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An infection surveillance system based on a hospital's digital twin [4D-Disease Outbreak Surveillance System (4D-DOSS)] is being developed in Singapore. It offers near-real-time infection surveillance and mapping capabilities. This early economic modelling study was conducted, using meticillin-resistant Staphylococcus aureus (MRSA) as the pathogen of interest, to assess the potential cost-effectiveness of 4D-DOSS. A Markov model that simulates the likelihood of MRSA colonization and infection was developed to evaluate the cost-effectiveness of adopting 4D-DOSS for MRSA surveillance from the hospital perspective, compared with current practice. The cycle duration was 1 day, and the model horizon was 30 days. Probabilistic sensitivity analysis was conducted, and the probability of cost-effectiveness was reported. Scenario analyses and a value of information analysis were performed. In the base-case scenario, with 10-year implementation/maintenance costs of 4D-DOSS of $0, there was 68.6% chance that 4D-DOSS would be cost-effective. In a more pessimistic but plausible scenario where the effectiveness of 4D-DOSS in reducing MRSA transmission was one-quarter of the base-case scenario with 10-year implementation/maintenance costs of $1 million, there was 47.7% chance that adoption of 4D-DOSS would be cost-effective. The value of information analysis showed that uncertainty in MRSA costs made the greatest contribution to model uncertainty. This early-stage modelling study revealed the circumstances for which 4D-DOSS is likely to be cost-effective at the current willingness-to-pay threshold, and identified the parameters for which further research will be worthwhile to reduce model uncertainty. Inclusion of other drug-resistant organisms will provide a more thorough assessment of the cost-effectiveness of 4D-DOSS. [ABSTRACT FROM AUTHOR]

Single-step real-time high-throughput monitoring of drug influences on bacterial cell behaviour has become important with growing interests in personalized therapy and medication. Conventional microchip assemblies to perform similar work do exist. However, most of these devices have complex set-ups incorporating micromixers, separators, pumps, or valves. These microcomponents can sometimes damage the entities being monitored because of the creation of unfavourable biological environments. This paper presents a microchip-based system that enables single-step mixing of two solutions in various ratios, without the need for additional microcomponents such as mixers and pumps, in order to screen effectively their combinatory effects on cell outcomes. In this work, in-vitro experiments were carried out using ampicillin at various concentrations to investigate their effects on Escherichia coli (E. coli). Results showed that the microchip provided effective screening, which yielded useful results such as effective dosages, ineffective dosages, and other possible outcomes; for instance, in this case, the occurrence of adaptive mutation of the bacteria at certain drug concentrations. Comparative microbiological laboratory tests were carried out as standard for confirmation of the results. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma (OSCC) is an aggressive, highly immunosuppressive cancer with a high mortality rate. Interactions between programmed cell death protein 1 (PD-1; on T cells) and programmed death ligand 1 (PD-L1; on tumor cells) within the tumor microenvironment facilitates T-lymphocyte exhaustion. Regulatory T cells (Treg) are a distinct lymphocyte population, expressing the transcription factor forkhead homeobox protein-3 (FoxP3), which downregulates immune responses in OSCC. PD-L1+ tumor cells and FoxP3+ Treg expression in OSCC has been associated with poor prognosis. This research investigates the expression of PD-L1+ cells and Tregs in control, dysplastic, and OSCC tissues. To investigate and compare the expression of PD-L1+ tumor cells and FoxP3+ Tregs in nondysplastic tisssue, dysplastic tissue, and OSCC using immunohistochemistry. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded, archival tissues. Qualitative and quantitative analyses of positively stained cells were undertaken and the dysplastic (n = 20) and OSCC groups (n = 20) were compared against the non-dysplastic control group (n = 20), using image analysis A higher proportion score and immunoreactive score for PD-L1+ and FoxP3+ Tregs was found in OSCC and dysplastic groups when compared to the nondysplastic control group (P <.05). There was no significant difference between the OSCC and dysplastic tissues. Significantly more PD-L1+ cells and Tregs were detected in dysplastic and OSCC tissues. An increase in PD-L1 and FoxP3 expression may serve as an indicator of progression from normal to a potentially malignant lesion. [ABSTRACT FROM AUTHOR]

The textile industry is one of the largest industries in world and is among the major waste generating industries. Number of physical and chemical treatments are followed by industries to control the waste water effluents. But the functional and operational cost for the processes is high. So continuous efforts are being done by Scholars to search the alternatives. In the paper, report on the study made to evaluate whether any improvement in treatment of dye house effluent is possible through use of adsorption technique is reported. Batch studies were conducted using low cost adsorbents such as Sugarcane baggase, Rice husk and Saw dust without activation. Colors used were C.I. Reactive Red 120, C.I. Reactive Blue 198 and C.I. Reactive Yellow 135. The results show that these adsorbents can be used for dye house effluents treatment at negligible cost. In the above context continuous studies were also done using above mentioned adsorbents followed by aerobic and anaerobic treatment. [ABSTRACT FROM AUTHOR]

Purpose: We prospectively sought to compare the incidence and properties of tunnel widening in patients undergoing anterior cruciate ligament reconstruction with quadrupled hamstring graft by use of either EndoButton CL (Smith & Nephew Endoscopy, Andover, MA) or Transfix (Arthrex, Naples, FL) on the femoral side with a bioabsorbable interference screw in the tibial tunnel by computed tomography scan. Methods: We included 34 patients in the study and randomized them into 2 groups--EndoButton and Transfix groups. An anteromedial portal technique was used to create the femoral tunnels in the EndoButton group, whereas a transtibial technique was used in the Transfix group. A bioabsorbable screw was used on the tibial side in both groups. Thirty patients completed the study protocol, and assessment was done at regular intervals until 12 months of follow-up was reached. The patients underwent computed tomography scans at 2 weeks, 3 months, and 6 months postoperatively. The diameters of the tunnels were measured perpendicular to the long axis of the tunnels on oblique coronal and oblique sagittal planes at 3 levels: aperture, midway, and suspension point. We performed functional scoring with the International Knee Documentation Committee 2000 Subjective Knee Evaluation score and Lysholm score. Results: Femoral tunnel widening at the aperture and at midway was significantly greater in the EndoButton group compared with the Transfix group. A decrease in the loop length in the EndoButton group was associated with lesser tunnel widening, although this was not found to be statistically significant with the numbers available. A trend toward decreased tunnel widening at the aperture on the tibial side was observed when the tip of the screw was 10 to 15 mm away from the aperture. Conclusions: Femoral tunnel widening was significantly less in the Transfix group compared with the EndoButton group. Level Of Evidence: Level II, prospective comparative study. [ABSTRACT FROM AUTHOR]

Abstract: The ideal method of fixation of intertrochanteric fractures of femur associated with compromised lateral femoral wall is still not clearly defined. The aim of the present study is to evaluate the outcome of proximal femoral nail in unstable intertrochanteric fractures with compromised lateral femoral wall in terms of low rate of complications and re-operation. Twenty-four consecutive patients who had sustained an unstable intertrochanteric fracture according to AO/OTA classification were operated with proximal femoral nail under image intensifier by a single surgeon within a week of sustaining trauma and were followed clinically and radiologically for at least 6 months. Twenty-three patients were available for follow-up after 24 weeks. One patient died due to effects of prolonged immobilization 2 months postoperative as the patient wasn''t able to bear weight on affected extremity due to screw cut-out and subsequent varus collapse in immediate postoperative period. There was a mean limb length shortening of 4.29 mm. In 19 of 23 (approx 83%) patients the shortening was less than 10 mm. Four of 24 patients (16%) had developed postoperative complications but none of the patients were re-operated during the subsequent follow-up of 6 months. Proximal femoral nail provides a good outcome in intertrochanteric fractures of the hip with fractured or compromised lateral femoral wall with an acceptable rate of technical difficulties and complications. [Copyright &y& Elsevier]

Review of turnover costs at a major medical center helps health care managers gain insights about the magnitude and determinants of this managerial challenge and assess the implications for organizational effectiveness. Here, turnover includes hiring, training, and productivity loss costs. Minimum cost of turnover represented a loss of >5 percent of the total annual operating budget. Editor's Note: This article is being reprinted with permission from Health Care Management Review 29(1), 2-7. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the effects of crocin, a pharmacologically active constituent of Crocus sativus L., in isoproterenol (ISO)-induced cardiotoxicity with reference to hemodynamic, antioxidant, histopathological and ultrastructural parameters. Rats were administered crocin (5, 10 and 20mg/kg/day) or vehicle orally for 21 days along with ISO (85mg/kg, subcutaneously, at 24h interval) on 20th and 21st day. On 22nd day ISO-control rats showed cardiac dysfunction as indicated by lowering of systolic, diastolic and mean arterial blood pressures. In addition, a significant decrease in maximum positive and negative rate of developed left ventricular pressure (±LVdp/dtmax) and an increase in left ventricular end-diastolic pressure (LVEDP) were observed. Furthermore, a marked reduction in the activities of myocardial creatine kinase-MB (CK-MB) isoenzyme, lactate dehydrogenase (LDH), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) levels along with an increase in content of malondialdehyde (MDA) were observed. Myocardial necrosis, edema and inflammation were evident from the light microscopic and ultrastructural changes. Crocin at the dose of 20mg/kg/day significantly modulated hemodynamic and antioxidant derangements. The preventive role of crocin on ISO-induced MI was reconfirmed by histopathological and ultrastructural examinations. The effect at the dose of 20mg/kg/day of crocin was more pronounced than that of other two doses (5 and 10mg/kg/day). The results suggest that crocin may have cardioprotective effect in ISO-induced cardiac toxicity through modulation of oxidative stress in such a way that maintains the redox status of the cell. [Copyright &y& Elsevier]

Abstract: Metabolic syndrome is a cluster of metabolic abnormalities and related clinical syndromes most important of which are coronary artery disease and type 2 diabetes mellitus. Insulin resistance along with visceral adiposity, dyslipidemia and chronic subclinical proinflammatory state are the main characteristic features of metabolic syndrome. Insulin resistance is not a disease, but a description of a physiologic state, and approximately one third of an apparently healthy population is sufficiently insulin resistant to be at increased risk. Our understanding of metabolic syndrome has improved tremendously over the years, but certain aspects of its pathogenesis still remain elusive to the scientific world. Further research and application of the knowledge can help in better management of type 2 diabetes mellitus and coronary artery disease, direct fallout of metabolic syndrome. In-depth knowledge of the markers of metabolic syndrome will help in better understanding of the condition. [Copyright &y& Elsevier]

Abstract: Background: Teledermatology is the science of telemedicine applied to the field of dermatology, with an aim to avoid travelling to nearest specialist facility. Methods: Patients from Air Force Stations Jaisalmer, Naliya, 5 Air Force Hospital, Jorhat and 9 Air Force Hospital, Halwara were consulted by the dermatologist at Command Hospital (Air Force) Bangalore through the telemedicine network provided by ISRO, Bangalore from March 06 to May 08. Result: 115 patients underwent teledermatology consultation using virtual teleconference (VTC)and this was compared with Store and Forward (S and F) consultation at all four stations as well as Face to Face (FTF) consultation at 5 Air Force Hospital Jorhat. Diagnosis concordance was 52.5% and 53% for Jorhat and Halwara for VTC vs S and F, while it was 75% and 25% for Jaisalmer and Naliya. For VTC vs FTF, the concordance improved to 60.66% and for S and F vs FTF it improved to 91.8%. Concordance was better for localized lesions than for generalized lesions especially of the papulosquamous group of disorders. Another reason for the discordance with VTC was poor resolution of cameras at the peripheral units. Conclusion: Teledermatology is useful for patient care in the absence of local specialist cover and the patients have to travel long distances resulting in loss of manhours.However, better camera resolution at peripheral centres will result in greater concordance. [Copyright &y& Elsevier]

The trend for energy and material recovery from wastes along with the need to reduce greenhouse gases has led to an increased interest in the study of thermal degradation of biomass. In this study, the thermal degradation of four rice husk (agricultural biomass) of varieties (Pusa, Parmal, HBC-19 and Basmati) was studied under non-isothermal heating in dynamic air atmosphere by using a simultaneous thermal analyser. Thermal degradation of rice husk had two different stages: 'cellulose and hemicellulose conversion' and 'lignin conversion.' Friedman, Ozawa–Flynn–Wall (O–F–W) and Kissinger methods were used to determine kinetic parameters. The results showed that the activation energy obtained from the Friedman method was in good agreement with the value obtained using O–F–W method. The values of activation energies calculated by using Kissinger method were much lower than those calculated by Friedman and O–F–W method. The results obtained in this study were compared with those of the literature. [ABSTRACT FROM AUTHOR]

Abstract: Background : In plateletpheresis blood is withdrawn from a donor in anticoagulant solution and separated into components. Platelets are retained and the remaining components are returned to the individual. Methods : The present study was aimed to compare the platelet yield and collection efficiency of Baxter CS 3000 plus and Haemonetics MCS plus cell separators and to study adverse donor reactions. Donors were selected as per the set criteria for single donor platelet (SDP) preparation. Donors'' samples for pre donation and post donation platelet count were collected in EDTA and for product counts in the sample pouch attached with apheresis kits. The results were obtained by haematology analyzer. Platelet yield and collection efficiency were calculated. Result : Results were tabulated for both the cell separators and analyzed. Platelet yield was marginally better with Baxter CS 3000 plus but collection efficiency was better with the Haemonetics MCS plus. Residual white cells were more in single donor platelet concentrate preparation by MCS plus. Adverse donor reactions were similar with both cell separators, in form of mild citrate toxicity and mild to moderate pain at phlebotomy site. Conclusion : Findings of the present study along with other factors such as less priming time for kit, portability of cell separator, better patient comfort owing to single arm venous access and lesser cost suggest that Haemonetics MCS plus is a better choice as compared to Baxter CS 3000 plus cell separator. [Copyright &y& Elsevier]

Summary: Objective: Armodafinil is the R-enantiomer of racemic modafinil and has a significantly longer half-life than the S-enantiomer. This study evaluated armodafinil 150mg/day as an adjunct treatment for residual excessive sleepiness in patients with obstructive sleep apnea/hypopnea syndrome (OSA/HS) who were otherwise well controlled with nasal continuous positive airway pressure (nCPAP). We assessed the ability of armodafinil to improve wakefulness and cognition and reduce fatigue in this population. Methods: In this 12-week, randomized, double-blind study, patients () received armodafinil (150mg) or placebo once daily. Efficacy assessments at baseline and weeks 4, 8, and 12 included the Maintenance of Wakefulness Test (MWT), Clinical Global Impression of Change (CGI-C), Cognitive Drug Research battery, Epworth Sleepiness Scale, and Brief Fatigue Inventory. Results: At final visit, mean (sd) MWT sleep latency increased from baseline by 2.3 (7.8)min with armodafinil and decreased by 1.3 (7.1)min in the placebo group (P=0.0003). Armodafinil improved clinical condition (CGI-C, 71% vs. 53% for armodafinil and placebo, respectively; P=0.0069). Armodafinil significantly improved episodic secondary memory (P=0.0102) and patient-estimated wakefulness (P<0.01) and reduced fatigue (P<0.05) compared with placebo. Armodafinil did not adversely affect nCPAP use. The most common adverse event associated with armodafinil was headache. Sleep macroarchitecture was not altered by armodafinil. Conclusion: Adjunct treatment with armodafinil significantly improved alertness, overall clinical condition, and long-term memory. Armodafinil also reduced fatigue and the impact of sleepiness on daily activities in patients with OSA/HS who have residual excessive sleepiness notwithstanding regular use of nCPAP. Armodafinil was well tolerated. [Copyright &y& Elsevier]

Abstract: Peripheral action of opioids for pain control, for which local inflammation has been shown to be crucial, is being increasingly used in clinical practice. The aim of this study was to evaluate the hypothesis that addition of fentanyl to lidocaine, when injected into inflamed dentoalveolar tissues, can improve the quality of analgesia during surgery. Seventy-one patients reporting with pain and tenderness in the maxillary tooth were assigned into the experimental (LAF) or control (LA) group in a prospective, randomized double-blind trial. The LAF group (n =36) was injected submucosally with a mixture of 40μg of fentanyl (0.8ml) and 2% lidocaine hydrochloride with 1:200000 adrenaline (2ml). In the LA group (n =35) 0.9% of saline (0.8ml) was added instead of fentanyl. The pain scores were recorded before injecting, 5min after injection, and immediately after surgery using a visual analogue scale. The mean pain scores were not significantly different at all time intervals. Twelve patients in the LAF group (2.75±0.72ml) and ten patients in the LA (2.90±0.70ml) group required additional local anaesthetic to achieve pain control. In conclusion, there was no improvement in quality of intraoperative analgesia on addition of fentanyl to lidocaine in inflamed dentoalveolar tissues. [Copyright &y& Elsevier]

MRI-guided transurethral ultrasound ablation (TULSA) is an incision-free in-bore procedure for customized prostate ablation using directional thermal ultrasound under real-time MRI thermometry guidance and control. MRI thermometry during treatment measured 98% (95-99%) thermal coverage with ablation precision of ± 1.4 mm, confirmed by immediate posttreatment CE-MRI. The TACT Pivotal study of MRI-guided TULSA for whole-gland ablation in men with localized prostate cancer met its primary PSA endpoint, with low rates of toxicity and residual disease. [Extracted from the article]

Abstract: Background: Cutaneous tuberculosis forms a small subset of extrapulmonary tuberculosis. The present study is an attempt to observe the clinico morphological pattern seen in cases of cutaneous tuberculosis over a period of 5 years, and to correlate them with mantoux reactivity and human immunodeficiency virus (HIV) status. Methods: All cases of cutaneous tuberculosis observed among the dermatology in patients and those attending out patient department were included in the study. The basis of diagnosis was clinical, histopathological and microbiological. Intradermal mantoux test and serological test in the form of enzyme-linked immunosorbent assay (ELISA) for tuberculosis was done. HIV screening was carried out in 32 cases. CD4 counts were done in all HIV positive cases. Results: A total 0.02% patient attending the dermatology centre had cutaneous tuberculosis. The spectrum of infection included 19 (51%) cases of lupus vulgaris, 7 (19%) cases of papulonecrotic tuberculids, six cases each of tuberculosis verrucosa cutis and scrofuloderma. One case had scrofuloderma and lupus vulgaris and another both scrofuloderma and papulonecrotic tuberculide. One case of lichen scrofulosorum was seen in a seven year old boy. 11 cases revealed evidence of systemic tuberculosis. Seven cases of HIV with CD4 counts between 50–500 cells/μl were observed in this study. [Copyright &y& Elsevier]