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Although the Affordable Care Act (ACA) has been shown to broadly affect access to care, there is little data examining the change in insurance status with regard to nonelective spinal trauma, infection, and tumor patients. The purpose of this study is to evaluate the changes in insurance status before and after implementation of the ACA in patients who present to the emergency room of a single, level 1 trauma and regional spinal cord injury center. Patient demographic and hospital course information were derived from consult notes and electronic medical record review. Spinal consults between January 1, 2013, and December 31, 2015, were initially included. Consults between January 1 and December 31, 2014, were subsequently removed to obtain two separate cohorts reflecting one calendar year prior to ("pre-ACA") and following ("post-ACA") the effective date of implementation of the ACA on January 1, 2014. Compared with the pre-ACA cohort, the post-ACA cohort had a significant increase in insurance coverage (95.0% versus 83.9%, P < 0.001). Post-ACA consults had a significantly shorter length of stay compared with pre-ACA consults (7.94 versus 9.19, P < 0.001). A significantly greater percentage of the post-ACA cohort appeared for clinical follow-up subsequent to their initial consultation compared to the pre-ACA cohort (49.5% versus 35.3%, P < 0.001). Spinal consultation after the implementation of the ACA was found to be a significant positive predictor of Medicaid coverage (odds ratio = 1.96 [1.05, 3.82], P = 0.04) and a significant negative predictor of uninsured status (odds ratio = 0.28 [0.16, 0.47], P < 0.001). Increase in overall insurance coverage, increase in patient follow-up after initial consultation, and decrease in hospital length of stay were all noted after the implementation of the ACA for spinal consultation patients presenting to the emergency department.

The purpose of this study was to examine the relationship between timing of preoperative surgical antibiotic prophylaxis and postoperative surgical site infections (SSIs) among patients with 1-level to 3-level lumbar fusion.Patients having undergone a primary 1-level to 3-level lumbar fusion at a single institution were allocated into 5 groups based on the time from preoperative antibiotic administration to incision (group A, 0-15 minutes; group B, 16-30 minutes; group C, 31-45 minutes; group D, 46-60 minutes; and group E, 61+ minutes). Timing of antibiotic administration as a continuous variable was also analyzed. All patients received irrigation with 3 L of normal saline containing bacitracin as well as local administration of vancomycin powder. SSIs were identified by the definition set forth by the 2017 Centers for Disease Control and Prevention guidelines.Among 1131 patients, 27 (2.4%) were found to have an SSI. Compared with patients with antibiotic administration within 0-15 minutes before incision, patients with administration 61+ minutes before incision (group 4) had significantly higher odds of developing an SSI (P0.001). Patients had a 1.05-fold higher likelihood of infection for each additional minute delay of administration before incision (P0.001). Receiver operating characteristic analysis reported an area under the curve of 0.733 and 0.776 for time as a continuous and categorical variable, respectively. Age (P = 0.02), body mass index (P = 0.03), diabetes mellitus diagnosis (P = 0.04), and type of antibiotic (P = 0.004) were significant predictors of SSI.Our results show that preoperative antibiotic administration beyond 1 hour in patients who have undergone lumbar fusion is associated with higher rates of SSI.

Tumor depth is a reliable parameter to predict nodal metastasis in oral cancers; therefore, the authors embarked upon a prospective observational study to define the relationship between the tumor depth and the risk of cervical lymph node involvement as well to determine the optimal tumor depth cutoff point for nodal metastasis.The aim was to study the predictive value of depth of invasion (DOI) and tumor size on risk of cervical node metastasis in squamous cell carcinoma of the oral cavity.Biopsy-proven Stage I-Stage III oral cavity squamous cell carcinoma patients were included in this prospective, observational study. Various histopathological characteristics (DOI, tumor size, lympho-vascular invasion [LVI], perineural spread, and grade of differentiation) were analyzed to predict the cervical node metastasis.The impact of the clinical and histopathological parameters of primary tumor on cervical lymph node metastasis was analyzed by univariate as well as multivariate logistic regression analyses using NCSS 12 version 12.0.5 statistical software.The independent predictors of cervical lymph node metastasis were DOI (P = 0.0014) and LVI (P = 0.0414). The incidence of cervical metastasis increased markedly when the DOI was over 5 mm, and it was a statistically significant (P0001) association.DOI is a significant predictor of cervical nodal metastasis and tumor depth 5 mm can be considered as a cutoff value in staging and management of early oral squamous cell carcinoma.

Lung Cancer is the most commonly occurring type of cancer in the world. Despite all the research in the field of lung cancer is still maintains a extremely high mortality rate and a cure rate of of less than 15%. Majority of lung cancer patients are diagnosed at a very advanced stage which is why randomized clinical trials have come under intense scrutiny from the medical practitioners and have led to a new resurgence of interest in its screening methods and development of newer techniques to improve its efficiency. The existing screening and detection techniques have known to be slow, cost ineffective and have other discrepancies such as false positives. Keeping this in mind we propose to use ensemble learning methods to train our data-set to overcome the drawbacks and improve upon the individual algorithms.

Objectives Gastric varices (GV) have been classified by the Sarin classification for over two decades. However, a subset of these varices does not fit into this classification. We share our experience on GV in past 20 years and propose a modification. Materials and Methods Consecutive patients with portal hypertension (PHT) posted for esophagogastroduodenoscopy were screened for GV between 1996 and 2016 at a tertiary-care hospital. GV were categorized as gastroesophageal varices (GOV1, GOV2) and isolated gastric varices (IGV1, IGV2) by Sarin’s classification. Patients with varices in esophagogastric region as well as distally in the stomach or duodenum, thus having efferent drainage into the superior as well as inferior vena cava simultaneously, remain unclassified and were coined as GOV3. Statistical Analysis Descriptive data was represented as mean (standard deviation) or median (interquartile range) or number (percentage). Chi-squared test, t-test, and logistic regression were done to compare groups and identify outcomes of interest. Results GV were recognized in 400 (11.5%) of 3,476 patients with PHT. Underlying disease was cirrhosis in 301 (75.2%), extrahepatic portal venous obstruction in 78 (19.5%), noncirrhotic portal fibrosis in 18 (4.5%) and Budd–Chiari syndrome in 3 (0.75%) patients with GV. GOV1, GOV2, IGV1, IGV2, and combined GOV1 with GOV2 were seen in 170 (42.5%), 154 (38.5%), 17 (4.3%), 5 (1.3%), and 12 (3.0%) patients; respectively. GOV3 were identified in 42 (10.5%) patients. Ninety-three patients with GV presented with gastrointestinal bleed and frequency of GOV2 was higher and GOV1 and GOV3 were lower among bleeders than non-bleeders. Conclusions A significant proportion of patients with GV remain uncategorized by current classification among PHT patients. Addition of GOV3 in Sarin’s classification will make it more comprehensive, uniform, and reproducible for future studies.

IgG4-related sclerosing cholangitis (ISC) is a frequent occurrence. However, its diagnosis is difficult. This review summarizes the clinical features, pathogenesis, differential diagnosis, and management of ISC. A precise diagnosis of ISC is important. Diagnosis is based on the Japanese criteria which has recently been provided. The characteristic features of plasma cell infiltration and raised IgG4 levels along with classical histopathological and imaging findings help in diagnosis. Steroid therapy is very effective in ISC. Immunomodulatory drugs have also shown promising results. Diagnostic approach of ISC mainly involves imaging modalities. Japanese diagnostic criteria is important in its diagnosis. It is also extremely important to differentiate IgG4 sclerosing cholangitis from various other cholangiopathies. Steroid therapy stays the treatment of choice. The role of other immunomodulators needs to be researched and reciprocated in clinical setting before it replaces steroid therapy.

This article presents two hybrid multioutput buck–boost quasi-Z-source converters (q-ZSCs) capable of giving two dc and one ac outputs simultaneously from a single dc input. One dc and the ac outputs of the proposed multioutput q-ZSCs have both buck and boost capabilities and the other dc output has the property of boosting the input voltage, thereby capable of giving a wide range of voltage gain both for dc and ac outputs. The rationale behind proposing two variants of the hybrid multioutput q-ZSCs is to have more flexibility on voltage gains as per the load requirements. The proposed converters are derived from the quasi-Z-source concept and hence inherit all the properties of q-ZSI, which realize buck/boost, single-stage inversion, and power conditioning with improved reliability along with inherent shoot-through protection capability. All the three outputs of the proposed converters can be independently controlled making them suitable for various applications. The proposed converters can be utilized for various modern multioutput dc–dc and dc–ac power conversion applications, such as renewables and the uninterrupted power supplies. Detailed steady-state operation, loss/efficiency analysis of the proposed converter, and discussion on the hybrid pulsewidth modulation are presented in this article. In order to bring out the advantages of the proposed multioutput converter, a detailed comparative analysis among the proposed and other closely related existing multioutput converters is carried out in this article. A 310-W prototype is developed to verify the performance of the proposed multioutput buck–boost q-ZSC.

BACKGROUND There is a paucity of information regarding treatment strategies and variables affecting outcomes of revision lumbar fusions. OBJECTIVE To evaluate the influence of primary vs different surgeon on functional outcomes of revisions. METHODS All elective lumbar fusion revisions, March 2018 to August 2019, were retrospectively categorized as performed by the same or different surgeon who performed the primary surgery. Oswestry Disability Index (ODI) and clinical variables were collected. Multiple logistic regression identified multivariable-adjusted odds ratio (OR) of independent variables analyzed. RESULTS Of the 130 cases, 117 (90%) had complete data. There was a slight difference in age in the same (median: 59; interquartile range [IQR], 54-66) and different surgeon (median: 67; IQR, 56-72) groups (P = .02); all other demographic variables were not significantly different (P > .05). Revision surgery with a different surgeon had an ODI improvement (median: 8; IQR, 2-14) greater than revisions performed by the same surgeon (median: 1.5; IQR, -3 to 10) (P

Aim Relative adrenal insufficiency (RAI) has been reported in critically ill patients with cirrhosis. We evaluated the prevalence of RAI and its relationship to clinical course in non-septic cirrhosis patients with ascites. Methods The study included 66 consecutive non-septic cirrhosis patients with ascites. RAI was defined by a delta cortisol lower than 9 μg/dL and/or a peak cortisol lower than 18 μg/dL. Results Sixty-six patients with cirrhosis and ascites were studied. The mean Child-Turcotte-Pugh (CTP) and model for end stage liver disease (MELD) scores were 10.6 ± 1.9 and 21.5 ± 7.3, respectively. The prevalence of RAI in patients with cirrhosis and ascites was 47% (31/66). The prevalence of RAI in patients with and without spontaneous bacterial peritonitis, renal failure and type 1 hepatorenal syndrome (HRS) was comparable. Baseline hyponatremia was common in RAI (42% versus 17%, p = 0.026). There was a significant correlation of prevalence of RAI with prothrombin time, international normalized ratio, MELD scores and CTP class. During follow-up, there was no association between RAI and the risk to develop new infections, severe sepsis, type 1 HRS and death. Conclusions RAI is common in non-septic cirrhotic patients with ascites and its prevalence increases with severity of liver disease. However, it does not affect the short-term outcome in these patients.

In today’s generation of fast Internet and improved connectivity, people are in a great hurry to reach their destination as fast as possible. In this scenario, the people who rely on public transport for their daily commute really need to know when their buses will come to their stop and what is the exact location of the bus. This paper tries to solve the problem of today’s world by building an Android app which will help to track the live location of the bus. The system uses a GPS-enabled mobile phone with the Android application installed in driver’s phone which will help to track the live location of the bus. User can just login to the Android application and can see the buses available in his/her or vicinity.

The (CNC) stands for Computer Numerical Control.It is an advanced technology that has automated many manufacturing applications concerning parts machining as well as other applications. This work presents the implementation of a low-cost desktop size 3-axis CNC machine. It has been built from free software and cheap components. It is able for light duty cutting, painting, carving, and drawing. The control system of the machine consists of a PC and a microcontroller running Grbl software, which is an open source free program. The PC has the task of loading files written in a special programming language for CNCs, which is called G-code. It sends the lines of this file to the microcontroller, which parses the code, interpolates the motion commands, and drives the stepper motors of the machine. The system is built and tested experimentally to prove its operation, robustness, and accuracy. Also this paper presents techniques for speech-to-text and speech-to-speech automatic summarization based on speech unit extraction and concatenation. For the latter case, sentences, words, and between-filler units are investigated as units to be extracted from original speech. These methods are applied to the summarization of unrestricted-domain spontaneous presentations and evaluated by objective and subjective measures. It was confirmed that proposed methods are effective in spontaneous speech summarization.

In recent years several legged/wheeled robots have been developed and proved their effective functionality in locomotion on uneven terrains. Many robotics researchers have been focusing on improving the locomotion speed, as well as the stability and robustness of such robots. High-speed locomotion of robots is however subject to various design challenges, especially in the development of actuators. The robotic applications which require high-speed motion in high torque operations along with the ability to manage dynamic physical interactions are not satisfied by the conventional robotics actuators deploying high reduction gearings. In this work, we present a quasi-direct drive actuator designed for continuous high-speed motions in high torque such as wheeled motions in mobile robot or joint motion in dynamic legged robots. The presented actuator exploits low reduction gearing so that it can render over 25Nm continuous torque while the actuator speed can exceed 20 rad/s. Such characteristics enable exhibiting dynamic motions and dealing with large external impacts. The selection of motor and design of the gearing unit was carried out iteratively so that commercial items with minimum customization are employed and the outer diameter of the motor and the gearbox can be matching. A single-level planetary gearbox is devised for the reduction unit to ensure highly back drivability and transparency of the actuator thereby making the actuator robust against external impacts and allowing for accurate torque control using motor current measurement. The gear set design was carried out based on the AGMA gear torque calculation. Given the radial space required for the gearbox dealing with the torque requirements, the actuator motor was chosen to be small in height (pancake type), which ensures high torque density within smaller dimensions at high-speed operation. The mechanical design of the actuator is presented in this paper and the FEM analysis conducted for the design of critical parts is reported. Finally, actuator specifications in terms of size and performance are compared with similar state-of-the-art actuators.

BACKGROUND Glenoid deformity is commonly encountered in patients undergoing reverse shoulder arthroplasty (RSA). Augmented baseplates can correct glenoid deformity while potentially avoiding certain complications encountered with structural bone graft. Limited evidence exists to support the use of metallic augmented baseplates in RSA. METHODS We performed a retrospective review to identify all patients treated with an augmented baseplate during primary RSA with a minimum of 1 year of clinical and radiographic follow-up. Preoperative radiographs and advanced imaging were used to determine glenoid morphology and deformity. Postoperative radiographs were used to evaluate for deformity correction, radiographic complications, and early baseplate loosening or failure. Prospectively collected clinical data and patient-reported outcome scores were determined. RESULTS Primary RSA was performed with an augmented baseplate in 44 patients (mean age, 72 ± 6 years; 15 half-wedge and 29 full-wedge augmentations). Glenoid retroversion was significantly improved for the entire cohort (P = .001). Among the 22 patients with either Walch type B2, B3, or C glenoid morphology, glenoid version improved from 28° ± 8° to 16° ± 8° (P = .001). Glenoid inclination, as determined by the β angle, was significantly improved for the entire cohort (P < .001). Among the 18 patients with Favard type E2 or E3 glenoid morphology, glenoid inclination improved from 67° ± 7° to 81° ± 8° (P < .001). Postoperative range of motion and functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale score for pain significantly improved within the entire cohort (P < .05). No patients had evidence of baseplate loosening or failure of the glenoid component. Acromial stress fractures developed in 5 patients (11.4%), and 2 patients (4.5%) underwent a reoperation unrelated to the glenoid component. DISCUSSION AND CONCLUSION Primary RSA with an augmented baseplate results in excellent short-term clinical outcomes and significant deformity correction in patients with advanced glenoid deformity. There were no complications related to the augmented baseplate or glenoid component. The rate of acromial stress fractures appears higher than typically reported and warrants further investigation.

STUDY DESIGN This is a retrospective observational study. OBJECTIVE This study evaluates the impact of postoperative fever on the rate of readmission among lumbar fusion patients. SUMMARY OF BACKGROUND DATA Postoperative fever is a common event across surgical specialties that often triggers an extensive work-up that can significantly increase hospital costs and length of stay, although the results are usually negative for infection. There is a paucity of literature studying postoperative fever in lumbar fusion patients. MATERIALS AND METHODS A retrospective chart review of all the patients who underwent elective posterior lumbar spinal fusion from January, 2018 to November, 2018 was conducted. Fever was defined as a temperature >100.4oF. Patients were categorized into 4 groups based on their highest recorded temperature postoperatively. The association between demographic variables, tests ordered per patient, length of stay, and readmission rates per group were analyzed using a t test, and 1-way analysis of variance for continuous outcomes, and the Fisher exact test for categorical variables. RESULTS Of 107 patients, 58% had no fever recorded, 17.75% had temperatures between 100.5 and 100.90oF, 18.69% temperatures between 101 and 101.90oF, and 4.67% of patients temperatures equal or higher than 102.0oF. The number of tests per patient increase with the range of temperatures analyzed (P

Global emerge of zoonotic novel corona virus (COVID-19) became a pandemic and its effect to mankind is talk of the town now a days. This tiny, invisible enemy has affected every country in the world and almost every living directly or indirectly and nationwide complete lockdown has triggered a short-term environmental impact. Since 2003, corona virus came into existence in the form of Severe Acute Respiratory Syndrome (SARS) and more evolved Middle East Respiratory Syndrome (MERS) in 2012. This time, at the end of December 2019, outbreak of novel corona virus COVID-19 (also known as SARS-CoV2, nCoV-2019) draw attention as global health emergency. World Health Organization (WHO) report says that the outbreak of this virus is so immense, it has already affected 35,57,235 people and caused death to 2,45,150 people worldwide and 46,433 Indians got affected with 1568 death as on 5th May 2020 (2:00 am) and these numbers are increasing exponentially day by day. Virologist, micro-biologist and science community are hammering their head very hard to find out cure and vaccine against this powerful virus and to prevent mass demise of mankind. In order to curb the spread of COVID-19, Janta curfew on 22.03.2020 and nationwide complete lockdown was implemented in India for 21 days (phase-I, from 25.03.2020 to 14.04.2020) to stop community transmission of third stage, for 19 days (phase-II, 15.04.2020 to 03.05.2020) and 14 days (phase-III, 04.05.2020 to 17.05.2020) complete lockdown to minimize the community transmission effect. During complete lockdown and quarantine period a drastic change in Earth’s atmosphere, including reduction in emission of greenhouse gases, air pollution (~50% fall in air quality index), noise pollution, water pollution and solid waste pollution, have been recorded by government agencies as well as private agencies. In this paper we considered data of Janta curfew, phase-I and phase-II lockdown to link between geological and environmental aspect related to environmental impact due to emerge of COVID-19 and massive reduction in pollution level during complete lockdown in India. We propose future lockdown strategies to minimize the emission of greenhouse gas by ~100 Mt to ~200Mt (3.33% to 6.66%) of GHGtotal per year by 2-4 days per month nationwide lockdown or ~70 Mt to ~140 Mt (2.33% to 4.66%) of GHGtotal per year by 2-4 days per month complete lockdown of energy sectors only.

Post-transplant malignancy is emerging as an important cause of mortality in patients with cirrhosis undergoing liver transplant (LT). However, establishing the exact relationship between the two needs further evaluation. It has been observed that approximately 30% deaths after 10 years of hepatic transplantation occur due to de novo malignancies. Various known risk factors include immunosuppression, age of patient, alcoholic liver disease (ALD) or primary sclerosing cholangitis, smoking, and oncogenic viral infections. There is scanty literature on the post-transplant malignancy risk in patients with alcoholic cirrhosis. The current evidence suggests a particularly increased risk of oropharyngeal and lung cancers in patients transplanted for ALD. Abstinence from alcohol, smoking and other tobacco-containing products along with optimization of immunosuppression are paramount for decreasing the risk of post-transplant malignancies.

The recent observation of unusually high thermal conductivity exceeding 1000 W m-1 K-1 in single-crystal boron arsenide (BAs) has led to interest in the potential application of this semiconductor for thermal management. Although both the electron/hole high mobilities have been calculated for BAs, there is a lack of experimental investigation of its electronic properties. Here, a photoluminescence (PL) measurement of single-crystal BAs at different temperatures and pressures is reported. The measurements reveal an indirect bandgap and two donor-acceptor pair (DAP) recombination transitions. Based on first-principles calculations and time-of-flight secondary-ion mass spectrometry results, the two DAP transitions are confirmed to originate from Si and C impurities occupying shallow energy levels in the bandgap. High-pressure PL spectra show that the donor level with respect to the conduction band minimum shrinks with increasing pressure, which affects the release of free carriers from defect states. These findings suggest the possibility of strain engineering of the transport properties of BAs for application in electronic devices.

Disasters are the unfortunate suddenly occurring events which collapse a living society within a moment. Facebook, the most trending social media have initiated an active role to response the crisis developing a safety check feature to know about the demand of victims in an area. Through this feature the Facebook authority can confirm the requirement of the affected people in a specific area. This research have introduced a mathematical model for multi-objective solid transportation problem to quick delivery of the relief products to the devastating society according to the most prior demand of an area acquiring the best information through safety check feature launched by Facebook with limited resources. The two main objectives of the model are to minimize the total cost and minimize the total time so that relief can be executed under a limited budget responding quickly to the affected area. In this paper, fuzzy goal programming is adopted to solve the multi-objective solid transportation problem. To contemplate the performance of the model, a numerical example is presented in this paper. The numerical example is solved with LINGO optimization solver.

This article focuses on the trends of law journals published by law schools in India. The article comprises a short overview of the free access to law movement around the world, and it is an attempt to showcase the growing open access to law movement in India. The article visualizes results of the responses received over the publications of legal scholarship in journals by 23 Indian law schools. The article appends recommendations for greater visibility of AW journals published by law schools in India.

Sun is a clean and renewable source of energy and produces solar energy by converting solar radiations into useful electricity through solar cells. Solar energy is obtained from solar radiations by the phenomenon of photoelectric effect. Solar panels are installed in open atmospheric conditions and undergo with environmental effects. These solar panels are subjected to various defects and faults during operation; therefore, proper condition monitoring is needed. Data loggers are used to remotely monitor the condition of solar panels, i.e., voltage, current, temperature, and other atmospheric parameters on the screen of personal computer. QR codes are normally used in commercial applications for information exchange but in this research work a novel technique based on QR code is used to view the variations of values and graphs for different parameters of solar panels via well-designed recording system through an Android app generated for particular QR code. By scanning the QR code, live variations of graphs and values in video form for solar panel data can be visualized which are not possible after time of visualization through data logger is lost. Therefore the research work presents a unique technique for visualizing recorded data in video form for solar panels as off-line whenever needed through a simple Android mobile generated QR code.

Artificial Neural Networks are being used in many applications and forecasting is one of such application where it solves the purpose like stock market predictions, sales forecasting, etc., over the past. In this paper, ANN models are used for forecasting solar power. Multilayer perceptron (MLP) neural network models have been tested for different combinations of transfer functions and net input function on different number of neurons and layers for forecasting solar power. The evaluation and implementation of models are being measured by mean square error.

Tuning defect levels in 2D semiconductors without significantly altering the integrity of the materials remains one of the most difficult challenges, which critically restricts their usage in elect...

The present work aims at improving the design of an energy conversion system operating on solar radiation harvesting and converting it into electricity with the help of thermopiles. Here, the major...

Treatment of Hepatitis C virus (HCV) in patients with severe renal insufficiency is cumbersome as sofosbuvir is mainly excreted by the kidneys. There is paucity of data on the use of sofosbuvir and NS5A inhibitors in these patients. We hereby report our experience of treating chronic hepatitis C in patients with severe renal insufficiency with full dose sofosbuvir and NS5A inhibitors. Forty-seven patients with severe renal insufficiency (on dialysis n = 39, predialysis n = 8) with HCV infection were treated between December 2015-August 2017 with full dose sofosbuvir with ledipasvir or daclatasvir for 12/24 weeks depending on the genotype and the presence or absence of cirrhosis. The distribution of HCV genotype was genotype 1 in 32 (68.1%), genotype 3 in 13 (27.7%) and 4 in 2 (4.3%) patients. Among 12 (25.5%) patients with cirrhosis, 7 (14.9%) were decompensated with ascites. All patients had end of treatment response, and sustained viral response at 12 weeks was achieved in 45 (95.7%) patients. There was significant improvement in liver stiffness at 3 months after treatment (8.8 (3.8-42) to 7.1 (3.3-24.1) kPa; (P = 0.047)). There was no change in haemoglobin and eGFR with treatment in predialysis group (haemoglobin- 10.2 ± 1.5 g/dL vs 9.6 ± 1.3 g/dL, P = 0.44; eGFR- 19.8 ± 9.4 mL/min vs 17.9 ± 8.5 mL/min, P = 0.67). Therapy was very well accepted. Full dose sofosbuvir with NS5A inhibitors is a well tolerated and effective therapy for HCV infection in severe renal insufficiency.

In this paper, junctionless quadruple gate (JLQG) MOSFET is analyzed for its temperature-dependent characteristics. The junctionless MOSFET makes manufacturing simpler because it has no p-n junction as the doping of the channel is same as source/drain (S/D) region. Various performance parameters for short channel effects (SCEs), analog/RF, and linearity distortion of the JLQG MOSFET such as drain current (ID), transconductance (gm1), transconductance generation factor (TGF), output conductance (gd), early voltage (VEA), intrinsic gain (gm/gd), cut-off frequency (fT), gain frequency product (GFP), transconductance frequency product (TFP), gain trans-conductance frequency product (GTFP), second order derivative (gm2), third order derivative (gm3), second order voltage intercept point (VIP2), third order voltage intercept point (VIP3), third order input intercept point (IIP3), and third order intermodulation distortion (IMD3) with respect to temperature variations are presented and discussed. The study reveals the different zero-crossing points for temperature-dependent characteristics leading to guidelines for temperature-insensitive designs using JLQG MOSFETs.

Image encryption is a critical area of cyber security that has emerged as a topic of interest for recent researches. This paper proposes a novel method for image encryption using chaos theory. Logistic maps are used to generate a set of 24 keys that are used to encrypt the image. The complete design is simple and efficient based on permutation, diffusion and optimization. The results obtained showed increased randomness in the encrypted images which is a primary parameter for quality of cipher. We have performed analysis on the proposed approach using histogram analysis, entropy and correlation coefficient.

This paper examines a Junctionless quadruple gate (JLQG) MOSFET for analog and linearity distortion performance by numerically calculating transconductance and its higher order derivatives (gm1, gm2and gm3), VIP2, VIP3, IIP3 and IMD3. Influence of various physical device parameters: channel length, height (or width), gate oxide thickness, and channel doping concentration on the linearity distortion parameters are analyzed. From the numerical calculations it has been shown that the desirable characteristics for analog application at a given technology node are obtained for higher values of tSi, tox, and Nd. The present analysis also reveals the guidelines for the design of JLQG MOSFETs with least linearity distortion.

Background: Early breast cancer patients admitted in the surgical oncology department of Savera Cancer and Multispeciality Hospital. Patients were divided in two treatment arms; Arm A and Arm B. Arm A patient went through MRM and Arm B patients went through BCS. This study included prospective cases of 1 year from June 2019 to June 2020. Method: In all MRM group patients all breast tissue, skin, nipple areola complex and level 1, 2, 3 lymph nodes removed. In all BCS group patients lump was removed with an envelope of normal appearing breast tissue. In all resected specimens free surgical margin was ensured via histopathology reports (HPR). Patients were reviewed in early post operative period for complications and follow up done at the end of 1st, 3rd, 6th and 12th month for recurrence. In treatment Arm A (MRM) 08 patients developed arm ede Result: ma; 05 patients developed shoulder dysfunction; 07 patients developed ap necrosis; 07 patients developed arm dysesthesia. Whether in treatment ARM B (BCT) 04 patient had Seroma formation; 13 patients developed wound infection & wound contracture. Complications were reported in 35% of MRM group (35 out of 100 cases), while they were absent in 65% (65 out of 100). However, in the BCS group, complications were reported in 6.66% cases only (15 out of 100 cases), while were absent in 93.33% (75 out of 100). P value by statistical analysis being 0.283, the difference being statistically insignicant. Recurrence were present in 6.66% of MRM group (8/100) while they were absent in 92.34 % (92/100). However in BCS group recurrences were present in 3.33 % (3/100) and were absent in 97.67% (97/100). P value by statistical analysis being 1, the difference being statistically insignicant. Grading of complications has been captured from CTCAE Version 5.0 (Common Terminology Criteria for Adverse Events). Conclusion: There is slight signicant difference in the recurrence rate, whether the patient had undergone BCS or MRM based on our short term follow-up. However a long term follow-up is required.

Purpose The purpose of this paper is to identify the critical challenges in the implementation of cloud enterprise resource planning (ERP). The challenges identified were customization, organizational change, long-term costs, business complexity, loss of information technology competencies, legal issues, integration, data extraction, monitoring, migration, security, network dependency, limited functionality, awareness, performance, integrity of provider, perception, and subscription costs. Here the small and medium enterprises (SMEs) and large organizations were differentiated with respect to the challenges identified. This paper also suggested ranked lists of challenges both for SMEs and large organizations. Design/methodology/approach An online survey was conducted and data of 93 respondents were analyzed. Exploratory factor analysis and one-way analysis of variance (ANOVA) was used to statistically test the data. Here the SMEs and large organizations were differentiated with respect to the challenges identified. Findings This study shows that SMEs and large organizations differ from each other for most of the challenges except business complexity, integration, monitoring, security, limited functionality, performance, and integrity of provider. Also from the ranked list of challenges in cloud ERP, security was the top concern for both SMEs and large organizations. Originality/value The findings may help organizations to get a broad idea about the challenges which are critical for the implementation of cloud ERP.

To facilitate the next generation of White Light Emitting Diodes (WLEDs) with higher color rendering and warm lighting, the development of inorganic phosphor for efficient conversion of photons from blue/near-UV light to other visible wavelengths is essential. In this regard, we demonstrate a systematic, cost effective, solution-processable, easily scalable and fully controllable synthesis of a series of RbBaScSi 3 O 9 :xEu 2+ (x = 0.2, 0.5, 2, 5, 7), a new cyan emitting scandium silicate based phosphor with 79% internal quantum efficiency under n-UV excitation with robust thermal performance. The concept as well as the methodology of using a “Mineral Inspired Approach” emerges as a new blueprint for the rational design of novel phosphor for phosphor converted WLEDs. The structural refinement, electronic structural calculation using “Density Functional Theory”, characteristic photoluminescence study, lifetime measurement as well as the thermal quenching properties of the phosphor has been investigated in detail. Owing to the highly efficient cyan emission at λ max ∼492 nm a full-width at half-maximum of 63 cm −1 that shows only very low thermal quenching (89.28% relative to the PL intensity at 150 °C with respect to that of measured at room temperature), reflects the great potential for the industrial application of this particular phosphor.

In this paper, a quasi-3-D analytical model for Junction-less quadruple MOSFET is presented. The model is developed based on an equivalent number of gates by solving two 2-D Poisson's equations instead of solving complex full 3-D Poisson's equation considering it as two double gate MOSFETs. The model is verified for different channel length, height (or width), oxide thickness, doping concentration, and bias voltages. The presented device is then analysed for digital, analog and RF performance parameters using numerical computations. It has been shown in the paper that the JLQG provides improved gain and SCEs with increase of channel length and decrease in height (or width), oxide thickness and doping concentration whereas a higher cut-off frequency is obtained by decreasing channel length and increase in height (or width), oxide thickness and doping concentration. The doping affects the device performance parameters the most.

Background/Aims: The aim of the study was to evaluate the safety of non-anesthesia provider (NAPP) administered propofol sedation in patients undergoing non-advanced gastrointestinal (GI) endoscopic procedures. Materials and Methods: Pubmed, Embase, Cochrane central register of controlled trials, Scopus, and Web of Science databases were searched for prospective observational trials involving non-advanced endoscopic procedures. From a total of 608 publications, 25 [colonoscopy (9), upper GI endoscopy (5), and combined procedures (11)] were identified to meet inclusion criteria and were analyzed. Data was analyzed for hypoxia rates, airway intervention rates, and airway complication rates. Results: A total of 137,087 patients were involved. A total of 2931 hypoxia episodes (defined as an oxygen saturation below 90%) were reported with a pooled hypoxia rate of 0.014 (95% CI being 0.008-0.023). Similarly, pooled airway intervention rates and pooled airway complication rates were 0.002 (95% CI being 0.006–0.001) and 0.001 (95% CI being 0.000–0.001), respectively. Conclusions: The rates of adverse events in patients undergoing non-advanced GI endoscopic procedures with NAPP sedation are extremely small. Similar data for anesthesia providers is not available. It is prudent for anesthesia providers to demonstrate their superiority in prospective randomized controlled trials, if they like to retain exclusive ownership over propofol sedation in patients undergoing GI endoscopy.

A high gain embedded dual switched capacitor boost-based impedance source DC-DC converter is presented in this paper. The converter is continuous input current based high gain converter which uses fewer passive components, lower capacitors voltage stress to achieve high voltage gain and inherits all the properties of impedance source network. This converter is suitable for batteries, photovoltaic, fuel cells for microgrid applications where the available input voltage is low and needs to step up by a huge value. The detailed analysis of operating principle and steady-state analysis are discussed to show the advantages of the proposed DC-DC converter. To verify the operation of the proposed converter, a hardware prototype is designed and implemented in the laboratory and the corresponding results are discussed in this paper.

This paper proposes a switched-capacitor multilevel inverter (SC-MLI), which ensures the peak inverse voltage (PIV) across all the switches within the dc source voltage. A total of thirteen (or higher) voltage levels can be generated using only one dc source in the proposed SC-MLI. The number of dc sources reduce significantly in the prosed circuit. In addition, voltage gain of three (or higher) is achieved through the proposed SC-MLI. As the PIV of the switches are within the input dc source voltage in the proposed SC-MLI, it requires lower rated power devices and also the total standing voltage (TSV) reduces. The capacitors in the proposed SC-MLI are self-balanced. The proposed SC-MLI has been compared with existing SC-MLIs in terms of PIV, TSV, and active/passive components in this work. The performance of the proposed 13-level SC-MLI has been validated through a 550 W experimental prototype.

There is controversy regarding the inclusion of granulocyte colony stimulating factor (G-CSF) in the treatment of decompensated cirrhosis. Previous studies tested only a single cycle of G-CSF administration or were underpowered to detect changes in survival time. We performed an adequately powered study to determine whether multiple cycles of G-CSF increased the survival of patients 1 year after the start of therapy.We conducted an open-label trial of 100 patients with decompensated cirrhosis without acute-on-chronic liver failure at a tertiary center from July 2016 through June 2018. The patients were assigned randomly to a group given 5 days of G-CSF every 3 months, with standard medical therapy, in 4 cycles (group A, n = 50), or standard medical therapy alone (group B, n = 50). The primary outcome was survival for 12 months after treatment began. Secondary outcomes were an increase in the number of CD34+ cells at day 6 compared with day 0, along with reductions in Child-Turcotte-Pugh and model for end-stage liver disease scores, increased control of ascites, reduced decompensation and episodes of infection, fewer hospitalizations, lower liver stiffness measurements, increased quality of life and nutrition, fulfilment of liver transplant criteria, and fewer adverse events at 12 months after the start of treatment.Groups A and B were comparable at baseline. Survival at 12 months after initiation of treatment was significantly higher in group A (74%) than in group B (42%) (P .001). Blood samples from patients in group A had significantly more CD34+ cells on day 6 than on day 0 (P .001); there was no significant change in group B. Compared with patients in group B, patients in group A had significant reductions in Child-Turcotte-Pugh and model for end-stage liver disease scores, increased ascites control, fewer infections and hospitalizations, lower liver stiffness measurements, an increased quality of life, and a lower number fulfilled the liver transplant criteria (P .05). There was no improvement in nutrition in either group compared with baseline. G-CSF was safe and well tolerated.Administration of multiple cycles of G-CSF increases the numbers of hematopoietic stem cells and survival of patients with decompensated cirrhosis receiving standard medical treatment. The addition of G-CSF to medical treatment might provide a bridge to liver transplantation for these patients. ClincialTrials.gov no: NCT03415698.

This paper presents a multiport power divider for base station antenna application. Over these years, power dividers have been changing their structures and technology in order to be compatible with the newer changes adopted in designing of communication systems. From being operated as a single-frequency component to being flexible with dual-frequency bands, Wilkinson power dividers have come a long way to become an important and integral part of various RF/microwave devices. The recent technologies for cellular communication have motivated researchers to work on miniaturization and harmonic suppression of power dividers to make them more compact and efficient. Both equal and unequal power dividers are largely employed for L and S-Band applications (GSM, CDMA, Personnel communication systems). S- Parameters such a return loss, insertion loss and isolation between output ports plays an important role in their designing.In this paper the sector microstrip multiple port power dividers is analyzed by using the fullwave finite element method. Design a new type power divider with different geometrical and physical parameters namely the substrate dielectric constant, substrate height and power divider radius. The maximum error in calculating the centre frequency of the power divider does not exceed. 10-port, 7-port, 5-port, 4-port and 3-port, sector microstrip power dividers are realized on epoxy substrates using PCB fabrication. Good agreement is found between the experimental and numerical results obtained from both the finite element method and the ready-made software package HFSS.

Van der Waals heterostructures formed by stacking different atomically thin layered materials have emerged as the sought-after device platform for electronic and optoelectronic applications. Determining the spatial extent of all the encapsulated components in such vertical stacks is key to optimal fabrication methods and improved device performance. Here we employ electrostatic force microscopy as a fast and non-invasive microscopic probe that provides compelling images of two dimensional layers buried over 30 nm below the sample surface. We demonstrate the versatility of the technique by studying heterojunctions comprising graphene, hexagonal boron nitride and transition metal dichalcogenides. Work function of each constituent layer acts as a unique fingerprint during imaging, thereby providing important insights into the charge environment, disorder, structural imperfections and doping profile. The technique holds great potential for gaining a comprehensive understanding of the quality, flatness as well as local electrical properties of buried layers in a large class of nanoscale materials and vertical heterostructures.

The central library of National Law University Delhi has rich collection of law e-books from various publishers. These e-books were available to the faculty and students through different publisher platforms and it was difficult to find them subject-wise. Library is currently using LIBSYS-7 automation software. The paper depicts detailed experiment carried out to weave these e-books into library catalogue through LIBSYS-7. The whole technical process is described step by step and searching e-books through OPAC. The e-books can be searched subject-wise along-with print books and their full text can be downloaded through OPAC. This experiment establishes library catalogue as core source of information of all library resources. Users get benefitted to a great extent in finding their desired e-book through library catalogue. Other libraries having rich e-book collection may adopt this practice for the benefit of their end-users. dx.doi.org/10.14429/djlit.36.1.8912

Background: Diabetic foot is the most important surgical manifestation of diabetes. With foot infection a major cause of morbidity bacterial infection play an important role in diabetic foot ulcers. Aim of this study was proposed to establish the bacterial profile and anti-microbial pattern of ulcer in an attempt to evaluate the role of infection in the foot lesions of diabetic patient. Associated factors like incidence, age, sex, predisposing factors, duration of diabetes, ulcer grade, hospital stay, modes of treatment, antibiotics sensitivity and other outcomes were also evaluated. Methods: This is a Prospective cohort study. The patients were admitted in surgical ward as provisional diagnosed cases of diabetic foot, were subjected to investigations including blood sugar (fasting, P.P, random), renal function test, x-ray of affected foot, fundus examination, grading of ulcer and various modes of treatment was given. Gross examination and culture from ulcers were done. Study was done in 104 patients over 1 year period. Results: One hundred four patients with diabetic foot were evaluated. Incidence of diabetic foot was 1.26%. Majority of cases were from rural areas (82.7%). Newly diagnosed cases of diabetes at admission (22.11%), majority of cases culture was positive (94.1% of 85). Staphylococcus was the predominant organism (61.17%), there were patients who were not on any mode of treatment (29.8%). Conclusions: Staphylococcus aureus a gram positive cocci was the most common micro-organism grown on culture from the ulcer (61.17%), next common micro-organism was Klebsiella (16.47%) gram negative bacilli. Piperacillin and metronidazole were most commonly used antibiotics. Diabetes was controlled by human actrapid (human regular insulin) in majority of the patients. Majority belonging to rural areas (82.7%). Most of the cases were relieved (77.88%). Only two cases fatality (1.92%) occurred during study period.

Background: Gastrointestinal perforation constitutes one of the most common causes of surgical emergency. The main objective was to study different causes of perforation peritonitis and there sign, symptom. Factors affecting morbidity and mortality. Methods: It was prospective 1 year study conducted in surgical ward of Department of surgery SGMH Rewa (M.P.) during the period August 2014-July 2015.A total of 277 cases of gastrointestinal perforation peritonitis were studied. Patients are selected on the basis of symptom, sign at the time of admission and operative finding. All patients have been studied and results are compared with previous similar studies. Results: Abdominal pain was present in all cases of perforation peritonitis. 89.9% of patient had distension of abdomen, 79.9% complained of fever and 34.3% with vomiting. On per abdominal examination tenderness and distension was present in all cases of perforation. 96.5% of cases had guarding/rigidity. 82.7% of cases had gas under the diaphragm with majority of them in peptic ulcer perforation and minimum in appendicular perforation. Conclusions: Patient with higher age group had higher mortality compare to younger age group. Mortality was maximum 32% in age group of >60 years. Overall mortality in our study was 12.63% and was due to delayed presentation to hospital, delayed operative intervention due to shock and septicaemia, with co-morbidity being the additive factors.

Background: Appendicitis is one of the commonest conditions responsible for the admission of patients to hospital for surgical treatment. Aim of study was to find the incidence of appendicular lesions according to age and sex and to analyze clinical condition of appendicitis according to Alvarado score and to investigate and correlate the finding with clinical symptoms in relation to TLC, X-Ray abdomen and Ultrasound and to manage the cases accordingly conservatively or subjected to emergency or elective appendectomy. Prospective cohort study. Methods: The Patients with classical symptoms and sign of acute, recurrent and chronic appendicitis were admitted in surgical ward were subjected to investigations including haemoglobin, TLC & DLC, Blood Sugar, Blood Grouping, X-ray chest, x-ray abdomen and ultrasound of abdomen. Patients were evaluated according to Alvarado score. Study was done in 385 patients over 1 year period. Results: Three hundred eighty five patients with Appendicitis were evaluated and incidence of appendicular lesions was 4.28%. Maximum incidence of appendicitis was in age group 21-30 years (33.50%), (30.39%) patients were of Alvarado score 6 or more. Majority of cases 315 (81.82%) out of 385 treat conservatively and 70 (18.18%) patients were operated. Patients with Alvarado score >7, 13 (3.37%) had positive operative findings and 11 (2.85%) had positive histopathological examination and patients with TLC > 10000, 11 (2.85%) had positive operative findings and 11 (2.85%) had positive histopathological examination and polymorph >75,28 (7.27%) had positive operative findings and 28(7.27%) had positive histopathological examination. Conclusions: In this study we found that clinical score is a simple, rapid and non-invasive method to early diagnosis of appendicitis. TLC are inflammatory marker are also useful in early diagnosis of acute appendicitis. Ultrasound abdomen is also useful to confirm the diagnosis. The majority of our patients presented early disease. Conservative approach of treatment gave positive response and then we planned for elective appendectomy after regular interval. Because of these negative appendectomy rate are decreasing and morbidity period are also decreasing pre or post appendectomy. There was much less post-operative complication, which were higher in emergency appendectomy. In our study we concluded that timely intervention reduce the negative appendectomy and reduce the length of morbidity.

Background: The people of new world are highly susceptible to gall bladder disorder, which include cholelithiasis and its complication and malignancies. Gall bladder and rest of biliary system diseases are known from ancient time. The ladder of development of treatment has shifted from conservative attitude to the most modern intervention by endoscopy and laparoscopy. This study aims to look at the demographics, operative morbidity and pathology of the removed gallbladder in the local population. Methods: This is a prospective study in which 350 patients presenting with definitive diagnosis of gallbladder disorders or presenting with clinical features suggestive of cholecystitis and later on diagnosed as acute cholecystitis or other gallbladder disorders, were included in the study. Their demographic data, symptomatology and associated illness were documented. In acute condition we followed conservative line of treatment and who are not responding to conservative measure or who were admitted for routine surgery we followed operative measure either laparoscopic or open cholecystectomy, the gallbladder specimen was sent for histopathological examination and bile was sent for bacteriological examination. Results: The incidence of the gallbladder disorders was 4.23% of the total admission and maximum number of patients recorded in the month of October. The ratio of male: female was 1:4.3 and most of the female were multipara. Maximum number of patients recorded in the age group of 31- 40 year. Maximum number of patients belongs to middle socioeconomic group and consumed mixed diet. Majority of patients present with pain in abdomen. 69.43% patients treated conservatively rest were treated by open or laparoscopic cholecystectomy. 24.30% patients had positive culture for bacteriological examination and most commonly isolated organism was E.Coli. All the patients had chronic cholecystitis on histopathological examination. Conclusions: The result showed most common disorder of gallbladder was acute calculous cholecystitis and gallbladder disorders were more common in multiparous females of 4 th decade. Most of the patients presented with pain in right hypochondrium. All the patients with acute condition were responded to conservative management. In operative intervention laparoscopic cholecystectomy is much better than open cholecystectomy because of reduced hospital stay with lesser post-operative morbidity.

Background: Cancer is on rise. WHO estimates that by 2030, the incidence of cancer will increase by 68% as compared to 2012. This study evaluates epidemiological profile of Cancer in the Vindhya region. Design of this study was combination of retrospective and prospective study. Methods: All cancer patients admitted in surgery ward of S. S. medical college, Rewa between 2010 to 2014 were included in the study. Data regarding age, gender, religion, socio-economic status, residence, dietary habits, addiction and site of cancer as well as mortality pattern of cancer was tabulate, analyzed and compared. Results: 1186 cases were included in this study which constituted 3.02% of total admissions in surgical ward. 50.25% were males, 49.75% were females. Most common age groups were middle age group i.e. 35-64 years (25.30% males, 32.29% females, total 57.59%) and geriatric (19.48% males, 11.38% females, total 30.86%). 95.78% were Hindus, 4.22% were Muslims. 70.40% were BPL, 29.60% were APL. 67.20% belonged to rural areas, 32.80% were from urban areas. 75.89% were vegetarians, 24.11% were non-vegetarians. 25.97% were addicted to tobacco alone, 1.52% to alcohol alone and 18.63% to both tobacco and alcohol. Breast cancer was the most prevalent cancer (19.06%), followed by cancer gall bladder (10.55%). Among males, colorectal cancer was the commonest (11.24%), gall bladder was the 4 th commonest (8.22%). Among females, breast was the commonest (37.12%) and gall bladder was the 2 nd commonest (12.88%). Gall bladder cancer was the commonest (13.93%) in geriatric age group, 2 nd commonest (9.37%) in the middle age group and 5 th commonest in the young age group (7.63%). 18.38% of all and 46.40% of gall bladder cancer presented with metastasis. 91 cancer deaths were recorded accounting for 3.64% of all deaths and the case fatality rate of cancer was 7.67%. Gall bladder cancer was the commonest cause of Cancer deaths overall (14.29%) and in females (20.00%) and 2nd commonest among males (10.70%) after Ca stomach (12.50%). Cancer gall bladder was the commonest cause of death in middle age (16.34%) and 2 nd commonest in geriatric age group (15.63%). Conclusions: Cancer affects all genders, ages and demographic profiles. Cancer of gall bladder has emerged as a major cause of morbidity and mortality in this study.

BACKGROUND CONTEXT Surgical site infections (SSIs) in patients who have undergone lumbar fusion surgery can be a devastating complication and a common indication for revision surgery. The functional decline and economic burden put on the patient as a result of infection can drastically affect postoperative outcomes. As such, studies have identified potential areas of intervention, including: optimizing patient comorbidities, thoroughly supervising the operating room, and administering antibiotic prophylaxis. Guidelines have established a goal to infuse antibiotics within one hour prior to incision. PURPOSE The aim of this study was to examine the relationship between timing of preoperative surgical antibiotic prophylaxis and adverse outcomes (e.g. SSIs, 90-day readmissions, and revision surgery) with subgroup analysis stratified by type of antibiotic. While most antibiotics are administered within one hour of surgery, certain circumstances (ie, prolonged case duration, long operating room turnover) may delay the time from antibiotic administration to incision. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A cohort of patients status post elective one- to three-level lumbar fusion performed between January 2013 and December 2018 was identified at a single, high-volume academic medical center using a database query via Standardized Query Language (SQL). OUTCOME MEASURES The primary outcome of interest was surgical site infections (SSIs), with secondary outcomes of interest including: 90-day readmission and revision surgery. METHODS SQL query and electronic medical record (EMR) chart reviews were used to identify patient demographics, surgical case characteristics, and postoperative complications. Patients were allocated into 5 groups based on the time period from preoperative antibiotic administration to incision (Group A = 0-15 min, Group B = 16-30 min, Group C = 31-45 min, Group D = 46 – 60 min, and Group E = 61+ min). SSIs were identified by the definition set forth by the CDC. Statistical analysis, including a logistic regression model, was used to examine the relationship between patient/case characteristics, preoperative antibiotic timing, and postoperative outcomes. RESULTS From 1,131 patients included in the final analysis, 26 SSIs were identified. Univariate analysis revealed patients in Group E had significantly longer lengths of operation (p: 0.044) and higher mean comorbidity scores (p: 0.012) compared to all other groups. Logistic regression analysis revealed that Group E patients were 1.4 times more likely to develop an SSI and 7.2 times more likely to be readmitted within 90 days compared to Group A. Furthermore, Groups B-D did not show evidence of significantly higher odds of infection compared to Group A. When stratified by antibiotic type, patients treated with Vancomycin showed the lowest incidence of SSI when administered between 16-30 minutes, however Cefazolin showed the lowest incidence when administered between 0-15 minutes. Among 26 SSIs, nine cultures showed evidence of multi-drug resistance, with two treated preoperatively with vancomycin and seven treated with cefazolin. CONCLUSIONS Our results present that preoperative antibiotic administration beyond one hour in patients who have undergone lumbar fusion is associated with higher rates of SSI. Furthermore, the utility of vancomycin to minimize the risk of SSI is optimal when administered between 16 and 30 minutes prior to incision. An effective antibiotic prophylaxis regiment depends on patient characteristics and the pharmacokinetics of antibiotic selection, while minimizing side effects and multi-drug resistant organisms. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Control, state estimation and motion planning of highly articulated snake robots have been challenging tasks for researchers. As a result, formulating gaits for the modular structure, for motion on flat trajectories as well as overcoming obstacles is mathematically complicated. This paper presents a novel design of a Compliant Omni-directional snake robot (COSMOS) consisting of mechanically and software linked spherical robot modules. This design eliminates the problems of planar snake robots to handle versatile motions with complex gait analysis, by leveraging Omni-directional motion capabilities of spherical robots. The robot is also capable of climbing smooth obstacles by introducing compliant joints in the links interconnecting adjacent modules. This paper also presents the basic robot gaits and their motion analysis which clearly demonstrate the robot design advantages such as fast turn speed and simpler motion planning strategies. Experimental results that verify the effectiveness of this robot architecture and gaits that have been designed to traverse flat terrain are included. Also, the spring stiffness of the passive joints which provide the vertical compliance in the links joining the modules is calculated and simulation results for obstacle climbing are included.