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This case report demostrates an unusual occurence of orbital metastasis along with liver metastasis 5 years following enucleation for ciliochoroidal melanoma with no extraocular extension. It exemplifies that metastasis of the tumour can occur in the ipsilateral orbit after enucleation. Importance of close clinical follow-up after enucleation for choroidal melanoma, careful socket examination, and regular systemic metastatic workup is demonstrated. To the best of our knowledge, this is the first case report of uveal melanoma with ipsilateral orbital metastasis.

The proliferation of omnichannel practices and emerging technologies opens up new opportunities for companies to collect voluminous data across multiple channels. This study examines whether leveraging omnichannel data can lead to, statistically and economically, significantly better predictions on consumers’ online path-to-purchase journeys, given the intrinsic fluidity in and heterogeneity brought forth by digital transformation of traditional marketing. Using an omnichannel data set that captures consumers’ online behavior in terms of their website browsing trajectories and their offline behavior in terms of physical location trajectories, we predict consumers’ future path-to-purchase journeys based on their historical omnichannel behaviors. Using a state-of-the-art deep-learning algorithm, we find that using omnichannel data can significantly improve our model’s predictive power. This enhanced predictive power benefits various heterogeneous online firms, regardless of their size, offline presence, mobile app availability, or whether they are selling single- or multi-category products. Using an illustrative example of targeted marketing, we further quantify the economic value of the improved predictive power and the value of data.

An 8-year-old girl presented with painless decreased vision and leukocoria in the right eye since 6 days. There was no antecedent history of trauma. Visual acuity in the right eye was counting fingers 1 m. Ocular examination revealed right exotropia, conjunctival congestion, anterior chamber cells

Many IoT devices lack the necessary interfaces (keyboards, screens) for entering passwords or changing default ones. For these devices, bootstrapping trust can be challenging. We address the problem of device pairing in the absence of any shared secrets. Pairing is a two-phase process that requires the mutual authentication between the two parties and the agreement to a common key that can be used to further bootstrap essential cryptographic mechanisms. We propose a secret-free and in-band trust establishment protocol that achieves the secure pairing of commercial off-the-shelf (COTS) wireless devices with a hub. As compared to the state-of-the-art, our protocol does not require any hardware/firmware modification to the devices, or any out-of-band channels, but can be applied to any COTS device. Furthermore, our protocol is resistant to active signal manipulations attacks that include recently demonstrated signal nullification at an intended receiver. These security properties are achieved in-band with the assistance of a helper device such as a smartphone and by exploiting hard-to-forge signal propagation laws. We perform extensive theoretical analysis to verify the security of the proposed protocol. In addition, we validate our theoretical results with experiments using COTS devices and USRP radios.

Introduction: Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (KF-HD). We determined both AF incidence and burden in patients with KF-HD using implantable loop recorder (ILR) monitoring. Methods: Patients with KF-HD were enrolled and received an ILR. In 6 monitoring months, the incidence of AF events lasting ≥6 minutes was captured. Demographic, clinical, and dialysis characteristics were collected, and associations with incident AF were estimated using negative binomial regression models and expressed as incidence rate ratios and 95% CIs. Results: We enrolled 66 patients with KF-HD (mean age = 56 years, 70% male); 59 (90%) were without previously diagnosed AF. AF lasting ≥6 minutes was detected in 18 of 59 subjects (31%) without previously diagnosed AF and in 5 of 7 subjects (71%) with a previous AF diagnosis. Among the 23 with detected AF, episodes were present on 16% of patient days. Although 14 of 23 patients (61%) had AF on 2.5 vs. 2.5 mEq/l: incidence rate ratio = 0.62; 95% CI, 0.48–0.80) was associated with lower AF risk whereas higher dialysate bicarbonate concentrations (>35 vs. 35 mEq/l: incidence rate ratio = 3.18; 95% CI, 1.13–8.94) were associated with higher AF risk. Conclusion: New AF was detected in approximately one-third of patients with KF-HD. AF affects a substantial proportion of patient days and may be an underappreciated cause of stroke in KF-HD.

Social media platforms for healthcare services are changing how patients choose physicians. The digitization of healthcare reviews has been providing additional information to patients when choosing their physicians. On the other hand, the growing online information introduces more uncertainty among providers regarding the expected future demand and how different service features can affect patient decisions. In this paper, we derive various service-quality proxies from online reviews and show that leveraging textual information can derive useful operational measures to better understand patient choices. To do so, we study a unique data set from one of the leading appointment-booking websites in the United States. We derive from the text reviews the seven most frequently mentioned topics among patients, namely, bedside manner, diagnosis accuracy, waiting time, service time, insurance process, physician knowledge, and office environment, and then incorporate these service features into a random-coefficient choice model to quantify the economic values of these service-quality proxies. By introducing quality proxies from text reviews, we find the predictive power of patient choice increases significantly, for example, a 6%–12% improvement measured by mean squared error for both in-sample and out-of-sample tests. In addition, our estimation results indicate that contextual description may better characterize users’ perceived quality than numerical ratings on the same service feature. Broadly speaking, this paper shows how to incorporate textual information into an econometric model to understand patient choice in healthcare delivery. Our interdisciplinary approach provides a framework that combines machine learning and structural modeling techniques to advance the literature in empirical operations management, information systems, and marketing. This paper was accepted by David Simchi-Levi, operations management.

Multilingual Sentiment analysis plays an important role in a country like India with many languages as the style of expression varies in different languages. The Indian people speak in total 22 different languages and with the help of Google Indic keyboard people can express their sentiments i.e reviews about anything in the social media in their native language from individual smart phones. It has been found that machine learning approach has overcome the limitations of other approaches. In this paper, a detailed study has been carried out based on Natural Language Processing (NLP) using Simple Neural Network (SNN) ,Convolutional Neural Network(CNN), and Long Short Term Memory (LSTM)Neural Network followed by another amalgamated model adding a CNN layer on top of the LSTM without worrying about versatility of multilingualism. Around 4000 samples of reviews in English, Hindi and in Bengali languages are considered to generate outputs for the above models and analyzed. The experimental results on these realistic reviews are found to be effective for further research work.

Purpose To report the phenomenon of spontaneous regression in presumed ocular surface squamous neoplasia (OSSN) Methods Retrospective chart review of clinically diagnosed cases of OSSN during 2016 to 2019 Results Of the 449 OSSN lesions, spontaneous regression was seen in 8 lesions (2%). The mean age at diagnosis of OSSN was 37 years (median, 36 years; range, 21 to 59 years). All were males with unilateral, treatment-naïve tumors. Mean duration of symptoms was 3 months (median, 2 months; range, 1 to 12 months). All tumors arose within the interpalpebral region, located in the nasal quadrant in 88% (n = 7) and in temporal quadrant in 12% (n = 1). The mean tumor diameter was 4 mm (median, 4 mm; range, 3 to 5 mm). Lesions showed nodular (n = 4; 50%) or placoid (n = 4; 50%) morphology. The other features included keratin production and intrinsic vascularity (n = 8; 100%), feeder vessels (n = 4; 50%), and intratumoral pigmentation (n = 4; 50%). The diagnosis of OSSN was confirmed by classic anterior segment optical coherence tomography (AS-OCT) features. Tumors regressed after a mean period of 5 months (median, 4 months; range, Conclusion OSSN can spontaneously regress in 2% of cases. Immune-mediated reversal of dysplastic changes may explain this phenomenon. Précis In this study, spontaneous regression of presumed ocular surface squamous neoplasia was noted in 2% patients. Tumor regression resulted in restoration of normal epithelial architecture and no recurrences were observed during the follow-up period.

Localized inflammatory or reactive overgrowths are quite more common clinical findings on human gingiva. Most of the lesions are benign and innocuous though some have potency to transfer in to a malignant lesion. These types of lesions are difficult to identify clinically as their appearance are quite similar so only Histopathological evaluation can detect their identity. In this case report we displayed a case of Peripheral Ossifying Fibroma in maxillary anterior tooth region in 32 year old female patient along with clinical, Histopathological evaluation along with present and future treatment details. Peripheral ossifying fibroma (POF) is usually a fibromatic, non neoplastic enlargement of the gingiva which shows areas of calcification or ossification. Synonyms for POF include Peripheral cementifying fibroma, Peripheral fibroma with calcification, Calcifying or ossifying fibrous epulis and Calcifying fibroblastic granuloma. Keywords: Gingival overgrowth, Ossifying fibroma, Peripheral ossifying fibroma, Peripheral cementifying fibroma

Recent trends in real-time applications have raised the demand for high-throughput embedded platforms with integrated CPU-GPU based Systems-On-Chip (SoCs). The enhanced performance of such SoCs, however, comes at the cost of increased power consumption, resulting in significant heat dissipation and high on-chip temperatures. The prolonged occurrences of high on-chip temperature can cause accelerated in-circuit ageing, which severely degrades the long-term performance and reliability of the chip. Violation of thermal constraints leads to on-board dynamic thermal management kicking-in, which may result in timing unpredictability for real-time tasks due to transient performance degradation. Recent work in adaptive software design have explored this issue from a control theoretic stand-point, striving for smooth thermal envelopes by tuning the core frequency. Existing techniques do not handle thermal violations for periodic real-time task sets in the presence of dynamic events like change of task periodicity, more so in the context of heterogeneous SoCs with integrated CPU-GPUs. This work presents an OpenCL runtime extension for thermal-aware scheduling of periodic, real-time tasks on heterogeneous multi-core platforms. Our framework mitigates dynamic thermal violations by adaptively tuning task mapping parameters, with the eventual control objective of satisfying both platform-level thermal constraints and task-level deadline constraints. We consider multiple platform-level control actions like task migration, frequency tuning and idle slot insertion as the task mapping parameters. To the best of our knowledge, this is the first work that considers such a variety of task mapping control actions in the context of heterogeneous embedded platforms. We evaluate the proposed framework on an Odroid-XU4 board using OpenCL benchmarks and demonstrate its effectiveness in reducing thermal violations.

A 66-year-old diabetic, hypertensive, and hypothyroid female presented in the emergency department with cardiac arrest, for which cardiopulmonary resuscitation was immediately initiated. She had been on oral fexofenadine for 36 h prior to the event. Post successful resuscitation, her cardiac rhythm showed high-grade atrioventricular block. Patient was treated with mechanical ventilatory support and temporary transvenous pacing. No treatable cause could be identified, and she recovered completely following fexofenadine discontinuation, without need for a permanent pacemaker. She has remained asymptomatic during 1 year of follow-up with no documented arrhythmias. An electrophysiological study at 6 months revealed prolonged HV interval (70 ms) with 1:1 AV conduction and no inducible arrhythmias. This is probably the first reported case of fexofenadine-induced cardiac arrest in a patient without previous history of heart disease.

Safeguarding is an action that promotes the welfare of children and adults and aims to protect them from harm and maltreatment. This article will focus on children and the role of the anaesthetist. As an anaesthetist, you may not see signs of abuse often, but you will see children in different settings and should be able to clearly communicate any worrying concerns. Reading this article will increase your knowledge of laws and statutory advice for safeguarding.

We propose a roadmap for leveraging the tremendous opportunities the Internet of Things (IoT) has to offer. We argue that the combination of the recent advances in service computing and IoT technology provide a unique framework for innovations not yet envisaged, as well as the emergence of yet-to-be-developed IoT applications. This roadmap covers: emerging novel IoT services, articulation of major research directions, and suggestion of a roadmap to guide the IoT and service computing community to address key IoT service challenges., Comment: Accepted for publication in for publication in Communications of the ACM (CACM) 2021

It is very important to have a slag detection system (SDS) in steelmaking to detect slag and prevent its flow for improving the quality of steel produced. Slag raking is used for removing slag from...

Aim: Fetal movement counting may assist clinicians to intervene at the right time and improve perinatal outcomes, but may sometimes cause unnecessary interventions. A recent Cochrane review in 2015 concludes that there is insufficient evidence to influence practice. This prospective observational study was conducted to evaluate pregnancy outcomes of 103 pregnant women presenting with primary complaints of reduced fetal movements to our Institute. Materials and Methods: All patients underwent ultrasonography (USG) and non-stress testing (NST) as preliminary investigations and were followed up till delivery. Labor outcomes like onset of labor, mode of delivery, neonatal outcomes like APGAR scores, admission to NICU for > 24 hours, birth weight, neonatal complications and maternal complications were noted. Results: One hundred and three pregnant women presented with reduced fetal movements, of whom, 65% were term primigravida between the ages of 18-26 years. 47.5% belonged to the high risk pregnancy group. The rates of admission (62.1%), induction (77.7%) and cesarean section (43.7%) were high in this group. Pregnancy outcomes did not differ between single and multiple episodes of reduced fetal movements. Based on risk categorization we found that a single episode of reduced fetal movement was associated with approximately 70% good neonatal outcomes, whereas there was 50% risk of adverse neonatal outcomes with multiple episodes. Though this was clinically significant we could not establish statistical significance for this result. Conclusion: Reduced fetal movement can occur in both low and high risk pregnant population. Pregnancy outcomes between single and multiple episodes of RFM were not significantly different. Keywords : Outcomes, Pregnancy, Reduced fetal movement.

Collision avoidance for fixed-wing unmanned aerial vehicles (UAVs), using a novel methodology of avoidance map, is addressed in this work. Avoidance map is defined as a mapping in the control input...

Trademarks of an establishment cannot solely be associated with identification of origin or source. It performs an imperative task of building brand name and value. The dilution theory rejects the opinion that the role of a trademark is solely based on the recognition of the root or source of its origin and that it is not only a figurative representation but carries a creative aspect as well. For the most recent decade, the greatest inquiry in trademark law has been the manner by which to demonstrate weakening or dilution. Dilution has turned out to be a dauntingly slippery idea. The principal issue with dilution law is that it gives a cure without a supportable hypothesis of the harm or damage. Even though lately the concept has been recognized in International as well as domestic jurisdiction putting an immense responsibility on domestic jurisdiction to protect trademarks against dilution, very little has been discussed or clarified regarding the theory of dilution. Ambiguity of such nature facilitated this research trying to spot some light on the theory of dilution comparing it from divergent angles in different jurisdictions. The paper also highlights the interpretation mechanism of the courts of the dilution provision and explains the concept further with reference to important cases under the U.S. laws and European judgments in the context of the Dilution laws and draws a comparative analysis of the effectiveness of the legal framework present in India with that of the USA.

To provide data that can guide community-targeted practices, policies, and interventions in urban metropolitan areas, we used geospatial analysis to examine the community-level opioid overdose death determinants and their spatial variation across a study area. We obtained spatial datasets containing multiple, high-quality measures of socioeconomic conditions, public health status, and demographics for analysis and visualization in geographic information systems. We employed a multiscale modeling approach (multiscale geographically weighted regression; MGWR) to provide a comprehensive and robust analysis of opioid overdose death determinants, explain how geospatial patterns vary across scales across Milwaukee County in 2019, and examine the differential influence of factors locally, regionally, and globally. We subsequently examined how associations varied with the racial/ethnic composition of communities by dividing Milwaukee County into White-majority, Black-majority, and Hispanic-majority regions according to census data and conducting separate, independent modeling processes. Overall, the multiscale model explained 83% of opioid overdose death variability across neighborhoods in Milwaukee County using 12 selected variables. Statistical analysis and geovisualization of patterns, trends, and clusters using MGWR unveiled dramatic racialized health disparities in Milwaukee, showing how factors that influenced opioid overdose deaths varied across diverse communities in Milwaukee. The observed geographic variation in relationships included the impact of naloxone availability and incarceration rates on overdose deaths with pronounced differences between White communities and communities of color. Understanding, community-level factors that contribute to overdose risk should guide targeted community-level solutions. Overall, our findings demonstrate the value of precision epidemiology using MGWR analysis for defining and guiding responses to public health challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00554-x.

On March 11, 2020, the World Health Organization (WHO) released a statement characterizing COVID-19 as a pandemic that has, as of October 2020, caused almost 36 million confirmed global cases and over 1 million deaths. One of the long-term complications suggested by researchers is fibrosis. It has been hypothesized that the combination of ongoing pulmonary injury caused by COVID-19 and the inability to promptly repair damage results in interstitial matrix widening and eventual compression and destruction of alveoli and capillaries. Here we focus on pathogenesis, risk factors, different infectious causes of fibrosis along with COVID-19, and potential treatment options that might reduce its effects. Key words: COVID-19, pulmonary fibrosis, mechanism, treatment

Background: Resilience is a dynamic capability which helps people to survive on challenges given appropriate social and personal contexts. Objective: To determine the resilience and to find out the association between resilience and selected socio-demographic variables, if any. Methodology: An institution based mixed method study was conducted among MBBS students from April to May, 2018 at IQ City Medical College by using Child and Youth Resilience Measures Questionnaire (CYRM-28). Multivariate analysis of variance (MANOVA) was performed using SPSS-21software.Results: Older students, Males, 8th semester batch, and day boarder were more resilient in certain areas. In individual and contextual domain, score gradually increased with increase in age groups. Resilience score were more or less similar among both the sexes. 8th semester students were found to be more resilient in all the domains. Personal skills, social skills, psychological care giving, education, played much larger role in differences across the sex, age, semester, and accommodation. Conclusion:Thus counselling and more teacher student bonding are required to propagate the resilience of the medical students. More emphasis has to be given on identified areas so as to make our future doctors more strong and resilient.

Introduction: Polycystic ovarian syndrome is the most common endocrine and metabolic heterogeneous disorder among reproductive-aged women. Obesity worsens the metabolic, clinical and endocrine features of PCOS, mainly by increasing insulin resistance and hyperinsulinemia: Obesity rates are increasing due to changing lifestyles, including unhealthy food habits. The objective of this study was to characterize the dietary pattern and BMI of PCOS women and to compare it with healthy controls. Materials and Methods: This study was a case-control study. Study Population was women in the age group 15-45 years with complaints s/o PCOS and age matched control group .PCOS cases were diagnosed using Rotterdam criteria and the controls were age matched women without PCOS. All the women were subjected to a detailed history taking and physical examination. The data was entered in Excel sheet and Statistical analysis was done using SPSS version 23. Results: The average age of PCOS cases was 24.64 years. There was a statistically significant increase in history of snacking with ingestion of high caloric and oily food in PCOS cases compared to control women. PCOS women were more overweight and Obese compared to Control women and this difference was also statistically significant. Conclusion: The results of this study suggests with PCOS is associated with an increased intake of food high in calorie and saturated fat and that women who are obese or overweight are more likely to develop PCOS. Lifestyle modifications like healthy diet and regular exercise should be the front line therapy in PCOS women. Keywords: BMI, Dietary Influences, PCOS, Snacking.

A 65 year-old-gentleman underwent dual chamber pacemaker implantation (DDDR, St Jude Medical) 7 years back for infra-hisian complete heart block. He was completely asymptomatic and came for his annual routine check-up. After undergoing ECG with and without magnet, he was prepared for device evaluation. After placing the programmer wand over the chest as soon as the 'interrogate' button on the programmer screen was pressed, the patient immediately experienced pre-syncope but recovered instantly as the wand was promptly withdrawn. After taking him to the casualty room with all resuscitation measures in hand, a repeat attempt of interrogation was made after connecting ECG, which revealed reproducible loss of capture (LOC), exclusively during wand placement. A differential diagnosis of lead failure, battery depletion or wand related issues were considered. However, serial ECGs recorded without wand raised the possibility of AutoCapture malfunction. With all precautions, the device was programmed to fixed ventricular output mode after which interrogation could be performed safely. There was a remaining battery longevity of 2 years with acceptable lead parameters and stable threshold. He continues to be asymptomatic at 10 months of follow up. This article is protected by copyright. All rights reserved.

The employment conditions in India were steadily deteriorating in the 2000s. Agriculture not just stopped accommodating new workers but was increasingly rendering many of the already employed workers—mostly less educated—redundant. Meanwhile, non-agriculture was generating employment at an increasingly slower pace and was also generating it basically for the educated. So, it was failing to absorb the labour moving out of agriculture. Under these conditions, progressive exclusion of the less educated from employment and decelerating employment growth of the educated emerged as the main trends, which showed up in declining employment rate, rising unemployment rate and, ironically enough, steady improvement in the average quality of employment. All this was happening in a period of rapid economic growth. The proximate explanation is that growth was less rapid than the skill-biased technological change that was associated with it. The deeper reason is that the benefits of growth accrued to a thin top layer of the population—the rich.

Yanjie Wang,1 Josephine Etowa,2 Bishwajit Ghose,3 Shangfeng Tang,4 Lu Ji,5 Rui Huang6 1Xinxiang Medical University, Xinxiang, 453003, Henan, People’s Republic of China; 2School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; 3Organisation pour l’environnement et Développement Durable, Lomé, BP: 80867, Togo; 4School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 5School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 6School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of ChinaCorrespondence: Rui HuangSchool of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of ChinaEmail hys19810612@163.comIntroduction: Using data from Malawi Demographic and Health Survey (2015– 16), in the present study, we aimed to assess the role of exposure to family planning information through various mass media on the utilization of maternal healthcare services.Methods: The sample population included 13,217 women aged 15– 49 years with a history of at least one childbirth. Outcome measures included essential maternal healthcare services such as early and adequate use of antenatal care, skilled delivery service. Multivariate logistic regression models were used to find the association between maternal healthcare services and exposure to family planning messages by controlling for sociodemographic characteristics.Results: Women who reported receiving family planning message through internet [odds ratio=1.48, 95% CI=1.15, 1.91], radio [odds ratio=1.15, 95% CI=1.05, 1.26], TV [odds ratio=1.53, 95% CI=1.32, 1.76] and mobile phone [odds ratio=1.23, 95% CI=1.02, 1.48] had higher odds of having timely ANC care. For using adequate number of ANC, the associations were significant for TV [odds ratio=1.41, 1.23, 1.62] and mobile phone [odds ratio=1.20, 95% CI=1.01, 1.43] only. For the use of facility delivery, a strong association was observed for poster [odds ratio=1.43, 95% CI=1.12, 1.82] and TV [odds ratio=2.99, 95% CI=1.78, 5.03]. The odds of using all three services varied noticeably between urban and rural areas, eg, receiving family planning messages through internet increased the odds of antenatal care and facility delivery services in the urban areas only, whereas that from poster was associated only for facility delivery and only in the rural areas.Conclusion: The findings indicate a positive association on media communication regarding family planning on the uptake of maternal healthcare services.Keywords: mass media, family planning, health communication, maternal healthcare utilisation, Malawi

Background: Being born preterm increases the risk of both morbidity and mortality but with improved care the chances of survival is increasing. The age of viability was earlier dened at 28weeks but in the best of centres it has now come down to 25weeks. Extremely low birth weight (ELBW) babies who weigh less than 1000gms are particularly at risk of dying with the overall mortality in this group ranging from 30% to 50 % in the best of centres. This study was conducted to nd out the immediate outcome of extremely low birth weight babies born in a tertiary care centre, of a resource poor country like India. Objective:To evaluate the immediate morbidity and mortality of Extremely Low Birth Weight Babies in the NICU setup of a tertiary care hospital. Study Design:Retrospective Observational Cohort Study Place of Study: Department of Paediatrics, Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, India Period of Study:January 2018 to December 2020 Methods: The study was a retrospective analysis of data of babies born with a birth weight of less than 1000gms and admitted to the Neonatal Intensive care unit of Ramakrishna Mission Seva Pratishthan. The maternal demographic prole and delivery outcome were recorded along with the neonatal morbidity and mortality in a predesigned proforma. These data were then pooled and analysed. Results: The total number of ELBW babies born during this period was 31 out of whom 15 succumbed(48%). The studies in the developed world too shows the mortality in this group to range between 30 to 50 %. Most of the deaths occurred in the rst few days of life due to birth asphyxia. The commonest morbidity was Respiratory Distress Syndrome (RDS) (71%), followed by sepsis (64.5%), anemia (54.8%) and hyperbilirubinemia (51.6%). Necrotising Enterocolitis (NEC) was found in 9.7% of babies. 16 babies (52%) survived and went home in a stable condition. Retinopathy Of Prematurity (ROP) was detected in 11 of these babies for whom laser therapy was done with the advise for follow up. Conclusion: This study shows that in a resource poor country like India too, the percentage of babies who can be salvaged amongst the extremely low birth weight babies, matches with those in the developed countries, though a question remains about their long term morbidity

Background: Quality by design-based software’s in analytical research and development normally encompasses multiple objectives. For decades, this task has been attempted through trial and error, supplemented with the previous experience, knowledge, and wisdom of analytical researchers. Objective: The study analyzes the current QbD-assisted software’s, such as design-experts, minitab, fusion product development, etc., and its broad implementations in an analytical research and development. Methods: The traditional approach may fails to meet the intended purpose by trial and error procedure during analytical research and development. However, modern scientific technology is equipped with highly advanced features associated with the software of the QbD paradigm. The impact and interactions between the critical process variables and critical method attributes such as resolution, tailing, etc. can be well understood by the screening, optimization, and robustness studies based on the principles of experimental design. Results: The design of experiments assimilate statistical multi-variate analysis instead of one factor at a time approach. This also provides a prominent, most reliable quality output, which is also essential for getting highly robust method as well as to obtain homogenous product development. Conclusion: The present review, critically discussed about the various QbD based multivariate software and their applications in drug development and analytical research.

OBJECTIVE: Infectious disease emergencies like the 2013-2016 Ebola epidemic and the 2009 influenza and current SARS-CoV-2 pandemics illustrate that vaccines are now given to diverse populations with preexisting pathologies requiring pharmacological management. Many natural biomolecules (steroid hormones, fatty acids, vitamins) and ~60% of prescribed medications are processed by hepatic cytochrome P450 (CYP) 3A4. The objective of this work was to determine the impact of infection and vaccines on drug metabolism. METHODS: The impact of an adenovirus-based vaccine expressing Ebola glycoprotein (AdEBO) and H1N1 and H3N2 influenza viruses on hepatic CYP 3A4 and associated nuclear receptors was evaluated in human hepatocytes (HC-04 cells) and in mice. RESULTS: CYP3A activity was suppressed by 55% in mice 24 h after administration of mouse-adapted H1N1, while E‚10% activity remained in HC-04 cells after infection with H1N1 and H3N2 due to global suppression of cellular translation capacity, indicated by reduction (70%, H1N1, 56%, H3N2) of phosphorylated eukaryotic translation initiation factor 4e (eIF4E). AdEBO suppressed CYP3A activity in vivo (44%) and in vitro (26%) 24 hours after infection. CONCLUSION: As the clinical evaluation of vaccines for SARS-CoV-2 and other global pathogens rise, studies to evaluate the impact of new vaccines and emerging pathogens on CYP3A4 and other metabolic enzymes are warranted to avoid therapeutic failures that could further compromise the public health during infectious disease emergencies.

Background In low-middle-income countries, unmet need for family planning (FP) constitutes a major challenge for prevention of unintended pregnancies and associated health and psychological morbidities for women. The factors associated with unmet need for family planning have been studied for several countries in sub-Saharan Africa, but not much is known about the situation in Gambia and Mozambique. The purpose of this study was to perform a comparative analysis of the prevalence of unmet need for FP, and its sociodemographic correlates in Gambia and Mozambique to better inform FP policies and programs aimed at reducing associated negative health outcomes for women and their families. Methods In this analysis we used nationally representative data from Demographic and Health Surveys in Gambia (2013) and Mozambique (2011). Sample population were 23,978 women (n = 10,037 for Gambia and 13,745 for Mozambique) aged 15–49 years. Women who want to stop or delay childbearing but were not using any contraceptive method were considered to have unmet need for FP. Association between unmet need for FP and the explanatory variables was measured using binary logistic regression models Results Prevalence of unmet need for FP was 17.86% and 20.79% for Gambia and Mozambique, respectively. Having employment in professional/technical/managerial position showed an inverse association with unmet need both in Gambia [OR = 0.843, 95% CI 0.730, 0.974] and Mozambique [OR = 0.886, 95% CI 0.786, 0.999]. Education and household wealth level did not show any significant association with unmet need. The only positive association was observed for rural [OR = 1.213, 95% CI 1.022, 1.441] women in the richer households in Gambia. Having access to electronic media [OR = 0.698, 95% CI 0.582, 0.835] showed a negative effect on having unmet need in Mozambique. Women from female headed households in Gambia [OR = 0.780, 95% CI 0.617, 0.986] and Mozambique [OR = 0.865, 95% CI 0.768, 0.973] had lower odds of unmet need for FP. Conclusion The situation of unmet need for FP in Gambia and Mozambique was better than the Sub-Saharan African average (25%). Nonetheless, there is room for improvement in both countries. Significant assocations with lower unmet need for family planning and women’s occupational status (more education & higher skilled employment), access to mass media communication, and female-headed households provide possible areas for intervention for improved FP opportunities in the region.

The internet of things (IoT) is rapidly becoming one of the most popular emerging technologies in business and society. One of the major verticals that has recently begun to effectively use IoT technologies is the retail industry. Given the unprecedented opportunities IoT generates for brands and retailers, it is important to glean timely insights regarding the business value of IoT and understand whether the introduction of an IoT technology as an alternative purchase channel for consumers affects the sales of physical products. Using empirical data from a multinational online retailer who adopted an IoT technology that largely automates the consumers’ purchases and employing a quasi-experimental framework, we study the effect of the introduction of IoT as an alternative sales channel on product sales. Our analyses reveal a statistically and economically significant increase in sales and demonstrate the business value of the IoT channel for retailers and brands. In addition, we conduct other analyses of IoT to delve into the effect of heterogeneity and empirically validate the underlying mechanisms by examining the impact of IoT for products in different price ranges, levels of substitutability, and product categories. For instance, our analyses reveal that less expensive and more differentiated products, as well as experience and utilitarian goods, can accrue higher benefits leveraging more effectively novel IoT technologies. This is the first paper to study the impact of an IoT technology on product sales, drawing important implications for devices and technologies largely automating the purchase process.

The COVID-19 pandemic has been a threat of unprecedented scale for societies, business, and healthcare systems across the world. In Canada and the United States, the immigrants including the African, Caribbean and Black (ACB) community and those of Hispanic origin are facing the brunt of the pandemic and account for a disproportionately higher percentage of hospital admission and mortality from the virus. Needless to mention, these ACB community are also the most disadvantaged socioeconomic demographic strata in North America who share a not only a heightened risk of infection, but also the adverse health, social, and financial consequences that arise from the lockdown and similar adjustment policies. In Canada, the ACB community share a long-standing history of social marginalization and have shown to represent the population with highest prevalence of HIV and other infectious diseases, to which COVID-19 seems to be no exception. The situation is extraordinarily challenging and requires bold and comprehensive policy measure to remedy the short-term outcomes and building resilience for the caregiving of ACB population in the long-term. This can be achieved by conducting expert assessments regarding the current knowledge gaps and formulating evidence-based strategies and best-practice policies. The current paper presents the views of experts on social indicators, health disparity and infectious diseases in an effort to shed light on the current knowledge gaps in the COVID-care for the ACB population, and thereby propose some policies to address these gaps.

Women’s sexual health and wellbeing with cervical or vaginal cancer may be largely affected by complications from external beam radiotherapy (EBRT) and utero-vaginal brachytherapy (BT), of which vaginal stenosis is the main complication. The objective of this study was to assess the impact of support by a nurse sexologist on sexuality, vaginal side-effects, and the quality of clinical follow-up in patients treated with brachytherapy for cervical or vaginal cancer. We performed a retrospective study of the sexuality of women treated for cervical or vaginal cancer. Data from patients with cervical or vaginal cancer who underwent brachytherapy between 2013 and 2017 were collected at Institut Universitaire de Cancer de Toulouse-Oncopole (IUCT-Oncopole). Patients were divided into two groups: group A (intervention group) received support from a nurse sexologist and group B (control group) did not. The chi-square test and a logistic multivariate model were used for data analysis. A total of 156 patients were included in this study, including 57.7% who were followed by a nurse sexologist. We observed low compliance in using vaginal dilators after brachytherapy and/or radiotherapy over time regardless of the group, and patients’ sexual activity was inadequately addressed. Information regarding the resumption of sexuality 2 months after treatment was missing in 1.1% of patients in group A and in 36.4% of patients in group B. Multivariate analysis showed that patients in group A had a lower risk of developing vaginal stenosis with OR crude = 0.5 (95% CI = 0.25–0.92) and OR adj. = 0.5 (95% CI = 0.26–1.09) compared with those in group B. This retrospective study highlights the lack of information collected by physicians during follow-up concerning the sexuality of patients with cervical or vaginal cancer treated by EBRT and BT. The support offered by nurse sexologists in improving patients’ sexual activity and reducing their physical side-effects such as vaginal stenosis is likely to be beneficial. A prospective study is currently being conducted to validate the present findings.

Code flaws or vulnerabilities are prevalent in software systems and can potentially cause a variety of problems including deadlock, hacking, information loss and system failure. A variety of approaches have been developed to try and detect the most likely locations of such code vulnerabilities in large code bases. Most of them rely on manually designing code features (e.g., complexity metrics or frequencies of code tokens) that represent the characteristics of the potentially problematic code to locate. However, all suffer from challenges in sufficiently capturing both semantic and syntactic representation of source code, an important capability for building accurate prediction models. In this paper, we describe a new approach, built upon the powerful deep learning Long Short Term Memory model, to automatically learn both semantic and syntactic features of code. Our evaluation on 18 Android applications and the Firefox application demonstrates that the prediction power obtained from our learned features is better than what is achieved by state of the art vulnerability prediction models, for both within-project prediction and cross-project prediction.

Enabling a team of unmanned aerial vehicles (UAVs) to cooperate and perform tasks collaboratively is a challenging problem. In this paper, sliding-mode-based collaborative maneuvering strategies ar...

We report the first time observation of endotaxial growth during thermal treatment of size-selected nanoclusters on a patterned substrate, when we fabricate highly ordered and partially embedded 3D crystalline Cu nanostructure arrays of controlled size in Si-substrates. For this purpose, we combine low energy cluster deposition on the ripple-patterned substrate with controlled annealing. We have investigated, in detail, the effect of the substrate pattern on the deposited size-selected clusters upon heat treatment. At the annealing temperature of 400 °C, nanosized islands are found to be organized into regular arrays, following the alignment of the substrate pattern exactly. The formed islands are trapped at the specific sites of the substrate where surface curvature is maximum and concave. It is also observed that the size of the produced nanoislands (or particles) in the direction of the ripple wave vector, i.e., across the ripples, are in congruence with the ripple wavelength. All the formed islands are partially buried in the substrate and the growth inside the substrate exhibits endotaxial growth. Such an embedded size-controlled nanoscale system can be very promising as sinter-resistant heterogenous catalyst with strong potential in clean energy technology and industrial chemical synthesis.

Background: Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. Objective: The present study was undertaken to see the relationship between iron deficiency anaemia and thyroid disorder in antenatal cases. Methods: A total of 100 cases attending the outpatient department of Obstetrics and Gynecology in their 1st trimester (from LMP to 12 weeks) were studied at Naval Hospital Powai during a period from Jan 2016 to Dec 2017. A detailed clinical and obstetric history was taken and patients were subjected to routine antenatal investigations along with thyroid profile. Results: Among 100 cases, 21 antenatal cases had increased TSH. Out of which 4 cases had overt hypothyroidism and 17 cases had subclinical hypothyroidism. 2 cases had decreased thyroid stimulating hormone in early trimester out of which only 1 had overt hyperthyroidism. In the same study 23 cases had mild iron deficiency anaemia and 4 had moderate anaemia. It was later correlated that out of 27 cases with anaemia 14 had hypothyroidism. 51% of the cases with anaemia had hypothyroidism and 60% of the hypothyroid cases had iron deficiency anaemia. Applying regression analysis between TSH and Hb level, there was a positive correlation between these two factors in cases. r2 value was found to be 0.2871. This was statistically significant with a P value of less than 0.005. Conclusion: It is concluded that there is increased prevalence of thyroid disorders and iron deficiency anaemia in antenatal cases and there is relationship between iron deficiency anaemia and hypothyroid cases.

Paediatric intensive care units (PICU) provide care to the most critically ill or injured children. Children are admitted to PICU with a wide variety of illnesses, injuries and following a range of surgical procedures. High staff-to-patient ratios are required both because of the potentially rapid evolution of critical illness in children, as well as the complexity of the supportive therapies offered. Definitive evidence for specific paediatric therapies is often limited with extrapolation taken from adult experience, but there are increasing international collaborative efforts that have produced consensus treatment guidelines that serve to promote the use of best practice therapies. This article reviews therapies and techniques that define care in the PICU and in particular outline principles of management of acute respiratory distress syndrome (ARDS), septic shock and traumatic brain injury (TBI). Neonatal and cardiac intensive care medicine topics are outside the scope of this article.

Intravenous fluid and electrolyte management in paediatrics requires an understanding of the indication for intravenous fluid therapy and the underlying pathophysiology in order to meet requirements and avoid adverse events. Careful consideration needs to be given to the rate as well as the composition of intravenous therapy, and children's ongoing need should be reviewed regularly. Fluid therapy can be separated into maintenance fluids, replacement fluids that address electrolyte deficits and ongoing losses, and resuscitation fluids. We review the critical considerations when prescribing intravenous fluid for children and consider the challenges of non-osmotic secretion of anti-diuretic hormone (ADH), hyponatraemic encephalopathy and other electrolyte abnormalities. Fluid management in children with diabetic ketoacidosis is also reviewed.

The centralization of paediatric critical care services in most developed countries has seen an increase in the need for critically unwell and traumatically injured children to be transported for definitive care. This, in combination with the rising demand for paediatric critical care beds, has driven the development of stand-alone paediatric critical care retrieval teams, often sharing the skills and knowledge of medical and nursing staff from multiple paediatric intensive care units. Anaesthetists may be required to assist with, or lead the resuscitation and stabilization and occasionally undertake the transfer of the critically unwell or injured child. Preparation for paediatric retrieval is performed by teams in referring hospitals and knowledge of retrieval processes, and local organization can ease the referral process. We consider the approach to the child who will require transfer to a paediatric critical care unit.

Introduction and Objective: Laparoscopic surgery is increasingly exercised in urology due to improvements in technical capabilities and experience. It comes with many advantages compared to open surgery such as lesser degree of pain and haemorrhage, shorter hospital stay and better cosmetic results. This study is carried out to evaluate the outcomes and complications of urological laparoscopic surgery cases performed Chittagong Medical College Hospital, Chattogram, Bangladesh. Methods: This was a hospital based prospective observational study of total 29 patients, who received laparoscopic surgery of different kinds between January 2017 and September 2019 for urological causes with a minimum one month follow-up. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications after surgery and need for conversion to open surgery. Results: The mean age was 45.03 years where 12 patients were women and 17 were male. All patients underwent trans-peritoneal procedures where2 patients received renal cyst excision, 4 simple nephrectomy, 5 ureterolithotomy, 9 radical nephrectomy, 1 radical cystectomy, 2 adrenalectomy, 3 pyelolithotomy and 3 pyeloplasty. Three of the 29 patients required conversion to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 87.5 (70-105) min, simple nephrectomy 141.25 (120-170) min, ureterolithotomy 120 (100-140) min, radical nephrectomy 215.56 (180-260) min, pyelolithotomy 120 (100-140) min, and pyeloplasty 156.67 (130-190) min. The mean hospital stay was 4.59±1.7 (2-8) days. Conclusions: The success and complications rate of the laparoscopic urological surgeries performed in our hospital were consistent with those reported in the literature. In the light of technological advances and increasing experience, we believe that laparoscopic surgery is an effective technique with excellent outcome along with a safe and feasible alternative to open surgery in the field of urology. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.17-23

COVID-19 pandemic is the highlight of the 21st century that took drastic effects on humanity. Over 23 million confirm infected with the majority with mild infection. However, over 62,000 cases are in critical condition with varying degrees of ARDS. A potential complication of severe ARDS could be Post COVID-19 Pulmonary fibrosis. Possible use of biomarkers to detect progression to fibrosis, along with prompt treatment of acute lung injury caused by COVID-19 and administration anti-fibrotic therapies, could be the next best method to treat this permanent and devastating sequela of COVID-19. Bangladesh Crit Care J September 2020; 8(2): 102-107

Quinine has been used for centuries as a drug for malaria treatment. Chloroquine (CQ) and its 4-aminoquinoline analog hydroxychloroquine (HCQ) have been used during the last two centuries for the treatment and prophylaxis of malaria. Since the inception of COVID-19 in Wuhan, China, in late December 2019, physicians and researchers have tried to use old drugs to treat this pandemic. This review discusses possible modes of action of CQ and HCQ in vitro that might treat this viral infection. The diverse cellular, immunological, and antiviral mechanisms reported in the literature suggest that CQ and HCQ might be useful drugs against COVID-19. Both drugs increase the pH in intracellular organelles, which limits viral replication. However, randomized controlled trials have not found any benefit as either for prophylaxis or treatment of COVID-19. In addition, fatal adverse events associated with these drugs have resulted in the issuance of precautionary measures when recommending these drugs in COVID-19 patients. The search for other innovative drugs to cure COVID-19 and an expedited approval for a vaccine are ongoing at present.

The goal of feature ranking is to find the optimal list of features. The feature ranking methods use different search techniques to select features. An optimal feature selection results in an optimal feature ranking list, so, it is necessary to use a stochastic search method to select features. In this article, a new DE selection operator is introduced. To know the value of the features its fitness function is calculated using Shannon and singular value decomposition entropy. The index of the selected feature is computed by JI, MCI, and AA Index to know the feature list stability. Hence, DE/EI parent selection operator is proposed. The six fitness functions: SMCI, SVDMCI, SJI,SVDJI, SAA, and SVDAA, are thoroughly tested on ten UCI data sets and their performance is measured with different classifiers like Naive Bayes and Support Vector Machine. The experimental results show that the proposed method can efficiently be consolidated into any evolution that is based on a parent selection framework.

Background Difficulties in performing the activities of daily living (ADL) are common among middle-aged and older adults. Inability to perform the basic tasks as well as increased healthcare expenditure and dependence on care can have debilitating effects on health and quality of life. The objective of this study was to examine the relationship between self-reported difficulty in activities of daily living (ADL), health and quality of life among community-dwelling, older population in South Africa and Uganda. Methods We analyzed cross-sectional data on 1495 men and women from South Africa (n = 514) and Uganda (n = 981) which were extracted from the SAGE Well-Being of Older People Study (WOPS 2011–13). Outcome variables were self-reported health and quality of life (QoL). Difficulty in ADL was assessed by self-reported answers on 12 different questions covering various physical and cognitive aspects. The association between self-reported health and quality of life with ADL difficulties was calculated by using multivariable logistic regression models. Results Overall percentage of good health and good quality of life was 40.4% and 20%, respectively. The percentage of respondents who had 1–3, 3–6, > 6 ADL difficulties were 42.4%7, 30.97% and 14.85%, respectively. In South Africa, having > 6 ADL difficulties was associated with lower odds of good health among men [Odds ratio = 0.331, 95%CI = 0.245,0.448] and quality of life among men [Odds ratio = 0.609, 95%CI = 0.424,0.874] and women [Odds ratio = 0.129, 95%CI = 0.0697,0.240]. In Uganda, having > 6 ADL difficulties was associated lower odds of good health [Odds ratio = 0.364, 95%CI = 0.159,0.835] and quality of life [Odds ratio = 0.584, 95%CI = 0.357,0.954]. Conclusion This study concludes that difficulty in ADL has a significant negative association with health and quality of life among community-dwelling older population (> 50 years) in South Africa and Uganda. The sex differences support previous findings on differential health outcomes among men and women, and underline the importance of designing sex-specific health intervention programs.

Introduction Toxicity of chemotherapy drugs is the leading cause of poor therapeutic outcome in many cancer patients. Gastrointestinal (GI) toxicity and hepatotoxicity are among the most common side effects of current chemotherapies. Emerging studies indicate that many chemotherapy-induced toxicities are driven by drug metabolism, but very few reviews summarize the role of drug metabolism in chemotherapy-induced GI toxicity and hepatotoxicity. In this review, we highlighted the importance of drug metabolizing enzymes (DMEs) in chemotherapy toxicity. Areas covered Our review demonstrated that altered activity of DMEs play important role in chemotherapy-induced GI toxicity and hepatotoxicity. Besides direct changes in catalytic activities, the transcription of DMEs is also affected by inflammation, cell-signaling pathways, and/or by drugs in cancer patients due to the disease etiology. Expert opinion More studies should focus on how DMEs are altered during chemotherapy treatment, and how such changes affect the metabolism of chemotherapy drug itself. This mutual interaction between chemotherapies and DMEs can lead to excessive exposure of parent drug or toxic metabolites which ultimately cause GI adverse effect.

The novel coronavirus (COVID-19), with its complex and unique pathophysiology, is an emerging threat for global health and is affecting the health and social wellbeing of the population in unprecedented ways, one of the most noticeable of which is skyrocketing sales of alcoholic beverages. Increased alcohol drinking is strongly correlated with weak immune system and heightened risk of pulmonary infections. Increased level of drinking to cope with the stress resulting from disruption in daily living can further increase the susceptibility to COVID-19 related morbidity and mortality, and delay recovery. Countermeasures against controlling the virus, such as physical distancing, should therefore be accompanied by those on limiting sales and consumption of alcohol as well. In order to prevent the risk of overconsumption during the pandemic, and minimise the risk for post-pandemic increase in alcohol use disorders and associated mental health issues, public health services and programmes should pay special attention to the underlying factors and take evidence-based measures to address them.

A no-show appointment is clinically defined as a scheduled appointment in which a patient fails to attend without prior notification to the provider or staff. In primary care clinics, no-show rates have been shown to range from 15% to 30%. Smaller studies have shown that interventions including phone calls, emails or text message reminders can reduce no-show rates.1–9 Our retrospective review sought to evaluate a similar intervention performed at the Multispecialty Residency Clinic (MSC). A test of two proportions was performed to evaluate the effect of a 24-hour reminder phone call. The no-show rate before initiating a 24-hour phone call was 17.8%, and following the intervention this rate improved to 16%, an observed reduction of 1.9% with a 95% confidence interval (CI) from 0.1% to 3%, p = 0.003. New patient encounters, established patient visits and cancellations were analyzed as secondary endpoints to further evaluate the effects of a reminder phone call. Our retrospective analysis is the largest to date regarding the effectiveness of utilizing phone call reminders to reduce no-show rates in the setting of a residency clinic and has confirmed a significant 2% reduction in no-show appointments.

In this paper, an attitude determination methodology for a space vehicle is presented. The proposed method uses the line-of-sight vectors, connecting landmarks captured in the images of an on-board camera to the center of perspective, as directional references. It solves the problem of landmark identification, in the event of warping of camera images, by using a reference catalog of well-mapped distinctive features of planets or large space objects. The knowledge of the orbital position of the camera is further utilized to reduce the search space within the catalog of landmarks. Post landmark identification, if more than one vector directions are available, the attitude corresponding to the rotational transformation of the reference frame to the camera fixed frame are extracted from the set of reference vectors and their corresponding observed vectors. The absolute three axis attitude updates so obtained can either supplement other sensors or serve as a back-up option in case of failure or performance degradation of conventional attitude sensors on-board a spacecraft at its end-of-life.