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Patients managed non-operatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where non-operative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed non-operatively to evaluate variability in non-operative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered.Using ACS NSQIP infrastructure and methodology, surgical consultations for acute appendicitis, acute cholecystitis, and small bowel obstruction (SBO) were sampled at 13 hospitals that volunteered to participate in the EGS clinical data registry. Standard NSQIP variables and 16 EGS-specific variables were abstracted with 30-day follow-up. To determine the influence of complications in non-operative patients, rates of adverse outcomes were identified and hospitals were ranked by performance with and then without including non-operative cases.2,091 patients with EGS diagnoses were included, 46.6% with appendicitis, 24.3% with cholecystitis, and 29.1% with SBO. The overall rate of non-operative management was 27.4%, 6.6% for appendicitis, 16.5% for cholecystitis, and 69.9% for SBO. Despite comprising only 27.4% of patients in the EGS Pilot, non-operative management accounted for 67.7% of deaths, 34.3% of serious morbidities, and 41.8% of hospital readmissions. After adjusting for patient characteristics and hospital diagnosis mix, addition of non-operative management to hospital performance assessment resulted in 12 of 13 hospitals changing performance rank, with 4 hospitals changing by 3 or more positions.This study identifies a gap in performance evaluation when non-operative patients are excluded from surgical quality assessment and demonstrates the feasibility of incorporating non-operative care into existing surgical quality initiatives. Broadening the scope of hospital performance assessment to include non-operative management creates an opportunity to improve the care of all surgical patients, not just those who have an operation.III, Prognostic and Epidemiological.

Introduction: Gait is the normal way of walking pattern. The visual system of sighted subjects furnishes information concerning the environment from distant and plays important role in maintaining the stability and planning of the route during locomotion. During movement of the sighted subject, the visual perception of the surroundings enables the orientation towards the goal. Movement and position of limbs is also important in order to adjust foot clearance or foot placement to regulate the walking pace. Aim: To compare the gait pattern among blind and blind folded sighted subjects as well as among healthy and underweight blind and blind folded sighted subjects. Materials and Methods: The cross-sectional study was conducted in Department of Physiology, RKDF Medical College Hospital and Research Centre, Bhopal, Madhya Pradesh, India, from October 2019 to April 2021. A total of 181 sighted and 150 blind subjects aged between 10-17 years were taken in the study. Foot print method was used to record spatial components. The temporal components were measured with stop watch. Rivermead Visual Gait Analysis (RVGA) was used to analyse kinematic characteristics. The estimation of healthy and underweight subjects were done by calculation of Body Mass Index (BMI). Quantitative data was expressed as mean±standard deviation. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: The mean value of gait in blind folded sighted and blind subjects was found to be 3.28±0.48 and 2.01±0.79 km/hr respectively and was found statically significant having (p-value=0.001). The results of mean value of gait on the basis Body Mass Index (BMI), the healthy blind folded sighted and healthy blind subjects showed 3.29±0.46 and 1.99±0.75 respectively (p-value=0.001). Similarly, the gait pattern in underweight blind folded sighted and underweight bind subjects was observed to be 3.26±0.61 and 1.98±0.77 km/hr respectively (p-value=0.001). Conclusion: The gait pattern was found to be significantly better among the blind folded sighted subjects in comparison to the blind subjects.

A cornerstone of modern biomedical research is the use of mouse models to explore basic pathophysiological mechanisms, evaluate new therapeutic approaches, and make go or no-go decisions to carry new drug candidates forward into clinical trials. Systematic studies evaluating how well murine models mimic human inflammatory diseases are nonexistent. Here, we show that, although acute inflammatory stresses from different etiologies result in highly similar genomic responses in humans, the responses in corresponding mouse models correlate poorly with the human conditions and also, one another. Among genes changed significantly in humans, the murine orthologs are close to random in matching their human counterparts (e.g., R(2) between 0.0 and 0.1). In addition to improvements in the current animal model systems, our study supports higher priority for translational medical research to focus on the more complex human conditions rather than relying on mouse models to study human inflammatory diseases.

In North West Himalayan region, farmers tend to face problems related to production and natural resource management due to steep slopes; fragile geology and frequent landslides which leads to high soil erosion. The present study was conducted with the objective to assess the impact of Farmer FIRST Project on the livelihood of beneficiary farmers of study area. A sample of 300 farmers comprising of 180 beneficiary and 120 non-beneficiary farmers were selected through multi stage random sampling. To delineate the impact, with-without and before-after comparison on different aspects of Farmer FIRST Project were carried out. Study revealed that there exists a significant difference between beneficiary farmers and non-beneficiary farmers on various aspects, viz. awareness level, change in decision making behaviour, change in marketing behaviour, change in yield, change in income, change in cropping intensity and change in average annual employment days. Before-after comparison of beneficiary farmers showed that there is a significant increase in crop yield, cultivable area and average annual employment days. Hence, there is a need of upscaling the project for inclusion of more numbers of farmers and securing their livelihood.

Satellite communication systems need to be integrated with emerging cooperative relaying techniques to provide seamless connectivity and high-speed broadband access for mobile users in future wireless networks. In this paper, we study a multi-antenna multiuser hybrid satellite-terrestrial relay network (HSTRN) employing opportunistic user scheduling with outdated channel state information (CSI) and amplify-and-forward relaying with co-channel interference (CCI). By adopting Shadowed-Rician fading for satellite links and Nakagami-m fading for terrestrial links, we derive novel and accurate expressions for outage probability and ergodic capacity of the proposed HSTRN, and further examine its achievable diversity order. More importantly, we conduct the performance analysis by taking both uncorrelated and correlated Shadowed-Rician fading channels into account and show that the antenna correlation at the satellite does not affect the overall system diversity order. Our derived analytical expressions provide efficient tools to characterize the impact of CCI, outdated CSI, and antenna correlation on the system performance of HSTRN with an arbitrary number of satellite antennas, number of interferers, number of users, and integer values of the per-hop fading severity parameters. Our results provide useful guidelines in the design of futuristic HSTRNs for satellite mobile communications.

The Government of India in its annual budget 2016-17 set a policy target of doubling farmers' income by 2022. Agriculture sustains livelihood for more than half of the India's total population. Doubling farmers' income in such a short period is an overwhelming task for decision makers, scientists and policy makers. Doubling farmers' income is possible through increasing total output and better price realization in market, reduction in production costs, diversification of product, efficient post-harvest management, value addition, etc. In this paper, efforts have been made to detail issues, challenges and strategies to achieve the target of doubling farmer's income. Specific strategies suggested for achieving the target of doubling farmers' income were market management, agricultural input management, risk management and agricultural extension strategies.

The effectiveness of an extension system referred to its ability to meet the farmer needs in providing the new technology which suits to their conditions and results in better production. Recently the demand for information on agricultural practices and technology among the farmers is increasing day by day but fulfilment of these demands exclusively by public agricultural extension system is limited. To address this challenge, information communication technology (ICT) has the immense role in supplementing the extension system. Among the ICT tools, mobile phone, because of its affordability, accessibility, minimum skill requirement, widespread network etc., has emerged as important tool for information and knowledge dissemination to the smallholder and marginal farmers. But it is necessary to study how effective they are in achieving the respective objectives.The present investigation was conducted to study the effectiveness of mKRISHI® PAWS (Personalised Advisory on Water and Soil) in Dehradun district of Uttarakhand state. An ex-post facto research design was used for this study. Total 136 messages were sent to the respondents. The data was collected from 240 beneficiary farmers of the north-western Himalayan region. The effectiveness of the mKRISHI® PAWS in technology advisory and delivery services were measured by developing an effectiveness index for the purpose. Results showed that 93.8% of farmers perceive that quality of information regarding the latest NRM technologies in soil and water conservation was excellent and 83.75% of the farmers felt that the information regarding the latest NRM technologies in soil and water conservation was appropriate to their condition. The study revealed that the extension services delivered by mKRISHI® PAWS were found to be highly effective by majority of the farmers. 34.58% farmers perceived that the mKRISHI® PAWS was very highly effective as a mean of getting their information needs.

The Indian Institute of Soil and Water Conservation (IISWC) and its Research Centres have developed many successful model watershed projects in India in the past and implemented many Soil and Water Conservation (SWC) technologies for sustainable watershed management. While many evaluation studies were conducted on these projects in the past, there has been no assessment of the post-adoption status of the SWC technologies over a longer period. It was imperative to appraise the behaviour of the farmers with regard to the continuance or discontinuance of the technologies adopted, diffusion or infusion that took place and technological gaps that occurred in due course of time in the post watershed programme. Therefore, it was realized that the post-adoption behaviour of beneficiary farmers who have adopted different soil and water conservation technologies for watershed management projects should be studied in detail. The research study was initiated in 2012 as a core project at Vasad as the lead Centre along with IISWC headquarter Dehradun, and Centres Agra, Bellary, Chandigarh, Datia, Kota & Ooty, with the specific objectives of the study to measure the extent of post-adoption behaviour (continued-adoption, discontinuance, technological gap, diffusion and infusion) of farmers towards the adopted SWC technologies of watershed management. In the present study various indices regarding continued adoption, dis-adoption (discontinuance), technological gap, diffusion, infusion regarding soil and water conservation technologies for watershed management were developed for measurement of post-adoption behaviour of farmers. It was revealed that a little less than three-fourth (73%) of SWC technologies continued to be adopted and more than one-fourth (27%) were discontinued by farmers. Out of the total continue adopted SWC technologies by farmers, a little less than one-fifth (19%) of technologies continued to be adopted with a technological gap. More than one-fourth (28%) of SWC technologies were also diffused to other farmers’ fields in nearby villages and on an average 1.2 technologies were also infused into the farmers׳ fields from outside by their own efforts in the watersheds developed by the IISWC and its Centres.

A simple, accurate, and precise HPLC method was developed and validated for determination of rimonabant in human plasma. Following liquid-liquid extraction, chromatographic separation was accomplished using C18 column with mobile phase consisting of acetonitrile : water (90 : 10, v/v), drug was detected at 260 nm using UVdetector. The LOD and LOQ were 3.0 and 10.0 μg/L, respectively. The method is linear in the interval 50.0–1000.0 μg/L. The average extraction recovery of drug from plasma was found to be 92.2%. The percent CV of the method was found to be less than 10.8%, and accuracy was found between 94.5 and 106.7%. The assay may be applied to a pharmacokinetic and bioequivalence study of rimonabant.

Background: Laparoscopic appendectomy for nonperforated appendicitis is associated with improved outcomes; however, laparoscopy has been challenged for perforated appendicitis owing to higher morbidity compared with open or staged procedures. The purpose of this study was to determine whether the laparoscopic approach for perforated appendicitis results in improved outcomes compared with open appendectomy. Methods: Postoperative patient records for confirmed perforated appendicitis from 2005 to 2008 were reviewed retrospectively. Demographics, surgical approach, conversion rate, and outcomes were tabulated, including length of stay (LOS), intra-abdominal and wound infections, and duration of antibiotic therapy. Results: The incidence of perforation was 27.9% in 885 total patients. The conversion rate from laparoscopic to open for perforated appendicitis was 16%. Hospital LOS was significantly lower in the laparoscopic group (P < .05). The incidence of postoperative abscess was not significantly different; however, the incidence of wound infection and duration of antibiotic therapy were significantly lower in the laparoscopic group (P < .05). Conclusion: Successful laparoscopic appendectomy reduces LOS, antibiotic therapy, and wound infections compared with open appendectomy in perforated appendicitis without increasing the incidence of postoperative abscess. We conclude that perforated appendicitis can be managed effectively by laparoscopic appendectomy in a high percentage of patients with improved outcomes compared with open appendectomy. [Copyright &y& Elsevier]

Background: The role of the ventricular assist device (VAD) in the management of heart failure is expanding. Despite its success, the clinical course for patients requiring noncardiac surgery (NCS) during VAD support is not well described. The objective of this study was to identify VAD patients requiring NCS (+NCS) and compare outcomes with those not requiring NCS (–NCS). Methods: Patients undergoing VAD implant from 2000 to 2007 were reviewed. NCS procedures, survival, and complications were collected. Survival at 1 year from implant, overall survival at the study conclusion, survival time from implant, and outcome of VAD therapy were compared between groups. Results: We enrolled 142 subjects. Demographics did not differ between groups. Twenty-five subjects (18%) underwent 27 NCS procedures. Perioperative survival was 100% and 28-day survival was 64%. Survival to discharge was 56%. Bleeding occurred in 48%. Infection occurred in 33%. Estimated blood loss was 355 mL, and the international normalized ratio at time of NCS was 1.9. Laparoscopy was performed in 3 cases. There was no difference in 1-year survival (59% vs 54%), survival at study conclusion (44% vs 46%) or survival time (517 vs 523 days) between +NCS subjects and –NCS subjects. There were similar causes of death in both groups. The +NCS group was on VAD support longer (245 vs 87 days; P < .01), and less likely to undergo heart transplantation (12% vs 35%; P < .01). Conclusion: NCS is not uncommon during VAD therapy. Bleeding and infection were common complications. Despite this, NCS seems to be feasible and safe and does not seem to increase mortality in the VAD population. [Copyright &y& Elsevier]

The article focuses on the directional sound technology Audio Spotlight patented by Holosonic Research Labs. It states that the sound technology uses a concentrated sound beam that focuses on individual subjects. It tells that the technology is being utilized by museums which allow visitors to enjoy interactive exhibits undisturbed. It notes that Audio Spotlight should be aligned with the law in order to regulate the sound technology, prevent technology abuse, and protect the public. It also discusses the advantages, compositions, and legal protections of Audio Spotlight.

The article discusses a court case wherein the Time Warner Telecom Inc. argued that the Federal Communication Commission's (FCC) determination that Digital Subscriber Line (DSL) is an information service rather than a telecommunications service. The Supreme Court examined the regulation regarding the Communications Assistance for Law Enforcement Act. The court dismissed Time Warner's arguments for lack of supporting precedent.

Neutrophil hyperactivity contributes to organ failure, whereas hypofunction permits sepsis. The chemokine receptors CXCR1 and CXCR2 are central to polymorphonuclear neutrophil (PMN) function. We prospectively assessed CXCR function and expression in PMNs from trauma patients at high risk for pneumonia and their matched volunteer controls. CXCR2-specific calcium flux and chemotaxis were desensitized by injury, returning toward normal after 1 week. CXCR1 responses were relatively maintained. These defects appeared to be caused by preferential suppression of CXCR2 surface expression. To evaluate potential mechanisms of in vivo chemokine receptor regulation further we studied cross-desensitization of chemokine receptors in normal PMNs. Susceptibility to desensitization was in the order CXCR2 > CXCR1 > formyl peptide or C5a receptors. Trauma desensitizes CXC receptors, with CXCR2 being especially vulnerable. Desensitization is most marked immediately postinjury, generally resolving by Day 7. High-affinity chemoattractant receptors responsible for PMN chemotaxis from bloodstream to tissue appear to be regulated by injury. Receptors for end-target chemoattractants regulate CXCR1 and CXCR2 but resist suppression themselves and respond normally after injury. CXCR2 desensitization occurs before pneumonia, which developed in 44% of these patients. Suppression of high-affinity PMN receptors, like CXCR2, may predispose to pneumonia after trauma or other inflammatory conditions that lead to systemic inflammatory response syndrome. [ABSTRACT FROM AUTHOR]