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Problem definition: The U.S. federal government makes significant investments in technology programs to deliver essential services to the public. The execution of a program is monitored against a baseline—an aggregate plan representing the program’s planned budget, schedule and scope. Recent reports suggest that federal technology programs are re-baselined multiple times, resulting in additional spending of taxpayer money. Although a program’s scope has often been considered a driver of baseline changes, we have a limited understanding of the execution factors that may affect this relationship. Academic/Practical Relevance: With increasing bipartisan scrutiny of federal spending in technology programs and continuing debate in the media about their execution, a nuanced understanding of the drivers of baseline changes in federal technology programs is a critical and contemporary line of inquiry relevant to both policymakers and managers. Our study also responds to recent calls in the operations management literature for research on public sector operations. Methodology: The study sample comprises detailed archival data on 240 U.S. federal government technology programs across 24 federal agencies. We estimate a negative binomial regression specification that accounts for agency fixed effects and several program-specific characteristics to test four hypotheses on the interrelationships between a program’s scope, granularity, management competency, execution methodology and baseline changes.. Results: The results indicate that program scope is positively associated with the number of baseline changes. However, increasing levels of program granularity and program management competency attenuate this positive relationship. Additional analysis highlights the significant savings in taxpayer contributions that can occur by reducing baseline changes in programs of greater scope through an increase in the levels of program granularity and program management competency. Managerial Implications: The study results emphasize the need for federal agencies to invest greater efforts in granularizing a program and in identifying managers with high levels of program management competency when program scope is high, as such efforts can translate into a reduction in the number of baseline changes. The results also highlight the role of number of baseline changes as a valuable in-process metric for program managers and federal agencies to monitor the execution of federal technology programs and identify programs with greater potential. for experiencing cost overruns.

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.

Background: Heart failure (HF) affects many patients who are older and frail, presenting multiple physical barriers to accessing specialty care in a traditional ambulatory clinic model. Here, we present an assisted virtual care model in which a home visiting nurse facilitated video visits with a HF cardiologist to follow homebound, frail, and older patients with HF. Methods: This is a pragmatic, quasi-experimental, pre–post, single-centre study. It included homebound, frail, and older patients with HF from 2015 to 2019 who were followed for 1 year; in-person clinic visits were completely replaced by nurse-facilitated virtual video visits. Outcomes evaluated included annualized hospitalization rate, number of hospitalization days, and number of emergency department visits. Results: A total of 49 patients were included, with a median age of 86 (83-93) years, and were followed for 1 year after enrollment. Among patients enrolled, HF with preserved ejection fraction was the most common subtype (57%). Compared to the year prior to enrollment, patients had a lower mortality-adjusted all-cause annualized hospitalization rate in the year following enrollment (2.57 vs 1.78, P < 0.0001). Compared to the year prior, the number of mortality-adjusted all-cause hospitalization days was significantly lower in the year following enrollment (27.2 vs 21.4, P < 0.0001). There was a reduction in the number of all-cause annualized emergency department visits (3.10 vs 2.27, P = 0.003). Conclusions: Nurse-assisted virtual visits may be a preferable strategy for homebound, frail, and older patients with HF to receive longitudinal care. This approach may represent a plausible strategy to care for other patients with significant barriers to accessing specialized cardiac care. Résumé: Contexte: L’insuffisance cardiaque (IC) touche de nombreux patients âgés et fragiles, et dresse maints obstacles physiques à l’accès aux soins spécialisés au sein d’un modèle classique de soins cliniques ambulatoires. Dans le présent article, nous exposons un modèle de soins virtuels assistés où une infirmière visiteuse assure par vidéoconsultation, avec un cardiologue, le suivi de patients âgés et fragiles atteints d’IC confinés à la maison. Méthodologie: Une étude monocentrique et pragmatique, quasi expérimentale de type « avant-après », a été menée de 2015 à 2019 auprès de patients âgés et fragiles atteints d’IC confinés à la maison. Les patients ont été suivis durant un an; les consultations en personne ont été entièrement remplacées par des vidéoconsultations effectuées par une infirmière. Les paramètres évalués comprenaient le taux annualisé d’hospitalisation, le nombre de jours d’hospitalisation et le nombre de consultations aux urgences. Résultats: Au total, 49 patients dont l’âge médian était de 86 ans (83-93 ans) ont été suivis durant un an à compter de leur admission à l’étude. L’IC à fraction d’éjection préservée était le sous-type d’IC le plus fréquent (57 %) chez les patients participant à l’étude. Par comparaison à l’année précédente, le taux annualisé d’hospitalisation toutes causes confondues ajusté en fonction de la mortalité a été plus faible chez les patients au cours de l’année où ils ont été suivis dans le cadre de l’étude (2,57 vs 1,78, P < 0,0001). Toujours par comparaison à l’année précédente, le nombre de jours d’hospitalisation toutes causes confondues ajusté en fonction de la mortalité a été significativement inférieur chez les patients au cours de l’année où ils ont été suivis dans le cadre de l’étude (27,2 vs 21,4, P < 0,0001). Le nombre annualisé de consultations aux urgences toutes causes confondues a quant à lui diminué (3,10 vs 2,27, P = 0,003). Conclusions: Les consultations virtuelles assistées par une infirmière peuvent constituer une stratégie à privilégier dans la prestation de soins longitudinaux à des patients âgés et fragiles atteints d’IC qui sont confinés à la maison. Cette approche pourrait représenter une stratégie plausible pour prodiguer des soins à d’autres patients qui sont confrontés à d’importants obstacles limitant leur accès à des soins spécialisés en cardiologie.

The increasing use of smart metering infrastructure invites security threats through trusted insiders in spite of the devices’ authentication phase. Trusted insiders equipped with high privilege are also become vulnerable to being attacked. In the presence of these malicious or compromised insiders, it becomes difficult to achieve an efficient, transparent, reliable, and cost-effective smart grid. Addressing the issues arising from an insider attack, we explore post-authentication attacks and present a reputation score-based model using blockchain technology. The reputation of a device is computed based on the neighbor’s opinion. The opinions and incentives are stored on a blockchain to ensure integrity, availability, and decentralization. We analyze the latency of the proposed model by modifying the open-source Go Ethereum and security effectiveness through a reputation simulator. In addition to this, storage, communication, resource usage overhead, and security requirements are also analyzed to prove the efficiency of the proposed model for the lightweight smart metering infrastructure.

OBJECTIVES Organ failure (OF) and infected necrosis (IN) are the most important predictors of mortality in necrotizing acute pancreatitis (AP). We studied the relationship between timing (onset and duration) and patterns of OF with mortality and the impact of IN on mortality. METHODS Consecutive patients with necrotizing AP between January 2017 and February 2020 were analyzed retrospectively for OF and its impact on outcome. Organ failure was divided as single OF, simultaneous multiple OF (SiMOF) and sequential multiple OF (SeMOF). Mortality was compared for timing of onset, total duration and patterns of OF. RESULTS Among 300 patients with necrotizing AP, 174 (58%) had OF. Mortality was not associated with onset of OF (P = 0.683) but with duration of OF (P = 0.006). Mortalities for single OF, SiMOF, and SeMOF were 11.8%, 30.4%, and 69.2% respectively (P < 0.001). On Cox proportional hazard analysis, adjusted hazard ratio of risk of mortality for OF with IN versus IN, SiMOF versus single OF and SeMOF versus single OF was 3.183, 2.878, and 8.956, respectively (P = 0.023

The Indian Society of Gastroenterology (ISG) felt the need to organize a consensus on Helicobacter pylori (H. pylori) infection and to update the current management of H. pylori infection; hence, ISG constituted the ISG's Task Force on Helicobacter pylori. The Task Force on H. pylori undertook an exercise to produce consensus statements on H. pylori infection. Twenty-five experts from different parts of India, including gastroenterologists, pathologists, surgeons, epidemiologists, pediatricians, and microbiologists participated in the meeting. The participants were allocated to one of following sections for the meeting: Epidemiology of H. pylori infection in India and H. pylori associated conditions; diagnosis; treatment and retreatment; H. pylori and gastric cancer, and H. pylori prevention/public health. Each group reviewed all published literature on H. pylori infection with special reference to the Indian scenario and prepared appropriate statements on different aspects for voting and consensus development. This consensus, which was produced through a modified Delphi process including two rounds of face-to-face meetings, reflects our current understanding and recommendations for the diagnosis and management of H. pylori infection. These consensus should serve as a reference for not only guiding treatment of H. pylori infection but also to guide future research on the subject.

Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD.We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy.Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure.PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.

Subgroup analyses are assessments of treatment effects based on certain patient characteristics out of the total study population and are important for interpretation of pivotal oncology trials. However, appropriate use of subgroup analyses results for regulatory decision-making and product labeling is challenging. Typically, drugs approved by the FDA are indicated for use in the total patient population studied; however, there are examples of restriction to a subgroup of patients despite positive study results in the entire study population and also extension of an indication to the entire study population despite positive results appearing primarily in one or more subgroups. In this article, we summarize key issues related to subgroup analyses in the benefit–risk assessment of cancer drugs and provide case examples to illustrate approaches that the FDA Oncology Center of Excellence has taken when considering the appropriate patient population for cancer drug approval. In general, if a subgroup is of interest, the subgroup analysis should be hypothesis-driven and have adequate sample size to demonstrate evidence of a treatment effect. In addition to statistical efficacy considerations, the decision on what subgroups to include in labeling relies on the pathophysiology of the disease, mechanistic justification, safety data, and external information available. The oncology drug review takes the totality of the data into consideration during the decision-making process to ensure the indication granted and product labeling appropriately reflect the scientific evidence to support patient population for whom the drug is safe and effective.

The glossectomy procedure, involving surgical resection of cancerous lingual tissue, has long been observed to affect speech production. This study aims to quantitatively index and compare complexity of vocal tract shaping due to lingual movement in individuals who have undergone glossectomy and typical speakers using real-time magnetic resonance imaging data and Principal Component Analysis. The data reveal that (i) the type of glossectomy undergone largely predicts the patterns in vocal tract shaping observed, (ii) gross forward and backward motion of the tongue body accounts for more change in vocal tract shaping than do subtler movements of the tongue (e.g., tongue tip constrictions) in patient data, and (iii) fewer vocal tract shaping components are required to account for the patients' speech data than typical speech data, suggesting that the patient data at hand exhibit less complex vocal tract shaping in the midsagittal plane than do the data from the typical speakers observed.

Objectives Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non-dialysis patients. Design/setting/participants A pre- and post-retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). Intervention Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co-management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. Measurements Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. Results Patient characteristics: general rehabilitation patients (n = 1395, mean age = 79.7, 50.1% female) and dialysis rehabilitation patients (n = 838, mean age = 72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD = 5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD = 5.88). Changes in length of stay (24.9%-28.1% reduction) and service interruption frequency (34.3%-49.7% reduction) were also observed. Conclusion Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care.

Clothing plays vital role to maintain heat balance between human body and environment. Heat balance must be maintained to keep a person comfortable. Several factors contribute to the thermal properties of textile material, including structure of yarn and fabric which are the key parameters in deciding fabric thermal behaviour. This paper deals with the study of thermal properties of herringbone weave produced with or without structurally modified wool/polyester yarns in the weft. Experimental results are then compared with results obtained through finite element analysis. In the fabric unit, air occupies more volume as compared to fibre volume. Therefore, air should be considered during finite element analysis to obtain good results. In this research, fabric unit cell used for analysis of thermal resistance consists of two domains i.e, air domain and yarn domain. In steady state thermal study, boundary condition was set as 22 °C at one face as it approaches to a comfortable indoor temperature and other face of fabric was set at 35 °C as it directly contacts human skin, and its temperature is nearly equal to skin temperature. The results obtained through finite element analysis show a good co-relation between experimental and predicted values of thermal resistance.

Public health supply chains are channels through which health commodities are distributed among end clients. In developing countries, significant resource constraints hamper the effective and efficient delivery of health commodities, leading to supply chain failures such as “stock‐outs.” While the prevalence of commodity stock‐outs is well‐acknowledged, there is little by way of systematic and rigorous empirical research that sheds light on the factors that drive such stock‐outs in developing countries. The study documented in this article is anchored in the “logistics cycle” framework that is well‐accepted and widely adopted by organizations involved in managing public health supply chains. Using this framework, we empirically investigate how commodity range and a health facility's logistics management information system (LMIS) practices impact the likelihood of stock‐outs. We estimate our models using a novel field dataset spanning 4000 health facilities across five developing countries. Our results indicate that the likelihood of stock‐outs increases with an expansion in the range of health commodities offered through the public health supply chain. However, the detrimental impact of offering a wider range of health commodities is more severe in resource‐constrained rural facilities relative to their urban counterparts. Further, we find that urban facilities can significantly reduce the likelihood of stock‐outs by updating their LMIS records on a daily basis. However, in rural facilities, daily LMIS updating is beneficial only when used in conjunction with an electronic LMIS. Our findings have implications for resource allocation to reduce the risk of health commodity stock‐outs in developing countries.

The new farm laws remain a contentious issue in the political debates and discussions from their enactment. Protests are being organised across the country for their repeal. Rice is an important crop, produced and consumed by almost every farmer in India. Hence, the issue lodges an important place in the agriculture canvas of the country. In this context, this articles makes the first attempts to discuss the commodity-specific implications of these laws. In this article, we have provided an elaborate view on the three farm laws enacted in the year 2020 namely (1) The Farmers' Produce Trade and Commerce (Promotion and Facilitation) Act, 2020; (2) Farmers (Empowerment and Protection) Agreement on Price Assurance and Farm Services Act, 2020; and (3) Essential Commodities (Amendment) Act, 2020 and discussed their possible implications on rice marketing in India.

Dissolution of one component from multi-component yarn by suitable chemical treatment brought a significant change in structure that ultimately enhance the performance in terms of thermo-physiologi...

Introduction To assess the safety profile of the intravitreal ranibizumab biosimilar molecule, Razumab® (Intas Pharmaceuticals, Ahmedabad, India) in chorioretinal disorders under real-world conditions. Methods This was a multicenter, retrospective chart review which included patients from 15 centers receiving intravitreal Razumab (IVRz) injections from 2016 to 2020. Patient demographics, ocular examination data, and detailed safety information regarding serious adverse events (SAE) or serious adverse drug reactions (sADR), and non-serious AEs (nsAE) or non-serious ADRs (nsADR) occurring within 1 month of IVRz injections were compiled. Results A total of 6404 eyes of 6404 patients received 9406 IVRz injections [mean (± SD) = 1.49 (± 0.63)] during 4.25 years. Adverse events were reported after 1978 injections (21.03%): 64.16% nsAE, 32.96% nsADR, 2.37% sADR, and 0.51% SAE. The most frequent adverse events were subconjunctival hemorrhage (8.2% of total injections), transient blurring of vision (6.5% of total injections), and mild ocular pain (5.27% of total injections). Serious ocular (31 cases with retinal pigment epithelial tears [0.33%], two cases of non-infectious vitritis [0.02%], and one case of endophthalmitis [0.01%]) and systemic (seven patients with non-fatal myocardial infarction [0.12%] and six patients with non-fatal cerebrovascular accident [0.09%]) adverse events were infrequent. Conclusion The study reports the largest pooled safety data on IVRz use in a real-world scenario. The results did not raise any new ocular or systemic safety concerns for the biosimilar agent, with the incidence and spectrum of adverse reactions similar to those reported with other anti-vascular endothelial growth factor (anti-VEGF) drugs. The real-world evidence suggests that IVRz is a safe anti-VEGF agent in the management of chorioretinal disorders. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00345-2.

Drug induced liver toxicity is a serious health complication leading to high mortality rates and post marketing withdrawal of drugs. Although considered to be the gold standard biomarkers; aspartate aminotransferase, alanine aminotransferase, total bilirubin and alkaline phosphatase have been found to have specificities beyond liver, therefore more specific and predictive markers for the detection of antitubercular drug mediated liver damage are required. Unfortunately, the effectiveness of currently used first line antitubercular drugs namely isoniazid, rifampicin, pyrazinamide is often accompanied with liver injury, impeding the cure of patients. Keeping in view, the prognostic and diagnostic applications of microRNAs in various diseases, we tried to assess the importance of microRNAs 122 and 192 in antitubercular drug associated liver injuries. The study included subjects having tuberculosis of any type with antitubercular drug induced liver injury; naïve or newly diagnosed tuberculosis patients, tuberculosis patients on drugs not having toxicity and healthy controls. Observations from this study revealed that expression levels of miR-122 and miR-192 were significantly decreased in the serum of antitubercular drug induced liver injury patients only. Therefore, these microRNAs or the pathways associated with them can be used as a tool to predict or cure antitubercular drug associated liver injury in future.

Objective To describe the demographic and clinical characteristics of frail and homebound community-dwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. Design Retrospective, cross-sectional chart-review study using data from patient records. Setting Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. Patients 171 patients received a HMR between January 1, 2016, and May 31, 2018. Intervention Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. Main Outcome Measures Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. Results Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. Conclusions Frail and homebound community-dwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.

Background: The metabolic syndrome (MetS) is associated with elevated urinary albumin (UA) excretion and C-reactive protein (CRP). However, potential differences in CRP levels on the association between individual components of the MetS and microalbuminuria (MA; 30–300 μg/mL) and/or UA (0–300 μg/mL) by race/ethnicity is unknown. Methods: We analyzed National Health and Nutrition Examination Surveys (NHANES) data, (1999–2010) for adults (≥20 years of age) with the MetS (N = 5700). The Sobel–Goodman mediation test examined the influence of CRP on the association between individual MetS components and both MA and UA by race/ethnicity. We applied machine learning models to predict UA. Results: CRP mediated the association between waist circumference (WC) and MA in Whites and Hispanics but not in Blacks. However, in general, the proportion of the total effect of MetS components on UA, mediated by CRP, was: 11% for high-density lipoprotein cholesterol (HDL-C) and 40% for WC (P

The purpose of this study is to analyze outcomes of combined antegrade–retrograde dilations (CARD). This retrospective study was conducted on 14 patients with a history of head and neck cancer, treated with radiation therapy that was complicated by either complete or near-complete esophageal stenosis. All patients had minimal oral intake and depended on a gastrostomy tube for nutrition. Swallow function before and after CARD was assessed using the Functional Oral Intake Scale, originally developed for stroke patients and applied to head and neck cancer patients. Patients undergoing CARD demonstrated a quantifiable improvement in swallow function (p = 0.007) that persisted at last known follow-up (p = 0.015) but only a minority (23.1%) achieved oral intake sufficient to obviate the need for tube feeds. Complication rates were 24% per procedure or 36% per patient, almost all complications required procedural intervention, and all complications occurred in patients with complete stenosis. Our study suggests further caution when considering CARD, careful patient selection, and close post-operative monitoring.

Introduction The vast Indian population represents a potential case load of rotator cuff (RC) tears in the millions and repair options include both open and arthroscopic techniques. Indian shoulders are different from Western shoulders both in terms of morphology and functional demand. Despite this, the uptake of shoulder surgery in India has been extremely slow, due to various factors. Aims/objective The purpose of this review is to better understand functional outcomes of rotator cuff repair (RCR) in the Indian population. This will help Indian surgeons to discuss outcomes with their patients in an evidence based manner and provide for cross study comparisons of new data. Methods A search of online databases (Cochrane, Embase, Medline and Google Scholar) was performed for the period of January 2001–March 2020. Specific inclusion and exclusion criteria were adopted for the purposes of systematic review according to PRISMA guidelines. The primary outcome was assessment of functional outcome using validated instruments (such as UCLA score, ASES score etc.). Results A total of fourteen studies representing a pooled patient population set of 785 patients were included in this review. Of the fourteen studies included in this review, a total of three studies evaluated functional outcomes after mini-open repair whereas eleven studies evaluated outcomes after arthroscopic rotator cuff repair (ARCR). The pooled mean outcome measured showed significant improvement (pre-operative vs post-operative; average follow-up); CM 12 months), UCLA (11 (+/- 5) vs 31 (+/- 1); 26 months), ASES (25 (+/- 5) vs 84 (+/- 4); 12 months), and VAS (8 (+/- 1) vs 1.0; 22 months). Conclusion Overall the studies included in this systematic review show a significant improvement in functional outcomes. Both mini-open and arthroscopic repair offer favourable outcomes for RCR in the Indian population, and there appears to be no difference in outcome measures between single and double row repairs. Most of the studies included in this systematic review offer weak evidence and are underpowered, hence further studies with more patients and better design are needed to validate these findings. Level of Evidence Systematic review Level III.

BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.ConclusionsHarmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.

Study the clinical profile of meconium aspiration syndrome (MAS) in neonates, in relation to birth weight, gestational age and their immediate outcome. Prospective observational cross sectional study. All preterm, term and post term infants, appropriate for gestational age with birth weight, delivered normally or by caesarean section or forceps, fulfilling all the inclusion criteria for MAS who were admitted to NICU, during the 9 months from January 2020 to September 2020 were included in the study. Over nine months' period, 574 neonates were admitted in NICU under that 312 neonates were in respiratory distress, out of which78 neonates were suffered with MAS. A detailed antenatal and natal history was elicited. Complications during delivery and details of resuscitation at birth, was done wherever required. Endo-tracheal intubation was done and bag and tube ventilation was given wherever needed. In MAS neonates, APGAR score at 1 minute and 5 minutes and gestational age was assessed with New Ballard’s score. A detailed clinical examination was carried out and respiratory distress was monitored by using Downes score system. Score > 6 was taken as an indication for assisted ventilation. 574 babies were admitted to NICU during the study period and out of them 312 were with respiratory distress. During the study period 78 (25%) babies had MAS. Conservative management was given to 59 cases (75.64%) and only 19 cases (24.36%) needed artificial ventilation, where indication was birth asphyxia, acute respiratory failure or other complications like pneumothorax. Out of 19 ventilated babies, 15 babies died and 4 babies survived and were discharged in good health. Conclusions: 1.Increased incidence of meconium aspiration syndrome was associated with increase in the gestational age (more in term and post term neonate, birth weight > 2.5kgs, 2. Highest mortality was associated with thick meconium and with low APGAR score at 5 minutes.

BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection (≥ 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home- and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination.

Background: Assessment of abnormal biomechanics, anatomical differences is the part and parcel of preparticipation evaluation. This can provide useful information about the cause and mechanism of certain sports injury, and strategies for injury prevention. However, there have been only few previous investigations which can conclusively correlate certain foot type with specific knee injury. Objective: To determine any relationship between foot type and ACL injury. Method: A Case- Control study design was adopted for this clinical study to investigate foot- type as a risk factor for ACL injury.35 professional football players with a surgical history of ACL reconstruction and 35 professional football players without any history of ACL injury participated in our study. Foot types were determined by measuring their medial longitudinal arch angle and rearfoot-leg eversion angle. Questionnaire which included other variables of ACL injury were filled and analyzed to eliminate their interference in this study. Results: There was a significant relationship between pronated foot type as a risk factor for ACL injury. The Odds ratio calculated {OR=6.44, Lower limit=2.134(95% Confidence interval)} , suggested the acceptance of alternative hypothesis of pronated foot’s correlation to ACL injury. Conclusions: This suggests that pronated foot is a risk factor for ACL injury in football players. How to cite this article: Vivek KS, Zutshi K, Wardhan D. Is Foot Type an Indicator of Anterior Cruciate Ligament Injury in Football Players? Ind J Youth Adol Health 2020; 7(2): 16-22. DOI: https://doi.org/10.24321/2349.2880.202009

Acute pancreatitis (AP) is a common disorder with high mortality in severe cases. Several markers have been studied to predict development of severe AP (SAP) including serum resistin with conflicting results. This study aimed at assessing the role of baseline serum resistin levels in predicting SAP.This prospective study collected data from 130 AP patients from July 2017 to Nov 2018. Parameters measured included demographic profile, serum resistin at admission, severity scores, hospital stay, surgery, and mortality. Patients were divided into two groups, severe and non-severe AP. The two groups were compared for baseline characteristics, serum resistin levels, hospital stay, surgery and mortality.Among 130 patients, 53 patients had SAP. SAP patients had higher BMI, baseline CRP, APACHE II and CTSI scores (We found that serum resistin is not a useful marker for predicting the severity of AP and does not correlate with increasing body weight.

Background Clinical trials show that antimicrobial-impregnated central venous catheters reduce catheter-related bloodstream infection in adults and children receiving intensive care, but there is insufficient evidence for use in newborn babies. Objectives The objectives were (1) to determine clinical effectiveness by conducting a randomised controlled trial comparing antimicrobial-impregnated peripherally inserted central venous catheters with standard peripherally inserted central venous catheters for reducing bloodstream or cerebrospinal fluid infections (referred to as bloodstream infections); (2) to conduct an economic evaluation of the costs, cost-effectiveness and value of conducting additional research; and (3) to conduct a generalisability analysis of trial findings to neonatal care in the NHS. Design Three separate studies were undertaken, each addressing one of the three objectives. (1) This was a multicentre, open-label, pragmatic randomised controlled trial; (2) an analysis was undertaken of hospital care costs, lifetime cost-effectiveness and value of information from an NHS perspective; and (3) this was a retrospective cohort study of bloodstream infection rates in neonatal units in England. Setting The randomised controlled trial was conducted in 18 neonatal intensive care units in England. Participants Participants were babies who required a peripherally inserted central venous catheter (of 1 French gauge in size). Interventions The interventions were an antimicrobial-impregnated peripherally inserted central venous catheter (coated with rifampicin–miconazole) or a standard peripherally inserted central venous catheter, allocated randomly (1 : 1) using web randomisation. Main outcome measure Study 1 – time to first bloodstream infection, sampled between 24 hours after randomisation and 48 hours after peripherally inserted central venous catheter removal. Study 2 – cost-effectiveness of the antimicrobial-impregnated peripherally inserted central venous catheter compared with the standard peripherally inserted central venous catheters. Study 3 – risk-adjusted bloodstream rates in the trial compared with those in neonatal units in England. For study 3, the data used were as follows: (1) case report forms and linked death registrations; (2) case report forms and linked death registrations linked to administrative health records with 6-month follow-up; and (3) neonatal health records linked to infection surveillance data. Results Study 1, clinical effectiveness – 861 babies were randomised (antimicrobial-impregnated peripherally inserted central venous catheter, n = 430; standard peripherally inserted central venous catheter, n = 431). Bloodstream infections occurred in 46 babies (10.7%) randomised to antimicrobial-impregnated peripherally inserted central venous catheters and in 44 (10.2%) babies randomised to standard peripherally inserted central venous catheters. No difference in time to bloodstream infection was detected (hazard ratio 1.11, 95% confidence interval 0.73 to 1.67; p = 0.63). Secondary outcomes of rifampicin resistance in positive blood/cerebrospinal fluid cultures, mortality, clinical outcomes at neonatal unit discharge and time to peripherally inserted central venous catheter removal were similar in both groups. Rifampicin resistance in positive peripherally inserted central venous catheter tip cultures was higher in the antimicrobial-impregnated peripherally inserted central venous catheter group (relative risk 3.51, 95% confidence interval 1.16 to 10.57; p = 0.02) than in the standard peripherally inserted central venous catheter group. Adverse events were similar in both groups. Study 2, economic evaluation – the mean cost of babies’ hospital care was £83,473. Antimicrobial-impregnated peripherally inserted central venous catheters were not cost-effective. Given the increased price, compared with standard peripherally inserted central venous catheters, the minimum reduction in risk of bloodstream infection for antimicrobial-impregnated peripherally inserted central venous catheters to be cost-effective was 3% and 15% for babies born at 23–27 and 28–32 weeks’ gestation, respectively. Study 3, generalisability analysis – risk-adjusted bloodstream infection rates per 1000 peripherally inserted central venous catheter days were similar among babies in the trial and in all neonatal units. Of all bloodstream infections in babies receiving intensive or high-dependency care in neonatal units, 46% occurred during peripherally inserted central venous catheter days. Limitations The trial was open label as antimicrobial-impregnated and standard peripherally inserted central venous catheters are different colours. There was insufficient power to determine differences in rifampicin resistance. Conclusions No evidence of benefit or harm was found of peripherally inserted central venous catheters impregnated with rifampicin–miconazole during neonatal care. Interventions with small effects on bloodstream infections could be cost-effective over a child’s life course. Findings were generalisable to neonatal units in England. Future research should focus on other types of antimicrobial impregnation of peripherally inserted central venous catheters and alternative approaches for preventing bloodstream infections in neonatal care. Trial registration Current Controlled Trials ISRCTN81931394. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 57. See the NIHR Journals Library website for further project information.

A High Aspect Ratio (HAR) electrostatic comb-drive microactuator of polymethyl-methacrylate (PMMA) is designed to deliver nearly 40 µm uniaxial displacement at 25 V DC. The HAR comb-drive microstructures are fabricated via one-step X-ray lithography (OXL). Polyimide-Au X-ray mask is fabricated and used to pattern 200 μm, 500 μm and 800 μm thick PMMA by deep X-ray lithography (DXRL), followed by drying/release and selective metallization for the development of HAR electrostatic microactuator. The release was optimized with the help of various low-surface-tension liquids. 200 μm and 500 μm thick microstructures were successfully released whereas, 800 μm structures could not be released due to the higher depth and associated capillary force. In addition, non-uniform distribution of Au on the side walls of overlapped region of comb fingers, during metallization, resulted in uneven distribution of electrostatic force followed by short-circuiting of HAR (i.e. 40) microactuator. These are the potential issues in the fabrication of HAR microstructures and devices by OXL and discussed in details in this paper.

Purpose The development and application of intelligent models to perform vibration-based condition monitoring in industry seems to be receiving attention in recent years. A number of such research studies using the artificial intelligence, machine learning, pattern recognition, etc., are available in the literature on this topic. These studies essentially used the machine vibration responses with known machine faults to develop smart fault diagnosis models. These models are yet to be tested for all kinds of machine faults and/or different operating conditions. Therefore, the purpose is to develop a generic machine faults diagnosis model that can be applied blindly to any identical machines with high confidence level in accuracy of the predictions. Methods In this paper, a supervised smart fault diagnosis model is developed. This model is developed using the available measured vibration responses for the different rotor faults simulated on an experimental rotating rig operating at a constant speed. The developed smart vibration-based machine learning (SVML) model is then blindly tested to identify the healthy and faulty conditions of the rig when operating at different speeds. Results and conclusions Several scenarios are proposed and examined during the development of the SVML model. It is observed that scenario of the vibration measurements simultaneously from all bearings from a machine is capable to fully map the machine dynamics in the VML model. Therefore, this developed when applied blindly to the sets of data at a different machine speed, the results are observed to be encouraging. The results clearly show a possibility for a centralised vibration-based condition monitoring (CVCM) model for identical machines operating at different rotating speeds.

Objectives This study aimeded to examine acute and late effects of five consecutive sessions of Swedish massage on hamstring flexibility and agility of players.Methods: Arandom sample of 34 female players having bilateral tight hamstrings [passive straight leg raise ≤70° and active knee extension test ≥ 30°] was randomly allocated to two equal groups. Study design involved 7 minute massage given on each posterior thigh for 5 continuous days; followed by 5 days of no massage. Experimental group received classical Swedish massage whereas control group received only superficial stroking. Outcome measures were Passive straight leg raise [PSLR], Active knee extension test [AKET], Passive knee extension test [PKET], Back saver sit and reach test [BSSR] for flexibility and 5-0-5 change of direction test for agility measured pre and post intervention on each days of massage and also on 10th day. Two way ANOVA with post hoc t-test was the tool of statistical analysis with significance level 0.05.Results: Significant [p ≤ 0.05] post intervention increase in all parameters of flexibility was observed each day in experimental group within PSLR (8%–12% ↑), AKET (10%24% ↓) and PKET (12%–30% ↓) and highly significant (p ≤ 0.001) increase on 5th and 10th day in BSSR (4%–21% ↑) for both legs. Pre and post intervention values for control group were not significantly different. No significant changes were observed in agility performance of both groups.Conclusion: Swedish massage of posterior thigh appears to acutely increase flexibility of hamstrings in female athletes, which persisted for 5 days even after cessation of massage.

Despite several recent advances in therapy in inflammatory bowel disease (IBD), 5-aminosalicylic acid (5-ASA) therapy has retained its place especially in ulcerative colitis. This consensus on 5-ASA is obtained through a modified Delphi process, and includes guiding statements and recommendations based on literature evidence (randomized trials, and observational stud ies), clinical practice, and expert opinion on use of 5-ASA in IBD by Indian gastroenterologists. The aim is to aid practitioners in selecting appropriate treatment strategies and facilitate optimal use of 5-ASA in patients with IBD. (Intest Res 2020;18:355-378)

Operations planning and management of a large open pit mine is an enormous and complex task, particularly for mines having long life. The long-term planning of open pit mine is a dynamic process and should be reviewed periodically for enhancing the NPV and life of mine. Pit optimization through soft computing can be gainfully applied to resolve a number of important problems that arise in developing suitable planning strategies and management of a mine. Pit optimization starts with the assumption of initial production capacities and the estimates for the related costs and commodity prices. Once the economic parameters are known, the analysis of the ultimate pit limits of the mine is undertaken to determine the portion of the deposit that can be mined economically and safely from geotechnical stability view point. In this research, pit optimization for a heterogeneous iron ore deposit (Deposit-A) has been carried out successfully using Whittle Software. The key aspect investigated was the optimal pit shell across a range of selling prices, as it enables understanding the characteristics of the deposit and potential development strategies considering the areas of greater value. The methodology can be very well utilized when fluctuations in the selling price occur, for predicting the future selling price of the commodity and also strategizing mining plan. For the deposit investigated, it was found that the mine is likely to generate final product of 66.55 MT of Lump Ore (+ 10 mm − 150 mm) and Fines Ore 156.45 MT (− 10 mm) during the life of the mine. The NPV is found to be highly sensitive to the price of Fine ore as quantity of fines in total ore body is around 70%. Except waste, all ore types, no matter how inferior the grade is having (around 10 MT of low grade coming in between Fe @ 45% and Fe @ 25% can be also utilized), are mineable and can be suitably blended to give a product mix of Fe @ 61.68% and more.

Background Aorto-oesophageal fistula (AOF) is a rare, catastrophic disease with an extremely poor prognosis. A ruptured thoracic aortic aneurysm is a common aetiology for AOF. The clinical presentation is usually massive haematemesis and collapse. Timely diagnosis and appropriate treatment are crucial in managing AOF.Case summary We hereby report two cases of AOF, who underwent successful emergency thoracic endovascular aortic repair (TEVAR) to control active bleed and exsanguination. Case 1, an elderly lady with atherosclerotic aneurysm had TEVAR followed by open surgery for oesophageal rent and necrosed left main bronchus. Case 2 had mycotic tubercular aneurysm who later had infected graft-stent following TEVAR.Discussion Open surgery is the conventional treatment for AOF; however, TEVAR can be an alternative and less invasive approach in selected high-risk patients. Various management issues related to TEVAR with AOF have been discussed in the article.

Background Early ambulation of patients with total joint replacement (TJR) has been shown to improve outcomes while reducing length of stay and postoperative complications. Limited physical therapy (PT) resources and late-in-the-day cases may challenge day-of-surgery (POD0) ambulation. At our institution, a Mobility Technician (MT) program, composed of specially trained nurse's aides, was developed to address this issue. Purpose The purpose of this study was to compare the effectiveness of the MT model with a traditional PT model in the early ambulation of patients with TJR. Methods Patients undergoing unilateral primary TJR at a single institution between June 1, 2014, and October 31, 2018, were included. Ambulation measures were retrospectively assessed between pre- and post-MT program groups. Results This study included 11,777 patients with TJR. Following the MT program, number of POD0 ambulations, POD0 ambulation distance, and total distance ambulated all increased while time-to-first ambulation decreased. Conclusion Preliminary analyses indicate that the MT program has been successful in the early ambulation of patients with TJR.

Background and study aims Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation. Patients and methods EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures. Results Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) (P = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures (P = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations (P = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and muscularis propria (2.14 vs. 5.80; P = 0.001). Conclusion EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.

Intra-abdominal hypertension (IAH) can adversely affect the outcome in patients of acute pancreatitis (AP). Effect of percutaneous drainage (PCD) on IAH has not been studied. We studied the effect of PCD on IAH in patients with acute fluid collections.Consecutive patients of AP undergoing PCD between Jan 2016 and May 2018 were evaluated for severity markers, clinical course, hospital and ICU stay, and mortality. Patients were divided into two groups: with IAH and with no IAH (NIAH). The two groups were compared for severity scores, organ failure, hospital and ICU stay, reduction in IAP and mortality.Of the 105 patients, IAH was present in 48 (45.7%) patients. Patients with IAH had more often severe disease, BISAP ≥2, higher APACHE II scores and computed tomography severity index (CTSI). IAH group had more often OF (87.5% vs. 70.2%, p = 0.033), prolonged ICU stay (12.5 vs. 6.75 days, p = 0.007) and higher mortality (52.1% vs. 15.8%, p 0.001). After PCD, IAP decreased significantly more in the IAH group (21.85 ± 4.53 mmHg to 12.5 ± 4.42 mmHg) than in the NIAH group (12.68 ± 2.72 mmHg to 8.32 ± 3.18 mmHg), p =0.001. Reduction of IAP in patients with IAH by40% at 48 h after PCD was associated with better survival (63.3% vs. 36.7%, p = 0.006).We observed that patients with IAH have poor outcome. PCD decreases IAP and a fall in IAP40% of baseline value predicts a better outcome after PCD in patients with acute fluid collections.

Splanchnic vein thrombosis is an uncommon life-threatening form of venous thrombosis. It is one the common complication among MPN’s. In the western studies the prevalence of JAK2V617F mutation among SVT patient is high and ranges from 7 to 59%. The frequency of this mutation among Indian SVT patients is heterogenous. This was a prospective case control study. A total 52 cases of SVT and 40 controls were screened for JAK2V617F mutation along with other routine thrombophilic risk factors. Out of total 52 cases, 10 had BCS, 2 had MVT and rest 40 were of PVT/EHPVO. The JAK2V617F mutation was seen in two cases and not in controls. Among the thrombophilic markers, heterozygous FVL mutation, PC, PS and presence of APA were seen in 2, 3, 1 and 3 cases respectively. In addition, eight cases also showed deranged risk factors (5 inherited and 3 acquired), however the repeat testing was not performed due to loss of follow up. Among controls, one person showed presence of APA and one person showed multiple thrombophilic risk factor deficiency. JAK2V617F mutation was observed in 3.8% among north Indian SVT patients. The frequency of mutation is on the lower side as compared to the available Indian data. The other thrombophilia markers (both inherited and acquired) are more frequent (18%) and patients should be routinely screened for these thrombophilia markers.

Of late, intensive farming for higher food production is often associated with many negative implications for soil systems, such as decline of soil organic matter (SOM), increase in risks of soil erosion by wind and/or water, decline in soil biological diversity, increase in degradation of soil physical quality, lower nutrient-use efficiency, high risks of groundwater pollution, falling water tables, increasing salinization and waterlogging, in-field burning of crop residues, pollution of air and emission of greenhouse gases (GHG), leading to global warming, and decline in factor productivity. These negative implications necessitate an objective review of strategies to develop sustainable management practices, which could not only sustain soil health and ensure food security, but also enhance carbon sequestration, decrease GHG emissions, and offer clean and better ecosystem services. Conservation agriculture (CA), that includes reduced or no-till practices along with crop residue retention and mixed crop rotations, offers multiple benefits. Adoption of a system-based CA conserves water, improves and creates more efficient use of natural resources through the integrated management of available soil nutrients, water, and biological resources, and enhances use efficiency of external inputs. Due to apparent benefits of CA, it is increasingly being adopted and now covers about 180 million hectares (Mha) worldwide. However, in South Asia its spread is low (

This study analyzed the determinants of morbidity, mortality, and case fatality rate (CFR) of the ongoing pandemic of severe acute respiratory syndrome coronavirus-2 disease 2019 (COVID-19). Data for 210 countries and territories available in public domains were analyzed in relation to mandatory vaccination with Bacille-Calmette-Guerin (BCG), population density, median age of the country population, health care expenditure per capita, life expectancy at birth, healthy life expectancy, literacy rate, per capita gross domestic production adjusted to purchasing power (PPP), burden of tuberculosis (TB), acquired immunodeficiency disease caused by human immunodeficiency virus (HIV-AIDS), malaria, cardiovascular disease (CVD), neoplasm, diabetes, deaths due to energy-protein (food) deficiency (EPD), and per capita government spending on safe water and sanitation. Mandatory BCG vaccination showed a highly significant (p

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports sug...

As high-income countries face the challenge of providing better and more efficient integrated health and social care to high-needs and high-cost populations, they may require innovative policy supp...

The anatomy of the neck is complex and the pathology derived from this is myriad. Despite this, consideration of the age of onset, and knowledge of natural history and typical behavior patterns can lead to the correct diagnosis in most cases of unknown swelling, lump, or sepsis.

This is defined as short lingual frenulum, which restricts tongue movement and may interfere with tooth development.

Background: Aim: To evaluate the usefulness of regular monitoring of blood glucose in early diagnosis of hypoglycemia in breastfed late preterm neonate. A total of 100 consecutively born bre Methods: astfed late preterm neonates were studied and assessed for development of hypoglycemia against age of onset, symptomatology, gestational age and sex of the baby, parity and age of mother, and mode of delivery. Serial blood glucose was done at 0, 1, 3, 6, 12, 24, 48 and 72 hours of life to identify hypoglycemia. Blood glucose was estimated from heel prick capillary samples using glucometer. Association of both maternal and neonatal risk factors was studied in relation to hypoglycemia. The overall incidence of hypoglycemia was 15%. O Results: ut of 15 hypoglycemic babies 12(80%) developed symptoms and only 3(20%) were asymptomatic. Most (90%) of the hypoglycemia occurred on the rst day of life. Babies born to primi mothers were more prone for hypoglycemia (25%). Highest incidence was seen in babies weighing less than 2 kg (50%). Symptoms of hypoglycemia included poor feeding (66%), lethargy (58%), jitteriness (41%), and weak cry (25%). Th Conclusion: ere is a signicant incidence of hypoglycemia in late preterm babies in spite of being on breast feeds. Babies born to primiparous mothers are more prone for hypoglycemia. Also hypoglycemia was very high in babies having birth weight below 2 kg. Therefore it is very important to regularly monitor the blood glucose levels in all late preterm babies even if they are on exclusive breast feeding.

Power has totally different attributes than other material commodities as electrical energy stockpiling is a costly phenomenon. Since it should be generated when demanded, it is necessary to forecast its demand accurately and efficiently. As electrical load data is represented through time series pattern having linear and non-linear characteristics, it needs a model that may handle this behavior well in advance. This paper presents a scalable and hybrid approach for forecasting the power load based on Vector Auto Regression (VAR) and hybrid deep learning techniques like Long Short Term Memory (LSTM) and Convolutional Neural Network (CNN). CNN and LSTM models are well known for handling time series data. The VAR model separates the linear pattern in time series data, and CNN-LSTM is utilized to model non-linear patterns in data. CNN-LSTM works as CNN can extract complex features from electricity data, and LSTM can model temporal information in data. This approach can derive temporal and spatial features of electricity data. The experiment established that the proposed VAR-CNN-LSTM(VACL) hybrid approach forecasts better than more recent deep learning methods like Multilayer Perceptron (MLP), CNN, LSTM, MV-KWNN, MV-ANN, Hybrid CNN-LSTM and statistical techniques like VAR, and Auto Regressive Integrated Moving Average (ARIMAX). Performance metrics such as Mean Square Error, Root Mean Square Error, and Mean Absolute Error have been used to evaluate the performance of the discussed approaches. Finally, the efficacy of the proposed model is established through comparative studies with state-of-the-art models on Household Power Consumption Dataset (UCI machine learning repository) and Ontario Electricity Demand dataset (Canada).

Atherosclerosis is a chronic inflammatory disease that may ultimately lead to local proteolysis, plaque rupture, and thrombotic vascular disease, resulting in myocardial infarction, stroke, and sudden cardiac death. Circulating monocytes are recruited to the arterial wall in response to inflammatory insults and differentiate into macrophages which make a critical contribution to tissue damage, wound healing, and also regression of atherosclerotic lesions. Within plaques, macrophages take up aggregated lipoproteins which have entered the vessel wall to give rise to cholesterol-engorged foam cells. Also, the macrophage phenotype is influenced by various stimuli which affect their polarization, efferocytosis, proliferation, and apoptosis. The heterogeneity of macrophages in lesions has recently been addressed by single-cell sequencing techniques. This article reviews recent advances regarding the roles of macrophages in different stages of disease pathogenesis from initiation to advanced atherosclerosis. Macrophage-based therapies for atherosclerosis management are also described.

Objective Guidelines for a structured assessment in community paramedicine home visit programmes have not been established and evidence to inform their creation is lacking. We sought to investigate the relevance of assessment items to the practice of community paramedics according to a pre-established clarity-utility matrix. Design We designed a modified-Delphi study consisting of predetermined thresholds for achieving consensus, number of rounds of for scoring items, a defined meeting and discussion process, and a sample of participants that was purposefully representative. Setting and participants We established a panel of 26 community paramedics representing 20 municipal paramedic services in Ontario, Canada. The sample represented a majority of paramedic services within the province that were operating a community paramedicine home visit programme. Measures Drawing from a bank of standardised assessment items grouped according to domains aligned with the International Classification on Functioning, Disability, and Health taxonomy, 64 previously pilot-tested assessment items were scored according to their clarity (being free from ambiguity and easy to understand) and utility (being valued in care planning or case management activities). Assessment items covered a broad range of health, social and environmental domains. To conclude scoring rounds, assessment items that did not achieve consensus for relevance to assessment practices were discussed among participants with opportunities to modify assessment items for subsequent rounds of scoring. Results Resulting from the first round of scoring, 54 assessment items were identified as being relevant to assessment practices and 3 assessment items were removed from subsequent rounds. The remaining 7 assessment items were modified, with some parts removed from the final items that achieved consensus in the final rounds of scoring. Conclusion A broadly representative panel of community paramedics identified consensus for 61 assessment items that could be included in a structured, multidomain, assessment instrument for guiding practice in community paramedicine home visit programmes. Trail registration number NCT58273216.

ObjectiveTo evaluate the impact of early intervention using combined swallow therapy, consisting of traditional swallow exercises and transcutaneous neuromuscular electrical stimulation, on patients with advanced oropharyngeal squamous cell carcinoma.MethodsA cohort study of 60 prospectively enrolled patients was performed. Thirty patients with advanced oropharyngeal squamous cell carcinoma starting combined swallow therapy two weeks after surgery that continued throughout chemoradiotherapy were compared with a matched cohort of 30 patients starting combined swallow therapy after cancer treatment completion. Gastrostomy tube status, modified barium swallow, and Functional Oral Intake Scale scores were assessed before and after therapy.ResultsBoth cohorts demonstrated a statistically significant improvement in Functional Oral Intake Scale scores. All patients in the early intervention cohort discontinued gastrostomy tube use, compared with one-third in the control cohort, with greater improvements in Functional Oral Intake Scale scores. The tongue base was the site of greatest improvement in the early intervention group.ConclusionEarly initiation of combined swallow therapy may optimise swallow outcomes in patients with advanced oropharyngeal squamous cell carcinoma.