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Although many studies concerning the detection of influenza virus have been published, a paper-based, label-free electrochemical immunosensor has never been reported. Here, we present a cost-effective, handmade paper-based immunosensor for label-free electrochemical detection of influenza virus H1N1. This immunosensor was prepared by modifying paper with a spray of hydrophobic silica nanoparticles, and using stencil-printed electrodes. We used a glass vaporizer to spray the hydrophobic silica nanoparticles onto the paper, rendering it super-hydrophobic. The super-hydrophobicity, which is essential for this paper-based biosensor, was achieved via 30–40 spray coatings, corresponding to a 0.39–0.41 mg cm−2 coating of nanoparticles on the paper and yielding a water contact angle of 150° ± 1°. Stencil-printed carbon electrodes modified with single-walled carbon nanotubes and chitosan were employed to increase the sensitivity of the sensor, and the antibodies were immobilized via glutaraldehyde cross-linking. Differential pulse voltammetry was used to assess the sensitivity of the sensors at various virus concentrations, ranging from 10 to 104 PFU mL−1, and the selectivity was assessed against MS2 bacteriophages and the influenza B viruses. These immunosensors showed good linear behaviors, improved detection times (30 min), and selectivity for the H1N1 virus with a limit of detection of 113 PFU mL−1, which is sufficiently sensitive for rapid on-site diagnosis. The simple and inexpensive methodologies developed in this study have great potential to be used for the development of a low-cost and disposable immunosensor for detection of pathogenic microorganisms, especially in developing countries.

A collaborative pharmacist–primary care provider (PharmD-PCP) team approach to medication-therapy management (MTM), with pharmacists initiating and changing medications at separate office visits, holds promise for the cost-effective management of hypertension, but has not been evaluated in many systematic trials. The primary objective of this study was to examine blood pressure (BP) control in hypertensive patients managed by a newly formed PharmD-PCP MTM team versus usual care in a university-based primary care clinic. This randomized, pragmatic clinical trial was conducted in hypertensive patients randomly selected for PharmD-PCP MTM or usual care. In the PharmD-PCP MTM group, pharmacists managed drug-therapy initiation and monitoring, medication adjustments, biometric assessments, laboratory tests, and patient education. In the usual-care group, patients continued to see their PCPs. Participants were aged ≥18 years, were diagnosed with hypertension, had a most recent BP measurement of ≥140/≥90 mm Hg (≥130/≥80 mm Hg if codiagnosed with diabetes mellitus), were on at least 1 antihypertensive medication, and were English speaking. The primary outcome was the difference in the mean change from baseline in systolic BP at 6 months. Secondary outcomes included the percentage achieving therapeutic BP goal and the mean changes from baseline in diastolic BP and low- and high-density lipoprotein cholesterol. A total of 166 patients were enrolled (69 men; mean age, 67.7 years; PharmD-PCP MTM group, n = 75; usual-care group, n = 91). Mean reduction in SBP was significantly greater in the PharmD-PCP MTM group at 6 months (–7.1 [19.4] vs +1.6 [21.0] mm Hg; P = 0.008), but the difference was no longer statistically significant at 9 months (–5.2 [16.9] vs –1.7 [17.7] mm Hg; P = 0.22), based on an intent-to-treat analysis. In the intervention group, greater percentages of patients who continued to see the MTM pharmacist versus those who returned to their PCP were at goal at 6 months (81% vs 44%) and at 9 months (70% vs 52%). No significant between-group differences in changes in cholesterol were detected at 6 and 9 months; however, the mean baseline values were near recommended levels. The PharmD-PCP MTM group had significantly fewer PCP visits compared with the usual-care group (1.8 [1.5] vs 4.2 [1.0]; P < 0.001). A PharmD-PCP collaborative MTM service was more effective in lowering BP than was usual care at 6 months in all patients and at 9 months in patients who continued to see the pharmacist. Incorporating pharmacists into the primary care team may be a successful strategy for managing medication therapy, improving patient outcomes and possibly extending the capacity of primary care. ClinicalTrials.gov identifier: NCT01973556.

Introduction Oral squamous cell carcinoma (OSCC) is characterized by a high risk of cervical lymph node metastasis; however, it is still not clear whether patients with early stage OSCC with clinical N0 neck should undergo elective neck dissection (END) at the time of primary tumor removal, or they should undergo a conservative approach of observation (OBS), with therapeutic neck dissection at the time of lymph nodal recurrence. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared these two approaches. Methods PubMed and Scopus databases were searched for RCTs published in English language related to END and OBS in patients with early stage OSCC with clinical N0 neck. A meta-analysis was performed using random effects model with hazard ratio (HR) as the effect size for survival parameters and odds ratio (OR) as the effect size for lymph nodal recurrence. Results A total of 7 RCTs, comprising 1250 patients were included in the meta-analysis. Results of the meta-analyses showed that as compared to OBS approach, END could significantly improve overall survival (HR 0.67; 95% CI 0.53, 0.86) and disease-free survival (HR 0.64; 95% CI 0.46, 0.89), and significantly reduce lymph nodal recurrence (OR 0.28; 95% CI 0.12, 0.66). After correcting for heterogeneity, the disease specific survival was also found to be improved by the END approach (HR 0.53; 95% CI 0.29, 0.98). Conclusion The results of this meta-analysis suggest that elective neck dissection at the time of resection of the primary tumor not only leads to a reduced chance of nodal recurrence, but also confers a survival benefit in patients with clinically node-negative early stage oral cancer.

Objective. To evaluate the effect of providing educational video podcasts to first-year pharmacy students enrolled in a self-taught pharmaceutical calculations module. Methods. Six video podcasts were designed and posted online for pharmacy students to review prior to taking pharmaceutical calculations quizzes over the course of one year. The video podcasts demonstrated how to solve the most difficult problems on each of the six quizzes. Quiz performance was compared for the 2017-2018 year (no videos available) and the 2018-2019 year (videos available). Students provided feedback about the videos in a year-end survey. Results. Overall quiz scores and passing rates improved during the 2018-2019 academic year. Enhanced student performance on three of the six quizzes was demonstrated. A majority of students strongly agreed that the videos were helpful. Conclusion. Watching video podcasts was effective in improving pharmacy students’ performance on calculations quizzes. The students indicated that the podcasts were helpful in improving their math skills and facilitated their learning of the material.

Newcastle disease (ND), caused by Newcastle disease virus (NDV), is a contagious disease that affects a variety of domestic and wild avian species. Though ND is vaccine-preventable, it is a persistent threat to poultry industry across the globe. The disease represents a leading cause of morbidity and mortality in chickens. To better understand the epidemiology of NDV among commercial and backyard chickens of Odisha, where chicken farming is being prioritized to assist with poverty alleviation, a cross-sectional study was conducted in two distinct seasons during 2018. Choanal swabs ( n = 1361) from live birds (commercial layers, broilers, and backyard chicken) and tracheal tissues from dead birds ( n = 10) were collected and tested by real-time reverse transcription polymerase chain reaction (RT-PCR) for the presence of matrix (M) and fusion (F) genes of NDV. Risk factors at the flock and individual bird levels (health status, ND vaccination status, geographical zone, management system, and housing) were assessed using multivariable logistic regression analyses. Of the 1371 samples tested, 160 were positive for M gene amplification indicating an overall apparent prevalence of 11.7% (95% CI 10.1–13.5%). Circulation of virulent NDV strains was also evident with apparent prevalence of 8.1% (13/160; 95% CI: 4.8–13.4%). In addition, commercial birds had significantly higher odds (75%) of being infected with NDV as compared to backyard poultry ( p = 0.01). This study helps fill a knowledge gap in the prevalence and distribution of NDV in apparently healthy birds in eastern India, and provides a framework for future longitudinal research of NDV risk and mitigation in targeted geographies—a step forward for effective control of ND in Odisha.

Objective. To implement and evaluate the effectiveness of an interactive health literacy program by measuring pharmacy students’ knowledge and confidence. Design. A health literacy module consisting of a lecture and workshop was incorporated into a self-care course for first-year pharmacy students. Active-learning activities included practicing health literacy tools, discussing faculty-created video vignettes, and improving readability of patient education monographs. A non-validated survey assessed knowledge and confidence before and after training. Assessment. Fifty-three students (88%) completed a pre-training survey, and 60 (100%) completed a post-training survey. Students’ confidence improved in six of seven areas (p<.001). Students’ knowledge significantly improved in three of 14 areas (p<.01) pertaining to the average American reading level, high-risk age groups, and correlation of late prescription refills to low health literacy. Although knowledge increased in other areas, the improvements were not significant. Conclusion. An interactive, multifaceted health literacy training program significantly improved pharmacy students’ knowledge and confidence in recognizing and being able to assist patients with low health literacy.

Background There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. Methods The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived—a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. Discussion The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. Trial status Protocol version – V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) Trial registration The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries ( https://www.who.int/clinical-trials-registry-platform/network/primary-registries ) Reference No. CTRI/2022/02/040307 . Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.

IntroductionThere are around 250 million adolescents (10–19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those living in slum communities are particularly at risk due to poor living conditions, financial difficulty and limited access to support services. Adolescents’ Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) is a cluster randomised controlled trial of an intervention that intends to improve the mental health of adolescents living in slum communities in India. The aim of this paper is to describe the process evaluation protocol for ARTEMIS trial. The process evaluation will help to explain the intervention outcomes and understand how and why the intervention worked or did not work. It will identify contextual factors, intervention barriers and facilitators and the adaptations required for optimising implementation.MethodsCase study method will be used and the data will include a mix of quantitative metrics and qualitative data. The UK Medical Research Council’s guidance on evaluating complex interventions, the Reach, Efficacy, Adoption, Implementation and Maintenance Framework and the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Safety/Side Effects and, Equity criteria will be used to develop a conceptual framework and a priori codes for qualitative data analysis. Quantitative data will be analysed using descriptive statistics. Implementation fidelity will also be measured.DiscussionThe process evaluation will provide an understanding of outcomes and causal mechanisms that influenced any change in trial outcomes.Ethics and disseminationEthics Committee of the George Institute for Global Health India (project number 17/2020) and the Research Governance and Integrity Team, Imperial College, London (ICREC reference number: 22IC7718) have provided ethics approval. The Health Ministry’s Screening Committee has approved to the study (ID 2020-9770).Trial registration numberCTRI/2022/02/040307.