Improvement in Inhaler Techniques After Training and Counseling in Patients With Chronic Obstructive Pulmonary Disease or Asthma.

Background Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma significantly impair quality of life and impose a substantial burden on healthcare systems. Proper inhalation technique is important for effective management of these diseases, yet remains poorly performed by many patients. This study evaluated the impact of structured counseling and training sessions on inhaler use among patients with COPD and asthma, aiming to enhance technique correctness and disease control. Methodology This cross-sectional study analyzed 150 patients with asthma and COPD who fulfilled the inclusion criteria for inhalation techniques. Patients were counseled regarding the proper seven-step inhalation technique for each inhaler type [metered-dose inhaler (MDI), MDI with spacer, and dry powder inhaler (DPI)] through practical demonstration at baseline visits. Correct use of inhalers was assessed by a predefined checklist for each inhaler device at the baseline visit and after three months. The correctness of the inhalation technique was evaluated by scoring each of the seven steps. The disease control assessment was done using the COPD assessment test (CAT) and asthma control test (ACT) at the baseline visit and after three months. Results In this study of 150 patients, there were 97 (64.7%) males and 53 (35.3%) females. In total, 67 (44.7%) were diagnosed with asthma and 83 (55.3%) with COPD. The mean age was 45.33 ± 12.62 years. Post-counseling improvements in inhaler technique were marked, with MDI users enhancing their technique score from an average of 4.4 to 6.1, MDI with spacer from 4.56 to 6.26, and DPI from 4.92 to 6.24 (p < 0.001 for all). Disease control also showed significant gains; CAT scores decreased for MDI users from 23.4 to 20.5, MDI with spacer from 23.92 to 20.96, and DPI from 24.89 to 21.96. Concurrently, ACT scores increased for MDI users from 16.4 to 18.0 (p = 0.002), MDI with spacer from 17.29 to 19.04, and DPI from 16.42 to 18.37 (p < 0.001 for both), reflecting substantive advances in managing COPD and asthma symptoms. Furthermore, patients with primary education exhibited a significant boost in technique mastery post-counseling (p < 0.001), underscoring the potential of well-crafted counseling to transcend educational barriers in promoting effective inhaler use. Conclusions Post-counseling, inhaler technique improved significantly across all types, with MDI with spacer users demonstrating the most progress. Technique scores increased notably (p < 0.001), and disease control scores for COPD and asthma, measured by CAT and ACT, also showed significant improvements (p < 0.001). Remarkably, primary education level participants exhibited substantial technique gains post-intervention, emphasizing the effectiveness of counseling irrespective of initial educational status in enhancing inhaler use and disease management.

ChatGPT-4 Generates More Accurate and Complete Responses to Common Patient Questions About Anterior Cruciate Ligament Reconstruction Than Google's Search Engine.

Purpose: To replicate a patient's internet search to evaluate ChatGPT's appropriateness in answering common patient questions about anterior cruciate ligament reconstruction compared with a Google web search. Methods: A Google web search was performed by searching the term "anterior cruciate ligament reconstruction." The top 20 frequently asked questions and responses were recorded. The prompt "What are the 20 most popular patient questions related to 'anterior cruciate ligament reconstruction?'" was input into ChatGPT and questions and responses were recorded. Questions were classified based on the Rothwell system and responses assessed via Flesch-Kincaid Grade Level, correctness, and completeness were for both Google web search and ChatGPT. Results: Three of 20 (15%) questions were similar between Google web search and ChatGPT. The most common question types among the Google web search were value (8/20, 40%), fact (7/20, 35%), and policy (5/20, 25%). The most common question types amongst the ChatGPT search were fact (12/20, 60%), policy (6/20, 30%), and value (2/20, 10%). Mean Flesch-Kincaid Grade Level for Google web search responses was significantly lower (11.8 ± 3.8 vs 14.3 ± 2.2; P = .003) than for ChatGPT responses. The mean correctness for Google web search question answers was 1.47 ± 0.5, and mean completeness was 1.36 ± 0.5. Mean correctness for ChatGPT answers was 1.8 ± 0.4 and mean completeness was 1.9 ± 0.3, which were both significantly greater than Google web search answers (P = .03 and P = .0003). Conclusions: ChatGPT-4 generated more accurate and complete responses to common patient questions about anterior cruciate ligament reconstruction than Google's search engine. Clinical Relevance: The use of artificial intelligence such as ChatGPT is expanding. It is important to understand the quality of information as well as how the results of ChatGPT queries compare with those from Google web searches.

Experimental development of lightweight manipulators with improved design cycle time that leverages off-the-shelf robotic arm components.

The growing market for lightweight robots inspires new use-cases, such as collaborative manipulators for human-centered automation. However, widespread adoption faces obstacles due to high R&D costs and longer design cycles, although rapid advances in mechatronic engineering have effectively narrowed the design space to affordable robot components, turning the development of lightweight robots into a component selection and integration challenge. Recognizing this transformation, we demonstrate a practical framework for designing lightweight industrial manipulators using a case-study of indigenously developed 5 Degrees-of-Freedom (DOF) cobot prototype. Our framework incorporates off-the-shelf sensors, actuators, gears, and links for Design for Manufacturing and Assembly (DFMA), along with complete virtual prototyping. The design cycle time is reduced by approximately 40% at the cost of cobot real-time performance deviating within 2.5% of the target metric. Our physical prototype, having repeatability of 0.05mm calculated as per the procedure defined in ISO 9283:1998, validates the cost-effective nature of the framework for creating lightweight manipulators, benefiting robotic startups, R&D organizations, and educational institutes without access to expensive in-house fabrication setups.

Defect-engineered dual Z-scheme core-shell MoS2/WO3-x/AgBiS2 for antibiotic and dyes degradation in photo and night catalysis: Mechanism and pathways.

Water pollution caused by antibiotics and synthetic dyes and imminent energy crises due to limited fossil fuel resources are issues of contemporary decades. Herein, we address them by enabling the multifunctionality in dual Z-scheme MoS2/WO3-x/AgBiS2 across photolysis, photo Fenton-like, and night catalysis. Defect, basal, and facet-engineered WO3-x is modified with MoS2 and AgBiS2, which extended its photoresponse from the UV-NIR region, inhibited carrier recombination, and reduced carrier transfer resistance. The electric field rearrangement leads to a flow of electrons from MoS2 and AgBiS2 to WO3-x and intensifies the electron population, which is crucial for night catalysis. When MoS2/WO3-x/AgBiS2 was employed against doxycycline hydrochloride (DOXH), it removed 95.65, 81.11, and 77.92 % of DOXH in 100 min during photo-Fenton (PFR), night-Fenton (NFR), and photocatalytic (PCR) reactions, respectively. It also effectively removed 91.91, 98.17, 99.01, and 98.99 % of rhodamine B (RhB), Congo red (CR), methylene blue (MB), and methylene orange (MO) in Fenton reactions, respectively. ESR analysis consolidates the ROS generation feature of MoS2/WO3-x/AgBiS2 using H2O2 with and without irradiation. This work provides a strategy to eliminate the deficiencies of WO3-x and is conducive to the evolution of applications seeking to combat environmental and energy crises.

Chemical Composition, Repellent, and Oviposition Deterrent Potential of Wild Plant Essential Oils against Three Mosquito Species.

In this study, the chemical composition, repellent, and oviposition deterrent effects of five plant essential oils (EOs) extracted from Lantana camara (Verbenaceae), Schinus terebinthifolia (Anacardiaceae), Callistemon viminalis (Myrtaceae), Helichrysum odoratissimum (Asteraceae), and Hyptis suaveolens (Lamiaceae) were evaluated against Aedes aegypti, Anopheles gambiae, and Culex quinquefasciatus. When tested at 33.3 µg/cm2, L. camara, S. terebinthifolia, C. viminalis, and H. odoratissimum were effective repellents against Ae. aegypti (89%, 91%, 90%, and 51% repellency, respectively), but they were less repellent against An. gambiae (66%, 86%, 59%, and 49% repellency, respectively). Interestingly, L. camara, S. terebinthifolia, C. viminalis, and H. odoratissimum exhibited 100% repellency against Cx. quinquefasciatus at 33.3 µg/cm2. In time-span bioassays performed at 333 µg/cm2, the EO of L. camara exhibited 100% repellence against Ae. aegypti and An. gambiae for up to 15 min and against Cx. quinquefasciatus for 75 min. The oviposition bioassays revealed that L. camara exhibited the highest activity, showing 85%, 59%, and 89% oviposition deterrence against Ae. aegypti, An. gambiae, and Cx. quinquefasciatus, respectively. The major compounds of L. camara, S. terebinthifolia, and C. viminalis were trans-ß-caryophyllene (16.7%), α-pinene (15.5%), and 1,8-cineole (38.1%), respectively. In conclusion, the L. camara and S. terebinthifolia EOs have the potential to be natural mosquito repellents.

Thrombocytopenia and Grading of Esophageal Varices in Patients With Chronic Liver Disease.

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson's correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 103 (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 103. Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 103. Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 103. These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades (P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices (r = -0.645, P < 0.000). Conclusions A negative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased.

Unusual Dzyaloshinskii-Moriya Interaction in Graphene/Fe3GeTe2 Van der Waals Heterostructure.

Dzyaloshinskii-Moriya interaction (DMI) is shown to induce a topologically protected chiral spin texture in magnetic/nonmagnetic heterostructures. In the context of van der Waals spintronic devices, graphene emerges as an excellent candidate material. However, due to its negligible spin-orbit interaction, inducing DMI to stabilize topological spins when coupled to 3d-ferromagnets remains challenging. Here, it is demonstrated that, despite these challenges, a sizeable Rashba-type spin splitting followed by significant DMI is induced in graphene/Fe3GeTe2. This is made possible due to an interfacial electric field driven by charge asymmetry together with the broken inversion symmetry of the heterostructure. These findings reveal that the enhanced DMI energy parameter, resulting from a large effective electron mass in Fe3GeTe2, remarkably contributes to stabilizing non-collinear spins below the Curie temperature, overcoming the magnetic anisotropy energy. These results are supported by the topological Hall effect, which coexists with the non-trivial breakdown of Fermi liquid behavior, confirming the interplay between spins and non-trivial topology. This work paves the way toward the design and control of interface-driven skyrmion-based devices.

Multifunctional magnetic tags with photocatalytic and enzyme-mimicking properties for constructing a sensitive dual-readout ELISA.

ELISA has become the gold standard for detecting harmful substances due to its specific antibody recognition and sensitive enzyme-catalyzed reactions. In this study, multifunctional magnetic Prussian blue nanolabels (MPBNs) were synthesized using a simple gentle two-step method to achieve a dual-readout mode. The MPBNs provide a sensitive colorimetric signal by efficiently catalyzing the oxidation of TMB and exhibit prominent photocatalytic degradation activity towards Rhodamine B (RhB). Supplemented by the quenching effect of oxTMB, the fluorescence was enabled to serve as a sensitive second signal. The magnetic property of the labels facilitates the separation and enrichment of the target, thereby improving sensitivity. Utilizing the versatile MPBNs, the visual limit of detection (vLOD) for Staphylococcus aureus is as low as 100 CFU/mL, with a quantitative analysis range of 102-108 CFU/mL. The introduction of photocatalytic reactions into immunoassay has opened up a new signal response system with strong momentum for development and application.

Glomus tumor of the foot dorsum: A case report of a neglect podiatric entity.

Key Clinical Message: Podiatrists and orthopedists should be vigilant for chronically evolving, hyperalgic soft lumps in the foot with vascular radiological features, prompting early detection of glomus tumor, timely mass removal, providing pain relief and improving patient's quality of life. Abstract: Glomus tumors refers to a rare group of benign perivascular neoplasms that originate from a neuromyoarterial structure called a glomus body. These tumors are characterized by their painful nature and predominant distribution in the extremities mainly the fingers, the hands and the feet. Nonetheless, the diagnosis is usually made after several years of symptoms experience as the lesions are mostly small, not palpable, and have variable presentations. Radiological workup especially with magnetic resonance imaging is very useful for diagnosing the tumoral process, however, confirmation can only be obtained by histological analysis. The treatment is purely surgical, and it is successful in most cases. Herein, we describe a case of glomus tumor of the foot dorsal side among a middle age male patient.

Generalized Bézier-like model and its applications to curve and surface modeling.

The subject matter of surfaces in computer aided geometric design (CAGD) is the depiction and design of surfaces in the computer graphics arena. Due to their geometric features, modeling of Bézier curves and surfaces with their shape parameters is the most well-liked topic of research in CAGD/computer-aided manufacturing (CAM). The primary challenges in industries such as automotive, shipbuilding, and aerospace are the design of complex surfaces. In order to address this issue, the continuity constraints between surfaces are utilized to generate complex surfaces. The parametric and geometric continuities are the two metrics commonly used for establishing connections among surfaces. This paper proposes continuity constraints between two generalized Bézier-like surfaces (gBS) with different shape parameters to address the issue of modeling and designing surfaces. Initially, the generalized form of C3 and G3 of generalized Bézier-like curves (gBC) are developed. To check the validity of these constraints, some numerical examples are also analyzed with graphical representations. Furthermore, for a continuous connection among these gBS, the necessary and sufficient G1 and G2 continuity constraints are also developed. It is shown through the use of several geometric designs of gBS that the recommended basis can resolve the shape and position adjustment problems associated with Bézier surfaces more effectively than any other basis. As a result, the proposed scheme not only incorporates all of the geometric features of curve design schemes but also improves upon their faults, which are typically encountered in engineering. Mainly, by changing the values of shape parameters, we can alter the shape of the curve by our choice which is not present in the standard Bézier model. This is the main drawback of traditional Bézier model.

Racial and Ethnic Disparities in Serious Illness Conversation Quality during the COVID-19 Pandemic.

CONTEXT: The COVID-19 pandemic disproportionately impacted non-Hispanic Black and Hispanic patients. However, little is known about the quality of serious illness communication in these communities during this time. OBJECTIVE: We aimed to determine whether racial and ethnic disparities manifested in serious illness conversations during the pandemic. METHODS: This was a retrospective, observational, cohort study of adult patients with a documented serious illness conversation from March 2020 to April 2021. Serious illness conversation documentation quality was assessed by counting the median number (IQR) of conversation domains and their elements included in the documentation. Domains included (1) values and goals, (2) prognosis and illness understanding, (3) end-of-life care planning, and (4) life-sustaining treatment preferences. A multivariable ordinal logistic regression analysis was conducted to assess associations between differences in serious illness documentation quality with patient race and ethnicity. RESULTS: Among 291 patients, 149 (51.2%) were non-Hispanic White; 81 (27.8%) were non-Hispanic Black; and 61 (21.0%) were Hispanic patients. Non-Hispanic Black patients were associated with fewer domains (OR 0.46 [95% CI 0.25, 0.84]; P=.01) included in their serious illness conversation documentation compared to non-Hispanic White patients. Both non-Hispanic Black (OR 0.35 [95% CI 0.20, 0.62]; P<.001) and Hispanic patients (OR 0.29 [95% CI 0.14, 0.58]; P<.001) were associated with fewer elements in the values and goals domain compared to non-Hispanic White patients in their serious illness documentation. CONCLUSION: During the COVID-19 pandemic, serious illness conversation documentation among non-Hispanic Black and Hispanic patients was less comprehensive compared to non-Hispanic White patients.

Transcription factor ZmDof22 enhances drought tolerance by regulating stomatal movement and antioxidant enzymes activities in maize (Zea mays L.).

KEY MESSAGE: The Dof22 gene encoding a deoxyribonucleic acid binding with one finger in maize, which is associated with its drought tolerance. The identification of drought stress regulatory genes is essential for the genetic improvement of maize yield. Deoxyribonucleic acid binding with one finger (Dof), a plant-specific transcription factor family, is involved in signal transduction, morphogenesis, and environmental stress responses. In present study, by weighted correlation network analysis (WGCNA) and gene co-expression network analysis, 15 putative Dof genes were identified from maize that respond to drought and rewatering. A real-time fluorescence quantitative PCR showed that these 15 genes were strongly induced by drought and ABA treatment, and among them ZmDof22 was highly induced by drought and ABA treatment. Its expression level increased by nearly 200 times after drought stress and more than 50 times after ABA treatment. After the normal conditions were restored, the expression levels were nearly 100 times and 40 times of those before treatment, respectively. The Gal4-LexA/UAS system and transcriptional activation analysis indicate that ZmDof22 is a transcriptional activator regulating drought tolerance and recovery ability in maize. Further, overexpressed transgenic and mutant plants of ZmDof22 by CRISPR/Cas9, indicates that the ZmDof22, improves maize drought tolerance by promoting stomatal closure, reduces water loss, and enhances antioxidant enzyme activity by participating in the ABA pathways. Taken together, our findings laid a foundation for further functional studies of the ZmDof gene family and provided insights into the role of the ZmDof22 regulatory network in controlling drought tolerance and recovery ability of maize.

Disseminated Cryptococcosis Post Eculizumab Therapy: A Case Report and Literature Review.

Eculizumab is a biologic medication used for the treatment of complement-related disorders including anti-acetylcholine receptor antibody-positive generalized myasthenia gravis. It targets C5 complement, preventing its cleavage into active terminal components. Thus, vaccination against encapsulated organisms is advised before starting this treatment. C5 also has a critical role against Cryptococcus neoformans infection. Here, we present a case of a 34-year-old man with a history of myasthenia gravis who was treated with prednisone and azathioprine in addition to eculizumab that was added to his regimen about a year ago, and who came to the hospital with headache, and was found to have Cryptococcus meningitis with disseminated cryptococcosis. The patient was negative for human immunodeficiency virus. He was treated with antifungal medications, and his condition improved. Although rarely reported, it is important to have a low threshold for diagnosis of cryptococcosis in patients on eculizumab given its complement inhibition mechanism of action.

Binary and ternary complex formation and characterization of artemisinin with sulfobutyl ether ß-cyclodextrin and oleic acid.

Drug-resistant malaria is a global risk to the modern world. Artremisinin (ART) is one of the drugs of choice against drug-resistant (malaria) which is practically insoluble in water. The objective of our study was to improve the solubility of artemisinin (ART) via development of binary complexes of ART with sulfobutylether ß-cyclodextrins (SBE7 ß-CD), sulfobutylether ß-cyclodextrins (SBE7 ß-CD) and oleic acid (ternary complexes). These are prepared in various drugs to excipients ratios by physical mixing (PM) and solvent evaporation (SE) methods. Characterizations were achieved by powder X-ray diffraction (PXRD), scanning electron microscopy (SEM) and attenuated total reflectance Fourier Transform Infrared (ATR-FTIR) spectroscopy. The aqueous-solubility in binary complexes was 12-folds enhanced than ternary complexes. Dissolution of binary and ternary complexes of artemisinin in simulated gastric fluid (pH 1.6) was found highest and 35 times higher for ternary SECx. The crystallinity of artemisinin was decreased in physical mixtures (PMs) while SECx exhibited displaced angles. The attenuated-intensity of SECx showed least peak numbers with more displaced-angles. SEM images of PMs and SECx showed reduced particle size in binary and ternary systems as compared to pure drug-particles. ATR-FTIR spectra of binary and ternary complexes revealed bonding interactions among artemisinin, SBE7 ß-CD and oleic acid.

An efficient computational scheme for solving coupled time-fractional Schrödinger equation via cubic B-spline functions.

The time fractional Schrödinger equation contributes to our understanding of complex quantum systems, anomalous diffusion processes, and the application of fractional calculus in physics and cubic B-spline is a versatile tool in numerical analysis and computer graphics. This paper introduces a numerical method for solving the time fractional Schrödinger equation using B-spline functions and the Atangana-Baleanu fractional derivative. The proposed method employs a finite difference scheme to discretize the fractional derivative in time, while a θ-weighted scheme is used to discretize the space directions. The efficiency of the method is demonstrated through numerical results, and error norms are examined at various values of the non-integer parameter, temporal directions, and spatial directions.

Demonstration of the synergistic effect of biochar and Trichoderma harzianum on the development of Ralstonia solanacearum in eggplant.

Soil degradation has been accelerated by the use of chemical pesticides and poor agricultural practices, which has had an impact on crop productivity. Recently, there has been a lot of interest in the use of eco-friendly biochar applications to enhance soil quality and sequester carbon in sustainable agriculture. This study aimed to determine the individual and combined effects of Leaf Waste Biochar (LWB) and the bio-control agent Trichoderma harzianum (BCA) on the development of bacterial wilt in eggplants (Solanum melongena) caused by Ralstonia solanacearum (RS). The effects of LWB and BCA on eggplant physiology and defense-related biochemistry were comprehensively examined. Inoculated (+RS) and un-inoculated (-RS) eggplants were grown in potting mixtures containing 3% and 6% (v/v) LWB, both with and without BCA. The percentage disease index was considerably reduced (90%) in plants grown in the 6% LWB+ BCA amended treatments. Moreover, the plants grown in LWB and inoculated with BCA had higher phenolics, flavonoids and peroxidase contents compared to the non-amended control. The level of NPK was significantly increased (92.74% N, 76.47% P, 53.73% K) in the eggplants cultivated in the 6% LWB + BCA composition. This study has shown that the association of T. harzianum with biochar improved plant growth and reduced R. solanacearum induced wilt. Furthermore, the combined impact of biochar and T. harzianum was greater in terms of wilt suppression and increase in plant physiological measurements when the biochar concentration was 6%. Biochar and bio-control agents triggered biochemical alterations, thus enhancing the management of disease-infested soils.

Solution of time-fractional gas dynamics equation using Elzaki decomposition method with Caputo-Fabrizio fractional derivative.

In this article, Elzaki decomposition method (EDM) has been applied to approximate the analytical solution of the time-fractional gas-dynamics equation. The time-fractional derivative is used in the Caputo-Fabrizio sense. The proposed method is implemented on homogenous and non-homogenous cases of the time-fractional gas-dynamics equation. A comparison between the exact and approximate solutions is also provided to show the validity and accuracy of the technique. A graphical representation of all the retrieved solutions is shown for different values of the fractional parameter. The time development of all solutions is also represented in 2D graphs. The obtained results may help understand the physical systems governed by the gas-dynamics equation.