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The technological advancement in the field of IoT and cloud computing along with the use of handheld gadgets generate huge amount of data. To process and share these data with fine-grained access control while maintaining confidentiality using cloud servers is a challenging task. Individuals as well as the organizations apprehend to use public cloud to share their private data due to security issues. Ciphertext-policy-attribute-based-encryption(CPABE) achieves one-to-many encryption with data confidentiality and fine-grained access control. Due to the computational intensive operations of encryption and decryption the performance of CPABE as a solution in resource-constraint environment is not encouraging enough. Some of the existing models use the resources of cloud servers to carry out outsourced computation either with compromised security or with communication-overhead. To reduce the computational time of encryption and decryption we propose a scheme LIKC which incorporates the outsourcing mechanism using a proxy server. With the imploration the computation time get reduced without compromising the security. It also supports attribute-revocation to support flexible data sharing. The proposed model is implemented using python charm crypto. The output reveals that LIKC is able to produce promising results in comparison to the data sharing models for this study.

Background Expanded-spectrum quinolones (ciprofloxacin) are highly effective against gram-negative bacteria, but significant resistance to quinolones has been increasingly reported. We sought to evaluate the prevalence of gram-negative ciprofloxacin-resistant isolates (CRIs) from our hospital and their mechanism of action. Methods Gram-negative CRIs were identified as per standard procedures and confirmed using the Ezy MICTM Strip (HiMedia). DNA from 67 CRIs was amplified for the quinolone resistance–determining region (QRDR) and plasmid-mediated quinolone resistance genes. Thirty isolates positive for QRDR DNA were sequenced by Sanger's method to detect mutation. Results Of the isolates, 42.5% were found to be CRIs, the majority (74.42%) from inpatient departments, and Escherichia coli (64.19%) was the predominant isolate. Among the CRIs, 24.55% were ESBL producers and 35.29% were multidrug resistant. The polymerase chain reaction results showed the majority were amplified by QRDR target regions of gyrA (35.4%) while 4.61% were amplified for the plasmid-mediated fluoroquinolone resistance region of the qnrB gene. Further sequencing of QRDR-positive genes showed point mutations with amino acid changes at codons Ser83 and Asp87 in the gyrA gene and Ser80, Glu84, and Leu88 positions in the parC gene. Conclusion Ciprofloxacin resistance observed in our study was mostly due to point mutations. Hence, strategies for rational use of ciprofloxacin and adherence to the dose and duration of treatment could be helpful to prevent selection and spread of mutant CRIs/strains.

Partitional clustering-based image segmentation is one of the most significant approaches. K-means is the conventional clustering techniques even though very sensitive to noise and easy convergences to local optima depending on the initial cluster centers. In addition, the computational time of K-means algorithm is also very high due to the repetitive distance calculation between pixels and cluster centers. In order to solve these problems, this paper presents a Histogram-based Fast and Robust Crisp Image Clustering (HFRCIC) technique. Local spatial information is often introduced to an objective function to improve the noise robustness of the clustering technique. At first, the local spatial information has been introduced into HFRCIC by incorporating morphological reconstruction which assures noise-immunity as well as image detail-preservation. Then clustering has been executed depending on gray levels in the place of pixels of the image. As result, the execution time is low as the number of gray levels is usually much smaller than the number of pixels in the image. Due to the random initialization of centers, HFRCIC easily stuck into local optima as HFRCIC is greedy in nature and an efficient local optimizer. Therefore, Nature-Inspired Optimization Algorithms (NIOA) are successfully employed to overcome the problem within reasonable computational time. Here, Stochastic Fractal Search (SFS) has been employed to find the optimal cluster centers. The experimental study has been performed over synthetic images, real-world images and white the gray level conversion of RGB imaged for white blood cell (WBC) segmentation. Visual and numerical results indicate the superiority of the proposed HFRCIC with SFS(HFRCIC-SFS) over state-of-the-art image segmentation algorithms and NIOA-based crisp image clustering techniques.

This paper presents an efficient image encryption scheme based on permutation followed by diffusion, where both of these phases use 2-d Sine logistic modulation map (SLMM) with different initial values. In addition, diffusion uses another map as 1-d Logistic chaotic map (LCM). The initial values of these chaotic maps are obtained from an external key of 64 bytes along with 32-byte hash value from the corresponding plain-image to incorporate plain-text sensitivity. Initially, confusion of the plain-image is implemented by applying row-level and column-level permutations. Then, this permuted image is used for subsequent diffusion, applied on block-level considering block size of 64 bytes. This diffusion process is accomplished by overlaying with chaotic matrix derived from LCM, followed by substitution of those overlaid bytes by DNA encoding along with SLMM to attain an encrypted image with an entropy nearly 8. Furthermore, all the chaotic values generated from the aforementioned maps are highly sensitive on the key as well as on the plain-image. This scheme is thoroughly verified on different sized plain-images with modern statistical analyses to prove the robustness of this scheme. Eventually, comparison with other schemes reinforces its competence and suitability to implement it in real-time system.

Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies accounting for

In Machine Learning (ML), Feature Selection (FS) plays a crucial part in reducing data’s dimensionality and enhancing any proposed framework’s performance. However, in real-world applications, FS work suffers from high dimensionality, computational and storage complexity, noisy or ambiguous nature, high performance, etc. The area of FS is very vast and challenging in its nature. There are lots of work that have been reported on FS over the various area of applications. This paper has discussed FS’s framework and the multiple models of FS with detailed descriptions. We have also classified the various FS algorithms with respect to the data, i.e., structured or labeled data and unstructured data for the different applications of ML. We have also discussed what essential features are, the commonly used FS methods, the widely used datasets, and the widely used work done in the various ML fields for the FS task. Here we try to view the multiple comparison experimental results of FS work in different result discussions. This paper draws a descriptive survey on FS with the associated area of real-world problem domains. This paper’s main objective is to understand the main idea of FS work and identify the core idea of how FS will be applicable in various problem domains.

Clustering is one of the most vital image segmentation techniques. However, proper image clustering has always been a challenging task due to blurred and vague areas near to concerned object boundaries. Therefore, rough set based clustering techniques like Rough k-means (RKM) has been employed in image clustering domain because rough set concept can handle the overlapping clusters to a great extent. RKM shows the performance in image clustering domain as a similarity based clustering model like K-Means and Fuzzy C-Means. Therefore, this paper presents an up-to-date review on rough set based image clustering approaches with their merits and demerits. The measures of similarity as well as the evaluation criteria for rough clustering are also discussed in this study. Beside that the key issues which are involved during the development of rough set based clustering models are investigated in this paper.

Nowadays, many users outsource their data to a remote cloud server. Access control techniques are an indispensable tool to prevent unauthorized users from accessing the data stored in the remote server. Ciphertext-policy attribute-based encryption (CP-ABE) would be a promising tool to resolve the secure data sharing issues in cloud computing to facilitate the authorized users to access their data. Many of the CP-ABE-based existing works suffer from higher computational at the user end. We propose a scheme named centralized multi-authority cloud storage with revocation (CEMAR) to withstand challenging scenarios. In the proposed model, the decryption process is partly outsourced to the cloud server to reduce the computational burden at the user end without violating its security. Besides this, the required key is stored in the cloud server to improve the communication cost of the decryption process. Further, we used the Random-Oracle assumption to establish the soundness of the model under the chosen plain text attack and showed that CEMAR is secure.

Connected vehicular cloud computing (CVCC) is a promising technology that integrates cloud computing and vehicular ad-hoc network (VANET) for road condition monitoring tasks. However, maintaining security and privacy is crucial for wide deployment of such framework. Existing researches fail to address critical security flaws in CVCC scenario. This paper performs cryptanalysis on the CVCC based road condition monitoring scheme recently proposed by Wang et al. (2019). The scheme fails to achieve anonymity, unlinkability and nonrepudiation. Moreover, honest but curious RSUs may collude with each other to learn sensitive information, such as vehicle user’s trajectory. Also, an attacker can induce forged emergency case into the system through replay attack. Furthermore, in the scheme, the cloud server cannot segregate a threshold number of current reports, from a threshold number of combination of old and current reports. Along with this cryptanalysis, this paper proposes a secure road condition monitoring scheme in cloud based VANET, addressing the critical issues identified in the existing works. The security of the proposed scheme has been thoroughly evaluated using an adversary model, BAN Logic and AVISPA tool. Moreover, the performance of the proposed scheme is analyzed and compared with the existing schemes in terms of security and computation overhead.

A critical issue in data mining and machine learning is feature selection. The crucial part is how to specify the eminent problem-relevant features out of a collection of features contained in a dataset. Feature selection process goes with the pre processing steps in knowledge revelation (KDD process). It aids in eliminating the unnecessary (redundant) and unrelated (irrelevant) features in order to improve the fulfillment of classifying algorithms. It chooses the most optimal count of features that is best suited to classification model which in turn advance the learning process. As such, the correctness (accuracy) of classification increases. Thus, in this paper we have proposed a two-staged hybrid arrangement of model that contains filter-based approach in the first stage to filter out the unnecessary and unrelated features and then providing these acquired features as input to the next stage that is the wrapper method by availing the recent swarm based algorithm, namely, salp swarm algorithm or SSA. The proposed model is named as MRMR-SSA. The binary version of SSA is utilized to evaluate the features that can either take the feature as 1 or discard it as 0. Specific classifiers like XGBoost, AdaBoost, Random forests and Logistic Regression are made in use in this paper. Accuracy is considered to measure the performance of each classifier. An analogy is made for the proposed hybrid feature selection approach with a few familiar algorithms specifically MRMR-PSO, MRMR-GA, MRMR-ALO and MRMR-ACO. The proposed hybrid approach leaves behind other given hybrid methods.

BACKGROUND As defined by World Health Organization (WHO), stroke is accountable for 5 million deaths and 5 million disabled patients throughout the world. The prevalence of stroke is in rising trend in Indian subcontinent and therefore is a source of socioeconomic concern. This study was conducted to evaluate the aetiological and clinical profile in stroke patients with special reference to baseline intracranial haemorrhage (ICH) score in haemorrhagic stroke in North East India. METHODS The study was carried out among in-patients of Medicine Department at Assam Medical College and Hospital, Dibrugarh in North East India from March 2019 to February 2020. A total of 112 patients who presented with symptoms suggestive of stroke were assessed. Mean ± standard deviation was used to express continuous variables. Frequency and percentage were used to express categorical variables. Test of significance for qualitative data was assessed by chi-square test (for 2 x 2 tables). P-value less than 0.05 was taken as statistically significant. RESULTS In our study stroke was common in 40 – 60 years age group which comprised 50 % of total patients. Stroke was more common in males with a sex ratio of 1.24:1. 73.2 % of patients suffered haemorrhagic stroke and 22.3 % suffered ischemic stroke whereas 4.5 % suffered cardio-embolic stroke. Hypertension was the most prevalent and an important risk factor with 80.3 % (P = 0.001), followed by smoking with 39 % (P = 0.021), chronic alcohol consumption with 37 % (P = 0.028) and diabetes with 22 %. The most common site of haemorrhage was basal ganglia (28 %) followed by thalamus (24 %). Patients presenting with intraventricular extension, infratentorial location, low Glasgow Coma Scale (GCS) score (< 4) or having high ICH score (≥ 3) at the time of presentation were associated with increased mortality in haemorrhagic stroke (P = 0.010). CONCLUSIONS Haemorrhagic strokes (73.2 %) are the most common type. Hypertension is the most prevalent and an important risk factor (80.3 %). Basal ganglia (28 %) are the most common sites involved in haemorrhagic stroke; infratentorial location is associated with poor prognosis. Patients presenting with low GCS score (< 4) or having high ICH score (≥ 3) at the time of presentation are associated with increased mortality in haemorrhagic stroke. KEY WORDS Stroke, Hypertension, Basal Ganglia, GCS Score, ICH Score

A study was conducted to examine the interrelationships among socioeconomic factors, household consumption patterns, calorie intake and greenhouse gas emissions factors in rural eastern India based on household survey data. Findings indicated that higher monthly per capita incomes (12.1–80.1$) were associated with greater average calorie intakes (2021–2525 kcal d−1). As estimated by the FEEDME model, in total 17.2% of the population was calorie malnourished with a regional disparity of 29.4–18.2% malnourishment. Greenhouse gas (GHG) emissions were calculated only on the basis of crop and livestock production and consumption. Rice accounted for the highest share of total GHG emissions, on average 82.6% on a production basis, which varied from 58.1% to 94.9% in regional basis. Rice contributed the greatest share (~ 65% and 66.2%) in terms of both calories and GHG emissions (CO2 eq y−1), respectively, on a consumption basis. We conclude that extensive rice farming and increasing animal product consumption are dominant factors in the higher carbon footprint in this region and are likely to further increase with increase in per capita income. This study provides useful information to help for better crop planning and for fine-tuning food access policy, to reduce carbon footprint and calorie malnutrition.

The significant technological evolution for the machining of Ti-6Al-4V alloy has been a continuous talk for scientific and academic researchers. The analysis for a new methodology for improving performance and the implications needs to be explored further in this advanced aerospace alloy steel. Despite the advanced performance and due to the adverse characteristics of titanium alloy, for instance, thermal conductivity, chemical reactivity, and extreme temperature strength obstruct its potential application in the field of machining. The application of this titanium alloy revealing a great perspective in the field of the aeronautical realm. With this backdrop, this scoping review work aims for the apples-to-apples comparison machining conditions, characterization techniques, and influence of main cutting input parameters on output efficiencies during the turning process. A state of art recent technologies, issues, challenges, and with this the machining of material is also illustrated along with the possible research future directions.

As a gut-restricted, nonabsorbed therapy, polymeric bile acid sequestrants (BAS) play an important role in managing hyperlipidemia and hyperglycemia. Similarly, nonabsorbable sequestrants of dietary phosphate have been used for the management of hyperphosphatemia in end-stage renal disease. To evaluate the potential utility of such polymer sequestrants to treat type 2 diabetes (T2D) and its associated renal and cardiovascular complications, we synthesized a novel polymeric sequestrant, SAR442357, possessing optimized bile acid (BA) and phosphate sequestration characteristics. Long-term treatment of T2D obese cZucker fatty/Spontaneously hypertensive heart failure F1 hybrid (ZSF1) with SAR442357 resulted in enhanced sequestration of BAs and phosphate in the gut, improved glycemic control, lowering of serum cholesterol, and attenuation of diabetic kidney disease (DKD) progression. In comparison, colesevelam, a BAS with poor phosphate binding properties, did not prevent DKD progression, whereas losartan, an angiotensin II receptor blocker that is widely used to treat DKD, showed no effect on hyperglycemia. Analysis of hepatic gene expression levels of the animals treated with SAR442357 revealed upregulation of genes responsible for the biosynthesis of cholesterol and BAs, providing clear evidence of target engagement and mode of action of the new sequestrant. Additional hepatic gene expression pathway changes were indicative of an interruption of the enterohepatic BA cycle. Histopathological analysis of ZSF1 rat kidneys treated with SAR442357 further supported its nephroprotective properties. Collectively, these findings reveal the pharmacological benefit of simultaneous sequestration of BAs and phosphate in treating T2D and its associated comorbidities and cardiovascular complications. SIGNIFICANCE STATEMENT: A new nonabsorbed polymeric sequestrant with optimum phosphate and bile salt sequestration properties was developed as a treatment option for DKD. The new polymeric sequestrant offered combined pharmacological benefits including glucose regulation, lipid lowering, and attenuation of DKD progression in a single therapeutic agent.

Aggressive osteoblastoma (AO) is a rare variant of osteoblastoma characterized histologically by epithelioid osteoblasts and clinically by local recurrences if not excised completely. Aggressive osteoblastoma has been described in various unusual sites; however, based on our search of the literature, involvement of the tarsal navicular has not been previously described. Herein, we report what we believe to be the first case of aggressive osteoblastoma involving the tarsal navicular in a 35-year-old woman. The tumor showed osteoid surrounded by epithelioid cells along with numerous osteoclastic giant cells. Absence of necrosis, mitosis, and infiltration into the surrounding native bone helped rule out the possibility of low-grade osteosarcoma.

Background: Leprous neuropathy is a significant, yet preventable, cause of disability worldwide. Decompressive surgery and oral steroids have been used along with Multi Drug Therapy (MDT) for treating leprous neuropathy with varied success as reported in literature. Methods: We prospectively studied 16 peripheral nerves in 10 patients with leprous neuropathy of less than a year duration and not responding to steroid therapy in 3 weeks. The patients were divided into 2 groups: Group-A (decompressive nerve surgery was done within 12 weeks of onset of neurological deficit), and Group-B (nerve decompression was performed after 12 weeks from onset of neurological deficit). Post-operatively patients were assessed for regression of deformity, sensory, motor, vasomotor recovery and neuropathic pain. Results: Median age of patients was 32 years (range; 18 years to 46 years). Mean motor score and mean grip strength was significantly better for group A patients at 2 years follow-up (p < 0.05). Mean sensory score improved significantly in both the groups (p < 0.05). Similarly, mean VAS score for neuropathic pain improved significantly in both the groups (p < 0.05). Recovery of autonomic function was observed in 3 nerves in group A and 1 in group B. Conclusions: The cases who underwent nerve decompression surgery within 12 weeks had better functional outcomes, especially in terms of motor recovery, than those who were operated after that. Studies involving larger number of patients are required to draw firm conclusions.

Pathological color image segmentation is an exigent procedure due to the existence of imperceptibly correlated, and indistinct multiple regions of concern. Multi-level thresholding has been introduced as one of the most significant image segmentation procedures for pathological analysis. However, finding an optimal set of threshold values is an extremely time-consuming task, and crucially depends on the objective function criterion. In order to solve these problems, this paper presents a multi-level hematology color image thresholding approach with the assistance of a two-stage strategy called Eagle Strategy coupled with Whale Optimization Algorithm (ES-WOA), analyzing the performance over five well-known objective functions, namely; Kapur’s entropy, Fuzzy entropy, Tsallis’ entropy, Otsu’s method, and Cross entropy. A rigorous comparative study is performed among classical WOA and existing eagle strategy based optimization algorithms, considering a set of hematology color images, and common performance indexes evaluated by each objective function tested. Experimental results indicate that proposed ES-WOA in combination with Tsallis’ entropy outperforms the rest of tested algorithms in terms of computational effort, image segmentation quality, and robustness. For example, ES-WOA with Tsallis’ produces segmented images with average Peak Signal-to-Noise Ratio (PSNR) values 16.0371, 17.9975, 21.1353, and 23.0759 for threshold values 2, 3, 4, and 5, respectively, which are superior to other tested methods. Additionally, the numerical results are statistically validated using a nonparametric approach to eliminate the random effect in the obtained results.

BACKGROUND: The aim of this study is to describe the anatomy of the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA), including the location of the perforators, number of perforators, and proximal and distal origins of the artery. MATERIALS AND METHODS: The study was done by dissecting both wrists of 11 fresh-frozen cadavers. In each specimen, skin incision and dissections were done in the forearm by the Henry approach. Radial artery was identified and cannulated and dye was injected. The dye consisted of the mixture of polyvinyl chloride and acetone in the ratio of 1:4, to which red-colored resin was added. The artery of interest 1,2 ICSRA was dissected and its anatomical characteristics such as distal origin, proximal origin, number of perforators, and largest perforator were measured. RESULTS: Of the 22 wrists dissected, only in 19 wrists we were able to recognize the perforators. Average number of perforators seen was 3.05 (range 1–5). Average distance of the largest perforator from the radial styloid was 11.79 mm (range 6–19 mm). The average distance of the distal origin of 1,2 ICSRA from the radial styloid was 6.71 mm distal to radial styloid. It ranged from 16 mm distal to styloid process to 6 mm proximal to the styloid process. The average distance of proximal origin of 1,2 ICSRA from the radial styloid was 40.52 mm proximal to the radial styloid (range 25–66 mm). The maximum density of perforators of 2.84 was noticed to be in the region of 6–18 mm from the distal articular margin. CONCLUSION: The distal origin of 1,2 ICSRA in our study was much more distal in comparison to the western population. The detailed anatomy of the 1,2 ICSRA presented in this study may guide in planning and dissection to maximize the vascularity of a pedicled bone graft based on this vessel for the management of scaphoid nonunions and other carpal pathologies.

We report two cases of histoplasmosis in orthotopic liver transplant (OLT) recipients to illustrate the variable presentations, complications encountered during treatment, the spectrum of diagnostic modalities, and case outcomes. Case 1 describes the insidious presentation of presumed gastrointestinal histoplasmosis 12 years after OLT, which was defined by months of intermittent diarrhea and focal colonic disease on colonoscopy. A diagnosis of Histoplasma capsulatum was ultimately made by broad range PCR performed on colonic tissue. Due to the patient’s inability to tolerate itraconazole, treatment consisted of two weeks of liposomal amphotericin B with resolution of colonic ulcers on follow-up colonoscopy. Case 2 illustrates a case of severe pulmonary histoplasmosis with dissemination in an OLT recipient one year after transplantation. Treatment was complicated by the development of acute respiratory distress syndrome requiring mechanical ventilation and hemodynamic shock requiring extracorporeal membrane oxygenation therapy. A review of the literature on histoplasmosis in OLT recipients accompanies our cases and emphasizes the epidemiology, clinical manifestations, diagnosis, treatment, and prevention.

Cancer is one of the most critical disease. In particular, Leukemia is the most common type of cancer which produces an excessive quantity of leucocytes, replacing normal blood cells. Early detection of leucocytes cells can save human life. Recently, researchers have contributed to the development of computer assisted pathology techniques to automatically detect cancer at early stage. Commonly, assisted pathology systems are based on artificial vision techniques to identify cancer cells in the human body. Blood image segmentation techniques for Leukemia have been proposed based on automatic thresholding schemes involving traditional clustering methods. However, traditional clustering methods are sensitive to initial cluster positions, where the incorrect centering values results into false positive cancer diagnosis. On the other hand, Nature-Inspired Optimization Algorithms (NIOA) are stochastic search methods for finding the optimal solution for complex multimodal functions where traditional optimization approaches are not suitable to operate. Since blood image segmentation is considered as a complex computational task, NIOA methods yield an interesting alternative to proper blood cell segmentation. In this paper, the Stochastic Fractal Search (SFS) algorithm is implemented in order to provide non-false positive segmented outcomes for Leukemia identification. In the experimental study, the proposed approach is compared against traditional clustering methods as well as some NIOAs techniques. The numerical results indicate that SFS, provide superior results in terms of accuracy, time complexity, and quality parameters.

Background: The coronavirus disease 2019 (COVID-19) pandemic is a global health emergency that could potentially have a serious impact on public health, including mental health. Elderly people are more vulnerable to the stress associated with the COVID-19 outbreak, and there is a dearth of epidemiological data on this issue. Aim: We conducted a web-based survey to evaluate the mental health concerns of middle-aged and elderly populations related to the COVID-19 outbreak from Haryana, India. Materials and Methods: An online survey was conducted from April 17 to May 01, 2020 using the principles of the snowball recruiting technique. The mental health concerns of the potential study participants were evaluated using the Hindi version of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scales. Results: There were a total of 1006 responses, out of which 266 were excluded from the analysis. The mean age of the participant was 58.68 (standard deviation [SD] = 8.05) years, and around 36' of respondents were the elderly with an age range of 60–79 years. The mean and SD of the GAD and PHQ were 2.51 (3.69) and 2.80 (4.86), respectively. The overall prevalence of anxiety and depressive symptoms was 19.7' and 21.5', respectively, (GAD-7 and PHQ-9 cutoff score of more than 05). We found a significant association between mental health outcomes with the presence of comorbid illness and physical activeness during the lockdown period. Conclusion: The present study represents a preliminary report on the psychological impact of the novel coronavirus outbreak in the Indian middle-aged and elderly community. The findings can be preliminary evidence for conducting a larger longitudinal study to guide policy-makers for subsequent research and clinical intervention strategy for mental health concerns related to COVID-19.

Background Patients with haemophilia who are not adequately treated experience a lifetime burden of joint complications and loss of functional ability due to repeated bleeding episodes caused by low levels of clotting factor VIII or IX in the blood. These complications can significantly impact day-to-day life, including active participation in school and academic study in children with haemophilia (CwH). Treatment with factor replacement therapy can help to prevent this, but access to factor has been challenging in low-resource settings such as Northeast India. This study shows the impact of factor replacement therapy on bleeding episodes, joint complications and school absence among CwH in this setting. Methods A retrospective observational study was undertaken to examine the impact of receiving regular factor replacement therapy (prophylaxis or on demand) on school absences among CwH registered with the haemophilia treatment centre at Assam Medical College and Hospital. Annual bleed rate (ABR), Haemophilia Joint Health Score (HJHS) and Functional Independence Score in Haemophilia (FISH) were also assessed. Results Thirty-eight CwH were eligible for the study; 26 (68.4%) were on prophylaxis therapy and 12 (31.5%) received on-demand therapy. In the year before starting regular treatment, the mean ABR was 37.8 (+20.0), HJHS was 31.1 (+18.1) and mean FISH score was 21.1 (+4.2). At the end of the study period the mean (+SD) ABR in prophylactic therapy was significantly lower at 5.8 (+4.6) (p Conclusions Treatment with factor replacement significantly reduces school absence in CwH and correlates strongly with joint health and functional improvement, with the effect slightly better with prophylaxis than on-demand therapy. Low dose prophylaxis is a good treatment option in low-resource settings, but improvements are also needed in rates of diagnosis.

Flower pollination algorithm (FPA) is a new bio-inspired optimization algorithm, which has shown an effective performance on solving many optimization problems. However, the effectiveness of FPA significantly depends on the balance achieved by the exploration and exploitation evolutionary stages. Since purely exploration procedure promotes non-accurate solutions, meanwhile, purely exploitation operation promotes sub-optimal solutions in the presence of multiple optima. In this study, three global search and two local search strategies have been designed to improve balance among evolutionary stages, increasing the efficiency and robustness of the original FPA methodology. Additionally, some parameter adaptation techniques are also incorporated in the proposed methodology. The modified FPA has been successfully applied for histopathological image segmentation problem. The experimental and computational effort results indicate its effectiveness over existing swarm intelligence algorithms and machine learning methods.

Sequestrectomy in chronic osteomyelitis leads to large bony defect in some cases. It needs segemental bone grafting of which fibula is commonly used in children. Few instances might need revision graft due to fracture. We have done a technique of periosteal sparing fibular graft removal in a 9 year old child with the usage of regenerate of the same side for revision procedure. Donor and recipient site healed at 6 months and 2 years respectively with no ankle deformity. This is an easy and versatile technique which can be extrapolated to several other disorders requiring repeated bone graft.

Cat scratch disease (CSD) infrequently mimics malignancy. We reviewed 11 such cases at MD Anderson Cancer Center and an additional 36 reported from the literature. Breast cancer, sarcoma, and lymphoma were the most commonly suspected malignancies. Most patients were young, female, had prior cat exposure, and had no systemic symptoms. Regional lymphadenopathy was the most common finding.

Continuous health status monitoring of the persons equipped with Wireless Body Area Network (WBAN) is one of the key emerging technologies in the area of e-healthcare. In this technology, WBANs and Medical Service Providers (MSPs) are connected via a cloud infrastructure, where WBAN continuously uploads the present readings of physiological parameters via base station such as smart phone, smart watch, etc. Cloud analyzes the physiological parameters and whenever any medical emergency of the user is detected, it checks the infrastructural parameters including the location information of all MSPs connected to it and finds the most appropriate MSP to handle the medical emergency. This MSP selection task has to be performed efficiently so that the medical treatment of the user can start as early as possible. In the existing works, a trusted third party, namely, trusted authority (TA) actively participates in the MSP selection process, which may take undue advantages. The aim of the work in this paper is to remove the role of TA during MSP selection process. However, TA will participate in the system setup phase such that it cannot obtain any advantage in compromising the MSP selection task. The proposed scheme has been scrutinized through an adversary model and simulated using ProVerif tool to verify the security and privacy.

BackgroundCombining an immune checkpoint inhibitor with a tumor vaccine may modulate the immune system to leverage complementary mechanisms of action that lead to sustained T-cell activation and a potent prolonged immunotherapeutic response in metastatic castration resistant prostate cancer (mCRPC).MethodsSubjects with asymptomatic or minimally symptomatic mCRPC were randomly assigned in a 1:1 ratio to receive either atezolizumab followed by sipuleucel-T (Arm 1) or sipuleucel-T followed by atezolizumab (Arm 2). The primary endpoint was safety, while secondary endpoints included preliminary clinical activity such as objective tumor response and systemic immune responses that could identify key molecular and immunological changes associated with sequential administration of atezolizumab and sipuleucel-T.ResultsA total of 37 subjects were enrolled. The median age was 75.0 years, median prostate specific antigen (PSA) was 21.9 ng/mL, and subjects had a median number of three prior treatments. Most subjects (83.8%) had at least one treatment-related adverse event. There were no grade 4 or 5 toxicities attributed to either study drug. Immune-related adverse events and infusion reactions occurred in 13.5% of subjects, and all of which were grade 1 or 2. Of 23 subjects with Response Evaluation Criteria in Solid Tumors measurable disease, only one subject in Arm 2 had a partial response (PR) and four subjects overall had stable disease (SD) at 6 months reflecting an objective response rate of 4.3% and a disease control rate of 21.7%. T-cell receptor diversity was higher in subjects with a response, including SD. Immune response to three novel putative antigens (SIK3, KDM1A/LSD1, and PIK3R6) appeared to increase with treatment.ConclusionsOverall, regardless of the order in which they were administered, the combination of atezolizumab with sipuleucel-T appears to be safe and well tolerated with a comparable safety profile to each agent administered as monotherapy. Correlative immune studies may suggest the combination to be beneficial; however, further studies are needed.Trial registration numberNCT03024216.

Purpose Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [18F]FDG PET/CT, and SPECT/CT with 99mTc-UBI 29-41. Methods Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%). Results Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P < 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [18F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64–0.92) and 0.80 (95% CI: 0.64–0.98), respectively. SPECT/CT with 99mTc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [18F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80–1.00). Conclusion [18F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [18F]FDG PET/CT. The diagnostic performance of SPECT/CT with 99mTc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study.

In this paper, we present a novel vision-based framework for tracking dynamic objects using guidance laws based on a rendezvous cone approach. These guidance laws enable an unmanned aircraft system equipped with a monocular camera to continuously follow a moving object within the sensor's field of view. We identify and classify feature point estimators for managing the occurrence of occlusions during the tracking process in an exclusive manner. Furthermore, we develop an open-source simulation environment and perform a series of simulations to show the efficacy of our methods., To be published in the 2021 International Conference on Unmanned Aircraft Systems (ICUAS)

Common presentation of primary gallbladder carcinoma is with abdominal pain, or it may be detected incidentally in postcholecystectomy specimen for cholelithiasis. Primary gallbladder carcinoma spreads to adjacent hepatic parenchyma and locoregional nodes. Lung is a common extra-abdominal site, with other sites being relatively rare. We report a case of primary gallbladder carcinoma, which presented with elbow swelling in the absence of locoregional nodal spread detected on whole-body F-FDG PET/contrast-enhanced CT at initial evaluation.

Seasonal influenza vaccines represent a positive intervention to limit the spread of the virus and protect public health. Yet continual influenza evolution and its ability to evade immunity pose a constant threat. For these reasons, vaccines with improved potency and breadth of protection remain an important need. We previously developed a next-generation influenza vaccine that displays the trimeric influenza hemagglutinin (HA) on a ferritin nanoparticle (NP) to optimize its presentation. Similar to other vaccines, HA-nanoparticle vaccine efficacy is increased by the inclusion of adjuvants during immunization. To identify the optimal adjuvants to enhance influenza immunity, we systematically analyzed TLR agonists for their ability to elicit immune responses. HA-NPs were compatible with nearly all adjuvants tested, including TLR2, TLR4, TLR7/8, and TLR9 agonists, squalene oil-in-water mixtures, and STING agonists. In addition, we chemically conjugated TLR7/8 and TLR9 ligands directly to the HA-ferritin nanoparticle. These TLR agonist-conjugated nanoparticles induced stronger antibody responses than nanoparticles alone, which allowed the use of a 5000-fold-lower dose of adjuvant than traditional admixtures. One candidate, the oil-in-water adjuvant AF03, was also tested in non-human primates and showed strong induction of neutralizing responses against both matched and heterologous H1N1 viruses. These data suggest that AF03, along with certain TLR agonists, enhance strong neutralizing antibody responses following influenza vaccination and may improve the breadth, potency, and ultimately vaccine protection in humans.

Vestibular schwannomas (VSs) are tumors that commonly occur in the eighth cranial nerve. They are usually associated with type 2 neurofibromatosis. They are uncommon in children, and sporadic cases of pediatric VS are even rarer. In general, VSs are benign lesions with less than 1% chance of intratumoral hemorrhage. Adult cases of hemorrhage in VS are well documented. We present the first pediatric case of intratumoral hemorrhage in VS in the absence of any features of NF in an 11-year-old child who complained of holocranial headache and sensorineural hearing loss in the left ear. We further discuss the pathogenesis and clinical features, and review the literature of intratumoral hemorrhage in patients of VS.

A configuration of energy storage system with STATCOM features (E-STATCOM) using modular multilevel converter (MMC) is presented in this paper. It helps to integrate large wind farms into the grid complying grid codes. The E-STATCOM has the capability to provide active and reactive power supports according to the requirements. The proposed topology can handle higher power at improved efficiency compared to the conventional converter-based configurations. The energy storage system (ESS) of E-STATCOM is formed with battery and ultracapacitor to meet the demand of both high-power-density and high-energy-density loads. Also, the combination can improve the transient performance and lifespan of the battery. In this paper, the integration of hybrid energy storage system (H-ESS) with the MMC to form an E-STATCOM and associated control-related issues are discussed. An algorithm to balance the state of charge among the distributed ESS is proposed. A procedure to determine size of the H-ESS is also discussed. The complete system is simulated in PSCAD, and the effectiveness of E-STATCOM is checked for the integration of a large wind farm with the grid.

In the realm of image processing domain, segmentation is an indispensable method for various applications. One can segment an image according to shape, size, regularities, structure, color, etc. Multi-level thresholding for image segmentation is one of the most promising methods for segmentation in the recent era. However, multi-level thresholding is computationally expensive, tedious and also challenging because of finding the optimal threshold values. Thus, to address this issue, this study presents a stochastic fractal search (SFS) with fuzzy entropy-based multi-level thresholding model for the proper segmentation of color satellite images. To prove the superiority of SFS algorithm, a comparative study is performed with four well-known nature-inspired optimization algorithms, namely particle swarm optimization (PSO), cuckoo search (CS), harmony search (HS) and artificial bee colony (ABC) algorithms. The experiment has been conducted on various satellite images, and the result shows that SFS with fuzzy entropy-based model provides superior-quality segmented images over other methods in terms of fitness value, computational time and values of quality metrics. The experimental study also shows that computational time of SFS algorithms is 2.5% less than CS algorithms and 8%, 9%, 15% less than ABC, PSO, HS, respectively, on average when the same number function evaluations has been considered as stopping criterion.

In the realm of the pathological test, pathologists diagnose diseases viewing specimen on pathological slides based on the size, shape, texture, colour, and darkness of cells. There is no doubt that the detection process is critical and highly depends on experience. In most of the cases, it has been found that the visibility of the microscopic images is not very clear due to improper brightness and contrast. In this paper, the authors propose a new grey level image enhancement technique called fuzzy entropic bi-histogram fuzzy contrast stretching (FEBHFCS) method which is developed depending on the concept of fuzzy logic and appropriate histogram thresholding. The FEBHFCS method is associated with three controlling parameters which crucially influence the FEBHFCS’s image enhancement efficiency, and manual selection of these parameters does not provide full automation to the FEBHFCS. Therefore, this study formulates the image enhancement as a maximization problem which has been solved by employing bat algorithm with the combination of fractal dimension and quality index based on local variance as the objective function. The proposed FEBHFCS provides superior results to some well-known existing histogram equalization variants and has been applied for colour images through one proposed improved hue–saturation–value (HSV) colour model which has the capability to preserve the hue and tackle the out-of-gamut problem. Experimental results show that the proposed improved HSV colour model produces better outcomes than some existing classical and improved colour models by considering the quality of the enhanced colour images and computational time.

Manipulation of a linear network opinion dynamics by a single selfish agent is considered. The selfish agent is modeled as measuring a projection (statistic) of current network opinions, which may be either myopic or global. The agent then enacts a local feedback control using this measurement. The selfish agent’s ability to manipulate network-wide opinions to a desired reference is assessed, both under nominal conditions and in the presence of a second, stubborn agent. Specifically, it is shown that low-gain proportional and proportional-integral controllers can be applied to manipulate network-wide opinions or opinion statistics. A nonlinear variant on the opinion-dynamics model, where the agents’ opinions are capped, is also briefly studied. The control strategies are illustrated using a 62-node dolphin social network model.

Introduction: Fresh frozen plasma (FFP) prepared from whole blood contains plasma proteins and all the coagulation factors including factor V and factor VIII. Many FFP transfusion guidelines have been published till now. However, the administration is inappropriate without any scientific basis or clinical indication in many hospital settings. Aims and Objectives: A retrospective study was carried out between February 2016 and August 2016 in the regional blood transfusion center of our institution to assess the appropriate usage of FFP in obstetrics and Gynecology. It was done using the FFP transfusion guidelines based on the British Committee for Standards in Hematology and College of American Pathologists. Materials and Methods: Blood bank requisition forms received from patients of obstetrics and gynecology department during this period were screened. Indications for transfusion requests were studied and further divided into appropriate and inappropriate requests. Results: A total of 901 units of FFP were issued to 250 patients during this period. Appropriate usage of FFP was found in 67% and inappropriate usage in 33% of the 250 patients evaluated. Bleeding related to surgery with deranged coagulation profile constituted the most common appropriate indication for FFP infusion, and severe anemia was the most inappropriate indication for FFP use. Conclusion: The usage of FFP requires a proper understanding and knowledge about the appropriate and inappropriate usages. It also involves training and supervising the medical staff at regular intervals. Computerized audit programs are required to do a prospective monitoring of the FFP issue and usage in any clinical setting. Further studies are required on the usage of FFP specifically in obstetric and gynecology patients to improve the utilization of this precious blood product.

Background Pyogenic liver abscesses (PLAs) are an uncommon, but potentially life threatening infection. We report a case of PLA due to Streptococcus constellatus, a member of the Streptococcus anginosus group (SAG) bacteria, commonly found as commensals of the oropharyngeal, gastrointestinal and genitourinary flora. Case The patient, a 42-year-old man with no premorbidities, non-smoker and non-alcoholic, presented to our hospital with high-grade fever associated with chills and rigors and right upper quadrant pain of one month duration. Culture of the ultrasound-guided liver aspirate yielded a pure growth of S. constellatus subspecies constellatus identified by conventional biochemical tests. In a standard antimicrobial disk-diffusion test, the isolate was susceptible to cefepime, cefotaxime, ceftriaxone, vancomcyin, levofloxacin, clindamycin and linezolid. Treatment with parenteral ceftriaxone alongwith appropriate surgical management led to resolution of the abscess with no recurrence of infection at three months follow-up. Conclusions The pathogenic potential of SAG has generally been disregarded because of the commensal nature of these microorganisms; however, streptococci belonging to this group have been increasingly reported as relevant pathogens in abscesses and blood cultures. An underlying condition, such as diabetes, cirrhosis or cancer or some medical manipulation, such as dental extraction, acupuncture, or hemorrhoidectomy is associated with the majority of patients with SAG abscess. However, the present case highlights the need to include S. constellatus and other members of the SAG while investigating for etiology of PLA, even in immunocompetent adults.

BACKGROUND: The efficacy of a single bolus dose of epidural dexamethasone added to levobupivacaine–fentanyl combination for labor analgesia has not been studied. In this randomized double-blind controlled trial, we assessed the effect of epidural dexamethasone in reducing the hourly average consumption of epidural levobupivacaine–fentanyl combination in laboring parturients and to study its effect on pain score, maternal satisfaction, maternal and neonatal outcome. METHODS: Sixty adult ASA I-II single-gestation full-term primigravid laboring parturients with cervical dilation ≤ 5 cm were randomly assigned to two equal-sized groups. Combined spinal–epidural block was performed in all the parturients. After placing the epidural catheter in epidural space, 8 mg of preservative-free dexamethasone was administered to the dexamethasone group, and 0.9% saline to the placebo group. All parturients received continuous background infusion of 5 ml of 0.1% levobupivacaine with 2 μg/ml of fentanyl with the provision of patient-controlled bolus of 5 ml of 0.1% levobupivacaine with 2 μg/ml of fentanyl (lockout interval 15 min). The primary outcome measure was the hourly total consumption of levobupivacaine–fentanyl mixture. The secondary outcome measures were maternal satisfaction, pain score, maternal hemodynamic parameters, fetal heart rate, duration of second stage of labor, mode of delivery, Apgar scores and adverse effects. RESULTS: Hourly drug consumption and hourly bolus requirement were significantly lower in the dexamethasone group than placebo group (6.97 ml ± 1.22 vs. 8.40 ml ± 2.59 and 0.41 ± 0.26 vs. 0.72 ± 0.55, respectively, P = 0.008 for both). There were no significant differences in other outcome measures. CONCLUSION: Epidural dexamethasone significantly decreased average hourly drug consumption and the number of boluses in laboring parturients, thus providing epidural drug dose-sparing effect.

Ophthalmic complications in the lung transplant population are a little-known entity. It includes a spectrum of diseases ranging from infections such as cytomegalovirus (CMV) retinitis, herpetic keratitis, Pseudallescheria boydii to non-infectious complications such as posterior subcapsular cataracts (PSCs), cyclosporine retinopathy, and post-transplant lymphoproliferative disorder (PTLD). These diseases can be attributed to high levels of immunosuppression, advanced age, and drug-specific side effects. Underlying comorbidities such as diabetes mellitus may also play a role in the pathogenesis. Patients can present with varied symptoms such as blurry vision, floaters or eye pain. Prompt diagnosis often requires a high index of suspicion. With increasing numbers of transplants being performed worldwide, it is imperative for the pulmonologist and transplant physician to recognize these often subtle symptoms. Any visual symptom should trigger an ophthalmological evaluation in order to manage these complications; some of which pose the risk of systemic dissemination and significant morbidity. The following article provides an in-depth review of the common presenting symptoms, treatments and recent advances related to common ophthalmic complications following lung transplantation. While this article focuses on the lung transplant sub-population, the authors would like to point out that some of these complications are shared by other solid-organ transplants as well, by virtue of their shared immunosuppressive therapies.

Severe acute respiratory syndrome coronavirus 2 can lead to life‐threatening coronavirus disease 2019 (COVID‐19) infections in patients with hematologic malignancies, particularly among hematopoietic cell transplant (HCT) recipients. We describe two patients with COVID‐19 during the pre‐engraftment period after HCT and review previous reports of COVID‐19 in HCT recipients. Because of significant mortality from COVID‐19, primarily after allogeneic HCT, early, preemptive, and optimal directed therapy may improve outcomes and reduce the mortality rate but still needs to be established in clinical trials.

The renewable energy is rising everyone’s attention due to increasing demands. The electrical losses to be found in the wind system and the performance of the system decreased in the presence of losses. The research outlined in this paper is capable of knowing the state of the wind system when there are electrical losses in the wind system. In this article, we considered the location of the Muppadal Wind Power Station, as it is a town in the southernmost Indian district of Kanyakumari and is a major wind system site in Tamil Nadu. It was the biggest producer of renewable energy in Tamil Nadu and India. Various scenarios were examined in order to examine the state of the system. This investigation helps the researcher to understand the status of Wind turbine, converter and battery during different level of electrical losses in the system. This work was carried out using HOMER software.

Background To compare the efficacy and safety of bioavailable turmeric extract versus paracetamol in patients with knee osteoarthritis (OA). Methods In this randomized, non-inferiority, controlled clinical study, patients of knee OA were randomized to receive bioavailable turmeric extract (BCM-95®) 500 mg capsule two times daily or paracetamol 650 mg tablet three times daily for 6 weeks. The primary outcome measure was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. The secondary outcome measures were WOMAC total, WOMAC stiffness, and WOMAC physical function scores. Responder analysis of individual patients at different levels (≥ 20%, ≥ 50%, and ≥ 70%) for WOMAC score was calculated. TNF alpha and CRP levels were evaluated and adverse events (AE) were also recorded. Results Seventy-one and seventy-three knee OA patients, respectively in bioavailable turmeric extract and paracetamol groups, completed the study. Non-inferiority (equivalence) test showed that WOMAC scores were equivalent in both the groups (p value d) of 0.5 whereas CRP and TNF-α were better reduced with turmeric extract than paracetamol. After 6 weeks of treatment, WOMAC total score, pain, stiffness, and function scores got a significant improvement of 23.59, 32.09, 28.5, and 20.25% respectively with turmeric extract. In the turmeric extract group, 18% of patients got more than 50% improvement and 3% of patients got more than 70% improvement in WOMAC pain and function/stiffness score and none of the patients in the paracetamol group met the criteria. CRP and TNF-α got significantly reduced (37.21 and 74.81% respectively) in the turmeric extract group. Adverse events reported were mild and comparatively less in the turmeric extract group (5.48%) than in the paracetamol group (12.68%). Conclusion The results of the study suggest that bioavailable turmeric extract is as effective as paracetamol in reducing pain and other symptoms of knee osteoarthritis and found to be safe and more effective in reducing CRP and TNF-α. Trial registration Clinical Trials Registry – India CTRI/2017/02/007962. Registered on 27 February 2017

Propelled by recent policy initiatives and technological developments, India’s digital payment system is a promising success story in the making. At the same time, the data also points towards an increasing usage of cash. While aggregate country-level data can indicate overall preferences of citizens, we use a novel online survey-based dataset to understand how factors such as ‘perception’ and ‘trust’ in digital payments, and experience with online frauds, affect the payment behaviour of consumers. While demographic factors like age, gender and income are relevant factors which determine this choice, we find compelling evidence that a person’s usage of digital payment methods is influenced by her perception of these instruments, as well as her trust in the overall payments framework and banking system in general. We find that the degree to which past-experience with online fraud deters usage of digital payments varies with the purpose of the transaction.