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Brain metastasis (BrM) is an area of unmet medical need that poses unique therapeutic challenges and heralds a dismal prognosis. The intracranial tumor microenvironment (TME) presents several challenges, including the therapy-resistant blood–brain barrier, a unique immune milieu, distinct intercellular interactions, and specific metabolic conditions, that are responsible for treatment failures and poor clinical outcomes. There is a complex interplay between malignant cells that metastasize to the central nervous system (CNS) and the native TME. Cancer cells take advantage of vascular, neuronal, immune, and anatomical vulnerabilities to proliferate with mechanisms specific to the CNS. In this review, we discuss unique aspects of the TME in the context of brain metastases and pathways through which the TME may hold the key to the discovery of new and effective therapies for patients with BrM.

The electric power distribution plays a crucial part in the power systems to maintain the power quality and stability of the system for loss mitigation and voltage regulation. The reactive power compensators like a capacitor, DG, and DSTATCOM play a vital role in power quality and stability improvement by providing proper reactive power in the distribution system. This article provides a critical review and comparative analysis of various compensating devices allocation to achieve power loss mitigation and voltage regulation in the radial distribution system (RDS). The Bat Algorithm (BA) and Voltage Stability Index (VSI) are utilized for determining the optimal size and site of the compensating devices in the RDS. Further, the application of Blockchain technology is utilized for voltage regulation of energy trading RDS. To show the effectiveness of the present study, an IEEE 33 test system is considered. All three compensators are implemented in IEEE 33 test system and compared with existing approaches. The present study is very much helpful to the Distribution Network Operators for selecting the suitable compensator in real-time applications.

Introduction: Ocular burns are ophthalmic emergencies due to their visual morbidity. The extent of ocular surface involvement at the time of presentation is critically associated with visual outcome. Comprehensive ocular examination and prompt management is needed to optimize visual outcome. Objective: This study aims to evaluate the epidemiological trends, clinical features of patients with ocular burns and to determine their relationship with visual outcome. Methods:This prospective, cross-sectional study was conducted on 96 consecutive in-patients who were admitted in the Department of Plastic surgery and Burns in our hospital and sought opinion for ocular burns, irrespective of age and sex. The main outcome measures evaluated were clinical features of ocular burns and prognostic factors associated with visual impairment. Results: In our study, the mean age (S.D.) of patients was 32.83+/- 18.70 years with both males and females equally affected. The most common mode of injury was thermal injury due to domestic accidents (88.5%). 74% of patients had bilateral ocular presentation. Lid burns (42.2%) and lid edema (41.1%) were the most common ocular findings. About 5.2% of eyes showed corneal involvement. About 14 eyes (7.3%) had severe ocular complications among which one eye developed phthisis bulbi. 20 eyes (16.1%) had visual acuity of less than 6/60 causing visual morbidity. In multivariate logistic regression analysis, corneal involvement (p

Agriculture is the primary source of livelihood for farmers in many underdeveloped regions, so due to climate change or other risks, crop insurance is thought to be essential, but the research question answered in the current study pertains to insurance program performance. The government-administered crop insurance program was analysed using a mixed methods design. A multiple case study was conducted in the TamilNadu region (India) to analyse the program, identify the causal factors, and collect relevant claim secondary data. Then the R statistical program was applied to analyse crop performance by developing a linear model of crop actual yields versus threshold yields (rabi, paddy, and kharif) using claim payments as the dependent variable. R statistical regression model programming was explained in detail. Recommendations were provided to economic decision makers on how to enhance agricultural insurance and rural development.

No abstract available. Article truncated after 150 words. History of Present Illness: A 55-year-old man with a past medical history significant for endocarditis secondary to intravenous drug use, osteomyelitis of the right lower extremity was admitted for ankle debridement. Pre-operative assessment revealed no acute illness complaints and no significant findings on physical examination except for the ongoing right lower extremity wound. He did well during the approximate one-hour “incision and drainage of the right lower extremity wound”, but became severely hypotensive just after the removal of the tourniquet placed on his right lower extremity. Soon thereafter he experienced pulseless electrical activity (PEA) cardiac arrest and was intubated with return of spontaneous circulation being achieved rapidly after the addition of vasopressors. He remained intubated and on pressors when transferred to the intensive care unit for further management. PMH, PSH, SH, and FH: • S/P Right lower extremity incision and drainage for suspected osteomyelitis as above • Distant history of endocarditis related …

Mucormycosis, formerly known as zygomycosis, is a potentially fatal invasive fungal disease (IFD) caused by fungi in the Mucorales order and the zygomycetes class. Mucormycosis is a rare but deadly fungal infection that generally affects those who have weakened immune systems. The infection has the potential to spread throughout the body. Death is a possibility with this type of severe infection. It’s important to get treatment. If left untreated, mucormycosis can be fatal. Zygomycosis has a high mortality of 70–100%. The prevalence of mucormycosis in India is approximately 80 times that of developed countries, with 0.14 cases per 1000 population. The main aim and purpose of this review related to overview and history, causative agents, epidemiology, etiopathogenesis, transmission, types, clinical features, recent advances in diagnosis and treatment of Mucormycosis. A systematic literature search was conducted in the electronic databases of PubMed, Google Scholar and relevant sources. It will be helpful for those who work in the medicine field to explore their knowledge about mucormycosis.

BACKGROUND AND PURPOSE: Asymmetries in the circle of Willis have been associated with several conditions, including migraines and stroke, but they may also be age-dependent. This study examined the impact of age and age-dependent changes in cerebral perfusion on circle of Willis anatomy in healthy children and adults. MATERIALS AND METHODS: We performed an observational, cross-sectional study of bright and black-blood imaging of the proximal cerebral vasculature using TOF-MRA and T2 sampling perfection with application-optimized contrasts by using different flip angle evolution (T2-SPACE) imaging at the level of the circle of Willis in 23 healthy children and 43 healthy adults (4–74 years of age). We compared arterial diameters measured manually and cerebral perfusion via pseudocontinuous arterial spin-labeling between children and adults. RESULTS: We found that the summed cross-sectional area of the circle of Willis is larger in children than in adults, though the effect size was smaller with T2-SPACE-based measurements than with TOF-MRA. The circle of Willis is also more symmetric in children, and nonvisualized segments occur more frequently in adults than in children. Moreover, the size and symmetry of the circle of Willis correlate with cerebral perfusion. CONCLUSIONS: Our results demonstrate that the circle of Willis is different in size and symmetry in healthy children compared with adults, likely associated with developmental changes in cerebral perfusion. Further work is needed to understand why asymmetric vasculature develops in some but not all adults.

BACKGROUND: Mucormycosis is a rapidly progressing, life threatening, opportunistic fungal infection caused by angioinvasive mucorales species of the phylum zygomycetes.The major risk factors of the disease are uncontrolled diabetes mellitus, COVID-19 infection,prolonged usage of high dose of systemic corticosteroids,immunocompromised status and neutropenia. These create a nidus for fungal infection through nasal mucosa which spreads up through paranasal sinuses into orbit manifesting as rhino-orbital mucormycosis. AIM 1. To study the epidemiology and various clinical patterns of presentation of rhino-orbital mucormycosis in post covid patients. 2. To analyse the risk factors associated with progression of rhino-orbital mucormycosis in post covid patients. METHODS: A retrospective study of 25 patients diagnosed as rhino-orbital mucormycosis in post covid patients at Government Kilpauk Medical College Hospital between April and July 2021 was done. RESULTS: In our study,males (64%) are more commonly affected with age preponderance of 51-60 years(28%). The mean age of presentation was 52.1+/-4.49years.The most common symptom of the disease is nasal discharge with sinus and orbital pain(52%).The most common form of presentation is orbital apex syndrome in seven patients(28%).Five patients had loss of vision, of which four were due to central retinal artery occlusion(16%) and one due to cavernous sinus thrombosis.MRI imaging of these patients showed sinus involvement(100%) in all cases ,orbital(48%) and cerebral involvement(8%).The major risk factors responsible for progression of disease in our study are uncontrolled diabetes, prolonged usage of high dose steroid therapy, medial wall involvement, optic nerve head involvement and artery thrombosis. CONCLUSION: Post covid patients presenting with nasal discharge with sinus and orbital pain symptoms need to be diagnosed and managed properly to avoid spread of infection and fatal complications. Aggressive surgical debridement of infected tissues helps in increasing the survival rate of the patients. Patients with risk factors need to be closely monitored to prevent vision loss and cosmetic disfigurement surgeries.

Net of factors (IoT) is also a bunch of numerous sensory gadgets and actuators connected over a wireless or wi-fi channel for statistics transmission. IoT is growing on a everyday for the past few years. The little print are substantially extended inside the upcoming years. Moreover to improved extent, IoT gadgets produce big amounts of information in lots of unique methods with unique statistics first-rate described by their pace through the years and dependence. The gadget gaining knowledge of (ml) algorithm plays an vital role in protection and authorization supported the invention of artificial biotechnology to enhance the utilization and security of IoT structures. Attackers frequently looked for gaining knowledge of algorithms to need advantage of being susceptible to IoT systems designed for smart. Protection for IoT gadgets by way of detecting spam the usage of ml. Unsolicited mail detection on IoT employing a system getting to know Framework is proposed.

Yield forecasting is based totally entirely on soil, water and vegetation to be a possible subject. Deep-based depth-based fashions are widely accustomed extract important plant functions for predictive purposes. Although such strategies are necessary to resolve the matter of predicting yields there are the subsequent abnormalities: they can't create an indirect or indirect map between raw facts and yield values; and also the full functionality of this excess is explained within the high satisfaction of the published works. Deep durability provides guidance and motivation for the above-mentioned errors. Combining master intensity and deep mastering, deep reinforcing mastering creates a comprehensive yield prediction framework which will plan the uncooked facts in crop prediction rates. The proposed project creates a version of the Deep Recurrent Q-Network Support Vector Machine deep mastering set of rules over Q-Learning to strengthen the mastering set of rules for predicting yield. Sequential downloads of the Recurrent Neural community are fed by fact parameters. The Q-mastering community creates a predictive yield environment based totally on input criteria. The precise layer displays the discharge values of the Support Vector Machine on the Q values. The reinforcement master component contains a mix of parametric functions on the sting that helps predict the yield. Finally, the agent obtains a measure of the mixture of steps performed by minimizing the error and increasing the accuracy of the forecast. The proposed model successfully predicts this crop yield that's hip by keeping the initial distribution of facts with 93.7% accuracy.

In chronic infections and in cancer, persistent antigen stimulation under suboptimal conditions can lead to the induction of T-cell exhaustion. Exhausted T cells are characterized by an increased expression of inhibitory markers and a progressive and hierarchical loss of function. Although cancer-induced exhaustion in CD8 T cells has been well-characterized and identified as a therapeutic target (i.e., via checkpoint inhibition), in-depth analyses of exhaustion in other immune cell types, including CD4 T cells, is wanting. While perhaps attributable to the contextual discovery of exhaustion amidst chronic viral infection, the lack of thorough inquiry into CD4 T-cell exhaustion is particularly surprising given their important role in orchestrating immune responses through T-helper and direct cytotoxic functions. Current work suggests that CD4 T-cell exhaustion may indeed be prevalent, and as CD4 T cells have been implicated in various disease pathologies, such exhaustion is likely to be clinically relevant. Defining phenotypic exhaustion in the various CD4 T-cell subsets and how it influences immune responses and disease severity will be crucial to understanding collective immune dysfunction in a variety of pathologies. In this review, we will discuss mechanistic and clinical evidence for CD4 T-cell exhaustion in cancer. Further insight into the derivation and manifestation of exhaustive processes in CD4 T cells could reveal novel therapeutic targets to abrogate CD4 T-cell exhaustion in cancer and induce a robust antitumor immune response.

Lithium-ion battery is generally used as energy storage device in spacecraft and other applications. Spacecraftbattery modeling and energy balance estimation is critical. The proposed genetic algorithm driven generic estimation - energy balance (GAGE-EB) model uses cell open circuit voltage characteristics, internal resistance ( $r_{\text{int}}$ ) characteristics, and coulomb counting. The cell characteristics are obtained by offline tests. For series-parallel or parallel-series configured battery, the model estimates deliverable capacity and internal resistance by accurately matching the terminal voltage. Estimated parameters are used to check the energy balance for new load and generation profiles. The GAGE-EB model is validated for electrical performance with various cell types and battery configurations with respect to experimental data and is within 1% and 2% accuracy for voltage and capacity estimation, respectively.

The Severe Acute Respiratory Syndrome (SARS) coronavirus-2 is a novel coronavirus belonging to the family Coronaviridae originating in Wuhan, China has created a impact across the globe. The disease has been declared a pandemic by the WHO on March 11, 2020. In this review, an update on virology, pathophysiology, clinical presentation with detailed update on oral manifestations .

Electrospinning is an inexpensive and versatile technique for fabricating micro- and nano- scaled fibers. There have been limited attempts to employ it for the fabrication of thermochromic (TC) fibers, and the fabrication of a three-component (dye, developer, and solvent) TC material has required the use of a more complicated coaxial electrospinning technique. Herein, a simple and novel method for creating thermochromic fibers by electrospinning single strands of poly (methyl methacrylate) (PMMA) with embedded thermochromic powder of a polymer encapsulated three-component system was employed. Unlike past leuco dye-based thermochromic fibers, an unmodified syringe tip can be used for the spinning process and only one flow rate needs to be determined. A solution of solvent (either N-dimethylformamide or chloroform), PMMA, and a commercially available black thermochromic powder was prepared and spun using a custom-made electrospinning apparatus. The spun fibers exhibited a clear color transition from grey to white and had average diameters of 2.53 µm and 1.96 µm for chloroform and N-dimethylformamide based fibers, respectively. The fibers were characterized by scanning electron and optical microscopy to determine their morphology, Fourier transform infrared spectroscopy to determine their chemical composition, and differential scanning calorimetry and thermogravimetric analysis to characterize their thermal properties.

Purpose: To study the prevalence of dry eye in a hospital-based population and to study the tear film parameters in dry eye patients presenting with symptoms of grittiness and foreign body sensation attending the ophthalmology outpatient department of Karpaga Vinayaka Institute of Medical Sciences, Chengalpattu, Tamil Nadu. Materials and Methods: Cross Sectional study conducted in the out patient department of our department among patients presenting with symptoms suggestive of dry eyes both male and female patients consenting to the study were included. Results: A total of 125 participants were enrolled, of these 38 had dry eye, 67 had long duration of work. 86 patients had complaints suggestive of dry eye. 38 had all 3 parameters tested abnormal. Tear film was evaluated with Schirmer test, TBUT, TMH and a proforma to record patient demographic details, symptoms, test values and dry eye diagnosis. Conclusion: our study showed 86 participants with symptoms such as grittiness, foreign body sensation, dryness, burning sensation and 38 patients had dry eye and required treatment such as lubricants. Poor quality and function of tears, combined with subnormal ocular surface, makes patients symptomatic and on evaluation show ocular surface disease dry eye which can be treated accordingly to relieve the patient of symptoms and improve the quality of life. Thus routine and early examination of tear function and ocular surface parameters should form a part of the workup of all patients with symptoms of dry eye. Keywords: Dry eye, Grittiness, Schirmer test, TMH, TBUT.

We report the clinical and microbiological features of contact lens-related mixed infectious keratitis caused by a spore-forming filamentous fungus and a rare gram-negative bacterial infection. A 66-year-old Caucasian female presented with right eye (OD) pain after sleeping in her 2-weekly contact lenses for 3 days. On presentation, corrected distance visual acuity was 0.46 LogMAR OD and 0.20 in the left eye. Slit lamp biomicroscopy revealed a 1.9 mm by 1.9 mm area of dense stromal infiltrate with epithelial defect. Corneal scrapes grew Aspergillus fumigatus and Pseudomonas koreensis, and culture-directed microbial therapy with oral and topical voriconazole and topical fortified gentamicin along with regular debridement resulted in slow resolution of the infection, leaving a dense stromal scar in the visual axis requiring penetrating keratoplasty. Mixed infectious keratitis caused by filamentous fungi and gram-negative bacteria is rare. Pseudomonas koreensis infection has not been previously reported as a cause of infectious keratitis in humans. In our experience, these mixed infections require prolonged systemic and topical therapy and the secondary scarring may require surgical intervention for vision rehabilitation.

Split cord malformation (SCM) is a developmental disorder that is usually symptomatic and diagnosed in childhood. The majority of these lesions are in the thoracic and lumbar spine, with only 1%-3% of cases found in the cervical spine. This is a case report of a 55-year-old female patient with an unremarkable medical history who presented with neck pain. Upon workup, she was found to have extensive developmental anomalies throughout her cervical and thoracic spine, including an incidentally found type 2 SCM and multiple autofused vertebrae. There are only 6 similar studies published in the literature. There was extensive facet degeneration in her cervical spine, which was suspected to be the etiology of her neck pain. This case illustrates the rare finding of asymptomatic adult cervical SCM and the likely significance of her autofused vertebrae causing accelerated symptomatic facet spondylosis.

The coronavirus disease 2019 (COVID-19) is highly infectious, with the current pandemic causing significant morbidity and mortality worldwide. As large numbers of frontline healthcare workers (HCWs) have also been infected and several have died, there is much global concern about protective measures for them, particularly those performing surgery or other procedures with close patient contact. Since the beginning of the pandemic, there has been and there remains a shortage in the supply of personal protective equipment (PPE), including the N95 filtering facepiece (FFP) respirator, for HCWs. N95 respirators have filtration efficiency of 95% of aerosol particles. Surgical N95 respirators are used where fluid resistance is also required together with respiratory protection, e.g. during surgery or interventional procedures. The shortage of N95 respirators may be overcome by extended use and reuse - comprising rotation and decontamination by approved techniques. The additional role of powered air-purifying respirators (PAPR) is also discussed.

AIM: To estimate the proportion of incidence of glaucoma cases in a screening camp conducted at a tertiary Ophthalmology centre. BACKGROUND: 1,2 Glaucoma is the second leading cause of blindness in the adult population in India .The diagnosis of glaucoma was based on the presence of at least two of the following criteria:IOP ≥ 21 mmHg,glaucomatous optic disc abnormalities,and glaucomatous visual field defects. MATERIALS AND METHODS: A prospective, cross sectional study was conducted on 100 consecutive individuals aged more than 40 years who came to our hospital Ophthalmology department from 08-March, 2020 to 14-March, 2020. All subjects underwent a comprehensive eye examination including brief history taking, slit lamp examination, applanation tonometry, gonioscopy, pachymetry, dilated fundus examination using slit lamp biomicroscopy with 90D lens and automated perimetry. RESULTS: One hundred individuals including 43 males and 57 females are screened.The screening result found to be positive in 9 (9%) subjects who underwent further diagnostic evaluation which concluded 3 cases of Normotension glaucoma,5 cases of Primary angle closure glaucoma and 1 individual with Secondary Glaucoma. CONCLUSION: Periodical glaucoma screening helps to detect more number of glaucoma cases thereby preventing blindness. Routine glaucoma screening for individuals more than 40 years should be strictly followed by Ophthalmologists in the society

The COVID 19 Pandemic has revolutionized the traditional classroom education with a new teaching paradigm called online class. While conducting classes online, the genuine students grasp the essence of the subjects at the same time some students are trying to do some spoofing activity in the class or meeting though they are virtually available online. The spoofing may include that the students may not physically present in the class instead their friends or relatives will join in the meeting. The proposed system proposed has developed a novel method to find the difference between the live face and a spoofing face. It also helps in identifying the spoofing person in two stages and ensures that the actual person is attending the online class or meeting. The state-of-the-art development in the face recognition techniques help to identify the spoofing person. If any spoofing activity is detected; it alerts the teacher or organizer that the attendee is not physically present and/or not belonging to the class.

Introduction: The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery (BMRS) remains an area of active investigation. Here, we report outcomes for patients with BMRS treated with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy, LITT)followed by consolidation radiosurgery (cSRS). Methods: Clinical outcome of 20 patients with 21histologically confirmed BMRS treated with SLA followed by consolidation SRS and >6 months follow-up were collected retrospectively across three participating institutions. Results: Consolidation SRS (5 Gy x 5 or 6 Gy x 5) wascarried out 16-73 days (median of 26 days) post-SLA of BMRS. There were no new neurological deficits after SLA/cSRS. While 3/21 (14.3%) patients suffered temporary Karnofsky Performance Score (KPS) decline after SLA, no KPS declines was observed after cSRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of cSRS (severe headache that resolved with steroid therapy (n=1) and new onset seizure (n=1)). With a median follow-up of 228 days (range: 178-1367 days), the local control rate at 6 and 12 months (LC6, LC12) was 100%. All showed diminished FLAIR volume surrounding the SLA/cSRS treated BMRS at the six-month follow-up; none of the patients required steroid for symptoms attributable to these BMRS. These results compare favorably to the available literature for repeat SRS or SLA-only treatment of BMRS.Conclusions: This multi-institutional experience supports further investigations of SLA/cSRS as a treatment strategyfor BMRS.

A significantly large amount of thermal energy is lost from or gained in buildings as a result of solar radiation. A comfortable temperature can be maintained by correctly designing and arranging a building’s windows and smart roof coatings. Single layer or multilayer thin film coatings, with spectrally desirable characteristics, are deposited on glass or roof surfaces and can greatly improve a building’s energy efficiency. Thermochromic materials present some advantages due to their reversible color and phase change behavior near ambient temperature. For example, a thermochromic coating on a roof’s surface can change color (black to white) reversibly when heated at around 30 °C, reflecting solar radiation and reducing a building’s cooling needs. In the present study, various thermochromic coatings on glass slides are investigated. In this work, the effect of non-toxic titanium dioxide (TiO2), used as a UV radiation protective coating on thermochromic particles (such as a three-component blue dye synthesized in the lab or a commercially available black dye), is discussed. The composite coatings of the chosen components can reduce a building’s cooling and heating energy needs and provide an environmentally sustainable solution for a green economy. Several physico-chemical characterization techniques were used to understand the surface, interfacial, spectroscopic, and thermal behavior of TiO2 or SiO2 coatings and phase change thermochromic materials for applications in thermal storage and enhanced energy efficiency.

The 21st century is witnessing a fast-paced digital revolution. A significant trend is that cyber and physical environments are being unprecedentedly entangled with the emergence of Internet of Things (IoT). IoT has been widely immersed into various domains in the industry. Among those areas where IoT would make significant impacts are building construction, operation, and management by facilitating high-class services, providing efficient functionalities, and moving towards sustainable development goals. So far, IoT itself has entered an ambiguous phase for industrial utilization, and there are limited number of studies focusing on the application of IoT in the building industry. Given the promising future impact of IoT technologies on buildings, and the increasing interests in interdisciplinary research among academics, this paper investigates the state-of-the-art projects and adoptions of IoT for the development of smart buildings within both academia and industry contexts. The wide-ranging IoT concepts are provided, covering the necessary breadth as well as relevant topic depth that directly relates to smart buildings. Current enabling technologies of IoT, especially those applied to buildings and related areas are summarized, which encompasses three different layers based on the conventional IoT architecture. Afterwards, several recent applications of IoT technologies on buildings towards the critical goals of smart buildings are selected and presented. Finally, the priorities and challenges of successful and seamless IoT integration for smart buildings are discussed. Besides, this paper discusses the future research questions to advance the implementation of IoT technologies in both building construction and operation phases. The paper argues that a mature adoption of IoT technologies in the building industry is not yet realized and, therefore, calls for more attention from researchers in the relevant fields from the application perspective.

Healthcare innovation is impeded by high costs, the need for diverse skillsets, and complex regulatory processes. The COVID-19 pandemic exposed critical gaps in the current framework, especially those lying at the boundary between cutting-edge academic research and industry-scale manufacturing and production. While many resource-rich geographies were equipped with the required expertise to solve challenges posed by the pandemic, mechanisms to unite the appropriate institutions and scale up, fund, and mobilize solutions at a time-scale relevant to the emergency were lacking. We characterize the orthogonal spatial and temporal axes that dictate innovation. Improving on their limitations, we propose a “pre-emptive innovation infrastructure” incorporating in-house hospital innovation teams, consortia-based assembly of expertise, and novel funding mechanisms to combat future emergencies. By leveraging the strengths of academic, medical, government, and industrial institutions, this framework could improve ongoing innovation and supercharge the infrastructure for healthcare emergencies.

Aims To investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing reverse total shoulder replacement. Patients and methods This retrospective study included 15 patients with symptomatic rotator cuff arthropathy who underwent reverse total shoulder arthroplasty (rTSA) under ISB-RA without general anaesthesia in the beach chair position from 2010 to 2018. The mean patient age was 77 years (range 59-82 years). Patients had associated medical comorbidities: American Society of Anesthesiologists (ASA) grade 2-4. Assessed parameters were: duration of anaesthesia, intra-operative systolic blood pressure variation, sedation and vasopressor use, duration of post-operative recovery, recovery scores, length of stay, and complications. A robust cost analysis was also performed. Results The mean (range) duration of anaesthesia was 38.66 (20-60) min. Maximum and minimum intra-operative systolic blood pressure ranges were 130-210 and 75-145 mmHg, respectively (mean [range] drop, 74.13 [33-125] mmHg). Mean (range) propofol dose was 1.74 (1-3.0) mg/kg/h. The Median (interquartile range) post-operative recovery time was 30 (20-50) min. The mean (range) postoperative recovery score (local scale, range 5-28 where lower values are superior) was 5.2 (5-8). The mean (range) length of stay was 8 (1-20 days); the two included patients with ASA grade 2 were both discharged within 24 hours. One patient with predisposing history developed pneumonia; however, there were no complications related to ISB-RA. The mean (range) cost per patient was £101.36 (£59.80-£132.20). Conclusions Our data demonstrate that rTSA under ISB-RA is safe, comfortable, and cost-effective. Notably, patients with ASA grade 2 who underwent rTSA under ISB-RA had a reduced length of stay and were discharged within 24 hours. Clinical relevance rTSA under ISB-RA is potentially a safe, cost-effective, and viable alternative for patients with multiple comorbidities.

Based on recent power quality studies, voltage dip and swells in the medium and low voltage distribution grid are regarded as the most frequent form of power quality problems. Their effect is serious on sensitive loads. The effect varies from load disturbances to major economic losses to millions of dollars. Different solutions have been developed to defend sensitive loads against such disturbances, but the most powerful and efficient solution is considered to be the DVR..In this paper, the hardware setup of DVR to relieve the voltage dip and swell has implemented by the use of the micro-controller and control circuit for the H-bridge inverter. The system suggested in the article provided has a limited variety of changing devices that decreases the intricacy of the circuit as well as using the microcontroller (LPC2148) to use a simple control circuit. The multi-level inverters give almost sinusoidal result waveform, the result exists with polished harmonic account and switching losses that are less than the traditional level inverter, and thus smaller filter dimension is needed. Regular cascaded MLI as well as various other current7-level reduced switch topologies making use of carrier-based PWM methods, the performance top quality in terms of THD, and also switching losses of the brand-new MLI compared.

Minimally invasive lumbar laminectomies utilize tubular retractors to minimize tissue disturbance, blood loss, and hospital length of stay compared to open operations. Here, we highlight the operative treatment of a 68-yr-old male entailing a 2-level minimally invasive lumbar laminectomy and foraminotomy at L2-L3 and L3-L4. The patient initially presented with symptoms of treatment-refractory lower extremity numbness and limited ambulation. His imaging demonstrated coronal scoliosis and severe lumbar central and foraminal stenosis at L2-L3 and L3-L4, with enlarged spinous processes, laminae, and facets. The patient consented to the procedure and publication of their image. The operation proceeded with the patient in a prone position with paramedian dissection to the lamina through a minimally invasive tubular retractor. Laminectomies and foraminotomies were performed at each level with high-speed drill and a Kerrison rongeur, with care to identify and protect the relevant spinal nerve roots. Postoperatively, the patient reported significantly reduced numbness and improved ambulation, with a well-healed surgical incision notably smaller than those produced in an open operation.

Environmental nanotechnology is holding an immense position in modern days’ science and engineering. These advanced ‘nanomaterials’ are being utilized for diverse range of applications but with the ideology of saving environment. Environmental sector is being tackled with the aim of developing sensors for detecting, monitoring and analysing the toxic contaminants so as to protect and remediate environment. In the presented chapter we have tried to illustrate applications of nanofields, and resulting impacts on the four spheres of the earth. Many efforts are being taken to have a check on the negative impacts of the nanotechnology but still there are many prevailing discrepancies that need to be confronted.

White Blood Cell (WBC) cancer or leukemia is one of the serious cancers that threaten the existence of human beings. In spite of its prevalence and serious consequences, it is mostly diagnosed through manual practices. The risks of inappropriate, sub-standard and wrong or biased diagnosis are high in manual methods. So, there is a need exists for automatic diagnosis and classification method that can replace the manual process. Leukemia is mainly classified into acute and chronic types. The current research work proposed a computer-based application to classify the disease. In the feature extraction stage, we use excellent physical properties to improve the diagnostic system’s accuracy, based on Enhanced Color Co-Occurrence Matrix. The study is aimed at identification and classification of chronic lymphocytic leukemia using microscopic images of WBCs based on Enhanced Virtual Neural Network (EVNN) classification. The proposed method achieved optimum accuracy in detection and classification of leukemia from WBC images. Thus, the study results establish the superiority of the proposed method in automated diagnosis of leukemia. The values achieved by the proposed method in terms of sensitivity, specificity, accuracy, and error rate were 97.8%, 89.9%, 76.6%, and 2.2%, respectively. Furthermore, the system could predict the disease in prior through images, and the probabilities of disease detection are also highly optimistic.

In our work we consider SOAR cognitive architecture with its various types of memories. Here , 8 Queen’s problem is solved by SOAR agent using multiple memories with residing productions using given initial and goal board positions and also study how to improve problem solving mechanism by reducing the processing time to reach goal. By this intelligence of agent also get improved as complexity (time) decreases.

Surface water and groundwater are intrinsically connected, such as in low elevation areas like coastal plains with phreatic aquifers. In urban areas, inter-related issues regarding water resources, land use, and urban policies are particularly important. This chapter presents a spatial approach for identification of the most susceptible areas to flooding and appropriate measures to minimise it, based on urban and hydrologic criteria, using a geographic information system as a spatial decision support system. Knowledge modelling in this decision-making process is the most crucial part of the approach because it considers the expertise of various professionals, policies, regulations, and other determinants and helps to structure all decision-making data and rationale. The analysis of the Brazilian case comes with more significant challenges that involve legal and technical aspects of urban planning and water management in a spatial analysis approach. Results show that a closer relationship between urban planners and water managers in coastal cities should help in land-use planning actions and policies for avoiding problems, such as floods and saltwater intrusion in coastal aquifers, and stimulating interdisciplinary urban planning teams as an essential condition for urban environmental management as well for the resilience of present and future cities.

This paper explores the role of regulation and legislation on influencing the development and diffusion of technologies and methods of crop production. To do this, the change in pesticide registration under European Regulation 1107/2009 ‘Placing Plant Protection Products on the Market’ was followed through the UK’s agricultural system of innovation. Fieldwork included: a series of interviews conducted with scientists, agronomists and industry organisations; a programme of visiting agricultural events; as well as sending an electronic survey to British potato growers. The innovation system is noted to have made the legislation less restrictive than originally proposed. The most notable system response to the legislation is the adjustment of agrochemical company pesticide discovery strategy and their expansion into biologically derived treatments. There have also been other innovation responses: agricultural seed companies have been breeding in pathogen resistance in their cultivars; agricultural consultancies are prepared to recommend pathogen-resistant seeds; scientists are using the change as justification for adopting their solutions; the agricultural levy boards funded research into off-label pesticide uses; and producers, potato growers in particular, have been seeking advice, but not changing their growing practices.

Women’s patterns of time-use, which proxy the work burdens associated with productive and reproductive activities, are an important determinant of nutrition and well-being in LMICs. However, there is a lack of empirical evidence on how patterns of time-use translate into patterns of physical activity and energy expenditure, particularly in rural areas where seasonal agricultural labour plays such an important role. We address this gap by integrating energy expenditure data derived from wearable tri-axial accelerometers with time-use data from conventional recall-based surveys. Using datasets from agricultural households in four rural communities in India and Nepal, our results show that there are significant gender differences in the patterns of time-use and energy expenditure. Men and women participate equally in productive work, however, women shoulder most of the additional reproductive work burdens in rural households at the expense of leisure opportunities. Our results provide insights into women’s responses to opportunities for productive work and highlight the nature of trade-offs they face.

INTRODUCTION Radiation necrosis (RN) occurs in 9–14% of patients after stereotactic radiosurgery (SRS) for brain metastases (BM). Medical management (MM) with steroids is a common first-line therapy, with variable response and numerous side effects, especially regarding immunotherapy. Laser interstitial thermal therapy (LITT) has been introduced as an efficacious, steroid-reducing alternative, however limited data exists comparing LITT to MM. METHODS Patients with biopsy-proven RN after SRS for BM who received LITT or MM at two academic centers were retrospectively reviewed. Treatment failure was defined as radiographic progression that necessitated a change in management. Measurements of total (TLV) and contrast-enhancing lesion volume (ceLV) were obtained from MRI by semi-automated analysis using the BrainLab iPlan Cranial 3.0 software. RESULTS Eighty-one patients were followed for 11.7 (4.3–27.0) months and 57 (70%) received LITT. Steroid cessation occurred at a median of 37 days post-LITT compared to 162 days after MM (p< 0.01). Treatment failure occurred in 5% of LITT patients at 4.0 (3.2–4.8) months and 13% of MM patients at 4.4 (4.1–5.3) months (p >0.05). Patients were 3.2 times more likely to be weaned off steroids when treated with LITT compared to MM (p< 0.01), when controlled for age, pre-operative ceLV, and post-operative seizure on multivariate analysis. Both groups demonstrated decreasing TLV and ceLV between baseline and last follow-up MRI. At 6–9 months, the LITT cohort demonstrated a -59% change in ceLV compared to -7% with MM (p >0.05). The LITT cohort demonstrated a significant decrease in ceLV between scans at 0–2 and 6–9 months (p< 0.01). The MM group did not demonstrate a statistically significant decrease in ceLV until 12 months. CONCLUSION This study suggests that LITT for RN significantly reduces the time to steroid cessation, and earlier radiographic response to treatment by LITT. Large, prospective trials are needed to validate these findings.

The authors would like to acknowledge the Biotechnology and Biological Sciences Research Council (BBSRC) and Mars Wrigley Confectionery for their financial support on a collaborative Global Challenges Research Fund (GCRF) project entitled “Development of novel value chain from cocoa pod husks in Indonesia: Technological, environmental and socio-economic challenges of a value chain” (BB/P022995/1). The uptake of innovative technologies and practices in agriculture aimed at the valorisation of natural resources can be scant in Low and Middle Income Countries (LMICs). Integration of financial viability assessments with farmers and environmental evaluations can help to understand some aspects of the low uptakes of innovations. Using the case study of Cocoa Pod Husk (CPH) valorisation in Indonesia, we provide insights into (i) a choice modelling method to assess the economic viability of CPH valorisation and (ii) an agronomic trial assessing the consequences on soil quality of diverting CPH from its role as a natural fertilizer. The economic viability assessment suggested that farmers require higher levels of compensation than might be expected to collect or process CPH (a small proportion of farmers would undertake all processing activities for 117 GBP/t CPH). The agronomic trial concluded that CPH plays only a minor role in the maintenance of soil phosphorus, calcium and magnesium, but it plays an important role for crop potassium. CPH removal would reduce the partial balances for carbon and nitrogen by 15.6% and 19.6%, respectively. Diversion of CPH from current practices should consider the long-term effects on soil quality, especially because it might create increased reliance on mineral fertilizers. Publisher PDF

The International Telecommunication Union (ITU) is currently deliberating on the finalization of candidate radio interface technologies (RITs) for IMT-2020 (International Mobile Telecommunications) suitability. The candidate technologies are currently being evaluated and after a couple of ITU-Radiocommunication sector (ITU-R) working party (WP) meetings, they will become official. Although, products based on the candidate technology from 3GPP (5G new radio (NR)) is already commercial in several operator networks, the ITU is yet to officially declare it as IMT-2020 qualified. Along with evaluation of the 3GPP 5G NR specifications, our group has evaluated many other proponent technologies. 3GPP entire specifications were examined and evaluated through simulation using Matlab and using own developed simulator which is based on the Go-language. The simulator can evaluate complete 5G NR performance using the IMT-2020 evaluation framework. In this work, we are presenting latency parameters which has shown some minor differences from the 3GPP report. Especially, for time division duplexing (TDD) mode of operation, the differences are observed. It might be possible that the differences are due to assumptions made outside the scope of the evaluation. However, we considered the worst case parameter. Although, the report is submitted to ITU but it is also important for the research community to understand why the differences and what were the assumptions in scenario for which differences are observed., Accepted in 2020 IEEE 3rd 5G World Forum (WF-5G) Conference

Cognitive decline is common among patients with low- and high-grade glioma and can significantly impact quality of life. Although cognitive outcomes have been studied after therapeutic interventions such as surgery and radiation, it is important to understand the impact of the disease process itself prior to any interventions. Neurocognitive domains of interest in this disease context include intellectual function and premorbid ability, executive function, learning and memory, attention, language function, processing speed, visuospatial function, motor function, and emotional function. Here, we review oncologic factors associated with more neurocognitive impairment, key neurocognitive tasks relevant to glioma patient assessment, as well as the relevance of the human neural connectome in understanding cognitive dysfunction in glioma patients. A contextual understanding of glioma-functional network disruption and its impact on cognition is critical in the surgical management of eloquent area tumors.

The rise of immunotherapy (IT) in oncological treatment has greatly improved outcomes in a number of disease states. However, its use in tumors of the central nervous system (CNS) remains limited for multiple reasons related to the unique immunologic tumor microenvironment. As such, it is valuable to consider the intersection of IT with additional treatment methods that may improve access to the CNS and effectiveness of existing IT modalities. One such combination is the pairing of IT with localized hyperthermia (HT) generated through technologies such as laser interstitial thermal therapy (LITT). The wide-ranging immunomodulatory effects of localized and whole-body HT have been investigated for some time. Hyperthermia has demonstrated immunostimulatory effects at the level of tumor cells, immune cells, and the broader environment governing potential immune surveillance. A thorough understanding of these effects as well as the current and upcoming investigations of such in combination with IT is important in considering the future directions of neuro-oncology.

Skin cancer is a highly contagious disease that spreads over the human body very rapidly within a short period of time. Skin cancer and rashes may seem to be similar to each other in the eyes of a dermatologist so it is not easy to determine whether the skin is affected by rashes or skin cancer. Rashes are generic terms used by people and doctors to denote the changes in the skin such as skin infections, skin allergies, skin diseases. Dermatologist identifies skin cancer from rashes when skin does not heal over medication for a prolonged period of time and continues to spread rapidly to other parts of the skin meanwhile knowing the differences between rashes and skin cancer can help a person seek the necessary help or avoid anxiety about a noncancerous rash. The objective of the paper is to differentiate skin cancer from rashes and helps in detecting skin cancer in human skin. Pervious researches were successful in classifying the skin cancer types using image classification and this modal detects and differentiates skin cancer images from rashes images by using CNN[Convolutional neural network] and classify the images as skin cancer or rashes. The model is able to classify the image as skin cancer affected image or rashes image and obtained an average accuracy of 80.2% for 20 epochs.

The cerebellum was long perceived to be a region of limited importance with primary functions in the regulation of motor control. A degree of its functional topography in motor modulation has been traditionally appreciated. However, an evolving body of evidence supports its role in a range of cognitive processes, including executive decision making, language, emotional processing, and working memory. To this end, numerous studies of cerebellar stroke syndromes as well as investigations with functional magnetic resonance imaging and diffusion tensor imaging have given clinicians a better model of the functional topography within the cerebellum and the essential lanes of communication with the cerebrum. With this deeper understanding, neurosurgeons should integrate these domains into the perioperative evaluation and postoperative rehabilitation of patients with cerebellar tumors. This review aims to discuss these understandings and identify valuable tools for implementation into clinical practice.

Biosensors are emerging as efficient (sensitive and selective) and affordable analytical diagnostic tools for early-stage disease detection, as required for personalized health wellness management. Low-level detection of a targeted disease biomarker (pM level) has emerged extremely useful to evaluate the progression of disease under therapy. Such collected bioinformatics and its multi-aspects-oriented analytics is in demand to explore the effectiveness of prescribed treatment, optimize therapy, and correlate biomarker level with disease pathogenesis. Owing to nanotechnology-enabled advancements in sensing unit fabrication, device integration, interfacing, packaging, and sensing performance at point-of-care (POC) made diagnostics according to the requirements of disease management and patient disease profile i.e., in a personalized manner. Efforts are continuously being made to promote state of art biosensing technology as a next-generation non-invasive disease diagnostics methodology. Keeping this in view, this progressive opinion article describes personalized health care management related analytical tools which provide access to better health for everyone, overall to manage healthy tomorrow timely. Considering accomplishments and predictions, such affordable intelligent diagnostics tools are urgently required to manage COVID-19 pandemic, a life-threatening respiratory infectious disease, where a rapid, selective and sensitive detection of human beta severe acute respiratory system coronavirus (SARS-COoV-2) protein is the key factor., Graphical abstract Image 1, Highlights • Investigating efficient and effective novel diagnostic biosensor is in demand. • These miniaturized nano-enabled sensors are suitable for POC diagnostics. • Smartphone assisted POC diagnostics is making personalized diagnostics possible. • AI is managing bioinformatics and big data analytics to optimize personalized wellness. • AI supported IoT-based diagnostics is emerging for targeted disease management. • AI and IoT assisted POC diagnostics are needed for COVID-19 pandemic management.

Building energy simulation programs are used for optimal sizing of building systems to reduce excessive energy wastage. Such programs employ thermo-dynamic algorithms to estimate every aspect of the target building with a certain level of accuracy. Currently, almost all building simulation tools capture static features of a building including the envelope, geometry, and Heating, Ventilation, and Air Conditioning (HVAC) systems, etc. However, building performance also relies on dynamic features such as occupants&rsquo, interactions with the building. Such interactions have not been fully implemented in building energy simulation tools, which potentially influences the comprehensiveness and accuracy of estimations. This paper discusses an information exchange mechanism via coupling of EnergyPlus&trade, a building energy simulation engine and PMFServ, an occupant behavior modeling tool, to alleviate this issue. The simulation process is conducted in Building Controls Virtual Testbed (BCVTB), a virtual simulation coupling tool that connects the two separate simulation engines on a time-step basis. This approach adds a critical dimension to the traditional building energy simulation programs to seamlessly integrate occupants&rsquo, interactions with building components to improve the modeling capability, thereby improving building performance evaluation. The results analysis of this paper reveals a need to consider metrics that measure different types of comfort for building occupants.

Interstitial lung disease with nephrotic syndrome and junctional epidermolysis bullosa is caused by biallelic mutations in the integrin gene ITGA3 and is associated with death in infancy. We describe a variant of this syndrome with delayed presentation of symptoms and prolonged survival.