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OBJECTIVES: To study the prevalence, evolution, and clinical factors associated with acute kidney injury in children admitted to PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. DESIGN: Multicenter observational study. SETTING: Fifteen PICUs across the United Kingdom. PATIENTS: Patients admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 between March 14, 2020, and May 20, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Deidentified data collected as part of routine clinical care were analyzed. All children were diagnosed and staged for acute kidney injury based on the level of serum creatinine above the upper limit of reference interval values according to published guidance. Severe acute kidney injury was defined as stage 2/3 acute kidney injury. Uni- and multivariable analyses were performed to study the association between demographic data, clinical features, markers of inflammation and cardiac injury, and severe acute kidney injury. Over the study period, 116 patients with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 were admitted to 15 United Kingdom PICUs. Any-stage acute kidney injury occurred in 48 of 116 patients (41.4%) and severe acute kidney injury in 32 of 116 (27.6%) patients, which was mostly evident at admission (24/32, 75%). In univariable analysis, body mass index, hyperferritinemia, high C-reactive protein, Pediatric Index of Mortality 3 score, vasoactive medication, and invasive mechanical ventilation were associated with severe acute kidney injury. In multivariable logistic regression, hyperferritinemia was associated with severe acute kidney injury (compared with nonsevere acute kidney injury; adjusted odds ratio 1.04; 95% CI, 1.01-1.08; p = 0.04). Severe acute kidney injury was associated with longer PICU stay (median 5 days [interquartile range, 4-7 d] vs 3 days [interquartile range, 1.5-5 d]; p < 0.001) and increased duration of invasive mechanical ventilation (median 4 days [interquartile range, 2-6 d] vs 2 days [interquartile range, 1-3 d]; p = 0.04). CONCLUSIONS: Severe acute kidney injury occurred in just over a quarter of children admitted to United Kingdom PICUs with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. Hyperferritinemia was significantly associated with severe acute kidney injury. Severe acute kidney injury was associated with increased duration of stay and ventilation. Although short-term outcomes for acute kidney injury in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 appear good, long-term outcomes are unknown.

Ovarian germ cell tumors are rare tumors, mainly diagnosed in young females with a good prognosis if presented earlier. The objective of this study was to evaluate the clinicopathological features, treatment and outcome of the malignant ovarian germ cell tumors. We retrospectively reviewed 37 patients of malignant ovarian germ cell tumors registered at the Department of Radiation Oncology All India Institute of Medical Sciences (AIIMS), Patna, from August 2014 to September 2019, and analyzed their demographic profile, treatment, outcome and survival. The median age at presentation was 15 years with a median duration of symptoms of 18 weeks. Abdominal pain and abdominal pain with lump were the main presenting symptoms of 45.9% and 45.9%, respectively. The median pre-chemotherapy value of AFP was 286 ng/ml, βHCG was 8.2 mIU/ml, and LDH was 470 U/L. Fertility-preserving surgery was done in 64.9% of cases. 35.1%, 21.6%, 29.7% and 13.5% cases were in stage I, stage II, stage III and stage IV, respectively. Adjuvant systemic chemotherapy was indicated in 94.6%, and chemotherapy was not indicated in 5.4% of patients. Non-dysgerminoma was the most common histopathological type (67.7%) followed by mixed germ cell tumors and dysgerminoma in 18.9% and 13.5%, respectively. The mean follow-up duration was 40 months, 32.4% of patients developed recurrence, and mean time to recurrence was 25 months. Malignant ovarian germ cell tumor is a treatable disease, and selected patients may be managed with fertility-preserving surgery. It was observed in this study that malignant ovarian germ cell tumors have a good prognosis.

In 2018, the government commissioned four paediatric and five adult airborne high consequence infectious diseases (HCID) units in preparation for the emergence of a new airborne viral infection in the UK. St Mary’s Hospital (Imperial College Healthcare NHS Trust), London was one of the paediatric centres, partnered with the Royal Free Hospital for adults. St Mary’s was ideally placed to look after children with possible airborne HCID, with a newly designed and built suite of HCID rooms and an expert and collaborative group of paediatric intensivists and infectious diseases consultants. It was exciting to prepare for these eventualities, which felt unlikely as we focused instead on Brexit and the environment. In retrospect, I am ashamed of thinking that this would be exciting, as we now live through a pandemic whose proportions go well beyond my wildest nightmare. In mid-January 2020, all trusts in England were contacted by the chief medical officer with advice about ‘Wuhan Novel Coronavirus’, later named SARS-CoV-2. The four key principles were to identify possible cases as soon as possible, isolate to prevent transmission to other patients and staff, avoid direct physical contact unless wearing appropriate personal protective equipment, and get specialist advice from a local microbiologist, virologist or infectious disease physician at your local trust. At this time, there were 10 confirmed cases outside of China and none in Europe. Locally, preparations were underway both at a trust level and locally within paediatrics. Together with the site team, adequate supplies of personal protective equipment (PPE) were identified and training exercises prepared for immediate response teams in donning and doffing protocols. A programme for ‘fit-testing’ all staff members for FFP3 respiratory masks was initiated. Algorithms for management of suspected cases presenting to all areas of the trust, including adult and paediatric A+E, ambulatory care and maternity services, …

Teratomas are nonseminomatous germ cell tumors composed of elements derived from more than one germinal layers (endoderm, mesoderm, and ectoderm). Malignant transformation of teratoma in the testis is well known; however, benign somatic neoplasm arising in a testicular teratoma is a rare occurrence. We report a case of meningothelial variant of meningioma arising in a pure and mature teratoma of the testis in a 5-year-old boy. Immunohistochemistry was positive for epithelial membrane antigen and vimentin. To our knowledge, this is the first report of meningothelial meningioma in a prepubertal testicular teratoma.

The rapidly growing body of research on the effect of emotional expressions in negotiation has been the subject of several narrative reviews. Through meta-analysis, we combine relevant findings, compare and integrate moderators, and examine the mediating mechanisms quantitatively. The analysis incorporates 64 published and unpublished studies conducted over three decades. The findings suggest that, generally, negotiators expressing negative emotions will increase counterparts’ concession-making, which presumably enables them to claim more individual value. Expressing negative emotions diminishes trust and other subjective outcomes. Relationships between negative emotions and negotiation outcomes are moderated by factors that are both theoretical (i.e., power, culture, emotion regulation) and methodological (i.e., characteristics of research design, phases of negotiation). Additionally, we tested theoretical frameworks from Emotions as Social Information theory, which describes the processes through which negative emotions influence negotiation outcomes. The effects for concessions are mediated by inference of limits, inference of toughness, and affective reactions. The effect of negative emotions on individual outcomes is mediated by complementary affective reactions. Based on the existing body of work, we make specific calls for further research. Refereed/Peer-reviewed

This article applies a quantitative analysis of gender diversity variables to custom data sets of 2011 and 2016 Australian Bureau of Statistics Census data for Film, TV and Radio employment. Prima facie, employment figures across a whole sector or employment segment can appear to be broadly representative of the Australian population, but looking more closely, it becomes apparent that the 'devil is in the level'. Although there is often parity at the macro level, drilling down into specific roles and their differential levels of seniority and power reveals inequalities between those in key and more secure gatekeeping positions and those further down the organisational hierarchy. Focusing on gender, this article will argue that the lack of diversity at senior levels of employment is a key contributing factor to lack of diversity within cultural and creative industries, reinforcing power imbalances and social and economic inequity. Refereed/Peer-reviewed

Background: Clinicians observed a cluster of children with unexplained inflammation requiring admission to United Kingdom (UK) paediatric intensive care units (PICUs) in April 2020. Despite multiple guidelines, which treatments are effective in Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) is unknown. Methods: Multicentre observational study of children (

Today, artificial intelligence and deep learning techniques constitute a prominent part in the area of medical sciences. These techniques help doctors detect diseases early and reduce their burden as well as chances of errors. However, experiments based on deep learning techniques require large and well-annotated dataset. This paper introduces a novel dataset of 500 peripheral blood smear images, containing normal, Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia images. The dataset comprises almost 1700 cancerous blood cells. The size of the dataset is increased by adding images of a publicly available dataset and forming a heterogeneous dataset. The heterogeneous dataset is used for the automated binary classification task, which is one of the major tasks of the proposed work. The proposed work perform binary as well as three-class classification tasks involving state-of-the-art techniques based on machine learning and deep learning. For binary classification, the proposed work achieved an accuracy of 97 % when fully connected layers along with the last three convolutional layers of VGG 16 are fine tuned and 98 % for DenseNet 121 along with support vector machine. For three-class classification task, an accuracy of 95 % is obtained for ResNet 50 along with support vector machine. The preparation of the novel dataset is done under the opinion of various expertise that will help the scientific community for medical research supported by machine learning models.

Introduction: Secondary thrombocytosis has been identified in many solid tumors including ovarian carcinoma and has a poor prognostic value in many cases. Platelets and Platelet-related factors may contribute to metastasis, invasion and primary tumor growth. Objective: The objective of the present study is to determine the incidence of thrombocytosis in ovarian carcinoma and its importance as a poor prognosticator. Materials and methods: One sixty cases of epithelial ovarian tumors were studied prospectively between the period of October 2010 to June 2012 in the Department of Pathology, Kasturba Medical College Mangalore. Other causes of secondary thrombocytosis were excluded from the study. All the data for all the cases were obtained and were statistically analysed by Chi-square test and Fisher’s exact test .Results: One sixty cases were studied in the present study. Mean age in the present study was 43.64 years and the mean age of patients with malignancy was 53.18 years. Majority of the cases were benign (64.3%), followed by malignant (31.3%) and borderline tumors (4.4%). Mean platelet count in the study was 321x109 /L, and 80% of malignant cases had thrombocytosis as compared to 42.9% of borderline cases and 5.8% of benign cases, which is highly significant (p=0.0001).Predominant cases of ovarian carcinomas were in stage III (80%) followed by stage IV (17.5%) and stage II (2.5%). Conclusion: Pre-operative secondary thrombocytosis is a frequent finding in ovarian carcinoma and is significantly associated withadvanced FIGO stage. The presence of thrombocytosis acts as a poor prognosticator in epithelial ovarian carcinoma.

Objectives: Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category. Material and Methods: A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology. Results: The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively. Conclusion: FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.

Hypercoagulable and proinflammatory states induced by the novel coronavirus (SARS-CoV-2) lead to thrombotic and embolic events. In this case report, the authors describe how they successfully managed acute critical limb ischaemia in a patient of COVID-19 illness with severe pulmonary disease and high thrombus burden in the infrapopliteal arteries.

Inflammatory myofibroblastic tumour (IMT) of ovary is an uncommon benign neoplasm that can mimic malignancy. It often occurs in children and young adults. Lung is the most common site of IMT. Precise etiology is not known but recent reports suggested the role of benign reactive process in its pathogenesis. A 32 year old female patient presented to the gynaecology out patient department with complaints of lower abdominal pain and increased frequency of micturition with burning since 15 days. On per abdominal examination, an irregular lump of 18 weeks size with restricted mobility was palpable in suprapubic region. Laboratoratory investigations revealed normocytic normochromic anaemia with neutophilic leucocytosis and raised ESR. Her serum CA 125 levels were slightly raised (44.30 u/ml). Imaging studies showed an infiltrating mass in the pelvis. The patient underwent total abdominal hysterectomy with bilateral salpingo oopherectomy and omentectomy. Histopathological examination of which revealed IMT of right ovary with extension to right parametrium and adjacent bladder. As IMT is a mimicker of malignancy due to its infiltrative growth. Histopathological examination is mandatory for its diagnosis and treatment. Misdiagnosis can lead to unnecessary extensive debulking surgeries and even chemotherapy. Rarity of this entity in the ovary has made this case worth reporting. DOI: 10.21276/APALM.1285

IntroductionMedication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.ObjectivesTo describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contributory role of individual process step discrepancies to these errors.MethodsWe conducted a prospective observational study of simulated resuscitations subject to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios.ResultsAt least one medication error was observed in every simulated case, and a large magnitude or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration.ConclusionsMedication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.Strengths and limitations of this studyThis study is one of the first to use HRA methods to link task discrepancies with resultant medication errors, as well as to link these discrepancies directly to potential harm. This effort has demonstrated that a significant fraction of the burden of error in the paediatric emergency drug administration process originates during the preparation and administration phase and that most of these errors are likely to be undetected in clinical practice.This study was subject to a number of limitations. Although we went to considerable lengths to replicate the paediatric emergency environment, the simulation environment cannot truly reflect the clinical environment during a genuine emergency.Furthermore, this study was conducted at a single site and participants were not blinded to the purpose of the study, so it is potentially subject to preparation bias.Participants were recruited from the paediatric emergency unit, intensive care unit and general paediatrics ward and had variable experience of emergency cases. However, all participants worked in clinical units that manage critically ill children.

Criminal Justice Social Work in India has existed for over seven decades, yet it has remained a limited and neglected subject area with a narrow client group. The narrow client group consists of offenders that are within the criminal justice system and crime prevention. Criminal Justice Social Work has failed to evolve into a more sophisticated and analytical field. This article illustrates the progressive withdrawal of social work from the arena of criminal justice because of its submission to a narrow conceptualisation of criminal justice social work. This article further discusses on the essential curricula requirements for developing a robust program for Criminal Justice Social Work and concludes with the premise that while many challenges face Criminal Justice Social Work, with the re-emergence of the neo-liberal state, it is one of the most relevant fields of practice for marginalised and vulnerable persons.

Introduction: Adnexal masses are a common diagnosis in Gynaecology out-patient department. It can be benign or malignant. To arrive on a diagnosis, patient should be subjected to clinical examination and a variety of investigations. Management is tailored according to the diagnosis, age of the patient and the reproductive goal of the patient in future. Aim: To evaluate the proportion of benign and malignant aetiology in patients presented with adnexal mass and secondarily to correlate preoperative diagnosis with the histopathological diagnosis. Materials and Methods: A prospective observational study was conducted, where patients with adnexal masse presented during one year were included. After work-up for all the patients, appropriate case based management was done. Clinical diagnosis of benign or malignant as pre-operative was co-related with histo-pathology and proportion of benign and malignant cases were noted. Results: Total 81 cases with the diagnosis of adnexal mass were included in the study. Mean age of presentation was 36.26 years. Most common presentation was pain in abdomen; 70 (86.4%) patients had benign masses, while 11 (13.6%) masses were malignant including two cases of borderline variety. Both patients underwent exploratory laparotomy with peritoneal lavage with total abdominal hysterectomy with bilateral salpingo-oophorectomy with infracolicomentectomy. Conclusion: All Adnexal masses need to be evaluated clinically and radiologically. All investigations should aim at to differentiate benign and malignant masses. Preoperative diagnosis of benign or malignant mass is very important to plan optimum management of the case.

Introduction: Leprosy also known as Hansen’s disease is one of the oldest disease known to mankind. It is a chronic infectious disease caused by Mycobacterium leprae. It still remains as a major public health problem facing India. Nearly, 60% of all world leprosy cases are reported from India. The spectrum of presentation of leprosy is very wide. Histopathology is an important tool in making a definitive diagnosis. The objective of the study is to describe the histopathological profile of leprosy in the state of Bihar. Aim: To study the histopathological spectrum of leprosy at a tertiary care centre of Bihar. Materials and Methods: A retrospective hospital-based study of clinically diagnosed leprosy cases was conducted over a period of 28 months (January 2015 to April 2017). Lesional skin biopsies obtained were fixed, processed and stained with Haematoxylin and Eosin (H&E) followed by Ziehl-Neelsen (ZN) staining. The lesions were classified on microscopy as per Ridley-Jopling classification. Results: A total of 200 cases were studied. Highest incidence was in the 11 to 30 years age group for both males and females. Males were more affected (M:F=2.4:1). Most common clinical feature was loss of sensation. The commonest reported histopathological type was borderline lepromatous (43%) followed by borderline (17%). Overall ZN staining was positive in 56 (28%) cases. Conclusion: The spectrum of presentation of leprosy is very wide and there is clinical overlap between different types of leprosy. Histopathology still remains the gold standard for early diagnosis and classification of the disease. Accurate diagnosis forms the backbone for appropriate treatment and preventing deformities and drug resistance.

Endometrial ossification is a rare occurrence seen in reproductive age group. Patients usually present with complaints of menorrhagia and secondary infertility. We report a case of endometrial ossification in a 28-year-old female who presented with abdominal pain and menorrhagia. On transvaginal ultrasonography, a hyperechoic area within the uterine cavity, suggestive of an intrauterine foreign body was noted. Histopathological examination of the endometrial curettage showed bony spicules with chronic inflammatory cell infiltration. Key words: Bony, Endometrial, Infertiltiy, Menorrhagia, Ossification, Spicules

Endometrial stromal sarcoma with sex cord differentiation is a very unusual neoplasm affecting the uterine cavity with an incidence of only 0.25%. They can cause difficulties in diagnosis due to it is histologic appearance and rarity of occurrence. Histopathological diagnosis still remains the cornerstone of diagnosis. Immunohistochemistry and molecular studies are also very helpful. We report a case of a 47-year-old patient who was diagnosed clinically and radiologically as intramural leiomyoma, but on histopathology examination and immunohistochemically proved to be endometrial stromal sarcoma with sex cord differentiation.

Task conflict has been the subject of a long-standing debate in the literature - when does task conflict help or hurt team performance? We propose that this debate can be resolved by taking a more precise view of how task conflicts are perceived in teams. Specifically, we propose that in teams, when a few team members perceive a high level of task disagreement while a majority of others perceive low levels of task disagreement - that is, there is positively skewed task conflict, task conflict is most likely to live up to its purported benefits for team performance. In our first study of student teams engaged in a business decision game, we find support for the positive relationship between skewed task conflict and team performance. In our second field study of teams in a financial corporation, we find that the relationship between positively skewed task conflict and supervisor ratings of team performance is mediated by reflective communication within the team. Refereed/Peer-reviewed

Voice is critical to organizational success as it helps in the development of new ideas and the solving of problems. Due to its purported benefits, much research over the past two decades has focus...

The session includes four research presentations that address the role of personality, gender, and other individual differences in negotiation and conflict contexts. The papers adopt different yet ...

Background: Cancer of the uterine cervix is the second most common cancer among women world-wide and accounts for 17% of all cancer deaths among females aged 30-69 years in India. Locally advanced cervical cancer is rampant in Bihar because of the high prevalence of associated risk factors. However, there is lack of organized screening programmes and treatment facilities for these patients. Thus, the study aimed at screening women for cervical cancer opportunistically during their visit to the health centres and to assess the various socio-demographic and other risk factors associated with positive screening test results.Methods: Using purposive sampling technique, all women aged 18-59 years who visited the centre for any purpose were interviewed using a pre-designed questionnaire. All eligible women were screened using the conventional Pap Smear and evaluation was done using the 2014 Bethesda system. This study is still underway and 71 women have been screened so far. An interim analysis was done.Results: Only 4.23% of the women ever had Pap smear testing in their life earlier. Mean age was 35.3±9.12 years and majority of the women were married and multi-parous. Vaginal discharge (55.74%) was the most common perceived gynecological morbidity. Most (36.62%) smears were reported as inflammatory cervical smears while epithelial cell abnormalities were seen in 4 (5.63%) cases.Conclusions: This study reiterates the need to start organized cervical screening program not only at tertiary center but also at primary health centers which will definitely help to reduce the burden to some extent

This article reports the case of a 40 year old woman who presented to the gynaecologic outpatient clinic with pain lower abdomen and an abdominopelvic lump. Clinical assessment, biochemical and radiological investigations revealed bilateral complex ovarian masses. Surgical exploration and histology of ovarian masses confirmed a rare bilateral borderline seromucinous cystadenoma. The purpose of this paper is to highlight the importance of thorough examination of women with symptoms of ovarian tumour which can be vague and to emphasize the necessity of a good collaboration between various medical specialties (primary physician/gynaecologist, oncosurgeon, radiologist and histopathologist) for correct diagnosis, optimum care and best outcome. This article also provides overview of the pathology and biology of borderline ovarian tumours, diagnosis, principles of surgical management and to appreciate the value of follow up.

Gout is a metabolic disease that occurs either because of increased uric acid production or decreased uric acid secretion. It most commonly affects middle-aged to elderly men and postmenopausal women. Chronic tophaceous gout frequently occurs after 10 years or more of recurrent polyarticular gout. Gouty tophi are deposition of monosodium urate (MSU) crystals in and around joints as well as soft tissues. We present a case of chronic tophaceous gout in a 21-year-old male, which occurred after 4 years of onset of gouty arthritis. The patient presented with tophaceous gout in four forms, that is, periarticular subcutaneous tophi, disseminated intradermal tophi, ulcerative form, and miliarial tophi along with multiple sinuses discharging chalky white material. The case was diagnosed as chronic tophaceous gout on the basis of raised serum uric acid, imprint smear showing needle-shaped crystals and negatively birefringent crystals on polarized microscopy. The case is interesting for varied morphological forms of tophaceous gout in a patient at an early age and shorter interval between onset of gouty arthritis and tophaceous gout.

Problem Decline in myeloid-derived suppressor cells (MDSCs) and Th2 cytokines levels lead to early miscarriage (EM) but how the hormonal milieu of the body regulates MDSCs and Th1/Th2 cytokine balance is still a matter of investigation. Method of study Peripheral blood and decidua samples were collected from 20 EM patients, and 20 healthy pregnant women opted for elective abortion. MDSCs and G-MDSCs levels were analyzed in peripheral blood mononuclear cells, and Th1/Th2 cytokines levels were determined in serum via flow cytometry. Estrogen (E2), Progesterone (P4), and Testosterone levels were measured via ELISA. Further, proliferation and apoptosis in decidual samples were checked via immunoblot/immunohistochemistry of estrogen receptor -α (ER-α), STAT-3/pSTAT-3, and caspase-3, respectively. Results Our results clearly indicate that in EM patients; decline in E2 and P4 significantly correlates with decline in MDSCs, particularly with subtype granulocytic MDSCs (G-MDSCs) and skewness of the Th1/Th2 cytokines balance toward Th1 response. Downregulation of ER- α and increased caspase-3 expression in endometrium decidua signifies poor endometrial receptivity in EM. STAT-3 activation regulates proliferation, differentiation and suppressive potency of MDSCs. In decidua of EM, significantly lower expression of pSTAT-3 indicates that these processes pertaining to MDSCs are compromised. Conclusion Altogether, this unfavorable systemic milieu may drive toward early breakdown of maternal-fetal tolerance in EM. Therefore, regulated crosstalk of E2, P4 with MDSCs and balanced Th1/Th2 cytokines is prerequisite for successful pregnancy.

Voice, or the expression of work-related suggestions or opinions, can help teams access and utilize members' privately held knowledge and skills and improve collective outcomes. However, recent research has suggested that sometimes, rather than encourage positive outcomes for teams, voice from members can have detrimental consequences. Extending this research, we highlight why it is important to consider voice centralization within teams, or the extent to which voice is predominantly emanating from only a few members rather than equally spread across all members. We argue that, under certain circumstances, voice centralization is harmful to the utilization of members' expertise in the team and, thereby, to team performance. Specifically, we propose that voice centralization is likely to have negative effects when it occurs around members who are more socially dominant or are less reflective. We find support for our arguments in a sample of 78 teams (319 team members) working on graduate student projects in a business school over a semester. Overall, through our theory and results, we showcase why it is important for future studies to examine the distribution of voice among team members. (PsycINFO Database Record

We present a case of 20-year-old woman who presented with a large pedunculated skin covered mass lesion arising from the left thigh, measuring 40 × 25 cm, with no history of pain or skin ulceration and a feeling of a lump with dragging pain in the left side of the abdomen for about 7 years. Subsequently, ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging of abdomen and left thigh region were carried out. The lesion was broad-based toward the left upper thigh with a central core of interspersed fat supplied by branches of the superficial and deep femoral arteries. Another lesion was seen in the left retroperitoneum anterior to the psoas muscle in a left paravertebral location encasing the left common iliac vessels extending into the left pelvic cavity and inguinal region inferiorly. The lesion showed dense post-acoustic shadowing on ultrasound, mild enhancement on contrast-enhanced computed tomography, and appeared hypointense on T1- and T2-weighted images. A left thigh lesion was excised, whereas incisional biopsy was done for the left retroperitoneal lesion. The diagnosis of a giant fibroepithelial polyp arising from the left thigh and left retroperitoneal fibromatosis was made. This is the first report of such a giant fibroepithelial polyp arising from the thigh with associated retroperitoneal fibromatosis.

Background: Aim of current study was to determine whether the Sperm Penetration Assay (SPA) can be used as a test to discriminate the infertile male from fertile one. We have also correlated the SPA with semen analysis. Methods: Sperm characteristics namely Semen analysis and the sperm penetration assay were tested in 44 infertile and 10 fertile men. Sperm penetration assay was determined by using zona free hamster eggs. Results: With decreasing spermatozoa concentration in the semen there was significant decrease in percentage penetration of zona free Hamster eggs (p 0.05). Conclusions: The Sperm penetration assay could discriminate the infertile group from fertile group significantly (p

The act of reviewing is the backbone of the academic enterprise as it ensures high-quality outputs. A number of scholars in the early stages of their academic career find themselves in reviewer pos...

An 18-year-old man presented with complaint of large size lump of 22×18×10 cm in the left axilla for >4 years duration. He also had complaint of restricted movement of left upper limb at shoulder joint. His upper limb was always in the abducted position for last 9 months because of large size of

BackgroundMedication is the most prevalent therapeutic intervention in patient management.1 Medication errors are incidents that have occurred in the medication cycle of prescribing, dispensing, administering, monitoring, or providing medicines advice, regardless of whether they caused harm.1 In a hospital setting, medication error rates are similar amongst adults and children but there is three times the potential to cause harm in the latter. Due to the complexities that are associated with prescribing for children and the potential for the lack of necessary metabolic reserves to buffer any consequences,2 ensuring high quality prescribing in paediatrics is paramount and this requires multidisciplinary team (MDT) collaboration. Pharmacy contributions: The introduction of weekly Safety Huddles was started on the Paediatric Intensive Care Unit (PICU) in March 2017 – led by the PICU consultant, paediatric risk nurse and pharmacist. Safety Huddles are short MDT briefings, involving the ward-based medical, nursing & pharmacy teams, providing a platform for all staff to understand things that are happening within the ward and anticipate further risks to improve patient safety and care. The aim is to create an open environment where staff regularly communicate and feel safe to raise concerns about patient safety. The Safety Huddle comprises of three main aspects: pharmacy updates as ‘top tips’; Datix incident reports and issues/concerns of the week. Pharmacy interventions are collected on a daily basis and fed back to the individual prescriber immediately where possible as the exchange of information must be rapid to optimise engagement. These then form the weekly ‘top tips’ which are shared with the whole MDT, along with Datix reports and any particular concerns where learning and action points are developed and agreed through contribution by all.OutcomeThe concept of Safety Huddles has been adapted and fully established throughout all paediatric and neonatal specialities at the Trust. There has been an increase in the number of incidents reported since the implementation of the Safety Huddles. Error themes and their impact are looked at so the team learn from improvement and harm occurrence or near misses. The measurement of interventions provides a weekly update to the individual team to see if these are being carried out effectively and to improve where necessary. It allows identification of triggers and incorporates problem solving through the involvement of all members of the team, improving staff, patient and family experience and communication in addition to reducing harm, allowing Trust values to be met. Lessons learned: Safety Huddles are held in the spirit of learning and improvement. It allows integration with the wider team, empowering the team to work unanimously towards the ultimate goal of delivering the best patient care.ReferencesDepartment of Health and Social Care. The Report of the Short Life Working Group on reducing medication- related harm. February 2018.Department of Health. Medicines Standard: National Service Framework for Children, Young People and Maternity Services. October 2004. Department of Health. Building a Safer NHS or Patients: Improving Medication Safety. January 2004.

Objectives To expose the rarity of the phenomena of congenital laryngeal cysts. Additionally, a discussion is presented in support of the basic similarities between laryngeal duplication cyst and bronchogenic cyst and a proposal to use the term ‘bronchogenic cyst’ (appended by the location) is put forth. Materials and methods Three cases of cysts of the larynx, two in the neonate and one, in a child were discovered in the pediatric age group from the archives of the Department of Pathology, Kasturba Medical College, Mangalore. Observations Laryngeal duplication cyst/bronchogenic cyst in a 6-day-old male infant was lined by predominantly respiratory with focal squamous epithelium. The wall contained fibromuscular bundles within a myxoid stroma studded with seromucinous glands. The fibromuscular bundles were positive for smooth muscle actin (SMA) and negative with desmin. A 3-year-old male child diagnosed of laryngocele had the cyst lined by respiratory epithelium and the wall densely infiltrated with lymphoid cells. A 20-day-old male neonate with laryngomalacia had a small arytenoid cyst lined by squamous epithelium. Conclusion On morphological grounds, a laryngeal duplication cyst may be called a bronchogenic cyst and published reports do not deny that both these entities are cognate. Hence, pathologists should enjoy the freedom to write ‘bronchogenic cyst’ as the final impression if the histological features should so indicate. Otolaryngologtists however might term the congenital cyst as Type 1, 2a or 2b (according to Forte's classification) taking into account the laryngoscopic, radiologic, intraoperative and pathological findings.

Data on the immunogenicity and memory induction of pneumococcal conjugate vaccines in very preterm infants is limited. We vaccinated 69 full term and 68 preterm infants (median gestational age (GA) 30 weeks) with a 7-valent pneumococcal conjugate vaccine (PCV7) at 2/3/4 months of age, followed by a plain polysaccharide booster at 12 months of age. IgG-GMC (ELISA) was significantly lower in preterm infants to six vaccine serotypes (ST) at 2 months and 5 months of age, to five ST at 12 months of age and to three ST at 13 months of age. A significantly lower proportion of preterm infants achieved IgG levels>or=0.35 microg/ml to ST 4, 6B and 9V at 5 months and to ST 4, 6B, 18C, 19F and 23F at 12 months of age. Fold rises following the polysaccharide booster were comparable to those of term infants. At least 93% of both cohorts achieved IgG>or=0.35 microg/ml to all STs following booster vaccination. Pneumococcal conjugate vaccine at an accelerated schedule of 2/3/4 months of age is likely to provide protection against pneumococcal disease for preterm infants. Antibody concentrations wane over the first year of life in both preterm and term infants and booster vaccination is therefore likely to be important.

Trust and liking are attitudes with important implications for automation reliance in single-advisor settings; however, the extent to which their relationships with reliance generalise to settings in which the user receives conflicting advice from a human and automation is unknown. Participants completed an X-ray screening task and received simultaneous advice from what they believed was another human and an automated aid. High disuse was found for both advisors. Among participants who relied on advice, those with greater relative liking for the automation than for the human significantly increased their reliance on the automation relative to the human during the first half of the task. No significant relationships were found between relative trust or relative liking with reliance in the later part of the task, suggesting that reliance processes in dual-advisor settings may differ from those in single-advisor settings. Refereed/Peer-reviewed

The article discusses the need for social work practice in police stations. The first part presents the current state of the Indian Criminal Justice System (CJS). The next section situates CJS within the mandate of a welfare state. The issues related to policing and corrections in the country precede the section elucidating the role of and challenges faced by a social worker in the police station. It suggests that Social Work practice within the CJS would facilitate a tactical shift in its approach to address the domain of civil and political rights. The article concludes that while there is need for a partnership between social workers and police, the divergent cultures and mandates of the two professions makes it difficult, even though both have a commitment to protection.

The study explores employees" perception of emotional after-effects of change prevalent in an organization. Data of 100, at middle level, was collected from business process outsourcing organization, based in India. The Cronbach"s alpha of the questionnaire was 0.797 & Pearson correlation was 0.896 (p

The current study examines how using a multidimensional battery of predictors (high-school grade point average (GPA), SAT/ACT, and biodata), and weighting the predictors based on the different values institutions place on various student performance dimensions (college GPA, organizational citizenship behaviors (OCBs), and behaviorally anchored rating scale (BARS)), can increase the proportion of some ethnic subgroups often disadvantaged by the use of only traditional measures such as the SAT/ACT. The sample consisted of 836 students from 10 universities across the United States. Results show that meaningfully different proportions of groups would be admitted to universities when the predictors included noncognitive measures and the weights for the various components in the battery were based on performance dimensions other than first-year GPA. These dimensions should reflect institutional values. Refereed/Peer-reviewed

Team power asymmetry, defined as formal power differences among team members, is a ubiquitous structural reality for teams in many organisations. Such power differences have the dual potential to both hurt and benefit team outcomes (Van der Vegt et al., 2010). Recent research suggests that the relationship between power asymmetry and learning behaviours in teams is complicated and likely contingent on contextual factors. We explore one such contingency factor of “Experienced Hardships” and show that team power asymmetry can, under certain circumstances, have a positive and generative effect of creating a sense of egalitarianism which thereby can promote team learning. We integrate theories of adversarial growth and sense breaking/making to specifically propose that teams with high power asymmetry are likely to develop a psychological sense of egalitarianism when they experience hardships, and this egalitarianism, in turn, promotes learning. We find support for our arguments in two field samples of teams. ...

Context: Dysplastic changes are well documented in myelodysplastic syndromes (MDS). However, they are also observed in non-MDS hematological conditions. Aims: To evaluate the megakaryocytic alterations in the bone marrow aspirations in cases of non-MDS related thrombocytopenia. Setting and Design: A prospective study of 144 bone marrow aspirates was conducted in the department of pathology, Kasturba Medical College, Mangalore. The aspirates were studied to assess the number and morphology of the megakaryocytes in non-MDS related thrombocytopenia and evaluate their significance when compared to changes in MDS. Materials and Methods: The bone marrow aspiration smears were stained with Leishman stain and examined under light microscope. Statistical Analysis Used: Fisher′s exact test. A P value less than 0.05 was considered significant. Sensitivity and specificity was calculated for those features which were significant in the relevant hematological disorders. Results: The sensitivity of immature megakaryocytes, dysplastic forms and micromegakaryocytes in cases of immune thrombocytopenic purpura was 100%, 89% and 42% respectively. The specificity of emperipolesis was 74%. In cases of infection-associated thrombocytopenia, immature megakaryocytes had a sensitivity of 100% and cytoplasmic vacuolization were 86% specific. The sensitivity of the dysplastic forms in megaloblastic anemia was 75%. However, no platelet budding was observed. The presence of micromegakaryocyte had a specificity of 83% in MDS, and was statistically significant when compared to cases of non-MDS conditions (P< 0.05). Conclusions: Careful understanding of the morphological changes of megakaryocytes in bone marrow aspirates can improve the diagnostic accuracy for a wide range of hematological disorders thereby enabling proper therapeutic interventions.

Data on the immunogenicity and memory induction of pneumococcal conjugate vaccines in very preterm infants is limited. We vaccinate 69 full term and 68 preterm infants (median gestational age (GA) 30 weeks) with a 7-valent pneumococcal conjugate vaccine (PCV7) at 2/3/4 months of age, followed by a plain polysaccharide booster at 12 months of age. IgG-GMC (ELISA) was significantly lower in preterm infants to six vaccine serotypes (ST) at 2 months and 5 months of age, to five ST at 12 months of age and to three ST at 13 months of age. A significantly lower proportion of preterm infants achieved IgG levels ≥ 0.35 μg/ml to ST 4, 6B and 9V at 5 months and to ST 4, 6B, 18C, 19F and 23F at 12 months of age. Fold rises following the polysaccharide booster were comparable to those of term infants. At least 93% of both cohorts achieved IgG ≥ 0.35 μg/ml to all STs following booster vaccination. Pneumococcal conjugate vaccine at an accelerated schedule of 2/3/4 months of age is likely to provide protection against pneumococcal disease for preterm infants. Antibody concentrations wane over the first year of life in both preterm and term infants and booster vaccination is therefore likely to be important.

This paper is presenting a model for a better prediction of long term job performance as seen by a Multinational Automotive Company from the West side of Romania. This study is discussing a human resources procedure on recruiting and selection assessment and its valid connection to the annual personnel performance evaluation individual scores. Does the hiring rating score can predict long term job performance? The answer to this question is yes, depending on what recruiting and selection assessment score is combined from. This study concludes that age, gender, professional expertise, background professional experience, level of numerical and verbal abilities and interview rating predict in a proper manner long term job performance. Even better, if we replace classical weighted scoring algorithm with a fuzzy expert system, it gives more accuracy to predicting long term job performance.