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Background Psychiatric factors such as depression, anxiety, and life stressors have been shown to negatively affect diabetes self-management and A1C in children and adolescents. However, less is known about how trauma exposure and symptoms of post-traumatic stress disorder (PTSD) may affect type 1 diabetes. Objectives To determine the rates of trauma exposure and PTSD symptoms in patients aged 7–21 years with type 1 diabetes and to examine the relationships among trauma exposure, PTSD, anxiety, depression, and diabetes self-management. Methods Patients underwent standardized psychiatric screening questionnaires during clinic visits. A1C at goal was defined as Results Of the participants, 38.4% (n = 99, mean age 13.8 ± 3.5 years, 51.5% female) had trauma symptoms and functional impairment concerning for PTSD. Rates of trauma secondary to accidental injury, medical traumatic stress, natural disaster, and witness to family violence were 28.3, 22.2, 10.1, and 6.1%, respectively. Neither PTSD nor anxiety nor depression symptoms were associated with behavioral nonadherence (P = 0.546, P = 0.337, and P = 0.697, respectively), but the subscales for significant school avoidance and generalized anxiety disorders were associated with behavioral nonadherence (P = 0.023 and P = 0.032, respectively). Those who reported suicidal ideation had higher mean A1C than those who did not (A1C 8.9 vs. 8.3, P = 0.047). Conclusion Although trauma was common among youth with type 1 diabetes, neither trauma nor PTSD was associated with changes to self-management. However, certain forms of anxiety and suicidal ideation were associated with poor self-management and higher A1C, respectively.

Pyrexia or fever of unknown origin is defined as prolonged fever in an immunocompetent patient that has an unknown cause despite standard investigations. Infections, non-infectious inflammatory diseases, malignancy and other diseases can all cause pyrexia of unknown origin. The diagnostic work-up is based on the identification of potential diagnostic clues, and further investigation is based on the differential diagnosis of these clues. When diagnostic clues are absent, 18F-FDG-PET-CT is the single test with the highest contributory value, aiding final diagnosis in half of all patients. In Western Europe, up to 50% of patients remain without a diagnosis despite extensive investigation. Mortality is low in undiagnosed cases, and spontaneous resolution of fever is relatively common.

Diagnosis of interstitial lung disease (ILD) requires a multidisciplinary discussion approach that includes clinicians, radiologists, and pathologists. Surgical lung biopsy (SLB) is currently the recommended standard in obtaining pathologic specimens for patients with ILD requiring a tissue diagnosis. The increased diagnostic confidence and accuracy provided by microscopic pathology assessment of SLB specimens must be balanced with the associated risks in patients with ILD. This document was developed by the SLB Working Group of the Pulmonary Fibrosis Foundation, composed of a multidisciplinary group of ILD physicians, including pulmonologists, radiologists, pathologists, and thoracic surgeons. In this document, we present an up-to-date literature review of the indications, contraindications, risks, and alternatives to SLB in the diagnosis of fibrotic ILD; outline an integrated approach to the decision-making around SLB in the diagnosis of fibrotic ILD; and provide practical information to maximize the yield and safety of SLB.

Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

Financial literacy has been identified as an important functional area that attains a special concern in the Indian government policies and plans specially designed for the financial market. SEBI has issued various guidelines and awareness programs towards investment financial products, digital payment systems, consumer protection and so on. Therefore, the purpose of the present article is to analyze the level of financial literacy among youngsters in India. The study examined the relationship between the antecedents of financial literacy, that is, financial attitude, financial knowledge and financial behavior. The theoretical purposed model was tested with the help of primary data that was collected with the help of the self-structured questionnaire. A total of 647 responses were obtained from the respondents belonging to the holy city Mathura, Uttar Pradesh, India. To identify the financial literacy antecedents and their inter-relationship, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modeling were applied to the collected data. The findings indicated that in the case of the Indian population, financial attitude and financial behavior were significantly associated with financial literacy. The moderation analysis reveals that males are more particular about financial knowledge and financial behavior in comparison to females. Respondents belonging to the age group of 26–30 years have better financial knowledge. Respondents who have income more than ₹800 thousand and below two years have more financial knowledge. This article contributes to the theoretical body of knowledge by providing insights about the interesting topic of financial literacy by identifying its antecedents. The study also highlights the impact of the demographic variables as moderators on the antecedents of financial literacy. The outcomes of the study are vital for the government in the designing of public policies. The findings are helpful for the educational program designers for the outlining of the programs and syllabus for the subjects taught in the schools and colleges. The findings are useful for the bank managers to understand the psychological behavior as well as demographic variables for the effective marketing and communication of their financial products.

Purpose: To determine the effect of previous renal stone surgery on result and complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: Total 300 patients were enrolled in the study. We enrolled 100 surgery-naive cases (those with no history of any renal surgery) as control and labeled them as Group A. Group B comprised 100 cases who had PCNL in the past. Group C constituted 100 patients who had open renal stone surgery in the past. Stones were classified using Guy's stone score. PCNL was performed by standard technique in prone position and technical features encountered during operation and outcomes were compared between groups. Complications were graded using modified Clavien grading system. Results: There were no differences between the three groups in age, gender, body mass index, stone burden, and stone opacity. Multiple calyceal stones and distorted pelvicalyceal system anatomy were more in Group C, but stone score showed no statistically significant difference from other groups. The mean operative time (68.91 ± 21.27 min) and fluoroscopy time (264.40 ± 74.90 s) were longer in Group C, but there was no statistically significant difference between the groups. Multiple access was significantly more common in Group C compared to the other two groups (P < 0.001). Access location too did not show any statistically significant difference between the groups. Postoperative complications were more in previous stone surgery patients, but did not show statistically significant difference. Conclusion: PCNL is a safe and effective treatment modality for patients with renal stones regardless of history of previous PCNL or open renal surgery.

Azadirachta indica Linn (A. indica), is a marvelous traditional Indian medicine with a key therapeutics role in health management. Studies have revealed the anti-inflammatory, immunomodulatory and antioxidative role of A. indica. Inflammatory immune cells generate high level of ROS for stimulated severe AHR and airway inflammation. Therefore, the present study is designed to investigate the ameliorating potentiality of the leaves extract of A. indica in the OVA-induced lung injury, airway inflammation and oxidative stress. BALB/c mice were sensitized with ovalbumin (OVA) to induce asthma symptoms and prednisolone was used as a standard drug for treatment. The animals were divided into six groups: Group I: Untreated control mice, Group II: Ova-induced asthmatic mice, Group III: Prednisolone treated ova-induced asthmatic mice, Group IV: Vehicle treated ova-induced asthmatic mice, Group V: A. indica (100mg/kgBW/day) treated ova-induced asthmatic mice, Group VI: A. indica (200mg/kgBW/day) treated ova-induced asthmatic mice. Mice were sacrificed by cervical dislocation 24 hrs after the last challenge. Further, broncheoalveolar lavage fluid (BALF), serum and lungs were collected to study the cell count, activity of EPO, ROS generation, antioxidative enzyme activities, and histology of lungs. The results expressed bronchoconstriction in the lungs of asthmatic group marked by elevated total and differential cell count. Further, the antioxidant enzyme activities were also altered with enhanced ROS production. The alterations observed in the asthmatic mice were significantly ameliorated following treatment with A. indica leaf extract as compared to the standard drug, prednisolone treated mice and control group. The findings suggest therapeutic potentiality of A. indica for ameliorating asthma symptoms in the future.

Objective Interstitial lung disease (ILD) is a major cause of morbidity and mortality in connective tissue diseases (CTDs). We aimed to assess the effect of rituximab ± mycophenolate mofetil (MMF) compared with MMF on pulmonary function and prednisone dosage in patients with CTD-related ILD (CTD-ILD). Methods This retrospective study included 83 patients from Stanford and Centre Hospitalier de l'Universite de Montreal. Fifteen patients received rituximab ± MMF (rituximab group), and 68 patients received MMF only (control group). Results Median ILD duration at the start of treatment was longer in the rituximab group at 47 months (range: 4-170) versus 6.5 months (range: 0-164) in controls. Forced vital capacity (FVC) decreased by 3.0% (range: 11%-21%) after treatment in the rituximab group, whereas it increased by 2.0% (range: 14%-25%) in the control group (p = 0.025). Diffusing capacity of carbon monoxide (DLCO) decreased by 3.0% (range: 10%-12%) after treatment in the rituximab group, whereas it increased by 4.5% (range: 30%-36%) in the control group (p = 0.046). Mixed model analysis controlling for ILD duration, baseline DLCO, systemic sclerosis, pulmonary hypertension, and prednisone use showed no significant difference in FVC or DLCO between groups at 6 months or 1 year. The average daily prednisone dose score decreased after treatment in the rituximab group, whereas it remained unchanged in the control group (p = 0.017). Conclusion Rituximab ± MMF did not significantly change pulmonary function compared with MMF alone, but it did result in a relative decrease in average daily prednisone dose in a population with recalcitrant CTD-ILD.

Objective Giant parathyroid adenomas (GPAs) are a rare type of parathyroid adenoma (PA) weighing >2 to 3 g. The objective of this manuscript is to report a case of giant parathyroid adenoma and highlight the risk of postoperative hypocalcemia. Methods We describe the presentation and work-up of a woman with GPA confirmed with histopathology as well as management of postoperative hypocalcemia. Results A 66-year-old Caucasian female with chronic fatigue was found to have elevated calcium levels at 13.7 mg/dL (normal, 8.9 to 10.2 mg/dL) and elevated parathyroid hormone levels at 1,240 pg/mL (normal, 12 to 72 pg/mL). Contrast enhanced computed tomography scan of the neck showed a 5.6 cm heterogeneous mass posterior to the right thyroid. The patient underwent right parathyroidectomy and histopathology confirmed the diagnosis of a giant parathyroid adenoma (GPA) weighing 28.7 g. Postoperatively, the patient developed hypocalcemia secondary to hungry bone syndrome and was treated aggressively with intravenous calcium supplementation. At 4 weeks postoperatively, she had normal calcium levels without any calcium supplementation. Conclusion GPAs are a rare variant of PA, and could be a distinct clinical entity with features different from both PA and parathyroid carcinoma. We further postulate that the risk of postoperative hypocalcemia secondary to hungry bone syndrome could be higher among patients with GPA compared to patients with PA. These hypotheses needs to be validated with further studies. Abbreviations CT computed tomography GPA giant parathyroid adenoma HBS hungry bone syndrome PA parathyroid adenoma PTH parathyroid hormone

The paper confers the use of phytochemicals in resisting of several diseases caused by different microbes/pathogen. In the current scenario, there is a high demand for proven plant therapies, herbal drugs, and other natural products, as well as their therapeutic application, which are often found to be more effective than synthetic pharmaceuticals in chronic diseases. In many cases, plant extracts, herbal formulations, and phytochemicals perfectly supplement the typical therapy and at the same time do not cause side effects for example skin irritation, gastrointestinal problems. It is an urgent demand to find out complete therapeutic potential and adverse effects, of these phytochemical compounds because of the continued rise of drug‐resistant bacterial infections.

The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury.

Background Limited data are available on the association between clinically measured disease severity markers and quality of life (QOL) in idiopathic pulmonary fibrosis (IPF). The study examined the associations between objective disease severity metrics and QOL in a contemporary IPF population. Methods This study evaluated baseline data from patients enrolled in the multicenter, US-based Idiopathic Pulmonary Fibrosis Prospective Outcomes Registry between June 2014 and July 2018. Disease severity metrics included FVC % predicted, diffusing capacity for carbon monoxide (Dlco) % predicted, supplemental oxygen use with activity, supplemental oxygen use at rest, and two summary scores (the Gender-Age-Lung Physiology index, based on gender, age, and % predicted values for Dlco and FVC; and the Composite Physiologic Index, based on % predicted values for Dlco, FVC, and FEV1). Multivariable adjusted regression models were used to examine cross-sectional associations between each severity measure and St. George's Respiratory Questionnaire (SGRQ) total score. Results Among 829 patients with complete SGRQ data, the median (interquartile range) SGRQ score at enrollment was 40 (26-53), with higher scores indicating worse QOL. Modest SGRQ impairments were observed with increasing Gender-Age-Lung Physiology score (2.9 [1.8-4.0] per 1-point increase] and with increasing Composite Physiologic Index scores (3.0 [2.4-3.6] per 5-point increase). Substantial SGRQ impairments were observed for oxygen use with activity (15.6 [12.9-18.2]), oxygen use at rest (16.2 [13.0-19.4]), and decreasing Dlco (5.0 [4.0-6.1] per 10% decrease in % predicted). Conclusions Objective measures of disease severity, including severity scores, physiologic parameters, and supplemental oxygen use, are associated with worse QOL in patients with IPF. Trial Registry ClinicalTrials.gov; No.: NCT01915511; URL: www.clinicaltrials.gov.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is considered a preinvasive lesion that may progress to carcinoid tumour [1]. Histologically, it is marked by a proliferation of neuroendocrine cells that is confined to the basement membrane (neuroendocrine cell hyperplasia; NECH), and/or has invaded past the basement membrane (carcinoid tumourlet) [2]. Tumourlets equal to or larger than 5 mm are classified as carcinoid tumours. Per the World Health Organization 2021 criteria, DIPNECH can be pathological (based solely on characteristic histological features) or clinical (diagnosed per characteristic symptoms and imaging findings, e.g. respiratory symptoms, bilateral pulmonary nodules, mosaic attenuation on computed tomography (CT)) [2]. In contrast to some lung diseases or neoplasms that can cause secondary, reactive NECH/tumourlets to form, DIPNECH is marked by such hyperplasia without an identifiable cause., DIPNECH is a rare disease that is often misdiagnosed. In this study, it primarily affected elderly white women who were non-smokers. Lung nodules could slowly progress over years to carcinoid tumours. Average growth rate per nodule was 0.8 mm per year. https://bit.ly/3q1HD1k

After emerging in China in late 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread worldwide, and as of mid-2021, it remains a significant threat globally. Only a few coronaviruses are known to infect humans, and only two cause infections similar in severity to SARS-CoV-2: Severe acute respiratory syndrome-related coronavirus, a species closely related to SARS-CoV-2 that emerged in 2002, and Middle East respiratory syndrome-related coronavirus, which emerged in 2012. Unlike the current pandemic, previous epidemics were controlled rapidly through public health measures, but the body of research investigating severe acute respiratory syndrome and Middle East respiratory syndrome has proven valuable for identifying approaches to treating and preventing novel coronavirus disease 2019 (COVID-19). Building on this research, the medical and scientific communities have responded rapidly to the COVID-19 crisis and identified many candidate therapeutics. The approaches used to identify candidates fall into four main categories: adaptation of clinical approaches to diseases with related pathologies, adaptation based on virological properties, adaptation based on host response, and data-driven identification (ID) of candidates based on physical properties or on pharmacological compendia. To date, a small number of therapeutics have already been authorized by regulatory agencies such as the Food and Drug Administration (FDA), while most remain under investigation. The scale of the COVID-19 crisis offers a rare opportunity to collect data on the effects of candidate therapeutics. This information provides insight not only into the management of coronavirus diseases but also into the relative success of different approaches to identifying candidate therapeutics against an emerging disease. IMPORTANCE The COVID-19 pandemic is a rapidly evolving crisis. With the worldwide scientific community shifting focus onto the SARS-CoV-2 virus and COVID-19, a large number of possible pharmaceutical approaches for treatment and prevention have been proposed. What was known about each of these potential interventions evolved rapidly throughout 2020 and 2021. This fast-paced area of research provides important insight into how the ongoing pandemic can be managed and also demonstrates the power of interdisciplinary collaboration to rapidly understand a virus and match its characteristics with existing or novel pharmaceuticals. As illustrated by the continued threat of viral epidemics during the current millennium, a rapid and strategic response to emerging viral threats can save lives. In this review, we explore how different modes of identifying candidate therapeutics have borne out during COVID-19.

Patient: Female, 74-year-old Final Diagnosis: ACTH-dependent Cushing’s syndrome • ectopic ACTH syndrome Symptoms: Edema • general fatigue • recurrent mechanical fall Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Endocrinology and Metabolic • Family Medicine • General and Internal Medicine • Nephrology • Oncology Objective: Unusual clinical course Background: Adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (CS) secondary to an ectopic source is an uncommon condition, accounting for 4–5% of all cases of CS. Refractory hypokalemia can be the presenting feature in patients with ectopic ACTH syndrome (EAS), and is seen in up to 80% of cases. EAS can be rapidly progressive and life-threatening without timely diagnosis and intervention. Case Report: We present a case of a 74-year-old White woman who first presented with hypokalemia, refractory to treatment with potassium supplementation and spironolactone. She progressively developed generalized weakness, recurrent falls, bleeding peptic ulcer disease, worsening congestive heart failure, and osteoporotic fracture. A laboratory workup showed hypokalemia, hypernatremia, and primary metabolic alkalosis with respiratory acidosis. Hormonal evaluation showed elevated ACTH, DHEA-S, 24-h urinary free cortisol, and unsuppressed cortisol following an 8 mg dexamethasone suppression test, suggestive of ACTH-dependent CS. CT chest, abdomen, and pelvis, and FDG/PET CT scan showed a 1.4 cm right lung nodule and bilateral adrenal enlargement, confirming the diagnosis of EAS, with a 1.4-cm lung nodule being the likely source of ectopic ACTH secretion. Due to the patient’s advanced age, comorbid conditions, and inability to attend to further evaluation and treatment, her family decided to pursue palliative and hospice care. Conclusions: This case illustrates that EAS is a challenging condition and requires a multidisciplinary approach in diagnosis and management, which can be very difficult in resource-limited areas. In addition, a delay in diagnosis and management often results in rapid deterioration of clinical status.

Endocrine disorders are known to involve all organ systems of the body, including the skin. The cutaneous manifestations of endocrine disorders can range from common findings such as acanthosis nigricans, pretibial myxedema, acne, hirsutism, hyper or hypopigmentation to rare cutaneous findings such as miliaria rubra, calciphylaxis, lentigines, and calcinosis cutis. These cutaneous symptoms can sometimes be the presenting symptoms or can even be pathognomonic of the underlying endocrine condition. In some cases, the cutaneous symptoms from an underlying endocrine abnormality may be the most prominent. These symptoms can significantly affect the quality of life of individuals. Often, individuals may seek health care from a dermatologist or primary care physician for isolated skin symptoms. Therefore, it is imperative for physicians to recognize the skin symptoms as the manifestation of the endocrine disorder for prompt diagnosis and treatment of the underlying endocrine disorder.

Background Hospitalizations are common among patients with idiopathic pulmonary fibrosis (IPF). We investigated the impact of hospitalizations on outcomes in patients with IPF. Methods The IPF-PRO Registry is an observational US registry that enrolled patients with IPF that was diagnosed or confirmed at the enrolling center in the previous 6 months. Associations between patient characteristics and hospitalization, and between hospitalization and mortality, were analyzed using Cox regression models. Results A total of 1002 patients with IPF were enrolled into the IPF-PRO Registry. Over a median follow-up time of 23.7 months (maximum: 67.0 months), 568 patients (56.7%) had at least one hospitalization. Of these patients, 319 (56.2%) had at least one respiratory-related hospitalization and 120 (21.1%) had at least one hospitalization with ventilatory support. Younger age (HR 0.68 [95% CI 0.55, 0.84] per 5-year increase for patients Conclusions Data from the IPF-PRO Registry demonstrate that hospitalizations are common among patients with IPF. The risk of mortality during hospitalization or within 90 days of discharge was high, particularly among patients who were hospitalized for a respiratory cause or received ventilatory support. Trial registration ClinicalTrials.gov, NCT01915511. Registered 5 August 2013, https://clinicaltrials.gov/ct2/show/NCT01915511

AimContinuous glucose monitoring (CGM) derived times in range (TIR) correlates with hemoglobin A1c (A1c) among patients with type 2 diabetes mellitus (T2DM); however, there is a paucity of data evaluating its association with microvascular complications. We conducted this systematic review to examine the association between TIR and microvascular complications of diabetic retinopathy (DR), diabetic nephropathy (DN) and peripheral diabetic neuropathy (DPN).MethodWe conducted a comprehensive literature search on online database of PubMed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full texts original articles that evaluated association between CGM-derived TIR and risk of microvascular complications which were published between 2010 and June 2021, were included in our systematic review. The quality of included studies were evaluated using National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using qualitative synthesis.ResultEleven studies were included in the systematic review. The mean sample size, baseline A1c, and diabetes duration were 1271 (105-5901), 8.2 % (SD 0.5 %) and 11.3 years, respectively. Majority of studies were conducted in Asia (10 out 11). Four studies evaluated the relationship between CGM-derived TIR and DR and CGM-derived TIR and DN, while seven studies evaluated the relationship between CGM-derived TIR and DPN. A 10 % increase in TIR was associated with a reduction in albuminuria, severity of diabetic retinopathy, and prevalence of diabetic peripheral nephropathy and cardiac autonomic neuropathy. In addition, an association was observed between urinary albumin-to-creatinine ratio but not with estimated glomerular filtration rate.ConclusionThis review summarizes recent evidence supporting an association between CGM-derived TIR and microvascular complications among patients with T2DM. A larger□scale multi-center investigation that includes more diverse participants is warranted to further validate the utility of TIR as a predictor for diabetic microvascular complications.

The molecular mechanisms of olfaction, or the sense of smell, are relatively underexplored compared with other sensory systems, primarily because of its underlying molecular complexity and the limited availability of dedicated predictive computational tools. Odorant receptors (ORs) allow the detection and discrimination of a myriad of odorant molecules and therefore mediate the first step of the olfactory signaling cascade. To date, odorant (or agonist) information for the majority of these receptors is still unknown, limiting our understanding of their functional relevance in odor-induced behavioral responses. In this study, we introduce OdoriFy, a Web server featuring powerful deep neural network–based prediction engines. OdoriFy enables (1) identification of odorant molecules for wildtype or mutant human ORs (Odor Finder); (2) classification of user-provided chemicals as odorants/nonodorants (Odorant Predictor); (3) identification of responsive ORs for a query odorant (OR Finder); and (4) interaction validation using Odorant–OR Pair Analysis. In addition, OdoriFy provides the rationale behind every prediction it makes by leveraging explainable artificial intelligence. This module highlights the basis of the prediction of odorants/nonodorants at atomic resolution and for the ORs at amino acid levels. A key distinguishing feature of OdoriFy is that it is built on a comprehensive repertoire of manually curated information of human ORs with their known agonists and nonagonists, making it a highly interactive and resource-enriched Web server. Moreover, comparative analysis of OdoriFy predictions with an alternative structure-based ligand interaction method revealed comparable results. OdoriFy is available freely as a web service at https://odorify.ahujalab.iiitd.edu.in/olfy/.

Summary Oncogenic osteomalacia secondary to glomus tumor is extremely rare. Localization of causative tumors is critical as surgical resection can lead to a complete biochemical and clinical cure. We present a case of oncogenic osteomalacia treated with resection of glomus tumor. A 39-year-old woman with a history of chronic sinusitis presented with chronic body ache and muscle weakness. Biochemical evaluation revealed elevated alkaline phosphatase hypophosphatemia, increased urinary phosphate excretion, low calcitriol, and FGF23 was unsuppressed suggestive of oncogenic osteomalacia. Diagnostic studies showed increase uptake in multiple bones. Localization with MRI of paranasal sinuses revealed a sinonasal mass with concurrent uptake in the same area on the octreotide scan. Surgical resection of the sinonasal mass was consistent with the glomus tumor. The patient improved both clinically and biochemically postoperatively. Along with the case of oncogenic osteomalacia secondary to a glomus tumor, we have also discussed in detail the recent development in the diagnosis and management of oncogenic osteomalacia. Learning points Tumor-induced osteomalacia is a rare cause of osteomalacia caused by the secretion of FGF23 from mesenchymal tumors. Mesenchymal tumors causing TIO are often difficult to localize and treat. Resection of the tumor can result in complete resolution of biochemical and clinical manifestations in a very short span of time. Glomus tumor can lead to tumor induced osteomalacia and should be surgically treated.

Context. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description. A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions. Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.

Background Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease for which diagnosis and management remain challenging. Defining the circulating proteome in IPF may identify targets for biomarker development. We sought to quantify the circulating proteome in IPF, determine differential protein expression between subjects with IPF and controls, and examine relationships between protein expression and markers of disease severity. Methods This study involved 300 patients with IPF from the IPF-PRO Registry and 100 participants without known lung disease. Plasma collected at enrolment was analysed using aptamer-based proteomics (1305 proteins). Linear regression was used to determine differential protein expression between participants with IPF and controls and associations between protein expression and disease severity measures (percent predicted values for forced vital capacity [FVC] and diffusion capacity of the lung for carbon monoxide [DLco]; composite physiologic index [CPI]). Multivariable models were fit to select proteins that best distinguished IPF from controls. Results Five hundred fifty one proteins had significantly different levels between IPF and controls, of which 47 showed a |log2(fold-change)| > 0.585 (i.e. > 1.5-fold difference). Among the proteins with the greatest difference in levels in patients with IPF versus controls were the glycoproteins thrombospondin 1 and von Willebrand factor and immune-related proteins C-C motif chemokine ligand 17 and bactericidal permeability-increasing protein. Multivariable classification modelling identified nine proteins that, when considered together, distinguished IPF versus control status with high accuracy (area under receiver operating curve = 0.99). Among participants with IPF, 14 proteins were significantly associated with FVC % predicted, 23 with DLco % predicted, 14 with CPI. Four proteins (roundabout homolog-2, spondin-1, polymeric immunoglobulin receptor, intercellular adhesion molecule 5) demonstrated the expected relationship across all three disease severity measures. When considered in pathways analyses, proteins associated with the presence or severity of IPF were enriched in pathways involved in platelet and haemostatic responses, vascular or platelet derived growth factor signalling, immune activation, and extracellular matrix organisation. Conclusions Patients with IPF have a distinct circulating proteome and can be distinguished using a nine-protein profile. Several proteins strongly associate with disease severity. The proteins identified may represent biomarker candidates and implicate pathways for further investigation. Trial registration ClinicalTrials.gov (NCT01915511).

Design and development of a novel 22 kW th hot water generation system comprising a biomass-gasification unit in the core and an integrated fire-tube water heat exchanger in the annulus is reported. Producer gas from the gasifier is combusted in a burner and the resulting hot flue gases are routed back through the helical tube to heat the water contained within the annular shell. This allows recovery of the thermal energy typically lost from the outer surface of a conventional gasification system. The simple design improvisation leads to a doubling of the overall efficiency ( ≈ 48 % ) compared to a standard system with physically separated gasifier and heat exchanger units ( ≈ 24 % ). The developed system holds promise in domestic and industrial water heating applications. Overall, this integrated design presents an efficient and environment-friendly waste-to-value concept and proposes a meaningful use of the underutilized 36 EJ/annum potential of biomass from crop residue globally.

The main aim of the study is to find the effect of the financial advertisement on the respondent’s information selection, processing and analysing it while making the financial purchase decisions. The study identified the important factors that affect the investment decision-making process and explored them by using the exploratory factor analysis. The conceptual model has been tested using the AMOS SEM software. The factor analysis identified the four important factors that are affecting the financial decision-making, that is, financial literacy, celebrity endorsement, perceived reality and entertainment. The hypothesis testing reveals that advertisement, perceived reality and entertainment are affecting the information processing and financial decision-making process, whereas financial literacy and celebrity endorsement do not have significant effects on the financial product purchase. The results are useful for the advertisers, policy makers and the financial service providers so as to increase the sale of financial products by focusing on the variables extracted by the research.

Background Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a variable clinical course and high mortality. We used data from a large national US registry of patients with IPF to investigate relationships between patient characteristics, including markers of disease severity, and mortality. Methods The analysis cohort comprised patients enrolled in the IPF-PRO Registry from its inception on 5 June 2014 to 26 October 2017. The primary criterion for inclusion in this registry is that patients must be diagnosed or confirmed with IPF at the enrolling centre within 6 months. Associations between patient characteristics and markers of disease severity at enrolment and mortality outcomes were investigated using univariable, multivariable and adjustment models. Results Among 662 patients enrolled, 111 patients died or had a lung transplant over a follow-up period of 30 months. The probability of being free of both events at month 30 was 50.6% (95% CI: 40.0, 60.2). When patient characteristics and markers of disease severity were jointly examined in a multivariable analysis, oxygen use at rest (hazard ratio [HR] 2.44 [95% CI: 1.45, 4.10]), lower forced vital capacity (FVC) % predicted (HR 1.28 [95% CI: 1.10, 1.49] per 10% decrease) and diffusion capacity for carbon monoxide (DLco) % predicted (HR 1.25 [95% CI: 1.04, 1.51] per 10% decrease) were significantly associated with increased risk of death or lung transplant. The risk of death or lung transplant increased with increasing age in patients ≥62 years old (HR 1.18 [95% CI: 0.99, 1.40] per 5-year increase), and decreased with increasing age in patients

Congestive heart failure (CHF) is a cardiac abnormality in which heart is not able to pump sufficient blood to meet the requirement of all the parts of the body. This study aims to diagnose the CHF accurately using heart rate variability (HRV) signals. The HRV signals are non-stationary and nonlinear in nature. We have used eigenvalue decomposition of Hankel matrix (EVDHM) method to analyze the HRV signals. The lowest frequency component (LFC) and the highest frequency component (HFC) are extracted from the eigenvalue decomposed components of HRV signals. After that, the mean and standard deviation in time domain, mean frequency calculated from Fourier-Bessel series expansion, k-nearest neighbor (k-NN) entropy, and correntropy features are evaluated from the decomposed components. The ranked features based on t-value are fed to least-squares support vector machine (LS-SVM) classifier with radial basis function (RBF) kernel for automated diagnosis of CHF HRV signals. The study is performed on three normal datasets and two CHF datasets. Our proposed system has yielded an accuracy of 93.33%, sensitivity of 91.41%, and specificity of 94.90% using 500 HRV samples. The automated toolkit can aid cardiac physicians in the accurate diagnosis of CHF patients to confirm their findings with our system. Hence, it will help to provide timely treatment for CHF patients and save life.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes the coronavirus disease 2019 (COVID-19). This highly transmissible and pathogenic virus has caused a significant threat to health care workers (HCW) as well as human health and public safety. Several studies have shown the value and effectiveness of messenger ribonucleic acid (mRNA) vaccines (mRNA) protecting HCWs from symptomatic or asymptomatic SARS-CoV-2 infections. New research is needed to demonstrate the effectiveness of vaccines where the follow-up periods are more extended than prior research. This study uses a "real-world" cohort of HCWs and provides insight into the effectiveness of the mRNA vaccines against HCWs with symptomatic SARS-CoV-2 infection. Symptomatic SARS-CoV-2 infection occurred in 5 fully vaccinated HCWs and 124 unvaccinated HCWs (incidence rate, 4.14 vs. 95.53 per 100 000 person-days, respectively, incidence risk ratio (IRR), 0.0433 [95% CI, 0.018-0.1]). Receipt of the authorized mRNA vaccines was associated with a significantly lower incidence of symptomatic SARS-CoV-2 infection for a median follow-up of 139 days. Ways to enhance complete vaccination and, subsequently, optimal immunity is required to lift masking restrictions in the health care settings.

Summary Hypothyroidism is a common medical condition and is often easily managed with excellent outcomes, when treated adequately. Compliance with levothyroxine (LT4) therapy is often compromised because of the need for a daily and lasting schedule. Overt rhabdomyolysis due to under-treatment or non-compliance is a rare occurrence. We report a case of rhabdomyolysis leading to acute kidney injury (AKI) on chronic kidney disease (CKD) requiring hemodialysis (HD) in a 68-year-old Caucasian male due to non-compliance with levothyroxine (LT4) therapy. Our patient 'ran out of levothyroxine' for approximately 4 weeks and developed gradually progressive muscle pain. The diagnosis of severe AKI due to rhabdomyolysis was made based on oliguria, elevated creatinine kinase (CK), and renal failure. Resuming the home dose of LT4 failed to correct CK levels, and there was a progressive decline in renal function. Although increasing doses of LT4 and three cycles of HD improved CK levels, they remained above baseline at the time of discharge. The patient recovered gradually and required HD for 4 weeks. CK levels normalized at 6 weeks. Through this case report, we highlight that non-compliance with LT4 therapy can lead to life-threatening complications such as renal failure and hence the need to educate patients on the significance of compliance with LT4 therapy should be addressed. Learning points Non-compliance to levothyroxine therapy is common and can lead to serious complications, including rhabdomyolysis. Rhabdomyolysis is an uncommon presentation of hypothyroidism and severe rhabdomyolysis can result in renal failure requiring hemodialysis. Rhabdomyolysis associated with hypothyroidism can be further exacerbated by concomitant use of statins.

Context Finding the source of adrenocorticotropic hormone (ACTH)-independent cortisol-producing adenoma in the patients with subclinical Cushing syndrome (SCS) and bilateral adrenal nodules is sometimes challenging. Computed tomography (CT) and positron emission tomography are helpful, but adrenal venous sampling (AVS) is the gold standard approach. However, interpretation of AVS is important to improve the accuracy of decision-making for surgery. We report a case and review of the literature to assess the benefit of using adrenal vein cortisol to metanephrine ratio to determine the source of cortisol production in SCS and bilateral nodules. Evidence Acquisition Three authors searched PubMed for data on patients with SCS who had AVS procedure and measurements of cortisol and catecholamines. Case Description A 51-year-old woman with SCS and hypertension crisis presented to our clinic. Paraclinical investigations revealed that she had an ACTH-independent cortisol-producing adenoma and her CT scan showed bilateral adrenal nodules. After AVS, cortisol (high to low) lateralization ratio could not determine the source of cortisol production but the cortisol to metanephrine ratio localized the source to the left side, which included the larger nodule according to CT measurements. Left adrenalectomy led to clinical and paraclinical improvement. Conclusion There is a possibility of co-secretion of other steroids accompanied with cortisol in the setting of ACTH-independent SCS. Moreover, cortisol measurement alone and interpretation of AVS results based on cortisol values may not help lateralizing the source of cortisol production with bilateral adrenal nodules. Therefore, we suggest applying cortisol to metanephrine ratio with the same gradient (gradient > 2.3, highest to lowest concentration) when the source of cortisol production cannot be determined by cortisol lateralization ratio.

Objective: American College of Graduate Medical Education (ACGME) recommends ongoing care of 10 patients per resident however its implication is unclear. We hypothesized EMR quality to vary based on patient load and call status. Methods: We conducted a double-blind, single-center, retrospective observational study between 2017 and 2019 to investigate the quality and accuracy of resident documentation using the Responsible Electronic Documentation (RED) Checklist, a validated scoring system. Results: A total of 234 independent charts were analyzed and 80 met scoring criteria. Average patients per residents was 4, 9.1, 7.2, and 5.5 on “call” day (D0), “post-call” day (D1), “mid-call” day (D2), and “pre-call” day (D3), respectively. Mean RED checklist scores were 68.1%, 57%, 68.6%, and 72.1% on the above call status. The difference in score between D3 and D1 was statistically significant ( P = .00042). There was a negative correlation between score and number of patients per resident ( r = −0.286, P = .010). Conclusion: EMR documentation quality is directly impacted by patient load and resident call status with the lowest documentation quality on post-call day, correlating with patient load.

Cost-effective and environment-friendly energy storage device is major concern to reduce environment pollution which is major source of fossil fuels. Rechargeable batteries and super capacitor are the promising storage devices used to provide power because of their high energy and power densities, and because of limited power densities of the batteries, it has been restricted in use of electric vehicles and hybrid electric vehicles. So, to enhance the performance of these storage devices, nanotechnology and nanomaterials will play very crucial role in present energy sector. Because of fast diffusion of ions and high particle volume, improved electronic conductivity provided by nanomaterials leads to high current, which is very promising candidate for high energy and power storage. Because of versatile nature of nanomaterials limitations like high reactivity, chemical instability can be overcome by fictionalization of their surfaces and their synthesis process. Present chapter discusses the synthesis methods of nanomaterials, and their application in energy-related application will focus more towards batteries and super capacitor. Chapter also discussed the potential of nanomaterials incorporated into biomasses and hydrogen storage as an aid or addictive to enhance the efficiency of bioenergy storage and conversion. Nanomaterials contribute to better performance of biofuels, biodiesel, and hydrogen production. In addition to prominence, the obvious advantages of nanomaterials and their limitations and challenges of nanomaterials while being used for batteries and super capacitor systems have also been elaborated in this chapter.

In this modern era, women have shown excellence in all walks of life and stand equally with men in all sectors. So has increased violence against women due to this exposure. Hence, women security during travel is one of the critical issues faced by society, from the past and even today. The paper aims at providing a technological solution to this problem. For this, a system for forewarning and safeguarding the female cab users using machine learning is developed. An Android application is developed to collect data, and a virtual panic environment was created to collect the anomalies. The accelerometer data along the three coordinates was captured corresponding to normal and anomalies. Three machine learning models viz support vector machines, logistic regression, and Naive Bayes are trained on data collected, and their test performance is compared in terms of accuracy. This trained model is further integrated with an Android application for real-time data collection and feedback.

There has been rising interest in reduced precision in the training of deep neural networks (DNNs) that is used from the single-precision (FP32) to different precision format (FP16, FP8, bfloat16) due to the rapid increase in model sizes, which require less representational space when stored in lower precision. However, training a DNN in reduced precision format (FP16, FP8, and bfloat16) is challenging, because the data format may be inadequate for representing the gradients during backpropagation. In this research paper, we compare the various novel approaches to train a DNN using the different reduced precision formats and explore the challenges that we get during the training of DNN in reduced precision. Besides, we also examine various layers in the neural network which make a significant reduction in the backpropagation and also observe that when should get sufficient precision.

There has been an alarming increase in the number of accidents that occur due to drowsiness. Research so as to analyze and rectify this state has become a necessity. Here, a system has been developed which would detect drowsiness with sufficient reliability using electroencephalogram (EEG) signals. The study was conducted on nine males and nine females, whose EEG waveforms are obtained with the help of a wireless neuro-headset, while subjects underwent a virtual driving experiment. Preprocessing of the raw EEG signals is done by Principal Component Analysis (PCA). The resultant signals are then normalized and smoothed. Subsequently, the preprocessed signal is segmented and the time-frequency features are extracted using Continuous Wavelet Transform (CWT). Transfer learning approach is adopted in this paper to discriminate between the 3 states, ‘Drowsy’, ‘Asleep’ and ‘Awake’. An existing pre-trained ResNet50 model, fine-tuned using the scalograms obtained from CWT, is utilized for evaluating the state of driver.

In current vogue, it is required more storage space as well as security being increasing internet user’s day by day. Cloud computing is appropriate platform to provide services over the internet. Cloud computing influences some technologies such as SOA to data security. In future, some of industry and vendors are expecting changes in IT trends and processes. We discuss here the data security & future of cloud computing. We will also review of current services provided by cloud computing in different arena.

Although opiate use can result in various endocrine disorders, isolated adrenocorticotropic hormone (ACTH) deficiency resulting in secondary adrenal insufficiency remains uncommon. We present a case of a 54-year-old woman with a history of chronic opiate use who presented with a four-month history of worsening fatigue and syncopal episodes. Laboratory workup revealed a low ACTH with low baseline cortisol and normal levels of rest of the anterior pituitary hormones. The imaging study did not reveal any pituitary abnormality. The patient was diagnosed with opiate-induced isolated ACTH deficiency. Her symptoms improved after treatment with hydrocortisone. This case would further improve clinician's awareness towards opiate-induced endocrinopathies, including isolated ACTH deficiency, which can present with nonspecific signs and symptoms, creating a diagnostic challenge.

Rationale Two antifibrotic medications, nintedanib and pirfenidone, have been approved for the treatment of idiopathic pulmonary fibrosis (IPF) in the US. Few data have been published on the use of these medications in clinical practice. Objective To investigate patterns of use of antifibrotic medications in the US. Methods The IPF-PRO Registry, a multicenter US registry, has enrolled patients with IPF that was diagnosed or confirmed at the enrolling center in the past 6 months. Data from patients enrolled from 5 June 2014 to 4 March 2018 were used to determine antifibrotic medication use ("treatment") in the enrollment window and a follow-up window approximately 6 months later. Associations between patient characteristics and treatment status were tested using logistic regression. Results Overall, 551 of 782 eligible patients (70.5%) were treated in the enrollment window. Younger age, lower FVC % predicted, oxygen use with activity, worse self-rated health based on the Short Form-12 (SF-12) or St George's Respiratory Questionnaire score, referral to the enrolling center by a pulmonologist, use of lung biopsy in diagnosis, and carrying a diagnosis of IPF to the enrolling center were associated with being treated. Among 534 patients treated at enrollment who had follow-up data, 94.0% remained treated in follow-up. Better self-rated health based on the SF-12 mental component score or EuroQoL score, and not using oxygen with activity at enrollment, were associated with continuing treatment in follow-up. Among 172 patients who were untreated at enrollment and had follow-up data, 29.7% started treatment in follow-up. Lower DLco % predicted, a family history of ILD, a history of sleep apnea, and a definite diagnosis of IPF at enrollment were associated with starting treatment in follow-up. Conclusions The majority of patients in the IPF-PRO Registry were receiving an approved medication for IPF at enrollment. Treatment at enrollment was associated with greater disease severity, more compromised quality of life and the use of oxygen with activity. Clinical trial registered with ClinicalTrials.gov (NCT01915511).

Background: Psychiatric factors, such as depression, anxiety, and life stressors, have been shown to negatively affect diabetes adherence and glycemic control in children and adolescents. However, less is known about how trauma exposure and symptoms of post-traumatic stress disorder (PTSD) may impact adherence and glycemic control. Objectives: Determine the rates of trauma exposure and PTSD symptoms in patients ages 7-21 with type 1 diabetes (T1DM). Examine the relationship between trauma exposure, PTSD, Anxiety, behavioral adherence and glycemic control. Methods: We enrolled 99 patients (mean age 13.8 ± 3.5 years, 51.5% female) who had been diagnosed with T1DM for at least 6 months and underwent standardized psychiatric screening questionnaires during their clinic visits. HbA1c at goal was defined by HbA1c < 7.5% and behavioral adherence were defined by self-monitoring of blood glucose (SMBG) ≥ 4/day or continuous glucose monitoring (CGM) calibration ≥ 2/day and/or CGM use ≥ 75%. All participants and/or their guardians provided assent and consent. Chi-square tests were used to assess the relationships between trauma, PTSD, anxiety and behavioral adherence. One-way ANOVA was conducted to examine group differences between HbA1c scores and the presence of suicidal ideation. Results: 38.4% of participants had trauma symptoms and functional impairment. Rates of trauma secondary to accidental injury, medical traumatic stress, natural disaster and witness to family violence were 28.3%, 22.2%, 10.1%, and 6.1%, respectively. Neither trauma exposure nor PTSD predicted diabetes adherence. Anxiety was significantly associated with diabetes nonadherence (p=0.006). The group with suicidal ideation had higher HbA1c compared to the group without suicidal ideation (8.92 ± 1.40 vs. 8.30 ± 1.35, p=0.047). Conclusions: Although trauma was common among young patients with T1DM, other factors, such as anxiety and suicidal ideation, maybe more important indicators of adherence and glycemic control. Disclosure R. Raj: None. M. Nguyen: None. A. Morales: None. A.L. Meadows: None. Funding Children’s Miracle Network/Kentucky Children’s Hospital Research Fund; National Institutes of Health (UL1TR001998)

BackgroundMatrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) play important roles in the turnover of extracellular matrix and in the pathogenesis of idiopathic pulmonary fibrosis (IPF). This study aimed to determine the utility of circulating MMPs and TIMPs in distinguishing patients with IPF from controls and to explore associations between MMPs/TIMPs and measures of disease severity in patients with IPF.MethodsThe IPF cohort (n = 300) came from the IPF-PRO Registry, an observational multicenter registry of patients with IPF that was diagnosed or confirmed at the enrolling center in the past 6 months. Controls (n = 100) without known lung disease came from a population-based registry. Generalized linear models were used to compare circulating concentrations of MMPs 1, 2, 3, 7, 8, 9, 12, and 13 and TIMPs 1, 2, and 4 between patients with IPF and controls, and to investigate associations between circulating levels of these proteins and measures of IPF severity. Multivariable models were fit to identify the MMP/TIMPs that best distinguished patients with IPF from controls.ResultsAll the MMP/TIMPs analyzed were present at significantly higher levels in patients with IPF compared with controls except for TIMP2. Multivariable analyses selected MMP8, MMP9 and TIMP1 as top candidates for distinguishing patients with IPF from controls. Higher concentrations of MMP7, MMP12, MMP13 and TIMP4 were significantly associated with lower diffusion capacity of the lung for carbon monoxide (DLCO) % predicted and higher composite physiologic index (worse disease). MMP9 was associated with the composite physiologic index. No MMP/TIMPs were associated with forced vital capacity % predicted.ConclusionsCirculating MMPs and TIMPs were broadly elevated among patients with IPF. Select MMP/TIMPs strongly associated with measures of disease severity. Our results identify potential MMP/TIMP targets for further development as disease-related biomarkers.

Softmax function is widely used in artificial neural networks for multiclass classification, multilabel classification, attention mechanisms, etc. However, its efficacy is often questioned in literature. The log-softmax loss has been shown to belong to a more generic class of loss functions, called spherical family, and its member log-Taylor softmax loss is arguably the best alternative in this class. In another approach which tries to enhance the discriminative nature of the softmax function, soft-margin softmax (SM-softmax) has been proposed to be the most suitable alternative. In this work, we investigate Taylor softmax, SM-softmax and our proposed SM-Taylor softmax, an amalgamation of the earlier two functions, as alternatives to softmax function. Furthermore, we explore the effect of expanding Taylor softmax up to ten terms (original work proposed expanding only to two terms) along with the ramifications of considering Taylor softmax to be a finite or infinite series during backpropagation. Our experiments for the image classification task on different datasets reveal that there is always a configuration of the SM-Taylor softmax function that outperforms the normal softmax function and its other alternatives.

Biomass from crop residue remains an underutilized and inexpensive energy resource around the world. Inadequate supply chain management forces farmers to resort to field burning of crop residue, resulting in environmental, health, and economic issues. In this study, we conceptualize a novel approach for biomass utilization which jointly addresses the common and often concurrent issues of energy, environment, and water. We propose to use the thermal energy from the combustion of the producer gas obtained from biomass gasification to power an off-the-grid refrigeration system which can condense moisture from air. We conduct a detailed thermodynamic analysis of vapor-adsorption cycle-based atmospheric water harvesting (AWH) system to develop an integrated modeling framework. We use the ambient weather data to report that the biomass-powered AWH can condense 800–1200 L of water per 1000 kg of biomass. Based on the local population and biomass availability, this can meet up to 10–12% of the potable water requirements in certain states of India. We also discuss the immediate challenges underlying this waste-to-value concept. Finally, we discuss that the proposition to jointly address energy, water, and the environment issues may motivate key paradigm shifts in policies required for practical implementation of this technology.

The nonstationary characteristics present in electroencephalogram (EEG) signal require a crucial analysis that can reveal a method for diagnosis of neurological abnormalities, especially epilepsy. This article presents a new technique for automated classification of epileptic EEG signals based on iterative filtering (IF) of EEG signals. The superiority of IF over empirical mode decomposition for the classification of seizure EEG signals is presented. In this article, EEG epochs are decomposed into their intrinsic mode functions (IMFs) using IF. Amplitude envelope (AE) function is extracted from these modes, using the discrete separation energy algorithm. The features are extracted from these IMFs and AE functions. The feature set includes K-nearest neighbor entropy estimator, log energy entropy, Shannon entropy, and Poincar $\acute{\text{e}}$ plot parameters. These features are tested for their discriminative strength, on the basis of their $p$ -values, for classification of EEG signals into seizure, seizure-free, and normal classes. This proposed methodology has obtained a high classification accuracy using random forest classifier and takes far less time, which can be suitable for real-time implementation.

An 80-year-old Caucasian male presented with fever of 3-week duration. Outpatient workup for infectious etiologies was negative and due to persistent fever, he was hospitalized for further evaluation of fever of unknown origin (FUO). Physical examination and laboratory studies remained unremarkable; however a follow-up CT scan of chest, abdomen, and pelvis with contrast done to rule out malignancy as an underlying cause of FUO revealed heterogeneous thyroid gland with surrounding hazy changes suggestive of thyroiditis. Thyroid function tests confirmed the diagnosis of subacute thyroiditis. The patient was started on prednisone with good response in his symptoms and was eventually discharged to home. The importance of our case lies in the fact that diagnosing subacute thyroiditis in the absence of classical symptoms of neck pain can be challenging and a physician should have a very high index of suspicion especially in an elderly patient where FUO can be the sole presentation.