Evaluation and deployment of a unified MPPT controller for hybrid Luo converter in combined PV and wind energy systems

This work emphasizes the development and examination of a Hybrid Luo Converter integrated with a unified Maximum Power Point Tracking (MPPT) for both grid and independent hybrid systems. The primary objectives of this hybrid system are to efficiently harness power from intermittent and variable renewable sources while elevating low-voltage energy inputs to utility-grade levels. Unlike previous studies employing specific MPPT algorithms for solar and wind sources, this work aims to simplify the control system by utilizing a unified MPPT controller. This research also introduces a novel approach involving dual-lift hybrid Luo converters to create hybrid systems, operating exclusively or concurrently based on the availability of renewable resources. To maximize power generation from all renewable sources, a unified MPPT algorithm is developed. The hybrid system, incorporates 500 W wind and 560 W PV systems, the innovative Luo converter, and the unified MPPT controller. A comprehensive comparative analysis is presented, comparing the hybrid system's performance with that of traditional control algorithms, such as the Perturb & Observe, and Radial Basis Function Network controllers. The successful prototype of the converter validates the practicality of the proposed approach.

Concomitant or sequential pulmonary infection with non-tuberculous mycobacteria and Aspergillus

Non-tuberculous mycobacteria (NTM) and Aspergillus are ubiquitous organisms that have the potential to cause significant pulmonary disease in certain clinical contexts. An association is known to exist between NTM and Aspergillus lung infections. However, it is unclear if NTM infection predisposes to Aspergillus infection or vice versa. It is also unclear whether treatment for one results in a favourable ecological niche that facilitates the growth of the other and promotes subsequent clinical disease. An improved understanding of the link between these two pulmonary pathogens is critical to guide improvements in clinical practice, and ultimately, enhance outcomes among patients who are at risk of experiencing these infections, either concomitantly or sequentially. Here, we discuss the association between pulmonary NTM and Aspergillus infections. We address the frequency with which coinfection or sequential infections are reported to occur, predisposing risk factors that have been identified and the impact on clinical outcomes. Current data on the mechanistic links between NTM and Aspergillus lung infections are also considered. The potential implications for routine clinical practice are explored.

Balloon dissection versus telescopic dissection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a systematic review, meta-analysis, and trial sequential analysis

OBJECTIVES

To compare the outcomes of balloon dissection and telescopic dissection in patients undergoing laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

METHODS

A systematic review in accordance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies comparing the outcomes of balloon dissection and telescopic dissection in patients undergoing laparoscopic TEP inguinal hernia repair. Random effects modelling was applied to calculate pooled outcome data.

RESULTS

A total of 936 patients from eight studies were included. The included population in both groups were comparable in terms of baseline characteristics. There was no difference between the two techniques in terms of operation time (MD: - 4.14 min, P = 0.05), conversion to another technique (RD: - 0.02, P = 0.29), recurrence (RD: - 0.00, P = 0.84), haematoma (OR: 1.34, P = 0.61), seroma (OR: 0.63, P = 0.56), surgical site infection (RD: 0.00, P = 1.00), urinary retention (OR: 0.92, P = 0.86), postoperative pain score on day 1 (MD: - 0.16, P = 0.69) and day 7 (MD: - 0.16, P = 0.61). Trial sequential analysis of randomised trials suggested that evidence for operative time and conversion to other technique is subject to type 1 and type 2 error.

CONCLUSIONS

Balloon dissection and telescopic dissection during TEP inguinal hernia repair are comparable in terms of operative and postoperative outcomes. The available evidence for operative time and conversion to other technique is subject to type 1 and type 2 error. In presence of comparative clinical outcomes, the cost-effectiveness analysis in future studies may play an important role in determining the dissection technique of choice.

Synthesis and upconversion emission studies of CaYF5:Ho3+/Yb3+ phosphor and its applications in optical thermometry, fingerprint detection, and security ink†

In this work, a CaYF₅:Ho³⁺/Yb³⁺ upconversion phosphor was synthesized and its structural, morphological, and optical properties were studied. The upconversion emission study was performed at an excitation pump power density of 5 W cm⁻² and emissions at 544 nm, 650 nm and 747 nm due to the ⁵F₄(⁵S₂) → ⁵I₈, ⁵F₅ → ⁵I₈ and ⁵F₄(⁵S₂) → ⁵I₇ transitions of the Ho³⁺ ion, respectively were observed. From temperature-dependent upconversion spectra temperature sensitivity was calculated and sensitivity is found to be 14 × 10⁻³ K⁻¹ for the synthesized upconversion phosphor. The photothermal conversion efficiency of the prepared sample in ethanol medium was tested. Moreover, the sample was used to develop latent fingerprints on various surfaces and good contrast in recorded images is observed. The invisible ink was prepared using the upconversion phosphor and then written words were recorded in upconversion emission mode.

In this work, a CaYF₅:Ho³⁺/Yb³⁺ upconversion phosphor was synthesized and its structural, morphological, and optical properties were studied. Apart from these studies, latent fingerprint detection and security ink applications were also demonstrated using this phosphor.

Isolated bilateral lateral geniculate body necrosis following acute pancreatitis: A rare cause of bilateral loss of vision in a young female

Sudden bilateral visual loss because of bilateral lateral geniculate body (LGB) necrosis is a very rare entity. The mechanisms causing these isolated lesions have still not been fully understood. We report a case of sudden loss of vision in a 22-year-old female following an attack of acute pancreatitis, just after starting the paleo diet. Neuroimaging revealed bilateral LGB necrosis. Multidisciplinary approach was sought and she was subsequently managed successfully. On follow-up, her visual acuity showed improvement, and neuroimaging revealed resolution of hyperintensities in bilateral LGB with residual blooming suggestive of old hemorrhagic gliosis. The possible reasons for isolated lesions of the LGB are hemorrhagic infarction and osmotic demyelination. In the present case, we postulate a vascular pathology, possibly hypo-perfusion because of shock following acute pancreatitis.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

POS0565 WORSE OUTCOMES LINKED TO ETHNICITY FOR EARLY INFLAMMATORY ARTHRITIS IN ENGLAND AND WALES: A NATIONAL COHORT STUDY

Background

Patients from ethnic minority backgrounds suffer considerable health inequality, with generally poorer health outcomes relative to the rest of the population.1 Further exploration of these differences is essential if we are to deliver the best care for all, and close the health gap for our patients.

Objectives

We used the National Early Inflammatory Arthritis Audit (NEIAA) to assess variability in care quality and treatment outcomes across ethnicities for patients diagnosed with early inflammatory arthritis (EIA) in England and Wales.

Methods

NEIAA is an observational cohort design. Data were from adult patients newly diagnosed with EIA, and seen by rheumatology in England and Wales between May 2018 and March 2020. Quality of care outcomes were assessed against six metrics contained within the National Institute for Health and Clinical Excellence (NICE) Quality Standard for Rheumatoid Arthritis.2 Clinical outcomes were measured using DAS28. Outcomes were compared between ethnic groups (White, Black, Asian, Mixed, Other), and adjusted for confounders (age, sex, smoking, comorbidity, seropositivity and disease severity at presentation) using Logistic regression models with multiple imputation for missing data.

Results

Data for 35,807 eligible patients were analysed, of whom 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minority backgrounds: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. A total of 12,955 patients had confirmed EIA. Of those, 11,315 were White and 1,640 were from ethnic minority backgrounds: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.

Of 35,160 eligible patients who had data available, 14,803 (42.1%) were assessed by rheumatology within three weeks of referral. Of 9,900 EIA-eligible patients with data available, 5,642 (57.0%) started treatment within six weeks of referral. There were no significant differences in these outcomes by ethnicity. Ethnic minority patients did, however, have lower odds of disease remission at three months, relative to patients of White ethnicity (adjusted odds ratio 0.79; 95% CI: 0.65-0.96; p=0.02). This difference was due to lower odds of disease remission in Black and Asian patients, relative to White patients (Table 1). Ethnic minority patients were significantly less likely to receive initial treatment with methotrexate (0.68; 95% CI: 0.52-0.90; p=0.008) or with glucocorticoids (0.63, 95% CI: 0.49-0.80; p< 0.001).

Table 1.

Associations between ethnicity and disease remission at three months in EIA patients

ModelOdds ratio95% CIP-valueUnadjustedAll ethnic minority0.76(0.62,0.93)0.01backgroundsBlack0.48(0.34,0.67)<0.001Asian0.74(0.59,0.93)0.01Mixed0.61(0.28,1.35)0.22Other1.09(0.71,1.68)0.67Age and sex-adjustedAll ethnic minority0.78(0.63,0.96)0.01backgroundsBlack0.49(0.35,0.69)0.00Asian0.75(0.60,0.94)0.01Mixed0.63(0.28,1.39)0.25Other1.11(0.71,1.71)0.63Fully-adjustedAll ethnic minority0.79(0.65,0.96)0.02backgroundsBlack0.57(0.41,0.79)0.001Asian0.76(0.62,0.93)0.009Mixed0.63(0.27,1.46)0.29Other1.04(0.71,1.54)0.80

Conclusion

The results from this large cohort demonstrate that some minority ethnic groups are less likely to reach disease remission in the early months following an EIA diagnosis. Our results are not explained by delays in referral or treatment. Intitial treatment strategies varied across ethnic groups. These data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.

References

[1]Greenberg JD, Spruill TM, Shan Y, Reed G, Kremer JM, Potter J, et al. Racial and ethnic disparities in disease activity in patients with rheumatoid arthritis. Am J Med. 2013;126(12):1089-98.

[2]NICE quality standard for rheumatoid arthritis in over 16s. Nice.org.uk. 2013 [cited 25 January 2022]. Available from: https://www.nice.org.uk/guidance/qs33/documents/previous-version-of-quality-standard.

Disclosure of Interests

Maryam Adas: None declared, Sathiyaa Balachandran: None declared, Sam Norton: None declared, Edward Alveyn: None declared, Mark Russell Speakers bureau: Has received speaker fees and educational grants from Janssen, Lilly, Menarini, Pfizer and UCB, Tom Esterine Speakers bureau: Patient review of P.I.S and consent form into lay language for KCL that was linked to Pharma company., Paul Amlani-Hatcher: None declared, Sarah Oyebanjo: None declared, Heidi Lempp: None declared, Jo Ledingham: None declared, Kanta Kumar Speakers bureau: Has received training form Pfizer and speaker fees 2021 from Janssen., Paid instructor for: Has received training form Pfizer, James Galloway Speakers bureau: Has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB., Shirish Dubey: None declared.

Air pollution prediction with machine learning: a case study of Indian cities

The survival of mankind cannot be imagined without air. Consistent developments in almost all realms of modern human society affected the health of the air adversely. Daily industrial, transport, and domestic activities are stirring hazardous pollutants in our environment. Monitoring and predicting air quality have become essentially important in this era, especially in developing countries like India. In contrast to the traditional methods, the prediction technologies based on machine learning techniques are proved to be the most efficient tools to study such modern hazards. The present work investigates six years of air pollution data from 23 Indian cities for air quality analysis and prediction. The dataset is well preprocessed and key features are selected through the correlation analysis. An exploratory data analysis is exercised to develop insights into various hidden patterns in the dataset and pollutants directly affecting the air quality index are identified. A significant fall in almost all pollutants is observed in the pandemic year, 2020. The data imbalance problem is solved with a resampling technique and five machine learning models are employed to predict air quality. The results of these models are compared with the standard metrics. The Gaussian Naive Bayes model achieves the highest accuracy while the Support Vector Machine model exhibits the lowest accuracy. The performances of these models are evaluated and compared through established performance parameters. The XGBoost model performed the best among the other models and gets the highest linearity between the predicted and actual data.

An Overview of Vehicular Emission Standards

In India, the ambient air quality has been degrading from past few decades especially in urban areas. Vehicular emissions are amongst one of the major reasons for the deterioration of ambient air quality in such areas. This article is an effort to review the vehicular emission standards of the major countries (USA, Europe, Japan and Australia) and compare with Indian emission standards. However, there exists several differences in present emission standards followed by different countries. For instance, emission standards in USA are fuel neutral, while no separate weight categorization exists among light-duty vehicles (LDVs). In Europe, Japan, Australia and India, separate weight categorization and emission limits for both petrol and diesel vehicles are provided. It was observed that different driving test cycles used by different countries are the reasons for numerical differences in vehicular emission standards. To rectify this, a worldwide harmonized test cycle (WHTC) is introduced by United Nations Economic Committee for Europe (UNECE) that would represent real-world driving and verifies that the statutory emission limits are not exceeded during actual driving. Countries like Japan and Europe have already been following the WHTC, while some other countries may introduce the same in near future. Yet the real-world emissions across the world keeps on diverging. In such situation, harmonization of vehicle emission standards worldwide is a bit challenging, based on dynamics of road conditions, driving patterns, environmental conditions, etc. Thus, more concerted research is needed for evolution of a common universal emission standards implementable worldwide so that the uniformity in information and policies available to the common public could be maintained.

Instruction strategies for drug calculation skills: A systematic review of the literature

BACKGROUND

Medication errors and unsafe medication practices are a leading cause of injury and avoidable harm worldwide.

OBJECTIVES

The aim of this review was to (i) explore and identify evidence-based strategies to teach medication calculation skills by determining the most common errors and assess the quality, level, and role of the evidence, and (ii) describe instruction strategies for drug calculation skills development or improvement based on seven research-based principles for smart teaching.

DESIGN

Systematic review.

DATA SOURCES

CINAHL, PubMed, and PsycINFO.

REVIEW METHODS

The review followed Whittemore and Knafl's framework steps with an assessment of the studies reporting using PRISMA, STROBE, COREQ and categorizing their methods by evidence hierarchy and roles. Two authors independently assessed eligibility and extracted data.

RESULTS

From the total 1793 articles, 51 studies met the eligibility criteria. The studies included 9210 nursing students/nurses and mainly used a quantitative approach (67.5%), followed by qualitative (22.5%) and mixed methods (10.0%), with the students/nurses doing arithmetic and conceptual mistakes. The findings presented were low levels of evidence III (23.5%) and V (41.2%), quality Level B (82.4%), and 47.1% focused on choosing the appropriate teaching and intervention approaches (role of the evidence). The teaching strategies addressed multiple smart teaching principles, but mainly prior knowledge (principle 1, 39.2%). The least used strategies were those addressing the levers that influence motivation and behaviors such as value, expectations, and environment climate (principle 3, 13.7%). Two studies addressed five principles simultaneously.

CONCLUSIONS

Regarding teaching strategies, the most recurring strategies were early diagnostic assessments on knowledge, anxiety and/or self-confidence, considering knowledge organization with scaffolding complex tasks, being explicit about objectives and expectations, and usage of e-learning. However, e-learning was mainly used after 2018. Considering the low levels and quality of evidence, we recommend higher levels of research design for future research. Randomized Controlled Trials could be conducted when randomizing teaching methods per semester or questions embedded in software. Web-base software could be used to support teaching and research approaches.

Comparative Evaluation of Microleakage of Three Different Restorative Materials (Cention N, Zirconomer Improved and Glass Hybrid Restorative System) in Class V Cavity Restoration Using Stereomicroscope: In vitro Study

Aim and Objective: Microleakage is the most important factor responsible for the destruction of restoration margins. The aim of this study was to compare and evaluate the microleakage of three different restorative materials namely glass hybrid restorative system, zirconomer improved and Cention N under stereomicroscope. Materials and Methods: In this in-vitro experimental study, 45 Class V cavities were prepared on the buccal surface of maxillary premolars. The prepared cavities were divided into three groups for restoration with Cention N(group I), Zirconomer Improved(group II), Equiaforte (group III). All the samples were thermocycled for 500 cycles between 5-55°C initially and then immersed in 0.5% methylene blue for 24 hours before sectioning. All the sectioned samples were observed for microleakage under a stereomicroscope. Results: Data was analyzed using one way ANOVA test for comparison between three groups and the result revealed statistically significant difference between the groups(p<0.05). Post hoc Tukey test was used for intergroup comparison and it was observed that both Cention and Equiaforte are inferior to Zirconomer improved in terms of microleakage (p<0.05). Conclusion: Zirconomer improved exhibited lower microleakage when compared to Cention N and Equiaforte cements.

Synthesis of NaYF4:Ho3+/Yb3+ colloidal upconversion phosphor and its application for OCT-based imaging, temperature sensing, fingerprinting and security ink

In this work, an NaYF4:Ho3+/Yb3+ upconversion phosphor in colloidal form was synthesized and then its suitability for image contrast enhancement in optical coherence tomography (OCT) and photothermal (PT) OCT imaging was analysed.

Monitoring of Chemical Markers in Extraction of Traditional Medicinal Plants (Piper nigrum, Curcuma longa) Using In Situ ReactIR

BACKGROUND

The fingerprinting and quantification of marker compounds from medicinal plants is a domain of the herbal industry for quality/quantity control parameters.

OBJECTIVE

The main objective of this study is the application of the in situ ReactIR technique for measuring the concentration of different components during the extraction process of different medicinal plants.

METHOD

In this study we have performed the extraction of two-marker compounds, viz. piperine from Piper nigrum and curcumin from Curcuma longa plants, using various solvents (dichloromethane and methanol). The progress of extraction was monitored using an in situ Fourier transform infrared (FTIR) probe instrument and an automated reactor.

RESULTS

In this communication, using the in situ ReactIR technique we developed a method which demonstrates the relative quantification of marker analytes, optimizes extraction time and type of solvents to be used for different analytes during the extraction process.

CONCLUSIONS

To the best of our knowledge, this is the first report of relative quantification and structural information of marker compounds during the process of extraction using in situ FTIR.

HIGHLIGHTS

The present study highlights the real-time monitoring, in situ quantification, and structural information of marker compounds during the process of extraction of medicinal plants using in situ FTIR.

O-172 Metabolic imaging of cumulus cells to predict embryo implantation potential

Study question

Can non-invasive metabolic imaging detect variations in cumulus cell metabolic parameters associated with a viable pregnancy of the corresponding embryo?

Summary answer

Noninvasive metabolic imaging can detect differences in the cumulus cell metabolic signatures between embryos that led to a viable pregnancy and those that did not. 

What is known already

Bidirectional metabolic cooperativity between the human oocyte and its surrounding cumulus cells is essential for the oocyte to acquire full developmental competency. However, the relationship between cumulus cell metabolism and oocyte viability is not well established. Metabolic imaging uses Fluorescence Lifetime Imaging Microscopy (FLIM) to non-invasively measure autofluorescence of the endogenous molecules, NADH and FAD+, which are essential coenzymes for cellular respiration and glycolysis. This technique enables quantitative information for these coenzyme concentrations and regarding metabolite enzyme engagement. We have previously shown that this technique is an effective tool for quantitatively measuring metabolic state of mouse embryos.

Study design, size, duration

Cumulus cell clusters (n = 617 from 193 patients) were dissected from cumulus-oocyte complexes prior to insemination or ICSI, vitrified, warmed and their metabolic function assessed. We conducted a prospective observational study to evaluate to what extent cumulus cells from an oocyte that led to a viable pregnancy (presence of a viable fetus &gt;7 weeks gestation) after transfer of the corresponding embryo metabolically differed from those that did not. We also evaluated the associations with embryo morphology.

Participants/materials, setting, methods

Cumulus cell metabolism was assessed non-invasively using FLIM to measure the autofluorescence of NADH and FAD+. Overall a single FLIM measurement provides a total of 8 metabolic parameters (4 for NADH and 4 for FAD+). An additional parameter, the Redox Ratio was also acquired (NADH intensity / FAD+ intensity). We used multilevel models to investigate the association of cumulus cell metabolic parameters with the morphology of the corresponding embryo and clinical outcome.

Main results and the role of chance

Of the cumulus samples analyzed, 75 corresponded to embryos that did not result in a viable pregnancy, and 24 that did so. Significant associations were observed between cumulus cell FAD+ fraction bound to enzyme (p = 0.007), FAD+ long lifetime (p = 0.01) and FAD+ short lifetime (p &lt; 0.001) and the clinical outcome of the corresponding embryo. These significant associations held up after controlling for age. We used a support vector machine algorithm to distinguish between embryos that led to a viable pregnancy and those that did not. The optimum hyperplane derived from a support vector machine algorithm predicted whether a sample with random cumulus cell metabolic parameters will lead to a viable pregnancy or not with an accuracy of 80%. Embryo morphological assessments were stratified as excellent, good, fair and poor. We found no significant associations between cumulus cell metabolic signatures and embryo morphology evaluated on day 3. Significant associations of FAD+ short lifetime (p &lt; 0.001) and day 5 embryo morphology were found. However, these associations were not significant after controlling for age. 

Limitations, reasons for caution

Although we observed significant variations in metabolic parameters, further studies with larger sample sizes are required. Despite our validation studies showing no significant effect of vitrification on cumulus cell metabolic parameters, analyses with fresh clusters are needed to confirm our results.

Wider implications of the findings

Noninvasive FLIM imaging detects metabolic variations of cumulus masses and their association with embryo viability. The ability to correlate metabolic measurements of cumulus clusters, in combination with embryo morphology assessments and patient clinical characteristics, with embryo fate paves the way for this approach to be used in a clinical setting.

Trial registration number

5RO1HD092559-03

A validation framework to assess performance of commercial deformable image registration in lung radiotherapy

INTRODUCTION

Deformable image registration (DIR) can play an important role in the context of adaptive radiotherapy. The AAPM Task Group 132 (TG-132) has described several quantitative measures for DIR error assessment but they can only be accurately defined when there is a ground-truth present in high-contrast regions. This work aims to set out a framework to obtain optimal results for CT-CT lung DIR in clinical setting for a commercially available system by quantifying the DIR performance in both low- and high-contrast regions.

METHODS

Five publicly available thorax datasets were used to assess the DIR quality. A "Ghost fiducial" method was implemented by windowing the contrast in a new feature provided by Varian Velocity v4.1. Target registration error (TRE) of the landmarks and Dice-similarity coefficient of the tumour were calculated at three different contrast settings to assess the algorithm in high- and low-contrast scenarios.

RESULTS

For the original unedited dataset, higher resolution DIR methods showed best performance acceptable within the recommended limit according to TG-132, when actual displacements were less than 10 mm. The relation of the actual displacement of the landmarks and TRE shows the limited capacity of the algorithm to deal with movements larger than 10 mm.

CONCLUSION

This work found the performance of DIR methods and settings available in Varian Velocity v4.1 to be a function of contrast level as well as extent of motion. This highlights the need for multiple metrics to assess different aspects of DIR performance for various applications related to low-contrast and/or high-contrast regions.

Endophyte roles in nutrient acquisition, root system architecture development and oxidative stress tolerance

Plants associate with communities of microbes (bacteria and fungi) that play critical roles in plant development, nutrient acquisition and oxidative stress tolerance. The major share of plant microbiota is endophytes which inhabit plant tissues and help them in various capacities. In this article, we have reviewed what is presently known with regard to how endophytic microbes interact with plants to modulate root development, branching, root hair formation and their implications in overall plant development. Endophytic microbes link the interactions of plants, rhizospheric microbes and soil to promote nutrient solubilization and further vectoring these nutrients to the plant roots making the soil-plant-microbe continuum. Further, plant roots internalize microbes and oxidatively extract nutrients from microbes in the rhizophagy cycle. The oxidative interactions between endophytes and plants result in the acquisition of nutrients by plants and are also instrumental in oxidative stress tolerance of plants. It is evident that plants actively cultivate microbes internally, on surfaces and in soils to acquire nutrients, modulate development and improve health. Understanding this continuum could be of greater significance in connecting endophytes with the hidden half of the plant that can also be harnessed in applied terms to enhance nutrient acquisition through the development of favourable root system architecture for sustainable production under stress conditions.

Expression and functional role of IGFs during early pregnancy in placenta of water buffalo

Adequate vascularisation is a key factor for successful fetal development. We hypothesized that Insulin-Like Growth Factor (IGF) family members regulate angiogenesis along with promoting fetal development and growth. In this experiment, we determined the expression and functional role of IGF family in placental compartments (caruncle; CAR, cotyledon; COT) during different stages of early pregnancy in the water buffalo (Bubalus bubalis). Samples were collected from early pregnancy 1 (EP1, 28-45 days), early pregnancy 2 (EP2, 45-90 days), and third stage of estrous cycle (11-16 days), which was taken as control. In addition, the role of IGF1 on mRNA expression of vWF, StAR, CYP11A1, 3βHSD, PCNA, and BAX were elucidated in cultured trophoblast cells (TCC) obtained from EP2. Quantitative real-time PCR (q-PCR), westernblot, and immunohistochemistry were done to investigate the gene expression, protein expression, and localization of examined factors, and RIA was also done to assess progesterone (P₄) concentration. Expression of IGFs, its receptors and binding proteins were found to be significantly higher (p < 0.05) in both CAR and COT as compared to control during early pregnancy, except binding proteins IGFBP1, 3 and 4 which were significantly (p < 0.05) downregulated in COT with advancement of pregnancy. mRNA expression was consistent with the findings of immunoblotting and immunolocalization experiments. Trophoblasts cell culture (TCC) study showed a significant time and dose-dependent effect of IGF1 onsteroidogenic transcript, which was found to be maximum at 100 ng/ml that paralleled with P₄ accretion in the media (p < 0.05). Further, IGF1 upregulated the transcripts of vWF, PCNA, and downregulated BAX at the same concentration (p < 0.05). Overall, our results demonstrated that the expression of IGFs is a site-specific phenomenon in placentome, which indicates autocrine/paracrine and endocrine function. Our in-vitro finding support that IGF1 plays a critical role in placental development by promoting angiogenesis, steroid synthesis, and cell proliferation during early pregnancy.

An efficient algorithm to detect DDoS amplification attacks

Domain name system (DNS) plays a critical part in the functioning of the Internet. But since DNS queries are sent using UDP, it is vulnerable to Distributed Denial of Service (DDoS) attacks. The attacker can take advantage of this and spoof the source IP address and direct the response towards the victim network. And since the network does not keep track of the number of requests going out and responses coming in, the attacker can flood the network with these unwanted DNS responses. Along with DNS, other protocols are also exploited to perform DDoS. Usage of Network Time Protocol (NTP) is to synchronize clocks on systems. Its monlist command replies with 600 entries of previous traffic records. This response is enormous compared to the request. This functionality is used by the attacker in DDoS. Since these attacks can cause colossal congestion, it is crucial to prevent or mitigate these types of attacks. It is obligatory to discover a way to drop the spoofed packets while entering the network to mitigate this type of attack. Intelligent cybersecurity systems are designed for the detection of these attacks. An Intelligent system has AI and ML algorithms to achieve its function. This paper discusses such intelligent method to detect the attack server from legitimate traffic. This method uses an algorithm that gets activated by excess traffic in the network. The excess traffic is determined by the speed or rate of the requests and responses and their ratio. The algorithm extracts the IP addresses of servers and detects which server is sending more packets than requested or which are not requested. This server can be later blocked using a firewall or Access Control List (ACL).

Prevalence of teenage pregnancy in 2015-2016 and its obstetric outcomes compared to non-teenage pregnancy at Hospital Tuanku Ja'afar Seremban (HTJS), Negeri Sembilan, Malaysia: A retrospective case-control study based on the national obstetric registry

OBJECTIVE

To determine the prevalence of teenage pregnancy and compare its obstetric and perinatal outcomes with those of non-teenage pregnancy.

METHOD

This retrospective hospital-based case-control study was conducted in the Department of Obstetrics and Gynaecology in Hospital Tuanku Ja'afar Seremban. The study made use of the Malaysian National Obstetric Registry (NOR) records of teenage pregnant women aged 11-19 at Hospital Tuanku Ja'afar Seremban over a 12-month period between May 2015 and May 2016 (n=164). Socio-demographic profiles, obstetric outcomes, and perinatal outcomes were detailed for each pregnant woman. The results were compared to a control group of 169 pregnant women aged 20-30 who also delivered in hospital Tuanku Ja'afar Seremban during the same period. The aim of this study was to assess the obstetric outcomes of teenage pregnancy and to compare them with those of the control group. A chi-squared test was used to identify the statistical significance of the relationship between teenage pregnancy rates and obstetric outcomes. Results with p <0.05 was considered statistically significant.

RESULTS

The prevalence of teenage pregnancy was 2.8%. The mean age of the teenage group was 17.9; that of the control group was 26.4. Teenage mothers had a significantly higher risk of anemia (p<0.05), episiotomy (p<0.001), preterm labor (p<0.001), and delivering low-birthweight babies (p<0.001). There were no significant differences between the two groups in mode of delivery, antenatal complications, birth outcomes, APGAR scores at 5th minute, or neonatal complications.

CONCLUSION

The prevalence of teenage pregnancy in this study is relatively low but is associated with an increased risk of some perinatal complications. The primary care physician's role is pivotal in educating adolescents on sexual health, providing continual care in hospitals, and empowering teenagers in their reproductive health decisions.

LSPR-mediated improved upconversion emission on randomly distributed gold nanoparticles array

The Au thin film was fabricated on silica glass substrate (a) and UCNPs were fabricated over (a) to get the plasmonic resonance (image b) with the coupling of metal. The UC emission enhancement after confinement of metal and NPs were simulated (c).

Expression and functional role of fibroblast growth factors (FGF) in placenta during different stages of pregnancy in water buffalo (Bubalus bubalis)

The present study documented the expression and functional role of Fibroblast growth factors (FGFs) family and their receptors (Fibroblast growth factor receptor, FGFRs) in placenta (Cotyledon; COT, Caruncle; CAR) during different stages of pregnancy in water buffalo. Samples were collected from Early pregnancy 1 (EP1); Early pregnancy 2 (EP2); Mid pregnancy (MP) and Late pregnancy (LP) while diestrus stage of oestrus cycle (NP) was taken as control. In addition, modulatory role of FGF2 on mRNA expression of von Willebrand factor (vWF), Proliferating cell nuclear antigen (PCNA), steroidogenic acute regulatory protein (StAR), cytochrome P450 cholesterol side-chain cleavage (CYP11A1), 3β-hydroxysteroid dehydrogenase (3βHSD) and BCL2 Associated X (BAX) were studied in cultured trophoblast cells (TCC), obtained from EP2. Real-time PCR (qPCR), Western blot, and immunohistochemistry were applied to investigate mRNA and protein expressions, and the localization of examined factors whereas, P4 secretion was assessed by RIA. The mRNA and protein expression of FGFs and its receptors were maximum (P < 0.05) during EP (EP1 and EP2) in COT. However, FGFR1 and FGFR4 were upregulated (P < 0.05) during EP2 and MP in COT. Similarly, the mRNA and protein expression of FGFs and its receptors were upregulated (P < 0.05) during all stages of pregnancy in CAR. FGF family members were localized in the cytoplasm of trophoblast cells as well as in fetal blood vessels. At 100 ng/ml dosage, FGF2 stimulated the transcript of vWF maximally (P < 0.05). P4 secretion in trophoblast cells treated with FGF2 was maximum with the highest dose at 72 h. These findings corroborate that FGF acts locally in the trophoblast cells to modulate steroid hormone viz. progesterone synthesis, promote angiogenesis and favors cell survivability indicating that this factor may play an essential role in the regulation of placental formation and function in buffalo.

Urinary Ascites and Transient Intestinal Obstruction in a Preterm Infant: An Interesting Case of Posterior Urethral Valve

Posterior urethral valve (PUV) is the most common congenital cause of bladder outflow obstruction in male neonates. We report a preterm neonate with PUV who presented as nonimmune fetal hydrops with intestinal obstruction in the antenatal period. The mother of our patient is a 33-year-old woman who started her prenatal care at our hospital at 30 weeks' gestation. Her sonogram done at 32 weeks in our hospital revealed fetal hydrops. It showed polyhydramnios, mild pyelectasis of right kidney, normal left kidney, and fetal ascites. Amniocentesis revealed bile stained amniotic fluid. Ultrasound during the procedure showed dilated fetal bowel loops with increased echoes. Following delivery at 32 weeks postnatal exam showed ascites with absence of skin edema, pleural, or pericardial effusion. The abdominal sonogram showed distended urinary bladder and bilateral hydroureteronephrosis. Bladder catheterization was done which relieved the bladder outlet obstruction. Voiding cystourethrogram was done later which confirmed PUV and bilateral grade 5 vesicoureteral reflux. The formation of urinary ascites in PUV serves as a pop-off mechanism to relieve the intravesical and intrarenal pressure. When this happens by mechanisms other than bladder rupture, it can lead on to transient intestinal obstruction and hepatic synthetic defects.

Correction to: Testing for medical school selection: What are prospective doctors' experiences and perceptions of the GAMSAT and what are the consequences of testing?

The wrong acknowledgement and funding information were provided in the original publication.

Testing for medical school selection: What are prospective doctors' experiences and perceptions of the GAMSAT and what are the consequences of testing?

Written tests for selection into medicine have demonstrated reliability and there is accumulating evidence regarding their validity, but we know little about the broader impacts or consequences of medical school selection tests from the perspectives of key stakeholders. In this first Australian study of its kind, we use consequential validity as a theoretical lens to examine how medical school students and applicants view and experience the Graduate Medical Schools Admission Test (GAMSAT), and the consequences of testing. Participants (n = 447) were recruited from five graduate-entry medical schools across Australia and a publicly available online test preparation forum. An online survey was used to gather demographic information, and quantitative and qualitative data. Quantitative data were analysed via descriptive statistics and qualitative data were thematically analysed. The findings showed there was a considerable financial burden associated with preparing for and sitting the GAMSAT and moderate agreement regarding the GAMSAT as a fair selection method. The main unintended consequences of using the GAMSAT as a selection tool included barriers related to test affordability and language, and socialisation into the hidden curriculum of medicine. Selection tools such as the GAMSAT have some limitations when the goals are to support equitable participation in medicine and professional identity development. Our study highlights the value interpretive and theoretically-informed research in contributing to the evidence base on medical school selection.

Role of pneumonectomy for lung cancer in current scenario: An Indian perspective

BACKGROUND

Surgical treatment for lung cancer has evolved from pneumonectomy to lobectomy/sleeve resection around the world. Although condemned for poor outcomes, pneumonectomy may still be required in a select group of patients in developing countries. With the better patient selection, optimization of medical comorbidities, better perioperative care; pneumonectomy may show better results. Thus, there is a need to reconsider the role of pneumonectomy in patients with locally advanced lung cancer in the current scenario.

PATIENTS AND METHODS

The aim of this study was to analyze the demographic and clinicopathologic profile of lung cancer patients and the role of pneumonectomy at a tertiary cancer center in India. The records of patients, who underwent surgery for lung cancer at our institute from January 2011 to April 2014, were analyzed retrospectively, and various parameters in pneumonectomy were compared to lobectomy patients.

RESULTS

Out of 48 patients undergoing major lung resections, nearly 80% patients were symptomatic at presentation and were mostly in advanced stages, thus requiring neoadjuvant chemotherapy in 45.8% cases and pneumonectomy in 41.6% patients. There was no difference in morbidity and mortality in pneumonectomy (25%, 5%) versus lobectomy (21.2%, 3.5%). Disease-free survival at 1, 2, and 3 years after pneumonectomy (71.8%, 51.4%, and 42.8%) was comparable to lobectomy (73.3%, 66.1%, and 55.6%). After neoadjuvant therapy, survival was not affected by the type of surgery.

CONCLUSIONS

In the Indian scenario, as the majority of lung cancer patients present at an advanced stage, pneumonectomy still plays a major role, and the acceptable postoperative outcome can be achieved with aggressive perioperative management.

Negative pressure wound therapy versus gauze dressings for the treatment of contaminated traumatic wounds

OBJECTIVE

This compares hospital suction negative pressure wound therapy (NPWT) with conventional gauze dressings in traumatic soft-tissue injury at a tertiary care centre.

METHODS

A prospective control study was conducted between September 2012 and November 2014. Patients with one or more traumatic soft-tissue injuries with contaminated wounds were allocated to either a test group (received NPWT) or control group (received conventional gauze). Wounds were assessed by two orthopaedic surgeons. If grade A was achieved, the wound was covered with split-thickness skin graft, flap or delayed primary closure; otherwise, revision debridement and NPWT/saline gauze dressings were applied. Descriptive statistics (mean, standard deviation and proportions) were used to summarise the study variables. The 95% confidence intervals (CI) for difference of mean were used. Chi-square test and Fisher's exact test were used to observe an association between the qualitative data and outcome variables. Unpaired T-Test and Mann-Whitney U test were used for analysis of the quantitative data. A p<0.05 was considered statistically significant.

RESULTS

A total of 104 patients were included. The mean number of dressings per patient was significantly lower in the NPWT group (3.4) than in the control group (20.7) (p<0.001). The time between injury and complete closure (12.5 versus 21.4 days) as well as duration of hospital stay (17.3 versus 23.8 days) was significantly less in the NPWT group (p<0.05).

CONCLUSION

NPWT has a role in healing traumatic wounds and can be delivered effectively through hospital suction NPWT, which can also reduce the cost of therapy. We recommend its regular use in all patients presenting with post-traumatic, soft-tissue injuries when primary coverage is not possible.