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Purpose: To study the ophthalmologic manifestations of systemic sclerosis (SSc) and its correlation with autoantibody profile. Methods: A cross-sectional study on 200 eyes of 100 consecutive adult patients diagnosed with SSc was performed at a tertiary care center in Northern India. The examination of ocular adnexa, anterior segment, and posterior segment with slit-lamp biomicroscopy, tear film break-up time (TBUT), Schirmer’s II test, and choroidal thickness measurement by swept-source ocular coherence tomography was done. Autoantibody profile was available for 85 patients, and its statistical association with the ocular examination findings was analyzed. Results: In total, 100 patients (93 females and 7 males) were included. The mean age was 45.11 ± 11.68 years, and the mean disease duration was 6.93 ± 3.68 years. Meibomian gland disease was more commonly found in patients with the diffuse subtype of SSc (P = 0.037). Choroidal thickness was increased in 34% and decreased in 7% (reference range = 307 ± 79 µm) patients. Reduced TBUT, meibomian gland dysfunction, and eyelid stiffness had a statistically significant association with the presence of anti-Scl-70 antibody (P = 0.003,

Background: Dermatoscopy is a noninvasive method of examining skin lesions under high magnification, gradually replacing the need for invasive biopsies. Training is required to gain clinical competency. Gamification employs game-like elements to enhance education engagement and is an engaging means of delivering medical education. We sought to use gamification and a mobile-based platform to deliver dermatoscopy education to physicians. Methods: We developed SKIN@GoPRIME, an interactive smartphone platform. Thirty physician participants were randomly assigned to watch an online dermatoscopy lecture or to use SKIN@GoPRIME. Twenty-eight participants completed prelearning and postlearning quizzes and provided feedback on SKIN@GoPRIME. Results: Users of SKIN@GoPRIME demonstrated a significant 1.71-point mean score improvement (P = .0018). The group that watched the online dermatoscopy lecture had a higher 2.36-point mean score improvement (P = .00021). Both family medicine and internal medicine physicians demonstrated a significant mean score increase of 1.29 (P = .049) and 2.14 (P = .023), respectively, after using SKIN@GoPRIME. Based on feedback, 83% believed that SKIN@GoPRIME can be used to acquire the applied competencies required for their job scope. Discussion and Conclusion: SKIN@GoPRIME, a novel learning tool via gamification effectively delivers dermatoscopy education, although it is not shown to be more effective than lectures. Larger studies are required to further validate the effectiveness of gamified learning techniques in dermatoscopy education. Future studies should involve the optimization of SKIN@GoPRIME to more effectively deliver dermatoscopy education.

Abstract Background Leucovorin (folinic acid) is a commonly used antidote for severe toxicity with low-dose methotrexate, but its optimum dose is unclear, varying from 15 to 25 mg every 6-h. Methods Open-label RCT included patients with severe low-dose (≤ 50 mg/week) methotrexate toxicity defined as WBC ≤ 2 × 10^9/L or platelet ≤ 50 × 10^9/L and randomized them to receive either usual (15 mg) or high-dose (25 mg) intravenous leucovorin given every 6-h. Primary outcome was mortality at 30-days and secondary outcomes were hematological recovery and mucositis recovery. Trial Registration number: CTRI/2019/09/021152. Results Thirty-eight patients were included, most with underlying RA who had inadvertently overdosed MTX (taken daily instead of weekly). At randomization, the median white blood and platelet count were 0.8 × 10^9/L and 23.5 × 10^9/L. 19 patients each were randomized to receive either usual or high-dose leucovorin. Number (%) of deaths over 30-days was 8 (42) and 9 (47) in usual and high-dose leucovorin groups (Odds ratio 1.2, 95% CI 0.3 to 4.5, p = 0.74). On Kaplan–Meier, there was no significant difference in survival between the groups (hazard ratio 1.1, 95% CI 0.4 to 2.9, p = 0.84). On multivariable cox-regression, serum albumin was the only predictor of survival (hazard ratio 0.3, 95% CI 0.1 to 0.9, p = 0.02). There was no significant difference in hematological or mucositis recovery between the two groups. Conclusion There was no significant difference in survival or time-to hematological recovery between the two doses of leucovorin. Severe low-dose methotrexate toxicity carried a significant mortality.

Introduction:Pediatric sudden sensorineural hearing loss (SSNHL) is a rare otological emergency. With the emergence of the Coronavirus 19 pandemic, alcohol-based hand sanitizers are among the essential household items. Many hand sanitizers are frequently coupled with scents that young children may find pleasant.Case Report:A 5-year-old girl presented to our clinic with hearing loss after the consumption of alcohol-based hand sanitizer. A pure tone audiogram showed bilateral SSNHL. The child was prescribed systemic corticosteroids resulted in a slight improvement in hearing thresholds. The child was followed up at 6 and 18 months showing no further improvement in hearing thresholds.Conclusion:Although various infective, vascular, and immune responses have been proposed, alcohol-based hand sanitizer consumption has not been reported to present with SSNHL to the best of our knowledge. In the current scenario of the Coronavirus pandemic, otorhinolaryngologists must keep in mind that SSNHL may occur as a result of hazardous alcohol-based hand disinfectant consumption.

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Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.

India is the world's third-largest carbon dioxide (CO2) emitter, with the transportation sector accounting for most of this emission. Using the logarithmic-mean Divisia index (LMDI) decomposition method and Tapio decoupling, this study examines the driving factors and their relationship with economic growth for the Indian transportation sector. Transportation-related energy consumption is decomposed into six factors. From 2001 to 2020, CO2 emissions from the Indian transportation sector increased from 155.9 Mt to 368.2 Mt. Roadways produce 88% of all CO2 emissions. Energy systems, economic advancement, and population scale increase CO2 emissions, whereas energy performance and transportation form decrease. Transport advancement demonstrates both tendencies intermittently. CO2 emissions from Indian transportation exhibit a weak decoupling. The increasing demand for vehicles, reliance on conventional fuel, and increase in energy consumption indicate a positive correlation with the increase in the nation's CO2 emissions, while the transition from coal to electric locomotives and the increased use of electric vehicles offset the increase in emissions. In short, the government should update strategic sustainable transport policy measures and emphasize renewable energy. This study will assist policymakers in formulating robust sustainable transportation policies.

Introduction: Osteochondromas are the most common benign bone tumors, common in long bones, and rare in the foot and ankle. They usually occur in skeletally immature bones and do not recur. Malignant transformation is rare but should be considered in such cases of recurrence and properly investigated. Case report: We hereby present a rare case of navicular bone exostosis which was first managed nonoperatively failing which excisional biopsy was done. But the lesion recurred after 1 year with compression and impingement of the extensor digitorum longus tendon with subsequent tendinosis. After the failure of conservative management, surgical intervention was done with exophytic lesion excision and naviculectomy. After this patient was symptomatically relieved. Discussion: This is the first case of recurrence of navicular bone osteochondroma. Arthrodesis was not done due to minimal or no joint erosion/arthrosis and left for final management in case symptoms recur after bone excision. Management of small bone osteochondroma is difficult and debatable since no clear guidelines have been suggested for it.

Masquelet technique is one of the modalities for the treatment of long bone defect. Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate. We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia. We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane. Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union. We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.

Thermo-hydraulic performance of a Double Pass Parallel Flow Solar Air Heater (DPPFSAH) roughened with perforated multi-V ribs has been studied experimentally in a prior study and the effect of variation in open area ratio and change in relative roughness width has been analysed and reported. The current work builds upon the aforementioned earlier study by discussing in detail the methodology and various steps involved in the development of a correlation for variable parameters with Nusselt number and friction factor for DPPFSAH. The outcomes show that perforations in the multi-V ribs lead to a considerable rise in the Nusselt number, a 9.66 times increase in the thermo-hydraulic performance parameter and nearly a four times increase in friction factor compared to multi-V ribs with smoothed walls. Empirical correlations for the Nusselt number and friction factor were obtained for the double pass parallel flow solar air heater with perforated multi-V ribs established with ±14% and ±7%.

SARS-CoV-2 spike protein is an essential component of numerous protein-based vaccines for COVID-19. The receptor-binding domain of this spike protein is a promising antigen with ease of expression in microbial hosts and scalability at comparatively low production costs. This study describes the production, purification, and characterization of RBD of SARS-CoV-2 protein, which is currently in clinical trials, from a commercialization perspective. The protein was expressed in Pichia pastoris in a large-scale bioreactor of 1200 L capacity. Protein capture and purification are conducted through mixed-mode chromatography followed by hydrophobic interaction chromatography. This two-step purification process produced RBD with an overall productivity of ~21 mg/L at >99% purity. The protein’s primary, secondary, and tertiary structures were also verified using LCMS-based peptide mapping, circular dichroism, and fluorescence spectroscopy, respectively. The glycoprotein was further characterized for quality attributes such as glycosylation, molecular weight, purity, di-sulfide bonding, etc. Through structural analysis, it was confirmed that the product maintained a consistent quality across different batches during the large-scale production process. The binding capacity of RBD of spike protein was also assessed using human angiotensin-converting enzyme 2 receptor. A low binding constant range of KD values, ranging between 3.63 × 10−8 to 6.67 × 10−8, demonstrated a high affinity for the ACE2 receptor, revealing this protein as a promising candidate to prevent the entry of COVID-19 virus.

Abstract In contrast to the conventional approach of directly comparing genomic sequences using sequence alignment tools, we propose a computational approach that performs comparisons between sequence generators. These sequence generators are learned via a data-driven approach that empirically computes the state machine generating the genomic sequence of interest. As the state machine based generator of the sequence is independent of the sequence length, it provides us with an efficient method to compute the statistical distance between large sets of genomic sequences. Moreover, our technique provides a fast and efficient method to cluster large datasets of genomic sequences, characterize their temporal and spatial evolution in a continuous manner, get insights into the locality sensitive information about the sequences without any need for alignment. Furthermore, we show that the technique can be used to detect local regions with mutation activity, which can then be applied to aid alignment techniques for the fast discovery of mutations. To demonstrate the efficacy of our technique on real genomic data, we cluster different strains of SARS-CoV-2 viral sequences, characterize their evolution and identify regions of the viral sequence with mutations.

Energy is a basic requirement for development in the world. The continuously rising demand for energy resources and the fast depletion of fossil fuel is raises researcher's concern to focus on alternative sources of energy that can replace the shortage of fossil fuels soon. Biodiesel is recognized as one of the potential alternative renewable energy fuels that can be easily available in a wide range in every part of the world. This paper reviews biodiesel's prospect and focuses on the different fuel properties (physicochemical) of 100 biodiesels from first-, second- and third-generation followed by the evaluation of CI engine characteristics. It has been observed that the fuel properties of first-, second- and third-generation biodiesel are compatible with the ASTM standards. The present paper discussed the potential of various generations of biodiesel feedstocks from production perspectives. This paper also examined many aspects of these feedstocks which include different biodiesel feedstock sources, biodiesel conversion technology, and second-generation biodiesel performance and emission characteristics. Most of the studies showed that biodiesel derived from plant feedstock is costly than diesel. Thus, more influence is to be given to non-edible sources. However, the engine characteristics are shown promising behavior with biodiesel and a slight increase in NOX is also reported on using various biodiesel.

Abstract Background In a response to the pandemic, urgent care centers (UCCs) have gained a critical role as a common location for COVID-19 testing. We sought to characterize the changes in testing accessibility at UCCs between March and August 2020 on the basis of testing availability (including rapid antigen testing), wait time for test results, cost of visits, and cost of tests. Methods Data were collected using a secret shopper methodology. Researchers contacted 250 UCCs in 10 states. Investigators used a standardized script to survey centers on their COVID-19 testing availability and policies. UCCs were initially contacted in March and re-called in August. T-tests and chi-square tests were conducted to identify differences between March and August data and differences by center classification. Results Our results indicate that both polymerase chain reaction (PCR) tests to detect COVID-19 genetic material and rapid antigen COVID-19 tests have increased in availability. However, wait times for PCR test results have significantly increased to an average of 5.79 days. Additionally, a high proportion of UCCs continue to charge for tests and visits and no significant decrease was found in the proportion of UCCs that charge for COVID-19 testing from March to August. Further, no state reported a majority of UCCs with rapid testing available, indicating an overall lack of rapid testing. Conclusions From March to August, COVID-19 testing availability gradually improved. However, many barriers lie in access to COVID-19 testing, including testing costs, visit costs, and overall lack of availability of rapid testing in the majority of UCCs. Despite the passage of the CARES Act, these results suggest that there is room for additional policy to improve accessibility to testing, specifically rapid testing.

BackgroundRemote monitoring through digital technology offers a promising solution for the diverse medical, psychological and social issues that plague patients with COVID-19 under home-isolation, but remain neglected due to a lack of streamlined medical services for these patients.MethodsThis prospective cohort study determined the feasibility of remote telemonitoring of healthcare workers with mild COVID-19 under home isolation during the Omicron (B1.1.529) wave and characterized their clinico-demographic profile. A holistic monitoring model comprising of mandatory phone calls at the beginning and end of isolation, assisted by home oximetry, predesigned google forms, and opt-in software-based (eSanjeevani OPD) teleconsultation was employed. Factors associated with development of symptomatic disease were also determined.ResultsOut of 100 COVID-19 positive healthcare workers under home-isolation, data for 94 participants was available [median age 27(20–52) years, 56(60%) females]. 93(99%) patients were previously vaccinated for COVID-19 (median time from last dose = 248 days); 34(36%) had a past history of COVID-19. Fever (67%), myalgia (69%), sore throat/dry cough (70%), and running nose (45%) were the most common symptoms. No patient progressed to moderate-severe disease or required care escalation during the remote monitoring period. Most participants reported several additional psychosocial concerns which were adequately addressed. Symptomatic patients had higher BMI (24.1 vs. 21.8kg/m2, p = 0.01) compared to asymptomatic patients. Age, past infection with COVID-19, and time since last vaccine dose were not different between symptomatic and asymptomatic patients.ConclusionCOVID-19 patients under home isolation have multi-faceted medical and psychosocial issues which can be holistically managed remotely through digital technology.

Introduction: Synovial sarcoma is a rare tumor, and the spine is its infrequent site of occurrence. Past studies which depict challenges during surgery and survival in patients treated with synovial sarcoma of the spinal region are limited. Case report: We present a 13-year-old male, with a lump over the posterior aspect of the neck on the right side. MRI & USG guided biopsy revealed synovial sarcoma affecting paraspinal muscles of the right side with bony erosions over the spinous process of cervical vertebrae. PET scan results confirmed paraspinal muscles as the primary site of the tumor with no evidence of distant metastasis. The patient underwent marginal excision followed by radiotherapy. The patient was regularly followed up for 2.5 years. Discussion: Wide excision of synovial sarcoma affecting the spine is a challenging task with the risk of tumor spillage, especially with cystic components. We used low-strength cautery and gentle dissection to avoid rupture of the cyst wall. The patient is disease-free during his 2.5 years of follow-up. However, we are awaiting a long-term follow-up to assure whether the patient remains disease-free or not.

Introduction: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue neoplasm having a high risk of recurrence and metastasis. Data regarding treatment & survivorship of EMC involving foot is limited. Case report: 46-year-old male, presented to our clinic with painful swelling over the plantar aspect of his left foot. T2-weighted MRI revealed a hyperintense lesion measuring 8.3 ​× ​3.1 ​× ​2.7 cm. Histopathological reports were consistent with the diagnosis of EMC. Definitive surgery of wide excision of the tumor was performed. There was no evidence of local recurrence or metastasis in 7 months of follow-up. Discussion: EMC is an important differential diagnosis of masses arising from the plantar aspect of the foot. Intraoperative use of ultrasonography could be a useful aid in surgeries of soft tissue sarcoma. A plastic surgeon's opinion before excising large tumors of the plantar aspect of the foot would decrease wound-related complications. EMC's wide excision seems to be a better alternative over amputation; however; we are currently awaiting long-term results.

Nowadays, microgrids with hybrid renewable energy sources are increasing, and it is a promising solution to electrify remote areas where distribution network expansion is not feasible or economical. This study aims to find an ideal hybrid system grounded on solar, wind, diesel, biomass, hydro, and battery. This study utilizes the hybrid optimization model for electric renewable (HOMER) software to size the important components, perform technical, financial evaluation, renewable factor, estimate the harmful emissions, and sensitivity analysis. For optimum system selection, the lowest cost of energy is used as the criteria. Four different configurations of renewable energy sources are analyzed and found PV-WT-MH-CT-BT-DG-BG is the most feasible hybrid system amongst all configurations. The proposed PV-WT-MH-CT-BT-DG-BG hybrid system is more economic as the lowest cost of energy 0.196$, low operating cost 36,184$, low net present cost 831,217$. Also, this hybrid system is more environmentally friendly as it has less emission and a high renewable factor of 81.2%.

Abstract Background Ovarian toxicity is a dreaded complication of cyclophosphamide (CYC). With the use of lower cumulative doses of intravenous CYC (modified NIH regimens) and availability of better markers of ovarian toxicity, the incidence of ovarian dysfunction needs reassessment. Lupus disease activity, by itself, is also believed to affect ovarian function negatively. Methods This single-centre prospective cohort study recruited 50 female patients of severe lupus aged 18–40 years. Twenty-five patients each received induction with either monthly intravenous CYC (0.5–0.75 g/m2) for 6–9 months or daily oral mycophenolate mofetil (MMF). Details of menstrual irregularities; serum levels of FSH, LH, estradiol, AMH, and inhibin B; and sonographic assessment of ovarian volume and antral follicular count were done at baseline and 6 months after treatment. Amenorrhoeic patients were re-evaluated at 1 year. Results Mean (SD) age of subjects in the CYC and MMF groups was 31.4 (6.3) and 28.4 (4.4) years, respectively. Mean (SD) SLEDAI at the initiation of therapy was 7.2 (2.5) in the CYC group and 5.8 (3.4) in the MMF group. The mean cumulative dose of CYC used was 4.6 (1.8) g. Three patients in the CYC group (versus none in MMF) had amenorrhoea at 6 months—two of these regained menses within 6 months, while only one (4%) developed sustained amenorrhoea (lasting more than 12 months) at 41 years of age, likely menopause. Serum FSH levels increased (p = 0.03), while AMH (p = 0.002) and inhibin B (p

The present work deals with the optimization of the process parameters of in situ transesterification of dry spirogyra Algae–Jatropha powder along with engine efficiency and combustion analysis of the prepared biofuel. Three operational parameters, namely catalyst concentration (0–5 wt.%), methanol to dry algae–Jatropha curcas powder (v/v) (20–60%), and reaction time (60–180 min) at a constant reaction temperature of 50 °C, were selected. Response surface methodology (RSM) was used to design the experiments. The maximum biodiesel yield of 88.5% was obtained under the optimized conditions of a catalyst concentration of 3.396% (w/w), methanol/oil ratio of 19.86, and reaction time of 180 min. At varying loads, the performance and emissions of a diesel engine linked to a power source and fueled with various biodiesel mixes (Diesel, B5, B10, and B20) were tested. It was found that BSFC decreased as the applied load increased for all of the evaluated fuels. All of the biodiesel blends had greater BSFC than the diesel fuel. However, a substantial decrease in the emissions, including hydrocarbon (HC) and carbon monoxide (CO), was observed with the increase in NOx emissions. This method of preparing biodiesel will be beneficial in order to cater to the needs of the transportation sector because it has a lower energy consumption and less engine emissions.

In this work, we have demonstrated the refractive index (RI) based sensing of Escherichia Coli (E-Coli) by introducing a novel plus shaped cavity in optical fiber. This plus-shaped cavity increases the interaction between the signal and the analytes, that improves the sensitivity. The proposed sensor model is achieved by combining the lateral and vertical slots in optical fiber core structure. The sensing ability of the plus shaped cavity has been examined in visible range, where the RI of E-Coli ranges from 1.38 to 1.395. The numerical investigation of sensor structure has been done by employing the finite difference time domain (FDTD) method. The geometrical analysis of plus shaped cavity indicates that; the maximum output power is achieved at the slot width of 600 nm. The proposed cavity is capable of sensing the presence of E-Coli with the autocorrelation function and sensitivity of 99.54 % and 2125 nm/RIU, respectively.

The traveling salesman problem is a well-known NP-hard problem in combinatorial optimization. This paper shows how to solve it on an Ising Hamiltonian based quantum annealer by casting it as a quadratic unconstrained binary optimization (QUBO) problem. Results of practical experiments are also presented using D-Wave’s 5,000 qubit Advantage 1.1 quantum annealer and the performance is compared to a classical solver. It is found the quantum annealer can only handle a problem size of 8 or less nodes and its performance is subpar compared to the classical solver both in terms of time and accuracy.

The present study describes the single-step transesterification method of biodiesel production from high free fatty acid (FFA) waste cooking oil blended with algae oil using a homogeneous base catalyst. Due to high FFA contents, two step transesterification is needed to convert oil into biodiesel and therefore the high FFA content of waste cooking oil is decreased by blending it with low FFA content algae oil, which would further lead only to single step transesterification of low FFA oil. The design and optimization studies were conducted using Response Surface Methodology (RSM). The box-Behnken design technique is applied to optimize the three process parameters, i.e., catalyst concentration (0–2 wt%), methanol concentration (v/v) (20–60%) and reaction time (60–180 min) at a uniform reaction temperature of 50 °C. The result of the current study indicates that an effective biodiesel yield of 92% can be obtained at the optimized condition of catalyst concentration of 1.5% (w/w), methanol/oil ratio of 21:1 and reaction time of 110 min at a constant reaction temperature of 50 °C. This analysis clearly shows that this study can resolve the storage problem of high FFA oils from different feedstock and RSM can be successfully used to model the reaction to maximize the biodiesel yield.

Due to rising population growth and economic development, there is indeed a growing demand for electricity. Both in aspects of generation and transmission, conventional power firms are striving to manage these demands. Moreover, the ubiquitous utilization of electricity and other power generators, which are mainly driven from fossil fuels, seems to have some limitations, like declining performance and restricted energy production. As a result, use of renewable energy sources is incredibly important. Decentralized power generation in remote regions has become the primary requirement of society, based on renewable energy. Particularly in comparison with the electrification of urban areas, rural electrification is quite expensive. Microgrid’s development utilizing hybrid power is a potential solution for the electrification of rural regions where the transmission chain of network’s extension is unfeasible or inefficient. This research aims to structure a power generation model associated with different HRES combinations using a HOMER software application at a location in India. In the findings of this research, it has been observed that NPC, O&M, COEs, and RF of on-grid energy systems are better than off-grid energy systems. In the study, between eight hybrid system combinations, the lowest COE of 0.034 $/kWh is obtained with the PV-WT-MH-GRID-CT system in the on-grid scenario. This analysis shows NPC, COE, O&M, and renewable fraction are sensitive to the variation in all the considered sensitivity parameters1,2,3,4.

Recent advancements in green building technologies (GBTs) have grown substantially, as an outcome of the environmental, economic and societal benefits. It has the potential to move toward sustainable development, specifically related to climate change. In GBTs, the main objective is to use energy, water and other resources in a balanced way, without using them extensively. This will improve the environmental conditions. Green buildings (GBs) are beneficial when it comes to energy consumption and emissions; low maintenance and operation costs; boosting health and productivity; etc. There is a lack of a critical review of the past or present research work in the area of the Green Building Technology (GBT) sector to identify the future roadmap for sustainable green building technologies. A critical review, with the help of proper research methodology, was identified. The scope of this study is to analyze the existing work on different issues, and find different key issues in green building research, which has minimal use of natural resources, is cost-effective and is designed and constructed for a longer duration, considering future prospects. This paper examines the state of green building construction today and makes recommendations for further study and development which will be necessary for a sustainable future. In order to encourage research, this study also identified a few possible future research directions in sustainable development.

Current approach for the detection of cancer is based on identifying genetic mutations typical to tumor cells. This approach is effective only when cancer has already emerged, however, it might be in a stage too advanced for effective treatment. Cancer is caused by the continuous accumulation of mutations; is it possible to measure the time-dependent information of mutation accumulation and predict the emergence of cancer? We hypothesize that the mutation history derived from the tandem repeat regions in blood-derived DNA carries information about the accumulation of the cancer driver mutations in other tissues. To validate our hypothesis, we computed the mutation histories from the tandem repeat regions in blood-derived exomic DNA of 3874 TCGA patients with different cancer types and found a statistically significant signal with specificity ranging from 66% to 93% differentiating Glioblastoma patients from other cancer patients. Our approach and findings offer a new direction for future cancer prediction and early cancer detection based on information derived from blood-derived DNA.

While rapid and accessible diagnosis is paramount to monitoring and reducing the spread of disease, COVID-19 testing capabilities across the U.S. remain constrained. For many individuals, urgent care centers (UCCs) may offer the most accessible avenue to be tested. Through a phone survey, we describe the COVID-19 testing capabilities at UCCs and provide a snapshot highlighting the limited COVID-19 testing capabilities at UCCs in states with the greatest disease burden.

Background: Coaching institutes attract students aspiring for admission to professional courses and jobs. Physical stress during coaching includes poor study posture and sitting on chairs improperly in overcrowded classes for prolonged periods. Many students attending the coaching institutes report to outpatient clinics of multiple specialties with musculoskeletal disorders (MSD). Materials and Methods: We carried out a cross-sectional study of 500 coaching students. We ascertained the 12-month MSD (period prevalence) and last 7-day MSD (point prevalence) using the Nordic Musculoskeletal Questionnaire. The duration of attending classes, hours of daily study, and duration of sitting continuously at a stretch were also enquired. Results: A total of 488 responses were retrieved. Males and females accounted for 63.9% and 36.1%, respectively. The respondents' mean age was 18.6 ± 1.06 years; mean body mass index was 21.4; mean duration of attending classes was 15.6 ± 7.66 months; mean hours of daily study were 4.78 ± 1.71 hours; mean duration of sitting continuously at a stretch was 2.2 hours. The overall prevalence of MSD was 87.1%. The mean frequency of MSD per participant was 2.6. Most participants reported pain in the neck region and lower back (43%), followed by ankle/foot (36%), followed by upper back (32%), followed by shoulder (28%); knee, elbow, and wrist/hand were lesser than 20%, while hip/thigh pain was the least common symptom (8%). Conclusion: This study serves to sensitize the medical community to this largely under-reported problem in young individuals who are in the phase of life preparing for their future career while inadvertently risking their long-term health in the process.

In prospective study from November 2011- November 2013, we performed 44 laparoscopic nephrectomies for benign non-functioning kidney diseases. Twenty eight patients underwent laparoscopic transperitoneal nephrectomies (63.6%), ten were laparoscopic assisted (22.7%) and six (13.6%) were converted to open. Patient's age, gender, laterality and etiology of renal failure were noted. Outcomes were measured as operative time, intraoperative and post operative complications, blood loss, pain score and hospital stay. Patients were followed up at one, three and 12 weeks and 6 monthly thereafter. Of the 44, ten (22.7%) were 15-24 years old, 32 (72%) between 25-50 years and two were more than 50 years old. Females were 54.6%. 22 patients had either right or left nephrectomy. Pelviureteric-junction (PUJ) obstruction was the commonest cause, 26 cases (59.0%). Operative time: less than two hours in 30 (68.2%) patients, more than two hours in 14 cases. Blood loss: less than 100 ml in 12 (27.3%), 100-200 ml in 20 (45.4%) and more than 200 ml in 12 (27.3%) patients. All four major complications were converted to open, two had injury to mesocolic veins and two had vascular stapler malfunction. Post-operative complications: surgical site infection (SSI), paralytic ileus and mild grade fever in six cases each and non infected benign intra abdominal collection in two cases. Maximum pain score on POD-1: four in 20 cases (45.7%), two in 24 (54%). Two had pain score between 3-4 three weeks after surgery. Oral intake started by POD-2 in 30 (68.2%) and by POD-4 in 100% cases. 22 (50%) patients were ambulating by POD-2, 16 (36.7%) by POD-4. Our study and randomized and non-randomized published literature report acceptables complication and conversion rates. In conclusion, laparoscopic nephrectomy for benign non functional kidney is a better alternative to open nephrectomy

Isolated radial head fractures are rare and comprise about 2% of all fractures around the elbow. Bilateral radial head fractures are even rarer and few cases have been reported. We present a case of bilateral elbow effusion in a 28-year-old male patient. An initial diagnosis of inflammatory arthritis was made but on investigation it turned out to be a case of bilateral radial head fracture. The patient was managed conservatively with 10 days of immobilisation in above elbow slab followed by active elbow range of movement exercises. On follow-up at 6 months, the patient had near normal range of movements without pain or elbow instability.

India is a nation with a diverse economy that requires tremendous resources to completely meet the desires of its compatriots in various sectors. In terms of energy resources and requirements, coal-based power plants can fulfill the bulk of these electricity needs. India is very reliant on coal, which is used in power plants as a primary energy source. However, the usage of coal energy at a higher level continuously pollutes the atmosphere. The Indian power market alone accounts for half of the country’s CO2 emissions, which implies that significant action is needed to contain environmental pollution. Carbon Capture and Storage (CCS) is a bridging technique and feasible alternative for the carbon fired plant processing of CO2. However, the application of CCS in coal-fired power stations is still uncommon in the nation. At the UNFCCC Paris Summit, India committed to reduce its carbon emission intensity by approximately 30–33% by 2030. In this work, several CCS systems, possible CO2 origins, and emission levels in India are discussed. Various advanced methods for CO2 capture and separation are also highlighted. Furthermore, the current work discusses CCS situations and the applications of CCS in India along with its manifold challenges.

Introduction: Asthma and Chronic Obstructive Pulmonary Disease (COPD) patients constitute a major portion of the inflow of a medical Out Patient Department (OPD). Incorrect use of Metered Dose Inhalers (MDI) is a significant barrier in improving the quality of medical care given to most patients with chronic respiratory diseases. Aim: This study was carried out to analyse the issues pertinent to incorrect MDI use and to assess the impact of a quality improvement initiative involving practical demonstration of correct technique using a standardized checklist. Materials and Methods: This was an interventional pre and post-test study conducted in medical OPD among COPD or asthma patients already on MDI. A baseline assessment of correctness of MDI use technique was done based on ADMITGINA guidelines, following which a practical demonstration of correct technique was done. These patients were followed up after one month and their technique was reassessed. The mean score was calculated for each patient pre and post intervention based on the correctness of steps and was compared using paired t-test. Results: Total 56 out of 102 patients completed the study. The mean score of MDI technique knowledge was 3.5±1.5, which increased to 6.7±1.2 after intervention (p

Purple-appearing urinary catheter and urosac can be alarming to the patient's attenders and doctors. It may be misinterpreted and overinvestigated if the underlying causes and mechanisms of this phenomenon are not understood. Urinary tract infection with sulfatase- and phosphatase-producing bacteria is implicated in the pathogenesis. We hereby report the appearance of purple color of urinary bag and catheter in an elderly female patient with dementia and chronic paraplegia on long-term Foley's catheterization.

Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech.

Histoplasmosis is caused by a dimorphic fungus Histoplasma capsulatum in endemic areas, mainly America, Africa, and Asia. In India, it is being reported from most states; however, it is endemic along the Ganges belt. We report a case of an apparently immunocompetent male who presented with 3-month history of fever, cough, and weight loss with recent onset odynophagia and had hepatosplenomegaly and mucocutaneous lesions over the face. The differential diagnosis of leishmaniasis, tuberculosis, leprosy, fungal infection, lymphoproliferative malignancy, and other granulomatous disorders was considered, but he succumbed to his illness. Antemortem skin biopsy and bone marrow aspiration along with postmortem liver, lung, and spleen biopsy showed disseminated histoplasmosis. This case highlights the need for an early suspicion of progressive disseminated histoplasmosis in the presence of classical mucocutaneous lesions even in an immunocompetent patient suffering from a febrile illness. Cure rate approaches almost 100% with early treatment, whereas it is universally fatal if left untreated.

The performance of Watson & Ahumada's model of human visual motion sensing is compared against human psychophysical performance. The stimulus consists of random dots undergoing rotary motion, displayed in a circular annulus. The model matches psychophysical observer performance with respect to most parameters. It is able to replicate some key psychophysical findings such as invariance of observer performance to dot density in the display, and decrease of observer performance with frame duration of the display.Associated with the concept of rotary motion is the notion of a center about which rotation occurs. One might think that for accurate estimation of rotary motion in the display, this center must be accurately known. A simple vector analysis reveals that this need not be the case. Numerical simulations confirm this result, and may explain the position invariance of MST(d) cells. Position invariance is the experimental finding that rotary motion sensitive cells are insensitive to where in their receptive field rotation occurs.When all the dots in the display are randomly drawn from a uniform distribution, illusory rotary motion is perceived. This case was investigated by Rose & Blake previously, who termed the illusory rotary motion the omega effect. Two important experimental findings are reported concerning this effect. First, although the display of random dots evokes perception of rotary motion, the direction of motion perceived does not depend on what dot pattern is shown. Second, the time interval between spontaneous flips in perceived direction is lognormally distributed (mode approximately 2 s). These findings suggest the omega effect fits in the category of a typical bistable illusion, and therefore the processes that give rise to this illusion may be the same processes that underlie much of other bistable phenomenon.