Combined Standardized Precipitation Index and ANFIS Approach for Predicting Rainfall in the Tropical Savanna Region

Climate change has affected many sectors in the world. Therefore, the Prediction of climatic factors is essential in case to achieve sustainability in human life. Rainfall prediction is also important as the agricultural sector depends on rainfall, and human life depends on agricultural products. This study presents the Standardized Precipitation Index (SPI) prediction using the adaptive neuro-fuzzy inference system (ANFIS). Various models (6 nos.) with different combinations of Rainfall and SPI values are prepared to predict the SPI index. Out of these six models, the M2 model (SPI3 SPI4 R4) performed best in the case of SPI 5. (RMSE value is 0.059, the R2 value is 0.987, and the value of the coefficient of determination is 0.993. In the case of SPI 6, the M1 model (SPI5 SPI4 SPI3 R5) performed best (RMSE value is 0.042, the R2 value is 0.992, and the value of the coefficient of determination is 0.996. The outcome may be helpful to the policymakers, scientists, researchers and government authorities in building a policy for sustainable water resources management in the region

A SOFTWARE REQUIREMENT ENGINEERING TECHNIQUE USING OOADA-RE AND CSC FOR IOT BASED HEALTHCARE APPLICATIONS

<p>This Internet of things is one of the most trending technology with wide range of applications. Here we are going to focus on Medical and Healthcare applications of IOT. Generally such IOT applications are very complex comprising of many different modules. Thus a lot of care has to be taken during the requirement engineering of IOT applications. Requirement Engineering is a process of structuring all the requirements of the users. This is the base phase of software development which greatly affects the rest of the phases. Thus our best should be given in the engineering of requirements because if the effort goes down here, it will greatly affect the quality of the end product. In this study we have presented an approach to improve the requirements engineering phase of IOT applications development by using Object Oriented Analysis and Design Approach(OOADA) along with Constraints Story Card(CSC) templates.</p

2209. Reducing Inappropriate Antibiotic Prescribing for the Treatment of Urinary Tract Infections (UTI) in Urgent Care Clinics

Abstract Background In 2020, The Joint Commission released new standards to promote expansion of antimicrobial stewardship into the ambulatory care setting. Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in the outpatient setting and therefore an opportunistic area for intervention. The aim of our study was to evaluate current outpatient prescribing patterns for the treatment of UTIs and develop a methodology to improve antibiotic prescribing. Methods A single-center, retrospective study was conducted across 5 Jackson Health-University of Miami Urgent Care Clinics (UCC) in Miami, Florida. We utilized ICD-10 diagnosis codes to identify adults diagnosed with UTIs between January 1, 2021 and October 31, 2022. We identified the top five prescribers and audited 10% of their prescriptions. The data was analyzed and as our intervention, we shared results with UCC leadership and disseminated provider-specific report cards to highlight inappropriate prescribing practices. After this, we allowed 3 months for change to occur and set a goal of reducing the percentage of inappropriate UTI durations by 50%. Results For baseline data, 123 charts were reviewed. We identified 95 patients with cystitis (77.3%), 26 pyelonephritis (21.1%), and 2 asymptomatic bacteriuria (1.6%). Inappropriate prescribing ranged from 17.6% to 80.6% between the UCC prescribers (Figure 1). Various types of prescribing opportunities were identified, with the most common being prolonged length of therapy (Figure 2). For post-intervention, 114 charts were reviewed. We identified 90 patients with cystitis (78.9%), 22 pyelonephritis (19.3%), and 2 asymptomatic bacteriuria (1.8%). Inappropriate durations of UTI treatment were reduced by 25% (Figure 3), with the greatest improvement seen in nitrofurantoin prescribing (Figure 4). Figure 1 Figure 2 Figure 3 Conclusion Retrospective audit and feedback using provider-specific report cards was an effective antimicrobial stewardship strategy for the ambulatory care setting. Our intervention led to reduced durations of UTI treatment for nitrofurantoin but not necessarily with fluoroquinolones, trimethoprim/sulfamethoxazole, or beta-lactams. Next steps will include providing more education to further promote appropriate use of all classes of antibiotics. Figure 4 Disclosures Lilian M. Abbo, MD, MBA, Ferring: Advisor/Consultant|Pfizer: Advisor/Consultant|Regeneron: Grant/Research Support|Shionogi: Advisor/Consultan

Agenesis of the Corpus Callosum Due to Defective Glial Wedge Formation in Lhx2 Mutant Mice

Establishment of the corpus callosum involves coordination between callosal projection neurons and multiple midline structures, including the glial wedge (GW) rostrally and hippocampal commissure caudally. GW defects have been associated with agenesis of the corpus callosum (ACC). Here we show that conditional Lhx2 inactivation in cortical radial glia using Emx1-Cre or Nestin-Cre drivers results in ACC. The ACC phenotype was characterized by aberrant ventrally projecting callosal axons rather than Probst bundles, and was 100% penetrant on 2 different mouse strain backgrounds. Lhx2 inactivation in postmitotic cortical neurons using Nex-Cre mice did not result in ACC, suggesting that the mutant phenotype was not autonomous to the callosal projection neurons. Instead, ACC was associated with an absent hippocampal commissure and a markedly reduced to absent GW. Expression studies demonstrated strong Lhx2 expression in the normal GW and in its radial glial progenitors, with absence of Lhx2 resulting in normal Emx1 and Sox2 expression, but premature exit from the cell cycle based on EdU-Ki67 double labeling. These studies define essential roles for Lhx2 in GW, hippocampal commissure, and corpus callosum formation, and suggest that defects in radial GW progenitors can give rise to ACC

Equitable utilisation of Indian community based health insurance scheme among its rural membership: cluster randomised controlled trial

Objective To evaluate alternative strategies for improving the uptake of benefits of a community based health insurance scheme by its poorest members

Aspartate aminotransferase to platelet ratio index as a prospective predictor of hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection.

BACKGROUND AND AIM: APRI (aspartate aminotransferase [AST] to platelet ratio index) is widely used to assess fibrosis and cirrhosis risk, especially in hepatitis C virus (HCV)-infected patients. Few studies have evaluated APRI and hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) risk. Prospective evidence is needed to assess whether APRI predicts HCC risk in HBV patients. METHOD: In a prospectively enrolled clinical cohort of 855 HBV patients with a 1-year exclusion window (followed for \u3e 1 year and did not develop HCC within 1 year), the predictive value of APRI in HCC risk was evaluated by Cox proportional hazards model using univariate and multivariate analyses and longitudinal analysis. RESULTS: Higher APRI prospectively conferred a significantly increased risk of HCC in univariate analysis (quartile analysis, P trend = 2.9 × 10(-7) ). This effect remained highly significant after adjusting for common host characteristics but not cirrhosis (P trend = 7.1 × 10(-5) ), and attenuated when cirrhosis is adjusted (P trend = 0.021). The effect remained prominent when the analysis was restricted to patients with a more stringent 2-year exclusion window (P trend = 0.008 in quartile analysis adjusting all characteristics including cirrhosis), indicating that the association was unlikely due to including undetected HCC patients in the cohort, thus minimizing the reverse-causation limitation in most retrospective studies. Longitudinal comparison demonstrated a persistently higher APRI value in HBV patients who developed HCC during follow-up than those remaining cancer free. CONCLUSION: APRI might be a marker of HCC risk in HBV patients in cirrhosis-dependent and -independent manners. Further studies are warranted to validate this finding and test its clinical applicability in HCC prevention