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With the fast advancement of AI technology in recent years, many excellent Data Augmentation (DA) approaches have been investigated to increase data efficiency in Natural Language Processing (NLP). The reliance on a large amount of data prohibits NLP models from performing tasks such as labelling enormous amounts of textual data, which require a substantial amount of time, money, and human resources; hence, a better model requires more data. Text DA technique rectifies the data by extending it, enhancing the model's accuracy and resilience. A novel lexical-based matching approach is the cornerstone of this work; it is used to improve the quality of the Machine Translation (MT) system. This study includes resource-rich Indic (i.e., Indo-Aryan and Dravidian language families) to examine the proposed techniques. Extensive experiments on a range of language pairs depict that the proposed method significantly improves scores in the enhanced dataset compared to the baseline system's BLEU, METEOR and ROUGE evaluation scores. [ABSTRACT FROM AUTHOR]

Objective: Premature rupture of membranes (PROMs) is one of the common causes of preterm birth which has a major contribution to maternal and fetal adverse outcomes. Infection may be contributing to premature rupture of membrane or it may be a consequence. The aim of our study was to assess the common pathogens colonizing the endocervix in women with PROM and pregnancy outcomes. Materials and methods: In this prospective observational study, seventy antenatal women with PROM after 24 weeks of gestation were studied from January 2020 to July 2021. Two swabs were taken from the endocervix. Swabs were subjected to gram staining and culture. The association of endocervical culture positivity with chorioamnionitis, mode of delivery, and neonatal outcome was evaluated. Results: In the study, 24.2% of endocervical cultures were positive. The pathogens isolated were Escherichia coli in 11.4%, Staphylococcus hemolyticus in 2.9%, budding yeast in 2.9%, 1.4% each with Klebsiella pneumoniae and Methicillin-resistant Staphylococcus aureus (MRSA). The culture was positive in 30.3% of subjects with preterm PROM and 18.9% with PROM (p = 0.40). The incidence of chorioamnionitis was higher with endocervical culture-positive cases as compared to culture-negative women (p = 0.05). There was no association of endocervical culture positivity with the neonatal intensive care unit (NICU) admission, duration of membrane rupture, and mode of delivery. Conclusion: In our study, the most common bacteria inhabiting the endocervix in PROM was E. coli. There is a definite influence of bacterial endocervical colonization on pregnancy outcomes but further studies are needed to corroborate the findings. [ABSTRACT FROM AUTHOR]

Lavender is a highly valuable medicinal and aromatic perennial shrub lacking superior and stable varieties for varied environments in the western Himalayas. In the present experiment, estimates of genotypic effects and their interaction with the environment under various conditions of Himachal Pradesh were investigated to identify superior and stable genotypes. For that, seven selections with a check were evaluated at four different locations in randomized block design with three replications during 2020 and 2021. The pooled analysis of variance showed that genotypic and environmental main effects were highly significant for all the traits under study while, G×E interaction was significant (p=0.05) for plant height, spike length and spike yield. The highest mean performance for all the traits revealed that location-4 has favourable conditions for lavender cultivation, and LOH15141 followed by LOH15040 were the best performers over all the locations. These high-performing genotypes were clustered together with the check in a major cluster. The stability parameters of the Eberhart and Russell model showed that LOH15141 is stable and superior for both spike yield and essential oil content, further confirmed by GGE biplot analysis. GGE biplot analysis revealed that all the tested locations formed a single mega-environment. The strong positive yield contribution described through Pearson's correlation coefficients and genotypic path diagram states that plant height, number of spikes and spike length were significant contributors to the spike yield and could be used as selection criteria to improve spike yield due to their high heritability and genetic advance. [ABSTRACT FROM AUTHOR]

Melioidosis is a potentially fatal infectious disease that requires an extended period of treatment for complete resolution of the infection. It can lead to chronic and severe infections, and it is more common in diabetic patients. Melioidosis is also a significant concern in India primarily because its chronic nature, potential for dissemination, extended treatment requirements, and the risk of relapse lead to its resemblance to tuberculosis. This case series included osteomyelitis patient presented in emergency with sepsis MODS, disseminated melioidosis patient with systemic involvement including spleen, kidney and lungs, skin abscess at more than one site, urosepsis, splenic abscess, Melioidotic arthritis. Many of these patients had altered blood sugar levels, and in 3 cases, individuals were even diagnosed with diabetes during their episode of melioidosis the treatment duration generally involved an 8-week course of intravenous antibiotics. However, oral medications may need to be continued for several months if necessary for complete recovery. [ABSTRACT FROM AUTHOR]

The accumulation of damage due to repeated loading is considered as the primary reason for the fatigue cracking of bituminous pavements. Due to the intermittent nature of loading in the field, the bituminous mixtures tend to heal during the rest period resulting in increased fatigue life. The healing of the bituminous mixtures is predominantly governed by the binder component, and hence quantifying the healing potential of the binder is indicative of the healing potential of the mix. Currently, the increased use of recycled asphalt pavements (RAP) in new construction, as well as rehabilitation has triggered the use of rejuvenators for restoring the RAP binder properties. As such, the rheological and physico-chemical evaluation of blender RAP binders (with rejuvenators) is critical. In the present study, four different rejuvenators are used for rejuvenating the RAP binder, which include two types of Paraffinic oils, Tall oils and Fatty acids. The healing potential of the RAP binder blended with different rejuvenators is investigated with the help of Linear Amplitude Sweep (LAS) tests carried out in two ways. The first method is a continuous LAS test without any rest period and the second method incorporates rest periods of various duration at different damage levels. The advantages of incorporating rest periods in a LAS test have been quantified in terms of improved binder healing potential. In addition, the physico-chemical properties of the blended RAP binders were assessed through SARA analysis. An attempt has been made to explain the fatigue performance and healing potential of blended RAP binders in LAS tests by virtue of their chemical composition obtained from physico-chemical analysis (SARA analysis). Also, the effectiveness of various rejuvenators in improving the healing potential of RAP binders has been evaluated. [ABSTRACT FROM AUTHOR]

Networked computers can potentially support classrooms to be more interactive. It can help students share representations amongst themselves and work together on a shared virtual activity space. In research on the role of shared screens or shared virtual workspace in learning settings, there has been less attention paid to contexts where learners are co-located. This paper looks at the impact of the shared screen in a computational game environment on mathematics learning and practices and the construction of learners' emotions and social status in classroom interactions. We designed two versions of a simple arithmetic game: a solo version in which the student played the game alone and a multi-player version in which the screen was shared, and the players could see the arithmetic moves of the other players. We implemented these two versions of the game in a 4th-grade classroom in a suburban school in a large metropolis in India. Classroom sessions were video recorded, computer logs were collected, and field notes were taken. Focus group sessions were held with the students. We coded a portion of the data to get at patterns of classroom interactions. Then we drew on qualitative video analysis tools to analyze specific episodes to understand the fine timescale dynamics of dominant interaction patterns in each setting. Our analysis shows that the shared screen served as a shared memory device, keeping a record of all the students' posts, and was entangled in the moment-to-moment dynamics of self- and peer- assessments of arithmetic. These findings suggest that thoughtful integration of networked digital tools in computer-supported learning environments can increase student–student interactions and support disciplinary learning. [ABSTRACT FROM AUTHOR]

Background: Control of cerebral blood flow (CBF) is complex and is only beginning to be elucidated. There is paucity of information on how implementation of pneumoperitoneum and head-up tilt under general anaesthesia affects CBF. This study was designed to observe changes that occur in the internal carotid artery (ICA) blood flow with pneumoperitoneum and head-up position and corelate these changes with changes in cardiac output in patients undergoing laparoscopic cholecystectomy. Methods: ICA blood velocity and diameter was measured by Doppler ultrasound in 35 ASA grade I and II patients undergoing laparoscopic cholecystectomy, at four time points: awake, after anaesthesia induction, after induction of pneumoperitoneum, and after head-up tilt; and ICA blood flow was calculated. Simultaneously, heart rate, blood pressure, and end-tidal carbon dioxide (ETCO2) were recorded, and cardiac output was calculated. Results: ICA blood flow decreased upon anesthesia induction from 164 mL/minute to 151 ml/minute (p>0.05). ICA blood flow increased with pneumoperitoneum (from 164 mL/minute to 179ml/minute p= 0.04). Head-up tilt resulted in decrease in ICA blood flow (from 164 mL/minute to 151ml/minute, P = 0.09). Conclusion: ICA blood flow significantly increased after the creation of pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy under general anaesthesia. Induction of anaesthesia and head-up tilt, however, did not have any significant change in ICA blood flow. We suggest that ICA blood flow during anaesthesia is influenced by an interplay of actions of anaesthetic agents, positive pressure ventilation and patient position besides the changes in blood pressure, ETCO2 and cardiac output. [ABSTRACT FROM AUTHOR]

Objective Indian hospitals (especially government-run public sector hospitals) have a nonexistent antimicrobial stewardship program (AMSP). After successfully initiating AMSPs in tertiary care hospitals of India, the Indian Council of Medical Research envisages implementing AMSP in secondary care hospitals. This study is about the baseline data on antibiotic consumption in secondary care hospitals. Materials and Methods It was a prospective longitudinal observational chart review type of study. Baseline data on antibiotic consumption was captured by a 24-hour point prevalence study of antibiotic usage and bacterial culture rate. The prescribed antibiotics were classified according to the World Health Organization (WHO) Access, Watch, and Reserve classification. All data were collated in Microsoft Excel and summarized as percentages. Results Out of the 864 patients surveyed, overall antibiotic usage was 78.9% (71.5% in low-priority areas vs. 92.2% in high-priority areas). Most of the antibiotic usage was empirical with an extremely low bacterial culture rate (21.9%). Out of the prescribed drugs, 53.1% were from the WHO watch category and 5.5% from the reserve category. Conclusion Even after 5 years of the launch of the national action plan on AMR (NAP-AMR) of India, AMSP is still non-existent in small- and medium-level hospitals in urban cities. The importance of trained microbiologists in the health care system is identified as a fulcrum in combating antimicrobial resistance (AMR); however, their absence in government-run district hospitals is a matter of grave concern and needs to be addressed sooner than later. [ABSTRACT FROM AUTHOR]

Background Intestinal parasites are a major public health problem in tropical countries. Over 1.5 billion people are infected with soil-transmitted helminths (STH), of which 225 million are in India. Parasitic infections are associated with poor sanitation, lack of safe potable water, and improper hygiene. Materials and Methods The study was undertaken to ascertain the impact of control strategies, namely open-defecation free drive and mass drug administration of single dose albendazole. Stool samples received at AIIMS Bhopal Microbiology laboratory, across all age groups, were studied for protozoan trophozoites/cysts and helminthic ova. Results Out of 4,620 stool samples, 389 (8.41%) were positive either for protozoal or helminthic infections. Protozoan infections were more common than helminthic infections with Giardia duodenalis infection being the most common, 201 (51.67%), followed by Entamoeba histolytica , 174 (44.73%). The helminthic infections constituted 14 (3.5%) of the positive stool samples with Hookworm ova in 6 (1.5%) cases. Conclusion This study proves that strategies, namely "Swachh Bharat Abhiyan" and "National Deworming Day" started in 2014 and 2015 led to significant reduction of intestinal parasite infections in Central India, with a higher reduction of STH compared with protozoan parasite infection being ascribed to the activity spectrum of albendazole. [ABSTRACT FROM AUTHOR]

Carbon in many different forms especially, Graphene, Carbon nanotubes (CNTs), and Fullerene is emerging as an important material in the areas of the biomedical field for various applications. This review comprehensively describes the nano antibiotic effect of carbon-based nanocomposites: epicenter on graphene, carbon nanotubes, and fullerene Composites. It summarises the studies conducted to evaluate their antimicrobial applications as they can disrupt the cell membrane of bacteria resulting in cell death. The initial section gives a glimpse of both "Gram"—positive and negative bacteria, which have been affected by Graphene, CNTs, and Fullerene-based nanocomposites. These bacteria include Staphylococcus Aureus, Bacillus Thuringiensis, Enterococcus faecalis, Enterococcus faecium, Bacillus subtilis, Escherichia coli, Klebseilla pneumoniae, Pseudomonas aeroginosa, Pseudomonas syringae, Shigella flexneri,Candida Albicans, Mucor. Another section is dedicated to the insight of Graphene, and its types such as Graphene Oxide (GO), Reduced graphene oxide (rGO), Graphene Nanoplatelets (GNPs), Graphene Nanoribbons (GNRs), and Graphene Quantum Dots (GQDs). Insight into CNT, including both the types SWCNT and MWCNT, studied, followed by understanding fullerene is also reported. Another section is dedicated to the antibacterial mechanism of Graphene, CNT, and Fullerene-based nanocomposites. Further, an additional section is dedicated to a comprehensive review of the antibacterial characteristics of Graphene, CNT, and nanocomposites based on fullerene. Future perspectives and recommendations have also been highlighted in the last section. [ABSTRACT FROM AUTHOR]

Emergencies and disasters place an exceptional demand on the managerial skills of the humanitarian aid community. Most of the developing countries lack in such kind of resilience and effective humanitarian supply chain. Therefore, the purpose of this paper is to identify and analyse the factors to develop the resilience in the humanitarian supply chain. Based on the literature review, total 12 factors related to resilient humanitarian supply chain have been identified. Some of these factors are process oriented and some are result oriented. Interpretive structural modelling with Fuzzy MICMAC analysis is used to develop structural relationships among these factors and to find the driving and the dependence power of these factors. Government support, strategy and capacity planning; and continuous assessment of project progress have emerged as the major drivers for the development of resilient humanitarian supply chain. By managing these driving factors, humanitarian aid programme can be made resilient and agile. The findings will be useful for the humanitarian aid agencies to develop effective and sustainable aid relief programme. [ABSTRACT FROM AUTHOR]

Knowledge is an intangible asset that can increase employees' and organisation's effectiveness. Limited research has been done to upgrade existing knowledge management systems in the Industry 4.0 environment. Hence, this study identifies thirteen critical factors for developing a knowledge management system in Industry 4.0 environment. Interpretive Structural Modelling (ISM) is utilised to develop the structural relationships among these factors. Finally, fuzzy MICAMC is used to categorise the factors based on driving-dependence value. The results reveal the direct and indirect effects of these factors in developing a KM system in the digital age. Findings suggest that top management support, development of knowledge management strategy, knowledge friendly culture, creation and maintenance of digital infrastructure, and employees training are the major drivers for developing a KM system in Industry 4.0 environment. Organizations can use the proposed framework to prioritise their actions to develop a KM system in the Industry 4.0 environment. [ABSTRACT FROM AUTHOR]

Patients with DM are at significant risk for developing the disease, whereas hazardous alcohol use and chronic renal disease are other notable risk factors. Patients with coinfections of other tropical illnesses and COVID-19 present with severe clinical manifestations and outcomes may be particularly poor. The clinical management further becomes complicated considering that there are high rates of coinfections with COVID-19 in tropical countries and such patients with coinfections also have a high risk of mortality [[4]]. [Extracted from the article]

One of the most prevalent forms of tumor found in males all over the world is prostate cancer. The main risk factors are age and family history. Magnetic Resonance Imaging (MRI) is highly recommended for detecting and localizing prostate cancer. It is very important for precise segmentation of the prostate region in MRI scans to improve the treatment possibilities and the chance of patient survival with prostate cancer. Manually segmenting the prostate region is a daunting task and often time-consuming because of the variation in shapes of prostates among patients, poor delineation of the boundary, and the use of different MRI modes. In this paper, we propose an automatic segmentation model for the prostate regions in MRI scans based on Unet and Xception net. To boost the performance of model, local residual connections are added in the decoder stage of the Unet. The empirical results are compared to different Unet based models with different preprocessing methods to assess the effectiveness of the proposed model. The experimentations are performed to support the fact that the proposed model performs better than other methods taken under study. [ABSTRACT FROM AUTHOR]

Computational materials discovery efforts are enabled by large databases of properties derived from high-throughput density functional theory (DFT), which now contain millions of calculations at the generalized gradient approximation (GGA) level of theory. It is now feasible to carry out high-throughput calculations using more accurate methods, such as meta-GGA DFT; however recomputing an entire database with a higher-fidelity method would not effectively leverage the enormous investment of computational resources embodied in existing (GGA) calculations. Instead, we propose here a general procedure by which higher-fidelity, low-coverage calculations (e.g., meta-GGA calculations for selected chemical systems) can be combined with lower-fidelity, high-coverage calculations (e.g., an existing database of GGA calculations) in a robust and scalable manner. We then use legacy PBE(+U) GGA calculations and new r2SCAN meta-GGA calculations from the Materials Project database to demonstrate that our scheme improves solid and aqueous phase stability predictions, and discuss practical considerations for its implementation. [ABSTRACT FROM AUTHOR]

Objectives Surgical-site infections (SSIs) can complicate virtually any surgical procedure. While SSI can result from numerous causes, contamination of the surgical field can also contribute to it. Intraoperative bacterial contamination during clean orthopaedic procedures can be detected using perioperative cultures. We hypothesized that perioperative cultures could be used to predict possibility of development of SSI in patients undergoing clean orthopaedic surgeries. Materials and Methods We conducted a prospective cohort study at a tertiary care hospital over a 2-year period. Intraoperative surgical wound lavage fluid and closed suction drain tip obtained in the postoperative period were sent for aerobic culture. All patients were followed up to look for the development of SSI for a period of at least 30 days for those undergoing nonimplant surgery, and 90 days for those with implant surgery. Statistical Analysis Means with standard deviation of the continuous data were calculated. Fisher's exact test and chi-square test were used for the analysis of the categorical variables. Relative risk and odds ratio were calculated to evaluate the association of the parameters under study with SSI. Results A total of 384 patients satisfying the inclusion and exclusion criteria were included. Perioperative cultures detected surgical wound contamination in 39 patients (10.1%). Forty-five patients (11.7%) developed SSI during the follow-up period. Skin commensals constituted 59% of perioperative contaminants and accounted for 20% of the SSIs. The relative risk of developing SSI with perioperative contamination was 0.41 (95% confidence interval: 0.09–1.63). Conclusion Intraoperative surgical-site contaminants could be detected using perioperative cultures. However, these contaminants did not lead to SSI. Timely treatment of perioperative contamination with appropriate antibiotics and local wound care probably helped in the reduction of SSI. [ABSTRACT FROM AUTHOR]

Data visualization is powerful in persuading an audience. However, when it is done poorly or maliciously, a visualization may become misleading or even deceiving. Visualizations give further strength to the dissemination of misinformation on the Internet. The visualization research community has long been aware of visualizations that misinform the audience, mostly associated with the terms "lie" and "deceptive." Still, these discussions have focused only on a handful of cases. To better understand the landscape of misleading visualizations, we open‐coded over one thousand real‐world visualizations that have been reported as misleading. From these examples, we discovered 74 types of issues and formed a taxonomy of misleading elements in visualizations. We found four directions that the research community can follow to widen the discussion on misleading visualizations: (1) informal fallacies in visualizations, (2) exploiting conventions and data literacy, (3) deceptive tricks in uncommon charts, and (4) understanding the designers' dilemma. This work lays the groundwork for these research directions, especially in understanding, detecting, and preventing them. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of human papilloma virus (HPV) infection and the pattern of HPV genotype distribution are much-needed parameters to assess the risk of cervical cancer among females. However, due to less availability of data on HPV burden and its genotypes from various geographical regions in India makes cervical cancer screening modalities and vaccination strategies difficult to implement.Objective: The present study was conducted to identify the various genotypes particularly high-risk HPV types in premalignant or malignant cervical lesions.Methods: The study was a hospital-based cross-sectional study wherein 295 symptomatic women were screened by Pap smear and multiplex real-time PCR was performed for HPV genotypes identification in women with abnormal cervical cytology.Results: Out of 295 women, 237 (80.3%), 45 (15.3%), and 13 (4.4%) women had normal Pap smear, squamous cell carcinoma and precancerous cytology, respectively. Among these 58 women having abnormal cervical cytology, HPV was detected in 48 (81.0%) participants. Most common HPV genotypes in our study were HPV 16 (n = 29; 60.4%) followed by mixed infections; i.e., more than one type of HPV was detected (n = 10, 20.8%). HPV 18 was detected only in 6.25%, whereas other high-risk HPV genotypes were found to be 12.5%.Conclusion: HPV positivity was >80% in women having abnormal Pap smear. The prevalence of HPV 18 was found to be much less in Central India, compared to other parts of country. HPV 16 was the most common genotype followed by mixed HPV genotype infections. It is evident from our study that symptomatic women even if having normal Pap smear should be screened for HPV and followed up with periodic Pap smears for detecting any change in cervical cytology, thus preventing cervical cancer in women. [ABSTRACT FROM AUTHOR]

Extended surfaces are widely investigated for their ability to enhance the heat transfer rates in different applications. Pin-fin and plate-fin heat sinks are used in a variety of cases involving a miniaturized to the large systems. The present study compares the performance of the pin-fin and the plate-fin heat sink under similar forced flow conditions. The experimental data for a modified pin fin heat sink with wings and a plate-fin heat sink with dimples are collected for the Reynolds number in the range of 6800–15100. The Nusselt number, friction factor, and thermo-hydraulic performance (THP) are examined for different geometries of the heat sink and the enhancements brought out in the heat transfer and friction are gauged relative to the smooth plate. The pin fin heat sink yields two-fold enhancement in heat transfer as compared to the plate-fin heat sink. The maximum thermo-hydraulic performance of the pin-fin heat sink with wings is found to be 4.52 at a pitch ratio (S/Df) of 2 and Wing length ratio (Lw/Df). For the plate fin heat sink with dimples, the maximum thermo-hydraulic performance is found to be 4.67 at dimple diameter ratio (D/d) of 0.5 and dimple pitch ratio (s/d) of 2.5. The correlations of the Nusselt number and friction factor are proposed for different geometries of fins. [ABSTRACT FROM AUTHOR]

Introduction: An admission of a pregnant woman to an intensive care unit (ICU) is considered as an objective marker of maternal near miss. Only a few studies from the Indian subcontinent have reported on the ability of ICU scoring systems in predicting the mortality in obstetric patients. Methods: A prospective analysis of all critically ill obstetric patients admitted to the critical care department was done. Results: In the period between April 2013 and September 2017, there were 101 obstetric admissions to the critical care ICU. Of these, 82 patients (81.2%) were discharged from the hospital, 18 patients (17.8%) died, and one left against medical advice. The common diagnoses seen in these patients were cardiac failure (n = 39; 38.6%); pregnancy-induced hypertension (n = 26; 25.7%); acute respiratory distress syndrome (n = 20; 19.8%); intra-abdominal sepsis (n = 19; 18.8%); tropical diseases (n = 19; 18.8%); and tuberculosis (n = 13; 12.9%).When we compared the survivors with the nonsurvivors, a higher severity of illness score and a low PaO2/FiO2 were found to increase the odds of death. The area of distribution under the receiver operator characteristic curve was 0.726 (95% confidence interval [CI] = 0.575-0.877), 0.890 (95% CI = 0.773-1.006), 0.867 (95% CI = 0.755- 0.979), and 0.850 (95% CI = 0.720-0.980) for the PaO2/FiO2, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively, for predicting mortality. The standardized mortality ratio was better with SAPSII than with APACHE II. Conclusions: Cardiac dysfunction is a leading cause of ICU admission. Obstetric patients frequently require ventilatory support, intensive hemodynamic monitoring, and blood transfusion. The APACHE II score is a good index for assessing ICU outcomes. [ABSTRACT FROM AUTHOR]

This research presents an error estimation approach with the combination of traditional multilevel techniques used to minimize errors for an accurate prediction and to investigate the behavior of such an algorithm for a satellite. The traditional techniques mentioned above are a combination derived from multiple regression techniques and perform a case study for data analysis. A linear plot can easily be predicted, however if a system tends to deviate toward non-linearity the overall result derived from such an algorithm can be non-reliable since each value would depict a completely different output at different levels. The stability of the fixed regression derived is used to determine the accuracy of the system. [ABSTRACT FROM AUTHOR]

Case: Multilevel lumbar spondylolistheses have been reported, but only secondary to degenerative processes. We describe a case where grade 4 anterolisthesis occurred (L3,4,5 over S1) because of multiple level traumatic pedicle avulsion rather than facetal/pars interarticularis/posterior ligamentous complex disruption in a 42-year-old man who presented with paraparesis after a fall from height. Decompression was performed at the L5 level, and pedicle screw fixation was performed at L3, L5, and S1 levels. Conclusion: Although such an injury pattern seems catastrophic, it is deemed relatively stable because of the intact posterior ligamentous complex. Restoration of anatomy with stabilization allowed early mobility and satisfactory neurological recovery. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly recommended for the diagnosis of mediastinal lymphadenopathy with malignant and nonmalignant etiology. EBUS-TBNA has been preferred over mediastinoscopy because of several advantages such as comparable diagnostic accuracy, safety, cost-effectiveness, and less invasiveness. Hemorrhage, mediastinitis, pneumonia, mediastinal abscess, empyema, lung abscess, pericarditis, and pneumothorax have been reported as major complications of EBUS-TBNA. Equipment malfunction has been observed mostly in the form of breakage of EBUS scope parts such as working channel, optical fibers, and ultrasound probe. Needle malfunction either involving assembly leading to inability to retract the needle within the sheath or accidental breakage of the needle tip has also been reported but the evidence is still limited. We encountered an accidental breakage of needle tip while performing EBUS-TBNA procedure in a 58-year-old male having subcarinal lymphadenopathy suspected to have lung cancer. We were able to successfully retrieve the broken fragment bronchoscopically without any complications. [ABSTRACT FROM AUTHOR]

Background: There is global shortage of Personal Protective Equipment due to COVID-19 pandemic. N95 Filtering Facepiece Respirators (N95-FFRs) provide respiratory protection against respiratory pathogens including SARS-CoV-2. There is scant literature on reprocessing methods which can enable reuse of N95-FFRs. Aim: We conducted this study to evaluate research done, prior to COVID-19 pandemic, on various decontamination methods for reprocessing of N95-FFRs. Methods: We searched 5 electronic databases (Pubmed, Google Scholar, Crossref, Ovid, ScienceDirect) and 1 Grey literature database (OpenGrey). We included original studies, published prior to year 2020, which had evaluated any decontamination method on FFRs. Studies had evaluated a reprocessing method against parameters namely physical changes, user acceptability, respirator fit, filter efficiency, microbicidal efficacy and presence of chemical residues post-reprocessing. Findings and conclusions: Overall, we found 7887 records amongst which 17 original research articles were finally included for qualitative analysis. Overall, 21 different types of decontamination or reprocessing methods for N95-FFRs were evaluated. Most commonly evaluated method for reprocessing of FFRs was Ultraviolet (Type-C) irradiation (UVGI) which was evaluated in 13/17 (76%) studies. We found published literature was scant on this topic despite warning signs of pandemic of a respiratory illness over the years. Promising technologies requiring expeditious evaluation are UVGI, Microwave generated steam (MGS) and based on Hydrogen peroxide vapor. Global presence of technologies, which have been given Emergency use authorisation for N95-FFR reprocessing, is extremely limited. Reprocessing of N95-FFRs by MGS should be considered for emergency implementation in resource limited settings to tackle shortage of N95-FFRs. Systematic review identifier: PROSPERO, PROSPERO ID: CRD42020189684, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020189684). [ABSTRACT FROM AUTHOR]

Disease associated with SARS-CoV-2 also termed as Coronavirus disease 2019 or COVID-19, has become a potential threat to public health by spreading across more than 200 countries worldwide within a short span of time. Tuberculosis (TB) is already existing as unprecedented pandemic worldwide over several years. Both diseases have many overlapping features but there are striking differences too. There is usually chronicity of symptoms in TB as compared to acute or rapid progression in COVID-19. Little evidence exists regarding TB and COVID-19 coinfection. It is anticipated that person with TB either in active, previously treated or latent forms are more at risk of poor outcomes with COVID-19. The relationship between the two diseases is still unclear at present, and more studies are needed to enable analyses of interactions and determinants of outcomes in patients affected by both the diseases. Most of the countries across the world imposed nationwide lockdown to promote social distancing, which is one important preventive measure to mitigate the spread of COVID-19 pandemic. However, it becomes quite challenging to ensure smooth functioning of programmatic services, leading to disruption of routine TB care, leading to transmission of infection. Health authorities should frame polices that can support TB patients by providing diagnostic, management and prevention services without any interruption during this era of ongoing COVID-19 pandemic. Effort should be made to control both the diseases simultaneously and avoid unfavourable outcome in near future. [ABSTRACT FROM AUTHOR]

This paper investigates the performance of adaptive neural networks through simulations for satellite systems involving three-axis attitude control algorithms. PID tuning is the method employed traditionally. An optimally tuned, to minimizes the deviation from set point. It also responds quickly to the disturbances with some minimal overshoot. However, the disadvantage of poor performance has been observed in these controllers when manual tuning is used which in itself a monotonous process is. The PID controller using Ziegler-Nichols has more transient responses of satellite such as Overshoot, Settling time, and Steady state errors. For overcome this technique, the proposed analysis implemented an Adaptive Neural Network with PID tuning. The paper aims to combine two feedback methods by using neural networks. These methods are feed-forward and error feedback adaptive control. The research work is expected to reveal the inside working of these neural network controllers for state and error feedback input states. An error driven adaptive control systems is produced, when the neural networks acquire the knowledge of slopes and gains regarding the error feedback, while, with state feedback the system will keep trying to approximate a stable approach in order to stabilize the attitude of the satellite. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric patients are a special group of patients whose management is challenged by concerns for fetal viability, altered maternal physiology, and diseases specific to pregnancy. Materials and methods: A prospective analysis of all obstetric patients admitted to the critical care department was done to assess reasons for transfer to the critical care unit (CCU) and the interventions required for management of these patients. Results: Between June 2013 and September 2017, obstetric admission comprised 95 women (5.9%) of the total critical care admissions. There were 77 patients (81.1%) who were discharged from the hospital and 18 patients (18.9%) died. In most of the cases, the primary reasons for shifting the patient to the CCU were severe preeclampsia with pulmonary edema (22.1%), eclampsia (8.4%), acute respiratory distress syndrome (ARDS) (14.7%), and hypovolemic shock in antepartum hemorrhage (APH) and postpartum hemorrhage (PPH) (10.5 and 13.7%, respectively). It was seen that 73 patients (76.8%) required ventilator support, 58 patients (57.4%) required vasopressor support, and intensive hemodynamic monitoring and blood/blood products were transfused in 55 patients (54.5%). The need for ventilator support was more in patients with a lower PaO2/FiO2 and a higher APACHE II score. Patients with a high severity of illness score and a lower PaO2/FiO2 had higher odds of requiring vasopressors. Low hemoglobin at the time of transfer to the CCU and a prolonged hospital stay were found to predict the need for blood transfusion. Conclusion: Obstetric patients are susceptible to critical illnesses but timely management improves the outcome of these young women. [ABSTRACT FROM AUTHOR]

Due to the increasing complexity of manufacturing processes and automation, maintenance of all machines and equipments has become challenging task for production managers today. Due to lack of sensitivity for maintenance, share of maintenance cost in total product cost is also increasing along with decreased productivity. Organizations are either quite slow or getting failed in updating their maintenance systems with time. Keeping in view the importance of maintenance in today's context, this study has tried to develop a framework for a sustainable maintenance system for manufacturing organizations. Usually organizations are not able to identify critical factors for effective maintenance. Therefore, in this context, the study has identified fourteen factors for the effective maintenance management from the literature review. Some of these factors are process oriented and some are result oriented. Interpretive structural modeling approach is applied for the development of structural relationship among the factors from a strategic perspective. Fuzzy MICMAC analysis is then carried out to categorize these factors based on their driving and dependence value. Further to prioritise major driving factors, Technique for order preferences by similarity of an ideal solution approach has been also applied. It is observed that top management support and commitment, strategic planning and implementation, continuous upgradation of maintenance system to reduce manufacturing lead time and cost are major factors to ensure the sustainable competitive advantage. [ABSTRACT FROM AUTHOR]

In this chapter, we examine a significant shift in research in the learning sciences, mathematics education, and science education that increasingly attends to the co-construction of power and learning. We review articles in these fields that embody a new sense of theoretical and methodological possibilities and dilemmas, brewing at the intersections of critical social theory and the methodological approaches of interaction analysis and microgenetic analysis. We organize our review into three thematic categories: (1) the dynamic construction of identity and ideology, (2) attending to the organization of a learning environment, and (3) leveraging and repurposing tools. Reading across these thematic areas, we identify and outline a burgeoning subfield that we term critical interaction and microgenetic analysis. By bringing this collection of articles together, this chapter provides collective epistemic and empirical weight to claims of power and learning as co-constituted and co-constructed through interactional, microgenetic, and structural dynamics. In our conclusions, we suggest six analytical commitments that are important to hold when engaging in critical interaction and microgenetic analysis. [ABSTRACT FROM AUTHOR]

Objectives. The primary objective is to determine the frequency of history findings associated with cardiac syncope. Second, to determine the frequency of abnormal electrocardiograms (EKG) in patients presenting with typical vasovagal syncope. Methods. Retrospective chart review from January 2006 to April 2017 of children aged 5 to 18 years presenting to the emergency department with a chief complaint of syncope. Target population was all patients with first episode of syncope and a documented EKG. Excluded patients were those with head trauma, drug intoxication, current pregnancy, seizure, and any endocrine problem. Patients with cardiac causes of syncope were identified by an abnormal EKG or echocardiogram. Specific history findings (past cardiac history, chest pain, palpitations, syncope with exercise, absence of prodrome with syncope) were compared with those with and without cardiac etiology of syncope. The possibility of missing a patient with cardiac cause of syncope based on specific history findings was identified. Results. Of the total 4115 visits of patients with chief complaints of syncope, 2293 patients (55.7%) met the inclusion criteria. Nine patients (0.39%) were identified with cardiac etiology of syncope. The remaining were determined to be of vasovagal origin. All patients with cardiac etiology of syncope were found to have one positive specific history findings. A total of 1972 patients were identified with absence of specific history findings; no patient had a cardiac etiology of syncope. Conclusions. This study identifies screening questions to identify cardiac syncope. Implementing these standard questions could potentially decrease resource utilization and time for evaluation as well as guide follow-up. [ABSTRACT FROM AUTHOR]

Cryopyrin‐associated periodic fever syndrome (CAPS) represents an increasingly recognized disease group entity, with varied presentations. CAPS includes 3 clinical entities, namely, familial cold‐induced autoinflammatory syndrome (FCAS; MIM #120100), Muckle‐Wells syndrome (MWS; MIM #191900) and chronic inflammatory neurologic cutaneous and articular syndrome (CINCA; MIM #607115); which share several overlapping clinical features. These patients often present with early‐onset episodes of fever and rash, and variable systemic signs and symptoms, making it a great mimicker of other systemic autoimmune diseases. The episodes are transient and related to exposure to cold temperature and worsen in the winter season. We hereby present a case presenting with recurrent seasonal fever and rash, diagnosed as FCAS/ MWS overlap based on clinical signs and symptoms and positive testing for NLRP3 gene mutation. We also discuss the clinical presentation and complications of CAPS, chiefly FCAS and MWS, along with the previously described pediatric cases of CAPS. We tried to review the complexities of management of such patients, including the genetic diagnosis and the role of biological therapy. Based on the review of the literature, given the evident broad spectrum of symptoms and signs, use of next‐generation sequencing can help in prompt diagnosis and early initiation of biological agents, which may play a great role in reducing the complications that these patients may experience in the long run. [ABSTRACT FROM AUTHOR]

Background: Tinkering, an ad hoc approach to solving a problem, involves manipulating objects to characterize and build knowledge about a particular system in an exploratory way, often with the goal of getting some product/idea to produce desired behavior. Tinkering contrasts more deliberate activity toward understanding how a phenomenon works. Purpose Some researchers have argued that tinkering is an unproductive engineering design practice because it does not always lead to progress in design and/or conceptual learning while others have argued for tinkering as a productive design practice. We speak to this disagreement regarding the productivity of tinkering for novice designers by closely analyzing tinkering episodes. Design/Method: We present a microgenetic account of two tinkering episodes to contribute to a more refined understanding of what tinkering is. The research setting is in a summer camp for high school girls using a design‐based Arduino component. Results: Our analyses demonstrate that tinkering is neither universally productive nor unproductive in engineering design; we show that tinkering can help participants make progress toward some instructional goals such as supporting the engagement of students in some engineering design practices. We also show that tinkering can hinder progress toward other goals such as developing a robust solution to a design problem. Conclusions: We argue for a more nuanced understanding of productivity (of tinkering and other design practices), which is local and defined with respect to specific goals and actors. [ABSTRACT FROM AUTHOR]

Digital society has caused an evolution in pharma marketing strategies. Many digital channels are changing doctors' and patients' habits due to technological advancements. Pharmaceutical companies can target doctors based on their preferences by using digital platforms like advertisement, emails, paid searches, telephone calls, etc. Effective implementation of digital marketing techniques provides companies to expand their market reach and gain high profits. The marketers can gain good profits if they can select only those physicians with a high probability of responding positively. This means they can efficiently use their resources by reaching out to only a few physicians instead of mailing or telephoning every prospect on their list. In this paper, we are focusing on creating a digital strategy in which companies can have high sales in less effort by using response modeling. [ABSTRACT FROM AUTHOR]

Amyloidosis secondary to juvenile idiopathic arthritis is a known complication of poorly controlled systemic juvenile idiopathic arthritis (SJIA), occurring in 1–2% of the patients. The IL-6 inhibitor tocilizumab is effective in controlling systemic signs and symptoms of sJIA and may be of therapeutic benefit in secondary amyloidosis. Herein, we report the clinical timeline of a 10-year boy with sJIA and secondary amyloidosis, who showed a sustained improvement of systemic symptoms and a reduction in proteinuria with tocilizumab. Compared to the data on adult patients affected with the secondary amyloidosis, there are very few reports on therapeutic options for the children affected with SJIA and secondary amyloidosis in the paediatric population. While doing a systematic literature search for writing this review, we could only retrieve nine case reports and one case series of the children affected with SJIA and secondary amyloidosis, including five cases which were treated with tocilizumab. We also looked into the clinical and biochemical response to various agents that have been used in the previous cases, including tocilizumab. The available literature and the present case report suggest that tocilizumab may be considered as a safe and effective option to treat SJIA-related secondary amyloidosis. [ABSTRACT FROM AUTHOR]

Lung recruitment maneuvers are rescue measures commonly used to improve oxygenation in severely hypoxemic patients with acute respiratory distress syndrome (ARDS), who fail to improve on standard treatment. After recruitment, appropriate level of positive end.expiratory pressure (PEEP) is applied to prevent alveolar de.recruitment during expiration. Computed tomography scan of thorax and quasi.static pressure.volume curves have played a pivotal role are important in the assessment of recruitment, but they have several limitations. Lung ultrasound (LUS), which is now easily available in nearly every Intensive Care Unit, could be an attractive alternative method for assessing lung recruitment. It is noninvasive, easily repeatable and is devoid of radiation hazards. We are presenting a case of 24.year.old female patient with moderate ARDS in whom bedside LUS was successfully used into assessing lung recruitment as well as into determining the appropriate level of PEEP. [ABSTRACT FROM AUTHOR]

The heat transfer and flow performance of the plate fin heat sink in a horizontal rectangular channel with dimples and protrusions on the fin surfaces has been experimentally investigated in forced convection. The Nusselt number and friction factor are obtained by varying the system parameters as depth and pitch of the dimples for inline and staggered arrangements. The Reynolds number is considered in the range of 6800 to 15,200. The effect of depth and pitch of dimples are examined under constant heat flux while keeping the constant diameter of dimples. Experimental results indicate that the heat transfer and flow performance of fin array are significantly influenced by increasing the depth of dimples. The heat transfer from fin array is enhanced and the flow resistance is increased by decreasing the pitch ratio (s/d) and increasing the depth ratio (D/d). The maximum fin performance of dimpled fin heat sink corresponds to the staggered arrangement of dimpled heat sink with dimple pitch ratio (s/d) of 2.5 and dimple depth ratio (D/d) of 0.5. [ABSTRACT FROM AUTHOR]

Introduction: Upper airway imaging can often identify the anatomical risk factors for sleep apnea and provide sufficient insight into the pathophysiology of obstructive sleep apnea (OSA). Materials and Methods: We conducted a case–control, observational study at a tertiary care hospital in North India. All cases and controls underwent lateral cephalometry and magnetic resonance imaging (MRI) for craniofacial and upper airway evaluation. Only the cases had polysomnography testing for confirmation of OSA and assessing the severity of disease. Results: Forty cases and an equal number of matched controls were recruited. On X‑ray cephalometry, it was observed that the cases had a significantly larger hyoid mandibular distance and soft palate length; and shorter mandibular length. The MRI cephalometric variables were significantly different, the soft palate length, tongue length, and submental fat were longer while the retropalatal and retroglossal distance was shorter amongst the cases. A statistically significant positive correlation was found between the cephalometric parameters and the indices of severity of OSA. An increased hyoid mandibular distance and soft palate length, and a decrease in the lower anterior facial height were found to be predictive of severe OSA (Apnea–Hypopnea Index –>30/h). An increased hyoid mandibular distance, soft palate length, and the tongue length and a reduced mandibular length were found to be predictive of need for continuous positive airway pressure (CPAP) pressures of ≥15 cm H2O. There were significant differences between the cephalometric parameters of the Indian OSA patients and patients from other ethnicities reported in the literature. Conclusions: OSA patients had a significantly smaller upper airway compared to age‑, sex‑, and body mass index‑matched controls and cephalometric variables correlated with the indices of OSA severity. The cephalometric assessment was also predictive of severe OSA and the need for higher pressures of CPAP. This indicates the important role of upper airway anatomy in the pathogenesis of OSA. [ABSTRACT FROM AUTHOR]

We aimed to determine the frequency of blood glucose and electrocardiogram (EKG) abnormalities in previously healthy children who present to an emergency department (ED) with a diagnosis of benign syncope. Chart review of consecutive children aged 5 to 18 years presenting to the pediatric ED from 2004 to 2014 with a discharge diagnosis of benign syncope was done. Of 969 patients, hypoglycemia (serum glucose <60 mg/dL) was present in only 3 cases (0.3%). Of 754 patients with EKG performed, only 4 cases (0.6%) was an abnormality requiring further cardiac evaluation identified; cardiac echocardiogram was performed in 3 of these 4 patients, which revealed no cardiac pathology. Financial analysis for performing blood glucose measurement and EKG on these patients amounted to total health care cost of $222 526. We concluded that previously healthy children with syncope rarely have hypoglycemia or underlying cardiac abnormality. The routine performance of tests can incur significant health care expenditure. [ABSTRACT FROM AUTHOR]

The association of Addison's disease and chronic lymphocytic thyroiditis is a well-known disease complex, historically known as Schmidt disease. Here, we present the case of a patient who presented with primary Addison's disease and on further evaluation was also found to have a subclinical hypothyroidism without a positive marker of autoimmunity. The coexistence of these endocrine disorders simultaneously without thyroid peroxidase antibody positivity and steroid replacement alone in such a case resulting in complete recovery of thyroid function had not described in the literature. [ABSTRACT FROM AUTHOR]