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The recent pandemic improved awareness amongst the public of the need for rapid blood tests for community and home settings. In this work, we evaluated the performance of a digital, lipid panel test in microfluidic assay format which can be read using a smartphone camera. The PocDoc Lipid test is embedded within a cardiovascular screening application that utilizes the QRISK3 risk prediction algorithm to determine an individual's risk of having a cardiovascular event in the next 10 years and their healthy heart age. The test can be used to screen for individuals at risk of hyperlipidemia (e.g. high total cholesterol or triglycerides) and for individuals at high risk of cardiovascular disease at home or in community or surgery settings. The device was evaluated in a performance evaluation study, using 125 whole blood samples, following CLSI guidelines. Performance evaluation of the PocDoc device demonstrated accuracy that meets international NCEP guidelines and that is on par with other point-of-care tests. Sensitivity and specificity analysis supports the use of PocDoc to identify patients with hyperlipidemia or at high risk of cardiovascular disease. Bland-Altman analysis suggests that this point-of-care device can be used as an alternative to venous blood collection. This single-step model for cardiovascular disease risk measurement which can be done at home or in community settings may improve cardiovascular disease prevention.

This research paper presents the mathematical model to design a stepped pin profile tool and its durability index. A mathematical model is being developed by considering tools that should generate the same heat as conventional conical tools and stepped tools by varying the shoulder to pin diameter ratio (D/d). Aluminum alloy AA6061-T6 with a thickness of 6 mm fabricated using a butt-type weld configuration and newly developed conical stepped pin profile tools with water as a cooling medium. The result shows that a conical stepped tool shows better mechanical properties of the welded joints compared with a conventional conical tool. When compared to other stepped conical pin profile tools, one with a (D/d) of 3 has superior mechanical and microstructural properties and as the D/d ratio increases, the tool pin durability index falls.

Acute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19), and its severity is linked to the adverse outcomes of multiorgan involvement. We attempted to assess the clinical outcomes and determinants of mortality in patients admitted to our COVID-19 care center from May to November 2020 who developed AKI through a retrospective examination of their case records. The data of those who developed AKI were analyzed for their clinical parameters, clinical presentation, history, laboratory parameters, urine output measurements, requirements for dialysis, treatment, and treatment outcomes (discharge or death). These outcomes were correlated to the comorbidities, laboratory parameters, the Kidney Disease Improving Global Outcomes (KDIGO) AKI stage, sequential organ failure assessment score, and need for dialysis or renal replacement therapy. Of 1890 patients admitted, 132 (6.98%) patients developed AKI. Of 450 deaths from all causes, 67 (14%) were in AKI patients. There were 100 (75.8%) males and 32 (24.8%) females. The mean age was 62.05 ± 11.48 years. The median duration of stay was 7 days (interquartile range: 4––11.75 days). The number of patients in AKI Stages 1, 2, and 3 was 1 (0.75%), 64 (48.48%), and 67 (50.75%), respectively. The most common symptoms were breathlessness (85.6%), fever (84.5%), myalgia (81.19%), and weakness (76.5%). Multivariate analysis showed that the determinants of mortality were a partial pressure of oxygen saturation (pO2) of 85%, not receiving remdesivir, and KDIGO Stage >2.

Rationale and Objectives: Information evaluating the efficacy of 2D synthesized mammography (2Ds) reconstructions in microcalcification detection is limited. This study used stereotactic biopsy data for microcalcifications to evaluate the stepwise implementation of 2Ds in screening mammography. The study aim was to identify whether 2Ds + digital breast tomosynthesis (DBT) is non-inferior to 2D digital mammography (2DM) + 2Ds + DBT, 2DM + DBT, and 2DM in identifying microcalcifications undergoing further diagnostic imaging and stereotactic biopsy. Materials and Methods: Retrospective stereotactic biopsy data were extracted following 151,736 screening mammograms of healthy women (average age, 56.3 years; range, 30–89 years), performed between 2012 and 2019. The stereotactic biopsy data were separated into 2DM, 2DM + DBT, 2DM + 2Ds + DBT, and 2Ds + DBT arms and examined using Fisher’s exact test to compare the detection rates of all cancers, invasive cancers, DCIS, and ADH between modalities for patients undergoing stereotactic biopsy of microcalcifications. Results: No statistical significance in cancer detection was seen for 2Ds + DBT among those calcifications that underwent stereotactic biopsy when comparing the 2Ds + DBT to 2DM, 2DM + DBT, and 2DM + 2Ds + DBT imaging combinations. Conclusion: These data suggest that 2Ds + DBT is non-inferior to 2DM + DBT in detecting microcalcifications that will undergo stereotactic biopsy.

Abstract The genesis, dynamics, and impacts of a severe dust storm over the central Himalaya during June 13–17, 2018 have been investigated using in situ measurements, satellite data, and model reanalysis. A low‐pressure system over northern India and prevalence of strong winds (∼20 ms−1) triggered the dust storm leading to poor visibility conditions and five‐fold enhancement in the fine particulate matter (PM2.5) over the central Himalaya. Enhancements in Aerosol Optical Depth (AOD) were observed to be stronger over the Himalayan foothills site (Lumbini) than that over the Indo‐Gangetic Plain (IGP) site‐Gandhi College. The sharp reductions in Angstrom exponent (α) from about 1.2 to 0.3 indicated the dominance of coarse‐mode aerosols during the dust episode. Model results show an enhancement in the dust from 1.5 to 2.5 Tg (∼70%) over the northern Indian subcontinent, with about half of the contribution from the regional source (Thar Desert). Interestingly, dust storm also had significant impacts on turbulent kinetic energy (2.9–9.6 m2 s−2), vertical momentum flux (0.9–3.3 Nm−2), and sensible heat flux (34.8 to −33.9 Wm−2), suggesting turbulent mixing of aerosols and cooling near the surface over the Himalayas. Our study highlights that the large‐scale dust storms exposed to additional dust and pollution from regional sources can profoundly impact the air quality, heat fluxes, and radiative balance over the northern Indian subcontinent. The study would also help in evaluating the results of climate models and to assess the impacts of dust on the hydrological processes and melting Himalayan glaciers.

Shock loading of materials alters the microstructure and considerably degrades mechanical performance. Here, shock loading of a nanocrystalline Cu–Ta alloy is found to induce minor changes to microstructure and mechanical performance, attributed to the annihilation of defects during deformation.

Background: The AO Foundation's Association for the Study of Internal Fixation has advocated rigid fixation with implants in the form of plates and screws. Focus is on development of implants which are stronger, more acceptable to the body, cheaper, and durable. Aim: The aim of this study was to find the factors responsible for implant breakage. Materials and Methods: We have retrospectively analyzed the data from January 2008 to December 2018 (10 years). Information on sociodemographic characteristics, clinical features, and radiographic features was retrieved from the hospital information system. Data were entered and analyzed with Epi Info software. Results: Of the 37 patients, there were 33 (89.2%) males and four (10.8%) females in the age group of 17-95 years. The most common site for implant breaks was observed to be the shaft of the femur (40.5%), and the most common type of implants which broke were locking intramedullary nails (62.1%). Conclusion: The factors responsible for breakage of implants were observed to be: retrauma, failure of compliance with advice about ambulation, absence of union at fracture sites, and persistent infection. Out study shows the importance of educating patients properly about physiotherapy and rehabilitation protocols.

Crack growth kinetics in crystalline materials is examined both from the point of continuum mechanics and discrete dislocation dynamics. Kinetics ranging from the Griffith crack to continuous elastic-plastic cracks are analyzed. Initiation and propagation of incipient cracks require very high stresses and appropriate stress gradients. These can be obtained either by pre-existing notches, as is done in a typical American Society of Testing and Materials (ASTM) fatigue and fracture tests, or by in situ generated stress concentrations via dislocation pile-ups. Crack growth kinetics are also examined using the modified Kitagawa–Takahashi diagram to show the role of internal stresses and their gradients needed to sustain continuous crack growth. Incipient crack initiation and growth are also examined using discrete dislocation modeling. The analysis is supported by the experimental data available in the literature.

Introduction: The objective of the study to compare outcome and complications of Colonic interposition and Gastric pull-up in treatment of corrosive esophageal stricture. Methodology: This cohort study was conducted on the patients admitted in the surgical wards of SMIMER hospital, Surat with clinically diagnosed corrosive esophageal stricture. The cases were then followed for a period of 6 months from the date of commencement of surgical procedure. Results: The study included 25 patients of corrosive oesophageal stricture, 12 were operated by colonic interposition and 13 were operated by gastric pull up method. Most common reason for indication of surgery was failure to dilatation. Mean duration of surgery of patients operated by colonic interposition method was 5.41 hours while it was 3.57 hours for patients operated by gastric pull-up method. Mean post-operative pain score of patients operated by colonic interposition method was 4 while it was 2.77 for patients operated by gastric pull-up method. Conclusion: Gastric pull up was better method compared to colonic interposition in the management of corrosive oesophageal stricture due to the relative technical ease, excellent healing power of the anastomosis, wide anastomotic stoma at the neck and only one single anastomosis is required.

Background: Patients with fracture femur experience severe pain on movement during positioning for spinal anaesthesia. Fascia Iliaca Compartment Block (FICB) has been used effectively for providing analgesia during positioning of the patient for spinal anaesthesia. Aim: To test the hypothesis that, adding dexamethasone would significantly prolong the duration of Bupivacaine in FICB. Materials and Methods: Sixty patients aged 18 to 80 years posted for ORIF (Open Reduction and Internal Fixation) of fracture femur were included to receive FICB. This was a prospective, randomized, double blind study done at tertiary medical college hospital. Thirty patients received 38ml of 0.25 % bupivacaine with 2ml saline and another 30 patients received 38ml of 0.25 % bupivacaine with 2ml dexamethasone (8mg). Thirty minutes after FICB, patient satisfaction during positioning for spinal anesthesia was recorded. In the post-operative period, duration of analgesia and the total doses of rescue analgesics were recorded in both the groups. Results: Patients who received Bupivacaine with dexamethasone had significant prolongation of analgesia and required fewer doses of rescue analgesics as compared to patients who received Bupivacaine alone for FICB. However, the onset of analgesia, VAS scores and patient satisfaction during positioning for spinal anaesthesia were similar in both groups. Conclusion: Our study shows that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexamethasone.

We used a physically motivated internal state variable plasticity/damage model containing a mathematical length scale to idealize the material response in finite element simulations of a large-scale boundary value problem. The problem consists of a moving striker colliding against a stationary hazmat tank car. The motivations are (1) to reproduce with high fidelity finite deformation and temperature histories, damage, and high rate phenomena that may arise during the impact accident and (2) to address the material postbifurcation regime pathological mesh size issues. We introduce the mathematical length scale in the model by adopting a nonlocal evolution equation for the damage, as suggested by Pijaudier-Cabot and Bazant in the context of concrete. We implement this evolution equation into existing finite element subroutines of the plasticity/failure model. The results of the simulations, carried out with the aid of Abaqus/Explicit finite element code, show that the material model, accounting for temperature histories and nonlocal damage effects, satisfactorily predicts the damage progression during the tank car impact accident and significantly reduces the pathological mesh size effects.

Background: UTI (urinary tract infection) is the most common among all hospital acquired infections world wide. In UTI, most common organism is E.coli. Organism responsible for the hospital acquired infection may have tendency to develop multiple drug resistance. E.coli acquired from the hospital source and community source may differ in their resistant against antibiotics Aim: to study and to compare the antibiotic resistant pattern with special reference to ESBL (extended spectrum β lactamase) in the community acquired and hospital acquired common gram negative bacilli causing UTI. Methods and materials: E.coli from symptomatic UTI cases from both community acquired and hospital acquired UTI were tested for the antimicrobial susceptibility testing against 18 drug of various groups performed by Kirby Bauer's disc diffusion method. Isolates resistant to third generation cephalosporin were tested for ESBL production by double disk synergy test method. Results: Overall E.coli was (70.96%) among the all gram negative bacilli of UTI patients. The majority (67%) of the isolates were from female. ESBL prevalence was 16.67% and 30% among community acquired and hospital acquired E.coli respectively. Cephalosporin group of sensitivity was widely varied among both the group compare to other groups of antibiotics and more resistance was found in hospital strain Discussion and Conclusion: Almost double prevalence of ESBL among hospital strain compared to community strain leads to change in line of management when a hospitalized patient has tendency to develop UTI, plain cephalosporin should not be administered in other diseases also.

Human T-lymphotropic virus type 1 (HTLV-1) causes leukaemia or chronic inflammatory disease in approximately 5% of infected hosts. The level of proviral expression of HTLV-1 differs significantly among infected people, even at the same proviral load (proportion of infected mononuclear cells in the circulation). A high level of expression of the HTLV-1 provirus is associated with a high proviral load and a high risk of the inflammatory disease of the central nervous system known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). But the factors that control the rate of HTLV-1 proviral expression remain unknown. Here we show that proviral integration sites of HTLV-1 in vivo are not randomly distributed within the human genome but are associated with transcriptionally active regions. Comparison of proviral integration sites between individuals with high and low levels of proviral expression, and between provirus-expressing and provirus non-expressing cells from within an individual, demonstrated that frequent integration into transcription units was associated with an increased rate of proviral expression. An increased frequency of integration sites in transcription units in individuals with high proviral expression was also associated with the inflammatory disease HAM/TSP. By comparing the distribution of integration sites in human lymphocytes infected in short-term cell culture with those from persistent infection in vivo, we infer the action of two selective forces that shape the distribution of integration sites in vivo: positive selection for cells containing proviral integration sites in transcriptionally active regions of the genome, and negative selection against cells with proviral integration sites within transcription units.