Diagnosis of cutaneous T-cell lymphoma by insurance type before and after the Affordable Care Act: a national database study

The Affordable Care Act (ACT) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes

Welding

Friction welding method is one of the most simple, economical and highly productive methods in joining similar and dissimilar metals. It is widely used in the automotive, aircraft and aerospace industrial applications. For many applications it is often necessary to join aluminium (6061) to make finished part. In this project the main aim is to weld the small thickness of aluminum (6061) plates for that friction welding machine used is of higher cost. Here the aim is reduce the cost of friction welding machine with simple parts like three phase A.C induction motor, bush, frame stand, friction tool, universal vice, vertical moving bed, horizontal moving bed, etc. The result expected would be of same strength as that of old friction welding machine. It is very easy and at same time production time is very much reduced. This machine is best suitable for mass production

Formulation and Evaluation of Colon Targated Prednisolone Compression Coated Tablet

Colonic delivery refers to targeted delivery of drugs into the lower GI tract, which occurs primarily in the large intestine (i.e. colon). These delayed mechanisms are designed to improve the efficacy of the drug by concentrating the drug molecules where they are needed most, and also minimize the potential side effects and drug instability issues associated with premature release of drug in the upper parts of the GIT, namely stomach and small intestine. The drugs used in the treatment of Irritable bowel syndrome, ulcerative colitis, diarrhea, and colon cancer are ideal candidates for local colon delivery. The selection of carrier for particular drugs depends on the physiochemical nature of the drug as well as the disease for which the system is to be used. Factors such as chemical nature, stability and partition coefficient of the drug and type of absorption enhancer chosen influence the carrier selection. Compression coating has gained increased interest in the recent years for creating modified released products. It involves the compaction of granular materials around a preformed tablet core using specially designed tableting equipment. Compression coating is a dry process. This type of tablet (compression coated tablet) has two parts, internal core and surrounding coat. The core is a small porous tablet and prepared on one turret. For preparing the final tablet, a bigger die cavity in another turret is used in which first the coat material is filled to half and then core tablet is mechanically transferred, again the remaining space is filled with coat material and finally compression force is applied. Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract. Types of IBD include: Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum. Crohn's disease. This type of IBD is characterized by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues. Both ulcerative colitis and crohn's disease usually involve severe diarrhea, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications. For the past 30 years, corticosteroids have been the mainstay of therapy in patients with moderate to severe active inflammatory bowel disease. Initial treatment is prednisone, 40 to 60 mg per day. In severely ill hospitalized patients, reasonable initial therapy is hydrocortisone, 100 mg administered intravenously every eight hours. Intravenous therapy generally produces rapid improvement of symptoms, with maximal benefit occurring when the corticosteroid has been administered for six to eight days. Once improvement has occurred, prednisone is tapered by 5 to 10 mg per week until the dosage is 15 to 20 mg per day. This dosage is then tapered by 2.5 to 5 mg per week until the drug is discontinued The objective of this study was to design compression coated tablets of Prednisolone for an effective and safe therapy of ulcerative colitis and inflammatory bowel disease using pectin and xanthan gum and HPMC as carriers. The core tablets of Prednisolone coated with pectin: HPMC in the ratio 1:1 and 1:2 and xanthan gum: HPMC in the ratio 1:1 and 1:2 . Pectin: HPMC coated pellets offer a greater degree of protection from premature drug release in the upper GI tract than pectin alone. The pectin is still available for enzymatic degradation, which allows greater drug release under conditions that may be expected to pertain in the colon. It is possible by careful formulation of the compression coated tablet to have different drug release profiles, whereby an increase in the amount of drug released can be induced by the action of pectinolytic enzymes. By changing the other variables such as the pectin and HPMC ratio or the molecular weight of the polymers, it may be possible to produce a system with a release profile, which is tailored to meet the particular requirements of any individual drug. From the results it can be concluded that pectin: HPMC coated tablets could be used to treat the inflammatory conditions of the colon. Natural polysaccharides such as xanthan gum, are not digested in the human stomach or small intestine, but are degraded in the colon by resident bacteria. HPMC delayed the drug release in the small intestine, but was degraded by colonic bacterial enzymes thereby releasing the drug. Xanthan gum is a high molecular weight extracellular polysaccharide. The molecule consists of a backbone identical to that of cellulose, with side chains attached to alternate glucose residues. It is a hydrophilic polymer, which until recently had been limited for use in thickening, suspending and emulsifying water based systems. It appears to be gaining appreciation for fabrication of matrices, as it not only retards drug release, but also provides time- independent release kinetics with added advantages of biocompatibility and inertness. Based on drug release in the colon compressed coated tablets with mixture of pectin was more successful to produce a drug targeting to the colon with minimum amount released in the other parts of gastro intestinal tract

The Effect of Pre-Injury Anti-Platelet Therapy on the Development of Complications in Isolated Blunt Chest Wall Trauma: A Retrospective Study

INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%). On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2). As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing blunt chest wall trauma

BIOMEDICAL APPLICATIONS OF LARGE SCALE WIRELESS NETWORKS

The protection of the collected data is a major unsolved issue, with challenges coming from the stringent resource constraints of MSN devices, and the high demand for both security/privacy and practicality. In this paper, we propose a lightweight and secure system for MSNs. The system employs hash-chain based key updating mechanism and proxy protected signature technique to achieve efficient secure transmission and fine-grained data access control. Furthermore, we extend the system to provide backward secrecy and privacy preservation

ENHANCED CONTROL STRATEGY FOR HIGH SPEED WIRELESS NETWORKS

In 4G cellular networks, call admission control (CAC) has a direct impact on quality of service (QoS) for individual connections and overall system efficiency. Reservation-based CAC schemes have been previously proposed for cellular networks where a certain amount of system bandwidth is reserved for high-priority calls, e.g., hand-off calls and real-time new calls. Traditional reservation-based schemes are not efficient for 4G vehicular networks, as the reserved bandwidth may not be utilized effectively in low hand-off rates. We propose a channel borrowing approach in which new best effort (BE) calls can borrow the reserved bandwidth for high-priority calls. Later, if a hand-off call arrives and all the channels are busy, it will pre-empt the service of a borrower BE call if there exists any. Our focus in this paper is on the system modeling and performance evaluation of the proposed scheme. We present two system models that approximate the operation of the proposed scheme. For these models, we derive the CBP and CDP analytically. It is shown that our analytical results are very close to the ones obtained from simulations

Attitude and perception versus reality of COVID-19 vaccination among healthcare professional: a survey

Background: The pandemic of COVID-19 infection has almost paralyzed the world since the first infection was reported in December 2019. We have seen 3 waves of infection in the country, out of which the second wave caused by the delta variant was the most severe. Along with the preventive measures of masking, maintaining social distance, and handwashing, the vaccines seemed to be the most logical next step. Many vaccines received emergency use approvals with hardly any efficacy and adverse effects data available with the process inducing a significant amount of anxiety among the public. This survey was aimed at understanding the attitude and perception of our hospital employees towards COVID-19 vaccination. Methods: This is a cross-sectional study conducted among health care workers (HCW) at CMC, Vellore between March 2021 to July 2021. The HCWs who are willing to participate in this study were recruited and collected the quantitative data on their attitude and perception towards COVID vaccine. In-depth interviews were conducted among those who did not take vaccine to understand the reasons for not taking vaccine. The data were analyzed using statistical package for the social sciences (SPSS). Results: The survey results were analyzed on 435 HCWs. 58.4 percent of the HCWs trust the institutional protocols as the trusted source of information about vaccine. Most of the HCWs agreed that vaccines are the only protective way, and they are safe and effective. Conclusions: Sensitization and awareness programs with transparency of vaccine development processes, safety and efficacy will help remove barriers

A Cross Sectional Study of the Prevalence of Retinopathy in Patients with Chronic Kidney Disease on Hemodialysis in a Tertiary Care Centre in Chengalpattu District, South India

Context: Many studies have reported varying proportions of retinopathy among cases with chronic kidney disease (CKD). Cases with severe grades of CKD were more likely to develop ocular complications, especially diseases which occurs due to small vessel pathology. Aim: To estimate the prevalence of various types of retinopathies in patients with CKD undergoing hemodialysis in a tertiary care centre in South India. Settings and Design: The outpatient Department of Ophthalmology and Hemodialysis unit of Nephrology, Karpaga Vinayaga Institute of Medical Sciences from January 2022 to June 2023 A cross-sectional hospital-based observational study in a low resource setting. Methods and Material: The study consists of 28 patients who were known cases of CKD on hemodialysis. Patients underwent complete ocular evaluation and findings were noted. The pre hemodialysis values of blood urea and serum creatine, hemoglobin, liver function tests and vital parameters were also noted. Data analysis was done utilising version 20 of Statistical Packages for the Social Sciences (SPSS). Results: 56 eyes of 28 patients on hemodialysis were studied. The mean age was 53 years + 10.9 with a male preponderance. 31.6% had retinopathy of which 26.3% had hypertensive retinopathy and 5.3% had diabetic retinopathy. This is contrary to the previous studies that have reported a higher incidence of diabetic retinopathy in patients with end stage CKD. Hypertension resulted in CKD earlier than diabetes. Conclusion: The results emphasize the importance of frequent eye examination in patients with CKD to identify retinopathy earlier, thus potentially averting permanent vision impairment

Unravelling the cellular and molecular pathogenesis of bovine babesiosis: is the sky the limit?

The global impact of bovine babesiosis caused by the tick-borne apicomplexan parasites Babesia bovis, Babesia bigemina and Babesia divergens is vastly underappreciated. These parasites invade and multiply asexually in bovine red blood cells (RBCs), undergo sexual reproduction in their tick vectors (Rhipicephalus spp. for B. bovis and B. bigemina, and Ixodes ricinus for B. divergens) and have a transovarial mode of transmission. Babesia parasites can cause acute and persistent infections to adult naïve cattle that can occur without evident clinical signs, but infections caused by B. bovis are associated with more severe disease and increased mortality, and are considered to be the most virulent agent of bovine babesiosis. In addition, babesiosis caused by B. divergens has an important zoonotic potential. The disease caused by B. bovis and B. bigemina can be controlled, at least in part, using therapeutic agents or vaccines comprising live-attenuated parasites, but these methods are limited in terms of their safety, ease of deployability and long-term efficacy, and improved control measures are urgently needed. In addition, expansion of tick habitats due to climate change and other rapidly changing environmental factors complicate efficient control of these parasites. While the ability to cause persistent infections facilitates transmission and persistence of the parasite in endemic regions, it also highlights their capacity to evade the host immune responses. Currently, the mechanisms of immune responses used by infected bovines to survive acute and chronic infections remain poorly understood, warranting further research. Similarly, molecular details on the processes leading to sexual reproduction and the development of tick-stage parasites are lacking, and such tick-specific molecules can be targets for control using alternative transmission blocking vaccines. In this review, we identify and examine key phases in the life-cycle of Babesia parasites, including dependence on a tick vector for transmission, sexual reproduction of the parasite in the midgut of the tick, parasite-dependent invasion and egression of bovine RBCs, the role of the spleen in the clearance of infected RBCs (IRBCs), and age-related disease resistance in cattle, as opportunities for developing improved control measures. The availability of integrated novel research approaches including "omics" (such as genomics, transcriptomics, and proteomics), gene modification, cytoadhesion assays, RBC invasion assays and methods for in vitro induction of sexual-stage parasites will accelerate our understanding of parasite vulnerabilities. Further, producing new knowledge on these vulnerabilities, as well as taking full advantage of existing knowledge, by filling important research gaps should result in the development of next-generation vaccines to control acute disease and parasite transmission. Creative and effective use of current and future technical and computational resources are needed, in the face of the numerous challenges imposed by these highly evolved parasites, for improving the control of this disease. Overall, bovine babesiosis is recognised as a global disease that imposes a serious burden on livestock production and human livelihood, but it largely remains a poorly controlled disease in many areas of the world. Recently, important progress has been made in our understanding of the basic biology and host-parasite interactions of Babesia parasites, yet a good deal of basic and translational research is still needed to achieve effective control of this important disease and to improve animal and human health