Traditional underwriting today remains a slow, manual, document-centric process that imposes high operational costs and protracted cycle times. Underwriters spend up to 40% of their time on low-value tasks, and policy decisions can take weeks (or months for complex cases). This inefficiency causes premium leakage (estimated 3-10%) and lost opportunities for dynamic pricing. Motivated by this "time tax," we develop an integrated AI architecture that shifts underwriting from reactive assessment to proactive prediction. The framework combines Intelligent Document Processing (IDP) for data ingestion, deterministic rules engines for business logic, probabilistic machine learning models (e.g. XGBoost risk scoring), and advanced agentic AI (multi-LLM orchestration). We describe each layer technically and show how the system reduces quote times by ~90% and operational costs by ~50% while improving risk selection. A phased implementation roadmap (2025-2027) is outlined, showing early gains (40% cycle-time reduction) and eventual "touchless" underwriting for standard risks. Finally, we address governance: as regulators (NAIC and state authorities) mandate AI explainability and fairness, insurers must embed transparency tools and human oversight into the design. The findings indicate that an AI-enabled underwriting engine is not only feasible but essential-carriers delaying this digital transformation risk falling behind competitors that can price and bind risk in real time.

e17033 Background: Node-positive penile squamous cell carcinoma (PSCC) carries a poor prognosis, yet the survival benefit of systemic chemotherapy remains uncertain given the lack of completed randomized trials and reliance on limited phase II and retrospective data. Although NCCN guidelines recommend chemotherapy for patients with ≥3 positive lymph nodes, whether chemotherapy benefit differs by pathologic nodal burden has not been formally evaluated using interaction analysis. We hypothesized that chemotherapy is associated with improved overall survival (OS) among patients with high nodal burden (≥3 nodes) but not among those with low nodal burden (1–2 nodes). Methods: Using the National Cancer Database (2004–2022), we identified adults with pathologically node-positive, nonmetastatic PSCC who underwent regional lymph node dissection with numeric nodal counts available. Heterogeneity of treatment effect by nodal burden was formally assessed using a chemotherapy × nodal burden interaction term. Nodal burden was classified as low (1–2 positive nodes) or high (≥3 positive nodes). OS was estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariable Cox proportional hazards regression adjusted for age, race, ethnicity, Charlson-Deyo comorbidity score, T stage, tumor grade, primary tumor surgery, radiotherapy, facility type, insurance status, and year of diagnosis. A 90-day landmark analysis was performed to mitigate immortal time bias. Results: Among 1,300 patients, 589 (45%) received chemotherapy. A statistically significant chemotherapy × nodal burden interaction was observed (p = 0.009), indicating differential survival associations by nodal burden. In the overall cohort, chemotherapy was not associated with OS (log-rank p = 0.47). Among patients with high nodal burden, chemotherapy was associated with improved OS (adjusted HR 0.76, 95% CI 0.59–0.98, p = 0.03; log-rank p = 0.002), with median OS of 35.9 months compared with 20.6 months for those not receiving chemotherapy. In contrast, among patients with low nodal burden, chemotherapy was not associated with improved OS (adjusted HR 1.19, 95% CI 0.95–1.49, p = 0.13; median OS 59.0 vs 65.7 months; log-rank p = 0.79). Findings were consistent in landmark analyses (interaction p = 0.008). Conclusions: In this large national cohort, the association between chemotherapy and survival in node-positive, nonmetastatic PSCC differed significantly by pathologic nodal burden. Chemotherapy was associated with improved survival among patients with ≥3 positive lymph nodes but not among those with limited nodal involvement. These findings demonstrate clinically meaningful heterogeneity in chemotherapy benefit and may inform more precise patient selection for systemic therapy in node-positive PSCC.

Patients undergoing endobronchial ultrasound-guided fine needle aspiration may have multiple comorbidities, contributing to higher risks of hypoxia and adverse events, such as arrhythmias. The current study compared the efficacy of two oxygenation modalities: the high-flow nasal cannula (HFNC) vs. conventional oxygen therapy (CNC). Patients were randomized to either the HFNC or the CNC arm. HFNC and CNC were initiated and escalated as per predefined protocols. The number of desaturation events [fall in saturation of peripheral oxygen (SpO2) by 3% from the baseline] and change in levels of transcutaneous CO2 (tcCO2) from baseline were noted. Subgroup analysis was done in patients with cardiopulmonary comorbidities and in patients with SpO2<97%. A total of 122 patients were randomized. Overall, there was no significant difference in the number of desaturation events and change in tcCO2 levels; however, in patients with cardiopulmonary comorbidities (obstructive sleep apnea, heart diseases, and stable chronic obstructive airway disease), 50% in the HFNC arm had no desaturation compared to 11.7% in the CNC arm (p=0.007). 41.17% of patients in the HFNC arm had a rise in tcCO2 levels, compared to 36.11% of patients in the CNC arm (p>0.5). In patients with SpO2<97%, 48.88% in the HFNC arm had no desaturations compared to 14.70% in the CNC arm (p=0.001); there was no statistical difference in rise in tcCO2. Hence, HFNC would be a better modality for oxygenation in patients with a high risk of hypoxia without increasing the risk of hypercapnia.

Erosion and weathering are two of the several exogenic processes that control the intensity and patterns of landform evolution. Based on previous studies, the varied erosion rates observed in the geological past depends on factors like mean relief (morphology), climate, lithology, and time. Meteorite impact craters have unique geomorphic features, being characterized by both negative relief features (the bowl-shaped depression) and positive features (such as elevated rims; additionally, central elevated areas for complex craters). This makes them a suitable morphologic feature to study both erosion and deposition. This study estimates the long-term erosion of Ramgarh crater in western India, a crater debated on its morphology and erosion rates. This study uses a paleo-digital elevation model (paleo-DEM), a reconstruction of the crater morphology at similar to 528 Ma- the potential upper age of formation of Ramgarh, along with previously established models with suitable modifications to quantify erosion from the final stage to the present day. The type of projectile and its physical characteristics such as diameter and volume were also estimated. Reconstruction of the crater's paleo-position was achieved through GPlates (a GIS-based paleo-reconstruction model), followed by recreating the transient and final crater morphology (including parameters such as crater diameter and true depth, rim height, and thickness of proximal ejecta) for two age limits (528 Ma and 395 Ma). The intermittent morphology of the crater was generated using mathematical equations to depict the sequence of changes through time. The erosion of the crater, quantified in terms of cumulative volume, is between 0.41 and 0.58 km(3). This range is based on four conditions pertaining to two different final crater rim heights (mathematically derived) as well as two age limits. Overall, this study provides valuable insights into the long-term morphological evolution of Ramgarh crater and contributes to the understanding of impact crater's erosion processes.

Case Presentation A 23-year-old man presented to the ED with a history of respiratory distress, cough, and fever for 10 days. He was evaluated in the ED, where he received a diagnosis of pulmonary edema, secondary to mitral regurgitation with mitral valve prolapse syndrome. He was treated with antibiotics and diuretics and discharged to home. Three months later, he returned to the ED with similar complaints, for which he was treated symptomatically and discharged. After 4 months, the patient once again appeared with worsening respiratory distress and cough with fever. The dyspnea was not accompanied by orthopnea, pedal edema, or palpitation. The patient was admitted to the medical ICU. He had no history of arthralgia, myalgia, skin rash, or other signs of autoimmune disease. He denied any history of smoking, work-related or occupational exposures, drug intake, or recent travel.

The antiferromagnetic topological insulator MnBi2Te4 (MBT) exhibits an ideal platform to study exotic topological phenomena and magnetic properties. The transport signatures of magnetic phase transitions in the MBT family materials have been well-studied. However, their mechanical properties and magneto-mechanical coupling have not been well-explored. We use nanoelectromechanical systems to study the intrinsic magnetism in MBT thin flakes via their magnetostrictive coupling. We investigate mechanical resonance signatures of magnetic phase transitions from antiferromagnetic (AFM) to canted antiferromagnetic (cAFM) to ferromagnetic (FM) phases versus magnetic field at different temperatures. The spin-flop transitions in MBT are revealed by frequency shifts of mechanical resonance. With temperatures going above TN, the transitions disappear in the resonance frequency map, consistent with transport measurements. We use a magnetostrictive model to correlate the frequency shifts with the spin-canting states. Our work demonstrates a technique to study magnetic phase transitions, magnetization and magnetoelastic properties of the magnetic topological insulator.

Chromite is a significant mineral within the spinel group, functioning as a petrogenetic indicator and an important resource for numerous industrial uses. This study investigates the chromite occurrence of the Nuggihalli Schist Belt (NSB), which belongs to the Archean supracrustal greenstone belts of Western Dharwar Craton (WDC), southern India, through a comprehensive spectroscopic analysis. Chromites of the study area occur as diverse textures within ultramafic rocks, reflecting the complex evolutionary processes involving multiple stages of crystallization, and post-magmatic alterations. Based on the modal abundance, the chromite samples have been classified into three distinct groups, that is, Group I (80-90%), Group II (60-80%), and Group III (<60%). The chromites of this study were characterized using multiple spectroscopic techniques such as X-ray diffraction (XRD), Fourier Transform Infrared (FTIR) spectroscopy, Visible-Near-InfraRed (VNIR) spectroscopy, and laser Raman analysis. XRD spectra of chromite exhibit their characteristic 2 theta peaks at 12 degrees,18 degrees,24 degrees, and 35 degrees. The FTIR data reveal transmittance in and around 960-976 and 1001-1007 cm(-1), corresponding to the vibrations of oxygen ions perpendicular to the bond axis and the oscillations of Cr-ions within the isotropic field of their tetrahedral and octahedral coordination, respectively. Laser Raman spectra show intensity peaks at around similar to 610, similar to 520, similar to 450, and 684 cm(-1), which are attributed to E-g and F-2g and A(1g) vibrational modes of Cr3+ ions. The shortward shift observed in the 684 cm(-1) peak is due to the compositional changes and Fe3+ substitution (chromite to ferritchromite) in the crystal structure. VNIR spectroscopy of chromite reveals a prominent absorption band at around 2000 nm. The observed shift in the 2000 nm band center is distinct to groups I, II, and III, indicating an abundance-dependent band shift. Through this study, we have correlated the characteristic spectral features and their shift across the various groups of chromite and the corresponding textures, which in turn give implications regarding the stages of crystallization and subsequent alteration. This study also contributes significantly to the spectral database of ore minerals, potentially aiding effective and precise future mineral exploration.

India is undergoing a complex triple transition—economic, demographic, and epidemiological—that is reshaping its public health priorities. Economic development and urbanization have improved infrastructure and access but have also contributed to lifestyle-related non-communicable diseases (NCDs). Simultaneously, demographic changes such as population aging have increased the vulnerability to chronic conditions. Despite this shift, communicable diseases (CDs) remain a major concern, especially in low Epidemiological Transition Level (ETL) states like Bihar, Jharkhand, and Uttar Pradesh. While the share of CDs in the total disease burden declined from 53.6% in 1990 to 27.5% in 2016, India still contributes 26% of global tuberculosis cases and over 65% of malaria cases in the WHO South-East Asia Region. The dual burden of CDs and NCDs imposes a significant economic burden, disproportionately affecting vulnerable populations due to persistent health inequities and poor access to care. This challenge is compounded by low public health expenditure, which stood at only 1.84% of GDP in 2019–20, and high out-of-pocket expenses (39.4%), increasing household financial strain. Addressing this requires a strengthened public health system—equitable, integrated, and adequately funded—to effectively manage the coexisting burdens of infectious and chronic diseases, and respond to the evolving needs of India’s transitioning population.

Chromite mineralization within Archean greenstone belts is of considerable economic significance; however, the exploration of these deposits in remote and rugged terrains presents substantial challenges. This study evaluates the remote sensing techniques using multi- spectral satellite data from ASTER, Sentinel-2A, and Landsat 8 to enhance chromite mineralization zonation mapping and spatial accuracy in the Nuggihalli Schist Belt (NSB) in southern Peninsular India. Analyses of spectral signatures revealed distinct absorption and reflectance patterns, enabling precise identification of minerals/rocks such as chromite, meta-basalt, meta-pyroxenite, granite gneiss, and serpentinite from the study area. Image processing methods, such as Principal Component Analysis (PCA) and Minimum Noise Fraction (MNF), improved the identification of litho units and highlighted subtle variations in the chromite mineralization zone, despite difficulties caused by spectral resemblance. Classification techniques like Spectral Angle Mapper (SAM) and Support Vector Machine (SVM) were employed to map chromite-bearing zones. Landsat 8 data yielded the highest overall accuracy and Kappa coefficient values for both SAM and SVM classifications. SVM performed superior technique, achieving 51.9 % overall accuracy (Kappa coefficient = 0.351) for ASTER data, 40.3 % (k = 0.283) for Sentinel-2A, and 55 % (k = 0.55) for Landsat 8. Landsat 8 data emerged as the most effective dataset for classification, achieving the highest overall accuracy. Complementary spectral and petrographic analyses of rock and ore samples, along with field validation, affirmed the reliability of remote mapping, demonstrating the effectiveness of these integrated techniques for chromite exploration within Archean greenstone belts. The results underscore the global potential of remote sensing in mineral exploration, particularly for identifying economically significant chromite deposits associated with similar greenstone belts across the globe. (c) 2024 COSPAR. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Foreign body aspiration is a common cause of hemoptysis. The exact cause may sometimes be hidden and may not be revealed in chest radiology but may eventually come to light with bronchoscopy and may prevent complications.