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Rectal duplication cysts are a rare clinical entity accounting for 4% of all intestinal duplications. The presenting symptoms depend upon their size, location and age of the patient. We report a rare neonatal presentation of rectal duplication cyst which was present as a swelling in the infracoccygeal region in a female child since birth. MRI suggested a cystic swelling adjacent to the rectum. Excision was done by posterior sagittal approach at 1 month of age. Histopathology confirmed it to be a rectal duplication cyst.

Abstract: Aesculus L. is a genus of 12 to 19 woody species, representing one of the most acclaimed examples of inter-continental incoherence of the plants native to temperate regions of the Northern Hemisphere. It is traditionally valued in Ayurveda and the Chinese system of medicine for its various species that possess antitumor, cardioprotective, anti-inflammatory and neuroprotective activities. Current studies on this genus have revealed the presence of specific saponins with a multi-spectrum of pharmacological actions and therapeutic applications. A repertoire of literature related to the biological, taxonomical, phytochemical and ethnopharmacological aspects of Aesculus genus and its uses in different indigenous populations was explored. An inventory of all the species of this genus that were found to be useful as per ethnopharmacological literature was prepared. The ethnobotany, phytochemistry and pharmacology of the individual species are outlined in this review. The extensive information cited here has adduced the likely areas where the important species of this genus can illustrate significant therapeutic intervention in the management of chronic disorders including diabetes, hypercholesterolemia and cancer. The wide range of its pharmacological actions is attributed to the distinct phytochemicals occurring in the species, especially the triterpenoidal saponins like aescin. This review amplifies the recent studies on phytochemical and pharmacological aspects, which alludes that these species have noteworthy therapeutic potential.

AIM: To study the pediatric patients in a developing country undergoing peripheral lymph node excision biopsy in terms of demographics and histopathological ndings and evaluate the diagnostic yield of peripheral Lymph node excision biopsy in children. MATERIALS AND METHODS: A retrospective study of 402 patients was done of the children undergoing peripheral lymph node st st excision biopsy in a tertiary care center from 1 January 2013 to 31 December 2018 (6 years). Demographics, histopathological ndings and yields were studied. RESULTS: Out of the 402 patients, 218 (54.2%) were males and 184(45.8%) were females. Male to female ratio 1.18: 1. Maximum patients belonged to the age group of 4-6years (26.87%) followed by the age group of 2-4years of age (22.89%). Most common group of nodes excised were cervical (77.9%) followed by axillary and inguinal lymph nodes (9.2%) each. The most common etiology was reactive lymphoid hyperplasia (63.18%) in our study followed by tuberculous lymphadenitis(31.84%). Specic ndings were seen in 35.58% and non-specic ndings were seen in 64.42% patients. Malignancy was seen in 8 patients (2%). CONCLUSION: Peripheral Lymphadenopathy in pediatric population is always a diagnostic challenge. While FNAC tends to be investigation of choice for adults, in a developing country with limited resources and high prevalence of tuberculosis, peripheral lymph node biopsy is the gold standard with a good diagnostic yield and should always be considered for patients with persistent lymphadenopathy. Clinical significance: The study highlights the importance of excision biopsy in peripheral lymphadenopathy in children in a developing nation with limited resources and high prevalence of infectious diseases.

David MG Halpin,1 Robyn Kendall,2 Soham Shukla,3 Alan Martin,4 Dhvani Shah,5 Dawn Midwinter,6 Kai M Beeh,7 Janwillem WH Kocks,8– 11 Paul W Jones,12 Chris Compton,12 Nancy A Risebrough,13 Afisi S Ismaila3,14 1University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK; 2ICON Health Economics, ICON plc, Vancouver, BC, Canada; 3Value Evidence and Outcomes, GSK, Collegeville, PA, USA; 4Value Evidence and Outcomes, GSK, Uxbridge, UK; 5ICON Health Economics, ICON plc, New York, NY, USA; 6Biostatistics, GSK, Brentford, UK; 7Insaf Respiratory Research Institute, Wiesbaden, Germany; 8General Practitioners Research Institute, Groningen, the Netherlands; 9Observational and Pragmatic Research Institute, Singapore; 10Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 11Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 12Global Respiratory Franchise, GSK, Brentford, UK; 13ICON Health Economics, ICON plc, Toronto, ON, Canada; 14Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: David MG Halpin, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK, Tel +44 01392 201178, Email d.halpin@nhs.netPurpose: The 24-week INTREPID trial demonstrated the clinical benefits of once-daily single-inhaler triple therapy (SITT) with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) versus non-ELLIPTA multiple-inhaler triple therapy (MITT) in patients with symptomatic chronic obstructive pulmonary disease (COPD). This analysis assessed the cost-effectiveness of FF/UMEC/VI versus non-ELLIPTA MITT for the treatment of symptomatic COPD from a United Kingdom (UK) National Health Service (NHS) perspective.Patients and Methods: The analysis was conducted using the validated GALAXY COPD disease progression model. Baseline characteristics, treatment effect parameters (forced expiratory volume in 1 second and St. George’s Respiratory Questionnaire score [derived from exploratory COPD Assessment Test score mapping]), and discontinuation data from INTREPID were used to populate the model. UK healthcare resource and drug costs (2020 British pounds) were applied, and costs and outcomes were discounted at 3.5%. Analyses were conducted over a lifetime horizon from a UK NHS perspective. Model outputs included exacerbation rates, total costs, life years (LYs), quality-adjusted LYs (QALYs) and incremental cost-effectiveness ratio per QALY. Sensitivity analyses were conducted to assess the robustness of the results by varying parameter values and assumptions.Results: Over a lifetime horizon, FF/UMEC/VI provided an additional 0.174 (95% confidence interval [CI]: 0.024, 0.344) LYs (approximately 2 months), and 0.253 (95% CI: 0.167, 0.346) QALYs (approximately 3 months), at a cost saving of £ 1764 (95% CI: −£ 2600, −£ 678) per patient, compared with non-ELLIPTA MITT. FF/UMEC/VI remained the dominant treatment option, meaning greater benefits at lower costs, across all scenario and sensitivity analyses.Conclusion: Based on this analysis, in a UK setting, FF/UMEC/VI would improve health outcomes and reduce costs compared with non-ELLIPTA MITT for the treatment of patients with symptomatic COPD. SITT may help to reduce the clinical and economic burden of COPD and should be considered by physicians as a preferred treatment option.Keywords: chronic obstructive pulmonary disease, cost-effectiveness, health technology assessment, pragmatic, real-world, triple therapy

Aims: To find the knowledge and attitude among physiotherapy interns towards physiotherapy and total knee replacement in case of osteoarthritis of knee. Material and Methods : A cross-sectional observational study was carried out using a structured questionnaire. The structured questionnaire was designed to assess the knowledge and attitude among physiotherapy interns towards physiotherapy and total knee replacement in case of osteoarthritis of knee across the colleges in Gujarat. The data was analyzed by using the Statistical Package for Social Sciences (SPSS) statistical software, version 16. Results: Total 250 Interns students were participated in the study. Majority of Physiotherapy students believed 75-100% successful in improving functional mobility. Physiotherapy is effective in mild and moderate stage of osteoarthritis knee. Physiotherapy was considered as an alternative to total knee replacement by 85% of Interns, and they think that it can delay or avoid total knee replacement in patient with minimal symptoms, and if patient with minimal symptoms are advised for total knee replacement then they take an effort as to discuss with the orthopedic surgeons to take physiotherapy as first treatment option. Conclusion: Interns knowledge and attitude on Physiotherapy for osteoarthritis knee concludes that physiotherapy is effective in mild to moderate stage of osteoarthritis knee for improving functional mobility .Their opinion for advising criteria of total knee replacement to the individual having NPRS 8-10, Flexion range of motion restriction of 45-90 degrees, Extension range of motion restriction 0-45 degrees, Fixed flexion deformity, Medial Instability and ADL’s affection i.e. Getting out from chair, sit to stand, crossed leg sitting, squatting etc. Keywords : Osteoarthritis of knee, total knee replacement, Interns physiotherapy students. Physiotherapy.

Congenital malformations of the lungs are rare. Congenital pulmonary airway malformation and bronchopulmonary sequestrations are commoner malformations amongst them. Co-existence of both in a single lesion is extremely rare. Such hybrid lesions or rather malformations have been sparsely reported. We report a similar lesion in an eleven years old male who presented with hemoptysis and diagnosed to have a hybrid lesion.

Soham Shukla,1 Dhvani Shah,2 Alan Martin,3 Nancy A Risebrough,4 Robyn Kendall,5 Claus F Vogelmeier,6 Isabelle Boucot,3 Lee Tombs,7 Leif Bjermer,8 Paul W Jones,3 Edward Kerwin,9 Chris Compton,3 François Maltais,10 David A Lipson,11,12 Afisi S Ismaila1,13 1Value Evidence and Outcomes, GSK, Collegeville, PA, USA; 2ICON, New York, NY, USA; 3Value Evidence and Outcomes, GSK, Brentford, Middlesex, UK; 4Global Health Economics, and Outcomes Research and Epidemiology, ICON, Toronto, ON, Canada; 5Global Health Economics, and Outcomes Research and Epidemiology, ICON, Vancouver, BC, Canada; 6Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany; 7Precise Approach Ltd, Contingent Worker on Assignment at GSK, Brentford, Middlesex, UK; 8Respiratory Medicine and Allergology, Lund University, Lund, Sweden; 9Altitude Clinical Consulting and Clinical Research Institute of Southern Oregon, Medford, OR, USA; 10Centre de Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada; 11Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 12Respiratory Clinical Sciences, GSK, Collegeville, PA, USA; 13Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Afisi S IsmailaValue Evidence and Outcomes, GlaxoSmithKline 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USATel +1 919 315 8229Email afisi.s.ismaila@gsk.comIntroduction: Dual bronchodilators are recommended as maintenance treatment for patients with symptomatic COPD in the UK; further evidence is needed to evaluate cost-effectiveness versus monotherapy. Cost-effectiveness of umeclidinium/vilanterol versus umeclidinium and salmeterol from a UK healthcare perspective in patients without exacerbations in the previous year was assessed using post hoc EMAX trial data.Methods: The validated GALAXY model was populated with baseline characteristics and treatment effects from the non-exacerbating subgroup of the symptomatic EMAX population (COPD assessment test score ≥ 10) and 2020 UK healthcare and drug costs. Outputs included estimated exacerbation rates, costs, life-years (LYs), and quality-adjusted LYs (QALYs); incremental cost-effectiveness ratio (ICER) was calculated as incremental cost/QALY gained. The base case (probabilistic model) used a 10-year time horizon, assumed no treatment discontinuation, and discounted future costs and QALYs by 3.5% annually. Sensitivity and scenario analyses assessed robustness of model results.Results: Umeclidinium/vilanterol treatment was dominant versus umeclidinium and salmeterol, providing an additional 0.090 LYs (95% range: 0.035, 0.158) and 0.055 QALYs (− 0.059, 0.168) with total cost savings of £ 690 (£ 231, £ 1306) versus umeclidinium, and 0.174 LYs (0.076, 0.286) and 0.204 QALYs (0.079, 0.326) with savings of £ 1336 (£ 1006, £ 2032) versus salmeterol. In scenario and sensitivity analyses, umeclidinium/vilanterol was dominant versus umeclidinium except over a 5-year time horizon (more QALYs at higher total cost; ICER=£ 4/QALY gained) and at the lowest estimate of the St George’s Respiratory Questionnaire treatment effect (fewer QALYs at lower total cost; ICER=£ 12,284/QALY gained); umeclidinium/vilanterol was consistently dominant versus salmeterol. At willingness-to-pay threshold of £ 20,000/QALY, probability that umeclidinium/vilanterol was cost-effective in this non-exacerbating subgroup was 95% versus umeclidinium and 100% versus salmeterol.Conclusion: Based on model predictions from a UK perspective, symptomatic patients with COPD and no exacerbations in the prior year receiving umeclidinium/vilanterol are expected to have better outcomes at lower costs versus umeclidinium and salmeterol.Keywords: COPD treatment, cost-effectiveness, umeclidinium, salmeterol, umeclidinium/vilanterol

The structure of a hydrogel network determines its ability to dissipate stress upon deformation, as well as its ability to swell in water. By designing systems with cross-linkable thiol groups in the monomers, radical thiol–ene chemistry was used to form controlled networks for acrylamide monomers. The use of radical thiol–ene chemistry effectively suppressed homo-polymerization of the bis(acrylamide) monomer and resulted in networks of alternating thiol and acrylamide monomers. Additionally, if the stoichiometry between the monomers is controlled, the network should approach that of ideality. In the case of bis(acrylamide) monomers, the incorporation of hydrogen-bond donors into the network creates a single network hydrogel with the benefits of high strength and ductility from the simultaneous incorporation of chemical and physical cross-links. Additionally, this strategy suppresses the formation of homo-polymerization in the acrylamide monomer to achieve an alternating network, which is supported with NMR characterization of base-digested fragments. For three different monomer compositions, the resulting gels had high compressive strength (up to 40 MPa) and tunable mechanical properties. The high mechanical strength of the 1 : 1, thiol : ene gel composition is due to the uniform distribution of cross-links, which creates defect-free networks for efficient stress transfer. The present one-pot synthetic strategy toward controlled gel networks affords monomer versatility and synthetic ease, as well as the potential for mechanically robust materials.

Background We assessed the cost-effectiveness of single-inhaler fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) versus FF/VI or UMEC/VI from a Canadian public healthcare perspective, incorporating data from the IMPACT trial in chronic obstructive pulmonary disease (COPD) (NCT02164513). Methods Baseline inputs and treatment effects from IMPACT were populated into the validated GALAXY-COPD disease progression model. Canadian unit costs and drug costs (Canadian dollars [C$], 2017) were applied to healthcare resource utilization and treatments. Future costs and health outcomes were discounted at 1.5% annually. Analyses were probabilistic, and outputs included exacerbation rates, costs, and life years (LYs) and quality-adjusted life years (QALYs) gained. Results Compared with FF/VI and UMEC/VI over a lifetime horizon, the analyses predicted that treatment with FF/UMEC/VI resulted in fewer moderate and severe exacerbations, more LYs and more QALYs gained, with a small incremental cost. The base-case incremental cost-effectiveness ratio (ICER) per QALY gained was C$18,989 (95% confidence interval [CI]: C$14,665, C$25,753) versus FF/VI and C$13,776 (95% CI: C$9787, C$19,448) versus UMEC/VI. FF/UMEC/VI remained cost-effective versus both FF/VI and UMEC/VI in all sensitivity analyses, including in scenario analyses that considered different intervention and comparator discontinuation rates, and treatment effects for subsequent therapy. Conclusion Treatment with FF/UMEC/VI was predicted to improve outcomes and be a cost-effective treatment option for patients with symptomatic COPD and a history of exacerbations compared with FF/VI or UMEC/VI, in Canada.

Introduction The cost-effectiveness of long-acting muscarinic antagonist (LAMA) umeclidinium bromide (UMEC) 62.5 μg as add-on therapy to other maintenance COPD treatments is unknown. Methods This analysis assessed the cost-effectiveness of the following in COPD: UMEC + fluticasone furoate/vilanterol 100/25 μg (FF/VI); UMEC + fluticasone propionate/salmeterol 250/50 μg (FP/SAL); and UMEC + several alternative choices of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). The model was informed with direct and indirect data from previously published studies, with a UK perspective and a lifetime horizon. Sensitivity analyses were also performed. Results For the lifetime horizon, compared with FF/VI, FP/SAL and ICS/LABAs, addition of UMEC was associated with incremental costs per quality-adjusted life-years (QALY) of £4050, £7210 and £5780, respectively, and incremental costs per life year gain of £3380, £6020 and £4940. All UMEC-containing regimens resulted in numerically lower exacerbation rates versus comparator regimens over a lifetime horizon. Conclusions Addition of UMEC to various ICS/LABA treatments was associated with higher cost than ICS/LABA alone, but was cost-effective in most scenarios.

BackgroundThe IMPACT trial demonstrated superior outcomes following 52 weeks of once-daily single-inhaler treatment with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) (100/62.5/25 μg) compared with once-daily FF/VI (100/25 μg) or UMEC/VI (62.5/25 μg). This study evaluated the cost-effectiveness of FF/UMEC/VI compared with FF/VI or UMEC/VI for the treatment of chronic obstructive pulmonary disease (COPD) from a UK National Health Service perspective.MethodsPatient characteristics and treatment effects from IMPACT were populated into a hybrid decision tree/Markov economic model. Costs (GB£ inflated to 2018 equivalents) and health outcomes were modelled over a lifetime horizon, with a discount rate of 3.5% per annum applied to both. Sensitivity analyses were performed to test the robustness of key assumptions and input parameters.ResultsCompared with FF/VI and UMEC/VI, FF/UMEC/VI provided an additional 0.296 and 0.145 life years (LYs) (discounted) and 0.275 and 0.118 quality-adjusted life years (QALYs), at an additional cost of £1129 and £760, respectively. Incremental cost-effectiveness ratios (ICERs) for FF/UMEC/VI were £4104/QALY and £3809/LY gained versus FF/VI and £6418/QALY and £5225/LY gained versus UMEC/VI. At a willingness-to-pay threshold of £20 000/QALY, the probability that FF/UMEC/VI was cost-effective was 96% versus FF/VI and 74% versus UMEC/VI. Results were similar in a subgroup of patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline.ConclusionsFF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised cost-effectiveness threshold levels.

Background: The role of endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic intervention for choledocholithiasis is long established. Endoscopic therapy involves stone extraction using conventional methods after performing endoscopic biliary sphincterotomy. The objective of this study was to determine the outcome of patients with choledocholithiasis being treated in our setup.Methods: This retrospective observational study was conducted at T.N.M.C. and BYL Nair Hospital, Mumbai from January 2017 to October 2017. All patients with choledocholithiasis proven radiologically were admitted. All patients underwent elective endoscopic retrograde cholangiopancreatography. In patients in whom ERCP failed, open surgical clearance of the common bile duct was done.Results: A total of 50 cases of choledocholithiasis were admitted during the study period. Age distribution in our study was from 27 years to 81 years of which, 46% were males and 54% were females. Successful clearance of CBD with balloon sweep, dormia basket, CBD stenting or sphincterotomy alone was done in 38 patients (76%). Nine patients (18%) required repeat ERCP/ more than one sitting for clearance of CBD. Most of the patients had stone size of >10 mm (8 out of 9 patients i.e. 88.89%). Three patients were referred for surgical intervention due to non-retrieval of calculus. All these patients had stone size >15 mm (100%).Conclusions: In our study 94% patients eventually achieved successful clearance with ERCP. Also, the size of the stone was an independent risk factor that affected the outcome of ERCP.

Aims: Heart failure with reduced ejection fraction (HFrEF) has a substantial impact on costs and patients’ quality-of-life. This study aimed to estimate the cost-effectiveness of implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy pacemakers (CRT-P), cardiac resynchronization therapy defibrillators (CRT-D), and optimal pharmacologic therapy (OPT) in patients with HFrEF, from a US payer perspective. Materials and methods: The analyses were conducted by adapting the UK-based cost-effectiveness analyses (CEA) to the US payer perspective by incorporating real world evidence (RWE) on baseline hospitalization risk and Medicare-specific costs. The CEA was based on regression equations estimated from data from 13 randomized clinical trials (n = 12,638). Risk equations were used to predict all-cause mortality, hospitalization rates, health-related quality-of-life, and device-specific treatment effects (vs. OPT). These equations included the following prognostic characteristics: age, QRS duration, New York Heart Association (NYHA) class, ischemic etiology, and left bundle branch block (LBBB). Baseline hospitalization rates were calibrated based on RWE from Truven Health Analytics MarketScan data (2009–2014). A US payer perspective, lifetime time horizon, and 3% discount rates for costs and outcomes were used. Benefits were expressed as quality-adjusted life-years (QALYs). Incremental cost-effectiveness analysis was conducted for 24 sub-groups based on LBBB status, QRS duration, and NYHA class. Results: Results of the analyses show that CRT-D was the most cost-effective treatment at a $100,000/QALY threshold in 14 of the 16 sub-groups for which it is indicated. Results were most sensitive to changes in estimates of hospitalization costs. Limitations: Study limitations include small sample sizes for NYHA I and IV sub-groups and lack of data availability for duration of treatment effect. Conclusions: CRT-D has higher greater cost-effectiveness across more sub-groups in the indicated patient populations against as compared to OPT, ICD, and CRT-P, from a US payer perspective.

In this paper we propose a novel, cloud-based framework to support citizens and city officials in the building permit process. The proposed framework is efficient, user-friendly, and transparent with a quick turn-around time for homeowners. Compared to existing permit systems, the proposed smart city permit framework provides a pre-permitting decision workflow, and incorporates a data analytics and mining module that enables the continuous improvement of both the end user experience and the permitting and urban planning processes. This is enabled through a data mining-powered permit recommendation engine as well as a data analytics process that allow a gleaning of key insights for real estate development and city planning purposes, by analyzing how users interact with the system depending on their location, time, and type of request. The novelty of the proposed framework lies in the integration of a pre-permit processing front-end with permit processing and data analytics & mining modules, along with utilization of techniques for extracting knowledge from the data generated through the use of the system. The proposed framework is completely cloud-based, such that any city can deploy it with lower initial as well as maintenance costs. We also present a proof-of-concept use case, using real permit data from New York City.

In the recent years, machine learning and deep learning techniques are being applied on brain data to study mental health. The activation of neurons in these models is static and continuous-valued. However, a biological neuron processes the information in the form of discrete spikes based on the spike time and the firing rate. Understanding brain activities is vital to understand the mechanisms underlying mental health. Spiking Neural Networks are offering a computational modelling solution to understand complex dynamic brain processes related to mental disorders, including depression. The objective of this research is modeling and visualizing brain activity of people experiencing symptoms of depression using the SNN NeuCube architecture. Resting EEG data was collected from 22 participants and further divided into groups as healthy and mild-depressed. NeuCube models have been developed along with the connections across different brain regions using Synaptic Time Dependent plasticity (STDP) learning rule for healthy and depressed individuals. This unsupervised learning revealed some distinguishable patterns in the models related to the frontal, central and parietal areas of the depressed versus the control subjects that suggests potential markers for early depression prediction. Traditional machine learning techniques, including MLP methods have been also employed for classification and prediction tasks on the same data, but with lower accuracy and fewer new information gained.

Transportation is the most essential need of human beings. Making cars smart will be a breakthrough, where they automatically learn to drive on streets. We will look forward to map the road by itself and self-learn the survival on the roads. Self-driving vehicles detect and avoid obstacles and objects. It may happen that while driving a person suffers from a heart attack or severe headache, then based on his facial expressions, our system will automatically send SMS to his family members. Also, if the user is feeling sleepy, using mobile phones, or looking outside for long time mistakenly, then our system will raise an alarm in such situations. Autonomous car is making sure of reaching its last stop safely and cleverly, thus escaping the risk of human mistakes and taking the necessary decisions related to the real world. Lane- and obstacle-detection algorithms are used to provide the required control to the car.

Gone are the days when software was used only for complex mathematical calculations or graphical motions alone. Today, it is software that has exponentially grown to become more powerful and more human—most obviously in applications such as ‘Chatbots.’ The year 2017 marks the Chatbot revolution in various industries like health, career, insurance, customer care support. Artificial intelligence (AI), which is the key player in enabling human-like behavior intelligently, is dramatically changing business. Chatbots, fueled by AI, are becoming a viable option for human–machine interaction. Deep learning algorithms have made it possible to build intelligent machine. In this research, we have developed a HealthBot using TensorFlow and Natural Language Processing (NLP) techniques. There is no denying that efficient patient engagement is a key challenge for all healthcare organizations and any company that can unravel this challenge can effectively earn high returns of investments. Chatbots are one of the major overhauls that hospitals can easily provide more customized care for patients while cutting down on the waiting period. The proposed HealthBot lists the common symptoms; then, based on user’s health issue it gets deeper into the conversations predicting the health problem of the user. Such bots are needed for today’s fast-moving population where they have no time to keep a tab on their health. Neural network implementation adds more accuracy to the responses. The proposed Chatbot model is a retrieval-based bot and of closed domain. Finally, the HealthBot is deployed on the Flask, a Python web development framework.

Introduction and objective Exacerbations associated with chronic obstructive pulmonary disease (COPD) are costly and affect health related quality of life (HRQoL) for patients. An economic model was developed to estimate the cost-effectiveness of once-daily single-inhaler triple-therapy, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) Trelegy®, 100 µg/62.5 µg/22 µg and dual therapy, umeclidinium/vilanterol (UMEC/VI) Anoro®, 55 µg/22 µg from a UK NHS perspective using results from the IMPACT study (NCT02164513). Patients and methods The model combines a decision tree for the within-trial period (52 weeks) and a Markov model to predict lifetime costs and outcomes of FF/UMEC/VI compared with UMEC/VI. Risk equations for prediction of exacerbations (by severity of COPD) and FEV1 decline (based on exacerbation history) were derived using data from the TORCH study (NCT00268216). Baseline characteristics, efficacy and medication use were based on data from IMPACT. Direct costs, including drug acquisition costs were calculated using UK NHS reference costs and drug prices. Healthcare resource utilisation was based on published sources. Costs (2018 £) and health outcomes were discounted at 3.5% and modelled on a lifetime horizon. Sensitivity analyses were performed to evaluate the robustness of the model to variations in the underlying input parameters and assumptions. Results Patients treated with FF/UMEC/VI had fewer moderate and severe exacerbations, more life years gained, improved HRQoL and higher total costs compared with patients treated with UMEC/VI based on deterministic analyses (table 1). The incremental cost-effectiveness ratio (ICER) was £7451 per QALY gained. Sensitivity analyses identified that results were most sensitive to drug acquisition cost, utilities associated with moderate COPD and severe COPD, mortality risk in very severe COPD, and exacerbation rates. The ICERs ranged from £1110 to £13 793 per QALY. Probabilistic sensitivity analysis indicated a 73% chance that FF/UMEC/VI is cost-effective versus UMEC/VI at a willingness to pay threshold of £20 000 per QALY. Funding GSK (study number HO-17–17596). ICON Health Economics received funding from GSK to conduct the study only.

Introduction and objectives The IMPACT trial (NCT02164513) showed superior exacerbation reduction and lung function improvement with once-daily single inhaler triple therapy, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/22 µg, compared with once-daily FF/VI 100/22 µg, for patients with symptomatic COPD and a history of exacerbations. An economic model was developed to assess the cost-effectiveness of FF/UMEC/VI vs FF/VI from a UK NHS perspective, using results from IMPACT. Methods The model combined a decision-tree for the trial period, with longer-term outcomes extrapolated via a Markov model with health states reflecting COPD severity and exacerbation history. Disease progression and exacerbation rates were determined by risk equations based on the 3 year Towards a Revolution in COPD Health study (TORCH, NCT00268216). The model was populated with baseline characteristics, efficacy and medication use from IMPACT, while healthcare resource use and utility estimates came from the literature. Medication and healthcare resource use were costed using UK drug prices and unit costs (2018 £). Results are for a lifetime horizon with costs and health outcomes (except life-years) discounted at 3.5%. Results Treatment with FF/UMEC/VI, compared with FF/VI, resulted in fewer moderate and severe exacerbations (6.460 and 1.501 vs 6.686 and 1.528), more life-years (8.874 vs 8.577) increased quality-adjusted life years (QALYs, 6.565 vs 6.291) and higher total costs (£24 843 vs £23,549). Patients receiving FF/UMEC/VI gained an additional 0.275 QALYs for an additional cost of £1,294, compared to those receiving FF/VI, to give an incremental cost-effectiveness ratio (ICER) of £4712 per QALY gained. In deterministic sensitivity/scenario analyses, ICERs ranged from dominant to £7502 per QALY gained, with results most sensitive to drug acquisition costs, utility associated with moderate COPD, duration of treatment effect and time horizon. In probabilistic sensitivity analysis, the probability of FF/UMEC/VI being cost-effective vs FF/VI was 95% at a willingness-to-pay threshold of £20 000 per QALY. Conclusions Treatment with FF/UMEC/VI was predicted to improve health outcomes and to be a cost-effective option for patients with symptomatic COPD and a history of exacerbations, when compared with FF/VI, in the UK. Funding GSK (study number HO-17–17596). ICON Health Economics received funding from GSK to conduct the study only.

Dhvani Shah,1 Nancy A Risebrough,2 Johnna Perdrizet,1 Neeraj N Iyer,3 Cory Gamble,4 Tam Dang-Tan3 1ICON, Commercialisation and Outcomes, Health Economics, New York, NY, USA; 2ICON, Commercialisation and Outcomes, Health Economics, Toronto, ON, Canada; 3HEOR & Data Analytics, Novo Nordisk Inc, Plainsboro, NJ, USA; 4Medical and Scientific Affairs, Novo Nordisk, Plainsboro, NJ, USA Background: The Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcomes Results (LEADER) clinical trial demonstrated that liraglutide added to standard-of-care (SoC) therapy for type 2 diabetes (T2D) with established cardiovascular disease (CVD) or elevated cardiovascular (CV) risk was associated with lower rates of death from CVD, nonfatal myocardial infarction (MI), or nonfatal stroke than SoC alone.Objective: The objective of this study was to assess the cost-effectiveness (CE) and budget impact of liraglutide vs SoC in T2D patients with established CVD or elevated CV risk, over a lifetime horizon from a US managed care perspective.Methods: A cohort state-transition model (costs and benefits discounted at 3% per year) was used to predict diabetes-related complications and death (CV and all-cause). Events, treatment effects, and discontinuation rates were from LEADER trial; utility and cost data (US$, 2017) were from literature. Sensitivity analysis explored the impact of uncertainty on results. Additionally, a budget impact analysis was conducted to evaluate the financial impact of liraglutide use in this population, with displacement from dulaglutide, assuming a health care plan with 1 million members.Results: Liraglutide patients experienced 6.3% fewer events, had event-related cost-savings of $15,182, gained additional life-years of 0.67 and quality-adjusted life-years (QALYs) of 0.57, and had additional total costs ($60,928) vs SoC. Liraglutide was cost-effective with an incremental CE ratio of $106,749/QALY which was below the willingness-to-pay threshold of $150,000/QALY accepted by the Institute of Clinical and Economic Research. Liraglutide was cost-effective across all sensitivity analyses, except when the hazard ratio for all-cause mortality varied. The budget impact was neutral, with a per-plan-per-year and per-member-per-month cost-savings of $266,334 and $0.02, respectively.Conclusion: From a US-managed care perspective, for T2D patients with established CVD or elevated CV risk, liraglutide is a cost-effective and a budget neutral treatment option for health care plans. Keywords: liraglutide, cardiovascular disease, type 2 diabetes, cost-effectiveness, budget impact

Background: IMPACT (InforMing the PAthway of COPD Treatment, NCT02164513), showed superior exacerbation reduction and lung function improvement with single inhaler, once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/22μg vs once-daily FF/VI 100/22μg, for patients with moderate/severe COPD. Objectives: The cost-effectiveness of FF/UMEC/VI vs FF/VI was assessed, from a Canadian public payer perspective. Methods: A validated linked risk equation model (Briggs, Med Decis Making 37;4 2017), which predicts COPD disease progression, associated healthcare costs and health outcomes, was populated with baseline characteristics, efficacy and medication use from IMPACT. Canadian healthcare resource unit costs and drug costs were applied, with future costs and health outcomes discounted at 1.5% annually. Analysis was probabilistic, with a lifetime horizon and outputs including exacerbation rates, costs (2017 CAD), quality-adjusted life years (QALYs) gained and incremental cost effectiveness ratio (ICER) per QALY. Results: Compared with FF/VI, FF/UMEC/VI treatment resulted in fewer moderate and severe exacerbations (10.52 and 3.38 vs 11.13 and 3.48), mean (95% CI) incremental costs and QALYs of $2,598 ($2,010, $3,268) and 0.13 (0.09, 0.18), and an ICER of $19,649 per QALY ($15,406, $26,454). The probability of FF/UMEC/VI being cost-effective vs FF/VI was 100% at a willingness-to-pay threshold of $50,000 per QALY. Results were most sensitive to time horizon, and efficacy of treatment post-discontinuation. Conclusions: FF/UMEC/VI was predicted to improve health outcomes and to be a cost-effective option for treatment of moderate/severe COPD compared with FF/VI, in Canada.

The population is growing day by day. World is moving towards advanced technologies which makes life easier and hence there is a need of smart city. Such smart city also needs smart malls which deliver the wonderful experience of shopping. Whereas many e-commerce sites give priority to each and every consumer by sending notifications about upcoming offers and sale, about the launch of new products, and predicting and showing a list of items customers may like to buy. Malls are pretty bad at advertising offers and giving personalized experience to customers and make them feel special. Our system will provide a great experience of personalized shopping which will help them to buy the product. Our system will make use of customer’s previous purchase record, and current offers going on in the mall. The system will sort best offers that will be most relevant to his/her shopping style. The system will advertise using LCD’s and speakers that will come along with it, which will make it much more interactive with customers using Raspberry Pi which will make it a low-cost system. Also when the customer reaches nearby the mall, he will be shown only those products advertises in which he/she would be interested, this will make him/her feel special because of giving preferences to their choices. The user will also get notified by Android app or email, whenever products or offers of their interest that would be launch in the mall. The system will keep customers connected to the mall even if they are working in an office or resting at home or roaming in the mall.

The proposed research attempts to emulate a statistical report making system, which takes into considerations, the activities of user and their behavior online by means of their interactions on varied array of social media platforms. It is possible that youngsters may come across incidents on Internet, which probably may be inappropriate for their age group or may push them towards certain erratic psychological behaviors. This study caters to such arising needs, for various individuals—young or old, alike, so as to keep a tab upon their own online activities through browsing history which may be directly/indirectly blend into their human characteristics. On social media, people express their likes, dislikes, thoughts, opinions, and feelings which sum up to be their own personality. This data (thoughts and opinions on social platform and browsing history) can be exponentially aggregated to identify user’s personality traits. It can then be used for self-monitoring, parental monitoring, or for businesses who wish to hire employees based on their personality criteria, if approved by concerned users. For this study, we have used supervised machine learning algorithms like Naive Bayes and Support Vector Machines. We have evaluated their performance through the combinations of different feature extraction process like BOW, TF, and TF-IDF with each classifier. In conclusion, we have found that TF-IDF with SVM has the best performance.

The use of information technology in varied applications is growing exponentially which also makes the security of data a vital part of it. Authentication plays an imperative role in the field of information security. In this study, biometrics is used for authentication purpose and also describes the combinational power of biometrics and cloud computing technologies that exhibit the outstanding properties of flexibility, scalability, and reduced overhead costs, in order to reduce the cost of the biometric system requirements. The massive computational power and unlimited storage provided by cloud vendors make the system fast. The purpose of this research is to precisely design a biometric-based cloud architecture for online signature recognition on Windows Tablet PC, which will make the signature recognition system (SRS) more scalable, pluggable, and faster, thereby categorizing it under “Bring Your Own Device” category. For extracting the features of the signature to uniquely identify the user, Webber local descriptor (WLD) process is used. The real-time implementation of this feature extraction process as well as the execution of the classifier for the verification process is deployed on Microsoft Azure public cloud. For performance evaluation, total acceptance ratio (TAR) and total rejection ratio (TTR) are used. The proposed online signature system gives 78.10% PI (performance index) and 0.16 SPI (security performance index).

Background Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective. Methods A linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George’s Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model. Results Over a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (− 0.053; 95% CI: − 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: − £645, − £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (− 0.033; 95% CI: − 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses. Conclusions For treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost. Trial registration 201316, NCT02207829; 201315, NCT02236611

Additional file 1: Table S1. Model inputs: drug cost. Table S2. Model results: 5-year horizon. Table S3. Model results: 10-year horizon. Table S4. Model results: Scenario Analyses UMEC versus TIO (Analysis 1) and UMEC versus GLY (Analysis 2). Figure S1. Net benefit acceptability curves for UMEC versus TIO (A) and UMEC versus GLY (B).

It is well known that people suffering from visual impairments face many difficulties in travelling independently. Due to this, they rely on some form of external aids, which include a variety of tools and techniques like a stick. Such tools are called Electronic Travel Aids (ETA). Sometimes even with the use of this stick, the safety of the blind person is not guaranteed. The stick may not always detect all the obstacles in the path.. The objective of this project is to build a blind man stick that can detect obstacles, potholes and thus help the blind person travel independently. The system is constructed using ultrasonic sensors, a Programmable Interrupt Controller (PIC 16F877A) that has an On-chip Analog-to-Digital Converter (ADC), a vibrator, buzzer and a power supply. The software used in this system includes Embedded ‘C’, Pickit 2 Programmer, MPLAB.

Introduction: The cost-effectiveness of treatments for chronic obstructive pulmonary disease (COPD) is needed. Objectives To evaluate the cost effectiveness of once-daily umeclidinium bromide 62.5 µg (UMEC) in combination with inhaled corticosteroids/long-acting β2-agonists (ICS/LABA) versus other long-acting muscarinic antagonists (LAMA)+ICS/LABA triple therapy combinations in the United Kingdom (UK). Methods: A linked-equation model estimated the disease progression, associated health service costs, and impact on quality-adjusted life-years and survival (Briggs et al. Med Decis Making 2016). Statistical risk equations for clinical endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Model baseline inputs and treatment effects were obtained from a network meta-analysis (Chounta et al. ATS 2016). For the base case, a lifetime horizon was used and costs and effects were discounted at 3.5%. Analyses were performed from the UK National Health Service perspective. Results: UMEC+ICS/LABA improved health outcomes versus other LAMA+ICS/LABA combinations with lower costs over the lifetime. Results remained consistent at a 5- or 10-year time horizon. Sensitivity analyses showed that variation in main parameters did not alter the results. Conclusions In COPD, UMEC+ICS/LABA is cost saving and improves health outcomes versus other LAMA+ICS/LABA triple combinations in the UK. Funding GSK (HO-15-8059)

Introduction: Information about the cost effectiveness of add-on treatments for chronic obstructive pulmonary disease (COPD) is needed. Objectives To evaluate the cost effectiveness of once-daily umeclidinium bromide 62.5μg (UMEC) added to inhaled corticosteroids/long-acting β2-agonists (ICS/LABA) versus ICS/LABA in the United Kingdom (UK). Methods: A linked-equation model estimated disease progression, associated health service costs, and impact on quality-adjusted life-years and survival. Statistical risk equations for clinical endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Model baseline inputs and treatment effects were obtained from GSK trials (Siler et al. COPD 2016;13:1–10; Siler et al. Respir Med 2015;109:1155–63) and discontinuation rates from the UPLIFT study. A lifetime horizon was used and costs and effects were discounted at 3.5%. Analyses were performed from the UK National Health Service perspective. Results: Against slightly higher costs, UMEC added to ICS/LABA resulted in improved outcomes. Incremental cost-effectiveness ratios remained within recognised cost-effectiveness thresholds. Sensitivity analyses showed that variation in main parameters did not alter the results including at shorter time horizons of 5 and 10 years. Conclusions Against slightly higher costs, UMEC improves health outcomes when added to ICS/LABA in COPD in the UK. Funding GSK (HO-15-8059)

Acetaminophen is a commonly-used analgesic in the US and, at doses of more than 4 g/day, can lead to serious hepatotoxicity. Recent FDA and CMS decisions serve to limit and monitor exposure to high-dose acetaminophen. This literature review aims to describe the exposure to and consequences of high-dose acetaminophen among chronic pain patients in the US. Each year in the US, approximately 6% of adults are prescribed acetaminophen doses of more than 4 g/day and 30,000 patients are hospitalized for acetaminophen toxicity. Up to half of acetaminophen overdoses are unintentional, largely related to opioid-acetaminophen combinations and attempts to achieve better symptom relief. Liver injury occurs in 17% of adults with unintentional acetaminophen overdose.