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Heart sound-based detection of cardiovascular diseases is a critical task in clinical diagnostics, where early and accurate identification can significantly improve patient outcomes. In this study, we investigate the effectiveness of combining traditional acoustic features and transformer-based Wav2Vec embeddings with advanced machine learning models for multi-class classification of five heart sound categories. Ten engineered acoustic features, i.e., Log Mel, MFCC, delta, delta-delta, chroma, discrete wavelet transform, zero-crossing rate, energy, spectral centroid, and temporal flatness, were extracted as regular features. Four model configurations were evaluated: a hybrid CNN + LSTM and XGBoost trained with either regular features or Wav2Vec embeddings. Models were assessed using a held-out test set with hyperparameter tuning and cross-validation. Results demonstrate that models trained on regular features consistently outperform Wav2Vec-based models, with XGBoost achieving the highest accuracy of 99%, surpassing the hybrid model at 98%. These findings highlight the importance of domain-specific feature engineering and the effectiveness of ensemble learning with XGBoost for robust and accurate heart sound classification, offering a promising approach for early detection and intervention in cardiovascular diseases.

Previous studies suggest that the winter surface freshening in the southeastern Arabian Sea (SEAS) contributes to the development of very high Sea Surface Temperatures (SST) thereby influencing the following summer monsoon onset. Here, we use forced and coupled simulations with a regional ocean general circulation model to explore the SEAS Sea Surface Salinity (SSS) variability mechanisms and impact on the monsoon. Both configurations capture the main SEAS oceanographic features, and confirm that the winter SSS decrease results from horizontal advection of Bay of Bengal freshwater by the cyclonic circulation around India during fall. A coupled model sensitivity experiment where salinity has no effect on mixing indicates that the salinity stratification reduces the SEAS mixed layer cooling by vertical processes by 3 °C seasonally. Salinity however enhances mixed layer cooling by a similar amount through concentrating negative winter surface heat fluxes into a thinner mixed layer, resulting in no climatological impact on SST and summer monsoon rainfall. The Indian Ocean Dipole (IOD) is the main driver of the winter SEAS SSS interannual variability (r ~ 0.8). Salty anomalies generated in the western Bay of Bengal during fall by positive IOD events are indeed transported by the cyclonic climatological coastal circulation, reaching the SEAS in winter. By this time, warm IOD-induced SST anomalies in the SEAS are already decaying, and the SEAS SSS anomalies hence do not contribute to their development. Overall, our model results suggest a weak climatological and interannual impact of the SEAS winter freshening on local SST and following monsoon onset.

Objectives To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis. Materials and methods The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups ( n  = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.5 0 C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer’s exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test. Results The cryotherapy group achieved haemostasis in less time ( p  < 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group ( P  < 0.005). The overall success rate of pulpotomy after 12 months was 88% ( n  = 22) in both study groups( p  < 0.05). Conclusions Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis. Clinical relevance The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

Amyloid-related imaging abnormalities (ARIA) are the principal safety concern limiting anti-amyloid therapies for Alzheimer’s disease, yet their biology remains unclear. Here we show, through multi-omic profiling of peripheral blood from three ARIA+ patients and matched controls, that ARIA is associated with coordinated reprogramming of CD8 + T cells. CD8+ effector memory (TEM) and terminally differentiated (TEMRA) subsets were expanded, clonally enriched, and transcriptionally primed for cytotoxicity and vascular trafficking. Transcription factor inference and metabolomics converged on glycolytic reprogramming favoring short-lived effector function. Ligand-receptor modeling revealed enhanced monocyte-to-T cell signaling through antigen presentation, adhesion, and chemokine axes, while integration with a cerebrovascular atlas confirmed that ARIA-associated TEMRAs are transcriptionally “addressed” for vascular engagement. Together, these findings identify a peripheral immune signature linking metabolic reprogramming, clonal CD8+ expansion, and altered intercellular communication to ARIA, with implications for biomarker development and risk mitigation pending validation in larger cohorts. Johnson et al. link ARIA, a complication of anti-amyloid therapy, to clonal expansion of cytotoxic CD8 + T cells with glycolytic reprogramming and vascular trafficking potential, with implications for biomarker development and risk mitigation.

Abstract Background: This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. Materials and Methods: This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Results: Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. Conclusions: This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.

Rooftop solar PV in India has seen good progress in the Commercial and industrial sectors, but the progress in the domestic sector is relatively slow due to the high initial installation cost. Thus, there arises the need for good market models for Rooftop Solar (RTS) implementation. This paper conducts a comparative study of workable RTS market models by employing the discounted cash flow method, as per the recent regulatory guidelines. Market models are formulated and tested for a typical residential high-rise apartment complex in India comprising 15 storied buildings with a combined maximum demand of 180kVA. The results suggest that the centralized community RTS model of 80kWp capacity with upfront financing is suitable when compared to the decentralized individual model, as it has the lowest levelized cost of 3.39 ₹/kWh and a payback period of 5.5 years. With the federal subsidy, the prosumer levelized cost reduces to 2.06 ₹/kWh with a payback period of 3.3 years. Thus grid parity is achieved for all tariff tier rates. With adaptive staggering strategy, this scheme is validated to be more attractive for the urban residential microgrids, as the solar installation of 80kWp and its cost can be staggered and even reduced over the planning period. Hence capital installation and operation costs can be distributed over the stipulated time interval. The study result gives RTS stakeholders insight into selecting  the most cost-effective market model to suit their requirements. Financial analysis of the proposed models provides input to the customers, developers, and policymakers to assess the financial merit of adopting the suitable business model for RTS development. The proposed analysis can be replicated for high-rise residential buildings, especially in cities with high electricity tariffs. With time, a decrease in solar PV installation price and an increase in grid price are expected; hence, the overall investment cost gets reduced and staggered.

Demyelination occurs with aging and is exacerbated in neurodegenerative diseases. During demyelination, microglia upregulate expression of APOE , the gene encoding for the brain’s primary lipid transport protein apolipoprotein E (ApoE), which also mediates microglial engulfment and elimination of myelin debris. Compared to the E3 allele of APOE , the E2 allele decreases risk for Alzheimer’s disease (AD), while the E4 allele increases AD risk and is associated with an increased severity and progression of multiple sclerosis. Previous work shows that mice expressing E2 exhibit improved microglial function and remyelination compared to mice expressing E4. However, whether microglial-derived APOE is responsible for driving these differences following demyelination, and if microglia-selective expression of E2 is sufficient to provide protection, is unknown. We sought to determine if microglia-specific replacement of the E4 allele with E2 can rescue myelin loss and promote remyelination, even in the presence of continued E4 expression by other central nervous system (CNS) cells. Using a novel APOE allelic “switch” model in which we can induce a replacement of E4 with E2 exclusively in microglia, we characterize the glial cell response and lipid profile of mice that underwent either lysophosphatidylcholine (LPC) or cuprizone (CPZ)-induced demyelination and subsequent remyelination. We found that although alterations to the brain lipid profile were subtle, microglial E2 replacement significantly improved remyelination, lessened microgliosis, and decreased astrocytic lipid droplet load following CPZ-remyelination. Our results indicate that microglia-specific E2 expression, in the presence of continued E4 expression, may provide protection against myelin loss via both cell-autonomous and non-autonomous immunometabolic mechanisms. Graphical Abstract

This paper presents an overlay-based one-way coupled Eulerian-Lagrangian computational approach designed to investigate the dynamics of particulate phases in extreme high-speed, high-altitude flight conditions characterized by very low particulate mass loading. Utilizing the Direct Simulation Monte Carlo method to generate accurate gas flow fields, this study explores two canonical hypersonic flow systems. First we focus on the hypersonic flow over a sphere-cone, revealing the formation of dust-free zones for small particulate diameters and describing the particulate interaction with gas shocks. As particulate diameter and flight speed increase, the characteristics of the particulate phase evolve, leading to the emergence of distinctive features such as high particulate concentration bands or regions void of particulates. Subsequently, the investigation considers flow over a double-cone, emphasizing the behavior of particulate phases in separated vortex-dominated systems where particulate-inertia-driven interactions with vortices result in unique particulate-free zones in the vicinity of the primary and secondary vortices. Additionally, the paper addresses the importance of using realistic fractal-like particulate shapes and demonstrates that the shape effect tends to decelerate the fractal aggregates and trap them along the boundaries of the primary vortex. This research contributes to a deeper understanding of particulate phase dynamics in extreme flight conditions, offering insights relevant to aerospace and aerodynamic applications.

Objective:Quadratus lumborum (QL) block has emerged as a good option to be included in multimodal analgesia for abdominal surgeries. The aim of the present study was to compare the effectiveness of the QL block with the more established transversus abdominis plane (TAP) block along with a control group in terms of duration of analgesia as the primary outcome in total abdominal hysterectomy (TAH).Methods:This randomised, double-blind, controlled trial was performed after ethics committee approval and written informed consent. Ultrasound-guided QL (group Q) and TAP (group T) blocks were administered on either side using 20mL of 0.25% bupivacaine after surgery under general anaesthesia, and group C did not receive any intervention.Results:There was a significant difference in the duration of analgesia among the groups (P ¼ .00). It was significantly longer in group Q (mean ¼ 8.05 hours; 95% CI, 7.28, 8.81) compared to group T (mean ¼ 5.59 hours; 95% CI, 4.63, 6.45) and group C (mean ¼ 1.19 hours; 95% CI, 1.04, 1.34). The verbal rating score (P ¼ .001) and the cumulative analgesic consumption (P ¼ .00) were the least in group Q. There was no complication in any of the groups. However, the level of satisfaction in patients receiving QL blocks did not differ significantly than in those receiving TAP block.Conclusion:It is highly recommended to include QL block as a part of multimodal analgesia in TAH as it is superior to TAP block in analgesic effect.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with increasing recognition of cardiovascular disease (CVD) as a major contributor to mortality. National data on cardiovascular deaths among individuals with IPF remains limited, and the impact of various disparities is unclear. The purpose of this study was to examine trends in the United States mortality rate involving cardiovascular deaths and pre-existing pulmonary fibrosis. This was a retrospective cohort study conducted by gathering mortality data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) publicly available database between the years 1999 and 2020. Death certificate data was extrapolated in this database, from which the subset of pulmonary fibrosis patients (ICD-10 J84.1) were analyzed for cardiovascular-related deaths (I00-I99). Statistical analysis was then conducted via the Joinpoint regression software. There were 47,814 cardiovascular-related deaths with underlying pulmonary fibrosis between 1999 and 2000. The overall age-adjusted mortality rate (AAMR) per 100,000 increased from 59.1 in 1999 to 134.5 in 2020 (Annual percent change [APC] = 3.37%,  < 10⁻⁶). Males had a higher AAMR and more pronounced increase than females (APC = 4.09%,  < 10⁻⁶; APC  = 1.63%,  = 0.056). White individuals had the highest AAMR with the steeper upward mortality trend. Cardiovascular deaths with underlying pulmonary fibrosis have consistently increased from 1999 to 2020, highlighting the urgent need for preventative techniques and the necessity for additional targeted public health interventions based on demographic disparities.