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Background: Few validated instruments exist for use in hidradenitis suppurativa (HS) trials. Objectives: To develop a novel HS Investigator Global Assessment (HS‐IGA) and to validate its psychometric properties. Methods: Development of HS‐IGA involved discussion among stakeholders, including patients, within HISTORIC. Data from replicate phase III randomized controlled trials evaluating HS treatment were utilized. Multivariate models identified lesion type and body region as variables of importance. Classification and regression trees for ordinal responses were built. Validation included assessment of test–retest reliability, predictive validity, responsiveness and clinical meaningfulness. Results: There were 3024 unique measurements available in PIONEER I. Mean and median lesion counts by region were largely <10 and were highest in axillary and inguinal regions. The mean and median number of regions involved were ≤ 3 for individual lesions and combinations. Regardless of lesion type, axillary and inguinal regions most influenced the HS‐IGA score. Accordingly, regions were combined into a six‐point IGA based on the maximum lesion number in either upper or lower body regions with a score of 0 (0–1 lesions), 1 (2–5), 2 (6–10), 3 (11–15), 4 (16–20) and 5 (≥ 20 lesions). The intraclass correlation coefficient for test–retest reliability was 0·91 (95% confidence interval 0·87–0·94). Spearman's rank order correlations (SROCs) with HS‐PGA and Hidradenitis Suppurativa Clinical Response (HiSCR) were 0·73 and 0·51, respectively (P < 0·001 for both comparisons). SROCs with Dermatology Life Quality Index (DLQI), pain numerical rating scale and HS‐QoL were 0·42, 0·34 and –0·25, respectively (P < 0·001 for all comparisons). HS‐IGA was responsive at weeks 12 and 36. Predictive convergent validity was very good with HS‐PGA (area under the curve = 0·89) and with HiSCR (area under the curve = 0·82). Predictive divergent validity was low with DLQI and HS‐QoL. Conclusions: HS‐IGA has moderate‐to‐strong psychometric properties and is simple to calculate. [ABSTRACT FROM AUTHOR]

To support high bandwidth demands, optical networks are widely used for the past few decades. In this manuscript, the author proposes the pure fiber Bragg Grating (FBG) based remote node architecture that is responsible for realizing the flexible, energy-efficient, and reliable optical access network. The architecture can transmit the data to the user end with better reliability and improved bit error rate (BER) performance. The proposed architecture can support point-to-point (P2P) dedicated, point to multipoint broadcasted data transmission. The architecture can broadcast the downstream data to all the available users in the network or within a group of specific users associated with a particular optical distribution network (ODN). The architecture also provides an excellent feature of scaling and/or extending the legacy network as it grows shortly. The proposed architecture can transmit data at a very high speed (up to 40 Gbps) for transmission distances up to 20 km without the use of any amplifier for handling various internet applications in a smart city with higher reliability, least complexity, lower power, and cost consumption. The architecture can reduce the energy consumption of upto ~ 30% of the total energy consumption. For the considered conditions, it can save average energy of up to 42 Wh per day, accumulating to upto 15.33 KWh for the entire year. The proposed architecture may be useful for the realization of the concept of smart cities and for supporting the next generation of access networks. [ABSTRACT FROM AUTHOR]

Background: The shortage of available organs for life-saving transplants persists worldwide. While a majority support donating their organs or tissue when they die, many have not registered their wish to do so. When registered, next of kin are much more likely to follow-through with the decision to donate. In many countries, most people visit their family physician office each year and this setting is a promising, yet underused, site where more people could register for deceased organ donation. Our primary aim was to evaluate the effectiveness of an intervention to promote organ donation registration in family physician's offices.Methods: We developed an intervention to address barriers and enablers to organ donation registration that involved physician office reception staff inviting patients to register on a tablet in the waiting room while they waited for their appointment. We conducted a cross-sectional stepped-wedge cluster randomized controlled registry trial to evaluate the intervention. We recruited six family physician offices in Canada. All offices began with usual care and then every two weeks, one office (randomly assigned) started the intervention until all offices delivered the intervention. The primary outcome was registration for deceased organ donation in the provincial organ registration registry, assessed within the 7 days of the physician visit. At the end of the trial, we also conducted interviews with clinic staff to assess any barriers and enablers to delivering the intervention.Results: The trial involved 24,616 patient visits by 13,562 unique patients: 12,484 visits in the intervention period and 12,132 in the control period. There was no statistically significant difference in the percentage of patients registered for deceased organ donation in the intervention versus control period (48.0% vs 46.2%; absolute difference after accounting for the secular trend: 0.12%; 95% CI: - 2.30, 2.54; p=0.92). Interviews with clinic staff indicated location of the tablet within a waiting room, patient rapport, existing registration, confidence and motivation to deliver the intervention and competing priorities as barriers and enablers to delivery.Conclusions: Our intervention did not increase donor registration. Nonetheless, family physician offices may still remain a promising setting to develop and evaluate better interventions to increase organ donation registration.Trial Registration: NCT03213171. [ABSTRACT FROM AUTHOR]

To handle the massive high-speed internet traffic, free space optics (FSO) or single-mode fiber (SMF) based fiber optic communication is being used everywhere across the world. These technologies are capable of providing huge bandwidth and transmitting the data at very high speed with low energy consumption. FSO is a very convenient technology to quickly expand the legacy network in the adverse geographical areas. However, its link performance is highly dependent of inconsistent weather conditions. SMF based fiber optic link has a very low loss and its performance is almost independent on the weather conditions. Though, the installation and maintenance of fibers are quite complex and costly. Individually, FSO or SMF links have their limitations and have to be integrated to leverage their benefits. In this paper, we integrated FSO/SMF links and compared the performance of the proposed architecture which is capable of providing high-speed dual-rate data transmission. The proposed architecture transmits data over either FSO or SMF or both links simultaneously and has 100% more reliability against any one of the link failures. In case of operational link failure (FSO/SMF), data may be switched to the alternative working link (SMF/FSO), simply by tuning the transmitted signal by 50 GHz. The proposed architecture is also reliable against the optical line terminal transceiver (TRx) failure as each user located in the network can be served by two transceivers (1 Gbps and 10 Gbps). The proposed architecture also supports the wavelength division multiplexing overlay transmission for broadcasting the common signal to all the available users in the networks. The architecture reduces ~ 27% of the energy consumption by utilizing the appropriate link of hybrid architecture and TRx according to weather conditions and traffic load. The integrated architecture looks attractive for providing energy-efficient, high speed, and reliable internet coverage to the areas where there is a difficulty of laying fibers and has frequent fiber faults. The architecture is useful for strengthening and boosting rural and urban development. [ABSTRACT FROM AUTHOR]

This paper aims to improve the traffic system through an imaging receiver. Different modulation schemes for visible light communication (VLC) are investigated, including On–Off Keying (OOK), L-Pulse Position Modulation (L-PPM), and Inverse L-Pulse Position Modulation (I-L-PPM) schemes. Considering a road with three lanes, the received information changes according to many factors such as the communication distance and the number of pixels for the imaging receiver. A simple traffic model has been proposed and analyzed for optimizing several remarkable characteristics, including signal to noise ratio (SNR), required average power, bit error rate (BER), and modulation scheme. The simulation results show that, an imaging receiver with 64 × 64 pixels is a good choice for a communication distance in the range 10–50 m between vehicle and traffic light. Also, in the three lanes, the received information increases with the number of pixels. The replacement of a photodiode with an imaging receiver enhances the SNR and reduces both required transmitter power and BER. It is found that 10 dB less power is required in 16-PPM scheme requires than that required by the 16-I-PPM, but in the expense of bandwidth used. [ABSTRACT FROM AUTHOR]

Residential sector accounted for 24% of the total electricity consumption in India during 2009–10 and has almost remained around one-quarter over the last decade. A total of 163 same urban households were surveyed in 2018 to ascertain the change in penetration and use of energy-efficient (EE) appliances therein over 2010–18. There was a significant increase in their penetration across each enduse category with main changes being in air conditioners (ACs) (47%) and LED lights (over 38 times) over 2010–18. The weighted average relative electricity consumption decreased from 0.89 to 0.44 for ACs (1.5TR), 0.42 to 0.23 for lighting lamps, 0.95 to 0.54 for tubelights, 0.98 to 0.68 for refrigerators, and 0.94 to 0.69 for TVs, indicating the lowering of average energy consumption due to EE appliances. The annual electricity savings at household level were found statistically significant for transitions to EE ACs and ceiling fans. [ABSTRACT FROM AUTHOR]

The world is moving toward digitization due to the Internet. One of the most cutting-edge online services is e-filing. E-administration has made ready for the advancement of E-Filing of personal expense forms on the Web. Citizens can now effectively record their profits even from home with this framework. E-filing is a revolution in data innovation that offers personal government forms a great deal of flexibility. The Income Tax Department communicates with taxpayers more frequently. This paper discusses the impression of citizens on E-Filing of profits. The primary data collected in this paper was collected using a static questionnaire that was analyzed with SPSS. "The survey is endeavoring to know the level of care and level of purpose among 95 respondents which integrate individuals and shippers". A well-organized survey is used to complete the review, and a meeting is led by them. This paper plainly endeavors to learn about the idea, mindfulness level and degree of utilization of E-Filing among individual citizens in Indore city. [ABSTRACT FROM AUTHOR]

CO 2 capture and storage (CCS) is increasingly being viewed as an important part of India's energy transitions by several practitioners. Ensemble modeling scenarios consistent with the Paris Agreement indicate that investments by the end of this decade towards CO 2 transport and geologic storage would need to be $1–8 billion/year in India. These large-scale investments are accompanied by multiple technical, environmental, financial and societal interlinkages that interface with sustainable development. This review begins by summarizing some of these considerations in context of geologic CO 2 storage. It then devotes individual sections to discussing how sustainable development goals (SDGs) could align with these projects and play a synergistic role for decarbonization. Four SDGs are particularly of interest. SDG-17 on global partnerships would be instrumental in facilitating low-cost financing for CCS investments. At the same time, other SDGs could be strategically used as co-benefits to CCS projects. These include SDG-8 on decent work, SDG-6 on clean water and SDG-9 on industry. We posit that it is not possible to study these SDG interlinkages in the global hypothetical. As such, this review takes a view of Indian geologic formations for CCS but also offers generalizable insights across other developing economies. • Contextually-explicit linkages between SDGs and CCS are discussed. • SDG-17 is critical for financing CCS in developing countries such as India. • SDGs 6, 8 and 9 are particularly relevant for understanding holistic benefits of CCS. • Illustration of CCS in aiding just transition and industry decarbonization is provided. [ABSTRACT FROM AUTHOR]

Speckle noise is an undesirable phenomenon that exhibits granular pattern which reduces the diagnostic capability of clinical ultrasound (US) images. In this study, a new speckle denoising method based on modelling of detail band shearlet coefficients of log‐transformed US images is presented. In each detail shearlet subband, coefficients corresponding to signal and speckle noise are modelled as normal inverse Gaussian and Gaussian priors, respectively. These coefficients, based on image local statistics are segmented into different regions of heterogeneity viz. homogeneous, heterogeneous and strongly heterogeneous regions, respectively, so as to control over smoothing of denoised images. Then, using the prior distributions maximum a posteriori (MAP) estimation is performed over all regions of detail bands except those regions that represent strongly heterogeneous coefficients. For better performance, an adaptive weight function is also used in the MAP expression which reduces the loss of feature information. Experimentation is done on noise‐free synthetic kidney and foetus US images and a set of 60 real US images. The results are presented for objective and subjective quality assessment of the proposed method and five other methods for speckle denoising. The potential of the proposed method in comparison to other methods can easily be ascertained from the obtained denoising results. [ABSTRACT FROM AUTHOR]

Purpose: To study the various pain assessment tools based on their psychometric properties and ease of use.Methods: Published articles on psychometric properties of pain tools were accessed and data collected for low back pain (LBP)-specific tools, generic tools, neuropathic LBP tools, tools for cognitively impaired patients, and tools for acute LBP.Results: Among the LBP-specific tools, Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) have good construct validity and reliability, and responsiveness over short intervals. Quebec Back Pain Disability Scale (QBPDS) gauges only disability and sleep. Among the generic tools, McGill Pain Questionnaire (MPQ), West Haven-Yale Multidimensional Pain Inventory (MPI), and Brief Pain Inventory (BPI) show good responsiveness, but BPI is the only tool validated for LBP. Neuropathic Pain Scale (NPS) and Short Form-MPQ-2 (SF-MPQ-2) are both reliable tools for neuropathic LBP. For cognitively impaired patients, Pain Assessment in Advanced Dementia (PAINAD), Abbey Pain Scale (APS), and Doloplus-2 are all reliable tools, but PAINAD has good construct validity. For acute pain, Clinically Aligned Pain Assessment (CAPA) is reliable and responsive, but presently, unidimensional tools and SF-MPQ-2 are the tools most preferred.Conclusion: Based on psychometric properties and ease of use, the best tools for LBP seem to be RMDQ/ODI (among LBP-specific tools), BPI (among generic tools), SF-MPQ-2/NPS (for neuropathic LBP), PAINAD (for cognitively impaired patients), and unidimensional tools and SF-MPQ-2 (for acute pain). Overall, BPI seems to be a tool that can be relied upon the most. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

This research aims to analyze the significance and function of MUDRA bank as a means of providing financial support to the micro, small, and medium-sized enterprise (MSME) sector. The study relies on secondary data sources, including the official website of MUDRA.org, the PMMY report, newspapers, periodicals, and other public materials. The micro, small, and medium-sized enterprise (MSME) sector significantly contributes to the growth and advancement of the Indian economy. The advancement of this sector is of utmost importance in order to fulfill the national objectives of promoting participation in the financial system and the creation of substantial numbers of jobs in both urban and rural areas. The actualization of the Pradhan Mantri MUDRA Yojana (PMMY) Scheme and the establishment of a specialized bank for the micro, small, and medium-sized enterprise (MSME)sector, known as MUDRA Bank, have provided a substantial impetus to the expansion of the Indian MSME sector. These initiatives aim to enhance the economic impact of the industry on India's Gross Domestic Product (GDP). Which now stands at 38%. This financial institution significantly enhances the self-assurance of young, educated, and talented individuals, enabling them to strive to become entrepreneurs as first-generation participants. Additionally, it facilitates the expansion of existing small firms by providing them with opportunities to broaden their operations. The primary goals of MUDRA Bank encompass the promotion of entrepreneurial endeavors and the expansion of capacities and operations for small business units. Additionally, it aims to mitigate the issue of excessive indebtedness while establishing a structured credit system. [ABSTRACT FROM AUTHOR]

Perceptions in physicians and pharmacists are a common impediment to the utilization of generic medicines in clinical practice. As a multinational initiative to accelerate access to high-quality generic medicines, Dr Reddy's Laboratories Ltd has developed the Generic dRug Adoption Framework. Currently available in four languages (English, Portuguese, Spanish, and Russian) and four (Malaysia, Brazil, Colombia, and Ukraine) countries, the framework will enable physicians and pharmacists to identify high-quality generics and help towards switching from originator to generic medicines. This can help to increase the adoption and access for generic medicines. The platform is not intended to guide treatment decisions but can help healthcare providers to differentiate a high-quality generic medicine based on parameters of effectiveness, safety, quality, and costs. [ABSTRACT FROM AUTHOR]

Background: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery.Methods: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater (≥ 26.5 μmol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery.Results: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease.Interpretation: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388. [ABSTRACT FROM AUTHOR]

Background: Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans.Methods: We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 bio markers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma N-terminal pro-B-type natriuretic peptide and plasma high-sensitivity C-reactive protein).Results: Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9).Interpretation: Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media.Trial Registration: ClinicalTrials.gov, no. NCT01225094. [ABSTRACT FROM AUTHOR]

India's contributions to meeting global mean temperature increases of 2 °C or well below 2 °C would require transformational changes in its energy systems. A bottom-up model analyzes alternate futures (reference, intended nationally determined contributions and low-carbon scenarios) assuming equal per-capita cumulative emissions rights from 2011 through 2050. The cumulative CO2 budget for India for low-carbon scenarios during this period is estimated to be around 115 Bt-CO2, as against 165 Bt-CO2 for the reference scenario. To achieve such emission reductions, while maintaining high economic growth and meeting sustainable development goals, the paper projects that a range of endemic transformations are required such as shifting toward cleaner fuels, resource efficient technologies, widespread use of Information and communication technology (ICTs) to balance demand and supply (e.g. smart grids), substituting demand in transport (e.g. work from home), aggressive promotion of renewables, lifestyle changes, and CO2 capture, storage and use. Modeling decarbonization to meet the needs of the increasing population and urbanization faces myriad challenges due to the distributed nature of technologies used to provide various services, involving risks and uncertainties. The paper finally outlines specific opportunities and challenges faced to meet the increased mitigation ambition to limit the warming to 2 °C and below. [ABSTRACT FROM AUTHOR]

Background: There is a worldwide shortage of organs available for transplant, leading to preventable mortality associated with end-stage organ disease. While most citizens in many countries with an intent-to-donate "opt-in" system support organ donation, registration rates remain low. In Canada, most Canadians support organ donation but less than 25% in most provinces have registered their desire to donate their organs when they die. The family physician office is a promising yet underused setting in which to promote organ donor registration and address known barriers and enablers to registering for deceased organ and tissue donation. We developed a protocol to evaluate an intervention to promote registration for organ and tissue donation in family physician waiting rooms.Methods/design: This protocol describes a planned, stepped-wedge, cluster randomized registry trial in six family physician offices in Ontario, Canada to evaluate the effectiveness of reception staff providing patients with a pamphlet that addresses barriers and enablers to registration including a description of how to register for organ donation. An Internet-enabled tablet will also be provided in waiting rooms so that interested patients can register while waiting for their appointments. Family physicians and reception staff will be provided with training and/or materials to support any conversations about organ donation with their patients. Following a 2-week control period, the six offices will cross sequentially into the intervention arm in randomized sequence at 2-week intervals until all offices deliver the intervention. The primary outcome will be the proportion of patients visiting the office who are registered organ donors 7 days following their office visit. We will evaluate this outcome using routinely collected registry data from provincial administrative databases. A post-trial qualitative evaluation process will assess the experiences of reception staff and family physicians with the intervention and the stepped-wedge trial design.Discussion: Promoting registration for organ donation in family physician offices is a potentially useful strategy for increasing registration for organ donation. Increased registration may ultimately help to increase the number of organs available for transplant. The results of this trial will provide important preliminary data on the effectiveness of using family physician offices to promote registration for organ donation.Trial Registration: ClinicalTrials.gov, ID: NCT03213171 . Registered on 11 July 2017. [ABSTRACT FROM AUTHOR]

The total electricity consumption from commercial sector was about 9% during 2013–14 in India. Load research survey was carried out to study the usage patterns for all types of electric appliances used in commercial establishments at income, appliance and end-use levels in Gujarat state of India – one of the most progressive states. Penetration level of efficient appliances, electricity load curves and Energy Performance Index (EPI) were estimated. The mean EPI was 98 kWh/m 2 /year (SD = 105.5) for surveyed small commercial establishments (low income) while mean EPI was 181 kWh/m 2 /year (SD = 68) for surveyed large commercial establishments (Malls). Electricity saving potentials was estimated if electric appliances at these commercial establishments were replaced with efficient appliances. Four alternate scenarios were analyzed using cost of conserved energy (CCE) curves with various efficiency enhancement options – following at least commercial sub-category level median EPIs, following average EU equivalent EPI levels, following average EPI levels of equivalent US commercial establishments, and following the best available technologies (BAT). The average energy savings ranged between 14% and 25% across buildings and scenarios. Energy efficient air-conditioner and LED lights offer the highest energy savings potential among appliances. [ABSTRACT FROM AUTHOR]

Urban commons are currently not studied holistically under the rationale used by the ecosystem cascade framework. In this paper, we build on the ecosystem cascade framework to present a conceptual model that provides a comprehensive view of urban common resources and allows decision-makers to develop suitable interventions to meet objectives of sustainability and equity. The model looks at the role of and explains the linkages between urban commons' biophysical structures, user population characteristics, power dynamics, use behavior, benefits generated, and management strategies. The model adds to existing literature by focusing on direct benefits and equity and by elaborating on the role of transaction costs and management strategies in governing urban commons. Considering direct benefits allows for a complete picture of overall benefits while making governance decisions, as opposed to considering benefits received only through human effort. Focusing on power asymmetries between stakeholders highlights the inequities created in accessing benefits from urban commons. Elaborating on management strategies provides greater insight into the complexities of managing urban commons and the impacts that governance decisions can have. Finally, including transaction costs highlights the factors that influence costs of managing resources. We illustrate the use of the model with literature from urban India. [ABSTRACT FROM AUTHOR]

The paper estimates the Indian carbon dioxide (CO2) emissions over the last two decades at sectoral and sub-regional levels to identify hotspots of CO2emissions, providing possible insights for focused carbon mitigation efforts pan-India. The CO2emissions are also estimated at the level of 1151 large point sources to identify hotspots for mitigation and also to demonstrate future possibilities for CO2storage in nearby geological sinks. India's CO2emission grew at around 5% compound annual growth rate (CAGR) between the years 1990 and 2013. From the 1897 Mt of CO2emission electricity generation, transport and iron & steel industry contributed 48%, 11.6% and 7.9% respectively. Districts of Kachchh, Sonbhadra and Korba were the largest CO2emitters, mainly due to the location of coal-based mega power projects. The district-level emissions estimates show a flattening of the distribution curve of CO2emissions over the years, indicating that more districts are now crowding up the higher emission space, partly driven by income effects. Our estimate of CO2emission intensity of the Indian economy shows 11% decoupling of growth of emissions and gross domestic product during 2005–2013, 2005 being the base year for India under the Paris climate change agreement. [ABSTRACT FROM PUBLISHER]

A flexible hybrid wavelength division multiplexing-time division multiplexing passive optical network architecture that allows dual rate signals to be sent at 1 and 10 Gbps to each optical networking unit depending upon the traffic load is proposed. The proposed design allows dynamic wavelength allocation with pay-as-yougrow deployment capability. This architecture is capable of providing up to 40 Gbps of equal data rates to all optical distribution networks (ODNs) and up to 70 Gbps of a asymmetrical data rate to the specific ODN. The proposed design handles broadcasting capability with simultaneous point-to-point transmission, which further reduces energy consumption. In this architecture, each module sends a wavelength to each ODN, thus making the architecture fully flexible; this flexibility allows network providers to use only required OLT components and switch off others. The design is also reliable to any module or TRx failure and provides services without any service disruption. Dynamic wavelength allocation and pay-as-you-grow deployment support network extensibility and bandwidth scalability to handle future generation access networks. [ABSTRACT FROM AUTHOR]

• Ring based Hybrid FSO- Fiber Optic Architecture. • Same wavelength transmission for downstream and upstream Transmission. • A reliable hybrid 4 × 10 Gbps fiber optic-FSO based ring architecture. • Backup protection at CO side as well as at user side. This paper proposes a reliable hybrid 4 × 10 Gbps fiber optic-FSO based ring architecture. The proposed architecture aims to provide reliable and bandwidth-efficient transmission. The proposed architecture has a fault protection capability in presence of the link failure occurring at the feeder network (FN) and distribution network (DN) towards the central office (CO) and optical networking unit (ONU) respectively. To avail the benefits of free space optics (FSO), it is integrated with the optical fiber at the user end. The architecture transmits the data on the ring in only a clockwise direction for both downstream and upstream transmission and therefore enables the utilization of the same wavelengths without any interference. i.e. the proposed architecture improves the bandwidth utilization and needs only half of the spectrum. In the proposed architecture, four 10 Gbps signals are propagated through a 20 km single-mode fiber (SMF) and a 200 m length of free-space/optical fiber link for the downstream and upstream transmissions. We also compared the signal transmission performance of architecture in terms of bit error rate (BER) for different weather conditions of the FSO link at the user side. The architecture works well for the different weather conditions and can transmit data through the FSO link for upto 700 m and 200 m for clear and heavy rain weather conditions respectively. Protection against faults in the fiber links; improves the survivability and reliability of the network. The proposed architecture is useful in rural and urban hilly areas where signal transmission interrupts frequently due to various geographical challenges. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to assess the risk of hospitalization with acute kidney injury in a population of older adults and compare patients prescribed sodium picosulfate to a similar group of patients prescribed with polyethlyene glycol (PEG). While no difference in risk of acute kidney injury comparing sodium picosulfate to PEG was observed, a higher risk of hypotension and acute dialysis among patients prescribed PEG was found.

Aim. To assess the gastrosparing effect of amtolmetin guacyl (AMG) against other nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with osteo-/rheumatoid arthritis. Methods. A literature search was done in the electronic databases (PubMed, Google Scholar, Embase, and Scopus) with key words “amtolmetin guacyl”, “amtolmetin”, and “arthritis”; filters were applied to obtain publications between 01-Jan-1985 and 01-Oct-2015, which were “clinical trials” in osteo-/rheumatoid arthritis patients and in “English language.” Studies were assessed using the Jadad criteria and trials with score ≥ 3 were included in the analysis to compare the safety and efficacy of AMG against other NSAIDs. Results. Search yielded 19 publications of which 3 were included for analysis. Baseline characteristics of patients were comparable between the AMG group and other NSAIDs (diclofenac, celecoxib, and piroxicam) groups in all trials. Efficacy of AMG was similar to the other NSAIDs compared in the trials. The number of adverse events (AEs) reported was similar between both the groups; however, severe AEs reported were significantly lower in the AMG group. Of note was the significant lower number of duodenal ulcers after treatment in the AMG group. Conclusions. AMG has efficacy similar to other NSAIDs and a safer gastrointestinal AE profile when compared to the other NSAIDs. [ABSTRACT FROM AUTHOR]

This translates to an unadjusted risk difference of 23.2 (95% CI 14.4, 32.0) per 10,000 patients and a propensity score-weighted risk difference of 5.9 (95% CI -3.7, 15.5) per 10,000 patients. Biologic therapy is not associated with increased COVID-19 severity in patients with hidradenitis suppurativa: initial findings from the global hidradenitis suppurativa COVID-19 registry. Crude risk of COVID-19-related hospitalization, representing the real-world risk for patients with comorbidities, was higher in HS patients than controls. [Extracted from the article]

Neurocysticercosis is an infection of the central nervous system caused by larvae of the pork tapeworm Taenia solium. We report a case of large cyst in the cerebellopontine angle that increased in size under observation and surgery revealed it to be cysticercus. It was removed in toto and patient improved on follow-up. [ABSTRACT FROM AUTHOR]

Bringing down energy system emissions to zero is a key step to restrict the global temperature rise to "well below 2 °C". Recent studies have extensively discussed the integration of bioenergy with carbon capture and storage (BECCS) in existing energy systems to achieve net-zero emissions. India recently initiated a carbon dioxide-based enhanced oil recovery (CO 2 -EOR) project in the matured oil wells of western India. Using this project, we propose a bioenergy-CO 2 -EOR system to study the techno-economic feasibility and potential of BECCS towards net-zero emissions from energy systems. We use mixed integer linear programming for bioenergy and CO 2 source-sink matching. The proposed system breaks even, without any carbon price, at an oil price of around 56 USD per barrel (USD/bbl) if using CO 2 from bioethanol fermentation and at around 90 USD/bbl for bioelectricity plants. A carbon price between USD 20 to 40 per tonne of CO 2 makes the system feasible even below the oil price of 45 USD/bbl for the ethanol route. The system has net negative CO 2 emissions after accounting for the lifecycle emissions of produced oil, assuming a sequestration rate of 0.5 tonne of CO 2 per barrel of recovered oil. Further, the bioenergy-CO 2 -EOR system reduces crude oil imports, supports ethanol blending, provides additional income opportunities at local level, and reduces air pollution from crop residue burning in the fields. • We study bioenergy with carbon capture and storage-based enhanced oil recovery. • We use mixed integer linear programming for bioenergy and CO 2 source-sink matching. • The proposed system breaks even at oil price of around USD 56 per barrel. • A carbon price of USD 20–40 could make the system profitable for lower oil prices. • An integrated approach to BECCS is required to sustainably achieve net-zero emissions. [ABSTRACT FROM AUTHOR]

• Flexible and energy efficient TWDM PON architecture. • Capable of direct inter and intra Optical distribution network (ODN) communication. • Capable of direct inter-optical networking unit (ONU) communication. • Latency-aware and reliable optical network architecture for smart rural and urban communities. Nowadays, service reliability, operation cost, transmission latency of optical access networks are the major challenging issues that need to be addressed while planning and developing the next-generation passive optical networks (NG-PONs). This paper proposes a flexible, energy-efficient, time and wavelength division multiplexed (TWDM) PON architecture that has the capability of centralized optical line terminal (OLT) resource sharing with multiple optical networks. The architecture has the point-to-point direct inter-optical networking unit (dedicated inter-ONU) transmission capability among the various ONUs located within the same optical distribution network (ODN). Such transmission may also be referred to as direct intra-ODN communication. The architecture also has the potential of transmitting an inter-ONU signal to the ONUs residing in the different ODNs (inter-ODN) belonging to the same optical network (OPN). Such transmission may be referred as the direct inter-ODN or intra-OPN transmission. The architecture reduces the normalized energy consumption of approximately 2.21875 Wh per hour, normalized transmission latency of approximately 148 µs for the direct inter-ONU transmission. This is achieved by diverting the inter-ONU signal from the remote nodes (RNs) itself towards the intended ONUs. The percentage energy saving of the proposed architecture is approximately 74 % as compared to the conventional architecture. The proposed architecture is suitable for strengthening the existing information and communication technology (ICT) infrastructures and can be implemented in next-generation flexible, energy-efficient, latency-aware, and reliable optical networks for developing smart rural and urban communities. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Since heart fatty acid binding protein (H-FABP) is a myocardial protein that detects cardiac injury, we sought to determine whether plasma H-FABP was associated with AKI in the TRIBE-AKI cohort; a multi-center cohort of 1219 patients at high risk for AKI who underwent cardiac surgery. The primary outcomes of interest were any AKI (Acute Kidney Injury Network (AKIN) stage 1 or higher) and severe AKI (AKIN stage 2 or higher). The secondary outcome was long-term mortality after discharge. Patients who developed AKI had higher levels of H-FABP pre- and postoperatively than patients who did not have AKI. In analyses adjusted for known AKI risk factors, first postoperative log(H-FABP) was associated with severe AKI (adjusted odds ratio (OR) 5.39 (95% confidence interval (CI), 2.87-10.11) per unit increase), while preoperative log(H-FABP) was associated with any AKI (2.07 (1.48-2.89)) and mortality (1.67 (1.17-2.37)). These relationships persisted after adjustment for change in serum creatinine (for first postoperative log(H-FABP)) and biomarkers of cardiac and kidney injury, including brain natriuretic peptide, cardiac troponin-I, interleukin-18, liver fatty acid binding protein, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin. Thus, perioperative plasma H-FABP levels may be used for risk stratification of AKI and mortality following cardiac surgery. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the risk of gestational hypertension and preeclampsia among young women who are living kidney donors. Topics discussed include impact of nephrectomy on the future pregnancies of living kidney donors, comparison of preterm and low birth weight rates among donors and non-donors, and increased risk for gestational hypertension and preeclampsia among donors as compared to non-donors.

Importance: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each intervention has the potential for harm.Objective: To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury.Design, Setting, and Participants: A 2 × 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013.Interventions: Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine at 0.2 mg/d) or placebo patch that remained until 72 hours after surgery.Main Outcomes and Measures: Acute kidney injury was primarily defined as an increase in serum creatinine concentration from the preoperative concentration by either an increase of 0.3 mg/dL or greater (≥26.5 μmol/L) within 48 hours of surgery or an increase of 50% or greater within 7 days of surgery.Results: Aspirin (n = 3443) vs placebo (n = 3462) did not alter the risk of acute kidney injury (13.4% vs 12.3%, respectively; adjusted relative risk, 1.10; 95% CI, 0.96-1.25). Clonidine (n = 3453) vs placebo (n = 3452) did not alter the risk of acute kidney injury (13.0% vs 12.7%, respectively; adjusted relative risk, 1.03; 95% CI, 0.90-1.18). Aspirin increased the risk of major bleeding. In a post hoc analysis, major bleeding was associated with a greater risk of subsequent acute kidney injury (23.3% when bleeding was present vs 12.3% when bleeding was absent; adjusted hazard ratio, 2.20; 95% CI, 1.72-2.83). Similarly, clonidine increased the risk of clinically important hypotension. In a post hoc analysis, clinically important hypotension was associated with a greater risk of subsequent acute kidney injury (14.3% when hypotension was present vs 11.8% when hypotension was absent; adjusted hazard ratio, 1.34; 95% CI, 1.14-1.58).Conclusions and Relevance: Among patients undergoing major noncardiac surgery, neither aspirin nor clonidine administered perioperatively reduced the risk of acute kidney injury.Trial Registration: clinicaltrials.gov Identifier: NCT01082874. [ABSTRACT FROM AUTHOR]

IMPORTANCE Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each intervention has the potential for harm. OBJECTIVE To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. DESIGN, SETTING, AND PARTICIPANTS A 2 x 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. INTERVENTIONS Patients were assigned to take aspirin (200mg) or placebo 2 to 4 hours before surgery and then aspirin (100mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine at 0.2mg/d) or placebo patch that remained until 72 hours after surgery. MAIN OUTCOMES ANDMEASURES Acute kidney injury was primarily defined as an increase in serum creatinine concentration from the preoperative concentration by either an increase of 0.3mg/dL or greater (≥26.5 µmol/L) within 48 hours of surgery or an increase of 50%or greater within 7 days of surgery. RESULTS Aspirin (n = 3443) vs placebo (n = 3462) did not alter the risk of acute kidney injury (13.4% vs 12.3%, respectively; adjusted relative risk, 1.10; 95% CI, 0.96-1.25). Clonidine (n = 3453) vs placebo (n = 3452) did not alter the risk of acute kidney injury (13.0% vs 12.7%, respectively; adjusted relative risk, 1.03; 95% CI, 0.90-1.18). Aspirin increased the risk of major bleeding. In a post hoc analysis, major bleeding was associated with a greater risk of subsequent acute kidney injury (23.3% when bleeding was present vs 12.3%when bleeding was absent; adjusted hazard ratio, 2.20; 95%CI, 1.72-2.83). Similarly, clonidine increased the risk of clinically important hypotension. In a post hoc analysis, clinically important hypotension was associated with a greater risk of subsequent acute kidney injury (14.3% when hypotension was present vs 11.8% when hypotension was absent; adjusted hazard ratio, 1.34; 95%CI, 1.14-1.58). CONCLUSIONS AND RELEVANCE Among patients undergoing major noncardiac surgery, neither aspirin nor clonidine administered perioperatively reduced the risk of acute kidney injury. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the population pharmacokinetics (PK) of pertuzumab across clinical trials in a variety of solid tumors, evaluate the potential impact of patient characteristics on PK, and confirm the appropriateness of the fixed (non-weight-based) dose. Methods: Pertuzumab concentration data collected following intravenous administration during eleven phase I/II studies and the pivotal phase III trial CLEOPATRA were analyzed using nonlinear mixed-effects modeling. The potential impact of patient and laboratory characteristics and HER2 target-related variables on pertuzumab PK were investigated in a covariate analysis. The final model was used to confirm selection of fixed, non-weight-based dosing of pertuzumab, and to compare pertuzumab PK in CLEOPATRA with the other studies. Results: The analysis included 4,525 serum concentration measurements from 481 patients with solid tumors. Pertuzumab PK in the 2-25 mg/kg dose range was described by a two-compartment linear model with first-order elimination. The elimination clearance and central compartment volume were 0.235 L/day, and 3.11 L, respectively, and the terminal elimination half-life was 18.0 days. Baseline serum albumin and lean body weight had statistically significant effects on pertuzumab clearance; however, simulations showed that the magnitude of their effects on pertuzumab exposure was minimal compared with overall variability and was not clinically relevant. Thus, variations in these factors do not require dose adjustments. Conclusions: The fixed, non-weight-based dosing of pertuzumab, 840 mg loading dose followed by a 420 mg maintenance dose every 3 weeks, in patients with the solid tumors in this analysis is well supported by the population pharmacokinetic modeling and simulation results. [ABSTRACT FROM AUTHOR]

Spinal teratomas are rare spinal tumors. Most patients present with myelopathy, myeloradiculopathy, or radiculopathy. The authors describe the rare presentation of spinal teratoma with acute onset of backache followed by sudden paraplegia. [ABSTRACT FROM AUTHOR]

Griscelli syndrome 2 is a rare autosomal recessive disorder of pigmentary dilution of hair, skin, splenohepatomegaly, pancytopenia, immune and neurologic dysfunction. Clinical course is characterized by recurrent infection triggered by uncontrolled T-lymphocyte and macrophage activation, called hemophagocytic syndrome. Since the primary presentation is with depigmented hair, we attempt to highlight diagnostic difficulties in such cases in developing countries like ours where pigmentary changes in hair and skin are commonly attributed to severe malnutrition. We also evaluated phenotype of all 10 cases of genotype (c.C550T; p.R184X), collected from published literature worldwide and emphasize the potential role of above mutation as hotspot in Southeast Asian region. [ABSTRACT FROM AUTHOR]