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Background • Mineral buildups called kidney stones can be free-floating or affixed to the renal papillae and occur in the renal calyces and pelvis. A major morbidity is associated with the widespread problem of renal stone disease. Open surgical lithotomy and minimally invasive endourological procedures are now the standard for the management of kidney stone symptoms. However, individualized homeopathy (iHOM) has greatly improved treatment of Multiple Renal Calculi. Methods • In the OPD of Dr. D. Y. Patil Homoeopathic Medical College and Research Centre, a 26-year-old female patient with multiple renal calculus was treated homeopathically from August 2021 to January 2022. During the follow-up visits outcome was assessed. To assess whether the changes were due to homoeopathic medicine, an assessment using the modified Naranjo criteria was performed. Results • Over an observation period of 5 months beneficial result from iHOM medicine was seen and so can be used by the physicians in the treatment of Renal Calculi as a complementary health practice. Conclusion • Based on the totality of symptoms, individualized Homoeopathic Medicine (iHOM) Lycopodium Clavatum 30C was given and worked well to dissolve and expel all renal stones. Hence, homeopathy is effective in the fragmentation and ejection of renal calculi and remains one of the most popular treatments for urological problems. [ABSTRACT FROM AUTHOR]

• Computational thinking integration into a moral reasoning context. • Epistemic overlap between computational thinking, moral reasoning, and modeling. • Empathy as a resource for computational thinking. • Considerations for integration in socio-emotional learning settings in K12. In this work, we argue for expanding the scope of K-12 computational thinking (CT) integration contexts to include everyday scenarios involving moral reasoning. Epistemic overlap between computational thinking practices and moral reasoning suggest that these contexts are potentially rich sites to see "seeds of CT" in children's reasoning and can provide rich educational pathways for children into CT. Taking a case-study approach, we examine the reasoning of a second-grader, Ollie, on a task involving fair allocation of resources to victims of a natural disaster. Our analysis finds that Ollie's reasoning was rich with seeds of CT (e.g., problem formulation, abstraction, complex-systems thinking) and that empathy served as an important supporting role to the CT. This work has implications for curricular design, suggesting that fairness and resource allocation scenarios with built-in opportunities for empathy might provide rich sandboxes for CT integration. [ABSTRACT FROM AUTHOR]

Lavender is a highly valuable medicinal and aromatic perennial shrub lacking superior and stable varieties for varied environments in the western Himalayas. In the present experiment, estimates of genotypic effects and their interaction with the environment under various conditions of Himachal Pradesh were investigated to identify superior and stable genotypes. For that, seven selections with a check were evaluated at four different locations in randomized block design with three replications during 2020 and 2021. The pooled analysis of variance showed that genotypic and environmental main effects were highly significant for all the traits under study while, G×E interaction was significant (p=0.05) for plant height, spike length and spike yield. The highest mean performance for all the traits revealed that location-4 has favourable conditions for lavender cultivation, and LOH15141 followed by LOH15040 were the best performers over all the locations. These high-performing genotypes were clustered together with the check in a major cluster. The stability parameters of the Eberhart and Russell model showed that LOH15141 is stable and superior for both spike yield and essential oil content, further confirmed by GGE biplot analysis. GGE biplot analysis revealed that all the tested locations formed a single mega-environment. The strong positive yield contribution described through Pearson's correlation coefficients and genotypic path diagram states that plant height, number of spikes and spike length were significant contributors to the spike yield and could be used as selection criteria to improve spike yield due to their high heritability and genetic advance. [ABSTRACT FROM AUTHOR]

The accumulation of damage due to repeated loading is considered as the primary reason for the fatigue cracking of bituminous pavements. Due to the intermittent nature of loading in the field, the bituminous mixtures tend to heal during the rest period resulting in increased fatigue life. The healing of the bituminous mixtures is predominantly governed by the binder component, and hence quantifying the healing potential of the binder is indicative of the healing potential of the mix. Currently, the increased use of recycled asphalt pavements (RAP) in new construction, as well as rehabilitation has triggered the use of rejuvenators for restoring the RAP binder properties. As such, the rheological and physico-chemical evaluation of blender RAP binders (with rejuvenators) is critical. In the present study, four different rejuvenators are used for rejuvenating the RAP binder, which include two types of Paraffinic oils, Tall oils and Fatty acids. The healing potential of the RAP binder blended with different rejuvenators is investigated with the help of Linear Amplitude Sweep (LAS) tests carried out in two ways. The first method is a continuous LAS test without any rest period and the second method incorporates rest periods of various duration at different damage levels. The advantages of incorporating rest periods in a LAS test have been quantified in terms of improved binder healing potential. In addition, the physico-chemical properties of the blended RAP binders were assessed through SARA analysis. An attempt has been made to explain the fatigue performance and healing potential of blended RAP binders in LAS tests by virtue of their chemical composition obtained from physico-chemical analysis (SARA analysis). Also, the effectiveness of various rejuvenators in improving the healing potential of RAP binders has been evaluated. [ABSTRACT FROM AUTHOR]

Objective: The growing availability of cannabis products through home delivery services may affect cannabis-related health outcomes. However, research is impeded by a lack of data measuring the scale of home delivery. Prior research demonstrated that crowdsourced websites can be used to validly enumerate brick-and-mortar cannabis outlets. We piloted an extension of this method to explore the feasibility of measuring availability of cannabis home delivery. Method: We tested implementation of an automated algorithm designed to webscrape data from Weedmaps, the largest crowdsourced website for cannabis retail, to count the number of legal cannabis retailers offering home delivery to the geographic centroid of each Census block group in California. We compared these estimates to the number of brick-and-mortar outlets within each block group. To assess data quality, we conducted follow-up telephone interviews with a subsample of cannabis delivery retailers. Results: We successfully implemented the webscraping. Of the 23,212 block groups assessed, 22,542 (97%) were served by at least one cannabis delivery business. Only 461 block groups (2%) contained one or more brick-and-mortar outlets. In interviews, availability varied dynamically as a function of staffing levels, order sizes, time of day, competition, and demand. Conclusions: Webscraping crowdsourced websites could be a viable method for quantifying rapidly evolving availability of cannabis home delivery. However, key practical and conceptual challenges must be overcome to conduct a full-scale validation and develop methodological standards. Acknowledging data limitations, cannabis home delivery appears to be nearly universal in California, whereas availability of brick-and-mortar outlets is limited, underscoring the need for research on home delivery. [ABSTRACT FROM AUTHOR]

Patients with DM are at significant risk for developing the disease, whereas hazardous alcohol use and chronic renal disease are other notable risk factors. Patients with coinfections of other tropical illnesses and COVID-19 present with severe clinical manifestations and outcomes may be particularly poor. The clinical management further becomes complicated considering that there are high rates of coinfections with COVID-19 in tropical countries and such patients with coinfections also have a high risk of mortality [[4]]. [Extracted from the article]

Data visualization is powerful in persuading an audience. However, when it is done poorly or maliciously, a visualization may become misleading or even deceiving. Visualizations give further strength to the dissemination of misinformation on the Internet. The visualization research community has long been aware of visualizations that misinform the audience, mostly associated with the terms "lie" and "deceptive." Still, these discussions have focused only on a handful of cases. To better understand the landscape of misleading visualizations, we open‐coded over one thousand real‐world visualizations that have been reported as misleading. From these examples, we discovered 74 types of issues and formed a taxonomy of misleading elements in visualizations. We found four directions that the research community can follow to widen the discussion on misleading visualizations: (1) informal fallacies in visualizations, (2) exploiting conventions and data literacy, (3) deceptive tricks in uncommon charts, and (4) understanding the designers' dilemma. This work lays the groundwork for these research directions, especially in understanding, detecting, and preventing them. [ABSTRACT FROM AUTHOR]

Introduction: An admission of a pregnant woman to an intensive care unit (ICU) is considered as an objective marker of maternal near miss. Only a few studies from the Indian subcontinent have reported on the ability of ICU scoring systems in predicting the mortality in obstetric patients. Methods: A prospective analysis of all critically ill obstetric patients admitted to the critical care department was done. Results: In the period between April 2013 and September 2017, there were 101 obstetric admissions to the critical care ICU. Of these, 82 patients (81.2%) were discharged from the hospital, 18 patients (17.8%) died, and one left against medical advice. The common diagnoses seen in these patients were cardiac failure (n = 39; 38.6%); pregnancy-induced hypertension (n = 26; 25.7%); acute respiratory distress syndrome (n = 20; 19.8%); intra-abdominal sepsis (n = 19; 18.8%); tropical diseases (n = 19; 18.8%); and tuberculosis (n = 13; 12.9%).When we compared the survivors with the nonsurvivors, a higher severity of illness score and a low PaO2/FiO2 were found to increase the odds of death. The area of distribution under the receiver operator characteristic curve was 0.726 (95% confidence interval [CI] = 0.575-0.877), 0.890 (95% CI = 0.773-1.006), 0.867 (95% CI = 0.755- 0.979), and 0.850 (95% CI = 0.720-0.980) for the PaO2/FiO2, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively, for predicting mortality. The standardized mortality ratio was better with SAPSII than with APACHE II. Conclusions: Cardiac dysfunction is a leading cause of ICU admission. Obstetric patients frequently require ventilatory support, intensive hemodynamic monitoring, and blood transfusion. The APACHE II score is a good index for assessing ICU outcomes. [ABSTRACT FROM AUTHOR]

Introduction: We prospectively evaluated EUCAST rapid antimicrobial susceptibility testing methodology for susceptibility testing directly from blood culture bottles in comparison to CLSI disk-diffusion method. Methodology: During May-November 2019, positively flagged blood culture bottles showing Gram-negative micro-organisms were simultaneously processed by rapid antimicrobial susceptibility testing and CLSI methodology. Antibiotics tested were cefotaxime, ceftazidime, piperacillin-tazobactam, imipenem, meropenem, gentamicin, tobramycin and trimethoprim-sulphamethoxazole. Results: Overall, 80 isolates identified as Escherichia coli (n = 24, 30%), Klebsiella pneumoniae (n = 15, 18.7%), Pseudomonas aeruginosa (n = 16, 20%) and Acinetobacter baumannii (n = 25, 31.2%) were included. Categorical agreements of rapid antimicrobial susceptibility testing at 4-, 6- and 8-hour reading times were 88.1% (304/345), 90.8% (425/468) and 92.3% (467/506), respectively. Major Error rates were 14% (21/150), 4.9% (10/206) and 4/236 (1.7%), whereas Very Major Error rates were 1.1% (2/177), 1.3% (3/232) and 3.3% (8/243), respectively. Results categorized as "Area of Technical Uncertainty" were significantly lower at 8-hour (10.2% (39/384) vs 5.2% (28/534), 4- vs 8-hour, p = 0.003, Fischer's exact test}. Conclusions: Except for a slightly higher Very major error rate, rapid antimicrobial susceptibility testing at 8-hour is equivalent to Disk-diffusion method (CLSI-M100) using CLSI-M52 criteria for equivalence: (Categorical agreement ≥ 90%, Very major error ≤ 1.5% and Major error ≤ 3%). Poor Categorical agreements at all reading times were noted for piperacillin-tazobactam, ciprofloxacin and E. coli. Performance of rapid antimicrobial susceptibility testing methodology in resource limited settings brings unique challenge of identifying micro-organisms within 8 hours. We suggest reading and reporting of results at a single time point using rapid antimicrobial susceptibility testing method i.e. at 8-hour. [ABSTRACT FROM AUTHOR]

Case: Multilevel lumbar spondylolistheses have been reported, but only secondary to degenerative processes. We describe a case where grade 4 anterolisthesis occurred (L3,4,5 over S1) because of multiple level traumatic pedicle avulsion rather than facetal/pars interarticularis/posterior ligamentous complex disruption in a 42-year-old man who presented with paraparesis after a fall from height. Decompression was performed at the L5 level, and pedicle screw fixation was performed at L3, L5, and S1 levels. Conclusion: Although such an injury pattern seems catastrophic, it is deemed relatively stable because of the intact posterior ligamentous complex. Restoration of anatomy with stabilization allowed early mobility and satisfactory neurological recovery. [ABSTRACT FROM AUTHOR]

Juvenile fibromyalgia (JFMS) is a common disorder in the adolescent population with a prevalence of 1–6%. Our study looked at the prevalence of tinnitus in JFMS patients seen at a pediatric rheumatology clinic between 2016 and 2021. The objective of this study was to retrospectively assess prevalence of tinnitus and compare that with prevalence in non- JFMS patients presenting to the clinic. We also assessed prevalence of other sensory and pain symptoms, Widespread pain index >6 and abdominal pain in these two groups. Of the 290 forms evaluated, tinnitus was present in 31.1 % of JFMS subjects, versus only 3.5 % in non-JFMS subjects. There was a significant association between tinnitus and tingling and numbness among subjects with JFM (p = 0.005). On logistic regression analysis, the odds of having JFMS were 5.2 times higher among tinnitus patients compared to non-tinnitus (p = 0.003, 95 % CI 1.77–15.55). Tingling/numbness were also associated with 21.78 times increased odds for diagnosis of JFMS (p = 0.0003, 95 % CI 4.05–117.21). The odds of having JFMS were 22.6 times higher among patients with Widespread Pain Index >6 (p < 0.0001, 95 % CI 7.88–64.71). Tinnitus is a commonly prevalent condition in patients with JFMS. In patients with JFMS, there is a significant association between tinnitus and tingling/numbness. Further studies are needed to explore the underlying pathogenesis of these symptoms. [ABSTRACT FROM AUTHOR]

Background: There is global shortage of Personal Protective Equipment due to COVID-19 pandemic. N95 Filtering Facepiece Respirators (N95-FFRs) provide respiratory protection against respiratory pathogens including SARS-CoV-2. There is scant literature on reprocessing methods which can enable reuse of N95-FFRs. Aim: We conducted this study to evaluate research done, prior to COVID-19 pandemic, on various decontamination methods for reprocessing of N95-FFRs. Methods: We searched 5 electronic databases (Pubmed, Google Scholar, Crossref, Ovid, ScienceDirect) and 1 Grey literature database (OpenGrey). We included original studies, published prior to year 2020, which had evaluated any decontamination method on FFRs. Studies had evaluated a reprocessing method against parameters namely physical changes, user acceptability, respirator fit, filter efficiency, microbicidal efficacy and presence of chemical residues post-reprocessing. Findings and conclusions: Overall, we found 7887 records amongst which 17 original research articles were finally included for qualitative analysis. Overall, 21 different types of decontamination or reprocessing methods for N95-FFRs were evaluated. Most commonly evaluated method for reprocessing of FFRs was Ultraviolet (Type-C) irradiation (UVGI) which was evaluated in 13/17 (76%) studies. We found published literature was scant on this topic despite warning signs of pandemic of a respiratory illness over the years. Promising technologies requiring expeditious evaluation are UVGI, Microwave generated steam (MGS) and based on Hydrogen peroxide vapor. Global presence of technologies, which have been given Emergency use authorisation for N95-FFR reprocessing, is extremely limited. Reprocessing of N95-FFRs by MGS should be considered for emergency implementation in resource limited settings to tackle shortage of N95-FFRs. Systematic review identifier: PROSPERO, PROSPERO ID: CRD42020189684, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020189684). [ABSTRACT FROM AUTHOR]

Due to the increasing complexity of manufacturing processes and automation, maintenance of all machines and equipments has become challenging task for production managers today. Due to lack of sensitivity for maintenance, share of maintenance cost in total product cost is also increasing along with decreased productivity. Organizations are either quite slow or getting failed in updating their maintenance systems with time. Keeping in view the importance of maintenance in today's context, this study has tried to develop a framework for a sustainable maintenance system for manufacturing organizations. Usually organizations are not able to identify critical factors for effective maintenance. Therefore, in this context, the study has identified fourteen factors for the effective maintenance management from the literature review. Some of these factors are process oriented and some are result oriented. Interpretive structural modeling approach is applied for the development of structural relationship among the factors from a strategic perspective. Fuzzy MICMAC analysis is then carried out to categorize these factors based on their driving and dependence value. Further to prioritise major driving factors, Technique for order preferences by similarity of an ideal solution approach has been also applied. It is observed that top management support and commitment, strategic planning and implementation, continuous upgradation of maintenance system to reduce manufacturing lead time and cost are major factors to ensure the sustainable competitive advantage. [ABSTRACT FROM AUTHOR]

Objectives. The primary objective is to determine the frequency of history findings associated with cardiac syncope. Second, to determine the frequency of abnormal electrocardiograms (EKG) in patients presenting with typical vasovagal syncope. Methods. Retrospective chart review from January 2006 to April 2017 of children aged 5 to 18 years presenting to the emergency department with a chief complaint of syncope. Target population was all patients with first episode of syncope and a documented EKG. Excluded patients were those with head trauma, drug intoxication, current pregnancy, seizure, and any endocrine problem. Patients with cardiac causes of syncope were identified by an abnormal EKG or echocardiogram. Specific history findings (past cardiac history, chest pain, palpitations, syncope with exercise, absence of prodrome with syncope) were compared with those with and without cardiac etiology of syncope. The possibility of missing a patient with cardiac cause of syncope based on specific history findings was identified. Results. Of the total 4115 visits of patients with chief complaints of syncope, 2293 patients (55.7%) met the inclusion criteria. Nine patients (0.39%) were identified with cardiac etiology of syncope. The remaining were determined to be of vasovagal origin. All patients with cardiac etiology of syncope were found to have one positive specific history findings. A total of 1972 patients were identified with absence of specific history findings; no patient had a cardiac etiology of syncope. Conclusions. This study identifies screening questions to identify cardiac syncope. Implementing these standard questions could potentially decrease resource utilization and time for evaluation as well as guide follow-up. [ABSTRACT FROM AUTHOR]

Cryopyrin‐associated periodic fever syndrome (CAPS) represents an increasingly recognized disease group entity, with varied presentations. CAPS includes 3 clinical entities, namely, familial cold‐induced autoinflammatory syndrome (FCAS; MIM #120100), Muckle‐Wells syndrome (MWS; MIM #191900) and chronic inflammatory neurologic cutaneous and articular syndrome (CINCA; MIM #607115); which share several overlapping clinical features. These patients often present with early‐onset episodes of fever and rash, and variable systemic signs and symptoms, making it a great mimicker of other systemic autoimmune diseases. The episodes are transient and related to exposure to cold temperature and worsen in the winter season. We hereby present a case presenting with recurrent seasonal fever and rash, diagnosed as FCAS/ MWS overlap based on clinical signs and symptoms and positive testing for NLRP3 gene mutation. We also discuss the clinical presentation and complications of CAPS, chiefly FCAS and MWS, along with the previously described pediatric cases of CAPS. We tried to review the complexities of management of such patients, including the genetic diagnosis and the role of biological therapy. Based on the review of the literature, given the evident broad spectrum of symptoms and signs, use of next‐generation sequencing can help in prompt diagnosis and early initiation of biological agents, which may play a great role in reducing the complications that these patients may experience in the long run. [ABSTRACT FROM AUTHOR]

Background: Tinkering, an ad hoc approach to solving a problem, involves manipulating objects to characterize and build knowledge about a particular system in an exploratory way, often with the goal of getting some product/idea to produce desired behavior. Tinkering contrasts more deliberate activity toward understanding how a phenomenon works. Purpose Some researchers have argued that tinkering is an unproductive engineering design practice because it does not always lead to progress in design and/or conceptual learning while others have argued for tinkering as a productive design practice. We speak to this disagreement regarding the productivity of tinkering for novice designers by closely analyzing tinkering episodes. Design/Method: We present a microgenetic account of two tinkering episodes to contribute to a more refined understanding of what tinkering is. The research setting is in a summer camp for high school girls using a design‐based Arduino component. Results: Our analyses demonstrate that tinkering is neither universally productive nor unproductive in engineering design; we show that tinkering can help participants make progress toward some instructional goals such as supporting the engagement of students in some engineering design practices. We also show that tinkering can hinder progress toward other goals such as developing a robust solution to a design problem. Conclusions: We argue for a more nuanced understanding of productivity (of tinkering and other design practices), which is local and defined with respect to specific goals and actors. [ABSTRACT FROM AUTHOR]

Amyloidosis secondary to juvenile idiopathic arthritis is a known complication of poorly controlled systemic juvenile idiopathic arthritis (SJIA), occurring in 1–2% of the patients. The IL-6 inhibitor tocilizumab is effective in controlling systemic signs and symptoms of sJIA and may be of therapeutic benefit in secondary amyloidosis. Herein, we report the clinical timeline of a 10-year boy with sJIA and secondary amyloidosis, who showed a sustained improvement of systemic symptoms and a reduction in proteinuria with tocilizumab. Compared to the data on adult patients affected with the secondary amyloidosis, there are very few reports on therapeutic options for the children affected with SJIA and secondary amyloidosis in the paediatric population. While doing a systematic literature search for writing this review, we could only retrieve nine case reports and one case series of the children affected with SJIA and secondary amyloidosis, including five cases which were treated with tocilizumab. We also looked into the clinical and biochemical response to various agents that have been used in the previous cases, including tocilizumab. The available literature and the present case report suggest that tocilizumab may be considered as a safe and effective option to treat SJIA-related secondary amyloidosis. [ABSTRACT FROM AUTHOR]

Lung recruitment maneuvers are rescue measures commonly used to improve oxygenation in severely hypoxemic patients with acute respiratory distress syndrome (ARDS), who fail to improve on standard treatment. After recruitment, appropriate level of positive end.expiratory pressure (PEEP) is applied to prevent alveolar de.recruitment during expiration. Computed tomography scan of thorax and quasi.static pressure.volume curves have played a pivotal role are important in the assessment of recruitment, but they have several limitations. Lung ultrasound (LUS), which is now easily available in nearly every Intensive Care Unit, could be an attractive alternative method for assessing lung recruitment. It is noninvasive, easily repeatable and is devoid of radiation hazards. We are presenting a case of 24.year.old female patient with moderate ARDS in whom bedside LUS was successfully used into assessing lung recruitment as well as into determining the appropriate level of PEEP. [ABSTRACT FROM AUTHOR]

The heat transfer and flow performance of the plate fin heat sink in a horizontal rectangular channel with dimples and protrusions on the fin surfaces has been experimentally investigated in forced convection. The Nusselt number and friction factor are obtained by varying the system parameters as depth and pitch of the dimples for inline and staggered arrangements. The Reynolds number is considered in the range of 6800 to 15,200. The effect of depth and pitch of dimples are examined under constant heat flux while keeping the constant diameter of dimples. Experimental results indicate that the heat transfer and flow performance of fin array are significantly influenced by increasing the depth of dimples. The heat transfer from fin array is enhanced and the flow resistance is increased by decreasing the pitch ratio (s/d) and increasing the depth ratio (D/d). The maximum fin performance of dimpled fin heat sink corresponds to the staggered arrangement of dimpled heat sink with dimple pitch ratio (s/d) of 2.5 and dimple depth ratio (D/d) of 0.5. [ABSTRACT FROM AUTHOR]

Introduction: Upper airway imaging can often identify the anatomical risk factors for sleep apnea and provide sufficient insight into the pathophysiology of obstructive sleep apnea (OSA). Materials and Methods: We conducted a case–control, observational study at a tertiary care hospital in North India. All cases and controls underwent lateral cephalometry and magnetic resonance imaging (MRI) for craniofacial and upper airway evaluation. Only the cases had polysomnography testing for confirmation of OSA and assessing the severity of disease. Results: Forty cases and an equal number of matched controls were recruited. On X‑ray cephalometry, it was observed that the cases had a significantly larger hyoid mandibular distance and soft palate length; and shorter mandibular length. The MRI cephalometric variables were significantly different, the soft palate length, tongue length, and submental fat were longer while the retropalatal and retroglossal distance was shorter amongst the cases. A statistically significant positive correlation was found between the cephalometric parameters and the indices of severity of OSA. An increased hyoid mandibular distance and soft palate length, and a decrease in the lower anterior facial height were found to be predictive of severe OSA (Apnea–Hypopnea Index –>30/h). An increased hyoid mandibular distance, soft palate length, and the tongue length and a reduced mandibular length were found to be predictive of need for continuous positive airway pressure (CPAP) pressures of ≥15 cm H2O. There were significant differences between the cephalometric parameters of the Indian OSA patients and patients from other ethnicities reported in the literature. Conclusions: OSA patients had a significantly smaller upper airway compared to age‑, sex‑, and body mass index‑matched controls and cephalometric variables correlated with the indices of OSA severity. The cephalometric assessment was also predictive of severe OSA and the need for higher pressures of CPAP. This indicates the important role of upper airway anatomy in the pathogenesis of OSA. [ABSTRACT FROM AUTHOR]

We aimed to determine the frequency of blood glucose and electrocardiogram (EKG) abnormalities in previously healthy children who present to an emergency department (ED) with a diagnosis of benign syncope. Chart review of consecutive children aged 5 to 18 years presenting to the pediatric ED from 2004 to 2014 with a discharge diagnosis of benign syncope was done. Of 969 patients, hypoglycemia (serum glucose <60 mg/dL) was present in only 3 cases (0.3%). Of 754 patients with EKG performed, only 4 cases (0.6%) was an abnormality requiring further cardiac evaluation identified; cardiac echocardiogram was performed in 3 of these 4 patients, which revealed no cardiac pathology. Financial analysis for performing blood glucose measurement and EKG on these patients amounted to total health care cost of $222 526. We concluded that previously healthy children with syncope rarely have hypoglycemia or underlying cardiac abnormality. The routine performance of tests can incur significant health care expenditure. [ABSTRACT FROM AUTHOR]

Abstract: Problem solving in groups can be rich with tension for students. This tension may arise from conflicting approaches (conceptual and/or epistemological) and/or from conflict emerging in the social relations among group members. Drawing on video records of undergraduate students working collaboratively, we use three cases to illustrate the multifaceted ways in which conflict arises—combining conceptual, epistemological, and socioemotional dynamics—and a specific way of managing the tension that can emerge from the multifaceted conflict, “taking an escape hatch.” An escape hatch is a set of discourse moves through which participants close the conversational topic, thereby relieving tension, but before a conceptual resolution is achieved. We describe how epistemological twists and turns can be recruited as a means of managing the strong emotions experienced by the students, showing the coupling of emotion and epistemology in students’ conceptual sense making during group work. We help to provide the groundwork necessary for instructors to notice, understand, and respond to one way in which conceptual–epistemological–social–emotional aspects of interaction are coupled in the emergence of tension, rather than narrowly targeting instructional moves based on only conceptual or epistemological considerations. Instead, instructors should often respond to—and help students become aware of—the emotional component of peer interactions and its entanglement with the “cold cognitive” conceptual and epistemological components. [ABSTRACT FROM AUTHOR]

The relationship between ideology and learning remains insufficiently theorized and sparsely investigated in the learning sciences. Drawing on Stuart Hall’s theorization of ideology, Judith Butler’s notion of the (un)grievability of lives, and Sara Ahmed’s construct of stickiness, we illustrate how insights from critical social theory are indispensable to understanding processes of learning and how perspectives from the learning sciences can enrich critical social theory. Through the analysis of a classroom discussion on the use of militarized drones in an undergraduate engineering ethics course, we show how ideological convergence among participants constructed locally significant categories of “civilian,” “terrorist,” and (un)grievability, which narrowed the possible trajectories for students’ disciplinary learning in engineering and engineering ethics. Our analysis also shows that fleeting moments of ideological expansion offered opportunities for new learning; however, most of these instances of possibility were not sustained through the classroom discussion. We explicate how ideological convergences and expansions, as interactional achievements, profoundly matter for disciplinary learning and students’ identities. In conclusion, we explore the implications of our findings for broader contexts of learning and for the field of the learning sciences. [ABSTRACT FROM AUTHOR]

Abstract: Background: Quantitative researchers have noted the impact of mentoring and support programming for students from underrepresented groups in engineering. Qualitative researchers have also noted the importance of student agency in persistence through marginalization. Nevertheless, challenges and questions remain in identifying practices which are effective in supporting underrepresented students. Purpose: The study applies scholarship from critical theory and narrative as a new resource for approaching and understanding the process of supporting marginalized student agency. Method: A longitudinal interview study with a female undergraduate engineering student, Emilia, developed into a way for her to process marginalizing educational experiences and to develop new narratives that expanded her agency. After an in‐depth member check, Emilia became a co‐author contributing a post hoc account of the impact of these discussions. Results: Our analysis indicates that naming one's own oppression and creating narratives that repurpose and resituate stereotypical stories of oppression was a liberatory act for Emilia. We trace three marginalizing themes of the participant's experience that are subverted and resisted through the student co‐constructed narrative. Conclusions: The paper builds theory for diversity support, suggesting critical theorizing may present a new form of agency not yet represented in the literature. It also points to possible value for student participants from qualitative methodologies exploring student experiences. Finally, it suggests supporting critical theorizing as a potential new orientation for diversity practitioners. [ABSTRACT FROM AUTHOR]

Abstract: Background: To explain educational problems such as student attrition, engineering education literature often focuses on the characteristics of individuals. In 2006, Ray McDermott and Hervé Varenne called for examining the “cultural construction” of educational problems, uncovering how multiple actors create and inscribe meaning to the educational problem. Purpose: We apply the cultural construction framework to examine how the educational problem of a student being “not cut out for engineering” is constructed within the context of a specific electrical engineering course. We focus on culturally taken‐for‐granted course structures, practices, and interactions, all of which produce the local enactment of this common educational problem. Method: We used ethnographic methods, including field‐noted participant observations, one‐on‐one participant interviews, and video‐recorded student work on lab assignments. Coordinating multiple data streams enabled us to question explanations couched in terms of individual ability and background, and to illustrate how ability hierarchies were constructed in the educational context. Results: Our findings illustrate how several mundane and seemingly innocuous aspects of engineering classrooms add up to construct the educational problem of our focal student as “not cut out” for engineering. Contributions to this construction included lecture seating positions, interactional norms in lecture and lab, and labels made meaningful through institutional and interactional processes. Conclusions: The forces at play in constructing educational problems for students are deeply embedded in institutions, disciplines, and society, making it difficult to generate a simple list of instructional interventions. We highlight cultural construction analysis as a potentially fruitful orientation for researchers and practitioners to find the particular sites and tools for local intervention. [ABSTRACT FROM AUTHOR]

Background: Peripheral pulmonary lesions (PPLs) pose a diagnostic challenge, and the optimal investigation in many such cases remains unclear. Computed tomography (CT)-guided percutaneous needle biopsy (CT-PNB) has been the modality of choice for such lesions with a high diagnostic accuracy but with high rates of pneumothorax. Endobronchial ultrasound (EBUS) with a radial probe is an alternate diagnostic modality with increased diagnostic yield of bronchoscopy in the evaluation of PPL. We conducted a randomized controlled trial comparing the diagnostic accuracy and complication rates of radial EBUS with CT-guided lung biopsy for the evaluation of PPL. Methods: Fifty patients with PPL surrounded by lung parenchyma on all sides were randomly assigned to either radial EBUS or CT-PNB group (25 each). Results: Both groups had similar clinicoradiologic characteristics. The diagnostic accuracy of radial EBUS was comparable to CT-PNB with no statistically significant difference (72 vs. 84%; P = 0.306). However, the yield was significantly lower in right upper lobe lesions (20% vs. 83.3%; P = 0.03). CT-PNB group had significantly higher pneumothorax rates than radial EBUS (20% vs. 0%; P = 0.03). The lesions that were more than 2 cm, those with ultrasound feature of continuous hyperechoic margin around the lesion (P = 0.007), and the position of the ultrasound probe within the lesion (P < 0.001) were associated with a higher diagnostic yield with radial EBUS. Conclusion: Our findings suggest that radial EBUS is a safer investigation than CT-PNB with a comparable diagnostic accuracy for PPL not abutting the chest wall (CTRI/2017/02/007762). [ABSTRACT FROM AUTHOR]

The article presents a study for comparing and contrasting prominent perspectives on conceptual change and their effect on learning. Topics include epistemic agency and freedom feel by students in math classroom; effects of scholarships on learning sciences and personal epistemology; and importance of classroom discourse norms for students' engagement in the classroom.

A case of 60-year-old male with acute pulmonary embolism without hypotension but signs of right ventricular dysfunction and elevated cardiac biomarkers is reported in this study. The patient comes under intermediate high-risk category and was successfully thrombolysed with alteplase infused through pulmonary artery catheter. Catheter-directed thrombolysis (CDT) can be considered as much safer and effective alternative to systemic thrombolysis in such patients with lower risk of bleeding. This novel bedside method of pulmonary artery CDT with the advantage of no radiation exposure and real time monitoring of pulmonary artery pressures as an end-point of thrombolysis can be utilized in the near future. [ABSTRACT FROM AUTHOR]

Purpose – In present context of globalization, maintenance of production systems is very important. Many of the organizations are facing a lot of problems in maintenance management. Therefore the purpose of this paper is to identify the main barriers in maintenance management and to rank them for effective maintenance strategies. Design/methodology/approach – To rank the main barriers in maintenance management, technique for order preference by similarity to ideal solution is used. For giving score to different factors a team of three experts was made. All experts were having more than ten years of experience in area of maintenance management. Findings – Lack of top management support, lack of measurement of overall equipment effectiveness (OEE) and lack of strategic planning and implementation have emerged as top three barriers in implementation of maintenance systems in industries. Research limitations/implications – Findings imply that for successful maintenance, top management should be very supportive for taking different initiatives, training programmes, etc. Organizations should try to improve overall performance of machines known as OEE rather than only machines productivity. Originality/value – These findings will be highly useful for professionals from manufacturing sector in implementing effective maintenance management system. [ABSTRACT FROM AUTHOR]

Background: Control of cerebral blood flow (CBF) is complex and is only beginning to be elucidated. There is paucity of information on how implementation of pneumoperitoneum and head-up tilt under general anaesthesia affects CBF. This study was designed to observe changes that occur in the internal carotid artery (ICA) blood flow with pneumoperitoneum and head-up position and corelate these changes with changes in cardiac output in patients undergoing laparoscopic cholecystectomy. Methods: ICA blood velocity and diameter was measured by Doppler ultrasound in 35 ASA grade I and II patients undergoing laparoscopic cholecystectomy, at four time points: awake, after anaesthesia induction, after induction of pneumoperitoneum, and after head-up tilt; and ICA blood flow was calculated. Simultaneously, heart rate, blood pressure, and end-tidal carbon dioxide (ETCO2) were recorded, and cardiac output was calculated. Results: ICA blood flow decreased upon anesthesia induction from 164 mL/minute to 151 ml/minute (p>0.05). ICA blood flow increased with pneumoperitoneum (from 164 mL/minute to 179ml/minute p= 0.04). Head-up tilt resulted in decrease in ICA blood flow (from 164 mL/minute to 151ml/minute, P = 0.09). Conclusion: ICA blood flow significantly increased after the creation of pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy under general anaesthesia. Induction of anaesthesia and head-up tilt, however, did not have any significant change in ICA blood flow. We suggest that ICA blood flow during anaesthesia is influenced by an interplay of actions of anaesthetic agents, positive pressure ventilation and patient position besides the changes in blood pressure, ETCO2 and cardiac output. [ABSTRACT FROM AUTHOR]

Energy is an abstract science concept, so the ways that we think and talk about energy rely heavily on ontological metaphors: metaphors for what kind of thing energy is. Two commonly used ontological metaphors for energy are energy as a substance and energy as a vertical location. Our previous work has demonstrated that students and experts can productively use both the substance and location ontologies for energy. In this paper, we use Fauconnier and Turner's conceptual blending framework to demonstrate that experts and novices can successfully blend the substance and location ontologies into a coherent mental model in order to reason about energy. Our data come from classroom recordings of a physics professor teaching a physics course for the life sciences, and from an interview with an undergraduate student in that course. We analyze these data using predicate analysis and gesture analysis, looking at verbal utterances, gestures, and the interaction between them. This analysis yields evidence that the speakers are blending the substance and location ontologies into a single blended mental space. [ABSTRACT FROM PUBLISHER]

Background Students' identities and sense of belonging in a program affect whether they stay in engineering. Research suggests that students' ways of knowing and beliefs about what counts as knowing and learning - their personal epistemologies - can be aspects of their identities, or sense of self as knowers and learners. Purpose/Hypothesis Combining personal epistemology and identity theories suggests epistemological aspects of students' identities can influence whether they feel they belong in their engineering program. We have two research questions: Can a high-achieving engineering student be in danger of leaving a program because of a mismatch between epistemological aspects of his identity and his perceptions of the intellectual climate of their program? How does such a mismatch affect the student's day-to-day academic experiences? Design/Method For three years, we followed Michael, an electrical engineering student, through interviews and in-class observations. From more than 12 hours of semistructured clinical interviews, more than 10 hours of videotaped discussion sections, and two in-class observations in lectures, we produced a case study to characterize epistemological aspects of Michael's identity and how they influenced his perception of his program. Results Michael expressed and enacted a sense-making epistemology that is a fundamental aspect of his identity as a learner. Due to this sense-making aspect of Michael's identity, he often felt alienated from the intellectual climate of his program, and he considered leaving engineering. Conclusion Researchers focused on student retention should attend to epistemological aspects of student identities. Instructors and administrators focused on retention should attend to the epistemological messages students hear from their programs. [ABSTRACT FROM AUTHOR]

We show that molecular catalysts for fuel-forming reactions can be immobilized on graphitic carbon electrode surfaces via noncovalent interactions. A pyrene-appended bipyridine ligand (P) serves as the linker between each complex and the surface. Immobilization of a rhodium proton-reduction catalyst, [Cp"Rh(P)Cl]Cl (1), and a rhenium CO2-reduction catalyst, Re(P)-(CO)3Cl (2), afford electrocatalytically active assemblies. X-ray photoelectron spectroscopy and electrochemistry confirm catalyst immobilization. Reduction of 1 in the presence of p-toluenesulfonic acid results in catalytic H2 production, while reduction of 2 in the presence of CO2results in catalytic CO production [ABSTRACT FROM AUTHOR]

Background & objectives: Healthcare associated infections (HAIs) are responsible for morbidity and mortality among immunocompromised and critically ill patients. We undertook this study to estimate the burden of HAIs in the paediatric cancer patients in a tertiary care hospital in north India. Methods: This prospective, observational study, based on active surveillance for a period of 11 months was undertaken in a 4-bedded isolated, cubicle for paediatric cancer patients. Patients who stayed in the cubicle for ≥48 h, were followed prospectively for the development of HAIs. Results: Of the 138 patients, 13 developed 14 episodes of HAIs during the study period. Patient-days calculated were 1273 days. Crude infection rate (CIR) and incidence density (ID) of all HAIs were 9.4/100 patients and 11/1000 patient-days, respectively. Of the 14 episodes of HAIs, seven (50%) were of blood stream infections (HA-BSI), five (36%) of pneumonia (HAP) and two (14%) urinary tract infections (HA-UTI). The CIRs of HA-BSI, HAP and HA-UTI were 5.1, 3.6 and 1.4/100 patients, respectively. The corresponding IDs were 5.5, 3.9 and 1.6/1000 patient-days, respectively. Mean length of stay was significantly higher in patients who developed an HAI [13.8 (range 7-30), median (Interquartile range) 12 (11-14)] vs 7.5 days [range 2-28, median (interquartile range) 7 (5-9); P<0.0001]. Also mortality was significantly higher in patients who developed an HAI [23% (3/13) vs 3% (4/125), P<0.05]. Interpretation & conclusions: The incidence of HAIs in the paediatric cancer patients in the study was 11/1000 patient days, of which HA-BSIs were the commonest. HAIs were associated with an increase in morbidity and mortality amongst this high risk patient population. [ABSTRACT FROM AUTHOR]

Researchers have argued against deficit-based explanations of students’ difficulties with mathematical sense-making, pointing instead to factors such as epistemology. Students’ beliefs about knowledge and learning can hinder the activation and integration of productive knowledge they have. Such explanations, however, risk falling into a ‘deficit trap’—substituting a concepts/skills deficit with an epistemological one. Our interview-based case study of a freshman engineering major, ‘Jim,’ explains his difficulty solving a physics problem (on hydrostatic pressure) in terms of his epistemology, but avoids a deficit trap by modeling the dynamics of his epistemological stabilities and shifts in terms of fine-grained cognitive elements that include the seeds of epistemological expertise. Specifically, during a problem-solving episode in the interview, Jim reaches and sticks with an incorrect answer that violates common sense. We show that Jim has all the mathematical skills and physics knowledge he would need to resolve the contradiction. We argue that his difficulty doing so stems in part from his epistemological views that (i) physics equations are much more trustworthy than everyday reasoning, and (ii) physics equations do not express meaning that tractably connects to common sense. For these reasons, he does not view reconciling between common sense and formalism as either necessary or plausible to accomplish. But Jim’s in-the-moment shift to a more sophisticated epistemological stance highlights the seeds of epistemological expertise that were present all along: he does see common sense as connected to formalism (though not always tractably so), and in some circumstances, this connection is both salient and valued. [ABSTRACT FROM PUBLISHER]

The authors respond to a comment by professor J. D. Slotta in response to their critique on static and dynamic intuitive ontologies. The authors believe that Slotta has misinterpreted aspects of their position. The authors offer an explanation on their use of static ontologies and how their dynamic view could account for evidence of stabilities.

In a series of well-known papers, Chi and Slotta (M. T. H. Chi, 1992, 2005; M. T. H. Chi & J. D. Slotta, 1993; M. T. H. Chi, J. D. Slotta, & N. de Leeuw, 1994; J. Slotta & M. T. H. Chi, 2006; J. D. Slotta, M. T. H. Chi, & E. Joram, 1995) have contended that a reason for students' difficulties in learning physics is that students think about concepts as things rather than as processes and that there is a significant barrier between these 2 ontological categories. We contest this view, arguing that expert and novice reasoning often and productively traverses ontological categories. We cite examples from everyday, classroom, and professional contexts to illustrate this. We agree with Chi and Slotta that instruction should attend to learners' ontologies, but we find that these ontologies are better understood as dynamic and context dependent rather than as static constraints. To promote 1 ontological description in physics instruction, as suggested by Slotta and Chi, could undermine novices' access to productive cognitive resources that they bring to their studies and inhibit their transition to the dynamic ontological flexibility required of experts. [ABSTRACT FROM AUTHOR]

Objectives Surgical-site infections (SSIs) can complicate virtually any surgical procedure. While SSI can result from numerous causes, contamination of the surgical field can also contribute to it. Intraoperative bacterial contamination during clean orthopaedic procedures can be detected using perioperative cultures. We hypothesized that perioperative cultures could be used to predict possibility of development of SSI in patients undergoing clean orthopaedic surgeries. Materials and Methods We conducted a prospective cohort study at a tertiary care hospital over a 2-year period. Intraoperative surgical wound lavage fluid and closed suction drain tip obtained in the postoperative period were sent for aerobic culture. All patients were followed up to look for the development of SSI for a period of at least 30 days for those undergoing nonimplant surgery, and 90 days for those with implant surgery. Statistical Analysis Means with standard deviation of the continuous data were calculated. Fisher's exact test and chi-square test were used for the analysis of the categorical variables. Relative risk and odds ratio were calculated to evaluate the association of the parameters under study with SSI. Results A total of 384 patients satisfying the inclusion and exclusion criteria were included. Perioperative cultures detected surgical wound contamination in 39 patients (10.1%). Forty-five patients (11.7%) developed SSI during the follow-up period. Skin commensals constituted 59% of perioperative contaminants and accounted for 20% of the SSIs. The relative risk of developing SSI with perioperative contamination was 0.41 (95% confidence interval: 0.09–1.63). Conclusion Intraoperative surgical-site contaminants could be detected using perioperative cultures. However, these contaminants did not lead to SSI. Timely treatment of perioperative contamination with appropriate antibiotics and local wound care probably helped in the reduction of SSI. [ABSTRACT FROM AUTHOR]