Comparison of the model for end-stage liver disease and disease sodium values in prognosticating short term 3-month mortality in chronic liver disease

Background: Chronic liver disease (CLD) cirrhosis of liver is one of the common non communicable disease, accounting for significant morbidity and mortality in developing countries like India. several prognostic scoring systems have evolved from the need to prioritize patients for liver transplantation model for end-stage liver disease (MELD) and its variant, which includes sodium values (MELD-Na) have been recently popularized.Methods: Prospective observational study with follow-up telephone call every month for 3 months, with ppurposive sampling done on 60 patients admitted to AIMS BG Nagara Mandya district Karnataka India. Statistical analysis included the strength of association was assessed using Pearson's correlation and the ROC curve was drawn to assess the accuracy and diagnostic utility of the two models. A p<0.05 was considered statistically significant.Results: In the present study, the mean age of patients was 49.68±9.89 years of age. The strength of association between the MELD score and MELD-Na score was found to be a very strong positive strength of association (r=0.904, p<0.05). The mean MELD score and MELD-Na score was found to be higher in non-survivors’ group (28.5 and 30.5) compared to survivors group (22.03 and 25.67) which was statistically very significant.Conclusions: MELD-Na score was higher among the patients with outcome of death compared to the MELD score among the patient. The ROC curve showed a comparable result with MELD and MELD-Na scores. There was a relation of severity of hyponatremia with the child-Pugh scores.

Effect of Sagittal Dentoskeletal Discrepancies on the Vermilion Height and Lip Area

Objective:A frontal evaluation of the lips could provide important information during a routine clinical evaluation of facial aesthetics. There is a lack of ample evidence in the literature regarding variations in the vermilion height and lip area in various sagittal discrepancies when assessing facial aesthetics. The aim of this cross-sectional study was to evaluate and compare the vermilion height and lip area in dentoskeletal Class I, Class II, and Class III malocclusions.Methods:Subjects included female patients divided into four groups (Angle’s Class I bimaxillary proclination [Class I BMP], Class II Division I [Class II Div 1], Class III and Class I normal [Class I N]) with 36 samples each. Standardized frontal facial photographs were taken at rest and during a posed smile. Thirty-five landmarks on the upper and lower lips were identified for measurements of the vermilion height and lip area. A one-way analysis of variance was used to identify overall differences, and the post-hoc Bonferroni test was applied for multiple comparisons.Results:Class III showed a significantly smaller upper-lip area and significantly higher ratios of the upper-to-lower lip vermilion height/area. The ratios displayed an increasing trend from the midline to the corners of the mouth. Class I BMP and Class II Div 1 had significantly larger upper and lower-lip areas.Conclusion:Morphology of the lips is significantly correlated with underlying anteroposterior dentoskeletal discrepancies. During a clinical examination, a critical frontal evaluation of the lips is important as it is apparently indicative of the underlying sagittal discrepancy, especially in skeletal Class III malocclusions

Boost Interleaved Converter Integrated Voltage Multiplier Module for Renewable Energy System

This document presents a high step-up converter, which is apt for renewable energy system. Through a voltage multiplier unit composed of switched capacitors and coupled inductors, a conventional interleaved boost converter obtains high step-up gain without operating at extreme duty ratio. The design of the proposed converter not only reduces the current stress but also constrains the input current ripple, which decreases the conduction losses and lengthens the lifetime of the input source. In addition, due to the lossless passive clamp performance, leakage energy is recycled to the output terminal. Hence, large voltage spikes across the main switches are alleviated, and the efficiency is improved. Even the low voltage stress makes the low-voltage-rated MOSFETs be adopted for reductions of conduction losses and cost. Finally, the prototype circuit with 40-V input voltage, 380-V output, and 1000-W output power is operated to verify its performance. The highest efficiency is 97.1%. Index Terms - Voltage multiplier module. Boost–flyback converter, high step-up, photovoltaic (PV) system

Targeting DNA repair in Metastatic Castration-Resistant Prostate Cancer (mCRPC): Genomic Screening for a Clinical Trial of Rucaparib

Objectives: The high prevalence of men with mCRPC carrying pathogenic mutations in DNA damage repair (DDR) genes may have implications for clinical treatment, as poly(ADP-ribose) polymerase (PARP) inhibitors, such as rucaparib, have shown preliminary evidence of activity in these patients. The ongoing phase 2 TRITON2 study (NCT02952534) is evaluating rucaparib in mCRPC patients harboring a deleterious germline or somatic mutation in BRCA1, BRCA2, ATM, or other DDR gene. Here we present results from genomic screening of tissue and plasma samples from mCRPC patients. Methods: Comprehensive genomic profiling was performed by Foundation Medicine, Inc., using FFPE tumor tissue and plasma circulating cell-free DNA (cfDNA) samples. These next-generation sequencing (NGS) assays detect germline and somatic genomic alterations (GAs), but do not distinguish between them. Results: By Jan 15, 2019, prostate or metastatic tumor tissue samples from 1050 mCRPC patients were processed. Sequencing was successful for 68% of prostate samples, 82% of soft-tissue metastatic samples, and 57% of bone metastatic samples. In total, tissue sequencing results were obtained for 774 (74%) patients. GAs in BRCA1, BRCA2, or ATM were observed in 16.7% of patients’ tissue. In parallel, plasma from 654 mCRPC patients was collected and sequenced: 96% of plasma samples had sufficient cfDNA to obtain sequencing results, and sequencing success was independent of the location of metastases (visceral, nodal, or bone). GAs in BRCA1, BRCA2, or ATM were observed in 21.4% of patients’ plasma. There was high concordance between the alterations detected by the tissue and plasma assays. For example, in 86% of patients the plasma assay detected the same BRCA2 alteration present in tissue. Conclusions: Genomic profiling may help guide clinical decision-making for mCRPC patients. Tumor and plasma testing successfully identified patients with eligible somatic or germline GAs for enrollment into TRITON2. These data continue to support the utilization of plasma genomic testing, particularly in patients without a lesion that can be biopsied. Source of Funding: Clovis Oncology, Inc

Performance of the ocean state forecast system at Indian National Centre for Ocean Information Services

The reliability of the operational Ocean State Forecast system at the Indian National Centre for Ocean Information Services (INCOIS) during tropical cyclones that affect the coastline of India is described in this article. The performance of this system during cyclone Thane that severely affected the southeast coast of India during the last week of December 2011 is reported here. Spec-tral wave model is used for forecasting the wave fields generated by the tropical cyclone and vali-dation of the same is done using real-time automated observation systems. The validation results indicate that the forecasted wave parameters agree well with the measurements. The feedback from the user community indicates that the forecast was reliable and highly useful. Alerts based on this operational ocean state forecast system are thus useful for protecting the property and lives of the coastal communities along the coastline of India. INCOIS is extending this service for the benefit of the other countries along the Indian Ocean rim

Wave forecasting and monitoring during very severe cyclone Phailin in the Bay of Bengal

Wave fields, both measured and forecast during the very severe cyclone Phailin, are discussed in this communication. Waves having maximum height of 13.54 m were recorded at Gopalpur, the landfall point of the cyclone. The forecast and observed significant wave heights matched well at Gopalpur with correlation coefficient of 0.98, RMS error of 0.35 m and scatter index of 14%. Forecasts were also validated in the open ocean and found to be reliable (scatter index &#60; 15%). The study also revealed the presence of Southern Ocean swells with a peak period of 20-22 sec hitting Gopalpur coast along with the cyclone-generated waves

Predicting disease risk areas through co-production of spatial models: the example of Kyasanur Forest Disease in India’s forest landscapes

Zoonotic diseases affect resource-poor tropical communities disproportionately, and are linked to human use and modification of ecosystems. Disentangling the socio-ecological mechanisms by which ecosystem change precipitates impacts of pathogens is critical for predicting disease risk and designing effective intervention strategies. Despite the global “One Health” initiative, predictive models for tropical zoonotic diseases often focus on narrow ranges of risk factors and are rarely scaled to intervention programs and ecosystem use. This study uses a participatory, co-production approach to address this disconnect between science, policy and implementation, by developing more informative disease models for a fatal tick-borne viral haemorrhagic disease, Kyasanur Forest Disease (KFD), that is spreading across degraded forest ecosystems in India. We integrated knowledge across disciplines to identify key risk factors and needs with actors and beneficiaries across the relevant policy sectors, to understand disease patterns and develop decision support tools. Human case locations (2014–2018) and spatial machine learning quantified the relative role of risk factors, including forest cover and loss, host densities and public health access, in driving landscape-scale disease patterns in a long-affected district (Shivamogga, Karnataka State). Models combining forest metrics, livestock densities and elevation accurately predicted spatial patterns in human KFD cases (2014–2018). Consistent with suggestions that KFD is an “ecotonal” disease, landscapes at higher risk for human KFD contained diverse forest-plantation mosaics with high coverage of moist evergreen forest and plantation, high indigenous cattle density, and low coverage of dry deciduous forest. Models predicted new hotspots of outbreaks in 2019, indicating their value for spatial targeting of intervention. Co-production was vital for: gathering outbreak data that reflected locations of exposure in the landscape; better understanding contextual socio-ecological risk factors; and tailoring the spatial grain and outputs to the scale of forest use, and public health interventions. We argue this inter-disciplinary approach to risk prediction is applicable across zoonotic diseases in tropical settings

Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma

This randomised phase III trial compared standard of care Everolimus with the anti-PD1 monoclonal antibody Nivolumab in previously treated patients with locally advanced inoperable or metastatic clear cell renal cancer. 810 patients were randomised to receive either Everolimus 10 mg orally daily or 3 mg/kg of Nivolumab intravenously every two weeks. Patients were treated until unacceptable toxicity or disease progression. Patients could be treated beyond progression if the investigator believed that the patient was gaining clinical benefit. The primary endpoint was overall survival. The median survival was 25 months for Nivolumab and 19.8 months for Everolimus (p=0.002). The objective response rate was higher for Nivolumab (25 versus 5%; p=&#60;0.001).The median progression free survivals were 4.6 & 4.4 months (p=0.11). Grade 3 & 4 treatment related toxicities were observed in 19 & 37% of patients on Nivolumab or Everolimus respectively. In patients with previously treated renal cell carcinoma Nivolumab produced superior survival and more tolerable treatment than Everolimus

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd