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IntroductionPotentially preventable deaths occur worldwide within healthcare organisations. Organisational learning from incidents is essential to improve quality of care. In England, inconsistencies in how NHS secondary care trusts reviewed, investigated and shared learning from deaths, resulted in the introduction of national guidance on ‘Learning from Deaths’ (LfDs) in 2017. This guidance provides a ‘framework for identifying, reporting, investigating and learning from deaths’. Amendments to NHS Quality Account regulations, legally require NHS trusts in England to report quantitative and qualitative information relating to patient deaths annually. The programme intended trusts would share this learning and take measurable action to prevent future deaths.MethodWe undertook qualitative and quantitative secondary data analysis of all NHS secondary care trust LfDs reports within their 2017/18 Quality Accounts, to review how organisations are using the LfDs programme to learn from and prevent, potentially preventable deaths.ResultsAll statutory elements of LfDs reporting were reported by 98 out of 222 (44%) trusts. The percentage of deaths judged more likely than not due to problems in healthcare was between 0% and 13%. The majority of trusts (89%) reported lessons learnt; the most common learning theme was poor communication. 106 out of 222 trusts (48%) have shared or plan to share the learning within their own organisation. The majority of trusts (86%) reported actions taken and 47% discussed or had a plan for assessment of impact. 37 out of 222 trusts (17%) mentioned involvement of bereaved families.ConclusionsThe wide variation in reporting demonstrates that some trusts have engaged fully with LfDs, while other trusts appear to have disengaged with the programme. This may reveal a disparity in organisational learning and patient safety culture which could result in inequity for bereaved families. Many themes identified from the LfD reports have previously been identified in national and international reports and inquiries. Further work is needed to strengthen the LfDs programme.

There is growing interest in the use of the filtered basis functions (FBF) approach to track linear systems, especially nonminimum phase (NMP) plants, because of the distinct advantages it presents as compared to other popular methods in the literature. The FBF approach expresses the control input to the plant as a linear combination of basis functions. The basis functions are forward filtered through the plant dynamics and the coefficients of the linear combination are selected such that the tracking error is minimized. This paper proposes a two-stage robust filtered basis functions approach for tracking control of linear systems in the presence of known uncertainty. In the first stage, the nominal model for filtering the basis functions is selected such that a Frobenius norm metric which considers the known uncertainty is minimized. In the second stage, an optimal set of basis functions is selected such that the effect of uncertainty is minimized for the nominal model selected in the first stage. Experiments on a 3D printer, demonstrate up to 7 times improvement in tracking performance using the proposed method as compared to the standard FBF approach.

The fundamental aim of this paper is to show a developed framework that can help the visually impaired for dealing with their daily life activities such as navigation, reading, color detection and currency detection using a cost-effective model. 285 million individuals are assessed to be outwardly disabled around the world: 39 million are visually impaired and 246 have low vision. About 90% of the worlds outwardly hindered live in low-salary settings. Most of those can’t travel freely. Minimum amount of work is done with respect to interior navigation in current solutions, called Electronic Orientation Aids (EOA), potentially because of high cost for instrumentation and constrained capacities. We will likely separate these boundaries by presenting a framework that is generally economical for both the visually impaired and the organizations that prepare their structures. Utilizing RFID labels to set up a location–tagging framework inside structures with the end goal that the visually impaired can utilize RFIDs to find out their area and also for navigational purposes. The whole framework is actualized by utilizing Raspberry Pi Microcontroller running in Universal Windows. Highlighting various technologies and methods with their effective usefulness, design and working challenges and requirements of blind people, we discuss how this cost-effective solution can serve a great help in this undeniably essential social area.

Socioeconomic deprivation is associated with health inequalities. We explored relationships between socioeconomic group and outcomes after elective surgery in the UK National Health Service (NHS).We combined data from two observational studies in 115 NHS hospitals and determined socioeconomic group using the Index of Multiple Deprivation (IMD) quintiles based on place of residence. Postoperative complications and 3-yr survival were assessed using logistic and Cox regression. Univariate analyses were adjusted for age differences between IMD quintiles. Multivariable analyses were used to account for other baseline risk factors including sex and comorbid disease. Results are reported as n (%), hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals.Postoperative complications developed in 971/9051 patients (10.7%) and 1597/9043 patients (17.7%) died within 3 yr. Complication rates increased with deprivation (reference group least-deprived IMD5): IMD1 (OR=1.44 [1.17-1.78]; P0.001), IMD2 (OR=1.38 [1.12-1.70]; P0.01), IMD3 (OR=1.09 [0.88-1.35]: P=0.44), IMD4 (OR=0.89 [0.71-1.11]; P=0.30). More patients from the most deprived quintile died (IMD1) (n=349, 18.8%) compared with the least deprived (IMD5) (n=297, 15.9%) with a trend across the socioeconomic spectrum (P=0.01). After age adjustment, patients in the most deprived areas experienced reduced 3-yr survival: IMD1 (HR=1.43 [1.23-1.67]; P0.0001), IMD2 (HR=1.35 [1.15-1.57]; P0.001), IMD3 (HR=1.04 [0.89-1.23]; P=0.60), and IMD4 (HR=1.11 [0.95-1.30]; P=0.19). This finding persisted in risk-adjusted analyses. Increased complication rates only partially explained this reduced survival.Socioeconomic deprivation is associated with worse long-term outcomes after elective surgery. This risk factor should be considered when planning perioperative care for patients from deprived areas.

Background The use of RNA-based next-generation sequencing (NGS) assays to detect gene fusions for targeted therapy has rapidly become an essential component of comprehensive molecular profiling. For cytology specimens, the cell block (CB) is most commonly used for fusion testing; however, insufficient cellularity and/or suboptimal RNA quality are often limiting factors. In the current study, the authors evaluated the factors affecting RNA fusion testing in cytology and the added value of smears in cases with a suboptimal or inadequate CB. Methods A 12-month retrospective review was performed to identify cytology cases that were evaluated by a targeted RNA-based NGS assay. Samples were sequenced by targeted amplicon-based NGS for 51 clinically relevant genes on a proprietary platform. Preanalytic factors and NGS quality parameters were correlated with the results of RNA fusion testing. Results The overall success rate of RNA fusion testing was 92%. Of the 146 cases successfully sequenced, 14% had a clinically relevant fusion detected. NGS testing success positively correlated with RNA yield (P = .03) but was independent of the tumor fraction, the tumor size, or the number of slides used for extraction. CB preparations were adequate for testing in 45% cases, but the inclusion of direct smears increased the adequacy rate to 92%. There was no significant difference in testing success rates between smears and CB preparations. Conclusions The success of RNA-based NGS fusion testing depends on the quality and quantity of RNA extracted. The use of direct smears significantly improves the adequacy of cytologic samples for RNA fusion testing for predictive biomarkers.

Coronary artery aneurysm (CAA) is described as a localized dilatation of a coronary artery segment by more than 1.5-fold compared with the adjacent normal segments. The incidence of CAA varies from 0.3 to 5.3% with atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention (PCI) being the common etiologic factors. Owing to its varying presentation and absence of robust treatment guidelines, management of CAA is a challenge. Management of every patient must be tailored according to the presentation and expertise of the cardiac team available. Here, we present case reports of two patients with CAA who presented with acute coronary syndrome. As a result of unstable presentation, both patients underwent immediate intervention (CABG and PCI respectively) with successful revascularization having no complication and mortality.

There is growing interest in the use of the filtered basis functions (FBF) approach for feedforward tracking control of linear systems. The FBF approach expresses the control input to the plant as a linear combination of basis functions. The basis functions are forward filtered through the plant dynamics and the coefficients of the linear combination are selected such that the tracking error is minimized. It has been demonstrated that the FBF approach is more versatile compared to other methods in the literature. However, the tracking accuracy of the FBF approach deteriorates in the presence of model uncertainty, much like it does with other feedforward control methods. But, unlike other methods, the FBF approach presents flexibility in terms of the choice of the basis functions, which can be used to improve its accuracy in the presence of model uncertainty. This paper analyzes the effect of choice of the basis functions on the tracking accuracy of FBF, in the presence of uncertainty, using the Frobenius norm of the lifted system representation of FBF's error dynamics. Based on the analysis, a methodology for optimal selection of basis functions is presented. The effectiveness of the proposed methodology is demonstrated using examples. Large improvements in robustness are observed using the proposed optimal set of basis functions compared to popular basis functions, viz., B-splines, discrete cosine transform and block pulse functions.

Nuclear protein of the testis (NUT) carcinoma (NC) (formerly known as NUT midline carcinoma) is an aggressive pleomorphic squamous cell carcinoma with a dismal prognosis. Primary NC tumors are commonly located in the chest or head and neck regions. Imaging plays an indispensable role in the staging, management, treatment response assessment, and surveillance of NC. Primary pulmonary NC usually presents as a large mass with lymphadenopathy and pleural involvement. Primary head and neck NC presents as a large expansile necrotic mass in the sinonasal region with locoregional destruction and occasional cervical lymph node involvement. These imaging features are relatively non-specific but are consistent among patients. Currently, there are no standardized guidelines for the treatment of NC. Because of its rarity, paucity of reports in the medical literature, and the lack of awareness among radiologists, NUT carcinoma (NC) has been largely underdiagnosed and misdiagnosed. Clinical aggressive features and pleomorphic/undifferentiated squamous cell carcinoma should prompt genetic evaluation for NUT translocation to diagnose NC. In this article, we discuss NC's clinicopathologic and imaging features and treatment options, including emerging new treatments.

The Women in Anaesthesia Research Symposium (Prato, Italy; 4 June, 2019), supported by the British Journal of Anaesthesia in collaboration with Monash University, was organised to discuss challenges facing women in anaesthesia clinical practice and research. We provide an overview of institutional or departmental measures that were proposed during the symposium that may empower women in anaesthesia today.

ObjectiveTo identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery.DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesMedline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017.Eligibility criteriaRandomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded.Data extraction and synthesisReviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared.Results117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions.ConclusionsPredominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions.Study registrationProspero CRD42016035662.

Acral lentiginous melanoma (ALM) is a rare tumor that occurs on non-sun exposed skin areas of the hands and feet. Reports suggest that ALM exhibits poor prognosis, although mechanisms driving this remain poorly understood. Alterations in TERT and the Wnt/β-catenin (Wnt) pathway have been suggested to correlate with prognosis of ALM. Thus, immunohistochemical expression of β-catenin and LEF1 along with TERT amplification by FISH was investigated in 34 primary ALMs, 20 metastatic ALMs, 10 primary non-ALMs, and 15 acral nevi. Foot/toe was the most common primary tumor location (85%) for ALM. TERT amplification was detected in 6 of 28 (21.4%) primary ALM, 2 of 8 (25%) primary non-ALM, and 8 of 18 (44.4%) metastatic ALM, the latter showing significantly higher frequency compared with primary melanomas (P = 0.043). Most metastatic ALMs positive for TERT amplification lacked BRAF V600E (87.5%). Cytoplasmic and nonnuclear expression of β-catenin was variably detected in all cases. Metastatic ALM revealed lower expression of β-catenin compared with primary ALM (P = 0.017). No differences in LEF1 expression were detected among the groups; however, acral nevi showed decreased labeling with dermal descent, in contrast to melanoma. No molecular-genetic alteration correlated with prognosis. TERT amplification by FISH is a frequent finding in primary ALM and appears to increase in metastatic tumors, suggesting a role in tumor progression to metastasis. Although TERT amplification has been reported to be infrequent in primary non-ALM, it showed comparable frequency with ALM in our series. Our immunohistochemical findings are not fully supportive of activation of either canonical or noncanonical Wnt cascades in ALM. TERT amplification by FISH and LEF1 immunohistochemistry may help in the differential diagnosis between primary ALM and acral nevus. TERT amplification appears to be a promising target for therapy in patients with metastatic ALM.

Our effort is to analyze the effect of the rampant over the economies of 10 affected nations by studying their stock market values during the COVID-19 episode. We have endowed the nations with their respective stock markets stated in brackets - Brazil(Ibovespa), Canada (S&P/TSX Composite), France (AEX), Germany (DAX 30), India (NIFTY 50), Italy (FTSE MIB), Russia (IMOEX), Spain (IBEX 35), U.K. (FTSE 100), U.S.A. (DOW JONES INDUSTRIAL AVERAGE). We have gathered the indices of stock per country from 2 March to 23rd June, collected from official website of respective stocks. In order to collect data, we had to inculcate the fundamental lessons of Statistics. R-software aided us to plot the curves of stock values providing an ease to master our project. We also formulated a Python 3.7 language program code to solidify analysis on various aspects of economy of the countries and comparison between these aspects.

Feedforward (FF) control uses a priori knowledge about a given system and its disturbances to influence the system’s behavior in a pre-defined way. However, unlike feedback (FB) control, it does not adjust the control signal (or manipulated variable) in response to how the system actually reacts. In other words, FF control is proactive while FB control is reactive. Model-inversion-based FF (MIBFF) control is a specific type of FF control where the control variable is determined by inverting a model of the system to be controlled. It is very popular for its use in output tracking control problems, where the goal is to force the system’s output to follow a desired trajectory. Output tracking is critical in several different applications, e.g., in manufacturing, robotics, automotive, aerospace, and is typically achieved using a combination of FF and FB control. As motivating examples, consider MIBFF in ultra-precise wafer scanners used in photolithography (see Sidebar S1) and in desktop 3D printing (see Sidebar S2). As these motivating examples illustrate, non-minimum phase (NMP) zeros often arise in practical engineering applications due to non-collocated sensors and actuators, fast sampling, etc. MIBFF for systems with NMP zeros is arguably the most important (and certainly the most researched) issue related to MIBFF.

We analyze the trajectory of Organizational Research Methods ( ORM) during the first 20 years of its existence (i.e., 1998-2017). First, beginning with the inaugural volume, we review the editorials to create a qualitative account regarding ORM’s journey as narrated by the journal’s leaders in their own voices. Second, we examine the composition of the five senior editorial teams (i.e., editors and associate editors), including their qualitative-quantitative, micro-macro, and disciplinary orientation, as well as the types of articles published by ORM along the qualitative-quantitative and micro-macro distinctions. Third, we describe the 27 feature topics (i.e., set of articles addressing a common issue) published by ORM. Fourth, we offer information regarding ORM’s impact and influence based on impact factor data, journal lists, and other indicators (e.g., ORM articles that have received awards from professional organizations, most cited ORM articles out of a total of 484). Fifth, we identify the most frequently published ORM authors (and their disciplinary background) out of a total of 884 who have published at least one article. Finally, we discuss implications and outline opportunities and challenges as well as possible future directions for ORM. Overall, our review and analysis of the first 20 years of ORM allowed us to create a historical record for future generations, gain qualitative and quantitative insights into ORM’s trajectory and its impact and influence over time, and make predictions for the future of the journal and, more broadly, research on methodological issues.

Latent fingerprints (LFPs) are the major physical evidences for the identification of individuals during crime spot investigation. Till date, numerous methods were followed to visualize LFPs. However, simple, accurate, and cost-effective method has wide scope in advanced forensic field. In our work, Ca2SiO4:Dy3+ nanopowders (NPs) were fabricated via solution combustion route. The optimized sample was employed for the visualization of overlapped LFPs by the cost effective powder dusting method. The obtained results reveals the complete three levels of ridge characteristics with high sensitivity, reproducibility, selectivity, and reliability on various complex surfaces. The photoluminescence (PL) spectra consist of intense peaks at ∼ 480 and 574 nm owing to 4F9/2 → 6H15/2 and 4F9/2 → 6H13/2 4f transitions of Dy3+ ions, respectively. The photometric properties confirm that the samples exhibit intense white emission with high color purity. Therefore, the prepared NPs could be a definitive choice as an advanced luminescent NPs for forensic, solid state lighting and portable FED devices.

We review the literature on evidence-based best practices on how to enhance methodological transparency, which is the degree of detail and disclosure about the specific steps, decisions, and judgme...

Additive manufacturing (AM) is gaining attention as an alternative to traditional manufacturing processes. Of the available AM methods, material extrusion (ME) AM is predominant. High-quality ME AM demands accurate synchronization between positioning (motion) control and extrusion control, as poor synchronization leads to printing defects like over- and under-extrusion. Typically, extrusion control in ME AM is achieved via feedforward (FF) control techniques due to difficulties in sensing extrusion rate in real-time for feedback control. However, existing FF extrusion control techniques rely on simple linear models to control the highly nonlinear extrusion process, leading to quality issues like over- and under-extrusion. This paper presents two FF control strategies for mitigating over- and under-extrusion defects in ME AM. The first strategy uses a standard linear model of extrusion system but applies it to FF motion control rather than FF extrusion control. This has the net effect of synchronizing motion and extrusion control while avoiding some nonlinearities associated with the extrusion process. In the second approach, an empirical nonlinear model of the extrusion process is developed and adopted for the design of a nonlinear FF extrusion controller. Both approaches were validated experimentally on a fused filament fabrication (FFF) 3D printer, and respectively demonstrated up to 40.45% and 35.98% improvement in deposition accuracy (i.e., reduced over- and under-extrusion) compared to a standard FF extrusion control approach typically used in the literature. In addition, the proposed nonlinear FF controller was shown to be more versatile and lead to faster ME AM compared to the proposed linear FF motion control approach. A practical application of the proposed techniques for improving the quality of a variable-width pattern printed using a new concept of continuously varied extrusion was demonstrated.

Improvements in outcome measurement are needed to produce quality improvement in perioperative care. However, problems with the collection and use of outcome data persist in research and clinical practice. This is being addressed by several national programmes and initiatives to standardize and integrate outcome measurement. The use of different outcome measures is changing and there has been a transition towards patient-focused measures. Traditional measures of quality in perioperative care include mortality, morbidity and resource utilization measures. Patient-focused measures include patient-reported outcome measures and measures of patient experience. Each of these has advantages and disadvantages in different situations. The routine collection, analysis and dissemination of data relating to perioperative outcome is beneficial to patients, clinicians, hospitals, commissioners, regulators and researchers.

Most future industrial and organizational (I-O) psychology practitioners and researchers initially enroll in an introductory I-O psychology course during their junior or senior year of undergraduate studies, making introductory textbooks their first in-depth exposure to the field and an important knowledge base. We reviewed and analyzed the 6,654 unique items (e.g., journal articles, book chapters) published in 1,682 unique sources (e.g., scholarly journals, edited books, popular press publications) and authored by 8,603 unique individuals cited in six popular I-O psychology textbooks. Results showed that 39% of the top-cited sources are not traditional academic peer-reviewed journals, 77% of the top-cited articles were published in cross-disciplinary journals, and 58% of the top-cited authors are affiliated with business schools and not psychology departments. These results suggest that the science–practice divide in I-O psychology may develop later—perhaps after graduates obtain employment as either practitioners or researchers. Also, results suggest I-O psychology is closer to business and management than social psychology and psychology in general. We discuss additional implications for the science–practice divide, how to define and measure scholarly impact, and the future of I-O psychology as a field, including the movement of I-O psychologists to business schools and the sustainability of I-O psychology programs in psychology departments.

Purpose of Review This article offers an overview of the history and features of Improvement Science in general and some of its applications to Anaesthesia in particular. Recent Findings Improvement Science is an evolving discipline aiming to generate learning from quality improvement interventions. An increasingly common approach to improving Anaesthesia services is to employ large-scale perioperative data measurement and feedback programmes. Improvement Science offers important insights on questions such as which indicators to collect data for; how to capture that data; how it can be presented in engaging visual formats; how it could/should be fed back to frontline staff and how they can be supported in their use of data to generate improvement. Summary Data measurement and feedback systems represent opportunities for anaesthetists to work with multidisciplinary colleagues to help improve services and outcomes for surgical patients. Improvement Science can help evaluate which approaches work, and in which contexts, and is therefore of value to healthcare commissioners, providers and patients.

Introduction Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors. They are surgically curable but can be lethal if remain undiagnosed. We report a patient earlier diagnosed with malignant hyperthermia but later found to have pheochromocytoma on autopsy. Case report After a preprocedural pain block for elective right shoulder arthroscopy, a 53-year-old hypertensive white man developed chest pain. In the operating room, he had increased blood pressure. Postoperatively, his blood pressures dropped from 220/100 to 80/30 mm Hg. He later developed high fever with core temperature reaching a peak of 42.2°C, rapid breathing, and died after unsuccessful attempts to stabilize him. Autopsy Autopsy revealed a tumor in his right adrenal gland, measuring 10 cm in greatest dimension and weighing 530 g. It was red brown with a hemorrhagic and cystic cut surface. A thin rim of yellow-orange adrenal cortex was visible at the margin of the tumor, indicating that it originated from the underlying adrenal medulla. The left adrenal gland was unremarkable.Sections showed hypercellular tumor with zellballen architecture. The tumor cells were round to oval with finely granular basophilic cytoplasm and mild pleomorphism. A 24-hour urine sample collected before his death showed greater than 22727 μg/g Ratio to Creatinine metanephrines and normetanephrine, indicating that the tumor was active and secreted high levels of catecholamine. The cause of death was established as the complications of pheochromocytoma in the settings of general anesthesia for shoulder arthroscopy. The manner of death was natural. Conclusions Pheochromocytoma can mimic malignant hyperthermia, and it should always be considered and managed appropriately in such scenarios to avoid untoward consequences. Pathologists must also be aware of this when conducting an autopsy in cases with a previous clinical diagnosis of malignant hyperthermia.

Friend leukemia integration site 1 (FLI-1) nuclear transcription factor has been proposed as a suitable tool in the differential diagnosis of small round cell sarcomas. It has also been described as a nuclear marker of endothelial differentiation. Expression of FLI-1 has been demonstrated in Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) and vascular neoplasms. In the present study, we describe 2 cases of metastatic melanoma with small round blue cell morphology that showed strong nuclear expression of FLI-1. Because of the small round blue cell morphology and negative immunohistochemical staining for pan-melanocytic cocktail (HMB45, anti MART1 and anti-tyrosinase) and SOX10 in both cases, FLI-1 immunostaining was requested as part of the tumors workup. Ultimately, both cases were established as being metastatic melanoma. Dermatopathologists should be aware that melanoma can be strongly positive for FLI-1 and not misinterpret these cases for ES/PNET or vascular lesions, especially when melanomas show unusual morphology.

Fruit flies (Diptera: Tephritidae) with more than 5,000 described species in six subfamilies, is one of the largest insect families, and is among the ten largest families of the order Diptera. They are more diverse in the Oriental region with India harbouring 284 species in five subfamilies. Though they are commonly perceived to be frugivorous, they do exhibit diverse feeding habits as leaf miners, gall formers, saprophytes, flower head feeders, etc. Of the six subfamilies, Dacinae and Trypetinae are well studied owing to their economic importance as invasive pests of quarantine concern across the world. Immature taxonomy of Tephritidae is still in its infancy as III instar larvae of only 100 species has been studied so far. Even though phylogeny based on morphology could not resolve higher level classification of Tephritidae; deployment of molecular markers by various workers could elucidate the phylogenetic relationships between various genera of several tribes including Dacini. Taxonomy, diagnostic keys for various taxa, biology/habit, phylogeny, host plants, etc. of Tephritidae is dealt with.

Accurate tracking of nonminimum phase (NMP) systems is well known to require large amounts of control effort. It is, therefore, of practical value to minimize the effort needed to achieve a desired level of tracking accuracy for NMP systems. There is growing interest in the use of the filtered basis functions (FBF) approach for tracking the control of linear NMP systems because of distinct performance advantages it has over other methods. The FBF approach expresses the control input as a linear combination of user-defined basis functions. The basis functions are forward filtered through the dynamics of the plant, and the coefficients are selected such that the tracking error is minimized. There is a wide variety of basis functions that can be used with the FBF approach, but there has been no work to date on how to select the best set of basis functions. Toward selecting the best basis functions, the Frobenius norm of the lifted system representation (LSR) of dynamics is proposed as an excellent metric for evaluating the performance of linear time varying (LTV) discrete-time tracking controllers, like FBF, independent of the desired trajectory to be tracked. Using the metric, an optimal set of basis functions that minimize the control effort without sacrificing tracking accuracy is proposed. The optimal set of basis functions is shown in simulations and experiments to significantly reduce control effort while maintaining or improving tracking accuracy compared to popular basis functions, like B-splines.

Graphical models have emerged as a tool to map out the interplay between multiple measured and unmeasured variables, and can help strengthen the case for a causal association between exposures and outcomes in observational studies. In Part 1 of this methods series, we will introduce the reader to graphical models for causal inference in perioperative medicine, and set the framework for Part 2 of the series involving advanced methods for causal inference.

The tribe Dacini comprising four genera, namely Bactrocera Macquart, Dacus Fabricius, Monacrostichus Bezzi and Zeugodacus Hendel, is a derived lineage in Tephritidae. It is one of the most economically important tribes in Tephritidae harbouring several species of quarantine concern across the world. We describe two new species of Bactrocera Macquart, B . ( Parazeugodacus ) conica David & Ramani, sp. n. & B . ( B .) prabhui David, sp. n. from India. Postabdominal structures of males and/or females of 23 species of Bactrocera , 16 species of Zeugodacus and 8 species of Dacus from India are illustrated and described for the first time, which revealed similarities between Dacus and Zeugodacus with respect to epandrial shape and praeputium patterning. Bactrocera is unique in possessing oval shaped epandrium and an unpatterned praeputium. An analysis of phylogenetic relationships between three genera of the tribe Dacini from India based on morphological characters has been attempted for the first time. Cladistic analysis employing 51 characters of 62 species in Dacini, with seven species as outgroups revealed the monophyly of Dacini, Bactrocera and Dacus with supporting nonhomplasious synapomorphies. Ichneumonopsis Hardy, often included in the Gastrozonini, does not possess any synapomorphies of Dacini, eventhough it appeared at the base of the Dacini clade. Zeugodacus was retrieved as a monophyletic sister-group to Dacus based solely on a single homoplasious host plant character, with weak statistcal support.

A vehicular ad-hoc network commonly known as VANET is one of the rapid growing division of mobile ad-hoc network. In VANET cluster of elegant vehicles equipped with OBU (On Board Unit) are behaves as mobile nodes on highways and it is capable in providing Mobile-to-stationary Road Side Unit (V-to-RSU) and Mobile-to-Mobile (V-to-V) communication. Vehicular network is promising several useful services on National Highway like shelter applications as well as amusement applications. However, a number of limitations can bang the consistency of vehicular networks. Mobile-to-Mobile communication is considered to be noteworthy to provide a high level safety and it is ease to handle by drivers and travelers. Steering in this network is a major confront; hence we find many research issues in VANET. Location based navigation protocol has been recognized to be appropriate to VANETs for the reason that often altered network topology and extremely dynamic nature of mobile nodes. Even though VANET can establish communication between vehicle to vehicle, still embedded with some tribulations like, how to validate the message broadcasted from various vehicle range, and to route the vehicle's message to different vehicle communication range. To overcome these issues we are proposed to design an AVANET (Autonomous vehicular ad-hoc network). The AVANET can competent the entities, which can behave autonomously and get into an appropriate, network topology to make advanced connectivity for both V-to-RSU and V-to-V transportation. The simulation output of the proposed AVANET is designating the robustness against network detachment and indicates the high secured authentication between vehicles.

Data generated in digital devices need to be secured for its use by the authorized users. Different security algorithms such as symmetric and asymmetric cryptosystems have been developed to secure the data while in transmission as well as at rest. However, data is not secure while processing. This paper explores the concept of Homomorphic Encryption (HE) based solution for secured functional evaluation of data. The proposed FHE-AES/DH cloud security model executes encryption on the data and encrypted data is transmitted to the cloud server. The functional evaluation is carried out on uploaded data by the third party without knowing the contents. These models hide the content of data in order to protect security and privacy. A banking data set has been used for the case study. The FHE-AES model takes less time for functional evaluation compared to FHE-DH model.

An experiment was carried out at the Department of Seed Science and Technology, Junagadh Agricultural University, Junagadh, to characterize 28 wheat varieties of different species [17 varieties (MP 4010, HI 1500, HI 1531, HI 1544, GW 1, GW 503, DL 788-2, HD 2932, GW 11, GW 173, GW 190, GW 273, LOK 1, GW 322, MP 3288, GW 366 and GW 496) of Triticum aestivum, 9 varieties (HI 8381, HI 8498, HI 8627, HI 8713, A 28, A 206, GDW 1255, GW 1139 and RAJ 1555) of Triticum durum and 2 varieties (DDK 1025, DDK 1029) of Triticum dicoccum)] released for general cultivation in Gujarat at state level as well as at the National level in Central India based on the seed morphological characters. Based on the seed colour, the varieties were grouped into amber (25), white (1) and red (2). On the basis of seed shape, wheat varieties were separated in to round (2) ovate (7), oblong (12) and elliptical (7). On the basis of seed size, varieties were grouped into medium seed size (5), bold seed size (15) and very bold seed size (8). On the basis of seed hardness, varieties were grouped into soft (1), semi-hard (7) and hard (20). Based on the seed germ width, varieties were grouped into medium (15), wide (9) and narrow (4) seed germ width types. The varieties were grouped based on the seed crease into three groups, as medium (11),shallow (12) and deep (5) grain crease types. Based on the brush hair length, wheat varieties were grouped as short (17), medium (7) and long (4) brush hair length types.

Background Preoperative risk prediction is important for guiding clinical decision-making and resource allocation. Clinicians frequently rely solely on their own clinical judgement for risk prediction rather than objective measures. We aimed to compare the accuracy of freely available objective surgical risk tools with subjective clinical assessment in predicting 30-day mortality. Methods and findings We conducted a prospective observational study in 274 hospitals in the United Kingdom (UK), Australia, and New Zealand. For 1 week in 2017, prospective risk, surgical, and outcome data were collected on all adults aged 18 years and over undergoing surgery requiring at least a 1-night stay in hospital. Recruitment bias was avoided through an ethical waiver to patient consent; a mixture of rural, urban, district, and university hospitals participated. We compared subjective assessment with 3 previously published, open-access objective risk tools for predicting 30-day mortality: the Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality (P-POSSUM), Surgical Risk Scale (SRS), and Surgical Outcome Risk Tool (SORT). We then developed a logistic regression model combining subjective assessment and the best objective tool and compared its performance to each constituent method alone. We included 22,631 patients in the study: 52.8% were female, median age was 62 years (interquartile range [IQR] 46 to 73 years), median postoperative length of stay was 3 days (IQR 1 to 6), and inpatient 30-day mortality was 1.4%. Clinicians used subjective assessment alone in 88.7% of cases. All methods overpredicted risk, but visual inspection of plots showed the SORT to have the best calibration. The SORT demonstrated the best discrimination of the objective tools (SORT Area Under Receiver Operating Characteristic curve [AUROC] = 0.90, 95% confidence interval [CI]: 0.88–0.92; P-POSSUM = 0.89, 95% CI 0.88–0.91; SRS = 0.85, 95% CI 0.82–0.87). Subjective assessment demonstrated good discrimination (AUROC = 0.89, 95% CI: 0.86–0.91) that was not different from the SORT (p = 0.309). Combining subjective assessment and the SORT improved discrimination (bootstrap optimism-corrected AUROC = 0.92, 95% CI: 0.90–0.94) and demonstrated continuous Net Reclassification Improvement (NRI = 0.13, 95% CI: 0.06–0.20, p < 0.001) compared with subjective assessment alone. Decision-curve analysis (DCA) confirmed the superiority of the SORT over other previously published models, and the SORT–clinical judgement model again performed best overall. Our study is limited by the low mortality rate, by the lack of blinding in the ‘subjective’ risk assessments, and because we only compared the performance of clinical risk scores as opposed to other prediction tools such as exercise testing or frailty assessment. Conclusions In this study, we observed that the combination of subjective assessment with a parsimonious risk model improved perioperative risk estimation. This may be of value in helping clinicians allocate finite resources such as critical care and to support patient involvement in clinical decision-making., Danny Wong and colleagues reveal measures for predicting mortality after surgery., Author summary Why was this study done? Over 3 million postoperative deaths occur worldwide per year. Some of these may be avoidable through risk-assessment–based modification of treatment pathways, such as postoperative critical care admission. There are multiple methods for predicting which patients are at high risk of death or complications from surgery, but these are not widely used, with clinicians instead usually relying on their subjective clinical judgement alone. Before this study, there was little information about whether clinical judgement was of better, worse, or equivalent accuracy to objective risk scores. What did the researchers do and find? We conducted a 1-week cohort study in 274 hospitals in the UK, Australia, and New Zealand, during which we collected data on risk and surgical outcome on every patient who had an operation requiring an overnight stay in hospital. The clinical team (surgeons, anaesthetists) looking after the patient were asked to provide a subjective assessment of risk. We compared these assessments with the results of 3 freely available objective risk-assessment tools. We included data from 22,631 patients in our analyses and found that subjective assessment was as accurate as the best of the objective risk tools (the Surgical Outcome Risk Tool or SORT) for predicting death in hospital within 30 days of surgery. However, combining subjective and objective measurement using the SORT provided an even more accurate estimate. What do these findings mean? The new SORT–clinical judgement calculator can be used by clinicians to risk-stratify patients and so identify which individuals are most likely to benefit from limited resources such as access to postoperative critical care. At the policy level, the tool can be used to plan surgical services, including the number of critical care beds required to serve a surgical population. This study is limited by being conducted solely in high-income countries, limiting its global generalisability.

Machine tool feed drives are often subject to variable-frequency disturbance (cutting) forces due to varying spindle speeds or cutting tools. A proxy-based control allocation method has been proposed for energy optimal control of over-actuated systems (i.e., systems with more actuators than the number of outputs to be controlled). It has been applied to an over-actuated hybrid feed drive, consisting of a linear motor drive coupled to a screw drive, and its effectiveness has been demonstrated under fixed-frequency disturbance forces. This paper discusses the fundamental limit of the fixed-frequency approach and extends the proxy-based control allocation method to account for variable-frequency disturbance forces via a linear parameter-varying formulation. The controller gains are optimized using linear matrix inequality and scheduled as a function of disturbance frequency. Significant improvements in energy efficiency are demonstrated in simulations and experiments using the proposed gain-scheduling approach compared to the existing fixed-frequency approach.

Foy and colleagues summarise the challenges and opportunities for using audit and feedback to improve patient care.1 We agree that research should be embedded to improve the effect of national audits. In addition to the study designs described by Foy et al, an understanding of …