Entropy-driven nonequilibrium phonon-stimulated electron-phonon coupling in tin dioxide nanorods.

Nonequilibrium (NEQ) phonon fluctuation in a nanosystem has been studied through the statistical assessment of the entropy-production and -consumption events in ultrasmall tin dioxide (SnO_{2}) nanorods. Size- and shape-dependent alteration in free energy leading to modulation of the probability distribution function of the phonon dynamics has been observed from the x-ray diffraction and Raman scattering characterizations. The Gallavotti-Cohen nonequilibrium fluctuation theorem has been utilized to qualitatively describe the aforementioned behaviors under the influence of a global flux. The observation of entropy consumption and thermodynamically favorable entropy-production events indicates the presence of NEQ fluctuations in the phonon modes. The effective energy scale of fluctuation in driven phonon modes, dissipating energy faster than relaxation time, is quantified on the order of nanojoules. From optical absorption and photoluminescence studies, the observation of the electron-phonon coupled state confirms the interaction of the NEQ phonons with electrons. The strength of the coupling has been estimated from the temperature-independent Barry center shift and found to be enhanced to 5.35. Valence band x-ray photoelectron spectroscopy and Fourier transformed infrared spectroscopy analyses reconcile NEQ phonon mediated alteration of the valence band density of states, activation of silent phonon modes, and superior excitonic transitions, suitable for the new generation of ultrafast quantum device applications.

Observation of non-equilibrium fluctuation in the shear-stress-driven hemoglobin aggregates.

Non-equilibrium fluctuations caused by the rearrangement of hemoglobin molecules into an aggregate state under shear stress have been investigated experimentally. The flow response under the shear stress (σ) corroborates the presence of contrasting aggregate and rejuvenation states governed by entropy production and consumption events. From the time-dependent shear rate fluctuation studies of aggregate states, the probability distribution function (PDF) of the rate of work done is observed to be spread from negative to positive values with a net positive mean. The PDFs follow the steady-state fluctuation theorem, even at a smaller timescale than that desired by the theorem. The behavior of the effective temperature (Teff) that emerges from a non-equilibrium fluctuation and interconnects with the structural restrictions of the aggregate state of our driven system is observed to be within the boundary of the thermodynamic uncertainty. The increase in Teff with the applied σ illustrates a phenomenal nonlinear power flux-dependent aggregating behavior in a classic bio-molecular-driven system.

Culprit vessel only versus complete revascularization following thrombolysis in patients with ST elevation myocardial infraction and multivessel coronary artery disease - A prospective study.

OBJECTIVE: The present study compares the treatment outcomes of only culprit vessel PCI and complete revascularization in patients with STEMI and multivessel disease (MVD) following thrombolysis. METHODS: This was a single-center, prospective randomized study including a total of 108 patients presenting at a tertiary care center within 3-24 h post-thrombolysis and undergoing pharmacoinvasive PCI, and randomized into two groups: complete revascularization PCI group and culprit only PCI group. The primary outcomes were evaluated by cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina. The secondary outcomes include repeat revascularization and safety outcomes namely contrast induced nephropathy (CIN), cerebrovascular accident (CVA) and major bleeding were compared among both the groups at one year follow-up. RESULTS: Complete revascularization PCI group and culprit only PCI group had 54 patients in each group. Left ventricular ejection fraction did not show significant difference at discharge (p = 1) but was significantly improved in complete revascularization PCI group (p = 0.001) at one year follow-up. Reduced number of outcomes with a significant difference in both the groups were seen for primary outcomes such as cardiac mortality (p = 0.01), repeat MI/ACS (p = 0.01) and refractory angina (p = 0.038) along with repeat revascularization (p = 0.001) at one year follow-up. Complete revascularization did not show any statistically significant difference for CIN (p = 0.567), CVA (p = 0.153) and major bleeding (p = 0.322) then culprit only revascularization group. CONCLUSION: In patients with STEMI and MVD, complete revascularization was found more favourable in terms of primary and secondary outcomes compared to culprit only revascularization.

Impact of long-term resource conservation techniques on biogeochemical characteristics and biological soil quality indicators in a rice green-gram farming system.

Nutrient management in resource conservation practices influence the structural and functional microbial diversities and thereby affect biological processes and biochemical properties in soil. We studied the long-term effects of resource conservation technologies on functional microbial diversity and their interactions with soil biochemical properties and enzymatic activities in tropical rice-green gram cropping system. The experiment includes seven treatments viz., conventional practice (CC), brown manuring (BM), green manuring (GM), wet direct drum sowing, zero tillage, green manuring-customized leaf colour chart based-N application (GM-CLCC-N) and biochar (BC) application. The result of the present study revealed that microbial biomass nitrogen (N), carbon (C) and phosphorus (P) in GM practice were increased by 23.3, 37.7 and 35.1%, respectively than CC. GM, BM and GM-CLCC-N treatments provide higher yields than conventional practice. The average well color development value, Shannon index and McIntosh index were significantly higher by 26.6%, 86.9% and 29.2% in GM as compared to control treatment. So, from this study we can conclude that resource conservation practices like GM, GM-CLCC N and BM in combination with chemical fertilizers provide easily decomposable carbon source to support the microbial growth. Moreover, dominance of microbial activity in biomass amended treatments (GM, GM-CLCC N and BM) indicated that these treatments could supply good amount of labile C sources on real time basis for microbial growth that may protect the stable C fraction in soil, hence could support higher yield and soil organic carbon build-up in long run under rice-green gram soil.

Detection of faults and DG islanding in PV-Wind DC ring bus microgrid by using optimized VMD based improved broad learning system.

This paper presents a novel approach for the detection and classification of photovoltaic with wind based DC ring bus microgrid DC faults and DG (distributed generation) islanding events. This novel approach consists of adaptive variational mode decomposition (AVMD) and an improved broad learning system (IBLS). Initially, DC fault current signals are captured from the DC bus under different operating conditions and processed through the AVMD to decompose the signals into intrinsic mode functions (IMFs). The VMD is made adaptive by minimizing the objective function of the L-kurtosis index for optimal modal number (K) and penalty factor (σ) through the improved whale optimization (IWO) algorithm. From the optimal IMFs, the most significant IMFs are chosen based on the threshold of the L-kurtosis index, and they are passed through statistical features to extract efficient data. Further, the training and testing of this data set is carried out through IBLS for obtaining the accurate detection and discrimination of DC faults. The conventional BLS method is improved through elastic net ridge regression for calculating the weights. The effectiveness of the proposed AVMD based IBLS algorithm is verified by its superiority in terms of relative computation time (RCT), classification accuracy (CA) with the confusion matrix, and their performance indices by comparing with other existing methods under different case studies. Finally, the simplicity and practicability of the proposed work are tested and implemented in the dSPACE 1104 embedded processor.

Elucidation of dominant energy metabolic pathways of methane, sulphur and nitrogen in respect to mangrove-degradation for climate change mitigation.

Mangroves play a key role in ecosystem balancing and climate change mitigation. It acts as a source and sink of methane (CH4), a major greenhouse gas responsible for climate change. Energy metabolic pathways of methane production (methanogenesis) and oxidation (methanotrophy) are directly driven by sulphur (S) and nitrogen (N) metabolism and salinity in coastal wetlands. To investigate, how mangrove-degradations, affect the source-sink behaviour of CH4; the pathways of CH4, S and N were studied through whole-genome metagenomic approach. Soil samples were collected from degraded and undisturbed mangrove systems in Sundarban, India. Structural and functional microbial diversities (KEGG pathways) of CH4, S and N metabolism were analysed and correlated with labile carbon pools and physico-chemical properties of soil. Overall, the acetoclastic pathway of methanogenesis was dominant. However, the relative proportion of conversion of CO2 to CH4 was more in degraded mangroves. Methane oxidation was higher in undisturbed mangroves and the serine pathway was dominant. After serine, the ribulose monophosphate pathway of CH4 oxidation was dominant in degraded mangrove, while the xylulose monophosphate pathway was dominant in undisturbed site as it is more tolerant to salinity and higher pH. The assimilatory pathway (AMP) of S-metabolism was dominant in both systems. But in AMP pathway, adenosine triphosphate sulfurylase enzyme reads were higher in degraded mangrove, while NADPH-sulfite reductase abundance was higher in undisturbed mangrove due to higher salinity, and pH. In N-metabolism, the denitrification pathway was predominant in degraded sites, whereas the dissimilatory nitrate reduction pathway was dominant in undisturbed mangroves. The relative ratios of sulphur reducing bacteria (SRB): methanogens were higher in degraded mangrove; however, methanotrophs:methanogens was higher in undisturbed mangrove indicated lower source and greater sink capacity of CH4 in the system. Microbial manipulation in mangrove-rhizosphere for regulating major energy metabolic pathways of methane could open-up a new window of climate change mitigation in coastal wetlands.

Pulsatile flow in descending aorta: Can coarctation of aorta be ruled out by transesophageal echocardiography?

A 5-year-old child with L posed great arteries, large subpulmonic ventricular septal defect (VSD), atrial septal defect (ASD), and a large patent ductus arteriosus (PDA) with mild isthmic narrowing was scheduled for surgical correction. Intraoperatively, it was a case of anatomically corrected malposition of great arteries. Due to abnormal positioning of great vessels, the isthmus was ligated instead of the large PDA. The postoperative transesophageal echocardiography showed pulsatile flow in descending aorta as it was being filled by large PDA, and thus iatrogenic coarctation (CoA) was missed. It was detected in the intensive care unit due to the onset of acidosis on blood gas analysis and the presence of gradient between radial and femoral arterial line pressures. The patient was taken for redo surgery, the PDA was then ligated, resection of the isthmic narrowing and repair by end-to-end anastomosis was done.

Assessment of right ventricular systolic function by two dimensional speckle tracking echocardiography in rheumatic mitral valve disease.

We assessed the Right Ventricular (RV) systolic function using two dimensional (2D) speckle tracking echocardiography (STE) in Mitral valve disease before and after intervention. 90 patients divided into 3 groups of Mitral stenosis [MS], Mitral regurgitation [MR] and MS with MR were the study subjects. All the patients were subjected to conventional echocardiography and measurement of Right ventricular global longitudinal strain (RVGLS). Prior to intervention, subjects who demonstrated normal RV function by conventional methods, it was found that RVGLS was impaired significantly in the MS and MS with MR groups but normal in the MR group. After intervention, the RVGLS improved significantly in the MS group but not in the other groups. Right ventricular systolic pressure (RVSP) had a significant negative correlation to RVGLS in all 3 groups.

A unique bacterial and archaeal diversity make mangrove a green production system compared to rice in wetland ecology: A metagenomic approach.

Mangrove provides significant ecosystem services, however, 40% of tropical mangrove was lost in last century due to climate change induced sea-level rise and anthropogenic activities. Sundarban-India, the largest contiguous mangrove of the world lost 10.5% of its green during 1930-2013 which primarily converted to rice-based systems. Presently degraded mangrove and adjacent rice ecology in Sundarban-India placed side by side and create typical ecology which is distinct in nature in respect to soil physicochemical properties, carbon dynamics, and microbial diversities. We investigated the structural and functional diversities of bacteria and archaea through Illumina MiSeq metagenomic analysis using V3-V4 region of 16S rRNA gene approach that drives greenhouse gases emission and carbon-pools. Remote sensing-data base were used to select the sites for collecting the soil and gas samples. The methane and nitrous oxide emissions were lower in mangrove (-0.04 mg m-2 h-1 and -52.8 µg m-2 h-1) than rice (0.26 mg m-2 h-1 and 44.7 µg m-2 h-1) due to less availability of carbon-substrates and higher sulphate availability (85.8% more than rice). The soil labile carbon-pools were more in mangrove, but lower microbial activities were noticed due to stress conditions. A unique microbial feature indicated by higher methanotrophs: methanogens (11.2), sulphur reducing bacteria (SRB): methanogens (93.2) ratios and lower functional diversity (7.5%) in mangrove than rice. These could be the key drivers of lower global warming potential (GWP) in mangrove that make it a green production system. Therefore, labile carbon build-up potential (38%) with less GWP (63%) even in degraded-mangrove makes it a clean production system than wetland-rice that has high potential to climate change mitigation. The whole genome metagenomic analysis would be the future research priority to identify the predominant enzymatic pathways which govern the methanogenesis and methanotrophy in this system.

Multifuse multilayer multikernel RVFLN+ of process modes decomposition and approximate entropy data from iEEG/sEEG signals for epileptic seizure recognition.

In this paper, the extracted features using variational mode decomposition (VMD) and approximate entropy (ApEn) privileged information of the input EEG signals are combined with multilayer multikernel random vector functional link network plus (MMRVFLN+) classifier to recognize the epileptic seizure epochs efficaciously. In our experiment Bonn University single-channel intracranial electroencephalogram (iEEG) and Children's Hospital Boston-Massachusetts Institute of Technology (CHB-MIT) multichannel scalp EEG (sEEG) recordings are considered to evaluate the efficacy of the proposed method. The VMD is applied on chaotic, non-stationary, nonlinear, and complex EEG signal to decompose it into three band-limited intrinsic mode functions (BLIMFs). The Hilbert transform (HT) is applied on BLIMFs to extract informative spectral and temporal features. The ApEn is computed from the raw EEG signals as the privileged information and given to the multi-hidden layer structure to obtain the most discriminative compressed form. The scatter plots show the distinct nature of compressed privileged ApEn information among the seizure pattern classes. The linear as well as nonlinear mapping, local and global kernel function, high-learning speed, less computationally complex MMRVFLN+ classifier is proposed to recognize the seizure events accurately by importing the efficacious features with ApEn as the input. The advanced signal processing algorithm i.e., Hilbert Huang transform (HHT) with ApEn and MMRVFLN+ are combined to compare the performance with the proposed VMDHTApEn-MMRVFLN+ method. The proposed method has remarkable recognition ability, superior classification accuracy, and excellent overall performance as compared to other methods. The digital architecture of the multifuse MMRVFLN+ is developed and implemented on a high-speed reconfigurable FPGA hardware platform to validate the effectiveness of the proposed method. The superior classification accuracy, the negligible false positive rate per hour (FPR/h), simplicity, feasibility, robustness, and practicability of the proposed method validate its ability to recognize the epileptic seizure epochs automatically.

Aorto-left ventricular tunnel - A case report.

Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly with extracardiac channel connecting ascending aorta to the ventricle. It presents early in life due to congestive cardiac failure. We present a case of ALVT with unusual morphology in an 11-year-old male child with palpitations and dyspnea. We also describe the transesophageal echocardiography evaluation of ALVT.

Seasonal fluctuation in three mode of greenhouse gases emission in relation to soil labile carbon pools in degraded mangrove, Sundarban, India.

Tropical mangrove represents one of the most threatened ecosystems despite their huge contribution to ecosystem services, carbon (C) sequestration and climate change mitigation. Understanding the system in light of seasonal fluctuations on greenhouse gases (GHGs) emissions due to human interferences and the tidal effect is important for devising site-specific real-time climate change mitigation strategies. In order to capture the seasonal variations, the three modes of transport of GHGs through pneumatophore, ebullition as bubbles and water-soluble diffusion was quantified. The three unique techniques for the gas collection were used to estimate the GHGs [methane (CH4), nitrous oxide (N2O) and carbon dioxide (CO2)] emission, at three degraded-mangrove sites in Sundarban, India. We identified three degraded mangrove ecologies based on the remote sensing data of 1930 and 2013 (mangrove-covered area in Sundarban; 2387, 2136 km2, respectively). Samples were collected and analyzed for four seasons [winter (November-January), summer (February-April), pre-monsoon (May-June) and monsoon (July-October)], at three representative sites (Sadhupur, Dayapur, and Pakhiralaya). Monsoonal CH4 and CO2 fluxes (0.353 ± 0.026 and 64.5 ± 6.1 mmol m-2 d-1, respectively) were higher than winter and summer. However, the soil labile C pools showed the opposite trend i.e. more in summer followed by winter and monsoon. In contrast, the N2O fluxes were more during summer (54.2 ± 3.2 µmol m-2 d-1). The stagnant water had higher dissolved GHGs concentration compared to tidewater due to less salinity and a long time of stagnation. The mode of transport of GHGs through pneumatophore, ebullition, and water-soluble diffusion was also significantly varied with seasons, soil­carbon status and tidewater intrusion. Therefore, seasonal fluctuations of GHGs emission and tidal effect must be considered along with soil labile C pools for GHG-C budgeting and climate change mitigation in the mangrove ecosystem.

Steady expression of high oleic acid in peanut bred by marker-assisted backcrossing for fatty acid desaturase mutant alleles and its effect on seed germination along with other seedling traits.

Peanut (Arachis hypogaea L.) is an important nutrient-rich food legume and valued for its good quality cooking oil. The fatty acid content is the major determinant of the quality of the edible oil. The oils containing higher monounsaturated fatty acid are preferred for improved shelf life and potential health benefits. Therefore, a high oleic/linoleic fatty acid ratio is the target trait in an advanced breeding program. The two mutant alleles, ahFAD2A (on linkage group a09) and ahFAD2B (on linkage group b09) control fatty acid composition for higher oleic/linoleic ratio in peanut. In the present study, marker-assisted backcrossing was employed for the introgression of two FAD2 mutant alleles from SunOleic95R into the chromosome of ICGV06100, a high oil content peanut breeding line. In the marker-assisted backcrossing-introgression lines, a 97% increase in oleic acid, and a 92% reduction in linoleic acid content was observed in comparison to the recurrent parent. Besides, the oleic/linoleic ratio was increased to 25 with respect to the recurrent parent, which was only 1.2. The most significant outcome was the stable expression of oil-content, oleic acid, linoleic acid, and palmitic acid in the marker-assisted backcrossing-introgression lines over the locations. No significant difference was observed between high oleic and normal oleic in peanuts for seedling traits except germination percentage. In addition, marker-assisted backcrossing-introgression lines exhibited higher yield and resistance to foliar fungal diseases, i.e., late leaf spot and rust.

Association mapping reveals multiple QTLs for grain protein content in rice useful for biofortification.

Rice is the staple food for majority of the global population. But, rice grain has low protein content (PC). Mapping of QTLs controlling grain PC is essential for enhancement of the trait through breeding programs. A shortlisted panel population for grain protein content was studied for genetic diversity, population structure and association mapping for grain PC. Phenotyping results showed a wide variation for grain PC. The panel population showed a moderate level of genetic diversity estimated through 98 molecular markers. AMOVA and structure analysis indicated linkage disequilibrium for grain PC and deviation of Hardy-Weinberg's expectation. The analysis showed 15% of the variation among populations and 73% among individuals in the panel population. STRUCTURE analysis categorized the panel population into three subpopulations. The analysis also revealed a common primary ancestor for each subpopulation with few admix individuals. Marker-trait association using 98 molecular markers detected 7 strongly associated QTLs for grain PC by both MLM and GLM analysis. Three novel QTLs qPC3.1, qPC5.1 and qPC9.1 were detected for controlling the grain PC. Four reported QTLs viz., qPC3, QPC8, qPC6.1 and qPC12.1 were validated for use in breeding programs. Reported QTLs, qPC6, qPC6.1 and qPC6.2 may be same QTL controlling PC in rice. A very close marker RM407 near to protein controlling QTL, qProt8 and qPC8, was detected. The study provided clue for simultaneous improvement of PC with high grain yield in rice. The strongly associated markers with grain PC, namely qPC3, qPC3.1, qPC5.1, qPC6.1, qPC8, qPC9.1 and qPC12.1, will be useful for their pyramiding for developing protein rich high yielding rice.

Mechanism of plant mediated methane emission in tropical lowland rice.

Methane (CH4) is predominantly produced in lowland rice soil, but its emission from soil to atmosphere primarily depends on passage/conduit or capillary pore spaces present in rice plants. The gas transport mechanism through aerenchyma pore spaces of rice cultivars was studied to explore the plant mediated CH4 emission. Seven rice cultivars, based on the life cycle duration (LCD), were tested in tropical eastern India. Three LCD groups were, (a) Kalinga 1 and CR Dhan 204 (LCD: 110-120 days); (b) Lalat, Pooja and CR 1014 (LCD: 130-150 days); and (c) Durga and Varshadhan (LCD: 160-170 days). Rate of CH4emission, root exudates, root oxidase activities and shoot aerenchyma pore spaces were analyzed to study the mechanism of plant mediated emission from rice. Aerenchyma pore space was quantified in the hypothesis that it regulates the CH4 transportation from soil to atmosphere. The ratio of pore space area to total space was lowest in Kalinga 1 cultivar (0.29) and highest was in Varshadhan (0.43). Significant variations in the methane emission were observed among the cultivars with an average emission rate ranged from 0.86 mg m-2 h-1 to 4.96 mg m-2 h-1. The CH4 emission rates were lowest in short duration cultivars followed by medium and long duration ones. The greenhouse gas intensity considering average CH4 emission rate per unit grain yield was also lowest (0.35) in Kalinga 1 and relatively less in short and medium duration cultivars. Root exudation was higher at panicle initiation (PI) than maximum tillering (MT) stage. Lowest exudation was noticed in (197.2 mg C plant-1 day-1) Kalinga 1 and highest in Varsadhan (231.7 mg C plant-1 day-1). So we can say, the rate of CH4 emission was controlled by aerenchyma orientation, root exudation and biomass production rate which are the key specific traits of a cultivar. Identified traits were closely associated with duration and adaptability to cultivars grown in specific ecology. Therefore, there is possibility to breed rice cultivars depending on ecology, duration and having less CH4 emission potential, which could be effectively used in greenhouse gas mitigation strategies.

Simultaneous detection and serotyping of dengue infection using single tube multiplex CDC Dengue Real-Time RT-PCR from India.

Four antigenically different dengue virus serotypes (DENV-1, DENV-2, DENV-3 and DENV-4) are known to cause infections in humans. Some of these are known to cause more severe disease than the others. Chances for developing Dengue hemorrhagic fever-dengue shock syndrome (DHF-DSS) increases significantly with history of previous infection with one of the four serotypes. Therefore, early diagnosis, serotyping and providing early warning of dengue fever epidemics to concerned authorities becomes very important for better patient outcome and to curb the rapid spread in the community. During the 2014 outbreak, a total of 100 samples from suspected cases of dengue were collected. NS1 antigen based rapid test was used for serological diagnosis. Dengue complex one step reverse transcription-polymerase chain reaction was performed to look for presence of viral RNA. Single tube multiplex RT-PCR was also performed to look for infecting serotype. CDC Dengue Multiplex Real Time PCR assay was performed for rapid diagnosis and simultaneous serotyping of the dengue virus. Out of the 100 samples screened, 69 were found to be positive by NS1Ag Rapid test. 34 samples were found positive by dengue consensus RT-PCR assay. 22 samples were found to be positive by single tube Dengue multiplex RT-PCR assay. Serotype DEN-2 was present in maximum numbers followed by DEN-3. 44 samples were found positive by DENV CDC Multiplex Real time PCR assay. DEN-2 was found in maximum numbers followed by DEN-1. Dengue remains to be an important health problem in India and across the globe. Few serotypes of dengue are more dangerous than the others. Rapid diagnosis and serotyping remains the key for better patient management and prevention of disease spreading in the community. Highly sensitive, specific and rapid CDC real time RT-PCR assay was found to be most promising tool among all available molecular diagnostic methods. This will serve a rapid and reliable simultaneous dengue virus detection as well serotyping assay in near future for rapid identification of dengue suspected sample screening.

A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health Device Assessments in Modern Structural Heart Disease Clinics.

OBJECTIVES: This study sought to determine whether mobile health (mHealth) device assessments used as clinical decision support tools at the point-of-care can reduce the time to treatment and improve long-term outcomes among patients with rheumatic and structural heart diseases (SHD). BACKGROUND: Newly developed smartphone-connected mHealth devices represent promising methods to diagnose common diseases in resource-limited areas; however, the impact of technology-based care on long-term outcomes has not been rigorously evaluated. METHODS: A total of 253 patients with SHD were randomized to an initial diagnostic assessment with wireless devices in mHealth clinics (n = 139) or to standard-care (n = 114) in India. mHealth clinics were equipped with point-of-care devices including pocket-echocardiography, smartphone-connected-electrocardiogram blood pressure and oxygen measurements, activity monitoring, and portable brain natriuretic peptide laboratory testing. All individuals underwent comprehensive transthoracic echocardiography to assess the severity of SHD. The primary endpoint was the time to referral for therapy with percutaneous valvuloplasty or surgical valve replacement. Secondary endpoints included the probability of a cardiovascular hospitalization and/or death over 1 year. RESULTS: An initial mHealth assessment was associated with a shorter time to referral for valvuloplasty and/or valve replacement (83 ± 79 days vs. 180 ± 101 days; p <0.001) and was associated with an increased probability for valvuloplasty/valve replacement compared to standard-care (34% vs. 32%; adjusted hazard ratio: 1.54; 95% CI: 0.96 to 2.47; p = 0.07). Patients randomized to mHealth were associated with a lower risk of a hospitalization and/or death on follow-up (15% vs. 28%, adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83; p = 0.013). CONCLUSIONS: An initial mHealth diagnostic strategy was associated with a shorter time to definitive therapy among patients with SHD in a resource-limited area and was associated with improved outcomes. (A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health Device Assessments in Modern Structural Heart Disease Clinics; NCT02881398).

MR1-restricted mucosal-associated invariant T (MAIT) cells respond to mycobacterial vaccination and infection in nonhuman primates.

Studies on mucosal-associated invariant T cells (MAITs) in nonhuman primates (NHP), a physiologically relevant model of human immunity, are handicapped due to a lack of macaque MAIT-specific reagents. Here we show that while MR1 ligand-contact residues are conserved between human and multiple NHP species, three T-cell receptor contact-residue mutations in NHP MR1 diminish binding of human MR1 tetramers to macaque MAITs. Construction of naturally loaded macaque MR1 tetramers facilitated identification and characterization of macaque MR1-binding ligands and MAITs, both of which mirrored their human counterparts. Using the macaque MR1 tetramer we show that NHP MAITs activated in vivo in response to both Bacillus Calmette-Guerin vaccination and Mycobacterium tuberculosis infection. These results demonstrate that NHP and human MR1 and MAITs function analogously, and establish a preclinical animal model to test MAIT-targeted vaccines and therapeutics for human infectious and autoimmune disease.