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Introduction Cardiovascular disease (CVD) is a critical public health issue, with tobacco smoking the leading preventable cause. Perceptions of CVD risk in specific populations may differ by tobacco use status, potentially necessitating customized tobacco prevention measures. Methods Using data from the Youth Appalachian Tobacco Study (n=1104), CVD risk perceptions were defined by responses to three statements: ‘smoking causes heart disease’, ‘smoking causes strokes’ and ‘smoking causes high blood pressure’. Tobacco use status was characterized as never users, ever cigarette users, and ever non-cigarette users. Sociodemographic differences in CVD risk perceptions and tobacco use status were evaluated. Logistic regression analyses, adjusted for gender, race/ethnicity, and household tobacco use, were conducted. Results Among the sample, 24.1% were ever cigarette users and 10.1% were ever non-cigarette users. Compared to never users, ever cigarette users had higher odds of disagreeing that smoking causes heart disease (AOR=1.83; 95% CI: 1.23–2.73), stroke (AOR=1.54; 95% CI: 1.08–2.18) and hypertension (AOR=1.41; 95% CI: 1.00–1.99). White youth (vs racial/ethnic minorities) had fewer odds of disagreeing that smoking causes hypertension (AOR=0.44; 95% CI: 0.29– 0.68), and females (vs males) had fewer odds of disagreeing that smoking causes heart disease (AOR=0.69; 95% CI: 0.48–0.99). Conclusions Among Appalachian youth, CVD risk perceptions differed by tobacco use status and sociodemographic groups, such as race/ethnicity and gender. Findings from this study may be helpful in development of tobacco prevention efforts, such as health messaging for Appalachian youth.

This work aims to test the effectiveness of newly developed DFT-1/2 functional in calculating the electronic and optical properties of inorganic lead halide perovskites CsPbBr3. Herein, from DFT-1/2 we have obtained the direct band gap of 2.36 eV and 3.82 eV for orthorhombic bulk and 001-surface, respectively. The calculated energy band gap is in qualitative agreement with the experimental findings. The bandgap of ultra-thin film of CsPbBr3 is found to be 3.82 eV, which is more than the expected range 1.23-3.10 eV. However, we have found that the bandgap can be reduced by increasing the surface thickness. Thus, the system under investigation looks promising for optoelectronic and photocatalysis applications, due to the bandgap matching and high optical absorption in UV–Vis (Ultra violet and visible spectrum) range of electro-magnetic(em) radiation.

We report the comparative study of electronic and optical properties of (6,1) SWCNT from GGA and DFT-1/2 methods. (6,1) SWCNT is a low-bandgap semiconductor, which falls within ( $$n_1-n_2$$ )/3 $$\ne \,$$ integer. The calculated bandgaps are 0.371 eV and 0.462 eV from GGA and DFT-1/2, respectively. Thus, DFT-1/2 enhanced the electronic bandgap by 24.52%. From both GGA and DFT-1/2 approaches (6,1) SWCNT exhibits an indirect bandgap along $$\Gamma -\Delta$$ symmetry. However, the percentage change in direct–indirect bandgap is negligibly small, i.e., 4.1% and 3.7% from GGA and DFT-1/2, respectively. The refractive index measured along x-axis ( $$n_{x}$$ ) approaches unity, indicating transparent behaviour, while that along z-axis ( $$n_{z}$$ ) goes as high as $$\sim$$ 3.82 for photon energy $$0.0-0.15$$ eV, exhibiting opaque behaviour. Again, the value of $$n_z$$ drops below unity at photon energy $$\sim$$ 0.18 eV and again approaches $$\sim$$ 1 for higher energy ranges. The optical absorption is highly anisotropic and active within the infrared region.

Machine learning has been a trending topic for which almost every research area would like to incorporate some of the technique in their studies. In this paper, we demonstrate several machine learning models using two different data sets. One data set is the thermograms time series data on a cancer study that was conducted at the University of Louisville Hospital, and the other set is from the world-renowned Framingham Heart Study. Thermograms can be used to determine a patient’s health status, yet the difficulty of analyzing such a high-dimensional dataset makes it rarely applied, especially in cancer research. Previously, Rai et al.1 proposed an approach for data reduction along with comparison between parametric method, non-parametric method (KNN), and semiparametric method (DTW-KNN) for group classification. They concluded that the performance of two-group classification is better than the three-group classification. In addition, the classifications between types of cancer are somewhat challenging. The Framingham Heart Study is a famous longitudinal dataset which includes risk factors that could potentially lead to the heart disease. Previously, Weng et al.2 and Alaa et al.3 concluded that machine learning could significantly improve the accuracy of cardiovascular risk prediction. Since the original Framingham data have been thoroughly analyzed, it would be interesting to see how machine learning models could improve prediction. In this manuscript, we further analyze both the thermogram and the Framingham Heart Study datasets with several learning models such as gradient boosting, neural network, and random forest by using SAS Visual Data Mining and Machine Learning on SAS Viya. Each method is briefly discussed along with a model comparison. Based on the Youden’s index and misclassification rate, we select the best learning model. For big data inference, SAS Visual Data Mining and Machine Learning on SAS Viya, a cloud computing and structured statistical solution, may become a choice of computing.

Background To evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 CK, USMLE Step 3, and residency third-year in-service training exam (ITE) scores predict the results of American Board of Internal Medicine Certifying Exam (ABIM-CE). Methods We performed a retrospective review of USMLE Step 1, USMLE Step 2 CK, USMLE Step 3, third-year residency ITE scores and ABIM-CE results of IM residents at our residency program from 2004 through 2017. Statistical analysis was perfrormed using Pearson correlation coefficient, and logistic regression to assess the relationship between USMLE Step 1, USMLE Step 2CK, USMLE Step 3, 3rd year ITE scores and ABIM-CE results. We used Multivariate logistic regression to predict pass or fail results in ABIM-CE based on USMLE and third-year ITE test scores controlling for other covariates. Results Among 114 Internal Medicine MD residents included in the study, 92% (n = 105) passed the ABIM-CE. The OR of passing ABIM-CE was 2.70 (95% CI = 1.38–5.29), 2.31 (95% CI = 1.33–4.01), and 1.63 (95% CI = 0.81–3.29) with a ten-point increase in USMLE Step 1, USMLE Step 2 CK and USMLE Step 3 scores respectively. The OR of ABIM-CE passing chance was 2.96 (95% CI = 0.95–9.20), with a ten-point increase in the average score of the above three exams. A 5 % increase in ITE percentage raised the likelihood of passing ABIM-CE (OR 2.92, 95% CI 1.15–7.38). All residents who failed ABIM-CE had Step 1 scores n = 6) failed ABIM. Similarly, 9% of residents with USMLE Step 3 score Conclusion USMLE Step 1, USMLE Step 2 CK, and third-year ITE scores can predict the chances of passing ABIM-CE. The third-year ITE score has a higher preditive value compared to USMLE Step 1 and USMLE Step 2 scores. USMLE Step 1 scores more predictive of ABIM-CE results compared to USMLE Step 2CK scores. Thus, residency programs can identify internal medicine residents at risk of failing ABIM-CE and formulate interventions at an early stage during residency training. Measures such as enrolling them in question banks or board review courses can be helpful in improving their chances of passing ABIM-CE.

In this work, we present our predictions on lithium niobate LiNbO3 concerning its structural, electronics, thermal and optical properties. These predictions are done by means of first-principles ca...

Non-vitamin K antagonist oral anticoagulants (NOACs) include thrombin inhibitor dabigatran and coagulation factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban. NOACs have several benefits over warfarin, including faster time to the achieve effect, rapid onset of action, fewer documented food and drug interactions, lack of need for routine INR monitoring, and improved patient satisfaction. Local hemostatic measures, supportive care, and withholding the next NOAC dose are usually sufficient to achieve hemostasis among patients presenting with minor bleeding. The administration of reversal agents should be considered in patients on NOAC's with major bleeding manifestations (life-threatening bleeding, or major uncontrolled bleeding), or those who require rapid anticoagulant reversal for an emergent surgical procedure. The Food and Drug Administration (FDA) has approved two reversal agents for NOACs: idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban. The American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS) have released an updated guideline for the management of patients with atrial fibrillation that provides indications for the use of these reversal agents. In addition, the final results of the ANNEXA-4 study that evaluated the efficacy and safety of andexanet alfa were recently published. Several agents are in different phases of clinical trials, and among them, ciraparantag has shown promising results. However, their higher cost and limited availability remains a concern. Here, we provide a brief review of the available reversal agents for NOACs (nonspecific and specific), recent updates on reversal strategies, lab parameters (including point-of-care tests), NOAC resumption, and agents in development.

Pyoderma gangrenosum (PG) is an uncommon but severe extra-intestinal manifestation (EIM) of inflammatory bowel disease (IBD). The incidence and risk factors for PG are disputed. To assess the incidence of PG and identify factors associated with PG in IBD patients. A search of electronic databases (Ovid and PubMed) was conducted between 1966 and 2019. Studies that calculated the incidence of PG in IBD patient cohorts were included. Patient demographics, IBD subtype, and EIM presence were recorded. A review of our institutional database of 1057 IBD patients was conducted. A multivariate regression model and meta-analysis were conducted to identify risk factors for PG. A random effects model was used to combine the data of included studies. Fourteen studies were included in addition to 1057 IBD patients and 26 PG cases from the Louisville cohort. In total, there were 379 cases of PG in the cumulative cohort of 61,695 IBD patients. The PG incidence in individual studies ranged from 0.4 to 2.6%. In the institutional cohort, ocular EIMs and a permanent stoma were significant risk factors for PG. In the meta-analysis, PG was associated with female gender (RR = 1.328, 95% CI 1.161–1.520), Crohn’s disease (RR = 1.193, 95% CI 1.001–1.422), erythema nodosum (RR = 9.281, 95% CI 6.081–14.164), and ocular EIM (RR = 4.55, 95% CI 3.04–6.81). There was study heterogeneity when assessing IBD subtype, ocular, and joint EIMs. There are conflicting data on the incidence and risk factors for PG. This meta-analysis confirms an association between PG and female gender, Crohn’s disease, erythema nodosum, and ocular EIM that have been described in smaller studies.

In this paper, we investigate the electronic, optical, and thermoelectric properties of Ga2SSe monolayer by using density functional theory. Via analysis of the phonon spectrum and ab initio molecular dynamics simulations, Ga2SSe is confirmed to be stable at room temperature. Our calculations demonstrate that Ga2SSe exhibits indirect semiconductor characteristics and the spin–orbit coupling (SOC) effect has slightly reduced its band gap. Besides, the band gap of Ga2SSe depends tightly on the biaxial strain. When the SOC effect is included, small spin–orbit splitting energy of 90 meV has been found in the valence band. However, the spin–orbit splitting energy dramatically changes in the presence of biaxial strain. Ga2SSe exhibits high optical absorption intensity in the near-ultraviolet region, up to 8.444 × 104 cm−1, which is needed for applications in optoelectronic devices. By using the Boltzmann transport equations, the electronic transport coefficients of Ga2SSe are comprehensively investigated. Our calculations reveal that Ga2SSe exhibits a very low lattice thermal conductivity and high figure of merit ZT and we can enhance its ZT by temperature. Our findings provide further insight into the physical properties of Ga2SSe as well as point to prospects for its application in next-generation high-performance devices.

Groundwater is an important source for drinking and irrigation purposes. Due to anthropogenic activities, heavy metals have been leaching due to industrial waste and agricultural activities to the ...

Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionallyperformed using four ports. With the aim of improving patient’s comfort, port numbers have beenreduced to single port. But feasibility and the extra expense that comes with single and doubleport LC has made them less attractive. Three port LC can be a safe alternative to four port LC, andvarious research has shown its safety. This study compares the three port LC with the traditionalfour port LC with the objective of assessing feasibility and benefit of the decreased port number.We evaluated 217 patients who were randomly allocated for three port and four port LC. Both thegroups were compared for operative time, assessment of postoperative pain, days of hospital stayand postoperative recovery time after discharge. The parameters were compared using StatisticalPackage for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LCand 94 underwent four port LC. The larger number were females (79.7%), and with comparable agegroup of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesicrequirement, average hospital stay and port site infection rates were comparable in both groups ofpatients. The average time taken for operation was less in three port LC than the four port LC butthis was not statistically significant. There is no significant difference between 3 port and 4 port LCin terms of time required for the surgery, conversion rate, complication and duration of hospital stay Keywords : Four-port laparoscopiccholecystectomy, laparoscopiccholecystectomy, three-portlaparoscopic cholecystectomy

The grown films of FCA Heusler alloy on the R-plane sapphire with and without the W (001) seed layer were studied using scanning atomic and magnetic force microscopies, supplemented with the result...

AIMS The current opioid crisis in the USA is a formidable challenge for the healthcare system, and the general population. Our objective is to characterize the burden of opioid-related disorders in an inpatient setting in the USA for the years 2016, 2017 and 2018 using the National Inpatient Sample (NIS). METHODS A cross-sectional analysis of the NIS was performed to identify and analyse hospitalizations with an opioid-related diagnosis in 2016, 2017 and 2018. Descriptive statistics and regression models were utilized to define the demographics of the population of interest and measure the outcomes. RESULTS We identified 962 900 discharges with opioid-related diagnosis in 2016, 982 710 in 2017 and 942 110 in 2018. The majority were age

Inspired by the successfully experimental synthesis of Janus structures recently, we systematically study the electronic, optical, and electronic transport properties of Janus monolayers In2 XY (X/Y = S, Se, Te with X ≠ Y) in the presence of a biaxial strain and electric field using density functional theory. Monolayers In2 XY are dynamically and thermally stable at room temperature. At equilibrium, both In2STe and In2SeTe are direct semiconductors while In2SSe exhibits an indirect semiconducting behavior. The strain significantly alters the electronic structure of In2 XY and their photocatalytic activity. Besides, the indirect–direct gap transitions can be found due to applied strain. The effect of the electric field on optical properties of In2 XY is negligible. Meanwhile, the optical absorbance intensity of the Janus In2 XY monolayers is remarkably increased by compressive strain. Also, In2 XY monolayers exhibit very low lattice thermal conductivities resulting in a high figure of merit ZT, which makes them potential candidates for room-temperature thermoelectric materials.

There has been an exponential growth in the number of people living in urban areas since the middle of the twentieth century, and by the end of 2018, more than half of the world population lived in cities. This rapid urbanisation has created unprecedented challenges, among which the provision of domestic water has received increasing attention. Water is a basic need for humans and is the basis for socio-economic development. However, in many developing countries, governments have difficulties keeping pace with the fast rate of urbanisation due to limited financial resources and a lack of technical expertise. This ultimately results in a number of water-related problems, such as the lack of provision of an adequate water supply and improper sanitation, degradation of ecosystems and stormwater management failures. Moreover, climate change is exacerbating these water-related problems by influencing the hydrological cycle.

Colonoscopy is a low-risk procedure performed for screening and diagnostic purposes. About 15 million colonoscopies were carried out in the United States in 2012 with this number projected to increase. Injury to the spleen as a complication of colonoscopy is still a rather rare occurrence. We report a case of significant splenic injury, American Association of Surgery for Trauma (AAST) grade III with hemoperitoneum, in a patient following diagnostic colonoscopy, managed conservatively without the need for invasive or salvage surgical procedure.

The structural stability and optoelectronic properties of the ternary Ba1−xBexS alloys along with the pure binary compounds BaS and BeS in the rock-salt (B1) and zinc-blende (B3) phases were investigated by the density functional theory (DFT) within the full-potential linearized augmented plane wave (FP-LAPW) method implemented in the Wien2k package. The generalized gradient approximation of Wu and Cohen (WC-GGA) was used for the exchange-correlation potential (Vxc) to compute the equilibrium structural parameters, lattice constant (a), and bulk modulus (B). In addition to the GGA approach, the modified Becke-Johnson potential of Tran and Blaha (TB-mBJ) scheme coupled with the spin-orbit interaction was used to calculate the band gap energies. Results reveal that BaS, Ba0.75Be0.25S, and Ba0.5Be0.5S compounds are stable in the rock-salt phase, while Ba0.25Be0.75S and BeS are found to be stable in the zinc-blende phase. The computed results for the band structures and optical constants are compared with other available theoretical calculations and experimental measurements.

Recurrent Clostridium difficile infection (CDI) is a perpetual problem that leads to increased economic burden, higher healthcare cost, and significant morbidity and mortality. Its treatment remains a challenge. While various treatment approaches have been attempted with different levels of success, robust data establishing the superiority of one approach over the others is lacking. In this article, we review the current evidence pertaining to conventional pharmacological treatment as well as fecal microbiota transplantation (FMT) as a novel, rapidly emerging treatment modality for recurrent CDI.

An increase in the human population, urbanization, industrialization, infrastructural development, and current agricultural practices acts as major factors leading to the decline of the groundwater table in the region. The present study analyzes the noticeable effect of anthropogenic pressure on the groundwater table in the Bist-Doab region in Punjab, India, from 1996 to 2016. Statistical techniques, viz., Mann-Kendall Z statistics and Sen’s slope, were used to estimate the water table decline in the area. The results indicate that there was a slight increase in the groundwater table in the Kandi belt of Siwalik foothills and south-western parts of the region. In the rest of the areas, a significant declining trend was observed in the groundwater table. The decline in the water table ranged from 56 to 149 cm per year in the pre- and post-monsoon seasons due to increasing in rice cultivated area, which is an alarming situation in the aquifer system of the region. Hence, to reduce the further decline of the groundwater table, water management practices need to be encouraged in the region. There is requiring immediate attention to change the present land-use/cover practices and to grow less water-consuming crops instead of high water-consuming crops to reduce the pressure on groundwater.

Introduction Youth tobacco use rates in Appalachia exceed the US national average, and e-cigarette use has increased. Thus, further research is needed to understand how these youth receive and share product information. Methods Middle and high school students in rural Appalachia were surveyed (N=1103). The primary outcome, tobacco use, was categorized as: never users, cigarette-only users, smokeless-only users, e-cigarette-only users, and polytobacco users. Associations between receiving or sharing conventional tobacco-related or e-cigarette-related information via specific communication channels and tobacco use were assessed. Results Participants who received tobacco information from friends and family (FF) (OR=1.87; 95% CI: 1.35-2.57), public displays (PUB) (OR=1.49; 95% CI: 1.09-2.05), and digital media (DIG) (OR=1.95; 95% CI: 1.41-2.70) and e-cigarette information via the same communication channels, FF (OR=2.65; 95% CI: 1.93-3.65), PUB (OR=1.62; 95% CI: 1.17-2.26), and DIG (OR=2.24; 95% CI: 1.61-3.12), had greater odds of being polytobacco users, compared to never users. Participants who received e-cigarette-related information from FF (OR=2.42; 95% CI: 1.42-4.13) and PUB (OR=2.13; 95% CI: 1.25-3.65) had greater odds of being e-cigarette-only users compared to never users. Participants who shared e-cigarette-related information with FF had greater odds of being e-cigarette-only users (OR=3.16; 95% CI: 1.80-5.58) and polytobacco users (OR=4.48; 95% CI: 3.16-6.35) compared to never users. Conclusions Receiving and sharing tobacco-related and e-cigarette-related information via multiple communication channels is associated with e-cigarette and polytobacco use among Appalachian youth. Several channels may need to be utilized in health campaigns to influence youth.

Microorganisms area treasure in terms of theproduction of various bioactive compounds which are being explored in different arenas of applied sciences. In agriculture, microbes and their bioactive compounds are being utilized in growth promotion and health promotion withnutrient fortification and its acquisition. Exhaustive explorations are unraveling the vast diversity of microbialcompounds with their potential usage in solving multiferous problems incrop production. Lipopeptides are one of such microbial compounds which havestrong antimicrobial properties against different plant pathogens. These compounds are reported to be produced by bacteria, cyanobacteria, fungi, and few other microorganisms; however, genus Bacillus alone produces a majority of diverse lipopeptides. Lipopeptides are low molecular weight compounds which havemultiple industrial roles apart from being usedas biosurfactants and antimicrobials. In plant protection, lipopeptides have wide prospects owing totheirpore-forming ability in pathogens, siderophore activity, biofilm inhibition, and dislodging activity, preventing colonization bypathogens, antiviral activity, etc. Microbes with lipopeptides that haveall these actions are good biocontrol agents. Exploring these antimicrobial compounds could widen the vistasof biological pest control for existing and emerging plant pathogens. The broader diversity and strong antimicrobial behavior of lipopeptides could be a boon for dealing withcomplex pathosystems and controlling diseases of greater economic importance. Understanding which and how these compounds modulate the synthesis and production of defense-related biomolecules in the plants is a key question—the answer of whichneeds in-depth investigation. The present reviewprovides a comprehensive picture of important lipopeptides produced by plant microbiome, their isolation, characterization, mechanisms of disease control, behavior against phytopathogens to understand different aspects of antagonism, and potential prospects for future explorations as antimicrobial agents. Understanding and exploring the antimicrobial lipopeptides from bacteria and fungi could also open upan entire new arena of biopesticides for effective control of devastating plant diseases.

An ab initio generalized gradient approximation study, plus Hubbard (U = 4.1 eV) correlation, of (La0.25Bi0.75)2FeCrO6 alloy, in the pnma structure/ferrimagnetic order of transition rare earth d-La electrons, shows an optimum optical absorption of about 103 cm−1 near an ideal bandgap around 1.52 eV, with local magnetic moments of (Cr3+, Fe3+) found to be (− 2.56, 4.14) μB, making it a promising candidate for photovoltaics and photoferroics. Tuned-gap La-Bi2FeCrO6 active layer should own enhanced light absorption and carrier mobility, could be suitable light absorbers, and should be an efficient alternative to many absorbers like wide-bandgap chalcopyrite for solar cells, failing to reach highest efficiency, or even compete with their metal–organic halide perovskite counterparts.

We examined the relationship between persistent osteoporosis medication use and fracture risk among female Medicare beneficiaries diagnosed with osteoporosis using Medicare claims, 2009–2012. Persistent use was associated with reduced risk of fracture and significantly lower total health care costs in the follow-up period. Results were consistent using different analytical methods. This study aimed to examine the relationship between medication persistence and fracture risk among female Medicare beneficiaries diagnosed with osteoporosis. Elderly female Medicare beneficiaries diagnosed with osteoporosis and initiated on osteoporosis medication January 1, 2009–June 30, 2011, were included. Persistent medication use was defined as continuous use (no gap ≥ 60 days) for 1 year or longer. The key outcome was fragility fracture. A difference-in-difference analysis was performed at the log scale of fracture rate using a Poisson regression model with months 1–6 before medication initiation as the pre-initiation period and up to 18 months after as the post-initiation period. Total health care costs were compared using a similar approach. Sensitivity analyses were conducted using different pre- and post-initiation periods. The study included 294,369 patients; 32.9% were persistent osteoporosis medication users and 67.1% non-persistent (

In this work, the process parameters optimization problems of abrasive waterjet machining process are solved using a recently proposed metaheuristic optimization algorithm named as Jaya algorithm and its posteriori version named as multi-objective Jaya (MO-Jaya) algorithm. The results of Jaya and MO-Jaya algorithms are compared with the results obtained by other well-known optimization algorithms such as simulated annealing, particle swam optimization, firefly algorithm, cuckoo search algorithm, blackhole algorithm and bio-geography based optimization. A hypervolume performance metric is used to compare the results of MO-Jaya algorithm with the results of non-dominated sorting genetic algorithm and non-dominated sorting teaching–learning-based optimization algorithm. The results of Jaya and MO-Jaya algorithms are found to be better as compared to the other optimization algorithms. In addition, a multi-objective decision making method named PROMETHEE method is applied in this work in order to select a particular solution out-of the multiple Pareto-optimal solutions provided by MO-Jaya algorithm which best suits the requirements of the process planer.

If we want to convert our rural population into knowledge driven, progressive, self sufficient, self reliant, sustainable society, the role of Information and Communication Technologies (ICT’s) cannot be ignored. Timely availability information is considered as most important factor in Indian agriculture. At present ICT is the technology of this millennium. Transferring the developed technology to all end users is time-consuming and tiresome task and is often not completed due to paucity of resources and lack of manpower. In India, agriculture and rural development has gained significantly from ICT due to its widespread extension and adoption. In this era of internet, ICT is committed to provide real, timely accurate authentic information to the farmers and rural peoples.

Submerged arc welding (SAW) is characterized as a multi-input process. Selection of optimum combination of process parameters of SAW process is a vital task in order to achieve high quality of weld and productivity. The objective of this work is to optimize the SAW process parameters using a simple optimization algorithm, which is fast, robust and convenient. Therefore, in this work a very recently proposed optimization algorithm named Jaya algorithm is applied to solve the optimization problems in SAW process. In addition, a modified version of Jaya algorithm with oppositional based learning, named “Quasi-oppositional based Jaya algorithm” (QO-Jaya) is proposed in order to improve the performance of the Jaya algorithm. Three optimization case studies are considered and the results obtained by Jaya algorithm and QO-Jaya algorithm are compared with the results obtained by well-known optimization algorithms such as Genetic algorithm (GA), Particle swarm optimization (PSO), Imperialist competitive algorithm (ICA) and Teaching learning based optimization (TLBO).

Material removal rate and surface roughness are the most important performance measures in nano-finishing processes and these are largely influenced by the process parameters. The optimum combination of process parameters for nano-finishing processes is determined in this paper using a recently proposed optimization algorithm, named as Jaya algorithm. The results show the better performance of the Jaya algorithm over the other approaches attempted by the previous researchers such as genetic algorithm and desirability function approach for the same nano-finishing processes. The results obtained by the Jaya algorithm are useful for the real production systems.

A note published by Chinta et al. (2016) [Chinta, S., Kommadath, R. & Kotecha, P. (2016) A note on multi-objective improved teaching–learning based optimization algorithm (MO-ITLBO). Information Science, 373, 337-350.] reported some impediments in implementation of MO-ITLBO algorithm. However, it is observed that their comments are based on incorrect understanding of TLBO, ITLBO and MO-ITLBO algorithms. Their raised issues are thoroughly addressed in this paper and it is proved that MO-ITLBO algorithm has no lacunae.

The electronic, optical and thermoelectric properties of bulk and surface of CuInTe2 were investigated by first-principles calculation based on full potential linearized augmented plane wave (FP-LAPW) method. The electron-exchange correlation is taken as generalized gradient approximation (GGA). To improve the energy band gap a modified version of semi-local orbital independent potential called modified Becke Johnson (mBJ) potential is used. The calculated energy band gap of CuInTe2 is in good agreement with available experimental and theoretical results. Both the bulk and surface of CuInTe2 is a direct band gap semiconductor, shows a transition along ( Γ − Γ ) symmetry point. The calculated band gap of surface and bulk within GGA/mBJ are 0.38/0.63 eV and 0.75/1.13 eV, respectively. This shows an optical interaction of materials at UV range, which can exploited as a heterojunction absorptive layer for solar cell materials. The thermoelectric properties were also calculated based on the Boltzmann semi-local transport theory. The flat and sharp bands along ( Γ − Γ ) in bulk and surface is responsible for high value of Seebeck coefficient and electrical conductivity, respectively. The higher value of Seebeck coefficient and electrical conductivity is a key to enhance the thermoelectric efficiency.

Key Clinical Message Blastic plasmacytoid dendritic cell neoplasm is an aggressive neoplasm with a median survival of only a few months despite treatment. An exhaustive immunohistochemical workup is required to differentiate it from myeloid sarcoma and extranodal NK/T cell lymphoma. Treatment is with induction using a regimen utilized for leukemia. Allogeneic hematopoietic stem cell transplantation is recommended for those who achieve remission following induction.

The thermoanalytical technique differential scanning calorimetry (DSC) has been applied to characterize protein denaturation patterns (thermograms) in blood plasma samples and relate these to a subject's health status. The analysis and classification of thermograms is challenging because of the high-dimensionality of the dataset. There are various methods for group classification using high-dimensional data sets; however, the impact of using high-dimensional data sets for cancer classification has been poorly understood. In the present article, we proposed a statistical approach for data reduction and a parametric method (PM) for modeling of high-dimensional data sets for two- and three- group classification using DSC and demographic data. We compared the PM to the non-parametric classification method K-nearest neighbors (KNN) and the semi-parametric classification method KNN with dynamic time warping (DTW). We evaluated the performance of these methods for multiple two-group classifications: (i) normal versus cervical cancer, (ii) normal versus lung cancer, (iii) normal versus cancer (cervical + lung), (iv) lung cancer versus cervical cancer as well as for three-group classification: normal versus cervical cancer versus lung cancer. In general, performance for two-group classification was high whereas three-group classification was more challenging, with all three methods predicting normal samples more accurately than cancer samples. Moreover, specificity of the PM method was mostly higher or the same as KNN and DTW-KNN with lower sensitivity. The performance of KNN and DTW-KNN decreased with the inclusion of demographic data, whereas similar performance was observed for the PM which could be explained by the fact that the PM uses fewer parameters as compared to KNN and DTW-KNN methods and is thus less susceptible to the risk of overfitting. More importantly the accuracy of the PM can be increased by using a greater number of quantile data points and by the inclusion of additional demographic and clinical data, providing a substantial advantage over KNN and DTW-KNN methods.

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate, 1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.

Sickle β+-thalassemia rarely manifests with acute splenic sequestration crisis in adults. We report a case of a 20-year-old female who presented with fever and left upper quadrant abdominal pain. Laboratory studies revealed hemolytic anemia. Tests for autoimmune hemolysis and hemolytic diseases were negative except for Hemoglobin (Hb) electrophoresis, which revealed sickle cell trait (Hb AS). Infectious workup was unremarkable. Computed tomography scan of the abdomen showed marked splenomegaly. The patient received blood transfusions and empiric antibiotics with no improvement; thus, splenectomy was performed. Pathology specimen revealed peripheral serpiginous infarcts alternating with surrounding acute inflammation and small capillaries plugged with sickle cell shaped red blood cells consistent with splenic sequestration. DNA test later revealed beta-globin mutations consistent with sickle cell-beta+ thalassemia. Post-splenectomy, there was a gradual improvement in her clinical symptoms with concomitant rise in Hb to 10.6 g/dl at discharge.

Severe bleeding requiring blood transfusions following endoscopic, percutaneous gastrostomy tube placement is a rare complication. We describe a case of severe recurrent haemorrhage with bright red blood from rectum from endoscopic, percutaneous gastrostomy tube placement, which ultimately required removal of the percutaneous endoscopic gastrostomy tube.

In the present study, groundwater suitability for domestic and irrigation purposes was analyzed in the alluvial aquifers of the Bist-Doab region of Punjab, India, using various indices such as WQI, WAWQI, MCDA, RSC, SAR, PI, %Na, KR, MH, PS, K, and Ka. Since it is difficult to assess the suitability of groundwater for irrigation based on various indices individually, a composite groundwater quality index for irrigation (CGQII) was used in the study which transforms nine indices to a single value for each sample. Results reveal that the groundwater of a few blocks was found unsuitable for domestic use due to chemical leaching from fertilizers, pesticides, and agricultural and industrial wastes. Whereas, the groundwater of mainly southwestern parts was found unsuitable for irrigation due to long-term water accumulation in aquifers and continuous use of sodium-ion-rich groundwater. The findings conclude that anthropogenic activities have played a significant role in making groundwater unfit for domestic and irrigation purposes in the study area. The present study also emphasizes continuous monitoring and evaluation of groundwater quality, which will help in strategic planning and management for the conservation of groundwater resources in the region.

Computational investigations, concerning structural, elastic, electronic, optical, and thermometric properties of the MgLu2X4 (X = S, Se) spinel compounds are performed. The calculations are carried out by employing the first-principles L(APW + lo) method designed within density functional theory (DFT). Our ground-state calculations are found to be consistent with experimental data wherever available. Similarly, calculations of the elastic constants demonstrate that both MgLu2S4 and MgLu2Se4 are brittle and anisotropic in nature. The dominant bonding between the atoms is found covalent and strongly favouring their mechanical stability. From the calculations of electronic band structure, both compounds are found direct bandgap semiconductors at Γ- Γ with bandgap energy of 3.119 eV for MgLu2S4 and 2.480 eV for MgLu2Se4. Our analysis of electronic and optical parameters suggest them suitable candidates for optoelectronic devices particularly from visible to extreme violet region applications whereas the calculated results of thermoelectric properties highlight their remarkable thermoelectric response for a workable range of temperature.

6556 Background: CAR T-cell therapy is a type of adoptive cell transfer (ACT). In 2017 CAR T-cell therapy was approved by the Food and Drug Administration (FDA) for management of diffuse large B-cell lymphoma refractory to at least two prior lines of therapy (DLBCL) including primary mediastinal large B-cell lymphoma (PMBCL), and B cell precursor acute lymphoblastic leukemia (ALL) up to 25 years of age that is refractory or in second or later relapse. Since its inception, several patients underwent CAR T-cell therapy but data on real world outcome is limited. In this study we aim to evaluate the in-hospital outcomes of CAR T-cell therapy in the United States in 2018. Methods: This is a cross-sectional study using National Inpatient Sample 2018 database. Discharges with the ICD-10-PCS code for CAR T-cell therapy and ICD-10-CM code of ALL, DLBCL or PMBCL were included in the study. We analyzed their in-hospital outcomes (Total discharges, length of stay in days, hospitalization cost, and mortality - number of deaths). We applied the cost to charge ratio to hospitalization charges to estimate the mean hospitalization cost. The weighted sample represents national estimates. Results: We identified 785 discharges with CAR T cell therapy and diagnosis of ALL, DLBCL or PMBCL. 155 (19.75 %) were ALL, 620 (78.98%) DLBCL, and 10 (1.27%) PMBCL. Mean length of stay for the study cohort was 23.26 days. Specifically, for ALL mean LOS was 33.67 days, DLBCL 20.76 days, and PMBCL 17 days. Mean hospitalization cost for the study cohort was $285,989, specifically for ALL it was $342,228, DLBCL $274,102, PMBCL $179,431. There were a total of 60 (7.6%) deaths in the study cohort. Diagnosis specific mortality was 20 (12.9%) in ALL, 40 (6.4%) in DLBCL and none in PMBCL. Conclusions: Majority of discharges who underwent CAR T-cell therapy were DLBCL followed by ALL and PMBCL. CAR-T Cell hospitalizations have high costs and long length of stays. Mean length of stay was highest in ALL discharges, least in PMBCL. Mean hospitalization cost was higher in DLBCL discharges compared to ALL and was least in PMBCL discharges. The in-hospital mortality with the CAR-T cell therapy appears to be higher than reported in clinical trials, especially for ALL. [Table: see text]

In this study, we used first principles calculations to investigate the influence of extracting the SnO (ML) monolayer, through electronic, optical and transport properties. Our simulation results of high optical transmission of SnO-ML comprehend the previously reported theoretical results. It shows around 96% optical transmission. These characteristics suggest that the SnO-ML is a potential material for optoelectronic and solar cell applications. In terms of thermoelectric properties, the electrical conductivity has been significantly improved at low temperature, the power factor and figure of merit are enhanced in SnO-ML. The materials’ specifications considered that two-dimensional materials SnO-ML are better thermoelectric materials and may be efficient for thermoelectric energy conversion.