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Optimizing costs and sustainability for gamma knife radiosurgery: A cost and breakeven analysis at India’s largest neurosurgery centre

Background Establishing and maintaining gamma knife facility incurs significant costs, mandating healthcare institutions to meticulously assess financial implications for sustainability. Methods This study explores the financial implications of setting up and operating a Gamma Knife facility, with an aim to ascertain user charges for achieving breakeven. The study was conducted from January to June 2019 at the largest neurosurgery centre of an Institute of National Importance (INI), in Delhi, India. Applying both Traditional and Time-Driven Activity-Based Costing (TD-ABC) methodologies, capital and operating expenses were calculated. (1US$ = INR 70.4 –Average value for the year 2019). Results The average cost per gamma knife radio surgery procedure was calculated to be US $2,469 (INR 1,73,832), with major costs attributed to machinery & equipment (43.6%), followed by manpower (32.5%), electricity (9.67%), equipment maintenance (8.61%) etc. The initial investment to establish a Gamma Knife facility is significantly higher with an MRI unit (Model A) at US $ 9,836,423 (INR 69,24,84,164) compared to one without (Model B) at US $7,294,986 (INR 51,35,66,988). Currently, the patient has to pay US $1,065 (INR 75,000) for a gamma knife radio surgery, which poses a challenge for achieving breakeven since the variable cost for the same is US $1,367 (INR 96,239) per procedure. Conclusion The study serve as a tool for strategic planning, pricing adjustments, and enhancing operational efficiencies, thus ensuring that such high-end technologies can be sustainably integrated into the public healthcare landscape of a developing country like India.

Analysis of mechanical properties and energy evolution mechanism of frozen calcareous clay under multi-factor interaction

Paediatric sedation with intranasal dexmedetomidine: Protocol for a systematic review and meta-analysis

Introduction Sedation ensures a child remains motionless during a procedure and decreases anxiety. Several pharmacologic regimes exist for paediatric sedation. However, often, intravenous cannulation is required, causing distress for the child. Creating a low-stress environment for children during medical procedures is crucial. Intranasal dexmedetomidine offers a promising alternative by either removing the need for intravenous cannulation or significantly reducing stress and anxiety when cannulation is necessary. We aim to investigate the safety and efficiency of sedating children with intranasal dexmedetomidine. Methods and analysis We will systematically search MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), CENTRAL, Clinicaltrials.gov, and the WHO ICTRP portal. We will include all randomized controlled trials (RCT) that investigate the use of intranasal dexmedetomidine compared to alternative sedatives for premedication or sedation of children. Two researchers will independently screen title/abstract and full-text articles for eligibility using Covidence. Our primary outcome is sedation success rate. RCTs that meet the inclusion criteria will form the unit of analysis. Data extracted from each study will be presented in table format (S2 Table). Information on parameters that describe safety and efficiency outcomes will be extracted and analysed. Outcome data will be reported as risk ratios and 95% confidence intervals (CI) for dichotomous outcomes or mean and standardized mean differences with 95% CI for continuous outcomes. The assessment of statistical heterogeneity will be examined using Chi2- and I2-statistics. PROSPERO registration number CRD42024532993 Discussion Sedation with intranasal dexmedetomidine is not common practice in all countries, though the medicament has the potential to provide a child-friendly approach to sedation and premedication. Reviews on the area are conflicting, and new RCT studies have been published. Our systematic review aims to comprehensively assess intranasal paediatric sedation, focusing on dexmedetomidine and guiding clinicians in daily decision-making for optimal paediatric sedation.

GNG2 inhibits brain metastases from colorectal cancer via PI3K/AKT/mTOR signaling pathway

Coping strategies and changes in type D personality were associated with depressive tendency at 9 months after percutaneous coronary intervention

Type D personality, characterized by negative affectivity and social inhibition, has been associated with both the psychophysiology of coronary artery disease (CAD) and depressive disorders. However, few reports have described the impact of coping strategies in these patients. This study aimed to analyze the characteristics of type D personality and the coping strategies adopted by patients with CAD and to explore the factors associated with depressive tendencies during follow-up. Among 84 patients with CAD (median age 66.5 years, nine women) who underwent percutaneous coronary intervention (PCI), we examined pre-discharge characteristics for personality and coping strategies. We prospectively evaluated associations with the persistence or improvement of depressive tendencies at 9 months. Our findings revealed that persistence of depressive tendencies at 9 months was inversely associated with the adoption of the “planning” coping strategy (odds ratio [OR]: 0.80). We observed worsening depressive tendencies in patients with type D personality who transitioned from non-type D during follow-up. Conversely, improvement in depressive tendencies was associated with the adoption of “planning” (OR: 1.47), “evasive thinking” (OR: 1.47), and “positive interpretation” (OR: 1.43) coping strategies, and inversely associated with the adoption of the “abandonment or resignation” strategy (OR: 0.71). The persistence or improvement of depressive tendencies at 9 months post-PCI was associated with the adoption of specific coping strategies. Changes in type D personality during follow-up were associated with the status of depressive tendency. Personality-oriented treatment incorporating specific coping strategies may provide new strategies to prevent depression and improve care for patients with CAD.

Damage constitutive model and mechanical properties of a concrete limestone composite after acid corrosion

Induction of stigma-like structures in saffron (Crocus sativus L.): Exploring factors and metabolite analysis

Saffron (Crocus sativus L.) has held significant cultural and medicinal value since the Greek-Minoan civilization. As a triploid spice with vegetative propagation from the Iridaceae family, the three-branch style of C. sativus flowers, known as saffron, constitutes the most economically valuable part of the plant, renowned for its diverse medicinal properties. This study explores the in vitro induction of stigma-like structures (SLSs) from various explants of the Ghaen ecotype flower. The study found that the optimal sampling time for the majority of explants was the third week of October. Ovary explants exhibiting a prolonged response to hormonal treatments for the production of SLSs. Furthermore, intact, and injury ovary explants were found to be the most effective explant types for inducing SLSs. The explants were cultured on MS, 1/2MS, LS and B5 basal media supplemented with various combinations and concentrations of plant growth regulators. The results indicated that the B5 medium, enriched with 5–10 mg/ L BAP and 5–10 mg/ L NAA was the most effective treatment for inducing SLSs in all types of explants. Quantitative and qualitative analyses of saffron compounds in SLSs indicated similarities with natural saffron, albeit at significant lower concentrations: crocin (up to 10.2 mg/g), picrocrocin (up to 4.8 mg/g), and safranal (up to 9.7 mg/g). The highest accumulation of the three studied secondary metabolites was observed in the SLSs of style (24.4 mg/g), stigma (28.3 mg/g), and ovary (21.4 mg/g) explants, respectively. This study introduces a comprehensive procedure for producing SLSs containing the three most important metabolites of saffron for the first time.

Coregistration of eye movements and EEG reveals frequency effects of words and their constituent characters in natural silent Chinese reading

Abstract We conducted two experiments to examine the lexical and sub-lexical processing of Chinese two-character words in reading. We used a co-registration electroencephalogram (EEG) for the first fixation on target words. In Experiment 1, whole-word occurrence frequency and initial constituent character frequency were orthogonally manipulated, while in Experiment 2, whole-word occurrence frequency and end constituent character frequency were orthogonally manipulated. Results showed that word frequency facilitated eye-tracking measures, while initial and end character frequencies inhibited them. Classical word frequency effects on N170 and N400 in the posterior region and reversed word frequency effects over the anterior region were consistently observed in both experiments. Experiment 1 revealed an inhibiting effect of initial character frequency on anterior N170. In Experiment 2, interaction between end-character frequency and word frequency showed reliable effects on anterior N170 and N400. These results demonstrate both facilitating and inhibiting word frequency effects, along with inhibiting effects of character frequency and that word frequency moderates the inhibiting effects of end constituent character frequency during natural silent Chinese reading.

Iron deficiency and fatigue in inflammatory bowel disease: A systematic review

Background It is unclear what impact iron deficiency has on fatigue in people with inflammatory bowel disease (IBD). This systematic review examined the evidence of whether iron deficiency, with or without anaemia, was associated with fatigue in IBD. Fatigue is a common symptom in patients with IBD that can be difficult to manage and treat. A greater understanding of the role and contribution of iron deficiency to fatigue may help improve the management of this condition. Methods The databases searched were MEDLINE, OVID, CINAHL and Web of Science. Inclusion criteria were studies measuring iron status for iron deficiency (ID) and patient-reported outcome measures (PROMs) for fatigue in patients with IBD of any level of disease activity. Assessment of bias was conducted using the Newcastle Ottawa Scale. Studies were grouped for syntheses according to whether exposure was iron deficiency without anaemia (IDWA) or ID regardless of haemoglobin level. Results Two hundred and eighty-five individual database results were identified and screened; 32 complete records were reviewed, from which seven studies with 1425 individuals were deemed eligible for inclusion in the results synthesis. Considerable variation in the methods and statistical analysis used to investigate the relationship between ID and fatigue prevented any quantitative synthesis. Studies varied by population disease activity levels, approaches used to define ID and PROMs used to measure fatigue. Three studies directly compared fatigue scores in IDWA to those not iron deficient, two of which showed patients with IDWA had significantly lower fatigue scores. Four studies used ID irrespective of anaemia as the exposure and reported mixed results on fatigue, with only one study reporting a higher prevalence of fatigue in the ID group. Conclusions There was marked heterogeneity between studies in this review. Two studies found evidence of a slight increase in fatigue levels in patients with IDWA. Though this does not explain all fatigue in patients with IBD, iron replacement should be considered to improve fatigue in iron-deficient patients.

Assessing drywell designs for managed aquifer recharge via canals and repurposed wells

Sex-specific associations of serum testosterone with gray matter volume and cerebral blood flow in midlife individuals at risk for Alzheimer’s disease

Testosterone, an essential sex steroid hormone, influences brain health by impacting neurophysiology and neuropathology throughout the lifespan in both genders. However, human research in this area is limited, particularly in women. This study examines the associations between testosterone levels, gray matter volume (GMV) and cerebral blood flow (CBF) in midlife individuals at risk for Alzheimer’s disease (AD), according to sex and menopausal status. A cohort of 294 cognitively normal midlife participants, 83% female, ages 35–65 years, with an AD family history and/or Apolipoprotein E epsilon 4 (APOE-4) genotype, underwent volumetric Magnetic Resonance Imaging (MRI) to measure GMV and MR-Arterial Spin Labeling (ASL) for measurement of CBF. We used voxel-based analysis and volumes of interest to test for associations between testosterone (both total and free testosterone) and brain imaging outcomes, stratified by sex and menopausal status. Higher total and free testosterone levels were associated with larger GMV in men, with peak effects in frontal and temporal regions. Conversely, in women, higher testosterone levels correlated with higher CBF, with peak effects in frontal and limbic regions, subcortical areas and hypothalamus. Among women, associations between testosterone and GMV were observed at the premenopausal and perimenopausal stages, but not postmenopause, whereas associations of testosterone with CBF were significant starting at the perimenopausal stage and were more pronounced among hormone therapy non-users. Results were independent of age, APOE-4 status, midlife health indicators, and sex hormone-binding globulin levels. These findings indicate sex-specific neurophysiological effects of testosterone in AD-vulnerable regions in midlife individuals at risk for AD, with variations observed across sex and menopausal status. This underscores the need for further research focusing on the neuroprotective potential of testosterone in both sexes.

N2 influences on CH4 accumulation and displacement in shale by molecular dynamics

Business environment and its impact on high-quality economic development: A configurational analysis of enhancement pathways

The nexus between the business environment and high-quality economic development is pivotal for fostering sustainable growth. This study delves into their interrelationship, recognizing its profound practical significance. We have developed a comprehensive index system to evaluate high-quality economic development, encompassing four key dimensions: green development quality, robust economic growth, innovation dynamics, and equitable societal benefits. Concurrently, a business environment index system has been constructed, capturing the nuances of government functionality, social context, and market dynamics. Employing system theory and a configurational approach, this research utilizes the fsQCA method to decode the intricate mechanisms, dynamic pathways, and synergistic interactions among diverse elements within the business environment that influence high-quality economic development. The empirical findings underscore the substantial impact of the business environment on high-quality economic development, highlighting two primary catalyst pathways: the "Rule of Law-Government Efficiency" trajectory and the "Market-Led-Credit Environment" route. These pathways reveal that government efficiency, credit accessibility, legal frameworks, market fairness, and openness are instrumental in driving high-quality economic development. Conversely, inefficiencies in the market mechanism and governmental roles often result in suboptimal development trajectories. The study advocates for policy formulations that recognize and leverage regional distinctiveness, optimizing local resources and strengths to spur high-quality economic development tailored to each region’s unique context.

Short bouts and long-term exercise reduce sedentary-induced bone loss and microstructural changes by modulating bone formation and resorption in healthy young male rats

The impact of tuberculosis-induced hyperglycemia on pulmonary microbiota and airway mucus secretion in individuals not previously diabetic: A systematic review and meta-analysis protocol

The lung environment harbours a community of microbes that play a significant role in health and disease, including innate protection against pathogenic microorganisms. Infection with Mycobacterium tuberculosis, psychological stress associated with the tuberculosis (TB) disease, and the metabolites from the rifampicin treatment regimen have been reported to induce hyperglycemia and consequently type 2 diabetes mellitus (T2DM) in individuals not previously diabetic. The high glucose concentration is proposed to alter the composition of the lung microbiota and airway homeostasis, exerting an influence on TB disease and treatment outcomes. In this systematic review, we propose to synthesize literature on TB-induced hyperglycemia and its impact on lung microbiota and secretion of airway mucus in individuals not previously diabetic. A systematic search will be carried out on PubMed, EMBASE, MEDLINE, PROQUEST, Cochrane, SCOPUS, and manually on Google Scholar and references of relevant articles to identify other studies. We will review published articles that include studies on TB-induced hyperglycemia, pulmonary microbiome, mucin secretion, and (or) airway surface liquid upon TB diagnosis and during treatment. The quality of the study articles will be assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis will be conducted using random effect model for heterogeneity to pool estimates on microbial diversity. Egger’s test will be performed to explore any selective reporting bias. The findings of the systematic review and the meta-analysis will be reported as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol guidelines. This protocol was developed and uploaded onto the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number: CRD42024482248.

Using low-cost sensors to assess common air pollution sources across multiple residences

Abstract The rapid development of low-cost sensors provides the opportunity to greatly advance the scope and extent of monitoring of indoor air pollution. In this study, calibrated particle matter (PM) sensors and a non-negative matrix factorisation (NMF) source apportionment technique are used to investigate PM concentrations and source contributions across three households in an urban residential area. The NMF is applied to combined data from all houses to generate source profiles that can be used to understand how PM source characteristics are similar or differ between different households in the same urban area. PM2.5 and PM10 concentrations in all three houses were greater, more variable, and significantly different to ambient concentrations recorded at a nearby ambient monitoring site. Concentrations were also significantly different between houses, with the World Health Organisation 24-h guideline limits for PM2.5 breached in one household. The applied methodology was highly successful at modelling concentrations for all the houses (R2 $$\ge$$ ≥ 0.983), finding that across the houses the I/O (indoor to outdoor sources ratio) was the lowest for PM1 (down to 0.08), and greatest for PM10 (up to 4.93). Whilst the sources could not be clearly distinguished further than being outdoors or indoors, the methodology provides clear insights to source variability within and between the monitored houses. These results highlight the importance of monitoring indoor air pollution to improve pollution exposure estimates, as whilst people may live in areas with acceptable ambient air quality, they can be exposed to unhealthy concentrations in their own homes. This method may be applied in future studies for extended periods to investigate the influence of source seasonality on PM concentrations or scaled up to investigate source variability across larger geographical areas.

Feasibility and resource utilization of nurse-administered subcutaneous immunoglobulin therapy in antibody deficiency: A cross-sectional study

Primary and secondary antibody deficiencies (PAD and SAD) are amongst the most prevalent immunodeficiency syndromes, often necessitating long-term immune globulin replacement therapy (IRT). Both intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) have demonstrated efficacy in antibody deficiency. Comparative analyses of these two routes of administration are limited to nurse-administered IVIG and home therapy with self-administered SCIG. A third programmatic approach, SCIG administered by nurses in hospital-based outpatient infusion clinics, combines certain advantages of IVIG and home SCIG such as the provision of nursing support and the reduced risk of systemic reactions associated with the subcutaneous route. This cross-sectional study aimed to compare the viability and resource utilization of nurse-administered SCIG with IVIG in patients with antibody deficiency. We hypothesized that nurse-administered SCIG would require a similar amount of infusion clinic time per month as IVIG, despite more frequent dosing, due to shorter individual appointments, while maintaining high patient satisfaction. Information on infusion duration, time in the infusion chair, direct nursing time, and treatment satisfaction using the Life Quality Index was collected. Time measures for each patient were expressed as minutes/4 weeks to account for the more frequent dosing of nurse-administered SCIG compared to IVIG. We determined that the total time, infusion time, and nursing time needed to provide nurse-administered SCIG was comparable to IVIG. The more frequent dosing of SCIG was offset by the shorter times required per infusion. Patients reported favorable treatment satisfaction with both nurse-administered SCIG and IVIG. We conclude that nurse-administered SCIG may be a useful treatment modality for well-selected individuals.

Screen time exposure and executive functions in preschool children

Comparing the technical and individual possession statistics of academy players across different age groups in match-play

Background Youth soccer players in the UK transition into the professional game at 16 years of age. Understanding the differences between youth and professional standards can help coaches and clubs to support player development during this transition. Objectives To (i) assess the differences in technical and possession statistics between different age groups (U16, U18, U23) and outfield positions (central defender [CD], wide defender [WD], central midfielder [CM], attacking midfielder [AM], wide midfielder [WM], striker [ST]), within an English academy soccer programme, during match-play. Methods All matches were monitored using foot-mounted inertial measurements units (F-IMU; Playermaker™) to quantify the technical (touches and releases from the feet) and individual possession statistics (Time on the ball, Time on the ball per possession) from each match. Teams were instructed to play a 1-4-3-3 formation as part of their clubs playing philosophy, with positions defined per this formation. Data were analysed using a multi-variate ANOVA Two-tailed statistical significance was accepted as p ≤ 0.05 and measures of effect size were calculated using partial eta-squared (η2). Magnitude of the effect sizes were small (0.2<ES<0.6), moderate (0.6<ES<1.2), large (1.2<ES<2) and very large (≥2). Results Trivial to small effect sizes were observed across age groups for both technical and possession-based statistics during match-play. Across all age groups and positions, CD`s had the highest number of technical actions (touches and releases), whereas ST`s & AM`s, had the highest amount of time in possession of the ball. Further, positional analysis showed ST`s and AM`s had moderate to large decreases in time on the ball per possession at the U23’s age group in comparison to the U16 and U18’s, with no technical differences observed within the same positional analysis. Conclusion Attacking players (AM & ST) are required to move the ball quicker as they progress from U16 to U23’s within the current English football academy. Further exploration is required to assess if these changes are context specific given requirements of those age groups.

The current landscape of personalised preventive approaches for non-communicable diseases: A scoping review

Introduction Personalised prevention offers a promising tool to reduce the impact of non-communicable diseases, which represent a growing health burden worldwide. However, to support the adoption of this innovation it is needed to clarify the current state of available evidence in this area. This work aims to provide an overview of recent publications on personalised prevention for chronic conditions. Materials and methods A scoping review of scientific literature from Medline, Scopus, Web of Science and grey literature was conducted. Eligible articles included prospective primary studies and clinical practice directives on personalised preventive approaches for chronic diseases published between January 2017 to December 2023. The review followed Arksey-O’Malley guidelines and PRISMA-ScR checklist. Results We identified 121 publications including 60 primary cohort studies and 61 clinical practice directives. We extracted 249 personalised preventive approaches, 27% in primary prevention, 27% in secondary prevention, and 46% in tertiary prevention. In primary prevention, 50% of the 67 approaches were from cohort studies, mainly targeting cardiovascular diseases, and 50% from directives primarily focused on cancer. Secondary prevention included 66 approaches, 73% from directives mainly concerning breast cancer. Tertiary prevention included 116 approaches, evenly distributed among the two publication types and focusing mostly on cancer and cardiovascular diseases. Lastly, tertiary prevention is the most represented level of prevention both in primary research studies and directives (54% and 41% respectively). Conclusions Our study highlights a significant focus on personalised prevention in oncology in the past few years, with numerous recently issued clinical practice directives. We identified substantial original research in personalised primary prevention of cardiovascular diseases, indicating growing interest in the field. However, the distribution of primary studies and directives across the three preventive levels anticipate challenges in generating evidence of clinical utility in primary and secondary prevention, with most approaches falling under tertiary prevention.