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Purpose The OsteoCool Tumor Ablation Post-Market Study (OPuS One) was a prospective, multi-national, single-arm study to investigate safety and effectiveness of radiofrequency ablation (RFA) for palliation of painful lytic bone metastases with 12 months of follow-up. RFA has demonstrated effective palliation of osseous metastases in small clinical studies with short-term follow-up; however, a long-term assessment with robust subject numbers is lacking. Materials and Methods Prospective assessments were conducted at Baseline, 3 days, 1 week, and 1, 3, 6, and 12-months. Pain and quality of life were measured prior to RFA and postoperatively using the Brief Pain Inventory, European Quality of Life—5 Dimension, and European Organization for Research and Treatment of Cancer Care Quality of Life Questionnaire for palliative care. Radiation, chemotherapy and opioid usage, and related adverse events were collected. Results 206 subjects were treated with RFA at 15 institutions in OPuS One. Worst pain, average pain, pain interference and quality of life significantly improved at all visits starting 3 days post-RFA and sustained to 12 months (P Conclusion RFA for lytic metastases provides rapid (within 3 days) and statistically significant pain and quality of life improvements with sustained long-term relief through 12 months and a high degree of safety, independent of radiation. Level of Evidence: 2b, Prospective, Non-Randomized, Post-Market study This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Purpose:Vertebroplasty (VP) and balloon kyphoplasty (KP) are minimally invasive stabilization procedures for pathologic vertebral compression fractures (VCF). Concurrent administration of photodynamic therapy (PDT) as a tumor-ablative modality has yet to be studied in humans as a potential complement to improved mechanical stability that is afforded by vertebral cement augmentation (VCA).Patients and Methods:This first-in-human trial used a single 6 mg/m2 dose of the clinical photosensitizer Visudyne with escalating laser light doses. Following a cohort of light-only controls (n = 6), the drug and light treatment groups (n = 6 each) were 50, 100, 150, and 200 J/cm. VCA was performed within 15 minutes following PDT. Patients were clinically reviewed at 1 and 6 weeks. The primary outcome measure was safety from a neurologic perspective.Results:Thirty patients comprising a variety of primary tumors were treated with PDT and either KP or VP. Vertebral PDT was technically feasible and delivered in all study patients. No dose groups showed significant increases in pain as defined by the generic SF-36 as well as disease-specific EORTC-QLQ-BM22 and EORTC-QLQ-C15-PAL questionnaires. The 50 and 100 J/cm groups showed the most significant pain reduction (P < 0.05). Twelve (40%) patients experienced complications during the study including 3 patients with further vertebral fracture progression by 6 weeks despite VCA. No complications were directly attributed to PDT.Conclusions:Using the parameters described, vertebral PDT as an adjunct to VCA is safe from a pharmaceutical and neurologic perspective. The results of this trial motivate scale-up study evaluating potential PDT efficacy in vertebral metastatic treatment.

Table S1 highlights the inclusion/exclusion criteria for the PDT clinical trial in table format.

Figure S1 shows an overview of the PDT fiber set-up and placement for a kyphoplasty case.

To examine the safety and efficiency of balloon-assisted gastrostomy for insertion of large bore feeding tubes compared to conventional techniques using dilators. Retrospective review of all fluoroscopically guided percutaneous gastrostomy tube insertions between July 2017 and September 2019 was performed. Collected data points included patient demographics, initial pathology, type of gastrostomy tube (G tube) inserted [(Avanos standard balloon retained (Mic-G), or low-profile balloon retained (Mic-Key)], type of insertion technique (balloon-assisted or -nested dilator technique), fluoroscopy time, amount of sedation required, technical success, and complications. The focus of the study was method of tract dilatation – either balloon-assisted gastrostomy (BAG group) versus nested or sequential dilators (dilator group). Two hundred patients were included in this study; 100 patients were evaluated in each group. There were no significant differences between the two groups. The overall rate of minor complications (grades 1 and 2, according to the CIRSE classification system) was higher in the dilator group (11%, compared to 7% in the BAG group) but did not reach statistical significance. Males were associated with lower risk of minor complications (OR 0.19, 95% CI (0.07, 0.53)), while age did not present a significant association. Patients in the BAG group received a significantly lower amount of fentanyl (p

In 2021, the UK system for regulating the conduct of parliamentarians was briefly plunged into crisis. The government responded to a proposal to sanction one of its MPs – who had been found to have egregiously breached the Code of Conduct and accompanying rules - by threatening to change the whole system. This highly unusual interference by the executive branch, though withdrawn within 24 hours, violated the axiom that the executive should not have a say in disciplining members of the legislature because this might compromise parliament’s ability to hold the government to account. Yet the ensuing debate has prompted calls to move the UK system yet further away from self-regulation and grant more powers of oversight to ‘external’ roles and bodies. This article draws on interviews with MPs to analyse whether this longstanding trajectory of reform is in line with how these “rule makers” perceive the system’s flaws. It concludes that, over the years, MPs have to a large extent forfeited the right to regulate their own conduct by repeatedly shirking their responsibilities to regulate themselves effectively. Moreover, the constant focus on ‘fixing’ the procedures for investigating and sanctioning misconduct has crowded out a more constructive discussion about how to promote ethical behaviour.

Purpose of review Bone metastases are responsible for considerable morbidity, which can significantly limit a patient's quality of life. This article aims to review minimally invasive, image-guided locoregional treatments for symptomatic bone metastases as an adjunct to conventional treatment modalities. Recent findings Conservative therapy and radiation therapy (RT) can be effective at addressing pain, however, they require time to achieve optimal efficacy and do not address the instability and progressive collapse of pathological fractures. Vertebral and pelvic augmentation with cement enhances structural stability and can prevent progressive collapse and deformity. Ablative therapies, including radiofrequency ablation (RFA), cryoablation, and photodynamic therapy (PDT), induce cellular destruction of tumor tissue. RFA and PDT can be combined with cement augmentation in a single sitting. Summary Minimally invasive image-guided treatments can provide rapid pain relief, enhance mechanical stability, and improve quality of life. These treatments are associated with low complication rates and are suitable for frail patients. They can be used as companion procedures to conventional treatments, or function as an alternative for patients with radioresistant biologies or those with dose limitations from prior RT sessions.

Background The purpose of this case series is to assess the safety and efficacy, as well as the overall survival (OS) and progression free survival (PFS) of patients with intrahepatic cholangiocarcinoma (ICC) treated with percutaneous ablation, transarterial arterial chemoembolization (TACE) or a combination of both at our institution. Methods Ten patients with pathological diagnosis of adenocarcinoma treated at out institution between January 1st 2013 and January 1st 2019 were reviewed. Three patients received a combined TACE and ablation treatment, three patients received TACE without ablation and four patients were treated with ablation only. Ablation technical success was determined by absence of residual tumor in the ablation zone on follow-up imaging one-month post-ablation. TACE response was assessed using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Technical success was defined as injection of chemoembolic material in the involved liver lobes. PFS and OS were calculated from the date of diagnosis. Results In the TACE and radiofrequency ablation (RFA) group, OS was 12, 55 and 56 months; PFS was 5, 6 and 32 months, one patient died and two others remain alive. In the TACE group, OS was 29, 10 and 5 months; PFS was 15, 10 and 4 months. All three patients remain alive. In the ablation group, OS and PFS were 16, 31, 30 and 40 months. All patients remain alive. Overall, 9 of 10 patients are alive, with a Median OS and PFS of 29.5 and 15.5 months, respectively, with some patients remain alive over four years following initial presentation. Conclusions Our study shows that ablation and TACE in combination with more traditional modalities such as chemoradiation and surgical resection can extend survival in patients with ICC significantly. Locoregional therapy is well tolerated with only minor adverse events. The use of stereotactic body radiation therapy (SBRT) with ablation demonstrated the synergistic nature of using multiple lines of interventions.

We present an unusual but severe complication of peritoneal dialysis (PD) catheter removal resulting in significant haemorrhage and hospitalisation. A patient presented for PD catheter removal under local anaesthesia in the interventional radiology suite and was noted to have a heavily calcified deep Dacron cuff. This cuff was intimately associated with a deep inferior epigastric perforating (DIEP) vessel. Removal of the catheter resulted in shearing of DIEP vessel and pseudoaneurysm formation. Despite attempted surgical management with ligation haemorrhage continued, requiring urgent angiographic embolisation to stop the bleeding. Intimate relationship between DIEP vessel and Dacron cuff due to calcification was the cause of this complication. This case report represents a rare but important complication associated with PD catheter removal, highlighting that when calcification is seen at the deep cuff, caution should be exercised and there should be access to angiography suite in case of complication.

Objective: Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un). Methods: A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations were explored, lobe-specific nodal dissection, extracapsular extension, highest lymph node station status, carcinoma in situ at the bronchial resection margin, and pleural lavage cytologic examination result. Revised categories of R0, R(un), R1, and R2 were tested for survival impact. Results: In all, 14,293 cases were R0, 263 were R1, and 156 were R2 (median survivals not reached, 33 months, and 29 months, respectively). R status correlated with T and N categories. A total of 9290 cases (63%) had three or more N2 stations explored and 6641 cases (45%) had lobespecific nodal dissection, correlated with increasing pN2. Extracapsular extension was present in 62 of 364 cases with available data (17%). The highest station was positive in 942 cases (6.4%). The pleural lavage cytologic examination result was positive in 59 of 1705 cases (3.5%): 13 had carcinoma in situ at the bronchial resection margin. After reassignment because of inadequate nodal staging in 56% of cases, 6070 cases were R0, 8185 were R(un), 301 were R1, and 156 were R2. In node-positive cases, the median survival times were 70, 50, and 30 months for RO, R(un) (p < 0.0001), and R1 (p < 0.001), respectively, with no significant difference between RO and R(un) in pN0 cases. Conclusions: R descriptors have prognostic relevance, with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Purpose of the study: The adolescence period holds a special significance because this period marks multi-developmental changes in an individual. The present study was conducted to find out the association between assertiveness, self-esteem, academic achievement and stress among the students. Methodology: Correlational design was employed for the present research. Participants of the study comprised 120 high school students with an equal number of male and female students and the age range of 12 to 19 years. The scales used for data collection are namely-Rathus assertiveness schedule (RAS), Rosenberg self-esteem (RSE), perceived stress scale (PSS), and academic achievement scale. Main Findings: Correlation coefficient and hierarchical regression were employed as statistical techniques. Hierarchical regression analysis indicated in step one that gender and residence predicted 15.50 percent of the total variance in self-esteem while in step two assertiveness predicted 00.30 percent of change in self-esteem. The findings also reported that gender and residence predicted 04.00 percent of the total variance in academic achievement while in step two, assertiveness predicted 01.40 percent of a total change in academic achievement. In another finding, gender and residence predict 19.60 percent of a total change in stress while in step two assertiveness predicted 00.30 percent of change in stress. Applications of this study: The findings of the study exhibit that assertiveness has little role in predicting factors such as self-esteem and academic achievement. Implications: Further researches may be conducted to figure out the correlates possess significant magnitude to state about self-esteem, academic achievement,, and level of stress. Novelty/Originality of this study: The study is the first of its kind among the students in a conflict-ridden area of Kashmir and comparative in nature to add to the existing knowledge.

A series of court cases between the 1960s and the 1980s focusing on patient autonomy changed the approach to mental health treatment in the United States. The process of involuntary psychiatric treatment can vary greatly between states; thus, all mental health practitioners need to have a strong grasp of their respective state and institutional policies. In this article, we examine the Texas mental health law regarding consent to psychoactive medications and involuntary medications. The Texas Health and Safety Code requires the use of a legally authorized representative to consent to psychoactive medications when patients lack capacity due to a mental illness. We argue that the use of a legally authorized representative is ethical and improves psychosocial outcomes. Using a case example, we explore the interplay among patient rights to treatment, autonomy, ethics, and the law. Consistent application of this process will facilitate treatment according to the current standard of practice.

PURPOSE To provide evidence-based recommendations to practicing clinicians on management of patients with stage III non–small-cell lung cancer (NSCLC). METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary oncology, community oncology, research methodology, and advocacy experts was convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 127 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address evaluation and staging workup of patients with suspected stage III NSCLC, surgical management, neoadjuvant and adjuvant approaches, and management of patients with unresectable stage III NSCLC. Additional information is available at www.asco.org/thoracic-cancer-guidelines .

Tomato crops are infected with various diseases that impair tomato production. The recognition of the tomato leaf disease at an early stage protects the tomato crops from getting affected. In the present generation, the emerging deep learning techniques Convolutional Neural Network (CNNs), Recurrent Neural Network (RNNs), Long-Short Term Memory (LSTMs) has manifested significant progress in image classification, image identification, and Sequence Predictions. Thus by using these computer vision-based deep learning techniques, we developed a new method for automatic leaf disease detection. This proposed model is a robust technique for tomato leaf disease identification that gives accurate and better results than other traditional methods. Early tomato leaf disease detection is made possible by using the hybrid CNN-RNN architecture which utilizes less computational effort. In this paper, the required methods for implementing the disease recognition model with results are briefly explained. This paper also mentions the scope of developing more reliable and effective means of classifying and detecting all plant species.

Purpose: To identify patient and procedural factors associated with extrusion of the Dacron cuff from the subcutaneous tunnel of tunneled hemodialysis catheters (THDCs). Materials and methods: Single center 5-year retrospective analysis of 625 catheters in 293 adult patients. Patient data included age, gender, body mass index (BMI), and common comorbidities. Procedural details included type of procedure (new insertion vs. exchange), operator seniority, side of insertion, catheter model and presence of catheter wings skin-sutures. Complications were reported as cumulative risk over time and Cox proportional hazards model was used to evaluate risk factors for cuff extrusion (CE). Results: Median patient follow-up was 503 days (188,913 catheter-days) and median catheter survival 163 days. CE occurred in 23.8% of catheters, at a rate of 0.79 per 1,000 catheter-days and a median time of 64 days. It was more common than infection (14.6%) and inadequate flow (15.5%). The 1-month and 12-month risk of CE was 5.9% and 21.3% respectively. A first episode of CE was a strong predictor of future CE episodes. The only patient factor that affected the risk of CE was BMI (Hazard Ratio 2.36 for obese patients). Procedural factors that affected the risk of CE, adjusted for BMI, were catheter model, type of procedure (lower risk for new insertions) and catheter wings skin-sutures; the latter reduced the 30-day CE risk by 76% without increasing catheter-related infections. Conclusion: Cuff extrusion is common in long-term THDCs. The risk increases with obesity, history of previous cuff extrusion, certain catheter models and absence of wing-sutures.

Purpose Magnetic resonance guided focused ultrasound surgery (MRgFUS) can be used to noninvasively treat symptomatic uterine fibroids by heating with focused ultrasound sonications while monitoring temperature with magnetic resonance (MR) thermometry. While prior studies have compared focused ultrasound simulations to clinical results, studies involving uterine fibroids remain scarce. In our study, we perform such a comparison to assess suitability of simulations for treatment planning. Methods Sonications (N = 67) were simulated retrospectively using acoustic and thermal models based on the Rayleigh integral and Pennes bioheat equation followed by MR-thermometry simulation in seven patients who underwent MRgFUS treatment for uterine fibroids. Spatial accuracy of simulated focus location was assessed by evaluating displacements of the centers of mass of the thermal dose distributions between simulated and treatment MR thermometry slices. Temperature-time curves and sizes of 240 equivalent minutes at 43°C (240EM43 ) volumes between treatment and simulation were compared. Results The simulated focus location showed errors of 2.7 ± 4.1, -0.7 ± 2.0, and 1.3 ± 1.2 mm (mean ± SD) in the anterior-posterior, foot-head, and right-left directions for a fibroid absorption coefficient of 4.9 Np(m-1 MHz-1 ) and perfusion parameter of 1.89 kg(m-3 s-1 ). Linear regression of 240EM43 volumes of 67 sonications of patient treatments and simulations utilising these parameters yielded a slope of 1.04 and a correlation coefficient of 0.54. The temperature rise ratio of simulation to treatment near the end of sonication were 0.47 ± 0.22, 1.28 ± 0.60, and 1.49 ± 0.71 for 66 sonications simulated utilising fibroid absorption coefficient of 1.2, 4.9, and 8.6 Np(m-1 MHz-1 ) respectively and the aforementioned perfusion value. The impact of perfusion on peak temperature rise is minimal between 1.89 and 10 kg(m-3 s-1 ), but became more substantial when utilising a value of 100 kg(m-3 s-1 ). Conclusions The results of this study suggest that perfusion, while in some cases having a substantial impact on thermal dose volumes, has less impact than ultrasound absorption for predicting peak temperature elevation at least when using perfusion parameter values up to 10 kg(m-3 s-1 ) for this particular array geometry, frequencies, and tissue target which is good for clinicians to be aware of. The results suggest that simulations show promise in treatment planning, particularly in terms of spatial accuracy. However, in order to use simulations to predict temperature rise due to a sonication, knowledge of the patient specific tissue parameters, in particular the absorption coefficient is important. Currently, spatially varying patient specific tissue parameter values are not available during treatment so simulations can only be used for planning purposes to estimate sonication performance on average. This article is protected by copyright. All rights reserved.

Resumo: Objetivos: Caracterizar a população do estudo, estimar a taxa de letalidade intra-hospitalar por estado e analisar fatores associados aos óbitos por COVID-19. Métodos: Foi realizado estudo de coorte retrospectiva de crianças e adolescentes hospitalizados com diagnóstico de COVID-19 confirmado por transcrição reversa seguida de reação em cadeia da polimerase (RT-PCR), tendo como desfecho óbito por COVID-19 ou recuperação, entre 1º de março e 1º de agosto de 2020. A fonte de dados foi o Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe), ao qual são notificados pacientes internados com Síndrome Respiratória Aguda Grave (SRAG). Consideraram-se crianças os pacientes com idade entre 0 e 11 anos completos e adolescentes aqueles com idade entre 12 e 18 anos completos. Realizou-se análise bi e multivariável por meio de Regressão de Poisson com variância robusta, utilizando-se como medida de associação final o Risco Relativo ajustado (RRa). Resultados: Dos 4.930 casos analisados, 2.553 (51,8%) eram do sexo masculino. A raça/cor autodeclarada parda foi a mais frequente, com 2.335 (47,4%). A unidade federativa de Roraima apresentou a maior taxa de letalidade intra-hospitalar, com 68,8% (n = 11/16). A análise multivariada mostrou que pertencer ao grupo etário adolescente (RR = 1,59; IC95% 1,12 - 2,25; p = 0,009), ter sido classificado como SRAG-crítico (RR = 4,56; IC95% 2,77 - 7,51; p < 0,001) e apresentar imunopatia (RR = 2,24; IC95% 1,58 - 3,17; p < 0,001) como comorbidade configuraram-se como fatores associados ao óbito pela COVID-19. Conclusão: Observou-se que ser adolescente, ter classificação de SRAG-crítico e imunopatia como comorbidade foram importantes fatores associados ao óbito. Recomenda-se vigilância ativa e cuidados diferenciados a portadores de doenças crônicas e condições imunológicas especiais. Abstract: Objectives: To characterize the study population, estimating the in-hospital lethality rate by state and analysing associated factors with COVID-19-related deaths. Methods: A retrospective cohort study was carried out of hospitalised children and adolescents diagnosed with COVID-19, confirmed by RT-PCR, whose outcome was death by COVID-19 or recovery, from 2020 March 1 to August 1. The data source was the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe in Brazilian acronym), where patients with Severe Acute Respiratory Syndrome (SARS) are notified. Children were defined as those between the ages of 0 and 11, and adolescents those between 12 and 18. A bi and multivariate analysis were performed using Poisson Regression with robust variance, with adjusted Relative Risk as the final association measure. Results: A total of 4,930 cases were analysed; 2,553 (51.8%) were males, 2,335 (47.4%) were brown-skinned. The Federative Unit of Roraima presented the highest in-hospital case-fatality rate, with 68.8% (11/16). Multivariate analysis showed that belonging to the age group adolescent (RR = 1.59; 95%CI 1.12 - 2.25; p = 0.009), SARS-critical patient (RR = 4.56; 95%CI 2, 77 - 7.51; p < 0.001) and presenting immunological disorders (RR = 2.24; 95%CI 1.58 - 3.17; p < 0.001) as comorbidities were statistically associated factors with death by COVID-19. Conclusion: It was observed that adolescents, SARS-critical patients, and presence of immunological disorders were important factors associated with death. Active surveillance and differentiated care are recommended for patients with chronic diseases and special immunological conditions.

In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors ‘on the ground’ to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforcement challenges conspires to limit the efforts of local regulators to achieve the GSMS goals, shedding new light on the relationship between apparent ‘misconduct’ and structural constraints.

Incoming governments sometimes abuse their power to manipulate the allocation of government contracts so as to buy loyalty from cronies. While scandals suggest such practices are relatively widespread, the extent of such partisan favoritism is difficult to measure and the conditions under which it flourishes under-theorized. Drawing on theory regarding the role of institutions as constraints on corruption, we identify three spheres of political influence over government contracting and show how elites can manipulate two of those spheres to increase their opportunities to influence the procurement process and minimize external accountability, facilitating the corrupt allocation of contracts to partisan allies. Using an innovative big data methodology, we then identify the effects of a change in government on procurement markets in two countries, Hungary and the United Kingdom, which differ in terms of political influence over these institutions. We find that politically-favored companies secure 50–60% of the central government contracting market in Hungary but only 10% in the UK.

Founded in 2020, the Thoracic Surgery Medical Student Association is the first national organization dedicated to supporting medical students interested in pursuing cardiothoracic surgery. Our inaugural survey aimed to describe their basic characteristics and needs.An Institutional Review Board-approved, nonincentivized, anonymous electronic survey was distributed to any medical students enrolled in Liaison Committee on Medical Education-accredited medical schools through social media such as Twitter, national organizations (Association of Women Surgeons, Thoracic Surgery Resident Association), and medical school cardiothoracic surgery interest groups. Their basic characteristics, attitudes, and preferences regarding cardiothoracic surgery were recorded.Of the 167 students from 117 unique schools who completed the survey, 53% identified as White and 57% identified as female. Stages of training were well distributed: 16% first-year medical students, 33% second-year medical students, 16% third-year medical students, 21% fourth-year medical students, and 14% dual degree/research students. Most participants (57%) did not have (32%) or were not aware of having (25%) a thoracic surgery training program at their home institution. The majority (72%) of students reported not having a cardiothoracic surgery interest group at their home institution. The most desired areas of cardiothoracic were networking (31%) and mentorship (28%).There is a significant need to directly engage medical students who are interested in cardiothoracic surgery considering limited exposure at home institutions through a lack of cardiothoracic surgery interest groups and cardiothoracic residency programs. The Thoracic Surgery Medical Student Association is poised to address these areas with directed networking by connecting cardiothoracic surgery faculty and residents from other institutions with medical students interested in pursuing cardiothoracic surgery.

Tomatoes are the most common vegetable crop widely cultivated in the agricultural fields in India. The tropical climate is ideal for its growth, however certain climatic conditions and various other factors affect the normal growth of tomato plants. Apart from these climatic conditions and natural disasters, plant disease is a major crisis in crop production and results in economic loss. The traditional disease detection methods for tomato crops could not produce the expected outcome and the detection period for diseases was slow. The early detection of diseases can give better results than the existing detection models. Thus, computer vision-based technology deep learning techniques could be implemented for earlier disease detection. This paper introduces a comprehensive analysis of the disease classification and detection techniques implied for tomato leaf disease identification. This paper also reviews the merits and drawbacks of the methodologies proposed. This paper finally proposes the early disease detection technique to identify tomato leaf disease using hybrid deep-learning architecture.

To characterize the study population, estimating the in-hospital lethality rate by state and analysing associated factors with COVID-19-related deaths.A retrospective cohort study was carried out of hospitalised children and adolescents diagnosed with COVID-19, confirmed by RT-PCR, whose outcome was death by COVID-19 or recovery, from 2020 March 1 to August 1. The data source was the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe in Brazilian acronym), where patients with Severe Acute Respiratory Syndrome (SARS) are notified. Children were defined as those between the ages of 0 and 11, and adolescents those between 12 and 18. A bi and multivariate analysis were performed using Poisson Regression with robust variance, with adjusted Relative Risk as the final association measure.A total of 4,930 cases were analysed; 2,553 (51.8%) were males, 2,335 (47.4%) were brown-skinned. The Federative Unit of Roraima presented the highest in-hospital case-fatality rate, with 68.8% (11/16). Multivariate analysis showed that belonging to the age group adolescent (RR = 1.59; 95%CI 1.12 - 2.25; p = 0.009), SARS-critical patient (RR = 4.56; 95%CI 2, 77 - 7.51; p0.001) and presenting immunological disorders (RR = 2.24; 95%CI 1.58 - 3.17; p0.001) as comorbidities were statistically associated factors with death by COVID-19.It was observed that adolescents, SARS-critical patients, and presence of immunological disorders were important factors associated with death. Active surveillance and differentiated care are recommended for patients with chronic diseases and special immunological conditions.Caracterizar a população do estudo, estimar a taxa de letalidade intra-hospitalar por estado e analisar fatores associados aos óbitos por COVID-19.Foi realizado estudo de coorte retrospectiva de crianças e adolescentes hospitalizados com diagnóstico de COVID-19 confirmado por transcrição reversa seguida de reação em cadeia da polimerase (RT-PCR), tendo como desfecho óbito por COVID-19 ou recuperação, entre 1º de março e 1º de agosto de 2020. A fonte de dados foi o Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe), ao qual são notificados pacientes internados com Síndrome Respiratória Aguda Grave (SRAG). Consideraram-se crianças os pacientes com idade entre 0 e 11 anos completos e adolescentes aqueles com idade entre 12 e 18 anos completos. Realizou-se análise bi e multivariável por meio de Regressão de Poisson com variância robusta, utilizando-se como medida de associação final o Risco Relativo ajustado (RRa).Dos 4.930 casos analisados, 2.553 (51,8%) eram do sexo masculino. A raça/cor autodeclarada parda foi a mais frequente, com 2.335 (47,4%). A unidade federativa de Roraima apresentou a maior taxa de letalidade intra-hospitalar, com 68,8% (n = 11/16). A análise multivariada mostrou que pertencer ao grupo etário adolescente (RR = 1,59; IC95% 1,12 - 2,25; p = 0,009), ter sido classificado como SRAG-crítico (RR = 4,56; IC95% 2,77 - 7,51; p0,001) e apresentar imunopatia (RR = 2,24; IC95% 1,58 - 3,17; p0,001) como comorbidade configuraram-se como fatores associados ao óbito pela COVID-19.Observou-se que ser adolescente, ter classificação de SRAG-crítico e imunopatia como comorbidade foram importantes fatores associados ao óbito. Recomenda-se vigilância ativa e cuidados diferenciados a portadores de doenças crônicas e condições imunológicas especiais.

Resumo Objetivo Descrever o surto de varicela entre imigrantes venezuelanos em abrigos e ocupações nos municípios de Pacaraima e Boa Vista, Roraima, Brasil, e as medidas de controle implementadas. Métodos Estudo descritivo do tipo ‘série de casos’, realizado entre 21 de novembro e 13 de dezembro de 2019, sobre banco de dados secundários da investigação do surto disponibilizado pela Coordenação-Geral do Programa Nacional de Imunizações. Na análise descritiva, utilizaram-se medidas de frequência simples e relativa e foram calculadas medidas de tendência central e dispersão. Resultados Dos 9.591 imigrantes, detectaram-se 38 casos ativos e 1.459 suscetíveis à varicela. Dos casos ativos, 23 eram do sexo feminino e a faixa etária mais acometida foi a de menores de 9 anos (17 casos). Conclusão Identificaram-se pessoas suscetíveis a varicela na investigação; foram adotadas ações de imunização que controlaram a transmissão, evitando casos graves, óbitos e sobrecarga da rede de assistência à saúde local. Resumen Objetivo Describir el brote de varicela entre inmigrantes venezolanos en albergues y ocupaciones en los municipios de Pacaraima y Boa Vista, Roraima, Brasil, y las medidas de control implementadas. Métodos Estudio descriptivo del tipo “serie de casos”, entre el 21 de noviembre y 13 de diciembre de 2019, utilizando datos secundarios de la investigación del brote, puesto a disposición por la Coordinación General del Programa Nacional de Inmunizaciones. En el análisis descriptivo, se utilizaron medidas de frecuencia simple y relativa y se calcularon medidas de tendencia central y dispersión. Resultados Entre los 9.591 inmigrantes se detectaron 38 casos activos y 1.500 susceptibles a la varicela. Entre los casos activos, 23 fueron mujeres y el grupo de edad más afectado fue de menores de 9 años (17 casos). Conclusión Se identificaron personas susceptibles a la varicela, lo que llevó a adopción de acciones de inmunización que controlaran la transmisión, previniendo casos graves, muertes y sobrecarga de la red local de atención. Abstract Objective To describe chickenpox outbreak among Venezuelan immigrants in shelters and occupancies in the municipalities of Pacaraima and Boa Vista, the state capital of Roraima, Brazil, and the control measures implemented. Methods This was a descriptive case series study, conducted between November 21 and December 13, 2019, based on secondary database obtained from the outbreak investigation made available by the General Coordination for the National Immunization Program. Descriptive analysis was performed using simple and relative frequency measurements, and measures of central tendency and dispersion were calculated. Results Of the 9,591 immigrants, 38 active cases and 1,459 susceptible to varicella were identified. With regard to active cases, 23 were female, and those aged under 9 years (17 cases) were the most affected. Conclusion People susceptible to chickenpox were identified during the investigation. Immunization actions aimed at reducing transmission were adopted, thus preventing severe cases, deaths and overload in local health care system.

The global crisis prevailing in the wake of the spread of COVID-19 has raised several speculations about the impact of the lockdown on the mental health of people. The dataset presented here is the assessment of the psychological distress experienced by people in India following the implementation of lockdown as a measure to curtail the spread of the coronavirus. The data was collected through a survey conducted by employing an online questionnaire assessing the socio-demographic information (9-items) as well as the administration of the short version of the General Health Questionnaire (GHQ-12 items) originally developed by Goldberg (1972). The period of data collection is between 9th April 2020 and 20th April 2020 where a total of 1,894 responses were obtained. The Google forms containing the questionnaire of the study were shared publicly through emails and via the social media forum like WhatsApp and Facebook. Thereby, those who took the initiative to fill-up the responses were included as the survey participants. Thus, the final sample had participants representing 17 states and Union territories of India. The entire dataset is stored in a Microsoft Excel Worksheet (.xls) and the questionnaire is attached as a supplementary file. The data is beneficial for the timely assessment of the nature and degree of the psychological distress experienced by people in India during the COVID-19 crisis. It could further be an assistance to the Government, policymakers as well as health care workers to take the adequate measures to ensure sound mental health among people.

While core to our understanding of corruption in public office, conflicts of interest pose a complex regulatory challenge. Practically, the term relies on a conceptual distinction between public and private duties which – in a world of outsourcing, secondments and New Public Management – has become blurred. Most regulation trusts individuals to recognise their own conflicts and insulate decisions from personal and social obligations, yet we know that humans are prone to situational biases and struggle with ambiguity. Regulation should address the difficulties of avoiding bias, while training should allow individuals to explore risks in safe contexts. Professional groups may be important for creating peer support networks and helping to socialise members into norms of integrity. Such ‘soft’ regulation is not a substitute for rules and sanctions but might enhance the utility of traditional ‘hard’ approaches, by helping individuals become more self-aware and better able to make informed decisions about their conduct.

International audience; Purpose To evaluate the effectiveness of radiofrequency (RF) ablation as measured by change in worst pain score from baseline to 3 mo after RF ablation for the palliative treatment of painful bone metastases. Materials and Methods One hundred patients (mean age, 64.6 y) underwent RF ablation for metastatic bone disease and were followed up to 6 mo. Subjects’ pain and quality of life were measured before RF ablation and postoperatively by using the Brief Pain Index and European Quality of Life questionnaires. Opioid agent use and device-, procedure-, and/or therapy-related adverse events (AEs) were collected. Results Eighty-seven patients were treated for tumors involving the thoracolumbar spine and 13 for tumors located in the pelvis and/or sacrum. All ablations were technically successful, and 97% were followed by cementoplasty. Mean worst pain score decreased from 8.2 ± 1.7 at baseline to 3.5 ± 3.2 at 6 mo (n = 22; P < 0.0001 for all visits). Subjects experienced significant improvement for all visits in average pain (P < .0001), pain interference (P < .0001), and quality of life (P < .003). Four AEs were reported, of which 2 resulted in hospitalization for pneumonia and respiratory failure. All 30 deaths reported during the study were attributed to the underlying malignancy and not related to the study procedure. Conclusions Results from this study show rapid (within 3 d) and statistically significant pain improvement with sustained long-term relief through 6 mo in patients treated with RF ablation for metastatic bone disease.