Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective ...was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting.
The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training—including information provision, joint goal setting, carer training, and task-specific training—that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3–6 on the modified Rankin scale (range, 0 no symptoms to 6 death) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707).
Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78–1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 14%patients in the intervention group vs 82 13% in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 13% intervention patients vs 110 events in 79 13% control patients; p=0·80).
Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care.
The National Health and Medical Research Council of Australia.
Helium is the second-most abundant element in the Universe after hydrogen and is one of the main constituents of gas-giant planets in our Solar System. Early theoretical models predicted helium to be ...among the most readily detectable species in the atmospheres of exoplanets, especially in extended and escaping atmospheres
. Searches for helium, however, have hitherto been unsuccessful
. Here we report observations of helium on an exoplanet, at a confidence level of 4.5 standard deviations. We measured the near-infrared transmission spectrum of the warm gas giant
WASP-107b and identified the narrow absorption feature of excited metastable helium at 10,833 angstroms. The amplitude of the feature, in transit depth, is 0.049 ± 0.011 per cent in a bandpass of 98 angstroms, which is more than five times greater than what could be caused by nominal stellar chromospheric activity. This large absorption signal suggests that WASP-107b has an extended atmosphere that is eroding at a total rate of 10
to 3 × 10
grams per second (0.1-4 per cent of its total mass per billion years), and may have a comet-like tail of gas shaped by radiation pressure.
To study the statistics of the epidemiology, co-morbidities, clinical presentations, management and prognosis of the study group.
This is a retrospective study conducted in a tertiary care hospital ...in South India, among 100 subjects, between May 2021 and August 2021 when the Mucor mycosis cases were frequently being diagnosed and treated amongst COVID-19 infected patients.
The results showed that 34.0% were between 51-60 years with 100% patients confirmed COVID positive through RTPCR tests. 86.0% had confirmed mucor on CT scan. 50.0% had both eyes vision of 6/60 on presentation. 67.% had periorbital swelling with 51% having prior co-morbidities.63.0% patients received tablet Posaconazole 30mg as medical treatment and 60.0% required no surgical management.10.0% required orbital exenteration and 21.0% required partial maxillectomy.2% experienced orbital apex syndrome as associated complications.97.0% were discharged post treatment with 3% mortality. There was a positive correlation of medical management with respect to anterior segment and posterior segment findings P<0.001 and P=0.79. There was a positive correlation between surgical treatment and anterior and posterior segment findings P<0.001 and P=0.43. There was a positive correlation between co-morbidities and death P<0.001, with 32.0% uncontrolled diabetics.
This study shows that immune suppression is directly related to infectivity by mucor mycosis. In order to contain symptomatology and grave prognosis amongst patients, early diagnosis, affordable treatment and follow-up including patient education about the etiology and pathogenesis of the disease must be available.
Metabolic remodeling is now widely regarded as a hallmark of cancer, but it is not clear whether individual metabolic strategies are frequently exploited by many tumours. Here we compare messenger ...RNA profiles of 1,454 metabolic enzymes across 1,981 tumours spanning 19 cancer types to identify enzymes that are consistently differentially expressed. Our meta-analysis recovers established targets of some of the most widely used chemotherapeutics, including dihydrofolate reductase, thymidylate synthase and ribonucleotide reductase, while also spotlighting new enzymes, such as the mitochondrial proline biosynthetic enzyme PYCR1. The highest scoring pathway is mitochondrial one-carbon metabolism and is centred on MTHFD2. MTHFD2 RNA and protein are markedly elevated in many cancers and correlated with poor survival in breast cancer. MTHFD2 is expressed in the developing embryo, but is absent in most healthy adult tissues, even those that are proliferating. Our study highlights the importance of mitochondrial compartmentalization of one-carbon metabolism in cancer and raises important therapeutic hypotheses.
Motivated by recent spectroscopic evidence for carbon-rich atmospheres on some transiting exo-planets, we investigate the influence of the C/O ratio on the chemistry, composition, and spectra of ...extrasolar giant planets both from a thermochemical-equilibrium perspective and from consideration of disequilibrium processes like photochemistry and transport-induced quenching. We find that although CO is predicted to be a major atmospheric constituent on hot Jupiters for all C/O ratios, other oxygen-bearing molecules like H
O and CO
are much more abundant when C/O
1, whereas CH
, HCN, and C
H
gain significantly in abundance when C/O
1. Other notable species like N
and NH
that do not contain carbon or oxygen are relatively unaffected by the C/O ratio. Disequilibrium processes tend to enhance the abundance of CH
, NH
, HCN, and C
H
over a wide range of C/O ratios. We compare the results of our models with secondary-eclipse photometric data from the
and conclude that (1) disequilibrium models with C/O ~ 1 are consistent with spectra of WASP-12b, XO-1b, and CoRoT-2b, confirming the possible carbon-rich nature of these planets, (2) spectra from HD 189733b are consistent with C/O ≲ 1, but as the assumed metallicity is increased above solar, the required C/O ratio must increase toward 1 to prevent too much H
O absorption, (3) species like HCN can have a significant influence on spectral behavior in the 3.6 and 8.0
m
channels, potentially providing even more opacity than CH
when C/O
1, and (4) the very high CO
abundance inferred for HD 189733b from near-infrared observations cannot be explained through equilibrium or disequilibrium chemistry in a hydrogen-dominated atmosphere. We discuss possible formation mechanisms for carbon-rich hot Jupiters, including scenarios in which the accretion of CO-rich, H
O-poor gas dominates the atmospheric envelope, and scenarios in which the planets accrete carbon-rich solids while migrating through disk regions inward of the snow line. The C/O ratio and bulk atmospheric metallicity provide important clues regarding the formation and evolution of the giant planets.
We present an atmospheric transmission spectrum of the ultra-hot Jupiter WASP-76 b by analyzing archival data obtained with the Space Telescope Imaging Spectrograph (STIS) on board the
Hubble
Space ...Telescope (HST). The dataset spans three transits, two with a wavelength coverage between 2900 and 5700 Å, and the third one between 5250 and 10 300 Å. From the one-dimensional, time dependent spectra we constructed white and chromatic light curves, the latter with typical integration band widths of ~200 Å. We computed the wavelength dependent planet-to-star radii ratios taking into consideration WASP-76’s companion. The resulting transmission spectrum of WASP-76 b is dominated by a spectral slope of increasing opacity towards shorter wavelengths of amplitude of about three scale heights under the assumption of planetary equilibrium temperature. If the slope is caused by Rayleigh scattering, we derive a lower limit to the temperature of ~870 K. Following-up on previous detection of atomic sodium derived from high resolution spectra, we re-analyzed HST data using narrower bands centered around sodium. From an atmospheric retrieval of this transmission spectrum, we report evidence of sodium at 2.9
σ
significance. In this case, the retrieved temperature at the top of the atmosphere (10
−5
bar) is 2300
−392
+412
K. We also find marginal evidence for titanium hydride. However, additional high resolution ground-based data are required to confirm this discovery.
Metabolic reprogramming has been proposed to be a hallmark of cancer, yet a systematic characterization of the metabolic pathways active in transformed cells is currently lacking. Using mass ...spectrometry, we measured the consumption and release (CORE) profiles of 219 metabolites from media across the NCI-60 cancer cell lines, and integrated these data with a preexisting atlas of gene expression. This analysis identified glycine consumption and expression of the mitochondrial glycine biosynthetic pathway as strongly correlated with rates of proliferation across cancer cells. Antagonizing glycine uptake and its mitochondrial biosynthesis preferentially impaired rapidly proliferating cells. Moreover, higher expression of this pathway was associated with greater mortality in breast cancer patients. Increased reliance on glycine may represent a metabolic vulnerability for selectively targeting rapid cancer cell proliferation.
Broad absorption signatures from alkali metals, such as the sodium (Na I) and potassium (K I) resonance doublets, have long been predicted in the optical atmospheric spectra of cloud-free irradiated ...gas giant exoplanets
. However, observations have revealed only the narrow cores of these features rather than the full pressure-broadened profiles
. Cloud and haze opacity at the day-night planetary terminator are considered to be responsible for obscuring the absorption-line wings, which hinders constraints on absolute atmospheric abundances
. Here we report an optical transmission spectrum for the 'hot Saturn' exoplanet WASP-96b obtained with the Very Large Telescope, which exhibits the complete pressure-broadened profile of the sodium absorption feature. The spectrum is in excellent agreement with cloud-free, solar-abundance models assuming chemical equilibrium. We are able to measure a precise, absolute sodium abundance of logε
= Formula: see text, and use it as a proxy for the planet's atmospheric metallicity relative to the solar value (Z
/Z
= Formula: see text). This result is consistent with the mass-metallicity trend observed for Solar System planets and exoplanets
.
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