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Accurate and fast extraction of step parameters from video recordings of gait allows for richer information to be obtained from clinical tests such as Timed Up and Go. Current deep-learning methods are promising, but lack in accuracy for many clinical use cases. Extracting step parameters will often depend on extracted landmarks (keypoints) on the feet. We hypothesize that such keypoints can be determined with an accuracy relevant for clinical practice from video recordings by combining an existing general-purpose pose estimation method (OpenPose) with custom convolutional neural networks (convnets) specifically trained to identify keypoints on the heel. The combined method finds keypoints on the posterior and lateral aspects of the heel of the foot in side-view and frontal-view images from which step length and step width can be determined for calibrated cameras. Six different candidate convnets were evaluated, combining three different standard architectures as networks for feature extraction (backbone), and with two different networks for predicting keypoints on the heel (head networks). Using transfer learning, the backbone networks were pre-trained on the ImageNet dataset, and the combined networks (backbone + head) were fine-tuned on data from 184 trials of older, unimpaired adults. The data was recorded at three different locations and consisted of 193 k side-view images and 110 k frontal-view images. We evaluated the six different models using the absolute distance on the floor between predicted keypoints and manually labelled keypoints. For the best-performing convnet, the median error was 0.55 cm and the 75% quartile was below 1.26 cm using data from the side-view camera. The predictions are overall accurate, but show some outliers. The results indicate potential for future clinical use by automating a key step in marker-less gait parameter extraction.

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Spelt Triticum aestivum L. subsp. spelta (cv. Wirtas), einkorn Triticum monococcum L. (cv. Samopsza) and emmer Triticum dicoccum Schrank (Schuebl) (cv. Plaskurka biala and Plaskurka ciemna) spring wheat cultivars were analyzed and compared to common wheat Triticum aestivum L. subsp. aestivum (cv. Harenda, Kandela, Mandaryna, Serenada, Goplana, Kamelia, Nimfa, Rusalka, Struna, Zadra) cultivated in an organic production system. Moreover, the performance of four common wheat cultivars (cv. Harenda, Kandela, Mandaryna, Serenada) grown in organic, conventional and integrated production systems were compared. The UHPLC-DAD-MS and TLC-DPPH• analyses of specific substances (phenolic acids and alkylresorcinols) were evaluated to ascertain the potential of spring wheat cultivars for promoting human health and suitability for cultivation in an organic production system. The highest yield was observed for the T. aestivum L. subsp. aestivum (modern hull-less) cv. Nimfa (4.45 t/ha), which also demonstrated the lowest resistance to Fusarium spp. infection. Among the contemporary hull-less cultivars, cv. Mandaryna and cv. Harenda exhibited the highest resistance to this pathogen (2.4% and 3.7% of grains infected by Fusarium, respectively), while simultaneously displaying the highest organic phenolic acid content (900.92 and 984.55 µg/g of the grain) and the highest antioxidant potential. It is noteworthy that the cereal hulls of T. monococcum L. (old hulled) (cv. Samopsza) exhibited a markedly elevated content of phenolic acids (approximately 4000 µg/g of the grain). This may have contributed to the reduced incidence of Fusarium infection (9.3% of grains infected) observed in the grains of this cultivar. Furthermore, the hulls proved to be a rich source of phenolics with high antioxidant activity, which is beneficial for human and animal health.

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One of the important genes for eyespot development in butterfly wings is Distal-less. Its function has been evaluated via several methods, including CRISPR/Cas9 genome editing. However, functional inhibition may be performed at the right time at the right place using a different method. Here, we used a novel protein delivery method for pupal wing tissues in vivo to inactivate a target protein, Distal-less, with a polyclonal anti-Distal-less antibody using the blue pansy butterfly Junonia orithya. We first demonstrated that various antibodies including the anti-Distal-less antibody were delivered to wing epithelial cells in vivo in this species. Treatment with the anti-Distal-less antibody reduced eyespot size, confirming the positive role of Distal-less in eyespot development. The treatment eliminated or deformed a parafocal element, suggesting a positive role of Distal-less in the development of the parafocal element. This result also suggested the integrity of an eyespot and its corresponding parafocal element as the border symmetry system. Taken together, these findings demonstrate that the antibody-mediated protein knockdown method is a useful tool for functional assays of proteins, such as Distal-less, expressed in pupal wing tissues, and that Distal-less functions for eyespots and parafocal elements in butterfly wing color pattern development.

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Objective: This study aimed to examine the trends in gender, ethnicity and less-than-full-time (LTFT) training in reconstructive plastic surgery from 2009 to 2020 in the UK by comparing them to overall surgical specialties. Methods: We analysed NHS Digital workforce data from 2009 to 2020 by examining trends in gender, ethnicity and LTFT working among reconstructive plastic surgery consultants and registrars and comparing them to overall surgical specialties. Data were analysed using linear regression models. Results: The percentage of female reconstructive plastic surgery consultants and registrars increased significantly over the period, with reconstructive plastic surgery groups having higher percentages of females than overall surgical specialties. LTFT working trends varied, with declining trends among consultants and increasing trends among registrars. Ethnicity trends were complex, varying between different ethnic categories and between consultants and registrars, but showing an increase in diversity within the workforce. Conclusion: The demographics of reconstructive plastic surgeons in the UK became more diverse from 2009 to 2020 with trends indicating that this will continue in the future. However, there were significant variations among the different groups and levels of seniority, suggesting the need for targeted interventions to promote diversity and inclusivity in surgical specialties.

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Introduction: Less-invasive surfactant administration (LISA) is associated with better respiratory outcomes in preterm infants with respiratory distress syndrome. However, mechanical ventilation (MV) shortly after the LISA procedure has been related to lower survival. This study aimed to analyze the trends and main predictors of continuous positive airway pressure (CPAP) failure after LISA. Material and methods: Preterm infants born between 230 and 336 weeks gestational age (GA) in two level III neonatal units who received surfactant were included (2017-2022). Demographic data, lung ultrasound (LUS) scores, the saturation/fraction of inspired oxygen (SF) ratio, technique, time to surfactant administration, and the main neonatal outcomes were collected. Results: Over the study period, 289 inborn preterm infants received surfactant, 174 with the LISA method (60.2%). Patients who received surfactant after intubation in the delivery room (n = 56) were more immature and exhibited worse outcomes. Patients who received surfactant via an endotracheal tube in the neonatal intensive care unit (n = 59) had higher LUS scores and a lower SF ratio than those treated with LISA. The LISA method was associated with less death or bronchopulmonary dysplasia (BPD), with an adjusted odds ratio (aOR) = 0.37 [95% confidence interval (CI), 0.18-0.74, p = 0.006]. CPAP failure after LISA (defined as the need for intubation and MV in the first 72 h of life) occurred in 38 patients (21.8%), inversely proportional to GA (38.7% at 23-26 weeks, 26.3% at 27-30 weeks, and 7.9% at 30-33 weeks (p < 0.001). CPAP failure after LISA was significantly related to death, with an aOR = 12.0 (95% CI, 3.0-47.8, p < 0.001), and moderate to severe BPD, with an aOR = 2.9 (95% CI, 1.1-8.0, p = 0.035), when adjusting for GA. The best predictors of CPAP failure after LISA were GA, intrauterine growth restriction, temperature at admission, the SF ratio, and the LUS score, with a Nagelkerke's R 2 = 0.458 (p < 0.001). The predictive model showed an area under the curve = 0.84 (95% CI, 0.75-0.93, p < 0.001). Conclusions: CPAP failure after LISA is still common in extremely preterm infants, leading to an increase in death or disability. Clinicians must acknowledge the main risk factors of CPAP failure to choose wisely the right patient and the best technique. LUS and the SF ratio at admission can be useful when making these decisions.

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BACKGROUND: Less invasive surfactant administration (LISA) has become the preferred method of surfactant administration for spontaneously breathing babies on continuous positive airway pressure (CPAP). SUMMARY: The development of LISA followed the need to combine CPAP and surfactant replacement as mainstay treatment options for respiratory distress syndrome, thereby avoided exposure to positive pressure ventilation. KEY MESSAGES: This review summarises the current knowns and unknowns of LISA including the physiological concept, its relevance for short-term and long-term outcomes and the challenges for practical implementation of LISA as part of a less invasive respiratory care bundle. Further, we provide an update of the evidence on alternatives to LISA, for example, nebulised surfactant administration, pharyngeal deposition of surfactant and delivery via supraglottic airway.

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Purpose: To control medical costs and regulate the behavior of providers, China has formed an original widely piloted case-based payment under the regional global budget, called the Diagnosis-Intervention Packet (DIP). This study aimed to evaluated the impact of the DIP payment reform on medical costs, quality of care, and medical service capacity in a less-developed pilot city in Northwest China. Patients and Methods: We used the de-identified case-level discharge data of hospitalized patients from January 2021 to June 2022 in pilot and control cities located in the same province. We performed difference-in-differences (DID) analysis to examine the differential impact of the DIP reform for the entire sample and between secondary and tertiary hospitals. Results: The DIP payment reform resulted in a significant decrease of total expenditure per case in the entire sample (5.5%, P < 0.01) and tertiary hospitals (9.3%, P < 0.01). In-hospital mortality rate decreased significantly in tertiary hospitals (negligible in size, P < 0.05), as did all-cause readmission rate within 30 days in the entire sample (1.1 percentage points, P < 0.01) and secondary hospitals (1.4 percentage points, P < 0.01). Proportion of severe patients increased significantly in the entire sample (1.2 percentage points, P < 0.05) and tertiary hospitals (2.5 percentage points, P < 0.01). We did not find the DIP reform was associated with a significant change in relative weight per case. Conclusion: The DIP payment reform in the less-developed pilot city achieved short-term success in controlling medical costs without sacrificing the quality of care for the entire sample. Compared with secondary hospitals, tertiary hospitals experienced a greater decline in medical costs and received more severe patients. These findings hold lessons for less developed countries or areas to implement case-based payments and remind them of the variations between different levels of hospitals.

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OpenPose-based motion analysis (OpenPose-MA), utilizing deep learning methods, has emerged as a compelling technique for estimating human motion. It addresses the drawbacks associated with conventional three-dimensional motion analysis (3D-MA) and human visual detection-based motion analysis (Human-MA), including costly equipment, time-consuming analysis, and restricted experimental settings. This study aims to assess the precision of OpenPose-MA in comparison to Human-MA, using 3D-MA as the reference standard. The study involved a cohort of 21 young and healthy adults. OpenPose-MA employed the OpenPose algorithm, a deep learning-based open-source two-dimensional (2D) pose estimation method. Human-MA was conducted by a skilled physiotherapist. The knee valgus angle during a drop vertical jump task was computed by OpenPose-MA and Human-MA using the same frontal-plane video image, with 3D-MA serving as the reference standard. Various metrics were utilized to assess the reproducibility, accuracy and similarity of the knee valgus angle between the different methods, including the intraclass correlation coefficient (ICC) (1, 3), mean absolute error (MAE), coefficient of multiple correlation (CMC) for waveform pattern similarity, and Pearson's correlation coefficients (OpenPose-MA vs. 3D-MA, Human-MA vs. 3D-MA). Unpaired t-tests were conducted to compare MAEs and CMCs between OpenPose-MA and Human-MA. The ICCs (1,3) for OpenPose-MA, Human-MA, and 3D-MA demonstrated excellent reproducibility in the DVJ trial. No significant difference between OpenPose-MA and Human-MA was observed in terms of the MAEs (OpenPose: 2.4° [95%CI: 1.9-3.0°], Human: 3.2° [95%CI: 2.1-4.4°]) or CMCs (OpenPose: 0.83 [range: 0.99-0.53], Human: 0.87 [range: 0.24-0.98]) of knee valgus angles. The Pearson's correlation coefficients of OpenPose-MA and Human-MA relative to that of 3D-MA were 0.97 and 0.98, respectively. This study demonstrated that OpenPose-MA achieved satisfactory reproducibility, accuracy and exhibited waveform similarity comparable to 3D-MA, similar to Human-MA. Both OpenPose-MA and Human-MA showed a strong correlation with 3D-MA in terms of knee valgus angle excursion.

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Background: A landing error scoring system (LESS) is widely used to evaluate landing maneuvers. Poor landing maneuvers, such as lateral bending of the trunk, are thought to be associated with a risk of lower-extremity injury. However, no studies have examined the association between landing and trunk muscle function, which is associated with a high risk of lower-extremity injury. Hypothesis/Purpose: This study examined whether an association exists between landing movements and a high risk of lower-extremity injury and trunk muscle function. It was hypothesized that athletes with poor activation of deep trunk muscle (transversus abdominis and internal oblique) would have lower LESS scores. Study Design: Cross-sectional study. Methods: The trunk muscle thickness at rest and during the plank was measured using ultrasonography. The percent of change in muscle thickness (during plank/at rest) was calculated. The LESS was measured using the Physimax. Based on the LESS scores, patients were divided into high- (LESS > 6) and low-risk (5 > LESS) groups for lower extremity injury. The relationship between the high-risk group and trunk muscle thickness was examined using a stepwise regression analysis. Results: The high-risk group had significantly lower muscle thicknesses of the transversus abdominis (p=0.02) and transversus abdominis plus internal oblique abdominis (p=0.03) muscles during the plank. Additionally, the high-risk group showed significantly lower percent of change in muscle thickness of the internal oblique (p=0.02) and transversus abdominis plus internal oblique (p=0.01) muscles. Only the percentage of change in the thickness of the internal oblique and transverse abdominal muscles was extracted from the regression as a factor. Conclusion: The findings indicated that athletes with landing movements and a high risk of injury, as determined based on the LESS results, had low trunk muscle function, and a relationship was observed between the change in thickness of transversus abdominis and internal oblique abdominis muscles. Level of Evidence: 3B.

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The aim of the research problem of the article was to try to popularize the upcycling trend in the production of sustainable cosmetics and to confirm their effectiveness. The development of recycled raw materials is a new discovery in the chemical industry. Manufacturers emphasize the production of more environmentally friendly raw materials. Conscious consumers choose cosmetics whose production is based on sustainable development. Instead of throwing away waste from various industries, let us use it to produce active substances used in hair cosmetics. The production of the collagen series was created in accordance with the principles of upcycling, which involves obtaining collagen water, which is waste generated during the production of supplements. The main goal of the work was to learn cosmetic recipes for styling, washing and conditioning hair based on collagen waste, as well as to compare the results of people using the product in question. The aim of the study was also to demonstrate the effectiveness of the treatment in preventing split ends and hair breakage, usually caused by mechanical stress (brushing), as well as to confirm the effectiveness of other tests. The article presents procedures and parameters confirming the effectiveness of treatment with the tested hair products. The following tests were carried out: hair thickness and density, colour uniformity, shine factor and scalp hydration. All parameters numerically confirmed the beneficial effects of products containing collagen water used in hair care.

L'objectif Synthèse: de l'article était de vulgariser la tendance de l'upcycling dans la production de cosmétiques durables et de confirmer leur efficacité. Le développement de matières premières recyclées est une nouvelle découverte dans l'industrie chimique. Les fabricants mettent l'accent sur la production de matières premières plus respectueuses de l'environnement. Les consommateurs responsables vont choisir des cosmétiques dont la production s'appuie sur des principes de développement durable. Les déchets provenant de diverses industries peuvent servir à la fabrication de substances actives utilisées dans les produits de soins des cheveux. La fabrication de produits à base de collagène reposait sur le principe de l'upcycling, qui consistait à obtenir de l'eau de collagène issue des déchets générés lors de la production de compléments alimentaires. Le but principal était d'apprendre des recettes de cosmétiques pour le coiffage, le lavage et le soin des cheveux à partir de déchets de collagène, et de comparer les résultats avec des personnes utilisant le produit en question. L'objectif de l'étude était de démontrer l'efficacité des soins dans la prévention des fourches et de la casse, généralement causés par un stress mécanique tel que le brossage, et de confirmer l'efficacité d'autres tests. L'article présente les procédures et paramètres confirmant l'efficacité du traitement avec les soins capillaires testés. Les tests suivant ont été menés : épaisseur et densité des cheveux, uniformité de la couleur, brillance et hydratation du cuir chevelu. Les chiffres ont parlé et tous les paramètres ont confirmé les effets bénéfiques des produits contenant de l'eau de collagène dans les soins capillaires.

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Background: In large supplementary feeding programs for children, it is challenging to create and sustain contextual, acceptable, nutritionally complete, and diverse supplemental foods. For example, the Indian Supplementary Nutrition Program (SNP) supplements the dietary intake of children, pregnant and lactating women, and severely acutely malnourished (SAM) children by offering dry take home rations (THRs) or hot cooked meals (HCMs) across India, but an optimization tool is necessary to create local contextual recipes for acceptable and nutritionally adequate products. Objectives: This study aimed to create a linear programming (LP) model to optimize diverse food provisions for a SNP to meet its program guidelines, using locally available foods, within budgetary allocations. Methods: A LP algorithm with appropriate constraints was used to generate an optimal THR based on raw foods, or an optimal weekly HCM menu comprised of a lunch meal with mid-morning snacks, based on user choices of foods and recipes. The database of foods used was created by a prospective survey conducted across all states of India for this purpose, such that the recipe and food optimization was diverse and specific to the guidelines for each beneficiary group. Results: An interactive web-based app, which can optimize feeding programs at any population level, was developed for use by program implementers and is hosted at https://www.datatools.sjri.res.in/SNP/. In the Indian example analyzed here, the recommended optimized diets met the guidelines for diversified and nutritionally complete SNP provision but at a cost that was almost 25% higher than the present Indian budget allocation. Conclusions: The optimization model developed demonstrates that contextual SNP diets can be created to meet macronutrient and most essential micronutrient needs of large-scale feeding programs, but appropriate diversification entails additional costs.

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The use of plant genetic resources (PGR)-wild relatives, landraces, and isolated breeding gene pools-has had substantial impacts on wheat breeding for resistance to biotic and abiotic stresses, while increasing nutritional value, end-use quality, and grain yield. In the Global South, post-Green Revolution genetic yield gains are generally achieved with minimal additional inputs. As a result, production has increased, and millions of hectares of natural ecosystems have been spared. Without PGR-derived disease resistance, fungicide use would have easily doubled, massively increasing selection pressure for fungicide resistance. It is estimated that in wheat, a billion liters of fungicide application have been avoided just since 2000. This review presents examples of successful use of PGR including the relentless battle against wheat rust epidemics/pandemics, defending against diseases that jump species barriers like blast, biofortification giving nutrient-dense varieties and the use of novel genetic variation for improving polygenic traits like climate resilience. Crop breeding genepools urgently need to be diversified to increase yields across a range of environments (>200 Mha globally), under less predictable weather and biotic stress pressure, while increasing input use efficiency. Given that the ~0.8 m PGR in wheat collections worldwide are relatively untapped and massive impacts of the tiny fraction studied, larger scale screenings and introgression promise solutions to emerging challenges, facilitated by advanced phenomic and genomic tools. The first translocations in wheat to modify rhizosphere microbiome interaction (reducing biological nitrification, reducing greenhouse gases, and increasing nitrogen use efficiency) is a landmark proof of concept. Phenomics and next-generation sequencing have already elucidated exotic haplotypes associated with biotic and complex abiotic traits now mainstreamed in breeding. Big data from decades of global yield trials can elucidate the benefits of PGR across environments. This kind of impact cannot be achieved without widescale sharing of germplasm and other breeding technologies through networks and public-private partnerships in a pre-competitive space.

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INTRODUCTION: Children ≤5 years of age with Ewing's sarcoma (ES) possibly have a distinct disease biology, data on which are scarce. We evaluated clinical features, outcomes, and prognostic factors of ES among children with age ≤5 years. METHODS: Children with ES registered between 2003 and 2019 were included. Baseline clinical and treatment details were retrieved from medical records. Prognostic factors were identified using multivariable Cox regression. Clinical features and outcomes of children ≤5 years were compared with those greater than 5 years by chi-square and log-rank tests. Propensity score-matched (PSM) analysis was done to evaluate the impact of age on survival in the metastatic and localized subgroups. RESULTS: Out of the 859 patients, 86 (10%) were ≤5 years of age (median age 4 years, 60 males [69.8%]). The most common location was the extremities (37.2%), followed by thorax (27.9%) and head and neck (H&N) (22.1%); baseline metastases were seen in 25 patients (29.8%). The median event-free-survival (EFS) and overall survival (OS) were 25.6 and 68.7 months, respectively. Metastatic disease predicted inferior OS (hazard ratio [HR] = 2.54, p = .018) and EFS (HR = 2.47, p = .007], symptom duration ≤3 months predicted an inferior OS (HR = 2.17, p = .048). Compared to age greater than 5 years, younger children had more H&N and less pelvic primaries (p < .001) and lesser baseline metastases (p = .037). PSM analysis did not reveal any significant impact of age on OS in the metastatic (HR = 1.59, p = .29) or localized cohort (HR = 1.77, p = .09). CONCLUSIONS: Children with ES ≤5 years of age have a distinct favorable clinical presentation. However, age is not an independent prognostic factor for survival outcomes when adjusted for confounders.

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BACKGROUND: Postoperative resorption of hard and soft tissues occurs as a consequence of tooth extraction. The Benex®-Control extractor allows minimally invasive extraction of the tooth without causing pronounced iatrogenic trauma. The aim of this study was to verify whether the resorption of the tissues after extraction can be reduced by using the Benex® system compared to the conventional extraction method. METHODS: Postoperative intraoral scans were superimposed after surgery (t0), after 7 days (t1), after 14 days (t2), after 30 days (t3), after 60 days (t4), and after 90 days (t5) within the two groups (study n = 14, control n = 16), and defined regions of interest (ROIs) (1-8) and volume changes were analyzed. In addition, the influence of gingival thickness and the thickness of the labial cortical plate was investigated. RESULTS: The greatest decrease in volume was observed in both groups in ROI3, although there was no significant difference observed between the groups. In the presence of an adjacent tooth, there was less volume loss in the affected ROIs (1, 2 and 7, 8). The thickness of the gingiva and the bony lamella did not significantly influence the change in volume. CONCLUSIONS: Due to the small cohort, the results are limited, and the hypothesis is rejected.

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BACKGROUND: OpenAI's ChatGPT is a source of advanced online health information (OHI) that may be integrated into individuals' health information-seeking routines. However, concerns have been raised about its factual accuracy and impact on health outcomes. To forecast implications for medical practice and public health, more information is needed on who uses the tool, how often, and for what. OBJECTIVE: This study aims to characterize the reasons for and types of ChatGPT OHI use and describe the users most likely to engage with the platform. METHODS: In this cross-sectional survey, patients received invitations to participate via the ResearchMatch platform, a nonprofit affiliate of the National Institutes of Health. A web-based survey measured demographic characteristics, use of ChatGPT and other sources of OHI, experience characterization, and resultant health behaviors. Descriptive statistics were used to summarize the data. Both 2-tailed t tests and Pearson chi-square tests were used to compare users of ChatGPT OHI to nonusers. RESULTS: Of 2406 respondents, 21.5% (n=517) respondents reported using ChatGPT for OHI. ChatGPT users were younger than nonusers (32.8 vs 39.1 years, P<.001) with lower advanced degree attainment (BA or higher; 49.9% vs 67%, P<.001) and greater use of transient health care (ED and urgent care; P<.001). ChatGPT users were more avid consumers of general non-ChatGPT OHI (percentage of weekly or greater OHI seeking frequency in past 6 months, 28.2% vs 22.8%, P<.001). Around 39.3% (n=206) respondents endorsed using the platform for OHI 2-3 times weekly or more, and most sought the tool to determine if a consultation was required (47.4%, n=245) or to explore alternative treatment (46.2%, n=239). Use characterization was favorable as many believed ChatGPT to be just as or more useful than other OHIs (87.7%, n=429) and their doctor (81%, n=407). About one-third of respondents requested a referral (35.6%, n=184) or changed medications (31%, n=160) based on the information received from ChatGPT. As many users reported skepticism regarding the ChatGPT output (67.9%, n=336), most turned to their physicians (67.5%, n=349). CONCLUSIONS: This study underscores the significant role of AI-generated OHI in shaping health-seeking behaviors and the potential evolution of patient-provider interactions. Given the proclivity of these users to enact health behavior changes based on AI-generated content, there is an opportunity for physicians to guide ChatGPT OHI users on an informed and examined use of the technology.

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The concept of "Less is more" has been gaining increasing awareness and acceptance in Critical Care. In 2017, we attempted to systematically answer the question "Can less be more in intensive care" with empirical data. We reviewed all the critical care randomized clinical trials (RCTs) between 1 January 2008 and 5 October 2016 in the New England Journal of Medicine (NEJM). This article attempts to repeat the earlier exercise using data from 5 October 2016 to 31 December 2023. This analysis of critical care RCTs in the NEJM has shown three findings. Approximately three-quarter of RCTs in critical care in the NEJM between 2008 and 2023 failed to show benefit or harm. In the years 2008-2016, patients in the intervention cohort had a higher mortality compared to controls, but in the years 2016-2023, the difference in overall mortality in patients in the intervention and control arms was not statistically significant. Compared to the years 2008-2016, in the years from 2016 to 2023, the number of RCTs showing harm decreased and those showing benefit increased. How to cite this article: Kapadia F, Bharadwaj S, Sharma R. Is "Less be More" Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine. Indian J Crit Care Med 2024;28(6):533-551.

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An ultra-low quiescent current output-capacitor-less low dropout (OCL-LDO) regulator for power-sensitive applications is proposed in this paper. To improve the gain of the OCL-LDO feedback loop, the error amplifier employs a combination of a cross-coupled input stage for boosting the equivalent input transconductance and a negative resistance technique to improve the gain. Meanwhile, in order to address the issue of transient response of the ultra-low quiescent current OCL-LDO, a sub-threshold slew-rate enhancement circuit is proposed in this paper, which consists of a transient signal input stage and a slew-rate current increase branch. The proposed OCL-LDO is fabricated in a 0.18 µm CMOS process with an effective area of 0.049 mm2. According to the measurement results, the proposed OCL-LDO has a maximum load current of 100 mA and a minimum quiescent current of 640 nA at an input voltage of 1.2 V and an output voltage of 1 V. The overshoot and undershoot voltages are 197 mV and 201 mV, respectively, and the PSR of the OCL-LDO is -72.4 dB at 1 kHz when the load current is 100 µA. In addition, the OCL-LDO has a load regulation of 7.6 µV/mA and a line regulation of 0.87 mV/V.

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INTRODUCTION: Xylene (XL) is the most commonly used clearing agent in Papanicolaou staining. XL is hazardous and toxic chemical and prolonged exposure to XL can cause many ill-health effects. The health risk due to XL can be minimized by substituting XL with less hazardous clearing reagents such as Pine Oil (PO), Eucalyptus oil (EO), or Limonene (LM). The objective of this study was to compare the clearing ability, staining quality, preservation of morphology, physical properties, and cost of XL, PO, EO, and LM. METHODS: Four smears were prepared from each of 50 serous effusions and were subjected to Papanicolaou stain. Out of four smears, one each was exposed to clearing specifically with XL (control), PO (test), EO (test), and LM (test). Test smears were compared with control for clearing, staining and morphology; graded as excellent, good or fair and further scored as 3, 2, 1, and the quality index (QI) was calculated. Statistical analysis was performed and the p value was calculated. In addition, the physical properties and cost of all the reagents were compared. RESULTS: QI was 0.96 for both XL and PO, whereas 0.92 and 0.54 for EO and LM, respectively. Compared to XL, the quality of staining, clearing and morphology of PO and EO were statistically not significant, whereas the difference was statistically significant with LM (p = 0.005). Physical properties such as volatility, flammability, miscibility with alcohol and DPX and the refractive indices of all the reagents were almost similar and all were recyclable. Odor was pungent for XL and EO but was pleasant for PO and LM. The cost was less for PO as compared to others. CONCLUSION: PO was a natural, less hazardous, less toxic, and economical clearing agent and can be considered as a substitute for XL.

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Now, the present power generation and distribution companies are working on renewable energy systems because their features are low-level atmospheric pollution, producing less greenhouse pollutants, more reliability, good static performance, and high robustness. In this work, the sunlight Photovoltaic (PV) system is selected because of its advantages are easily available in the atmosphere, high flexibility, zero carbon footprint, easy to maintain, and less transportation cost. However, solar networks produce nonlinear I-V characteristics. Due to the non-linear nature of the solar system, the extraction of peak voltage from the PV module is a very tough task. So, in this article, a variable modified step grey wolf method is integrated with the adaptive-neuro-fuzzy-inference-system to improve the energy production of solar systems. The features of this proposed maximum power point tracking controller are fast identification of the solar system operating point, generating the less fluctuated oriented converter load power, providing more MPP tracking accuracy, less dependence on the solar system installation, and useful for all environmental bad weather conditions. Another problem of solar systems is less voltage production which is improved by introducing a wide voltage gain-boost converter circuit. The features of this converter circuit are less development cost because it does not require more power electronics switches. Here, the proposed IGWM with an AFLC-fed sunlight system is investigated by using MATLAB/Simulink.