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Background The COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner. Objective We aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital. Methods A retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic. Results The study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001). Conclusions Teleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the ‘hybrid care’ which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient’s needs.

Supplemental Nutrition Assistance Program (SNAP) enrollment has increased dramatically during the COVID19 economic crisis Currently, one in three households with children experiences food insecurity, the greatest prevalence in modern times 1 SNAP effectively reduces poverty and improves food insecurity,2 and the current recession has increased many US households' reliance on federal nutrition programs These new developments have intensified ongoing public debate about the most effective program designs for promoting food security and dietary quality SNAP fruit and vegetable (FV) incentives aim to improve diet quality for participants by providing matching funds for FVs purchased with electronic benefit transfer (EBT) SNAP incentives encourage healthy eating behaviors by subsidizing FV purchase and consumption FV incentives have been piloted nationwide, providing important evidence than can inform optimal program design However, incentives are not uniformly available to all SNAP participants, and there are currently insufficient federal resources appropriated to expand incentives nationwide We review the scientific evidence base for FV incentives and their correlation with healthy eating behaviors, highlight potential challenges for scaling FV incentive programs, and explain the public health opportunity associated with nationwide expansion of evidencebased FV incentives

There has been an increased demand for Energy Storage Systems (ESS) as they power most of today's remote devices and are needed to sustain the ongoing transportation electrification revolution to curb pollution levels. State-of-Charge (SOC) and State-of-Health (SOH) assessment of batteries is vital to prevent unexpected shutdown of battery powered consumer electronics and to determine the expected range from an Electric Vehicle. SOC & SOH estimators demand high-quality curated battery parameter data such as current, temperature and voltage over several charge/discharge cycles. Experiments needed to collect such data are expensive and tedious. Lack of diversity in open access battery datasets have hindered research in this area. This paper is focused on synthetic generation of battery parameters from sparse datasets. The goal is to produce high-fidelity heterogeneous time-series datasets which help to overcome the problem of lack of data in the ESS domain.

OBJECTIVES: Greater number and increased frequency of farmers’ markets are an important strategy to improve community-level diet quality by increasing fruit and vegetable availability, yet fall short of addressing health disparities due to a predominantly affluent, white clientele. Introducing Supplemental Nutrition Assistance Program (SNAP) financial incentives at farmers’ markets increases patronage and sales amongst people with economic disadvantage, however SNAP participant incentive program awareness and farmers’ market sales remain low. This study examined whether a digital campaign promoting SNAP incentive programs increases farmers’ market SNAP participation. METHODS: This study was a parallel RCT, with randomization of zip codes to receive (a) digital promotions or (b) no additional promotions. The study sample included target zip codes (n = 96) near New England farmers’ markets with SNAP incentive programs (n = 23). The intervention was a 13-week campaign, placing digital ads on Facebook and the Fresh EBT app promoting SNAP incentive program savings at farmers’ markets. The study measured farmers’ market SNAP shopping patterns and sales as well as digital campaign delivery and engagement. Data were collected July 1 – September 30, 2020. RESULTS: The digital campaign reached 251,966 people, generated 2 million impressions, and resulted in 12,849 clicks. During Summer 2020, zip codes randomized to receive digital promotions had 33.1 SNAP transactions (SE: 6.9) and control zip codes had 18.1 transactions (SE: 4.3), or 82% more transactions associated with promotions (P = 0.068). There were also more new customers from promotion zip codes (10.8 [SE = 2.5] customers) than control zip codes (5.7 [SE = 1.4] customers), or 90% more new customers (P = 0.075). SNAP and incentive sales were higher from promotion zip codes ($1392 [SE: $306]) than control zip codes ($949 [SE: $273]), or 47% greater (P = 0.284), but sales differences were not statistically significant unless controlling for Summer 2019 farmers’ market sales. CONCLUSIONS: Digital SNAP incentive program promotions can increase farmers’ market SNAP participation, the primary study outcome, leveraging SNAP to expand farmers’ market reach and associated nutrition benefit to historically marginalized populations. FUNDING SOURCES: USDA Food Insecurity Nutrition Incentives Program.

Electrohysterogram (EHG) is a noninvasive approach for recording the electrical activity of the uterine muscles (myometrium). It is also known as Uterine Electromyogram (Uterine-EMG). Since it is a non-invasive alternative, it is a safe and painless procedure to monitor uterine activity. In this paper, a wavelet transformation technique was used to preprocess the raw EHG signal, to remove artifacts present in it. A secondary time series was computed from the peak intervals of the EHG signals. This was followed by the extraction of the non-linear features from this time series. The classification of labor and non-labor signals was performed with a KNN algorithm. An accuracy of 90.32% was achieved with the KNN model. With supervised learning models, labor contractions were correctly identified in women who had just entered their third trimester but had not crossed the 37th week mark. With this knowledge, potential cases of preterm births could be identified. This knowledge could assist doctors in premeditating the prevention of still-births.

The protocols for managing intractable idiopathic epistaxis have evolved with advances in endoscopic techniques. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) has been the treatment of choice for idiopathic intractable epistaxis. If TESPAL fails, transantral ligation of internal maxillary artery (IMA) used to be the dictum along with radiological interventions. Here we discuss about the role of endoscopic IMA ligation in cases of failed TESPALs. Retrospective study at a tertiary hospital was performed. 28 cases of intractable idiopathic epistaxis underwent TESPAL in our institution of which 2 cases had rebleed. We also had two referred cases of failed TESPALS. Of this 4 patients, three patients underwent endoscopic IMA ligation and one patient underwent selective embolisation. All the patients who underwent endoscopic IMA ligation for failed TESPAL had no further episodes of epistaxis. One patient who underwent selective embolization also had no further episodes of bleed but had transient facial pain and trismus. When TESPAL fails, endoscopic IMA ligation can be considered as an alternative procedure before resorting to embolization.

BackgroundThe first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.MethodsMARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site’s local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.DiscussionA mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform.We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.

Single logic style based decoder consumes more no of transistors, more power. Mixed logic design is alternative to this. Mixed logic style combines different logic style in one circuit. Hence a circuit gets advantage of different logic style.2-4 mixed decoder with enable offers low power compared to conventional CMOS logic style. Circuits are simulated using T-spice at 32nm technology node. Proposed decoder shows a 12% reduction in power.

Background: Chronic rhinosinusitis (CRS) with its classical symptoms of nasal obstruction, nasal discharge, and headache is relatively a common disease in otorhinolaryngology practice. The objectives of the present study was to correlate the operative findings in such patients with the CT findings, using the Perioperative sinus endoscopy (POSE) scoring system and to correlate the maximum scores obtained in the POSE scoring system and Lund-Mackay scoring system.Methods: A prospective study was conducted from January 2014 to March 2015 in 50 patients suffering from chronic rhinosinusitis who underwent endoscopic sinus surgery in the age group of 36-60 years of age. Results: Agger nasi cells were the most common wandering ethmoid cell detected (90%) followed by various types of frontal cells (54%), Haller cells (26%) and least commonly Onodi cells (12%). Almost perfect agreement was obtained for rest of the criteria which included middle turbinate status, ethmoid cavity mucosal edema and ethmoid cavity polypoid change. Lund-Mackay scoring system was used to score findings in the CT scan and POSE scoring system used to score peroperative findings in the study and this study reveals excellent correlation (Pearson correlation value of 0.879).Conclusions: Novel POSE scoring is a new entity which has the potential to be a valid system to score preoperative and perioperative findings. In the current study POSE scoring shows excellent correlation with Lund Mackay scoring which is an established scoring system used in the evaluation CT scan.

Moebius syndrome is a rare congenital neurological disorder. The most frequent mode of presentation is facial diplegia with bilateral lateral rectus palsy, but there are variations. Here, we report a rare case of Moebius syndrome in a 15-month-old child with unilateral facial palsy, bilateral abducens nerve palsy with Dandy Walker variant, and complete agenesis of corpus callosum.

Background: Nutrition has been recognized as a basic pillar for social and economic development. One in every three malnourished children in the world lives in India. The objective of this study was to measure the prevalence and to study the selected factors associated with underweight among the under-five children in a rural area of Puducherry. Aims: This study aims to study the prevalence of underweight among children under-five years of age and to study the associated risk factors. Methodology: This was a cross-sectional study conducted over a period of 13 months with a sample size of 500. The anthropometric assessments were taken and plotted on the Indian Academy of Pediatrics growth charts.Results: The prevalence of underweight was found to be 23.8%. The age of the child, gender, socioeconomic status, duration of exclusive breast feeds, birth order, and birth weight were found to have statistical significance in underweight. However, the maternal education did not show any significance in underweight. Conclusion: Nutritional status of under-five years children is one of the important indicators of overall development of community and thus country. Intervention to reduce the burden of underweight should be directed toward the education of the mothers regarding the importance of nutrition by community health workers.

Basosquamous cell carcinoma (BSC) is a rare cutaneous lesion with features of both basal cell carcinoma and squamous cell carcinoma. We report a case of a 75-year-old male presented in our outpatient department with an ulceroproliferative lesion left pinna extending into the external auditory canal at Stage II temporal bone malignancy. Wide excision pinna and lateral temporal bone resection with reconstruction with a pedicled fascial flap was carried out.