An ultra energy-efficient hardware platform for neuromorphic computing enabled by 2D-TMD tunnel-FETs

Brain-like energy-efficient computing has remained elusive for neuromorphic (NM) circuits and hardware platform implementations despite decades of research. In this work we reveal the opportunity to significantly improve the energy efficiency of digital neuromorphic hardware by introducing NM circuits employing two-dimensional (2D) transition metal dichalcogenide (TMD) layered channel material-based tunnel-field-effect transistors (TFETs). Our novel leaky-integrate-fire (LIF) based digital NM circuit along with its Hebbian learning circuitry operates at a wide range of supply voltages, frequencies, and activity factors, enabling two orders of magnitude higher energy-efficient computing that is difficult to achieve with conventional material and/or device platforms, specifically the silicon-based 7 nm low-standby-power FinFET technology. Our innovative 2D-TFET based NM circuit paves the way toward brain-like energy-efficient computing that can unleash major transformations in future AI and data analytics platforms.

Emerging universality classes in thermally assisted activation of interacting diffusive systems: A perturbative hydrodynamic approach

Thermal activation of a particle from a deep potential trap follows the Arrhenius law. Recently, this result has been generalized for interacting diffusive particles in the trap, revealing two universality classes-the Arrhenius class and the excluded volume class. The result was demonstrated with the aid of numerical analysis. Here, we present a perturbative hydrodynamic approach to analytically validate the existence and range of validity for the two universality classes.

Prognosticating acute traumatic spinal cord injury using Neurofilament (NF), Neuron Specific Enolase (NSE), Matrix Metalloproteinases (MMPs), and S-100B as biomarkers

BACKGROUND

Spinal cord injury (SCI) can result in lifelong disability. Currently, the literature suggests that biomarkers are helpful in prognosticating SCI, but there is no specific biomarker to date. This is the first study that predicted the prognosis dynamically using biomarkers.

AIM

To elucidate the role of biomarkers in prognosticating acute traumatic SCI.

METHODS

Blood samples were obtained from 35 patients of acute traumatic SCI at presentation, immediate post-op, and at 6 weeks. At 6 months follow-up, patients were divided into two groups, i.e, improved and non-improved based on the improvement in the ASIA grade compared to presentation. A non-parametric test was used for comparing mean NSE, MMP-2, S100-B, and NF serum levels at presentation, immediate post-op, and 6 weeks post-op follow-up between the two groups.

RESULTS

There was a significant difference (p = 0.03) in the NF values at presentation between the two groups. The difference of NSE values at 6 weeks was also significant (p = 0.016) between the two groups. S-100B levels were also significantly different between both groups at presentation (p=0.016), and at the immediate post-op stage (p=0.007). MMP-2 levels neither displayed any specific trend nor any significant difference between the two groups.

CONCLUSION

Higher NF values at presentation, and higher S-100B levels at presentation and immediate post-operative period correlated with poor outcome. Also, increased NSE values after surgery are indicative of no improvement. These levels can be used at various stages to predict the prognosis. However, further studies are required on this topic extensively to know the exact cut-off values of these markers to predict the prognosis accurately.

CLINICAL TRIALS REGISTRY NUMBER

REF/2020/01/030616.

Operational priorities for engaging with India's private healthcare sector for the control of tuberculosis: a modelling study

OBJECTIVES

To estimate the potential impact of expanding services offered by the Joint Effort for Elimination of Tuberculosis (JEET), the largest private sector engagement initiative for tuberculosis (TB) in India.

DESIGN

We developed a mathematical model of TB transmission dynamics, coupled with a cost model.

SETTING

Ahmedabad and New Delhi, two cities with contrasting levels of JEET coverage.

PARTICIPANTS

Estimated patients with TB in Ahmedabad and New Delhi.

INTERVENTIONS

We investigated the epidemiological impact of expanding three different public-private support agency (PPSA) services: provider recruitment, uptake of cartridge-based nucleic acid amplification tests and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared with a continuation of current TB services.

RESULTS

Our results suggest that in Delhi, increasing the use of adherence support mechanisms among private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of US$170 000 (US$110 000-US$310 000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of US$18 000 (US$12 000-US$29 000).

CONCLUSION

Results illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.

Arrhenius law for interacting diffusive systems

Finding the mean time it takes for a particle to escape from a metastable state due to thermal fluctuations is a fundamental problem in physics, chemistry, and biology. Here, we consider the escape rate of interacting diffusive particles, from a deep potential trap within the framework of the macroscopic fluctuation theory-a nonequilibrium hydrodynamic theory. For systems without excluded volume, our investigation reveals adherence to the well-established Arrhenius law. However, in the presence of excluded volume, a universality class emerges, fundamentally altering the escape rate. Remarkably, the modified escape rate within this universality class is independent of the interactions at play. The universality class, demonstrating the importance of excluded volume effects, may bring insights to the interpretation of escape processes in the realm of chemical physics.

Estimation of dietary intake of sodium, potassium, phosphorus and protein in healthy Indian population and patients with chronic kidney disease

Introduction

Poor nutritious diet is a major risk element for non-communicable diseases (NCD), which are of considerable public health concern. Given the diverse dietary patterns in India, precise determination of nutrient consumption is crucial for disease management. The present study assessed the dietary intake of sodium, potassium, protein, and phosphorus among North Indians.

Methods

This cross-sectional study included healthy adults and adults with stage 2 to 4 chronic kidney disease (CKD). We analysed sodium, protein, potassium and phosphorus intakes using one-time 24-h urinary excretion. Dietary intake was also analysed in subgroups based on sex, body mass index, blood pressure and abdominal obesity. We evaluated the performance of various equations available to estimate sodium intake using a spot urine sample with respect to the sodium excretion measured in a 24-h urine sample. Descriptive statistics was used along with t-test for statistical significance.

Results

A total of 404 subjects (182 adult healthy subjects and 222 adults with CKD) with a mean age of 47.01 ± 11.46 years were studied. Mean dietary intakes of sodium, salt, potassium, protein and phosphorus were 2.94 ± 1.68 g/day, 7.42 ± 4.24 g/day, 1.43 ± 0.59 g/day, 47.67 ± 14.73 g/day and 0.86 ± 0.39 g/day, respectively. There were no differences in nutrient consumption between adults who were healthy and those with CKD. Consumption of sodium, salt, protein, potassium, and phosphorus among healthy population vs. those with CKD were 2.81 ± 1.60 vs. 3.05 ± 1.73 g/day (p = 0.152), 7.08 ± 4.04 vs. 7.70 ± 4.37 g/day (p = 0.143), 47.16 ± 14.59 vs. 48.08 ± 14.86 g/day (p = 0.532), 1.38 ± 0.59 vs. 1.48 ± 0.58 g/day (p = 0.087) and 0.86 ± 0.41 vs. 0.87 ± 0.37 g/day (p = 0.738), respectively. Men had higher consumption of these nutrients than women. Compared to non-hypertensives, hypertensive subjects had higher consumption of salt (8.23 ± 4.89 vs. 6.84 ± 3.59 g/day, p = 0.002) and potassium (1.51 ± 0.63 vs. 1.38 ± 0.55 g/day, p = 0.024), however, no difference were found in protein and phosphorus intakes. In terms of performance of equations used to estimate 24-h sodium intake from spot urinary sodium concentration against the measured 24-h urinary sodium excretion, INTERSALT 2 equation exhibited the least bias [1.08 (95% CI, -5.50 to 7.66)].

Conclusion

The study shows higher-than-recommended salt and lower-than-recommended potassium intake in the north Indian population compared to those recommended by guidelines. The dietary protein intake is below the recommended dietary allowance. These findings help the development of targeted policies for dietary modification to reduce the risk of the development and progression of CKD.

A FACS-based novel isolation technique identifies heterogeneous CTCs in oral squamous cell carcinoma

Purpose

Isolating circulating tumour cells (CTCs) from the blood is challenging due to their low abundance and heterogeneity. Limitations of conventional CTC detection methods highlight the need for improved strategies to detect and isolate CTCs. Currently, the Food and Drug Administration (FDA)-approved CellSearch™ and other RUO techniques are not available in India. Therefore, we wanted to develop a flexible CTC detection/isolation technique that addresses the limitation(s) of currently available techniques and is suitable for various downstream applications.

Methods

We developed a novel, efficient, user-friendly CTC isolation strategy combining density gradient centrifugation and immuno-magnetic hematogenous cell depletion with fluorescence-activated cell sorting (FACS)-based positive selection using multiple CTC-specific cell-surface markers. For FACS, a stringent gating strategy was optimised to exclude debris and doublets by side scatter/forward scatter (SSC/FSC) discriminator, remove dead cells by 4',6-diamidino-2-phenylindole (DAPI) staining, and eliminate non-specific fluorescence using a "dump" channel. APC-labelled anti-CD45mAB was used to gate remaining hematogenous cells, while multiple epithelial markers (EpCAM, EGFR, and Pan-Cytokeratin) and an epithelial-mesenchymal transition (EMT) marker (Vimentin) labelled with fluorescein isothiocyanate (FITC) were used to sort cancer cells. The technique was initially developed by spiking Cal 27 cancer cells into the blood of healthy donors and then validated in 95 biopsy-proven oral squamous cell carcinoma (OSCC) patients. CTCs isolated from patients were reconfirmed by Giemsa staining, immuno-staining, and whole transcriptome amplification (WTA), followed by qRT-PCR. In vitro culture and RNA sequencing (RNA-Seq) were also performed to confirm their suitability for various downstream applications.

Results

The mean detection efficiency for the Cal 27 tongue cancer cells spiked in the whole blood of healthy donors was 32.82% ± 12.71%. While ~75% of our patients (71/95) had detectable CTCs, the CTC positivity was independent of the TNM staging. The isolated potential cancer cells from OSCC patients were heterogeneous in size. They expressed different CTC-specific markers in various combinations as identified by qRT-PCR after WTA in different patients. Isolated CTCs were also found to be suitable for downstream applications like short-term CTC culture and RNA-Seq.

Conclusion

We developed a sensitive, specific, flexible, and affordable CTC detection/isolation technique, which is scalable to larger patient cohorts, provides a snapshot of CTC heterogeneity, isolates live CTCs ready for downstream molecular analysis, and, most importantly, is suitable for developing countries.

Defect interactions in a two-dimensional sheared lamellar mesophase

The interaction between two edge dislocations in a sheared lyotropic lamellar liquid-crystalline medium is examined. The model is a mesoscale hydrodynamic model based on a free-energy functional that is minimised for a sinusoidal concentration modulation coupled with concentration and momentum equations. The defect dynamics are analysed as a function of the system size and the Ericksen number, the ratio of the shear stress and the characteristic free-energy density for deformation. Three different regimes are observed as the Ericksen number is increased when the edge dislocations are sheared towards each other, such that there is compression of layers between the defects: (a) defect motion that reduces the cross-stream separation till there is a steady spacing with plug flow between the defects, (b) defect attraction and cancellation resulting in a well-aligned state, and (c) defect creation due to a compressional instability between the defects resulting in an increase in the disorder. When the edge dislocations are sheared away from each other, such that there is extension of the layers between the defects, two distinct regimes are observed as the Ericksen number is increased: (a) bending of layers and a plug flow between the defects at their initial separation, and (b) buckling of the layers leading to creation of more defects and a dynamical steady state between defect creation and cancellation. These regimes are found to be robust for different values of the system size, from 32 to 128 layers, and for different values of the dimensionless groups that characterise the ratio of mass/momentum convection and diffusion.

Directional synchrony among self-propelled particles under spatial influence

Synchronization is one of the emerging collective phenomena in interacting particle systems. Its ubiquitous presence in nature, science, and technology has fascinated the scientific community over the decades. Moreover, a great deal of research has been, and is still being, devoted to understand various physical aspects of the subject. In particular, the study of interacting active particles has led to exotic phase transitions in such systems which have opened up a new research front-line. Motivated by this line of work, in this paper, we study the directional synchrony among self-propelled particles. These particles move inside a bounded region, and crucially their directions are also coupled with spatial degrees of freedom. We assume that the directional coupling between two particles is influenced by the relative spatial distance which changes over time. Furthermore, the nature of the influence is considered to be both short and long-ranged. We explore the phase transition scenario in both the cases and propose an approximation technique which enables us to analytically find the critical transition point. The results are further supported with numerical simulations. Our results have potential importance in the study of active systems like bird flocks, fish schools, and swarming robots where spatial influence plays a pertinent role.

Guanidinium-Functionalized Polymer Dielectrics for Triboelectric Bacterial Detection

Development of rapid detection strategies that target potentially pathogenic bacteria has gained increasing attention due to the increasing awareness for better health and safety. In this study, we evaluate an intrinsically antimicrobial polymer, 2Gdm, which is a poly(norbornene)-based functional polymer featuring guanidinium groups as side chains, for bacterial detection by the means of triboelectric nanogenerators (TENGs) and triboelectric nanosensors (TENSs). Attachment of bacteria to the sensing layer is anticipated to alter the overall triboelectric properties of the underlying polymer layer. The positively charged guanidinium functional groups can interact with the negatively charged phospholipid bilayer of bacteria and lead to bacterial death, which can then be detected by optical microscopy, X-ray photoelectron microscopy, and more advanced self-powered sensing techniques such as TENGs and TENSs. The double bonds present along the poly(norbornene) backbone allow for thermally induced cross-linking to obtain X-2Gdm and thus rendering materials remain stable in water. By monitoring the change in voltage output after immersion in various concentrations of Gram-negative Escherichia coli (E. coli) and Gram-positive Streptococcus pneumoniae (S. pneumoniae), we have demonstrated the utility of X-2Gdm as a new polymer dielectric for autonomous bacterial detection. As the bacterial concentration increases, the amount of adsorbed bacteria also increases, resulting in a decrease in the surface potential of the X-2Gdm thin film; this reduction in surface potential can cause a decrease in the triboelectric output for both TENGs and TENSs, which serves as a key working mechanism for facile bacterial detection. TENG and TENS systems are capable of detecting E. coli and S. pneumoniae within a range of 4 × 105 to 4 × 108 CFU/mL with a limit of detection of 106 CFU/mL. This report highlights the promising prospects of employing TENGs and TENSs as innovative sensing technologies for rapid bacterial detection by leveraging the electrostatic interactions between bacterial cell membranes and cationic groups present on polymer surfaces.

Construction of Triboelectric Series and Chirality Detection of Amino Acids Using Triboelectric Nanogenerator

Triboelectrification necessitates a frictional interaction between two materials, and their contact electrification is characteristically based on the polarity variance in the triboelectric series. Utilizing this fundamental advantage of the triboelectric phenomenon, different materials can be identified according to their contact electrification capability. Herein, an in-depth analysis of the amino acids present in the stratum corneum of human skin is performed and these are quantified regarding triboelectric polarization. The principal focus of this study lies in analyzing and identifying the amino acids present in copious amounts in the stratum corneum to explain their positive behavior during the contact electrification process. Thus, an augmented triboelectric series of amino acids with quantified triboelectric charging polarity by scrutinizing the transfer charge, work function, and atomic percentage is presented. Furthermore, the chirality of aspartic acid as it is most susceptible to racemization with clear consequences on the human skin is detected. The study is expected to accelerate research exploiting triboelectrification and provide valuable information on the surface properties and biological activities of these important biomolecules.

Human factors in pelvic exenteration: themes in high-performing teams

AIM

The aim of this study was to investigate the role of human factors in pelvic exenteration and how team performance is optimized in the preoperative, intraoperative and postoperative phases.

METHOD

Qualitative analysis of focus groups was used to capture authentic human interactions that reflect real-world multiprofessional performance. Theatre teams were treated as clusters, with a particular focus group containing participants who worked together regularly.

RESULTS

Three focus groups were conducted. Four themes emerged - driving force, technical skills, nontechnical skills and operational aspects - with a total of 16 subthemes. Saturation was reached by group 2, with no new subthemes emerging after this. There was some interaction between the themes and the subthemes. Broadly speaking, driving force led to the development of specialised technical skills and nontechnical skills, which were operationalized into successful service through operational aspects.

CONCLUSION

This study of teams performing pelvic exenteration is the first in the field using this methodology. It has generated rich qualitative data with authentic insights into the pragmatic aspects of developing and delivering a service. In addition, it shows how the themes are connected or 'coupled' in a network, for example technical and non-technical skills. In a complex system, 'tight coupling' leads to both high performance and adverse events. In this paper, we report the qualitative aspects of high performance by pelvic exenteration teams in a complex sociotechnical system, which depends on tight coupling of several themes.

Time toxicity associated with early phase clinical trial participation

BACKGROUND

Early phase cancer clinical trials (EPCTs) involve experimental drugs being used for the first time in humans. These studies are designed for dose determination and safety, and represent the most time intensive of all clinical trials for both clinicians and patients. We sought to quantify the amount of patient time consumed through EPCT participation.

PATIENTS AND METHODS

A retrospective audit of patients treated in the EPCT unit at Liverpool Hospital, Sydney was carried out from 2013 to 2023. We defined 'time toxicity' (TT) as a composite measure where time-toxic days were considered days with any health care system contact, including clinic visits, infusions, procedures or blood work.

RESULTS

A total of 219 patients across 36 EPCTs were included. The median age was 65 years (range 31-81 years). Patients spent a median of 29% (range 4%-100%) of their days in direct contact with the health care system during their study. Protocol-specified visits accounted for the greatest contribution to total TT in 101 (46%) patients. In 7% (n = 16) of patients, unscheduled visits due to either adverse events or cancer-related symptoms accounted for the greatest TT. TT reduced as patients completed additional cycles of treatment. Patients who completed >10 cycles spent 14% of their days interacting with health care systems compared with 35% for those who completed ≤2 cycles. No statistically significant difference in TT was noted between dose-expansion and dose-escalation studies or trials focusing on immune-oncology versus targeted therapy.

CONCLUSIONS

Our study is the first to report TT in EPCTs with an extended follow-up. Clinicians should be aware of TT when discussing risks and benefits. TT also may not be the appropriate term when describing the time patients invest during EPCTs. Toxicity implies a negative impact, but for many patients, trial participation would be seen as positive. There should be efforts to streamline health care visits to limit TT in EPCTs.

A Potent Kalihinol Analogue Disrupts Apicoplast Function and Vesicular Trafficking in P. falciparum Malaria

Here we report the discovery of MED6-189, a new analogue of the kalihinol family of isocyanoterpene (ICT) natural products. MED6-189 is effective against drug-sensitive and -resistant P. falciparum strains blocking both intraerythrocytic asexual replication and sexual differentiation. This compound was also effective against P. knowlesi and P. cynomolgi. In vivo efficacy studies using a humanized mouse model of malaria confirms strong efficacy of the compound in animals with no apparent hemolytic activity or apparent toxicity. Complementary chemical biology, molecular biology, genomics and cell biological analyses revealed that MED6-189 primarily targets the parasite apicoplast and acts by inhibiting lipid biogenesis and cellular trafficking. Genetic analyses in P. falciparum revealed that a mutation in PfSec13, which encodes a component of the parasite secretory machinery, reduced susceptibility to the drug. The high potency of MED6-189 in vitro and in vivo, its broad range of efficacy, excellent therapeutic profile, and unique mode of action make it an excellent addition to the antimalarial drug pipeline.

Effect of duration of pneumoperitoneum on renal function in patients undergoing laparoscopic surgeries: a prospective observational study

This study aimed to assess the effect of pneumoperitoneum and, thereby, raised intra-abdominal pressure for different durations (≤ 1 h, 1-3 h and > 3 h) on renal function. One hundred and twenty adult patients were allocated to four groups-the Control Group A (N = 30; patients undergoing non-laparoscopic surgery) or Group B (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum < 1 h) or Group C (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum 1-3 h) or Group D (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum > 3 h). The baseline, intraoperative (at the end of pneumoperitoneum/surgery), and postoperative (after 6 h) values of blood urea levels, creatinine clearance, and serum cystatin C were compared. The results showed that the raised IAP (10-12 mmHg) and varying durations of pneumoperitoneum (from less than 1 h to more than 3 h) did not significantly affect renal function measured in terms of change in serum cystatin levels from baseline to 6 h in postoperative period. The varying durations of pneumoperitoneum also did not significantly affect serum creatinine or blood urea levels in the postoperative period. CTRI registration: CTRI/2016/10/007334.

Thermodynamic trade-off relation for first passage time in resetting processes

Resetting is a strategy for boosting the speed of a target-searching process. Since its introduction over a decade ago, most studies have been carried out under the assumption that resetting takes place instantaneously. However, due to its irreversible nature, resetting processes incur a thermodynamic cost, which becomes infinite in the case of instantaneous resetting. Here, we take into consideration both the cost and the first passage time (FPT) required for a resetting process, in which the reset or return to the initial location is implemented using a trapping potential over a finite but random time period. An iterative generating function and a counting functional method à la Feynman and Kac are employed to calculate the FPT and the average work for this process. From these results, we obtain an explicit form of the time-cost trade-off relation, which provides the lower bound of the mean FPT for a given work input when the trapping potential is linear. This trade-off relation clearly shows that instantaneous resetting is achievable only when an infinite amount of work is provided. More surprisingly, the trade-off relation derived from the linear potential seems to be valid for a wide range of trapping potentials. In addition, we have also shown that the fixed-time or sharp resetting can further enhance the trade-off relation compared to that of the stochastic resetting.

Bipolar magnetic switching and large exchange-bias in Fe-substituted SmCrO3

Rare-earth orthochromite is an interesting system in the view of its complex magnetic ordering due to competing interaction between different magnetic ions. Here, Fe-substituted SmCrO3samples were prepared by solid-state route to investigate their intriguing magnetic properties towards exploring its application potential. The magnetic studies revealed antiferromagnetic (AFM) ordering at Nèel temperature (TN) ∼ 181 K, magnetic compensation temperatures (TCOMP) at ∼137 K and 50 K, and spin-reorientation temperature (TSR) at 64 K in SmCr0.8Fe0.2O3sample. Additionally, the system exhibited negative magnetization under field-cooled conditions which allowed the field as well as temperature controllable magnetization switching behavior. Notably, the Fe-substituted SmCrO3sample displayed a remarkable exchange bias (HEB) value of ∼1.39 T at 10 K due to the coexistence of ferromagnetic and AFM ordering at different cationic sites. TheM-Hloops recorded under positive and negative field-cooled conditions ruled out the minor-loop effect. Theoretical models applied on the training effect studies confirmed the observed exchange-bias effect.

Dysregulated Genes and Signaling Pathways in the Formation and Rupture of Intracranial Aneurysm

Intracranial aneurysm (IA) has the potential to rupture. Despite scientific advances, we are still not in a position to screen patients for IA and identify those at risk of rupture. It is critical to comprehend the molecular basis of disease to facilitate the development of novel diagnostic strategies. We used transcriptomics to identify the dysregulated genes and understand their role in the disease biology. In particular, RNA-Seq was performed in tissue samples of controls, unruptured IA, and ruptured IA. Dysregulated genes (DGs) were identified and analyzed to understand the functional aspects of molecules. Subsequently, candidate genes were validated at both transcript and protein level. There were 314 DGs in patients with unruptured IA when compared to control samples. Out of these, SPARC and OSM were validated as candidate molecules in unruptured IA. PI3K-AKT signaling pathway was found to be an important pathway for the formation of IA. Similarly, 301 DGs were identified in the samples of ruptured IA when compared with unruptured IAs. CTSL was found to be a key candidate molecule which along with Hippo signaling pathway may be involved in the rupture of IA. We conclude that activation of PI3K-AKT signaling pathway by OSM along with up-regulation of SPARC is important for the formation of IA. Further, regulation of Hippo pathway through PI3K-AKT signaling results in the down-regulation of YAP1 gene. This along with up-regulation of CTSL leads to further weakening of aneurysm wall and its subsequent rupture.

Rate enhancement of gated drift-diffusion process by optimal resetting

"Gating" is a widely observed phenomenon in biochemistry that describes the transition between the activated (or open) and deactivated (or closed) states of an ion-channel, which makes transport through that channel highly selective. In general, gating is a mechanism that imposes an additional restriction on a transport, as the process ends only when the "gate" is open and continues otherwise. When diffusion occurs in the presence of a constant bias to a gated target, i.e., to a target that switches between an open and a closed state, the dynamics essentially slow down compared to ungated drift-diffusion, resulting in an increase in the mean completion time, ⟨TG⟩ > ⟨T⟩, where T denotes the random time of transport and G indicates gating. In this work, we utilize stochastic resetting as an external protocol to counterbalance the delay due to gating. We consider a particle in the positive semi-infinite space that undergoes drift-diffusion in the presence of a stochastically gated target at the origin and is moreover subjected to rate-limiting resetting dynamics. Calculating the minimal mean completion time ⟨Tr⋆G⟩ rendered by an optimal resetting rate r⋆ for this exactly solvable system, we construct a phase diagram that owns three distinct phases: (i) where resetting can make gated drift-diffusion faster even compared to the original ungated process, ⟨Tr⋆G⟩<⟨T⟩<⟨TG⟩, (ii) where resetting still expedites gated drift-diffusion but not beyond the original ungated process, ⟨T⟩≤⟨Tr⋆G⟩<⟨TG⟩, and (iii) where resetting fails to expedite gated drift-diffusion, ⟨T⟩<⟨TG⟩≤⟨Tr⋆G⟩. We also highlight various non-trivial behaviors of the completion time as the resetting rate, gating parameters, and geometry of the set-up are carefully ramified. Gated drift-diffusion aptly models various stochastic processes such as chemical reactions that exclusively take place in certain activated states of the reactants. Our work predicts the conditions under which stochastic resetting can act as a useful strategy to enhance the rate of such processes without compromising their selectivity.

Mpemba effect in a Langevin system: Population statistics, metastability, and other exact results

The Mpemba effect is a fingerprint of the anomalous relaxation phenomenon wherein an initially hotter system equilibrates faster than an initially colder system when both are quenched to the same low temperature. Experiments on a single colloidal particle trapped in a carefully shaped double well potential have demonstrated this effect recently [A. Kumar and J. Bechhoefer, Nature 584, 64 (2020)]. In a similar vein, here, we consider a piece-wise linear double well potential that allows us to demonstrate the Mpemba effect using an exact analysis based on the spectral decomposition of the corresponding Fokker-Planck equation. We elucidate the role of the metastable states in the energy landscape as well as the initial population statistics of the particles in showcasing the Mpemba effect. Crucially, our findings indicate that neither the metastability nor the asymmetry in the potential is a necessary or a sufficient condition for the Mpemba effect to be observed.

The relationship between structure and rheology in a three-dimensional sheared lamellar mesophase

The evolution of a lamellar mesophase from an initially disordered state under shear is examined using simulations of a mesoscale model based on a concentration field ψ that distinguishes the hydrophilic and hydrophobic components. The Landau-Ginzburg free-energy functional is augmented by a term that is minimised for sinusoidal modulations in the concentration field with wavelength λ = (2π/k), and the dynamical equations are the model H equations. The structure and rheology are determined by the relative magnitudes of the diffusion time for coarsening, (λ²/D) and the inverse of the strain rate ^-1, and the Ericksen number, which is the ratio of the shear stress and the layer stiffness. When the diffusion time is small compared with the inverse of the strain rate, there is a local formation of misaligned layers, which are deformed by the imposed flow. There is near-perfect ordering with isolated defects at low values of the Ericksen number, but the defects result in a significant increase in viscosity due to the high layer stiffness. At high values of the Ericksen number, the concentration field is deformed by the mean shear before layers form via diffusion. Cylindrical structures aligned along the flow direction form after about 8-10 strain units, and these evolve into layers with disorder through diffusion perpendicular to the flow. The layers are not perfectly ordered, even after hundreds of strain units, due to the creation and destruction of defects via shear. The excess viscosity is low because the layer stiffness is small compared with the applied shear at a high Ericksen number. This study provides guidance on how the material parameters and imposed flow can be tailored to achieve the desired rheological behaviour.

Free drug provision for tuberculosis increases patient follow-ups and successful treatment outcomes in the Indian private sector: a quasi experimental study using propensity score matching

BACKGROUND

The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes.

METHODS

We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 and 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure.

RESULTS

After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637).

CONCLUSIONS

Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients' continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients.

Resetting-mediated navigation of an active Brownian searcher in a homogeneous topography

Designing navigation strategies for search-time optimization remains of interest in various interdisciplinary branches in science. Herein, we focus on active Brownian walkers in noisy and confined environments, which are mediated by one such autonomous strategy, namely stochastic resetting. As such, resetting stops the motion and compels the walkers to restart from the initial configuration intermittently. The resetting clock is operated externally without any influence from the searchers. In particular, the resetting coordinates are either quenched (fixed) or annealed (fluctuating) over the entire topography. Although the strategy relies upon simple governing laws of motion, it shows a significant ramification for the search-time statistics, in contrast to the search process conducted by the underlying reset-free dynamics. Using extensive numerical simulations, we show that the resetting-driven protocols enhance the performance of these active searchers. This, however, depends robustly on the inherent search-time fluctuations, measured by the coefficient of variation of the underlying reset-free process. We also explore the effects of different boundaries and rotational diffusion constants on the search-time fluctuations in the presence of resetting. Notably, for the annealed condition, resetting is always found to expedite the search process. These features, as well as their applicability to more general optimization problems from queuing systems, computer science and randomized numerical algorithms, to active living systems such as enzyme turnover and backtracking recovery of RNA polymerases in gene expression, make resetting-based strategies universally promising.

Rapid Escherichia coli Cloned DNA Detection in Serum Using an Electrical Double Layer-Gated Field-Effect Transistor-Based DNA Sensor

In this study, a rapid diagnosis platform was developed for the detection of Escherichia coli O157:H7. An electrical double layer (EDL)-gated field-effect transistor-based biosensor (BioFET) as a point-of-care testing device is demonstrated with its high sensitivity, portability, high selectivity, quick response, and ease of use. The specially designed ssDNA probe was immobilized on the extended gate electrode to bind the target complementary DNA segment of E. coli, resulting in a sharp drain current change within minutes. The limit of detection for target DNA is validated to a concentration of 1 fM in buffer solution and serum. Meanwhile, the results of a Kelvin probe force microscope were shown to have reduced surface potential of the DNA immobilized sensors before and after the cDNA detection, which is consistent with the decreased drain current of the BioFET. A 1.2 kb E. coli duplex DNA synthesized in plasmid was sonicated and detected in serum samples with the sensor array. Gel electrophoresis was used to confirm the efficiency of sonication by elucidating the length of DNA. Those results show that the EDL-gated BioFET system is a promising platform for rapid identification of pathogens for future clinical needs.

Universal Framework for Record Ages under Restart

We propose a universal framework to compute record age statistics of a stochastic time series that undergoes random restarts. The proposed framework makes minimal assumptions on the underlying process and is furthermore suited to treat generic restart protocols going beyond the Markovian setting. After benchmarking the framework for classical random walks on the 1D lattice, we derive a universal criterion underpinning the impact of restart on the age of the nth record for generic time series with nearest-neighbor transitions. Crucially, the criterion contains a penalty of order n that puts strong constraints on restart expediting the creation of records, as compared to the simple first-passage completion. The applicability of our approach is further demonstrated on an aggregation-shattering process where we compute the typical growth rates of aggregate sizes. This unified framework paves the way to explore record statistics of time series under restart in a wide range of complex systems.

Dose-Response Evaluation of Scopoletin, a Phytochemical, in a High-Fructose High-Fat Diet-Induced Dyslipidemia Model in Wistar Rats

The putative hypolipidemic properties of scopoletin have not been fully confirmed due to a lack of validation in an irreversible chronic hyperlipidemia animal model. The druggability also needs to be studied in terms of bioavailability in the vascular compartment. Accordingly, we conducted a study to assess the hypolipidemic and pharmacokinetic behavior of scopoletin in the high-fructose high-fat diet (HFHFD)-induced dyslipidemia model in Wistar rats. A total of 42 rats were studied, with 6 in each of the 7 groups. A 60-day HFHFD opted for induction of dyslipidemia. Group I and groups II-VII received normal rat chow diet and HFHFD, respectively. Oral scopoletin (1, 5, 10 mg/kg) and atorvastatin 5 mg/kg were administered in groups III-VI, respectively, once daily for the next 15 days. A separate group, group VII, was used for the pharmacokinetic assessment comparing the scopoletin 10 mg/kg intraperitoneally (IP) in group VII versus the oral (group V). Pharmacokinetic blood sampling was performed on the 10th day of continuous once-daily therapy. Rats were sacrificed for the histological examination. All three scopoletin dosages significantly decreased the total cholesterol, low-density lipoproteins, and triglycerides (P < .05 for all), but not in a dose-dependent manner. Atherogenic Index of plasma, Castelli's risk indices, and histopathological findings confirmed the protective effect of scopoletin. The IP administration showed a 23.18% higher exposure than the oral route (P < .001 for area under the curve and P < .05 for concentration-maximum). This study confirms the hypolipidemic efficacy of scopoletin in a more robust irreversible model of dyslipidemia. Scopoletin's gut absorption in the disease state may also boost the initial phase exploratory clinical trial.

A cross-sectional study to find association of VDR gene polymorphism with non-syndromic congenital ichthyosis and with vitamin D deficiency

Though development of vitamin D deficiency and rickets in patients with congenital ichthyosis (CI) have recently been observed, yet exact cause of such association is not properly understood. To evaluate association between Vitamin D Receptor (VDR) polymorphism and CI, and to identify risk factors responsible for development of vitamin D deficiency in ichthyosis. In this cross-sectional study, detailed history of patients and controls was noted and certain biochemical investigations were made. Immunohistochemical staining of skin tissue was done for VDR expression in epidermal and dermal region of ichthyosis patients. VDR polymorphism was assessed in all participants. Ninety-six subjects, were recruited. Mean serum vitamin D was significantly lower among ichthyosis patients. Cdx-2 polymorphism was found to be significantly associated with ichthyosis (p = 0.009). Within the diseased group, Fok-1 (p = 0.035), age (p = 0.020) and alkaline phosphatase (ALP) (p = 0.007) emerged as factors which might be associated with vitamin D deficiency. Cdx2 polymorphism was significantly associated with CI patients. Also, association of Fok-1 polymorphism along with age and raised serum ALP levels emerged as potential factors for determining CI-related vitamin D deficiency.

Microscopic theory of adsorption kinetics

Adsorption is the accumulation of a solute at an interface that is formed between a solution and an additional gas, liquid, or solid phase. The macroscopic theory of adsorption dates back more than a century and is now well-established. Yet, despite recent advancements, a detailed and self-contained theory of single-particle adsorption is still lacking. Here, we bridge this gap by developing a microscopic theory of adsorption kinetics, from which the macroscopic properties follow directly. One of our central achievements is the derivation of the microscopic version of the seminal Ward-Tordai relation, which connects the surface and subsurface adsorbate concentrations via a universal equation that holds for arbitrary adsorption dynamics. Furthermore, we present a microscopic interpretation of the Ward-Tordai relation that, in turn, allows us to generalize it to arbitrary dimension, geometry, and initial conditions. The power of our approach is showcased on a set of hitherto unsolved adsorption problems to which we present exact analytical solutions. The framework developed herein sheds fresh light on the fundamentals of adsorption kinetics, which opens new research avenues in surface science with applications to artificial and biological sensing and to the design of nano-scale devices.

Shape-Tunable BaTiO3 Crystals Presenting Facet-Dependent Optical and Piezoelectric Properties

BaTiO₃ octahedra, edge-, and corner-truncated cubes, and cubes with four tunable sizes from 132 to 438 nm are synthesized by a solvothermal growth approach. Acetic acid treatment can cleanly remove BaCO₃ impurity. Rietveld refinement of X-ray diffraction patterns and Raman spectra help to confirm the particles have a tetragonal crystal structure. The crystals also exhibit size- and facet-dependent bandgap shifts. BaTiO₃ octahedra show larger piezoelectric, ferroelectric, and pyroelectric effects than truncated cubes and cubes. The measured dielectric constant differences should be associated with their various facet-dependent behaviors. Piezoelectric nanogenerators fabricated from BaTiO₃ octahedra consistently show the best performance than those containing truncated cubes and cubes. In particular, a nanogenerator with 30 wt.%-incorporated octahedra displays an open-circuit voltage of 23 V and short-circuit current of 324 nA. The device performance is also highly stable. The maximum output power reaches 3.9 µW at 60 MΩ. The fabricated nanogenerator can provide sufficient electricity to power light-emitting diodes. This work further demonstrates that various physical properties of semiconductor crystals show surface dependence.

Triboelectric Nanosensor Integrated with Robotic Platform for Self-Powered Detection of Chemical Analytes

Rapid on-site detection of hazardous chemicals is imperative for remote security and environmental monitoring applications. However, the implementation of current sensing technologies in real environments is limited due to an external high-power requirement, poor selectivity and sensitivity. Recent progress in triboelectric nanosensors and nanogenerators presents tremendous opportunities to address these issues. Here, we report an innovative self-powered triboelectric nanosensor for detection of Hg²⁺ ions, a harmful chemical pollutant, in a rapid single step on-site detection mechanism. Based on the mechanism of solid-liquid contact electrification, tellurium nanowire (Te NW) arrays serving as a solid triboelectric material as well as the sensing probe underwent periodic contact and separation with the Hg²⁺ solution, leading to the in situ formation of mercury telluride nanowire (HgTe NWs) owing to the selective binding affinity of Te NWs toward Hg²⁺ ions. To realize the on-site sensing potential, Te NW arrays were mounted onto the robotic hands equipped with additional wireless transmission functionality for rapid detection of Hg²⁺ ions in resource-limited settings by employing a simple "touch and sense" mechanism. Such a demonstration of direct integration of self-powered sensors with robotics would lead to the development of low-cost, automated chemical sensing machinery for the on-field detection of harmful analytes.

Fick-Jacobs description and first passage dynamics for diffusion in a channel under stochastic resetting

The transport of particles through channels is of paramount importance in physics, chemistry, and surface science due to its broad real world applications. Much insight can be gained by observing the transition paths of a particle through a channel and collecting statistics on the lifetimes in the channel or the escape probabilities from the channel. In this paper, we consider the diffusive transport through a narrow conical channel of a Brownian particle subject to intermittent dynamics, namely, stochastic resetting. As such, resetting brings the particle back to a desired location from where it resumes its diffusive phase. To this end, we extend the Fick-Jacobs theory of channel-facilitated diffusive transport to resetting-induced transport. Exact expressions for the conditional mean first passage times, escape probabilities, and the total average lifetime in the channel are obtained, and their behavior as a function of the resetting rate is highlighted. It is shown that resetting can expedite the transport through the channel-rigorous constraints for such conditions are then illustrated. Furthermore, we observe that a carefully chosen resetting rate can render the average lifetime of the particle inside the channel minimal. Interestingly, the optimal rate undergoes continuous and discontinuous transitions as some relevant system parameters are varied. The validity of our one-dimensional analysis and the corresponding theoretical predictions is supported by three-dimensional Brownian dynamics simulations. We thus believe that resetting can be useful to facilitate particle transport across biological membranes-a phenomenon that can spearhead further theoretical and experimental studies.

Measurement of the ν_{e}-Nucleus Charged-Current Double-Differential Cross Section at ⟨E_{ν}⟩=2.4 GeV Using NOvA

The inclusive electron neutrino charged-current cross section is measured in the NOvA near detector using 8.02×10^{20} protons-on-target in the NuMI beam. The sample of GeV electron neutrino interactions is the largest analyzed to date and is limited by ≃17% systematic rather than the ≃7.4% statistical uncertainties. The double-differential cross section in final-state electron energy and angle is presented for the first time, together with the single-differential dependence on Q^{2} (squared four-momentum transfer) and energy, in the range 1  GeV≤E_{ν}<6  GeV. Detailed comparisons are made to the predictions of the GENIE, GiBUU, NEUT, and NuWro neutrino event generators. The data do not strongly favor a model over the others consistently across all three cross sections measured, though some models have especially good or poor agreement in the single differential cross section vs Q^{2}.

A self-powered multifunctional dressing for active infection prevention and accelerated wound healing

Interruption of the wound healing process due to pathogenic infection remains a major health care challenge. The existing methods for wound management require power sources that hinder their utilization outside of clinical settings. Here, a next generation of wearable self-powered wound dressing is developed, which can be activated by diverse stimuli from the patient's body and provide on-demand treatment for both normal and infected wounds. The highly tunable dressing is composed of thermocatalytic bismuth telluride nanoplates (Bi₂Te₃ NPs) functionalized onto carbon fiber fabric electrodes and triggered by the surrounding temperature difference to controllably generate hydrogen peroxide to effectively inhibit bacterial growth at the wound site. The integrated electrodes are connected to a wearable triboelectric nanogenerator (TENG) to provide electrical stimulation for accelerated wound closure by enhancing cellular proliferation, migration, and angiogenesis. The reported self-powered dressing holds great potential in facilitating personalized and user-friendly wound care with improved healing outcomes.

Effects of metformin on clinical, hormonal and relevant gene expression parameters in patients of acne - an observational study

BACKGROUND

Acne vulgaris is associated with insulin resistance and elevated insulin-like growth factor-1 (IGF-1). Metformin is commonly used for treatment of acne in patients with PCOS. However, benefits of metformin in patients with acne in general are not well established.

OBJECTIVE

To study effectiveness of metformin in non-PCOS acne patients and to understand the mechanisms of action of metformin in non-PCOS acne.

METHODOLOGY

In this observational study, 30 clinically confirmed acne vulgaris patients were treated with metformin (1000 mg/day) for three months without any other topical or systemic active intervention for acne. The effect of metformin at clinical, hormonal and genetic level was assessed.

RESULTS

Metformin monotherapy significantly (p#x003C;0.0001) decreased the global acne grading score for acne followed by marginal increase in insulin with a significant (p=0.028) increase in insulin-like growth factor-1 (IGF-1). A significant (p=0.0003) decrease in free androgen index resulting from a significant (p<0.0002) increase in sex hormone-binding globulin (SHBG) with decrease in testosterone was observed. The homeostasis model assessment insulin resistance (HOMA-IR) was not significantly changed. Forkhead box O1 (FoxO1) expression was significantly (p=0.006) downregulated upon metformin treatment at mRNA level without any significant changes at protein level. Expression of lipogenic genes, namely 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMG-CoA reductase), squalene epoxidase and acyl CoA synthetase (p=0.0005, 0.0249, 0.0268, respectively) were also downregulated.

CONCLUSION

Metformin monotherapy led to significant clinical improvement in acne, possibly by reducing testosterone, inhibiting FoxO1 and reducing lipid synthesis by decreasing the expression of lipogenic genes.

Microfluidic nanodevices for drug sensing and screening applications

The outbreak of pandemics (e.g., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 in 2019), influenza A viruses (H1N1 in 2009), etc.), and worldwide spike in the aging population have created unprecedented urgency for developing new drugs to improve disease treatment. As a result, extensive efforts have been made to design novel techniques for efficient drug monitoring and screening, which form the backbone of drug development. Compared to traditional techniques, microfluidics-based platforms have emerged as promising alternatives for high-throughput drug screening due to their inherent miniaturization characteristics, low sample consumption, integration, and compatibility with diverse analytical strategies. Moreover, the microfluidic-based models utilizing human cells to produce in-vitro biomimetics of the human body pave new ways to predict more accurate drug effects in humans. This review provides a comprehensive summary of different microfluidics-based drug sensing and screening strategies and briefly discusses their advantages. Most importantly, an in-depth outlook of the commonly used detection techniques integrated with microfluidic chips for highly sensitive drug screening is provided. Then, the influence of critical parameters such as sensing materials and microfluidic platform geometries on screening performance is summarized. This review also outlines the recent applications of microfluidic approaches for screening therapeutic and illicit drugs. Moreover, the current challenges and the future perspective of this research field is elaborately highlighted, which we believe will contribute immensely towards significant achievements in all aspects of drug development.

Clinical and metabolic characteristics of males with early-onset androgenetic alopecia

Background Men with early-onset androgenetic alopecia (AGA) often have an abnormal hormonal milieu. Objective To ascertain the clinico-phenotypic characteristics and the prevalence of hormonal and metabolic changes in men with early-onset AGA. Methods Consecutive male patients less than 30 years of age with a Norwood-Hamilton grade ≥3 AGA were recruited in this comparative cross-sectional study. After endocrine evaluation they were classified into two groups, that is, Group A consisting of subjects with an altered hormonal profile and Group B with normal hormonal profiles. The groups were assessed for differences in disease phenotype and severity (Norwood-Hamilton grade), insulin resistance and parameters of metabolic syndrome (ATP III guidelines). Results Altered hormonal profiles were seen in 34 of the 100 subjects with AGA, while insulin resistance and metabolic syndrome were noted in 44 and 26 respectively. Altered hormonal profiles were significantly associated with insulin resistance and severe alopecia (grade 4 and above Hamilton-Norwood Scale). Insulin resistant Group A patients had a significantly higher prevalence of severe alopecia (>grade 4) (P = 0.0036). The prevalence of metabolic syndrome was similar in both groups. Limitation The cross sectional study design was a drawback of this study. Further, a control arm without AGA was not included and the sample size of 100 was selected arbitrarily. Conclusion An altered hormonal profile and insulin resistance was noted in a third of the males with early-onset AGA. Subjects with altered hormonal profiles had a higher prevalence of insulin resistance and were likely to have severe grades of AGA.

Temporal Modulation of DNA Methylation and Gene Expression in Monolayer and 3D Spheroids of Dental Pulp Stem Cells during Osteogenic Differentiation: A Comparative Study

BACKGROUND

Human mesenchymal stem cells are being used for various regenerative applications in past decades. This study chronicled a temporal profile of the transcriptional pattern and promoter methylation status of the osteogenic related gene in dental pulp stem cells (DPSCs) derived from 3-dimensional spheroid culture (3D) vis a vis 2-dimensional (2D) monolayer culture upon osteogenic induction.

METHODS

Biomimetic properties of osteogenesis were determined by alkaline phosphatase assay and alizarin red staining. Gene expression and promoter methylation status of osteogenic genes such as runt-related transcription factor-2, collagen1α1, osteocalcin (OCN), and DLX5 (distal-homeobox) were performed by qPCR assay and bisulfite sequencing, respectively. Furthermore, µ-Computed tomography (micro-CT) was performed to examine the new bone formation in critical-sized rat calvarial bone defect model.

RESULTS

Our results indicated a greater inclination of spheroid culture-derived DPSCs toward osteogenic lineage than the monolayer culture. The bisulfite sequencing of the promoter region of osteogenic genes revealed sustenance of low methylation levels in DPSCs during the progression of osteogenic differentiation. However, the significant difference in the methylation pattern between 2D and 3D derived DPSCs were identified only for OCN gene promoter. We observed differences in the mRNA expression pattern of epigenetic writers such as DNA methyltransferases (DNMTs) and methyl-cytosine dioxygenases (TET) between the two culture conditions. Further, the DPSC spheroids showed enhanced new bone formation ability in an animal model of bone defect compared to the cells cultivated in a 2D platform which further substantiated our in-vitro observations.

CONCLUSION

The distinct cellular microenvironment induced changes in DNA methylation pattern and expression of epigenetic regulators such as DNMTs and TETs genes may lead to increase expression of osteogenic markers in 3D spheroid culture of DPSCs which make DPSCs spheroids suitable for osteogenic regeneration compared to monolayers.

P-065 PROSPECTIVE STUDY OF QUALITY OF LIFE OUTCOMES OF TOTALLY TRANSFASCIAL SUTURE FIXATION OF MESH WITH CLOSURE OF DEFECT IN LAPAROSCOPIC VENTRAL HERNIA REPAIR

Aim

To study the Quality of life Outcome in totally transfacial suture fixation of mesh with primary closure of defect in laparoscopic ventral hernia repair with regards to:

Materials & Methods

Patients who visited the OPD of General Surgery, KGMU, Lucknow, UP and was diagnosed as a case of symptomatic ventral and incisional hernia fulfilling the inclusion and exclusion criteria were enrolled.

Results

A total of 40 patients from OPD department of General Surgery were enrolled. Maximum numbers of patients in the study i.e. 14(35%) belong to M4. Mean BMI is 28.6. Mean defect size was 3.25 cm (Range- 2cm to 5 cm). Mean duration of hospital stay was 2.85 days. With this procedure the patients were able to resume his/her daily routines very early and a mean of 4.65 days was recorded among the 40 patients involved in the study. Also a mean of 11.6 days was recorded as the time taken to return to office works which was all within two weeks after the operation. Carolina's comfort scale measure quality of life score in pre-op and post-op period on sensation of mesh,pain sensation and limitation of movement . where the scores were added and the mean sensation of mesh at post-operative period was 0.30.

Conclusion

There was significant improvement in dimensions of body pain, physical function, vitality, emotional role, mental health and sensation of mesh in small and medium size hernia, with totally transfascial suture fixation of mesh.

Cerebrospinal fluid and plasma procalcitonin for the diagnosis of neonatal bacterial meningitis

AIM

There is a paucity of data on cerebrospinal fluid (CSF) procalcitonin (PCT) to diagnose neonatal meningitis. We evaluated CSF PCT to diagnose bacterial meningitis among neonates with suspected sepsis.

METHODS

Neonates undergoing lumbar puncture (LP) as part of sepsis workup were included.

INDEX TESTS

CSF PCT, plasma PCT, CSF:plasma PCT ratio and CSF cytochemistry. Reference Standards: 'Definite meningitis' defined by positive CSF culture and/or gram stain and/or broad-based primer 16S rDNA polymerase chain reaction. 'Definite or probable' meningitis is defined as definite meningitis or abnormal cytochemistry.

RESULTS

Of 216 eligible neonates, 18 had 'definite meningitis' and 37 'definite or probable meningitis'. Median (Q₁ , Q₃ ) CSF PCT level was significantly higher in 'definite meningitis' compared to 'no definite meningitis' (0.429 (0.123, 1.300) vs. 0.181 (0.119, 0.286) ng/mL respectively, P = 0.028). Likewise, it was significantly higher in 'definite or probable meningitis' compared to no meningitis (0.245 (0.136, 0.675) vs. 0.170 (0.116, 0.28), P = 0.01). The area under the receiver operator characteristics curve of CSF PCT level for definite meningitis was 0.656 and for 'definite or probable meningitis' 0.635. Paired comparisons of area under the receiver operator characteristics curve of CSF PCT with the other index tests showed no significant differences. Based on a priori cut-off of 0.2 ng/mL, CSF PCT level had a sensitivity (95% confidence interval) of 67% (50, 80), specificity 58% (54, 61), LR⁺ 1.6 (1.1, 2.0) and LR^- 0.6 (0.3, 0.9).

CONCLUSIONS

Higher values of CSF PCT are associated with neonatal bacterial meningitis. However, the diagnostic performance of CSF PCT is modest and not significantly different from standard tests.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Mitigating long queues and waiting times with service resetting

What determines the average length of a queue, which stretches in front of a service station? The answer to this question clearly depends on the average rate at which jobs arrive at the queue and on the average rate of service. Somewhat less obvious is the fact that stochastic fluctuations in service and arrival times are also important, and that these are a major source of backlogs and delays. Strategies that could mitigate fluctuations-induced delays are, thus in high demand as queue structures appear in various natural and man-made systems. Here, we demonstrate that a simple service resetting mechanism can reverse the deleterious effects of large fluctuations in service times, thus turning a marked drawback into a favorable advantage. This happens when stochastic fluctuations are intrinsic to the server, and we show that service resetting can then dramatically cut down average queue lengths and waiting times. Remarkably, this strategy is also useful in extreme situations where the variance, and possibly even mean, of the service time diverge-as resetting can then prevent queues from "blowing up." We illustrate these results on the M/G/1 queue in which service times are general and arrivals are assumed to be Markovian. However, the main results and conclusions coming from our analysis are not specific to this particular model system. Thus, the results presented herein can be carried over to other queueing systems: in telecommunications, via computing, and all the way to molecular queues that emerge in enzymatic and metabolic cycles of living organisms.

"DOST" Model to Link and Support Drug Resistant TB Patients From Private Sector: An Experience From Delhi, India

Background

The National TB Elimination Programme (NTEP) has quite successfully involved private sector for referral of presumptive drug resistant TB (DR-TB) patients for molecular testing and referral for DR-TB management. There was a challenge as all the referred patients were not reaching to the facilities. A “DOST” intervention model was implemented to strengthen the patient care pathway. We conducted this study to describe the patient care cascade, the clinico-demographic characteristics of patients linked to the treatment and to estimate the mean turn-around time for drug resistant TB care services.

Methods

It is a cross-sectional study conducted at New Delhi during the period July 2019-December 2020 under programmatic settings.

Results

A total of 9,331 patients were subjected to CB-NAAT test and 382 (4%) were found to be resistant for rifampicin and 231 (76%) were initiated on treatment in the public sector under NTEP.

Conclusion

The DOST intervention model developed to link the DR-TB patients from private sector to the public sector DR-TB centers is found to be efficient and effective.

Income inequality and mobility in geometric Brownian motion with stochastic resetting: theoretical results and empirical evidence of non-ergodicity

We explore the role of non-ergodicity in the relationship between income inequality, the extent of concentration in the income distribution, and income mobility, the feasibility of an individual to change their position in the income rankings. For this purpose, we use the properties of an established model for income growth that includes 'resetting' as a stabilizing force to ensure stationary dynamics. We find that the dynamics of inequality is regime-dependent: it may range from a strictly non-ergodic state where this phenomenon has an increasing trend, up to a stable regime where inequality is steady and the system efficiently mimics ergodicity. Mobility measures, conversely, are always stable over time, but suggest that economies become less mobile in non-ergodic regimes. By fitting the model to empirical data for the income share of the top earners in the USA, we provide evidence that the income dynamics in this country is consistently in a regime in which non-ergodicity characterizes inequality and immobility. Our results can serve as a simple rationale for the observed real-world income dynamics and as such aid in addressing non-ergodicity in various empirical settings across the globe. This article is part of the theme issue 'Kinetic exchange models of societies and economies'.