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In this paper, the authors investigate the synchronization criteria of fuzzy impulsive sampled data control for Hindmarsh–Rose (H–R) neuronal system with time-delay. For the stability analysis, Lyapunov–Krasovskii functionals (LKF) are employed to deduce the conditions that guarantee the asymptotical stability of the proposed T–S fuzzy H–R neuron system. By utilizing free-matrix based inequality, some sufficient conditions are derived and expressed in terms of linear matrix inequalities. The obtained sufficient conditions can be checked easily by standard available software packages in MATLAB. Finally, some numerical simulations are given to validate the effectiveness of the proposed conditions.

A previously healthy 12-year-old boy presented to the emergency department on the seventh day of illness with classical symptoms of postinflammatory multisystemic syndrome in children temporally associated with SARS-CoV-2 (fever, vomiting, loose stools and rashes all over the body) with COVID-19 seropositivity, high inflammatory markers and elevated cardiac enzymes with cardiogenic shock with multiple organ dysfunction syndrome. After having improved over the first 48 hours following intravenous immunoglobulin and pulsed steroids, this young boy developed sudden cardiac arrest and died. No reversible cause could be identified at the time of resuscitation. Despite an apparent clinical recovery in the myocardial function, it is likely that the myocardium remains arrhythmogenic due to cytokine-induced myocardial inflammation. There are several reports in the literature of fatality in multisystemic inflammatory syndrome in children (MISC) due to cardiovascular complication during the acute phase of the illness. To the best of our knowledge, this is the first report of sudden cardiac death in a child with MISC days after recovery from critical illness, suggesting that fatal outcome remains a potential risk during follow-up, even when there is no evidence of coronary aneurysm. Further studies are needed to identify clinical characteristics of such high-risk children presenting with MISC. We will need to follow these children closely to understand what implications they may have in the long term, and this helps in raising awareness among families of such children.

Background The Joint Committee on Surgical Training (JCST) have published a series of quality indicators (QIs) which act as a benchmark against which the quality of surgical training can be assessed. This audit aims to compare core surgical training (CST) rotas in our region against the JCST QI 10's minimum standard of 5 consultant supervised training sessions per week. Methods Core surgical trainees in one training region were contacted requesting their on-call rotas from rotations undertaken during the 2019/20 academic year. Rotas were analysed in a protocolised manner, with the number of potential training sessions available calculated and compared against the JCST QI 10 minimum recommendation. Results Twenty-four rotas were assessed across 17 hospitals. Only six (25%) of rotas achieved the JCST QI 10 standard. There was a mean deficit of 18.5 (±29.5) training sessions per 6-month rotation. Rotas compliant with JCST QI 10 used a mean rota pattern of 1 in 11 compared to 1 in 9 for those failing to meet the target. Further analysis, comprising of the addition of expected consultant led training whilst on call, led to an improvement in compliance to 9 (38%) and 13 (54%) of rotas when there was an addition of 0.5 h and 1 h of consultant supervised training time per on-call session respectively. Conclusion Many core surgical trainee rotas in the region are non-compliant with JCST QI 10, indicating a lack of regular consultant-led training opportunities. A move to a reduced on-call commitment with the use of supporting medical practitioners could be considered to improve this.

In 2012, a global outbreak of invasive Mycobacterium chimaera (M. chimaera) infection was identified in patients after cardiopulmonary bypass surgery. Investigations revealed the source to be heater-cooler unit (HCU) exhaust, with point-source contamination discovered at the LivaNova HCU manufacturing plant (London, UK). We report our experience with affected HCUs at a high-volume pediatric cardiac surgery center in the United States.A multidisciplinary task force was established for outbreak management, including removing contaminated HCUs from service. Patients identified as exposed to affected HCUs were systematically contacted. A call center was created for patient/family inquiries, and symptomatic patients were assessed using an institutional triage protocol, including laboratory/culture data and infectious diseases consultation.Cardiopulmonary bypass surgeries were performed in 4276 patients (median age: 2.1 years; range: 0-48.4 years) between October 2010 and October 2016. Call center volume was highest in the first 6 weeks after patient notification, totaling 307 calls and yielding 70 clinical patient assessments. Presenting symptoms included fatigue (60%), fever (49%), night sweats (46%), myalgias (34%), and weight loss (24%). Among the 70 assessed patients, echocardiogram (n = 30), cardiac computed tomography (n = 2), cardiac magnetic resonance imaging (n = 1), and pulmonary computed tomography (n = 1) did not reveal abnormalities suggestive of active infection. Infectious diseases consultation occurred in 23 (33%) patients. Acid-fast bacilli blood cultures were obtained in 30 patients; all were negative.Through a highly coordinated outreach effort, no patients have been found to have M. chimaera infection in the 6 years after exposure to contaminated HCUs. Ongoing vigilance for cases that may yet manifest is needed.

To develop a claims-based model to predict persistent high-dose opioid use among patients undergoing total knee replacement (TKR).Using Medicare claims (2010-2014), we identified patients ages ≥65 years who underwent TKR with no history of high-dose opioid use (mean 25 morphine milligram equivalents [MMEs]/day) in the year prior to TKR. We used group-based trajectory modeling to identify distinct opioid use patterns. The primary outcome was persistent high-dose opioid use in the year after TKR. We split the data into training (2010-2013) and test (2014) sets and used logistic regression with least absolute shrinkage and selection operator regularization, utilizing a total of 83 preoperative patient characteristics as candidate predictors. A reduced model with 10 prespecified variables, which included demographic characteristics, opioid use, and medication history was also considered.The final study cohort included 142,089 patients who underwent TKR. The group-based trajectory model identified 4 distinct trajectories of opioid use (group 1: short-term, low-dose; group 2: moderate-duration, low-dose; group 3: moderate-duration, high-dose; and group 4: persistent high-dose). The model predicting persistent high-dose opioid use achieved high discrimination (receiver operating characteristic area under the curve [AUC] 0.85 [95% confidence interval (95% CI) 0.84-0.86]) in the test set. The reduced model with 10 predictors performed equally well (AUC 0.84 [95% CI 0.84-0.85]).In this cohort of older patients, 10.6% became persistent high-dose (mean 22.4 MME/day) opioid users after TKR. Our model with 10 readily available clinical factors may help identify patients at high risk of future adverse outcomes from persistent opioid use after TKR.

Summary Introduction Extralevator abdominoperineal excision (ELAPE) for low rectal tumours necessitates a reliable method of reconstructing the perineum. The senior author developed the partial myocutaneous gluteal (PMG) flap. We present 49 consecutive reconstructions with the refinement of the original procedure. Methods We conducted a retrospective observational review of patients undergoing ELAPE and PMG reconstruction from 2012 to 2019, with at least 1 year follow-up. The procedure was modified iteratively following our original series, to minimise perineal herniation, specifically by greater mobilisation of the inferior gluteus maximus muscle and separation of the muscle and fasciocutaneous components, allowing closure of the defect around the coccygeal remnant. Perineal herniation and wound complications were recorded. Laparoscopic and open resection techniques were compared, as were outcomes before and after modification of the flap. Results There were no flap failures in our cohort of 49 patients. Two patients (4%) required return to theatre acutely for perineal wound complications: one wound dehiscence and one flap-related haematoma. Five patients had evidence of perineal hernia, three prior to any modification of the flap and two following. Three had symptoms of which two required elective repair. The flap modifications were made in response to these cases. There were no significant differences in perineal outcomes for laparoscopic versus open, and before and after flap modification. Conclusions Over the last 8 years, we have refined our perineal reconstruction technique following instances of perineal herniation and major wound dehiscence. We believe that the PMG flap provides robust and reliable option for the reconstruction of perineal extralevator abdominoperineal defects.

The low temperature solution growth method was adopted for growing semi organic single crystal zinc boro glutrate (ZBG). The surface morphology was investigated by SEM analysis. Analysis of microhardness has been done, measurement of the Vickers hardness number Hv. Dielectric studies show a decrease in dielectric loss and dielectric constant with an increase in frequency and a constant value in the higher frequencies, suggesting that the crystal is also of good optical quality in nature.

Concern over growing fossil fuel depletion has led to the search for renewable fuels with efficiencies comparable to those seen today for conventional fuels. The present article discusses the potential and opportunities to be used in various applications for alternative fuels. The properties of these fuels and their fuel efficiency are discussed in detail. Vegetable oils provide a very positive scenario for fossil fuels to be used as alternatives. The use of biodiesel leads to a major reduction of unburned hydrocarbons, carbon Monoxide, particulate matter and nitrogen oxides in traditional diesel engines. Different alternative fuels have been compared to traditional fuels and it is clear that the use of these fuels can be greatly reduced by the use of blended fuels. Many alternative fuels have properties close to those of conventional fuels, so it is already well known the technologies needed to deal with them. Hydrogen is an exception, and its ignition characteristics differ considerably from those of conventional fuels. Therefore, difficulties in the storage, transport and use of hydrogen as a fuel are important. Therefore, difficulties are essential in storing, transporting and using hydrogen as fuel. There is also discussion of other technologies, such as alternate routes to conventional fuel alternatives, such as CTL. The discussion on emulsified oils, including the use of oxygenates, eventually took place.

Storm nowcasting relies on reasonably fast sampled radar data, and deep learning (DL) can be used to harness this vast amount of data. Despite all the publications on this topic over the past five years, there are still ad hoc assumptions and a lack of standardization. This work addresses aspects that have not yet been analyzed on the development of DL models for nowcasting systems, such as the effects of different history lengths or using non-convex metrics during the training phase. For example, we show that even if the loss function is varied, it does not significantly influence the predictions, and that the number of predicted frames has a significant impact. We used the experiments' results to propose different models and compare their performance against other DL models. The results show that the proposed models outperform, in many aspects, the existing implementations.

Deep learning is emerging as a powerful tool in scientific applications, such as radar-based convective storm nowcasting. However, it is still a challenge to extend the application of a well-trained deep learning nowcasting model, which demands to incorporate the learned knowledge at a certain location to other locations characterized by different precipitation features. This article designs a transfer learning framework to tackle this problem. A convolutional neural network (CNN)-based nowcasting method is utilized as the benchmark, based on which two transfer learning models are constructed through fine-tune and maximum mean discrepancy (MMD) minimization. The base CNN model is trained using radar data in the source study domain near Beijing, China, whereas the transferred models are applied to the target domain near Guangzhou, China, with only a small amount of data in the target area. The influence of a varying number of target data samples on the nowcasting performance is quantified. The experimental results demonstrate that the deep transfer learning models can improve the nowcasting skills.

Background: Ovarian cancer is one of the leading causes of death worldwide. Polymers have low cytotoxicity and high functionalizability and are hence used for drug delivery systems, tissue engineering, and polymer therapeutics. In drug delivery systems, polymer-drug conjugates have shown considerable promise, especially in anticancer chemotherapy. Objective: Anticancer Drug Delivery Systems (DDS) deliver drugs to the tumor site leading to reduced exposure of the drugs to healthy cells and hence reduced side effects. Efforts have been made in the past to develop effective DDS using stimuli-responsive polymers like thermosensitive and pH-sensitive polymers. Conclusion: Elastin-like Polypeptides (ELP), one of the thermoresponsive polymers, have been identified as drug carriers in anticancer therapy. ELP-drug conjugates have the potential and can be used effectively in combination with hyperthermia for targeting drugs to solid tumors. This review reports on the use of ELPs in cancer therapy, its biomedical applications, and recent developments to target drugs to ovarian solid tumors.

Ochratoxins (OTs) with nephrotoxic, immunosuppressive, teratogenic, and carcinogenic properties are thermostable fungal subordinate metabolites. OTs contamination can occur before or after harvesting, during the processing, packing, distribution, and storage of food. Mold development and mycotoxin contamination can occur in any crop or cereal that has not been stored properly for long periods of time and is subjected to high levels of humidity and temperature. Ochratoxin A (OTA) presents a significant health threat to creatures and individuals. There is also a concern of how human interaction with OTA will also express the remains of OTA from feedstuffs into animal-derived items. Numerous approaches have been studied for the reduction of the OTA content in agronomic products. These methods can be classified into two major classes: inhibition of OTA adulteration and decontamination or detoxification of food. A description of the various mycotoxins, the organism responsible for the development of mycotoxins, and their adverse effects are given. In the current paper, the incidence of OTA in various fodder and food materials is discussed, which is accompanied by a brief overview of the OTA mode of synthesis, physicochemical properties, toxic effects of various types of ochratoxins, and OTA decontamination adaptation methods. To our knowledge, we are the first to report on the structure of many naturally accessible OTAs and OTA metabolism. Finally, this paper seeks to be insightful and draw attention to dangerous OTA, which is too frequently neglected and overlooked in farm duplication from the list of discrepancy studies.

Background Inflammatory bowel disease (IBD) is increasingly diagnosed in South Asia. This survey by the Tamil Nadu Chapter of the Indian Society of Gastroenterology (TNISG) documents the demography, clinical profile, and therapeutic practices related to IBD in Tamil Nadu. Methods TNISG members from 32 institutions completed an online cross‐sectional questionnaire on IBD patients from March 2020 to January 2021. Results Of 1295 adult IBD patients, 654 had Crohn's disease (CD), 499 ulcerative colitis (UC), and 42 IBD‐unclassified (IBD‐U). CD and UC showed a unimodal age distribution. A total of 55% were graduates or postgraduates. A positive family history was noted in 30, other risk factors were uncommon. In CD, the pattern of involvement was ileocolonic (42.8%), ileal (34.7%), colonic (18.9%), and upper gastrointestinal (3.5%); while in UC, disease was characterized as extensive (44.9%), left‐sided (41.7%), or proctitis (13.4%). Perineal disease, perianal fistulae, and bowel obstruction were noted in 4.3, 14.0, and 23.5%, respectively, of CD. The most widely used drugs were mesalamine, azathioprine, and corticosteroids. Surgery was undertaken in 141 patients with CD and 23 patients with UC. Of the 138 patients with pediatric IBD (≤16 years), 23 were characterized as very early onset IBD (VEO‐IBD), 27 as early‐onset, and 88 as adolescent IBD. VEO‐IBD were more likely to have a positive family history of IBD and were more likely to have perineal disease and to have the IBD‐U phenotype. Among pediatric IBD patients, corticosteroids, mesalamine, and azathioprine were the most commonly used medications, while 25 pediatric patients received biologics. Conclusion This study provides important information on demography, clinical profile, and treatment practices of IBD in India., Regional differences in inflammatory bowel disease (IBD) profile inform our understanding of the disease as well as prevention, and health planning. This study provides a snapshot of IBD presentation and practices in India at a time when the country is in the second of four phases of IBD transition. The apparently mild nature of IBD, the consequent widespread use of mesalamine, and the association of Crohn's disease with higher levels of education, compared to ulcerative colitis, are of notable interest.

Quantum engineering in kesterite solar cells reveals a blending advancement keeping in mind that copper zinc tin sulfide (CZTS)-based material requires high-research implementation as a replacement for copper indium gallium selenide (CIGS) materials. In this article, quantum well-solar cells (QWSCs) on kesterite material is proposed in which CZTS x Se1− x and CZTS material is taken as well and barrier materials with different Sulfur (S) and Selenium (Se) content. All the optical, electrical, and material properties are investigated in detail to achieve high efficiency. The focus on the incorporation of a high number of quantum wells (QWs) (2 to 100 QWs) and performance analysis show the uniqueness of the study. Quantum efficiency (QE) of the solar cell with separate internal and external absorptions is also investigated here. Different issues on carrier propagation, recombination, and collection are emphasized to highlight the effect of carrier quantization in the material. A remarkable efficiency of 38% with 88% fill factor (FF) could be achieved from the broad range of the proposed structure, which may show a new path for next-generation solar cells.

Context With the addition of active surveillance and thermal ablation (TA) to the urologist’s established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. Objective To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. Evidence acquisition A collaborative critical review of the medical literature was conducted. Evidence synthesis We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. Conclusions Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. Patient summary With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.

Biomarkers are substances that are either secreted by the tumor or produced by the body in response to the presence of cancer. Biomarkers serve as an objective measure for evaluation of normal and pathological processes as well as pharmacological responses to a therapeutic intervention. Cancer studies are usually difficult to interpret, especially based on the contemporary medical diagnosis. In this circumstance, biomarkers are developing as reliable diagnostic metabolites, which have many promising applications in oncological screening, differential diagnosis, risk assessment, response to treatment, and examining the progression of disease. Genome or protein based prognostic biomarkers are available, for numerous cancer types, for potential inclusion into clinical prognostic staging methods. However, there lies difficulty in translating these biomarkers into clinical outcomes. This review concerns important biomarkers related to wide varieties of cancer and also elucidates mode of action of few major biomarkers.

Coronavirus called as coronavirus diseases (COVID)-19 (severe acute respiratory syndrome coronavirus [SARS‐CoV]‐2) is a viral infection which is spreading to a great extent and affecting many people worldwide, many developed and developing countries are severely affected by the virus. The World Health Organization (WHO) is taking serious preventive measures to stop this viral infection worldwide. The coronavirus is a big threat to human beings and controlling the emerging viral infections is a global concern. Antiviral drug such as Remdesivir has been approved by the FDA, but combating against these viral infections is a great challenge to scientists and researchers with the available few antiviral drugs due to severe side effects and toxicity. Many drugs such as hydroxy chloroquin, Remdesivir, and vaccines have been recommended for combating this virus. Few Polyherbal formulations and Ayurvedic formulations containing antiviral phytoconstituents have been recommended to boost the immunity. Some drugs and phytoconstituents are under different phases of human clinical trials. The currently available synthetic drugs and vaccines for the treatment of viral infections have severe side effects. Medicinal plants play a critical role in treating viral infections by developing immunity against viral diseases. Some medicinal plants which were used as antipyretic, analgesic, and anti-inflammatory activity helped in treating various diseases and viral infections. Many plants contain flavonoids such as quercetin, luteolin, apigenin, and polyphenols such as thymoquinone, phytosteroids such as cucurbitacin and others which may likely to act as antioxidants and immunomodulatory that can fight against COVID-19. The current review provides information on phytochemical constituents present in medicinal plants, their mechanism of action, in silico molecular docking studies and human clinical trials to treat viral disorders.

An accurate electrical equivalent circuit model for boron‐substitution doped graphene field effect transistor (GFET) is proposed to analyse the effects of memoryless non‐linearity on transconductance. The proposed equivalent circuit model is verified with the simulated results of an industry‐standard circuit simulation tool. The fundamental figures of merit (FOMs), such as the second‐ and third‐order harmonic distortion terms (HD2 and HD3), gain compression point (Ain,1dB), second‐ and third‐order intermodulation distortion terms (IM2 and IM3), and second‐ and third‐order input intercept points (AIIP2 and AIIP3) are mathematically modelled for B‐substitution doped GFET to examine the linear behaviour of the device. The expressions are validated by performing the single tone and double tone simulation test to the proposed equivalent circuit model using the industry‐standard circuit simulator. The proposed model is compatible and predicts accurate results for both B‐substitution doped and undoped GFET. The simulation results are having an excellent agreement with the mathematical model, which are also compared with the undoped GFET and conventional MOSFET. It is also observed that by B‐substitution doping the graphene sheet significantly induces the bandgapt and hence enhances the linear behaviour of the B‐substitution doped GFET and promises highly desirable linearity requirement in the analog/RF applications.

Summary Background Computer-aided detection (CADe) techniques based on artificial intelligence algorithms can assist endoscopists in detecting colorectal neoplasia. CADe has been associated with an increased adenoma detection rate, a key quality indicator, but the utility of CADe compared with existing advanced imaging techniques and distal attachment devices is unclear. Methods For this systematic review and network meta-analysis, we did a comprehensive search of PubMed/Medline, Embase, and Scopus databases from inception to Nov 30, 2020, for randomised controlled trials investigating the effectiveness of the following endoscopic techniques in detecting colorectal neoplasia: CADe, high definition (HD) white-light endoscopy, chromoendoscopy, or add-on devices (ie, systems that increase mucosal visualisation, such as full spectrum endoscopy [FUSE] or G-EYE balloon endoscopy). We collected data on adenoma detection rates, sessile serrated lesion detection rates, the proportion of large adenomas detected per colonoscopy, and withdrawal times. A frequentist framework, random-effects network meta-analysis was done to compare artificial intelligence with chromoendoscopy, increased mucosal visualisation systems, and HD white-light endoscopy (the control group). We estimated odds ratios (ORs) for the adenoma detection rate, sessile serrated lesion detection rate, and proportion of large adenomas detected per colonoscopy, and calculated mean differences for withdrawal time, with 95% CIs. Risk of bias and certainty of evidence were assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings 50 randomised controlled trials, comprising 34 445 participants, were included in our main analysis (six trials of CADe, 18 of chromoendoscopy, and 26 of increased mucosal visualisation systems). HD white-light endoscopy was the control technique in all 50 studies. Compared with the control technique, the adenoma detection rate was 7·4% higher with CADe (OR 1·78 [95% CI 1·44–2·18]), 4·4% higher with chromoendoscopy (1·22 [1·08–1·39]), and 4·1% higher with increased mucosal visualisation systems (1·16 [1·04–1·28]). CADe ranked as the superior technique for adenoma detection (with moderate confidence in hierarchical ranking); cross-comparisons of CADe with other imaging techniques showed a significant increase in the adenoma detection rate with CADe versus increased mucosal visualisation systems (OR 1·54 [95% CI 1·22–1·94]; low certainty of evidence) and with CADe versus chromoendoscopy (1·45 [1·14–1·85]; moderate certainty of evidence). When focusing on large adenomas (≥10 mm) there was a significant increase in the detection of large adenomas only with CADe (OR 1·69 [95% CI 1·10–2·60], moderate certainty of evidence) when compared to HD white-light endoscopy; CADe ranked as the superior strategy for detection of large adenomas. CADe also seemed to be the superior strategy for detection of sessile serrated lesions (with moderate confidence in hierarchical ranking), although no significant increase in the sessile serrated lesion detection rate was shown (OR 1·37 [95% CI 0·65–2·88]). No significant difference in withdrawal time was reported for CADe compared with the other techniques. Interpretation Based on the published literature, detection rates of colorectal neoplasia are higher with CADe than with other techniques such as chromoendoscopy or tools that increase mucosal visualisation, supporting wider incorporation of CADe strategies into community endoscopy services. Funding None.

INTRODUCTION Serum eye drops (SED) are an important treatment for patients with chronic and severe ocular surface disease (OSD). Despite a long history of use, there is a paucity of information on patient-reported outcomes, particularly comparing autologous SED (Auto-SED) and allogeneic SED (Allo-SED). National Health Service Blood and Transplant is the national provider of SED service for patients in the UK. PURPOSE To evaluate and compare patient-reported outcome measures (PROMs) in patients receiving Auto-SED and Allo-SED for severe OSD. MATERIALS AND METHODS PROMs were retrospectively collected from all new patients commencing treatment with Auto-SED and Allo-SED between January 2017 and September 2018, using the Ocular Surface Disease Index (OSDI) 12-item questionnaire. A linear mixed model was used to evaluate the change in OSDI scores between baseline and follow-up. RESULTS During the study period, 279 patients who received either Auto-SED (n = 71) or Allo-SED (n = 208) were included in the analysis. Baseline and follow-up OSDI scores were available for 161 of these (49 Auto-SED and 112 Allo-SED). There was a significant reduction in mean OSDI score for both Auto-SED (59.06-24.63, p

Introduction and Aim:Corona virus disease 2019 (Covid-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has affected over 200 countries and territories. The aim of the present study is to evaluate the role of eosinopenia in differentiating COVID-19 suspect from other flu-like illnesses in an outpatient setting. Materials and Methods:It was a retrospective case control study in which data of 1252 suspected COVID 19 patients who visited the fever clinic were enrolled. Among this, 701 patients were found to have COVID-19 pneumonia and 551 had other flu-like illnesses. CBC (complete blood count) and CRP(C- reactive protein) were taken in all patients along with chest x-ray as routine protocol. Results:Among the 701 positive patients, eosinopenia was seen in 527 patients and had a sensitivity of 75.2 % and specificity of 68.6 %. When combined with other lab parameters such as the increased CRP and lymphopenia, the specificity rises up to 78.6 %. Conclusion:Our study shows that eosinopenia as an independent variable, is a reliable marker to differentiate COVID-19 suspect patients from other flu-like illnesses on outpatient basis, however when combined with other parameters like lymphopenia and CRP the specificity increases further.

Objective To assesses if active surveillance (AS) is an appropriate treatment modality for patients with intermediate risk (IR) prostate cancer (PCa) utilizing population-level data to compare the survival outcomes of men with low risk (LR) and IR PCa initially treated with AS, watchful waiting (WW) or active treatment (AT). Methods In total, 166,244 patients were initially identified in the surveillance, epidemiology, and end results database using biopsy Gleason grade group (GG) alone—GG1 and GG2. In total, 94,891 patients with GG1 and GG2 disease were further stratified by National Comprehensive Cancer Network risk categories—LR, favorable IR (fIR), and unfavorable IR (uIR). Predictors of cancer-specific (CSS) and overall survival (OS) were analyzed, stratified by risk classification and initial treatment—AT (first-line curative surgery or radiotherapy), AS or WW, utilizing the new “Watchful waiting recode (2010+)” variable. Results We found GG2 patients on AS had worse CSS and OS than GG2 patients who received AT and GG1 patients treated with AS or AT; these trends persist within the National Comprehensive Cancer Network fIR and uIR cohorts. WW patients (GG1, GG2, LR, fIR, and uIR) had the worst survival outcomes of any cohort (log-rank tests P Conclusions We demonstrate a significantly worse 5-year CSS and OS for men with GG2, fIR, and uIR PCa treated with AS compared to AT. Our analysis suggests that AS should not be the preferred treatment modality for IR PCa.

Endomyocardial fibrosis (EMF) is characterized by fibrous tissue deposition on the endocardial surface leading to impaired filling of one or both ventricles, resulting in either right or left heart failure or both. Although Sinus node dysfunction and tachyarrhythmia - atrial fibrillation, ventricular tachycardia, have been commonly reported, complete heart block (CHB) necessitating a pacemaker is rare in EMF. Transvenous pacing is technically limited by fibrotic obliteration of the affected ventricle that results in poor lead parameters, and alternative pacing strategy like epicardial pacing may be required in many. We report three cases of EMF, who were treated with an alternative pacing strategy.

The aim of this article was to study the spectrum of scrub typhus meningitis/meningoencephalitis (STM) cases in children. Children ≤14 years of age with acute undifferentiated febrile illness were included. Immunoglobulin M (IgM) enzyme-linked immunosorbent assay was done in blood and cerebrospinal fluid (CSF) of children with suspected STM. Demographic, clinical, and laboratory details were expressed as descriptive statistics. Factors associated with neurological involvement were identified on univariate analysis. A total of 76 children had ST during the study period (meningitis/meningoencephalitis = 8 [10.5%], of which 5 [62.5%] had detectable ST IgM antibodies in CSF). The included children were 4 to 12 years of age with boys > girls. Headache and vomiting were common in those with STM, whereas hyponatremia and thrombocytopenia were common in those without STM. All children with STM recovered with sequelae in one child (right lateral rectus palsy). There was no mortality. STM has an incidence of 10.5% in children with ST from Eastern India. Headache and vomiting were significant predictors of STM, whereas hyponatremia and thrombocytopenia were significant predictor of non-STM.

Multiple inputs multiple outputs (MIMO) is a reliable technique which can manage the increased wireless data traffic in the future generation of wireless communication network and it is an emerging area of research. Multiple signal paths that exist between the transmitter and receiver are utilized by the MIMO technique to produce spatial multiplexing. During the entire communication, two factors namely energy efficiency and low power consumption need to be considered as the important parameters to design an effective multimedia communication system. Hence, this paper proposes a MIMO-OFDM (Orthogonal Frequency-Division Multiplexing) multimedia model with very low power consumption that provides better energy-efficiency. The MIMO technique is integrated into an OFDM scheme to deliver enhanced QoS for multimedia wireless communication. The research proposed uses the RSTBC system (Rateless Space-Time Block Code) to code video data on mobile networks in order to optimize the power constraint scheme. The Wyner–Ziv coding scheme is proposed here to enhance the flexibility of high-speed video coding models. The Modified Dragonfly Optimization algorithm (MDOA) is designed to decrease the power consumption of mobile communication systems and optimize their energy efficiency. During the optimization process, the MDOA generates the confidence to minimize the mean square error (MSE) value. The MIDO algorithm is used for broadcasting and for effective promotion of hierarchical visual communication to increase energy efficiency and decrease energy consumption. The experiment is conducted using the MDOA algorithm demonstrate that the proposed algorithm can guarantee maximum efficiency for the MIMO-OFDM approach in terms of bit error rate, signal to noise ratio, mean square error (MSE), power consumption, processing time, and energy efficiency.

Objective Medication nonadherence is linked to worsened clinical outcomes and increased costs. Existing system-level adherence interventions rely on insurer claims for patient identification and outcome measurement, yet suffer from incomplete capture and lags in data acquisition. Data from pharmacies regarding prescription filling, captured in retail dispensing, may be more efficient. Data sources Pharmacy fill and insurer claims data. Study design We compared adherence measured using pharmacy fill data to adherence using insurer claims data, expressed as proportion of days covered (PDC) over 12 months. Agreement was evaluated using correlation/validation metrics. We also explored the relationship between adherence in both sources and disease control using prediction modeling. Data extraction methods Large pragmatic trial of cardiometabolic disease in an integrated delivery network. Principal findings Among 1113 patients, adherence was higher in pharmacy fill (mean = 50.0%) versus claims data (mean = 47.4%), although they had moderately high correlation (R = 0.57, 95% CI: 0.53-0.61) with most patients (86.9%) being similarly classified as adherent or nonadherent. Sensitivity and specificity of pharmacy fill versus claims data were high (0.89, 95% CI: 0.86-0.91 and 0.80, 95% CI: 0.75-0.85). Pharmacy fill-based PDC predicted better disease control slightly more than claims-based PDC, although the difference was nonsignificant. Conclusions Pharmacy fill data may be an alternative to insurer claims for adherence measurement.

Public sector crisis is so complex and multidimensional that it becomes imperative to understand the nature of its function, characteristics and the obligations of the State. Also, the types of cri...

Present guidelines recommend a multidisciplinary team (MDT) approach to diabetic foot ulcer (DFU) care, but relevant data from Asia are lacking. We aim to evaluate the clinical and economic outcomes of an MDT approach in a lower extremity amputation prevention programme (LEAPP) for DFU care in an Asian population. We performed a case-control study of 84 patients with DFU between January 2017 and October 2017 (retrospective control) vs 117 patients with DFU between December 2017 and July 2018 (prospective LEAPP cohort). Comparing the clinical outcomes between the retrospective cohort and the LEAPP cohort, there was a significant decrease in mean time from referral to index clinic visit (38.6 vs 9.5 days, P < .001), increase in outpatient podiatry follow-up (33% vs 76%, P < .001), decrease in 1-year minor amputation rate (14% vs 3%, P = .007), and decrease in 1-year major amputation rate (9% vs 3%, P = .05). Simulation of cost avoidance demonstrated an annualised cost avoidance of USD $1.86m (SGD $2.5m) for patients within the LEAPP cohort. In conclusion, similar to the data from Western societies, an MDT approach in an Asian population, via a LEAPP for patients with DFU, demonstrated a significant reduction in minor and major amputation rates, with annualised cost avoidance of USD $1.86m.

Water tank Electricity generator is the most efficient type of renewable energy Source. Through this paper the design and structural unit of water tank power generation system using household tank water. Water flows through the household pipes has kinetic energy that has the potential to generate electricity for general uses like garden lighting. According to the above detail, electricity generation is challenging once. To overcome this drawback a three existing components namely the air bladder nozzle for water pressure maintenance, U-tube piping, and broad nozzle pipe are connected at the end. These help us to give better resultant in electricity generation. This method is used to reduce a small amount of fuel consumption like coal and petroleum. By Arrange the required component the electricity is generated in case if the overhead household tank is kept at a minimum of 3 meters or more than 3 meters then the kinetic energy produce by the water in a pipeline is high. Hence this paper gives an idea to develop a small amount of electricity using a household water tank in daily life.

Case Presentation A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. His medical history included hypertension, diabetes mellitus, chronic kidney disease, morbid obesity, paroxysmal atrial fibrillation, and tobacco use. He was taking amiodarone, carvedilol, furosemide, pregabalin, and insulin. The patient appeared to be in mild respiratory distress. He was afebrile and had saturation at 93% on 3 L of oxygen, heart rate of 105 beats/min, BP of 145/99 mm Hg, and respiratory rate of 18 breaths/min. On auscultation, there were crackles on bilateral lung bases and chronic bilateral leg swelling with hyperpigmented changes. His WBC count was 6.0 K/cumm (3.5 to 10.6 K/cumm) with absolute lymphocyte count 0.7 K/cumm (1.0 to 3.8 K/cumm); serum creatinine was 2.81 mg/dL (0.7 to 1.3 mg/dL). He had elevated inflammatory markers (serum ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and creatinine phosphokinase). Chest radiography showed bilateral pulmonary opacities that were suggestive of multifocal pneumonia ( Fig 1 ). Nasopharyngeal swab for SARS-CoV-2 was positive. Therapy was started with ceftriaxone, doxycycline, hydroxychloroquine, and methylprednisolone 1 mg/kg IV for 3 days. By day 3 of hospitalization, he required endotracheal intubation, vasopressor support, and continuous renal replacement. Blood cultures were negative; respiratory cultures revealed only normal oral flora, so antibiotic therapy was discontinued. On day 10, WBC count increased to 28 K/cumm, and chest radiography showed persistent bilateral opacities with left lower lobe consolidation. Repeat respiratory cultures grew Pseudomonas aeruginosa ( Table 1 ). Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.

Historical data discovery is a challenging task for any study in radar meteorology when the region of interest is recorded in weather observations. Weather radars exist in overlapping networks around the globe and are observing the atmospheric conditions around the clock. The observations are stored according to date, time, and location, as opposed to an indexing scheme based on the phenomena present in the scans themselves. Performing feature-based searches in these voluminous data sets is, at current, impossible. This research seeks to enable users seeking to study such phenomena as a mechanism for locating events of interest by leveraging recent progress from the fields of transfer learning and computer vision. Specifically, this work illustrates a methodology for performing image classification of precipitation regimes on colormapped weather radar scan images, as opposed to the raw data itself. This system reduces the data needed to perform this classification by two orders of magnitude, increasing throughput and democratizing usage of the deep learning tools for this task by allowing training and testing of the models on modest compute systems.

Rheumatic heart disease (RHD) is a condition in which the valves of the heart are damaged, it is mainly caused by Group A Streptococcus, it mainly affects the paediatrics and young adults. Inflammation occurs in the joints, heart and blood vessels due to group A streptococcus. The exact pathogenesis of rheumatic heart disease is unknown. It is manifested as fatigue, chest pain and shortness of breath; pulmonary hypertension, heart failure are some of the complications of the disease. Endocarditis, viral myocarditis and prolapse of the mitral valve are the differential diagnosis of rheumatic heart disease. It is diagnosed by revised Jones and World Heart Federation criteria. Benzylpenicillin is the first-line drug for rheumatic heart disease, followed by oral Penicillin V, Erythromycin can be recommended. Paediatrics who are allergic to Penicillin Azithromycin, Erythromycin can be recommended based on Indian paediatrics and World Health Organization guidelines. It is prevented by reducing the exposure to infection in high-risk regions; treat with appropriate antibiotics; prevent recurrence of infections and complications. The aim of this review is to highlight rheumatic heart disease in paediatric population.

Azoles are the first-line antifungal agents used for the treatment of Aspergillus infection. There is an increasing concern for azole resistance all over the world mainly from agricultural fungicid...

Blue light imaging (BLI) has been shown to improve the characterization of colorectal polyps among the endoscopy experts. We aimed to determine if this technology could be taught to endoscopy trainees while maintaining high accuracy and interobserver agreement.Twenty-one gastroenterology trainees (fellows) from two academic institutions participated in this prospective study. Each trainee completed a web-based learning comprising four modules: pre-test, didactic videos explaining the BLI Adenoma Serrated International Classification (BASIC), interactive examples, and post-test assessment. The pre- and post-test modules consisted of reviewing video images of colon polyps in high definition white light imaging and BLI and then applying the BASIC classification to determine if the polyps were likely to be adenomatous. Confidence in adenoma identification (rated '1' to '5'), accuracy in polyp (adenoma vs. non-adenoma) identification, and agreement in characterization per BASIC criteria were derived.Trainee accuracy in the adenoma diagnosis improved from 74.7% (pre-test) to 85.4% (post-test) (P 0.01). There was a trend towards higher accuracy in polyp characterization with subsequent years of training (1st year fellows 77.4%, 2nd year 88.5%, and final year 94.0%) with consistent improvements after the e-learning across years of trainees. Overall, trainees were able to identify adenoma with a high sensitivity of 86.9%, specificity 83.9%, positive predictive value of 84.4%, and negative predictive value of 86.5%. However, their interobserver agreement in adenoma diagnosis was moderate (k = 0.52).The novel BLI classification can be easily taught to gastroenterology trainees using an online module and accuracy improves with years of training reaching90% for colorectal polyp characterization.

Testing of living surgical bone and deceased tissue donors by NHS Blood and Transplant (NHSBT) has included individual donation (ID) nucleic acid testing (NAT) for HBV, HCV and HIV since 2008. Here, the well-established window period methodology was used to estimate residual risk (RR). Prevalence of viral markers was calculated among both tissue donor populations. Incidence was derived by adjusting incidence among new blood donors by the prevalence ratio for tissue and new blood donors. Residual risk (RR) was calculated as the product of incidence and duration of WP for single donor HBV NAT at 0.058 years (21 days), HCV NAT at 0.008 years (3 days) and HIV NAT at 0.014 (5 days). Between 2013 and 2017, 7886 living surgical bone donors were tested, 16 were positive for markers of HBV, HCV and HIV. HCV had the highest prevalence at 114/100,000 donors. Incidence and RR was highest for HBV at 3.55/100,000-person years and 0.32/100,000 donors (95% CI 0.11/100,000–1.42/100,000). Among 9751 deceased tissue donors tested, 22 were positive for viral markers. HBV had highest prevalence at 174/100,000 donors, and the highest incidence and RR at 8.12/100,000 person years and 0.74/100,000 donors (95% CI 0.08/100,000–2.99/100,000). Using ID NAT, RR of not detecting a HBV, HCV and HIV WP donation among tissue donors is less than 1/100,000 donors. These estimates provide a good starting point for discussing potential risks of viral transmission through tissue transplant with patients.

Heterojunction is regarded as a crucial step toward realizing high-performance devices, particularly, forming gradient energy band between heterojunctions benefits self-powered photodetectors. Therefore, in this paper, the synthesis of CsPbI3 nanorods (NRs) and its application as the interfacial layer in high-performance, all-solution-processed self-powered photodetectors are presented. For the bilayer photodetector ITO/ZnO(100 nm)/PbS-TBAI(150 nm)/Au, a responsivity of 3.6 A/W with a specific detectivity of 9.8 × 1012 Jones was obtained under 0.1 mW/cm2 white light illumination at zero bias (i.e. in self-powered mode). Meanwhile, the photocurrent was enhanced to an On/Off current ratio of 105 at zero bias with an open circuit voltage of 0.53 V for trilayer photodetector ITO/ZnO(100 nm)/PbS-TBAI(150 nm)/CsPbI3(250 nm)/Au, in which the CsPbI3 NRs layer works as the interfacial layer. As a result, a specific detectivity of 4.5 × 1013 Jones with a responsivity of 11.12 A/W was obtained under 0.1 mW/cm2 white light illumination, as well as the rising/decaying time of 0.57 s/0.41 s with excellent stability and reproducibility upto four weeks in air. The enhanced-performance is ascribed to the mismatch bandgap between PbS-TBAI/CsPbI3 interface, which can suppress the carrier recombination and provide efficient transport passages for charge carriers. Thus, it provides a feasible and efficient method for high-performance photodetectors.

Chronic venous insufficiency is a chronic disease of the venous system with a prevalence of 25% to 40% in females and 10% to 20% in males. Venous leg ulcers (VLUs) result from venous insufficiency. VLUs have a prevalence of 0.18% to 1% with a 1‐year recurrence of 25% to 50%, bearing significant socioeconomic burden. It is therefore important for regular assessment and monitoring of VLUs to prevent worsening. Our study aims to assess the intra‐ and inter‐rater reliability of a machine learning‐based handheld 3‐dimensional infrared wound imaging device (WoundAide [WA] imaging system, Konica Minolta Inc, Tokyo, Japan) compared with traditional measurements by trained wound nurse. This is a prospective cross‐sectional study on 52 patients with VLUs from September 2019 to January 2021 using three WA imaging systems. Baseline patient profile and clinical demographics were collected. Basic wound parameters (length, width and area) were collected for both traditional measurements and measurements taken by the WA imaging systems. Intra‐ and inter‐rater reliability was analysed using intra‐class correlation statistics. A total of 222 wound images from 52 patients were assessed. There is excellent intra‐rater reliability of the WA imaging system on three different image captures of the same wound (intra‐rater reliability ranging 0.978‐0.992). In addition, there is excellent inter‐rater reliability between the three WA imaging systems for length (0.987), width (0.990) and area (0.995). Good inter‐rater reliability for length and width (range 0.875‐0.900) and excellent inter‐rater reliability (range 0.932‐0.950) were obtained between wound nurse measurement and each of the WA imaging system. In conclusion, high intra‐ and inter‐rater reliability was obtained for the WA imaging systems. We also obtained high inter‐rater reliability of WA measurements against traditional wound measurement. The WA imaging system is a useful clinical adjunct in the monitoring of VLU wound documentation.