Time series analysis and short-term forecasting of monkeypox outbreak trends in the 10 major affected countries.

BACKGROUND: Considering the rapidly spreading monkeypox outbreak, WHO has declared a global health emergency. Still in the category of being endemic, the monkeypox disease shares numerous clinical characters with smallpox. This study focuses on determining the most effective combination of autoregressive integrated moving average model to encapsulate time dependent flow behaviour of the virus with short run prediction. METHODS: This study includes the data of confirmed reported cases and cumulative cases from eight most burdened countries across the globe, over the span of May 18, 2022, to December 31, 2022. The data was assembled from the website of Our World in Data and it involves countries such as United States, Brazil, Spain, France, Colombia, Mexico, Peru, United Kingdom, Germany and Canada. The job of modelling and short-term forecasting is facilitated by the employment of autoregressive integrated moving average. The legitimacy of the estimated models is argued by offering numerous model performance indices such as, root mean square error, mean absolute error and mean absolute prediction error. RESULTS: The best fit models were deduced for each country by using the data of confirmed reported cases of monkeypox infections. Based on diverse set of performance evaluation criteria, the best fit models were then employed to provide forecasting of next twenty days. Our results indicate that the USA is expected to be the hardest-hit country, with an average of 58 cases per day with 95% confidence interval of (00-400). The second most burdened country remained Brazil with expected average cases of 23 (00-130). The outlook is not much better for Spain and France, with average forecasts of 52 (00-241) and 24 (00-121), respectively. CONCLUSION: This research provides profile of ten most severely hit countries by monkeypox transmission around the world and thus assists in epidemiological management. The prediction trends indicate that the confirmed cases in the USA may exceed than other contemporaries. Based on the findings of this study, it remains plausible to recommend that more robust health surveillance strategy is required to control the transmission flow of the virus especially in USA.

Overarching Priorities for Health and Care Research in the United Kingdom: A Coproduced Synthesis of James Lind Alliance 'Top 10s'.

INTRODUCTION: James Lind Alliance (JLA) Priority Setting Partnerships (PSPs) produce 'Top 10' lists of health and care research priorities through a structured, shared decision-making process with patients or service users, carers and health or care professionals who identify questions that are most important to them. To date, over 150 PSPs in different areas of health and care have published research priorities. Some PSPs share similar priorities, which could be combined, promoted and addressed through collaborative research to increase value and reduce research waste. AIM: The aim of this study was to identify overarching themes common to JLA PSP priorities across different areas of health and care. METHODS: Our analysis included 'Top 10' research priorities produced by UK-based JLA PSPs between 2016 and 2020. The priorities were coded deductively by the Health Research Classification System (HRCS) health category and research activity. We then carried out online workshops with patients, service users and carers to generate new codes not already captured by this framework. Within each code, multistakeholder inductive thematic analysis was used to identify overarching themes, defined as encompassing priorities from three or more PSPs covering two or more health categories. We used codesign methods to produce an interactive tool for end users to navigate the overarching themes. RESULTS: Five hundred and fifteen research priorities from 51 PSPs were included in our analysis. The priorities together encompassed 20 of 21 HRCS health categories, the most common being 'generic health relevance' (22%), 'mental health' (18%) and 'musculoskeletal' (14%). We identified 89 overarching themes and subthemes, which we organised into a hierarchy with seven top-level themes: quality of life, caregivers and families, causes and prevention, screening and diagnosis, treatment and management, services and systems and social influences and impacts. CONCLUSION: There are many overarching themes common to research priorities across multiple areas of health and care. To facilitate new research and research funding, we have developed an interactive tool to help researchers, funders and patients or service users to explore these priority topics. This is freely available to download online. PATIENT OR PUBLIC CONTRIBUTION: Patients or service users and carers were involved throughout the study, including deciding the aims, designing the study, analysing priorities to identify themes, interpreting and reporting the findings.

Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review.

Atrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation. Comparing general anesthesia with conscious sedation, we find that general anesthesia provides superior catheter stability due to reduced respiratory variability, resulting in more effective lesion formation, and reduced pulmonary vein reconnection. The use of high-frequency jet ventilation under general anesthesia, delivering low tidal volumes, effectively minimizes left atrial movement, decreasing catheter displacement and procedure time, and reducing recurrence in paroxysmal atrial fibrillation. An alternative, high-frequency low tidal volume ventilation using conventional ventilators, also shows improved catheter stability and lesion durability compared to traditional ventilation methods. However, a detailed comparative study of high-frequency jet ventilation, high-frequency low tidal volume ventilation, and conventional mechanical ventilation in catheter ablation for atrial fibrillation is lacking. This review emphasizes the need for such studies to identify optimal anesthetic techniques, potentially enhancing patient outcomes in atrial fibrillation treatment. Our findings suggest that careful selection of anesthetic methods, including ventilation strategies, plays a crucial role in the success of catheter ablation for atrial fibrillation, warranting further research for evidence-based practice.

High-performance terahertz refractive index sensor for cancer cells detection.

Metamaterial absorbers in the terahertz region are highly desirable in sensing and detection. In this work, a novel terahertz refractive index sensor based on metamaterial absorber for sensing biomedical samples is reported. The proposed structure consists of three asymmetrical metallic resonators made of gold placed above on a gallium arsenide (GaAs) dielectric layer. Due to high-intensity field confinement in the sensing regime, four resonance modes with nearly 100% absorption are achieved with a high Q-factor of 456.5 in the absorption spectra. The design absorber is highly sensitive to the change of refractive index of the surrounding medium. Furthermore, the proposed sensor exhibits extremely high sensitivity of 1.87 THz/RIU and high FOM of 125 RIU-1 in the refractive index range from 1.35 to 1.39 with fixed analyte thickness of 45 µm. The design RI sensor can be fitted for biomedical sensing applications such sensing and detection of various cancerous cell as the RI varied in the range of 1.35-1.39. In addition, the design sensor has the ability to sense early stage infection of cancer cells with any of its four absorption bands due to its high quality factor, high sensitivity and high figure of merit.

Development of a validated search filter for Ovid Embase for degenerative cervical myelopathy.

BACKGROUND: Degenerative cervical myelopathy (DCM) is a recently proposed umbrella term for symptomatic cervical spinal cord compression secondary to degeneration of the spine. Currently literature searching for DCM is challenged by the inconsistent uptake of the term 'DCM' with many overlapping keywords and numerous synonyms. OBJECTIVES: Here, we adapt our previous Ovid medline search filter for the Ovid embase database, to support comprehensive literature searching. Both embase and medline are recommended as a minimum for systematic reviews. METHODS: References contained within embase identified in our prior study formed a 'development gold standard' reference database (N = 220). The search filter was adapted for embase and checked against the reference database. The filter was then validated against the 'validation gold standard'. RESULTS: A direct translation was not possible, as medline indexing for DCM and the keywords search field were not available in embase. We also used the 'focus' function to improve precision. The resulting search filter has 100% sensitivity in testing. DISCUSSION AND CONCLUSION: We have developed a validated search filter capable of retrieving DCM references in embase with high sensitivity. In the absence of consistent terminology and indexing, this will support more efficient and robust evidence synthesis in the field.

Primary care placements in the post-COVID era: A qualitative evaluation of a final year undergraduate clerkship.

INTRODUCTION: In March 2020, UK primary care changed dramatically due to the COVID-19 pandemic. It now has a much greater reliance on triaging, e-consultations, remote consultations, online meetings and less home visits. Re-evaluating the nature and value of learning medicine in primary care has therefore become a priority. METHOD: 70 final-year medical students placed in 38 GP practices (primary care centres) across the East of England undertook a 5-week clerkship during November 2020. A sample of 10 students and 11 supervising general practitioners from 16 different GP practices were interviewed following the placement. Qualitative analysis was conducted to determine their perceptions regarding the nature and value of learning medicine in primary care now compared with prior to the pandemic. RESULTS: A variety of models of implementing supervised student consultations were identified. Although contact with patients was felt to be less than pre-pandemic placements, triaging systems appeared to have increased the educational value of each individual student-patient contact. Remote consultations were essential to achieving adequate case-mix and they conferred specific educational benefits. However, depending on how they were supervised, they could have the potential to decrease students' level of responsibility for patient care. CONCLUSIONS: Undergraduate primary care placements in the post-COVID era can still possess the educationally valuable attributes documented in the pre-pandemic literature. However, this is dependent on specific factors regarding their delivery.

In situtailoring the morphology of In(OH)3nanostructures via surfactants during anodization and their transformation into In2O3nanoparticles.

The present work reports the effect of various surfactants on the morphology of In(OH)3nanostructures prepared via anodization. In-sheets were anodized in an environmentally benign electrolyte containing a small quantity of CTAB, CTAC, and PDDA surfactants at room temperature. The produced nanostructures were characterized using XRD, HRTEM, SAED, and EDAX. The morphology of indium hydroxide (In(OH)3) nanostructures was successfully tailoredin situwith the help of surfactants in 1 M KCl aqueous electrolyte. XRD results confirmed the formation of In(OH)3and indium oxyhydroxide (InOOH) nanostructures in the pristine form which were transformed into single-phase cubic In2O3nanoparticles (NPs) after calcination. HRTEM analyses showed that the morphology and size of the In(OH)3nanostructures can be tuned to form nanorods, nanosheets and nanostrips using different surfactants. The results revealed that CTAC and PDDA surfactants have a profound effect on the morphology of In(OH)3nanostructure compared to CTAB due to the higher concentration of Cl-ion. The possible mechanism of surfactants effect on the morphology is proposed. Furthermore, annealing converted the In(OH)3nanostructures into spherical In2O3NPs with uniform and homogeneous size. We anticipate that the morphology of other metal-oxides nanostructure can be tuned using this simple, facile and rapid technique. In2O3NPs prepared without and with CTAB surfactant were further explored for the non-enzymatic detection of hydrogen peroxide (H2O2). Electrochemical measurements showed enhanced electrocatalytic performance with fast electron transfer (∼2s) between the redox centers of H2O2and electrode surface. The In2O3NPs prepared using CTAB/Au electrode exhibited about 4-fold increase in sensitivity compared to the bare Au electrode. The biosensor also demonstrated good reproducibility, higher selectivity, and increased shelf life.

Ni and Co synergy in bimetallic nanowires for the electrochemical detection of hydrogen peroxide.

The development of a highly sensitive and selective non-enzymatic electrode catalyst for the detection of a target molecule was remained a great challenge. In this regard, bimetallic nanowires (BMNWs) are considered as promising electrode material for their fascinating physical/chemical properties superior to a single system. In this article, nickel cobalt (Ni x -Co) BMNWs with tunable stoichiometry were prepared by a template assisted electrodeposition method and their catalytic performance was investigated for the detection of hydrogen peroxide (H2O2). It has been found that Ni-Co (0.5:1) BMNWs/PC electrode exhibits superior non-enzymatic sensing ability toward H2O2 detection with a high selectivity. The electrode shows fast response within ∼3 s and an excellent reproducible sensitivity of 2211.4 µAmM-1 cm-2, which is the best compared to the individual Ni, Co, Ni-Co (0.3:1) BMNWs and previously reported electrodes. In addition, the electrode shows a linear response in the wide concentration range from 0.005 mM to 9 mM, low detection limit of 0.5 µM (S/N = 3.2) and a relatively long-term storage (50 d). Moreover, the sensor reveals excellent results for H2O2 detection in the real samples. The enhanced sensitivity of the Ni-Co (0.5:1) BMNWs based electrode may be due to the stable structure and synergy of Ni and Co. The results demonstrate that the catalytic activity of the electrode binary catalyst towards H2O2 detection can be improved by adjusting the Ni/Co ratio in BMNWs. The excellent performance of the electrode suggests that Ni-Co BMNWs are promising candidate for the construction of cost-effective electrochemical sensors for medical and industrial applications.

Research activity amongst DCM research priorities.

INTRODUCTION: Degenerative cervical myelopathy (DCM) is a progressive neurodegenerative disorder. DCM is common (estimated prevalence, 2% of adults) and significantly impacts quality of life. The AO Spine RECODE-DCM (Research Objectives and Common Data Elements in DCM) project has recently established the top research priorities for DCM. This article examines the extent to which existing research activity aligns with the established research priorities. METHODS: A systematic review of MEDLINE and Embase for "Cervical" AND "Myelopathy" was conducted following PRISMA guidelines. Full-text papers in English, exclusively studying DCM, published between January 1, 1995 and August 08, 2020 were considered eligible. Extracted data for each study included authors, journal, year of publication, location, sample size and study design. Each study was then analysed for alignment to the established research priorities. RESULTS: In total, 2261 papers with a total of 1,323,979 patients were included. Japan published more papers (625) than any other country. Moreover, 2005 (89%) of 2261 papers were aligned to at least one research priority. The alignment of papers to the different research priorities was unequal, with 1060 papers on the most researched priority alone (#15, predictors of outcome after treatment), but only 64 total papers on the least-researched 10 priorities. The comparative growth of research in the different priorities was also unequal, with some priorities growing and others plateauing over the past 5 years. DISCUSSION: Research activity in DCM continues to grow, and the focus of this research remains on surgery. The established research priorities therefore represent a new direction for the field.

The role of sex in the innate and adaptive immune environment of metastatic colorectal cancer.

BACKGROUND: Women with colorectal cancer (CRC) have a significant survival advantage over men. Sex influences on the tumour microenvironment (TME) are not well characterised, despite the importance of immune response in CRC. We hypothesised that sex-divergent immune responses could contribute to survival. METHODS: Using a murine model of metastatic CRC, we examined T cells, macrophages, and cytokines locally and systemically. TME and serum cytokines were measured by multiplex bead-based arrays, while FCA was used to identify cells and phenotypes. IHC provided spatial confirmation of T cell infiltration. RESULTS: Females had increased survival and T cell infiltration. CD8, CD4 and Th2 populations correlated with longer survival. Males had increased serum levels of chemokines and inflammation-associated cytokines. Within the TME, males had lower cytokine levels than females, and a shallower cytokine gradient to the periphery. Female tumours had elevated IL-10+ macrophages, which correlated with survival. CONCLUSIONS: These data demonstrate survival-associated differences in the immune response of males and females to metastatic CRC. Females showed changes in cytokine production accompanied by increased immune cell populations, biased toward Th2-axis phenotypes. Key differences in the immune response to CRC correlated with survival in this model. These differences support a multi-faceted shift across the TME.

TiO2 nanotube array-modified electrodes for L-cysteine biosensing: experimental and density-functional theory study.

We report a non-enzymatic facile method for the detection of L-cysteine (L-Cyst) using free-standing TiO2 nanotube (TNT) array-modified glassy carbon electrodes (GCEs). Self-organized, highly ordered, and vertically oriented TNT arrays were fabricated by anodization of titanium sheets in ethylene glycol-based electrolyte. Detailed electrochemical measurements were performed and it was found that modified GCE exhibited high current compared to the pristine counterpart. The high current of the modified electrode was attributed to the high surface area and enhanced electrocatalytic activities of the TNTs toward the L-Cyst oxidation. Under the optimum conditions, the modified electrode exhibited a high sensitivity of ∼1.68 µA mM-1 cm-2 with a low detection limit of ∼0.1 mM. The fabricated electrode was found to be sensitive to pH and electrolyte temperature. The real sample analysis of the proposed method showed a decent recovery toward L-Cyst addition in human blood serum. Furthermore, the density-funcational theory (DFT) analysis revealed that TNTs have greater affinity toward L-Cyst, having stronger binding distance after its adsorption. The higher negative E ads values suggested a stable and chemisorption nature. The density of states results show that the E gap of TNTs is significantly reduced after L-Cyst adsorption. The modified GCE showed excellent selectivity, enhanced stability, and fast response, which make TNTs a promising candidate for the enzyme-free detection of other biological analytes.

On the efficiency of foreign exchange markets in times of the COVID-19 pandemic.

We employ multifractal detrended fluctuation analysis (MF-DFA) to provide a first look at the efficiency of forex markets during the initial period of the ongoing coronavirus disease 2019 (COVID-19), which has disrupted the global financial markets. We use high-frequency (5-min interval) data of six major currencies traded in forex markets during the period October 1, 2019 to 31 March 31, 2020. Before applying MF-DFA, we examine the inner dynamics of multifractality through seasonal and trend decompositions using loess. Overall, the results confirm the presence of multifractality in forex markets, which demonstrates, in particular, (i) a decline in the efficiency of forex markets during the COVID-19 outbreak and (ii) heterogeneous effects on the strength of multifractality of exchange rate returns under investigation. The largest effect is observed for the Australian dollar, which shows the highest (lowest) efficiency before (during) the COVID-19 pandemic, assessed in terms of low (high) multifractality. The Canadian dollar and the Swiss Franc exhibit the highest efficiency during the COVID-19 outbreak. Our findings may help policymakers shape a comprehensive response to improve forex market efficiency during such a black swan event.

Concentrations, dietary exposure, and human health risk assessment of heavy metals in market vegetables of Peshawar, Pakistan.

The present study was carried out to assess heavy metal concentrations in ready-to-eat vegetables (RTEs) collected from open markets. Samples of RTEs including lettuce, coriander, and carrot were collected from five different local markets of Peshawar, Pakistan including Industrial estate, Board, Agriculture University, Firdos, and Hashtnaghri on four different dates, i.e., 21st March, 04th April, 19th April, and 05th May, 2016. The samples were analyzed through atomic absorption spectrophotometer to see the amount of heavy metals present in them. The elements studied were cadmium (Cd), chromium (Cr), copper (Cu), nickel (Ni), and lead (Pb). Maximum Cd, Cr, Cu, Ni, and Pb concentrations in samples collected from different markets were 0.68, 5.28, 12.31, 7.61, and 25.04 mg kg-1, respectively, whereas maximum Cd, Cr, Cu, Ni, and Pb concentrations in RTEs collected at different dates were 0.59, 4.08, 14.85, 7.23, and 21.97 mg kg-1, respectively. The mean Cd, Cr, and Pb concentrations exceeded the permissible limits, while Cu and Ni were found within the limits set by FAO/WHO in all studied RTEs. The daily dietary intake and hazard quotient (HQ) showed great variations. The HQ was found > 1 for Pb in all studied vegetables, while it was < 1 for Cd, Cr, Cu, and Ni with few exceptions. It can be concluded from the study that heavy metal concentrations were above the permissible toxicity levels and their continuous consumption may cause several health issues.

Advances in the Treatment of Keratoconus: Epithelial-On (EPI-On) Corneal-Collagen Cross-Linking (CXL) and CXL-Plus Procedures.

Keratoconus (KC) incidence is on the increase. The advent of corneal-collagen cross-linking (CXL) has revolutionized the management of KC. This systematic review looks at the efficacy and complications of two novel treatments within CXL: Epithelial-On (Epi-On) and CXL-plus procedures. Two separate literature searches were carried out up until July 1, 2021. Articles only published in the last two years were included to ensure that only the most recent articles were reviewed. A total of 15 articles were selected for this review. There were varied results regarding the efficacy of Epi-On. No significant difference was found between Epi-On and standard Epithelial-Off (Epi-Off) CXL. However, it was found that Epi-On was inferior to standard CXL in terms of reducing KMAX. There was a higher risk of progression in patients treated with Epi-On CXL, with an increased rate of patients requiring re-treatment due to the advancement of their KC. While some studies report CXL-plus procedures demonstrate long-term efficacy and safety, a considerable number of studies advise caution, reporting a significant deterioration in corrected distance visual acuity (CDVA). Consequently, a question persists regarding the safest and most efficacious approach, given the lack of robust large randomized controlled trials (RCTs) in the current literature.

Eliminating Trachoma in Africa: The Importance of Environmental Interventions.

Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.

Changing Cancer Trends in District Dir, Pakistan: Epidemiological Insights From a 10-Year Hospital-Based Study.

Background More alarming than the rise of cancer globally is its discreet changing profiles over the years. According to our knowledge, no new studies on cancer have taken place in Dir since 2004. Hence, we aimed to provide and analyze the cancer trends in district Dir, Malakand division, Khyber Pakhtunkhwa (KPK), regarding its prevalence and incidence, and compare it nationally and internationally. Methods A retrospective study was conducted by collecting data from 2647 clinically diagnosed cancer patients of all ages in district Dir, between the years 2008 and 2017, from the Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar. Statistical analysis was performed using SPSS version 20 and presented using different tables and figures. Results Out of the total patients, 52.7% were male and 47.3% were female. The most common types of cancers in both genders combined were breast (9.0%), acute lymphocytic leukemia (ALL) (6.0%), skin (5.7%), non-Hodgkin Lymphoma (NHL) (5.6%), and brain tumor (5.2%). The age-standardized incidence rate (ASIR) in males in 2017 was peaking in the age group 60-69 (2707.2) with the most prevalent cancer being NHL (7.7%). In females, ASIR was highest in the age group 30-39 (2500.8) with the majority having breast cancer (18.1%), and in children, ALL (30.9%) was most prevalent. Incidence was highest in 2014 with a staggering 15 cases/100,000 population. Cancer prevalence in females aged 50 and below was significantly higher (p<0.001) compared to males. Conclusion Our study highlights that cancer profiles in Dir in the past two decades have changed with certain results non-conforming to global and regional trends. A follow-up research should be carried out to further ascertain and analyze these diverging results in hopes of drawing a more concrete conclusion from these findings.

Myocardial infarction in young individual: A case report of polycythemia vera-induced acute inferior wall myocardial infarction.

Acute coronary syndrome is commonly associated with traditional cardiovascular risk factors such as smoking, hypertension, diabetes, and hyperlipidemia. Myocardial infarction in a young person presents a significant challenge because its etiology is least likely associated with atherosclerosis. Polycythemia vera refers to one of the rare causes of myocardial infarction, which involves enhanced erythrocyte levels, leukocytosis, thrombocytosis, splenomegaly, and a greater chance of vascular occlusion due to clotting in coronary arteries. A 22-year-old male from Pakistan, Asia without typical risk factors, presented with severe chest pain. Electrocardiography indicated acute inferior wall myocardial infarction, and streptokinase was administered. Subsequent investigations confirmed polycythemia vera. Treatment with hydroxyurea and aspirin was initiated, whereas normal coronary arteries in CT coronary angiogram were observed. This case highlights polycythemia vera's rare role in young individuals' heart attacks without known risk factors, emphasizing the need for early detection and specialized treatments involving hematologists to prevent future thrombotic episodes.