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Background: Hemispatial neglect or unilateral neglect is a failure to report, respond, or orient to stimuli that are presented contralateral to a brain lesion, provided that this failure is not due to elementary sensory or motor disorders. There is a complete lack of awareness of one half of space, at which point, patients behave as if that half of the world does not exist. The estimated prevalence of hemispatial neglect after unilateral stroke is 30%. In this study, the differential treatment using brain gym exercises alone or in combination with Mirror Box therapy for hemispatial neglect post-stroke shall be analysed. Methods: This is a single blinded parallel randomised clinical trial consisting of 2 experimental. 121 participants who met the inclusion criteria were distributed randomly in 3 groups using systematic random sampling. Effect of mirror box therapy for one experimental group and brain gym exercises for second experimental group were calculated after 6 months post treatment. Statistical analysis of outcome measures was done before and after treatment using paired t-test and Anova.Results: 40 patients were randomised to MBT group (n=40), 40 to BGT group (n=40) and 40 to CG (n=40) after excluding the dropouts.

Due to the depletion of traditional energy resources, emissions of greenhouse gases, climate change, etc., renewable energy resources (RER) based power generation is becoming the main source of the present and future power sector. The major RERs, including solar, wind, and small hydro, may provide reliable and sustainable solutions in the smart grid environment. Solar and wind energy-based power generation is more prevalent but varies in nature and is not even very predictable very efficiently. Therefore, it has become necessary to integrate two or more RER and develop a hybrid energy system (HES). The HESs provide a cost-effective and reliable power supply with reduced and/or almost negligible greenhouse gas emissions as well. Due to economic and power reliability concerns, the optimal sizing of components is necessary for the development of an optimum HES. In recent years, metaheuristic evolutionary algorithms have been widely used for optimal sizing of HES. Harris hawk’s optimizer (HHO) is a recently devised metaheuristics search method that has the ability to discover global minima and maxima. However, due to its weak exploitation capacity, the basic HHO algorithm’s local search is pretty slow and has a slow rate of convergence. Thus, to boost the exploitation phase of HHO, a new approach, random exploratory search centered Harris hawk’s optimizer (hHHO-ES), has been developed in the present work for optimal sizing of HES. The suggested approach is validated and compared to existing optimization approaches for a variety of well-known benchmark functions, including unimodal, multimodal, and fixed dimensions. Following this, it is used to develop HES, which will be capable of providing power to remote areas where grid supply is scarce. The objective function is formulated using net present cost (NPC) as a prime function under a set of constraints such as bounds of system components and reliability. The obtained results are compared with those from harmony search (HS) and particle swarm optimization (PSO) and found to be better.

A study to determine the proportion of diabetic cases handled by the hospitals in Jammu regarding orthopedic surgeries, especially among different age group, by employing a Bayesian model called Beta-binomial conjugate model using Bayesian sequential estimation method. From the hospital record of Government Medical College (GMC), Jammu. Data was collected and collated over a period of 3 years from 2014-2016 in terms of 4 quarters (Jan-March, April-June, July-Sep and OctDec). The study also compares the computed sample and Empirical Bayes estimates over the three year period and also the variances of the computed estimates and it has been strongly advocated that Empirical Bayes estimators are better estimators on the basis of efficiency and consistency and the proposed method can be employed successfully in any suitable location globally.

The patterns of dupilumab use, the first systemic drug approved for the treatment of atopic dermatitis (AD), is not well understood in the context of off-label systemic medications.To describe patterns of prescribing, switching and discontinuing systemic AD drugs, before and after the approval of dupilumab and understand variables associated with dupilumab prescription.Using longitudinal claims data, we identified patients with AD who initiated a systemic therapy (dupilumab, cyclosporine, methotrexate, azathioprine, mycophenolate) from March 2015 to February 2021, with a washout period of 1 year. We used Sankey plots to visualize longitudinal patterns of use at 3, 6 and 12 months and logistic regression to determine associates of dupilumab prescription.The number of patients starting systemic treatment increased from 319 before dupilumab approval to 1,358 after. Dupilumab use increased from 72% to 84%. In 2019-20, 36% of patients discontinued systemic treatment within a year compared to 62% in 2015-16. 92% of patients who started dupilumab in 2020-21 had received no other systemic treatment before. Patients60 years and those who used steroid-sparing topical treatments were more likely to receive dupilumab.Among new users of a systemic treatment for AD, dupilumab was most used treatment by far. This article is protected by copyright. All rights reserved.

Harris Hawk’s Optimizer (HHO) is a recently developed meta-heuristics search algorithm with inherent capability to explore global minima and maxima. However, the local search of the basic HHO algorithm is sluggish and has slow convergence rate due to its poor exploitation capability. In the present work, exploration and exploitation phase of HHO have been improved using a chaotic variant of the present optimizer. The proposed chaotic variant has been simulated and tested for 23 standard test functions and 10 different engineering design optimization problems of real life. To check the efficacy of the proposed algorithm, the test results of the proposed CHHO algorithm have been compared with others recently developed and well-known classical optimizers, such as PSO, DE, SSA, MVO, GWO, DE, MFO, SCA, CS, TSA, PSO-DE, GA, HS, Ray and Sain, MBA, ACO, MMA, etc. The experimental results reveal that the suggested method outperforms on most of the test functions and engineering design challenges with superior convergence.

In our cohort study, we sought to describe the utilization patterns of systemic immunomodulators in children with atopic dermatitis (AD) and how utilization changed after approval of dupilumab, the first systemic drug approved for the treatment of AD. Using US nationwide claims data, we identified children with AD who initiated a systemic therapy (dupilumab, cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil) from March 2015 to February 2021 and used Sankey plots to describe patterns of starting, switching, and discontinuing these drugs. Dupilumab use among children increased from 19.4% before approval in children to 88.3% after approval in 2019-20. Adherence to dupilumab may suggest better tolerance and improved outcomes in children with AD.

This article uses administrative data from the Social Security Administration to explore the employment patterns and characteristics of individuals awarded Supplemental Security Income (SSI) benefits between 2001 and 2009 who later became disability insured and qualified for Social Security Disability Insurance (SSDI). While these individuals are a small portion of all SSI and SSDI beneficiaries, they are particularly interesting because they demonstrate a desire and ability to work despite the health conditions that make them eligible for disability benefits. On average, 2.3% of SSI-first awardees enter SSDI after they become disability insured within 5 years of their SSI award. These SSI awardees are younger than other SSI awardees and are more likely to achieve work-related milestones during the 5 years after SSI award. Although awardees in this group show signs of an ability to work, they gradually start dropping out of the labor force starting 5 months before SSDI benefits begin and drop out in greater numbers through the first year of SSDI benefits. This suggests that some of them may work enough to achieve disability-insured status but stop when they enter SSDI.

Slime mold algorithm (SMA) is a recently developed meta-heuristic algorithm that mimics the ability of a single-cell organism (slime mold) for finding the shortest paths between food centers to search or explore a better solution. It is noticed that entrapment in local minima is the most common problem of these meta-heuristic algorithms. Thus, to further enhance the exploitation phase of SMA, this paper introduces a novel chaotic algorithm in which sinusoidal chaotic function has been combined with the basic SMA. The resultant chaotic slime mold algorithm (CSMA) is applied to 23 extensively used standard test functions and 10 multidisciplinary design problems. To check the validity of the proposed algorithm, results of CSMA has been compared with other recently developed and well-known classical optimizers such as PSO, DE, SSA, MVO, GWO, DE, MFO, SCA, CS, TSA, PSO-DE, GA, HS, Ray and Sain, MBA, ACO, and MMA. Statistical results suggest that chaotic strategy facilitates SMA to provide better performance in terms of solution accuracy. The simulation result shows that the developed chaotic algorithm outperforms on almost all benchmark functions and multidisciplinary engineering design problems with superior convergence.

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

For design and development of solar-based photovoltaic (PV) system, accuracy in obtaining data of solar energy has been a prime concern. Forecasting of global solar energy in clear or sunny weather...

Introduction: Appropriate use of antimicrobial agents is important and is essential if the usefulness of antibiotic is to be preserved and the further spread of resistance is to be limited. Antibiotics are one of the pillars of modern medicine are important in prophylaxis and treatment of infectious diseases. Objective: To assess rational use of antibiotics for prophylaxis and treatment among patients in orthopedic department who undergone surgery. Methods: A prospective and observational study was conducted on 300 medical records of orthopedic patients who undergone surgery. Data was collected by using structured questionnaire from Sep2019 to Dec 2019 and then analyzed using SPSS version 20.0 software. Results: Out of 300 patients who undergone surgery 179 patients were male and 121 patients were females. Based on age group classification 30 – 40 years of age i.e. 50 (38.46%) was mostly affected. The most common diagnosis was ORIF(43.07%) followed by THR (20%) of cases. The most frequently prescribed antibiotics for prophylaxis Cefuroxime (67.40%), amikacin (14.91%) and for treatment Cefuroxime (58.17%), amikacin (18.90%). The commonly used antibiotics combination for prophylaxis is Ceftriaxone + Amikacin+ Cefuroxime (20.68%) and treatment includes Ceftriaxone+ Cefuroxime + clavulanic acid (34.04%). It was found that 50% of cases for prophylaxis was inappropriate where as 73.07 % of treatment antibiotics failed to adhere guidelines. Conclusion: Generally, this study indicated that orthopedic patients underwent surgical procedures by majority of patients were ORIF and THR. Mostly prescribed antibiotics were cefuroxime, Amikacin. This study result indicated some level of inappropriateness in antibiotic prescription. Key words: Antibiotics, Surgery, Resistance, Prophylaxis, Treatment.

Objective To determine college health centers’ referral patterns for students seeking induced abortion. Study design We conducted a cross-sectional simulated patient study at 4-year colleges in Pennsylvania between June 2017 and May 2018. A researcher posing as a student seeking abortion referral contacted student health centers twice during the course of the study using a structured script, once as a minor (under 18 years), and once as an adult. The primary outcome was “direct referral”, defined as a referral to an abortion provider. We measured proportions of student health centers who provided no referral, “indirect referral” (referral to a non-specific provider), and “inappropriate referral” (referral to a non-abortion provider). We analyzed the relationship between the proportion of direct referrals and minor status of the caller as well as college characteristics (religious affiliation, location, student body mean income, and size). We included variables found to be significant as covariates in a generalized linear model that accounted for the cluster of multiple calls to each institution. Results We attempted contact with 115 institutions, once as a minor and once as an adult, resulting in 202 successful contacts. Direct referral was the most common outcome (49.5%), followed by inappropriate referral (33.7%) and no referral (21.8%). The proportion of direct referrals given to minors was similar when compared to adults (48.0% vs 52.0%, OR 0.82, 95% CI 0.47–1.42). Religiously affiliated institutions were less likely to provide a direct referral than non-religiously affiliated schools (aOR 0.47, 95% CI 0.30–0.75). With each increase in students’ household income tertile, health centers were more likely to provide a direct referral (aOR 1.22, 95% CI 1.05–1.42). Conclusions Half of college student health centers in Pennsylvania do not provide direct abortion referrals, and many provide inappropriate referrals. Student health centers at religiously affiliated institutions and those with poorer students are less likely to provide direct abortion referrals. Implications Student health providers should inform themselves about fake health clinics and local abortion providers. Colleges should train staff, create accurate resources and define clear policies around referral. Professional and policymaking organizations should affirm the duty of all college health centers, regardless of religious affiliation, to provide abortion referrals.

Breastfeeding rates among infants participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are consistently lower than those of WIC nonparticipants. The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias. We used novel data from the Feeding Infants and Toddlers Survey from 2008 and 2016. We defined our treatment group as infants eligible for WIC based on household income and our control group as infants in households with incomes just above the WIC eligibility threshold. The breastfeeding outcomes we analyzed were whether the infants were ever breastfed, breastfed through 6 months, and breastfed exclusively through 6 months. We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes.

This article examines the relationship between receiving support for postsecondary education (college or vocational training) from state vocational rehabilitation (VR) agencies and long-term outcomes for youth with mental health conditions (MHCs). We use longitudinal data to follow three cohorts of youth VR applicants for 9 years after they applied for VR services. The results show a strong relationship between receipt of postsecondary education support and long-term employment, earnings, and federal disability benefit receipt. For some outcomes, such as being employed in the 9 years after VR application, the number of years employed, and benefit receipt in the 9 years after VR application for those who did not receive benefits at the time of application, the association is larger for youth with MHCs than for those with other disabilities. These findings provide valuable descriptive estimates of the benefits of providing postsecondary education support for VR youth with MHCs and how these benefits compare with youth with other types of disabilities.

The utilisation of renewable energy sources (RES) in increasing drastically because of various issues including depletion of fossil fuels, greenhouse gas emissions, climate change and so on. As the power generated from RES is fluctuating in nature, therefore, the appropriate sizing of the hybrid model based on RES is utmost important. In this study, the grey wolf optimisation, a newly developed approach is used for the optimal sizing of the hybrid model. In this work, the optimal design of solar/biomass/biogas/battery-based hybrid system has been carried out to supply continuous electricity to various households of a cluster of villages of Haryana state of India. The results obtained from the proposed model have been compared with harmony search and particle swarm optimisation and found better.

Adverse childhood experiences (ACEs) are associated with negative health outcomes; however, screening for ACEs is not routinely performed among people living with HIV (PLWH). We conducted a single-center, cross-sectional pilot study to define the (1) prevalence of ACEs in PLWH and (2) acceptability of ACEs screening in routine out-patient clinical care. One hundred participants completed screening: median age of participants was 49 years (interquartile range: 38.5-59.5), 73% male, 66% Non-Hispanic Black/African American, and 47% gay/lesbian. Clinically significant ACEs score, defined as ≥4, was reported in 51%. High ACEs score was more common among participants

The onset of a disability or major health shock can affect the labor supply of not only those experiencing the event but also their family members. Potential caregivers face a tradeoff between time spent earning income for the family and providing care for their spouse, which could be affected by the availability of paid leave. We examine caregiving and labor supply decisions after a spouse’s disability or health shock and the role of paid leave laws implemented in California and New Jersey in the response using data from the Survey of Income and Program Participation (SIPP). We show that labor force participation of potential caregivers decreased after spousal work-limiting disability or chronic health condition and, to a lesser extent, work-limiting illness. We find that paid leave reduces the likelihood that potential caregivers decrease their work hours to provide caregiving to their spouse after a work-limiting disability or chronic health condition, but limited evidence of effects on other employment outcomes. Our findings demonstrate that spousal disability and health shocks have long-run effects on household labor supply and therefore could be mediated by paid leave; we conclude by discussing possible reasons for finding limited impact in this context. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Electrode-electrolyte interfaces (EEIs) affect the rate capability, cycling stability, and thermal safety of lithium-ion batteries (LIBs). Designing stable EEIs with fast Li+ transport is crucial for developing advanced LIBs. Here, we study Li+ kinetics at EEIs tailored by three nanoscale polymer thin films via chemical vapor deposition (CVD) polymerization. Small binding energy with Li+ and the presence of sufficient binding sites for Li+ allow poly(3,4-ethylenedioxythiophene) (PEDOT) based artificial coatings to enable fast charging of LiCoO2. Operando synchrotron X-ray diffraction experiments suggest that the superior Li+ transport property in PEDOT further improves current homogeneity in the LiCoO2 electrode during cycling. PEDOT also forms chemical bonds with LiCoO2, which reduces Co dissolution and inhibits electrolyte decomposition. As a result, the LiCoO2 4.5 V cycle life tested at C/2 increases over 1700% after PEDOT coating. In comparison, the other two polymer coatings show undesirable effects on LiCoO2 performance. These insights provide us with rules for selecting/designing polymers to engineer EEIs in advanced LIBs.

Disability onset and major health shocks can affect the labor supply of those experiencing the event and their family members, who face a tradeoff between time spent earning income and providing care. This decision could be affected by the availability of paid family leave. We examine the role of paid leave mandates in caregiving and labor supply decisions after a spouse's disability or health shock. Using data from the Survey of Income and Program Participation, we show that paid leave mandates reduce the likelihood that potential caregivers report decreasing their paid work hours to provide caregiving after a spouse's health shock. However, if caregivers are unlikely to have access to job protection, paid leave mandates also increase the likelihood of leaving the labor market to provide caregiving and working fewer weeks. There is limited evidence of an effect of paid leave on other employment outcomes. Our findings demonstrate that paid leave has some influence on household labor supply decisions after spousal health shocks, but its role should be considered together with the availability of job protection.

The electrical energy is playing a vital role in the development and sustainability of any country. The demand of electrical energy is rising due to the increased comfort levels, urbanization and technological advancements. Therefore, it is utmost important to invigorate the use of renewable energy resources for bridging the gap and accepting the challenges of increasing electrical energy demands and greenhouse gas emissions. In view of the above, the present research focuses on the optimal design and sizing of hybrid energy system (HES) based on renewable energy resources, including solar photovoltaic (SPV), wind energy system, biomass and biogas with battery to electrify the rural areas of India’s Haryana state. Different models of hybrid energy systems have been chosen and optimized using different intelligent approaches such as grey wolf optimization (GWO), harmony search (HS) and particle swarm optimization (PSO) on the MATLAB platform. Finally, the results are compared in view of minimizing net present cost (NPC) and cost of energy (COE) and found the most optimal solution.

Today’s scenario of growth for the demand of energy and concern for environmental benefits, has created a need for using renewable energy for meeting the demand for power production. Solar energy has emerged to be of utmost important Renewable Energy Sources (RES). The use of solar collector systems in many power plants has eased the conversion of solar energy into electrical power as compared to other sources. Since there is significant movement of the sun’s angle w.r.t. earth’s surface, which results in reducing the efficiency of the collector and the power delivered by solar systems. So, there lies a need for the design of such suntracking system that improves the panel efficiency by continuous tracking of the sun throughout the day. The present work explores distinct types of solar tracking system and its implementation for evaluating the performance of the solar power system. Tests were conducted on Parabolic Trough Collector (PTC) demonstrated at National Institute of Solar Energy (NISE), India. The present work consists of three sections wherein the first section deals with analyzing the solar radiation for Rajasthan station that represents hot & dry climatic conditions. The second section determines the distinct types of the solar tracking system and its implementation and the third section evaluates the energy yield for solar tracking system. It has been observed from the performance evaluation that the one-axis PTC with azimuth tracking performs better than the other configuration of the solar tracking system.