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BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.

Clinical research is necessary for an effective response to an emerging infectious disease outbreak. However, research efforts are often hastily organised and done using various research tools, with the result that pooling data across studies is challenging. In response to the needs of the rapidly evolving COVID-19 outbreak, the Clinical Characterisation and Management Working Group of the WHO Research and Development Blueprint programme, the International Forum for Acute Care Trialists, and the International Severe Acute Respiratory and Emerging Infections Consortium have developed a minimum set of common outcome measures for studies of COVID-19. This set includes three elements: a measure of viral burden (quantitative PCR or cycle threshold), a measure of patient survival (mortality at hospital discharge or at 60 days), and a measure of patient progression through the health-care system by use of the WHO Clinical Progression Scale, which reflects patient trajectory and resource use over the course of clinical illness. We urge investigators to include these key data elements in ongoing and future studies to expedite the pooling of data during this immediate threat, and to hone a tool for future needs.

Acromioclavicular (AC) joint dislocation constitutes 40% of shoulder injuries, impacting patients across diverse activities. The Rockwood Staging System guides assessment, prompting exploration of the novel TightRope with double endobutton fixation technique to restore AC joint function. This study aims to evaluate the outcomes of the TightRope with double endobutton fixation technique in 20 cases of AC joint dislocation, emphasizing its potential advantages over conventional methods. A case series involving 20 AC joint dislocation cases underwent comprehensive evaluation, including follow-ups and radiological assessments. Surgical interventions were performed using the TightRope with double endobutton fixation technique. The average age was 44.5 years, with a notable prevalence of severe dislocations (Classes V and VI). Surgical interventions demonstrated efficiency, with a brief hospital stay. The innovative technique yielded excellent outcomes, with 90% achieving high Constant-Murley scores. TightRope with double endobutton fixation emerges as a promising, minimally invasive strategy for AC joint dislocation, exhibiting potential in minimizing post-operative complications and expediting recovery. The study advocates for individualized interventions and emphasizes the need for further exploration of long-term implications. [ABSTRACT FROM AUTHOR]

Background: A prospective study to assess the prevalence of rotator cuff (RC) tears in patients with Type 2 diabetes mellitus. Aims and Objectives: The purpose of this study is to assess the prevalence of RC tear in Type 2 diabetes mellitus patients presenting with shoulder pain to the outpatient clinic. Materials and Methods: A total of 100 diabetic patients with shoulder pain and restriction of movements formed the study group and were prospectively studied using magnetic resonance imaging and were evaluated with regard to the presence of RC tear. The factors that were analyzed included HBA1C levels, duration of diabetes, and type of diabetic medication. All these factors were evaluated with regard to their correlation with RC tear. Results: In our study, we found that the prevalence of RC tear was 37% and there seemed to be a significant correlation between HBA1C levels (P=0.007) as well as prolonged duration of diabetes (P=0.006) with RC tear. It has been established in our study that the occurrence of RC tear is lesser in oral hypoglycemic agents group as compared to insulin group in treating diabetic patients. Conclusion: One independent risk factor for RC tear is diabetes. The prevalence of RC tear is higher in the diabetic population with increased HBA1c levels and prolonged duration of diabetes mellitus. Metformin usage in diabetes mellitus has been associated with reduced incidence of RC tear due to diminished impregnation of advanced glycation end products with in the RC tendon. [ABSTRACT FROM AUTHOR]

Manufacturing companies are increasingly challenged to deliver customizable products with shorter time to market and higher quality while adhering to sustainability requirements. To meet these challenges, the frequency and importance of production ramp-ups will increase in the future. However, most ramp-ups still fail to meet targets due to unpredictable equipment failures, operator errors, and system complexity. We propose a system dynamics model that captures the unique dynamics of ramp-up phases by integrating stability and disturbance factors that influence the key performance indicators overall equipment effectiveness, process capability, and production output. A systematic literature review informed the identification of stability factors, which were validated through expert interviews in the automotive industry. Our system dynamic simulation results indicate that control factors realistically influence production system behaviour during different ramp-up phases. Despite some limitations regarding the effects of maintenance personnel and engineering changes on key performance indicators, our model effectively simulates realistic ramp-up behaviour. The findings highlight the need for tailored models that consider specific ramp-up contexts and emphasize the importance of data acquisition for enhanced performance prognosis in future research. [ABSTRACT FROM AUTHOR]

In the never-ending digital realm, searching for particular information is a vital aspect of the Internet and is carried out by millions of users daily. More than half of all website visitors arrive there from a search engine, rather than actually typing in the URL. Search engines stand as the gateways to an ocean of information. Gaining insight into the evolutionary progression and operational mechanisms of these search engines is imperative for the facilitation of effective information retrieval processes. The domain of Information Retrieval (IR) is dedicated to structuring, storing, and effectively retrieving information from diverse sources. At the core of IR lies the formidable challenge of bridging the gap between the user’s information needs and the wealth of data available an effort which is made easier by search engines. Despite their remarkable ability to access vast information, challenges persist, including information over load, potential misinformation propagation, privacy concerns, contextual understanding limitations, and filter bubble creation. Understanding these drawbacks highlights the imperative for ongoing research and innovation to mitigate these shortcomings and optimize the user search experience. While search engines have revolutionized information retrieval, it is important to acknowledge and address the challenges they encounter. Through dedicated research and comprehensive analysis of diverse sources, this project is intended to uncover innovative solutions that can enhance search engine capabilities. By confronting issues such as information overload, misinformation, and privacy concerns head-on, we aspire to pave the way for more efficient, reliable, and user-centric search engine technologies in the future. [ABSTRACT FROM AUTHOR]

Locally advanced cervical cancer is treated primarily with radio-chemotherapy in which brachytherapy plays an important role. The quality of brachytherapy procedure depends on the training and experience of the radiation oncologist (RO). There is a lack of formal methodology for learning skill assessment. The present study was performed to establish primary learning curve for intracavitary brachytherapy. Forty-three skill parameters for performing intra-cavitary brachytherapy were identified- (A) pre-procedural: related to patient preparation and treatment plan decision, (B) intra procedural proficiency: intraoperative ultrasound and applicator placement, and (C) post procedural: X-Ray based 2 D point placement or Computed tomography (CT) or Magnetic resonance imaging (MRI) based delineation of clinical target volumes (CTVs) and organs at risk (OARs), treatment planning, applicator removal and post procedure care. Brachytherapy - Proficiency Assessment and Scoring System (Brachy-PASS) questionnaire, with a score of 0 to 4 per parameter was designed. The Brachy-PASS score was validated against objective scoring methodology previously reported with parameters- symmetry of ovoids, tandem bisecting ovoids on lateral X-ray, displacement of ovoids, applicator in the midline of the pelvis, and adequacy of packing. Five parameters of Brachy-PASS (central tandem placement, positioning the flange and ovoids, adequate packing, securing the applicator externally and independently being able to complete procedure) were compared against objective scoring. First 10 trainees were scored against both objective scoring and Brachy-PASS by two ROs. Further, 28 trainees were scored only with Brachy-PASS by two RO's and average score was obtained. Mann Whitney test was performed to assess the impact of number of procedures performed, and years of experience on the Brachy-PASS score. Learning curve was established correlating the number of procedures and the scores obtained setting 75% as the proficiency mark. Between January 2022 to September 2023, 38 radiation oncology trainees were evaluated. Twenty were post graduate year (PGY) 1-3, and 18 were PGY 4-5. Ten trainees had performed <15 procedures, and 28 had performed ≥15 procedures. Among the first 10 trainees, 8 had a positive correlation on comparison of Brachy-PASS scores (88% on Brachy-PASS vs 83.4% on objective scoring). The mean score was 143/172 (Range 109 to 164.5). There was a significant difference in overall scores in trainees who had performed <15 (10 trainees) (Mean=124) and ≥15 procedures (38 trainees) (Mean= 148.84) (p= 0.001). PGY 4 and 5 trainees had higher score than PGY 1-3 (153.8 vs 134). Learning curve was established and 8 trainees had scored less than 75% while 30 trainees had scored 75 % or above. A score of >75% was observed after performing 15 procedures in a vast majority of trainees and scores reached to 90% with upto 30 procedures. The R2 was 0.539 indicating a positive correlation between the score obtained with the number of procedures performed. No plateauing of scores was observed with further increase in procedures. With the current existent training practices, RO trainees need to perform >15 procedures to score more than 75% as proficiency threshold and > 30 to reach 90% proficiency in gynaecological intra-cavitary brachytherapy. Assessment indices with low scores need targeted training to improve overall quality of procedures and ensure care for patients. [ABSTRACT FROM AUTHOR]

Byline: Bharath. Kumar, Anand. Srivastava, Tapan. SinhaIntroduction: Bipolar transurethral resection of prostate (B-TURP) was introduced as an alternative procedure to minimize the surgical complications of monopolar TURP (M-TURP). However, there [...]

This article discusses the importance of 'public conscience' in B. R. Ambedkar's political thought. Ambedkar consistently defended public conscience as a democratic value in his writings and speeches. Public conscience referred to collective responsibility, social justice and the public deliberation of what constitutes the social good. Ambedkar consistently expressed the unequivocal belief that public conscience would bring about a moral transformation in Indian society through a collective ethical stance against all forms of social oppression. He conceptualized public conscience as a method by which a democratic and ethical Indian society could come about and flourish. This article interrogates his ideas concerning public conscience through a detailed reading of his works, focusing particularly on his 1943 speech, Ranade, Gandhi and Jinnah. [ABSTRACT FROM AUTHOR]