Behavioral economic implementation strategies to improve serious illness communication between clinicians and high-risk patients with cancer: protocol for a cluster randomized pragmatic trial

BACKGROUND

Serious illness conversations (SICs) are an evidence-based approach to eliciting patients' values, goals, and care preferences that improve patient outcomes. However, most patients with cancer die without a documented SIC. Clinician-directed implementation strategies informed by behavioral economics ("nudges") that identify high-risk patients have shown promise in increasing SIC documentation among clinicians. It is unknown whether patient-directed nudges that normalize and prime patients towards SIC completion-either alone or in combination with clinician nudges that additionally compare performance relative to peers-may improve on this approach. Our objective is to test the effect of clinician- and patient-directed nudges as implementation strategies for increasing SIC completion among patients with cancer.

METHODS

We will conduct a 2 × 2 factorial, cluster randomized pragmatic trial to test the effect of nudges to clinicians, patients, or both, compared to usual care, on SIC completion. Participants will include 166 medical and gynecologic oncology clinicians practicing at ten sites within a large academic health system and their approximately 5500 patients at high risk of predicted 6-month mortality based on a validated machine-learning prognostic algorithm. Data will be obtained via the electronic medical record, clinician survey, and semi-structured interviews with clinicians and patients. The primary outcome will be time to SIC documentation among high-risk patients. Secondary outcomes will include time to SIC documentation among all patients (assessing spillover effects), palliative care referral among high-risk patients, and aggressive end-of-life care utilization (composite of chemotherapy within 14 days before death, hospitalization within 30 days before death, or admission to hospice within 3 days before death) among high-risk decedents. We will assess moderators of the effect of implementation strategies and conduct semi-structured interviews with a subset of clinicians and patients to assess contextual factors that shape the effectiveness of nudges with an eye towards health equity.

DISCUSSION

This will be the first pragmatic trial to evaluate clinician- and patient-directed nudges to promote SIC completion for patients with cancer. We expect the study to yield insights into the effectiveness of clinician and patient nudges as implementation strategies to improve SIC rates, and to uncover multilevel contextual factors that drive response to these strategies.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT04867850 . Registered on April 30, 2021.

FUNDING

National Cancer Institute P50CA244690.

Study of Change in Physico-Chemical Parameters by Treatment of Sludge from Common Effluent Treatment Plant (CETP) with Earthworms

One of the most vital problems of environmental protection concern is that of solid waste disposal. This problem continues to grow with the growth of population and the development of industries. The Common Effluent Treatment Plant (CETP) already establishes itself as a service to society at large, contributing towards a cleaner environment. However, the inappropriate disposal of CETP’s hazardous sludge can cause serious environmental problems. The sludge if sent for landfilling may cause groundwater contamination, changing the soil fertility parameters as well. The research presented here is carried out to explore the ability of an epigeic earthworm Eudrilus eugeniae to transform the sludge produced from CETP into a value-added product i.e., vermicompost. In this study, six samples of feed mixture were used with different ratios of CETP sludge, cow dung, and sawdust. Physico-chemical parameters such as pH, Electrical Conductivity (EC), Volatile Solids (VS), Total Nitrogen (TN), Nitrate Nitrogen (NO3--N), Ammonium Nitrogen (NH4+-N) were characterized to analyze the quality of the compost formed. All these parameters are in the agreement with recommended standards of mature compost. The result shows that vermicomposting technique when used, epigeic earthworm Eudrilus eugeniae can work as a favorable alternative solution for the disposal of CETP sludge.

Serious Illness Communication Practices in Glioblastoma: An Institutional Perspective

Background: Early, high-quality advance care planning discussions are essential for supporting goal-concordant care among glioblastoma (GBM) patients. Objective: Using mixed methods, we sought to characterize current serious illness (SI) communication practices at our institution. Methods: The electronic medical records of 240 deceased GBM patients cared for at the Abramson Cancer Center in Philadelphia, PA between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains: prognosis, goals, end-of-life planning, and code status. Patient outcomes and SI conversation characteristics were analyzed using descriptive statistics. Standardized interviews about GBM care were held with five clinicians. Interview transcripts were analyzed using grounded-theory coding to identify emergent themes. Results: Nearly all patients (96%) had at least one documented SI conversation (median: 4, interquartile range [IQR] 2-7), mostly outpatient with medical oncology physicians. Median timing of first SI conversation was 360 days before death. SI conversations were not significantly associated with patient outcomes, including inpatient death and hospice enrollment. Seven themes emerged from clinician interviews: balancing hope and reality, anticipatory guidance, neglect of the "big picture," need for earlier conversations, care coordination, the role of clinical expertise, and communication training. Conclusion: SI conversations were documented early and often in our sample, but their quality was difficult to assess. Contrary to our quantitative findings, interviewees reported that SI conversations were late, infrequent, inadequate, and fragmented across specialties, failing to explore critical issues such as prognosis and functional decline.

Organ commercialism, trafficking and transplant tourism

The gap between demand and supply of organs continues to widen worldwide, encouraging transplant commercialism. While solid organ commerce is most prevalent in impoverished countries, commercialisation of body parts such as tissues is prevalent in economically developed countries. A number of international legal instruments and transplant societies define, condemn, and criminalise these practices and have issued statements related to organ commercialism. In contrast, limited attention has been paid to illicit and unethical activities associated with the procurement and clinical use of tissues. In India, The Transplantation of Human Organs (Amendment) Act, 2011, has taken multiple measures to combat organ and tissue commerce and as a result the number of such instances seems to be on the decline. However, the fight against unethical organ procurement through the internet and the social media is challenging and requires the cooperation of global bodies. Keywords: Organ trade, Declaration of Istanbul, tissue commerce, organ transplants, transplant tourism.

Combining tumor deposits with the number of lymph node metastases to improve the prognostic accuracy in stage III colon cancer: a post hoc analysis of the CALGB/SWOG 80702 phase III study (Alliance)☆

BACKGROUND

In colon cancer, tumor deposits (TD) are considered in assigning prognosis and staging only in the absence of lymph node metastasis (i.e. stage III pN1c tumors). We aimed to evaluate the prognostic value of the presence and the number of TD in patients with stage III, node-positive colon cancer.

PATIENTS AND METHODS

All participants from the CALGB/SWOG 80702 phase III trial were included in this post hoc analysis. Pathology reports were reviewed for the presence and the number of TD, lymphovascular and perineural invasion. Associations with disease-free survival (DFS) and overall survival (OS) were evaluated by multivariable Cox models adjusting for sex, treatment arm, T-stage, N-stage, lymphovascular invasion, perineural invasion and lymph node ratio.

RESULTS

Overall, 2028 patients were included with 524 (26%) TD-positive and 1504 (74%) TD-negative tumors. Of the TD-positive patients, 80 (15.4%) were node negative (i.e. pN1c), 239 (46.1%) were pN1a/b (<4 positive lymph nodes) and 200 (38.5%) were pN2 (≥4 positive lymph nodes). The presence of TD was associated with poorer DFS [adjusted hazard ratio (aHR) = 1.63, 95% CI 1.33-1.98] and OS (aHR = 1.59, 95% CI 1.24-2.04). The negative effect of TD was observed for both pN1a/b and pN2 groups. Among TD-positive patients, the number of TD had a linear negative effect on DFS and OS. Combining TD and the number of lymph node metastases, 104 of 1470 (7.1%) pN1 patients were re-staged as pN2, with worse outcomes than patients confirmed as pN1 (3-year DFS rate: 65.4% versus 80.5%, P = 0.0003; 5-year OS rate: 87.9% versus 69.1%, P = <0.0001). DFS was not different between patients re-staged as pN2 and those initially staged as pN2 (3-year DFS rate: 65.4% versus 62.3%, P = 0.4895).

CONCLUSION

Combining the number of TD and the number of lymph node metastases improved the prognostication accuracy of tumor-node-metastasis (TNM) staging.

Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Oncology, Dementia, Frailty, and Pulmonary Diseases

Prognostication has been described as "Medicine's Lost Art." Taken with diagnosis and treatment, prognostication is the third leg on which medical care rests. As research leads to additional beneficial treatments for vexing conditions like cancer, dementia, and lung disease, prognostication becomes even more difficult. This article, written by a group of palliative care clinicians with backgrounds in geriatrics, pulmonology, and oncology, aims to offer a useful framework for consideration of prognosis in these conditions. This article will serve as the first in a three-part series on prognostication in adults and children.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Cloning, characterisation and expression of the SERPINB14 gene, and association of promoter polymorphisms with egg quality traits in layer chicken

1. Ovalbumin (SERPINB14) is the most abundant protein present in egg white contributing about 54% of the total egg protein. In this study, the objectives were to clone and characterise the coding sequence of the SERPINB14 gene, to explore its expression profile, identify polymorphisms in the promoter of the gene and explore any association with egg quality traits in White Leghorn chickens.2. SNPs and mRNA expression of SERPINB14 in White Leghorn chicken lines were detected by PCR-single strand conformation polymorphism (SSCP) along with sequencing and qPCR. The open reading frame (ORF) was cloned in an expression plasmid vector and sequenced.3. The ORF of this gene was 1161 bp encoding a peptide of 386 amino acids. There were three SNPs observed in the coding region of the gene, one of which was of the mis-sense type, having c562G>A transition which resulted in substitution of alanine to threonine at position 188 in the protein sequence. In both the lines, an increase in expression of the gene was observed after onset of egg production with peak expression at the 40^th week of age compared to before onset of lay. The SERPINB14 gene was expressed in the magnum, but not in ovary and infundibulum, tissues of each White Leghorn line. The promoter region of the gene showed SNPs with three haplotypes; H1, H2, and H3. The haplo groups were associated with the egg weight and age at sexual maturity in the IWI line and Haugh unit and albumin index in the IWK line.4. It was concluded that the ORF of SERPINB14 gene in White Leghorn chicken lines is polymorphic. The promoter region of the gene is also polymorphic and has significant (P < 0.05) association with Haugh unit and egg weight in IWK and IWI chicken lines, respectively.

SARS-CoV-2 nosocomial infection: Real-world results of environmental surface testing from a large tertiary cancer center

BACKGROUND

Despite consensus guidelines, concern about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has dissuaded patients with cancer from seeking medical care. Studies have shown that contaminated surfaces may contain viable virus for up to 72 hours in laboratory settings. The purpose of this study was to investigate contamination of SARS-CoV-2 on commonly used environmental surfaces in a tertiary cancer care center.

METHODS

This study evaluated the incidence of SARS-CoV-2 viral RNA in high-touch outpatient and inpatient cancer center spaces. Surfaces were tested over a 2-week period after patient or staff exposure but before scheduled disinfection services according to the World Health Organization protocols for coronavirus disease 2019 (COVID-19) surface sampling. Samples were analyzed via reverse transcriptase-polymerase chain reaction for the presence of SARS-CoV-2 RNA.

RESULTS

Two hundred four environmental samples were obtained from inpatient and outpatient oncology clinics and infusion suites, and they were categorized as 1) public areas, 2) staff areas, or 3) medical equipment. One hundred thirty surfaces from 2 outpatient hematology and oncology clinics and 36 surfaces from an inpatient leukemia/lymphoma/chimeric antigen receptor T-cell unit were examined, and all 166 samples were negative for SARS-CoV-2. One of 38 samples (2.6%) from COVID-19+ inpatient units was positive. Altogether, the positive test rate for SARS-CoV-2 RNA across all surfaces was 0.5% (1 of 204).

CONCLUSIONS

This prospective, systematic quality assurance investigation of real-world environmental surfaces, performed in inpatient and outpatient hematology/oncology units, revealed overall negligible detection of SARS-CoV-2 RNA when strict mitigation strategies against COVID-19 transmission were instituted.

LAY SUMMARY

The potential risks of nosocomial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have deterred patients with cancer from seeking timely care despite consensus guidelines. This study has found negligible rates of environmental contamination with SARS-CoV-2 across a multitude of commonly used surfaces in outpatient and inpatient hematology/oncology settings with adherence to strict infection control protocols.

The perspectives of biomarker-based electrochemical immunosensors, artificial intelligence and the Internet of Medical Things toward COVID-19 diagnosis and management

The World Health Organization (WHO) has declared the COVID-19 an international health emergency due to the severity of infection progression, which became more severe due to its continuous spread globally and the unavailability of appropriate therapy and diagnostics systems. Thus, there is a need for efficient devices to detect SARS-CoV-2 infection at an early stage. Nowadays, the reverse transcription polymerase chain reaction (RT-PCR) technique is being applied for detecting this virus around the globe; however, factors such as stringent expertise, long diagnostic times, invasive and painful screening, and high costs have restricted the use of RT-PCR methods for rapid diagnostics. Therefore, the development of cost-effective, portable, sensitive, prompt and selective sensing systems to detect SARS-CoV-2 in biofluids at fM/pM/nM concentrations would be a breakthrough in diagnostics. Immunosensors that show increased specificity and sensitivity are considerably fast and do not imply costly reagents or instruments, reducing the cost for COVID-19 detection. The current developments in immunosensors perhaps signify the most significant opportunity for a rapid assay to detect COVID-19, without the need of highly skilled professionals and specialized tools to interpret results. Artificial intelligence (AI) and the Internet of Medical Things (IoMT) can also be equipped with this immunosensing approach to investigate useful networking through database management, sharing, and analytics to prevent and manage COVID-19. Herein, we represent the collective concepts of biomarker-based immunosensors along with AI and IoMT as smart sensing strategies with bioinformatics approach to monitor non-invasive early stage SARS-CoV-2 development, with fast point-of-care (POC) diagnostics as the crucial goal. This approach should be implemented quickly and verified practicality for clinical samples before being set in the present times for mass-diagnostic research.

Linear lesions in dermatology: a clinicoaetiopathological study

BACKGROUND

Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis.

AIMS

To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution.

METHODS

We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis.

RESULTS

Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus).

CONCLUSION

Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

Oncologist phenotypes and associations with response to a behavioral intervention to increase serious illness conversations

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Background: Interventions to increase serious illness conversations (SICs) between oncologists and patients may improve goal-concordant care, patient mood and quality of life. Randomized studies suggest that behavioral nudges to oncologists may prompt more and earlier SICs. Identifying characteristics of oncologists associated with response to such interventions may clarify barriers to SIC adoption. Methods: This was a secondary analysis of a randomized trial showing that machine learning (ML)-based behavioral nudges among 42 oncologist-advanced practice provider (APP) dyads (79 total oncology clinicians total) caring for 14,607 patients in a large academic health system led to a quadrupling of SIC rates (NCT03984773). Latent profile analysis identified oncologist phenotypes based on oncologist, patient, and practice data. We used difference-in-differences analyses among patients with predicted 180-day mortality risk ≥10% (n=2695 [12.6% of cohort]) to test the association between oncologist phenotype and response to the nudge, adjusted for patient and oncologist demographic and practice characteristics. Results: Three oncologist phenotypes were identified: 1) Higher-volume specialists 2) Lower-volume specialists; and 3) Higher-volume generalists. Compared with higher-volume specialists and higher-volume generalists, lower-volume specialists had fewer patients per week (9.2 vs 24.3 vs 53.2), fewer days in clinic per week (1.6 vs 2.5 vs 4.4), a higher proportion of new patients per week (34.9% vs 21.0% vs 17.6%), and higher baseline SIC rates (3.9% vs 1.6% vs 0.8%). Lower-volume specialists had a significantly greater response to the intervention than higher-volume specialists and generalists (see Table), demonstrating a nearly six-fold increase in SIC rate from baseline. Conclusions: Response to an ML-based behavioral nudge to prompt SICs was driven by specialist oncologists with lower patient volume and greater SIC adoption at baseline, although the nudge was associated with significantly higher SIC rates among all phenotypes. While effective among lower-volume oncologists, nudges to prompt supportive care interventions may have limited impact among higher-volume oncologists. Other strategies, including default involvement of specialty palliative care, may be more effective for higher-volume oncologists.[Table: see text]

A strategy to enhance the photocatalytic efficiency of α-Fe2O3

The photocatalytic dye degradation of pure α-Fe₂O₃ and different concentration of Co doped α-Fe₂O₃ is explored. Facile hydrothermal method were employed to prepare pristine, 2% and 4% Co-Fe₂O₃ nanoparticles. Further, synthesized product confirmation studies were employed from X-ray diffraction, UV-vis spectrometry, Fourier-transform infrared, Raman, scanning electron microscope and transmission electron microscope studies. The rhombohedral nanoparticles developed were enhanced photocatalytic action. Photocatalytic dye degradation studies were analyzed for prepared three samples and the photocatalytic efficacy of the obtained photocatalysts was compared experimentally. Methylene blue dye was degraded under UV-light irradiation with 364 nm. The results showed that 4% Co doped α-Fe₂O₃ sample exhibited better dye degradation with 92% efficiency. The 4% doping of cobalt ions enhanced the photocatalytic property of Fe₂O₃ and is a good candidate for methylene blue dye degradation above 90%. In addition, strategy for photocatalytic efficiency enhancement was proposed.

Asymmetrical Vortex over Slender Body A Computational Approach

Computational investigations were carried out on an ogive-cylinder configuration having a slenderness ratio of 7.5. The geometry of the nose tip was generated based on the physical geometry of the nose tip observed under a scanning electron microscope. Time-dependent simulations were performed on the slender body at a diameter Reynolds number of 3.0×104. Results indicated that the onset of vortex asymmetry was mainly due to the micro-tip imperfection existing at the tip. It was also observed that the variation in the roll angle of the model affected the flow physics largely which has been experimentally observed by several researchers in the past. The computed results were in better agreement with the referenced experimental data.

Optimized LMS algorithm for system identification and noise cancellation

Optimization by definition is the action of making most effective or the best use of a resource or situation and that is required almost in every field of engineering. In this work, the optimization of Least Mean square (LMS) algorithm is carried out with the help of Particle Swarm Optimization (PSO) and Ant Colony Optimization (ACO). Efforts have been made to find out the advantages and disadvantages of combining gradient based (LMS) algorithm with Swarm Intelligence SI (ACO, PSO). This optimization of LMS algorithm will help us in further extending the uses of adaptive filtering to the system having multi-model error surface that is still a gray area of adaptive filtering. Because the available version of LMS algorithm that plays an important role in adaptive filtering is a gradient based algorithm, that get stuck at the local minima of system with multi-model error surface considering it global minima, resulting in an non-optimized convergence. By virtue of the proposed method we have got a profound solution for the problem associated with system with multimodal error surface. The results depict significant improvements in the performance and displayed fast convergence rate, rather stucking at local minima. Both the SI techniques displayed their own advantage and can be separately combined with LMS algorithm for adaptive filtering. This optimization of LMS algorithm will further help to resolve serious interference and noise issues and holds a very important application in the field of biomedical science.

Complete genome sequence and genetic organization of a Garlic virus D infecting garlic (Allium sativum) from northern India

The present paper describes first full genome sequence of the Garlic virus D (GarV-D) from northern India with a genome size of 8425 bp long ssRNA. The infected leaves and bulbs of garlic variety Yamuna Safed (G-282) plants suspected for GarV-D infection were collected with the aim to identify contagion virus during March, 2018. The total RNA was extracted from the pooled garlic plants using TRIzol reagent and sequenced using an Illumina HiSeq 2000 platform. BLASTn search in the NCBI database identified contagion as GarV-D (MK518067). It shared 83.63-85.83% nucleotide sequence identities with other (GarV-D) isolates from Argentina (KF550407, KF555653, KR819505) and 83.15% with isolates from China (MF795136, MF363012). Keywords: Allium sativum; Allexivirus; Garlic virus D; India.

Alginate-gum acacia based sponges as potential wound dressings for exuding and bleeding wounds

The improper management of wound exudates can expose the wound to bacterial invasion, skin maceration etc. thereby resulting in prolonged wound healing. Biopolymers are characterized by hydrophilic functional groups which when employed for the development of wound dressings promote the wound dressings capability to absorb a high amount of wound exudates. Alginate-gum acacia sponges were prepared from a combination of biopolymers such as sodium alginate and gum acacia in varying amounts with carbopol via crosslinking with 1 and 2% CaCl₂. The prepared sponges were loaded with a combination of ampicillin and norfloxacin. In vitro antibacterial analysis revealed that the antibacterial activity of the loaded antibiotics was retained and the sponges were effective against gram-positive and gram-negative bacteria. The sponges displayed rapid and high absorption capability in the range of 1022-2419% at pH 5.5 simulating wound exudates, and 2268-5042% at pH 7.4 simulating blood within a period of 1-3 h. Furthermore, the whole blood clotting studies further revealed low absorbance values when compared to the control revealing the good clotting capability of the sponges. The unique features of the sponges revealed their potential application for the management of infected, high exuding and bleeding wounds.

Extraction of microplastics from commonly used sea salts in India and their toxicological evaluation

Microplastics (MPs) are one of the marine debris, accumulated in the ocean as a result of the successive breakdown of a large piece of plastics over several years. MPs are about less than 5 mM, have a detrimental impact on marine organisms/products (seafood/sea salts) and therefore they are considered as a global environmental pollutant. The occurrence and impact of MPs in commercial sea salts that are consumed by humans are not well studied so far. In the present study, we attempted to characterize and evaluate the in vitro toxicity of isolated MPs. Here, we have used ten brands of commercial sea salts of different origins for the identification and characterization of MPs. The average abundance of MPs in all commercial brands is < 700 MP/kg and the particle size range between 5.2 mM and 3.8 μM. The most common types of MPs were identified as fragments, fibers, and pellets. By Fourier-Transform infrared spectroscopy (FT-IR), it was found that the MPs in abundance were made of cellophane (CP), polystyrene (PR), polyamide (PA) and polyarylether (PAR). Further, in vitro toxicity assessment revealed that HEK-293 cells get detached upon treatment with MPs (MIC-75 μg mL^-1) Consequently, the AO/EB dual staining confirmed that the induction and rate of apoptosis were comparatively higher in microplastic treated HEK-293 cells. Taken together, the MPs identified are the origin of anthropogenic derivatives and they exert a lethal effect on human cells, which might be associated with health risk complications in human beings.

Practical consensus recommendations regarding the management of hormone receptor positive early breast cancer in elderly women

Breast cancer is a leading cause of death among women, and its incidence increases with age. Currently the treatment of breast cancer in older patients is almost identical to their younger counterparts. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists regarding the management of early breast cancer specifically in elderly women.

A Monte Carlo method based QSPR model for prediction of reaction rate constants of hydrated electrons with organic contaminants

The Monte Carlo algorithm was applied to formulate a robust quantitative structure-property relationship (QSPR) model to compute the reactions rate constants of hydrated electron values for a data set of 309 water contaminants containing 125 aliphatic and 184 phenyl-based chemicals. The QSPR models were computed with the hybrid optimal descriptors which were procured by combining the SMILES and hydrogen-suppressed molecular graph for both classes of compounds. Approximately 75% of the total experimental data set was randomly divided into training and invisible training sets, while approximately 25% was divided into calibration and validation sets. The authenticity and robustness of the developed QSPR models were also judged by the Index of Ideality of Correlation. In QSPR modelling of aliphatic compounds, the numerical values of r T r a i n i n g 2 , r V a l i d a t i o n 2 , Q T r a i n i n g 2 and Q V a l i d a t i o n 2 were in the range of 0.852-0.905, 0.815-0.894, 0.839-0.897 and 0.737-0.867, respectively. Whereas, in the QSPR modelling of phenyl-based compounds, the numerical values of r T r a i n i n g 2 , r V a l i d a t i o n 2 , Q T r a i n i n g 2 and Q V a l i d a t i o n 2 were in the range of 0.867-0.896, 0.852-0.865, 0.816-0.850 and 0.760-0.762, respectively. The structural attributes, which are promoters of l o g K e a q - increase/decrease are also extracted from the SMILES notation for mechanistic interpretation. These QSPR models can also be applied to compute the reaction rate constants of organic contaminants.

Terbinafine resistance in dermatophytes: Time to revisit alternate antifungal therapy

Resistant superficial dermatophytic infections of the skin and its appendages have emerged as a major health problem in India. Mutations in Squalene epoxidase gene have led to increasing incidence of resistance to terbinafine in dermatophytic isolates. We examined six patients with recalcitrant dermatophytosis attending Dermatology OPD at a tertiary care hospital and demonstrated terbinafine resistance by molecular method. Immediate hyperitivity (IH) reaction to Trichophytin antigen was highlighted in these patients. The patients were treated with alternate antifungals after demonstration of resistance to terbinafine based on the antifungal susceptibility testing (AFST). On follow up the patients responded well to the substitute but the duration of therapy had to be prolonged beyond six weeks.

Primary cardiac myxofibrosarcoma with osteoid differentiation mimicking a left atrial myxoma: A rare entity

Cardiac myxofibrosarcoma (MFS) is an uncommon entity. It is among the most challenging conditions to diagnose due to its rarity, high variability, and non-specific findings. These tumors often simulate left atrial myxoma or mitral stenosis at clinical presentation. Although, the definitive diagnosis of cardiac tumors depends on histopathological examination, various imaging techniques are also useful to study tumor characteristics to plan an appropriate treatment strategy. Here we highlight a case of primary cardiac MFS of left atrium (LA) showing areas of transition to undifferentiated pleomorphic sarcoma (UPS) with bone or osteoid formation, which is extremely rare and not well described. <Learning objective: Primary cardiac myxofibrosarcoma (MFS) is a rare and aggressive cardiac tumor. It is often confused with benign myxoma, leading to a delay in initiation of treatment. This delay can often lead to poor clinical outcomes. Our study will guide clinicians in early diagnosis, treatment, and counseling of patients with this rare entity. Echocardiography, together with magnetic resonance imaging, histology, and immunohistochemistry are essential in the diagnosis of MFS.>.

Teaching Pain Management in Serious Illness in the Era of the Opioid Epidemic: A Team-Based Intervention

INTRODUCTION

Despite the prevalence of pain in patients with serious illness, recent guidelines for opioid prescribing practices have largely excluded palliative care patients. In lieu of such guidelines, many have recommended adapting risk mitigation strategies from the chronic pain arena for palliative care and oncology populations. Teaching interventions are needed to demonstrate how these methods can be applied to patients with serious illness.

METHODS

We developed a teaching intervention for fourth-year medical students to improve knowledge about safe opioid prescribing practices in palliative care patients and emphasized both effective and safe pain management. A secondary aim of the intervention was to demonstrate how a palliative care interdisciplinary team works together to care for a complex patient near the end of life. The intervention lasted 1 hour and consisted of an interdisciplinary case presentation as well as a slide presentation.

RESULTS

Twenty-two medical students attended the session over 2 years. After the intervention, medical students better understood risk mitigation strategies and felt more strongly that opioids can be a useful tool in treating pain for patients with serious illness. Students' familiarity with palliative care interdisciplinary roles also improved after the intervention.

DISCUSSION

This session was a useful part of a palliative care 2-week classroom elective and was well received by students. The development of a survey tool that assesses student attitudes around effective and safe pain management in patients with serious illness may be of use to others who teach pain management in palliative care populations.

Fluctuation-induced current from freestanding graphene

At room temperature, micron-sized sheets of freestanding graphene are in constant motion, even in the presence of an applied bias voltage. We quantify the out-of-plane movement by collecting the displacement current using a nearby small-area metal electrode and present an Ito-Langevin model for the motion coupled to a circuit containing diodes. Numerical simulations show that the system reaches thermal equilibrium and the average rates of heat and work provided by stochastic thermodynamics tend quickly to zero. However, there is power dissipated by the load resistor, and its time average is exactly equal to the power supplied by the thermal bath. The exact power formula is similar to Nyquist's noise power formula, except that the rate of change of diode resistance significantly boosts the output power, and the movement of the graphene shifts the power spectrum to lower frequencies. We have calculated the equilibrium average of the power by asymptotic and numerical methods. Excellent agreement is found between experiment and theory.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.

Expression of p27 and p16 and their clinical significance in gastric cancer

BACKGROUND

Deregulated expression of cell cycle regulators p27 and p16 is associated with cancer progression. p27^kip1 and p16^INKa are a cyclin dependent kinase inhibitor whose major target is the cyclinE/CDK2 and cyclinD/CDK4/6 complex, respectively, that governs cell cycle transition from late G1 to S phase.

METHODS

We recruited biopsies of a total of 84 subjects including 72 primary tumor biopsies from histopathologically proven gastric carcinoma, 8 adjacent controls and 12 independent controls. We used gastric cancer cell line, AGS, for validation of our data. Expression profiling at transcript level was done by semi-quantitative RT-PCR and at proteome level by immunohistochemistry and immunofluorescence. Receiver operator characteristics analysis was done for determining the diagnostic utility of p27 and p16 with respect to the sensitivity and specificity.

RESULTS

We demonstrate that p27 and p16 are frequently over expressed in early stages of gastric carcinoma. Our semi-quantitative data show a significant upregulation of p27 (Mean ± SEM, 0.4771 ± 0.0895; p = 0.0001) and p16 (Mean ± SEM, 0.4676 ± 0.04305; p = 0.0001) at mRNA level. Concordant to semi-quantitative data, immunohistochemistry data also showed a significant upregulation of p27 (Mean ± SEM, 196.4 ± 10.84; p < 0.0001) and p16 (Mean ± SEM, 100.4 ± 23.71; p < 0.0001) at protein level.

CONCLUSIONS

The present study showed that the significant upregulation of p27 and p16 were associated with early events in gastric carcinogenesis. Our data suggests that clinical correlation of these differentially expressed genes may be useful as diagnostic biomarkers for early detection of gastric carcinoma and promising therapeutics target for GC patients.

In silico enhancement of azo dye adsorption affinity for cellulose fibre through mechanistic interpretation under guidance of QSPR models using Monte Carlo method with index of ideality correlation

Azo dyes are a group of chemical moieties joined by azo (-N=N-) group with potential usefulness in different industrial applications. But these dyes are not devoid of hazardous consequence because of poor affinity for the fibre and discharge into the water stream. The chemical aspects of 72 azo dyes towards cellulose fibre in terms of their affinity by QSPR have been explored in the present work. We have employed two approaches, namely balance of correlation without IIC (TF₁) and balance of correlation with IIC (TF₂), to generate 16 QSAR models from 8 splits. The determination coefficient of calibration and validation set was found higher when the QSPR models were developed using the index of ideality correlation (IIC) parameter (TF₂). The model developed with TF₂ for split 3 was considered as a prominent model because the determination coefficient of the validation set was maximum (r ² = 0.9468). The applicability domain (AD) was also analysed based on 'statistical defect', d(A) for a SMILES attribute. The mechanistic interpretation was done by identifying the SMILES attributes responsible for the promoter of endpoint increase and promoter of endpoint decrease. These SMILES attributes were applied to design 15 new dyes with higher affinity for cellulose fibre.

Nanotechnology and its challenges in the food sector: a review

Antibacterial activity of nanoparticles has received significant attention worldwide because of their great physical and chemical stability, excellent magnetic properties, and large lattice constant values. These properties are predominate in the food science for enhancing the overall quality, shelf life, taste, flavor, process-ability, etc., of the food. Nanoparticles exhibit attractive antibacterial activity due to their increased specific surface area leading to enhanced surface reactivity. When nanoparticles are suspended in the biological culture, they encounter various biological interfaces, resulting from the presence of cellular moieties like DNA, proteins, lipids, polysaccharides, etc., which helps antibacterial properties in many ways. This paper reviews different methods used for the synthesis of nanoparticles but is specially focusing on the green synthesis methods owing to its non-toxic nature towards the environment. This review highlights their antibacterial application mainly in the food sector in the form of food-nanosensors, food-packaging, and food-additives. The possible mechanism of nanoparticles for their antibacterial behavior underlying the interaction of nano-particles with bacteria, (i) excessive ROS generation including hydrogen peroxide (H₂O₂), OH^- (hydroxyl radicals), and O^- ₂ ² (peroxide); and (ii) precipitation of nano-particles on the bacterial exterior; which, disrupts the cellular activities, resulting in membranes disturbance. All these phenomena results in the inhibition of bacterial growth. Along with this, their current application and future perspectives in the food sector are also discussed. Nanoparticles help in destroying not only pathogens but also deadly fungi and viruses. Most importantly it is required to focus more on the crop processing and its containment to stop the post-harvesting loss. So, nanoparticles can act as a smart weapon towards the sustainable move.

Assessing Contact, Coverage, and Quality of continuum of care in Uttar Pradesh, India

Background

Given the high neonatal mortality in LMIC, strategies suggest a continuum of care (COC) as an effective framework to ensure timely and appropriate service provision throughout the MNCH continuum. However, the measurement approaches traditionally focus on assessing continuum of care from the lenses of time-based coverage and missing out on the quality of coverage and service delivery. This paper aims to assess the continuum of care based on these three parameters and the factors affecting its achievement.

Methods

Multistage sampling design identified live births and stillbirths in the last calendar year (March 2018-February 2019) across the 50 districts of Uttar Pradesh(n = 16646).COC was assessed on three measurements 1) Contact: Any contact with the health system across the continuum, 2)Coverage: Adequate contacts of the health system through outreach services and clinical care, and 3)Quality: receiving adequate services along with these contacts. Further, a multilevel regression model was used to estimate the factors associated with the continuum of care.

Results

64% (60.04-67.65) of the women and child received health system contact across the continuum while only 2.1% (1.57-2.78) and 2.8% (2.33-3.44) women and children achieved coverage and quality based COC, respectively. Achievement of COC coverage and COC quality is highly affected by the service delivery platform, with women at outreach platform being more likely to achieve adequate coverage while women at facilities are more likely to achieve quality services across ANC, delivery, and PNC.

Conclusions

Achievement of both coverage and quality based COC remains low in Uttar Pradesh, India. Even those who achieve contact(s) failed to receive quality services along with these contacts with health systems. Efforts should be focused on building quality service at the outreach and non-outreach platforms across the continuum of care for reducing the risk of neonatal mortality.

Key messages

Owing to the lack of an integrated approach for service delivery across outreach, clinical care and community care, continuum of care remains broken for most of the mothers and children. For targeting coverage and quality of COC, focus should be on improving the quality of service provision across the outreach platforms which are already in reach of the women.