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The treatment of choice for hepatorenal syndrome-acute kidney injury (HRS-AKI) is vasoconstrictor therapy in combination with albumin, preferably norepinephrine or terlipressin as recommended by recent guidelines. In the absence of larger head-to-head trials comparing the efficacy of terlipressin and norepinephrine, meta-analysis of smaller studies can provide insights needed to understand the comparative effects of these medications. Additionally, recent changes in the HRS diagnosis and treatment guidelines underscore the need for newer analyses comparing terlipressin and norepinephrine. In this systematic review, we aimed to assess reversal of hepatorenal syndrome (HRS) and 1-month mortality in subjects receiving terlipressin or norepinephrine for the management of HRS-AKI. We searched literature databases, including PubMed, Cochrane, Clinicaltrials.gov, International Clinical Trials Registry Platform, Embase, and ResearchGate, for randomized controlled trials (RCTs) published from January 2007 to June 2023 on June 26, 2023. Only trials comparing norepinephrine and albumin with terlipressin and albumin for the treatment of HRS-AKI in adults were included, and trials without HRS reversal as an endpoint or nonresponders were excluded. Pairwise meta-analyses with the random effects model were conducted to estimate odds ratios (ORs) for HRS reversal and 1-month mortality as primary outcomes. Additional outcomes assessed, included HRS recurrence, predictors of response, and incidence of adverse events (AEs). We used the Cochrane risk of bias assessment tool for quality assessment. We included 7 RCTs with a total of 376 subjects with HRS-AKI or HRS type 1. This meta-analysis showed numerically higher rates of HRS reversal (OR 1.33, 95% confidence interval [CI] [0.80-2.22]; P = 0.22) and short-term survival (OR 1.50, 95% CI [0.64-3.53]; P = 0.26) with terlipressin, though these results did not reach statistical significance. Terlipressin was associated with AEs such as abdominal pain and diarrhea, whereas norepinephrine was associated with cardiovascular AEs such as chest pain and ischemia. Most of the AEs were reversible with a reduction in dose or discontinuation of therapy across both arms. Of the terlipressin-treated subjects, 5.3% discontinued therapy due to serious AEs compared to 2.7% of the norepinephrine-treated subjects. Limitations of this analysis included small sample size and study differences in HRS-AKI diagnostic criteria. As more studies using the new HRS-AKI criteria comparing terlipressin and norepinephrine are completed, a clearer understanding of the comparability of these 2 therapies will emerge.

This paper investigates the use of micro-Doppler spectrogram signatures of flying targets, such as drones and birds, to aid in their remote classification. Using a custom-designed 10-GHz continuous wave (CW) radar system, measurements from different scenarios on a variety of targets were recorded to create datasets for image classification. Time/velocity spectrograms generated for micro-Doppler analysis of multiple drones and birds were used for target identification and movement classification using TensorFlow. Using support vector machines (SVMs), the results showed an accuracy of about 90% for drone size classification, about 96% for drone vs. bird classification, and about 85% for individual drone and bird distinction between five classes. Different characteristics of target detection were explored, including the landscape and behavior of the target.

Abstract Transient atmospheric vortices called monsoon low pressure systems (LPS) generate a large fraction of total rainfall over South Asia and often produce extreme precipitation. Here, we assess the influence of these storms on the occurrence of disasters, using information from the Emergency Events Database (EM-DAT) that we geocoded and then associated with LPS tracks. We show that more than half of hydro-meteorological disasters over South Asia during summer are associated with these LPS events. Weaker LPS (which are called monsoon lows) occur more frequently than stronger LPS (called monsoon depressions), but the stronger LPS produce a larger number of disasters. Furthermore, although many prior studies have shown that the peak rainfall in LPS falls southwest of the vortex centre, the disasters are concentrated on the northern edge of the LPS tracks, along the Himalayas and upper basins of the Ganga and Brahmaputra rivers. Observations show a sharp peak in rainfall on the day of disasters, confirming the physical link between LPS and these hydro-meteorological disasters. A similar peak in rainfall is found in weather forecasts made up to five days before the disaster, suggesting that short-term precipitation forecasts can be useful in disaster preparation.

BackgroundBile cast nephropathy (BCN) is an underdiagnosed renal complication associated with severe hyperbilirubinemia and is seen in patients with liver failure who have cholestatic complications. BCN-induced acute kidney injury (AKI) can require hemodialysis (HD), and the molecular adsorbent recirculating system (MARS) is a potentially useful therapeutic option.Case summaryA 57-year-old male presented with jaundice persisting for 1 month, with laboratory test results indicative of hyperbilirubinemia and AKI. Abdominal imaging and a biopsy confirmed biliary ductal dilation secondary to a pancreatic head mass. The patient had rapidly progressive renal failure and refractory hyperbilirubinemia, despite biliary decompression, and was started on HD. Subsequent therapy with albumin dialysis therapy using MARS was successful in reversing the AKI, the cessation of HD, and the restoration of native renal function.ConclusionIn the setting of BCN-induced AKI, timely initiation of MARS can provide a useful therapeutic strategy to reverse renal dysfunction and facilitate intrinsic renal recovery.

Calpainopathy is caused by mutations in the CAPN3. There is only one clinical and genetic study of CAPN3 from India and none from South India. A total of 72 (male[M]:female [F] = 34:38) genetically confirmed probands from 72 independent families are included in this study. Consanguinity was present in 54.2%. The mean age of onset and duration of symptoms are 13.5 ± 6.4 and 6.3 ± 4.7 years, respectively. Positive family history occurred in 23.3%. The predominant initial symptoms were proximal lower limb weakness (52.1%) and toe walking (20.5%). At presentation, 97.2% had hip girdle weakness, 69.4% had scapular winging, and 58.3% had contractures. Follow-up was available in 76.4%, and 92.7% were ambulant at a mean age of 23.7 ± 7.6 years and duration of 4.5 years, remaining 7.3% became wheelchair-bound at 25.5 ± 5.7 years of age (mean duration = 13.5 ± 4.6), 4.1% were aged more than 40 years (duration range = 5–20). The majority remained ambulant 10 years after disease onset. Next-generation sequencing (NGS) detected 47 unique CAPN3 variants in 72 patients, out of which 19 are novel. Missense variants were most common occurring in 59.7% (homozygous = 29; Compound heterozygous = 14). In the remaining 29 patients (40.3%), at least one suspected loss of function variant was present. Common recurrent variants were c.2051–1G > T and c.2338G > C in 9.7%, c.1343G > A, c.802–9G > A, and c.1319G > A in 6.9% and c.1963delC in 5.5% of population. Large deletions were observed in 4.2%. Exon 10 mutations accounted for 12 patients (16.7%). Our study highlights the efficiency of NGS technology in screening and molecular diagnosis of limb-girdle muscular dystrophy with recessive form (LGMDR1) patients in India.

Vehicle detection using data fusion techniques from overhead platforms (RGB/MSI imagery and LiDAR point clouds) with vector and shape data can be a powerful tool in a variety of fields, including, but not limited to, national security, disaster relief efforts, and traffic monitoring. Knowing the location and number of vehicles in a given area can provide insight into the surrounding activities and patterns of life, as well as support decision-making processes. While researchers have developed many approaches to tackling this problem, few have exploited the multi-data approach with a classical technique. In this paper, a primarily LiDAR-based method supported by RGB/MSI imagery and road network shapefiles has been developed to detect stationary vehicles. The addition of imagery and road networks, when available, offers an improved classification of points from LiDAR data and helps to reduce false positives. Furthermore, detected vehicles can be assigned various 3D, relational, and spectral attributes, as well as height profiles. This method was evaluated on the Houston, TX dataset provided by the IEEE 2018 GRSS Data Fusion Contest, which includes 1476 ground truth vehicles from LiDAR data. On this dataset, the algorithm achieved a 92% precision and 92% recall. It was also evaluated on the Vaihingen, Germany dataset provided by ISPRS, as well as data simulated using an image generation model called DIRSIG. Some known limitations of the algorithm include false positives caused by low vegetation and the inability to detect vehicles (1) in extremely close proximity with high precision and (2) from low-density point clouds.

INTRODUCTION:. Drug-induced liver injury (DILI) is a significant cause of acute liver injury and can present as cholestatic injury with or without associated hepatitis. Although most patients with DILI recover with supportive care, some can develop severe refractory cholestasis that impairs recovery of hepatic function, with subsequent progression to acute or chronic liver failure. Current pharmacotherapy and extracorporeal therapies such as hemodialysis have limited benefit. Albumin dialysis is an emerging strategy in the extracorporeal treatment of intoxications caused by protein bound drugs and can be used for the removal of albumin bound bilirubin and bile acids. CASES SERIES:. We describe the efficacy of albumin dialysis with the molecular adsorbent recirculating system (MARS) in the successful treatment of five patients with severe cholestatic DILI that was refractory to standard medical therapy. All patients had a sustained improvement in serum bilirubin levels after completing MARS therapy, with a complete resolution of their liver injury. DISCUSSION:. Our case series demonstrates that albumin dialysis could provide an important treatment strategy in the setting of severe refractory cholestatic DILI and be considered as a novel therapeutic option in specific cases of drug hepatotoxicity in which the causative agent has high protein binding characteristics.

Background: Free colon flap is the preferred method of hypopharynx reconstruction when the defect is substantial, or simultaneous voice reconstruction is planned. Most of the complications in free colon flaps are located at the anastomosis between colon and thoracic esophagus due to size mismatch of the lumen. We present our experience comparing a modified anastomosis technique and a conventional anastomosis technique at the distal end of interposed colonic segment. Methods: In this retrospective review, 94 patients, divided into two groups, underwent hypopharynx reconstruction. Group A (18 patients), conventional anastomoses between colon and thoracic esophagus was performed, while in Group B (76 patients), underwent the modified method of anastomosis. Results: The average follow-up period was 46 months in group A and 54 months in group B. Fistula formation was found in 2 patients from Group A, and 1 patient from Group B. Strictures were observed in 4 patients from Group A, and 1 patient from Group B. Difference between both groups regarding complications of leakage and stricture formation was statistically significant (p

With the rise in living standards and evolution of science, there is a rise in life expectancy world over. This demographic transition has led to a rise in older persons, increasing the dependency ratios and “demographic burden.” Management of such old patients requires special considerations and understanding as aging is a physiological phenomenon in which the functional capacity of organs decreases due to degenerative changes in the structure. An important aspect to remember in Geriatric Anesthesia is that in spite of adequate compensatory mechanisms for age-related changes, there is a limitation of physiological reserve, especially in stressful circumstances like perioperative period. Geriatric patients are more sensitive to all medications and anesthetic agents. Lesser amount of drug is required to achieve the desired clinical effect, but have a prolonged effect. This elderly but well-preserved patient, possibly a case of small gut obstruction was posted for emergency laparoscopy and proceed. Seeing his age and easy friability, a well-planned preoperative assessment and optimization was done prior to wheeling him into operation theater. Administration of short-acting anesthetic drugs in titrated quantities and awareness about postoperative cognitive dysfunction (POCD) helped us to get better and faster recovery in the patient.

Multimodal fusion approaches that combine data from dissimilar sensors can better exploit human-like reasoning and strategies for situational awareness. The performance of a six-layer convolutional neural network (CNN) and an 18-layer ResNet architecture are compared for a variety of fusion methods using synthetic aperture radar (SAR) and electro-optical (EO) imagery to classify military targets. The dataset used is the Synthetic and Measured Paired Labeled Experiment (SAMPLE) dataset, using both original measured SAR data and synthetic EO data. We compare the classification performance of both networks using the data modalities individually, feature level fusion, decision level fusion, and using a novel fusion method based on the three RGB-input channels of a residual neural network (ResNet). In the proposed input channel fusion method, the SAR and the EO imagery are separately fed to each of the three input channels, while the third channel is fed a zero vector. It is found that the input channel fusion method using ResNet was able to consistently perform to a higher classification accuracy in every equivalent scenario.

This article uses data from the first wave of the COVID Future Panel study to evaluate attitudes towards COVID-19 and their influence on traveler behaviors. An exploratory factor analysis identified two underlying constructs based on the measured attitudes, namely “Concern about Pandemic Response” and “COVID Health Concern.” A cluster analysis based on the factor scores yielded four groups with distinct attitudes. Those primarily concerned about the pandemic response traveled the most using private vehicles, while those equally concerned about the response to the pandemic and the health effects of COVID-19 were found to use personal bicycles and transit the most.

In this communication, we investigate the performance of the Non-dominated Sorting Genetic Algorithm II (NSGA-II) in many-objective optimization scenarios pertaining to joint radar and communication functionality. We introduce five objectives relevant to sensing and secure communications and develop a cost function where these objectives can be individually prioritized by a user. We consider three scenarios: Radar Priority, Communication Priority, and All (Objectives) Equal; we then demonstrate the optimization results using an orthogonal frequency-division multiplexing (OFDM) radarcom signal. The objectives with selected weights are shown to improve system performance and thereby validate the viability of our approach. The Radar Priority scenario showed the best improvement in probability of detection, PSLR, and PAPR. Compared to the baseline performance values, the improvements were: from 94.05% to 96%, from 11.7 to 13.6 dB, and from 9.46 to 7.09 dB, respectively. The communication scenario saw the best improvement in BER and clutter similarity (measured by NRMSE) from 3.52% to 0.39% and 0.87 to 0.59, respectively.

We formulate an active-gel theory for multicellular migration in the extra-cellular matrix (ECM). The cells are modeled as an active, polar solvent, and the ECM as a viscoelastic solid. Our theory enables to analyze the dynamic reciprocity between the migrating cells and their environment in terms of distinct relative forces and alignment mechanisms. We analyze the linear stability of polar cells migrating homogeneously in the ECM. Our theory predicts that, as a consequence of cell-matrix alignment, contractile cells migrate homogeneously for small wave vectors, while sufficiently extensile cells migrate in domains. Homogeneous cell migration of both extensile and contractile cells may be unstable for larger wave vectors, due to active forces and the alignment of cells with their concentration gradient. These mechanisms are stabilized by cellular alignment to the migration flow and matrix stiffness. They are expected to be suppressed entirely for rigid matrices with elastic moduli of order 10 kPa. Our theory should be useful in analyzing multicellular migration and ECM patterning at the mesoscopic scale.

Countries adopted the Paris Agreement to pursue efforts towards limiting the global average temperature increase to 1.5 °C above pre-industrial levels. To achieve this target, the global emission level will have to be negative by the second half of the century. This study aims to analyse different GHG mitigation pathways to achieve net zero emissions by 2050 in Nepal. The study first assesses the energy use and emissions in the Business-as-usual (BAU) scenario during 2010-2050 using the Asia-Pacific Integrated Model/Enduse (AIM/Enduse). In addition to the BAU scenario, the study has assessed six scenarios: a No Climate Policy (NCP) scenario (without carbon tax) and five carbon tax scenarios. The carbon tax rate varies from $10 to $800 per tCO2e among the five carbon tax scenarios. According to the study, the GHG emissions in 2050 is estimated to be 32.9 MtCO2e in the BAU, 30.3 MtCO2e in the NCP and 5.1 MtCO2e at the highest carbon tax scenario (i.e. at $800/tCO2e). The study then analyses options to achieve net zero emissions by 2050. This can be achieved through carbon offset by hydropower export and carbon sequestration by forests. The analyses show that a carbon tax can be an effective instrument in reducing GHG emissions and that forests can act as a carbon sink to offset the remaining emissions to achieve carbon neutrality.

Abstract We present the case of a 60-year-old diabetic who had acute-onset shortness of breath that was preceded by bilateral thigh and hip pain. He was initially admitted for septic arthritis with community-acquired pneumonia. His respiratory complaints resolved, but he continued to have thigh pain. Ultrasound of the lower limbs showed thrombosis of the deep veins of the thigh and MRI showed a collection in the right thigh suggestive of pyomyositis with thrombosis in deep veins abutting the collection. Contrast enhanced CT (CECT) chest showed multiple peripherally located pneumatoceles and cavities in both the lungs suggestive of septic emboli. Here, we present a case of pyomyositis of thigh muscles causing Deep vein thrombosis (DVT) and septic pulmonary emboli (reverse Lemierre’s syndrome).

Through-wall and through-barrier motion-sensing systems are becoming increasingly important tools to locate humans concealed behind barriers and under rubble. The sensing performance of these systems is best determined with appropriately designed calibration targets, which are ones that can emulate human motion. The effectiveness of various dynamic calibration targets that emulate human respiration, heart rate, and other body motions were analyzed. Moreover, these targets should be amenable to field deployment and not manifest angular or orientation dependences. The three targets examined in this thesis possess spherical polyhedral geometries. Spherical geometries were selected due to their isotropic radar cross-sectional characteristics, which provide for consistent radar returns independent of the orientation of the radar transceiver relative to the test target. The aspect-independence of a sphere allows for more accurate and repeatable calibration of a radar than using a nonspherical calibration artifact. In addition, the radar cross section (RCS) for scattering spheres is well known and can be calculated using far-field approximations. For Doppler radar testing, it is desired to apply these calibration advantages to a dynamically expanding-and-contracting sphere-like device that can emulate motions of the human body. Monostatic RCS simulations at 3.6 GHz were documented for each geometry. The results provide a visual way of representing the effectiveness of each design as a dynamic calibration target for human detection purposes.

Traditionally, the method used in the electricity generation expansion planning has concentrated only on the supply-side options to identify the sequence of generation additions meet the forecasted demand at a minimum cost. Electricity generation expansion planning with both supply- and demand-side options, commonly known as integrated resource planning are also being used in some developed countries. With growing environmental concerns, especially the emission of air-pollutants from the power generation, demand-side management and clean and efficient generation technology options in the power sector development are getting increasing attention. In this paper, we compare the traditional planning approach with integrated resource planning. We also analyze the implications of CO2 reduction targets for the power sector development in the framework of supply side planning by including clean supply-side technologies as candidate plants. During the planning horizon, generation capacity of 365 MW and a cumulative electricity generation or 61,681 GWh would be avoided through the use of efficient demand-side technologies compared to the business-as-usual (BAU) case. When the clean supply-side options considered in the least-cost planning process, three units of 100-MW biomass-based plants are selected. The long run average cost of generation is found to increase by 0.32, 0.65 and 1.61% at the level of CO2 emission reduction target of 5, 10, and 20%, respectively.

The need to classify targets and features in high-resolution imagery is of interest in applications such as detection of landmines in ground penetrating radar and tumors in medical ultrasound images. Convolutional neural networks (CNNs) trained using extensive datasets are being investigated recently. However, large CNNs and wavelet scattering networks (WSNs), which share similar properties, have extensive memory requirements and are not readily extendable to other datasets and architectures—and especially in the context of adaptive and online learning. In this paper, we quantitatively study several quantization schemes on WSNs designed for target classification using X-band synthetic aperture radar (SAR) data and investigate their robustness to low signal-to-noise ratio (SNR) levels. A detailed study was conducted on the tradeoffs involved between the various quantization schemes and the means of maximizing classification performance for each case. Thus, the WSN-based quantization studies performed in this investigation provide a good benchmark and important guidance for the design of quantized neural networks architectures for target classification.

Context: Agriculture is one of the occupations with the highest risk of injuries and fatalities but the farmers are ignorant about eye care and eye safety. Aim: The current study aims at understanding the occupational hazard and ocular morbidities associated with agriculture and the effect of safety eyewear. Settings and Design: Multicenteric, cross-sectional, observational study was conducted in two states of India: Tamil Nadu and Karnataka. Subjects were agriculture workers recruited by convenience sampling. Methods and Material: The study was done in three phases: Phase 1: Visual task analysis (VTA), Phase 2: Comprehensive eye examination, and Phase 3: Spectacle compliance assessment. The Standard of Living Index scale was administered to assess the socioeconomic status of the participants. Statistical Analysis Used: Descriptive statistics and logistic regression. Results: A study involving 276 workers (39.4% male, 65.2% female) found that VTA agricultural tasks were visually less demanding but hazardous, carrying the risk of ocular and nonocular injuries. Ocular injuries accounted for 9.4% (26 cases), while nonocular injuries accounted for 9.8% (27 cases). Spectacle compliance assessment revealed that 91.8% (157 out of 171 workers) reported improved visual comfort, reduced dust exposure, and enhanced safety with safety eyewear. Conclusions: This study illustrates numerous types of hazards associated with the occupation of farming. The study population had a 9.4% prevalence of ocular injuries. Refractive safety eyewear was reported to improve worker visual comfort. Keywords: Farmers, hazard, ocular injury, ocular morbidities, safety eyewear, Author(s): Suresh Janani [1,2]; Srinivasan Krithica [3]; Sachi B. Saranya [4]; Shinde Lakshmi [5]; Ram M. R. Nivethikka [1]; Jathanna J. Shefali [3]; Subramaniyam Saravanan [4]; K. Eshwari [6]; Ramesh [...]

Due to the fact that it reliably results in positive outcomes, lymph node flap transfer is becoming an increasingly popular surgical procedure for the prevention and treatment of lymphedema. This technique has been shown to stimulate lymphoangiogenesis and restore lymphatic function, as well as decreasing infection rates, minimizing pain, and preventing the recurrence of lymphedema. In this article, we investigate possible additional benefits of lymph node flap transfer, primarily the possibility that sentinel lymph nodes may be used to detect micro-metastasis or in-transit metastasis and may function as an additional lymphatic station after the excision of advanced skin cancer.

A semi-nonparametric generalized multinomial logit model, formulated using orthonormal Legendre polynomials to extend the standard Gumbel distribution, is presented in this paper. The resulting semi-nonparametric function can represent a probability density function for a large family of multimodal distributions. The model has a closed-form log-likelihood function that facilitates model estimation. The proposed method is applied to model commute mode choice among four alternatives (auto, transit, bicycle and walk) using travel behavior data from Argau, Switzerland. Comparisons between the multinomial logit model and the proposed semi-nonparametric model show that violations of the standard Gumbel distribution assumption lead to considerable inconsistency in parameter estimates and model inferences.

Lymphedema is a chronic disorder characterized by lymph stasis in the subcutaneous tissue. Lymphatic fluid contains several components including hyaluronic acid and has many important properties. Over the past few years, significant research has been performed to identify an ideal tissue to implant as a filler. Because of its unique composition, fat harvested from the lymphedema tissue is an interesting topic for investigation and has significant potential for application as a filler, particularly in facial rejuvenation. Over a 36-month period, we treated and assessed 8 patients with lymphedematous limbs who concurrently underwent facial rejuvenation with lymphedema fat (LF). We conducted a pre- and post-operative satisfaction questionnaire survey and a histological assessment of the harvested LF fat. The overall mean general appearance score at an average of 6 months after the procedure was 7.2±0.5, demonstrating great improvement. Patients reported significant improvement in their skin texture with a reading of 8.5±0.7 and an improvement in their self-esteem. This study demonstrates that LF as an ideal autologous injectable filler is clinically applicable and easily available in patients with lymphedema. We recommend the further study and clinical use of this tissue as it exhibits important properties and qualities for future applications and research.

Jean B Nachega,1,2,4 Chelsea Morroni,1 Richard E Chaisson,2–4 Rene Goliath,1 Anne Efron,4 Malathi Ram,2 Gary Maartens11University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa; 2Johns Hopkins University, Bloomberg School of Public Health, Departments of International Health and Epidemiology, 3Johns Hopkins University, School of Medicine, Department of Medicine, Division of Infectious Diseases, 4Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USAObjective: We determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART.Methods: We carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART.Results: We enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/µL, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2–1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2–2.2; P = 0.001).Conclusion: Although IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation.Keywords: ART, adherence, TB, HIV/AIDS, IRIS

INTRODUCTION:Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers. METHODS:The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period. RESULTS:We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care. CONCLUSION:The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada.

This paper describes the underlying methodology behind an adaptive multimodal radar sensor that is capable of progressively optimizing its range resolution depending upon the target scattering features. It consists of a test-bed that enables the generation of linear frequency modulated waveforms of various bandwidths. This paper discusses a theoretical approach to optimizing the bandwidth used by the multimodal radar. It also discusses the various experimental results obtained from measurement. The resolution predicted from theory agrees quite well with that obtained from experiments for different target arrangements.

Radio frequency identification (RFID) tags are small electronic devices working in the radio frequency range. They use wireless radio communications to automatically identify objects or people without the need for line-of-sight or contact, and are widely used in inventory tracking, object location, environmental monitoring. This paper presents a design of a covert RFID tag network for target discovery and target information routing. In the design, a static or very slowly moving target in the field of RFID tags transmits a distinct pseudo-noise signal, and the RFID tags in the network collect the target information and route it to the command center. A map of each RFID tag’s location is saved at command center, which can determine where a RFID tag is located based on each RFID tag’s ID. We propose the target information collection method with target association and clustering, and we also propose the information routing algorithm within the RFID tag network. The design and operation of the proposed algorithms are illustrated through examples. Simulation results demonstrate the effectiveness of the design.

Radio frequency (RF) circuit elements that are traditionally considered to be linear frequently exhibit nonlinear properties that affect the intended operation of many other RF systems. Devices such as RF connectors, antennas, attenuators, resistors, and dissimilar metal junctions generate nonlinear distortion that degrades primary RF system performance. The communications industry is greatly affected by these unintended and unexpected nonlinear distortions. The high transmit power and tight channel spacing of the communication channel makes communications very susceptible to nonlinear distortion. To minimize nonlinear distortion in RF systems, specialized circuits are required to measure the low level nonlinear distortions created from traditionally linear devices, i.e., connectors, cables, antennas, etc. Measuring the low-level nonlinear distortion is a difficult problem. The measurement system requires the use of high power probe signals and the capability to measure very weak nonlinear distortions. Measuring the weak nonlinear distortion becomes increasingly difficult in the presence of higher power probe signals, as the high power probe signal generates distortion products in the measurement system. This paper describes a circuit design architecture that achieves 175 dB of dynamic range which can be used to measure low level harmonic distortion from various passive RF circuit elements.

Foveated sight as observed in some raptor eyes is a motivation for artificial imaging systems requiring both wide fields of view as well as specific embedded regions of higher resolution. These foveated optical imaging systems are applicable to many acquisition and tracking tasks and as such are often required to be relatively portable and operate in real-time. Two approaches to achieve foveation have been explored in the past: optical system design and back-end data processing. In this paper, these previous works are compiled and used to build a framework for analyzing and designing practical foveated imaging systems. While each approach (physical control of optical distortion within the lens design process, and post-processing image re-sampling) has its own pros and cons, it is concluded that a combination of both techniques will further spur the development of more versatile, flexible, and adaptable foveated imaging systems in the future.

Thrombocytopenia in methotrexate (MTX)-treated cancer and rheumatoid arthritis (RA) patients connotes the interference of MTX with platelets. Hence, it seemed appealing to appraise the effect of MTX on platelets. Thereby, the mechanism of action of MTX on platelets was dissected. MTX (10 μM) induced activation of pro-apoptotic proteins Bid, Bax and Bad through JNK phosphorylation leading to ΔΨm dissipation, cytochrome c release and caspase activation, culminating in apoptosis. The use of specific inhibitor for JNK abrogates the MTX-induced activation of pro-apoptotic proteins and downstream events confirming JNK phosphorylation by MTX as a key event. We also demonstrate that platelet mitochondria as prime sources of ROS which plays a central role in MTX-induced apoptosis. Further, MTX induces oxidative stress by altering the levels of ROS and glutathione cycle. In parallel, the clinically approved thiol antioxidant N-acetylcysteine (NAC) and its derivative N-acetylcysteine amide (NACA) proficiently alleviate MTX-induced platelet apoptosis and oxidative damage. These findings underpin the dearth of research on interference of therapeutic drugs with platelets, despite their importance in human health and disease. Therefore, the use of antioxidants as supplementary therapy seems to be a safe bet in pathologies associated with altered platelet functions.

A method for determining the location of Global Systems for Mobile Communications (GSM) mobile transmitters is proposed. Our approach estimates the location of a source without the use of multilateration or Line-of-Sight (LOS) techniques. A Multipath Characteristic Database (MCD) containing the multipath feature vectors, for each possible transmitter location within an area of interest, is populated via ray-tracing software simulations. The multipath characteristics of interest are angle-of-arrival (AOA) (azimuth) and time-of-arrival (TOA). By minimizing the “distance” between estimated and simulated multipath feature vectors, an estimate for the actual source location can be obtained. The development of the estimation method is presented, followed by a detailed analysis of its estimation accuracy. Since the proposed method utilizes a simulated multipath signature database based upon the knowledge of the environment and the terrain, the need for a priori soundings from the area of interest is eliminated, thus making this location estimation system suitable for application in denied territories. Location accuracies compare favorably with the requirements for the location of wireless 9-1-1 callers as recommended by the Federal Communications Commission (FCC).

A spectrum sensing technique is described which is used to enhance the performance of harmonic step-frequency radar in the presence of harmful radio frequency (RF) interference (RFI). This technique passively monitors the RF spectrum for subbands of high signal-to-interference-plus-noise ratio (SINR) within a constrained bandwidth of interest. An optimal subband is selected for the harmonic radar that maximizes SINR and minimizes the range resolution cell size, two conflicting objectives. The approach is tested using an experimental setup that injects high power RFI into a harmonic step-frequency radar, which significantly degrades radar performance. It is shown that the proposed spectrum sensing technique significantly improves the SINR and the peak-to-average sidelobe power level of the harmonic radar at the sacrifice of range resolution.

Transient atmospheric vortices called monsoon low pressure systems (LPS) generate a large fraction of total rainfall over South Asia and often produce extreme precipitation. Here, we assess the influence of these storms on the occurrence of disasters, using information from the Emergency Events Database (EM-DAT) that we geocoded and then associated with LPS tracks. We show that more than half of hydro-meteorological disasters over South Asia during summer are associated with these LPS events. Weaker LPS (which are called monsoon lows) occur more frequently than stronger LPS (called monsoon depressions), but the stronger LPS produce a larger number of disasters. Furthermore, although many prior studies have shown that the peak rainfall in LPS falls southwest of the vortex centre, the disasters are concentrated on the northern edge of the LPS tracks, along the Himalayas and upper basins of the Ganga and Brahmaputra rivers. Observations show a sharp peak in rainfall on the day of disasters, confirming the physical link between LPS and these hydro-meteorological disasters. A similar peak in rainfall is found in weather forecasts made up to five days before the disaster, suggesting that short-term precipitation forecasts can be useful in disaster preparation.

Human tail is a curiosity, a cosmetic stigma and presents as an appendage in the lumbosacral region. Six patients of tail in the lumbosacral region are presented here to discuss the spectrum of presentation of human tails. The embryology, pathology and treatment of this entity are discussed along with a brief review of the literature.

A 7-year-old boy reported with endodermal sinus tumor of left testis, jejunal metastasis and intestinal obstruction. He was treated by high inguinal orchidectomy and resection of jejunal mass followed by chemotherapy.

Thrombocytopenia is a serious issue connected with the pathogenesis of several human diseases including chronic inflammation, arthritis, Alzheimer's disease, cardiovascular diseases (CVDs) and other oxidative stress-associated pathologies. The indiscriminate use of antibiotics and other biological drugs are reported to result in thrombocytopenia, which is often neglected during the treatment regime. In addition, augmented oxidative stress induced by drugs and pathological conditions has also been shown to induce thrombocytopenia, which seems to be the most obvious consequence of elevated rate of platelet apoptosis. Thus, blocking oxidative stress-induced platelet apoptosis would be of prime importance in order to negotiate thrombocytopenia and associated human pathologies. The current study presents the synthesis and platelet protective nature of novel ibuprofen derivatives. The potent anti-oxidant ibuprofen derivative 4f was selected for the study and the platelet protective efficacy and platelet aggregation inhibitory property has been demonstrated. The compound 4f dose dependently mitigates the oxidative stress-induced platelet apoptosis in both platelet rich plasma and washed platelets. The platelet protective nature of compound 4f was determined by assessing various apoptotic markers such as ROS generation, cytosolic Ca2+ levels, PS externalization, cytochrome C translocation, Caspase activation, mitochondrial membrane depolarization, cytotoxicity, LDH leakage and tyrosine phosphorylation of cytosolic proteins. Furthermore, compound 4f dose dependently ameliorated agonist induced platelet aggregation. Therefore, compound 4f can be estimated as a potential candidate in the treatment regime of pathological disorders associated with platelet activation and apoptosis. In addition, compound 4f can be used as an auxiliary therapeutic agent in pathologies associated with thrombocytopenia.