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Malnutrition:laboratory markers vs nutritional assessment

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Gastroenterology Report 2016年第4期4卷 272-280,I0001页

作者： Shishira Bharadwaj Shaiva Ginoya Parul Tandon tushar d.gohel John Guirguis Hiren Vallabh Andrea Jevenn Ibrahim Hanouneh department of Gastroenterology/Hepatology McMaster UniversityHamiltonOntarioCanada department of Gastroenterology/Hepatology Cleveland ClinicClevelandOHUSA

Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcarerelated ***,a major dilemma exists due to lack of a unified definition for the ***,there are no standard methods for screening and diagnosing patients with malnutrition,leading to confusion and varying practices among physicians across the *** role of inflammation as a risk factor for malnutrition has also been recently ***,serum proteins such as albumin and prealbumin(PAB)have been widely used by physicians to determine patient nutritional ***,recent focus has been on an appropriate nutrition-focused physical examination(NFPE)for diagnosing *** current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical *** studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively ***,a thorough NFPE has an unprecedented role in diagnosing malnutrition.

关键词： malnutrition physical examination serum markers

Current status of intestinal and multivisceral transplantation

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Gastroenterology Report 2017年第1期5卷 20-28,I0001页

作者： Shishira Bharadwaj Parul Tandon tushar d.gohel Jill Brown Ezra Steiger donald F.Kirby Ajai Khanna Kareem Abu-Elmagd Center for Gut Rehabilitation and Transplantation the Cleveland Clinic FoundationClevelandOHUSA

Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure(IF).Traditionally,patients with IF have been relegated to lifelong parenteral nutrition(PN)once surgical and medical rehabilitation attempts at intestinal adaptation have *** the past two decades,however,outcome improvements in intestinal transplantation have added another dimension to the therapeutic armamentarium in the field of gut *** has become possible through relentless efforts in the standardization of surgical techniques,advancements in immunosuppressive therapies and induction protocols and improvement in postoperative patient *** types of intestinal transplants include isolated small bowel transplant,liver-small bowel transplant,multivisceral transplant and modified multivisceral *** guidelines restrict intestinal transplantation to patients who have had significant complications from PN including liver failure and repeated *** an experimental stage to the currently established therapeutic modality for patients with advanced IF,outcome improvements have also been possible due to the introduction of tacrolimus in the early *** have shown that intestinal transplant is cost-effective within 1–3 years of graft survival compared with *** survival and quality of life as well as resumption of an oral diet should enable intestinal transplantation to be an important option for patients with IF in addition to continued *** research should focus on detecting biomarkers of early rejection,enhanced immunosuppression protocols,improved postoperative care and early referral to transplant centers.

关键词： intestinal transplant multivisceral transplant parenteral nutrition intestinal failure gut rehabilitation

Perspectives of physicians regarding screening patients at risk of hepatocellular carcinoma

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Gastroenterology Report 2016年第3期4卷 237-240,I0003页

作者： Shishira Bharadwaj tushar d.gohel department of Gastroenterology/Hepatology the Cleveland Clinic FoundationClevelandOhioUSA

Background and aims:Screening patients at risk for hepatocellular carcinoma(HCC)facilitates early detection of disease,with improved *** most common causes of HCC include chronic viral hepatitis infection—namely hepatitis B,hepatitis C,and *** aim of this study was to assess the awareness of screening among physicians involved in the management of patients at risk for ***:Three hundred physicians from three academic centers were invited to participate in a mailed survey *** main outcome measure was physicians’knowledge of the current HCC screening *** and clinical variables were obtained from the survey ***:A total of 177(59.0%)out of the 300 invited physicians responded to the survey questionnaire,including faculty members(n=129),residents(n=46),and fellows(n=2).The specialty areas of the responding physicians were internal medicine(62.1%),family medicine(16.4%),gastroenterology(15.3%),oncology(3.4%)and others(2.8%).The number of physicians who performed HCC screening in patients with cirrhosis secondary to chronic hepatitis B and chronic hepatitis C infection were 163(92.1%)and 167(94.4%),respectively;35.0%of them used alpha-fetoprotein(AFP)every 6 months,while 22.0%used imaging modalities every 6 months to screen for ***,22 physicians(12.4%)did not check for serum AFP levels and 33(18.6%)never used imaging to screen for ***:The majority of the participating physicians screen high-risk patients for ***,the most appropriate modality of screening(***)is not employed by most physicians and there is greater reliance on AFP levels.

关键词： hepatocellular carcinoma screening chronic liver disease cirrhosis

Assessing the Influence of dykes on the drainage Network of the Shivan River in North Maharashtra

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International Journal of Geosciences 2024年第8期15卷 582-589页

作者： Sandeep B. Bhise tushar P. Raut Suchitra S. Pardeshi Sudhakar d. Pardeshi department of Geography GMD Arts BW Commerce & Science College Sinnar Nashik India department of Geography Prof. Ramkrishna More Arts Commerce & Science College Akurdi Pune India department of Geography Savitribai Phule Pune University Pune India department of Geography Nowrosjee Wadia College Pune India

The prominent linear dyke ridges outcropped in the Narmada-Tapi dykes’ swarm represent an intrusion in the deccan Traps. Understanding the relationship among the underlying geological structures, the strike of the dykes, and the channel patterns is essential. dykes act as obstructions to stream flow, causing diversions, and their geometry and patterns significantly impact the rivers and streams that drain and cross the dyke swarm zone. For this study, Google Earth images, LISS III images, and Cartosat dEM were used to delineate the Shivan basin and extract dyke features. The Shivan River basin is a sixth-order drainage system that reflects superimposed drainage systems within the Tapi dyke swarm zone. About 65% (169 km2) of its area is controlled by dyke orientation. The dyke ridges align predominantly in an East-West (E-W) direction, a pattern mainly followed by lower-order streams, which have developed an insequent, transverse drainage network within the dyke swarm zone. In the lower parts of the Shivan basin, where the number of dykes decreases, the drainage network follows the general slope and is oriented in a North-South direction. The Shivan River and its tributaries have partially adjusted to the dyke orientation, resulting in a transverse drainage pattern in areas characterized by parallel dyke ridges.

关键词： deccan Traps Narmada-Tapi dyke Swarm Google Earth LISS III Cartosat dEM

Fish oil-based lipid emulsion:current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease

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Gastroenterology Report 2015年第2期3卷 110-114页

作者： Shishira Bharadwaj tushar gohel Omer J.deen Robert deChicco Abdullah Shatnawei Center for Human Nutrition Department of Gastroenterology/HepatologyThe Cleveland Clinic FoundationClevelandOHUSA

Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain *** nutrition(PN)is a lifesaving therapeutic modality for patients with intestinal *** PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with ***,prolonged PN is associated with short-term and long-term *** nutrition-associated liver disease(PNALd)is one of the long-termcomplications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these *** affects 30–60%of the adult population on long-term ***,PNALd is one of the indications for isolated liver or combined liver and intestinal *** is no consensus on how to manage PNALd,but fish oil-based lipid emulsion(FOBLE)has been suggested to play an important role both in its prevention and *** is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid *** have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term *** prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALd.

关键词： intestinal failure parenteral nutrition parenteral nutrition-associated liver disease fish oil-based lipid emulsion

Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates

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Gastroenterology Report 2016年第2期4卷 148-153,I0003页

作者： Tarun Rai Udayakumar Navaneethan tushar gohel Amareshwar Podugu Prashanthi N.Thota Ravi P.Kiran Rocio Lopez Madhusudhan R.Sanaka digestive disease Institute The Cleveland ClinicClevelandOHUSA

Background and aim:Adequate bowel preparation is important for safe and effective *** indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(AdR)of at least 25%in average-risk men and 15%in average-risk women aged over *** aim was to investigate the impact of bowel preparation on AdR and colonoscopy completion ***:This retrospective cohort study included patients who underwent colonoscopy between January 2008 and december *** main outcome measurements were AdR and colonoscopy completion rates to the ***:A total of 2519 patients was included;1030(41.0%)had excellent preparation,1145(45.5%)good-,240(9.5%)fair-,and 104(4.1%)poor *** completion rates were significantly lower in patients with poor or fair preparation(72.1%and 75.4%,respectively)than in those with good and excellent preparation(99.7%and 99.9%,respectively;Pd significantly lower than the QI of 95%(PdR in men and women combined was similar in all four grades of preparation(excellent,good,fair and poor)at 24.2%vs.26.8%vs.32.1%vs.22.1%,respectively;P¼*** the groups had AdR above the QI(25%for men and 15%for women)with evidence of significantly higher AdR in the women with excellent or good preparation and in men with excellent,good or fair *** multivariate analysis,male gender was significantly associated with increased AdR(Pdid not influence ***:Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good ***,there was no difference in AdR between the different grades of preparation.

关键词： bowel preparation adenoma detection rate colonoscopy completion rate quality indicators

Higher prevalence of colon polyps in patients with Barrett’s esophagus:a case-control study

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Gastroenterology Report 2014年第4期2卷 281-287页

作者： Arthi Kumaravel Prashanthi N.Thota Hyun-Ju Lee tushar gohel Mehulkumar K.Kanadiya Rocio Lopez Madhusudhan R.Sanaka Center of Excellence for Barrett’s Esophagus Department of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA department of Biostatistics Cleveland ClinicClevelandOhioUSA

Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk *** studies have shown variable prevalence of colon polyps in patients with *** aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without ***:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to december *** control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time *** criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis *** demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy ***:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control *** age at index colonoscopy was 618 years and 75%of patients were *** index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the *** multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during ***:Patients with BE had higher prevalence and incidence of colon *** has important clinical implications for screening and surveillance in BE patients.

关键词： Barrett’s esophagus colon polyps cancer prevention

Programmable microfluidic genotyping of plant dNA samples for marker-assisted selection

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Microsystems & Nanoengineering 2018年第1期4卷 413-422页

作者： Helena C.Zec Tony Zheng Lingshu Liu Kuangwen Hsieh tushar d.Rane Todd Pederson Tza-Huei Wang department of Biomedical Engineering Johns Hopkins UniversityBaltimoreMD 21218USA department of Mechanical Engineering Johns Hopkins UniversityBaltimoreMD 21218USA Pioneer Hi-Bred International Inc. JohnstonIA 50131USA

As demands to maintain the global food production continue to mount,multinational seed companies are turning to new dNA marker technologies to accelerate the rate of plant breeding and crop *** key to widespread adoption of molecular breeding is the availability of flexible and cost-effective tools that can perform combinatorial and high-throughput genotyping of single-nucleotide polymorphisms(SNPs)to guide the crop development *** this end,we have developed a programmable,droplet-based microfluidic device for genotyping maize genomic dNA.A unique feature of the microfluidic platform is the nano sample processors(NSPs),which allow the device to sequentially load an unrestricted number of unique dNA samples using only two inlets,overcoming the current limitation to the number of sample inputs due to small device *** and programmable droplet generation within the device allows each sample to be genotyped against a panel of markers on ***,we have successfully implemented the Invader assay for SNP genotyping in flowing,50-nL droplets,thus achieving significant reduction in consumption of reagents per reaction as compared with conventional genotyping *** a demonstration,we performed 240 Invader reactions(testing 8 dNA samples against 10 SNP markers)and achieved greater than 93% accuracy in SNP calling of plant dNA samples in a single droplet-based experiment.

关键词： droplets genotyping invader assay microfluidics single-nucleotide polymorphism

A Novel Machine Learning-Based Hand Gesture Recognition Using HCI on IoT Assisted Cloud Platform

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Computer Systems Science & Engineering 2023年第8期46卷 2123-2140页

作者： Saurabh Adhikari tushar Kanti Gangopadhayay Souvik Pal d.Akila Mamoona Humayun Majed Alfayad N.Z.Jhanjhi School of Engineering Swami Vivekananda UniversityIndia department of Computer Science and Engineering Sister Nivedita University(Techno India Group)KolkataWest BengalIndia Sambalpur University SambalpurIndia department of Computer Applications Saveetha College of Liberal Arts and SciencesSIMATS Deemed to be UniversityChennaiIndia department of Information Systems College of Computer and Information SciencesJouf UniversityKSA College of Computer and Information Sciences Jouf UniversitySakaka72341Saudi Arabia School of Computer Science(SCS) Taylor’s UniversitySubang Jaya47500Malaysia

Machine learning is a technique for analyzing data that aids the construction of mathematical *** of the growth of the Internet of Things(IoT)and wearable sensor devices,gesture interfaces are becoming a more natural and expedient human-machine interaction *** type of artificial intelligence that requires minimal or no direct human intervention in decision-making is predicated on the ability of intelligent systems to self-train and detect *** rise of touch-free applications and the number of deaf people have increased the significance of hand gesture *** applications of hand gesture recognition research span from online gaming to surgical *** location of the hands,the alignment of the fingers,and the hand-to-body posture are the fundamental components of hierarchical emotions in *** gestures may be difficult to distinguish from nonsensical motions in the field of gesture *** gestures may be difficult to distinguish from nonsensical motions in the field of gesture *** this scenario,it may be difficult to overcome segmentation uncertainty caused by accidental hand motions or *** a user performs the same dynamic gesture,the hand shapes and speeds of each user,as well as those often generated by the same user,vary.A machine-learning-based Gesture Recognition Framework(ML-GRF)for recognizing the beginning and end of a gesture sequence in a continuous stream of data is suggested to solve the problem of distinguishing between meaningful dynamic gestures and scattered *** have recommended using a similarity matching-based gesture classification approach to reduce the overall computing cost associated with identifying actions,and we have shown how an efficient feature extraction method can be used to reduce the thousands of single gesture information to four binary digit gesture *** findings from the simulation support the accuracy,precision,gesture

关键词： Machine learning gesture recognition framework accuracy rate precision rate gesture recognition rate sensitivity rate efficiency rate