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BACKGROUND Ankle fractures are among the most common injuries encountered by orthopaedic surgeons. An ankle is considered unstable when the loss of normal constraints around the ankle permits the talus to move in a non-physiologic pattern. Under such circumstances, the dynamic joint surface contact area within the ankle is diminished, which predisposes to articular cartilage damage and premature degeneration. In today’s time, many modalities are available for surgical fixation of bimalleolar fractures. Such interventions restore anatomy and biomechanics of the ankle joint. Even though there are plethora of foreign studies on similar matter, deficiency of such analysis has been depicted in literature from developing countries, particularly from South-East Asian region. In this study, we wanted to assess various methods of internal fixation in ankle fracture & evaluate their clinical and radiological outcome post-operatively. METHODS 26 ankle fracture patients in the age group of 18 - 60 years were included in this study. Fractures were classified pre-operatively based on Lauge-Hansen classification. Patients were followed up at regular intervals of 1st, 2nd, 3rd, 6th & 12 month after surgery and assessed by Baird and Jackson scoring system based on subjective, objective and radiographic criteria. Complications like infection, arthritis, stiffness & implant failure were assessed on regular follow-up. RESULTS Variety of methods (including k-wires, plates & screws) were used for surgical fixation. Majority of fractures resulted from road traffic accident (RTA). Patients were evaluated using Baird & Jackson scoring system during follow-up at 1st, 2nd , 3 rd, 6th & 12 month. All patients had poor scores for initial 3 months. Patients showed good to excellent result on final follow-up at 9 to 12 months after surgery. Complications were observed in 19 % cases with arthritis being most common. CONCLUSIONS Open reduction and internal fixation restores the articular congruity of the ankle joint. The operative result was satisfactory with good clinical outcome. KEYWORDS Ankle, Fracture, Anatomy, Modalities

Introduction: Celiac disease (CD) may be an underlying cause of malnutrition. Aim: The objective of this study was to find out the seroprevalence of CD in children suffering from severe acute malnutrition (SAM) in age group of 1–5 years. Materials and Methods: This was a prospective, observational, hospital-based study carried out at Malnutrition Treatment Centre attached with the ananta institute of medical science & research center Rajsamand, Rajasthan, from February 2019 to January 2020. A total of 220 children with SAM were enrolled and screened for CD on the basis of celiac serology (tissue transglutaminase [tTg]-immunoglobulin A/G [IgA/IgG]). Results: Celiac serology was positivity in 60 (27.28%) cases; out of total 60 seropositive cases, 28 (46.66%) cases were seropositive for both tTg-IgA and IgG, while only tTg-IgA and only tTg-IgG were positive in 18 (30%) and 14 (23.33%) cases, respectively. Mean serotiter of serum tTg-IgA and IgG in seropositive cases was 134.01±198.74 and 49.05±25.74 unit/ml. Conclusions: High seroprevalence of CD in SAM should be taken as alert as CD may be an underlying cause and responsible for malnutrition. These children should be screened by celiac serology (tTg-IgA/IgG) to rule out CD. Key words: Celiac disease, Seroprevalence, Severe acute malnutrition

Memristive devices (MD) are electrical devices which have many applications, including logic design, memory devices and neuromorphic systems. MD is lucrative due to its nonvolatility, no leakage current, better scalability and compatibility with CMOS. Here, we have shown the effect on current–voltage hysteresis curve by varying frequency, threshold voltage and dimensions of the device. Memristor metal oxide semiconductor (MeMOS)-based digital logic gates are designed and simulated in this thesis. We are using voltage threshold adaptive memristor (VTEAM) model in Cadence Virtuoso. MeMOS-based design leads to a reduction in the die area as compared to conventional CMOS.

For the last 60 years, acoustic wave devices have been used. In the last two decades, surface acoustic wave (SAW) devices have gained interest for sensor applications. The velocity and damping are sensitive to the outside parameter of SAW devices; therefore, they are attracting the people toward their use. A SAW device is consisting of a piezoelectric material with metal inter-digital transducer on its surface. When an electrical signal is applied, it converts into an acoustic wave.

PURPOSE Hereditary breast and ovarian cancer (HBOC) syndrome is primarily characterized by mutations in the BRCA1/2 genes. There are several barriers to the implementation of genetic testing and counseling in India that may affect clinical decisions. These consensus recommendations were therefore convened as a collaborative effort to improve testing and management of HBOC in India. DESIGN Recommendations were developed by a multidisciplinary group of experts from the Indian Society of Medical and Pediatric Oncology and some invited experts on the basis of graded evidence from the literature and using a formal Delphi process to help reach consensus. PubMed and Google Scholar databases were searched to source relevant articles. RESULTS This consensus statement provides practical insight into identifying patients who should undergo genetic counseling and testing on the basis of assessments of family and ancestry and personal history of HBOC. It discusses the need and significance of genetic counselors and medical professionals who have the necessary expertise in genetic counseling and testing. Recommendations elucidate requirements of pretest counseling, including discussions on genetic variants of uncertain significance and risk reduction options. The group of experts recommended single-site mutation testing in families with a known mutation and next-generation sequencing coupled with multiplex ligation probe amplification for the detection of large genomic rearrangements for unknown mutations. Recommendations for surgical and lifestyle-related risk reduction approaches and management using poly (ADP-ribose) polymerase inhibitors are also detailed. CONCLUSION With rapid strides being made in the field of genetic testing/counseling in India, more oncologists are expected to include genetic testing/counseling as part of their clinical practice. These consensus recommendations are anticipated to help homogenize genetic testing and management of HBOC in India for improved patient care.

Metastatic breast cancer (MBC) is cancer that has spread from the breast to another part of the body or has come back in another distant location. Treatment options for MBC depend on several factors, including where the cancer has spread, the patient's overall health, and the levels of hormone receptors and HER2 in the tumour. Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours.[7],[8],[9],[10] This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of these agents and the management of HER2 positive MBC for the benefit of community oncologists.

Substantial survival benefits exist for patients with early-stage breast cancer who undergo treatment with single-modality ovarian suppression, but its value is uncertain. Expert oncologist discussed to determine whether additional benefits exist with ovarian suppression plus multiple adjuvant therapy which provides a new treatment option that reduces the risk of recurrence in early breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Age has been linked to performance in multiple meta-analytical reviews. However, there is a lack of consensus in the extant literature about the exact nature of this relationship. Moreover, existin...

OBJECTIVE. The objective of our study was to correlate semiquantitative PET parameters—standardized uptake value (SUV) and total lesion glycolysis (TLG)—derived in simultaneous PET/MRI using MRI-ba...

Purpose The purpose of this paper is to argue for theoretical integration as a major step in consolidation of the vast leadership literature. It is an attempt to lay out a basic canvas that could be further used for building an integrated theory of leadership. Design/methodology/approach The concept matrix framework (Webster and Watson, 2002) has been used for analytical abstraction to organize the published research on leadership and distill certain commonalities. The paper finally proposes certain pivots for theoretical integration of the leadership literature. Findings A thorough analysis of the leadership literature and the identification of commonalities within the various theories help the authors to identify the change and collective filter, outcomes of leadership, organizational outcomes, leadership role, sources of leadership, processes within the larger leadership process and the context as the pivots for building an integrated theory of leadership. Research limitations/implications While the paper is not a detailed literature review and lacks predictive power, it is a synthesis of the published literature. The paper proposes a descriptive model meant to provide a sound foundation for an integrated theory of leadership. Practical implications The paper provides a framework to reduce the complexity and ambiguity of leadership research literature and could be utilized as a starting platform for an integrated theory of leadership. It is hoped that this shall also provide leaders and leadership training providers with a more holistic approach for leadership assessment and development. Originality/value Based on a survey of literature, the explanation of the leadership process, suggestions for evaluation of quality of leadership and pivots for theoretical integration are the main contributions.

Abhijeet, Amit, Alok and Saumitra met recently while attending a six-month residential course on entrepreneurship at a leading management institute in eastern India and decided to start a business venture together. They formed a partnership firm named Fiamchi, and explored the opportunity of producing the Pangasius breed of catfish in either open tanks or using the cage farming method. The opportunity looked attractive. There was good demand for fish locally. Also, technical and financial support was available through various government schemes. The cost-structure was such that their venture had a good chance of making profits. However, social issues peculiar to Jharkhand state, the region where they were planning to start their venture, made their decision to go ahead a tough one. A largely uneducated, poverty stricken, nature worshiping, tribal population lived in the area. There was a possibility that the local population would oppose the project due to their social and religious beliefs. Also, the region was affected by Naxalite violence. The entrepreneurs were concerned about the impact that the social unrest and violence would have on their venture. More importantly, they were also worried that the local population would initially allow them to commence their business but cause a “hold-up” at a later stage when the investments were already made. For a business dealing in the production of a rather fragile and perishable product, this sort of a ‘hold-up’ would have serious negative implications and lead to large losses. The case discusses four strategic alternatives that the entrepreneurs need to evaluate. They can either buy peace; collaborate in government projects in the region; approach local population through a not-for-profit or non-governmental organization; or seek corporate support through the corporate social responsibility activities of a large company active in the region.

FinFET is a type of multi-gate Metal Oxide Semiconductor Field Effect Transistor where gate covers around the slim tri-gate FinFET [1]. Since the channels are completely surrounded by the gate, the overall inversion layer is larger, which results more drain current. It can be optimized with multiple fins. This structure also characterize very little leakage current flow through the body when the transistor is in OFF state and therefore results in optimized performance and low static power.

Lung cancer, one of the most frequently diagnosed cancers worldwide has long relied on testing for the molecular biomarkers EGFR/ALK. However, achieving superior clinical outcomes for patients with lung cancer requires developing comprehensive techniques beyond contemporary EGFR/ALK testing. Current technologies are on par with molecular testing for EGFR/ALK in terms of efficacy, most of them failing to offer improvements perhaps primarily due to skepticism among clinicians, despite being recommended in the NCCN guidelines. The present study endeavored to minimize chemotherapy-dependence in EGFR/ALK-negative patient cohorts, and use evidence-based methods to identify ways to improve clinical outcomes. In total, 137 lung cancer cases obtained from 'PositiveSelect NGS data', comprising 91 males and 46 females, were investigated. EGFR- and ALK-positivity was used for data dichotomization to understand the therapeutic utility of rare gene alterations beyond just EGFR/ALK. Statistics obtained from PositiveSelect were collated with data from international studies to construct a meta-analysis intended to achieve better clinical outcomes. Upon dichotomization, 23% of cases harbored EGFR variants indicating that treating with EGFR TKIs would be beneficial; the remaining 77% exhibited no EGFR variants that would indicate favorable results using specific currently available chemotherapy practices. Similarly, 28% of cases had EGFR+ALK variants favoring EGFR/ALK-based targeted therapeutics; the remaining 72% harbored no EGFR/ALK variants with known beneficial chemotherapy routes. The present study aimed to overcome current inadequacies of targeted therapies in patients with a conventional EGFR/ALK-positive diagnosis and those in EGFR+ALK-negative cohorts. Upon analysis of the negative cohorts, significant and clinically relevant single nucleotide variants were identified in KRAS, ERBB2, MET and RET, with frequencies of 7, 1, 2 and 3% in patients who were EGFR-negative and 6, 1, 1, and 3% in patients who were EGFR and ALK-negative, respectively, enabling the use of targeted therapeutics aside from EGFR/ALK TKIs. From the results of the current study only 35% of the two negative arms (EGFR negative and EGFR+ALK negative) would be recommended NCCN or off-label chemotherapy; prior to the current study, the entire cohorts would have been recommended this treatment. The present study emphasizes the potential of comprehensive genomics in identifying hallmarks of lung cancer beyond EGFR/ALK, using broad-spectrum genetic testing and data-sharing among medical professionals to circumvent ineffective chemotherapy.

Human papillomavirus (HPV) associated head and neck squamous cell cancers (HNSCC) have become increasingly common in the West, but the same cannot be said about India. These cancers have a different biology and confer a better prognosis, however, its current role in the management of patients in India is not clearly defined. At the 35th Indian Cooperative Oncology Network conference held in September 2016, a panel of radiation, surgical and medical oncologists, pathologists, and basic scientists from across the country having experience in clinical research with respect to HPV in HNSCC reviewed the available literature from India. All the ideas and facts were thereafter collated in this report. Various topics of controversy in dealing with the diagnosis and management of HPV-associated HNSCC have been highlighted in this report in context to the Indian scenario. Furthermore, the prevalence of the same and its association with tobacco and high-risk sexual behavior has been touched on. Conclusively, a set of recommendations has been proposed by the panel to guide the practicing oncologists of the country while dealing with HPV-associated HNSCC.

Chronic myelogenous leukemia (LML) was recognized as a distinct entity in the mid-1800s. Since Nowell and Hunagerford initiated their research on CML in1960 our understanding in CML has been increasing. Imatinib became the preferred treatment from 2000 onwards as a result of its unprecedented success. The lack of structured Indian data on CML led to the formation of a CML data cansortuim which invited CML data albiet retro spartive form around the country including major cancer service providers both government and private. We provide a summary of published Indian data on CML here.

349 Background: In a real-world scenario, Fluorouracil-based triplet combination chemotherapies have limited feasibility with regards to toxicity, need for central venous access, and hospitalization. The primary objective of this study was to assess pathological tumor regression to Capecitabine-based triplet regimes, with the additional possible benefit of overcoming the aforementioned barriers. Methods: This Single-Arm, Prospective study investigated the primary outcome of histopathologic regression to perioperative Docetaxel, Oxaliplatin, and Capecitabine (DOX) combination regime in histologically confirmed resectable Esophageal, Esophagogastric Junction, and Gastric Adenocarcinomas. Three preoperative and 3 postoperative cycles of Docetaxel 60mg/m2 plus Oxaliplatin 100mg/m2 on Day 1, with Capecitabine 500mg/m2 twice daily from Day 1 to Day 21 were administered, with cycles repeating every 21 days. Histopathologic regression was assessed by Modified Ryan’s Schema on surgical specimen. The study had an 80% power (two-sided significance of 0.05) to detect a 20% pathological complete response. Secondary endpoints were Overall Survival, Progression-Free Survival, and Toxicity analysis. Results: Between June 2017 to May 2019, 28 patients (median age 54.5 years [Range 33 – 82]; Male 78.6%; ECOG PS 1/2 = 42.9%/57.1%) were enrolled in the study of which 92.9% completed preoperative chemotherapy. Of the 20 patients operated upon, 100% were R0 resections. Pathological complete response was observed in 20% (4/20). Ninety percent of the operated patients completed the postoperative treatment. The most common grade ≥3 toxicities were Palmar-Plantar Erythrodysesthesia (10.7%), Fatigue (10.7%), and Diarrhoea (7.1%). Conclusions: Perioperative DOX met its primary endpoint of 20% pathologic complete regression with a favourable toxicity profile and was feasible to administer in resectable Esophageal, Esophagogastric Junction, and Gastric Adenocarcinomas. This regimen deserves further evaluation in larger phase III trials.

Objective In India, cervical cancer accounts for almost 14% of all female cancer cases. Although poverty continues to cast a wide net over the Indian subcontinent, the preceding three decades have borne witness to improvements in nutrition and sanitation for many citizens. However, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. Treatment of cervical cancer is stage-specific and depends on the patient’s age, desire to preserve fertility, overall health, the clinician’s expertise, and accessibility to resources. There is a paucity of uniform treatment protocols for various stages of cervical cancer in India. Considering all these parameters, a need to optimize treatment paradigms for the Indian population emerged. Methods/materials Three expert panel meetings were held in different regions of India from 2016 to 2017. They were comprised of 15 experts from across the country, and included surgical oncologists, radiation oncologists, and medical oncologists. The panel members reviewed the literature from both national and global sources, discussed their clinical experience and local practices and evaluated current therapeutic options and management gaps for women diagnosed with cervical cancer. Results This article summarizes the expert opinion from these meetings. It discusses the available resources and highlights the current therapeutic options available for different cervical cancer stages: early stage disease, locally advanced tumors, recurrent/persistent/metastatic cancer. An Indian consensus governing treatment options emerged, including guidelines for use of the only approved targeted therapy in this disease, the anti-angiogenesis drug, bevacizumab. Conclusions The panel concluded that given the availability of state-of-the-art imaging modalities, surgical devices, radiotherapeutics, and novel agents in several population-dense urban centers, a uniform, multi-disciplinary treatment approach across patient care centers is ideal but not realistic due to cost and a paucity of third party payors for most Indian citizens. Preventative strategies including visual inspection with acetic acid to screen for precursor lesions (i.e., cervical intraepithelial neoplasia) with immediate referral for cervical cryotherapy and possible large-scale roll-out of the HPV vaccine in the near future can be expected to reduce mortality rates significantly in this country.

Lung cancer, one of the most frequently diagnosed cancers worldwide has long relied on testing for the molecular biomarkers EGFR/ALK. However, achieving superior clinical outcomes for patients with lung cancer requires developing comprehensive techniques beyond contemporary EGFR/ALK testing. Current technologies are on par with molecular testing for EGFR/ALK in terms of efficacy, most of them failing to offer improvements perhaps primarily due to skepticism among clinicians, despite being recommended in the NCCN guidelines. The present study endeavored to minimize chemotherapy-dependence in EGFR/ALK-negative patient cohorts, and use evidence-based methods to identify ways to improve clinical outcomes. In total, 137 lung cancer cases obtained from ‘PositiveSelect NGS data’, comprising 91 males and 46 females, were investigated. EGFR- and ALK-positivity was used for data dichotomization to understand the therapeutic utility of rare gene alterations beyond just EGFR/ALK. Statistics obtained from PositiveSelect were collated with data from international studies to construct a meta-analysis intended to achieve better clinical outcomes. Upon dichotomization, 23% of cases harbored EGFR variants indicating that treating with EGFR TKIs would be beneficial; the remaining 77% exhibited no EGFR variants that would indicate favorable results using specific currently available chemotherapy practices. Similarly, 28% of cases had EGFR+ALK variants favoring EGFR/ALK-based targeted therapeutics; the remaining 72% harbored no EGFR/ALK variants with known beneficial chemotherapy routes. The present study aimed to overcome current inadequacies of targeted therapies in patients with a conventional EGFR/ALK-positive diagnosis and those in EGFR+ALK-negative cohorts. Upon analysis of the negative cohorts, significant and clinically relevant single nucleotide variants were identified in KRAS, ERBB2, MET and RET, with frequencies of 7, 1, 2 and 3% in patients who were EGFR-negative and 6, 1, 1, and 3% in patients who were EGFR and ALK-negative, respectively, enabling the use of targeted therapeutics aside from EGFR/ALK TKIs. From the results of the current study only 35% of the two negative arms (EGFR negative and EGFR+ALK negative) would be recommended NCCN or off-label chemotherapy; prior to the current study, the entire cohorts would have been recommended this treatment. The present study emphasizes the potential of comprehensive genomics in identifying hallmarks of lung cancer beyond EGFR/ALK, using broad-spectrum genetic testing and data-sharing among medical professionals to circumvent ineffective chemotherapy.

Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is a more aggressive subtype of breast cancer and targeting the HER2 receptor has proven effective in improving the prognosis of these patients. Pertuzumab, a recombinant humanized monoclonal antibody and the first in a class of HER2 dimerization inhibitors approved for treating HER2+ breast cancer. It blocks ligand-dependent heterodimerization and ligand-independent homodimerization of HER2 with other HER members. When used in combination with trastuzumab and taxane, pertuzumab complements the action of trastuzumab and results in a comprehensive blockade of HER2 signaling pathway. This review article traces the development of pertuzumab from concept to its current use in HER2+ breast cancer treatment. A search of Medical Literature Published since 2007 was performed in PubMed using the keywords “pertuzumab,” “HER2+ breast cancer,” “HER2 targeted therapy,” “metastatic breast cancer,” and in search engines for ongoing trials with pertuzumab and incidence of cancer and breast cancer in India. A total of 35 publications and abstracts from the American Society of Clinical Oncology were selected for this review. Pertuzumab is approved in combination with trastuzumab and docetaxel for the treatment of patients with HER2+ metastatic BC, who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. The dual HER2 blockade of pertuzumab and trastuzumab is now accepted worldwide as a standard of care by various guidelines.

Breast and/or ovarian cancers are among the most common cancers in women across the world. In the Indian population, the healthcare burden of breast and/or ovarian cancers has been steadily rising, thus stressing the need for early detection, surveillance, and disease management measures. However, the burden attributable to inherited mutations is not well characterized. We sequenced 1010 unrelated patients and families from across India with an indication of breast and/or ovarian cancers, using the TruSight Cancer panel which includes 14 genes, strongly associated with risk of hereditary breast and/or ovarian cancers. Genetic variations were identified using the StrandNGS software and interpreted using the StrandOmics platform. We were able to detect mutations in 304 (30.1%) cases, of which, 56 mutations were novel. A majority (84.9%) of the mutations were detected in the BRCA1/2 genes as compared to non-BRCA genes (15.1%). When the cases were stratified on the basis of age at diagnosis and family history of cancer, the high rate of 75% of detection of hereditary variants was observed in patients whose age at diagnosis was below 40 years and had first-degree family member(s) affected by breast and/or ovarian cancers. Our findings indicate that in the Indian population, there is a high prevalence of mutations in the high-risk breast cancer genes: BRCA1, BRCA2, TP53, and PALB2. In India, socioeconomic inequality limiting access to treatment is a major factor towards increased cancer burden; therefore, incorporation of a cost-effective and comprehensive multi-gene test will be helpful in ensuring widespread implementation of genetic screening in the clinical practice for hereditary breast and/or ovarian cancers.

The necessity for rapid speed digital circuits has become more outstanding as the communication field and the portable multimedia are incorporating in the area of information processing and computing. The major shortcoming of the current era computers shows the way of decline in the presentation of fundamental arithmetic calculations and operations which can be defined as addition, subtraction, division, multiplication in terms of delay, carry propagation, high power consumption and large circuitry complications. This system defines the addition/subtraction of the carry free n digits because the carry propagation delay is the significant and vital feature in terms of the speed of any digital system. In this paper, we are giving the basic review of papers for the QSD Adder / Subtractor.

The objective of our study was to correlate semiquantitative PET parameters-standardized uptake value (SUV) and total lesion glycolysis (TLG)-derived in simultaneous PET/MRI using MRI-based attenuation correction with clinical and histopathologic prognostic factors in patients with breast cancer.Eighty-two invasive ductal carcinomas in 69 women were included in the study. All the subjects underwent whole-body (WB) PET/MRI (supine WB mode) and dedicated PET/MRI of the breast (prone breast imaging mode) for staging on a simultaneous PET/MRI system. The SUV and TLG values were calculated fromA significant correlation was observed between mean SUV (SUVSemiquantitative FDG parameters derived with MRI-based attenuation correction in simultaneous PET/MRI are reliable and correlate with clinicopathologic features such as grade as well as subtype and thus could be used in the prognostication of breast cancer.

Arithmetic Logic Unit plays a vital role in the central processing unit of the computer system. Addition is considered to be a primary part in the ALU. Power and speed are the major parameters to be kept in mind for designing an adder. Because of carry propagation, complexity and delay gets introduced in the adder circuit due to which addition, subtraction and multiplication obtains delay in the Arithmetic Logic unit. In order to reduce the delay, carry-free addition is introduced by QSD (Quaternary Signed Digit) Numbers. In this paper, a fast QSD Addition and Subtraction circuit is designed by use of MIG and COG Reversible Logic Gates. We can visualize from the results session that Delay gets reduced up to 83% for the QSD addition and up to 90% for the QSD subtraction.

Most of the structures in flowing water are a challenge to their stability and sustainable with different flow conditions. Recent, renewable energy research and development covers ocean and river energy platform in which flow of water drag considered in various conversion devices towards the offshore and onshore establishment. Various energy platforms have been suggested for offshore development. However, the stability of these platforms in water is a serious concern. To study the water interaction over circular and square cross-section cascade system under the water has been carried out. Water flow around the pillars or column of the energy platform are analyzed through simulation software. Very low velocity 0.5 m/s has been considered to analyze the system. Total fifteen numbers of cascade pillars having circular and square cross-section area were considered. K-ε turbulence model is adopted to calculate the flow interaction to the column. A velocity, pressure, and energy fields are found around the column.&nbsp

Head and neck cancers (HNCs) are malignant tumors of the upper aerodigestive tract and are the sixth most common cancer worldwide. In India, around 30-40% of all cancers are HNCs. Even though there are global guidelines or recommendations for the management of HNCs, these may not be appropriate for Indian scenarios. In an effort to discuss current practices, latest developments and to come to a consensus to recommend management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical and radiation oncologists and dentists) was formed. A review of literature from medical databases was conducted to provide the best possible evidence base, which was reviewed by experts during a consensus group meeting (January, 2019) to provide recommendations.

The article proposes a framework utilizing the Person–Organization (P–O) fit approach to facilitate spirituality in the workplace. The article argues that spirituality can be described on a continuum varying from low to high at both individual and organizational levels. The interaction of the two continuums is then used to suggest a model to facilitate workplace spirituality. Thus, the approach is to first consider the interaction of person (individual) and situation (organization) factors and then depending on the (in)compatibility of these two factors, look for specific ways to facilitate spirituality at work. Various suggestions and examples are included to illustrate the practical implementation of our recommendations.

Purpose – The purpose of this paper is to explore how practical wisdom rooted in Buddhism can help modern managers make decisions in contemporary business organizations. Design/methodology/approach – The paper suggests a model explaining how individual level Buddhist beliefs in Dependent Origination are reflected in behavior of individual through mindfulness, compassion and expansion of self. The model also explores the consequences of above mentioned behavior in terms of individual, group and organizational level decision making, respectively. Findings – The paper develops propositions which demonstrate the possibility of applying the practical wisdom of Buddhism into the individual, group and organizational decision-making processes. The paper proposes an integrative model and suggests initiatives that can be taken in business organizations and business schools for applying the practical wisdom gleaned from the Buddhist traditions. Research limitations/implications – The paper brought the core concepts of Buddhism as the main point of application in the decision-making process in management. However, this approach is perhaps difficult to grasp for the readers who may not be as conversant with that tradition. Originality/value – Rich eastern traditions have remained underexplored in contemporary business literature. This paper examines the potential contributions from the Buddhist heritage in the crucial decision-making domain in management.

Meaning of work as explored in this study refers to the function that organizational paid employment serves for people. Is work a means of fulfilling social and economic expectations? Is it a means through which an individual can learn and grow personally? Is it a means of earning a living? Or is it an opportunity for people to express and apply their talents and expertise? In the real world, work could mean all of these together. However, when participants were asked about the meaning of work, their responses indicated the predominance of one meaning at any given time. The intent of this research was to explore how the predominant meaning of work got constructed before people started working and how that affected their work choices. The research was based on the assumption that meaning of work is a dynamic concept, i.e. the same individual can hold different meanings of work at two different points in time. This assumption in effect also suggests that meaning is not determined by fixed personality characteristics of an individual, but gets constructed through the interaction of the social structures and the personal preferences of people. In order to understand how the meaning of work evolves even before one starts working, a process theory of the construction of meaning of work was developed inductively using the work narratives of 44 public sector bank employees in India. It was found that work means different things to different people, but for ease of comprehension and for the purpose of analysis, the meaning of work has been categorized under two broad headings — social meaning of work and personal meaning of work. When the main function of work is to fulfill social and economic expectations, the person can be said to hold a social meaning of work. If work is predominantly a means to satisfy personal aspirations and interests, then it holds a personal meaning. The narratives suggest that when individuals have multiple career or job alternatives to choose from and also possess a clear knowledge of their interests, then their work choices are driven by personal inclinations and work takes on a personal meaning. On the other hand, when the number of job alternatives is limited and an individual does not have insight into one's own interests then social expectations and metaphors related to work influence the meaning of work and work choices. The theoretical and managerial implications of the findings and limitations are also discussed.

Context: Treatment of patients with cleft lip and palate (CLP) anomaly requires a multidisciplinary approach from birth until adulthood. Many children with cleft anomaly are born in rural areas where resources for treatment and awareness on cleft care are limited. Consequently, many patients may receive limited or suboptimal care due to multitudes of reasons. Aims: The current study was aimed to record the baseline data on the spectrum of clinical profile of cleft patients, treatment protocols, quality of treatment and the residual treatment needs of patients with CLP anomaly visiting three major hospitals across Delhi and National Capital Region (NCR). The experience gained from the three-center study would be used to lay a framework to conduct a nationwide multicenter study in terms of logistics, feasibility and difficulties. Materials and Methods: The study titled "CLP anomaly in India: Clinical profile Risk factors and current status of treatment: A hospital based study" was started in 2010 as a Task Force project of Indian Council of Medical Research. The Pilot phase, which started in 2012, encompassed three cleft centers across Delhi and NCR, namely, All India Institute of Medical Sciences, Safdarjang Hospital and Medanta - The Medicity. Data for 126 non-syndromic CLP subjects was recorded on a specially designed performa. Each case was evaluated by a team of specialists comprising of a Plastic Surgeon, an Orthodontist, ENT Surgeon, Dental Surgeon, Speech therapist and an Audiologist. Clinical records included profile and intraoral photos, dental study models, audiometric and speech evaluation data. The current paper attempts to highlights a few of relevant observations of the pooled data from three centers. Results and Conclusions: The results indicate a lack of uniform protocol followed in providing care to cleft patients. A great variation was found in the quality of treatment received by many of the patients.

This study explores the mediating role of negative affect between three negative mentoring experiences of protégés: ( i) a mentor–protégé mismatch within the dyad; ( ii) the mentor’s distancing behaviour; and ( iii) the mentor’s work-related attitude, and one outcome of negative mentoring, namely, decline of organizational citizenship behaviour for the protégé. Drawing on affective events theory, it is suggested that negative mentoring experiences for the protégé may have far-reaching implications for the protégé and for the organization too.

Purpose To study relationships among pharmacokinetic and 18 F-fluorodeoxyglucose ( 18 F-FDG) PET parameters obtained through simultaneous PET/MRI in breast cancer patients and evaluate their combined potential for response evaluation. Methods The study included 41 breast cancer patients for correlation study and 9 patients (pre and post therapy) for response evaluation. All patients underwent simultaneous PET/MRI with dedicated breast imaging. Pharmacokinetic parameters and PET parameters for tumor were derived using an in- house developed and vendor provided softwares respectively. Relationships between SUV and pharmacokinetic parameters and clinical as well as histopathologic parameters were evaluated using Spearman correlation analysis. Response to chemotherapy was derived as percentage reduction in size and in parameters post therapy. Results Significant correlations were observed between SUVmean, max, peak, TLG with K trans (ρ = 0.446, 0.417, 0.491, 0.430; p ≤ 0.01); with Kep(ρ = 0.303, ρ = 0.315, ρ = 0.319; p ≤ 0.05); and with iAUC(ρ = 0.401, ρ = 0.410, ρ = 0.379; p ≤ 0.05, p ≤ 0.01). The ratio of ve/iAUC showed significant negative correlation to SUVmean, max, peak and TLG (ρ = 0.420, 0.446, 0.443, 0.426; p ≤ 0.01). Ability of SUV as well as pharmacokinetic parameters to predict response to therapy matched the RECIST criteria in 9 out of 11 lesions in 9 patients. Maximum post therapy quantitative reduction was observed in SUVpeak, TLG and K trans . Conclusion Simultaneous PET/MRI enables illustration of close interactions between glucose metabolism and pharmacokinetic parameters in breast cancer patients and potential of their simultaneity in response assessment to therapy.

TEM (Transmission Electron Microscopy) is an important morphological characterization tool for Nanomaterials. Quite often a microscopy image gets corrupted by noise, which may arise in the process of acquiring the image, or during its transmission, or even during reproduction of the image. Removal of noise from an image is one of the most important tasks in image processing. Denoising techniques aim at reducing the statistical perturbations and recovering as well as possible the true underlying signal. Depending on the nature of the noise, such as additive or multiplicative type of noise, there are several approaches towards removing noise from an image. Image De-noising improves the quality of images acquired by optical, electro-optical or electronic microscopy. This paper compares five filters on the measures of mean of image, signal to noise ratio, peak signal to noise ratio & mean square error. In this paper four types of noise (Gaussian noise, Salt & Pepper noise, Speckle noise and Poisson noise) is used and image de-noising performed for different noise by various filters (WFDWT, BF, HMDF, FDE, DVROFT). Further results have been compared for all noises. It is observed that for Gaussian Noise WFDWT & for other noises HMDF has shown the better performance results.

An AES is the most popular security algorithm and it is required to improve the performance of AES with increasing the demand of internet security. AES is a symmetric key algorithm in which only one key is requires for encryption and decryption process, key must be same. The AES implementation is possible for software and hardware but hardware implementation has better speed in comparison to software. In the proposed work, we implemented AES on FPGA as it provides reconfigurable hardware to verify the real-time implementation. The proposed design uses repetitive looping method with 128 bits block size and key size. AES implementation of our design is also compared with other designs to show the hardware utilization.

An efficient VLSI architecture of 1-D DWT based on lifting scheme is proposed for high speed applications. Multipliers are difficult to fabricate on chip and occupy more area. The paper presents multiplier-less DWT architecture. Since the lifting scheme suffers the longer critical path, irregular datapath, data dependencies. The critical path of proposed architecture is Ta which is the minimum possible critical path delay of DWT architecture. We have also used parallel flipping technique where addition and multiplication are processed in parallel manner. The proposed architecture archives 100% hardware utilization efficiency. The architecture is synthesized on Virtex-IV Xc4vfx20-12ff672 using VHDL.

In this paper a circuit for a new high performance and low power Radix-4 Booth Multiplier is presented. The Radix-4 four bit sales space Multiplier is implemented with the aid of the use of distinct power reduction strategies. To layout a 4*four bit multiplier it's miles necessary to design of sub models like sales space Encoder, Partial Product Multiplexer (PP-MUX), half and full Adder circuit distinctive types of electricity reduction strategies is presented. We reduce power and delay in order that sales space Encoder design MGDI (Modified gate diffusion input), Half and Full Adder design using GDI (gate diffusion input), PP-MUX design using Pass Transistor then all these constraint to combine the design hybrid model of 4*4 bit Radix-4 Booth Multiplier. This paper presents an accurate Hybrid topologies of simulating the power dissipation, delay and power delay product (PDP) using different techniques in 45 nm technology with supply voltage is 1 volt.

In digital VLSI circuits, perfectly accurate outputs are not always needed. So designers have started to design error tolerance circuits which provide good enough output for computation. On the basis of this fact, error tolerant adder (ETA) is designed which provides a way to achieve good power and speed performance. In this paper, an emerging logic style of circuit design, gate diffusion input (GDI) technique is adopted to design a 32-bit ETA. The proposed design reduces area in terms of area the transistor count to a great extent as well as improves the delay and power performance. Simulation results have shown that proposed design achieves 38% improvement in the Power-Delay-Product when compared to the existing design.

TEM (Transmission Electron Microscopy) are currently the most widely used techniques to study nanoparticles morphology. Removal of noise from an image is one of the most important tasks in image processing. Depending on the nature of the noise, such as additive or multiplicative type of noise, there are several approaches towards removing noise from an image. Image De-noising improves the quality of images acquired by optical, electro-optical or electronic microscopy. This paper compares five filters on the measures of mean of image, signal to noise ratio, peak signal to noise ratio & mean square error. In this work four types of noise (Gaussian noise, Salt & Pepper noise, Speckle noise and Poisson noise) is used and image de-noising performed for different noise. Further results have been compared for all noises. . In this paper four types of noise are used and image de-noising performed for different noise by various filters (WFDWT, BF, HMDF, FDE, and DVROFT). Further results have been compared for all noises. It is observed that for Gaussian Noise WFDWT & for other noises HMDF has shown the better performance results. Keyword: Nonmaterial, Noise, Denoising, Filters, Quality I. Introduction Image denoising can be considered as a component of processing or as a process itself. Image denoising involves the manipulation of the image data to produce a visually high quality image. Images get often corrupted by additive and multiplicative noise. In today's real time applications and requirements resolution we get from normal images is not sufficient. We need look insight its crystallographic structure, topography, morphology etc of a substance. As nanoscopic image has got wide and significant use in the medical research and applications and in many other domains. Due to acquisition TEM images contain electronic noise and white diffraction artifacts localized on the edges of the Nanomaterials Various types of filters have been proposed for removal of noise in these microscopic images. This paper discusses the major types of noise used in simulation in the first part, few types of filters being simulated on a nanoscopic image in the second part and comparative analysis in the third part.

Single maxillary denture often represents vigorous challenge to the practicing dentists. The difficulty arises when the maxillary dentures are set to fit the occlusion of natural mandibular teeth. The functionally generated pathway technique registers occlusal pathways of the posterior teeth in functional wax and is described as the “three-dimensional static expression consists of dynamic tooth movement.” The current article represents a technique for a patient who was rehabilitated with a maxillary complete denture, and a harmonious occlusion was achieved between the complete denture and the mandibular natural dentition. Functional maxillary denture is therefore in medical dentistry the successful culmination of human's high practice and represents the golden goal sought by every dental practitioner and expected by every denture patient.

Present technical scenario of communication system, adaptive filters has been widely used, in several applications such as adaptive interference cancellation, beamforming, prediction equalization, and plant identification. This research work proposes an area-efficient design of FPGA based least mean square. A control approach is used to minimize the state diagram of the FSM of the proposed filter design. Least mean square algorithm is usually used for low computational complexity, simplification, and better performance in different running environments.