Knowledge, attitude, and practice of breast self-examination is associated with general self-care and cultural factors: a study from Tamil Nadu, India.

AIM: Breast cancer is the most prevalent type of cancer among women. One form of care related to early detection of breast cancer is breast self-examination (BSE). However, evidence on knowledge, attitude, and practice (KAP) of BSE and its determining factors are minuscule in an Indian context. Therefore, the present study primarily examined the prevalence of KAP of BSE. Further, its association with general self-care and cultural factors was determined. METHODS: This cross-sectional study obtained data from 412 women (Mn age = 26.63) from two rural localities of Vellore district, Tamil Nadu, India. Self-reported questionnaires of KAP of BSE, self-care, and cultural factors were applied. Statistical analyses include independent sample t-test and binomial logistic regression. RESULTS: The majority of the sample had inadequate knowledge (58%), unfavourable attitudes (73.8%), and poor practice (89.6%) of BSE. The general self-care among the sample was moderate. Self-care was found to be a significant predictor of knowledge (b = 0.07, p < .05) and attitude (b = 0.092, p < .05) toward BSE. Shyness was identified as a negative predictor of KAP. Discouraged breast health discussions predicted inadequate knowledge, and not being educated by family/friends had a negative impact on knowledge and practice. A preference for same-gender physicians led to an unfavourable attitude toward BSE. CONCLUSION: The observed negative trends in KAP of BSE are concerning. The results imply that girls and women should be educated and encouraged to practice BSE and promote self-care behaviours. At the same time, efforts to reduce cultural barriers may be helpful to promote the KAP of BSE.

A Feasibility Study on Deep Learning Reconstruction to Improve Image Quality With PROPELLER Acquisition in the Setting of T2-Weighted Gynecologic Pelvic Magnetic Resonance Imaging.

OBJECTIVES: Evaluate deep learning (DL) to improve the image quality of the PROPELLER (Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction technique) for 3 T magnetic resonance imaging of the female pelvis. METHODS: Three radiologists prospectively and independently compared non-DL and DL PROPELLER sequences from 20 patients with a history of gynecologic malignancy. Sequences with different noise reduction factors (DL 25%, DL 50%, and DL 75%) were blindly reviewed and scored based on artifacts, noise, relative sharpness, and overall image quality. The generalized estimating equation method was used to assess the effect of methods on the Likert scales. Quantitatively, the contrast-to-noise ratio and signal-to-noise ratio (SNR) of the iliac muscle were calculated, and pairwise comparisons were performed based on a linear mixed model. P values were adjusted using the Dunnett method. Interobserver agreement was assessed using the κ statistic. P value was considered statistically significant at less than 0.05. RESULTS: Qualitatively, DL 50 and DL 75 were ranked as the best sequences in 86% of cases. Images generated by the DL method were significantly better than non-DL images ( P < 0.0001). Iliacus muscle SNR on DL 50 and DL 75 was significantly better than non-DL images ( P < 0.0001). There was no difference in contrast-to-noise ratio between the DL and non-DL techniques in the iliac muscle. There was a high percent agreement (97.1%) in terms of DL sequences' superior image quality (97.1%) and sharpness (100%) relative to non-DL images. CONCLUSION: The utilization of DL reconstruction improves the image quality of PROPELLER sequences with improved SNR quantitatively.

Pressure injury incidence and impact on patients treated with prone positioning for COVID-19 ARDS.

OBJECTIVE: To determine the incidence of pressure injuries (PIs) and their impact on clinical outcomes in patients treated with prone positioning for COVID-19 acute respiratory distress syndrome (ARDS). METHOD: All patients with COVID-19 ARDS who were treated with prone positioning were categorised as cases and those who were not treated with prone positioning were categorised as controls. Demographics, clinical data and confounding variables affecting outcomes were recorded. Outcome variables of mortality and length of stay in intensive care units (ICUs) for both groups were recorded. Both groups' incidence of PIs were recorded and compared using statistical tests. Fisher's exact test was used for categorical variables, and Mann-Whitney U test was used for continuous variables. RESULTS: The sample included 212 patients, treated with prone position (n=104) and without prone treatment (n=108). The incidence of PIs was n=75 (35.4%). PIs were significantly higher in patients in the prone position (n=51, 49%) compared with patients who were not (n=24, 22%); p=0.001. Patients in the prone position were found to have lower APACHE-2 scores, longer stays on the ventilator, ICU and in the hospital. CONCLUSION: PIs are more prevalent in patients in the prone position and it adversely impacts clinical outcomes; it prolongs the length of stay on the ventilator, in the ICU and in the hospital.

"Life after him was just hell": Young rural women's lived experiences of widowhood in Rajasthan, India.

This phenomenological study was conducted in rural Rajasthan, India, to explore young widows' lived experiences. On receipt of written informed consent, we interviewed 14 young widows. The data were analyzed in an idiographic style using the interpretive phenomenological approach. The perspective of loss and sociocultural contexts grounded the analysis. Six themes emerged corresponding to the women's widowhood experiences: becoming a widow; entangled by customs; stigmatization; the impossible marriage; hope in widowhood; and economic deprivation. The results underline the predicaments of young widows, and these experiences are largely framed by the sociocultural and gender norms prevailing in rural communities. The study's findings imply the need for strengthening social and legislative measures for young widows.

Rapid fat-water separated T1 mapping using a single-shot radial inversion-recovery spoiled gradient recalled pulse sequence.

T1 mapping is increasingly used in clinical practice and research studies. With limited scan time, existing techniques often have limited spatial resolution, contrast resolution and slice coverage. High fat concentrations yield complex errors in Look-Locker T1 methods. In this study, a dual-echo 2D radial inversion-recovery T1 (DEradIR-T1) technique was developed for fast fat-water separated T1 mapping. The DEradIR-T1 technique was tested in phantoms, 5 volunteers and 28 patients using a 3 T clinical MRI scanner. In our study, simulations were performed to analyze the composite (fat + water) and water-only T1 under different echo times (TE). In standardized phantoms, an inversion-recovery spin echo (IR-SE) sequence with and without fat saturation pulses served as a T1 reference. Parameter mapping with DEradIR-T1 was also assessed in vivo, and values were compared with modified Look-Locker inversion recovery (MOLLI). Bland-Altman analysis and two-tailed paired t-tests were used to compare the parameter maps from DEradIR-T1 with the references. Simulations of the composite and water-only T1 under different TE values and levels of fat matched the in vivo studies. T1 maps from DEradIR-T1 on a NIST phantom (Pcomp = 0.97) and a Calimetrix fat-water phantom (Pwater = 0.56) matched with the references. In vivo T1 was compared with that of MOLLI: R comp 2 = 0.77 ; R water 2 = 0.72 . In this work, intravoxel fat is found to have a variable, echo-time-dependent effect on measured T1 values, and this effect may be mitigated using the proposed DRradIR-T1.

Multiresolution-based weighted regularization for denoised image interpolation from scattered samples with application to confocal microscopy.

The problem of reconstructing an image from nonuniformly spaced, spatial point measurements is frequently encountered in bioimaging and other scientific disciplines. The most successful class of methods in handling this problem uses the regularization approach involving the minimization of a derivative-based roughness functional. It has been well demonstrated, in the presence of noise, that nonquadratic roughness functionals such as ℓ1 measure yield better performance compared to the quadratic ones in inverse problems in general and in deconvolution in particular. However, for the present problem, all well-evaluated methods use quadratic roughness measures; indeed, ℓ1 performs worse than the quadratic roughness when the sampling density is low. This is due to the fact that the mutual incoherence between the measurement operator (dirac-delta) and the regularization operator (derivative) is low in the present problem. Here we develop a new multiresolution-based roughness functional that performs better than ℓ1 and quadratic functionals under a wide range of sampling densities. We also propose an efficient iterative method for minimizing the resulting cost function. We demonstrate the superiority of the proposed regularization functional in the context of reconstructing full images from nonuniformly undersampled data obtained from a confocal microscope.

Single-center outcomes of artificial intelligence in management of pulmonary embolism and pulmonary embolism response team activation.

Multidisciplinary pulmonary embolism response teams (PERTs) have shown that timely triage expedites treatment. The use of artificial intelligence (AI) may help improve pulmonary embolism (PE) management with early CT pulmonary angiogram (CTPA) screening and accelerate PERT coordination. This study aimed to test the clinical validity of an FDA-approved PE AI algorithm. CTPA scan data of 200 patients referred due to automated AI detection of suspected PE were retrospectively reviewed. In our institution, all patients suspected of PE received a CTPA. The AI app was then used to analyze CTPA for the presence of PE and calculate the right-ventricle/left-ventricle (RV/LV) ratio. We compared the AI's output with the radiologists' report. Inclusion criteria included segmental PE with and without RV dysfunction and high-risk PE. The primary endpoint was false positive rate. Secondary end points included clinical outcomes according to the therapy selected, including catheter-directed interventions, systemic thrombolytics, and anticoagulation. Fifty-seven of 200 exams (28.5%) were correctly identified as positive for PE by the algorithm. A total of 143 exams (71.5%) were incorrectly reported as positive. In 8% of cases, PERT was consulted. Four patients (7%) received systemic thrombolytics without any complications. There were six patients (10.5%) who developed high-risk PE and underwent thrombectomy, one of whom died. Among 46 patients with acute PE without right heart strain, 44 (95%) survived. The false positive rate of our AI algorithm was 71.5%, higher than what was reported in the AI's prior clinical validity study (91% sensitivity, 100% specificity). A high rate of discordant AI auto-detection of suspected PE raises concerns about its diagnostic accuracy. This can lead to increased workloads for PERT consultants, alarm/notification fatigue, and automation bias. The AI direct notification process to the PERT team did not improve PERT triage efficacy.

Real-Time Ultrasound-Computed Tomography Fusion with Volume Navigation to Assess Pancreatic Cystic Lesions.

Transabdominal ultrasound is a promising imaging modality for pancreatic cystic lesions. This study aims to determine if transabdominal ultrasonography with CT fusion (TAUS-f) using volume navigation can be used to measure pancreatic cystic lesions (PCLs) compared to CT alone. We evaluated 33 patients prospectively with known PCLs. The readers evaluated each PCL's size and imaging characteristics on TAUS-f and CT alone. These were compared to endoscopic ultrasonography reports. A total of 43 PCLs from 32 patients were evaluated. The detection rate by TAUS-f was 93%. Two of the three undetected PCLs were in the tail of the pancreas. Inter-reader variabilities for TAUS-f and CT were 0.005 cm and 0.03 cm, respectively. Subgroup analysis by size and location demonstrated that inter-modality variability between TAUS-f and CT was smallest for lesions < 1.5 cm with a size difference of -0.13 cm for each reader and smallest in the pancreatic head with a size difference of -0.16 cm and -0.17 cm for readers 1 and 2. We found that TAUS-f effectively evaluates PCLs compared to CT alone, thus suggesting that it should be considered part of the surveillance algorithm for a subset of patients.

Rates of Intervention and Cancer Detection on Initial versus Subsequent Whole-body MRI Screening in Li-Fraumeni Syndrome.

Li-Fraumeni Syndrome (LFS) is a hereditary cancer predisposition syndrome with up to 90% lifetime cancer risk. Cancer screening, including annual whole-body MRI (WB-MRI), is recommended due to known survival advantage, with cancer detection rate of 7% on initial screening. Intervention and cancer detection rates on subsequent screenings are unknown. Clinical data for pediatric and adult patients with LFS (n = 182) were reviewed, including instances of WB-MRI screening and interventions based on screening results. For each WB-MRI screening, interventions including biopsy and secondary imaging, as well as rate of cancer diagnosis, were analyzed comparing initial versus subsequent WB-MRI. Of the total cohort (n = 182), we identified 68 adult patients and 50 pediatric patients who had undergone at least two WB-MRI screenings, with a mean of 3.8 ± 1.9 (adults) and 4.0 ± 2.1 (pediatric) screenings. Findings on initial screening led to an imaging or invasive intervention in 38% of adults and 20% of children. On follow up, overall intervention rates were lower for adults (19%, P = 0.0026) and stable for children (19%, P = NS). Thirteen cancers were detected overall (7% of adult and 14% of pediatric scans), on both initial (pediatric: 4%, adult: 3%) and subsequent (pediatric: 10%, adult: 6%) screenings. Rates of intervention after WB-MRI screening decreased significantly in adults between first and subsequent exams and remained stable in pediatric patients. Cancer detection rates were similar on screening (3%-4% initial, 6%-10% subsequent) for both children and adults. These findings provide important data for counseling patients with LFS about screening outcomes. PREVENTION RELEVANCE: The cancer detection rate, burden of recommended interventions, and rate of false-positive findings found on subsequent WB-MRI screenings in patients with LFS are not well understood. Our findings suggest that annual WB-MRI screening has clinical utility and likely does not result in an unnecessary invasive intervention burden for patients.

Lateral distribution of charged species along a polyelectrolyte probed with a fluorescence blob model.

The distribution of metal counterions binding onto the oppositely charged surface of a model polyelectrolyte, namely, DNA, was characterized by conducting fluorescence quenching experiments. In these experiments, DNA was used as a molecular ruler to measure the average distance (d(blob)) over which electron transfer takes place between DNA-intercalated ethidium bromide (DNA-EB) and the electrostatically bound divalent metal cations Ni(2+) and Cu(2+). Analysis of the fluorescence decays of DNA-EB quenched by Cu(2+) and Ni(2+) with the fluorescence blob model showed that d(blob) was equal to the Debye length (κ(-1)). This surprisingly simple result considering the overall complexity of the system under study led to the straightforward proposal that counterions bind to a polyelectrolyte by distributing themselves randomly into an array of self-defined subdomains of dimension κ(-1). In turn, this insight can be utilized to rationalize the complex behavior of polyelectrolytes in aqueous solution.

Prevalence of Hearing Impairment in Neonates of Mothers with Diabetes Mellitus: A Cross Sectional Study.

This study aims to find out the prevalence of hearing impairment in neonates of mothers with diabetes mellitus. The objective is to assess any correlation between the glycemic control and the development of neonatal hearing impairment. A total of 120 neonates of diabetic mothers were included in the study. Data was collected from hospital medical records, direct interview of parent or care taker and clinical examination of child done whenever possible. 120 Neonates were evaluated by OAE soon after birth. Those who failed the test are evaluated with BERA and results were statistically analysed. In our study prevalence of deafness in neonates of mothers with diabetes mellitus was 4.16%. Prevalence of hearing impairment was higher in neonates of mothers with pre gestational diabetes (9.09%) than gestational diabetes mellitus (3.06%). Mean of HbA1c was higher in mothers of neonates with hearing impairment than those without hearing impairment. Prevalence of deafness in neonates of mothers with diabetes mellitus was 4.16%, which is about sevena times higher than the prevalence of deafness in neonates without any risk factors. Prevalence was higher in neonates of mothers with pre gestational diabetes than neonates of mothers with gestational diabetes mellitus.

Environmental technology and wastewater treatment: Strategies to achieve environmental sustainability.

Water is the vital liquid for human subsistence and is used as a resource in various production processes. However, the degradation of the environment is being reflected in the water resources of the planet. One of the leading causes of water pollution is ineffective wastewater treatment, which results in greywater being returned to the environment without having gone through a decontamination process. Ideally, wastewater should have the lowest concentration of polluting materials to be reused and exploited in other activities, such as agriculture or the generation of renewable energy. However, in its various forms, technological progress plays a vital role in improving wastewater treatment processes, becoming a determining factor in improving greywater quality. This study examines how environmental technology contributes to wastewater improvement in 16 selected OECD countries during 2000-2019. Annualized information is used and collected from various official sources of information, subsequently processed with various econometric approaches. The results obtained show a heterogeneous behaviour in the quantiles of wastewater treatment, environmental technology and renewable energy are positively related to an increase in wastewater treatment between 0.09% - 0.20% and 3.5 e-12% - 5.74 e-12%, respectively. Based on the results obtained, the policy implications suggest promoting environmental technology to improve wastewater treatment.

An integrated CRITIC-TOPSIS- and Entropy-TOPSIS-based informative weighting and ranking approach for evaluating green energy sources and its experimental analysis on pyrolysis.

Selection of the most suitable biomass material for bio-fuel generation is a complex and multi-criteria decision problem as it engages many conflicting criteria which have to be assessed simultaneously. In the past, researchers have used subjective weighing techniques, which question the reliability of the approach. In this study, two objective weighing methods such as Criteria Importance Through Intercriteria Correlation (CRITIC) and Entropy are used to calculate the weights of evaluating criteria and Technique for Order of Preference by Similarity to an Ideal Solution (TOPSIS) is applied to select the suitable biomass material. This study considered six biomass alternatives such as lemongrass (A1), hard wood (A2), rice husk (A3), wheat straw (A4), rice straw (A5), and switch grass (A6), and seven important criteria such as volatile matter, fixed carbon, moisture and ash content, lignin, cellulose, and hemicellulose have been evaluated. Both the approaches show that switch grass has been the best alternative for yielding more bio-oil while rice straw is seen as the worst preferred option among the selected biomass materials. These approaches are systematic having simple computational procedure for determination of complete ranking of biomass materials. At the end of the study, the prediction is also validated by conducting pyrolysis experiments and characterization study. The experimental findings are identical and indicating a strong correlation between MCDM approach and real-time study.

Real time imaging of femtosecond laser induced nano-neurosurgery dynamics in C. elegans.

In this study we present for the first time the use of confocal microscopy and laser scanning brightfield microscopy (LSBF) for real time imaging of femtosecond laser nanosurgery and its dynamics in C. elegans. A single multimodal optical workstation that provides the ability to perform femtosecond laser nanosurgery and simultaneous confocal and LSBF imaging was used for the purpose. With this tool several dynamic phenomena concomitant with laser nanosurgery in C. elegans were observed and imaged. Some of these dynamic phenomena, like muscular contraction and single muscle cell stimulation, have been imaged for the first time during nano-neurosurgery of C. elegans.

Elevated plasma free fatty acids increase cardiovascular risk by inducing plasma biomarkers of endothelial activation, myeloperoxidase and PAI-1 in healthy subjects.

BACKGROUND: CVD in obesity and T2DM are associated with endothelial activation, elevated plasma vascular inflammation markers and a prothrombotic state. We examined the contribution of FFA to these abnormalities following a 48-hour physiological increase in plasma FFA to levels of obesity and diabetes in a group of healthy subjects. METHODS: 40 non-diabetic subjects (age = 38 +/- 3 yr, BMI = 28 +/- 1 kg/m2, FPG = 95 +/- 1 mg/dl, HbA1c = 5.3 +/- 0.1%) were admitted twice and received a 48-hour infusion of normal saline or low-dose lipid. Plasma was drawn for intracellular (ICAM-1) and vascular (VCAM-1) adhesion molecules-1, E-selectin (sE-S), myeloperoxidase (MPO) and total plasminogen inhibitor-1 (tPAI-1). Insulin sensitivity was measured by a hyperglycemic clamp (M/I). RESULTS: Lipid infusion increased plasma FFA to levels observed in obesity and T2DM and reduced insulin sensitivity by 27% (p = 0.01). Elevated plasma FFA increased plasma markers of endothelial activation ICAM-1 (138 +/- 10 vs. 186 +/- 25 ng/ml), VCAM-1 (1066 +/- 67 vs. 1204 +/- 65 ng/ml) and sE-S (20 +/- 1 vs. 24 +/- 1 ng/ml) between 13-35% and by > or = 2-fold plasma levels of myeloperoxidase (7.5 +/- 0.9 to 15 +/- 25 ng/ml), an inflammatory marker of future CVD, and tPAI-1 (9.7 +/- 0.6 to 22.5 +/- 1.5 ng/ml), an indicator of a prothrombotic state (all p < or = 0.01). The FFA-induced increase was independent from the degree of adiposity, being of similar magnitude in lean, overweight and obese subjects. CONCLUSIONS: An increase in plasma FFA within the physiological range observed in obesity and T2DM induces markers of endothelial activation, vascular inflammation and thrombosis in healthy subjects. This suggests that even transient (48-hour) and modest increases in plasma FFA may initiate early vascular abnormalities that promote atherosclerosis and CVD.

Author Correction: The emergence of Miocene reefs in South China Sea and its resilient adaptability under varying eustatic, climatic and oceanographic conditions.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The emergence of Miocene reefs in South China Sea and its resilient adaptability under varying eustatic, climatic and oceanographic conditions.

During the Miocene, extensive carbonate deposition thrived over wide latitudinal ranges in Southeast Asia despite perturbations of the global climate and thermohaline circulation that affected the Asian continent. Nevertheless, the mechanisms of its emergence, adaptability in siliciclastic-dominated margins and demise, especially in southern South China Sea (SCS), are largely speculative and remains enigmatic along with a scarcity of constraints on paleoclimatic and palaeoceanographic conditions. Here we show, through newly acquired high-resolution geophysical data and accurate stratigraphic records based on strontium isotopic dating, the evolution of these platforms from ~15.5-9.5 Ma is initially tied to tectonics and eustasy, and ultimately, after ~9.5 Ma, to changes in the global climate patterns and consequent palaeoceanographic conditions. Our results demonstrate at least two paleodeltas that provided favourable substratum of elevated sand bars, which conditioning the emergence of the buildups that inadvertently mirrored the underlying strata. We show unprecedented evidences for ocean current fluctuations linked to the intensification of the Asian summer monsoon winds resulting in the formation of drifts and moats, which extirpated the platforms through sediment removal and starvation. This work highlights the imperative role of palaeoceanography in creating favourable niches for reefal development that can be applicable to carbonate platforms elsewhere.

Total vulnerability of the littoral zone to climate change-driven natural hazards in north Brittany, France.

Current worldwide projections of sea-level rise show a staggering increase in water level of up to 2 m by 2100 owing to global warming exacerbated by anthropogenically induced climate change. While amplified rates of sea-level rise is an immense hazard to coastal communities, storm surges are expected to increase in intensity and frequency making it an equally significant threat to coastal populations. In France, these hazards are not uncommon with records of extreme tempests every thousand years in the Holocene. Despite these recurring devastating events, in the Bay of Saint-Brieuc, Brittany, legislated laws for coastal management do not entirely focus on protecting littoral zones from such calamities. 130,739 people are concentrated in 21 municipalities with major cities located at close proximity to the shoreline with numerous socio-economic activities, which increases the vulnerability of the coastal population and infrastructures; thus, affirming the indispensable need of a thorough vulnerability assessment. Here, we conduct a mechanistic appraisal of the vulnerability of the bay considering thirteen parameters within three governing sub-systems that demonstrate the multidimensional dynamics in these municipalities. In the occasion of an extreme climatic event, our results of total vulnerability show risks in the sub-systems highlighting erosional processes due to augmented hydrodynamics, socio-economic and administrative vulnerabilities associated with anthropogenic development. Eight municipalities of the bay portray moderate to very high vulnerability and the remaining exhibits a lower risk; however, not devoid of high vulnerabilities for certain sub-systems. We posit that a more accurate fit for predicting the total vulnerability of the region can be achieved by exclusively integrating physical-natural and administrative sub-system vulnerabilities. We propose generic but requisite recommendations for Integrated Coastal Zone Management such as surveillance of urban development along the coast, implementation of coastal defense systems and appropriate industrial corridors to attenuate and dispose hazardous refuse.

Anterolateral Ligament Reconstruction or Extra-Articular Tenodesis: Why and When?

Residual rotational laxity following anterior cruciate ligament (ACL) reconstruction has been identified as significant concern in many patients, despite evolution of techniques. The expanding body of knowledge on the anatomy and biomechanics of the anterolateral soft tissue restraints in rotational control of the knee has reignited an interest in extra-articular reconstruction techniques for augmenting ACL reconstruction. Reconstruction techniques currently used can be broadly categorized as either lateral extra-articular tenodesis or reconstruction of the anterolateral ligament. In this article, we outline the relevant anatomy, biomechanics, and rationale behind the indications and technique of our current extra-articular augmentation procedure.

Management of vascular complications of extra-corporeal membrane oxygenation.

Extra-corporeal membrane oxygenation (ECMO) is a well-established treatment for cardiopulmonary failure. Based on the requirement for cardiac and or respiratory support different configurations of ECMO circuits are utilized. Vascular complication of ECMO constitutes the most important determinant of treatment outcomes. The complications are primarily related to limb ischemia, vascular injury, hemorrhage, and infection. Endovascular and surgical treatment options are the cornerstone for managing vascular complications of ECMO.