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Water quality assessment of Shanti Sagara reservoir for drinking water supply and for water allocation to meet the demands in the semiarid climate is aimed. Seasonal water sampling (Pre monsoon, December 2021 & Post monsoon, May 2022) at 2 depths to investigate physico-chemical parameters and assess the Water Quality index based on IS 10500: 2012 is found to be poor in pre monsoon, December 2021 and very poor in post monsoon, May 2022. Trophic status of the reservoir assessed based on Carlson’s Trophic State Classification (Secchi Depth, Total Nitrogen and Total Phosphorous) indicated that the reservoir is Hypereutrophic for Post Monsoon. This calls for assessment of internal nutrient load (silt characteristics) and external loading from the reservoir catchment (fertilizer from agriculture land) and the domestic water and the sewage water has contributed to high concentration of phosphorous (P) in Rudrapura and Jakli near Somalapura. Soil texture (sandy clay, silty loam, silty clay and sandy clay loam) in the reservoir catchment compliments high concentration of suspended sediment that increasers the turbidity in the reservoir. Turbidity present in the water alters the taste, colour and odour of the water and oxygen from the surface cannot be mixed to the bottom layer and oxygen is not released by photosynthesis in absence of light penetration (high turbidity levels) resulting in anoxic condition. Total Nitrogen (TN) in the catchment soil that contributes to the bottom of the reservoir is found to be high (201-217 kg/acre). Agriculture runoff in the month of (May, 2022) owing to precipitation results in high sediment concentration, that contributes to high nitrogen levels in the reservoir. Nutrients in suspended Sediments that have entered the reservoir altered the nutrient cycle in the reservoir ecosystem. High nutrient concentration in the silt characteristics i,e total nitrogen (159-168 kg/acre) and phosphorous (10.1-13.4 kg/acre) is due to stratification caused do level to low in hypolimnion layer and anoxic condition during summer resulting in growth of Phytoplankton the eutrophication. The suggested nutrient management strategies for the reservoirs catchment are optimizing nutrient application to the crop land, microbial water treatment before supplying it for drinking purpose, soil conservation structures in the reservoir catchment to restrict sediment entry to the reservoir and sewage treatment plant for the rural settlement.

Atherosclerosis is the largest cause of death in the western world with the role of sex yet to be determined. The purpose of this review is to investigate the role sex may play in the development of atherosclerosis.Differences in plaque burden play a role in atherosclerotic outcome. Men have a higher prevalence of plaque burden, while women have less plaque rupture, necrotic core, and calcium. Differences in hormones, vascular anatomy, and overall lifestyle all play a role. Estrogen's cardioprotective effect is well known, but there is a lack of consensus on testosterone's role. There are varying rates of atherosclerosis between the sexes. Studies have also shown varying differences in the progression of plaque and the type of plaques between sexes. Further investigations need to be done to solidify the role sex may play as a variable in the development of atherosclerosis and how that may impact future treatment goals.

Background: Prediabetes (pDM) has recently drawn attention for being associated with poor outcomes after acute myocardial infarction (MI). We aimed to analyze the incidence and odds of type 1 MI admissions, and outcomes using a nationally representative sample. Methods: We queried the National Inpatient Sample (2018) to identify T1MI-related hospitalizations (T1RH) in young (18-44 years) adults with vs without pDM using ICD-10 codes. T1RHs with DM were excluded. Demographics, comorbidities and outcomes including major cardiovascular and cerebrovascular adverse events (MACCE) were compared between two cohorts. Results: Overall prevalence of pDM in young adults hospitalized in 2018 was 0.4% (31460/7851019). T1RH was found to be significantly higher in the pDM vs. non-pDM cohort (2.15%, 675/31460 vs. 0.3%, 21655/7820953) among all non-diabetic admissions in young adults. T1RH with pDM often had males (78.5 vs 72.8%), blacks (26.7 vs 21%), Hispanics (18.3 vs 11.5%), Asian/Pacific Islanders (6.9 vs 3.1%), patients from higher-income quartile (19.1 vs 15.8%), urban-teaching (81.5 vs 72.2%), Midwest (23.7 vs 21.9%) and West (23 vs 16.4%) region hospitals, and patients with higher rates of hyperlipidemia (68.1 vs 47.3%), obesity (48.9 vs 25.7%), fluid-electrolyte imbalance (18.5 vs 15.3%). The univariate (OR 7.9, 95CI 6.54-9.53) and adjusted multivariate analysis (OR 1.71, 95CI 1.38-2.12) revealed significantly higher odds of T1MI in the pDM vs non-pDM cohort (p[Table 1] . However, T1RH’s outcome for MACCE (adjusted) did not differ between two cohorts (P=0.074). Furthermore, T1RH with pDM had higher transfers to short-term facilities (6.7 vs 5.3%, p Conclusion: Young patients with prediabetes had significantly higher T1MI hospitalizations without any impact on subsequent MACCEs. This highlights the need for aggressive management of CVD risk factors in the young by primary care physicians to curtail acute cardiac events and healthcare costs.

Background: Sepsis-induced myocardial dysfunction with the resultant cardiomyopathy carries a high risk of mortality. We aimed to study the risk factors of cardiac arrest (CA) in Sepsis-related hospitalizations (SRH). Methods: We identified SRHs using the National Inpatient Sample (2018) and ICD10 codes to categorized them into with vs without CA. We then compared baseline characteristics and performed multivariate analysis adjusting for confounders to identify predictors of sepsis-associated CA. Results: Of SRH (1,345,595) in 2018, 0.8% (11,365) had a CA (Table1) . SRH with CA often had elderly (median age 70 vs 66 years), males (55.3% vs 48.8%), blacks (19.6% vs 13.3%), Hispanics (12.3 vs 11.7%), Medicare enrollees (69.9 vs 59.1%), and had patients from lower-income households (LIH, 36.9% vs 30.7%) than non-CA cohort. Statistically significant predictors for CA in SRH were age (5% increased risk every 5 years), male sex (aOR 1.28, 95CI 1.16-1.4), black (aOR 1.49, 95CI 1.3-1.7) & Hispanic (aOR 1.26, 95CI 1.09-1.45) race, LIH (aOR 1.31, 95CI 1.13-1.52), CHF (aOR 2.4, 95CI 2.16-2.68), pulmonary circulation disorder (aOR 2.14, 95CI 1.72-2.66), prior cardiac arrest (aOR 1.95, 95CI 1.16-3.27), coagulopathy (aOR 1.69, 95CI 1.5-1.9), alcohol abuse (aOR 1.42 95CI 1.17-1.74), PVD (aOR 1.36, 95CI 1.17-1.58), CKD (aOR 1.26, 95CI 1.14-1.39), cancer without metastasis (aOR 1.49, 95CI 1.24-1.8) and with metastasis (aOR 1.24, 95CI 1.01-1.52). Urban non-teaching vs rural (aOR 1.32, 95CI 1.1-1.57) and Southern vs Northeast hospitals (aOR 1.26, 95CI 1.09-1.46) showed higher odds of CA. Conclusion: SRH associated CA had high mortality with prevalent demographic and regional disparities, evident from black and Hispanic, males, patients from LHI and Southern hospitals revealing a higher risk of sepsis-associated CA. Congestive heart failure, pulmonary disease, prior cardiac arrest, coagulopathy, alcohol abuse, PVD, CKD, and cancers were the strongest predictors of CA in SRH.

Topical analgesics and topical rubefacients are widely used to control acute as well as chronic pain every day. Due to their availability without a prescription, consumers often overlook any potentially harmful effects and consider them largely benign. Here, we present a rare case of chemical burn triggered by a typical over-the-counter (OTC) analgesic containing menthol and methyl salicylate resulting in chemical burn, complicated by necrotizing infection treated by below the knee amputation.

Introduction: We aimed to characterize the clinical, epidemiological and echocardiographic features of infective endocarditis (IE) in the United States (US)-Mexico border population. Methods: A retrospective cohort design of all patients with diagnosis of IE in a tertiary university health system in El Paso, Texas. The primary outcome was a composite of death, stroke, other embolic events or heart failure. Patients were risk-stratified using the Simplified Risk Score Calculation (scores >=5 were considered high risk). Kaplan-Meier method was used to evaluate time to outcome which was subsequently compared between groups by Wilcoxon log-rank test and a priori multivariable proportional hazard model. Results: Final analytic sample was 155 patients with a median follow-up of 2.21 years. Prosthetic valve IE composed 10.3% of our patients. The most prevalent organism was S. aureus (35.5%), followed by streptococcus species (20.0%). Echocardiographic features of severe endocarditis (indication of surgery) were present in 123 patients (79.5%). Surgical treatment occurred in 23.2% of patients, and the median time to surgery was 12 days. A total of 53% of patients were in the high-risk score category and these patients were more likely to have a conservative, medical treatment compared to those with a low to intermediate risk score (62.2% vs 37.8%, p Conclusion: In a predominant Hispanic community of the US-Mexico border, high-risk IE patients were more likely to experience the composite outcome, and less likely to get surgical treatment. In multivariable analysis, uninsured patients had a significant higher risk of readmission, embolic events, heart failure or death.

Mice and mouse platelets are major experimental models for hemostasis and thrombosis; however, important physiological data from this model has received little to no quantitative, 3D ultrastructural analysis. We used state-of-the-art, serial block imaging scanning electron microscopy (SBF-SEM, nominal Z-step size was 35 nm) to image resting platelets from C57BL/6 mice. α-Granules were identified morphologically and rendered in 3D space. The quantitative analysis revealed that mouse α-granules typically had a variable, elongated, rod shape, different from the round/ovoid shape of human α--granules. This variation in length was confirmed qualitatively by higher-resolution, focused ion beam (FIB) SEM at a nominal 5 nm Z-step size. The unexpected α-granule shape raises novel questions regarding α-granule biogenesis and dynamics. Does the variation arise at the level of the megakaryocyte and α-granule biogenesis or from differences in α-granule dynamics and organelle fusion/fission events within circulating platelets? Further quantitative analysis revealed that the two major organelles in circulating platelets, α-granules and mitochondria, displayed a stronger linear relationship between organelle number/volume and platelet size, i.e., a scaling in number and volume to platelet size, than found in human platelets suggestive of a tighter mechanistic regulation of their inclusion during platelet biogenesis. In conclusion, the overall spatial arrangement of organelles within mouse platelets was similar to that of resting human platelets, with mouse α-granules clustered closely together with little space for interdigitation of other organelles.

BACKGROUND Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. OBJECTIVE The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. METHODS We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. RESULTS Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. CONCLUSIONS Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients. CLINICALTRIAL

STUDY DESIGN This was a retrospective cohort analysis. OBJECTIVE To identify the impact of Parkinson disease (PD) on 2-year postoperative outcomes following cervical spine surgery (CSS). SUMMARY OF BACKGROUND DATA (PD) patients are prone to spine malalignment and surgical interventions, yet little is known regarding outcomes of CSS among PD patients. MATERIALS AND METHODS All patients from the Statewide Planning and Research Cooperative System with cervical radiculopathy or myelopathy who underwent CSS were included; among these, those with PD were identified. PD and non-PD patients (n=64 each) were 1:1 propensity score-matched by age, sex, race, surgical approach, and Deyo-Charlson Comorbidity Index (DCCI). Demographics, hospital-related parameters, and adverse postoperative outcomes were compared between cohorts. Logistic regression identified predictive factors for outcomes. RESULTS Overall, patient demographics were comparable between cohorts, except that DCCI was higher in PD patients (1.28 vs. 0.67, P=0.028). PD patients had lengthier mean hospital stays than non-PD patients (6.4 vs. 4.1 d, P=0.046). PD patients also incurred comparable total hospital expenses ($69,565 vs. $57,388, P=0.248). Individual medical complication rates were comparable between cohorts; though PD patients had higher rates of postoperative altered mental status (4.7% vs. 0%, P=0.08) and acute renal failure (10.9% vs. 3.1%, P=0.084), these differences were not significant. Yet, PD patients experienced higher rates of overall medical complications (35.9% vs. 18.8%, P=0.029). PD patients had comparable rates of individual and overall surgical complications. The PD cohort underwent higher reoperation rates (15.6% vs. 7.8%, P=0.169) compared with non-PD patients, though this difference was not significant. Of note, PD was not a significant predictor of overall 2-year complications (odds ratio=1.57, P=0.268) or reoperations (odds ratio=2.03, P=0.251). CONCLUSION Overall medical complication rates were higher in patients with PD, while individual medical complications as well as surgical complication and reoperation rates after elective CSS were similar in patients with and without PD, though PD patients required longer hospital stays. Importantly, a baseline diagnosis of PD was not significantly associated with adverse two-year medical and surgical complications. This data may improve counseling and risk-stratification for PD patients before CSS. LEVEL OF EVIDENCE Level III.

110 Background: Social determinants of health (SDOH) have an impact of health and quality-of-life. However, most models of clinical disease and risk calculators do not incorporate SDOH. Many diseases have residual, unexplained risk after known risk factors have been incorporated. SDOH is important component of this residual risk and resources should be allocated to study their relation to disease. Here, we investigate the role of SDOH on the incidence and severity of respiratory diseases by evaluating the association of income level with lung cancer incidence and COVID-19 case fatality ratio in the state of Ohio. Methods: Socioeconomic data for the state of Ohio was manually collected. Lung cancer incidence was acquired from the National Cancer Institute’s online portal. COVID-19 case fatality ratios were downloaded from Johns Hopkins University’s GitHub repository. All three datasets contained complete information for each of Ohio’s 88 counties and were merged by county name. The first two datasets are up-to-date as of 2019, while the COVID-19 data was up-to-date as of 22 May 2021. Data manipulation, visualization, and statistical inference was conducted in the R programming language. Results: Median county-level income across Ohio was $52,722 (IQR: 47,273-59,166). Median county-level lung cancer incidence was 68.4 per 100,000 population (IQR: 62.0-80.6) and median COVID-19 case fatality ratio was 1.98% (IQR: 1.65-2.36). Data for counties with highest and lowest median income are shown in table. Lung cancer incidence and COVID-19 case fatality ratio were not significantly correlated ( n = 88, p > 0.05). Median income was significantly correlated with both, lung cancer incidence ( r = -0.49, p < 0.001) and COVID-19 case fatality ratio ( r = -0.41, p < 0.001). This implies that 24% of the variation in lung cancer incidence and 17% of the variation in COVID-19 case fatality ratio in counties across Ohio can be explained by median county income. Conclusions: SDOH is significantly associated with the incidence and severity of infectious and oncologic respiratory diseases. This association is strengthened since the disease variables themselves are uncorrelated, decreasing the likelihood of confounding. COVID-19 incidence was not used because of uncertainty in the mechanism of SDOH affecting transmission. However, theories suggest that oncologic incidence and infectious disease treatment are affected by SDOH. We validate these theories and encourage the incorporation of SDOH into clinical care and public health. Future directions include testing the association between income level and lung cancer severity in clinical datasets from medical institutions in Ohio.[Table: see text]

The current value-driven healthcare system encourages physicians to continuously optimize the value of the services they provide. Relative value units (RVUs) serve as the basis of a reimbursement model linking the concept that as the effort and value of services provided to patient's increases, physician reimbursement should increase proportionately. Spine surgery is particularly affected by these factors as there are multiple ways to achieve similar outcomes, some of which require more time, effort, and risk. Specifically, as the trend of spinal interbody fusion has increased over the past decade, the optimal approach to use-posterior versus anterior lumbar interbody fusion (PLIF vs. ALIF)-has been a source of controversy. Due to potential discrepancies in effort, one factor to consider is the correlation between RVUs and the time needed to perform a procedure. Therefore, the purpose of this study was to compare: 1) mean RVUs; 2) mean operative time; and 3) mean RVUs per unit of time between PLIF and ALIF with the utilization of a national surgical database. We also performed an individual surgeon cost benefit analysis for performing PLIF versus ALIF.The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was utilized to identify 6,834 patients who underwent PLIF (CPT code: 22630) and 6,985 patients who underwent ALIF (CPT code: 22558) between 2008 and 2015. The mean operative times (in minutes), mean RVUs, and RVUs per minute were calculated and compared using the Student's t-tests. In addition, the reimbursement amount (in dollars) per minute, case, day, and year for an individual surgeon performing PLIF versus ALIF were also calculated and compared. A p-value of less than 0.05 was used as the threshold for statistical significance.Compared to ALIF cases, PLIF cases had longer mean operative times (203 vs. 212 minutes, p0.001). However, PLIF cases were assigned lower mean RVUs than ALIF cases (22.08 vs. 23.52, p0.001). Furthermore, PLIF had a lower mean RVU/minutes than ALIF cases (0.126 vs. 0.154, p0.001). The reimbursement amounts calculated for PLIF versus ALIF were: $4.52 versus $5.53 per minute, $958.66 versus $1,121.95 per case, and $2,875.98 versus $3,365.86 per day. The annual cost difference was $78,380.92.The data from this study indicates a potentially greater annual compensation of nearly $80,000 for performing ALIF as opposed to PLIF due to a higher "hourly rate" for ALIF as is noted by the significantly greater RVU per minute (0.154 vs. 0.126 RVU/minutes). These results can be used by spine surgeons to design more appropriate compensation effective practices while still providing quality care.

Background Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients’ needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health–based communication, especially as implementation requires active participation from providers and patients.

Surgical management of advanced coats' disease has always been a challenge to a surgeon. Various different techniques have been tried. With the advancement in surgical instruments and machines, surgeons are now modifying older surgical techniques. We have tried a novel minimally invasive surgical technique for the management of advanced coats' disease patient having high bullous exudative retinal detachment. Intravitreal injection of Bevacizumab at the end of the surgery has a role in such cases.

Background: Since it was introduced as an Olympic sport in 1998, snowboarding has drawn the participation of individuals of all ages. Despite the growing popularity of this sport, individuals can suffer from a number of musculoskeletal injuries. The specific goals of the study were to: (I) compare the number of injuries and trends of snowboarding injuries; (II) identify the injury occurrences, trends, and incidence of snowboarding-related fractures; and (III) identify the injury occurrences and trends of snowboarding-related fractures by body part. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for snowboarding injuries and snowboarding-related fractures treated in US emergency departments (EDs) from 2010–2016. The weighted estimate of the number of injuries were obtained by using the NEISS statistical weight calculations that were provided in the data. An estimated total of 248,388 patients (mean age =20 years) experienced a snowboarding-related injury. Linear regression analysis was used to analyze annual trends of snowboarding-related fractures and the snowboarding-related fractures by body part; reported as the correlation coefficient (r) and the coefficient of determination (R 2 ). Results: The estimated annual number of injuries decreased from 56,223 injuries in 2010 to 17,667 injuries in 2016 (r=−0.967, R 2 =0.936, P

Platelet α-granule cargo release is fundamental to both hemostasis and thrombosis. Granule matrix hydration is a key regulated step in this process, yet its mechanism is poorly understood. In endothelial cells, there is evidence for 2 modes of cargo release: a jack-in-the-box mechanism of hydration-dependent protein phase transitions and an actin-driven granule constriction/extrusion mechanism. The third alternative considered is a prefusion, channel-mediated granule swelling, analogous to the membrane “ballooning” seen in procoagulant platelets. Using thrombin-stimulated platelets from a set of secretion-deficient, soluble N-ethylmaleimide factor attachment protein receptor (SNARE) mutant mice and various ultrastructural approaches, we tested predictions of these mechanisms to distinguish which best explains the α-granule release process. We found that the granule decondensation/hydration required for cargo expulsion was (1) blocked in fusion-protein-deficient platelets; (2) characterized by a fusion-dependent transition in granule size in contrast to a preswollen intermediate; (3) determined spatially with α-granules located close to the plasma membrane (PM) decondensing more readily; (4) propagated from the site of granule fusion; and (5) traced, in 3-dimensional space, to individual granule fusion events at the PM or less commonly at the canalicular system. In sum, the properties of α-granule decondensation/matrix hydration strongly indicate that α-granule cargo expulsion is likely by a jack-in-the-box mechanism rather than by gradual channel-regulated water influx or by a granule-constriction mechanism. These experiments, in providing a structural and mechanistic basis for cargo expulsion, should be informative in understanding the α-granule release reaction in the context of hemostasis and thrombosis.

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) is a procedure used to treat cervical myelopathy and radiculopathy. During the surgical approach, the sternocleidomastoid muscle and the carotid sheath are retracted laterally. Complications related to compression and retraction of the artery is infrequent. However, to our knowledge, there have been no studies that have evaluated carotid artery retraction and the development of a postoperative stroke in patients who have carotid artery stenosis. PURPOSE The purpose of this study was to determine the incidence of postoperative strokes after ACDF in patients with carotid artery stenosis. STUDY DESIGN/SETTING This study utilized the Statewide Planning and Research Cooperative System (SPARCS) database from 2009 to 2013. PATIENT SAMPLE Patients who underwent ACDF between 2009 and 2013. Patients less than age 18 years and patients who had a previous history of a stroke that predated the ACDF were excluded. OUTCOME MEASURES Primary outcome was the incidence of postoperative stroke after ACDF in patients with and without carotid artery stenosis. Secondary outcomes included other postoperative complications, lengths of stay (LOS), and total hospital charges. METHODS Patient demographics included age, sex, race, insurance provider, Charlson/Deyo scores, and total hospital charges for each visit. Using the ACDF cohort, patients who had a preoperative diagnosis of carotid stenosis were identified, and were propensity score matched in a 1:1 ratio to those without a diagnosis of carotid stenosis based on age, sex, and Charlson/Deyo scores. We evaluated postoperative complications, including the incidence of a postoperative stroke. There were 61 patients in the carotid stenosis cohort and 61 patients without carotid stenosis. In terms of the demographics, compared to the patients without carotid stenosis, the carotid stenosis cohort was older (68 vs. 60 years, p RESULTS The incidence of postoperative stroke in the carotid artery stenosis cohort was significantly higher compared to those without carotid artery stenosis (6.6 vs. 0%, p CONCLUSIONS Patients with carotid artery stenosis who underwent ACDF had a significantly greater incidence of developing a postoperative stroke, among other complications, compared to patients without carotid stenosis. These patients could potentially benefit from medical or surgical optimization of their carotid stenosis prior to undergoing ACDF.

Today with business globalisation, the use of third-party logistics service providers (3PLSPs) is becoming prevalent. With the worldwide increasing use of 3PL services, the need for carefully evaluating and selecting the best 3PL is becoming much more critical. Supply chain managers always face the dilemma of selecting the right 3PL. The current study presents an efficient data envelopment analysis (DEA) and analytic hierarchy process (AHP)-based decision framework for 3PL evaluation and selection for an outsourcing arrangement. The analysis results demonstrate the effectiveness of the integrated DEA-AHP model as a simple and flexible decision analysis tool for 3PL evaluation and selection. Further, the application of decision framework has been demonstrated with a real case situation. Finally, the study discusses the implications of the results in a real-life context and concludes with the managerial insights identifying a few inherent limitations of the approach utilised.

India is yet to accept semi/fully – autonomous cars and one of the reasons, was loss of control on bad roads. For a better handling on these roads we require advanced braking and that can be done by adapting electronics into the conventional type of braking. In Recent years, the automation in braking system led us to various benefits like traction control system, anti-lock braking system etc. This research work describes and experiments the method for recognizing road surface profile and calculating braking distance. An ultra-sonic surface recognition sensor, mounted underneath the car will send a high frequency wave on to the road surface, which is received by a receiver with in the sensor, it calculates the time taken for the wave to rebound and thus calculates the distance from the point where sensor is mounted. A displacement graph will be plotted based on the output of the sensor. A relationship can be derived between the displacement plot and roughness index through which the friction coefficient can be derived in Matlab for continuous calculation throughout the distance travelled. Since it is a non-contact type of profiling, it is non-destructive. The friction coefficient values received in real-time is used to calculate optimum braking distance. This system, when installed on normal cars can also be used to create a database of road surfaces, especially in cities, which can be shared with other cars. This will help in navigation as well as making the cars more efficient.

Objectives The purpose of this study was to compare the fixation afforded by a dorsal nonlocking plate with a volar locking plate in a fracture model simulating an extra-articular distal radius fracture with dorsal comminution (OTA [Orthopaedic Trauma Association] type 23-A3.2). Methods In 10 matched pairs of fresh-frozen cadaveric arms, a comminuted extra-articular dorsally unstable distal radius fracture (OTA type 23-A3.2) was created. The fractures were fixed with either dorsally placed nonlocking T-plate or volarly placed locking plate within matched pairs. The precycling stiffness with axial and torsional loading of the specimens was determined. The specimens were then loaded axially for 5000 cycles, and postcycling axial and torsional stiffness and load to failure were determined. Results The mean axial and torsional stiffness before and after cyclic loading of fractures stabilized with dorsal nonlocking plate was not significantly different than fractures fixed with volar locking plate. Although the mean load to failure was greater for the volar locking plate group than dorsal nonlocking plate group, the difference was not significant. Conclusions This study suggests that the fixation obtained with volar locking plates is as stable as fixation with a dorsal plate in acute healing period and can withstand the functional demands of the immediate postoperative period in dorsally comminuted unstable extra-articular distal radius fractures. Elimination of dorsal tendinopathy by using volar locking plates may lead to fewer long-term complications. Locking plates provided better stability in specimens with osteoporosis.