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Purpose To study the outcomes and complications of Nd: YAG laser capsulotomy in patients with uveitis. Methods This study retrospectively evaluated outcomes of Nd: YAG laser capsulotomy in 260 eyes of 260 patients with uveitis. The main indications for performing capsulotomy were a visually significant posterior capsule opacification (PCO) and inability to visualize the posterior segment. The presence of 5 or

Background Surgical clipping has been a gold standard procedure for management of intracranial aneurysms. Outcome studies of surgical clipping at institutional level are important to identify modifiable factors and further improve the results. These are even more important in areas where resources are limited, and patient presents late due to ignorance and lack of education. This study is a review of our institutional experience in microsurgical clipping of ruptured intracranial aneurysms.

Introduction. Posterior fossa tumours (PFTs) frequently present with ophthalmic complaints. The literature is mainly focused on PFTs affecting the pediatric age group, and the post-treatment visual outcomes (VOs) are scarcely reported. Objective. To evaluate the VOs at 6 months following the index surgery in patients with PFTs. Materials and methods. This retrospective study involved 50 patients of all age groups who underwent surgical resection of PFTs in the Department of Neurosurgery. The patients with PFTs, except those with low-grade tumours, received concurrent chemo-radiotherapy. Pre- and postoperative (6 months after the index surgery) ophthalmic examinations were done and compared. VOs included colour vision, night vision, visual acuity (VA), pupillary function (size, reactivity), papilledema grade, splinter haemorrhage, retinal venous dilatation, strabismus (esotropia and hypertropia), and nystagmus. Results. The patients were mainly aged 1–10 years (22%) with slight female predominance (52%). The most common PFTs were brainstem glioma and pilocytic astrocytoma (each 18%). At 6 months, there was no significant change in colour and night vision, pupil size and reactivity, splinter haemorrhage, and hypertropia (all p-values>0.05). A significantly lesser proportion of patients had moderate VA (p-value=0.013), retinal venous dilatation (p-value=0.001), and grade 1 (p-value=0.005) as well as grade 4 papilledema (p-value=0.041). Moreover, a significantly greater proportion of patients had grade 0 papilledema (p-value

This study assesses the impact of mergers and acquisitions on Environmental, Social, and Governance (ESG) performance and market value of acquiring companies operating in India. Data were collected and analyzed from 69 M&A announcements from January 2010 to June 2023, sourced from the Bloomberg database. The analysis reveals a positive correlation between the post-merger market value of acquiring firms and their ESG performance, indicating that an improvement in ESG factors is associated with increased market value after mergers. Additionally, a positive correlation was identified between acquiring companies’ post-merger ESG performance and their target firms’ pre-merger ESG performance. This finding suggests that when acquiring a target firm with high ESG performance, the acquirer is likely to experience an improvement in its own post-merger ESG performance. Moreover, both the post-merger market value and ESG performance of the acquirer are likely to improve with the profitability and size of firms but will have a negative impact based on the leverage components of the acquiring firms.

The self-drive rental sector has witnessed exponential growth in recent years due to rising demand for long and short-distance drives among millennials. This study aims to investigate the quality of services in the self-driving rental sector and its impact on customer adoption or rejection of service in India. The conceptual framework was developed using the SERVQUAL model and other important factors affecting consumers’ service adoption. A quantitative research method was deployed, and data were gathered through a survey method using a structured questionnaire (based on a 5-point Likert scale). The sample size comprised 385 respondents, 23-38 years old millennials (with 69% of males and 31% of females). The population sample was chosen from Delhi, Mumbai, and Bangalore, India. The data were collected in March 2023. The factor and regression analyses were applied along with chi-square and SEM analyses to test the research hypotheses. The results indicated that the absence of low prices (42%), customer assistance (28 %), and security issues is responsible for consumer rejection. The factors leading to dissatisfaction are the absence of consumer schemes and discounts, a lack of staff interaction and assistance, and poor service quality. The brands must focus on the negative impact arising from the absence of these factors and effectively address the areas of improvement to regain customer trust and garner customer loyalty.

This study investigates the sustained engagement of Generation Z with fitness apps using the Theory of Consumption Values (TCV) to identify the key determinants influencing this behaviour. The research examines the relationship between continued app usage and various constructs, including physical, emotional, epistemic, social, and conditional values. A particular focus is placed on health-conscious tendencies as a potential influencing factor. Data were collected from 412 Generation Z individuals in Pune through purposive sampling and analysed using Smart PLS. The findings reveal significant associations between continued app usage and constructs related to physical appearance, enjoyment, learning, social interactions, and usage conditions. However, factors related to general health and affiliation were found to be non-significant. Contrary to intuitive expectations, health consciousness did not emerge as a moderating factor. This comprehensive analysis offers nuanced insights into the motivational factors driving Generation Z’s commitment to fitness apps. The study highlights the importance of physical, emotional, epistemic, social, and conditional values in sustaining app engagement, while noting the limited role of health consciousness. These findings provide valuable implications for app developers and marketers targeting this demographic, suggesting a focus on enhancing enjoyment, learning, social interaction, and usage conditions to foster continuous engagement. This study contributes to the existing literature by providing a comprehensive analysis of the factors driving sustained engagement with fitness apps among Generation Z, a demographic that has been relatively underexplored in this context, especially in India.

This research developed a theoretical framework based on the uses and gratification theory to investigate the intention to continue usage of Health and Fitness Apps (HFAs). In addition, this study explored how health valuation moderates the relationship between determinants and users’ intention to continue usage. A total of 447 HFA users’ data was collected from Delhi NCR, India through a purposive sampling technique. Partial least square-structure equation modeling was used to test the role of potential predictors influencing users’ behavioral intention to continue. The machine learning algorithms were employed to identify the features of importance. The results revealed that system quality, networkability, recordability, and task technology fit have a positive influence on hedonic motivation and utilitarian motivation. While information quality influences hedonic motivation but does not affect utilitarian motivation. Health valuation positively moderates the relationship between information quality, system quality, and networkability to intention to continue usage. We also observed that hedonic motivation emerged as a key predictor of users’ intention to continue usage of HFAs. The results would possibly offer useful recommendations for HFA developers, marketers, and health policymakers. The quality of fitness apps should be the primary concern of app developers. Furthermore, gamification can be incorporated into HFAs as it may influence the users’ hedonic motivations. The research contributes by developing a uses and gratification theory tailored for the HFAs. Additionally, this research incorporates hedonic and utilitarian motivation as mediating variables and health valuation as a moderator.

There is a growing need for small and medium-sized businesses (SMEs) to employ Integrated Marketing Communication (IMC) components to develop a robust brand-focused communications strategy given the present uncertain market circumstances and the consequent market volatility. For SMEs, the IMC pillars are crucial for building a robust strategic presence, which in turn improves company success. A descriptive cross-sectional study was employed to establish the link between IMC components and business performance. Data from 845 SME managers or owners were collected from India and were analyzed using PLS-SEM. The results show a strong correlation between the five dimensions of IMC performance and enhanced company performance. The results of the moderation analysis also show that Market Orientation has little effect on the connection between IMC features and Business Performance. In this article, we’ll look at how SMEs can improve their company performance plans by incorporating market orientation and integrated marketing communication (IMC). SMEs, especially those in the service industry, would benefit greatly from this study’s findings regarding the need to use this managerial approach to boost SME performance.

AbstractIn the past few years there has been a remarkable surge in demand for robot service restaurants. However, as both the technology and the concept of such restaurants are relatively new, there is a limited understanding of how consumers would react to this new change in the service industry. This study focuses on the key factors influencing customer satisfaction and their intention to repeat the experience by using two staged hybrid PLS-SEM and Machine Learning approaches. The finding confirms that perceived enjoyment, speed, and novelty influence customer satisfaction, whereas perceived usefulness has no influence. Additionally, the study uncovers that customer satisfaction and trust positively mediate the relationship and establish the link with repeat experience. The machine learning models (Artificial Neural Network, Support Vector Machines, Random Forest, K-Nearest Neighbors, Elastic Net) predict the intention to repeat the experience of the service robot with an overall model fit of around 57%. We also discussed several new and useful theoretical and practical implications for enhancing the customer experience during the visit to the restaurants.

This paper aims to study the major pollutants of the four metro cities of India before and after covid 19 first wave. The cities considered for the study are Bangalore, Delhi, Mumbai, and Kolkata. The major pollutants considered for the study are PM2.5, PM10, NO, NO2, NOx, SO2, CO, and Ozone. The basic aim of the study is to find the effect of lockdown and covid restrictions on the level of pollutants across the four major cities of India. We used both parametric and non-parametric tests for the analysis using SPSS. From the study, it is clear that there is a significant decrease in all the major pollutants across India's major cities.

This research assesses the prediction of Bitcoin prices using the autoregressive integrated moving average (ARIMA) and long-short-term memory (LSTM) models. We forecast the price of Bitcoin for the following day using the static forecast method, with and without reestimating the forecast model at each step. We take two different training and test samples into consideration for the cross-validation of forecast findings. In the first training sample, ARIMA outperforms LSTM, but in the second training sample, LSTM exceeds ARIMA. Additionally, in the two test-sample forecast periods, LSTM with model re-estimation at each step surpasses ARIMA. Comparing LSTM to ARIMA, the forecasts were much closer to the actual historical prices. As opposed to ARIMA, which could only track the trend of Bitcoin prices, the LSTM model was able to predict both the direction and the value during the specified time period. This research exhibits LSTM's persistent capacity for fluctuating Bitcoin price prediction despite the sophistication of ARIMA.

During and following the COVID-19 pandemic, the world has witnessed a surge in high-flow oxygen therapy (HFOT) use. The ability to provide high oxygenation levels with remarkable comfort levels has been the grounds for the same. Despite the advantages, delay in intubation leading to poor overall outcomes has been noticed in subgroup of patients on HFOT. ROX index has been proposed to be a useful indicator to predict HFOT success. In this study, we have examined the utility of the ROX index prospectively in cases of acute hypoxemic respiratory failure (AHRF) due to infective etiologies. Seventy participants were screened, and 55 were recruited for the study. The majority of participants were males (56.4%), with diabetes mellitus being the most common comorbidity (29.1%). The mean age of the study subjects was 46.27±15.6 years. COVID-19 (70.9%) was the most common etiology for AHRF, followed by scrub typhus (21.8%). Nineteen (34.5%) experienced HFOT failure and 9 (16.4%) subjects died during the study period. Demographic characteristics did not differ between either of the two groups (HFOT success versus failure and survived group versus expired group). ROX index was significantly different between the HFOT success versus failure group at baseline, 2, 4, 6, 12 and 24 h. The best cut-off of ROX index at baseline and 2 h were 4.4 (sensitivity 91.7%, specificity 86.7%) and 4.3 (sensitivity 94.4% and specificity 86.7%), respectively. ROX index was found to be an efficient tool in predicting HFOT failure in cases with AHRF with infective etiology.

Introduction: Prosthetic valve thrombosis (PVT) is a serious complication seen with mechanical prosthetic cardiac valves and is associated with high mortality. Emergency surgery (thrombectomy or valve replacement) had been the traditional treatment, but now with intravenous thrombolytic therapy as an alternative to emergency surgery in patients with PVT has shown excellent success rate and acceptable risk. This study is aimed to determine efficacy and safety of use of thrombolytic agents (tPA or STK) in patients with PVT. Materials and Methods: This was a retrospective, single-center study of patients with PVT admitted between 2004 and 2020 at a tertiary care center in North India. The diagnosis of PVT was based on a history of prosthetic heart valve replacement, clinical presentation, and by diagnostic methods. All patients received either tenecteplase or streptokinase given as a bolus dose of 2.5 lac units over ½ h, followed by 1 lac units/h for 24–48 h depending on clinical response and complication, whereas tenecteplase (1 mg/kg of body weight) was given as bolus. Results: Of 72 patients, 45 patients received t-PA as a thrombolytic drug. Complete success was obtained in 39 patients (86.66%), whereas partial success in 3 (17.77%) and failure in 3 (6.66%). Among the patients who received streptokinase (n = 27), complete success was found in 23 patients (85.19%), whereas partial success was seen in 3 (11.11%) and failure was seen in 1 patient (3.7%). Conclusion: Thrombolysis is a reasonable option in patients with PVT. Our study has reiterated that major factors for PVT are warfarin poor compliance and subtherapeutic international normalized ratio. Postclosure clinical follow-up along with patient education should be followed in patients with mechanical prosthetic valve.

PURPOSEThe incidence of symptomatic brain metastasis at diagnosis in non–small-cell lung cancer (NSCLC) is 5%-10%, and up to 40% develop during the disease course. There is a paucity of data supporting the role of brain imaging at diagnosis in asymptomatic cases particularly from resource-constraint settings. Here, we present our experience of mandatory baseline brain imaging with contrast-enhanced computed tomography (CECT) scans of all patients with NSCLC.MATERIALS AND METHODSThis was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage.RESULTSA total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly.CONCLUSIONIn our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.

Coronavirus associated with Severe Acute Respiratory Syndrome (SARS) has been identified as Coronavirus Disease-2019 (COVID-19) Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), first detected in Wuhan, Hubei province, China, the National Health Commission of China received reports of 27 cases of pneumonia, including seven severe cases of unknown origin, on 30th December 2019. In order to diagnose COVID-19, the virus responsible for the pandemic, SARS-CoV-2, was analysed for its Ribonucleic Acid (RNA). It is possible to detect specific sequences of genes encoding the RNA dependent RNA polymerase (RdRP), nucleocapsid (N), envelope (E), and spike (S) proteins of viruses using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). There are four major groups of drugs recommended by treatment guidelines worldwide: antiviral drugs (eight drugs), antimalarial drugs (two drugs), systemic corticosteroids (five drugs), and immune-based therapy (seven drugs). The recommendations for the treatment with these drugs in all of the guidelines differ depending on the severity of the case and the health conditions of the patient. A successful preventative vaccine is the most important and time-sensitive measure in combating the COVID-19 pandemic. There were 12 SARS-CoV-2 vaccines approved/authorised for full or emergency use in various parts of the world as of 25th February 2021, with more than 200 million doses administered worldwide. Because the disease is still relatively new and healthcare is under considerable pressure, many questions remain unanswered. There is a lack of publications regarding the effectiveness and safety of these drugs in COVID-19 patients. In addition, community members with limited financial resources must still consider the costs associated with some of the proposed treatment regimens.

Abstract Background No data exist for the long-term outcome of metastatic colorectal cancer (mCRC) from the Southern part of Asia. The primary objective of the study is to evaluate the survival outcome of mCRC from an Indian tertiary care center. The study also aims to highlight the treatment pattern practiced and the unique clinico-pathologic characteristics. Methods This is a single-center retrospective observational study done at a large referral tertiary care center in North India. All patients with synchronous or metachronous mCRC who received at least one dose of chemotherapy for metastatic disease, registered between 2003 to 2017 were included. Primary outcome measures were overall survival and progression-free survival and prognostic factors of overall survival. Descriptive analysis was done for the clinicopathological characteristics and treatment patterns. Kaplan Meier method for overall survival and progression-free survival. Cox regression analysis was performed for the determination of the prognostic factors for overall survival. Result Out of 377 eligible patients, 256 patients (68%) had de novo metastatic disease and the remaining 121 (32%) progressed to metastatic disease after initial treatment. The cohort was young (median age, 46 years) with the most common primary site being the rectum. A higher proportion of signet (9%) and mucinous histology (24%). The three common sites of metastasis were the liver, peritoneum, and lung. In the first line, most patients received oxaliplatin-based chemotherapy (70%). Only 12.5% of patients received biologicals in the first-line setting. The median follow-up and median overall survival of study cohort were 17 months and 18.5 months. The factors associated with poor outcome for overall survival on multivariate analysis were ECOG performance status of > 1, high CEA, low albumin, and the number of lines of chemotherapy received (

Abstract Aims Determine the feasibility of implementing a heart failure (HF) management strategy that (i) uses a device‐based, remote, dynamic, multimetric risk stratification model to predict the risk of HF events and (ii) uses a standardized, centrally administered, ambulatory medication intervention protocol to reproducibly and safely decrease elevated risk scores. Methods and results Prospective, non‐randomized, single‐arm, multicenter feasibility study (Intervene‐HF) was conducted in HF patients implanted with a cardiac resynchronization therapy with implantable cardio defibrillator (CRT‐D) with TriageHF risk score feature. Certified HF nurses (CHFN) in the Medtronic Care Management Services Program implemented an ambulatory medication intervention strategy by following a standardized guided action pathway triggered by risk‐based alert. When CHFN received notification of increased risk score (HF care alert), they implemented a 3 day course of diuretic up‐titration (PRN) previously prescribed by a physician. Safety was monitored daily. Recovery after PRN was defined as ≥70% recovery of impedance toward baseline levels. Sixty‐six patients followed for 8.2 ± 3.9 months had 49 HF care alerts. Twenty‐three of 49 alerts did not receive PRN due to protocol‐mandated criteria. Twenty‐six of 49 alerts received PRN, 22 were completed, and 19 led to impedance recovery. Four interventions were stopped for safety without leading to an adverse event (AE). One of 26 PRNs was followed by a HF event. Eighty‐five per cent (22/26) of PRNs were completed without an AE; 69% (18/26) met the recovery criteria. Conclusions The Intervene‐HF study supports the feasibility of testing, in a large randomized clinical trial, an ambulatory medication intervention strategy that is physician‐directed, CHFN‐implemented, and based on individualized device risk stratification.

Background Prognosis of metastatic colorectal cancer (mCRC) is poor and goal of treatment is mainly palliative unless there is limited metastatic disease which is surgically resectable. Here, we report a case series of long-term survivors treated predominantly with chemotherapy. Methods This is a single-center retrospective analysis of patients of mCRC. Records of metastatic colorectal cancer patients registered at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, between the year 2005 and 2015 were retrieved and reviewed. Inclusion criteria were patients who survived 5 years or more, treated mainly by chemotherapy, with either initial presentation as metastatic disease or those who progressed after initial surgery with or without adjuvant therapy. The details about the patient characteristics, treatment, and outcome were collected. The data were censored on September 30, 2020. Results Records of 370 mCRC patients were reviewed. Thirty-one patients with all the available details fulfilled the criteria for inclusion in the study. Median age was 53 years (range, 22–74 years). Sixteen were women (51.6%). Twenty-four (77%) were newly diagnosed cases with initial presentation as metastatic disease. Commonest site of primary was on the left (21, 67.6%) followed by right side and transverse colon in 5 patients each. Liver was the most common site of metastasis (n = 18, 58.06%). In metastatic setting, the most common chemotherapy regimen used in the first line was CAPOX (n = 11, 35.48%). Only three patients could undergo metastatectomy. Monoclonal antibodies could be used only in 14 patients. Median overall survival (OS) of this cohort is 81.6 months (95% confidence interval [CI], 69.73–117.9). Conclusion A small but significant proportion of mCRC patients may achieve and maintain durable responses and long term survival with use of combination of chemotherapy with or without biologics.

Choice of initial revascularization strategy is unclear in Covid-19 patients with acute ST-elevation myocardial infarction (STEMI). We present clinical, angiographic profile, and response to therapy in 09 covid-19 STEMI patients. STEMI was the initial presentation in 6 and developed in first-week of covid symptoms in 3 patients. D-dimer and C-reactive protein was raised in all. Right coronary artery was the most common culprit artery. Five patients underwent primary-PCI. Three out of 4 patients who underwent thrombolysis, required rescue-PCI. All 9 patients had high thrombus burden with total or near-total occlusion of culprit artery and 3 of them required thrombosuction.

PURPOSEPublished experience with autologous stem-cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) from the Indian subcontinent is extremely limited. Here, we describe the activity and outcomes of this treatment modality at a large tertiary care center in India.PATIENTS AND METHODSWe retrospectively analyzed adult patients with NHL who were eligible for ASCT and autografted between January 1, 2002, and December 15, 2020, at our transplant unit. Toxicities, complications, and long-term outcomes were compared between patients who underwent transplant during 2002-2012 (group A) and 2013-2020 (group B).RESULTSOverall, 80 patients (group A, n = 37; group B, n = 43) underwent ASCT using peripheral blood stem cells. At a median follow-up of 57.6 months, the 5-year event-free survival (EFS) and overall survival (OS) were 43.5% and 47.6%, respectively, for all patients. More recently (group B), patients had reduced 100-day transplant-related mortality (2.3% v 21.6%, P < .01), improved 3-year EFS (52.9% v 37.3%, P = .04), and superior OS (at 3-year; 63.4% v 43.2%, P = .02). Patients in group B also tolerated the procedure better, with improved resource utilization. In multivariate analysis, an International Prognostic Index (IPI) ≥ 3 at diagnosis adversely affected EFS (hazard ratio [HR] = 2.82, P = .009) and OS (HR = 2.84, P = .01) after ASCT. Low pretransplant serum albumin levels were associated with inferior EFS (HR = 2.68, P = .02) and transplant-related mortality (odds ratio = 10.80, P = .02) after ASCT.CONCLUSIONIt is feasible to achieve comparable short- and long-term outcomes in patients with NHL undergoing ASCT in a resource-poor country with improved supportive care and expertise of the transplant team and center.

Abstract Aims OptiVol fluid index was developed as a transthoracic impedance‐based indicator of short‐term risk for heart failure hospitalization (HFH). OptiVol is calculated as the accumulating difference between daily impedance (measured impedance) and long‐term average impedance (reference impedance). Measured impedance alone was thought to have limited prognostic utility; however, measured impedance has the advantage of being simple, direct, and possibly additive to OptiVol fluid index in establishing long‐term HFH risk. We tested the hypothesis that directly measured impedance has independent prognostic value in predicting long‐term HFH risk and that changes in measured impedance result in a change in predicted long‐term HFH risk. Methods and results A retrospective analysis of 1719 patients studied in PARTNERS‐HF, FAST, and RAFT studies was performed. Baseline measured impedance was determined using daily values averaged over 1 month, from Month 6 to 7 post implant; change in measured impedance was determined from values averaged over 1 month, from Month 7 to 8 post implant compared with baseline. The predictive value of baseline measured impedance for HFHs was assessed beginning 7 months post implant. The predictive value of a change in measured impedance for a change in HFHs was assessed beginning 8 months post implant. Baseline measured impedance successfully predicted HFHs. For example, 3 year HFH rate for low baseline impedance 70 Ω (P = 0.004). In addition, when baseline measured impedance fell during follow‐up by >1%, 2%, or 3%, subsequent HFHs increased to 13%, 17%, or 18%, respectively. Finally, the prognostic value of measured impedance was additive to the prognostic value of the OptiVol fluid index. Conclusions Direct measurements of intrathoracic impedance using an implanted device can be used to stratify patients at varying risk of long‐term HFH. These direct measurements of impedance have practical clinical appeal because they are simple, continuous, and ambulatory.

Reliable communication imposes an upper limit on the achievable rate, namely the Shannon capacity. Wyner's wiretap coding ensures a security constraint and reliability, but results in a decrease of achievable rate. To mitigate the loss in secrecy rate, we propose a coding scheme in which we use sufficiently old messages as key and prove that multiple messages are secure with respect to all the information possessed by the eavesdropper. We also show that we can achieve security in the strong sense. Next, we study a fading wiretap channel with full channel state information of the eavesdropper's channel and use our coding/decoding scheme to achieve a secrecy capacity close to the Shannon capacity of the main channel (in the ergodic sense). Finally, we study a case where the transmitter does not have instantaneous information of the channel state of the eavesdropper, but only its distribution. Keywords: Physical layer security, Rate loss, Secret key, Wiretap channel, Secrecy capacity

Bionic-engineered tissues have been proposed for testing the performance of cardiovascular medical devices and predicting clinical outcomes ex vivo. Progress has been made in the development of compliant electronics that are capable of monitoring treatment parameters and being coupled to engineered tissues; however, the scale of most engineered tissues is too small to accommodate the size of clinical-grade medical devices. Here, we show substantial progress toward bionic tissues for evaluating cardiac ablation tools by generating a centimeter-scale human cardiac disk and coupling it to a hydrogel-based soft-pressure sensor. The cardiac tissue with contiguous electromechanical function was made possible by our recently established method to 3D bioprint human pluripotent stem cells in an extracellular matrix-based bioink that allows for in situ cell expansion prior to cardiac differentiation. The pressure sensor described here utilized electrical impedance tomography to enable the real-time spatiotemporal mapping of pressure distribution. A cryoablation tip catheter was applied to the composite bionic tissues with varied pressure. We found a close correlation between the cell response to ablation and the applied pressure. Under some conditions, cardiomyocytes could survive in the ablated region with more rounded morphology compared to the unablated controls, and connectivity was disrupted. This is the first known functional characterization of living human cardiomyocytes following an ablation procedure that suggests several mechanisms by which arrhythmia might redevelop following an ablation. Thus, bionic-engineered testbeds of this type can be indicators of tissue health and function and provide unique insight into human cell responses to ablative interventions.

Association between familial loading for alcohol use disorders (AUD) and event-related potentials (ERPs) suggests a genetic basis for these oscillations though much less is known about epigenetic pathways influenced by environmental variation. Early life adversity (ELA) influences negative outcomes much later in life. The stress-activated neuropeptide corticotropin-releasing hormone (CRH) contributes to the deleterious effects of ELA on brain structure and function in animals. Accordingly, we hypothesized that ELA would be related to cortical thickness and electrophysiological characteristics through an epigenetic effect on CRH receptor type-1 (CRHR1) methylation. A total of 217 adolescent and young adult participants from either multiplex alcohol dependence or control families were scanned using magnetic resonance imaging (MRI) at 3T and cortical thickness was determined. Longitudinal follow-up across childhood, adolescence, and young adulthood provided developmental ERP data and measures of adversity. Blood samples for genetic and epigenetic analyses were obtained in childhood. Cortical thickness and visual ERP components were analyzed for their association and tested for familial risk group differences. Visual P300 amplitude at Pz and cortical thickness of the left lateral orbitofrontal region (LOFC), were significantly related to risk group status. LOFC cortical thickness showed a negative correlation with CRHR1 methylation status and with childhood total stress scores from the Life Stressors and Social Resources Inventory (LISRES). Stress scores were also significantly related to P300 amplitude recorded in childhood. The present results suggest that early life adversity reflected in greater total LISRES stress scores in childhood can impact the methylation of the CRHR1 gene with implications for brain development as seen in cortical thickness and electrophysiological signals emanating from particular brain regions.

Purpose Osteosarcoma (OS) is a relatively chemosensitive primary bone tumor, with the peak age of onset occurring in late childhood and early adolescence. The treatment paradigm of nonmetastatic OS has typically been multimodality therapy, including neoadjuvant and adjuvant chemotherapy with definitive surgery. Over the years, various permutations and combinations of chemotherapeutic agents have been used. However, the majority of recent trials have still used high-dose methotrexate as the backbone, with cisplatin and doxorubicin (MAP). In the last decade, various strategies targeted to improving outcomes in OS have included the addition of a fourth drug to the three-drug MAP regimen, changing therapy according to histopathologic response and the addition of immunotherapies. Through this review, we sought to underscore a few pertinent issues related to chemotherapy in nonmetastatic OS, with special reference to challenges confronted in Indian settings. Methods We reviewed the literature, focusing on studies comparing high-dose methotrexate and non–high-dose methotrexate–containing regimens. In addition, this review focuses on non–methotrexate-containing triple-drug therapy. Results Although a high-dose methotrexate regimen has become standard of care in developed countries, there are few data to suggest that it is superior to a non–high-dose methotrexate regimen. Conclusion Developing countries with lack of infrastructure and logistics for high-dose methotrexate might resort to non–high-dose methotrexate–containing regimens with a simultaneous focus on early detection, decreasing abandonment, multidisciplinary clinics, improved surgery, and meticulous pathologic evaluations.

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was

Objective: Sleep problems is the most common side effect of methylphenidate (MPH) treatment in ADHD youth and carry potential to negatively impact long-term self-regulatory functioning. This study aimed to examine whether applying machine learning approaches to pre-treatment demographic, clinical questionnaire, environmental, neuropsychological, genetic, and neuroimaging features can predict sleep side effects following MPH administration. Method: The present study included 83 ADHD subjects as a training dataset. The participants were enrolled in an 8-week, open-label trial of MPH. The Barkley Stimulant Side Effects Rating Scale was used to determine the presence/absence of sleep problems at the 2nd week of treatment. Prediction of sleep side effects were performed with step-wise addition of variables measured at baseline: demographics (age, gender, IQ, height/weight) and clinical variables (ADHD Rating Scale-IV (ADHD-RS) and Disruptive Behavior Disorder rating scale) at stage 1, neuropsychological test (continuous performance test (CPT), Stroop color word test) and genetic/environmental variables (dopamine and norepinephrine receptor gene (DAT1, DRD4, ADRA2A, and SLC6A2) polymorphisms, blood lead, and urine cotinine level) at stage 2, and structural connectivities of frontostriatal circuits at stage 3. Three different machine learning algorithms ((Logistic Ridge Regression (LR), support vector machine (SVM), J48) were used for data analysis. Robustness of classifier model was validated in the independent dataset of 36 ADHD subjects. Results: Classification accuracy of LR was 95.5% (area under receiver operating characteristic curve (AUC) 0.99), followed by SVM (91.0%, AUC 0.85) and J48 (90.0%, AUC 0.87) at stage 3 for predicting sleep problems. The inattention symptoms of ADHD-RS, CPT response time variability, the DAT1, ADRA2A DraI, and SLC6A2 A-3081T polymorphisms, and the structural connectivities between frontal and striatal brain regions were identified as the most differentiating subset of features. Validation analysis achieved accuracy of 86.1% (AUC 0.92) at stage 3 with J48. Conclusions: Our results provide preliminary support to the combination of multimodal classifier, in particular, neuroimaging features, as an informative method that can assist in predicting MPH side effects in ADHD.

The telecommunication industry has witnessed a tremendous growth in recent times in India. It has not only been limited to voice calls, but also integrated into every aspect of human life. This has resulted in the rapid rise of market players, offering innovative products and services. In this changing scenario, we have tried to design and check a model of various factors such as loyalty, satisfaction and switching barriers (customer relationship management, alternative attractiveness and switching cost) influencing consumer retention strategies in Indian telecom service industry. A structured and undisguised questionnaire and a convenient sampling method have been used to collect the data from respondents from three most populous cities (Indore, Bhopal, and Ujjain) of Central India. Around 450 questionnaires were distributed, out of which 318 usable responses were received for final analysis. The instrument was checked for validity and reliability before the data was analyzed. The hypotheses were tested through Structure Equation Modelling (SEM) for direct effect, and Multiple Moderating Regression Analysis (MMRA) for moderating effect. The results suggested that loyalty, satisfaction, switching barriers and customer relationship management are positively related and have a direct influence on consumer retention, but the relationship with alternative attractiveness has been found weak. Switching cost, as moderating variable, was found to be very effective and showed significant deviation in the relationship between independent and dependent variables.

Over the years, the number of organizations investing in CSR activities has increased considerably. This increase is partially attributable to the intention of the organizations to give back to the society to repair and reduce the loss their intentional or unintentional actions might have caused to the environment. The government’s decision to make it mandatory for businesses to invest a small part of their net profit in social welfare activities has also helped nudge the organizations towards CSR activities. However, the question whether this investment influences customers’ intention to purchase the product in any manner remains an unresolved paradox. Limited researches have been conducted in this area to explore and establish the relationship if any between CSR and consumer purchase intention. This research focuses on the five different factors of CSR comprising of loyalty, morality, awareness, behavior and environment, which are identified from the previous literature. With the help of these factors, the authors researched and established the relationship between them and consumer purchase intention. In this descriptive research, the research questionnaire was distributed to 1500 respondents, using convenient sampling method, out of which 319 responses were finally obtained for the analysis purpose. After testing the reliability and validity of the data, the five hypotheses were tested using SEM (Structural Equation Modeling). It was found that all the five hypotheses were supported and thereby acknowledged the significant influence of CSR related activities performed by companies on the consumer purchase intention. The CSR driven morality is emerging to be the most important dimension that appears to influence the consumer purchase intentions. These finding will help decision-makers to formulate their promotion activities in such a manner that it aligns with the value system of the consumers and increase the overall consumer base.

Ischemic stroke of basal ganglia after head trauma is rare in children younger than 18 months and accounts for less than 2% of all ischemic strokes in childhood. The clinical history of these lesions is particularly favorable because they are usually small and facial-brachial-crural hemiparesis is typical of this pathology that regresses over a period of time. The most effective therapeutic approach appears to be a conservative one, although the best treatment regimen is still not well defined. It is necessary to exclude conditions such as heart disease, coagulopathies, and acute traumatic arterial dissections. The authors present a rare case of bilateral basal ganglia infarct in an 18-month-old child following head trauma managed conservatively with good recovery.

Multicasting in wireless systems is a natural way to exploit the redundancy in user requests in a content centric network. Power control and optimal scheduling can significantly improve the wireless multicast network’s performance under fading. However, the model-based approaches for power control and scheduling studied earlier are not scalable to large state spaces or changing system dynamics. In this paper, we use deep reinforcement learning, where we use function approximation of the Q-function via a deep neural network to obtain a power control policy that matches the optimal policy for a small network. We show that power control policy can be learned for reasonably large systems via this approach. Further, we use multi-timescale stochastic optimization to maintain the average power constraint. We demonstrate that a slight modification of the learning algorithm allows tracking of time varying system statistics. Finally, we extend the multi-time scale approach to simultaneously learn the optimal queuing strategy along with power control. We demonstrate the scalability, tracking and cross-layer optimization capabilities of our algorithms via simulations. The proposed multi-time scale approach can be used in general large state-space dynamical systems with multiple objectives and constraints, and may be of independent interest.

The metastasis to the eye in a patient of carcinoma of the cervix is rare. A case of carcinoma cervix in a 56-year-old female is described who presented with full chamber pseudohypopyon and deep vascularization in inferior quadrant of the cornea in the left eye. Magnetic resonance imaging revealed features suggestive of ocular metastasis in the anterior part of the uveal tract. Diagnosis was confirmed on cytology which showed features of squamous cell carcinoma. A high level of clinical suspicion in advanced cases of malignancies will help in early detection of ocular metastasis with unusual presentations.

Abstract In this paper, we study a K-user fading multiple access channel (F-MAC), with and without an eavesdropper (Eve). In the system without Eve, we assume that each user knows only its own channel gain and is completely ignorant about the other users’ channel state. The legitimate receiver sends a short acknowledgement message Acknowledge (ACK) if the message is correctly decoded and a No Acknowledge (NACK) if the message is not correctly decoded. Under these assumptions, we use game theoretic learning setup to make transmitters learn about the power allocation under each state. We use multiplicative weight no-regret algorithm to achieve an ε-coarse correlated equilibrium. We also consider the case where a user can receive other users’ ACK/NACK messages. Now, we can maximize a weighted sum utility and achieve Pareto optimal points. We also obtain Nash bargaining solutions, which are Pareto points that are fairer to the transmitting users. Fairness among users is quantified using Jain’s index. With Eve, we first assume each user knows only its own channel gain to the receiver as well as to Eve. The receiver decides whether to send an ACK or a NACK to the transmitting user based on the secrecy-rate condition. We use the above developed algorithms to get the equilibrium points. Next, we study the case where each user knows only the distribution of the channel state of Eve. Finally, we also consider the system where the users do not know even the distribution of the Eve’s channel.

Optic neuritis (ON) is the demyelinating inflammation of the optic nerve head usually associated with multiple sclerosis. It is usually associated with sudden onset loss of vision with dyschromatopsia and retro-orbital pain. Atypical features for a demyelinating ON include the absence of pain, severe visual loss, progression of visual loss, pain for more than 2 weeks, and lack of recovery after 3 weeks. Atypical features in fundus examination include marked swelling of the nerve with retinal exudates, peripapillary hemorrhages and bilateral presentation, which may occur either simultaneously or sequentially. Atypical ON requires careful consideration and differentiation from demyelinating ON and ischemic optic neuropathy since the treatment is different. We describe a patient who presented with recurrent, sequential episode of visual loss over 2 years, without evidence of any additional neurological deficits, sarcoidosis, or systemic autoimmune disease. A diagnosis of chronic relapsing inflammatory optic neuropathy was made, and she was given intravenous steroids for 3 days, which improved the vision from hand movement close to face to 5/60 in the right eye. She was given immunosuppressants for 3 months, and oral steroids were gradually tapered. Her present vision is the right eye is 6/6 with normal intraocular pressure and color vision.

Background Heart failure remains a leading cause of morbidity and mortality. Clinical prediction models provide suboptimal estimates of mortality in this population. We sought to determine the incremental value of implantable device diagnostics over clinical prediction models for mortality. Methods and Results RAFT (Resynchronization/Defibrillation for Ambulatory Heart Failure Trial) patients with implanted devices capable of device diagnostic monitoring were included, and demographic and clinical parameters were used to compute Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) heart failure risk scores. Patients were classified according to MAGGIC score into low (0–16), intermediate (17–24), or high (>24) risk groups. Mortality was evaluated from 6 months postimplant in accordance with the RAFT protocol. In a subset of 1036 patients, multivariable analysis revealed that intermediate and high MAGGIC scores, fluid index, atrial fibrillation, and low activity flags were independent predictors of mortality. A device‐integrated diagnostic parameter that included a fluid index flag and either a positive atrial fibrillation flag or a positive activity flag was able to significantly differentiate higher from lower risk for mortality in the intermediate MAGGIC cohort. The effect was more pronounced in the high‐risk MAGGIC cohort, in which device‐integrated diagnostic–positive patients had a shorter time to death than those who were device‐integrated diagnostic negative. Conclusions Device diagnostics using a combination of fluid index trends, atrial fibrillation burden, and patient activity provide significant incremental prognostic value over clinical heart failure prediction scores in higher‐risk patients. This suggests that combining clinical and device diagnostic parameters may lead to models with better predictive power. Whether this risk is modifiable with early medical intervention would warrant further studies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.

Background: Teleophthalmology has the potential to facilitate wider access to expert advice. It includes viewing of ophthalmic images by experts either on handheld devices like smartphones/tablets or office devices such as computer screens. However, to ensure rapid feedback, the turnaround time of any consultation must be kept to a minimum which requires use of handheld user-friendly devices. The purpose of this study was to assess whether images of different eye ailments viewed on smartphones and tablets are of comparable subjective quality as those viewed on a computer screen. Methods: This was a prospective study comparing the subjective quality of images on a smartphone, tablet and computer screen. Thirty images were analysed – 10 of extraocular morphology, 10 of the anterior segment pathology and 10 of retinal diseases. Ten ophthalmologists participated and were instructed to rate the overall quality of each image on a 7-point Likert scale (terrible-1, poor-2, average-3, fair-4, good-5, very good-6, excellent-7). Results: Overall smartphones were found to have higher ratings of subjective image quality (5.9 ± 0.48) than images displayed on tablets (5.13 ± 0.51) and computers (5.0 ± 0.37). The images were rated ‘good’ or ‘very good’ in all (100%) of the smartphone images. Fundus images and extraocular images were rated higher than anterior segment images on the smartphone. When comparing the two handheld devices with computers, both smartphones and tablets had similar image quality (p > 0.05, not significant) to computer images. However, for extraocular diseases, smartphone (6.1 ± 0.32) had significantly better image quality and images were easier to interpret compared to images on the computer (p < 0.05). Smartphones were rated ‘very good’ in 88.33% cases. All consultants (n = 10) were comfortable with the use of smartphone images and were already using it for teleconsultation at least three times in a month. Vision technicians reported minimum delay in getting advice when sending the images on mobile application to expert ophthalmologists. Conclusion: Smartphones can be used for teleconsultation. Subjective qualities of ophthalmic images on a smartphone are similar to those on tablets and computers. For rural communities that rely on teleconsultation, this small study provides useful evidence which may support the use of smartphones, tablets or computers for viewing ophthalmic images.

With increasing trend of polypharmacy, there are higher chances of drug-drug interactions leading to adverse effects, especially in psychiatric patients with co-morbid chronic medical problems. This case demonstrates a schizoaffective 30-year-old male on highly active antiretroviral therapy (HAART) who reported an incident of priapism potentially caused by an interaction between previously prescribed atypical antipsychotic, trazodone, norepinephrine dopamine reuptake inhibitor (NDRI), HAART, and newly added selective serotonin reuptake inhibitor (SSRI). This case emphasizes obtaining careful medication history, understanding cytochrome P450 (CYP450) enzyme and its subtypes, and discouraging polypharmacy. Clinicians must educate their patients about different sexual side effects as these can be socially stigmatizing and can further deteriorate mental health symptoms.

Introduction: Chronic respiratory diseases are an important cause of disability across the globe. The global burden of these diseases is showing a discernible upward trend. It is estimated that 500 million people suffer from them. Materials and Methods: The study was conducted with the aim to estimate the prevalence of chronic obstructive pulmonary disease (COPD) in a rural Indian population. For this, a population-based survey was conducted using modified British Medical Research Council questionnaire. This was followed by subjecting the respondents to Wright's mini peak flow meter to find out the peak expiratory flow rate to diagnose the COPD cases. Results: The prevalence of chronic bronchitis, bronchial asthma, and COPD was found to be 3.36%, 1.18%, and 4.21%, respectively. Conclusions: Chronic respiratory disorders are more prevalent among rural adults hinting to a rural-urban divide. Therefore, the focus of preventive strategies should take into account this difference.

Traumatic subconjunctival dislocation of the posterior chamber intraocular lens (PCIOL) is a rare and emergency condition. Here, we report an interesting variation of rare case of inferior subconjuctival dislocation of PCIOL in a 75-year-old female patient following blunt trauma to her right eye with cow's head. All the previous literature with subconjuctival dislocation of PCIOL has reported the superior dislocation of intraocular lens. Inferior subconjunctival dislocation has never been reported in previous literature.

Difficulty regulating positive mood and energy is a feature that cuts across different pediatric psychiatric disorders. Yet, little is known regarding the neural mechanisms underlying different developmental trajectories of positive mood and energy regulation in youth. Recent studies indicate that machine learning techniques can help elucidate the role of neuroimaging measures in classifying individual subjects by specific symptom trajectory. Cortical thickness measures were extracted in sixty-eight anatomical regions covering the entire brain in 115 participants from the Longitudinal Assessment of Manic Symptoms (LAMS) study and 31 healthy comparison youth (12.5 y/o;-Male/Female = 15/16;-IQ = 104;-Right/Left handedness = 24/5). Using a combination of trajectories analyses, surface reconstruction, and machine learning techniques, the present study aims to identify the extent to which measures of cortical thickness can accurately distinguish youth with higher (n = 18) from those with lower (n = 34) trajectories of manic-like behaviors in a large sample of LAMS youth (n = 115; 13.6 y/o; M/F = 68/47, IQ = 100.1, R/L = 108/7). Machine learning analyses revealed that widespread cortical thickening in portions of the left dorsolateral prefrontal cortex, right inferior and middle temporal gyrus, bilateral precuneus, and bilateral paracentral gyri and cortical thinning in portions of the right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex, and right parahippocampal gyrus accurately differentiate (Area Under Curve = 0.89;p = 0.03) youth with different (higher vs lower) trajectories of positive mood and energy dysregulation over a period up to 5years, as measured by the Parent General Behavior Inventory-10 Item Mania Scale. Our findings suggest that specific patterns of cortical thickness may reflect transdiagnostic neural mechanisms associated with different temporal trajectories of positive mood and energy dysregulation in youth. This approach has potential to identify patterns of neural markers of future clinical course.

According to literature, genital self-mutilation (GSM) is more commonly associated with psychosis as compared with self-mutilation as a whole. There have been many case reports of GSM in psychotic disorders. We describe herein a case of a Caucasian, employed, and married male suffering from bipolar disorder type II with history of self-mutilating behavior, who amputated his penis during symptom-free phase of his illness. Several features are reflected as risky elements for genital self-mutilation, for example, homosexual and transsexual tendencies, abandonment of the male genitals, lack of competent male for identification during childhood, feeling of guilt for sexual offences, and self-injuries in anamnesis. This report will highlight various factors responsible for self-mutilation in nonpsychotic and nondelusional person.

Central serous chorioretinopathy (CSR) is well described in the literature, with recognized associations such as systemic steroid therapy and stress; the association of blunt trauma with CSR is highly unusual. A 44-year-old male developed CSR rapidly after blunt trauma to his left eye with a significant reduction in visual acuity to hand movements. Serial optical coherence tomography and fundus fluorescein angiography images are presented. The patient was managed conservatively and spontaneous resolution occurred by 2 months with an excellent visual outcome. There was no evidence of an alternative underlying pathology for the presentation and particularly no signs of posterior uveitis. Investigations for an underlying vascular, inflammatory or infectious cause were all negative. The patient had previously had CSR in his other eye, and this may indicate a potential predisposition to developing the condition, triggered by blunt trauma.

Background. Long-term graft patency is the major factor impacting survival after coronary artery bypass grafting. Arteries are superior in this regard. Radial artery is considered the second best conduit after internal mammary artery. Several studies have shown excellent radial artery patency. We evaluated the morphologic characteristics of radial artery by three modalities, (i) preoperative Doppler ultrasound, (ii) intraoperative manual morphometry, and (iii) postoperative histology-based morphometry, and compared these with the aim of validating Doppler as a noninvasive test of choice for preoperative assessment of radial artery. Methods. This was a prospective study involving 100 patients undergoing coronary artery bypass grafting in which radial artery was used. The radial artery was assessed using preoperative Doppler ultrasound studies, intraoperative morphometry, and postoperative histopathology and morphometry. The morphometric measurements included (i) luminal diameter, (ii) intimal and medial thickness, and (iii) intima-media thickness ratio. Results. Using Bland-Altman plots, there was a 95% limit of agreement between the preoperative Doppler measurements and the postoperative histopathology and morphometry. Conclusion. Doppler ultrasound is an accurate screening test for evaluation of radial artery, in terms of intimal/medial thickness and luminal diameter as a conduit in coronary artery bypass grafting and has been validated by both morphometric and histopathology based studies.

Some wheelchair users have difficulty looking backward when backing up in confined spaces due to limited neck range of motion or low vision, which can lead to collisions which may result in personal injury or property damage. The Drive Safe System (DSS) was evaluated in a controlled laboratory setting with blindfolded able-bodied individuals on various backward driving tasks. Performance with the DSS was compared with a standard white cane used for navigation assistance by people with visual impairment. Results indicate that the DSS significantly reduced the number of collisions compared to using a cane (p = 0.0001) alone. There was no difference in task completion time when participants were using the cane or the DSS (p = 0.915). Users rated the DSS favourably as they experience less total workload (p = 0.026), less physical demand (p = 0.006), felt less frustrated (p = 0.002) and put less effort (p = 0.007) to achieve better performance when using the DSS, compared to using a cane. These findings suggest that the DSS can be a viable powered mobility solution for wheelchair users with visual impairments.