Community perspective and healthcare assessment in malaria endemic states of India: a cross-sectional study protocol.

INTRODUCTION: India's contribution to the malaria burden was highest in South-East Asia Region in 2021, accounting for 79% of the estimated malaria cases and 83% of malaria-related deaths. Intensified Malaria Control Programme supported by Global Funds to Fight against AIDS, Tuberculosis and Malaria has deployed crucial interventions to reduce the overall burden of malaria in India. Evaluation of utilisation of malaria elimination interventions by the community and assessment of the healthcare system is underway in eleven high malaria endemic states in India. Health system preparedness for malaria elimination, logistics, and supply chain management of diagnostic kits and anti-malarial drugs in addition to the knowledge, attitude and practice of the healthcare workers is also being assessed. METHODS AND ANALYSIS: The study is being undertaken in 11 malaria endemic states with a variable annual parasite incidence of malaria. In total, 47 districts (administrative unit of malaria control operations) covering 37 976 households are to be interviewed and assessed. We present here the protocol following which the study is being undertaken at the behest and approval of Ministry of Health and Family Welfare in India. ETHICS AND DISSEMINATION: No patients were involved in the study. Study findings will be shared with Institutional ethics board of National Institute for Malaria Research New Delhi (NIMR) in a timely, comprehensive, accurate, unbiased, unambiguous and transparent manner and to the National Vector-borne Disease (Malaria) Control Programme officers and the Community public who participated. Important findings will be communicated through community outreach meetings which are existing in the Health system. Results will be informed to study participants via local fieldwork supervised by District Malaria Officers. Also findings will be published in reputed journals based on Indian Council of Medical Research (ICMR) publication policy.The ICMR-NIMR ethics committee approved the study via letter No. NIMR/ECM/2023/Feb/14 dated 24 April 2023 for version 5. All standard ethical practices will be followed.

Comparison of intranasal dexmedetomidine and ketamine for paediatric premedication: A randomized study.

INTRODUCTION AND OBJECTIVES: Paediatric patients are given premedication in order to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child friendly method of administration is desirable. We compared intranasal administration of dexmedetomidine and ketamine in the operating room environment, to evaluate the Faces, Legs, Activity, Cry and Consolability (FLACC) score at the time of establishing intravenous access for induction of general anaesthesia. METHODS: This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 & 2, scheduled for general anaesthesia were enrolled. Patient's presedation behaviour was assessed by the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received Dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received Ketamine 5 mg/kg intranasally. After 45 minutes, patients were transferred to the operating table where intravenous cannulation was carried out and the response to needle insertion was assessed by FLACC scale. Vital signs, including the pulse-oximetry, heart rate and respiratory rate were monitored. Side effects such as nausea, vomiting, and agitation were also recorded. RESULTS: A significantly higher FLACC score was seen in Group D as compared to Group K (p = 0.001). The mean heart rate between two groups was found to be significantly (p = 0.001) lower in Group D compared to Group K. However, the proportion of adverse events was 8% in patients who received ketamine. CONCLUSIONS: Intranasal ketamine in a dose of 5 mg/kg is clinically more effective as premedication in children aged 2-10 years in comparison with intranasal dexmedetomidine in a dose of 1 mcg/kg.

A Comprehensive Review of Auditory and Non-Auditory Effects of Noise on Human Health.

OBJECTIVE: Excessive noise is unpleasant and induces several physiological and psychological effects. Noise pollution is a potential threat to humans, particularly those continuously exposed for extended periods throughout the day over many years. This review aims to examine the various auditory and non-auditory outcomes associated with prolonged exposure to noise pollution. MATERIALS AND METHODS: The review utilized a combination of relevant keywords to search the electronic databases. After screening based on the applied selection criteria for title, abstract, and full text, 44 articles were finally selected for critical review. RESULTS: We identified and analyzed research findings related to noise-induced hearing loss, tinnitus, and sleep disturbances along with non-auditory issues such as annoyance, cognitive impairments, and mental stress associated with cardiovascular disorders. Furthermore, the existing studies were compared and collated to highlight the unique challenges and significance of noise pollution as a distinctive environmental concern and to explore the ongoing efforts in its research and prevention, including the early detection and potential reversal of noise-induced hearing loss. CONCLUSION: The fundamental health consequences of noise pollution underscore the need for extensive research encompassing emerging noise sources and technologies to establish a health management system tailored to address noise-related health concerns and reduce noise exposure risk among populations. Finally, further research is warranted to ensure improved measurement of noise exposure and related health outcomes, especially in the context of occupational noise.

Malaria Vector Bionomics: Countrywide Surveillance Study on Implications for Malaria Elimination in India.

BACKGROUND: The biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. OBJECTIVE: This study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. METHODS: Mosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)-specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. RESULTS: Anopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with <39% mortality). Moreover, it showed resistance to malathion (with mortality rates ranging from 49% to 78%) in all districts except Angul in Odisha and Palwal in Haryana. In addition, resistance to deltamethrin was observed in districts of Maharashtra, Gujarat, Haryana, and Karnataka. CONCLUSIONS: Our study offers vital insights into the prevalence, resting behavior, and sibling species composition of malaria vectors in India. It is evident from our findings that resistance development in An. culicifacies, the primary vector, to synthetic pyrethroids is on the rise in the country. Furthermore, the results of our study suggest a potential change in the resting behavior of An. culicifacies in Madhya Pradesh, although further studies are required to confirm this shift definitively. These findings are essential for the development of effective vector control strategies in India, aligning with the goal of malaria elimination by 2030.

A role of NLRP3 and MMP9 in migraine progression: a systematic review of translational study.

Background: Migraines affect one billion individuals globally, with a higher occurrence among young adults and women. A significant survey in the United States indicated that 17.1% of women and 5.6% of men suffer from migraines. This study seeks to investigate the potential connection between NLRP3 and MMP9 in migraine pathology. Methods: The research involved searching databases such as PubMed, Scopus, Science Direct, Google Scholar, and Proquest, with the search concluding on March 31, 2024. Following PRISMA guidelines, PICO data were collected, focusing exclusively on animal models induced by Nitroglycerine (10 mg/kg), while excluding clinical studies. Results: The study, originally registered in Prospero Reg. No. CRD42022355893, conducted bias analysis using SYRCLE's RoB tool and evaluated author consensus using GraphPad v9.5.1. Out of 7,359 search results, 22 papers met the inclusion criteria. Inter-rater reliability among reviewers was assessed using Cohen's kappa statistics. Conclusion: This review summarizes 22 preclinical studies on Nitroglycerin (NTG), NLRP3, MMP9, and related biomarkers in migraine. They reveal that NTG, especially at 10 mg/kg, consistently induces migraine-like symptoms in rodents by activating NLRP3 inflammasome and stimulating proinflammatory molecule production. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42022355893.

Design, development, and performance of a versatile graphene epitaxy system for the growth of epitaxial graphene on SiC.

A versatile graphene epitaxy (GrapE) furnace has been designed and fabricated for the growth of epitaxial graphene (EG) on silicon carbide (SiC) in diverse growth environments ranging from high vacuum to atmospheric argon pressure. Radio-frequency induction enables heating capabilities up to 2000 °C, with controlled heating ramp rates achievable up to 200 °C/s. The details of critical design aspects and temperature characteristics of the GrapE system are discussed. The GrapE system, being automated, has enabled the growth of high-quality EG monolayers and turbostratic EG on SiC using diverse methodologies, such as confinement-controlled sublimation (CCS), open configuration, polymer-assisted CCS, and rapid thermal annealing. This showcases the versatility of the GrapE system in EG growth. Comprehensive characterizations involving atomic force microscopy, Raman spectroscopy, and low-energy electron diffraction techniques were employed to validate the quality of the produced EG.

Validating the utility of heavy water (Deuterium Oxide) as a potential Raman spectroscopic probe for identification of antibiotic resistance.

The impact of microbial infections is increasing over time, and it is one of the major reasons for death in both developed and developing countries. colistin is considered as the antibiotic of last choice for infections brought by major multidrug-resistant (MDR), gram-negative bacteria such as Enterobacter species, Acinetobacter species, and Pseudomonas aeruginosa. Existing approaches to diagnose these resistant species are relatively slow and take up to 2 to 3 days. In this work, we propose a novel interdisciplinary method based on Raman spectroscopy and heavy water to identify colistin-resistant microbes. Our hypothesis is based on the fact that resistant bacteria will be metabolically active in the culture medium containing antibiotics and heavy water, and these bacteria will take up deuterium instead of hydrogen to newly synthesized lipids and proteins. This effect will generate a 'C - D' bond-specific Raman spectral marker. Successful identification of this band in the spectral profile can confirm the presence of colistin-resistant bacteria. We have validated the efficacy of this approach in identifying colistin-resistant bacteria spiked in artificial urine and have compared sensitivity at different bacterial concentrations. Overall findings suggest that heavy water can potentially serve as a suitable Raman probe for identifying metabolically active colistin-resistant bacteria via urine under clinically implementable time and can be used in clinical settings after validation.

Artificial intelligence in age and sex determination using maxillofacial radiographs: A systematic review.

In the past few years, there has been an enormous increase in the application of artificial intelligence and its adoption in multiple fields, including healthcare. Forensic medicine and forensic odontology have tremendous scope for development using AI. In cases of severe burns, complete loss of tissue, complete or partial loss of bony structure, decayed bodies, mass disaster victim identification, etc., there is a need for prompt identification of the bony remains. The mandible, is the strongest bone of the facial region, is highly resistant to undue mechanical, chemical or physical impacts and has been widely used in many studies to determine age and sexual dimorphism. Radiographic estimation of the jaw bone for age and sex is more workable since it is simple and can be applied equally to both dead and living cases to aid in the identification process. Hence, this systematic review is focused on various AI tools for age and sex determination in maxillofacial radiographs. The data was obtained through searching for the articles across various search engines, published from January 2013 to March 2023. QUADAS 2 was used for qualitative synthesis, followed by a Cochrane diagnostic test accuracy review for the risk of bias analysis of the included studies. The results of the studies are highly optimistic. The accuracy and precision obtained are comparable to those of a human examiner. These models, when designed with the right kind of data, can be of tremendous use in medico legal scenarios and disaster victim identification.

Entanglement and quantum coherence of two YIG spheres in a hybrid Laguerre-Gaussian cavity optomechanics.

We theoretically investigate continuous variable entanglement and macroscopic quantum coherence in the hybrid L-G rotational cavity optomechanical system containing two YIG spheres. In this system, a single L-G cavity mode and both magnon modes (which are due to the collective excitation of spins in two YIG spheres) are coupled through the magnetic dipole interaction whereas the L-G cavity mode can also exchange orbital angular momentum (OAM) with the rotating mirror (RM). We study in detail the effects of various physical parameters like cavity and both magnon detunings, environment temperature, optorotational and magnon coupling strengths on the bipartite entanglement and the macroscopic quantum coherence as well. We also explore parameter regimes to achieve maximum values for both of these quantum correlations. We also observed that the parameters regime for achieving maximum bipartite entanglement is completely different from macroscopic quantum coherence. So, our present study shall provide a method to control various nonclassical quantum correlations of macroscopic objects in the hybrid L-G rotational cavity optomechanical system and have potential applications in quantum sensing, quantum meteorology, and quantum information science.

Navigating neurological disorders: harnessing the power of natural compounds for innovative therapeutic breakthroughs.

Novel treatments are needed as neurological issues become more frequent worldwide. According to the report, plants, oceans, microorganisms, and animals contain interesting drug discovery compounds. Alzheimer's, Parkinson's, and stroke reviews emphasize neurological disorders' complexity and natural substances' safety. Learn about marine-derived and herbal substances' neuroprotective characteristics and applications. Molecular pathways show these substances' neurological healing effects. This article discusses clinical usage of Bryostatin-1, Fucoidan, Icariin, Salvianolic acid, Curcumin, Resveratrol, etc. Their potential benefits for asthma and Alzheimer's disease are complex. Although limited, the study promotes rigorous scientific research and collaboration between traditional and alternative medical practitioners. Unexplored natural compounds, quality control, well-structured clinical trials, and interdisciplinary collaboration should guide future study. Developing and employing natural chemicals to treat neurological illnesses requires ethical sourcing, sustainability, and public awareness. This detailed analysis covers natural chemicals' current state, challenges, and opportunities in neurological disorder treatment. See also the graphical abstract(Fig. 1).

Development of correlations between various engineering rockmass classification systems using railway tunnel data in Garhwal Himalaya, India.

Engineering rockmass classifications are an integral part of design, support and excavation procedures of tunnels, mines, and other underground structures. These classifications are directly linked to ground reaction and support requirements. Various classification systems are in practice and are still evolving. As different classifications serve different purposes, it is imperative to establish inter-correlatability between them. The rating systems and engineering judgements influence the assignment of ratings owing to cognition. To understand the existing correlation between different classification systems, the existing correlations were evaluated with the help of data of 34 locations along a 618-m-long railway tunnel in the Garhwal Himalaya of India and new correlations were developed between different rock classifications. The analysis indicates that certain correlations, such as RMR-Q, RMR-RMi, RMi-Q, and RSR-Q, are comparable to the previously established relationships, while others, such as RSR-RMR, RCR-Qn, and GSI-RMR, show weak correlations. These deviations in published correlations may be due to individual parameters of estimation or measurement errors. Further, incompatible classification systems exhibited low correlations. Thus, the study highlights a need to revisit existing correlations, particularly for rockmass conditions that are extremely complex, and the predictability of existing correlations exhibit high variations. In addition to augmenting the existing database, new correlations for metamorphic rocks in the Himalayan region have been developed and presented that can serve as a guide for future rock engineering projects in such formations and aid in developing appropriate excavation and rock support methodologies.

Omics-driven utilization of wild relatives for empowering pre-breeding in pearl millet.

MAIN CONCLUSION: Pearl millet wild relatives harbour novel alleles which could be utilized to broaden genetic base of cultivated species. Genomics-informed pre-breeding is needed to speed up introgression from wild to cultivated gene pool in pearl millet. Rising episodes of intense biotic and abiotic stresses challenge pearl millet production globally. Wild relatives provide a wide spectrum of novel alleles which could address challenges posed by climate change. Pre-breeding holds potential to introgress novel diversity in genetically narrow cultivated Pennisetum glaucum from diverse gene pool. Practical utilization of gene pool diversity remained elusive due to genetic intricacies. Harnessing promising traits from wild pennisetum is limited by lack of information on underlying candidate genes/QTLs. Next-Generation Omics provide vast scope to speed up pre-breeding in pearl millet. Genomic resources generated out of draft genome sequence and improved genome assemblies can be employed to utilize gene bank accessions effectively. The article highlights genetic richness in pearl millet and its utilization with a focus on harnessing next-generation Omics to empower pre-breeding.

Scurvy masquerading as IgA vasculitis.

BACKGROUND: Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children. CASE PRESENTATION: We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy. CONCLUSION: Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential. Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role.

Bacillus tequilensis influences metabolite production in tomato and restores soil microbial diversity during Fusarium oxysporum infection.

This study evaluates cellular damage, metabolite profiling, and defence-related gene expression in tomato plants and soil microflora during Fusarium wilt disease after treatment with B. tequilensis PBE-1. Histochemical analysis showed that PBE-1 was the primary line of defence through lignin deposition and reduced cell damage. GC-MS revealed that PBE-1 treatment ameliorated stress caused by F. oxysporum infection. PBE-1 also improved transpiration, photosynthesis, and stomatal conductance in tomato. qRT-PCR suggested that the defence-related genes FLS2, SERK, NOS, WRKYT, NHO, SAUR, and MYC2, which spread infection, were highly upregulated during F. oxysporum infection, but either downregulated or expressed normally in PBE-1 + P treated plants. This indicates that the plant not only perceives the bio-control agent as a non-pathogen entity but its presence in normal metabolism and gene expression within the host plant is maintained. The study further corroborated findings that application of PBE-1 does not cause ecological disturbances in the rhizosphere. Activity of soil microflora across four treatments, measured by Average Well Colour Development (AWCD), showed continuous increases from weeks 1 to 4 post-pathogen infection, with distinct substrate usage patterns like tannic and fumaric acids impacting microbial energy source utilization and diversity. Principal Component Analysis (PCA) and diversity indices like McIntosh, Shannon, and Simpson further illustrated significant microbial community shifts over the study period. In conclusion, our findings demonstrate that B. tequilensis PBE-1 is an ideal bio-agent for field application during Fusarium wilt disease management in tomato.

Efficacy of maturase K and rpL20 protein extracted from C. procera leaves on Anophelesstephensi.

The present work is carried out to protein isolation, purification, and characterization from leaves, stem, and seed of C. procera and to evaluate the larvicidal potential on Anopheles stephensi. The whole protein was isolated using protein extraction buffer and precipitated by ammonium sulphate and larvicidal active protein was purified by the column chromatography. The homogeneity of larvicidal protein was confirmed by the SDS-PAGE. The identification of protein was done by the HPLC and LC-MS/ESI-MS. The crude protein from leaves showed 100% mortality of 3rd instar larvae of An. stephensi at the concentration of 5.5 mg/ml after 24 h of exposure. The crude protein from stem showed 25% mortality and no mortality observed was observed in seed protein. The leaves crude protein was further purified by ion exchange chromatography and eluted fractions were tested for larvicidal potential. The purified single protein fractions L2 and L3 from C. procera leaves showed 100% mortality at concentration of 0.06 mg/ml. The homogeneity of purified protein was confirmed by SDS-PAGE and two bands of 26 kDa and 15 kDa protein were observed. The peptide sequence "R.SQMLENSFLIENVMKR.L" was identified in the trypsin digested homogenous protein fraction L2 and "R.DRGSQKR.N" peptide sequence in L3 fraction by LC-MS/ESI-MS. The CprL2 peptide showed the sequence similarity with the protein maturase K and CprL3 peptide showed the sequence similarity with ribosomal protein L20 of C. procera. The conserved functional domain was also identified in both the CprL2 and CprL3 peptide. The identified proteins showed strong larvicidal efficacy at very low concentration. The identified proteins are novel and natural larvicidal agents against An. stephensi and hence can be used to control the malaria.

Toxicological effects of nanoparticles in plants: Mechanisms involved at morphological, physiological, biochemical and molecular levels.

The rapid advancement of nanotechnology has led to unprecedented innovations across diverse industries, including pharmaceuticals, agriculture, cosmetics, electronics, textiles, and food, owing to the unique properties of nanoparticles. The extensive production and unregulated release of synthetic nanoparticles may contribute to nanopollution within the ecosystem. In the agricultural sector, nanotechnology is increasingly utilized to improve plant productivity, enhance resistance to stressors, and reduce the usage of chemicals. However, the uncontrolled discharge of nanoparticles into the natural environment raises concerns regarding possible plant toxicological impacts. The review focuses on the translocation of these particles within the plants, emphasizing their phytotoxicological effects at morphological, physiological, biochemical, and molecular levels. Eventhough the beneficial aspects of these nanoparticles are evident, excessive usage of nanoparticles at higher concentrations may lead to potential adverse effects. The phytotoxicity resulting from excessive amounts of nanoparticles affects seed germination and biomass production, disrupts the photosynthesis system, induces oxidative stress, impacts cell membrane integrity, alters gene expression, causes DNA damage, and leads to epigenetic variations in plants. Nanoparticles are found to directly associate with the cell membrane and cell organelles, leading to the dissolution and release of toxic ions, generation of reactive oxygen species (ROS) and subsequent oxidative stress. The present study signifies and accumulates knowledge regarding the application of nanoparticles in agriculture and illustrates a clear picture of their possible impacts on plants and soil microbes, thereby paving the way for future developments in nano-agrotechnology. The review concludes by addressing current challenges and proposing future directions to comprehend and mitigate the possible biological risks associated with nanoparticles in agriculture.

Predicting post-treatment symptom severity for adults receiving psychological therapy in routine care for generalised anxiety disorder: a machine learning approach.

Approximately half of generalised anxiety disorder (GAD) patients do not recover from first-line treatments, and no validated prediction models exist to inform individuals or clinicians of potential treatment benefits. This study aimed to develop and validate an accurate and explainable prediction model of post-treatment GAD symptom severity. Data from adults receiving treatment for GAD in eight Improving Access to Psychological Therapies (IAPT) services (n=15,859) were separated into training, validation and holdout datasets. Thirteen machine learning algorithms were compared using 10-fold cross-validation, against two simple clinically relevant comparison models. The best-performing model was tested on the holdout dataset and model-specific explainability measures identified the most important predictors. A Bayesian Additive Regression Trees model out-performed all comparison models (MSE=16.54 [95 % CI=15.58; 17.51]; MAE=3.19; R²=0.33, including a single predictor linear regression model: MSE=20.70 [95 % CI=19.58; 21.82]; MAE=3.94; R²=0.14). The five most important predictors were: PHQ-9 anhedonia, GAD-7 annoyance/irritability, restlessness and fear items, then the referral-assessment waiting time. The best-performing model accurately predicted post-treatment GAD symptom severity using only pre-treatment data, outperforming comparison models that approximated clinical judgement and remaining within the GAD-7 error of measurement and minimal clinically important differences. This model could inform treatment decision-making and provide desired information to clinicians and patients receiving treatment for GAD.

Biological wastewater treatment: a comprehensive sustainability analysis using life cycle assessment.

The research conducts a life cycle assessment (LCA) on wastewater treatment (WWT) methods-membrane bioreactor (MBR), soil biotechnology (SBT), and bio-electrochemical constructed wetlands (BCW)-in comparison with the conventional activated sludge process (ASP). Employing SimaPro v9.5 with a cradle-to-gate system boundary, the analysis utilizes the IMPACT 2002 + method, employing per cubic meter of treated wastewater as the functional unit. The analysis shows that SBT exhibits the lowest environmental impacts among the considered WWT methods. The global warming potential was 0.0996 kg CO2 eq. for SBT, 1.33 kg CO2 eq. for MBR, 0.131 kg CO2 eq. for BCW, and 0.544 kg CO2 eq. for ASP. BCW demonstrates a 75.91% decrease, while MBR exhibits a 144.48% increase compared to ASP. Notably, electricity consumption emerges as the primary contributor to environmental impact in MBR and ASP. The resource impact category varies with a 138.15% increase in MBR and an 83.41% decrease in SBT compared to ASP. Additionally, the research indicates that the high human health impact observed in MBR results mainly from increased carcinogens (0.00176 kg C2H3Cl eq.), non-carcinogens (0.01 kg C2H3Cl eq.), and ionizing radiation (3.34 Bq C-14 eq.). The findings underscore the importance of considering treatment efficiency and broader environmental implications in selecting WWT methods. As the world emphasizes sustainability, such LCA studies provide valuable insights for making informed decisions in wastewater management.

Standardization of a silver stain to reveal mesoscale myelin in histological preparations of the mammalian brain.

BACKGROUND: The brain is built of neurons supported by myelin, a fatty substance that improves cellular communication. Noninvasive magnetic resonance imaging (MRI) is now able to measure brain structure like myelin and requires histological validation. NEW METHOD: Here we present work in small and large biomedical model mammals to standardize a silver impregnation method as a high-throughput histological myelin visualization procedure. Specifically, we built a new staining well plate to increase batch size, and then systematically varied the staining and clearing cycles to describe the staining response curve across taxa and conditions. We compared tissues fixed by immersion or perfusion, mounted versus free-floating, and cut as thicker or thinner slices, with two-weeks of post-fixation. RESULTS: The staining response curves show optimal staining with a single exposure across taxa when incubation and clearing epochs are held to within 3-9 min. We show that clearing was slower in mounted vs free-floating tissue, and that staining was faster and caused fracturing earlier in thinner sliced and smaller volumes of tissue. COMPARISON WITH EXISTING METHODS: We developed a batch processing approach to increase throughput while ensuring reproducibility and demonstrate the optimal conditions for fine myelinated fiber morphology visualization with short cycles (<9 minutes). CONCLUSIONS: We present our optimized protocol to reveal mesoscale neuroanatomical myelin content in histology across mammals. This standard staining procedure will facilitate multiscale analyses of myelin content across development as well as in the presence of injury or disease.

A comparative study between single injection (corner pocket approach) and double injection costoclavicular block: A randomized parallel arm, non-inferiority trial.

BACKGROUND: Previous studies have shown that ultrasound guided costoclavicular block may require a double shot to provide adequate, rapid sensory and motor blockade. In this trial, we hypothesized that if the corner pocket approach (between axillary artery and median cord) is used instead of the central approach (at the midpoint of the 3 cords) when performing single-shot costoclavicular block, the onset of blockade would be non-inferior to the double-shot technique. METHOD: Ninety patients undergoing upper limb surgery were randomized to 2 groups for ultrasound-guided costoclavicular block (CCB) at a tertiary hospital. One group received ultrasound guided single-shot CCB using the corner pocket approach and other received ultrasound guided double-shot - the first shot at the centre of the 3 cords and the second between the axillary artery and the median cord. An observer blinded to group assignment recorded blockade onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points). RESULTS: Of the 101 patients assessed for eligibility, 90 were recruited over period of 1 year (February 2022 to January 2023), with 45 in each group. Onset time was 22.1 ±â€¯3.1 min in the single-shot group and 22.4 ±â€¯2.9 min in the double-shot group. This difference was insignificant (P = .3). CONCLUSION: Time to onset of blockade and full anaesthesia are similar in single-shot corner pocket CCB vs double-shot CCB. Further studies are required to determine the minimum effective volume of local anaesthetic required for the described technique.