An Encoder-Decoder Approach for Packing Circles

The problem of packing smaller objects within a larger object has been of interest since decades. In these problems, in addition to the requirement that the smaller objects must lie completely inside the larger objects, they are expected to not overlap or have minimum overlap with each other. Due to this, the problem of packing turns out to be a non-convex problem, obtaining whose optimal solution is challenging. As such, several heuristic approaches have been used for obtaining sub-optimal solutions in general, and provably optimal solutions for some special instances. In this paper, we propose a novel encoder-decoder architecture consisting of an encoder block, a perturbation block and a decoder block, for packing identical circles within a larger circle. In our approach, the encoder takes the index of a circle to be packed as an input and outputs its center through a normalization layer, the perturbation layer adds controlled perturbations to the center, ensuring that it does not deviate beyond the radius of the smaller circle to be packed, and the decoder takes the perturbed center as input and estimates the index of the intended circle for packing. We parameterize the encoder and decoder by a neural network and optimize it to reduce an error between the decoder's estimated index and the actual index of the circle provided as input to the encoder. The proposed approach can be generalized to pack objects of higher dimensions and different shapes by carefully choosing normalization and perturbation layers. The approach gives a sub-optimal solution and is able to pack smaller objects within a larger object with competitive performance with respect to classical methods

Efficacy and safety of ferric carboxymaltose in Indian pregnant women with iron deficiency anemia

Background: Iron deficiency anemia (IDA) is a significant problem worldwide particularly in women. The aim of the study was to evaluate the effectiveness of intravenous ferric carboxymaltose (FCM) in in Indian pregnant women with anemia.Method: This was a single centre, prospective, observational, open label, clinical study at real life scenario with 4 weeks follow up. Fifty pregnant women with IDA and visiting to the Radhakrishna multispecialty hospital, Bangalore, for antenatal care were enrolled for the study. IV FCM was given as per the standard protocol. Change in the laboratory parameters such as hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), packed cell volume (PCV) level at baseline and after 4 weeks of completion of parenteral iron therapy was recorded and fatigue score was assessed. The pregnant women were monitored for the adverse events. Results: All pregnant women received a single IV infusion of FCM 1000 mg. A significant increase in the hemoglobin of 2.37±0.51 g/dl (p<0.001) was noted at 4 weeks, MCV rise of 19.89±21.94 (p<0.001) was noted at 4 weeks, MCHC rise was of 2.56±5.65 and PCV rise was of 4.45±2.67 (p<0.011) at over 4 weeks. Significant improvement in fatigue score was observed at 4 weeks after single FCM infusion. No adverse effects were observed in any pregnant woman throughout the duration of the study.Conclusions: This real-life observational study highlights IV FCM is effective in management of IDA in pregnant women and well tolerated. Trial registration number: CTRI/2021/02/030874

A RARE INSTANCE OF LEVOSULPIRIDE–INDUCED GALACTORRHOEA

Antipsychotics are well known to affect prolactin secretion, resulting in hyperprolactinemia and its consequent manifestations like amenorrhoea, galactorrhoea, gynaecomastia, etc. Levosulpiride is a novel antipsychotic drug with additional antidepressant, antiemetic and antidyspeptic actions. The authors report a case of levosulpiride-induced hyperprolactinemia, presenting as galactorrhoea in a female patient with dyspepsia at Kasturba Hospital, Manipal, in South India.Keywords: Hyperprolactinemia, Prolactin, Dyspepsia, Antipsychotic, Dopamin

Determination of Mineral Composition and Heavy Metal Content of Some Nutraceutically Valued Plant Products

Minerals and heavy metal concentrations of 23 plants (arial parts, leaves, bark, stem, root, rhizome, dried berries, seeds) possessing health-promoting effects and used in indigenous medicines (as medicinal food) were determined using inductively coupled plasma atomic spectrometry. Vital essential minerals and heavy metals were present in all the samples analyzed. The majority of the plant materials were rich in some of the essential minerals like Na, K, Ca, Fe, Mg, Cu, Mn, and Zn, which are known to be beneficial for health. The plant material of Vitiveria zizinalis had highest concentration of toxic heavy metals, including arsenic (53.1 mg/100 g), chromium (6.74 mg/100 g), cobalt (10.2 mg/100 g), mercury (3.6 mg/100 g), and nickel (3.28 mg/100 g). Results of the present study provide vital data on the availability of some essential minerals, which can be useful to provide dietary information for designing value-added foods and for food biofortification. Apart from this, data on the contaminant levels of heavy metals highlights the necessity on the quality and safety concerns about their use

A comparative study of circulating plasma lipid components and superoxide dismutase activity in pre and postmenopausal women

Background: Menopause is associated with increased oxidative stress and decreased antioxidative activity in females which leads to increased risk of cardiovascular and many other diseases. The objective was to compare the lipid profiles and superoxide dismutase (SOD) activity of pre and postmenopausal women in an attempt to establish the fact that menopause is associated with increased oxidative stress.Methods: A hospital based cross-sectional study was done at the department of obstetrics and gynaecology and biochemistry, Shri Mahant Indiresh Hospital, Dehradun, India. Out of total of 120 women, 60 women were in premenopausal group aged between 30-45 years and 60 women of 55-70 years of age group in post menopause status. Assessment of lipid profile was done by an automated chemistry analyzer (Vitors 5, I FS) and SOD activity was measured by colorimetric activity kit. Statistical analysis was done by Standard Microsoft Excel software.Results: Mean serum SOD level in premenopausal women was 4.80±1.73 U/ml and in postmenopausal was 1.35±0.58 U/ml. This variation was found to be extremely significant (p <0.0001). Changes in lipid components in pre and postmenopausal women showed that total cholesterol and triglycerides levels were higher in postmenopausal than premenopausal participants. These variations were also significant (p = 0.0003). Levels of HDL-C were lower in postmenopausal women than pre-menopausal group with a mean±SD of 51.5±12.20 mg/dl and 54.05±14.03mg/dl respectively.Conclusions: Findings of this study corroborate the hypothesis that gradual loss of ovarian function is associated with a decrease in antioxidant status. Menopause also leads to changes in lipid components, which can predispose women to cardiovascular diseases

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries