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BACKGROUND Postoperative prolonged air leakage is a frequent complication after lung resection. We have developed a new sealant based on a hydrophobically modified Alaska pollock-derived gelatin (ApGltn) sealant. The purpose of this study was to evaluate the adhesive strength of the ApGltn sealant in comparison with a fibrin sealant using a new spray system in ex vivo and in vivo models. METHODS Pleural defects in ex vivo and in vivo porcine models were created, to which the ApGltn sealant or the fibrin sealant was applied. The pressure resistance was assessed with a stepwise increase in airway pressure to confirm air leakage from the sealing site. Tissue samples covered with each sealant were obtained for histologic assessment. RESULTS In the ex vivo experiment, the leak pressures of the ApGltn sealant were significantly greater than those of the fibrin sealant (102.94 ± 15.6 cm H2O and 28.37 ± 5.1 cm H2O, respectively) (P < .01). In the in vivo experiment, the leak pressures of the ApGltn sealant were also significantly greater than those of the fibrin sealant (68.82 ± 18.04 cm H2O and 43.33 ± 7.13 cm H2O, respectively) (P = .043). The histologic examination confirmed that the ApGltn sealant adhered tightly to both the pleura and the surface of the pleural defect. CONCLUSIONS The ApGltn sealant has sufficiently high adhesive quality in ex vivo and in vivo porcine lungs, which could be considered suitable and effective for use in the prevention of air leakage from the lungs.

Background Expanded-spectrum quinolones (ciprofloxacin) are highly effective against gram-negative bacteria, but significant resistance to quinolones has been increasingly reported. We sought to evaluate the prevalence of gram-negative ciprofloxacin-resistant isolates (CRIs) from our hospital and their mechanism of action. Methods Gram-negative CRIs were identified as per standard procedures and confirmed using the Ezy MICTM Strip (HiMedia). DNA from 67 CRIs was amplified for the quinolone resistance–determining region (QRDR) and plasmid-mediated quinolone resistance genes. Thirty isolates positive for QRDR DNA were sequenced by Sanger's method to detect mutation. Results Of the isolates, 42.5% were found to be CRIs, the majority (74.42%) from inpatient departments, and Escherichia coli (64.19%) was the predominant isolate. Among the CRIs, 24.55% were ESBL producers and 35.29% were multidrug resistant. The polymerase chain reaction results showed the majority were amplified by QRDR target regions of gyrA (35.4%) while 4.61% were amplified for the plasmid-mediated fluoroquinolone resistance region of the qnrB gene. Further sequencing of QRDR-positive genes showed point mutations with amino acid changes at codons Ser83 and Asp87 in the gyrA gene and Ser80, Glu84, and Leu88 positions in the parC gene. Conclusion Ciprofloxacin resistance observed in our study was mostly due to point mutations. Hence, strategies for rational use of ciprofloxacin and adherence to the dose and duration of treatment could be helpful to prevent selection and spread of mutant CRIs/strains.

Shinsuke Kitazawa, Ashoka Indranatha Wijesinghe, Naoki Maki, Takahiro Yanagihara, Yusuke Saeki, Naohiro Kobayashi, Shinji Kikuchi, Yukinobu Goto, Hideo Ichimura, Yukio Sato Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, JapanCorrespondence: Yukio SatoDepartment of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, JapanTel +81 29 853 3210Fax +81 29 853 7991Email ysato@md.tsukuba.ac.jpPurpose: In performing surgery for lung cancer, emphysema is a risk factor related to postoperative respiratory complications (PRC). However, few studies have addressed the risk of radiological emphysematous volume affecting PRC. The aim of this study was to investigate the relationship between emphysematous volume as measured on 3-dimensional computed tomography and PRC.Patients and Methods: We reviewed 342 lung cancer patients undergoing lobectomy between 2013 and 2018. The percentage of low attenuation area (LAA%) was defined as the percentage of the lung area showing attenuation of − 950 Hounsfield units or lower. Preoperative factors including age, sex, body mass index, smoking index, respiratory function, tumour histology, and LAA% were evaluated. PRC included pneumonia, atelectasis, prolonged air leakage, empyema, hypoxia, ischemic bronchitis, bronchopleural fistula, and exacerbation of interstitial pneumonia. Uni- and multivariable analyses were performed to investigate the relationship between independent clinical variables and postoperative adverse events.Results: Median LAA% was 5.0% (range, 0– 40%) and PRC was observed in 50 patients (14.6%). Patients who presented with PRC showed significantly high LAA% compared to those without complications (median: 8.1% vs 3.8%; p < 0.001). Based on univariable analysis, age, sex, smoking index, percentage of forced expiratory volume in 1 s (FEV1.0%), histology, and LAA% were significant predictors for PRC. Multivariable analysis revealed higher LAA% as a significant risk factor for PRC (odds ratio = 1.040; 95% confidence interval, 1.001– 1.080; p = 0.046).Conclusion: In addition to respiratory function with spirometry, LAA% can be used as a predictor of PRC.Keywords: lung cancer, emphysema, radiology and other imaging, respiratory function tests, thoracic surgery

Objective Challenges in susceptibility testing of colistin along with increase in the prevalence of colistin-resistant carbapenemase-producing Enterobacteriaceae (CRE) pathogens needs addressal. Evaluation of user-friendly methods is necessary as an alternative to broth microdilution (BMD), the reference susceptibility testing method, for routine implementation in diagnostic clinical microbiology laboratories. Genotypic detection of the plasmid-mediated colistin resistance is also needed for infection control purposes. Materials and Methods Colistin susceptibility of 200 nonduplicate clinical CRE isolates from December 2017 to June 2019 was determined by BMD, agar dilution (AD), E test, and rapid polymyxin NP test and interpreted as per the European Committee on Antimicrobial Susceptibility Testing. The results of AD, E test, and NP test were compared with that of BMD, considering minimal inhibitory concentration (MIC) ≤ 2 µg/mL as susceptible and > 2 µg/mL as resistant. Presence of any plasmid-mediated colistin resistance (mcr-1 and 2) was evaluated in 27 colistin-resistant CRE isolates by polymerase chain reaction. Statistical Analysis Performance of different phenotypic methods was analyzed by comparing MIC results of AD and E test with that of reference BMD method. Agreement between BMD and the other two methods was expressed in terms of categorical agreement and essential agreement. Errors were expressed as very major error (VME: false-susceptible) and major error (ME: false-resistance) by AD/E test. VME and ME of 3% disagreement were considered unacceptable. Results Colistin resistance was found in 27 (13.5%) isolates by BMD method. The VME rates of both AD (11%) and E test (37%) could not meet the Clinical and Laboratory Standards Institute recommendation (< 3% VME rate is acceptable) as alternative tests to the reference BMD. Colistin NP test showed sensitivity and specificity of 85% and 98%, respectively. The percentage discordant result in NP test was highest in Enterobacter spp. (17%). None of the 27 colistin resistant isolates showed presence of mcr-1 and mcr-2 genes. Conclusion High VME rate in AD and E tests precludes their use as alternatives to BMD for colistin susceptibility testing. NP test with moderate sensitivity but excellent specificity can be a good alternative for testing colistin susceptibility in CRE isolates, except in Enterobacter spp. Absence of mcr-1 and mcr-2 gene necessitates the exploration of other mechanisms of colistin resistance.

Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 Escherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

The authors sought to estimate the prevalence of mental and substance use disorders and psychotropic medication prescriptions among working-age sudden-death victims.Using a written protocol, the authors screened for sudden deaths attended by emergency medical services (EMS) in a large metropolitan county in North Carolina from March 1, 2013, to February 28, 2015. Sudden-death cases were adjudicated by three cardiologists. Mental health and chronic disease diagnoses and treatments were abstracted from EMS, medical examiner, toxicology, and autopsy reports and from clinical records for the past 5 years before death.Sudden death was identified for 399 adults ages 18-64 years, 270 of whom had available medical records. Most sudden-death victims were White (63%) and male (65%), had a comorbid condition such as hypertension or respiratory disease, and had a mean±SD age of death of 53.6±8.8 years. Most victims (59%) had at least one mental health or substance use disorder documented in a recent medical record; 76%-78% of victims with a mental disorder had a documented psychotropic medication prescription. However, fewer than one-half (41%) had a documented referral to a mental health professional. The most common diagnostic categories were depressive, anxiety, and alcohol-related disorders. Almost one-half (46%) of the victims had a recent psychotropic prescription, most commonly antidepressants (29%) and benzodiazepines (19%).Mental illness, substance use disorders, and psychotropic medication prescriptions were prevalent among sudden-death victims. The health care needs of these individuals may be better addressed by collaborative care for general medical and mental disorders.

Branchial cleft anomalies are well described, with the second arch anomaly being the commonest. Remains of cervical sinus of His may persist as a branchial cyst. A branchial sinus is formed when 2nd branchial arch fails to meet the 5th pharyngeal arch. Peak age for presentation of branchial cysts is in the third decade and that of the congenital sinuses and fistulae is at birth. The association of a branchial cyst with branchial sinus is very rare. We are presenting two cases had branchial cyst along with branchial sinus. It was managed successfully with complete excision. Histopathological examination confirmed the association. Keywords: Branchial Sinus, Branchial cyst

Modern agriculture has been largely successful in meeting the energy needs of poor populations in developing countries. In the past 40 years, agricultural research has placed increased cereal production at its center. Recently, however, there has been a shift: agriculture must now not only produce more calories to reduce hunger, but also more nutrient-rich food to reduce hidden hunger. One in three people in the world suffer from hidden hunger, caused by a lack of minerals and vitamins in their diets, which leads to negative health consequences. Biofortification is a process of improvement of nutritional profile of plant-based foods through agronomic interventions, genetic engineering, and conventional plant breeding. Biofortification through agronomic approaches can be achieved by applying mineral fertilizers to the soil, foliar fertilization and soil inoculation with beneficial microorganisms. Biofortification through genetic engineering is an alternative approach when variation in the desired traits is not available naturally in the available germplasm, a specific micronutrient does not naturally exist in crops, and/or modifications cannot be achieved by conventional breeding.

Wire electrical discharge machining is widely used in fields like dies, punches, aerospace and automotive industries for machining conductive, exotic, high strength and temperature resistive materials with better precision and accuracy. Here, to achieve optimal performance is very difficult as there are many process parameters that determine the output characteristics. The objective of the present work is to predict the optimal set of process parameters such as current (I), pulse on/off time (TON/TOFF), wire tension and wire feed to achieve minimum Surface roughness (SR), wire consumption rate (WCR) and maximum material removal rate (MRR). In this work, experiments were carried out by pulse arc discharges generated between brass wire and specimen (D3 die steel) suspended in deionized water dielectric. The experiments were designed based on the five factors and its five levels using full factorial central composite design based on Response Surface Methodology. 52 runs of experiments were constructed based on central composite design procedure and results of the experimentation were analyzed by MINITAB software analytically as well as graphically. Second order regression model has been developed for predicting surface roughness (SR), wire consumption rate (WCR) and material removal rate (MRR) in terms of interactive and higher order machining parameters through response surface methodology. The results revealed that wire tension, current, and their interactions have significant effects on SR, whereas, pulse on time and current have significant effects on MRR and also been observed that wire feed and interaction between current and pulse off time have significant effects on WCR. Finally, the parameters were optimized for maximum MRR, minimum WCR with the desired surface roughness value using desirability function approach.

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common infections encountered in healthcare settings. Candida spp. were excluded as the causative agents of CAUTIs as per Centres for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions in 2015. Aim: To determine the impact of the 2015 definition change on the CAUTI rate of patients admitted to medical and surgical intensive care units (ICUs) of a tertiary care and teaching hospital in India. Method: CAUTI rates were compared in both the ICUs over a period of two years with inclusion and exclusion of Candida spp. Results: Out of the total 116 CAUTI episodes during the study period, a mean of 9.08 CAUTIs per 1000 catheter days were observed in both the ICUs when Candida spp. were included, but the mean CAUTI rate was reduced to 4.78/1000 catheter days when Candida spp. were excluded. Discussion/Conclusion: The mean CAUTI rate decreased by 46.03% solely by excluding Candida spp. This significant reduction in CAUTI rates may be applicable to institutions having high rates of candiduria in catheterised patients, but may not be applicable in centres where the incidence of candiduria is already low. Disregarding Candida as a causative agent of CAUTI did not impact rates of central line-associated bloodstream infections during the study period.

Background Ganglioneuroma is a rare neurogenic tumor which could grow into massive size in the thorax with minimal or no symptoms. Resection of these tumors will be challenging in view of large size and vascular encasement. Here, we report resection of a thoracic ganglioneuroma in a child with infiltration of spinal canal and lymph node metastasis, which is a very rare occurrence. Case presentation A 3-year and 10-month-old girl presented with a left side thoracic mass with minimal symptoms and signs. After the initial imaging with ultrasound scan and cross-sectional imaging, she had a true cut biopsy of the lesion confirming the diagnosis of ganglioneuroma. On exploration, she had a paraspinal thoracic mass extending from level of arch of aorta down to diaphragm with evidence of tumor infiltration of the intercostal spaces and spinal canal in multiple vertebral levels. Pathologically, she had infiltrated lymph nodes which were encircling the lower thoracic aorta. The tumor was resected successfully, and she recovered with a good functional status. Conclusion Thoracic ganglioneuroma has a good prognosis after complete resection even with spinal canal and lymph node infiltration. The resection could be arduous in case of massive size and vascular encasement; hence, benefit versus risk of complete resection should be carefully weighed.

Background Intraoperative localization of endoluminal lesions is can be difficult during laparoscopy. Preoperative endoscopic marking is therefore necessary. Current methods include submucosal tattooing using visible dyes, which in case of transmural injection can impair surgical dissection. Tattooing using indocyanine green (ICG) coupled to intraoperative near-infrared (NIR) laparoscopy has been described. ICG is only visible under NIR-light, therefore, it doesn’t impair the surgical workflow under white light even if there is spillage. However, ICG tattoos have rapid diffusion and short longevity. We propose fluorescent over-the-scope clips (FOSC), using a novel biocompatible fluorescent paint, as durable lesion marking. Methods In six pigs, gastric and colonic endoscopic tattoos using 0.05 mg/mL of ICG and markings using the fluorescent OSC were performed (T0). Simultaneously, NIR laparoscopy was executed. Follow-up laparoscopies were conducted at postoperative day (POD) 4–6 (T1) and POD 11–12 (T2). During laparoscopy, fluorescence intensity was assessed. In one human cadaver, FOSC was used to mark a site on the stomach and on the sigmoid colon, respectively. Intraoperative detection during NIR laparoscopy was assessed. Results Gastric and colonic ICG tattooing and OSC markings were easily visible using NIR laparoscopy on T0. All FOSC were visible at T1 and T2 in both stomach and colon, whereas the ICG tattooing at T1 was only visible in the stomach of 2 animals and in the colon of 3 animals. At T2, tattoos were not visible in any animal. FOSC were still visible in both stomach and colon of the human cadaver at 10 days. Conclusion Endoscopic marking using FOSC can be an efficient and durable alternative to standard methods.

BACKGROUND We wanted to do a retrospective study of the distribution pattern, outcome with possible predictors affecting the mortality in patients who had consumed aluminium phosphide and were admitted in our ICU and compare difference in mortality among the two different regimens used during two different time frames. METHODS 63 patients who were admitted to the ICU between Jan 2011 to Dec 2017 after consumption of aluminium phosphide were studied. Baseline clinical assessment and routine investigations including complete blood counts, renal function tests, electrolytes, ECG, ABG and 2D Echo were done. For the first 4 years from 2011 - 2014, a standard regimen based mainly on supportive care was followed. For the remaining 3 years from 2015 - 2017, an aggressive regimen involving coconut oil, ascorbic acid, magnesium, NaHCO3 and supportive measures were followed. RESULTS Out of the 63 patients admitted during the study period, 16 patients died, and the remaining 47 patients survived. Serum lactate, MAP (Mean Arterial Pressure) at admission, MAP after 24 hours, and presence of arrhythmias were found to be significantly associated with both need for ventilatory support and mortality. The time elapsed since consumption of compound was not found to be associated with either mortality or the need for ventilatory support. On subgroup analysis of two different regimens followed, one with only supportive measures and the other with coconut oil, ascorbic acid, magnesium and sodium bicarbonate, it was found that there was no significant difference with either of the regimens with respect to mortality or need for ventilatory support. (p>0.05) CONCLUSIONS The overall treatment in these cases is highly favourable as the mortality is 25.39% compared to the 40 - 80% mortality reported in literature. Serum lactate, Mean Arterial Pressure (MAP) at admission, MAP after 24 hours and presence of arrhythmias on admission were found to be significantly associated with mortality though none of them were found to predict mortality independently. Coconut oilbased regimens are very popular in the management of aluminium phosphide poisoning. However, in our study it didn’t show any added advantage in terms of either ventilatory requirement or mortality difference over conventional supportive measures.

Front line demonstration (FLD) is an appropriate means for demonstration as well as transfer of improved agricultural innovations to the farming community. Under centrally sponsored scheme on oilseed production technology under NMOOP scheme. The constraints in the production of sunflower crop were identified with a major emphasizes against the pest and diseases in the sunflower. The critical inputs required were identified from the recommended package of practices of Karnataka and their usages were discussed in practicing farmer's trainings at the farmer's field. The average two years data revealed that an average yield of demonstrated plot was obtained 15.81/ha over local check 10.75 q/ha and the average percentage increase in yield over local check was 52.87 per cent. The average extension gap was found to be 6.68. The hybrid DSFH-3 and KBSH-53 performed better at front line demonstrated plot as compared to local check. Further, benefit: cost ratio was recorded to be higher under demonstrated plot against local check during the study. Further, average higher benefit- cost ratio (2.45) was recorded under demonstrated plot against check (1.96). The yield levels were considerably low under local practices because of considerable variations in the extent of adoption of recommended package of practices depending upon the amount of risk involved in terms of cost, convenience, skill and knowledge about the concerned practice. The productivity was better over local practice under demonstrations. Hence, sunflower production technology have a broad scope for increasing the area and production at each and every level i.e., Farmers, State and National level.

The clinical manifestation of COVID-19 is diverse, oscillating from mild flu-like symptoms to more severe outcome, such as acute respiratory distress syndrome, multiple organ failure, and death. Advanced age and comorbidities, such as diabetes mellitus, high blood pressure, and history of cerebrovascular accidents are reported to have worse outcome. Chronic inflammation by cytokine storm and direct insult to pancreatic by COVID-19 might be postulated mechanisms of inducing or deteriorating diabetes. Individualized patient-centric treatment and optimal blood sugar control should be made based on disease severity, presence of comorbid condition, and complications related to diabetes, age, and other risk factors. Recent clinical trials have shown some hope to anti-interleukin antibody as a potential therapeutic option against COVID-19 especially in people with severe illness.

A significant concern in current coronavirus disease-2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation myocardial infarction (STEMI), due to reluctance to visit the hospital. We report a case of delayed presentation of STEMI as ventricular septal rupture during the COVID-19 pandemic, a rare presentation in the current age of primary percutaneous coronary intervention. (Level of Difficulty: Beginner.), Graphical abstract, A significant concern in current coronavirus disease 2019 (COVID-19) pandemic era is delay in first medical contact in patients with ST-segment elevation…

Aim Transanal total mesorectal excision is a promising novel sphincter-saving procedure for low rectal cancer. However, the transanal bottom-up dissection is associated with increased rates of iatrogenic urethral injuries. Near-infrared fluorescence (NIRF) imaging, given its deeper tissue penetration, has been explored in a limited number of studies for enhanced intra-operative urethral visualization. In this study, we explored the feasibility of a novel, ultrabright, biocompatible fluorescent polymer to coat urinary catheters for the purpose of intra-operative urethral visualization. Methods In an ex vivo experiment, using a near-infrared laparoscope, the fluorescent signal of a coated catheter (near-infrared coating of equipment, NICE) was qualitatively and quantitatively compared to the signal of indocyanine green (ICG)/Instillagel® mixtures and ICG-filled catheters at several concentrations. Also, in three male human torsos, using fluorescent urinary catheters, NIRF-guided perineal dissections and a transanal total mesorectal excision were performed. Intra-operative NIRF-based urethral visualization was performed systematically. Results During the qualitative and quantitative fluorescence signal assessment, NICE-coated catheters were clearly superior to the ICG-based solutions. In the cadaveric experiments, enhanced urethral visualization was possible even at early stages of dissection, when the organ was covered by several tissue layers. Conclusions NICE-coated catheters represent a promising potential to allow for NIRF-based intra-operative urethral visualization.

Background: Short stature is a term applied to a child whose height is two standard deviations or more below the mean height for children of that gender and chronologic age.Familial short stature and Constitutional Growth delay are considered as normal variants, the pathological short stature includes a wide variety of underlying disorders.Chronic systemic disorders, malnutrition, chromosomal or endocrinal disorders lead to a proportionate short stature.While most of the disproportionate short stature are secondary to skeletal dysplasias or resistant rickets.Etiological evaluation plays an important role in identification of physiological as well as pathological causes of short stature.Subjects and Methods:All children of age between 2 and 18 years with height below 2 standard deviation of mean for age and gender were included in the study. Result:A total of 100 children were studied who fulfilled the criteria of short stature, out of which 61 children were male and 39 were female children.Present study showed that females had more pathological variants (72%) than males (46%) whereas males had more physiological variants (54%) than females (28%) with P-value: 0.011Hypothyroidism was more common in females than males with 28% and 8% respectively. Genetic syndrome was more common in females than males with 10% and 3% respectively. Conclusion:Etiological evaluation is of pivotal role in identification of physiological as well as pathological causes of short stature and also helps in modifying the course of stature by means of early intervention.

Strong-coupling between excitons and confined photonic modes can lead to the formation of new quasi-particles termed exciton-polaritons which can display a range of interesting properties such as super-fluidity, ultrafast transport and Bose-Einstein condensation. Strong-coupling typically occurs when an excitonic material is confided in a dielectric or plasmonic microcavity. Here, we show polaritons can form at room temperature in a range of chemically diverse, organic semiconductor thin films, despite the absence of an external cavity. We find evidence of strong light-matter coupling via angle-dependent peak splittings in the reflectivity spectra of the materials and emission from collective polariton states. We additionally show exciton-polaritons are the primary photoexcitation in these organic materials by directly imaging their ultrafast (5 × 106 m s−1), ultralong (~270 nm) transport. These results open-up new fundamental physics and could enable a new generation of organic optoelectronic and light harvesting devices based on cavity-free exciton-polaritons, Exciton-polaritons are typically formed in organic systems when the molecules are confined between metallic or dielectric mirrors. Here, the authors reveal that interactions between excitons and moderately confined photonic states within the bare organic film can also lead to polariton formation, making them the primary photoexcitation.

A study was conducted to establish levels of awareness of oral cancer and its causes among an Indian population. A pre-tested structured questionnaire on Knowledge, Attitude and Practice [KAP] (open and closed ended questionnaire) was used to estimate the KAP score, followed by clinical examination of the oral mucosal lesions. The subjects were counselled immediately after completion of KAP scoring using a structured protocol of regarding tobacco cession, and given advice about intake of natural sources of anti-oxidants in the diet, of tomato, carrot and green leafy vegetables (GLV). Subjects who had a KAP score 50% or less were counselled using a structured protocol. Subjects who had a KAP score greater than 50% were also counselled and given the correct information to their incorrect answers. In the group of people with a KAP score 50% or less, continual behavioural therapy was given to remain tobacco free for life. The subjects were monitored weekly for between 30 and 40 days. Clinically suspect lesions of hyperplasic candidiasis, lichen planus, and all varieties of Leucoplakia were confirmed histopathologically and routine treatment (conservative or surgical) was started without delay for the group. Those cases with dysplastic changes (of all different grades) were also counselled. Regular follow-up was maintained over several months and re-assessment carried out at intervals and any improvement noted. CONCLUSION: This is a cost-effective and simple method for estimation of the score on knowledge, attitude, and practice (KAP), and determinants of the ill-effect of tobacco habit(s) and engaging the popolation-in-need for their appropriate understanding about oral cancer screening and education for prevention and control.

ObjectivesPreterm birth occurs in more than 10% of U.S. births and is the leading cause of U.S. neonatal deaths, with estimated annual costs exceeding $25 billion USD. Using real-world data, we modeled the potential clinical and economic utility of a prematurity-reduction program comprising screening in a racially and ethnically diverse population with a validated proteomic biomarker risk predictor, followed by case management with or without pharmacological treatment.MethodsThe ACCORDANT microsimulation model used individual patient data from a prespecified, randomly selected sub-cohort (N=847) of a multicenter, observational study of U.S. subjects receiving standard obstetric care with masked risk predictor assessment (TREETOP; NCT02787213). All subjects were included in three arms across 500 simulated trials: standard of care (SoC, control); risk predictor/case management comprising increased outreach, education and specialist care (RP-CM, active); and risk predictor/case management with pharmacological treatment (RP-MM, active). In the active arms, only subjects stratified as higher-risk by the predictor were modeled as receiving the intervention, whereas lower-risk subjects received standard care. Higher-risk subjects’ gestational ages at birth were shifted based on published efficacies, and dependent outcomes, calibrated using national datasets, were changed accordingly. Subjects otherwise retained their original TREETOP outcomes. Arms were compared using survival analysis for neonatal and maternal hospital length of stay, bootstrap intervals for neonatal cost, and Fisher’s exact test for neonatal morbidity/mortality (significance, pResultsThe model predicted improvements for all outcomes. RP-CM decreased neonatal and maternal hospital stay by 19% (p=0.029) and 8.5% (p=0.001), respectively; neonatal costs’ point estimate by 16% (p=0.098); and moderate-to-severe neonatal morbidity/mortality by 29% (p=0.025). RP-MM strengthened observed reductions and significance. Point estimates of benefit did not differ by race/ethnicity.ConclusionsModeled evaluation of a biomarker-based test-and-treat strategy in a diverse population predicts clinically and economically meaningful improvements in neonatal and maternal outcomes.Plain language summaryPreterm birth, defined as delivery before 37 weeks’ gestation, is the leading cause of illness and death in newborns. In the United States, more than 10% of infants is born prematurely, and this rate is substantially higher in lower-income, inner-city and Black populations. Prematurity associates with substantially increased risk of short- and long-term medical complications and can generate significant costs throughout the lives of affected children. Annual U.S. health care costs to manage short- and long-term prematurity complications are estimated to exceed $25 billion.Clinical interventions, including case management (increased patient outreach, education and specialist care), pharmacological treatment and their combination, can provide benefit to pregnancies at higher risk for preterm birth. Early and sensitive risk detection, however, remains a challenge.We have developed and validated a proteomic biomarker risk predictor for early identification of pregnancies at increased risk of preterm birth. The ACCORDANT study modeled treatments with real-world patient data from a racially and ethnically diverse U.S. population to compare the benefits of risk predictor testing plus clinical intervention for higher-risk pregnancies versus no testing and standard care. Measured outcomes included neonatal and maternal length of hospital stay, associated costs and neonatal morbidity and mortality. The model projected improved outcomes and reduced costs across all subjects, including ethnic and racial populations, when predicted higher-risk pregnancies were treated using case management with or without pharmacological treatment. The biomarker risk predictor shows high potential to be a clinically important component of risk stratification for pregnant women, leading to tangible gains in reducing the impact of preterm birth.

Purpose Alzheimer’s is the most commonly occurring neurodegenerative disease and progressive cognitive impairment is its major symptom due to which the patients tend to wander and get lost in unfamiliar places. This is a constant cause of worry for caretakers and a source of distress to the patients themselves. The paper aims to discuss this issue. Design/methodology/approach This paper presents a low-cost, autonomous, embedded systems-based wearable device for real-time location tracking using GPS and the concept of geo-fencing. The system provides real-time updates in the form of a text message sent to the mobile number of a family member or caregiver. Findings An alert is sent whenever the patient moves out of a certain “safe zone” area and sends subsequent updates after every 5 min of such an event. The system supports caregivers of patients with early and moderate Alzheimer’s disease. Social implications Alzheimer’s patients are prone to disorientation, confusion and tend to wander off. Since the device eliminates the need for the patients to operate it and is instead at the discretion of the system itself, the chances of it failing to help are minimized. Hence, with this project, the authors address the need for an autonomous device that can assist caretakers in tracking Alzheimer’s patients. Originality/value The various existing technologies that are in use now for tracking are often high in price, not tailored to Alzheimer’s and are non-autonomous. To overcome this, the authors utilized easily accessible technology into developing this system, which not only be affordable, but also addresses the major flaw in existing systems – which is that they rely on being operated by the patients themselves.

To address the disproportionate burden of preterm birth (PTB) in low- and middle-income countries, this study aimed to (1) verify the performance of the United States-validated spontaneous PTB (sPTB) predictor, comprised of the IBP4/SHBG protein ratio, in subjects from Bangladesh, Pakistan and Tanzania enrolled in the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, and (2) discover biomarkers that improve performance of IBP4/SHBG in the AMANHI cohort. The performance of the IBP4/SHBG biomarker was first evaluated in a nested case control validation study, then utilized in a follow-on discovery study performed on the same samples. Levels of serum proteins were measured by targeted mass spectrometry. Differences between the AMANHI and U.S. cohorts were adjusted using body mass index (BMI) and gestational age (GA) at blood draw as covariates. Prediction of sPTB < 37 weeks and < 34 weeks was assessed by area under the receiver operator curve (AUC). In the discovery phase, an artificial intelligence method selected additional protein biomarkers complementary to IBP4/SHBG in the AMANHI cohort. The IBP4/SHBG biomarker significantly predicted sPTB < 37 weeks (n = 88 vs. 171 terms ≥ 37 weeks) after adjusting for BMI and GA at blood draw (AUC= 0.64, 95% CI: 0.57–0.71, p < .001). Performance was similar for sPTB < 34 weeks (n = 17 vs. 184 ≥ 34 weeks): AUC = 0.66, 95% CI: 0.51–0.82, p = .012. The discovery phase of the study showed that the addition of endoglin, prolactin, and tetranectin to the above model resulted in the prediction of sPTB < 37 with an AUC= 0.72 (95% CI: 0.66–0.79, p-value < .001) and prediction of sPTB < 34 with an AUC of 0.78 (95% CI: 0.67–0.90, p < .001). A protein biomarker pair developed in the U.S. may have broader application in diverse non-U.S. populations.

Background: Pancytopenia is a relatively common hematological entity. It is a striking feature of many serious and life threatening illnesses ranging from simple drug – induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasias and leukemias. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Thus, identification of the correct cause will help in implementing appropriate therapy. Objectives: To study the clinical presentations in pancytopenia due to various causes. To evaluate hematological parameters including bone marrow aspiration and trephine biopsy wherever possible. Materials and Methods: This is a prospective study to evaluate patients with pancytopenia who presented to hematology unit, department of pathology, KIMS, Hubli over a period of two years. Patients on chemotoxic therapy and radiotherapy were excluded from the study. Results: A total of 115 patients were evaluated in this study. Among 115 cases, age of patients ranged from 3 – 80 years with a mean age of 42 years with male predominance. Male to female ratio was 1.5: 1. Most of the patients presented with generalized weakness and fever. Commonest physical finding was pallor followed by splenomegaly and hepatomegaly. Dimorphic anemia was the commonest blood picture. Bone marrow aspiration was conclusive in all cases. Commonest marrow finding was hypercellularity with megaloblastic erythropoiesis. Conclusion: Pancytopenia is not an uncommon hematological problem encountered in clinical practice and should be suspected on clinical grounds when a patient presents with unexplained anemia, prolonged fever and tendency to bleed. Hence, present study concludes the detailed primary hematological investigations along with bone marrow aspiration and bone marrow trephine biopsy in cytopenic patients is helpful for understanding the disease process, to diagnose or to rule out the causes of cytopenia. It is also helpfu

BackgroundNovel Coronavirus-19 infection with its original and mutant variant (seems to be more contagious) is an emerging threat today, nevertheless, the children population cannot be overlooked, as a certain risk group child are also infected in the UK. The children mainly present with respiratory symptoms ranging from mild to severe respiratory distress. The racial predilection, weight percentile, and consistency of management protocol of Paediatric COVID-19 infection is an important issue in the UK, needs to be addressed.ObjectivesThe objectives of the study were:(i) To identify the main presenting complaints among the children cohort with Covid-19 infection(ii) Whether children are the source of primary or secondary infection of COVID-19(iii) Whether the children visited with any comorbidity with COVID infection(iv) Any predilection of ethnicity and the(v) Pattern of disease progression with COVID-19.MethodsA pre-tested open and close-ended (dichotomous) questionnaire was developed and used for the study.The criteria for selection of the cases were- the children who presented with fever, respiratory and other symptoms, and who were admitted to the ward for treatment. The patient cohort was swabbed as per existing NHS guidelines for the detection of COVID-19 infection1. The data protection act and the patient’s confidentiality were strictly followed. The study was standardized as per protocol of the WHO guidelines, NHS website, and Public Health England including Royal College of Paediatrics and Child Health (RCPCH) guidelines 3,4. This was an observational study carried out among 158 children, ages ranging between 0 and 15 years. This study was carried out during the pandemic period of March-May 2020 at Queen’s Hospital under Barking, Havering, and Redbridge University Hospital NHS Trust. The laboratory investigations were carried out at the local and tertiary hospitals.ResultsFrom among 158 cases, 34 (21.3%) cases were COVID-19 positive, 8 (5%) cases suffered from Paediatric Inflammatory Multisystem Syndrome PIMS-TS. The demographic pattern which was expressed in number (n) of the cases by age, gender, and ethnicity.It is revealed that ethnicity-wise, the Black, and Asian children are affected more. 24% of children were not swabbed, 8.7% of cases were wrongly labelled. It is elucidated the percent distribution of the cases who were not swabbed and wrongly labelled and negative cases. Only one case(n=1) was detected as COVID-19 positive and PIMS. It is depicted the percent distribution of the total patients of COVID-19 positive and PIMS-TS cases.ConclusionsHealthy children are affected, no children with underlying co-morbidity was noted and the ethnicity predilection is Black and Asian group, similarly, weight of higher centile category of children is affected more. Although the severity of infection is mild among children, the consequence of this infection cannot be overlooked.To expedite the test and trace serviceTo develop strong liaison with tertiary care for sero-surveillanceTo develop a consistent follow-up protocolTo develop proper documentation systemDevelopment of appropriate swab technique and ensuring labelling whilst transferring the swab.Ensuring appropriate PPEValidation for a proven benefit of antibiotic at the onset of the COVID 19 infection.

Preterm births are the leading cause of neonatal death in the United States. Previously, a spontaneous preterm birth (sPTB) predictor based on the ratio of two proteins, IBP4/SHBG, was validated as a predictor of sPTB in the Proteomic Assessment of Preterm Risk (PAPR) study. In particular, a proteomic biomarker threshold of −1.37, corresponding to a ~two-fold increase or ~15% risk of sPTB, significantly stratified earlier deliveries. Guidelines for molecular tests advise replication in a second independent study. Here we tested whether the significant association between proteomic biomarker scores above the threshold and sPTB, and associated adverse outcomes, was replicated in a second independent study, the Multicenter Assessment of a Spontaneous Preterm Birth Risk Predictor (TREETOP). The threshold significantly stratified subjects in PAPR and TREETOP for sPTB (p = 0.041, p = 0.041, respectively). Application of the threshold in a Kaplan–Meier analysis demonstrated significant stratification in each study, respectively, for gestational age at birth (p &lt, 001, p = 0.0016) and rate of hospital discharge for both neonate (p &lt, 0.001, p = 0.005) and mother (p &lt, 0.001, p &lt, 0.001). Above the threshold, severe neonatal morbidity/mortality and mortality alone were 2.2 (p = 0.0083,) and 7.4-fold higher (p = 0.018), respectively, in both studies combined. Thus, higher predictor scores were associated with multiple adverse pregnancy outcomes.

INTRODUCTION: knowledge of the morphological pattern of ssure and lobes of lungs can contribute to decreases morbidity and mortality associated with cardiopulmonary surgeries. Anatomical variation of ssure in human lungs noticed as absent, incomplete or complete during routine dissection. My study was aimed at analyzing into the morphological mul AIM: tipattern of ssure and lobes of lungs. MATERIALS AND METHODS: The present study based on macroscopic examination of 60 (30 right and 30 left) embalmed human cadaveric lungs. After thoroughly observation of each lung specimens were noted pattern of lobes, ssure variation and studied in detail. All lungs specimen was photographed for record. In the present study following observation was made: Right sided lungs had, Incompl RESULT & CONCLUSION: ete Horizontal ssures in 11 lungs, absent horizontal ssures in 01 lung and incomplete oblique ssure in 08. Left sided lungs had, Incomplete oblique ssures in 09 lungs, knowledge of variation in the morphological pattern of ssure and lobes of lungs useful tool for medical clinicians, radiologist and cardiopulmonary surgeon for interpretation of correct location of bronchopulmonary segments.

Background Tigecycline, a new agent against multidrug-resistant (MDR) bacteria, is especially licensed for use in complicated skin and soft tissue and intra-abdominal infections. We aimed to study the recent in vitro activity of tigecycline against MDR Enterobacteriaceae skin and soft tissue isolates. Methods Consecutive isolates (56 Escherichia coli, 48 Klebsiella pneumoniae) were subjected to tigecycline susceptibility testing by Ezy MIC test and interpreted as per European Committee on Antimicrobial Susceptibility Testing. Results The minimum inhibitory concentrations (MICs) of tigecycline ranged from 0.016 to 48 μg/mL, with MIC50 0.19 μg/mL and MIC90 1.0 μg/mL respectively. Seven (6.7%) isolates were resistant to tigecycline, all K. pneumoniae. Conclusion Tigecycline remains a viable therapeutic option against MDR isolates, with excellent in vitro activity against E. coli and promising activity against K. pneumoniae. However, the limited availability of alternate therapeutic armamentarium necessitates its use with extreme judiciousness along with continuous monitoring for the emergence and spread of resistance., Highlights • Tigecycline has excellent in vitro activity against MDR E. coli. • Tigecycline has comparatively lower activity against MDR K. pneumoniae. • Tigecycline remains a viable therapeutic option against MDR E. coli isolates. • Limited availability of alternate therapy necessitates cautious use of tigecycline.

Background: Pregnancy-induced hypertension (PIH) includes hypertensive disorders peculiar to pregnancy that have their onset during pregnancy and subsides completely following delivery. In India, perinatal mortality rate (PNMR) in PIH is high as the emphasis is still on maternal salvage, and there is lack of tertiary care centers dealing with premature and low-birth-weight infants. Objective: The objective of the study was to determine the extent of perinatal problems and to evaluate the prognostic significance of various factors associated with PIH on perinatal outcome and determine its effects. Materials and Methods: The study included 200 consecutive births which took place from March 2018 to February 2019 on mothers admitted with PIH in District Hospital, Tumkur, Karnataka. Results: The incidence of PIH was 8.6% in this study. The incidence of preterm was 31% which was high in eclampsia (63). PNMR in the study is 345/1000 which is higher than in general PNMR of the hospital. Conclusion: PIH is a multisystem disease and threat to the well-being of the mother and her unborn child. Characterization of the neonatal consequences of maternal hypertension is complicated by the administration of antihypertensive and anticonvulsant medications to the mother; thus, the fetal outcome might be influenced by both maternal disease and pharmacological intervention.

Objectives: Circular Supply Chain Management has received greater industry interest in recent times due to growing concerns about environmental protection issues, recycling, sustainable development, and safety regulations. There are several barriers that hinders the implementation of circular supply chains in manufacturing organizations. In this context, this study reports a study in which 5 crucial barriers from a manufacturing context identified from literature. Method: The barriers are systematically analysed using Total Interpretive Structural Modelling (TISM) and the structural model has been developed. The prioritized barriers need to be focused to deploy circular supply chain without any hindrance. Findings: The identified barriers are: Lack of Top Management Commitment, Government Regulations, Volatile Customer requirements, Wrong business models, and Lack of recyclability facilities. Lack of Top Management Commitment and Wrong Business Models were found as the most Driving barriers and Lack of recyclability facilities was found as the most Driving Barrier. Application: The developed model will be useful for practitioners and industrial experts to fine tune their business models to deploy circularity without any hurdles. Keywords: Barriers, Business Model, Circular Supply Chains, Recyclability, Total Interpretive Structural Modeling

Objective: To evaluate the outcome of fracture Ankle dislocation managed with internal fixation.Method: This is a study of patients with “Fracture Ankle Dislocation” admitted in Orthopaedic ward in B.R.D medical college, Gorakhpur, meeting both inclusion and exclusion criteria who came to our hospital. Work up done for surgical management. Consent was taken from all the patient. This prospective randomized study was analyzed.Result: The result of this study is not in comparison with other studies as enumerated shows poor outcome as compare to other study with respect to the functional outcome following surgical stabilization of ankle fractures dislocation.

Introduction: Russell’s viper envenoming in dogs is a significant problem in Sri Lanka. The current study focused on investigating clinical profile, laboratory findings of three selected tests and to develop a treatment strategy with Indian polyvalent Anti-Venom Serum (AVS). It was also intended to report adverse effects and complications caused by both Russell's viper venom (RVV) and AVS in Russell’s Viper (RV) envenomed dogs. Objective: To evaluate and report the clinical manifestations, to find out the minimum effective vials of AVS and to record AVS induced adverse reactions of RV envenoming in dogs. Materials and methods: A prospective study was conducted on Russell's viper bitten dogs (n = 65) admitted to the Veterinary Teaching Hospital (VTH) in Sri Lanka. Indian polyvalent AVS was used to treat all the envenomed dogs. The number of vials of AVS that was administered to a patient was decided upon by a second degree polynomial model with a number of vials of AVS in the X axis verses Prothrombine Time (PT), Activated Partial Thromboplastine Time (aPTT) and Clotting Time (CT) in the Y axis respectively. Results: Varying degrees of pain were exhibited by all the victim dogs. Mild swelling and necrosis at the site of bite was seen in 54% (n = 35) and 37% (n = 24) of dogs respectively. Prolonged values of, PT, aPTT and CT were seen from all the RV envenomed dogs. The mean leukocyte count in these dogs was 39.79 × 103/μL (normal range; 4–20 × 103/μL) (IQR:29.05 × 103/μL-45.92 × 103/μL). Statistical analysis showed that the initial vials of 7 AVS would be the minimum required vials. Therefore, a range of 6–15 AVS vials in total were administered to these dogs and in 7.6% (n = 5) of dogs, the results of PT, aPTT and CT became normal with 6 AVS vials at 32–97 minutes. Acute Renal Failure (ARF) was detected from 29% (n = 19) of dogs as a complication. Conclusions: Systemic clinical signs of haemorrhagic lesions, cardio respiratory toxicities were common in Russell's viper envenomed dogs. Initially 6 vials of AVS must be administered. AVS induced reactions were reported commonly. Russell's viper envenoming was found to be lethal in dogs. Keywords: Daboia russelii, Dogs, Anti-Venom serum, Prothrombine time, Activated partial thromboplastine time, Clotting time

Objective: To define template architecture for large virtualized environment automation ecosystem. Methods/Statistical Analysis: This study proposes self-sustaining, highly scalable automation architecture with multiple services components supporting each other’s to deliver a reliable and scalable service in self-contained virtualized environment. This new proposed template architecture has been evaluated by building Proof of concept built using few readily available tools and few property application developed for this project. Finally we evaluated the architecture with varying load of storage, SAN networking and Backup and recovery workflow tasks. Stability, sustainability and self-load balancing capabilities are measure over time, by injecting dynamic work task to this framework. Findings: Large virtualized environment gives unlimited access to compute and storage resource on demand. One of the key enabler for this functionality is the robust automation framework. Due to limited technical expertise and lack any open source standard shinder migration of any existing mid-size virtualized IT assets into fully automated eco-system. This study tries to address this challenge by proposing new template open-ended architecture. This takes care of any organizational scalability, security, and compliance and maintainability issues. Application/Improvements: The proposed architecture can be used for implementing highly automated virtualized ecosystem in large virtualized environment. Keywords: Automation, Integrated Automation Framework, Orchestration, Scalable Architecture, Virtualized Environment

Monitoring patient's blood oxygen saturation (SpO 2 ) levels using pulse oximeter is important to physician. SpO 2 is also one of the major parameter that is being monitored to assess the respiratory health in Covid-19 infected patients during the ongoing pandemic. In pulse oximeters, the motion artifacts (MA), due to voluntary or involuntary movement of patient, will disturb the morphology of the photoplethysmographic (PPG) signals acquired through a finger/forehead sensor resulting in inaccurate SpO 2 values. The current work is focused on an efficient adaptive filtering method for MA reduction, which uses a wavelet reconstructed secondary MA noise as reference signal. It eliminates the use of an external sensor to be employed for estimating MA signal. This method while reducing the MA restored the PPG morphology and respiratory components facilitating accurate estimation SpO 2 , heart rate (HR).

Iatrogenic ureteral injuries (IUI) occur in 0.5–1.3% of cases during abdominal surgery. If not recognized intraoperatively, IUI increase morbidity/mortality. A universally accepted method to prevent IUI is lacking. Near-infrared fluorescent imaging (NIRF), penetrating deeper than normal light within the tissue, might be useful, therefore ureter visualization combining NIRF with special dyes (i.e. IRDye 800BK) is promising. Aim of this work is to evaluate the detection of ureters using stents coated with a novel biocompatible fluorescent material (NICE: near-infrared coating of equipment), during laparoscopy. female pigs underwent placement of NICE-coated stents (NS). NIRF was performed, and fluorescence intensity (FI) was computed. Successively, 0.15 mg/kg of IRDye 800BK was administered intravenously, and FI was computed at different timepoints. Ureter visualization using NS only was further assessed in a human cadaver. Both methods allowed in vivo ureter visualization, with equal FI. However, NS were constantly visible whereas IRDye 800BK allowed visualization exclusively during the ureteral peristaltic phases. In the human cadaver, NS provided excellent ureter visualization in its natural anatomical position. NS provided continuous ureteral visualization with similar FI as the IRDye 800BK, which exclusively allowed intermittent visualization, dependent on ureteral peristalsis. NS might prove useful to visualize ureters intraoperatively, potentially preventing IUI.

OBJECTIVE: The unprecedented demand for testing for the ongoing coronavirus disease-2019 (COVID-19) pandemic caused by SARS-CoV-2 has led to an acute shortage and limited availability of test reagents for which pooling of samples has been recommended in areas with low prevalence. Considering the possibility of dilution factor in pool testing, an attempt was made to find out possibility of any true positive sample/s in pools with late amplification. METHODS: The study was conducted on samples received from various collection centres in different districts of Odisha as well as from patients attending the screening clinic or admitted in COVID ward of the hospital. Nasal/nasopharyngeal/throat swabs received in viral transport media in cold chain were subjected to RT-PCR testing in a Biosafety Laboratory level-2 by including uniform volume of 4 units (samples) per pool. All confirmed and probable positive pools in screening assay were de-convoluted and individual samples tested for confirmatory assay. RESULT: Inclusion of an additional criteria of probable positive pool (Ct value >35 with non-sigmoid amplification curve or showing a line of amplification towards the end of the cycle) yielded 39 (15.5%) more true positive samples out of a total of 251 positive samples that would otherwise have been missed if only the classical criteria of positive (Ct within 35 with proper sigmoid curve) had been considered. CONCLUSION: The study highlights the importance of considering any indication of late amplification in the RT-PCR test to label a pool as positive to avoid missing any true positive sample in the pool. This article is protected by copyright. All rights reserved.

The advent of IOT has resulted in explosion of connected devices. These devices generally have limited computing capabilities and to overcome this there is a new distributed computing architecture in the form of edge computing. In this paradigm some part of the computation is performed at the edge of the network and the rest either in the end point nodes or the cloud depending on the task that needs to be completed. This method opens new challenges specially in the form of resource allocations in the edge computing framework. In this work we shall be looking into the major resource allocation paradigms present and new approaches to this problem

Shot peening (SP) process is performed on AA2024-T3 alloy to improve its fatigue strength, flexural strength and surface hardness. Response surface method (RSM) is used for designing the experiments. Experiments are conducted and the regression equations are framed using the Design Expert software. RSM based second order regression equations are used as input to Particle swarm optimisation (PSO) algorithm. PSO algorithm is used to find the best combination of shot peening process parameters, namely, peening pressure and peening distance for maximizing the responses. Validation of the solutions obtained from PSO is done by performing shot peening process with nickel balls. The results of mechanical properties of AA2024-T3 are found close to the predicted values obtained from PSO algorithm.

Outdoor luminaries’ management is one of the prominent areas for smart cities that improve the living standards of the citizens by reducing the emission of CO2, energy consumption, and cost. In this paper, a motion detection (MD)-based outdoor luminary intensity control system using sensors is proposed. This prototype designed controls luminary intensity during nighttime using different intensity controls, and especially at midnight time, it operates in motion detection mode using sensors and saves a lot of power wastage. It supports motion detection of high-speed vehicles on highways up to 120 kmph or more. The prototype is designed by using simple combinational circuits, integrated with renewable energy sources, and consumes less power.

Acute bacterial endocarditis is a rapid, difficult to manage, and frequently lethal disease. Potent antibiotics often cannot efficiently kill Staphylococcus aureus that colonizes the heart’s valves. S. aureus relies on virulence factors to evade therapeutics and the host’s immune response, usurping the host’s clotting system by activating circulating prothrombin with staphylocoagulase and von Willebrand factor–binding protein. An insoluble fibrin barrier then forms around the bacterial colony, shielding the pathogen from immune cell clearance. Targeting virulence factors may provide previously unidentified avenues to better diagnose and treat endocarditis. To tap into this unused therapeutic opportunity, we codeveloped therapeutics and multimodal molecular imaging to probe the host-pathogen interface. We introduced and validated a family of small-molecule optical and positron emission tomography (PET) reporters targeting active thrombin in the fibrin-rich environment of bacterial colonies. The imaging agents, based on the clinical thrombin inhibitor dabigatran, are bound to heart valve vegetations in mice. Using optical imaging, we monitored therapy with antibodies neutralizing staphylocoagulase and von Willebrand factor–binding protein in mice with S. aureus endocarditis. This treatment deactivated bacterial defenses against innate immune cells, decreased in vivo imaging signal, and improved survival. Aortic or tricuspid S. aureus endocarditis in piglets was also successfully imaged with clinical PET/magnetic resonance imaging. Our data map a route toward adjuvant immunotherapy for endocarditis and provide efficient tools to monitor this drug class for infectious diseases.