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Background: ‘M’ proteins or paraproteins refer to immunoglobulins that are produced by clonal plasma cells and are a characteristic feature of monoclonal gammopathies. Routine electrophoresis on agarose gel and immunofixation can be used to detect immunoglobulin paraprotein (M-protein). We aimed to evaluate the performance of agarose gel electrophoresis alone and in combination with immunofixation for detecting serum M-proteins. Methods: One hundred and twenty-three patients suspected of paraproteinemia were evaluated. Routine serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE) protocols were performed. Data from SPE, and SPE-IFE (gel images and electrophoretograms) were collected and reviewed. Results: 21% cases were confirmed using the SPE-IFE combination, and among them, 33% had positive light chain (λ) only on IFE. Similarly, nine cases with biclonal gammopathy on SPE were characterized by IFE. Conclusion: IFE can be a confirmatory test in cases where SPE results are not reliable and it can be a complementary test when characterization of the M protein detected on SPE is required.

[This corrects the article DOI: 10.1371/journal.pone.0264956.].

This study emphasizes the usage of Silica Fume (SF) and Marble Sludge Powder (MSP) as a partial replacement for fly ash in Fibre Reinforced Foamed Concrete (FRFC). The compressive strength for various samples was analyzed using Artificial Neural Network (ANN) methods. In this research work, the utilization of silica fume, fly ash, marble sludge powder, polypropylene fiber, and foaming agent in fiber-reinforced foamed concrete is presented and a sincere attempt has been made to use silica fume and marble sludge powder for the replacement of fly ash with various percentages. In addition to that polypropylene fiber (PPF) was used in various proportions of 0%, 0.1%, 0.2%, 0.3%, 0.4%, and 0.5%. The Feed Forward Propagation (FFP) network of the machine learning method with one hidden layer was taken as the ANN structure of FRFC. In this ANN work, cement, silica fume, fly ash, marble sludge powder, foaming agent, water, and polypropylene fiber were used as input parameters and compressive strength is the output parameter. The correlation coefficient with the ANN methods was found as 0.940 for compressive strength. In machine learning techniques, the ANN method was found to be accurate in estimating and analyzing strength prediction responses with effective parameters.

Background: The World Health Organization's “End TB Strategy” aims to end global tuberculosis (TB) epidemic through a holistic combination of health and social interventions placing the patients and communities at the heart of the response. This study aimed to assess the effectiveness of utilizing school children as ambassadors in TB advocacy. Materials and Methods: We adopted a quasi-experimental intervention design where students' awareness level was assessed before and after the intervention. A total of 185 student ambassadors were trained to conduct interventions in schools, and 920 students were randomly selected to assess the impact of the ambassador's intervention. A structured questionnaire was used to assess the correct and incorrect knowledge on specific aspects of TB. This intervention study was implemented in a phased manner which involved a participatory formative phase. A student-friendly and culturally relevant educational materials and activities for providing TB knowledge for the study student population were developed. Data collected from the baseline and end-line evaluation surveys were analyzed using STAT Ver. 16.0.– Stata Corp., June 2016, USA. Results: A significant increase (>80%; P < 0.05) in the correct knowledge on diagnosis and prevention for TB was noted among sampled students (n = 818) before and after intervention. Reduction in incorrect knowledge, like understanding TB as hereditary disease, was found to be less (50%; P < 0.05). Conclusions: School students lead intervention could significantly improve correct knowledge on TB and could be replicated.

Deep learning plays a major role in the present video processing tools and algorithms. To​ alleviate the limitations of present in-loop filters in the scalable extension of HEVC (SHVC), a combined residual network (CResNet) in-loop filtering is proposed in this paper. The proposed CResNet in-loop filter exploits layer information available in the spatial temporal domain to restrain the visual artifacts like blocking and ringing. Particularly, the block information related to current and co-located blocks of the spatial and temporal base layer reference frames are considered to optimize the in-loop filtering. The proposed architecture has four convolution layers at the base layer and two convolution layers at the enhancement layer that significantly reduces the coding complexity and memory. Additionally to completely train the input content and also to enhance the in-loop filter performance, the on/off level control flag for coding tree Unit (CTU) is sensed using rate distortion optimization (RDO) approach. The experimental results demonstrate that the proposed architecture provides up to 6.2% to 7.2% reduction in bit rate and 1.01 dB improvement in PSNR compared to the standard SHVC codec.

Objective: The influence of tuberculosis (TB)-immune reconstitution inflammatory syndrome (IRIS) on TB treatment outcomes and its risk factors were investigated among people with human immunodeficiency virus (HIV) and co-infected with TB. Methods: Newly diagnosed, culture-confirmed, pulmonary TB patients with HIV and enrolled in a clinical trial (NCT00933790) were retrospectively analysed for IRIS occurrence. Risk factors and TB outcomes (up to 18 months after initiation of anti-TB treatment [ATT]) were compared between people who experienced IRIS (IRIS group) and those who did not (non-IRIS group). Results: TB-IRIS occurred in 82 of 292 (28%) participants. Significant baseline risk factors predisposing to TB-IRIS occurrence in univariate analysis were: lower CD4+ T-cell count, CD4/CD8 ratio, haemoglobin levels, presence of extra-pulmonary TB focus, and higher HIV viral load; the last two retained significance in the multivariate analysis. After 2 months of ATT commencement, sputum smear conversion was documented in 45 of 80 (56.2%) vs. 124 of 194 (63.9%) (p = 0.23), culture conversion was in 75 of 80 (93.7%) vs. 178 of 194 (91.7%) (p = 0.57) and the median decline in viral load (log10copies/mm3) was 2.7 in the IRIS vs. 1.1 in the non-IRIS groups (p

ObjectivesThe COVID-19 virus is highly contagious primarily via aerosol transmission and has a high mortality rate. On March 13, 2020, the United States declared a national emergency in response to the COVID-19 pandemic. This study aims to enumerate the effect of the pandemic on vaccination rates during the COVID-19 lockdown and the aftermath in pediatric patients aged 6weeks-6 years.Study DesignA retrospective review of medical records was performed of missed well childcare visits at MetroHealth from March 1, 2020 to June 30, 2020. The sample size of 400 children aged 6 weeks to 6 years were randomly selected. Demographic data, number of calls made to attempt, scheduled WCC, no show rates for clinic appointments, number of missed WCC, location of MH facility, insurance type, vaccination status prior to the pandemic were collected. Statistical analysis was performed with SPSS software (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp).ResultsFrom this descriptive study, we found that 43.5% of patients were not up to date on their childhood vaccination. The mean age was 24.38 months (SD 20.15). There were slightly more males (52.8%) in the study than females (47.3%) and most children were of African American descent. More than 50% of patients missed a scheduled well child appointment and 27% had a missed at least two consecutive appointments.ConclusionThe COVID-19 pandemic has no doubt made a significant mark on health care; the effects would be both immediate and delayed, with vulnerable population being the most impacted. There is an urgent need to prevent a large-scale health disaster of catastrophic potential that could occur if an effective vaccination strategy is not implemented rapidly.

Background COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. Methods A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. Results Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66–3.41), income≥20000(AOR = 1.74, 95% CI, (1.16–2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09–2.46), contact tracing (AOR = 2.05, 95% CI (1.1–3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14–6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28–2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). Conclusion The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

Geopolymer concrete is a new technology that deserves more attention in the rapidly evolving sustainable construction industry. Furthermore, to avoid the depletion of natural resources, by-product waste management technologies are essential. Today, river sand is in short supply. DMS (Dredged Marine Sand), on the other hand, which faces disposal and land acquisition issues, proves to be a viable alternative to river sand. In this paper, a mixture of M-Sand and DMS was used in place of river sand, and non-destructive, Flexural strength of beam by monotonic loading and cyclic loadings were investigated. The findings indicated that DMS has attained flexural characteristics and with regard to cracks, very minor and vertical cracks are observed in all beams as in the case of monotonic loading. Further, they originate from the tension zone

Foam concrete is one of the light weight concrete which contains cement, filler, water and foaming agent. Nowadays, this foam concrete has very useful characteristics for building construction. It requires no compaction and can easily fill the irregular cavities. In construction industry, various types of industrial waste materials was used to improve the strength and durability properties of the concrete. The endeavours to improve the strength properties such as cement, silica fume, fly ash, foaming Agent, Poly Vinyl Alcohol (PVA) fiber and carbon fiber were used. The combination of two fibers were added in the foam concrete with the different proportion of 0.3%, 0.4% and 0.5%. This paper describes the strength properties such as compressive strength, split tensile strength, water absorption characteristics and prediction of compressive strength of the fibre reinforced foam concrete using python. The targeted design density of foam concrete is 1650 kg/m3. All the specimens were tested and determined the strength at the age of 7 days, 14 days and 28 days.

Utilization of waste materials in concrete manufacture provides a satisfactory solution to some of environmental concerns and problems associated with waste management. Agro waste such as rice husk ash and bagasse ash were used as pozzolanic material for development of blended cement. The properties of concrete with partial replacement of cement by rice husk ash and bagasse ash for about 30% were investigated which includes its compressive strength, split tensile, flexural strength, durability property such as acid attack and sulphate attack. Among the various percentage replacement of cement by rice husk ash and bagasse ash, the strength test result shows that the optimum percentage replacement was about 70 : 20 : 10 (Cement : RHA : BA) which gives the optimum proportion of 30% replacement of cement with rice husk ash and bagasse ash to produce high performance concrete and contribute to sustainable construction. The cement in the concrete replaced by Bagasse Ash and Rice Husk Ash by the percentage of 5%, 10%, 15%, 20%, 25% and 30%. This optimum proportion result obtained is beneficial in improving the mechanical strength and durability property of the concrete. In this project work Conplast 340 Superplasticizer was used to improve the workability of concrete with replacement materials.

Electronic waste, also known as electronic and electrical equipment waste, poses significant pollution issues for people and the environment. It's essential to think about new, efficient waste management methods, particularly those that emphasise recycling. Glass fibre and polypropylene fibre have the benefit of being lightweight, lowering the overall cost of building and promoting construction efficiency. The effectiveness of hybrid fibre-reinforced concrete using E plastic waste as coarse aggregate was investigated in the current study. The concept behind the research study is to replace 0% to 30% of the concrete's coarse aggregates with E-waste and 1% glass and 1% polypropylene fibres (each by weight of concrete). The results demonstrated that E-plastic aggregate may be successfully used in fibre-reinforced concrete, up to 20% of the weight of the coarse aggregate with hybrid fibre, leading to resource and waste depletion.

IntroductionDespite the exalted status of sputum mycobacterial load for gauging pulmonary tuberculosis treatment and progress, Chest X-rays supplement valuable information for taking instantaneous therapeutic decisions, especially during the COVID-19 pandemic. Even though literature on individual parameters is overwhelming, few studies have explored the interaction between radiographic parameters denoting severity with mycobacterial burden signifying infectivity. By using a sophisticated approach of integrating Chest X-ray parameters with sputum mycobacterial characteristics, evaluated at all the three crucial time points of TB treatment namely pre-treatment, end of intensive phase and completion of treatment, utilizing the interactive Cox Proportional Hazards model, we aimed to precisely deduce predictors of unfavorable response to TB treatment.Materials and methodWe extracted de-identified data from well characterized clinical trial cohorts that recruited rifampicin-sensitive Pulmonary TB patients without any comorbidities, taking their first spell of anti-tuberculosis therapy under supervision and meticulous follow up for 24 months post treatment completion, to accurately predict TB outcomes. Radiographic data independently obtained, interpreted by two experienced pulmonologists was collated with demographic details and, sputum smear and culture grades of participants by an independent statistician and analyzed using the Cox Proportional Hazards model, to not only adjust for confounding factors including treatment effect, but also explore the interaction between radiological and bacteriological parameters for better therapeutic application.ResultsOf 667 TB patients with data available, cavitation, extent of involvement, lower zone involvement, smear and culture grade at baseline were significant parameters predisposing to an unfavorable TB treatment outcome in the univariate analysis. Reduction in radiological lesions in Chest X-ray by at least 50% at 2 months and 75% at the end of treatment helped in averting unfavorable responses. Smear and Culture conversion at the end of 2 months was highly significant as a predictor (p2 zones, were 3.05 (95% CI: 1.12-8.23) and 1.92 (95% CI: 0.72-5.08) respectively. Patients without cavitation, zonal involvement ConclusionBaseline Cavitation, Opacities occupying >2 zones and 3+ smear grade individually and independently forecasted a poorer TB outcome. The interaction model revealed that Zonal involvement confined to 2 zones, without a cavity and smear grade up to 2+, constituting "minimal disease", had a better prognosis. Radiological clearance >50% along with smear conversion at the end of intensive phase of treatment, observed to be a reasonable alternative to culture conversion in predicting a successful outcome. These parameters may potentially take up key positions as stratification factors for future trials contemplating on shorter TB regimens.

Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

BackgroundHousehold contacts (HHC) of tuberculosis (TB) patients are at risk of TB infection and disease. The study assessed the utility of "Household contact card and register" for screening of HHC of pulmonary TB (PTB) patients for TB and explored the reasons for HHC not being screened and followed-up.MethodsThe "Household contact card and register" was implemented by the Health Care Workers (HCW) of the TB Control Programme in Chennai District for screening HHC of index PTB patients initiated on treatment between June and August, 2018. Contacts were required to be screened within 2 months of treatment initiation of the index patient. Details collected included age, gender, smoking, alcohol use, immunosuppressive conditions and TB treatment. Symptom screening along with chest radiograph and or sputum examination was attempted. Follow-up TB screening at 6 and 12 months were performed. Screening of HHC was compared pre and post implementation phase. Proportions were computed for the data analysed.ResultsHHC information was documented for 93% (1268/1364) of Index PTB patients. The main reasons of non-listing of HHC in 96 PTB patients were HCW non-availability or non-co-operation of the HHC. There were 2150 (80%) contacts who were screened for TB. Inconvenient time, feeling healthy, stigma, out-station visit were the main reasons for 537 contacts not undergoing TB screening. Anti-TB treatment was initiated in 21 (1%) of contacts diagnosed with TB. Preventive therapy was initiated in 59% (81/138) of contacts aged Conclusion"Household contact card and register" is a useful tool for HCWs for TB screening in HHC of PTB patients. Reasons for non-adherence to contact screening needs to be addressed.