women with benign ovarian mass were taken as control, which was 2233/5682, 2315/5875 and 2281/5068 respectively for the markers or algorithm. The pooled estimates of the markers or algorithm were sensitivity: ROMA (postmenopausal) (0.88, 95% CI 0.86–0.89) > ROMA (premenopausal) 0.80, 95% CI 0.78–0.83 > CA-125(0.84, 95% CI 0.82–0.85) > HE4 (0.73, 95% CI 0.71–0.75) specificity: HE4 (0.90, 95% CI 0.89–0.91) > ROMA (postmenopausal) (0.83, 95% CI 0.81–0.84) > ROMA (premenopausal) (0.80, 95% CI 0.79–0.82) > CA125 (0.73, 95%CI 0.72–0.74), Diagnostic odd’s ratio ROMA (postmenopausal) 44.04, 95% CI 31.27–62.03, ROMA (premenopausal)-18.93, 95% CI 13.04–27.48, CA-125-13.44, 95% CI 9.97–18.13, HE4-41.03, 95% CI 27.96–60.21 AUC(SE): ROMA (postmenopausal) 0.94(0.01), ROMA (premenopausal)-0.88(0.01), HE4 0.91(0.01), CA125-0.86(0.02) through bivariate random effects model considering the heterogeneity. Our study found ROMA as the best marker to differentiate EOC from benign ovarian masses with greater diagnostic accuracy as compared to HE4 and CA125 in postmenopausal women. In premenopausal women, HE4 is a promising predictor of Epithelial ovarian cancer; however, its utilisation requires further exploration. Our study elucidates the diagnostic performance of ROMA, HE4 and CA125 in EOC. ROMA is a promising diagnostic marker of Epithelial ovarian cancers in postmenopausal women, while HE4 is the best diagnostic predictor of EOC in the premenopausal group. Our study had only EOC patients as cases and those with benign ovarian masses as controls. Further, we considered the studies estimated using the markers by the same index test: CLIA or ECLIA. The good number of studies with strict inclusion criteria reduced bias because of the pooling of studies with different analytical methods, especially for HE4. We did not consider the studies published in foreign languages. Since a few studies were available for HE4 and CA125 in the premenopausal and postmenopausal group separately, data were inadequate for sub-group analysis. Further, we did not assess these markers' diagnostic efficiency stratified by the stage and type of tumour due to insufficient studies.

Abstract Background Emerging and reemerging pathogens are global challenges for public health and the pandemic of Coronavirus disease 2019is a reemerging case of an infectious disease caused by Severe Acute Respiratory Syndrome-Corornavirus-2. Health care worker worldwide are at higher risk worldwide and the situation is the same in Nepal. The knowledge and attitude of health workers will certainly mark the outcome towards this pandemic. So, this study aims to assess the knowledge and attitude of community health workers towards the prevention of COVID-19 virus. Methods A descriptive cross-sectional study was carried out among the community health workers of various provinces of Nepal. A semi-structured, self-administered questionnaire was prepared in Google form and circulated to the sampled health workers through various social media platforms like face book, messenger, Instagram and g-mails. A total of 650 invitations were send and among them 420 responded and among them only 399 provided complete response. Responses containing anonymized data was collected analyzed in using SPSS-version-20. The results were interpreted and was checked with various demographic and enabling factors using chi-square test and logistic regression model. Also, ethical approval was taken from NHRC (Nepal Health Research Council (protocol registration number: 360/2020P) prior to the conduction of study. Results Out the total sample size of 450, we took 399 responses taking into consideration all the inclusion criteria. So, from 399 valid response, 230 (47.6%) were males and 169 (42.4%) were females. 380 (95.2%) employed participants thought that wearing PPE will reduce the chances of getting COVID-19, majority of the participants 80.5% (321) responded that COVID-19 will successfully be controlled and staffs receiving excellent support from palika had high knowledge level. Knowledge level was significantly associated with the enabling factor “support from palika” (P = 0.045).45.9% of the respondents had no availability of COVID-19 response medical items for prevention of COVID-19 at their respective health facilities. Also the logistic regression analysis revealed that the odds of knowledge level was 2 times higher (AOR=1.913 at 95% CI: 1.266-2.891) compared to the female participants (Ref- female). Conclusions Proper and adequate knowledge and attitude towards COVID-19 is a paramount in the prevention and control of SARS-COV-2. Health care workers are knowledgeable about COVID-19 and are proactively practicing the preventive measures to minimize the spread of infection but some lack optimistic attitude. Hence, the constantly updated educational programs related to COVID-19 will surely contribute to improving the healthcare workers knowledge and attitude towards COVID-19.

Fritillaria roylei (Kshirakakoli) is a primal plant used in ancient times. But nowadays, due to biotic and abiotic stress the plant has entered in the list of threatened medicinal plant. In ancient texts effective uses of formulations containing kshirakakoli are well mentioned but the information is not written in simple language due to which the therapeutic value of the plant is not well understood by scientific fraternity. So, there is a major need to perform ethno medicinal survey for the formulations containing kshirakakoli and compare their therapeutic uses as mentioned in text with the modern system of medicine. In this study, a field survey was performed in 4 states i.e., Uttar Pradesh, Uttrakhand, Punjab and Himachal Pradesh where the conversation regarding usage of this plant or formulation was done with 24 local medical practitioners, 18 shopkeepers and 4 traditional healers. The information thus obtained were recorded and then compared. Results showed that the usage of kshirakakoli containing formulations was highest in Himachal Pradesh and Uttrakhand. Only few clinical studies have been done on these formulations. The effectiveness of the formulations against remedies alluded by the trado-medical practitioners claimed was found accurate as per ayurvedic textual literature. Hence, the ethno medicinal survey provides a precise guidance to scientists for future research on these kshirakakoli containing formulations that are useful in plethora of disorders.

In this study, the load frequency control of a two-area thermal generation system based on renewable energy sources is considered. When solar generation is used in one of the control areas, the system becomes nonlinear and complicated. Zero deviations in the frequencies and the flow of power through the tie lines are achieved by considering load disturbances. A novel grey wolf optimizer, which is a metaheuristic algorithm motivated by grey wolves is utilized for tuning the controller gains. The proportional, integral, and derivative gains values are optimized for the two-area Solar integrated Thermal Plant (STP). As the load connected to the system varies continuously with time, random load variation is also applied to observe the effectiveness of the proposed optimization method. Sensitivity analyses have also been adopted with the deviation in the time constants of different systems. Inertia constant variations of both areas are considered from −25% to +25%, with or without STP. The proposed algorithm shows good dynamic performance as shown from the simulation results in terms of settling time, overshoot values, and undershoot values. The power in the tie line achieves zero deviation quite rapidly in solar-based cases compared to those without STP.

Abstract Soil moisture predictability on seasonal to decadal (S2D) continuum timescales over North America is examined from the Community Earth System Modeling (CESM) experiments. The effects of ocean and land initializations are disentangled using two large ensemble datasets—initialized and uninitialized experiments from the CESM. We find that soil moisture has significant predictability on S2D timescales despite limited predictability in precipitation. On sub-seasonal to seasonal timescales, precipitation variability is an order of magnitude greater than soil moisture, suggesting land surface processes, including soil moisture memory, reemergence, land–atmosphere interactions, transform a less predictable precipitation signal into a more predictable soil moisture signal.

COVID-19 has infected more than 32 million people globally in more than 100 countries. Diabetes mellitus (DM) has emerged as an important factor involved in the fatal outcomes of COVID-19. Accumulating evidence suggests that that reciprocal relationship may exist between these two raging pandemics, thus making COVID-19 more challenging for people with diabetes. Furthermore, poorly managed glycaemia in diabetes patients leads to increased risk of severe complications and higher mortality rate. The association between COVID-19 severity and DM can be supported by several pathophysiological mechanisms, such as compromised innate immune system, deranged cell-mediated immunity and adipose tissue infiltration of pro-inflammatory macrophages. Exaggerated coagulation and pro-thrombotic milieu in diabetes can predispose to thromboembolic complications associated with fatal outcomes in diabetic patients with COVID-19. Impaired pulmonary function and elevated levels of furin associated with diabetes can increase the chances of COVID-19 infection in patients with diabetes. In addition, SARS-CoV-2 infection can trigger stress hyperglycaemia leading to augmented viral replication and severity of infection associated with poor clinical outcomes in diabetic patients with COVID-19. Endothelial dysfunction associated with virus-induced endothelialitis can lead to organ ischaemia and life-threatening complications associated with COVID-19 with underlying DM. Vitamin D deficiency and insulin resistance worsened by SARS-CoV2 can lead to higher mortality and morbidity observed in diabetic patients with COVID-19. Therefore, COVID-19 patients should be adequately monitored for the development of new-onset diabetes, due to deranged glycaemic control, owing to underlying COVID-19 disease, and diabetic patients with COVID-19 should be kept under strict glycaemic control to avoid life-threatening complications.

CONTEXT: Effect of fluid reflux on intraocular pressure (IOP) and therapeutic benefits. AIMS: The aim of this study is to compare two intravitreal injection techniques in terms of fluid reflux, short-term IOP changes, and therapeutic effect. SETTINGS AND DESIGN: A prospective, double-blinded, randomized interventional study. SUBJECTS AND METHODS: Sixty eyes were randomly allocated to two groups (direct intravitreal injection technique and oblique intravitreal injection technique). IOP was measured before and immediately after the injection of 0.1 ml comprising of bevacizumab (1.25 mg/0.05 ml) and dexamethasone (0.2 mg/0.05 ml) and then at 30 min after the injection. Occurrence and amount of vitreous reflux were recorded. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed preinjection and 6 weeks postinjection. RESULTS: IOP (mmHg ± standard deviation) increased significantly immediately after injection to 24.30 ± 3.02 (direct intravitreal injection) and 31.50 ± 3.49 (oblique intravitreal injection). These pressure rise differed significantly between both groups (mean difference: 7.2, P < 0.0001). Thirty minutes after injection, there was no significant difference in IOP increase between the groups. Occurrence and amount of fluid reflux were significantly higher with direct intravitreal injection. There was no significant difference in BCVA and CMT outcome between both groups. CONCLUSIONS: Direct intravitreal injection technique has lower rise in IOP and higher incidence of fluid reflux than the oblique intravitreal technique. Fluid reflux does not cause a therapeutic compromise in terms of BCVA or CMT changes, so the reflux fluid must be the vitreous not the drug. Thus, direct injection technique seems to be the preferred technique.

Blockchain is a recent revolutionary technology primarily associated with cryptocurrencies. It has many unique features including its acting as a decentralized, immutable, shared, and distributed ledger. Blockchain can store all types of data with better security. It avoids third-party intervention to ensure better security of the data. Deep learning is another booming field that is mostly used in computer applications. This work proposes an integrated environment of a blockchain-deep learning environment for analyzing the Electronic Health Records (EHR). The EHR is the medical documentation of a patient which can be shared among hospitals and other public health organizations. The proposed work enables a deep learning algorithm act as an agent to analyze the EHR data which is stored in the blockchain. This proposed integrated environment can alert the patients by means of a reminder for consultation, diet chart, etc. This work utilizes the deep learning approach to analyze the EHR, after which an alert will be sent to the patient's registered mobile number.

A limited number of previous studies investigated the impact of agile manufacturing on overall business performance, especially in the Indian context. The study investigates the influence of agile manufacturing attributes, namely: Leadership support, Human related issues, customer-related issues, and Information technology on business performance. The data was collected from 154 manufacturing industries and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). The results show a positive and significant influence of agile manufacturing attributes on the manufacturing industry's business performance.

Abstract Objective Liverworts possess historical adaptive strategies for abiotic stresses because they were the first plants that shifted from water to land. Proteomics is a state-of-the-art technique that can capture snapshots of events occurring at the protein level in many organisms. Herein, we highlight the comparison and optimization of an effective protein extraction and precipitation protocol for two-dimensional gel electrophoresis (2-DE) of liverworts. Results We compared three different protein extraction methods, i.e.,1.5 M Tris–HCl (pH 8.8), 50 mM Tris–HCl (pH 7.5), and polyvinylpolypyrrolidone (PVPP) extraction, followed by three precipitation methods, i.e., 80% ethanol, 80% acetone, and 20% tricholoroacetic acid (TCA)–acetone, in a liverwort Dumortiera hirsuta. Among these methods, 50 mM Tris–HCl (pH 7.5) extraction, followed by 20% TCA–acetone precipitation, appeared to be more suitable for 2-DE. Furthermore, we performed modifications during protein washing, re-solubilization in rehydration buffer and isoelectric focusing (IEF). The modifications provided us better results in terms of protein yield, resolution, spot numbers, and intensities for 2-DE gels of D. hirsuta and other two liverworts, i.e., Marchantia paleacea and Plagiochasma appendiculatum. Furthermore, we randomly selected spots from the 2-DE gel of D. hirsuta and identified using mass spectrometry, which confirms the applicability of this protocol for liverworts proteomics.

Substantial progress has been made to improve health in India in terms of availability, accessibility, cost-effectiveness, and quality. However, there are major health inequalities between and within the states. Strategic planning of health programs is required to address inequities in health. Need of the hour is to address this using a simplified strategic approach; who is left out, why are they left out, what causes are responsible for it and what are the determinants of inequality. The basic steps of strategic management, including strategic assessment, objectives, strategy formulation, and implementation, can be used to address the health equity. This article cites the examples of Serbia immunization programme, Government of India programme on Mission Indradhanush, and Thailand's universal health coverage to get better understanding to use strategic management to address health inequity. This approach is crucial in achieving sustainable development goals.

Background: In March 2020, a healthcare professional from a renowned private hospital, in the textile city of Bhilwara, Rajasthan, reported clustering of cases of pneumonia amongst doctors and paramedical staff suspected to be due to COVID-19. The basis of suspicion was clinico-eco-epidemiologic-radiological findings as, by that time, about 20 COVID19 cases were reported from the state of Rajasthan including a big Italian group of tourists who travelled extensively in Rajasthan, including Udaipur city. Objectives: The current study presents the field experience of the Central and the State Rapid Response Teams (RRTs) in the cluster containment at Bhilwara. Methods: The information regarding the sociodemographic profile of the cases was provided by the Senior Medical Officer In-charge. The containment strategy was modeled under 6 pillars. Google Maps was used for preparing spot map. Results: Immediate public health actions of cluster containment including contact tracing, quarantine, and isolation were initiated using epidemiological approach of mapping the cluster and taking care of reservoir of infection by the District Public Health Team supported by Multidisciplinary Rapid Response Team. This was supplemented by strict enforcement of lock down in the District taking care of daily need of the community by the leadership of administration with very strong intersectoral co-ordination (locally called “ruthless containment”). Conclusion: The forthcoming challenge resides in re-establishment of inter-district and inter-state travel, which can become a risk of re-entry of the new cases, which needs to be taken care of, with the help of stringent administrative measures and screening at all points of entry. The team in Bhilwara needs to remain vigilant to pick up any imported cases early before local transmission establishes.

Today, health is a human right in India, and the government is working hard for universalization of health services provision till the grassroots. Health without accountability is a challenging task in hand, and recently, state governments drafted a bill toward public health system to move in the strengthened direction of accountability mechanism. Accountability is the quality or state of being accountable, and it is an important component of the health-care reforms in India. This article provides more nuanced understanding of accountability which includes the specification of accountability, conceptual framework of accountability, and its potential approaches for how accountability is viewed today in India with reference to the Central, State, District, and other stakeholders. It examines the role of accountability in making accountable health plans, and its relationship governance/ownership structures as a key component of health-care reforms as improved accountability is a major element in improving the health system performance. The article elaborates on the definition of accountability in terms of answerability and sanctions and distinguishes the three types of accountability, namely financial, performance, and political/democratic. The article describes three accountability-enhancing strategies, namely reducing the pilferage, assuring acquiescence with procedures and standards, and improved learning from the past experience. The recent events in Indian health care put forward a serious issue on how accountability can be fixed if health mishaps happened and how we can make our health plans accountable to the needs and aspiration for the people of India. Overall, the accountability is discouraging and more needs to be done to enhance the accountability compliance in India.

India's commitment to achieve the goal of Universal Health Coverage is evidenced by the launch of Ayushman Bharat and the transformation of Sub-Centres into Health and Wellness Centre to provide secondary and comprehensive primary healthcare to the vast majority of its population. Successful implementation of these initiatives requires adequate and skilled human resources for health and a conducive work environment. There exists a deficiency of doctors and paramedical professionals in different parts of the country. The vacancies in different categories of health functionaries have increased after 2005 despite the National Rural Health Mission/National Health Mission initiatives to strengthen the health system. The distribution of doctors and paraprofessionals in health is skewed, favoring urban areas. Properly oriented, trained, and skilled health workforce and informed public participation are critical to provide quality services for achieving national health goals. Therefore, it is necessary to establish public health cadre in all states of India and ensure appropriately skilled workforce to meet the functional requirements of health-care delivery system at different levels. This will also help to move forward on the way to reach the Sustainable Development Goals.

Leadership skills in a public health professional (PHP) are more important today in view of rapidly changing disease pattern, higher priority to universal health coverage, health in all policies, health being demanded as a human right, and emergence of pandemics from zoonotic diseases. Most of us become accidental leaders as we never receive training in leadership skills. This not only undermines the effectiveness of PHP but also undermines the credibility of public health as a specialty. Jim Collin's five levels of leadership are useful to understand the various levels of leadership for a PHP. Technical excellence which denotes first level of leadership is necessary but not sufficient to become a leader. One needs team work, emotional competencies, prioritization ( first things first), listening skills, advocacy, negotiation, networking skills, along with conviction, commitment, and courage to do what one thinks is right. Leadership is a life-long journey, not a destination. Being engaged in leadership for more than a decade, I developed a three domain leadership capacity development model very useful in designing and conducting leadership development trainings to develop leadership skills among PHPs, academicians, and health researchers.

The “Green Revolution” (GR) technology-induced agricultural intensification has transformed India from food scarcity to a food surplus country. However, this has also resulted into several adverse repercussions. Increased application of chemical fertilizers and pesticides with stagnating/declining crop productivity has dovetailed with uncertain market conditions and climate change effects which has resulted in un-remunerative agriculture. Consequently, farmers have fallen into the debt trap due to the rising cost of crop production apart from health hazards due to serious exposure to harmful chemical pesticides. Natural Farming (NF), an agro-ecological approach to farming is believed to be an effective way to counter some of these challenges. The present paper presents field-level farmers’ experiences of NF adoption in three states of India—Andhra Pradesh, Karnataka, and Maharashtra. The study was conducted during February–March 2019 by surveying 295 NF adopted and 170 non-NF adopted farmers. It was found that NF practice has been followed by some farmers for more than 10 years but others have adopted during the recent past. There is variation in the practice followed by the NF farmers. There are farmers who are using Farm Yard Manure (FYM). A solid form of jeevamritha (liquid concoction of microbial inoculants) called as ghanajeevamritha was also found to be used by farmers in Andhra Pradesh. It was observed that non-NF yields are superior to NF yield without FYM. In most crops, however, NF with FYM had a greater yield than NF without FYM and non-NF farms. There has been a decrease in the variable cost and a marginal increase in the market price of NF produce. The study suggests that natural farming may be seen as one of the alternative practices which has potential to rejuvenate the agro-ecosystem, besides cost saving for the individual farmers.

The number of secondary cases from each primary case determines how fast an epidemic grows. It is known that all cases do not spread the infection equally; super spreaders play an important role as they contribute disproportionately to a much larger number of cases including in the ongoing COVID-19 pandemic. Super spreaders have been reported for more than a century, but limited information is available in scientific literature. An epidemic containment strategy needs to include early identification of super spreaders to limit an explosive growth. Super spreaders tend to get stigmatized, resulting in late reporting and hiding of cases. It is important for program managers to be sensitive to the manner in which related information is shared with media and general public.

With the launch of new Government of India's initiative Ayushman bharat that envisages conversion of all subcenters into health and wellness centers, the role of nursing professionals in primary health care will be undergoing paradigm shift. Nurses are approximately two-third of the population of health workforce in India. Nurses' scope of work has widened with additional roles and responsibilities due to shift in the pattern of burden of diseases. The emergence of zoonotic infectious diseases has further enlarged their responsibilities. The main areas, which need attention, are development of nursing workforce, selection and recruitment, placement as per specialization, and preservice and in-service training related to zoonotic surveillance. This article attempts to discuss the role of nurses under emerging zoonotic disease infections.

High voltage electric burns can cause various ocular injuries and may manifest in the form of conjunctival hyperemia, corneal opacities, uveitis, miosis, spasm of accommodation, cataract, retinal edema, papilledema, choroidal rupture, chorio-retinal necrosis/atrophy, retinal detachment and optic atrophy. The involvement of crystalline lens exclusively with sparing of other ocular structures is rare. We report a case of 16 year old male with bilateral total cataract after electrical injury by over-head high tension electric transmission cable accidentally falling on patient's head 6 months back. B scan showed no abnormality in both the eyes. The intra ocular pressure in both the eyes was within normal limits. Patient underwent lens aspiration with posterior chamber intraocular lens (PCIOL) implantation in both the eyes, under peribulbar anaesthesia (with an interval of 1 week between both the operations). Intra-operative and post-operative period were uneventful. Post operative BCVA was 6/6 in both eyes and fundus examination was within normal limits. Outcomes after surgery are very good if not associated with other ocular lesion like optic atrophy, chorio-retinal lesion, uveitis etc. This observation should encourage the ophthalmologist to undertake surgery for electric cataract, where necessary.

Emerging zoonoses are the product of socio economic and anthropogenic environmental changes. As human societies continue to develop, pathogens from animal hosts have continued to spill over into our population However, Peri-urban ecosystems remain neglected in the country. With a subsequent increase in demand for food, there has been an expansion of formal and informal livestock-based food production sectors in these areas. The increasing close contact between animals and humans in both work and living environments creates hot spots in peri-urban areas, thereby increasing vulnerability to zoonotic disease transmission and other health hazards associated with food safety, water, and sanitation-related diseases. This paper explores the efforts made by different research bodies to reduce the prevalence of zoonotic diseases in peri-urban areas.

Abstract The Community Land Model (CLM) is the land component of the Community Earth System Model (CESM) and is used in several global and regional modeling systems. In this paper, we introduce model developments included in CLM version 5 (CLM5), which is the default land component for CESM2. We assess an ensemble of simulations, including prescribed and prognostic vegetation state, multiple forcing data sets, and CLM4, CLM4.5, and CLM5, against a range of metrics including from the International Land Model Benchmarking (ILAMBv2) package. CLM5 includes new and updated processes and parameterizations: (1) dynamic land units, (2) updated parameterizations and structure for hydrology and snow (spatially explicit soil depth, dry surface layer, revised groundwater scheme, revised canopy interception and canopy snow processes, updated fresh snow density, simple firn model, and Model for Scale Adaptive River Transport), (3) plant hydraulics and hydraulic redistribution, (4) revised nitrogen cycling (flexible leaf stoichiometry, leaf N optimization for photosynthesis, and carbon costs for plant nitrogen uptake), (5) global crop model with six crop types and time‐evolving irrigated areas and fertilization rates, (6) updated urban building energy, (7) carbon isotopes, and (8) updated stomatal physiology. New optional features include demographically structured dynamic vegetation model (Functionally Assembled Terrestrial Ecosystem Simulator), ozone damage to plants, and fire trace gas emissions coupling to the atmosphere. Conclusive establishment of improvement or degradation of individual variables or metrics is challenged by forcing uncertainty, parametric uncertainty, and model structural complexity, but the multivariate metrics presented here suggest a general broad improvement from CLM4 to CLM5.