Background: The use of Tenecteplase (TNK) in Extended Time Window (ETW) for Acute Ischemic Stroke (AIS) remains an ongoing debate. Methods: Systematic review of 3 Randomized controlled trials (RCTs)- TIMELESS, TRACE 3, CHABLIS-T II was conducted. Results: 1198 patients were enrolled: 603 received TNK, while 595 were controls. All 3 trials included patients with Internal Carotid and/ or Proximal Middle Cerebral Artery Occlusions; however, in TRACE 3, patients did not have access to endovascular thrombectomy. TIMELESS and CHABLIS-T II showed better recanalization in the TNK group but the median Modified Rankin Score was 3 at 90 days in both groups, demonstrating no benefit in clinical outcomes. Symptomatic Intracranial hemorrhage (sICH) was similar in the two groups. In TRACE 3, there was an improvement in functional outcomes at 90 days in the TNK group (33.0% vs. 24.2%), but the incidence of sICH was also higher (3.0% and 0.8%, respectively). Conclusions: Better recanalization rates are seen with TNK in ETW, but may not be associated with improved functional outcomes at 90 days compared to medical management. Incidence of sICH also remains largely favorable, except in TRACE 3, which showed a higher incidence in the TNK group. There remains a need for more RCTs in this population.

Context effects occur when the preference between two alternatives is affected by the presence of an extra alternative. These effects are some of the most well studied phenomena in multi-alternative, multi-attribute decision making. Recent research in this area has revealed an intriguing pattern of results. On the one hand, these effects are robust and ubiquitous. That is, they have been demonstrated in many domains and different choice settings. On the other hand, they are fragile and they disappear or even reverse under different conditions. This pattern of results has spurred debate and speculation about the cognitive mechanisms that drive these choices. The attraction effect, where the preference for an option increases in the presence of a dominated decoy, has generated the most controversy. In this registered report, we systematically vary factors that are known to be associated with the attraction effect to build a solid foundation of empirical results to aid future theory development. We find a robust attraction effect across the different conditions. The strength of this effect is modulated by the display order (e.g., decoy top, target middle, competitor bottom) and mode (numeric vs. graphical) but not display layout (by-attribute vs. by-alternative).

The European Clozapine Task Force is a group of psychiatrists and pharmacologists practicing in 18 countries under European Medicines Agency (EMA) regulation, who are deeply concerned about the underuse of clozapine in European countries. Although clozapine is the most effective antipsychotic for people with treatment-resistant schizophrenia, a large proportion of them do not have access to this treatment. Concerns about clozapine-induced agranulocytosis and stringent blood monitoring rules are major barriers to clozapine prescribing and use. There is a growing body of evidence that the incidence of clozapine-induced agranulocytosis is very low after the first year of treatment. Maintaining lifelong monthly blood monitoring after this period contributes to unjustified discontinuation of clozapine. We leverage recent and replicated evidence on the long-term safety of clozapine to call for the revision and updating of the EMA’s blood monitoring rules, thus aiming to overcome this major barrier to clozapine prescribing and use. We believe the time has come for relaxing the rules without increasing the risks for people using clozapine in Europe.

This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to gather feedback on the framework’s strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework.

Hepatitis E virus (HEV) is a major cause of acute jaundice in South Asia. Gaps in our understanding of transmission are driven by non-specific symptoms and scarcity of diagnostics, impeding rational control strategies. In this context, serological data can provide important proxy measures of infection. We enrolled a population-representative serological cohort of 2,337 individuals in Sitakunda, Bangladesh. We estimated the annual risks of HEV infection and seroreversion both using serostatus changes between paired serum samples collected 9 months apart, and by fitting catalytic models to the age-stratified cross-sectional seroprevalence. At baseline, 15% (95 CI: 14–17%) of people were seropositive, with seroprevalence highest in the relatively urban south. During the study, 27 individuals seroreverted (annual seroreversion risk: 15%, 95 CI: 10–21%), and 38 seroconverted (annual infection risk: 3%, 95CI: 2–5%). Relying on cross-sectional seroprevalence data alone, and ignoring seroreversion, underestimated the annual infection risk five-fold (0.6%, 95 CrI: 0.5–0.6%). When we accounted for the observed seroreversion in a reversible catalytic model, infection risk was more consistent with measured seroincidence. Our results quantify HEV infection risk in Sitakunda and highlight the importance of accounting for seroreversion when estimating infection incidence from cross-sectional seroprevalence data.

The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.

Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.

Determination of membership of star clusters is a very important criterion in their study as they effect determination of cluster parameters like radius, age, distance, mass functions, etc. In an earlier study, we used published membership data of nine open star clusters as a training set to find new members from Gaia DR2 data using a supervised Random Forest (RF) model with a precision of around 90%. The number of new members found was almost double the published number. In this work, we would like to compare the earlier results with results obtained by applying the unsupervised method of Gaussian Mixture Modelling (GMM) and Density-Based Spatial Clustering of Applications with Noise (DBSCAN) to study the membership of open star clusters of varying ages and locations in the Galaxy using Gaia DR2 and EDR3 data. We shall discuss these techniques and focus on the caveats involved.

Determination of membership of star clusters is a very important criterion in their study as they effect determination of cluster parameters like radius, age, distance, mass functions, etc. In this paper, we apply the unsupervised method of Gaussian Mixture Modelling (GMM) to find membership of 9 open star clusters of varying ages and locations in the galaxy using Gaia DR3 data. We compare our results to help understand the efficiency of GMM. We find that this method works well with relaxed clusters with ages larger than their relaxation times they approximate Gaussians better.

The present study aimed to investigate the nutritional constituents of common market available spices in the United Arab Emirates. Seven commonly consumed spices namely, ginger (Zingiber officinale), cinnamon (Cinnamomum verum), black seed (Nigella sativa), fenugreek (Trigonella foenum-graecum), cardamom (Elettaria cardamomum), cloves (Syzygium aromaticum) and saffron (Crocus sativus) were obtained from local markets. Proximate analyses were performed according to AOAC procedures. Assessment of major (Ca, K, Mg, Na, P and S) and minor (Co, Cu, Fe, Mn and Zn) elements was conducted using inductively coupled plasma optical emission spectrometry (ICP-OES). Findings revealed varying macronutrient, micronutrient and mineral contents which are highly valuable for dietary purposes. The present study demonstrates that these edible spices could be used for nutritional support, due to their micro and macronutrient contents.

A steady supply of hosts at the susceptible stage for parasitism is a major component of mass rearing parasitoids for biological control programs. Here we describe the effects of storing 5th instar Plodia interpunctella larvae in dormancy on subsequent host development in the context of host colony maintenance and effects of the duration of host dormancy on the development of Habrobracon hebetor parasitoids reared from dormant hosts. We induced dormancy with a combination of short daylength (12L:12D) and lower temperature (15°C), conditions known to induce diapause in this species, and held 5th instar larvae of P. interpunctella for a series of dormancy durations ranging from 15 to 105 days. Extended storage of dormant 5th instar larvae had no significant impacts on survival, development, or reproductive potential of P. interpunctella, reinforcing that dormant hosts have a substantial shelf life. This ability to store hosts in dormancy for more than 3 months at a time without strong negative consequences reinforces the promise of using dormancy to maintain host colonies. The proportion of hosts parasitized by H. hebetor did not vary significantly between non-dormant host larvae and dormant host larvae stored for periods as long as 105 days. Concordant with a prior study, H. hebetor adult progeny production from dormant host larvae was higher than the number of progeny produced on non-dormant host larvae. There were no differences in size, sex ratio, or reproductive output of parasitoids reared on dormant hosts compared to non-dormant hosts stored for up to 105 days. Larval development times of H. hebetor were however longer when reared on dormant hosts compared to non-dormant hosts. Our results agree with other studies showing using dormant hosts can improve parasitoid mass rearing, and we show benefits for parasitoid rearing even after 3 months of host dormancy.

Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018–19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.

We used a standardised transect method to compare lowland forest termite assemblages in Buton Island, Sulawesi, with transects in Sundaland. The four Buton transects were extremely depauperate with species density ranging from 1 to 6 species, which is around 10% of the species density in 11 described Sundaland transects. Soil-feeding species were absent from the Buton transects but represent some 43% of species in the Sundaland transects. The Buton transects have relatively high soil pH (6.7–7.9), which may be associated with depauperate termite assemblages. Most termite genera recorded in Sulawesi are wood nesters that can raft in floating wood, which is probably how they arrived in Sulawesi. The Macrotermitinae (fungus-growers) do not raft and probably flew across serendipitously. Geographic isolation, both on Buton and in Sulawesi more generally, and Buton’s underlying geology causing high soil pH, may account for the near-absence of soil-nesters and soil-feeders, none of which are known to raft.

We study the effect of minor mergers on star formation using simulations. We use GADGET4 code which has both collisionless and hydrodynamical particles. Our goal is to establish a relation between gas percentage present in the galaxies and the star formation in the merged galaxy. We use 1:10 minor mergers and we run the isolated simulations with varying gas percentages in the primary galaxy. We observe that the gas particles convert into stars due to the impact of the minor merger. As the gas percentage increases in the primary disk of the galaxy, more number of stars are formed. We also observed that newly formed star particles settle down in the disk of the primary galaxy and increase the thickness of the disk. We also observe that the thickness of the stellar disk containing the old stars also increases due to the impact of the merger.

The World Health Organization set a target of a 15% relative reduction in the prevalence of insufficient physical activity (IPA) by 2025 among adolescents and adults globally. In Bangladesh, there are no national estimates of the prevalence of IPA among adolescents. The aim of this study was to estimate the prevalence of and risk factors associated with IPA among adolescent girls and boys. Data for 4865 adolescent girls and 4907 adolescent boys, collected as a part of a National Nutrition Surveillance in 2018–19, were analysed for this study. A modified version of the Global Physical Activity Questionnaire (GPAQ) was used to collect physical activity data. The World Health Organization recommended cut-off points were used to estimate the prevalence of IPA. Bivariate and multivariable logistic regression was performed to identify factors associated with IPA. Prevalences of IPA among adolescent girls and boys were 50.3% and 29.0%, respectively, and the prevalence was significantly higher among early adolescents (10–14 years) than late adolescents (15–19 years) among both boys and girls. The IPA prevalence was highest among adolescents living in non-slum urban areas (girls: 77.7%; boys: 64.1%). For both boys and girls, younger age, non-slum urban residence, higher paternal education and increased television viewing time were significantly associated with IPA. Additionally, residing in slums was significantly associated with IPA only among the boys. Higher maternal education was associated with IPA only among the girls. This study identified several modifiable risk factors associated with IPA among adolescent boys and girls in Bangladesh. These factors should be addressed through comprehensive public health interventions to promote physical activity among adolescent girls and boys.