Isolated intracholecystic metastasis of renal cell carcinoma: A report of a rare case.

Renal cell carcinomas are known for their unforeseeable metastatic pattern. They are known to have high metastatic potential, thus commonly associated with synchronous or metachronous metastatic presentation. At the time of diagnosis, approximately one-third of patients present with metastatic disease. We present a case of synchronous metastasis of clear cell carcinoma to the gallbladder in a 54-year-old male within two months after radical nephrectomy.

Associations of comorbid substance use disorders with clinical outcomes in schizophrenia using electronic health record data.

BACKGROUND AND HYPOTHESIS: Schizophrenia and comorbid substance use disorders (SUDs) are associated with poor treatment outcomes but differences between the associations of different SUDs with clinical outcomes are poorly characterized. This study examines the associations of comorbid SUDs with clinical outcomes in schizophrenia using a largescale electronic health record (EHR) database. DESIGN: Real-world data (RWD) analysis using the NeuroBlu database; de-identified EHR data were analysed. Multivariable logistic regression, Poisson and CoxPH models were used to compare the associations of specific comorbid SUDs with outcome variables. RESULTS: Comorbid SUD was significantly different on all outcome measures compared to no SUD (U = 1.44e7-1.81e7, all ps < .001), except number of unique antipsychotics (U = 1.61e7, p = .43). Cannabis (OR = 1.58, p < .001) and polysubstance (OR = 1.22, p = .007) use disorders were associated with greater CGI-S. Cannabis (IRR = 1.13, p = .003) and polysubstance (IRR = 1.08, p = .003) use disorders were associated with greater number of unique antipsychotics prescribed, while cocaine (HR = 1.87, p < .001), stimulants (HR = 1.64, p = .024), and polysubstance (HR = 1.46, p < .001) use disorders were associated with a shorter time to antipsychotic discontinuation. Conversely, alcohol use (IRR = 0.83, p < .001), cocaine use (IRR = 0.61, p < .001), opioid use (IRR = 0.61, p < .001), stimulant use (IRR = 0.57, p < .001) and polysubstance use (IRR = 0.87, p < .001) disorders were associated fewer inpatient days. CONCLUSION: Comorbid SUDs were generally associated with greater CGI-S and poorer clinical outcomes in patients with schizophrenia. Treatment strategies should target not only schizophrenia symptoms but also comorbid SUD to improve management of both conditions.

Low Prevalence of Soil-Transmitted Helminth Infections among Children in the States of Chhattisgarh and Himachal Pradesh, India, 2018.

Large-scale impact assessments of soil-transmitted helminth (STH) programs are essential for determining the frequency of mass drug administration (MDA). In baseline surveys, the prevalence of STHs in the Indian States of Chhattisgarh and Himachal Pradesh was 80.2% in 2015 and 29.0% in 2016, respectively. In 2018, we estimated the prevalence and intensity of STHs after six rounds of biannual MDA in Chhattisgarh and annual MDA in Himachal Pradesh. We conducted multistage cluster sampling surveys in preschool-age children (PSAC), school-age children (SAC), and adolescent cohorts. Stool samples from 3,033 respondents (PSAC, n = 625; SAC, n = 1,363; adolescents, n = 1,045) in Chhattisgarh and 942 respondents (PSAC, n = 192; SAC, n = 388; adolescents, n = 362) in Himachal Pradesh were examined for presence of STH infection using the Kato-Katz method. The overall cluster-adjusted prevalence in Chhattisgarh was 11.6% among all age groups (95% CI, 5.6-22.4)-an 85.5% reduction in the prevalence since 2015. Prevalence was not significantly different across cohorts (PSAC, 11.0% [95% CI, 5.0-22.6]; SAC, 10.9% [95% CI, 5.2-21.6]; adolescents, 12.8% [95% CI, 6.2-24.5]). Ascaris lumbricoides was the most common helminth, with most infections of light intensity. In Himachal Pradesh, only three STH infections were detected in 2018, resulting in a cluster-adjusted prevalence of 0.3% (95% CI, 0.1-1.7)-a 99.0% reduction in prevalence since 2016. All infections were of light intensity. Both states showed substantial improvements in socioeconomic and water, sanitation, and hygiene (WASH) indicators since the baseline surveys. Extensive reductions in prevalence and intensity are linked to sustained, high deworming coverage, as well as socioeconomic WASH indicators.

Prevalence of Factors Related to Depressive Symptoms Among Married Individuals.

Background There are multiple studies that indicate that the psychological well-being of a couple and their life satisfaction depend on the family and society. Various factors such as family, family values, marriage style, married life, and education have a great impact on people's lives both directly and indirectly. It is important to understand the effects of these factors on married individuals' lives that lead to depression so that appropriate measures can be taken for its prevention. Objectives This research aims to find the relationship of depressive symptoms among married individuals with various factors such as their marriage style, education, and having children. Materials and methods The study included 433 married individuals from Istanbul who met the criteria for depression. The early identification and prediction of depression in married individuals have been demonstrated to benefit significantly from machine learning techniques. In this study, we used decision tree (DT) and random forest (RF) predictive modeling techniques to create a model to predict the occurrence of depression among married individuals. Results The accuracy of the DT approach was found to be 80%, and the RF approach was 60%. Our results showed that as compared to conventional statistical methods, machine learning models performed better for classifying couples. Conclusion Future support systems that employ a range of data sources to identify individuals who are extremely susceptible to developing depression among married people may be developed using these effective models.

Contemporaneous Update and Enforcement of ABAC Policies.

Access control policies are dynamic in nature, and therefore require frequent updates to synchronize with the latest organizational security requirements. As these updates are handled, it is important that all user access requests be answered contemporaneously and correctly without any interruption or delay. In this paper, considering the context of Attribute Based Access Control (ABAC), we propose an approach that is capable of immediately materializing any update to the policy and ensuring that it is taken into account for any subsequent access requests. One possibility is to update the policy based on the incoming changes through ABAC policy mining techniques. However, it turns out that no existing mining approach can offer correct enforcement of policies when access requests are entertained during the updates. We provide a formal proof for this surprising result and then propose an approach called δwOP that does not suffer from this problem. Essentially, δwOP keeps track of the needed information from updates and uses this in conjunction with the existing ABAC policy rules to make access decisions. We present the complexity analysis as well as a comprehensive experimental evaluation to demonstrate the efficacy of the proposed approach for different types of changes.

Incremental Maintenance of ABAC Policies.

Discovery of Attribute Based Access Control policies through mining has been studied extensively in the literature. However, current solutions assume that the rules are to be mined from a static data set of access permissions and that this process only needs to be done once. However, in real life, access policies are dynamic in nature and may change based on the situation. Simply utilizing the current approaches would necessitate that the mining algorithm be re-executed for every update in the permissions or user/object attributes, which would be significantly inefficient. In this paper, we propose to incrementally maintain ABAC policies by only updating the rules that may be affected due to any change in the underlying access permissions or attributes. A comprehensive experimental evaluation demonstrates that the proposed incremental approach is significantly more efficient than the conventional ABAC mining.

Deploying ABAC policies using RBAC Systems.

The flexibility, portability and identity-less access control features of Attribute Based Access Control(ABAC) make it an attractive choice to be employed in many application domains. However, commercially viable methods for implementation of ABAC do not exist while a vast majority of organizations use Role Based Access Control (RBAC) or their temporal extensions, such as Temporal Role Based Access Control (TRBAC). In this paper, we present a solution for organizations having a RBAC/TRBAC that can deploy an ABAC policy. Essentially, we propose a method for the translation of an ABAC policy (including time constraints) into a form that can be adopted by an RBAC/TRBAC system. We experimentally demonstrate that time taken to evaluate an access request in RBAC and TRBAC systems is significantly less than that of the corresponding ABAC system. Since the cost of security management is more expensive under RBAC when compared to ABAC, we present an analysis of the different management costs and present mitigation approaches by considering various administrative operations.

Enabling the Deployment of ABAC Policies in RBAC Systems.

The flexibility, portability and identity-less access control features of Attribute Based Access Control (ABAC) make it an attractive choice to be employed in many application domains. However, commercially viable methods for implementation of ABAC do not exist while a vast majority of organizations use Role Based Access Control (RBAC) systems. In this paper, we present a way in which organizations having a RBAC system can deploy an ABAC policy. Thus, we propose a method for the translation of an ABAC policy into a form that can be adopted by an RBAC system. We compare the cost of enforcement in ABAC and RBAC with respect to time taken to evaluate an access request, and experimentally demonstrate that RBAC is significantly better in this respect. Since the cost of security management is more expensive under RBAC when compared to ABAC, we present an analysis of the different management costs and present mitigation approaches by considering various administrative operations.

Efficient bottom-up Mining of Attribute Based Access Control Policies.

Attribute Based Access Control (ABAC) is fast replacing traditional access control models due to its dynamic nature, flexibility and scalability. ABAC is often used in collaborative environments. However, a major hurdle to deploying ABAC is to precisely configure the ABAC policy. In this paper, we present an ABAC mining approach that can automatically discover the appropriate ABAC policy rules. We first show that the ABAC mining problem is equivalent to identifying a set of functional dependencies in relational databases that cover all of the records in a table. We also propose a more efficient algorithm, called ABAC-SRM which discovers the most general policy rules from a set of candidate rules. We experimentally show that ABAC-SRM is accurate and significantly more efficient than the existing state of the art.