Pulse Oximeter Perfusion Index as an Early Indicator of Onset of Sympathectomy After Epidural Anaesthesia

Objective: To establish a reliable indicator of epidural effectiveness, we compared the frequency of subjects achieving sympathectomy onset in patients undergoing lower limb surgeries under lumbar epidural anaesthesia in terms of changes in perfusion index (PI), mean arterial pressures (MAP), and toe temperature. Methodology:  This descriptive case series study was conducted at the Department of Anesthesiology, Holy Family Hospital, Rawalpindi from July 2018 - January 2019. A total of 96 patients were included, all of them received lumbar epidural catheters for lower limb surgeries and were given 10 ml of epidural bupivacaine 0.5% through the epidural catheter. Baseline values were recorded for PI in toe, MAP and temperature of toe. At 5, 10 and 20 minutes after epidural anaesthesia, these values were re-recorded. Data collection was completed before the start of surgery. Criteria for clinically evident sympathectomy was defined beforehand. The frequency of subjects reaching these predefined targets were analyzed at said time intervals using Mc-Nemar test at each time interval. Results: For PI 66/96, 88/96 and 96/96 of subjects in the study fulfilled the criteria of achieving sympathectomy at 5, 10 and 20 minutes , respectively, compared to 7/96 , 15/96 and 59/96 for MAP changes and 0/96, 29/96 and 45/96 for changes in temperature of toe. Conclusion: As per this study, PI seemed to be a faster, clearer and a more objective indicator of the onset of sympathectomy after epidural anaesthesia than toe temperature or MAP

DNA key based visual chaotic image encryption

With the exponential growth of Internet technologies, digital information exchanged over the Internet is also significantly increased. In order to ensure the security of multimedia contents over the open natured Internet, data should be encrypted. In this paper, the quantum chaotic map is utilized for random vectors generation. Initial conditions for the chaos map are computed from a DNA (Deoxyribonucleic acid) sequence along with plaintext image through Secure Hash Algorithm-512 (SHA-512). The first two random vectors break the correlation among pixels of the original plaintext image via row and column permutation, respectively. For the diffusion characteristics, the permuted image is bitwise XORed with a random matrix generated through the third random vectors. The diffused image is divided into Least Significant Bit (LSB) and Most Significant Bits (MSBs) and Discrete Wavelet Transform (DWT) is applied to the carrier image. The HL and HH blocks of the carrier image are replaced with LSBs and MSBs of the diffused image for the generation of a visually encrypted image. The detailed theoretical analysis and experimental simulation of the designed scheme show that the proposed encryption algorithm is highly secured. Efficiency and robustness of the proposed visually image encryption scheme is also verified via a number of attack analyses, i.e., sensitivity attack analysis (> 99%), differential attack analysis (NPCR > 99, UACI > 33), brute force attack (almost 7.9892), statistical attack (correlation coefficient values are almost 0 or less than zero), noise tolerance, and cropping attack. Further security analyses such as encryption quality (ID ≅ 1564, DH = 3.000), homogeneity (0.3798), contrast (10.4820) and energy (0.0144) of the scheme are also evaluated

Dynamic S-Box and PWLCM-Based Robust Watermarking Scheme

Due to the increased number of cyberattacks, numerous researchers are motivated towards the design of such schemes that can hide digital information in a signal. Watermarking is one of the promising technologies that can protect digital information. However, traditional watermarking schemes are either slow or less secure. In this paper, a dynamic S-Box based efficient watermarking scheme is presented. The original image was extracted at the receiver’s end without any loss of sensitive information. Firstly, the Secure Hash Algorithm is applied to the original image for the generation of the initial condition. Piece Wise Linear Chaotic Map is then used to generate 16 × 16 dynamic Substitution Box (S-Box). As an additional security feature, the watermark is substituted through dynamic S-Box. Hence, it is hard for the eavesdroppers to attack the proposed scheme due to the dynamic nature of S-Box. Lastly, lifting wavelet transform is applied to the host image and the High Low and High High blocks of host image are replaced with least significant bits and most significant bits of the substituted watermark, respectively. Robustness, efficiency and security of the proposed scheme is verified using Structure Similarity Index, Structure Dissimilarity Index, Structure Content, Mutual Information, energy, entropy, correlation tests and classical attacks analysis

EEG-Based Neonatal Sleep-Wake Classification Using Multilayer Perceptron Neural Network

Objective: Classification of sleep-wake states using multichannel electroencephalography (EEG) data that reliably work for neonates. Methods: A deep multilayer perceptron (MLP) neural network is developed to classify sleep-wake states using multichannel bipolar EEG signals, which takes an input vector of size 108 containing the joint features of 9 channels. The network avoids any post-processing step in order to work as a full-fledged real-time application. For training and testing the model, EEG recordings of 3525 30-second segments from 19 neonates (postmenstrual age of 37 ± 05 weeks) are used. Results: For sleep-wake classification, mean Cohen’s kappa between the network estimate and the ground truth annotation by human experts is 0.62. The maximum mean accuracy can reach up to 83% which, to date, is the highest accuracy for sleep-wake classification

Assessment of sublethal and transgenerational effects of spirotetramat, on population growth of cabbage aphid, Brevicoryne brassicae L. (Hemiptera: Aphididae)

The cabbage aphid (Brevicoryne brassicae L.) is a devastating pest of cruciferous crops causing economic damage worldwide and notably owing to its increasing resistance to commonly used pesticides. Such resistance prompts the development of integrated pest management (IPM) programs that include novel pesticides being effective against the aphids. Spirotetramat is a novel insecticide used against sap-sucking insect pests, particularly aphids. This study evaluated the toxicity of spirotetramat to adult apterous B. brassicae after 72 h using the leaf dipping method. According to the toxicity bioassay results, the LC50 value of spirotetramat to B. brassicae was 1.304 mgL−1. However, the sublethal concentrations (LC5 and LC15) and transgenerational effects of this novel insecticide on population growth parameters were estimated using the age-stage, two-sex life table theory method. The sublethal concentrations (LC5; 0.125 mgL−1 and LC15; 0.298 mgL−1) of spirotetramat reduced the adult longevity and fecundity of the parent generation (F0). These concentrations prolonged the preadult developmental duration while decreasing preadult survival, adult longevity and reproduction of the F1 generation. The adult pre-reproductive period was also extended by spirotetramat treatment groups. Subsequently, the population growth parameters such as the intrinsic rate of increase r, finite rate of increase λ and net reproductive rate R0 of the F1 generation were decreased in spirotetramat treatment groups whereas, the mean generation time T of the F1 generation was not affected when compared to the control. These results indicated the negative effect of sublethal concentrations of spirotetramat on the performance of B. brassicae by reducing its nymphal survival, extending the duration of some immature stages and suppressing the population growth of B. brassicae. Overall, we demonstrated that spirotetramat is a pesticide showing both sublethal activities, and transgenerational effects on cabbage aphid; it may be useful for implementation in IPM programs against this aphid pest

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec