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Muhammad B Qureshi,1 Jose O Garcia,1 Jaxon Quillen,2 Carolyn Mead-Harvey,2 Christina Wentz,3 Cherie B Nau,4 Muriel Schornack,4 Keith Baratz,4 Sanjay V Patel,4 Joanne Shen5 1Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 2Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA; 3Illinois College of Optometry, Chicago, IL, USA; 4Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 5Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USACorrespondence: Joanne Shen, Department of Ophthalmology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA, 85259, Tel +1 480-301-8085, Fax +1 480-301-7326, Email shen.joanne@mayo.eduPurpose: To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations.Patients and Methods: Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson’s Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests.Results: At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (− 17.26, p < 0.001), CFS OD (− 0.50, p < 0.001), and CFS OS (− 0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2.Conclusion: oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.Keywords: graft-versus-host disease, GVHD, chronic GVHD, dry eye disease, ocular GVHD, keratoconjunctivitis sicca, KCS

Madiha Bilal Qureshi,1 Muhammad Usman Tariq,1 Jamshid Abdul-Ghafar,2 Qurratulain Chundriger,1 Nasir Ud Din1 1Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan; 2Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, AfghanistanCorrespondence: Jamshid Abdul-GhafarDepartment of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, AfghanistanTel +93 792 827 287Email jamshid.jalal@fmic.org.afBackground: Synovial sarcoma (SS) is a high-grade spindle cell tumor that accounts for 5% to 10% of soft tissue sarcomas. The majority originate from the deep intramuscular soft tissues of extremities with common sites including knee, ankle and feet. Immunohistochemical (IHC) stain TLE1 (transducer-like enhancer of split 1) is a potent diagnostic marker for distinguishing SS from mimicking tumors.Methodology: The study was performed on 177 tumor cases, including 89 SS and 88 non-synovial sarcoma (N-SS) cases which were diagnosed at Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, from July 2019 to June 2020. Hematoxylin and eosin (H&E) and IHC stained glass slides of these cases were reviewed. TLE1 expression was assessed based on the Remmele scoring system.Results: Eighty-nine cases of SS and 88 cases of N-SS were included in the study. SS cases included 42 (47.2%) monophasic subtype, 6 (6.7%) biphasic subtype and 41 (46.1%) poorly differentiated subtype. Major tumor types in N-SS cases were 27 (30.7%) Ewing sarcoma (ES), 13 (14.8%) leiomyosarcoma, 10 (11.4%) undifferentiated sarcoma (US), 8 (9.1%) fibrosarcomatous dermatofibrosarcoma protuberans and 7 (8%) malignant peripheral nerve sheath tumor cases. Mean patients’ age for SS cases was 26.14 years and for N-SS cases was 32.64 years. All 89 SS cases showed positive TLE1 expression. Out of 88 N-SS cases, 71 (80.7%) were TLE1 negative and 17 (19.3%) showed positive expression.Conclusion: This study shows that TLE1 is a very sensitive and relatively specific IHC marker for SS. TLE1 expression can be observed in other soft tissue sarcomas but diffuse strong TLE1 expression is highly specific for SS. The diagnosis should not solely rely on TLE1 expression and morphologic features but should include soft tissue specific lineage markers to avoid misdiagnosis.Keywords: synovial sarcoma, monophasic synovial sarcoma, TLE1

The World Health Organization (WHO) recommends the use of annual mass drug administration (MDA) as the strategy for controlling and eliminating the five preventive chemotherapy neglected tropical diseases (PC-NTDs). The success of MDAs hinges on community acceptance, active participation, and compliance. This study aimed to explore the experiences and perceptions of community members, to obtain a more thorough understanding of their openness and willingness to participate in MDA and other NTD elimination activities. A mixed-methods approach was employed, utilizing qualitative and quantitative methods for comprehensive data collection. Eighteen key informant interviews (KIIs) and sixteen focus group discussions (FGDs) were conducted to explore community engagement, participation, medication utilization, and programme perception. Triangulation of findings from interviews and discussions with household survey results was performed to gain a deeper understanding of emerging themes. The household survey involved interviewing 1220 individuals (Abaji: 687; Bwari: 533). Audio tapes recorded KIIs and FGDs, with interview transcripts coded using Nvivo 12.0 software based on predefined themes. Descriptive analysis using SPSS version 21 was applied to quantitative data. Results indicated high awareness of mass drug administration (MDA) campaigns in both area councils (Abaji: 84.9%; Bwari: 82.9%), with a small percentage claiming ignorance (15.1%), attributed to lack of information or absence during health campaigns. Respondents primarily participated by taking medication (82.5%), with minimal involvement in other MDA campaigns. Perception of medicines was generally positive, with a significant association between participation level and performance rating ( p < 0.05). The study recommends leveraging high awareness and community responsiveness to enhance engagement in various MDA activities, ensuring sustainability and ownership of the programme.

Desmoplastic fibroma (DF) is an uncommon bone tumor that originates from the mesenchymal tissue and despite being benign, exhibits aggressive behavior locally. The following report describes the case of a 7-year-old boy with a rapidly enlarging swelling on the right side of the mandible. After a thorough clinical examination, radiographic imaging, and histopathological analysis, the diagnosis of DF was confirmed. Treatment planning was formulated considering both the tumor's tendency for local recurrence and the patient's well-being. Due to the patient's young age, segmental resection was not deemed appropriate, and an aggressive curettage and enucleation of the lesion followed by the bone graft was performed instead. The patient was kept under close follow-up for the first month of post-surgery and later reviewed after 3, 6, 9, and 12 months, respectively. Good bone healing was observed on radiographs. The patient did not show any signs of recurrence based on clinical or radiographic assessments and did not exhibit any neurosensory deficits as well., (© 2024. The Author(s).)

Objective: To identify choroidal nevus features associated with referral to a retina or ocular oncology subspecialist., Design: Population-based retrospective cohort study., Subjects: Patients diagnosed with choroidal nevus., Methods: Population-based retrospective cohort study of residents of Olmsted County, Minnesota, with an incident diagnosis of choroidal nevus from January 1, 2006, to December 31, 2015 using the Rochester Epidemiology Project, a medical record linkage system. Tumor features and patient demographics associated with referral to a retina or ocular oncology subspecialist were assessed. Wilcoxon rank sum test, chi-square test, and Fisher exact test were used for statistical analysis., Main Outcome Measures: Tumor features and patient demographics associated with referral to subspecialty care., Results: There were 826 incident diagnoses of choroidal nevus, of which 88 cases (11%) were referred, with highest level of referral being retina in 29 cases (33%) and ocular oncology in 59 cases (67%). None of the analyzed demographic features were associated with choroidal nevus referral to subspecialty care. Tumor features associated with referral (vs. not referred) included greater mean basal diameter (4.6 mm vs. 2.4 mm, P < 0.001), greater mean tumor thickness (0.7 mm vs. 0.1 mm, P < 0.001), greater distance to optic disc (6.9 mm vs. 3.4 mm, P = 0.02), halo around nevus (5.7% vs. 0.4%, P < 0.001), and drusen on OCT (51% vs. 25%, P = 0.002). Presence of orange pigment (8% vs. 0%, P = 0.14), subretinal fluid (9% vs. 2.5%, P = 0.09), and low internal reflectivity on A-scan (7.7% vs. 0%, P = 1.00) were not found more frequently in the subspecialty referral group., Conclusions: Greater basal diameter and mean tumor thickness of choroidal nevus were associated with referral to retina or ocular oncology. However, several features associated with increased risk of malignant transformation were not associated with subspecialty referral. These findings highlight the importance of educating eye care providers about high-risk tumor features associated with choroidal nevus transformation to melanoma. In the primary eye care setting where not all multimodal imaging may be available, we encourage color photography and OCT with referral for any features of basal diameter > 5 mm, presence of subretinal fluid, or thickness too large for capture by enhanced-depth imaging OCT., Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: Chondroblastoma (CB) is a benign cartilaginous bone neoplasm which commonly occurs in long bones of adolescents. CB can uncommonly involve foot. Its mimics include both benign and malignant lesions. H3K36M immunohistochemical (IHC) stain is a helpful tool for establishing the diagnosis of CB in such challenging situations. In addition, H3G34W IHC stain helps to rule out giant cell tumor which is the closest differential of CB. Our objective was to describe the clinicopathological features and frequencies of H3K36M, H3G34W and SATB2 IHC stains in CB of foot., Materials and Methods: We reviewed H&E slides and blocks of 29 cases diagnosed as "chondroblastoma" of foot at our institutions., Results: Patient's age ranged from 6 to 69 (mean: 23.3 and median: 23) years. Males were almost 5 times more commonly affected than females. Talus and calcaneum were involved in 13 (44.8 %) cases each. Microscopically, tumors were composed of polygonal mononuclear cells and multinucleated giant cells and chondroid matrix. Other histological features included aneurysmal bone cyst-like (ABC-like) change (44.8 %), osteoid matrix (31 %), chicken-wire calcification (20.7 %), and necrosis (10.3 %). H3K36M was expressed in 100 % and SATB2 in 91.7 % cases. H3G34W was negative in all cases, where performed. One out of 11 patients with follow up information developed local recurrence after 48 months., Conclusion: CB in foot occur at an elder age and show more frequent ABC-like changes as compared to long bones. Males are affected ~5:1 as compared to 2:1 in long bones. H3K36M are H3G34W are extremely useful diagnostic markers for CB, especially elderly (aged or higher) patients and we report the largest series of foot CB cases confirmed by immunohistochemistry., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Autism spectrum disorder is a severe, life-prolonged neurodevelopmental disease typified by disabilities that are chronic or limited in the development of socio-communication skills, thinking abilities, activities, and behavior. In children aged two to three years, the symptoms of autism are more evident and easier to recognize. The major part of the existing literature on autism spectrum disorder is covered by a prediction system based on traditional machine learning algorithms such as support vector machine, random forest, multiple layer perceptron, naive Bayes, convolution neural network, and deep neural network. The proposed models are validated by using performance measurement parameters such as accuracy, precision, and recall. In this research, autism spectrum disorder prediction has been investigated and compared using common parameters such as application type, simulation method, comparison methodology, and input data. The key purpose of this study is to give a centralized framework to use for researchers working on autism spectrum disorder prediction. The best results were obtained by using the random forest algorithm as it performs better than other traditional machine learning algorithms. The achieved accuracy is 89.23%. The workflow representations of the investigated frameworks assist readers in comprehending the fundamental workings and architectures of these frameworks., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Muhammad Shuaib Qureshi et al.)

Background: Although perceived barriers to applying to dermatology have been researched among medical students, there remains a dearth of literature dedicated to understanding perceptions that medical students have of the field of dermatology and dermatologists., Methods: A review of the literature in Embase, Pubmed, Scopus, Web of Science, and ScienceDirect were carried out to identify articles and abstracts between 2016 and 2021 relating to medical student perceptions of the field of dermatology. Peer-reviewed English studies measuring attitudes/level of interest in dermatology or other specialities, understanding of dermatologic topics, procedures, and/or scope of practice were included. Duplicate studies and conference abstracts were excluded. All publications were screened using the PRISMA-Sc guidelines. Findings were summarised and tabulated accordingly., Results: A total of nine articles met inclusion criteria and eight are included in this review since one was not accessible online. Notable findings include non-US medical students perceiving dermatology as monotonous, stigmatized, unfamiliar, and difficult to access with a misunderstanding of the diversity and severity of the conditions dermatologists treat. No data on US medical student perceptions was found. Perceptions were found to be influential in career planning: medical students may reject specialities after exposure to negative comments on the field. Factors attracting students to dermatology include the appeal of being a dermatologist, media portrayal, and dermatologists' influence on patients' lives. Completion of dermatology-related activities improved medical student interest, comfort, and understanding of the field. Early dermatology exposure in US undergraduate premedical students led to heightened interest in the field, more confidence in ability to find dermatology mentors, and increased perception that dermatology serves the needs of underserved communities., Conclusions: This review demonstrates the need to further investigate medical student perceptions of dermatology, particularly in the United States. Perceptions of medical specialities can impact medical student career choices. Understanding which misconceptions may be preventing students from exploring dermatology can inform efforts towards improving diversity, equity, and inclusion: translating to an equitable match and improving patient outcomes. Limitations include exclusion of articles published before 2016, geographic variability in studies, and limited data on evolving student perceptions over time., Competing Interests: The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported., (© 2022 The Authors. Skin Health and Disease published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

The effects of mutual coupling on the scanning characteristics of a four-element linear rectangular dielectric resonator antenna array (RDRA) are investigated for different inter-element spacing in this work. In particular, the gain and half-power beam width (HPBW) of an RDRA are studied for various scan angles in the E- and H-plane configurations. It is shown that for both the E and H planes, mutual coupling has an adverse effect on the performance of both phased array configurations. The H-plane array, however, is more stable than the E-plane array in terms of a gain and beam width performance comparison. The HPBW increases and gain decreases more in the E plane than the H plane when the scan angle is increased.

Background: The first instance of a robotic-assisted surgery occurred in neurosurgery; however, it is now more common in other fields such as urology and gynecology. This study aims to characterize the prevalence of robotic surgery among current neurosurgery programs as well as identify trends in clinical trials pertaining to robotic neurosurgery., Methods: Each institution's website was analyzed for the mention of a robotic neurosurgery program and procedures. The future potential of robotics in neurosurgery was assessed by searching for current clinical trials pertaining to neurosurgical robotic surgery., Results: Of the top 100 programs, 30 offer robotic cranial and 40 offer robotic spinal surgery. No significant differences were observed with robotic surgical offerings between geographic regions in the US. Larger programs (faculty size 16 or over) had 20 of the 30 robotic cranial programs (66.6%), whereas 21 of the 40 robotic spinal programs (52.5%) were at larger programs. An initial search of clinical trials revealed 223 studies, of which only 13 pertained to robotic neurosurgery. Spinal fixation was the most common intervention (six studies), followed by Deep Brain Stimulation (DBS, two studies), Cochlear implants (two studies), laser ablation (LITT, one study), and endovascular embolization (one study). Most studies had industry sponsors (9/13 studies), while only five studies had hospital sponsors., Conclusion: Robotic neurosurgery is still in its infancy with less than half of the top programs offering robotic procedures. Future directions for robotics in neurosurgery appear to be focused on increased automation of stereotactic procedures such as DBS and LITT and robot-assisted spinal surgery., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Surgical Neurology International.)

Purpose: To perform a retrospective characterization of one-star reviews of ophthalmologists on Yelp.com and to increase understanding of patient complaints on Yelp.com., Methods: A search was performed for reviews on Yelp.com using the keyword "ophthalmologist" for the top 8 most population-dense metropolitan areas in the United States. One-star reviews were collected and classified as procedural or nonprocedural. Complaints were also categorized as clinical, nonclinical, or both. Clinical complaints cited issues such as complications, reoperations, uncontrolled pain, misdiagnosis, unclear treatment plan, etc. Nonclinical complaints included comments such as physician bedside manner, other staff interpersonal manner, wait time, brevity of appointment time, etc., Results: 5,532 total reviews were assessed, of which 477 (9%) one-star reviews were included in the study for analysis. These reviews amounted to 1,120 distinct complaints. 287 (26%) were clinical in nature and 833 (74%) were nonclinical. Technical incompetence or error (50: 4%), unsatisfactory results (46: 4%), and complications (43: 4%) represented the most common clinical complaints while office staff interpersonal manner (182: 16%), wait time (174: 16%), and physician interpersonal manner (141: 13%) were the most common nonclinical complaints. Refractive surgery was the most frequently mentioned subspecialty (89: 8%). Patients undergoing an ophthalmic procedure (surgery, injection, etc.) wrote 64 reviews that resulted in 193 (17%) complaints. Nonprocedural patients wrote 413 reviews that resulted in 927 (83%) complaints. Compared with procedural reviews, nonprocedural reviews were less likely to include a clinical complaint (rate ratio, 0.3: P < .001)., Discussion: The majority of one-star reviews of ophthalmologists included in this study were nonclinical. Complaints referencing a procedural episode were more likely to include a clinical component in the review. In the era of intense medical consumerism and increased physician and health care institution competition for patient acquisition and retention, the characterization of excessively negative reviews allows identification of potential areas of concern for patients that use online review sites such as Yelp.com.

The present work investigates a novel four-port, multiple-input multiple-output (MIMO), single element dielectric resonator antenna (DRA) for sub-6 GHz band. The DRA is designed and fabricated into a symmetric cross shape and fed using a coplanar waveguide (CPW) feed. A single radiator with four ports is rarely found in the literature. The -10 dB impedance bandwidth covered by the antenna is from 5.52 GHz to 6.2 GHz (11.6%) which covers fifth generation (5G) new radio (NR) bands N47 and wireless local area network (WLAN) IEEE 802.11a band. The isolation between orthogonal ports is about 15 dB while the isolation between opposite ports is 12 dB. The radiation pattern of the proposed antenna is bidirectional due to the absence of a ground plane below the DRA. The orthogonal modes excited in the DRA are [Formula: see text] and [Formula: see text] through the four symmetrical CPW feeds. The simulated and measured results of the proposed design show that MIMO characteristics are achieved by pattern diversity between the ports. Due to the perfect symmetry of the design, the proposed work could be extended to MIMO array applications as well., Competing Interests: The authors have declared that no competing interests exist.

Manganism, the condition caused by chronic exposure to high levels of manganese, selectively targets the dopamine-rich basal ganglia causing a movement disorder with symptoms similar to Parkinson's disease. While the basis for this specific targeting is unknown, we hypothesize that it may involve complexation of Mn by dopamine derivatives. At micromolar concentrations, MnCl 2 accelerates the two-equivalent redox cycling of a dopamine-derived benzothiazine (dopathiazine) by an order of magnitude. In the process, O 2 is reduced to superoxide and hydrogen peroxide. This effect is unique to Mn and is not shared by Fe, Cu, Zn, Co, Ca or Mg. Notably, the effect of Mn requires the presence of inorganic phosphate, suggesting that phosphate may stabilize a Mn/catecholate complex, which reacts readily with O 2 . This or similar endogenous dopamine derivatives may exacerbate Mn-dependent oxidative stress accounting for the neurological selectivity of manganism., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Substantial information related to human cerebral conditions can be decoded through various noninvasive evaluating techniques like fMRI. Exploration of the neuronal activity of the human brain can divulge the thoughts of a person like what the subject is perceiving, thinking, or visualizing. Furthermore, deep learning techniques can be used to decode the multifaceted patterns of the brain in response to external stimuli. Existing techniques are capable of exploring and classifying the thoughts of the human subject acquired by the fMRI imaging data. fMRI images are the volumetric imaging scans which are highly dimensional as well as require a lot of time for training when fed as an input in the deep learning network. However, the hassle for more efficient learning of highly dimensional high-level features in less training time and accurate interpretation of the brain voxels with less misclassification error is needed. In this research, we propose an improved CNN technique where features will be functionally aligned. The optimal features will be selected after dimensionality reduction. The highly dimensional feature vector will be transformed into low dimensional space for dimensionality reduction through autoadjusted weights and combination of best activation functions. Furthermore, we solve the problem of increased training time by using Swish activation function, making it denser and increasing efficiency of the model in less training time. Finally, the experimental results are evaluated and compared with other classifiers which demonstrated the supremacy of the proposed model in terms of accuracy., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Muhammad Bilal Qureshi et al.)

In this paper, we have proposed a novel methodology based on statistical features and different machine learning algorithms. The proposed model can be divided into three main stages, namely, preprocessing, feature extraction, and classification. In the preprocessing stage, the median filter has been used in order to remove salt-and-pepper noise because MRI images are normally affected by this type of noise, the grayscale images are also converted to RGB images in this stage. In the preprocessing stage, the histogram equalization has also been used to enhance the quality of each RGB channel. In the feature extraction stage, the three channels, namely, red, green, and blue, are extracted from the RGB images and statistical measures, namely, mean, variance, skewness, kurtosis, entropy, energy, contrast, homogeneity, and correlation, are calculated for each channel; hence, a total of 27 features, 9 for each channel, are extracted from an RGB image. After the feature extraction stage, different machine learning algorithms, such as artificial neural network, k -nearest neighbors' algorithm, decision tree, and Naïve Bayes classifiers, have been applied in the classification stage on the features extracted in the feature extraction stage. We recorded the results with all these algorithms and found that the decision tree results are better as compared to the other classification algorithms which are applied on these features. Hence, we have considered decision tree for further processing. We have also compared the results of the proposed method with some well-known algorithms in terms of simplicity and accuracy; it was noted that the proposed method outshines the existing methods., Competing Interests: The authors declare that they have no conflicts of interest to report regarding the present study., (Copyright © 2021 Muhammad Fayaz et al.)

In this paper, a model based on discrete wavelet transform and convolutional neural network for brain MR image classification has been proposed. The proposed model is comprised of three main stages, namely preprocessing, feature extraction, and classification. In the preprocessing, the median filter has been applied to remove salt-and-pepper noise from the brain MRI images. In the discrete wavelet transform, discrete Harr wavelet transform has been used. In the proposed model, 3-level Harr wavelet decomposition has been applied on the images to remove low-level detail and reduce the size of the images. Next, the convolutional neural network has been used for classifying the brain MR images into normal and abnormal. The convolutional neural network is also a prevalent classification method and has been widely used in different areas. In this study, the convolutional neural network has been used for brain MRI classification. The proposed methodology has been applied to the standard dataset, and for performance evaluation, we have used different performance evaluation measures. The results indicate that the proposed method provides good results with 99% accuracy. The proposed method results are then presented for comparison with some state-of-the-art algorithms where simply the proposed method outperforms the counterpart algorithms. The proposed model has been developed to be used for practical applications.

Background: Although lower back injuries (LBIs) are common among National Collegiate Athletic Association (NCAA) female volleyball athletes, their incidence and etiology has not been well-defined., Purpose: To describe the epidemiology of LBIs in collegiate female volleyball athletes over a 5-year period from the academic years 2009 to 2010 and 2013 to 2014., Study Design: Descriptive epidemiology study., Methods: The incidence and characteristics of spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries by the total number of athlete-exposures (AEs). AEs were defined as any student participation in any single NCAA-sanctioned practice or competition. The injury rate was computed as the number of injuries per the total number of AEs and reported as a ration of injuries per 10,000 exposures. The ratio was then reported as overall number as well as stratified for event, time of season, and athletic NCAA division. Incidence rate ratios were then calculated to compare rates between event type. Results with 95% CIs that did not include 1.0 were considered statistically significant., Results: An estimated 3384 LBIs occurred in NCAA female volleyball players during this 5-year time frame. These LBIs occurred at a rate of 4.89 injuries per 10,000 AEs. LBIs were 2.76 times more likely in preseason when compared with regular season. More injuries occurred in practice (85%) when compared with competition (15%). The outside hitter and middle blocker were the most commonly position to sustain an LBI. Almost 70% of injuries were new injuries, and another 29% were recurrent injuries. The most common mechanism of injury was equally split between contact (50.4%) and overuse (45.5%) injuries, whereas the remaining mechanisms of injury were secondary for unknown reasons (4.14%). Most players returned to play within 24 hours (72.3%) followed by 1 to 6 days (16.4%), and finally 7 to 12 days (11.3%). No patient required surgical intervention., Conclusion: The rate of LBIs was high (4.89/10,000 AEs) and injuries commonly recurred (29.2%). Most injuries were new, with most athletes returning to play with 24 hours., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.L.M. has received education payments from Arthrex. A.C. has received consulting fees from Arthrex, Zimmer Biomet, and Trice Medical and speaking fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Cemento-ossifying fibroma (COF) and cementoblastoma (CB) are rare benign odontogenic tumors with a predilection for the mandible. Cemento-ossifying fibroma is a fibro-osseous lesion that originates in the tooth bearing areas of jaw and shows cementum-like tissue in a fibrotic stroma. Cementoblastoma is classically related to roots of teeth with the presence of calcified cementum-like material. To date, only a single case of concomitant unilateral COF and CB has been reported in the literature., Case Presentation: We present an unusual case of a 37-year-old female who presented with two discrete bilateral swellings in the right and left mandible for 10 years. The larger tumor involved the left posterior mandible with extension anteriorly to the left and right anterior mandibles, and the smaller tumor was present in right posterior mandible. Radiology revealed two distinct lesions involving both sides of mandible. Histopathological examination showed characteristic features of cemento-ossifying fibroma in sections of the larger tumor and cementoblastoma in sections of smaller tumor., Conclusion: This case shows the very unique bilateral co-existence of COF and CB, the second case reported in literature to date., (© 2021. The Author(s).)

Degradation in the polymeric insulators is caused due to the environmental stresses. The main aim of this paper is to explore the improved aging characteristics of hybrid samples by adding nano/micro silica in High Temperature Vulcanized Silicone Rubber (HTV-SiR) under long term accelerated aging conditions for 9000 hours. As HTV-SiR is unable to sustain environmental stresses for a long time, thus a long term accelerated aging behavior is an important phenomenon to be considered for field application. The aging characteristics of nano/micro filled HTV-SiR are analyzed by using techniques such as Scanning Electron Microscopy (SEM), Leakage Current (LC), Fourier Transform Infrared Microscopy (FTIR), Hydrophobicity Classification (HC), and breakdown strength for the aging time of 9000 hours. FTIR and leakage currents are measured after every cycle. All the co-filled samples revealed escalated aging characteristics as compared to the neat sample except the SN8 sample (8% nano-silica+20% micro-silica) after 9000 hours of aging. The highest loading of 6% and 8% nano-silica with 20% micro-silica do not contribute to the improved performance when compared with the neat and hybrid samples. However, from the critical experimental analysis, it is deduced that SN2 sample (2% nano-silica+20% micro-silica) is highly resistant to the long term accelerated aging conditions. SN2 has no cracks, lower loss percentages in the important FTIR absorption peaks, higher breakdown strength and superior HC after aging as compared to the unfilled and hybrid samples., Competing Interests: The authors have declared that no competing interests exist.

Encapsulated Papillary Carcinoma (EPC) is a rare breast tumor with excellent prognosis. Treatment and stage of EPC is influenced by invasion and high nuclear grade. Our aim was to study the clinicopathological features of EPC, especially high grade tumors and to compare the features of invasive and non-invasive tumors. We reviewed clinicopathological features of 25 cases of EPC diagnosed at our institution from 2006 till 2020. Patients' age ranged from 21 to 75 years (median 55 years). Tumor size ranged from 1 to 9 cm (median 3.5 cm). Overall, invasion was present in 44% cases. High nuclear grade was observed in 24% cases. Majority of these high grade tumors were below 40 years. All of these tumors were 4 cm or larger in size. Two third of these tumors were invasive. Hormone receptor negativity and lymph node involvement was observed in 1 out of 3 cases, when performed. Clinicopathological and histological features of invasive and non-invasive tumors were compared and only lymph node involvement was found to be significantly more frequent in invasive tumors (p = 0.049). Median follow up duration was 18 months. All patients were alive and disease free except for a single patient who died of cerebrovascular accident. EPC has excellent clinical course. Invasion and high nuclear grade should be carefully searched for as these features determine tumor stage and treatment., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Deployment of efficient and cost-effective parking lots is a known bottleneck for the electric vehicles (EVs) sector. A comprehensive solution incorporating the requirements of all key stakeholders is required. Taking up the challenge, we propose a real-time EV smart parking lot model to attain the following objectives: (a) maximize the smart parking lot revenue by accommodating maximum number of EVs and (b) minimize the cost of power consumption by participating in a demand response (DR) program offered by the utility since it is a tool to answer and handle the electric power usage requirements for charging the EV in the smart parking lot. With a view to achieving these objectives, a linear programming-based binary/cyclic (0/1) optimization technique is developed for the EV charge scheduling process. It is difficult to solve the problems of binary optimization in real-time given that the complexity of the problem increases with the increase in number of EV. We deploy a simplified convex relaxation technique integrated with the linear programming solution to overcome this problem. The algorithm achieves: minimum power consumption cost of the EV smart parking lot; efficient utilization of available power; maximization of the number of the EV to be charged; and minimum impact on the EV battery lifecycle. DR participation provide benefits by offering time-based and incentive-based hourly intelligent charging schedules for the EV. A thorough comparison is drawn with existing variable charging rate-based techniques in order to demonstrate the comparative validity of our proposed technique. The simulation results show that even under no DR event, the proposed scheme results in 2.9% decrease in overall power consumption cost for a 500 EV scenario when compared to variable charging rate method. Moreover, in similar conditions, such as no DR event and for 500 EV arrived per day, there is a 2.8% increase in number of EV charged per day, 3.2% improvement in the average state-of-charge (SoC) of the EV, 12.47% reduction in the average time intervals required to achieve final SoC.

Solid papillary carcinoma (SPC) is an uncommon breast tumor whose prognosis depends on invasive component. We studied clinicopathological features of SPC by reviewing 65 cases. Invasive component was seen in 75.4% cases. Almost all tumors with grade III nuclei had invasive component. Mean patients' age of invasive tumors was significantly higher than that of non-invasive tumors (P = .036). All patients were alive and disease free except for a single patient who developed distant metastasis and died of disease. SPC have excellent clinical course. Careful search for invasive component is mandatory, especially in tumors with older patient's age and higher nuclear grade., (© 2019 Wiley Periodicals, Inc.)

Background Soft-tissue sarcomas comprise a diverse group of sarcomas with characteristic histologic features. However, histology alone is not adequate for a definitive diagnosis for many tumors. In such cases, immunohistochemistry (IHC) plays a key role in determining the line of differentiation and exact characterization. Transducer-like enhancer of split 1 (TLE1) has been recently described as a novel marker for synovial sarcoma (SS). Its high sensitivity and specificity make it a potential marker that distinguishes SS from histologic mimics such as malignant peripheral nerve sheath tumor (MPNST), Ewing's sarcoma (ES), and fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP). The objective of our study was to assess the frequency of TLE1 immunohistochemical expression on SS cases of various subtypes. Methods This cross-sectional study was conducted at the Department of Histopathology, Aga Khan University, Karachi, Pakistan from February 3, 2018 to February 10, 2019. Tissue samples of 89 SS cases were selected for this study. Tumor sections were stained with hematoxylin and eosin (H&E), cytokeratin AEI/AE3 (CKAE1/AE3), epithelial membrane antigen (EMA), and TLE1 immunohistochemical stain. TLE1 expression was assessed based on the Remmele scoring system. Results Tissue samples of 89 SS cases were processed for the study. Mean (±) standard deviation (SD) of age was 25 (±7.36) years. Male:female ratio was 1.1:1. Of the 89 SS cases, 42 (47.2%) were monophasic, six (6.7%) were biphasic, and 41 (46.1%) were poorly differentiated. All the 89 cases showed positivity for TLE1 immunostain: 86 (96.6%) cases showed strong positivity, one (1.1%) case showed moderate expression, and two (2.2%) showed weak positivity. Conclusion This study shows that TLE1 is a highly sensitive immunostain for SS irrespective of the histologic type. However, it may show weak-to-moderate staining in poorly differentiated types. No statistically significant association was seen with respect to age group, gender, or type of SS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Qureshi et al.)

Fusion of the Global Positioning System (GPS) and Inertial Navigation System (INS) for navigation of ground vehicles is an extensively researched topic for military and civilian applications. Micro-electro-mechanical-systems-based inertial measurement units (MEMS-IMU) are being widely used in numerous commercial applications due to their low cost; however, they are characterized by relatively poor accuracy when compared with more expensive counterparts. With a sudden boom in research and development of autonomous navigation technology for consumer vehicles, the need to enhance estimation accuracy and reliability has become critical, while aiming to deliver a cost-effective solution. Optimal fusion of commercially available, low-cost MEMS-IMU and the GPS may provide one such solution. Different variants of the Kalman filter have been proposed and implemented for integration of the GPS and the INS. This paper proposes a framework for the fusion of adaptive Kalman filters, based on Sage-Husa and strong tracking filtering algorithms, implemented on MEMS-IMU and the GPS for the case of a ground vehicle. The error models of the inertial sensors have also been implemented to achieve reliable and accurate estimations. Simulations have been carried out on actual navigation data from a test vehicle. Measurements were obtained using commercially available GPS receiver and MEMS-IMU. The solution was shown to enhance navigation accuracy when compared to conventional Kalman filter.

A localization and tracking algorithm for an early-warning tracking system based on the information fusion of Infrared (IR) sensor and Laser Detection and Ranging (LADAR) is proposed. The proposed Kalman filter scheme incorporates Out-of-Sequence Measurements (OOSMs) to address long-range, high-speed incoming targets to be tracked by networked Remote Observation Sites (ROS) in cluttered environments. The Rauch⁻Tung⁻Striebel (RTS) fixed lag smoothing algorithm is employed in the proposed technique to further improve tracking accuracy, which, in turn, is used for target profiling and efficient filter initialization at the targeted platform. This efficient initialization increases the probability of target engagement by increasing the distance at which it can be effectively engaged. The increased target engagement range also reduces risk of any damage from debris of the engaged target. Performance of the proposed target localization algorithm with OOSM and RTS smoothing is evaluated in terms of root mean square error (RMSE) for both position and velocity, which accurately depicts the improved performance of the proposed algorithm in comparison with existing retrodiction-based OOSM filtering algorithms. The effects of assisted target state initialization at the targeted platform are also evaluated in terms of Time to Impact (TTI) and true track retention, which also depict the advantage of the proposed strategy.

Many low- and middle-income countries use national eye-care plans to guide efforts to strengthen eye-care services. The World Health Organization recognizes that evidence is essential to inform these plans. We assessed how evidence was incorporated in a sample of 28 national eye-care plans generated since the Universal eye health: a global action plan 2014-2019 was endorsed by the World Health Assembly in 2013. Most countries (26, 93%) cited estimates of the prevalence of blindness and 18 countries (64%) had set targets for the cataract surgical rate in their plan. Other evidence was rarely cited or used to set measurable targets. No country cited evidence from systematic reviews or solution-based research. This limited use of evidence reflects its low availability, but also highlights incomplete use of existing evidence. For example, despite sex-disaggregated data and cataract surgical coverage being available from surveys in 20 countries (71%), these data were reported in the eye health plans of only nine countries (32%). Only three countries established sex-disaggregated indicators and only one country had set a target for cataract surgical coverage for future monitoring. Countries almost universally recognized the need to strengthen health information systems and almost one-third planned to undertake operational or intervention research. Realistic strategies need to be identified and supported to translate these intentions into action. To gain insights into how a country can strengthen its evidence-informed approach to eye-care planning, we reflect on the process underway to develop Kenya's seventh national plan (2019-2023).

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs (gonads), they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum.We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis (hair expectoration).We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary tuberculosis. He underwent surgical resection of his cavitatory lesion and diagnosis of intrapulmonary teratoma was confirmed by histopathology as well. The patient made remarkable recovery with complete disappearance of his symptoms. From Pakistan no such case has ever been reported. Although it is very unusual but in patient with cavitatory lesion, intrapulmonary teratoma should always be kept in mind as differential diagnosis.

Mechanical circulatory support devices (MCSDs) have gained widespread clinical acceptance as an effective heart failure (HF) therapy. The concept of harnessing the kinetic energy (KE) available in the forward aortic flow (AOF) is proposed as a novel control strategy to further increase the cardiac output (CO) provided by MCSDs. A complete mathematical development of the proposed theory and its application to an example MCSDs (two-segment extra-aortic cuff) are presented. To achieve improved device performance and physiologic benefit, the example MCSD timing is regulated to maximize the forward AOF KE and minimize retrograde flow. The proof-of-concept was tested to provide support with and without KE control in a computational HF model over a wide range of HF test conditions. The simulation predicted increased stroke volume (SV) by 20% (9 mL), CO by 23% (0.50 L/min), left ventricle ejection fraction (LVEF) by 23%, and diastolic coronary artery flow (CAF) by 55% (3 mL) in severe HF at a heart rate (HR) of 60 beats per minute (BPM) during counterpulsation (CP) support with KE control. The proposed KE control concept may improve performance of other MCSDs to further enhance their potential clinical benefits, which warrants further investigation. The next step is to investigate various assist technologies and determine where this concept is best applied. Then bench-test the combination of kinetic energy optimization and its associated technology choice and finally test the combination in animals.

The global initiative for the elimination of avoidable blindness by the year 2020-(VISION 2020- The Right to Sight), established in 1999, is a partnership of nongovernmental organizations (NGOs), governments, bilateral organizations, corporate bodies and the World Health Organization. The goal is to eliminate the major causes of avoidable blindness by the year 2020. Significant progress has been made in the last decade. For example, the adoption of three major World Health Assembly resolutions (WHA 56.26, 59.25 and 62.1) requesting governments to increase support and funding for the prevention of blindness and eye care. Additionally, the approval of the VISION 2020 declaration, development of plans and establishment of prevention of blindness committees and a designation of a coordinator by most participating countries represent other major achievements. Furthermore there has been increased political and professional commitment to the prevention of visual impairment and an increase in the provision of high-quality, sustainable eye care. Most of these achievements have been attributed to the advocacy efforts of VISION 2020 at the international level. The full success of this global initiative will likely depend on the extent to which the WHA resolutions are implemented in each country. However, most ratifying countries have not moved forward with implementation of these resolutions. To date, only few countries have shown consistent government support and funding for eye care pursuant to the resolutions. One of the main reasons for this may be inadequate and inappropriate advocacy for eye care at the national level. As such it is believed that the success of VISION 2020 in the next decade will depend on intense advocacy campaigns at national levels. This review identified some of the countries and health programs that have had fruitful advocacy efforts, to determine the factors that dictated success. The review highlights the factors of successful advocacy in two countries (Australia and Pakistan) that secured continued government support. The review further explores the achievements of the HIV/AIDs control network advocacy in securing global and national government support. Common factors for successful advocacy at the national level were identified to include generation of evidence data and effective utilization of the data with an appropriate forum and media to develop a credible relationship with prominent decision makers. Aligning eye care programming to the broad health and development agendas was a useful advocacy effort. Also a broad all-encompassing coalition of all stakeholders provides a solid platform for effective and persistent advocacy for government support of eye care.

Purpose: To identify children aged 0-72 months with blinding xerophthalmia in the North West Frontier Province (NWFP) and its adjoining Federally Administered Tribal Areas (FATA) in Pakistan, using a new surveillance system, and to describe socio-economic and other characteristics of reported cases., Methods: All ophthalmologists in district headquarter hospitals in NWFP and agency headquarter hospitals in FATA were requested to participate in a surveillance programme for the detection of blinding xerophthalmia (corneal xerosis, corneal ulcers, keratomalacia and corneal scars related to vitamin A deficiency) for children aged 0-72 months. The surveillance included reporting of each case of blinding xerophthalmia presenting to the participating eye units over a period of 12 months and recording their socio-economic and other related characteristics., Results: Seventy six cases of blinding xerophthalmia were reported and there was almost no gender difference. Children came from 19 of 31 districts and agencies in NWFP and FATA with a working ophthalmologist. The commonest age at presentation was 25-48 months and almost half of them belonged to households with a monthly income of < Pak Rs. 1200 (US $ < 20). Precipitating systemic illnesses were diarrhea and fever with cough in 63.2% and 56.6% cases, respectively. Almost a third of children aged > 9 months had not been immunized against measles. A quarter of all children had not been adequately breast-fed, and 7 children (9%) had never been breastfed. Majority of the cases presented during summer and autumn months., Conclusions: Our surveillance data provide evidence that blinding xerophthalmia does occur in children in NWFP and its adjoining FATA. The surveillance system identified high risk age groups, systemic illnesses, seasons and community groups. The detection system detects minimal numbers of cases and it is likely that the problem is even more severe.

Background: Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan., Methods: In summer 2002, five community-based eye camps were set up in Karachi, Pakistan's largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all participants at the examination site. Our main outcome measure was diabetic retinopathy, which was classified as non-proliferative diabetic retinopathy (NPDR), severe NPDR, and proliferative diabetic retinopathy (PDR). Our grading was based on clinical examination., Results: A total of 912 subjects were screened for diabetes mellitus. Of these, 160 (17.5%) had diabetes- 1.8% had type I diabetes and 15.9% had type II diabetes. One hundred and eight individuals visited the hospital for ophthalmic examination. Of them, 15.7% had diabetic retinopathy. The prevalence of diabetic retinopathy was higher among individuals with type I diabetes, with greater duration of diabetes, and among women. The commonest form of diabetic retinopathy was non-proliferative (76.5% [mild: 35.3%, moderate: 29.4%, and severe: 11.8%]), followed by maculopathy (17.6%) and proliferative diabetic retinopathy (5.9%)., Conclusion: More systematic and population-based research is needed to estimate the prevalence of and identify risk factors for diabetic retinopathy in Pakistan.

Purpose: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan., Methods: Eye departments in all 18 public tertiary care centers in the country were requested to provide data on the number of glaucoma operations and admissions during 1998. Of these, 13 hospitals agreed to participate. Eye departments' log books or patients' records were used to collect data retrospectively on the total number of eye admissions, the total number of glaucoma admissions, the type of glaucoma, and the total number and type of glaucoma operations., Results: Glaucoma accounted for 8.1% (1,942/23,931) of all eye admissions. Open-angle glaucoma was responsible for 37.6% or 731 glaucoma admissions followed by secondary glaucoma (35.0%) and angle-closure glaucoma (18.2%). During 1998, 1,407 glaucoma-related operations were performed in the selected hospitals. The mean (+/-SD) and the median number of operations performed were 108.2 (+/-59.6) and 112 (range: 17-206), respectively. Trabeculectomies accounted for 1,043 (74.1 %) of all procedures. Their number ranged from 16 to 170 (median: 84) in the selected hospitals., Conclusions: We believe that the annual number of glaucoma operations performed in the public tertiary care hospitals in Pakistan is far less than required. In-depth research is therefore needed to explain if this is because of gaps in service provision or a genuine shift to medical management of glaucoma on an outpatient basis.