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Quality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India. The C-QIP is a clinic-based, open randomized trial of a multicomponent intervention vs usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained nonphysician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (ie, dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines. We recruited 410 socio-demographically diverse patients with CVD from 4 hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure. This study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings. Clinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659. [Display omitted] [ABSTRACT FROM AUTHOR]

The frequency of potholes and speed bumps on the roads has linearly increased due to ageing, inadequate maintenance, and a growth in the number of vehicles. We have discussed a prototype for the identification of potholes and speed bumps in order to guarantee safe mobility. Such critical road quality data may be made public or shared with local governments and other government agencies for the purpose of corrective action and road maintenance. A pothole detection system using image processing and cloud storage can be used to detect potholes from footage provided by a device, store the information into a cloud database, and analyze the data to identify areas that need repair. The system can also send alerts to users about upcoming potholes and notify road maintenance authorities of new pothole detections. In brief, the system uses image processing to detect potholes and cloud storage to store and analyze the data. It can also send alerts to users and road maintenance authorities. The model was built using YOLOv5 and trained on 70% of the dataset images. It was able to detect potholes with good accuracy in the output images. [ABSTRACT FROM AUTHOR]

The growing significance of online reviews in e-commerce platforms has a profound impact on consumers' purchase decisions. Unfortunately, dishonest sellers exploit this system by engaging in deceptive practices and manipulating reviews. These fake reviews are very hard to be detected by humans. Hence, the issue of detecting fake online reviews has gained significant attention due to their prevalence. Typically, the datasets available have much higher number of real reviews as compared to fake reviews, which leads to data imbalance problem. Machine learning algorithms struggle to learn from these datasets and give biased results. However, existing studies on this topic have not adequately addressed the challenges posed by imbalanced data. They have mostly used under-sampling or over-sampling to handle imbalance in datasets, which leads to potential information loss or overfitting due to replication. Hence, to handle this class imbalance problem without using sampling techniques, this paper proposes a novel SBiLM model using Siamese Neural Network with Bidirectional LSTM and Manhattan Distance. SBiLM takes pair of reviews as inputs and computes similarity between them using distance metric. The outcomes indicate that the SBiLM model exhibits better performance in terms of both accuracy and loss, when compared with traditional deep learning models on a highly imbalanced restaurant review dataset. This presents a promising strategy for tackling the issues related to data imbalance in the domain of fake review detection. [ABSTRACT FROM AUTHOR]

Cardiometabolic risk factors diabetes, obesity, and hypertension are highly prevalent and contribute to increased cardiovascular disease (CVD). Endothelial dysfunction precedes CVD development. The current study aimed to investigate the EC transcriptome among individuals with varying degree of cardiometabolic risk. Adult participants without CVD and various degrees of cardiometabolic risk factor burden (hypertension, diabetes, obesity) were included. Participants underwent brachial vein EC harvesting followed by RNA sequencing. To evaluate the association between cardiometabolic comorbidity burden and outcome transcripts we performed linear regression with multivariable models, adjusting for age, sex, and race/ethnicity. A total of 18 individuals were included in the present analysis (mean age 47 ± 14, 44% female, and 61% White adults). Endothelial cell RNA sequencing revealed 588 differentially expressed transcripts (p-adj <0.05) with excellent discrimination in unsupervised hierarchical clustering analysis. Gene ontology enrichment analysis revealed upregulated pathways associated with T-cell activation (NES = 2.22, p<0.001), leukocyte differentiation (NES= 2.16, p<0.001), leukocyte migration (NES= 2.12, p<0.001), regulation of cell-cell adhesion (NES= 1.91, p=0.006). Downregulated pathways of interest included endothelial cell proliferation (NES= -1.68, p=0.03) and response to interleukin-1 (NES= -1.61, p=0.04). Upregulated genes included VCAM1, CEACAM1, ADAM 17, and CD99L2, all with a log-2-fold change >3 and p-adj <0.05. These genes demonstrated a graded increase in mean normalized counts with increasing number of risk factors. We demonstrate a proinflammatory and pro-adhesive EC transcriptome associated with increased cardiometabolic risk factor burden offering insight into a potential mechanism linking these risk factors with the development of CVD. [ABSTRACT FROM AUTHOR]

Hereditary angioedema (HAE) due to C1-inhibitor deficiency or dysfunction is a rare genetic disorder that causes recurrent episodes of swelling in various parts of the body. Treatment goals of HAE aim to "normalize" life for all patients; however, lack of diagnostic facilities and limited access to effective treatment options in developing nations cause delays in diagnosis and place a significant burden on patients. In this review, we aim to highlight the burden of disease caused by C1-inhibitor HAE across the Asia-Pacific region, considering its epidemiology, morbidity and mortality, and socioeconomic and psychological impact. We also review the availability of guideline-recommended diagnostic facilities and treatments, and how patients are currently managed. Data were collected from published literature and HAE experts in the region, who provided information regarding diagnosis and management in their countries. Current practice was reviewed against international guidelines, as well as local guidelines/consensus used in Australia, Japan, and China. Suggestions are provided for improving the time to diagnosis in the region, increasing access to guideline-recommended treatments, and providing support to reduce the burden on patients and caregivers. There is an urgent need to improve HAE services and provide access to life-saving treatment in developing countries, and efforts should be made to increase awareness of guideline recommendations in high-income economies that do not currently provide long-term prophylactic treatments. [ABSTRACT FROM AUTHOR]

Based on the current guidelines in practice, a vast majority of the healthy Indian population is vitamin D deficient. Since the serum 25 hydroxycholecalciferol (25HCC) levels are affected by race and skin pigmentation, the normal range of vitamin D may differ in the Indians compared to the Western population. This study attempted to determine a population-specific threshold for 25 HCC levels associated with adequate bone health and calcium and phosphate homeostasis in healthy Indians. Subjects aged 20–50 years were included in the study. The exclusion criteria were obesity, chronic renal disease, liver failure, diabetes mellitus, thyroid disorders, a recent history of fracture, constant joint pain, and postmenopausal status. In addition, participants on prescribed medication such as glucocorticoids, anticonvulsants, or antifungals, as well as vitamin D and calcium supplementation, were also excluded. Blood samples were analyzed for serum calcium, phosphate, alkaline phosphatase, 25HCC, 1,25dihydroxycholecalciferol, parathyroid hormone (PTH), procollagen type-I N propeptide, and C-terminal telopeptide of type 1 collagen. Locally estimated smoothing scatter plot (LOESS) curves and Spearman correlation were utilized to study the correlation of all the biochemical parameters with 25 HCC to achieve thresholds. The study consisted of 270 healthy participants, out of which 97.8% were found to have vitamin D levels below 30 ng/ml. In addition, 8.8% had raised PTH, and 1.85% had hypocalcemia. Furthermore, 1.48% had raised serum alkaline phosphatase and hypophosphatemia, respectively. A weak inverse correlation was seen between 25 HCC and PTH (r s = −0.437, p < 0.001), as well as alkaline phosphatase (r s = −0.1475, p = 0.015), while a weak positive correlation was seen with serum phosphate (r s = 0.128, p = 0.047). For a healthy Indian population, the reference range of 25 HCC is much lower, and the lower limit of normal is approximately 13.5 ng/ml. This study indicates that vitamin D insufficiency in this population starts at 25 HCC values of 13.5 ng/ml and deficiency at 7 ng/ml. [ABSTRACT FROM AUTHOR]

Piglet diarrhoea is a multifactorial disease with serious implications for the swine industry worldwide, including India. The Escherichia coli (E. coli) pathotypes, i.e., enterotoxigenic E. coli (ETEC) and Shiga toxin-producing E. coli (STEC) are among the major bacterial agents attributed as causative agent for piglet diarrhoea, but studies related to genetic diversity, antibiogram profile and their correlation with risk factors of these pathogens are sparse. A total of 104 faecal swab samples were collected from 32 different piggery units of Haryana, India and confirmed as E. coli by standard microbiological methods. The identified E. coli were characterized as ETEC and/or STEC using PCR assays and were studied for their genetic diversity by phylogenetic analysis of the sequences. All the isolates were subjected to antimicrobial susceptibility testing. Further, the correlation of variables with presence or absence of ETEC and/or STEC was also investigated by using Fisher's exact test. Microbiological isolation led to identification of 208 E. coli isolates. A total of 17.3% (31/208) isolates were characterized as ETEC and 4.8% (10/208) isolates as STEC, whereas 2.4% (5/208) isolates exhibited both ETEC and STEC pathotype. Of the total studied piggery units (n = 32), ETEC were isolated from fourteen and both ETEC and STEC from eight farms. The phylogenetic analysis of Stx 2 gene revealed 100% homology with Stx 2eA variant from Germany, while analysis of ST II gene revealed a distinct nucleotide and amino acid substitution when compared with standard strains. The antibiotic susceptibility testing revealed maximum resistance to moxifloxacin (71.9%) followed by tetracycline (58.1%) and amoxicillin with a total of 41.8% (87/208) E. coli isolates designated as multi-drug resistant (MDR). The multiple antibiotic resistance index varied from 0.05 to 0.75. The statistical analysis suggested three factors viz., number of farm worker(s), frequency of using disinfectant for floor cleaning and use of antibiotic in feed as risk factors significantly associated (p < 0.05) with ETEC associated diarrhoea at piggeries under study. Current study warrants a need for systematic studies on the ETEC/STEC associated diarrhea and antibiotic resistance among these isolates to understand the mechanisms of origin and dissemination of drug resistant pathogens and to design suitable prevention and control measures to curb emergence of antibiotic resistance in the farm settings. [ABSTRACT FROM AUTHOR]

• Benzodiazepines terminated status epilepticus in 72% of cases. • There was a positive correlation between time to benzodiazepine and seizure cessation. • There was a positive correlation between time to benzodiazepine and respiratory complications. • Median time to seizure cessation was longer with an insufficient dose. • The commonest second-line anti-seizure medication was levetiracetam. We investigated the management and outcome of early and established status epilepticus including timing, dosing and selection of benzodiazepines along with the timing and efficacy of second line treatments. Retrospective single tertiary centre observational cohort study to identify all cases of SE between January 2019 and February 2022. 252 cases were identified. Seizures terminated spontaneously in 136 (54%) cases. 116 (46%) were given benzodiazepines, of which 29 (25%) were given at least one benzodiazepine by family/carers, and 72 (62.1%) received benzodiazepines by ambulance services. Benzodiazepines terminated seizures in 83 (71.6%) cases. The commonest benzodiazepine used was buccal midazolam (35.5%). Median time to first benzodiazepine was 14.5 (6–27) minutes. There was a positive correlation between time to first benzodiazepine and time to seizure cessation, progression to second- and third-line treatment, and respiratory complications (p <0.05). 73 (62.9%) cases received a correct benzodiazepine dose. Benzodiazepine underdosing was associated with longer seizure duration (p <0.05). 33 (28.4%) cases progressed to second-line treatment where mean time to treatment was 59.4 min (±32.3 min). The commonest second-line treatment was Levetiracetam (53.8%), followed by Phenytoin (43.6%) with SE termination in 57.5% cases. 14 (12.1%) cases progressed to third-line treatment; mean time to treatment was 60.6 min (±22.24 min). Respiratory complications occurred in 17 (6.75%) cases; none due to benzodiazepines. There were two deaths in refractory SE. Early administration of benzodiazepines and optimal dosing is associated with a higher rate of SE termination. Levetiracetam was the most commonly used second line treatment. [ABSTRACT FROM AUTHOR]

Similarities in initial presentations of temporomandibular joint (TMJ) involvement from juvenile idiopathic arthritis (JIA), idiopathic condylar resorption, and other forms of progressive TMJ destruction in children create diagnostic confusion. Treatment pathways, however, depend on determination of etiology. The purpose of this study was to compare TMJ magnetic resonance images (MRIs) of patients with joint degeneration localized to the TMJs to those with JIA and TMJ involvement. This is a retrospective cross-sectional study including subjects younger than 18 years that presented from February 2008 to October 2019 with clinical TMJ degeneration, a gadolinium-enhanced TMJ MRI and a negative pediatric rheumatologic workup (non-JIA group), and a series of age and sex-matched subjects with TMJ degeneration on gadolinium-enhanced MRI and JIA (JIA group). MRIs were evaluated in a blinded fashion by 1 pediatric radiologist. The primary outcome variable was the radiologist's accuracy in predicting study grouping, assessed in 1 randomly-selected joint per patient. Secondary outcome variables included MRI characteristics of inflammation, osseous damage and articular disc morphology. Independent samples t-tests, sensitivity/specificity, Fisher's exact and Mann-Whitney tests were computed as applicable, and P <.05 was considered significant. The sample included 34 subjects: 16 non-JIA (75% female, age 13.9 ± 2.8 years) and 18 JIA (77% female, age 13.6 ± 2.8 years) (P ≥.738). The radiologist correctly classified 64.7% of subjects as non-JIA or JIA (P =.078, sensitivity = 94.4%, specificity = 31.3%). Inflammatory and osseous findings were similar between groups (P ≥.073). The disc was anteriorly displaced in 9 non-JIA and 0 JIA joints (P <.001, sensitivity = 100%, specificity = 100%) and flattened in 3 non-JIA and 14 JIA joints (P =.006, sensitivity = 38.9%, specificity = 90.6%). Inflammatory and osseous findings on gadolinium-enhanced TMJ MRIs are insufficient to determine the etiology of progressive TMJ destruction. Disc characteristics, however, significantly differ between JIA and non-JIA etiologies and may be important in differentiating these conditions. [ABSTRACT FROM AUTHOR]

Difficult airway teams (DATs) are typically present to assist intubation at the initial mandibular distraction osteogenesis (MDO) operation for infants with Robin sequence (RS). In some institutions, the RS diagnosis triggers a "difficult airway" label for the infant, requiring DAT presence for future operations. By the time of distractor removal, however, breathing and airway anatomy are significantly improved. The objective of this study was to measure intubation difficulty and perioperative respiratory complications at MDO device removal as a proxy for the necessity for coordination with a DAT. This is a retrospective study including infants with RS from 2013 to 2021 who had MDO during infancy. Patients were excluded if they had a tracheostomy or MDO device failure. Predictor variables included demographic data, comorbidities, and apnea-hypopnea indices (AHIs) from pre- and immediate post-MDO polysomnograms. The primary outcome measures were number of intubation attempts, laryngoscopy grade, and perioperative respiratory events at the distractor removal operation. Descriptive statistics were computed including Fisher's exact, paired sample t-tests, and Wilcoxon rank tests, and P <.05 was considered statistically significant. The sample included 47 (60% male) patients with a mean age at MDO of 12.0 ± 15.7 weeks. Significant improvement in AHI was seen after MDO (pre-MDO: 26.8 ± 18.4 events/hour; post-MDO 2.78 ± 2.66 events/hour; P <.001). Average number of intubation attempts decreased from 2.09 ± 1.36 to 1.30 ± 0.75 (P <.001) and the most common post-MDO laryngoscopy grade was 1 (69%). There were no intraoperative and 2 (4%) minor postoperative respiratory events, both in patients with repaired congenital cardiac disease and not related to traumatic intubation. Neither difficult intubations nor perioperative respiratory events associated with intubation trauma were seen at distractor removal, suggesting that specialty airway assistance is not routinely needed after successful MDO. DAT presence should be determined on a case-by-case basis based on specific patient risk factors. [ABSTRACT FROM AUTHOR]

Prenatal diagnosis of craniofacial anomalies has improved family education and preparedness. Isolated cleft palate, however, remains difficult to identify sonographically. The aim of this study was to investigate the rate of incidental cleft palate identified on fetal magnetic resonance imaging (MRI) following the ultrasound detection of non-cleft abnormalities. This was a retrospective study of pregnant women who had fetal MRI performed between 2003 and 2017. To be included, the woman had to have been referred for fetal imaging for a non-cleft indication, with subsequent identification of an isolated cleft palate on MRI. Fetuses with a postnatal diagnosis of Robin sequence were excluded. The study sample included 30 women. Mean gestational age at MRI was 24 weeks 4 days± 38 days. Most referrals (76.7%) were for non-cleft craniofacial anomalies, of which micrognathia was the most common (63.3%). The annual incidence of occult cleft palate diagnosis was 0.4%, and a genetic syndrome was suspected based on imaging findings in 76.7%. Although rare, isolated cleft palate found incidentally on fetal imaging led to concern for a genetic syndrome in a high percentage of cases. This suggests that early referral for fetal MRI may provide critical information when sonographic fetal anomalies have been identified. [ABSTRACT FROM AUTHOR]

Security of the data is of utmost importance, whenever the data flows on the network. In the current times and t[i]mes to come, cyber security is going to occupy the center stage in the lifecycle of any software. Security is an evergreen and everlasting area, because of the continuous threat from Hackers and Crackers. The proposed work focuses on the protection of the data in the area of Social Network. It has been achieved by the design and development of a new encryption technique called as PentaPlicative Cipher Technique. The PentaPlicative Cipher Technique makes use of multiple keys such as Latitude, Longitude, IP Address and MAC Address of node et al. to securely encrypt the message that needs to be transmitted through a non-secure channel. The paper concludes with an effective comparison in terms of space and time Complexity between Triplicative and PentaPlicative Cipher Technique. [ABSTRACT FROM AUTHOR]

Background: Robin sequence (RS) is a triad of micrognathia, glossoptosis, and airway obstruction. Prenatal diagnosis of RS improves delivery planning and postnatal care, but the process for prenatal diagnosis has not been refined. The purpose of this study was to determine if dynamic cine magnetic resonance imaging (MRI) can improve the reliability of prenatal diagnosis for RS compared to current static imaging techniques.Materials and Methods: This is a retrospective cross-sectional study including fetuses with prenatal MRIs obtained in a single center from January 2014 to November 2019. Fetuses were included if they: 1) had a prenatal MRI with cine dynamic sequences of adequate quality, 2) were live born, and 3) had postnatal craniofacial evaluation to confirm RS. Patients without postnatal confirmation of their prenatal findings were excluded. The primary predictor variable was imaging type (cine or static MRI). Outcome variables were tongue and airway measurements: 1) tongue height, 2) length and width, 3) tongue shape index, 4) observation of tongue touching the posterior pharyngeal wall, and 5) measurement of oropharyngeal space. All measurements were made independently on the cine images and on static MRI sequences for the same cohort of subjects by a pediatric radiologist. Data were analyzed using paired samples t tests and Fisher exact tests, and significance was set as P < .05.Results: A total of 11 patients with RS were included in the study. The smallest airway space consistently demonstrated complete collapse on the cine series compared to partial collapse on static images (0 mm vs 1.7 ± 1.4 mm, P = .002). No other imaging variable was statistically significantly different between techniques.Conclusions: Cine imaging sequences on prenatal MRI were superior to static images in discerning complete collapse of the smallest airway space, an important marker of RS. This suggests a possible benefit to adding dynamic MRI evaluation for prenatal diagnosis of this condition. [ABSTRACT FROM AUTHOR]

Background and Aims: Diabetes is a chronic metabolic condition characterized by hyperglycemia and is associated with several complications. Prevalence of Diabetes in adult population in India ranges from 10.9 to 14.2% in urban area and 3.0-7.8% in rural area. Glycemic control is an important factor in preventing the complications associated with diabetes. HBA1c is the indicator of long-term glycemic control and slight variation in it significantly alters the risk of diabetic complications. Thus, the aim of this study was to study the change in HBA1c levels due to lock down in patients with diabetes.Methods: 307 patients with diabetes who had attended our endocrine OPD in last 3 months before nationwide 68 days lockdown from 24 March 2020 to 31 May 2020, and had recent HBA1c report in past and willing to participate were included in the study after informed consent from 2nd June 2020 to 14th June 2020 when first phase of Unlock started, to identify the change in HBA1c levels during the lockdown period in our patients with diabetes.Results: The patients were aged between 25-69 years and male to female ratio was 181:126 (1.44: 1). The mean age and mean duration of diabetes in our patients was 55.68 years and 7.95 years respectively. Increment of 0.51% was seen in mean HBA1c levels in our patient from 7.92% mean pre-lockdown HBA1c to mean of 8.43% after release of lock down.Conclusion: Glycemic control got deranged during lockdown period with significant increase of mean HBA1c by 0.51% in immediate post lock down period which may significantly increase the annual incidence of complications related to diabetes. [ABSTRACT FROM AUTHOR]

[Display omitted] Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, may occur only once or be recurrent, may exhibit wheals or not, and may be due to mast cell mediators, bradykinin, or other mechanisms. Several different taxonomic systems are currently used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize AE treatment. We developed a consensus on the definition, acronyms, nomenclature, and classification of AE (DANCE). The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific and medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022). The DANCE initiative resulted in an international consensus on the definition, classification, and terminology of AE. The new consensus classification features 5 types and endotypes of AE and a harmonized vocabulary of abbreviations/acronyms. The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic assessment and treatment of AE. DANCE does not replace current clinical guidelines, and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by physicians using sound clinical judgment. We anticipate that this new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care. [ABSTRACT FROM AUTHOR]

This paper investigates the applicability of the Just Transition Transaction (JTT), initially developed as a financial mechanism for South Africa's energy transition, to Southeast Asian (SEA) countries, including Indonesia, Vietnam, and the Philippines, which heavily rely on coal. Utilizing South Africa as a reference case study, we deconstruct the JTT and develop a novel framework of necessary and conducive features for evaluating its suitability for supporting a just energy transition in SEA. Our findings suggest that the JTT is well-suited for Indonesia and Vietnam but not as well suited for the Philippines. Recommendations for specific research avenues in estimating baselines and aligning emissions trajectories are provided. Finally, we propose a tiered JTT model to encourage a supranational transition in SEA and suggest the potential application of our methods for assessing similar mechanisms in other coal-reliant developing countries. • Use South Africa as Case Study to investigate JTT transition finance mechanism • Develop framework of necessary and conducive features of JTT • Use this framework to evaluate JTT's suitability for energy transition in SEA • JTT suitable for Indonesia and Vietnam, not as suitable for Philippines • Tiered JTT a suitable model to encourage transition at supranational level in SEA [ABSTRACT FROM AUTHOR]

Deliberate self-poisoning (DSP) is one of the leading causes of mortality and morbidity, with rodenticides being common compounds used by many victims. However, comprehensive data regarding the spectrum and outcome of rodenticide poisoning is scant. This retrospective study was conducted in the Emergency Department (ED) of a large tertiary care hospital in South India between January 2017 and December 2018. All patients with deliberate consumption of rodenticides were included in the analysis. During the study period, 1802 patients presented with DSP, among which 145 (8%) consumed rodenticide compounds. The mean (SD) age was 27.9 (10.7) years. Young adults (16–30 years) comprised 73% (106/145) of the study population. The majority (87%) were triaged as priority 2, while 10% were triaged as priority 1. Common rodenticide compounds consumed were yellow phosphorous (57%: 82/145), coumarins (12%: 17/145), zinc phosphide (19%: 27/145), and aluminum phosphide (1%: 1/145). A significant proportion of patients (18.6%) were under the influence of alcohol. Among the 73 males, 25 (34.2%) gave a history of co-consumption of alcohol. There was a history of previous DSP attempts in 6%. The majority (68%) of the patients were discharged alive from the hospital, and the in-hospital mortality rate was 9%. Age >30 years (adjusted OR: 2.2; 95% CI: 1.00–5.05; p value: 0.04) was an independent predictor of poor outcome. Rodenticide compound consumption for DSP is prevalent in young adults and is associated with significant mortality, especially with yellow phosphorous poisoning. The current trend in our country of the increasing use of highly fatal phosphorous compounds over the innocuous coumarin derivatives is a cause of grave concern. [ABSTRACT FROM AUTHOR]

Web Navigation Prediction is a popular area of research as users on the web are continuously growing. Capturing users' behavior provides insights about the user demands, accessibility patterns, and inconsistencies in the website design. Several navigation models have been developed in the past. Most of the models rely upon fixed threshold mechanism for prediction, which is inadequate as they require multiple computational steps which not necessarily give the best possible value. To combat this issue, we propose two models based on dynamic thresholds: All-Kth Modified Markov Model based on Geometric threshold (KMMM G) and (b) All-Kth Modified Markov Model based on Branching Factor Threshold (KMMM BF). Our experiments show that longer navigations are rare and are highly co-related. However, smaller navigations are more and are less co-related. Dynamic threshold models produce more optimum predictions as compare to fixed threshold models. KMMM B F performs the best and achieves the highest prediction accuracy, 78.53%, 91.32%, and 61.37% on CTI, MSWEB, and BMS dataset, respectively. [ABSTRACT FROM AUTHOR]

An efficient synthesis of water-stable and fluorescent ZnS quantum dots has been executed beginning with its organic predecessor possessing fluorenone for sensing bovine serum albumin (BSA) among other proteins. Moreover, the organic predecessor of quantum dots has also been utilized for sensing of F- ions with binding constant of 1.8 × 104 M−1. Various spectroscopic techniques such as high-resolution transmission electron microscopy (HRTEM), powder X-ray diffraction (PXRD), UV-visible (UV-vis), Fourier transform infrared (FTIR), thermogravimetric (TGA), Energy dispersive X-ray analysis (EDX), circular dichroism (CD) and Fluorescence (FL) spectroscopy have been utilized for the characterization of the developed quantum dots. The emission properties of quantum dots made them useful for the sensing of BSA and Cu2+ accompanied with secondary sensing of urea. The LODs value for BSA and Cu2+ were calculated as 213 and 211 nM, respectively. Demonstrating remarkable efficacy, these quantum dots have been successfully employed for the discernment of BSA in human blood and urine samples, achieving an outstanding recovery rate of up to 99.8%. • Synthesis of fluorescent, water-stable ZnS quantum dots for sensing of BSA and Cu2+ along with secondary sensing of urea. • Characterization of the developed quantum dots by HRTEM, PXRD, UV-vis, FTIR, TGA, EDX, CD and Fluorescence spectroscopy. • Organic predecessor of quantum dots for sensing of F- ions. • Successful detection of BSA in human blood and urine samples with good recovery. [ABSTRACT FROM AUTHOR]

While endovascular thrombectomy (EVT) is beneficial for patients with acute large vessel occlusion ischemic strokes, a significant portion of patients still do poorly despite successful recanalization. Identifying patients at high risk for poor outcomes can be helpful for future clinical trial design and optimizing acute stroke triage. Consecutive EVT patients were identified from 2016 to 2021 at a Comprehensive Stroke Center, and clinical information was recorded. Poor outcome was defined as a 90-day modified Rankin Scale (mRS) of 4 or greater despite achieving a modified thrombolysis in cerebral infarction (mTICI) score of 2b or greater. Multivariable regression analyses were used to identify risk factors for poor outcomes, and a scoring system was constructed. 483 patients with successful recanalization were identified. From a randomly selected training cohort (n = 357), the 10-point BAND score was constructed from independent risk factors for poor outcomes: baseline disability (1 point: baseline mRS ≥ 2), age (1 point: 60–69 years, 2 points: 70–79 years, 3 points: 80–84 years, 4 points: 85 years or older), NIHSS (2 points: 13–17, 3 points: 18–22, and 4 points: ≥ 23), and delay from last known normal (1 point: ≥ 6 h). The BAND score was significantly associated with rates of poor outcomes (p < 0.001), and it achieved an area under the receiver-operating characteristic curve (AUC) of 0.80 (95 %CI 0.76–0.85) in our training cohort and 0.78 (95 %CI 0.70–0.86) in our validation cohort (n = 126). Overall, the BAND score had a significantly higher AUC value than the widely validated THRIVE score and the THRIVE-EVT calculation (p = 0.001 and 0.029, respectively). Among patients with high BAND scores (7 or higher), 88.2 % had poor outcomes. The BAND score is a simple tool to predict poor outcomes despite successful recanalization. Future studies are needed to confirm the BAND score's external validity. [ABSTRACT FROM AUTHOR]

Explore how pediatric residents perceive the impact of a curriculum addressing racism on their knowledge, motivation, skills and behaviors, and investigate the contextual factors that promote or impede the curriculum's effectiveness. Open-ended, semistructured interviews were conducted at 2 academic medical centers between August 2019 and 2020 among pediatric residents who participated in the curriculum. Interviews were recorded, transcribed, and analyzed by using inductive content analysis. Pediatric residents (n = 16) were predominantly white (66.7%), female (86.7%) interns (60%) from the Midwest (40%). Six major themes emerged describing the perceived impact of the curriculum on: knowledge – (1) Understanding of race and racism as structural forces in a historical context; motivation – (2) Owning the issue of racism, (3) Having the curriculum makes a statement; skills – (4) Critical self-reflection, (5) Perceived development of skills to mitigate biases; and action-planning – (6) Turning insight into strategies to combat racism and improve patient care. Two additional themes emerged describing contextual factors that promoted or impeded the curriculum such as the content of the curriculum itself, the racial demographics of the participants, the implementation infrastructure and environmental factors such as the culture of the training program. Medical education addressing racism can facilitate the perceived acquisition of foundational knowledge regarding race and racism; motivation and skill-building to combat racism; and action planning aimed at improving patient care. Contextual factors should be considered when developing and implementing such curricula to not only promote racial equity but avoid unintended harms. [ABSTRACT FROM AUTHOR]

Rational and Objectives: Radiology has one of the lowest female representation rates in medicine and recruiting female residents is a challenge for some residency programs. There is limited understanding of gender differences among residency applicants during program selection. The study objective is to investigate which program factors were considered most important by radiology residency applicants and to assess for differences by gender, race and ethnicity.Materials and Methods: An anonymous survey was distributed electronically to diagnostic and interventional radiology residency programs in the US and Canada via the Association of Program Coordinators in Radiology (APCR). Residents were asked to evaluate the importance of 30 factors during evaluation of residency programs using a 5-point Likert scale (1 = not important, 5 = extremely important).Results: 370 residents and 1 fellow completed the survey. Of the respondents, 269 were male (72.5%) and 101 were female (27.2%). The most important factors to respondents during program selection were program culture (4.42), geographic location (4.17), fellowship placement (4.14), and imaging and/or procedure volume (3.98). There was a significant difference between male and female respondents in the importance of program culture (p = 0.002), composition of current residents (p = 0.007), percentage of current female residents (p < 0.0001), program size (p = 0.047), call schedule (p = 0.025), percentage of female faculty (p < 0.0001), faculty ethnic and racial diversity (p < 0.0001), resident ethnic and racial diversity (p < 0.0001), which female respondents ranked more highly.Conclusion: Applicants consider many factors during residency program selection. Program culture, geographic location, fellowship placement and imaging and/or procedural volume were most important. There were significant differences by gender, race and ethnicity in importance of several factors. [ABSTRACT FROM AUTHOR]

The concept of gap junctions and their role in intercellular communication has been known for around 50 years. Considerable progress has been made in understanding the fundamental biology of connexins in mediating gap junction intercellular communication (GJIC) and their role in various cellular processes including pathological conditions. However, this understanding has not led to development of advanced therapeutics utilizing GJIC. Inadequacies in strategies that target specific connexin protein in the affected tissue, with minimal or no collateral damage, are the primary reason for the lack of development of efficient therapeutic models. Herein, nanotechnology has a role to play, giving plenty of scope to circumvent these problems and develop more efficient connexin based therapeutics. AsODN, antisense oligodeoxynucleotides; BMPs, bone morphogenetic proteins; BMSCs, bone marrow stem cells; BG, bioglass; Cx, Connexin; CxRE, connexin-responsive elements; CoCr NPs, cobalt-chromium nanoparticles; cGAMP, cyclic guanosine monophosphate-adenosine monophosphate; cAMP, cyclic adenosine monophosphate; ERK1/2, extracellular signal-regulated kinase 1/2; EMT, epithelial-mesenchymal transition; EPA, eicosapentaenoic acids; FGFR1, fibroblast growth factor receptor 1; FRAP, fluorescence recovery after photobleaching; 5-FU, 5-fluorouracil; GJ, gap junction; GJIC, gap junctional intercellular communication; HGPRTase, hypoxanthine phosphoribosyltransferase; HSV-TK, herpes virus thymidine kinase; HSA, human serum albumin; HA, hyaluronic acid; HDAC, histone deacetylase; IRI, ischemia reperfusion injury; IL-6, interleukin-6; IL-8, interleukin-8; IONPs, iron-oxide nanoparticles; JNK, c-Jun N-terminal kinase; LAMP, local activation of molecular fluorescent probe; MSCs, mesenchymal stem cells; MMP, matrix metalloproteinase; MI, myocardial infarction; MAPK, mitogen-activated protein kinase; NF-κB, nuclear factor kappa B; NO, nitric oxide; PKC, protein kinase C; QDs, quantum dots; ROI, region of interest; RGO, reduced graphene oxide; siRNA, small interfering RNA; TGF-β1, transforming growth factor-β1; TNF-α, tumor necrosis factor-α; UCN, upconversion nanoparticles; VEGF, vascular endothelial growth factor. In this review, we discuss briefly the role of connexins and gap junctions in various physiological and pathological processes, with special emphasis on cancer. We further discuss the application of nanotechnology and tissue engineering in developing treatments for various connexin based disorders. [ABSTRACT FROM AUTHOR]

There is a paucity of studies investigating relationship between psychological distress and effectiveness of epidural steroid injection in patients with chronic lower back pain (CLBP). This prospective cohort study assessed whether the outcome can be predicted in CLBP patients undergoing epidural injection by pre-treatment psychological stress stratification using objective screening methods. 96 patients with CLBP were recruited to this prospective cohort study. Preoperative level of psychological distress was measured using Modified Zung Index (MZI) and Modified Somatic Perception Questionnaire (MSPQ); pain with Visual Analogue Score (VAS) and McGill Pain Questionnaire (MPQ) and back pain related disability with Oswestry Disability Index (ODI). Fluoroscopic caudal epidural steroid injection comprising 80 mg methylprednisolone and 8 mg of lignocaine was performed. Scores were repeated at 6, 12, and 26 weeks. Successful outcome was Minimal Clinically Important Change (MCIC) in any given measure. There were 60 (62.5%) not-distressed patients, 3(3.1%) purely somatising, 15(15.6%) depressed and 18(18.8%) with mixed distress. Preoperative VAS was 82.4, MPQ 18.2 and ODI 51.6. Average VAS and MPQ improved significantly at 6 and 26 weeks. Average magnitude of change of VAS and ODI did not differ between distressed and not-distressed. MPQ improved significantly more in the distressed. MZI was negatively associated with VAS MCIC at 6 weeks and 6 months but it failed to predict the outcome independently. MSPQ was the only individual predictor of MPQ-MCIC at any time; MSPQ≥8 could predict MPQ-MCIC at 6 months with 53%-sensitivity and 78%-specificity. None of psychological measures used showed a significant predictive value of ODI at any follow-up point Psychological distress may predict response only in certain outcome measures in patients suffering from nonspecific CLBP. If the interest lied primarily in pain and functional improvement, the psychological distress failed to discriminate the results at 6 months. [ABSTRACT FROM AUTHOR]

Background: Pharmacists in community-based settings document patient care using the Pharmacist eCare Plan (PeCP).Objective: To conduct a pilot evaluation of the PeCP use and documentation of Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes within select community-based pharmacies.Practice Description: Moose Pharmacy operates 7 locations in rural North Carolina that are part of the Community Pharmacy Enhanced Services Network (CPESN). The Moose Pharmacy Medication Adherence Program (MooseMAP) targets patients with a chronic condition who would benefit from medication synchronization, adherence packaging, and monthly calls.Practice Innovation: CPESN pharmacies use the PeCP to track a patient's concerns, goals, interventions, and medication-related information. The PeCP standard requires pharmacies to detail a patient's current medication regimen and health concerns as well as the pharmacy's interventions and patient's health over time.Evaluation Methods: Data were included if the patient was enrolled in MooseMAP and had a free-text note in the eCare Plan. Data were excluded if the medication-related problem (MRP) or intervention was a general health problem without a valid SNOMED CT code. Data were categorized into MRPs, medication interventions, education, and referrals. The International SNOMED CT browser and pharmacy health information technology (PHIT) value sets were searched; data sets without existing codes were submitted to the appropriate oversight authorities for future inclusion. Data were analyzed using descriptive statistics.Results: Emerging codes were identified that resulted in 91 recommendations to PHIT for development of new SNOMED CT codes and 113 recommendations to PHIT for inclusion in the PHIT value sets. In total, 66% of MRPs did not have a valid SNOMED CT code, and 78% of MRPs were not included in a PHIT value set. The most prevalent gap in MRP or intervention documentation related to medication use issues.Conclusion: Incorporating emerging codes into documentation systems should enable the profession to better communicate value to health care stakeholders. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) can result in severe life-threatening course requiring ventilatory support. This study highlights data pertaining to ventilated patients to enhance our understanding of COVID-19 as it evolves. A descriptive, retrospective analysis was carried out on 50 COVID-19 RT-PCR positive patients who received mechanical ventilation at a tertiary care hospital in counter-insurgency (CI) zone, from June to December 2020. Data pertaining to patient characteristics, treatment, ventilator support and outcomes was analysed. Out of 50 patients, 74% were aged 50 years and above with 60% patients having comorbidities. 39 patients received non-invasive ventilation (NIV) and 04 patients received invasive mechanical ventilation (IMV) while 07 patients were converted from NIV to IMV during the hospital stay. Out of the 50 patients who received ventilator support 25 (50%) survived to discharge. The overall survival was 47.3% amongst the males while it was 58.3% for the females. The majority of survivors were in the NIV category (61.5%) while only 9.0% survived amongst those who received IMV. Average length of stay on NIV for patients was 5.3 days and for IMV was 7.5 days. All 50 patients received therapy in the form of steroids, anticoagulants, broad spectrum antibiotics and antivirals. Remdesivir was given to 40 of these patients out of which 20 survived (50%). Interleukin-6 therapy (Tocilizumab) was given to five patients of which four survived (80%). This study helps us to gain insights into the outcomes of COVID-19 patients managed in a tertiary care hospital in CI zone. [ABSTRACT FROM AUTHOR]

In late 2019, the world saw a viral outbreak of unprecedented scale that sent a significant fraction of humankind into either quarantine or lockdown. Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was first recognized in Wuhan, China, in December 2019. We created and administered a 17-item questionnaire for health care professionals (HCPs) to assess their level of knowledge towards this ongoing and evolving pandemic. It was disseminated through Web- and mobile-based social networks. The questions were sourced and created from various standard national and international guidelines available at the time of writing. A total of 827 medical personnel participated in the study. Among them, 65.5% scored between 60% and 79%, indicating a moderate level of knowledge. There was no statistically significant difference in the scores of doctors, nursing officers and dental surgeons (p = 0.200). Participants had good knowledge regarding clinical symptoms, mode of transmission and preventive measures. But the study identified some gaps in knowledge in the implementation of management protocols, handling of dead bodies and biomedical waste management of COVID-19 cases. With this understanding, regular training, drills and knowledge dissemination along with skill development through learning correct practices focusing on HCP at all levels are the current needs. [ABSTRACT FROM AUTHOR]

Avascular necrosis (AVN) of femoral head is commonly seen in middle age groups and in its advanced stages, it is a common indication for total hip replacements (THRs). These patients invariably require revision surgeries in their lifetime and modalities to delay the first arthroplasty are necessary. Core decompression (CD) with bone marrow aspirate concentrate (BMAC) have proved successful in early stages of AVN, but their role in advanced stages remains unclear. The present review was done to assess the same. Is CD and BMAC combination effective in delaying radiographic progression and THRs in post collapse stages of AVN hip? A systematic review and meta-analysis was conducted to determine the overall efficacy of CD and BMAC in post collapse stages of AVN hip and to specifically compare primary outcomes like radiographic progression along with need of THR, with CD alone.Three data bases (PubMed, EMBASE and SCOPUS) were searched to identify relevant articles. The present review included 12 studies with 3 studies included in the meta-analysis. There were 270 hips across the 12 studies out of which 196 hips were treated with CD + BMAC. 39.8% cases worsened from stage 3 to stage 4, while the overall incidence of THR in stages 3 and 4 was 38.3%. On comparison with CD alone the combination of CD + BMAC did not show any enhanced efficacy in either delaying progression (Odds ratio of 1.41 (95% CI = 0.55–3.62) or in conversion to THR (Odds Ratio: 0. 92; 95% CI = 0.41–2.06) CD can be considered in stage 3 of AVN in younger population to delay the need of arthroplasty, before severe head distortion and arthritis sets in, and can be supplemented with bone strut grafts or tantalum rods, for supporting the articular cartilage. BMAC that has shown better results in early AVN, has not shown any additional benefits when compared to CD alone in advanced cases. [ABSTRACT FROM AUTHOR]

Background and Aims: How Mediterranean-style diets impact cardiovascular and health outcomes in patients with diabetes and chronic kidney disease (CKD) is not well known. Our aim was to investigate the association between diet quality, using Mediterranean Diet Scores (MDS) and health outcomes.Methods and Results: This is a post-hoc analysis of an RCT and longitudinal study investigating patients with diabetes and CKD. MDS was calculated annually. Scores were analyzed for correlation with lipids, HbA1c, serum potassium, health-related quality of life (HRQOL) and depression. 178 diet records from 50 patients who attended two or more visits were included. Mean MDS was moderate (4.1 ± 1.6) and stable over time. Stage 1-2 vs 3-5 CKD had lower raw MDS (3.8 ± 1.5 vs 4.6 ± 1.5, p < 0.001). Having hyperkalemia was associated with a lower raw MDS scores (3.6 ± 1.6 vs 4.2 ± 1.5, p = 0.03) but not energy adjusted MDS. MDS was not associated with HbA1c or lipids. High vs low MDS was associated with improved HRQOL (mental health 84.4 ± 14.3 vs 80.3 ± 17.1, p < 0.05; general health 62.6 ± 21.0 vs 56.3 ± 19.8, p < 0.001) and fewer depressive symptoms (9.1 ± 7.4 vs 11.7 ± 10.6, p = 0.01).Conclusions: Low MDS was associated with reduced kidney function and health related quality of life, but not other markers of cardiovascular risk. Further studies are needed to understand the nature and direction of the association between diet quality and disease outcomes in this population. [ABSTRACT FROM AUTHOR]

Seven maize inbred lines were evaluated for resistance against fall armyworm, Spodoptera frugiperda (J.E. Smith). Non-preference for oviposition in no- and multi-choice tests and feeding non-preference of neonates in multi-choice test was observed in lines CML 338, CM 500 and CML 72. Antibiosis was observed in CML 338, CML 72 and CML 71, in terms of significantly prolonged larval period (18.22–19.56 days), lower larval (111.52–131.80 mg) and pupal weights (105.65–127.67 mg), shorter adult longevity and lower fecundity as compared to susceptible inbred lines, BML 6 and LM 24. Larvae fed on CML 338 and CML 71 had significantly higher mortality and lower nutritional indices. Significantly higher foliar damage rating was observed on younger plants (10 days old) in all test inbred lines, as compared to older plants (20 and 30 days old) during 2020 and 2021. The mean foliar damage rating by fall armyworm larvae varied significantly among the test inbred lines being significantly lower in CML 338 and CML 71 compared to BML 6 and CM 500 that had higher damage at all crop stages when recorded at 7, 14 and 21 days after release. Functional Plant Loss Index (FPLI) was significantly lower in CML 338 and CML 71 (12.18–18.58%) followed by CML 72 (24.87%). Regression of FPLI on fall armyworm larval dry weight indicated presence of antibiosis and tolerance in CML 338, CML 71 and CML 72 towards fall armyworm. Overall, maize inbred lines CML 338, CML 71 and CML 72 with moderate resistance may be used for resistance breeding programme against this insect pest. • Fall armyworm larvae fed on maize inbreds CML 338 and CML 71 had significantly higher mortality and lower nutritional indices. • Larvae fed on CML 338, CML 72 and CML 71 had significantly lower larval - pupal weights, fecundity and shorter adult longevity. • Foliar damage was significantly higher on younger plants, and it was significantly lower in CML 338 and CML 71. • CML 338, CML 71and CML 72 had moderate resistance towards fall armyworm categorized as antibiosis and tolerance. [ABSTRACT FROM AUTHOR]

Oswestry disability Index(ODI) is the commonest patient reported outcome for assessment of disability due to low back pain. Its application to non-English speaking Punjabi population is limited as a validated and cross culturally adapted Punjabi version of ODI is not available. The purpose of the study was to analyse the psychometric properties of Punjabi version of Oswestry disability index (ODI-P) in patients with mechanical low back pain. The translation and cross-cultural adaptation of Punjabi version of ODI was done according to well recommended guidelines. The prefinal version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 113 patients with mechanical low back pain of more than two weeks duration. Psychometric properties comprising of internal consistency, test retest reliability, floor and ceiling effect, construct validity and factorial structure of the questionnaire were determined. ODI-P showed excellent internal consistency (Chronbach alpha of ODI-P is 0.72), test retest reliability (ICC 0.891) and construct validity (Spearman correlation coefficient with VAS 0.424). Factor analysis proved the questionnaire to be having a 1-factor structure with a total variance of 48.61%. ODI (P) is a reliable and valid instrument for measurement of disability related to mechanical low back pain in Punjabi population. It can be used both in research and clinical care settings in future. Image 1 [ABSTRACT FROM AUTHOR]

Purpose: Effective communication of important imaging results is critical to patient care but difficult to accomplish efficiently. To improve communication at their institution, the authors introduced a radiology report categorization system (RADCAT) that organizes diagnostic imaging reports and uses automated communication systems. The study objectives were to (1) describe RADCAT's design, (2) evaluate its implementation for appropriate imaging, and (3) evaluate the communication of important, nonurgent results with recommended follow-up.Methods: This retrospective study was performed in a multihospital adult and pediatric tertiary referral academic health system. The intervention, a radiology report categorization system with five levels of acuity and IT-supported communication workflows, was globally implemented in November 2017. The primary outcomes were the successful implementation of RADCAT to appropriate diagnostic imaging reports and the successful communication of important, nonurgent results with recommended follow-up to ordering providers and patients by the radiology quality assurance team.Results: Over 18 months after implementation, 740,625 radiology reports were categorized under the RADCAT system, with 42%, 28%, and 30% from the emergency department, inpatient, and outpatient settings, respectively. A random selection of 100 studies from the 23,718 total reports without RADCAT categorization identified 4 diagnostic radiology reports that erroneously lacked RADCAT grading. In 2019, of the 38,701 studies with nonurgent imaging follow-up recommendations, 38,692 (nearly 100.0%) were successfully communicated to providers or patients on the basis of quality assurance data.Conclusions: A comprehensive radiology report categorization system was successfully implemented across a multihospital adult and pediatric health system, demonstrating reliable communication of imaging results with recommendations for nonacute imaging follow-up. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is a dreaded complication leading to increased morbidity and mortality in patients having pelvi-acetabular fractures. These evidence based guidelines aim to provide the decision making ability in the prevention of venous thromboembolism in patients with pelvi-acetabular trauma planned for operative or non operative treatment. The patients were subclassified into 5 categories. The PICO framework was used to devise research questions in each category. The systematic reviews were performed for each research question. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess outcomes of critical interest. The guideline panel consisting of expert members of different subspecialties, analyzed the evidence and made recommendations. The guideline panel proposed 21 recommendations. There are five recommendations in category 1 to 3, two recommendations in category 4 and four recommendations in category 5. In pelvi-acetabular fractures there is strong evidence to suggest that thromboprophylaxis should be given. It should be initiated as early as possible after control of hemorrhage. The chemical prophylaxis is the preferred mode and LMWH is the preferred agent of choice. The mechanical methods can be used as an adjunct. The routine prophylactic use of IVC filters is not recommended. However, the use of retrievable IVC filters in high risk patients with established VTE in preoperative period can be considered. The use of newer directly acting oral anticoagulants is gaining importance. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic metabolic condition characterized with hyperglycemia and associated with several complications. Glycemic control is important factor in preventing the complications associated with diabetes. Pillars for good glycemic control are good life style modification with proper medication under medical guidance. The aim of this study was to study the effect of lock down on glycemic control in diabetic patients and possible factor responsible for this. – Out of 407 only 143 diabetic patients who attended the our endocrine OPD in last 3 months who had good glycemic control in past without any chronic complication and willing to participate were included in study. They were advised for the self-monitoring of blood glucose for identifying the glycemic control and with questionnaire designed possible factor was identified during the lockdown period. – The patients were aged between 18 and 65 years with mean age of 54.68 years and male to female ratio was 91:52.56 (39.16%) patients reported worsening of hyperglycemia and requiring addition of medications for control of blood glucose and 3 (2.09%) patients reported hypoglycemic events and medications were stepped down. Psychological stress was most common factor worsening of hyperglycemia followed by change in diet and exercise. • Overall Glycemic control got deranged in diabetic patients during the lockdown period. • Lifestyle changes and psychological stress identified as possible factors responsible for derangement of glycemic control. • Multidisciplinary approach is required which is patient centric for achieving good glycemic control. [ABSTRACT FROM AUTHOR]

The article focuses on the heels of the deaths of Ahmaud Arbery, Breonna Taylor, George Floyd, Rayshard Brooks, and so many others, has celebrated the independence of our country from British rule. Topics include the paradox of the American values of life, liberty, and the pursuit of happiness could not be clearer for the lives of Black Americans, and the history and pain of anti-Black racism while suggesting some initial steps in tearing down and rebuilding the foundation.

Several functional scoring tools are available to evaluate the outcomes of total hip replacements (THRs) for diseased or damaged hips. Majority of these scores were devised in western countries and their cross-cultural compatibilities are rarely demonstrated. The World Health Organisation quality of life (WHO QOL-BREF) questionnaire with 4 domains, is one of the best known multilingual instruments for such assessment. Its reliability has never been demonstrated for THRs and the present study was conceptualised for the same. THRs done over 6 years were followed up retrospectively. Revision THRs and hemiarthroplasties were excluded. All the cases were done by a single senior arthroplasty surgeon. Clinical examination was done and questionnaires for WHO QOL-BREF and Harris Hip scores were given to the patients. The number of patients included in the study was 96 with 115 operated hips. The average age of these patients was 41.40 years ranging from 17 to 80 years. There was strong male preponderance in our series of patients with 90 THRs. The mean score of domain 1 was 70.8 (SD 21.6), domain 2: 72.4 (SD 18.8), domain 3: 74.7 (SD 16.8) and domain 4: 75.4 (SD 14.8); showed significant functional improvement post THR in domain 2 (P = 0.0001), domain 3 (P = 0.0010) and domain 4(P = 0.0001), when compared to scores of general healthy population. Similarly, the scores were significantly improved in all domains as compared to cohorts of post-operative acetabular and hip fractures. The score was found to be a reliable tool with Cronbach's alpha of 0.912 and strong correlation was present with the standard Harris hip scores (p = 0.000). WHO QOL-BREF is a potent tool to assess the quality of life in patients undergoing THRs. It can be used as a single index of measurement and it is simple, reproducible and reliable. [ABSTRACT FROM AUTHOR]

Short segment fixation aims to restore spinal stability and alignment in thoracolumbar spine injuries while preserving spinal motion by decreasing the levels of spine involved in fixation. In its simplest form it applies to fixation one level above and one level below the fractured vertebra. It has proven effective with good clinical, functional and radiological results in well selected cases. However not insignificant rates of sagittal collapse and recurrence of kyphosis with or without clinical implications have also been reported. Most of the failures were attributed to lack of anterior column integrity and relatively inferior robustness of earlier posterior short segment constructs. With better understanding of fracture biomechanics, better implant designs and evolution of strategies to increase the biomechanical strengths of posterior constructs, the rates of kyphosis recurrence and implant failure have been significantly reduced. Although there is lack of robust evidence to guide a surgeon to the best approach for a particular fracture, adhering to basic biomechanical principals increases the efficacy and reliability of short segment fixation. This narrative review highlights the status of short segment fixation in dorsolumbar spine injuries with emphasis on patient selection and strategies to increase effectiveness and reduce failures of short segment fixation. [ABSTRACT FROM AUTHOR]

The era we live in today is full of uncertainty and varying customer demand. Firms are managing various difficulties including consistent change, shorter item life cycles, assorted client necessities and expanded vulnerability of interest. The purpose of this paper is to put forth the dimensions along which a firm can improve its performance and enhance its sustainability through supply chain agility. Supply chain agility is a key component of all successful firms today, be it in the services or in the manufacturing sector. It is believed that an agile company would tend to outshine its competitors, who have not adopted the agile principles. Seven dimensions of supply chain agility have been identified in this paper; and their effect on each other and on supply chain agility is assessed using Fuzzy DEMATEL. Four major factors- accessibility, alertness, flexibility and swiftness are identified as the key determinants of agility. It is found that the operational flexibility and analytical capabilities of a firm play the most crucial role in determining its agility as they had the maximum effect on the overall system. This study provides the management of companies with a clear guide map as to how they can improve their agility in today's highly competitive market and how one dimension of supply chain agility has an impact on another dimension. Identification of dimensions of agility and evaluating their impact on each other as well as on supply chain agility using Fuzzy DEMATEL is a new and unique contribution to the concept of agility. [ABSTRACT FROM AUTHOR]

Calcaneus malunion is a common sequela to calcaneal fractures and is a cause of pain and discomfort. Multiple approaches have been described to address the subtalar joint and the lateral wall. Type 2 malunion is the most commonly encountered problem, and is usually addressed by the sinus tarsi approach. This has some limitations, as exposure for lateral wall excision beneath the peroneal tendons maybe a problem. We have slightly modified the sinus tarsi approach by a more horizontal skin incision, which may even be extended proximally by 1–2 cm; this allows access to the lateral wall on either side of the peroneal tendons. The approach is described in detail. [ABSTRACT FROM AUTHOR]

• Mechanical thrombectomy is the treatment of choice for acute ischemic strokes from large vessel occlusions. • Blood pressure variability was similar between patients with good and bad functional independence. • The benefit of mechanical thrombectomy may overshadow the effect of blood pressure variability. • Higher systolic blood pressure during transport was associated with a low likelihood of a modified Rankin Scale score ≤2. • Maximum systolic blood pressure was not found to correlated with acute kidney injury. Mechanical thrombectomy is the treatment of choice for acute ischemic strokes from large vessel occlusions. Absolute blood pressure and blood pressure variability (BPV) may affect patients' outcome. We hypothesized that patients' outcomes were not associated with BPV during transport between hospitals in the era of effective thrombectomy. We performed a retrospective observational review of adult patients admitted to our comprehensive stroke center who underwent mechanical thrombectomy between January 1, 2015, and December 31, 2018. Data were collected from our stroke registry and transportation records. Outcomes were defined as 90-day modified Rankin Scale (mRS) ≤2 and any acute kidney injury (AKI) during hospitalization. We analyzed 134 eligible patients. The mean age was 66 years (standard deviation = 14 years). Forty percent achieved mRS ≤2, and 16% had an AKI. BPV and maximum systolic blood pressures during transport were examined as variables to determine outcome. We found BPV was similar between patients with good and bad functional independence. Furthermore, the maximum systolic blood pressure during transport (odds ratio = 0.98; 95% confidence interval, 0.96-0.99; P =.038), not BPV, was associated with a lower likelihood of mRS ≤2. No similar correlation of analyzed blood pressure variables could be found for AKI as an outcome. The maximum systolic blood pressure was associated with worse functional outcomes in stroke patients transported for thrombectomy. Prehospital clinicians should be cognizant of high blood pressure among patients with acute ischemic stroke from large vessel occlusion during transport and treat accordingly. [ABSTRACT FROM AUTHOR]

A comparison of various scale invariant crowd count analysis methods is conducted. The methods are chosen such that they have the ability to accurately predict crowd count from an arbitrary perspective. An investigation is conducted where their comparison is based on MAE (Mean Absolute Error) and MSE (Mean Squared Error) which are the chosen evaluation metrics and their architecture is discussed. Models are to be assessed based on their performance and subsequent results on the ShanghaiTech Dataset and the UCF-CC-50 Dataset. This is enough to give a thorough comparison of these models. The approach compares a variety of models that utilize Dilated Convolutional Neural Networks, Fully Convolutional Neural Networks and Multi-Scale Convolutional Neural Networks. [ABSTRACT FROM AUTHOR]

The Army Marches on its Stomach". To provide nutritious, wholesome, safe and quality food to the large Indian Armed Forces, spread over various terrains, ranging from the icy Himalayas to the burning deserts of Rajasthan or the humid jungles of the North East and over various platforms like tanks, ships and aircraft is a challenge. The major issue in this is to procure and supply the food while ensuring that it is safe and retains its quality till it is cooked. This vital part of the supply chain viz from farm to the military cook house is the responsibility of the Army Service Corps (ASC) supported by the Army Medical Corps (AMC) and the Remount and Veterinary Corps (RVC). The Food Inspection Organization of the ASC lays down the best practices to be followed in terms of inspection, sampling, analysis, dispatch and issue of both fresh and processed edible foodstuff. The Armed Forces have their own network of Composite Food Laboratories for sampling and analysis of the food items. To ensure superior quality the Defence Food Specifications are much higher than legislated by the Food Standards and Safety Authority of India (FSSAI) for the general public. This paper highlights the best practices followed to ensure food safety and quality control in the Indian Armed Forces. [ABSTRACT FROM AUTHOR]

Although accurate measurement of cup anteversion in hip replacement requires CT scans, however, its routine application, especially during follow-up, remains economically and ethically unreasonable. Thus, several methods have been devised for making this measurement on plain radiographs. In recent years, several ways have been adopted using software on digital radiographs. We present one such method which uses open access mathematical software GeoGebra. Anteversion was measured on 72 radiographs (36 cemented; 36 uncemented) by three different observers using this software. One observer repeated measurements at three weeks interval. The intraclass correlation coefficient for interobserver variability and intraobserver variability was 0.982 (0.973–0.989) and 0.986 (0.978–0.991) respectively. There was a significant difference in the reliability of the method for cemented and uncemented cups with higher reliability for cemented cups (p < 0.001). GeoGebra software can be used as a reliable alternative for measuring acetabular cup anteversion on good quality well centred digital radiographs of the pelvis. [ABSTRACT FROM AUTHOR]

Primary osteoarthritis of hip has been widely reported to be the leading cause for total hip replacement (THR) in the world. The other common causes are avascular necrosis of hip, inflammatory diseases and trauma sequelae. We report the prevalence of these disease as studied retrospectively at a tertiary healthcare centre and discuss the common age groups and sex ratios of these patients as compared to the West. Additionally, we compare the outcomes of these surgeries based on the aetiologies for which they were done. Patients who underwent primary THR in our institute within six years were called and retrospectively analysed. Revision cases were excluded. All the surgeries were done by a single experienced arthroplasty surgeon. On follow ups, functional scores were assessed using standard Harris hip score (HHS) and quality of life scores were assessed using the Short musculoskeletal functional assessment (SMFA) score. 118 hips in 99 patients (M:F- 3.2:1) with a mean age group of 43.22 years, were operated over a period of six years. Non traumatic avascular necrosis (AVN) of hip topped the list in our study with 42.4% of cases, followed by post-traumatic sequelae (30.5%). These were followed subsequently by primary osteoarthritis (OA) (14.4%) and the remaining were inflammatory pathologies (IA). The HHS of patients with non traumatic AVN hip, traumatic sequelae and primary osteoarthritis were significantly superior to inflammatory arthritis with a p value of 0.001, 0.001 and 0.016 respectively. Additionally the short musculoskeletal functional assessment score was also significantly higher in IA than AVN, OA and post trauma groups (p = 0.001, 0.037 and 0.002 respectively); where a higher score denotes inferior outcomes. In our part of the world, non traumatic AVN hip is the commonest indication for primary hip arthroplasty, followed by traumatic sequelae. The frequency of males undergoing hip arthroplasty is much more than females and at a younger age as compared to the West. Additionally, the functional outcomes in cases of inflammatory arthritis are inferior as compared to the other indications, probably because of associated contractures, deformity and spinal issues. [ABSTRACT FROM AUTHOR]

Semantic similarity is used to perceive the meaning of words in textual data and having several applications in the field of Computational linguistic and Natural language processing. Semantic similarity and semantic relatedness are interchangeable terms, in Semantic relatedness all types of semantic relationships are considered i.e. (has, part-of, contains etc.) whereas in semantic similarity only " is-a " type of relationship is used. Computing accurate similarity improves the efficiency of query processing and understanding of textual data more proficiently. In this work, a novel hybrid approach of corpus based and knowledge based method is proposed approach to compute the semantic relatedness among words. In this hybrid method, Latent semantic analysis is used to find the concepts and their correlation value and mapping is done for different words with the help of fuzzy formal concept analysis.To compute semantic relatedness on different words a fuzzy set similarity measure is used.The proposed approach has been evaluated on solar domain and attains improved results as compared to other baseline measures. This method can be used for any doamin as it is a generalized approach for similarity computation. [ABSTRACT FROM AUTHOR]

The weblog is dynamic and its size is growing exponentially with time in terms of navigation sessions. These stored sessions are used for Web Navigation Prediction (WNP). Each user had varied behavior on the web so is their navigated sessions. With a variety of large dynamic sessions, the task of navigation prediction is becoming challenging. There is a need for an effective method to handle large sessions with multiple labels for predicting user desired information. This paper analyses the performance of Deep Learning techniques like Multi-Layer Perceptron and Long-Short Term Memory based on parameters like number of hidden units, number of layers, activation function, optimization function, learning rate, and batch size. The networks were trained on six experimental parameter setups to form 216 models. The performances of these models are evaluated on two real datasets: BMS and CTI. It has been observed that Long-Short Term Memory performs best on most of the setups. [ABSTRACT FROM AUTHOR]