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BACKGROUND: Additional real-world studies are needed to more fully elucidate the effectiveness of antifibrotic treatment in slowing the progression of idiopathic pulmonary fibrosis (IPF). OBJECTIVE: To compare mortality and hospitalization between Medicare beneficiaries with IPF who initiate antifibrotic therapy and those who did not receive treatment. METHODS: A retrospective observational study of Medicare beneficiaries using the 100% Medicare Research Identifiable File was conducted. We included patients aged 67 years and over diagnosed with IPF (≥ 1 inpatient or ≥ 2 outpatient claims with IPF diagnosis, J84.112]) during the study period (January 1, 2010-December 31, 2017). Patients who initiated antifibrotic treatment (pirfenidone or nintedanib) between October 15, 2014 (FDA approval date) and December 31, 2017 (ie, treated patients) were compared with those who did not receive treatment during a historical period (January 1, 2012-October 14, 2014) before the availability of antifibrotics (ie, untreated historical controls). Patients were matched by propensity score, and the outcomes, mortality, and hospitalization (all cause and respiratory related) were compared using a Cox proportional hazards model. RESULTS: We identified 4,641 treated patients and 4,641 propensity score-matched controls who met all study criteria; 352 treated patients who lacked matches were excluded from the study. Cox regression analysis of treated patients vs matched controls showed a significantly lower risk of mortality (HR = 0.62, 95% CI = 0.57-0.68); lower risk of hospitalization (HR = 0.71, 95% CI = 0.67-0.76; HR = 0.70, 95% CI = 0.64-0.76); and lower rate in number of hospitalizations per month (incident rate ratio [IRR] = 0.65, 95% CI = 0.60-0.71; IRR = 0.65, 95% CI = 0.58-0.73). CONCLUSIONS: This study suggests that treatment with antifibrotics may confer a survival benefit and protection against all-cause and respiratory-related hospitalization for IPF patients. DISCLOSURES: This work was sponsored by F. Hoffmann-La Roche/Genentech, Inc. Corral is employed by Genentech, Inc. Reddy, Chang, Broder, and Gokhale are employed by Partnership for Health Analytic Research LLC, a health services research company, which was hired by Genentech to conduct this research. Mooney has received advisory board/consulting fees and research support from Genentech, unrelated to this work. Mooney also reports advisory board/consulting fees and research support from Boehringer Ingelheim; personal fees from Imvaria; and grants from Celgene and Pliant, unrelated to this work. Through their employment with Partnership for Health Analytic Research, Reddy, Chang, Broder, and Gokhale have been compensated to conduct research for AbbVie, Akcea, ASPC, Amgen, AstraZeneca, BMS, Boston Scientific Corporation, Celgene, Eisai, Ethicon, GRAIL, Helsinn, Illumina, Innovation and Value Initiative, Ionis, Jazz, Kite, Novartis, Otsuka, Pathnostics, PhRMA, Prothena, Sage, Verde Technologies, Genentech, Inc., Greenwich Biosciences, Inc., Mirum Pharmaceuticals, Inc., Sanofi US Services, Inc., Sunovion Pharmaceuticals, Inc., and Dompe US, Inc., unrelated to this work. This research was presented as an abstract at CHEST 2020 Annual Meeting (virtual), October 18-21, 2020, and American Thoracic Society 2020 Virtual Meeting, June 2020.

Introduction: Endoscopic repair of Cerebrospinal fluid (CSF) rhinorrhea has been the most popular and the most accepted among the Otorhinolaryngologists. The advancement in the endoscopes enable surgeons to manage cerebrospinal fluid rhinorrhea adequately with good result. Objective: The aim of this study was to evaluate the outcome of endoscopic CSF rhinorrhea repair with multilayer grafts. Outcome was identified in terms of postoperative complications like infection (mainly meningitis), nasal bleeding, graft failure and CSF leak, revision surgery. Methodology: A retrospective prospective study was conducted in 21 patients who had undergone endoscopic CSF rhinorrhea repair with use of multilayer grafts in a period of January 2016 to December 2018 in Department of ENT and Head and Neck Surgery in MAA ENT HOSPITAL, HYDERABAD, INDIA. All the patients were diagnosed according to history, clinical examination, diagnostic nasal endoscopy, CSF fluid analysis and radiological investigation. The materials used for the repair of CSF rhinorrhea were surgicel, temporalis fascia, conchal chondroperichrondrium, middle turbinate free mucoperiosteum graft, thigh fat and fascia lata. The follow up period of patients range from 14-44 months. The outcome of endoscopic CSF repair with use of multilayer grafts was evaluated by electronic records regarding recurrence of CSF rhinorrhea post-surgery, hospital admission, revision surgery and digital record of rigid endoscopic findings for the status of graft uptake and CSF leak. Results: In all patients, CSF leak was successfully repaired with use of multilayer grafts in first attempt without any complication. There was female predominance with male to female ratio of 1:6.The mean age of presentation was 43.09years. All 21 patients were presented with spontaneous CSF leak with unknown cause. In 21 patients only one patient presented with bilateral cerebrospinal fluid leak. Cribri form plate was the commonest site of defect in which defect medial to middle turbinate was the commonest followed by ethmoid roof and lateral wall of sphenoid. None of the patients developed meningitis after surgery. None of the patients required lumbar drain. None of the patients presented with cerebrospinal fluid rhinorrhea postoperatively. Conclusions: Endoscopic repair of Cerebrospinal fluid rhinorrhea with the use of multilayer grafts is the safer and effective method with good outcome.

The aims of this study were to compare radiological and functional outcomes of Ilizarov ligamentotaxis and locked volar plating in comminuted intra-articular distal radius fractures (AO type C2/C3) using a non-randomised superiority trial. A total of 72 patients with AO C2/C3 distal radius fractures were allotted into Ilizarov ligamentotaxis (n = 30) and locked volar plating (n = 42) groups based on patient preference. Primary outcome was the ability to achieve and stably maintain acceptable radiological parameters (post-operative, 6 weeks, 3 months, 12 months), and secondary outcome was functional scoring (at 12 months). All patients completed the study. All fractures united uneventfully. Plating was superior to Ilizarov in restoring ulnar variance (100% versus 80%, p value 0.004), but Ilizarov was superior to plating in restoring volar tilt (as opposed to neutral tilt, 83.3% versus 47.8%, p value 0.002). Both groups were comparable in restoring radial height, radial inclination and intra-articular reduction and stably maintaining all five parameters over long term. There was a statistically significant difference between the two groups with regard to mean ulnar variance (plating superior) and volar tilt (Ilizarov superior) at all stages of follow-up, whereas radial height and radial inclination were comparable at all points. There was no significant change of all radiological parameters over a follow-up period. At the end of one year, DASH score was slightly better (not clinically appreciable) in the Ilizarov group (8.47 versus 13.61, p value 0.03), but Gartland and Werley scores were comparable between both groups. Mean duration of external fixation in the Ilizarov group was 43.07 ± 8.94 days. Apart from five cases of pin site infections, there were no complications. Ilizarov ligamentotaxis is a comparable option to locked volar plating in achieving radiological restoration and clinical function in comminuted intra-articular distal radius fractures, AO types C2 and C3. Restoration of ulnar variance needs utmost care while performing Ilizarov ligamentotaxis. Ilizarov comes with the disadvantages of reduced patient preference, pin site infections, need for removal of external fixator and slightly slower return to activity. CTRI/2018/08/015549 Level III, Non-randomised prospective trial

A novel and efficient approach for modeling irregular domain boundaries and enforcing complex land-based constraints in wind farm layout optimization is presented. The presented method can be used to enforce constraints and represent complex domains for which an analytical expression is not available. The developed approach uses support vector domain description to obtain an analytical expression of the domain from data points sampled from the various regions for wind turbine placements. Such an analytical, continuous, differentiable description can then be used for wind farm layout optimization using gradient based and non-gradient based optimization algorithms. The applicability of the method was demonstrated on a wind farm layout optimization problem where several regions of the terrain were restricted. The method was shown to accurately and efficiently model regular, irregular, convex, non-convex and discontinuous domains/regions using only scattered data sampled from the domains. An efficient method for terrain modeling and interpolation is also presented. The proposed interpolation method uses quadtree decomposition to decompose the large interpolation problem into several smaller interpolation problems thereby reducing the complexity of the interpolation. The framework developed (libSVDD) is also made publicly available.

Aim: To understand the magnitude and pattern of genotype-environment interaction in vegetable type soybeans and to identify mega environment(s) and best performing genotype(s) across environments. Methodology: Five vegetable type soybean genotypes were evaluated across five geographical locations viz., Indore, Parbhani, Adilabad, Bengaluru and Pune, during rainy season of 2018. Genotypes were grown in a plot size of 1.35 x 3 m2 in three replications in randomized block design. Data on green pod yield, green seed test weight, days to 50% flowering, days to maturity and plant height were recorded using standard methods. GGE biplot analysis was performed using software “GGE Biplot version 7.0”. Results: In the present investigation, except in case of green seed test weight, in remaining four traits, major portion of variation was contributed by location (52.95-79.4%) followed by genotype (17.7-42.7%) and genotype x location interaction (2.21-4.29%). Through GGE biplot analysis, Bengaluru was found to be near ideal environment and genotypes Karune and Harasoya were found to be the best performers across the locations with respect to green pod yield. Interpretation: Bengaluru was found to be near ideal environment for vegetable type soybean evaluation. Selection for genotypes having wider adaptability can be conducted at this location. Genotypes Karune and Harasoya were found to be the best performers with respect to green pod yield. These two genotypes can be included as parents for breeding as vegetable type soybean. Key words: GEE biplot, Multienvironmental analyses, Soybean genotypes

Purpose Alcohol delamination of the corneal epithelium (ADCE) is a therapeutic option for patients with recurrent corneal erosion (RCE) who do not respond to nonsurgical management of lubricants and extended wear contact lens. The aim of the study is to report on three-year efficacy and safety of ADCE for RCE of traumatic etiology. Methods This is a retrospective review of consecutive patients who underwent ADCE for traumatic RCE in a local hospital between January 2010 and January 2020. The outcomes at a 3-year follow-up review are included. Nonsurgical therapy used; intra- and postoperative complications were recorded. ADCE was only offered to those who remained symptomatic despite maximum topical lubrications and/or extended wear contact lens. Success was defined as the absence of recurrence of corneal erosion. Results Twenty-six eyes of 26 patients with RCE caused by trauma underwent ADCE. The mean age of patients was 39 years. The follow-up period was a minimum of 36 months. Three eyes (11.5%) had recurrence of corneal erosion after ADCE at the 3-year follow-up. Recurrence was noted at months 2, 23, and 36 postoperatively in these patients. All patients reported significant improvement in symptoms associated with recurrent erosion. Ten eyes (38.5%) stopped all topical lubricants postoperatively. No intra- or postoperative complications were noted in our study. Conclusion This study documents the long-term safety and efficacy of alcohol delamination of corneal epithelium at 3 years for patients with RCE of traumatic origin.

Many viruses have been posing threat to the world from time to time and recently in this category, a novel coronavirus called COVID-19 (SARS-CoV2) was detected in December 2019 and is causing havoc all over the world COVID-19 spreading through person-to-person transmission routes including direct transmission, like cough, sneeze, droplet inhalation and contact transmission, like contact with oral, nasal and eye mucous membranes The operators in oral health care profession expose to great risk of COVID-19 infection due to face-to-face communication and their exposure to fluids from the conjunctiva, oral cavity, nose and also other body fluids, and handling with the sharp instruments Oral health care professionals (dentists and dental hygien-ists) play a prime role in preventing the spread of COVID-19 Several dental hospitals and clinics have been completely closed or have been providing minimal treatment for emergency cases However, prophylactic and emergency treatments are being provided in some countries and a few supporting regular dental treatment Oral health practitioners are prone to risk as they are hardly prepared for such unexpected global outbreak Lack of universal protocol or guidelines to control the infection and dental care provision during such a pandemic condition could be of better help The present study fills in the missing gap with necessary recommendations comprising of preventive steps for disease/infection transmission during dental practice to block the operator-to-patient and vice-versa transmission routes in dental clinics and hospitals © 2021, Radiance Research Academy All rights reserved

The purpose of this study was to compare 3D treatment plans implemented using 6 MV Linac with a retrofitted multileaf collimator (MLC) based cobalt-60 plans. In this retrospective study, DVH analysis was used to compare homogeneity of dose within the target and the dose received by critical organs. A prototype MLC designed and developed as a retrofit to current cobalt-60 teletherapy machines with a dedicated 3D treatment planning system was used. Cases representing 5 tumor sites like head & neck, glottis, lung, gall bladder, stomach were taken for the study, which were planned using Eclipse treatment planning system and treated with 6 MV photon beams. The plans were re-planned using the retrofit cobalt-60 MLC with same beam arrangement and dose prescription in Radiation Oncology planning system (ROPS). For each case, DVH data was evaluated for both types of beam energies. Conformity index (CI) and homogeneity index (HI) for target were calculated and compared. The conformal plans created using cobalt MLC for five sites were found to be similar to those planned using 6 MV photon beams. CI values close to unity reflected dose uniformity in the target volume while HI evaluated the hotspots in the target volume. It was concluded that plans created using retrofit prototype MLC developed for cobalt-60 teletherapy machines can provide dose distributions comparable to 6 MV photon beams. The prototype MLC developed can provide a promising treatment option for existing telecobalt machines in implementing conformal therapy in developing countries.

Conventional methods of groundwater targeting often result in failures due to improper selection of sites as a result of the lack of scientific database. Satellite-based mapping using geographic information system (GIS) has brought a paradigm shift in the mapping of the natural resources including groundwater. Remote sensing is a cost effective technique to carry out the groundwater prospects mapping which otherwise is difficult to achieve at national scale. A comprehensive database could be created on groundwater resource mapping and assessment using IRS LISS III satellite data from IRS-1C and its follow-on missions like IRS-1D and Resourcesat-1 for the entire India which was first of its kind. A national mission called National Rural Drinking Water Program was launched in the year 1999 to carry out groundwater prospects mapping at 1:50,000 scale for the entire country using 23.5 m resolution IRS LISS III satellite data. The objective of the project was to generate groundwater prospects maps on 1:50,000 scale in GIS format showing (a) different prospective zones in terms of yield and depth of aquifer and (b) tentative sites of different recharge structures suitable in the area. It is imperative that the mammoth task of preparing 4898 groundwater prospects maps on 1:50,000 scale for the entire country has become a reality due to the timely and continuous availability of LISS III satellite images from IRS-1C sensor and its follow-on missions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for the current global pandemic that has caused a death toll of >1.12 million worldwide and number continues to climb in several countries. Currently, there are neither specific antiviral drugs nor vaccines for the treatment and prevention of COVID-19. We screened in silico, a group of natural spice and herbal secondary metabolites (SMs) for their inhibition efficacy against multiple target proteins of SARS-CoV-2 as well as the human angiotensin-converting enzyme 2 protein. Docking and simulation results indicated that epicatechin, embelin, hesperidin, cafestol, murrayanine and murrayaquinone-A have higher inhibition efficacy over at least one of the known antiviral drugs such as Hydroxychloroquine, Remdesivir and Ribavirin. Combination of these potentially effective SMs from their respective plant sources was analysed, and its absorption and acute oral toxicity were examined in Wistar rats and classified as category 5 as per the Globally Harmonized System. The identified SMs may be useful in the development of preventive nutraceuticals, food supplements and antiviral drugs. Communicated by Ramaswamy H. Sarma, Graphical Abstract

Entrepreneurship and innovation are considered as key drivers for economic development. In this study, we made an attempt to answer the question as to what should be the policy framework to encourage entrepreneurship and foster innovative culture in India to achieve the desired level of economic development. Entrepreneurship is built upon pillars such as institutional and policy support, availability of capital and entrepreneurial culture. In an emerging economy like India, the government should institutionalise innovation and entrepreneurship and promote commercialisation of brilliant ideas by emulating the startup ecosystems in the developed nations. Besides the government, large and well-established companies in private sector and research institutes should nurture startups by extending hand-holding support and generous funding. If India wishes to be a leader in innovation, it needs to scale up its gross expenditure on R&D, that is, on par with the advanced economies by engaging more researchers, especially in the private sector. Our article has important implications for policymakers and all key stakeholders, as it can help in identifying and implementing the appropriate measures to eliminate the obstacles that entrepreneurs face and channels to support innovative entrepreneurial activities in India.

Single-stage, single-phase photovoltaic (PV) distributed generation (DG) systems rated below 5 kW are becoming popular because of the reduction in the cost of PV panels and also due to various policy initiatives. One cycle control (OCC) based inverters are ideally suitable for such DG systems because of its cost-effectiveness, simple structure, and phase-locked loop free implementation. These inverter-based DG systems should have a robust islanding detection method (IDM) incorporated into it and should fulfill the recent standard requirements. This article proposes a novel feedback-based passive IDM, which is suitable for OCC-based grid-connected PV inverter system. The proposed method relies on the inbuilt feedback nature of OCC-based system, which drives the voltage at the point of common coupling outside the normal range of operation during an islanding condition. The proposed IDM works effectively under the new standard requirements with negligible nondetection zone. The IDM does not rely on additional computational effort or injection of external disturbance into the grid. Simulation studies are performed to verify the effectiveness of the proposed IDM. A laboratory prototype has been developed, and experimental studies are conducted to ascertain the viability of the proposed method.

Introduction Little is known about the burden of hereditary transthyretin (ATTRv) amyloidosis, a genetic, progressive, and fatal disease caused by extracellular deposition of transthyretin amyloid fibrils. The study’s aim was to estimate costs and disease burden associated with ATTRv amyloidosis in a real-world setting. Methods Using IBM® MarketScan® Commercial and Medicare Supplemental data, we identified patients at least 18 years of age with newly diagnosed ATTRv amyloidosis. Diagnosis required at least one medical claim with relevant diagnosis code (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] 277.30–.31, 277.39; ICD-10-CM E85.0–.4, E85.89, E85.9) between January 1, 2014 and December 31, 2016, and at least one additional criterion occurring during study period (2013–2017): at least 15 days diflunisal use without more than a 30-day gap; liver transplant; or claim with codes E85.1 or E85.2. First diagnosis date was study index. Continuous enrollment 1-year pre-index (baseline) and post-index (follow-up) was required. Patients with baseline amyloidosis diagnosis were excluded. Outcomes of interest were comorbidities and 1-year follow-up healthcare utilization and costs (also reported quarterly). Results Among 185 qualifying patients, mean age was 59.2 years (standard deviation 15.2), 54.1% were female, and baseline Charlson comorbidity index was 2.2 (2.5). Neuropathy (30.3%), diabetes (27.0%), and cardiovascular-related comorbidities, including dyspnea (25.9%) and congestive heart failure (21.6%), were common during follow-up. Nearly a quarter of patients (24.9%) were hospitalized during follow-up. Most hospitalizations and emergency department visits occurred in the first quarter post-diagnosis (18.9%, 17.8%, respectively) and dropped in subsequent quarters. The annual mean total cost was $64,066, with inpatient services contributing the majority of the expenses ($34,461), followed by outpatient ($23,853), and then pharmacy ($5752). As with utilization, costs were highest in the first quarter post-diagnosis and dropped in subsequent quarters. Conclusion Patients newly diagnosed with ATTRv amyloidosis have substantial healthcare utilization and costs in the first year, primarily the initial months, post-diagnosis. Further research should examine later costs associated with disease progression and end-of-life care.

Background & Aims Emricasan, an oral pan-caspase inhibitor, decreased portal pressure in experimental cirrhosis and in an open-label study in patients with cirrhosis and severe portal hypertension, defined as a hepatic venous pressure gradient (HVPG) ≥12 mmHg. We aimed to confirm these results in a placebo-controlled study in patients with non-alcoholic steatohepatitis (NASH)-related cirrhosis. Methods We performed a multicenter double-blinded study, randomizing 263 patients with NASH-related cirrhosis and baseline HVPG ≥12 mmHg to twice daily oral emricasan 5 mg, 25 mg, 50 mg or placebo in a 1:1:1:1 ratio for up to 48 weeks. The primary endpoint was change in HVPG (ΔHVPG) at week 24. Secondary endpoints were changes in biomarkers (aminotransferases, caspases, cytokeratins) and development of liver-related outcomes. Results There were no significant differences in ΔHVPG for any emricasan dose vs. placebo (−0.21, −0.45, −0.58 mmHg, respectively) adjusted for baseline HVPG, compensation status, and non-selective beta-blocker use. Compensated patients (n = 201 [76%]) tended to have a greater decrease in HVPG (emricasan all vs. placebo, p = 0.06), the decrease being greater in those with higher baseline HVPG (p = 0.018), with a significant interaction between baseline HVPG (continuous, p = 0.024; dichotomous at 16 mmHg [median], p = 0.013) and treatment. Biomarkers decreased significantly with emricasan at week 24 but returned to baseline levels by week 48. New or worsening decompensating events (∼10% over median exposure of 337 days), progression in model for end-stage liver disease and Child-Pugh scores, and treatment-emergent adverse events were similar among treatment groups. Conclusions Despite a reduction in biomarkers indicating target engagement, emricasan was not associated with improvement in HVPG or clinical outcomes in patients with NASH-related cirrhosis and severe portal hypertension. Compensated patients with higher baseline HVPG had evidence of a small treatment effect. Emricasan treatment appeared safe and well-tolerated. Lay summary Cirrhosis (scarring of the liver) is the main consequence of non-alcoholic steatohepatitis (NASH). Cirrhosis leads to high pressure in the portal vein which accounts for most of the complications of cirrhosis. Reducing portal pressure is beneficial in patients with cirrhosis. We studied the possibility that emricasan, a drug that improves inflammation and scarring in the liver, would reduce portal pressure in patients with NASH-related cirrhosis and severe portal hypertension. Our results in a large, prospective, double-blind study could not demonstrate a beneficial effect of emricasan in these patients. Clinical Trial Number Clinical Trials.gov #NCT02960204.

The storage of coal mine overburden consumes vast tract of usable land with occasional slope failure and environment pollution of nearby area. In the present study, a comprehensive laboratory inves...

This study analyzed a privately insured pediatric population with and without narcolepsy to determine the impact of pediatric narcolepsy on comorbidities, health care utilization, and cost. Additional analyses compared narcolepsy type 1 and type 2.This retrospective cross-sectional study identified US patients with narcolepsy18 years of age with ≥2 claims with a diagnosis code of narcolepsy using Truven MarketScan® data 2011 to 2015. Patients were matched to controls without narcolepsy. Comorbid conditions, health care utilization, and costs were measured by calendar year. P values are nominal, and no adjustments for multiplicity or multiple comparisons were made.A total of 1427 pediatric patients with narcolepsy were identified and matched with 4281 controls from 2011 to 2015. Patients with narcolepsy had more comorbid conditions (mean 5.8 vs 2.4, nominal P 0.001). Respiratory diseases and mood disorders were more common in patients with narcolepsy than controls (57% vs 32% and 56% vs 14%, respectively; both nominal P 0.001). Compared to controls, patients with narcolepsy underwent more diagnostic tests (electroencephalogram, EEG [0.13 vs 0.0053]) and brain computed tomography, CT/magnetic resonance imaging, MRI (0.26 vs 0.022; both nominal P 0.001). Mean annual inpatient days (0.71 vs 0.15), emergency department visits (0.51 vs 0.15), and outpatient office visits (8.6 vs 2.3) were higher for patients with narcolepsy than controls (all nominal P 0.001). Annual mean health care costs were higher for patients with narcolepsy versus controls ($15,797 vs $2449, nominal P 0.001).Pediatric patients with narcolepsy had greater comorbidity, higher health care utilization, and higher costs than patients without narcolepsy.

Contains fulltext : 249821.pdf (Publisher’s version ) (Closed access) This parallel blocked randomized controlled trial was done in two groups of 30 patients each to determine if placement of an antibiotic oral pack on the hard palate after hard palatal fistula repair reduces nasal air emission and fistula re-occurrence. Group A had an oral pack on the hard palate for 5 days post-operatively while group B did not. In group A, percentage of nasal air emission was tested using nasometry with and without pack. Paired t-tests were performed to compare nasal emissions for patients with and without pack. Recurrence of fistulas after 6 months between group A and B was tested using odds ratio. Effect of nasal air emission on fistula rates was tested using paired t-tests. There was a significant increase (p

Structures which resist the normal as well as accidental loads due to natural hazards or manmade hazards have major role on risk. Risk may be synonym of loss of life or economy. In this script, qualitatively, it is referred as low risk and high risk and is a function of hazard levels and structural vulnerability and exposure time. In this paper, structures are referred to civil engineering buildings, equipment and piping systems. Every structural system will contribute to the risk. The risk levels are function of type of structural systems such as residential structures, office buildings, Industrial structures and lifeline structures. The risk level in industrial structures handling poisonous gases and liquids is high. Lifelines such as transport related structures, hospitals, water supply piping systems, evacuation centers including schools have to be treated exclusively/specially since these will contribute to the risk during and also after hazards especially natural one. For brevity, qualitative description is made on hazards and risk reduction targeting clear vision.

Introduction: Filariasis has been known from antiquity. Elephantiasis-painful, disfiguring swelling of the legs and genital organs-is a classic sign of late-stage disease. The genus is named after Wucherer, a Brazilian physician who reported microfilariae in chylous urine in 1868. Lymphatic filariasis is a devastating disease and it is found in more than 80 countries across the world [1,2]. Approximately 1 billion people across the world are at risk. It affects countries like south and Central America, West and East Africa, East Mediterranean, Southeast Asia, and Western Pacific. W bancrofti accounts for 90% of all filariasis cases in the world [3]. National Filaria Control Programme launched in 1955 has operational, training and research components [4]. The main strategies of which were the vector control, detection and treatment of filarial cases and delimitation of endemic areas. This program continues to be in place, in addition to the program to eliminate LF in India. Measurement of microfilaremia is a well-recognized gold standard for demonstrating the impact of interventions but is not an optimal method of monitoring or surveillance because of requirement of nocturnal blood collection and relatively less insensitive test for infection [5]. Materials and Methods: This study was carried out in Govt General Hospital & Filaria Clinic, Guntur District of Andhra Pradesh, and Ethical Permission for the study was obtained 90 samples were collected from those attending the Government General Hospital with signs and symptoms of filariae they were designated as Group I [Test]. 10 normal serum samples Group II [Normal Controls] and 10 serum samples Group III [Endemic Normal] from normal individuals in the endemic pockets identified by filarial control program officers which were detected smear negative were collected as controls Results: The results of ELISA were compared with the microfilariae detection by slide method, it was found that the only 2 cases each in the male and female, a total of 4 cases were detected by the slide methods rest all the cases were detected as negative. With ELISA method it was found that the total numbers of positive cases were 53 and total numbers of negative cases were 37 in the test group I. The comparison of the same results with the normal control samples revealed that all the cases were reported as negative by slide method however by ELISA 7 out of total 10 cases were detected with the antigens and antibodies to microfilariae. Discussion: We in the present study tried to compare the results obtained by conventional slide method of detection of filarial versus the ELISA method; we found that ELISA was far superior in detecting the filariae antigen, antibodies where the conventional slide methods failed to identify the microfilariae Conclusion: ELISA is superior & cost effective in detection of all cases of microfilariae. Since conventional methods may not able to reliably identify microfilariae in all samples, it is recommended that ELISA be used to detect the presence of microfilariae, particularly in Endemic areas.

The posture and positioning of pediatric dentist will greatly depend upon the type of dental chair they chose while treating children. Pediatric dentists working on a traditional adult chair for treating children frequently lean forward for close proximity to oral cavity; as a result of this poor posture, they are more prone to suffer from musculoskeletal disorders. Proper positioning of dentist during treatment will improve not only their comfort but also their career longevity. The aim of the study was to assess the comfort and need of pediatric dental chair compared with traditional adult dental chair for treatment and better management of children. Study design This is a questionnaire survey for postgraduate students consisting of 14 multiple-choice questions in English format. The questionnaire was structured to know whether the pediatric dental chair is beneficial compared to traditional adult dental chair while treating children. Results and conclusion Out of 92 responded members, 99% had an opinion that a pediatric dental chair is needed for treating children. They concluded that pediatric dental chair had many advantages over traditional adult dental chair while treating children and acceptance of pediatric dental chair among postgraduates is overwhelming. How to cite this article Reddy ER, Raju SS, Merum K, et al. Postgraduates' Perspective of Pediatric Dental Chair: A Questionnaire Study. Int J Clin Pediatr Dent 2020;13(3):251-254.

The localization and segmentation of optic disc (OD) in fundus images is a crucial step in the pipeline for detecting the early onset of retinal diseases, such as macular degeneration, diabetic retinopathy, glaucoma, etc. In this paper, we are proposing a novel convolutional neural network architecture for the precise segmentation of the OD in fundus images. We modify the basic architectures of DeepLab v3+ and U-Net models by integrating a novel attention module between the encoder and decoder to attain the finest accuracy. We also use fully-connected conditional random fields to further boost the performance of these architectures. We compare the results of our best proposed architecture against other established architectures for optic disc segmentation on our private dataset, as well as on publicly available datasets, namely, DRIONS-DB, RIM-ONE v.3, and DRISHTI-GS. The results obtained with the proposed method outperforms the existing methods in the literature.

Macro-Economic factors plays a major role in decision making. Evaluation of macroeconomic environment is required to examine the behaviour of stock prices, which further influences the investor’s investment behaviour. Even though some macro-economic factors are not directly related to the company or industry, but those factors has an impact on stock prices, further economic activity in the domestic and global level has its own impact on stock market. When economy of the country grows hastily, it leads to faster growth in the industry and vice versa. Financial market plays a central role in the performance of financial system of an economy. Stock market is a market where securities of listed companies are exchanged between different investors, it is very responsive market which, gives a stage to investors to invest their money in various securities. Market indices are the tools to measure the performance of various securities of stock market and Investors make use of those market indices to analyse performance of those industries in which, they prefer to invest. This study takes into account six macro-economic factors (Crude oil Price, Gold Price, Silver Price, Exchange Rate, Inflation and Interest Rate) to study & analyse the impact of these variables on selected sectoral indices at BSE, SENSEX, S&P BSE BANKEX, S&P BSE Oil and Gas, S&P BSE Capital Goods, S&P BSE Consumer Durables, S&P BSE Reality, S&P BSE PSU and S&P BSE Power. The study shows that gold price, exchange rate, consumer price index and interest rate are positively correlated with four indices but crude oil price and silver price have positively correlated with 3 indices. So from the result it is clear that investor need to take of all the variables for their investment decision and the investment banker also take care of these indicators before giving suggestion to their clients Index Terms: Macro -economic, Stock Market, Market Indices, SENSEX, BSE, Inflation, Interest rate

Background and Aim To evaluate the role of esophageal wall thickness (EWT) on computed tomography (CT) in predicting response to endoscopic dilatation of corrosive esophageal strictures. Methods This was a retrospective study. A review of the records of patients who underwent endoscopic dilatation of esophageal strictures between January 2010 and December 2017 was performed. Patients who had a CT evaluation prior to dilatations were included. CT‐EWT was measured at the maximum visible point. Clinical details and endoscopic dilatation parameters were recorded. Technical success, clinical success, and recurrent and refractory strictures were recorded. CT‐EWT and the clinical parameters were evaluated regarding their role in predicting the number of dilatations required to achieve technical and clinical success. Results A total of 250 patients underwent endoscopic dilatations during the study period; 84 patients underwent thoracoabdominal CT. Complete clinical, endoscopic, CT data and follow up were available for 64 patients. There were 36 males. The median age was 30 years (range, 14–70 years). A total of 750 dilatations were performed. The median number of dilatations required to achieve technical success was 8.5 (range, 1–51). Dilatations were performed after a median period of 3 months (range, 1–40). Median CT‐EWT was 7 mm (range, 3–22). On univariate, as well as multivariate, analysis, CT‐EWT and the clinical parameters were found to be poor predictors of the number of dilatations required to achieve technical and clinical success. Conclusion CT‐EWT has no additional role in predicting response to the endoscopic dilatation of corrosive esophageal strictures.

An inverse parameter estimation methodology for non-destructive simultaneous estimation of spatially varying thermal conductivity and specific heat in arbitrary 2D solid objects was develop...

Introduction: COVID-19 has a variable clinical presentation ranging from flu-like symptoms to respiratory failure. Most patients have a mild form of disease and often recover at home over a period of weeks. For some, the highest morbidity of COVID-19 may not be associated with the acute phase of the disease, but rather the longstanding post-viral pulmonary fibrosis. Case Description: A 49-year-old man with a past medical history of coronary artery disease, obstructive sleep apnea, hypertension, and type two diabetes mellitus presented to the emergency department with a four-day history of fever, nausea, and diarrhea. He denied cough or dyspnea. Chest radiograph revealed bibasilar ground glass opacifications. He was positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction testing. His oxygen saturation was 95% on room air and he was discharged home without treatment. Over the following days, he developed a dry cough and mild dyspnea, but he did not desaturate on room air. He was prescribed a short course of steroids by his outpatient pulmonologist. He gradually improved over the course of two weeks and he was never hospitalized. Computed tomography (CT) of the chest 10 weeks after diagnosis revealed bilateral patchy ground glass opacities in all lobes and interstitial components with architectural distortion in the lower lobes (Image 1). A pulmonary function test performed 12 weeks after diagnosis showed an FVC 83%, FEV1 85%, TLC 75%, RV 37%, and DCLO 88%. The patient continued to experience mild dyspnea with exertion 2 months after the resolution of the infection. Conclusion: Pulmonary fibrosis is not a post-viral phenomenon limited to severe cases of COVID-19 and can occur following mild presentations managed at home. Thus far, risk factors for the development of pulmonary fibrosis secondary to COVID-19 have been reported to be advanced age, disease severity, length of intensive care unit stay, smoking, and alcoholism. Our case report calls for a re-evaluation of these risk factors. While pharmaceutical treatments are typically only administered to hospitalized patients, there may be basis for treating mild cases with the intent of preventing post-viral pulmonary fibrosis. Further, outpatient clinicians may consider monitoring for changes in pulmonary architecture with pulmonary function tests or high-resolution CT scans in all recovered COVID-19 patients regardless of symptom severity.

This pre-specified analysis of DAPA-CKD assessed the impact of sodium-glucose cotransporter 2 inhibition on abrupt declines in kidney function in high-risk patients based on having chronic kidney disease (CKD) and substantial albuminuria. DAPA-CKD was a randomized, double-blind, placebo-controlled trial that had a median follow-up of 2.4 years. Adults with CKD (urinary albumin-to-creatinine ratio 200-5000 mg/g and estimated glomerular filtration rate 25-75 mL/min/1.73m2) were randomized to dapagliflozin 10 mg/day matched to placebo (2152 individuals each). An abrupt decline in kidney function was defined as a pre-specified endpoint of doubling of serum creatinine between two subsequent study visits. We also assessed a post-hoc analysis of investigator-reported acute kidney injury-related serious adverse events. Doubling of serum creatinine between two subsequent visits (median time-interval 100 days) occurred in 63 (2.9%) and 91 (4.2%) participants in the dapagliflozin and placebo groups, respectively (hazard ratio 0.68 [95% confidence interval 0.49, 0.94]). Accounting for the competing risk of mortality did not alter our findings. There was no heterogeneity in the effect of dapagliflozin on abrupt declines in kidney function based on baseline subgroups. Acute kidney injury-related serious adverse events were not significantly different and occurred in 52 (2.5%) and 69 (3.2%) participants in the dapagliflozin and placebo groups, respectively (0.77 [0.54, 1.10]). Thus, in patients with CKD and substantial albuminuria, dapagliflozin reduced the risk of abrupt declines in kidney function. HJLH and DC are co-primary authors. The DAPA-CKD Trial Committees and Investigators are listed in the Appendix.

Background Despite emerging treatments for hereditary transthyretin (ATTRv) amyloidosis, the disease is often misdiagnosed, with reported diagnostic delays of up to several years. Knowledge of the patient journey leading up to diagnosis may help to promote earlier intervention. The study’s objective was to examine patient clinical characteristics and healthcare utilization prior to ATTRv amyloidosis diagnosis. Methods Patients ≥ 18 years and newly diagnosed with ATTRv amyloidosis identified in IBM® MarketScan® Commercial and Medicare Supplemental data using a claims-based algorithm as follows: diagnosis required ≥ 1 medical claim with relevant amyloidosis diagnosis code (ICD-10-CM: E85.0-.4, E85.89, E85.9; excludes light chain and wild type) during identification (ID) period (1/1/2016–12/31/2017), and ≥ 1 occurrence of qualifying criteria during 2011–2017: ≥ 15 days diflunisal use without > 30-day gap, liver transplant, or claim with specific codes E85.1 or E85.2. The index date was defined as the date of first claim with amyloidosis diagnosis code in ID period. Patients had continuous enrollment ≥ 5 years pre-index date (look-back period). Occurrence of selected comorbid conditions and symptoms and healthcare utilization (testing, emergency department visits and hospitalization) measured during the look-back period; demographics, physician specialty, and Charlson comorbidity index (CCI) measured 1 year pre-index. Patients with an ICD-9/10 amyloidosis code during the look-back period were excluded. An ATTRv-free reference cohort was created from a random sample of enrollees who lacked any diagnosis of amyloidosis and matched 3:1 to ATTRv patients on age, gender, and region to provide reference values; same index and enrollment requirement as match. Results For the 141 qualifying patients with ATTRv and 423 matched controls, mean (standard deviation) age was 62.5 (14.2) years and 53.9% were female. Mean CCI for ATTRv cohort was 2.7 (3.0) versus 1.1 (1.9) among controls. Selected comorbidities, testing, visits, and hospitalization were common among patients with ATTRv during the look-back period with higher rates versus controls. Conclusions Patients with ATTRv amyloidosis experience multiple neurological, cardiovascular, and other clinical manifestations, testing, and hospitalization prior to diagnosis. Occurrence of potential markers of illness is most common in the year before diagnosis.

Kannada is a Dravidian Language spoken by over 80 million people all over the world; Kannada script’s character recognition system has wide range applications in education, healthcare, finance and many more sectors. Building it involves many phases and makes it more challenging because of the nature of script including horizontal skews and curves. Although challenging, several attempts have been made in the past to develop methods to either avoid the intermediate steps or reduce the complexity involved, thereby effecting the time and cost factors. The objective of this work is to understand Why, achieving effective recognition rates using recent technology is still challenging? And Is it possible to overcome the existing challenges and drawbacks by retraining different deep neural networks, using different Transfer Learning techniques? Four different Transfer Learning techniques, two different pre-trained deep neural networks and different dataset were employed, resulting in an exceptional recognition rate of 92.5%.

Heating, ventilation, and air-conditioning (HVAC) systems are omnipresent in modern buildings and are responsible for a considerable share of consumed energy and the electricity bill in buildings. On the other hand, solar energy is abundant and could be used to support the building HVAC system through cogeneration of electricity and heat. Micro-scale concentrated solar power (MicroCSP) is a propitious solution for such applications that can be integrated into the building HVAC system to optimally provide both electricity and heat, on-demand via application of optimal control techniques. The use of thermal energy storage (TES) in MicroCSP adds dispatching capabilities to the MicroCSP energy production that will assist in optimal energy management in buildings. This work presents a review of the existing contributions on the combination of MicroCSP and HVAC systems in buildings and how it compares to other thermal-assisted HVAC applications. Different topologies and architectures for the integration of MicroCSP and building HVAC systems are proposed, and the components of standard MicroCSP systems with their control-oriented models are explained. Furthermore, this paper details the different control strategies to optimally manage the energy flow, both electrical and thermal, from the solar field to the building HVAC system to minimize energy consumption and/or operational cost.

17 USC 105 interim-entered record; under review. The article of record as published may be found at https://doi.org/10.1016/j.energy.2020.119691 Wind farm development projects require a detailed survey of the eligible land. The land selected is often segmented into different region, each owned by different landowners with different land pricing. These regions are often complex shaped with irregular boundaries. Therefore, an efficient method for numerically modeling such irregular domains is needed. This work uses support vector data description (SVDD) to generate an analytical, continuous description of the irregular regions. Whereas other methods typically work well for modeling convex domains, the SVDD approach can be used to model irregular regions as a spherical boundary using various kernel mapping. It was demonstrated that the SVDD approach can be used to model any number of complex regions. An error analysis showed that the SVDD approach can construct accurate descriptions using a relatively small data set. The applicability of SVDD method in wind farm layout optimization is also demonstrated. The wind farm optimization study considered that the terrain is divided into several regions each owned by a different owner offering the land at a different price. Two different methods for considering the cost of the land are presented. The differences in optimal farm layouts using the two land cost models were also presented. In each case, the optimized wind farm layouts resulted in lower cost-of-energy relative to the reference wind farm. It was shown that the SVDD approach can also be used to restrict the placement of wind turbines in infeasible/ restricted regions. The library for support vector data description was also made available to the public. This research was performed while the author held an NRC Research Associateship award at the Naval Postgraduate School.

Civil engineering development has advanced dramatically over the years. The unsustainable use of resources in various activities involved in the engineering projects releases undesirable amounts of emissions and other waste streams into the environment causing negative environmental impacts including global warming, resource depletion, eutrophication and acidification among many others. In the past decade or so, considerable efforts have been made to incorporate sustainable practices into the design and construction of infrastructure projects with an aim to minimize the net negative environmental, economic and social impacts of the project. Over the past few years, several researchers have developed project specific tools to aid the practitioners to assess and compare the sustainability of the potential design alternatives in a project. In most cases, these tools focused mainly on the environmental impacts with a minimal (often a qualitative approach) or even no regard to the broader economic and social impacts of the alternative design options in a project. For the true sustainability assessment, it is imperative that the assessment methodology incorporates a quantitative and life cycle approach for the decision-making on the most sustainable design alternative in a project. In this regard, a framework “Quantitative Assessment of Life Cycle Sustainability (QUALICS)” is developed to quantify the overall sustainability of a project/activity and facilitate the decision-making process. The QUALICS framework is not just limited to civil engineering projects but can be used in projects of any engineering domain. The main aim of this paper is to describe the QUALICS framework and demonstrate its application to assess the overall sustainability of design alternatives in a project.

Background National Institute for Health and Care Excellence guidelines (NICE CG95) recommends computed tomography coronary angiography [CTCA] as the first line investigation for all patients with suspected typical or atypical angina irrespective of pre-test probability due to its excellent performance and cost effectiveness. However previous cost effectiveness analyses have not factored in the burden of lung nodules [LN] or extracardiac incidentalomas, which are commonly identified on CTCA. Purpose As we increasingly detect LN on CTCA scans, it is prudent that a uniform pathway is followed for surveillance of LN. The British Thoracic Society (BTS) has enabled evidence-based development of an algorithm for the management of LN which defines a cut off LN size of ≥5mm requiring further follow up. We aimed to assess the compliance of LN follow up in our patients according to radiology recommendation on CTCA reports and also to assess how well these recommendations adhere to BTS guidelines. Method 117 patients who underwent CTCA as the initial diagnostic investigation were retrospectively identified from the rapid access chest pain clinic database. Data was collected during a 1 year period between January - December 2017. Data was analysed to determine whether appropriate surveillance pathway was followed for repeat imaging. According to BTS guidelines, nodules ≥5mm should have a systematic work up for surveillance and hence we have stratified our data based on the nodule size. In case of multiple nodules, the largest nodule size was considered. Results Out of 117 patients, 77% patients were female with average age 57.8±9.0 years. 40% patients were found to have incidental LN with an average size of 4.63±1.92mm; 44% had a history of cigarette smoking. Among patient with nodules, 22 (19%) had CT thorax to assess interval change and interestingly 16 (73%) had persisting LN; whereas in 4 (18%), the LN resolved and only 2 (9%) showed increase in LN size. Repeat CT chest was advised for these 2 patients; 1 was advised to undergo biopsy which eventually ruled out malignancy. 6 patients (5%) from group 1 were recommended for repeat CT despite having LN size In the remaining 25 patients (21%) with LN, 15 (60%) did not have further surveillance imaging even though this was recommended by the reporting radiologist. Of these only 3 (12%) had LN ≥5mm which qualified for surveillance CT. Conclusion CTCA frequently detects incidentalomas especially LN which cannot be overlooked and require further imaging irrespective of the primary presentation. Our findings also suggest a discrepancy on surveillance CT recommendation against the current BTS guidelines, with potential significant impact on the overall cost effectiveness of CTCA. A systematic approach to LN surveillance could be best achieved with a multidisciplinary team approach (e.g. referral pathway to nodule MDT) and adherence to a standard guideline. Lung nodule surveillance following CTCA Funding Acknowledgement Type of funding source: None

Scarcity of natural aggregates in concrete construction is leading to explore the use of alternative materials, especially various industrial waste products. Mining industry is one such major source of waste materials. Sandstone, which is overlying coal seams, is the largest quantity of waste rock being produced by coal mining industry. Laterite is another waste comes from small scale quarries. An attempt is made to assess the use of laterite-GGBS and sandstone as partial replacement for sand in concrete. Sandstone samples were collected from the dumps of a coal mine in south India and laterite samples were collected from different quarries from the southwestern part of India. Various properties of mine waste samples were determined in the laboratory as per IS codes, the properties were found to be very close to that of natural river sand. Mix proportions were prepared for M20 grade concrete. Mechanical properties of concrete with different mixes (0, 25, 50, 75, and 100% replacement with sand) were determined and compared. As a result, the concrete mixes with the replacement of fine aggregates with 100% sandstone increased in strength properties i.e., compressive, splitting tensile, and flexural strength compared to laterite mixes, where the strength properties decreased with increase in replacement levels. This indicates that sandstone can be an effective replacement for the river sand in concrete.

Aim: Compare healthcare utilization and costs between Medicare beneficiaries with idiopathic pulmonary fibrosis (IPF) receiving pirfenidone or nintedanib. Methods: Retrospective cohort study of Medicare beneficiaries (100% Research Identifiable Files) with IPF who initiated pirfenidone or nintedanib between 15 October 2014 and 31 December 2015. Inverse probability of treatment weighting using propensity scores adjusted for baseline covariates. Outcomes: hospitalization and monthly costs. Results: Hazard and incidence rate ratios (95% CI) for all-cause (0.79 [0.68–0.91]; 0.69 [0.59–0.82]) and respiratory-related (0.80 [0.65–0.97]; 0.71 [0.57–0.90]) hospitalizations favored pirfenidone versus nintedanib. Monthly inpatient costs were lower for pirfenidone versus nintedanib patients; outpatient and pharmacy costs were similar. Conclusion: In patients with IPF, pirfenidone compared with nintedanib has a moderate but significant protective effect on hospitalization, corresponding to lower inpatient costs.

The development of drugs that target the Th17 axis has had a profound effect on the treatment and management of psoriasis. IL-23 inhibitors in particular, including guselkumab and risankizumab have been shown to be highly effective and have a favorable safety profile.1 Though recent studies have shown that in-class biologic switching can be effective in the treatment of psoriasis, no investigation has assessed the efficacy of an in-class IL-23 inhibitor switch.2,3.

Coronary artery aneurysm (CAA) is described as a localized dilatation of a coronary artery segment by more than 1.5-fold compared with the adjacent normal segments. The incidence of CAA varies from 0.3 to 5.3% with atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention (PCI) being the common etiologic factors. Owing to its varying presentation and absence of robust treatment guidelines, management of CAA is a challenge. Management of every patient must be tailored according to the presentation and expertise of the cardiac team available. Here, we present case reports of two patients with CAA who presented with acute coronary syndrome. As a result of unstable presentation, both patients underwent immediate intervention (CABG and PCI respectively) with successful revascularization having no complication and mortality.

Internet of Things (IoT), a parasitic innovation and one of a kind revolutionizing the cyber networks far and wide over the globe have infiltrated several sectors of human lives. Ensuring and elevating the quality of human living, it continues to evolve with time. The much-evolved version of IoT, Narrow Band Internet of things (NB-IoT) has left the world astonished owing to its unique ability to digitally transform lives with much lesser frequency of operation. The ability to coexist with technologies such as Artificial Intelligence (AI) and Machine Learning (ML) having a contained asset wastage, provides NB-IoT a high ground over existing innovations. With the introduction of error-correcting codes such as BCH in the client and server-side of the network, NB-IoT prospers over Industrial sectors ensuring nearly absolute error-free data transfer. BCH codes incorporated alongside NB-IoT structures a favored arrangement in ensuring the quality of data and assuring the well-defined future of several industrial sectors

Objective To investigate the clinical and health care burden of chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) in the United States. Study Design Retrospective, cross-sectional design with analyses of patient visits from 2 databases. Setting National Ambulatory Medical Care Survey (NAMCS, 2012-2016) and State Ambulatory Surgery and Services Databases (SASD, 2012-2015) in available states. Methods In each analysis, we identified patients (≥18 years old) with a diagnosis of CRSwNP ( ICD-9-CM : 471.x; ICD-10-CM : J33.x) in the visit record during the study period. CRS patients without polyps (CRSsNP: ICD-9-CM : 473.x, ICD-10-CM : J32.x; without CRSwNP codes) were identified for comparison. In the SASD, we focused on visits involving relevant sinus procedures. Outcomes included comorbidities, diagnostic testing, and prescribed medication (NAMCS) and surgery visit characteristics (SASD). Results We identified 2272 NAMCS records from physician offices (183 CRSwNP, 2089 CRSsNP). Most visits were for patients aged 99%) and completed quickly (99%), followed by routine discharge (>91%); follow-up visits were common (14.9%, 13.9%). Conclusion CRSwNP compared to CRSsNP patients have a distinct clinical experience, with moderately higher medication need and more extensive surgery.

Falls are a leading cause of injury and death in older generations. An in-home fall monitoring system increases safety while allowing for continued independence. The WiFi-based In-home Fall-detection Utility monitors a user by harnessing WiFi Channel State Information, distinguishes falls from normal daily activities, and, if a fall occurs, automatically notifies the user's selected emergency contacts.

Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed.

Purpose Thalassemia poses clear systemic and oral health problems. Clinicians must be aware of various dental treatment needs in these patients. This study was undertaken to assess body mass index (BMI), dental age, salivary alkaline phosphatase levels, malocclusion, and treatment needs in children with β thalassemia major. Materials and methods A total of 100 children within the age group of 2-15 years (50 thalassemic and 50 healthy controls) were included. Dental age, oral health status, malocclusion, and intervention urgency index was recorded. Unstimulated whole saliva samples were collected to assess the salivary alkaline phosphatase levels. The recorded data were statistically analyzed. Results A significantly greater number of thalassemia children were found to be in the underweight category. A significantly high OHI-S scores and low gingival index scores were observed in thalassemia children. Salivary alkaline phosphatase levels were significantly low in thalassemia children compared to the control group. Intervention urgency index scores were significantly high in thalassemia group of children. Conclusion Thalassemia children had low BMI, gingival index scores, salivary alkaline phosphatase levels and higher prevalence of malocclusion, and high OHI-S index scores compared to the healthy control group. Intervention urgency index scores revealed greater dental treatment needs in children with thalassemia. How to cite this article Rani ST, Reddy ER, et al. Comparative Evaluation of BMI, Dental Age, Salivary Alkaline Phosphatase Levels, and Oral Health Status in Children with β Thalassemia Major. Int J Clin Pediatr Dent 2019;12(4):303-306.

In the present paper, a methodology is presented for seismic fragility analysis of pressurized piping systems considering ratcheting. The methodology is applied for a typical piping system, which was considered for an international benchmark exercise on seismic margin assessment. A numerical tool, which was earlier validated with experimental results on ratcheting in pressurized piping components and systems, is used for evaluation of strains in piping system. Variations in damping and natural frequency of the piping system are considered for the fragility assessment in addition to ground motion variability. Twenty intra-plate earthquake records are considered for ground motion variability. Three performance levels are considered for the assessment: first one is the present design stress limit, remaining two are strain limits based on codal guidance and experiments. Response surface techniques in conjunction with Monte Carlo simulations are used for fragility evaluation.