BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Smart Governing System Based on Mesh Algorithm for Industrial Gas and Flame Detection with Alert System

The paper proposes a Wireless Sensor Network (WSN) solution for monitoring environmental parameters during industrial fires. The system includes sensors that collect real-time data on temperature ,humidity, and gas emissions. When the system detects a fire orgas out break ,it generates alerts and presents the data on a single webpage for easy visualization by first responders. The solution aims to provide near real time alerting, enabling prompt response to minimize the impact of industrial fires. The paper also presents experimental analysis of sensor node behavior during a fire in a test set-up, which demonstrated the effectiveness of the system in detecting fire outbreaks and generating alerts promptly. The proposed system has the potential to reduce the impact of industrial fires, including loss of human lives, vegetation, economic loss ,and environmental pollution

Interferon-α-mediated therapeutic resistance in early rheumatoid arthritis implicates epigenetic reprogramming

Objectives: An interferon (IFN) gene signature (IGS) is present in approximately 50% of early, treatment naive rheumatoid arthritis (eRA) patients where it has been shown to negatively impact initial response to treatment. We wished to validate this effect and explore potential mechanisms of action. Methods: In a multicentre inception cohort of eRA patients (n=191), we examined the whole blood IGS (MxA, IFI44L, OAS1, IFI6, ISG15) with reference to circulating IFN proteins, clinical outcomes and epigenetic influences on circulating CD19+ B and CD4+ T lymphocytes. Results: We reproduced our previous findings demonstrating a raised baseline IGS. We additionally showed, for the first time, that the IGS in eRA reflects circulating IFN-α protein. Paired longitudinal analysis demonstrated a significant reduction between baseline and 6-month IGS and IFN-α levels (p&lt;0.0001 for both). Despite this fall, a raised baseline IGS predicted worse 6-month clinical outcomes such as increased disease activity score (DAS-28, p=0.025) and lower likelihood of a good EULAR clinical response (p=0.034), which was independent of other conventional predictors of disease activity and clinical response. Molecular analysis of CD4+ T cells and CD19+ B cells demonstrated differentially methylated CPG sites and dysregulated expression of disease relevant genes, including PARP9, STAT1, and EPSTI1, associated with baseline IGS/IFNα levels. Differentially methylated CPG sites implicated altered transcription factor binding in B cells (GATA3, ETSI, NFATC2, EZH2) and T cells (p300, HIF1α). Conclusions: Our data suggest that, in eRA, IFN-α can cause a sustained, epigenetically mediated, pathogenic increase in lymphocyte activation and proliferation, and that the IGS is, therefore, a robust prognostic biomarker. Its persistent harmful effects provide a rationale for the initial therapeutic targeting of IFN-α in selected patients with eRA.</p

Smart Energy Consumption Control in Commercial Buildings Using Machine Learning and IOT

In recent years, the use of artificial intelligence (AI) techniques such as Artificial Neural Networks (ANNs) and Support Vector Machines (SVMs), in combination with the Internet of Things (IoT), has gained significant attention for optimizing energy consumption in commercial buildings. With the increasing demand for energy and the rising costs of energy, there is a pressing need for efficient methods for energy management in commercial buildings. Smart energy consumption control systems that utilize machine learning algorithms and IoT devices can provide real-time data on energy usage and automate energy usage decisions in commercial buildings. In this paper, we investigate the potential of ANN and SVM-based smart energy consumption control systems in commercial buildings. We aim to analyze the impact of using these algorithms on energy consumption patterns in commercial buildings and evaluate the efficiency and effectiveness of these systems in reducing energy consumption and costs while maintaining the desired level of comfort for the occupants. Our study will focus on comparing the performance of ANN and SVM-based algorithms in terms of energy consumption reduction and cost savings. The results of this study can provide valuable insights into the application of ANN and SVM-based smart energy consumption control systems in commercial buildings and contribute to the development of more sustainable and energy-efficient buildings

A Rare Case of Vault Angiofibroma

A 52-year-old female patient, para 2 live 2, who attained surgical menopause 10 years back, presented to the outpatient department (OPD) with complaints of white discharge per vagina for 6 months, which was watery in consistency and was not associated with foul smell or itching vulva. She had history of hysterectomy done for fibroid uterus 10 years back. On examination, she was afebrile and vital signs were within normal limits. Per abdomen examination, was normal, while, per speculum examination revealed a watery discharge per vaginum. The per vaginal examination revealed a firm, non-tender, globular mass felt arising from the vaginal vault and the mass did not bleed on touch. A globular mass of size 3 x 4 cms, pinkish white in colour, was seen occupying the whole of the vaginal vault with curdy white precipitates in the vaginal rugosities as well as over the mass.</jats:p