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Academic computing curricula generally focus on teaching the specific technological skills expected of new graduates in their disciplines. Yet when it comes to hiring these graduates, behavioral skills (also called soft skills) such as communication and personal integrity are almost always rated as being more important than the technological skills. This mixed-method research project adds to the understanding of skill expectations required for new hires by providing information from a global sample of project management professionals. Both the quantitative and qualitative results are in accord with the vast majority of the extant literature in that behavioral skills were seen as more critical than technical skills. Implications and recommendations for educators, curriculum developers, and prospective graduates are discussed.

Tumor depth is a reliable parameter to predict nodal metastasis in oral cancers; therefore, the authors embarked upon a prospective observational study to define the relationship between the tumor depth and the risk of cervical lymph node involvement as well to determine the optimal tumor depth cutoff point for nodal metastasis.The aim was to study the predictive value of depth of invasion (DOI) and tumor size on risk of cervical node metastasis in squamous cell carcinoma of the oral cavity.Biopsy-proven Stage I-Stage III oral cavity squamous cell carcinoma patients were included in this prospective, observational study. Various histopathological characteristics (DOI, tumor size, lympho-vascular invasion [LVI], perineural spread, and grade of differentiation) were analyzed to predict the cervical node metastasis.The impact of the clinical and histopathological parameters of primary tumor on cervical lymph node metastasis was analyzed by univariate as well as multivariate logistic regression analyses using NCSS 12 version 12.0.5 statistical software.The independent predictors of cervical lymph node metastasis were DOI (P = 0.0014) and LVI (P = 0.0414). The incidence of cervical metastasis increased markedly when the DOI was over 5 mm, and it was a statistically significant (P0001) association.DOI is a significant predictor of cervical nodal metastasis and tumor depth 5 mm can be considered as a cutoff value in staging and management of early oral squamous cell carcinoma.

The incidence of cases presenting with foreign bodies in the rectum is increasing. Most of the time, foreign bodies found in the rectum are a conventional object which is self-inserted for sexual activities or to hide it for some illegal trade. But it becomes challenging for the treating surgeons when they come across rare cases who present with an unusual foreign body in the rectum. The management of such unusual and large foreign bodies in the rectum is challenging due to the different nature of objects inserted, the time of insertion, pelvic anatomy, the amount of local contamination, and associated injuries. Apart from few anecdotal case reports, there is little evidence available in the current literature which deals with such unusual and large foreign bodies in the rectum. This study aims to acknowledge the surgeons about challenging situations posed by these unusually large foreign bodies in the rectum and helps them in dealing with it. Here, we are sharing the series of rare cases with unconventional and large foreign bodies in the rectum which have been managed successfully at our tertiary care institute. We find that even the larger rectal foreign body with blunt surfaces may be retrieved transanally without the need of laparotomy while a sharp and pointed foreign body will need surgical retrieval. Reluctance to seek medical help and multiple attempts of self-removal by the patients leads to the delay in the management. With proper evaluation and a diligent approach, laparotomy is rarely required.

BACKGROUND COVID 19 has been labelled as a global pandemic by the World Health Organization (WHO). The sudden rise in death toll and devastation associated with it has put the entire infrastructure, economy and health sector to test. The only way for the prevention and control of this infectious disease is rapid and accurate screening of masses. Public Health Authorities mainly use antibody testing in hot spots using a mix of RT-PCR and antibody testing nasopharyngeal and orpharyngeal swabs. Considering the potential risk factors, constraints of time, cost and manpower, mass screening for COVID is not possible through nasopharyngeal and oropharyngeal swabs alone. Hence, to search an alternate method to diagnose for the initial screening of patients is the need of the hour globally. Saliva can also be used as one of the diagnostic modalities for coronavirus, helping in the rapid testing of individuals at home or at hospital. The article intends to explain the evidence regarding the reliability of saliva as a diagnostic specimen in COVID-19 patients and demonstrates the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non - invasive diagnostic modality. KEY WORDS COVID 19, Throat Swab, Nasopharyngeal Swab, Saliva, Diagnostic Fluid

Carcinoma tongue is one of the commonest cancer of head and neck in India. Various pedicled and free flaps have been used to reconstruct the tongue defect following glossectomies. In this era of free flaps various loco- regional pedicled flaps have been overlooked and infrahyoid flap is one of them. This flap meets the functional and cosmetic acceptance of the tongue defect reconstruction with minimal morbidity to the donor site. This paper presents author’s experience of using infrahyoid flap in 10 patients of carcinoma tongue. In all the patient’s tongue defect was closed with the infrahyoid flap, in 1 case flap necrosed fully and in 1 partially. Functional outcome and quality of life in all the patients were acceptable.

These days RTA and violence are on the rise and accounting for more cases of trauma in which bony injuries are common .Fracture of tibial shaft is due to its subcutaneous location is very often involved in these kind of injuries.this study was done to evaluate the effectiveness of external fixator as primary and definitive treatment for open tibia fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured patients [1]. Intramedullary nailing is considered the method of choice for treatment of closed diaphyseal fractures of long bones. However, there is controversy in the literature regarding the best way of managing open type II and type III fractures, tibial shaft fractures with severe soft tissue injuries or compartment syndrome, multiply injured patients. Material and Methods: A total of 16 patients who satisfied our inclusion and exclusion criteria were taken and were treated with AO external fixator as primary or secondary to failed Intramedullary nailing . patients were assessed radiologically and clinically. Results: as per clinical parameters of Karlstrom and Olerud 37% patients had excellent outcome 31% had good outcome 18% had fair outcome and 12% had poor outcome. Conclusion: Meticulously primary wound debridement at earliest is an absolute. Which augments prognosis and prevents complication. External fixator is now accepted, reliable and convenient method to manage open Long Bones fracture.

The article touches upon current problems of speech genres functioning on the Internet and fits into the context of modern research in the field of virtual genre studies. The article discusses the speech genre of the movie announcement and describes the means of its language embodiment. The research is focused on the analysis of clichéd constructions and is based on 250 Indian film announcements written in Russian and posted on Indiankino.net. The author offers a descriptive model of the movie announcement speech genre which includes the following parameters: the communicative goal and type of speech genre, the image of the author and the addressee, the image of the future and the image of the past, the composition of movie announcement, the type of dictum content, means of its linguistic embodiment, non-verbal means. There is a special focus on the use of clichéd constructions in all compositional parts of the analyzed texts (name of the film, exposition, plot of the film, denouement). The research has shown that clichés function in every compositional element. The author singles out the main functions of clichéd constructions in the speech genre of the movie announcement: persuading function, advertising function, as well as text-building and genre-forming functions.

Background Gastrointestinal route is considered for feeding in subjects who are unable to swallow, either as a temporary or permanent option. Percutaneous endoscopic gastrostomy (PEG) is the preferred mode for long-term enteral nutrition. The aim was to study the outcome of protocol-based PEG placement in a tertiary medical center.Materials and Methods All the patients who underwent PEG placement between January 2017 and December 2019 were included in the retrospective study. Study variables were entered into a uniform structured proforma. The procedure was done by two people using Ponsky-Gauderer pull-technique. Fluoroscopy guidance was considered for placement in special situations. Post-procedure, all the patients were regularly followed as per protocol to evaluate for adverse events.Results One hundred and eighteen patients with placement of PEG were included in the study. The mean age of the patients was 49.6 ± 7 years with 67.8% males. The most common indication of PEG was inability to swallow associated with head injury (43, 36.4%), followed by carcinoma esophagus (35, 29.8%) and stroke (24, 20.3%). Fluoroscopy was useful in 38 (32%) for PEG site identification. Tube dislodgement (16, 13.5%) and aspiration pneumonia (20, 16.9%) were the common adverse events. Age more than 60 years and dysphagia in neurologic disorders accounted for more than 60% of adverse events. Forty-nine (42%) of the PEG patients expired due to either primary illness or due to sepsis after a median time of 139 days (range: 32–288 days). There was no difference in the survival in patients with or without PEG-related complications (p = 0. 74).Conclusions Fluoroscopy assistance helps in accurate PEG placement in one third. Age > 60 years and dysphagia in neurologic disorders were independent risk factors associated with PEG tube complications.

Head and neck cancers are a major healthcare burden in the Indian Subcontinent mainly due to tobacco consumption. While advances in treatment have resulted in better control rates and survival, relapse of tobacco consumption contributes to recurrences. The authors embarked upon a cross-sectional questionnaire-based study to assess the burden of tobacco relapse along with factors resulting into relapse. Patients on follow-up after treatment of tobacco-related head and neck cancers in a dedicated cancer institute were included in the study. Demographic data was noted, and responses were obtained on a five-point Likert’s scale for reasons of relapse which were analyzed with a median and interquartile range. Predictors of relapse were assessed using multivariate logistic regression analysis. In our sample size of 500, relapse rate was 15%, majority of which occurred in the first year of follow-up when disease was loco-regionally controlled. Most common causative factor for relapse was lower motivation to quit. Care givers must incorporate tobacco cessation counseling as an integral part of head and neck cancer treatment.

Goal-directed behaviour requires prospectively retrieving and evaluating multiple possible action outcomes. While a plethora of studies suggested sequential retrieval for deterministic choice outcomes, it remains unclear whether this is also the case when integrating multiple probabilistic outcomes of the same action. We address this question by capitalising on magnetoencephalography (MEG) in humans who made choices in a risky foraging task. We train classifiers to distinguish MEG field patterns during presentation of two probabilistic outcomes (reward, loss), and then apply these to decode such patterns during deliberation. First, decoded outcome representations have a temporal structure, suggesting alternating retrieval of the outcomes. Moreover, the probability that one or the other outcome is being represented depends on loss magnitude, but not on loss probability, and it predicts the chosen action. In summary, we demonstrate decodable outcome representations during probabilistic decision-making, which are sequentially structured, depend on task features, and predict subsequent action., Goal directed behavior requires the sequential retrieval and evaluation of the multiple choices for action and their deterministic outcomes. Here, the authors report sequential, decodable probabilistic outcome representations in magnetoencephalography (MEG) signals during a risky foraging task.

The number of computers connecting to the internet is getting increased day by day, while the number of computers connected is increasing then it is obvious that the amount of network-based attacks will also increase. In this way, we use a honeypot that is a framework trap that is set to act against unapproved utilization of PCs and data frameworks. Around the globe, a huge number of individuals get to the web each day, honeypot which can likewise be called Intrusion Detection Technology is another time of security innovation that screens device to avoid malicious sports. The whole factor of this research paper is an Intrusion Detection System and Intrusion Prevention System, elements accomplished via honeypot and honeytrap methodologies. A great deal of research went into this review paper and the discoveries propose that the honeypots are drawing in light of a legitimate concern for analysts as a significant security system that can be actualized to stop or occupy the assaults the system assaults and give a chance to find out increasingly more about the source and nature of these assaults. Hence we can say that a honeypot can be utilized as an examination apparatus to accumulate increasingly more data about the expanding number of system assaults that are going on consistently.

Evaluation of acquired demyelinating syndrome (ADS) without diagnostic biomarkers results in diagnostic and therapeutic challenges in pediatric population. Immune-mediated ADS of childhood responds well to steroid and intravenous immunoglobulin (IVIg) and in refractory cases with plasma exchange. Novel coronavirus disease 2019 (COVID-19) coinfection in such cases imposes technical challenges in management. An 11-year-old girl with quadriparesis and loss of vision and a magnetic resonance imaging (MRI) brain showing acute demyelinating encephalomyelitis (ADEM) and cerebrospinal fluid examination being noncontributory responded well with plasma exchange after failing steroid and IVIg is described. Coinfection with COVID-19 mandating personal protection in a temperate country imposed technical challenges in her management.

Avalanche hotspot formation can severely limit the current handling capability of power devices. Trench field plate power MOSFETs can be prone to avalanche hotspots, especially in the termination regions. Subtle differences between the active and termination regions can result in current focalization into a small area of the termination and destruct the device. The avalanche hotspots are ascribed to kinks and negative differential resistance (NDR) branches in the termination diode I-V characteristics. In this work, we investigate the electrostatic origin of such features and propose the use of an integrated termination ballast to suppress the hotspot formation. An enhancement of ~3x in avalanche current capability is demonstrated through unclamped inductive switching (UIS) experiments.

Laryngeal paraganglioma is a rare tumor with diagnostic challenge. Many a times it can be confused with laryngeal cancers. CECT and MRI has an important role in its diagnosis. Surgical excision is the treatment of choice. Our case presented with stridor. Emergency tracheostomy was done followed by workup for surgery. Excision of the tumor was done by laryngeal fissure.

Background and Aims: Pecs block and its variations provides perioperative analgesia, reduce PONV and other opioid related side effects. We hypothesized that COMIBPES block in addition to general anaesthesia will provide better postoperative analgesia when compared to general anaesthesia alone in breast cancer surgery patients. Methods: After obtaining permission from the institutional review board and registering the trial with Clinical Trials Registry of India (CTRI), we conducted a double blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection. Patients were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, postoperative nausea vomiting (PONV) and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively. Results: Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, compared to nil in group P, P< 0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1. Conclusion: COMBIPECS block is a valuable addition to general anaesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

BACKGROUND Dobutamine-atropine stress echocardiography (DSE) has lower sensitivity in patients with advanced liver disease (ALD) due to vasodilation. HYPOTHESIS Dopamine-atropine stress echocardiography (DopSE) may be an alternative to DSE in ALD patients by improving the blood pressure response to stress. METHODS The safety and tolerability of DSE and DopSE were compared in 10 volunteers. The safety, adverse effects, and efficacy of DopSE were then assessed in 105 patients, 98 of whom had ALD. Dopamine was infused in stepwise fashion from 5 µg/kg/min to a peak dose of 40 µg/kg/min. Atropine was given before and in early stages of dopamine infusion up to cumulative dose of 1.5 mg. The hemodynamic responses of 98 ALD patients were compared with 102 patients with ALD who underwent standard DSE. RESULTS In normal volunteers, systolic BP increased more with DopSE compared to DSE (61 ± 19 mm Hg vs 39 ± 15 mm Hg, P = .008). In 105 patients who underwent DopSE, none had adverse effects that required early stress termination. In the groups with ALD, the systolic BP increase (38 ± 28 mm Hg vs 12 ± 27 mm Hg, P

Background Our goal was to study the demographic, clinical and laboratory profile and outcome of scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in the pediatric age group. Methods We conducted a prospective observational study in a tertiary care teaching hospital over a period of 1 year. Children in the age group of 1 month to 12 years with IgM ELISA positive for scrub typhus were included in the study. HLH was diagnosed using HLH-2004 criteria. Demographic, clinical and laboratory profile, treatment and outcome of HLH patients were noted and also compared with non-HLH scrub typhus patients. Results Among 58 children with scrub typhus infection, 18 had HLH. The mean age of patients with HLH was 35.3 ± 44.8 months and 61% were male. Anemia, thrombocytopenia and hyperferritinemia were seen in all the patients. Hypertriglyceridemia, hypofibrinogenemia and coagulopathy were noted in 78%, 56% and 44%, respectively. All the patients were treated with intravenous doxycycline for an average duration of 9.5 days. Intravenous immunoglobulin and methylprednisolone were given in 33% and 22% cases, respectively. Complications like acute respiratory distress syndrome (ARDS) (p = 0.001) and MODS (p = 0.004) were significantly high in the HLH group. Younger age ( 7 days, presence of convulsion, ARDS and MODS were the clinical predictors of scrub typhus-associated HLH. Conclusion HLH in scrub typhus infected children is being increasingly recognized. Younger age, prolonged fever, presence of convulsion, ARDS and MODS should alert clinicians of the risk of HLH. Treating the primary cause usually cures the disease and immunomodulator therapy need not be routinely administered.

Background CTLA-4 pathway blockade with ipilimumab (IPI) ± nivolumab (NIVO; anti–PD-1) is an effective treatment for several cancers. A nonfucosylated version of IPI, BMS-986218, was developed to increase the effects of CTLA-4 blockade and enhance intratumoral regulatory T-cell depletion via its increased affinity for Fcγ receptors (FcγR, CD16) on natural killer T cells and macrophages, resulting in enhancement of antibody-dependent cellular cytotoxicity. Preclinical data supported the mechanism of action of BMS-986218 and demonstrated greater antitumor activity in an MC38 tumor model vs IPI.1 Here, we present initial results from the first-in-human phase 1/2a trial of BMS-986218 ± NIVO in previously treated patients with advanced cancer (NCT03110107). Methods Patients with ≥1 prior therapy received BMS-986218 2–70 mg intravenously Q4W. Safety, tolerability, pharmacokinetics, and pharmacodynamics were evaluated. Results As of December 12, 2019, 65 patients (median age, 61 years [range, 24–85 years]) received BMS-986218 monotherapy. TRAEs occurred in 52% of patients; most were grade 1–2. The most common (≥10%) TRAEs (any grade; grade 3) were pruritus (12%; 0%) and diarrhea (11%; 3%). Eight patients (12%) had grade 3 TRAEs; most resolved with protocol-defined management. No grade 4 TRAEs were reported; 1 grade 5 TRAE (pneumonitis; 2 mg) occurred. Seven patients (11%) discontinued treatment due to TRAEs; 4 dose-limiting toxicities occurred. The maximum tolerated dose has not been reached. BMS-986218 exposure increased dose proportionally, and the half-life was ≈2 weeks. Increased levels of serum chemokine ligands 9 and 10 and interferon-γ indicate that pharmacodynamic changes occurred at the lowest dose tested (2 mg [≈0.03 mg/kg]), similar to previous findings with IPI 3 mg/kg, and at higher doses (40–70 mg [≈0.06–1 mg/kg]), consistent with findings with IPI 10 mg/kg. In a subset of patients with paired biopsies, BMS-986218 was associated with an increased gene signature linked to CD8+ T-cell infiltration and inflammation. In a highly heterogeneous population, as part of dose escalation, BMS-986218 monotherapy treatment was associated with clinical activity in some patients. Updated data based on a September 2020 data cutoff will be presented. Conclusions BMS-986218 monotherapy demonstrated an acceptable safety profile and signs of clinical benefit in this heterogeneous patient population with select advanced cancers. Preliminary pharmacodynamic activity was consistent with enhanced effects of CTLA-4 blockade. Data from continuing dose escalation of BMS-986218 ± NIVO along with preclinical results provide support for ongoing monotherapy expansions and for BMS-986218 + NIVO expansions in patients with advanced cancer. Acknowledgements The authors acknowledge Dr Charles Drake while at Columbia University Medical Center, New York, NY, USA, for his contributions to the study. Trial Registration NCT03110107 Ethics Approval This study was approved by the WCG Independent Review Board, approval number 20170464 Reference Engelhardt J, Akter R, Valle J, et al. Preclinical characterization of BMS-986218, a novel nonfucosylated anti–CTLA-4 antibody designed to enhance antitumor activity. Presented at the American Association for Cancer Research (AACR) Virtual Annual Meeting II; June 22–24, 2020 [poster 4552].

The long and unconstrained nature of egocentric videos makes it imperative to use temporal segmentation as an important pre-processing step for many higher-level inference tasks. Activities of the wearer in an egocentric video typically span over hours and are often separated by slow, gradual changes. Furthermore, the change of camera viewpoint due to the wearer's head motion causes frequent and extreme, but, spurious scene changes. The continuous nature of boundaries makes it difficult to apply traditional Markov Random Field (MRF) pipelines relying on temporal discontinuity, whereas deep Long Short Term Memory (LSTM) networks gather context only upto a few hundred frames, rendering them ineffective for egocentric videos. In this paper, we present a novel unsupervised temporal segmentation technique especially suited for day-long egocentric videos. We formulate the problem as detecting concept drift in a time-varying, non i.i.d. sequence of frames. Statistically bounded thresholds are calculated to detect concept drift between two temporally adjacent multivariate data segments with different underlying distributions while establishing guarantees on false positives. Since the derived threshold indicates confidence in the prediction, it can also be used to control the granularity of the output segmentation. Using our technique, we report significantly improved state of the art f-measure for daylong egocentric video datasets, as well as photostream datasets derived from them: HUJI~(73.01%, 59.44%), UTEgo~(58.41%, 60.61%) and Disney~(67.63%, 68.83%).

This paper presents the silicon demonstration of a novel Trench MOSFET with ultra-low specific on-resistance Ron*A. With drain and source contact placement at the top silicon surface, our device combines the benefits of vertical current flow as leveraged in discrete power devices with ease of CMOS platform integration that has been a key advantage of LDMOS transistors commonly used in BCD technologies. Our unique process flow provides for an asymmetric placement of the field-plate inside the trench enabling best-in-class performance of Ron* $\mathrm{A}=53\mathrm{m} \Omega$ mm2 with a break-down voltage BV=127V. The performance is greater than 2 times compared to the best BCD technology and similar to the record performance of Ref [2] with a simpler process.

The active regions of a trench field plate power MOSFET experience RESURF which is essentially 2-D in nature and can be easily optimized. However, for the same design parameters, the 3-D regions in the device termination can experience significantly weakened RESURF causing them to become the bottleneck for breakdown, thus undermining the 2-D optimization. To strengthen the RESURF in the termination, floating body rings between the active and the termination regions are introduced. Through the coupling of these floating rings, the body in the termination acquires a voltage bias which strengthens the RESURF and increases the breakdown voltage. The working principles of this design are discussed, and the concept is verified through 3-D TCAD simulations.

Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as uncommon or unheard of as Scrub typhus. Scrub typhus very rarely presents itself with CNS manifestations. Here, we present the case of a 7-year-old girl from the Hooghly district in West Bengal, who presented to us with the history of fever, cerebellar signs, and sudden onset of visual loss. She was ultimately diagnosed with scrub typhus cerebellitis.

Long noncoding RNAs (lncRNAs) are noncoding RNAs with transcript length more than 200 nucleotides. Although poorly conserved, lncRNAs are expressed across diverse species, including plants and animals, and are known to be involved in regulation of various biological processes. To understand their biological significance, we first need to identify the lncRNAs accurately. However, distinguishing lncRNAs from coding transcripts is still a challenging task. Here, we describe a machine learning-based approach to accurately identify the plant lncRNAs. We describe the usage of plant long noncoding RNA prediction by random forests (PLncPRO), which employs machine learning-based random forest algorithm to recognize the lncRNAs from the set of given transcript sequences. Stepwise instructions have been provided to use PLncPRO to annotate the lncRNA sequences.

Chronic myelogenous leukemia (CML) is a chronic myeloproliferative neoplasm consistently associated with the BCR-ABL1 fusion gene located in the Philadelphia chromosome. The Blast Phase is diagnosed when blasts are ≥20% of the peripheral blood white cell count or of bone marrow nucleated cells or when there is an extramedullary blast proliferation. Megakaryocytic blast crisis as the presenting manifestation of CML is extremely rare and only 7 reported cases were found in the literature. Out of 34 cases of CML-Blast Phase between April 2015 and June 2016, 3 cases showed megakaryocytic differentiation. 2 of these presented in Blast phase as the first manifestation of CML and the third case was a known case of CML-Chronic phase. Flow cytometric immunophenotyping was performed on peripheral blood/bone marrow using 6- color flow cytometer Navios. On CD45 vs SSC two distinct populations of blasts were seen in two cases and single population in the third case. All the 3 cases were positive for CD61, cCD41, cCD61 confirming the megakaryocytic lineage. The clinical features, morphologic and cytogenetic findings help in the identification and distinction of megakaryocytic blast phase of CML from Acute Megakayoblastic Leukemia. The diagnosis of such rare presentation of CML is essential for determining the choice of treatment. Therefore including a megakaryocytic marker in the primary flow cytometry panel is important so that these cases are not under-diagnosed as Acute myeloid leukemia because of expression of CD13 and CD33 only.

In a rapidly globalizing world, high growth sectors like information technology (IT) hold the key to narrow or broaden the gulf between men and women at work. However, there is a serious underrepre...

This inquiry engaged graduate students in the Homeland Security and Emergency Management program course designated as Academic Community Engagement (ACE) at an Institution of Higher Education (IHE) in rural Texas. The purpose was to evaluate an American Red Cross (ARC) risk-reduction Home Fire Campaign initiative and to implement new strategies designed by students and grounded in after action reports (AARs) and principles of emergency management (EM). Vygotsky's model of social learning and Cultural Historical Activity Theory (CHAT) framed the study. Students partnered with the ARC, emergency responders, and civil society organizations to (a) assess the effectiveness of the ARC-led campaign; (b) apply EM principles in designing the student-led campaign; (c) implement EM principles to new capability-building strategies; and (d) offer recommendations. Comparative analyses of separate campaign events in the community revealed reciprocal benefits; solutions devised by students enhanced program effectiveness and expanded social capital; students reported deep contextualized learning.

Introduction: Cubitus varus (gunstock deformity) is the most common complication of supracondylar fracture of the humerus. Several osteotomies and various fixation techniques are described for its correction. The most commonly used is the lateral closing-wedge osteotomy, also known as French osteotomy with variable results. Persistent lateral condyle prominence leads to cosmetically unacceptable appearance and poor patient satisfaction. To avoid this problem, dome osteotomy is performed. We have evaluated results of dome osteotomy in our population. Material and Methods: This was a retrospective study carried out in our institute. Ten patients with cubitus varus treated by dome osteotomy were evaluated at 24 months. All patients were operated by triceps-splitting approach. Pre- and postoperative carrying angle of elbow, range of motion, and lateral condyle prominence index were compared according to Banerjee criteria. Results: Ten patients with average age of 9.1 years were followed up for 2 years. Mean gap between injury and surgery was 15 months. Postoperative improvement in carrying angle and lateral condylar prominence index was significant. One case developed ulnar neuropraxia, which recovered fully within 2 weeks. Pin tract infection was seen in three cases and skin infections in two cases. Conclusion: Dome osteotomy is a technically demanding surgery. The functional and cosmetic correction is better compared to that for French osteotomy.

Venous thromboembolism is a leading cause of morbidity and mortality especially in the elderly. Arrays of risk factors altering the blood flow, endothelial function and coagulability have been identified. However, the precise mechanisms that trigger clotting in major veins have not been fully elucidated. Activation of endothelial cells by hypoxia or inflammatory stimuli results in surface expression of adhesion molecules that facilitate the binding of circulating leukocytes and microvesicles. Subsequent leukocyte activation induces the release of potent procoagulant tissue factor that triggers thrombosis. Aging, immobility, smoking, surgery, OCP intake, cancer etc predispose to stasis, increased coagulation factor levels, impaired function of the venous valves, decreases in the efficacy of natural anticoagulants associated with the vessel wall, increased risk of immobilization and increased risk of severe infection. Prophylaxis is both mechanical and pharmacological with anticoagulation being the mainstay of treatment. Thus, better understanding the mechanisms of venous thrombosis may lead to the development of new therapeutic / preventive modalities. Recently, vitamin D, the sunshine hormone, has been in the limelight due to some experimental and epidemiological evidences showing its antithrombotic actions by various mechanisms. With emerging data about the potential association of vitamin D as an antithrombotic agent, our review has dissected the recent evidences of vitamin D having any beneficial effect on the markers of thrombosis or improvement among patients with deep vein thrombosis/pulmonary embolidm(DVT/PE).

Objectives The roles of deficient or deranged insulin, adiponectin and 25 hydroxy vitamin D (25[OH]D) levels regulating food intake, energy metabolism, glucose and lipid metabolism and body weight have been reported in the pathogenesis of prediabetes and type 2 diabetes mellitus. However, their congruity in the etiology of diabetes mellitus is unknown. Thus, the aim of the study was to investigate the roles of these parameters together and to establish their interrelationship in patients with prediabetes and diabetes. Methods The preliminary cross-sectional study included 77 persons with type 2 diabetes who were matched for age, sex and body mass index (BMI); 73 persons with prediabetes; and 52 healthy control subjects. Fasting serum levels of adiponectin, insulin and 25(OH)D were measured by commercially available immune assay kits, and routine biochemical parameters were analyzed in all study groups. Results The results show statistically significant lower levels of serum adiponectin and serum 25(OH)D and higher serum insulin levels in persons with prediabetes or type 2 diabetes with respect to controls. The changes in the serum adiponectin or serum 25(OH)D in persons with prediabetes and type 2 diabetes were found to be inversely correlated with the serum levels of insulin. Moreover, multiple linear regression analysis, with 25(OH)D, insulin and homeostatic model assessment-insulin resistance (HOMA-IR) as the variables, revealed that serum adiponectin levels might be an independent risk factor for the progression of prediabetes and type 2 diabetes in subjects. Conclusions The association of these hormones might act as a significant predictor of progression of prediabetes to type 2 diabetes. Decreased serum adiponectin levels might be an independent risk factor for progression to prediabetes and type 2 diabetes, which may help in developing experimental models of the disease or in identifying biomarkers or disease-modifying drugs.

Background: Pembrolizumab (P) is an anti-PD-1 antibody that blocks the interaction between programmed cell death protein 1 (PD-1) on T-cells and PD-L1 and PD-L2 on tumour cells. A phase Ib trial of P plus chemotherapy was undertaken to evaluate the safety and efficacy. Methods: Patients with advanced, metastatic solid tumours were enrolled onto one of six treatment arms. Pembrolizumab was given: with gemcitabine (G), G+docetaxel (D), G+nab-paclitaxel (NP), G+vinorelbine (V) or irinotecan (I) until progression or toxicity, or with liposomal doxorubicin (LD) for up to 15 cycles, progression or toxicity. Safety monitoring and response assessments were conducted. Results: Forty-nine patients were enrolled and treated. The most common adverse events were transaminitis, cytopenias, rash, diarrhoea, fatigue, nausea and vomiting. Arm 2 was closed due to poor accrual. The recommended phase II dose (RP2D) was determined for Arms 1, 3a, 4, 5 and 6. There were eight partial responses across multiple tumour types. Conclusions: Standard dose P can be safely combined with G, G+NP, G+V, I and LD. Efficacy was observed in multiple tumour types and evaluation to determine if response and duration of response are more robust than what would be expected for chemotherapy or immunotherapy alone requires further validation.

Task scheduling for large-scale computing systems is a challenging problem. From the users perspective, the main concern is the performance of the submitted tasks, whereas, for the cloud service providers, reducing operation cost while providing the required service is critical. Therefore, it is important for task scheduling mechanisms to balance users’ performance requirements and energy efficiency because energy consumption is one of the major operational costs. We present a time dependent value of service (VoS) metric that will be maximized by the scheduling algorithm that take into consideration the arrival time of a task while evaluating the value functions for completing a task at a given time and the tasks energy consumption. We consider the variation in value for completing a task at different times such that the value of energy reduction can change significantly between peak and non-peak periods. To determine the value of a task completion, we use completion time and energy consumption with soft and hard thresholds. We define the VoS for a given workload to be the sum of the values for all tasks that are executed during a given period of time. Our system model is based on virtual machines, where each task will be assigned a resource configuration characterized by the number of the homogeneous cores and amount of memory. For the scheduling of each task submitted to our system, we use the estimated time to compute matrix and the estimated energy consumption matrix which are created using historical data. We design, evaluate, and compare our task scheduling methods to show that a significant improvement in energy consumption can be achieved when considering time-of-use dependent scheduling algorithms. The simulation results show that we improve the performance and the energy values up to 49% when compared to schedulers that do not consider the value functions. Similar to the simulation results, our experimental results from running our value based scheduling on an IBM blade server show up to 82% improvement in performance value, 110% improvement in energy value, and up to 77% improvement in VoS compared to schedulers that do not consider the value functions.

Background: Allergic rhinitis (AR) known to be a common type of chronic rhinitis which affects 10-20% of the general population while asthma is another major health problem and leading cause of morbidity in the worldwide. Vitamin D, a steroid hormone known for its important role in immunological effects has a role in AR and asthma.Aims and Objectives: The aim of our study was to assess the serum vitamin D levels in patients with asthma and seasonal AR pre-treatment or post treatment with oral vitamin D supplementation (cholecalciferol – 1000 IU) and to study the pathogenesis of the disease.Materials and Methods: The study included 66 AR and asthma patients and 46 control subjects.Fasting serum samples of control and AR subjects were analyzed for routine biochemical parameters immediately after collection while aliquots of the samples were also stored at - 200 C for the assay of 25-hydroxyvitamin D by ELISA.Results: Serum vitamin D levels were found to be significantly lower in AR and asthma patients compared with controls (p < 0.0001). On receiving vitamin D supplementation (cholecalciferol – 1000 IU) we found an increase in vitamin D serum levels in AR and asthma patients as compared to controls (p < 0.0001).Conclusion: Supplementation of vitamin D may be beneficial in the prevention of the pathogenesis of AR and asthma.Asian Journal of Medical Sciences Vol.8(3) 2017 26-29

Symptoms of depression are present in a significant proportion of Alzheimer's disease (AD) patients. While epidemiological studies have shown a strong association between depression and AD, it has not been established whether depression is a risk factor or merely a co-morbidity of AD. It is also uncertain if depression affects the pathogenesis of AD. In this paper, we address these questions by measuring the serum levels of two common metabolic risk factors of AD and depression, inflammatory cytokines (IL 6 and TNF alpha) and serum 25-hydroxyvitamin D, in a case-control study. We measured the serum levels of IL 6, TNF α and 25-hydroxyvitamin D in age-matched healthy controls (n= 60) and in AD patients without depression (n=26) or AD patients with depression (n=34), and statistically analyzed the changes in these parameters among different groups under this study. Our results show that in AD there is a significant increase in IL 6 and TNF α and a marked decrease in 25-hydroxyvitamin D in the peripheral circulation compared to age-matched healthy controls. Furthermore, AD patients with depression have even significantly higher levels of IL 6 or TNF α and a lower level of 25-hydroxyvitamin D in circulation than in AD patients without depression. We also found a strong statistical correlation between the disease severity and the serum levels of IL 6, TNF α and 25-hydroxyvitamin D in AD patients with depression. These results suggest that altered circulating levels of common metabolic risk factors lead to the co-existence of depression with AD in many patients, and when they co-exist, the depression presumably affects the severity of AD presentations through more aggravated changes in these risk factors.

Ultrasound-guided Pecs block can provide perioperative analgesia for breast surgery. A single-injection technique (COMBIPECS) combines both Pecs 1 and Pecs 2 blocks in a single needle pass. This technique saves time and is equally effective as the modified Pecs block which uses 2 needle passes. We present a case series of 21 patients who received the COMBIPECS block as a part of multimodal analgesia for breast cancer surgery. The block was administered before the surgery after induction of general anesthesia. The patients needed minimal intraoperative analgesics and remained pain free in the postoperative period up to 24 hours after surgery.

Temporomandibular joint (TMJ) pain can be difficult to diagnose and treat. We describe a patient with left jaw pain after right hemimandibulectomy. The patient was initially managed conservatively, which failed to reduce pain. He was then administered inferior alveolar nerve block and TMJ injection with steroid and local anesthetic. These injections provided temporary pain relief that lasted approximately 1 month and the pain recurred. Computed tomography scan showed lateral displacement of left mandibular condyle. He was then given ultrasound-guided TMJ injection of steroid and local anesthetic. This injection provided lasting pain relief.

Background and aims Pecs block and its variations have become popular among anesthesiologists. While it provides perioperative analgesia, it also helps to reduce postoperative nausea vomiting (PONV) and other opioid related side effects. Earlier we had described a single injection technique of Pecs block, COMBIPECS. We present here a clinical study to assess the effectiveness of the block in breast cancer surgery. Methods We conducted an observer blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection, who were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, PONV and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively. Results Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, P Conclusions We chose a uniform surgical subset, implemented double blinding and provided PCA to all patients from post anesthesia care unit to 24 hours postoperatively. We concluded that COMBIPECS block is a valuable addition to general anesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

Purpose of review Studies from the 1990s and early 2000s documented the utility of dobutamine echocardiography for the prediction of functional recovery and prognosis with revascularization. The results of The Surgical Treatment of Ischemic Heart Failure (STICH) trial called into question the value of viability assessment using dobutamine echocardiography. The purpose of this review is to re-examine the literature on dobutamine echocardiography, put into context the STICH results, and provide insight into the current role of dobutamine echocardiography viability testing. Recent findings In contrast to the results of previous nonrandomized trials, the STICH trial showed that patients with viability defined by nuclear perfusion imaging or dobutamine echocardiography did not have improved survival with CABG compared with optimal medical therapy. Viability by dobutamine echocardiography was defined as the presence of contractile reserve in at least five segments with baseline dysfunction. The results of dobutamine echocardiography studies published before and after initiation of the STICH trial suggest that the definition of viability utilized in that trial may be suboptimal for assessment of improvement in global function and prognosis in patients undergoing revascularization. Assessment of global contractile reserve using wall motion score (WMS) or ejection fraction may be superior to utilization of a binary definition of viability confined to assessment of contractile reserve in a fixed number of segments because these indices provide information on both the magnitude and extent of contractile reserve of the entire left ventricle (LV). Summary Assessment of WMS or ejection fraction with dobutamine echocardiography may be the optimal means of evaluating the impact of viability on prognosis.Video abstract http://links.lww.com/HCO/A56.

Background At most institutions, internal medicine residents struggle with balancing clinical duties and learning opportunities, particularly during busy cardiology ward rotations. To improve learning experiences for residents, we helped develop a cardiology handbook app to supplement cardiology education. Objective The aim of this study was to report the development, implementation, and preliminary impact of the Krannert Cardiology Handbook app on graduate medical education. Methods In June 2017, 122 residents at Indiana University were invited to download the digital handbook in the Krannert app. The Krannert app featured a total of 13 chapters written by cardiology fellows and faculty at Indiana University. Residents were surveyed on their self-reported improvement in cardiology knowledge and level of satisfaction after using the Krannert app. Residents were also surveyed regarding their preference for a digital handbook app versus a paper handbook. Results Of the 122 residents, 38 trainees (31.1%) participated in survey evaluations. Among all respondents, 31 app users (82%) reported that the app helped improve their cardiology knowledge base. The app had an overall favorable response. Conclusions The Krannert app shows promise in augmenting clinical education in cardiology with mobile learning. Future work includes adding new topics, updating the content, and comparing the app to other learning modalities.

Key PointsQuestionCan poloxamer 188, an agent that is reported to reduce blood viscosity and cell-cell interactions, effectively reduce the duration of vaso-occlusive episodes (painful crises) in hospitalized patients with sickle cell disease? FindingsIn this randomized clinical trial that included 388 children and adults with sickle cell disease, treatment with poloxamer 188 vs placebo resulted in mean time to last dose of parenteral opioids during vaso-occlusive episodes of 81.8 vs 77.8 hours, a difference that was not statistically significant. MeaningAmong patients with sickle cell disease, poloxamer 188 did not significantly shorten the duration of painful vaso-occlusive episodes. ImportanceAlthough effective agents are available to prevent painful vaso-occlusive episodes of sickle cell disease (SCD), there are no disease-modifying therapies for ongoing painful vaso-occlusive episodes; treatment remains supportive. A previous phase 3 trial of poloxamer 188 reported shortened duration of painful vaso-occlusive episodes in SCD, particularly in children and participants treated with hydroxyurea. ObjectiveTo reassess the efficacy of poloxamer 188 for vaso-occlusive episodes. Design, Setting, and ParticipantsPhase 3, randomized, double-blind, placebo-controlled, multicenter, international trial conducted from May 2013 to February 2016 that included 66 hospitals in 12 countries and 60 cities; 388 individuals with SCD (hemoglobin SS, SC, S-beta(0) thalassemia, or S-beta(+) thalassemia disease) aged 4 to 65 years with acute moderate to severe pain typical of painful vaso-occlusive episodes requiring hospitalization were included. InterventionsA 1-hour 100-mg/kg loading dose of poloxamer 188 intravenously followed by a 12-hour to 48-hour 30-mg/kg/h continuous infusion (n=194) or placebo (n=194). Main Outcomes and MeasuresTime in hours from randomization to the last dose of parenteral opioids among all participants and among those younger than 16 years as a separate subgroup. ResultsOf 437 participants assessed for eligibility, 388 were randomized (mean age, 15.2 years; 176 [45.4%] female), the primary outcome was available for 384 (99.0%), 15-day follow-up contacts were available for 357 (92.0%), and 30-day follow-up contacts were available for 368 (94.8%). There was no significant difference between the groups for the mean time to last dose of parenteral opioids (81.8 h for the poloxamer 188 group vs 77.8 h for the placebo group; difference, 4.0 h [95% CI, -7.8 to 15.7]; geometric mean ratio, 1.2 [95% CI, 1.0-1.5]; P=.09). Based on a significant interaction of age and treatment (P=.01), there was a treatment difference in time from randomization to last administration of parenteral opioids for participants younger than 16 years (88.7 h in the poloxamer 188 group vs 71.9 h in the placebo group; difference, 16.8 h [95% CI, 1.7-32.0]; geometric mean ratio, 1.4 [95% CI, 1.1-1.8]; P=.008). Adverse events that were more common in the poloxamer 188 group than the placebo group included hyperbilirubinemia (12.7% vs 5.2%); those more common in the placebo group included hypoxia (12.0% vs 5.3%). Conclusions and RelevanceAmong children and adults with SCD, poloxamer 188 did not significantly shorten time to last dose of parenteral opioids during vaso-occlusive episodes. These findings do not support the use of poloxamer 188 for vaso-occlusive episodes. Trial RegistrationClinicalTrials.gov Identifier: NCT01737814 This phase 3 trial examines the effectiveness of poloxamer 188 in reducing the duration of painful vaso-occlusive episodes in children and adults with sickle cell disease compared with placebo.

Background: Aim of the study was to assess the clinicopathological profile and outcome of COVID 19 infection in children and newborn in a dedicated COVID tertiary care center.Methods: A retrospective study of a cohort of 105 children (1 month-12 years.) and 128 newborns admitted from 7th July to 7th August 2020. All the admitted children were COVID 19 positive and newborns were delivered from mother with COVID positive status. We collected data from medical records regarding epidemiology, clinical features, comorbidities, investigational report, treatment and outcome of the study population.Results: The median age of 105 children was 3 years with IQR (11 months-6 years) with almost equal sex distribution with higher disease prevalence and severity in younger age group. The mean duration of stay is 10.11 days (SD: 4.93). 35 (33.3%) children were asymptomatic, whereas 53 (50.5%) mildly symptomatic, 8 (7.6%) moderate disease severity, 9 (8.6%) critically ill at time of admission. Fever (57%) and Cough (23.8%) commonest symptoms. Hyper inflammatory syndrome was a new challenge in COVID affected children as well as concomitant infections like Dengue, Scrub and enteric fever, 38 (56%) children had comorbidities and 14 (13.3%) required PICU admission with 4 (3.8%) children. 42 out of 128 neonates became positive being born from 128 COVID positive mother and the rate of longitudinal transmission was more in outborn babies. None of the newborns tested swab positive within 48hrs of life and the preterm and LBW babies were relatively less infected. Most of the neonates were asymptomatic (84%) and we recorded zero death among COVID positive newborn.Conclusions: In the absence of comorbidities and concurrent infections, COVID 19 is relatively benign in Indian children.