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Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India's 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations.

The basic amenity for a highly civilized community needs water and drainage facilities; with uncontrolled population outrage, there arises demand for water consumption which naturally leads to effluent discharge. Even though the district has ample landscape, smart drainage facilities, the rainwater and storm runoff are still collected as pumped source for treatment to a long distance. These wastewaters diverted to the river surface due to insufficient retention time for treatment that naturally grounds a serious ecological damage. The concentration of organic and inorganic heavy metals determines the nature of contamination whether lighter low concentrated or severe high concentrated, meanwhile the level get diluted with streaming in the river surface. Deposited contaminants along the Porunai river basin are in dissolved stages that naturally lead to eutrophication which will cause pollution risk and indirectly affects the dependents covering three districts. With the support of GIS, online monitoring is incorporated to check the gathering of phosphorus, removal of phosphorus from the soil and nitrogen removal. The aim of the research focus is to study eutrophic nutrient limits in river Porunai which is a streaming of Thamirabarani and manimuthar. Nutrient removals from the designed reactors express the available measure of pollution risk. Life cycle study gives the life term of river front and a blueprint is framed based on reducing the mixing of unwanted water sources. In due course make it a place of recreation prevailing with current scenario and future prediction by means of statistical data compared with navigation studies.

The components of each stage have similarities as well as differences, which make each unique in its own right. As the film-making and the movie industry may have much we can learn from, some of these will be covered under the different sections of the paper, for example, “Writing Powerful Narratives,” depiction of emotional elements, specific industry-driven developments as well as the “cultural considerations” in both. For medical simulation and simulation-based education, the corresponding stages are as follows: Development Preproduction Production Postproduction and Distribution. The art of sim-making has many similarities to that of film-making. In fact, there is potentially much to be learnt from the film-making process in cinematography and storytelling. Both film-making and sim-making can be seen from the artistic perspective as starting with a large piece of blank, white sheet of paper, which will need to be colored by the “artists” and personnel involved; in the former, to come up with the film and for the latter, to engage learners and ensure learning takes place, which is then translated into action for patients in the actual clinical care areas. Both entities have to go through a series of systematic stages. For film-making, the stages are as follows: Identification of problems and needs analysis Setting objectives, based on educational strategies Implementation of the simulation activity Debriefing and evaluation, as well as Fine-tuning for future use and archiving of scenarios/cases.

Introduction: Chest compression fraction (CCF) is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation. Targeting a CCF of at least 60% is intended to limit interruptions in compressions and maximize coronary perfusion during resuscitation. We aimed to identify the mean CCF and its relationship with various factors affecting it. Methods: Patients presenting to the emergency department in cardiac arrest at a single center were prospectively included in this study. Resuscitation was provided by trained health-care providers. The feedback device Cprmeter2™ was placed on the patient's sternum at the beginning of resuscitation. The total time taken for the entire resuscitation was noted by the device and CCF calculated. Results: The mean CCF was analyzed using descriptive statistics and was found to be 71.60% ± 7.52%. The total duration of resuscitation (R = −0.55, P = < 0.001, min-max, 2.02–34.31, mean 12.25 ± 6.54), number of people giving chest compressions (R = −0.48, P = < 0.001, min-max, 1–6, mean 4.04 ± 1.12), and total number of team members in resuscitation (R = −0.50, P = < 0.001, min-max, 4–10, mean 6.65 ± 1.32) had negative correlation with CCF. Diurnal variation (day, n = 35; mean 69.20% ± 7% and night, n = 20; mean 75.80% ± 5.6%, P = 0.001) and patients receiving defibrillation (receiving n = 10 mean 67.00% ± 4.11% and not receiving n = 45 mean 72.62 ± 7.42%, P = 0.005) were found to significantly affect CCF. Conclusion: The mean CCF for cardiac arrest patients was well within the targets of guideline recommendation. CCF decreased when resuscitation lasted longer, during daytime when the defibrillator was used, the total team members increased, and also when the number of people giving chest compressions increased. CCF during resuscitation may improve if there is a focus on improving these factors and requires validation in multicentric settings.

The optical communication system is preferred over microwave and radio frequency communication systems because of license free operation. Simulative analysis of 10gbps bandwidth using different optical communication channels have been performed in this paper. The different modulation formats of QAM and PSK have been compared for its performances under all the three optical channels OWC, FSO, and LOS-FSO which are an unguided form of optical communication. The optical channels under these modulation formats are extensively used in Digital Video Broadcasting Communication. The parameters such as Q-factor, BER and Eye height can be obtained by varying the wavelengths in the range of 850 nm 1064 nm, 1330 nm and 1550 nm. From the design and performance analysis, the system with the maximum Q-factor and minimum BER can be found for the wavelength of 1064 nm.

Evaporation from open water is among the most rigorously studied problems in hydrology. Robert E. Horton, unbeknownst to most investigators on the subject, studied it in great detail by conducting experiments and heuristically relating his observations to physical laws. His work furthered known theories of lake evaporation, but it appears that it was dismissed as simply empirical. This is unfortunate because Horton's century-old insights on the topic, which we summarize here, seem relevant for contemporary climate-change-era problems. In rediscovering his overlooked lake evaporation works, in this paper we (1) examine several of his publications in the period 1915–1944 and identify his theory sources for evaporation physics among scientists of the late 1800s, (2) illustrate his lake evaporation formulae, which require several equations, tables, thresholds, and conditions based on physical factors and assumptions, and (3) assess his evaporation results over the continental U.S. and analyze the performance of his formula in a subarctic Canadian catchment by comparing it with five other calibrated (aerodynamic and mass transfer) evaporation formulae of varying complexity. We find that Horton's method, due to its unique variable vapor pressure deficit (VVPD) term, outperforms all other methods by ∼3 %–15 % of R2 consistently across timescales (days to months) and at an order of magnitude higher at subdaily scales (we assessed up to 30 min). Surprisingly, when his method uses input vapor pressure disaggregated from reanalysis data, it still outperforms other methods which use local measurements. This indicates that the vapor pressure deficit (VPD) term currently used in all other evaporation methods is not as good an independent control for lake evaporation as Horton's VVPD. Therefore, Horton's evaporation formula is held to be a major improvement in lake evaporation theory which, in part, may (A) supplant or improve existing evaporation formulae, including the aerodynamic part of the combination (Penman) method, (B) point to new directions in lake evaporation physics, as it leads to a “constant” and a nondimensional ratio (the former is due to Horton, John Dalton (1802), and Gustav Schübler (1831) and the latter to Jožef Štefan (1881) and Horton), and (C) offer better insights behind the physics of the evaporation paradox (i.e., globally, decreasing trends in pan evaporation are unanimously observed, while the opposite is expected due to global warming). Curiously, Horton's rare observations of convective vapor plumes from lakes may also help to explain the mythical origins of the Greek deity Venus and the dancing Nereids.

Background: The commercially available training phantoms being expensive, homemade models are popular surrogates for training. We intended to study how comparable our indigenously developed ultrasound phantom (IDUP) was with the commercially available model for ultrasound-guided vascular access (USGVA) training. We also assessed the change in confidence among trainees using a 21-h standardized program. Methods: A prospective randomized double-blinded, parallel design study, with sequential allocation, was done after a standardized point of care ultrasound training course. Over three consecutive courses, 48 trainees volunteered to take part in the study. The models (IDUP and commercial phantom) were allocated as model A and model B. In each course, participants were also allotted sequentially to either perform in-plane or out of plane approach first, at the testing stations. Wilcoxon signed-rank test was used to compare pretest with posttest scores. Results: There was a statistically significant difference between IDUP and commercial phantom with respect to the resemblance to human tissue on tactile feedback and ease to perform the procedure. However, both models did not show a statistically significant difference in terms of ease of use, visual resemblance to human tissue, needle visualization, and artifacts on ultrasonography display. A significant change in the confidence levels of participants was seen postcourse. Conclusion: IDUP was a comparable alternative to the commercial model for USGVA training in a resource-limited setting. A 21-h standardized training program improved the trainee's confidence in performing and teaching USGVA.

Background: Central venous catheter (CVC) placement is a frequently performed procedure in the emergency department (ED). We aim to compare two different ultrasound (US)-guided techniques, the short-axis (SAX) approach and the oblique axis (OAX) approach for the insertion of internal jugular vein (IJV) catheters in an ED setting. Methods: This prospective, observational study was conducted in the ED of a single tertiary care teaching hospital on patients requiring IJV cannulation. CVC placement was done using both the SAX and OAX approaches as per the ED physician's discretion. Outcome measures included acute complications, successful insertion of an IJV catheter, number of attempts, and access times. The Chi-square test was used to compare the study variables (acute complications, number of cannulation attempts, and successful cannulation) between the two approaches. Mann–Whitney U-test was applied to compare the mean differences of flash time and cannulation time. Results: Sixty patients were enrolled, of which 30 underwent IJV cannulation by the SAX technique and 30 by the OAX technique. We noted a total of 22 acute complications, 56.7% in the SAX group and 16.7% in the OAX group. A significant incidence of posterior venous wall puncture was noted in the SAX group (50.0%). No significant statistical differences were noted on analysis of other outcome measures. Conclusion: The OAX approach is a useful alternative technique to IJV cannulation in the ED setting. Further multicentric studies in this domain will be required to consider this technique as the primary approach to US-guided IJV cannulation in the ED setting.

Background: Disaster preparedness is one of the critical strategies for effectively managing disasters and has been an area of high focus in the healthcare sector over the past few decades. The current Indian medical undergraduate curriculum does not describe any novel methods for disaster preparedness training. There is a need for a better understanding of novel teaching-learning methods and modes for administering disaster preparedness training among Indian medical students. Objectives: Describe the undergraduate medical students' baseline knowledge and confidence level of disaster preparedness. Compare undergraduate medical students' knowledge scores and confidence levels on disaster preparedness after online and onsite delivery of the disaster preparedness module. Methods: In this educational interventional study, 103 medical students were divided into two groups and subjected to an online or onsite session of the validated disaster preparedness module (based on the COVID-19 pandemic), encompassing a simulation-based tabletop exercise. Baseline testing was done for 52 participants in the online group and 51 in the onsite group of the study. Post-intervention, they were assessed with single-response type MCQs for knowledge and Likert scale-based questions for confidence scores. The pretest and posttest scores were collected, and the data were analysed using two-tailed t-tests for paired analysis of within-group (online group or onsite group) and heteroscedastic analysis of between-group datasets. Results: One hundred and three participants completed the exercise—52 participants were from the online group, and 51 were from the onsite group. After the intervention, there was a statistically significant increase in knowledge and confidence in both online and onsite groups. There is, however, no significant difference in the 'percentage change' in 'knowledge' or 'confidence' between the groups. Conclusions: Our study indicates that the disaster preparedness module, delivered online and onsite, improves knowledge and confidence among undergraduate medical students. However, there is no superiority between one mode of delivery and the other. We conclude that online training can facilitate disaster preparedness training as a corollary to the prescribed traditional training methods for undergraduate medical students in India. [ABSTRACT FROM AUTHOR]

With the prevalence of Aerospace Technologies, the regulations of cybersecurity are becoming smarter, assured, and long-lasting. Modern communication network technologies have enormous growth in the cyber threats and masquerading attacks to steal data. Hence concepts and mechanisms are built and made into regulations for a safer environment. Unmanned aerial vehicles (UAVs), often known as drones, are becoming increasingly common, posing new problems in areas such as monitoring, agriculture, weather prediction, surveillance and other fields. This includes a large number of devices that, owing to a lack of energy or a system shutdown, might occasionally send incorrect signals and must be monitored autonomously by drones in remote regions. In this paper, we propose a energy intensive blockchain-based platform for controlling drone operations while ensuring trust and security for all parties involved. The goal of this paper is to explore the extent of Unmanned Aerial Vehicle (UAV) vulnerability to deceptive (Global Navigation Satellite System) GNSS signals by establishing the necessary conditions for UAV via GPS (Global Positioning System) spoofing. The existing algorithms used to mitigate spoofing attacks have unbounded long-term errors, which increase in time during its performance. An innovative idea is necessitating to eliminate those errors, thereby in the proposed work, Ethereum Blockchain has been implemented to create a blockchain network to mitigate the spoofing attacks. Blockchains are incredibly popular nowadays and is the basic technology for cryptocurrencies. Blockchain technology greatly impacts the applications in UAVs. The proposed methodology uses the network that has to be registered in the aerospace components through the ledger associated with relevant data communication in the Blockchain. When an intruder gets acquired with the data in the network with a single block, it cannot affect the entire network due to the data integrity in the ledgers that has been cryptographically assigned. The blockchain network intermittently verifies the geolocation data so that any outlying data would be detected and eliminated quickly. The data that has been verified is made available for the view of aviation and spacecraft operations through the distributed network. The proposed methodology outperforms the existing methods in intense drift error and, in the case of confidentiality and integrity, it has very low risk when compared to existing methods.