Machine learning-based prognostic model for 30-day mortality prediction in Sepsis-3.

BACKGROUND: Sepsis poses a critical threat to hospitalized patients, particularly those in the Intensive Care Unit (ICU). Rapid identification of Sepsis is crucial for improving survival rates. Machine learning techniques offer advantages over traditional methods for predicting outcomes. This study aimed to develop a prognostic model using a Stacking-based Meta-Classifier to predict 30-day mortality risks in Sepsis-3 patients from the MIMIC-III database. METHODS: A cohort of 4,240 Sepsis-3 patients was analyzed, with 783 experiencing 30-day mortality and 3,457 surviving. Fifteen biomarkers were selected using feature ranking methods, including Extreme Gradient Boosting (XGBoost), Random Forest, and Extra Tree, and the Logistic Regression (LR) model was used to assess their individual predictability with a fivefold cross-validation approach for the validation of the prediction. The dataset was balanced using the SMOTE-TOMEK LINK technique, and a stacking-based meta-classifier was used for 30-day mortality prediction. The SHapley Additive explanations analysis was performed to explain the model's prediction. RESULTS: Using the LR classifier, the model achieved an area under the curve or AUC score of 0.99. A nomogram provided clinical insights into the biomarkers' significance. The stacked meta-learner, LR classifier exhibited the best performance with 95.52% accuracy, 95.79% precision, 95.52% recall, 93.65% specificity, and a 95.60% F1-score. CONCLUSIONS: In conjunction with the nomogram, the proposed stacking classifier model effectively predicted 30-day mortality in Sepsis patients. This approach holds promise for early intervention and improved outcomes in treating Sepsis cases.

Wastewater reuse and pharmaceutical pollution in agriculture: Uptake, transport, accumulation and metabolism of pharmaceutical pollutants within plants.

The presence of pharmaceutical pollutants in water sources has become a growing concern due to its potential impacts on human health and other organisms. The physicochemical properties of pharmaceuticals based on their intended therapeutical application, which include antibiotics, hormones, analgesics, and antidepressants, is quite diverse. Their presence in wastewater, sewerage water, surface water, ground water and even in drinking water is reported by many researchers throughout the world. Human exposure to these pollutants through drinking water or consumption of aquatic and terrestrial organisms has raised concerns about potential adverse effects, such as endocrine disruption, antibiotic resistance, and developmental abnormalities. Once in the environment, they can persist, undergo transformation, or degrade, leading to a complex mixture of contaminants. Application of treated wastewater, compost, manures or biosolids in agricultural fields introduce pharmaceutical pollutants in the environment. As pharmaceuticals are diverse in nature, significant differences are observed during their uptake and accumulation in plants. While there have been extensive studies on aquatic ecosystems, the effect on agricultural land is more disparate. As of now, there are few reports available on the potential of plant uptake and transportation of pharmaceuticals within and between plant organs. This review summarizes the occurrence of pharmaceuticals in aquatic water bodies at a range of concentrations and their uptake, accumulation, and transport within plant tissues. Research gaps on pharmaceutical pollutants' specific effect on plant growth and future research scopes are highlighted. The factors affecting uptake of pharmaceuticals including hydrophobicity, ionization, physicochemical properties (pKa, logKow, pH, Henry's law constant) are discussed. Finally, metabolism of pharmaceuticals within plant cells through metabolism phase enzymes and plant responses to pharmaceuticals are reviewed.

Anti-cancer property and DNA binding interaction of first row transition metal complexes: A decade update.

Metal ions carry out a wide variety of functions, including acid-base/redox catalysis, structural functions, signaling, and electron transport. Understanding the interactions of transition metal complexes with biomacromolecules is essential for biology, medicinal chemistry, and the production of synthetic metalloenzymes. After the coincidental discovery of cisplatin, importance of the metal complexes in biochemistry became a top priority for inquiry. In this review, a decade update on various synthetic strategies to first row transition metal complex and their interaction with DNA through non-covalent binding are explored. Moreover, this effort provides an excellent analysis on the efficacy of theoretical and practical approaches to the systematic generation of new non-platinum based metallodrugs for anti-cancer therapeutics.

Bioenzyme mediated hydrodistillation (BMHD) for extraction of mint oil from mentha leaves: improvement in yield and menthol content.

The present study optimized pre-treatment conditions for bioenzyme-mediated hydro-distillation (BMHD) for extraction of mint oil from mentha leaves and the results were compared with those of traditional hydro-distillation (HD) method using response surface methodology. The bio-enzymes produced from moringa leaves had maximum pectinase activity (287.04 µg of sugar/min/ml) followed by xylanase (87.78 µg of sugar/min/ml) while endoglucanase, exoglucanase and amylase activities were comparatively low. The optimized conditions for HD were 69.08 temperature for 173.70 min with water:sample of 10.0. The optimized conditions for enzyme pre-treatment of mentha leaves by BMHD were enzyme concentration of 8%, for a period of 120 min at an incubation period of 40 â„ƒ. The yield (%) and menthol content (%) of the oil at optimized conditions by HD were 1.55 ml/100 g of sample and 56.40% menthol content, respectively, and for BMHD the yield and menthol content (%) of the oil at optimized conditions were 3.69% and 72.80%, respectively. It was found that BMHD leads to a 130% increase in the yield of mint oil and a 10% increase in menthol content as compared to the HD method. No significant difference in physical parameters was observed in mint oil extracted via both methods. Therefore, BMHD is a cost-effective and sustainable approach having an edge over the HD method without compromising the quality and could be a viable approach for commercial purposes.

Infusion of active compound into sliced button mushrooms through vacuum impregnation to improve functionality: Comparing response surface methodology and artificial neural network.

The present study explores the infusion of active compounds (ascorbic acid and calcium lactate) into sliced button mushrooms (Agaricus bisporus) to increase the nutritional value and reduce the browning effect of sliced mushrooms using the vacuum impregnation (VI) technique. The aim was to functionalize the vacuum-infused sliced mushrooms and evaluate the physicochemical properties of button mushrooms for diversifying food use. The central composite design was implemented to determine the optimized condition for the process with four independent factors, that is, immersion time (IT) 30-90 min, solution temperature (ST) 35-55°C, solution concentration (SC) 4%-12%, and vacuum pressure (VP) 50-170 mbar. The optimum VI processes obtained were ST-40°C, SC-8%, VP-140 mbar, and IT-65 min with a desirability function of 0.77. Statistically, two models (response surface methodology [RSM] and artificial neural network [ANN]) were employed to compare the better performance for the prediction of VI operational process parameters. The RSM model showed a better prediction of VI process parameters than the ANN model, with a higher R2 value (0.9228 vs. 0.8160) and lower root mean square error value (1.4004 vs. 2.1751), χ2 (2.4491 vs. 5.2762), mean absolute error (1.1177 vs. 1.1611), and absolute average deviation (4.3532 vs. 5.6746) for water loss. A similar pattern was observed for solute gain, ascorbic acid, titratable acidity, color change, firmness, and pH. Therefore, the VI process was found to be an effective method for enhancing the nutritional properties of sliced mushrooms. These findings concluded that the RSM model is more efficient for better prediction with good accuracy of the VI process than the ANN model.

Synthetic access to diverse thiazetidines via a one-pot microwave assisted telescopic approach and their interaction with biomolecules.

A one-pot microwave assisted telescopic approach is reported for the chemo-selective synthesis of substituted 1,3-thiazetidines using readily available 2-aminopyridines/pyrazines/pyrimidine, substituted isothiocyanates and 1,2-dihalomethanes. The procedure involves thiourea formation from 2-aminopyridines/pyrazines/pyrimidine with the substituted isothiocyanates followed by a base catalysed nucleophilic attack of the CS bond on the 1,2-dihalomethane. Subsequently, a cyclization reaction occurs to yield substituted 1,3-thiazetidines. These four membered strained ring systems are reported to possess broad substrate scope with high functional group tolerance. The above synthetic sequence for the formation of four membered heterocycles is proven to be a modular and straightforward approach. Further the mechanistic pathway for the formation of 1,3-thiazetidines was supported by computational evaluations and X-ray crystallography analyses. The relevance of these thiazetidines in biological applications is evaluated by studying their ability to bind bio-macromolecules like proteins and nucleic acids.

Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia.

South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).

Optimization of foaming process for development of modified aloe polysaccharide (MAP) juice and powder using foam-mat drying.

The present study was performed to optimize the modified aloe polysaccharide (MAP) foaming process and to determine the effect of drying process parameters on the quality of obtained MAP powder. The studied process parameters were glycerol monostearate (GMS), carboxymethyl cellulose (CMC), and whipping time (WT) which was varied between 1 and 4% w/v, 0.1-0.5% w/v, and 1-5 min, respectively. The optimized values of foaming process parameters were 3.87% GMS, 0.39% CMC, and 4.89 min WT with a desirability of 0.889. The optimized foamed MAP juice was dried at different foam thicknesses (FT) (1, 3, and 5 mm) and drying temperatures (DT) (50, 60, and 70 °C) to develop MAP powder and compared with non-foamed aloe powder developed under the same drying condition. Based on functional properties, the best GMS foamed MAP powder was achieved at 50 °C DT and 1 mm FT, recording powder yield (16%), solubility (20.85%), and polysaccharide content (282 mg/L). Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-023-01354-6.

Safety and durable immunogenicity of the TV005 tetravalent dengue vaccine, across serotypes and age groups, in dengue-endemic Bangladesh: a randomised, controlled trial.

BACKGROUND: Morbidity and mortality from dengue virus (DENV) is rapidly growing in the large populations of south Asia. Few formal evaluations of candidate dengue vaccine candidates have been undertaken in India, Pakistan, or Bangladesh. Tetravalent vaccines must be tested for safety and immunogenicity in all age groups and in those previously exposed and naive to DENV infections. TV005 is a live, attenuated tetravalent dengue vaccine. We evaluated the safety and immunogenicity of a single dose of TV005 across age groups in dengue-endemic Bangladesh. METHODS: We performed a randomised, placebo-controlled age de-escalating clinical trial of TV005 at a single clinical site in dengue-endemic Dhaka, Bangladesh, following a technology transfer from the USA. Healthy (as determined by history, clinical examination, and safety laboratory test results) volunteers aged 1-50 years were randomly assigned 3:1 (stratified by four age groups) to receive a single dose of TV005 vaccine or placebo. Participants were followed up for 3 years. The study was double blind and was unmasked at day 180; outcome assessors, clinic staff, and volunteers remained blind throughout. Primary outcomes were safety, evaluated per-protocol as proportion of volunteers with solicited related adverse events of any severity through 28 days post dosing, and post-vaccination seropositivity by day 180 using serotype-specific neutralising antibodies (PRNT50 ≥10). Secondary outcomes included viremia, impact of past dengue exposure, and durability of antibody responses. This study is registered with Clinicaltrials.gov, NCT02678455, and is complete. FINDINGS: Between March 13, 2016, and Feb 14, 2017, 192 volunteers were enrolled into four age groups (adults [18-50 years; 20 male and 28 female], adolescents [11-17 years; 27 male and 21 female], children [5-10 years; 15 male and 33 female], and young children [1-4 years; 29 male and 19 female]) with 48 participant per group. All participants were Bangladeshi. Vaccination was well tolerated and most adverse events were mild. Rash was the most common vaccine-associated solicited adverse event, in 37 (26%) of 144 vaccine recipients versus six (12%) of 48 placebo recipients; followed by fever in seven (5% of 144) and arthralgias in seven (6% of 108), which were only observed in vaccine recipients. Post-vaccine, volunteers of all ages (n=142) were seropositive to most serotypes with 118 (83%) seropositive to DENV 1, 141 (99%) to DENV 2, 137 (96%) to DENV 3, and 124 (87%) to DENV 4, overall by day 180. Post-vaccination, viraemia was not consistently found and antibody titres were higher (10-15-fold for DENV 1-3 and 1·6-fold for DENV 4) in individuals with past dengue exposure compared with the dengue-naive participants (DENV 1 mean 480 [SD 4·0] vs 32 [2·4], DENV 2 1042 [3·2] vs 105 [3·1], DENV 3 1406 [2·8] vs 129 [4·7], and DENV 4 105 [3·3] vs 65 [3·1], respectively). Antibody titres to all serotypes remained stable in most adults (63-86%) after 3 years of follow-up. However, as expected for individuals without past exposure to dengue, titres for DENV 1, 3, and 4 waned by 3 years in the youngest (1-4 year old) cohort (69% seropositive for DENV 2 and 22-28% seropositive for DENV 1, 3, and 4). INTERPRETATION: With 3 years of follow-up, the single-dose tetravalent dengue vaccine, TV005, was well tolerated and immunogenic for all four serotypes in young children to adults, including individuals with no previous dengue exposure. FUNDING: National Institutes of Health-National Institute of Allergy and Infectious Diseases Intramural Research Program and Johns Hopkins University. TRANSLATION: For the Bangla translation of the abstract see Supplementary Materials section.

Validation of a risk prediction model for COVID-19: the PERIL prospective cohort study.

Aim: This study aims to perform an external validation of a recently developed prognostic model for early prediction of the risk of progression to severe COVID-19. Patients & methods/materials: Patients were recruited at their initial diagnosis at two facilities within Hamad Medical Corporation in Qatar. 356 adults were included for analysis. Predictors for progression of COVID-19 were all measured at disease onset and first contact with the health system. Results: The C statistic was 83% (95% CI: 78%-87%) and the calibration plot showed that the model was well-calibrated. Conclusion: The published prognostic model for the progression of COVID-19 infection showed satisfactory discrimination and calibration and the model is easy to apply in clinical practice.d.

Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region.

INTRODUCTION: There is limited evidence on the associations between economic and social disparities in the Eastern Mediterranean region (EMR) with COVID-19 infections and deaths. This study aims to investigate the relationship between income inequalities using Gini coefficients and COVID-19 cases and deaths per million population in the EMR countries. METHODS: Country-level data on monthly COVID-19 cases and deaths between March 2020 and October 2021, along with data on selected confounders, were collected from publicly available databases. Mixed-effect negative binomial and inverse hyperbolic sine transformation regressions were estimated to examine the association. RESULTS: The study showed that, in the EMR, a unit increase in Gini coefficient is associated with approximately 7.2% and 3.9% increase in COVID-19 cases and deaths per million population, respectively. The magnitude and direction of the association between income inequality and COVID-19 cases and deaths per-million population still remain the same after excluding four warzone countries from the analysis. CONCLUSION: This increase in COVID-19 cases and deaths is underpinned by the fact that a large number of the population in the region is living in conditions of poverty, with inadequate housing, comorbidities and limited or virtually no access to essential healthcare services. Healthcare policy-makers across countries in the region need to implement effective interventions in areas of income inequality, where it may be linked to increasing the risk of COVID-19 cases and deaths.

COVID-19 and beyond: leveraging artificial intelligence for enhanced outbreak control.

COVID-19 has brought significant changes to our political, social, and technological landscape. This paper explores the emergence and global spread of the disease and focuses on the role of Artificial Intelligence (AI) in containing its transmission. To the best of our knowledge, there has been no scientific presentation of the early pictorial representation of the disease's spread. Additionally, we outline various domains where AI has made a significant impact during the pandemic. Our methodology involves searching relevant articles on COVID-19 and AI in leading databases such as PubMed and Scopus to identify the ways AI has addressed pandemic-related challenges and its potential for further assistance. While research suggests that AI has not fully realized its potential against COVID-19, likely due to data quality and diversity limitations, we review and identify key areas where AI has been crucial in preparing the fight against any sudden outbreak of the pandemic. We also propose ways to maximize the utilization of AI's capabilities in this regard.

Iodoxybenzoic Acid (IBX) in Organic Synthesis: A Septennial Review.

This study reviews the oxidative applications of 2-iodoxybenzoic acid (IBX) in organic synthesis, focusing on C-H functionalization, hetero-hetero bond formations, ring cleavage reactions, dehydrogenation, heterocyclic ring formations, and some miscellaneous reactions in a comprehensive and critical way. It compiles the literature starting from mid-2015 to date.

Synthesis of potent MDA-MB 231 breast cancer drug molecules from single step.

We have prepared novel potent breast cancer drug molecules from non-toxic and inexpensive method. Column chromatography is not necessary for purification of target molecules. The value of overall atom economy, environmental factor, environmental catalyst and product mass intensity gives additional merits for this synthetic method. Synthesized flexible dimeric imidazolium bromides showed less toxicity and gives excellent anticancer response against normal mammary epithelial cells. Novel dimeric pyridinium bromides showed excellent anticancer response against tested cancer cell lines. In cell cycle, novel flexible dimeric pyridinium bromides showed significant arrest in the G2/M phase by nearly three folds, when compared with control drug. We have studied the targeting epidermal growth factor receptor for all the synthesized flexible amino substituted and methyl substituted dimeric pyridinium bromides.

Application of thermosonication for guava juice processing: Impacts on bioactive, microbial, enzymatic and quality attributes.

The present work explores different conditions of thermosonication (TS) processing that would ensure microbiological and enzymatic safety for guava juice while simultaneously maximizing the preservation of its quality attributes. The guava juice was subjected to TS treatment (frequency: 40 kHz; power: 200 W; Temperature: 40, 60, and 80 °C; Time: 2, 6 and 10 min) and was compared with fresh and pasteurized (90 °C/60 s) juice samples. The objectives of the research work were to determine the effect of thermosonication on the quality attributes such as total soluble solids (TSS), pH, titratable acidity, cloud value, color attributes, total phenolic contents, total flavonoid contents, antioxidant activity, ascorbic acid levels, enzymatic, microbiological, and sensory properties. The thermosonicated and pasteurized samples showed no significant (p > 0.05) changes in pH, total soluble solids, and titratable acidity. TS improved the cloud value and color attributes. Furthermore, TS enhanced total phenols (10 to17%), flavonoids (5 to 25%), antioxidant activity (10.45% to 14.55%) and retention of ascorbic acid (61.98-83.32%) relative to control. Thermosonicated sample at 80 °C/10 min gives the maximum inactivation of Pectin methyl esterase (PME), Peroxidase (POD) and Polyphenol oxidase (PPO) enzymes. While both thermosonication and pasteurization drastically decreased the microbial count to undetectable levels, only TS exhibited modest improvement in sensory qualities. The results demonstrated that TS can enhance the overall safety, quality, and commercial viability of guava juice as a practical substitute to pasteurization.

Investigation of Acinetobacter baumannii Outbreak in a Burn Unit Revealed a Surprising Environmental Source.

We describe an outbreak of Acinetobacter baumannii in a 15-bed regional burn unit in an academic tertiary care medical center, and the investigations and control measures used to halt the outbreak are described. Nine cases of A. baumannii were reported in our burn unit in a one-year period, which was higher than our expected number of two-three cases per year. Our burn unit director requested an outbreak investigation, and our hospital's infection control department investigated thoroughly and found a source for that outbreak, which was never reported as a source in the previous literature. We identified table fans as the source of this outbreak. We then developed a strict fan policy, and after implementation of the policy, and terminal cleaning of rooms, only two cases per year of A. baumannii were reported in the next three-year period. We concluded that the table fans were colonized with A. baumannii and since they were used interchangeably in all patient rooms, caused this outbreak. There are no specific joint commission guidelines for the use of fans in hospitals. While fans can be used for the comfort of the patient, we should be cautious not to spread infections.

Metal-Oxides- and Metal-Oxyhydroxides-Based Nanocomposites for Water Splitting: An Overview.

Water electrolysis is an important alternative technology for large-scale hydrogen production to facilitate the development of green energy technology. As such, many efforts have been devoted over the past three decades to producing novel electrocatalysis with strong electrochemical (EC) performance using inexpensive electrocatalysts. Transition metal oxyhydroxide (OxH)-based electrocatalysts have received substantial interest, and prominent results have been achieved for the hydrogen evolution reaction (HER) under alkaline conditions. Herein, the extensive research focusing on the discussion of OxH-based electrocatalysts is comprehensively highlighted. The general forms of the water-splitting mechanism are described to provide a profound understanding of the mechanism, and their scaling relation activities for OxH electrode materials are given. This paper summarizes the current developments on the EC performance of transition metal OxHs, rare metal OxHs, polymers, and MXene-supported OxH-based electrocatalysts. Additionally, an outline of the suggested HER, OER, and water-splitting processes on transition metal OxH-based electrocatalysts, their primary applications, existing problems, and their EC performance prospects are discussed. Furthermore, this review article discusses the production of energy sources from the proton and electron transfer processes. The highlighted electrocatalysts have received substantial interest to boost the synergetic electrochemical effects to improve the economy of the use of hydrogen, which is one of best ways to fulfill the global energy requirements and address environmental crises. This article also provides useful information regarding the development of OxH electrodes with a hierarchical nanostructure for the water-splitting reaction. Finally, the challenges with the reaction and perspectives for the future development of OxH are elaborated.

Bangladesh in the era of malaria elimination.

Bangladesh has dramatically reduced malaria by 93% from 2008 to 2020. The strategy has been district-wise, phased elimination; however, the last districts targeted for elimination include remote, forested regions which present several challenges for prevention, detection, and treatment of malaria. These districts border Myanmar which harbors Plasmodium falciparum malaria parasites resistant to artemisinins, key drugs used in artemisinin-based combination therapies (ACTs) that have been vital for control programs. Challenges in monitoring emergence of artemisinin resistance (AR), tracking parasite reservoirs, changes in vector behavior and responses to insecticides, as well as other environmental and host factors (including the migration of Forcibly Displaced Myanmar Nationals; FDMNs) may pose added hazards in the final phase of eliminating malaria in Bangladesh.

Extreme Concentrations of Nitric Oxide Control Daytime Oxidation and Quench Nocturnal Oxidation Chemistry in Delhi during Highly Polluted Episodes.

Delhi, India, suffers from periods of very poor air quality, but little is known about the chemical production of secondary pollutants in this highly polluted environment. During the postmonsoon period in 2018, extremely high nighttime concentrations of NOx (NO and NO2) and volatile organic compounds (VOCs) were observed, with median NOx mixing ratios of ∼200 ppbV (maximum of ∼700 ppbV). A detailed chemical box model constrained to a comprehensive suite of speciated VOC and NOx measurements revealed very low nighttime concentrations of oxidants, NO3, O3, and OH, driven by high nighttime NO concentrations. This results in an atypical NO3 diel profile, not previously reported in other highly polluted urban environments, significantly perturbing nighttime radical oxidation chemistry. Low concentrations of oxidants and high nocturnal primary emissions coupled with a shallow boundary layer led to enhanced early morning photo-oxidation chemistry. This results in a temporal shift in peak O3 concentrations when compared to the premonsoon period (12:00 and 15:00 local time, respectively). This shift will likely have important implications on local air quality, and effective urban air quality management should consider the impacts of nighttime emission sources during the postmonsoon period.

Sample Size Calculations in Simple Linear Regression: A New Approach.

The problem tackled is the determination of sample size for a given level and power in the context of a simple linear regression model. The standard approach deals with planned experiments in which the predictor X is observed for a number n of times and the corresponding observations on the response variable Y are to be drawn. The statistic that is used is built on the least squares' estimator of the slope parameter. Its conditional distribution given the data on the predictor X is utilized for sample size calculations. This is problematic. The sample size n is already presaged and the data on X is fixed. In unplanned experiments, in which both X and Y are to be sampled simultaneously, we do not have data on the predictor X yet. This conundrum has been discussed in several papers and books with no solution proposed. We overcome the problem by determining the exact unconditional distribution of the test statistic in the unplanned case. We have provided tables of critical values for given levels of significance following the exact distribution. In addition, we show that the distribution of the test statistic depends only on the effect size, which is defined precisely in the paper.