Performance Evaluation of UK ADMS-Urban Model and AERMOD Model to Predict the PM10 Concentration for Different Scenarios at Urban Roads in Chennai, India and Newcastle City, UK

The pollutants and its effects on human health are now a major issue around the world. The impact of traffic and the resulting vehicle emissions has come to the forefront. Particulate matter is one among six criteria pollutants and air pollution related to particulate matter is now becoming a serious problem in developing as well as developed countries. One of the main sources is from the vehicles and the resuspension caused by the vehicular movement. Source apportionment studies of Chennai (Clean Air Asia: Air quality profile 2010 edition) showed that from the residential monitoring stations levels of particulate matter in Chennai lies in the range of 51–70 µg/m3. According to DoT of the total road emissions in UK, about 80 is generated from particulate matter which is due to road traffic even though there are no factors like resuspension in this country. In UK, 103 areas have been declared as local air quality management areas (LAQMA), while in India, 72 cities have been identified as non-attainment area with respect to various air pollutants. Chennai, India and Newcastle City, UK which are the cities under study are the one among them facing severe air pollution problems. The main objective of the paper is application and evaluation of UK ADMS-Urban and AERMOD model for the prediction of particulate matter (PM10) concentrations at urban roadways in Chennai and in Newcastle. The model evaluation has been carried out using traffic data of 2009, meteorological data provided by Laga Systems, Hyderabad for both the cities and the real-time monitored data of the year 2009. The results of the study identified the trends in pollutant patterns and its variation with the different parameters of meteorological data. The statistical descriptors, namely index of agreement (IA), fractional bias (FB), normalized mean square error (NMSE), geometric mean bias (MG) and geometric mean variance (VG) were used to understand the performance of the model. Results indicated that both the models have been able to predict the pollutant concentration with reasonable accuracy. The IA values for ADMS and AERMOD are found to be 0.39 and 0.37, and 0.48 and 0.44, respectively, for Chennai and Newcastle City

Tuberculous extensor tenosynovitis of the wrist with extensor pollicis longus rupture: a case report

<p>Abstract</p> <p>Introduction</p> <p>The tendon sheaths constitute an uncommon target of extra-articular tuberculosis.</p> <p>Case presentation</p> <p>We present a rare case of tuberculous tenosynovitis of the wrist involving the extensor tendon with rupture of the extensor pollicis longus tendon in a 55-year-old Indian man.</p> <p>Conclusion</p> <p>Prompt surgical debridement and tissue diagnosis are essential for the diagnosis and treatment of this type of infection. With an accurate and timely diagnosis, appropriate surgery and antituberculous treatment may eradicate these infections and prevent complications.</p

Business Risk in Changing Dynamics of Global Village 2

The monograph is prepared based on the presentations and discussions made at the II International Conference “BUSINESS RISK IN CHANGING DYNAMICS OF GLOBAL VILLAGE (BRCDGV 2019)”, November, 7th-08th, 2019, in Ternopil, Ukraine. The aim of this scientific international conference is to provide a platform for professional debate with the participation of experts from around the globe in order to identify & analyze risks and opportunities in today’s global business, and specifically in Ukraine. The conference will provide a framework for researchers, business elites and decision makers to uplift the business ties and minimise the risk for creating a better world and better Ukraine.The Conference is designed to call experts around the globe from different sectors of practices which are effected by globalization and watching changes in Europe as well as in Ukraine. It is an excellent platform for interactions and communication between academicians, corporate representatives, policy makers, representatives of organizations and community, as well as individuals being the part of this globalized world. The 1st edition of this conference was held at the University of Applied Sciences in Nysa, Poland (2017); the 2nd edition took place at Ternopil Ivan Puluj National Technical University, Ukraine (2019); the 3rd edition will be organized at Patna University, India (2020) in cooperation with Indo-European Education Foundation (IEEF, Poland) and its partner universities from Poland, India, Europe and other part of the world.Under modern conditions of globalization nowadays, economic activity is undergoing changes. Innovative technologies, new forms of business, dynamic changes taking place in the world today result in the emergence of the necessity to minimize risks in order to maximize benefits. The cooperation between experts from different fields with the aim to ensure sustainable growth – policymakers, scientists, universities representatives and business elites is essential nowadays. With the purpose to bring them together and discuss the main issues of todays’ global world this conference took place in Ternopil, Ukraine. As Ukraine is now passing through a dynamic period of changes, recommendations coming up from such discussions can be very beneficial for building stronger society and meet the risks globalization brings up. This monograph provides a useful review of economic, financial and policy issues in the context of globalization processes and has proven extremely popular with practitioners and industry advisors. This edition is given the continued high demand and interest for experts form different areas working on diminishing of business risks wishing to keep abreast of current thinking on this subject. According to many experts process of managing risks is currently one of the most relevant business technologies and at the same time it is a complex process which requires ground knowledge in the research field and practical experience. The popularity of business risks management is due to objective reasons such as dynamics of society, interconnections and interdependence between different players in the society, increasing role of human capital in the country’s sustainable developmen

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Tuberculosis of the Sternoclavicular Joint

Tuberculosis may affect almost every part of the body. However, it is very uncommon for tuberculosis to involve the sternoclavicular joint. Demonstration of acid-fast bacilli, which is the gold standard for diagnosis, is extremely rare in these lesions. Diagnosis is usually based on demonstration of granulomas on histopathology. Good radiographs and imaging studies are supportive for diagnosis. We report a case of 32-year-old male who presented with a tender swelling over the medial end of the clavicle with a sinus and signs of inflammation. The fine needle aspiration of the lesion demonstrated acid-fast bacilli on Ziehl–Neelsen staining. The patient was put on antitubercular chemotherapy for 1 year and made an uneventful recovery

Management of Proximal Humeral Fractures with Proximal Humerus Locking Plate—A Prospective Study

Background: Displaced proximal humeral fractures, which used to be treated conservatively in the past, often had compromised functional results. With the advancement of technology, these fractures are now more often managed operatively, fulfilling the demands of an active and productive life style by the patients. The aim of this study was to assess the functional outcome of management of proximal humeral fractures with Philos (Synthes; Johnson and Johnson, West Chester, Pennsylvania, USA) plate fixation. Methods: In this prospective study, 40 patients aged 18–80 years (mean age 52.4 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients were functionally evaluated based on subjective (35 points) and objective (65 points) parameters as per the constant scoring system. Results: All these operated patients were followed up for 18–36 months (average 27.3 months). Functional outcome based on the constant scoring system showed excellent results in 20 (50%), good in eight (20%), and moderate in eight (20%) patients. Four (10%) patients had poor functional results. Out of six cases of four-part fracture dislocations, avascular necrosis of the humeral head was observed in two patients. One of these two patients had avascular necrosis of the head along with nonunion of the fragment to the shaft. Conclusion: Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and minimal complications