Traffic Impact Assessment, Diversion and Management Plan for Surat Metro Line 1, Package –CS3, Surat

Package CS3 of Metro Line 1 in Surat City includes 3 stations i.e. Surat railway station, Maskati Hospital and Chowk Bazar. As per proposed Metro plan of Surat city, this line will originate from Sarthana station and will terminate at Dream City. The length of Line 1 is 21.61KM of which 14.59km is elevated whereas 7.02km is Underground and consists of 20 Stations. This metro line envisages use of public transport system in Surat city and shall cater the present and future travel demand of the catchment area and shall also reduce load from road based transport system of the corridor. During the construction phase of any Mass Rapid Transit System (MRTS) running along the Right of Way (ROW) of existing roadway system, Traffic diversion and management plan implementation becomes absolute mandatory to reduce congestion, conflicts increase level of safety and ease construction process. Similarly, for package CS3 of Surat Metro line 1, there is need of preparing an implementing Traffic Diversion and Management plan to create a synergy amongst construction activities, traffic flow, safety of pedestrian and construction worker with minimal impact on surrounding catchment. This study shall provide Traffic diversion and management plan which may help to cater the existing traffic and stir them in a smooth and non-congested flow with the help of signage’s, road markings, etc.

Optimizing the colorectal cancer screening programme using faecal immunochemical test (FIT) in Flanders, Belgium from the “interval cancer” perspective

Background Interval cancer (IC) is a critical issue in colorectal cancer (CRC) screening. We identified factors associated with ICs after faecal immunochemical test (FIT) screening and explored the impact of lowering FIT cut-off or shortening screening interval on FIT-ICs in Flanders. Methods FIT participants diagnosed with a CRC during 2013–2018 were included. Factors associated with FIT-ICs were identified using logistic regression. Distributions of FIT results among FIT-ICs were examined. Results In total, 10,122 screen-detected CRCs and 1534 FIT-ICs were included (FIT-IC proportion of 13%). FIT-ICs occurred more frequently in women (OR 1.58 [95% CI 1.41–1.76]) and ages 70–74 (OR 1.35 [1.14–1.59]). FIT-ICs were more often right-sided (OR 3.53 [2.98–4.20]), advanced stage (stage IV: OR 7.15 [5.76–8.88]), and high grade (poorly/undifferentiated: OR 2.57 [2.08–3.18]). The majority (83–92%) of FIT-ICs would still be missed if FIT cut-off was lowered from 15 to 10 µg Hb/g or screening interval was shortened from 2 to 1 year. Conclusions FIT-ICs were more common in women, older age, right-sided location, advanced stage and high grade. In Flanders, lowering FIT cut-off (to 10 µg Hb/g) or shortening screening interval (to 1 year) would have a minimal impact on FIT-ICs.

Oral Epithelial Dysplasia Grading Systems: A Systematic Review & Meta-Analysis

This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I^2 statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.

Gene Therapy Using Nanocarriers for Pancreatic Ductal Adenocarcinoma: Applications and Challenges in Cancer Therapeutics

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers worldwide, and its incidence is increasing. PDAC often shows resistance to several therapeutic modalities and a higher recurrence rate after surgical treatment in the early localized stage. Combination chemotherapy in advanced pancreatic cancer has minimal impact on overall survival. RNA interference (RNAi) is a promising tool for regulating target genes to achieve sequence-specific gene silencing. Here, we summarize RNAi-based therapeutics using nanomedicine-based delivery systems that are currently being tested in clinical trials and are being developed for the treatment of PDAC. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) genome editing has been widely used for the development of cancer models as a genetic screening tool for the identification and validation of therapeutic targets, as well as for potential cancer therapeutics. This review discusses current advances in CRISPR/Cas9 technology and its application to PDAC research. Continued progress in understanding the PDAC tumor microenvironment and nanomedicine-based gene therapy will improve the clinical outcomes of patients with PDAC.

Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

Background The importance of reducing low-value care (LVC) is increasingly recognized, but the impact of de-implementation on the patient-clinician relationship is not well understood. This mixed-methods study explored the impact of LVC de-implementation on the patient-clinician relationship. Methods Adult primary care patients from a large Virginia health system volunteered to participate in a survey (n = 232) or interview (n = 24). Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading a vignette about a clinician declining to provide a low-value service: antibiotics for acute sinusitis (LVC-antibiotics); screening EKG (LVC-EKG); screening vitamin D test (LVC-vitamin D); or an alternate vignette about a high-value service, and imagining that their own primary care clinician had acted in the same manner. A different sample of participants was asked to imagine that their own primary care clinician did not order LVC-antibiotics or LVC-EKG and then respond to semi-structured interview questions. Outcomes data included participant demographics, PDRQ-9 scores (higher score = greater relationship integrity), and content analysis of transcribed interviews. Differences in PDRQ-9 scores were analyzed using one-way ANOVA. Data were integrated for analysis and interpretation. Results Although participants generally agreed with the vignette narrative (not providing LVC), many demonstrated difficulty comprehending the broad concept of LVC and potential harms. The topic triggered memories of negative experiences with healthcare (typically poor-quality care, not necessarily LVC). The most common recommendation for reducing LVC was for patients to take greater responsibility for their own health. Most participants believed that their relationship with their clinician would not be negatively impacted by denial of LVC because they trusted their clinician’s guidance. Participants emphasized that trusted clinicians are those who listen to them, spend time with them, and offer understandable advice. Some felt that not providing LVC would actually increase their trust in their clinician. Similar PDRQ-9 scores were observed for LVC-antibiotics (38.9), LVC-EKG (37.5), and the alternate vignette (36.4), but LVC-vitamin D was associated with a significantly lower score (31.2) (p < 0.05). Conclusions In this vignette-based study, we observed minimal impact of LVC de-implementation on the patient-clinician relationship, although service-specific differences surfaced. Further situation-based research is needed to confirm study findings.

Impact of the COVID-19 Pandemic and Associated Lockdown Measures on the Management, Health and Behaviour of the Cystic Fibrosis Population in France During 2020 (MUCONFIN)

BackgroundMost of the studies on cystic fibrosis (CF) focused on SARS-CoV-2 prevalence and suggested a low incidence of infection in this population We aimed to assess in cystic fibrosis (CF) patients the impact on healthcare access, health, and behaviour of the pandemic and associated lockdown measures implemented in May 2020 in response to the first wave of SARS-CoV-2 infection.MethodsA national questionnaire opened online from May 10th, 2020 to June 11th, 2020 was completed by 751 CF-patients, aged 14 years and over. It comprised questions about access to healthcare, anxiety and depression, smoking, alcohol, drug and psychotropic drug consumption, adherence to CF treatment, and constraints. A semi-structured comprehensive interview was performed no later than one month after the end of the lockdown in 15 CF-patients.ResultsThe mean age of the population was 28 [IQR 20-37] years old. More than 75% of in-person consultations scheduled during the lockdown were cancelled and 27% were postponed, but telehealth consultations were proposed and accepted in almost 40% of cases. More than 75% of the scheduled physiotherapy sessions were cancelled and replaced mainly by self-drainage. Annual follow-up clinic visits were consistently postponed whereas required hospitalizations at CF centres for exacerbation were maintained in most cases. While 43% CF-patients had signs of anxiety, 51% presented symptoms of depression, both associated with increased use of psychotic medications and inversely correlated to COVID-19 prevalence. Among the lower and lower middle classes, very little medical information was obtained or requested by the patient, participation to sports or other activities was low, while excessive home confinement and isolation were more frequent. In contrast, in the upper middle and upper classes, individuals solicitated help to their CF centre, had more physical activities, and maintained contact with friends or families.ConclusionThe first lockdown in France had only minimal impact on the management care of CF-patients but was associated with increased symptoms of anxiety and depression, together with behavioural changes that varied with social class

Human Milk Oligosaccharides Reduce Murine Group B Streptococcus Vaginal Colonization with Minimal Impact on the Vaginal Microbiota

During pregnancy, GBS ascension into the uterus can cause fetal infection or preterm birth. In addition, GBS exposure during labor creates a risk of serious disease in the vulnerable newborn and mother postpartum.

The carbohydrate economy of fruit trees.

Since lack of water is a commonly occurring condition in nature, plants have developed many physiological responses to help them survive periods of water stress. Most of these responses cause changes in the carbohydrate economy of the tree through reduced photosynthesis, tree growth or cropping, but some of these effects can be managed to have minimal impact on overall tree productivity. Whether these responses influence economic production depends on: (i) the processes occurring at the time of a stress; (ii) how important these processes are to tree yield; and (iii) whether these processes rely heavily on the current level of photosynthesis or can use stored carbohydrates, like starch, to compensate for the lack of current photosynthesis in the leaves. This chapter discusses the carbohydrate economy of fruit trees. An outline is provided for how assimilates are distributed and used within a fruit or nut tree.

Multi-Omics Analysis of Oral Bacterial Biofilm on Titanium Oxide Nanostructure Modified Implant Surface: in Vivo Sequencing-Based Pilot Study in Beagle Dogs

Background and aimsSurface modifications of titanium implants play essential role in facilitating osteointegration and enhancing their antimicrobial properties, while the latter is critical for preventing infectious diseases caused by the biofilm. However, it remains unknown about how the surface modifications could affect the composition and functional gene expression of oral microbiota deposited on the titanium implants. In this study, we aimed to investigate the impact of different nanostructured surfaces on the biofilm in vivo.ResultsNanophase calcium phosphate were successfully deposited into or between the TiO2 nanotubes with a diameter of 70–90 nm. NT and NTN surfaces showed increased roughness than the MP surface. XPS spectra showed that the O 1s was mainly divided into two bands in MP and NT samples, including Ti-O and -OH, while the surface modification of TiO2 nanotube in NT accounted for the increased intensity of Ti-O with the reference to that in MP samples. After the deposition of calcium phosphate, two new elemental peaks of Ca and P can be identified from the XPS survey spectrum of NTN. Moreover, the O 1s of NTN sample could be differentiated into three peaks, while the new one represented the -PO band. The 16S rDNA sequencing results showed that NT and NTN had minimal impact on the diversity and community structure of oral microbiota. Metatranscriptomic sequencing revealed that differentially expressed genes (DEGs) mostly differed in the terms of the biological process and cellular component on different surfaces. Gene Ontology (GO) terms enrichment indicated that NTN down-regulate the genes associated in localization and locomotion. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis revealed that the DEGs were associated with microbial metabolism, protein synthesis and bacterial invasion of epithelial cells.ConclusionTiO2 nanotube and calcium phosphate-coated TiO2 nanotube despite improving the antimicrobial properties of implant surfaces, had unexpectedly minimal impact on the microbiome composition and diversity. Notably, nanostructured titanium surfaces could inhibit the bacterial migration and colonization, down-regulate the pathogen invasion pathways, and further destruct bacterial cellular membrane, all in all, conferred the bactericidal properties.

Archaeology of disaster in Indonesia: where are we now?

Natural disasters are a phenomenon that shaped the Indonesian Archipelago. Earthquakes and volcanic activities have become periodic experiences in the lives of people in this region. The geographical characteristics of Indonesia which are located at the confluence of active plates and part of the global volcanic chain are natural factors that make these islands vulnerable to disasters. Cultural historical studies have recorded various phenomena of past natural disasters in the archipelago. Some have had minimal impact, but others have resulted in the loss of civilization. Although the issue has become the important part of the civilization and profile of Indonesia, the archaeological study of disasters has not well developed. The existing studies so far are still very partial with the fragmentary results. Characterized with this complex character, the study of archaeological disaster requires a multidisciplinary approach. This paper attempts to discuss the archaeology of disasters in Indonesia including the background, current conditions and the prospects of future development. Particularly in discussing the role of local wisdoms in dealing with disasters as part of the civilization of the archipelago.