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Dermatoscopy is a noninvasive method of examining skin lesions under high magnification, gradually replacing the need for invasive biopsies. Training is required to gain clinical competency. Gamification employs game-like elements to enhance education engagement and is an engaging means of delivering medical education. We sought to use gamification and a mobile-based platform to deliver dermatoscopy education to physicians.

IMPORTANCE: In surgical patients, it is well known that higher hospital procedure volume is associated with better outcomes. To our knowledge, this volume-outcome association has not been studied in ambulatory surgery centers (ASCs) in the US. OBJECTIVE: To determine if low-volume ASCs have a higher rate of revisits after surgery, particularly among patients with multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: This matched case-control study used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. The study examined 2328 ASCs performing common ambulatory procedures and analyzed 4751 patients with a revisit within 7 days of surgery (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit). These cases were each closely matched to 5 control patients without revisits (23 755 controls). Data were analyzed from January 1, 2018, through December 31, 2019. MAIN OUTCOMES AND MEASURES: Seven-day revisit in patients (cases) compared with the matched patients without the outcome (controls) in ASCs with low volume (less than 50 procedures over 2 years) vs higher volume (50 or more procedures). RESULTS: Patients at a low-volume ASC had a higher odds of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21; 95% CI, 1.09-1.36; P = .001). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57; 95% CI, 1.27-1.94; P < .001). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84; 95% CI, 1.36-2.50; P < .001) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36; 95% CI, 1.01-1.83; P = .05) vs a higher-volume center. The findings were not statistically significant for patients without multimorbidity. CONCLUSIONS AND RELEVANCE: In this observational study, the surgical volume of an ASC was an important indicator of patient outcomes. Older patients with multimorbidity should discuss with their surgeon the optimal location of their care.

The present work investigates the deposition of nickel boron coatings by electroless method. A double bath scheme was adopted, and the bath temperature was also varied to get coatings in different boron range. The double bath coatings have higher microhardness, scratch hardness, wear and corrosion resistance compared to single bath deposits. The double bath scheme led to the formation of coatings with a compact crack-free morphology except at 95 °C bath temperature. The improvement in hardness was 16.85, 11.43 and 10% at 85, 90 and 95 °C bath temperature compared to the single bath coatings. The increase in scratch hardness was within 20–22%. A higher corrosion potential of − 180 and − 178 mV was also seen.

Due to the myriad applications of the Internet of Things (IoT) in various sectors like healthcare, military, industry, safety, etc., there is also a need to secure these systems efficiently. The devices in such networks need to provide services to users in a secure manner. User authentication is a mechanism through which we can provide secure communication between IoT devices. Recently Banerjee et al. outlined a lightweight anonymous user authenticated session key exchange scheme for Internet of Things deployment, which uses three-factor authentication of a user such as smart card, password and biometric. In this paper, we cryptanalyze their scheme and find that it is not secure against smart card loss attack and stolen verifier attack. Then we have proposed an improved scheme to overcome the weaknesses of their scheme. We present the formal security analysis of our scheme using the random oracle model and informal security analysis to show that our scheme is secure against many known attacks. Its formal security verification is carried out using ProVerif tool. Its performance analysis is carried out with the related schemes which shows that our scheme is more secure than other schemes. Also, our scheme does not contain any storage table at the gateway side for authentication.

Tibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done.

Purpose: The Judet’s technique of quadricepsplasty for an extension contracture of the knee joint offers the benefit of a sequential and controlled release of the intrinsic and extrinsic soft tissue constituents restricting the knee flexion. The main principle of our study was to analyze the clinical as well as functional outcome and to assess an extension lag following Judet’s quadricepsplasty for the knee extension contracture deformity. Materials and Methods: This is a retrospective cohort study comprises of thirty three patients, operated for extension contracture with Judet’s quadricepsplasty with the mean follow-up was 30 months. Knee range of motion of the operated knee was recorded preoperatively and at 6, 12 and 24 month follow-up after the surgery. Judet’s criteria were used to evaluate the outcomes following the procedure. Results: 92.42° (range, 60°–110°) of knee flexion was achieved after an average follow-up of 24 months compared to preoperative knee flexion was 14.09° (range 5°–25°), reflecting a 74.69° average improvement in knee flexion. Twelve patients had excellent results, nineteen had good results as per Judet’s criteria but there were no patients with extension lag. The two patients with fair results had superficial wound infection which healed without any further surgical intervention. Conclusions: Judet’s quadricepsplasty offers sequential release without extension lag of the knee joint. Patients with the knee extension contractures deformity can be successfully managed with the Judet’s quadricepsplasty to gain useful knee motion and function.

Continuously growing environmental issues have become a significant problem in the world. These ecological issues deteriorate our day to day life and are responsible for serious diseases. Also, the growing industrialization of the world has steeply risen and demanding petroleum products for their modernization. Economic development has also resulted in a considerable rise in energy demand. Biodiesel, a less polluting and sustainable fuel replacing diesel, has been gaining significant attention from researchers from all over the world. The utilization of vegetable oil and waste oil as fuel is found to be less polluting than the petrochemical products. The fundamental problem in biodiesel production is that it is more susceptible to oxidation, which results in increased viscosity of biodiesel concerning time, which in turn creates the problem. Therefore this review paper is focused on the current fossil fuel scenario concerning with respect to World and India along with the properties of biodiesel resources and its production processes.

Background: Leucovorin (folinic acid) is a commonly used antidote for severe toxicity with low-dose methotrexate, but its optimum dose is unclear, varying from 15 to 25 mg every 6-h. Methods: Open-label RCT included patients with severe low-dose (≤ 50 mg/week) methotrexate toxicity defined as WBC ≤ 2 × 10^9/L or platelet ≤ 50 × 10^9/L and randomized them to receive either usual (15 mg) or high-dose (25 mg) intravenous leucovorin given every 6-h. Primary outcome was mortality at 30-days and secondary outcomes were hematological recovery and mucositis recovery. Trial Registration number: CTRI/2019/09/021152. Results: Thirty-eight patients were included, most with underlying RA who had inadvertently overdosed MTX (taken daily instead of weekly). At randomization, the median white blood and platelet count were 0.8 × 10^9/L and 23.5 × 10^9/L. 19 patients each were randomized to receive either usual or high-dose leucovorin. Number (%) of deaths over 30-days was 8 (42) and 9 (47) in usual and high-dose leucovorin groups (Odds ratio 1.2, 95% CI 0.3 to 4.5, p= 0.74). On Kaplan–Meier, there was no significant difference in survival between the groups (hazard ratio 1.1, 95% CI 0.4 to 2.9, p= 0.84). On multivariable cox-regression, serum albumin was the only predictor of survival (hazard ratio 0.3, 95% CI 0.1 to 0.9, p= 0.02). There was no significant difference in hematological or mucositis recovery between the two groups. Conclusion: There was no significant difference in survival or time-to hematological recovery between the two doses of leucovorin. Severe low-dose methotrexate toxicity carried a significant mortality.

The purpose of this study is to calculate the characterized, normalized, and weighted factors for the environmental impact of a Li-ion battery (NMC811) throughout its life cycle. To achieve this, open LCA software is employed, utilizing data from product environmental footprint category rules, the Ecoinvent database, and the BatPaC database for a comprehensive Cradle to Grave assessment. The findings of the current study that certain processes have significant environmental implications, including climate change (fossil), resource usage (energy carrier), resource use (minerals and metals), and respiratory inorganic impacts. However, it is noteworthy that water scarcity contributes to 87% of the overall effect, primarily due to the utilization of acids in the hydrometallurgical process. Moreover, the impact categories mentioned above are heavily influenced by the electricity grid mix employed during both the production and consumption phases. Consequently, increasing the proportion of clean energy in the electrical grid mix has been identified as an effective strategy for reducing the Life Cycle Impact Assessment (LCIA) of Li-ion batteries.

•A sustainable approach for Food waste management has been discussed.•Biodiesel has been produced using food waste insitu transesterification.•Biodiesel production parameters has been optimized in the present paper.•This method eliminates the oil extraction step and energy consumption related to that step.•Biodiesel yield of 96.62% has been achieved using food waste insitu transesterification.

•Economic analysis of solar updraft tower power plant conducted.•Optimum levelized cost of electricity generation is ₹9.16 to ₹10.57 for 100 MW to 200 MW power plants.•The construction cost lies in between ₹4.5 cr. to ₹12 cr. per MW.•Large-scale SUTPP can be installed economically, with proper government subsidies and support.

•Economics of black liquor conversion to various high-value products was studied.•Black liquor to lignin was found to be the most attractive pathway with an IRR of ≈50%.•The IRR is the most sensitive to the lignin market price.

The present research work deals with the identification of the issues, which act as major barriers in greening supply chain. On the basis of literature review and discussion with the field experts, the eleven green supply chain issues were identified and analysed by using interpretive structural modelling (ISM). To visualise the driving and dependency nature of the identified issues, ISM model has been developed. The developed ISM model would help to understand the direct relationship among the considered issues. Further, to establish the direct and indirect relationship of one issue with respect to each other issue, fuzzy MICMAC has been used. The outcomes of this analysis may help the managers to build a path in order to improve the GSCM system of an organisation in respect of maximum economic output with minimum environmental impact.

In previous years natural fibers are frequently used to reinforce materials. The biodegradability is the main advantage of natural fibers. The disadvantage of using natural fibers in polymer composite material is their poor adhesion ability with a polymeric matrix which affects the various physical and mechanical properties of the composite material. To overcome this disadvantage, the surface of the natural fibers needs to be modified so that a good fiber-matrix adhesion can be established. The various treatment methods such as physical treatment and chemical treatment methods for the improvement of fiber-matrix adhesion have been discussed in this paper. So the overall objective of this review paper is to highlight the previous and recent studies related to the surface treatment of natural fibers and their reinforcement in thermoplastic polymer matrix composites. The improvement in various properties specifically mechanical properties by reinforcing these fibers into thermoplastic polymer matrix composites has also been reported in this paper.

Osteochondromas are the most common benign bone tumors, common in long bones, and rare in the foot and ankle. They usually occur in skeletally immature bones and do not recur. Malignant transformation is rare but should be considered in such cases of recurrence and properly investigated.

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue neoplasm having a high risk of recurrence and metastasis. Data regarding treatment & survivorship of EMC involving foot is limited.

Synovial sarcoma is a rare tumor, and the spine is its infrequent site of occurrence. Past studies which depict challenges during surgery and survival in patients treated with synovial sarcoma of the spinal region are limited.

Tuberous sclerosis (tuberous sclerosis complex) is rare hereditary disorder characterised by lesions in the brain (cortical tubers), skin (Ash leaf macules, Shagreen patch, skin tags), retina and various other organs. It manifests usually in childhood with seizures and mental retardation. Presentation with classical features favours easy and early diagnosis. However, it is a disease of variable expression with a broad range of clinical phenotypes. Incomplete forms (forme fruste) with atypical presentation can occur leading to missed or late diagnosis. We report a middle aged male patient who presented with new onset seizures. The characteristic skin lesions and MRI picture led to a diagnosis of tuberous sclerosis. Absence of common associations such as mental retardation and renal involvement were other features.

Reducing energy consumption in multiprocessor systems-on-chip (MPSoCs) where communication happens via the network-on-chip (NoC) approach calls for multiple voltage/frequency island (VFI)-based designs. In turn, such multi-VFI architectures need efficient, robust, and accurate runtime control mechanisms that can exploit the workload characteristics in order to save power. Despite being tractable, the linear control models for power management cannot capture some important workload characteristics (e.g., fractality, nonstationarity) observed in heterogeneous NoCs; if ignored, such characteristics lead to inefficient communication and resources allocation, as well as high power dissipation in MPSoCs. To mitigate such limitations, we propose a new paradigm shift from power optimization based on linear models to control approaches based on fractal-state equations. As such, our approach is the first to propose a controller for fractal workloads with precise constraints on state and control variables and specific time bounds. Our results show that significant power savings can be achieved at runtime while running a variety of benchmark applications.

Background:Data from Clostridium difficileinfection (CDI) in neutropenic patients are still scarce. Objective:To assess outcomes of CDI in patients with and without neutropenia. Methods:The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results:Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P= .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P< .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P= .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions:Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding:NoneDisclosures:None

In this work, we have demonstrated the refractive index (RI) based sensing of Escherichia Coli (E-Coli) by introducing a novel plus shaped cavity in optical fiber. This plus-shaped cavity increases the interaction between the signal and the analytes, that improves the sensitivity. The proposed sensor model is achieved by combining the lateral and vertical slots in optical fiber core structure. The sensing ability of the plus shaped cavity has been examined in visible range, where the RI of E-Coli ranges from 1.38 to 1.395. The numerical investigation of sensor structure has been done by employing the finite difference time domain (FDTD) method. The geometrical analysis of plus shaped cavity indicates that; the maximum output power is achieved at the slot width of 600 nm. The proposed cavity is capable of sensing the presence of E-Coli with the autocorrelation function and sensitivity of 99.54 % and 2125 nm/RIU, respectively.

Energy is a basic requirement for development in the world. The continuously rising demand for energy resources and the fast depletion of fossil fuel is raises researcher's concern to focus on alternative sources of energy that can replace the shortage of fossil fuels soon. Biodiesel is recognized as one of the potential alternative renewable energy fuels that can be easily available in a wide range in every part of the world. This paper reviews biodiesel's prospect and focuses on the different fuel properties (physicochemical) of 100 biodiesels from first-, second- and third-generation followed by the evaluation of CI engine characteristics. It has been observed that the fuel properties of first-, second- and third-generation biodiesel are compatible with the ASTM standards. The present paper discussed the potential of various generations of biodiesel feedstocks from production perspectives. This paper also examined many aspects of these feedstocks which include different biodiesel feedstock sources, biodiesel conversion technology, and second-generation biodiesel performance and emission characteristics. Most of the studies showed that biodiesel derived from plant feedstock is costly than diesel. Thus, more influence is to be given to non-edible sources. However, the engine characteristics are shown promising behavior with biodiesel and a slight increase in NOXis also reported on using various biodiesel.

Background: Ovarian toxicity is a dreaded complication of cyclophosphamide (CYC). With the use of lower cumulative doses of intravenous CYC (modified NIH regimens) and availability of better markers of ovarian toxicity, the incidence of ovarian dysfunction needs reassessment. Lupus disease activity, by itself, is also believed to affect ovarian function negatively. Methods: This single-centre prospective cohort study recruited 50 female patients of severe lupus aged 18–40 years. Twenty-five patients each received induction with either monthly intravenous CYC (0.5–0.75 g/m2) for 6–9 months or daily oral mycophenolate mofetil (MMF). Details of menstrual irregularities; serum levels of FSH, LH, estradiol, AMH, and inhibin B; and sonographic assessment of ovarian volume and antral follicular count were done at baseline and 6 months after treatment. Amenorrhoeic patients were re-evaluated at 1 year. Results: Mean (SD) age of subjects in the CYC and MMF groups was 31.4 (6.3) and 28.4 (4.4) years, respectively. Mean (SD) SLEDAI at the initiation of therapy was 7.2 (2.5) in the CYC group and 5.8 (3.4) in the MMF group. The mean cumulative dose of CYC used was 4.6 (1.8) g. Three patients in the CYC group (versus none in MMF) had amenorrhoea at 6 months—two of these regained menses within 6 months, while only one (4%) developed sustained amenorrhoea (lasting more than 12 months) at 41 years of age, likely menopause. Serum FSH levels increased (p= 0.03), while AMH (p= 0.002) and inhibin B (p&lt; 0.001) levels decreased significantly with 6 months of CYC therapy. Ovarian volume also reduced significantly (p= 0.005) with 6 months of CYC therapy, while antral follicular count reduced numerically (p= 0.32). Levels of AMH, inhibin-B, estradiol, ovarian volume, and antral follicular count after 6 months therapy were significantly lesser in the CYC group compared to the MMF group, despite being similar before the start of therapy. Conclusions: Ovarian dysfunction with monthly intravenous CYC (modified NIH regimen) was predominantly subclinical, with a negative effect on ovarian reserve. No premature ovarian failure was noted at 1 year. No ovarian dysfunction occurred in the MMF group, despite having patients with severe background lupus. Use of intravenous CYC for induction may thus not be restricted in young lupus females with incomplete families for fear of gonadotoxicity, especially in life- or organ-threatening situations, where the benefits outweigh this subclinical risk.