Late Changes Research Articles

Depositional architecture of a wave-dominated shoal-water fan delta (Manavgat Basin, southern Türkiye): implications for the Middle–Late Tortonian sea level changes and tectonics

Depositional architecture of a wave-dominated shoal-water fan delta (Manavgat Basin, southern Türkiye): implications for the Middle–Late Tortonian sea level changes and tectonics

The NHGRI-EBI GWAS Catalog: standards for reusability, sustainability and diversity.

The NHGRI-EBI GWAS Catalog serves as a vital resource for the genetic research community, providing access to the most comprehensive database of human GWAS results. Currently, it contains close to 7000 publications for >15000 traits, from which more than 625000 lead associations have been curated. Additionally, 85 000 full genome-wide summary statistics datasets-containing association data for all variants in the analysis-are available for downstream analyses such as meta-analysis, fine-mapping, Mendelian randomisation or development of polygenic risk scores. As a centralised repository for GWAS results, the GWAS Catalog sets and implements standards for data submission and harmonisation, and encourages the use of consistent descriptors for traits, samples and methodologies. We share processes and vocabulary with the PGS Catalog, improving interoperability for a growing user group. Here, we describe the latest changes in data content, improvements in our user interface, and the implementation of the GWAS-SSF standard format for summary statistics. We address the challenges of handling the rapid increase in large-scale molecular quantitative trait GWAS and the need for sensitivity in the use of population and cohort descriptors while maintaining data interoperability and reusability.

Lake sediments on the Adamawa Plateau (Central Cameroon) as archives of climate change and the Bantu impact during the last 4000 years BP

AbstractThis study investigates Late Holocene environmental changes in Central Cameroon induced by the combined effects of climate and human impact. For this purpose, sediments from lakes Dang, Massote, Fonjak and Ngaoundaba were studied through lithologic analysis including mineralogical composition and organic geochemistry combined with radiocarbon dates. From these analyses, the sediments at the base of lakes Massote and Dang cores are respectively dated to 4680–3530 and 4220–3580 cal yr BP, whereas the sediments of lakes Fonjak and Ngaoundaba seem to be younger, respectively dated to 3210–3000 and 1870–1740 cal yr BP. Lake sedimentation is dominated by organic matter (OM) poor deposits (OM < 3%) in the lower sections and OM-rich deposits (OM: 5–54%) in the upper sections. This shift from OM-poor to OM-rich sedimentation induced by climate variations occurred at $$\sim $$ ∼ 2800–2400 cal yr BP. The mineral assemblage is predominantly composed of kaolinite with minor contributions from chlorite, smectite, chlorite/smectite, illite/smectite, quartz, K-feldspar, gibbsite, plagioclase, siderite, hematite and goethite. These sediments are clastic, except for Lake Fonjak core sediments which correspond to peat intercalated with carbonate clay and clastic deposits. Age-depth models suggest that the sedimentation rate was 0.2 mm yr-1 for lakes Dang and Massote before $$\sim $$ ∼ 690–560 cal yr BP and $$\sim $$ ∼ 660–470 cal yr BP, respectively. Thereafter, it increased to 0.8 mm yr-1 in Lake Dang and 0.7 mm yr-1 in Lake Massote. Finally, Late Holocene environment changes in Central Cameroon consisted of the shift of open water lakes to marshy fringes with abundant vegetation induced by human activities and facilitated by increasing seasonality.

Chondroblastoma of Bone in Children: A Study of 3 Cases

Chondroblastoma is a benign bone tumor arising most often in the epiphyses of long bones. Nearly 90% occurred in patients between the ages of 5 and 25 years, but tumors were found in later adulthood and even in old age. A few chondroblastomas were predominantly cystic, and some contained zones that were indistinguishable microscopically from aneurysmal bone cysts. Conservative surgical removal, nearly always effective, should be thorough so as to minimize the risk of the occasional troublesome recurrence. Late sarcomatous change has been reported in a few cases whether radiation therapy was employed or not. We report a series of 3 boys with chondroblastoma, with an average age of 12 years. All our patients underwent biopsy for confirmation and then surgical treatment consisting of curettage of the lesion followed by bone autograft filling. The aim is to discuss the anatomoclinical and evolutionary aspects of this rare tumour, to evaluate the results of surgical treatment and to identify the factors influencing the rate of recurrence after treatment.

Ultrasound Findings After Breast Cancer Radiation Therapy: Cutaneous, Pleural, Pulmonary, and Cardiac Changes.

External beam radiation therapy (RT) can induce toxicity in patients surgically treated for breast cancer. Modern irradiation techniques have lowered the incidence and severity of radiation-induced injuries; however, their side effects on normal tissues remain challenging. This review illustrates early and late changes observed using ultrasound (US) imaging, including echocardiography, at the skin, muscle, pleura, lungs, and heart levels. The US findings and the potential role of this technique in detecting and grading early and late complications of RT are highlighted in this article. US has proven useful in the differential diagnosis of post-RT complications, including but not limited to cancer recurrence and toxicity from other sources, such as anticancer drugs. Additionally, considering the progressive nature of RT-induced injury, early detection of toxicity may be helpful in the individual stratification of damage risk and serve as a tool for patient screening and management. In these cases, US can be used as a radiation-free biomarker of RT side effects at the subclinical stage.

Carbon Cycle and Circulation Change in the North Pacific Ocean at the Initiation of Northern Hemisphere Glaciation Constrained by Boron‐Based Proxies in Diatoms

AbstractThe intensification of Northern Hemisphere glaciation (iNHG) at 2.73 Ma is associated with a reorganization of the subarctic Pacific Ocean and abrupt drop in opal mass accumulation rates. Uncertainty, however, remains around the extent to which these changes altered carbon dynamics and contributed to a reduction in atmospheric pCO2 and global temperatures. These issues are addressed here using the boron isotope (δ11B) proxy in diatom frustules to reconstruct past changes in the pH and pCO2 of ambient seawater. Diatom δ11B and [B] indicate a subarctic Pacific surface water increase of 0.3–0.5 pH units over the iNHG. This confirms that delivery of carbon and nutrients into surface waters was reduced at this time, explaining the drop in opal productivity and limiting CO2 outgassing from the ocean interior. We consider two hypotheses to explain this based on potential changes in circulation from the late Pliocene to early Pleistocene: “ventilation to stratification” or “stratification to ventilation.” The ventilation to stratification hypothesis, which posits a switch from vigorous Pacific Meridional Overturning Circulation in the Pliocene to stratification over iNHG, has received more attention in the literature. The stratification to ventilation hypothesis, which posits a modest increase in ventilation, is more consistent with modern and late Pleistocene analogs, the majority of models and δ13C data. These late Pliocene changes in the subarctic Pacific, in conjunction with other external and internal processes including those in the Southern Ocean, would have contributed to a lowering of atmospheric pCO2 and the long‐term expansion of ice‐sheets across the Northern Hemisphere.

The persisting conundrum of mantle viscosity inferred from mantle convection and glacial isostatic adjustment processes

Mantle viscosity exerts important controls on the long-term (i.e., >106 years) dynamics of the mantle and lithosphere and the short-term (i.e., 10 to 104 years) crustal motion induced by loading forces including ice melting, sea-level changes, and earthquakes. However, mantle viscosity structures inferred from modeling observations associated with mantle dynamic and loading processes may differ significantly and remain a hotly debated topic over recent decades. In this study, we investigate the effects of mantle viscosity structures on observations of the geoid, mantle structures, and present-day crustal motions and time-varying gravity by considering five representative mantle viscosity structures in models of mantle convection and glacial isostatic adjustment (GIA). These five viscosity models fall into two categories: 1) two viscosity models derived from modeling the geoid in mantle convection models with ∼100 times more viscous lower mantle than the upper mantle, and 2) the other three with less viscosity increase from the upper to lower mantles that are derived from modeling the late Pleistocene and Holocene relative sea level changes and other observations in GIA models. Our convection models use the plate motion history for the last 130 Myrs as the surface boundary conditions and depth- and temperature-dependent viscosity to predict the present-day convective mantle structure of subducted slabs and the intermediate wavelength (degrees 4–12) geoid. Our GIA models using different ice history models (e.g., ICE-6 G and ANU) compute the GIA-induced present-day crustal motions and time-varying gravity. Our calculations demonstrate that while the viscosity models with a higher viscosity in the lower mantle (∼2 × 1022 Pa.s) reproduce the degrees 4–12 geoid and seismic slab structures, they significantly over-predict the geodetic (i.e., GPS and GRACE) observations of crustal motions and time varying gravity. Our calculations also show that while two viscosity models derived from fitting the RSL data with averaged mantle viscosity of ∼1021 Pa.s for the top 1200 km of the mantle reproduce well the geodetic observations independent of ice models, they fail to explain the geoid and seismic slab structures. Therefore, our study highlights the persisting conundrum of mantle viscosity structures derived from different observations. We also discuss a number of possible ways including transient, stress-dependent and 3-D viscosity to resolve this important issue in Geodynamics.

Colour-Coding Aegean Elites: Status and Cultural Identities in Linear B Dyed Textiles and Late Bronze Age Socio-Political Changes

Abstract This paper analyses the dyed textiles that are recorded in Linear B tablets and explores their role within the changes that the Late Bronze Age Aegean socio-cultural and economic scenario underwent. Additionally, it addresses how Aegean elites visually conveyed cultural messages on power and identities through colours and coloured textiles. As such, this paper (i) hypothesises new associations between red-dyed textiles, the chronology of Linear B tablets from Knossos, and the socio-political and cultural development of the Late Bronze Age; (ii) contributes new insights into the cultivation of plants producing red dyes throughout the period of the Knossos tablets use; (iii) challenges the interpretation of terms referring to the red natural colour of the wool; (iv) critically reviews the interpretation of terms referring to the grey natural colour of the wool; (v) hypothesises a new interpretation of how green-dyed textiles were obtained.

Historical and Current Perspectives on the Criminal Codes as Guarantees of Legal Security in Slovakia

The author describes two crucial periods in Slovak legal history from the perspective of the principle of legal security in criminal law. Firstly, the 19th-century Criminal Code, known as the Csemegi Code, is at the center of attention as it ended the centuries-long legal insecurity resulting from the lack of criminal law codification. The author analyses its leading principles as the safeguard of legal security. In contrast, the second part of the article focuses on the second codification of criminal law in Slovak legal history, the Criminal Code of 1950. The author demonstrates how the totalitarian regime destroyed the principle of legal security in criminal law in Slovakia, only slowly rebuilding it after the death of Joseph Stalin through amendments in 1956 and new legislation in 1961. The current Slovak Criminal Code and Criminal Procedure Code have been in effect since 2006. In conclusion, the author draws attention to how the latest changes in criminal law codes caused turbulences and worries over the principle of legal security in Slovakia.

Long COVID in Immunocompromised and Immunocompetent Patients: A Clinical, Morphologic, and Virologic Portrait.

Coronavirus disease 2019 (COVID) primarily affects the lung and can lead to chronic/post-COVID syndrome. Some insights about late pulmonary changes occurring in patients recovering from COVID have been published, but the evidence of detailed pathologic changes coming from follow-up care patients with long COVID is limited. To evaluate tissue morphologic and viral features in transbronchial biopsies of long COVID patients (immunocompetent and immunocompromised). This retrospective observational study included 18 patients (9 immunocompetent and 9 immunocompromised) who were consecutively referred to outpatient clinic for post-COVID pneumonia, undergoing transbronchial biopsy. Several histologic changes were analyzed by computer-assisted morphometric analysis. As organizing pneumonia (OP) was consistently detected, fibrosis and inflammation were also evaluated in transbronchial biopsies from 28 control patients with histologic confirmation of OP. Tissue SARS-CoV-2 and the subgenomic transcripts were investigated. Morphologic findings were correlated with clinical and radiologic data. Long COVID patients showed lower inflammation than controls (P < .001) despite a similar fibrotic extension. When considering separately the 2 long COVID groups, the same inflammatory infiltrate extension was found, whereas a higher fibrotic remodeling characterized the immunocompetent subgroup (P = .05). Molecular investigation showed that SARS-CoV-2 was present in tissue samples obtained from 3 long COVID patients. Long COVID patients showed a peculiar OP pattern, with more vascular and fibrotic changes. SARS-CoV-2 RNA, even in replicative status, can be detected in lung biopsies of both immunocompetent and immunocompromised patients. This pilot study is a forerunner of more in-depth lung tissue investigations to gain a better understanding of long COVID pathobiology.

Modulation of neural oscillations in escitalopram treatment: a Canadian biomarker integration network in depression study

Current pharmacological agents for depression have limited efficacy in achieving remission. Developing and validating new medications is challenging due to limited biological targets. This study aimed to link electrophysiological data and symptom improvement to better understand mechanisms underlying treatment response. Longitudinal changes in neural oscillations were assessed using resting-state electroencephalography (EEG) data from two Canadian Biomarker Integration Network in Depression studies, involving pharmacological and cognitive behavioral therapy (CBT) trials. Patients in the pharmacological trial received eight weeks of escitalopram, with treatment response defined as ≥ 50% decrease in Montgomery–Åsberg Depression Rating Scale (MADRS). Early (baseline to week 2) and late (baseline to week 8) changes in neural oscillation were investigated using relative power spectral measures. An association was found between an initial increase in theta and symptom improvement after 2 weeks. Additionally, late increases in delta and theta, along with a decrease in alpha, were linked to a reduction in MADRS after 8 weeks. These late changes were specifically observed in responders. To assess specificity, we extended our analysis to the independent CBT cohort. Responders exhibited an increase in delta and a decrease in alpha after 2 weeks. Furthermore, a late (baseline to week 16) decrease in alpha was associated with symptom improvement following CBT. Results suggest a common late decrease in alpha across both treatments, while modulatory effects in theta may be specific to escitalopram treatment. This study offers insights into electrophysiological markers indicating a favorable response to antidepressants, enhancing our comprehension of treatment response mechanisms in depression.

Incidental detection of aluminum phosphide in abdominal subcutaneous fat- a rare reporting of chemical analysis findings in poisoning cases.

Aluminum phosphide (AlP) poses a significant health challenge in developing countries, primarily because of its accessibility to the unregulated market and the absence of specific antidotes. Although chemical analysis of routine viscera can provide valuable information regarding the type of poison present in the body during poisoning incidents, numerous factors can alter the test results of chemical analysis, such as decomposition changes, postmortem redistribution, and the chemical nature of drugs. Analytical methods are frequently impeded by the interference caused by coextracted putrefactive compounds, which can mask or alter the detection of drugs. This series of three cases is particularly noteworthy because it involves the postmortem detection of AlP in the abdominal subcutaneous fat of the deceased, a previously unreported occurrence. In the first case, the body showed findings of late postmortem changes, with stomach mucosa being congested and hemorrhagic, along with routine viscera, and abdominal subcutaneous fat was sent for toxicological analysis. To confirm these findings, in two further cases of suspected AlP poisoning, subcutaneous fat was sent along with routine viscera. Stomach mucosa in the other two cases showed findings similar to those in the first. In the third case, black paste-like material was noted as stomach content. All the cases revealed the presence of AlP in routine viscera samples and abdominal subcutaneous fat on gas chromatography-mass spectrometry (GC‒MS) analysis. Therefore, abdominal fat can serve as a suitable sample for toxicological analysis to identify the presence of AlP, even in cases with advanced putrefactive changes.

Assessment of the regional development of the agricultural sector in the context of digital transformation

Abstract The current stage of agricultural development is characterized by its susceptibility to the latest changes caused by the introduction of digital technologies into the processes of organizing economic activity. This leads to the need for an economic assessment of the state of the industry to determine its readiness for transformation in the context of digitalization. This issue is particularly relevant for the regional economy, in which high-tech digital agriculture can become a source of growth in the ecosystem of innovative development of the agro-industrial complex of the country. Therefore, the purpose of the article is to study certain aspects of the functioning of agriculture in the Novgorod region, which act as determinants of the development of the industry in the context of digitalization. The paper identifies the factors influencing the digital transformation of agricultural organizations, as well as identifies the specifics of the functioning of the industry in the region during the transition to a digital business model.

Novelties in the regulatory practice of reporting on sustainable development in the Russian Federation

Subject. The article analyzes the latest changes and trends in the regulation of sustainable development reporting in the Russian Federation. Objectives. The study is aimed to review the Russian regulatory framework for organizing and reporting on sustainable development in the context of expanding the agenda of the Sustainable Development Goals, consider the key aspects of sustainable development reporting in the Russian jurisdiction, including new requirements, methods of measuring effectiveness reflected in guidance documents of Russian regulators. Methods. The study employs general scientific research methods, like detailing, generalization, analysis, synthesis, and description. Results. The regulation of the process of reports on sustainable development preparation is being transformed in response to the changing market conditions and emergence of global reporting standards. The current state of regulatory practice is characterized by the lack of legislative consolidation of the obligation to prepare reports, which complicates the process of data comparability of these organizations demonstrating a responsible approach to business. I analyzed the approaches of the Bank of Russia and the Ministry of Economic Development of the Russian Federation to take into account ESG factors in the formation of the reports. Conclusions. The fragmented regulation of the preparation process of reports on sustainable development is caused by the absence of a single legal instrument of mandatory application, the existence of internal initiatives of regulatory authorities aimed at improving the reporting practices of economic actors who chose a sustainable development vector.

High-resolution chemofacies and pore system characterization of the Pennsylvanian Cline Shale, Midland Basin, Texas

The connections between the depositional environment, sediment chemistry, and pore structure of deep-water mudstones are still not completely understood. This study: 1) investigates the sediment chemistry and the depositional conditions of the Pennsylvanian Cline Shale chemofacies in the center of the Midland Basin, 2) characterizes the conditions favorable to organic matter accumulation of each mudstone chemofacies, and 3) examines the connection between the pore structure and the mudstones’ paleo-environmental and paleo-geochemical context and processes. This study uses X-ray fluorescence (XRF) and statistical methods (Isolation Forest, Principal Component Analysis, and K-means) to identify four chemofacies of 127 m of Cline Shale core from the Matthew 'D' 0906 well located in the Midland Basin depocenter in Glasscock County, Texas. In addition, petrographic and scanning electron microscopy and measurements by dual-energy computed tomography, X-ray diffraction, Rock-Eval pyrolysis, N2 isothermal adsorption tests, and mudrock reservoir properties were conducted on thin-sections, core slabs, and samples to understand the bulk geochemistry and petrophysical properties of the mudstones. Four chemofacies are identified: (1) Siliceous Mudstone with high Zr and low Ca and P, (2) Calcareous-argillaceous Mudstone I with high Ca and Zr, and low P, (3) Argillaceous Mudstone with high P and low Ca and Zr, and (4) Calcareous-argillaceous Mudstone II with high Ca and P, and low Zr. Based on elemental distribution, the first two and last two chemofacies are interpreted as low sea-level deposits and high sea-level deposits, respectively. Water stratification and P regeneration accounted for the highest total organic carbon (TOC) content, which resulted in the high porosity and pore volume of the low sea-level Siliceous Mudstone chemofacies, especially visible in the 8 nm–186 nm organic matter pores. Carbonate input hinders the development of the inorganic pore system, especially for organic lean Calcareous-argillaceous Mudstones. Nine sea-level cycles were observed in the cores and correlated to nine US mid-continent cycles attributed to the 405-kyr Milankovitch parameter (long orbital eccentricity) during the late Pennsylvanian. We hypothesize that late Pennsylvanian climate change, paced by orbital cycles, controlled the distribution and stacking pattern of mudstone chemofacies, which also controlled source rock quality and consequent pore system development.

Advantages Of Organizing Outsourcing In Uzbekistan

In this article, based on the implementation of the latest changes and reforms program, the development of entrepreneurship in the service sector, in particular, outsourcing, a relatively new form of business is entering Uzbekistan. Outsourcing is a modern form of business and the economic and legal basis for its implementation in Uzbekistan is given, and the advantages and disadvantages of outsourcing to business entities are described in detail.

Oral donor site evaluation in the early and late postoperative periods for augmentation and replacement urethroplasty

Introduction. The use of oral mucosa in augmentation and replacement urethroplasty is the gold standard for several reasons. Most commonly, the mucous membrane of the cheek, the underside of the tongue or lip is employed. Assessing postoperative complications in the donor area is crucial as it impacts patients' quality of life.Objective. To evaluate early and late postoperative changes in the donor area after oral graft extraction for urethroplastyMaterials &amp; methods. A retrospective analysis of the results of surgical treatment using oral mucosa from 2017 to 2022 was carried out. The study included 65 patients. The intensity of pain syndrome in the graft sampling area was assessed by patients on a visual analog scale (VAS). The donor area was sutured only in the case of tongue and lip mucosa sampling.Results. The mucous membrane of the oral cavity was harvested from different sites in 65 patients. Specifically, it was taken from the inside of the cheek in 49 patients (75.38%), from both inner sides of the cheeks in 13 (20.0%), the lower lip in two (3.07%) and the lower surface of the tongue in one (1.54%) patient, respectively. On the first day after surgery, the median pain level according to VAS was 4 points (range: 2 – 7), at the time of discharge — 3 points (1 – 6). After 120 days, a follow-up examination showed a regression of pain symptoms: the median was 0 points (0–1). In the late postoperative period, incomplete opening of the mouth was recorded in two patients (3.07%), cosmetic defect in the donor area in two (3.07%), discomfort during meals in six (9.23%), impaired sensitivity in the donor area in two (3.07%), exacerbation of chronic stomatitis and hypersalivation in two (3.07%) patients, respectively.Conclusion. The incidence of complications in the donor area is low, but for some patients this can result in a reduced quality of life. Using proper technique when extracting oral mucosa grafts reduces pain and the likelihood of early- and late-stage postoperative complications in this area.

Diagnosing the truck engine operation by evaluating engine oil wear and issuing maintenance recommendations

Abstract The lubricating oil of an internal combustion engine (i.c.e.) performs several functions having a major contribution to the reliability of the system, implying proper operation during the period of exploitation. Replacing the engine oil ahead reaching the turnover / time corresponding to preventive maintenance it turns out to be sometime an imperative action, with negative implications on operating costs. Any user of today vehicles desire to use the engine performances at full percentage, and for that an important condition becomes the changing of the oil at defined intervals of time/rollover intervals. Thus, it is very important to be aware when to replace because a late change of oil can affect the engine operation and, surely, the performance of the vehicle. Premature oil change influences costs, the environment and is considered a harmful action in terms of the process of depletion of resources. As regards the operating conditions, it is intended that they are similar for all vehicles taken into consideration. It is imperative that the study be carried out by investigating the operation of a single type of engine, with a single type of engine oil, for several vehicles with the same technical characteristics. It is considered that the transport fleets are the concrete source that falls under the already mentioned conditions and a methodology based on the analysis of the 10W30 oil samples used in the MX - 11 330 H2, EURO 6 engines of the DAF vehicles within the fleet of one transport company from Argeş county will be used. The authors of this paper will analyze the following properties of the oil: viscosity, density, flash point, contamination with fuel and water content, these being the most important in illustrating the degree of wear and tear of it. The information about the evolution during the exploitation period of these characteristics is the basis for the elaboration of maintenance strategies considering the three desiderata: the environmental issues, the vehicle’s reliability, and the operating costs of the vehicle.

명품 화장품에 대한 관계혜택이 전환장벽과 브랜드 충성도에 미치는 영향 - 온라인 및 오프라인 소매업태의 조절효과를 중심으로

This research explores the impact of relational benefits, which are the advantages gained from a sustained relationship with a specific brand, on switching barriers and brand loyalty among female consumers aged 20 to 50 residing in China when purchasing luxury cosmetics. The research analyzes the influence difference between different retail formats online and offline, aiming to reveal the shifting psychological dynamics of consumers amid the latest changes in China's consumer market. Using SPSS and AMOS programs, data from 500 participants were analyzed, with a focus on seven types of relational benefits: experiential benefits, confidence benefits, special treatment benefits, convenience benefits, economic benefits, information benefits and risk reduction benefits. The results indicate that relational benefits significantly enhance switching barriers and brand loyalty, and these effects vary distinctly between online and offline retail channels. The findings offer valuable insights for luxury cosmetic brands to formulate effective strategies in the Chinese market.

PRIVATE SECTOR INVOLVEMENT IN TUBERCULOSIS CONTROL IN A TRIBAL DISTRICT OF MAHARASHTRA, INDIA

Introduction: In India, the private sector caters about seventy percent of TB patients. The majority of private practitioners (PPs) are not updated with current National Tuberculosis Elimination Program (NTEP) guidelines resulting in wrong diagnosis and treatment leading to irrational use of the anti-tuberculosis drugs favoring the emergence and spread of drug resistance. Objectives: 1)To assess the knowledge of PPs about diagnosis and management of tuberculosis as per NTEP guidelines 2)To know the difficulties faced by PPs during the treatment of TB patients and measures to address them as per their perspective. Methodology: Study design &amp; study setting:- a cross-sectional study was undertaken in a tribal district of Maharashtra. 86 PPs interviewed with the help of a structured questionnaire and later conducted focused group discussion (FGD). The data was analyzed with percentages and proportions. Results: The majority 65(75%) of PPs had knowledge about NTEP guidelines but only 21(25%) PPs were updated with the latest changes in the program. PPs expressed concern over the non-availability of diagnostics for extra-pulmonary TB, occasional shortage of drugs, unawareness of patients about the gravity of the disease, and treatment compliance. To address it, they felt the need for awareness activities on social media continuously, round-the-clock services for investigations, incentive for successfully completing treatment to patients along with timely updating PPs about recent updates on NTEP. Conclusion: Continuous quality training regarding basic knowledge and recent updates in NTEP for PPs should be imparted NTEP implementation at the district needs to be strengthened to overcome the difficulties mentioned by PPs.