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We study a nearly Kaehler manifold Madmitting a closed conformal vector field V, and obtain three results under the following assumptions (i) Vis almost analytic, (ii) Mhas real dimension >6, is complete and strictly nearly Kaehler, and (iii) Mis complete strictly nearly Kaehler of global constant type.

Effective and efficient implementation of intelligent and/or agile manufacturing systems requires an enterprise level integration. The first step in this direction is to integrate design, process planning and scheduling. This paper describes a bidding-based approach to the integration of computer-aided design, process planning and real time scheduling. The product is represented in a STEP model with detailed design and administrative information including design specifications, batch size, and due dates. Upon arrival at the manufacturing facility, the product is registered in the shop floor manager which is essentially a coordinating agent. The shop floor manager broadcasts the product's requirements to the machines. The shop contains autonomous machines that have knowledge about their functionality, capabilities, tooling and schedules. Each machine has its own process planner and responds to the product's request in a way that is consistent with its capabilities and capacities. When more than one machine offers certain process(es) for the same requirements, they enter into negotiation. Based on processing time, due date and cost, one of the machines wins the contract. The successful machine updates its schedule and advises the product to request raw material for processing. The concept was implemented using a multi-agent system in an object-oriented programming language. The task decomposition and planning are achieved through contract nets. Examples are included to illustrate the approach.

ABSTRACTThermal conductivity, viscosity, density and heat capacity of biphenyl with ethylene glycol binary liquid mixture is predicted by using CHEMCAD, process simulation software , at temperatures ranging from 293.15 to 353.15 K and composition ranging from 0 to1 at a pressure of 1 atm. Prandtl number and excess thermal conductivity were calculated from the predicted data. The results obtained by this theoretical approach were reasonable and satisfactory.

Medical researches utilize data mining techniques for several years and have been well known to be successful one. In the medical data have certain characteristic that make their analysis very challenging and attractive. In the proposed medical data classification research, it contains relevant and irrelevant features. Here the irrelevant features to be reduced with the aid of oppositional fruit fly optimization algorithm. In the feature selection phase the optimal subset of features are finally divided into training and testing files. The output of training and testing files is given into classifier. This classification is to be performed with the aid of Modified Kernel Ridge Regression (MKRR). KRR gets knowledge about a linear function in the space induced by the respective kernel and the data. For MKRR non-linear kernels, this corresponds to a non-linear function in the original space. The form of the model acquire knowledge by Kernel Ridge is alike to support vector regression.

The World Alliance Societies of Echocardiography (WASE) study was conducted to describe echocardiographic normal values in adults and to compare races and nationalities using a uniform acquisition and measurement protocol. This report focuses on left ventricular (LV) diastolic function.

Objective:Molecular detection and serotyping are rapid, sensitive and accurate techniques for early diagnosis of paediatric dengue. The present study evaluates multiplex real-time polymerase chain reaction (PCR) for diagnosis of dengue virus in children hospitalised with severe dengue (SD) and attempts to establish an association of clinical severity with specific serotypes. Methods:Four hundred and eighty-five samples were received from hospitalised paediatric patients with suspected dengue from March 2019 to February 2020. Multiplex real time PCR was employed for diagnosis. An in-house real-time PCR that combined diagnosis and serotyping was established. Non-structural protein 1 (NS1) assay and real-time PCR were assessed for their accuracy in diagnosing severe paediatric dengue. Results:Three hundred and twenty-five (67%) patients were positive for dengue RNA by real-time PCR. All four serotypes were identified throughout the year; dengue serotype 2 (DEN-2) was predominant (61%) followed by DEN-3, 20%. Compared to the commonly used NS1 testing, multiplex real-time PCR showed greater sensitivity in diagnosing SD. Conclusions:Compared to NS1, multiplex real-time PCR is a rapid and accurate diagnostic test for children hospitalised with SD. DEN-2 was the predominant serotype in severe cases. Continued surveillance of serotypes should be carried out year-round in endemic areas.

The expansion of tricuspid valve (TV) interventions has underscored the need for accurate and reproducible three-dimensional (3D) transthoracic echocardiographic (TTE) tools for evaluating the tricuspid annulus and for 3D normal values of this structure. The aims of this study were to develop new semi-automated software for 3D TTE analysis of the tricuspid annulus, compare its accuracy and reproducibility against those of multiplanar reconstruction (MPR) reference, and determine normative values.

The facile uptake of CO2gas in a nonporous molecular crystal constituted by long molecules with carbazole and ethynylphenyl moieties was reported in experiments recently. Herein, the mechanism of gas uptake by this crystal is elucidated using atomistic molecular simulations. The uptake of CO2is shown to be facilitated by (i) the capacity of the crystal to expand in volume because of weak intermolecular interactions, (ii) the parallel orientation of the long molecules in the crystal, and (iii) the ability of the molecule to marginally bend, yet not lose crystallinity because of the anchoring of the terminal carbazole groups. The retention of crystallinity upon sorption and desorption cycles is also demonstrated. At high enough pressures, near-neighbor CO2molecules sorbed in the crystal are found to be oriented parallel to each other.

This study addresses the nonlinear free convective flow of a conducting dusty nanofluid (multi wall carbon nanotubes + water + micrometer sized dust particles) over a stretched cylinder at different temperatures (10 °C and 50 °C) in the presence of Cattaneo–Christov heat flux, heat source. The mainly arising equations of motion such as continuity, momentum and energy are simplified with the suitable dimensionless variables and solved numerically using the Runge–Kutta method. A numerical simulation is executed with inclusion of multi-wall carbon nanoparticles and dust particles into different temperatures (10 °C and 50 °C) of base fluid water. Calculations for the wall friction coefficient and Nusselt number are carried out and demonstrated in tables. To authenticate the attained results we have offered the comparison with the already published results. A few graphical pictures are plotted to scrutinize the physical insight of the numerically modeled problem for the several flow parameters and found that the multi-walled carbon nanotubes + water at 10 °C dusty nanofluid shows better heat and mass transfer rate compared to temperature at 50 °C. Due to nonlinear convection the friction factor is reduced in the presence of the magnetic field. The Biot number encourages the wall friction, heat and mass transfer rates of both cases.

India is one among the four Asian countries with the greatest number of deaths due to pneumococcal infection among children under 5 years. pneumococcal conjugate vaccine (PCV) has been introduced in a phased manner in five major Indian states. Ambiguity remains in choosing the appropriate type of PCV and optimum schedule with maximum effectiveness specific for each country. Here, we discuss the evidences with respect to serotype coverage, immunogenicity, reactogenicity and dosage schedule for introduction of PCV13 in India. In addition, the expected PCV impact and the challenges are detailed. PCV13 is expected to provide >75% serotype coverage for invasive pneumococcal disease (IPD) serotypes in Indian children combined with the replacement by nonvaccine serotypes which is unpredictable due to lack of complete data. Nasopharyngeal (NP) surveillance is easy, feasible and can replace IPD surveillance in resource-poor settings. Continuous IPD as well as NP surveillance in all the regions are necessary to assess the impact of PCV in India.

We report follow-up results from the randomized, placebo-controlled, phase 3 HELIOS trial of ibrutinib+bendamustine and rituximab (BR) for previously treated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without deletion 17p. Overall, 578 patients were randomized 1:1 to either ibrutinib (420 mg daily) or placebo, in combination with 6 cycles of BR, followed by ibrutinib or placebo alone. Median follow-up was 34.8 months (range: 0.1–45.8). Investigator-assessed median progression-free survival (PFS) was not reached for ibrutinib+BR, versus 14.3 months for placebo+BR (hazard ratio [HR] [95% CI], 0.206 [0.159–0.265]; P< 0.0001); 36-month PFS rates were 68.0% versus 13.9%, respectively. The results are consistent with the primary analysis findings (HR = 0.203, as assessed by independent review committee, with 17-month median follow-up). Median overall survival was not reached in either arm; HR (95% CI) for ibrutinib+BR versus placebo: 0.652 (0.454–0.935; P= 0.019). Minimal residual disease (MRD)-negative response rates were 26.3% for ibrutinib+BR and 6.2% for placebo+BR (P< 0.0001). Incidence of treatment-emergent adverse events (including grades 3–4) were generally consistent with the initial HELIOS report. These long-term data support improved survival outcomes and deepening responses with ibrutinib+BR compared with BR in relapsed CLL/SLL.

A 36 year old man, a victim of road traffic accident, with head injury and epistaxis, was taken to a district hospital. He was intubated with an orotracheal tube and [...]

Normal values for three-dimensional (3D) right ventricular (RV) size and function are not well established, as they originate from small studies that involved predominantly white North American and European populations, did not use RV-focused views, and relied on older 3D RV analysis software. The World Alliance Societies of Echocardiography study was designed to generate reference ranges for normal subjects around the world. The aim of this study was to assess the worldwide capability of 3D imaging of the right ventricle and report size and function measurements, including their dependency on age, sex, and ethnicity.

AimsThe aim of this study was to compare the effectiveness of a femoral nerve block and a periarticular infiltration in the management of early post-operative pain after total knee arthroplasty (TKA).Patients and MethodsA pragmatic, single centre, two arm parallel group, patient blinded, randomised controlled trial was undertaken. All patients due for TKA were eligible. Exclusion criteria included contraindications to the medications involved in the study and patients with a neurological abnormality of the lower limb. Patients received either a femoral nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol and 0.25 mg of adrenaline all diluted with 0.9% saline to make a volume of 150 ml.ResultsA total of 264 patients were recruited and data from 230 (88%) were available for the primary analysis. Intention-to-treat analysis of the primary outcome measure of a visual analogue score for pain on the first post-operative day, prior to physiotherapy, was similar in both groups. The mean difference was -0.7 (95% confidence interval (CI) -5.9 to 4.5; p = 0.834). The periarticular group used less morphine in the first post-operative day compared with the femoral nerve block group (74%, 95% CI 55 to 99). The femoral nerve block group reported 39 adverse events, of which 27 were serious, in 31 patients and the periarticular group reported 51 adverse events, of which 38 were serious, in 42 patients up to six weeks post-operatively. None of the adverse events were directly attributed to either of the interventions under investigation.Conclusion Periarticular infiltration is a viable and safe alternative to femoral nerve block for the early post-operative relief of pain following TKA.Cite this article: Bone Joint J2017;99-B:904–11.

Treatment options in Graves’ disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves’ disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves’ disease. All patients (n= 659) who received treatment for a new diagnosis of Graves’ disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29–57.5) months. The age adjusted incidence of adult onset Graves’ disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n= 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed. Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy. In the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves’ disease presented in this study will help clinicians and patients in decision making.

The presence of noisy annotations in large-scale facial expression datasets has been a key challenge to Facial expression recognition (FER) performance in the wild. Convolutional neural networks tend to fit clean data in the early stages, however, they memorize noisy labels as training progresses which is detrimental to performance. Our proposed architecture consists of a pair of classifier networks (CNs) and an Instance discrimination network (IDN) all built on top of a shared base network. An IDN is designed to identify each image instance in the training dataset. We inventively use the IDN as a technique to promote feature learning as well as regularize our model. We design a three phase training methodology to protect the model from overfitting noisy labels as training progresses while also utilising all the training samples. (1) A Warmup phase initially co-trains the pair of CNs and the shared base network purely based on supervision loss defined over all samples. (2) A Filtration phase partitions the training dataset into clarified and messy samples based on the predictions of the CNs and ground-truth. (3) A Noise robust training phase uses a joint loss consisting of supervision loss over clarified samples, consistency loss over messy samples and a loss contribution from IDN over all samples. We thus carefully avoid supervision over messy samples, instead the IDN supplements consistency loss in learning features from messy samples. We demonstrate the effectiveness of our method on standard FER benchmark datasets as well as on synthetic noisy label datasets. Codes are available at https://github.com/gnvikas/NoisyFER.

Restrictive cardiomyopathy is the least common type of primary cardiomyopathies. Electrocardiographic recording is abnormal in 99% of patients with RCM. Biatrial enlargement, obliquely elevated ST segment with notched or biphasic late peaking T waves are considered characteristic ECG finding. Significant ST depression with T inversion mimicking subendocardial ischemia has also been reported in patients with RCM and is even suggested as a predictor of sudden cardiac death. We noted a similar ECG pattern in a 16 yr girl with Idiopathic restrictive cardiomyopathy. Coronaries were normal, stress perfusion imaging did not show any perfusion defect. This diffuse resting ST depression with T inversion in precordial & inferior leads along with ST elevation in aVR was persistent for more than six months.

A safe and healthy work piece is important for sustainable manufacturing process. Green laser surface hardening is a heat treatment process on a part of its application does not use water or oil as quenching media, because it is self-quenching and less detrimental to the environment. Since it is an energy saving process it is fast being adopted by manufacturing industries. Quenching media used in conventional heat treatment process for a sudden cooling of the heated work piece to get hard structure transformation. Unfortunately the reactions of quenchant with hot working also have several negative health, production cost, and environmental impact.This paper focuses the experimental investigation into the roller of green surface hardening on energy saving, the production cost of the industrial components. A comparative study of surface hardening under conventional and laser sources was conducted using similar components. The results show that the quality of hardening improved in laser hardening but the process time increased marginally at one stage and reduced at other shapes of manufacturing. In analyzing the process cost laser hardening show cast saving notably.

The unprecedented interest in high bandwidth applications in the mm-wave range has set off a wave of research exploring techniques that enable wide tuning range voltage-controlled oscillators (VCOs). Low frequency CMOS LC-VCOs (< 10 GHz) have been well studied in the literature and several approaches have been developed to optimize their performance. However, there lie several interesting challenges in the mm-wave space, specifically close to the f_T/f\max, that motivate the need for analyzing the tuning range and phase noise in mm-wave VCOs. This paper presents a detailed analysis of the ultimate performance bound in simultaneously achieving low phase noise and wide tuning range in CMOS VCOs. The analysis is conducted on a 130 nm CMOS process, and confirmed by measurement results on three VCOs at 26 GHz, 34 GHz and 40 GHz. Finally, the impact of CMOS technology scaling (from 130 nm down to 45 nm), on the achievable performance bounds is analyzed and presented. [ABSTRACT FROM PUBLISHER]

The childhood burden of disease attributable to Streptococcus pneumoniaeis particularly high in India. The immunogenicity and safety of 13-valent pneumococcal conjugate vaccine (PCV13) were compared with 7-valent pneumococcal conjugate vaccine (PCV7) in a randomized, active-controlled, double-blind trial conducted at 12 sites in India.

Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement.At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient’s surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 µg/ml (sd3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion.The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.

Nanoparticles-based drug delivery systems have considerable potential for the treatment of tuberculosis (TB). A series of PLGA polymers with different molar feed ratios (P2:87/13, P3:83/17, P5:63/37, P6:76/24, P9:53/47) were synthesized by direct melt poly condensation method. The resulting biodegradable polymers were characterized by FTIR and 1H NMR spectroscopy. The preparation of the drug (Pyrazinamide (PZA)) encapsulated PLGA polymers were carried out by double emulsion – solvent evaporation technique. The drug loaded PLGA-NPs were analyzed by UV-visible spectroscopy and scanning electron microscopy. The drug loading efficiency and drug release kinetics varies in the following order: P9>P5>P6>P3>P2. Among the formulations, PP9 showed a uniform as well as sustained drug release. The drug release kinetics has been evaluated by Zero-order, First order, Higuchi and Koresmeyer- Peppas models and the release mechanism has also been investigated

. A series of biodegradable amphiphilic tri-block copolymers (PLGA–PEG–PLGA) have been derived from the diblock copolymer poly (lactic–co–glycolic acid (PLGA)) and polyethylene glycol (PEG). The mycobacterium tuberculosis (MTB) drug pyrazinamide (PZA) loaded polymer nanoparticles (NPs) have been prepared by probe-sonication followed by w/o/w double emulsification technique. The copolymers have been characterized by FTIR and 1HNMR spectroscopic techniques, TG-DTA analysis, GPC analysis and powder XRD pattern. The MTB drug loaded polymeric NPs have been characterized by FESEM, powder XRD, HRTEM and XPS analysis. The drug loading efficiency, drug content and in vitro drug release studies have been carried out by spectrophotometry. The drug loading efficiency and drug content of triblock copolymeric NPs were higher than these of diblock copolymeric microparticles (MPs). The in vitro drug release studies indicate that the NPs exhibit initial burst release followed by controlled release of PZA for longer durations. The drug release kinetics mechanism has been evaluated by zero order, first order, Korsemeyer-Peppas (KP) and Higuchi models.

Molecularly imprinted polymers were synthesized to screen suitable functional monomers for the detection of organochlorine pesticides, heptachlor and DDT. Three functional monomers i.e., methacrylic acid (MAA), 4-vinyl pyridine (4VP) and styrene were investigated. Rebinding experiments show that while MAA is best for the detection of heptachlor, 4-vinyl pyridine suits well for DDT. The experimental findings are corroborated through density functional theory calculations. Molecular complexes of the monomer-pesticide were investigated for their binding energies. Computed binding energies agreed well with the experimentally obtained imprinting factors. The computed structures have been examined for the nature of interactions which stabilize the complex. Electrostatic interactions, studied through potential maps are able to explain the observed stabilization of the complexes.

Purpose:Multidrug-resistant TB (MDR-TB) has been reported in almost all parts of the world. Childhood TB is accorded low priority by national TB control programs. Probable reasons include diagnostic difficulties, limited resources, misplaced faith in BCG and lack of data on treatment. Good data on the burden of all forms of TB among children in India are not available. Objective:To study the drug sensitivity pattern of tuberculosis in children aged from 3 months to 18 years and the outcome of drug-resistant tuberculosis by BACTEC culture system and PCR-based DNA sequencing technique. Materials and Methods:This is a retrospective study. One hundred and fifty-nine clinical specimens were processed for Ziehl-Neelsen stain, Mycobacterial culture by BACTEC method, phenotypic DST for first-line drugs for Mycobacterium tuberculosis(M. tuberculosis) isolates and PCR-based DNA sequencing was performed for the M. tuberculosisisolates targeting rpoB, katG, inhA, oxyR-ahpC, rpsL, rrsand pncA. Results and Conclusion:Out of the 159 Mycobacterial cultures performed during the study period, 17 clinical specimens (10.7%) were culture positive for M. tuberculosis. Among the 17 M. tuberculosisisolates, 2 were multidrug-resistant TB. PCR-based DNA sequencing revealed the presence of many novel mutations targeting katG, inhA, oxyR-ahpCand pncAand the most commonly reported mutation Ser531Leu in the rpoBgene. This study underlines the urgent need to take efforts to develop methods for rapid detection and drug susceptibility of tubercle bacilli in the pediatric population.

The article discusses the use of laser-treated bottom rollers, draft sliver yarn made of natural or manmade fibres, for textile machines. Some problems experienced by rollers include wear and tear, compressive stresses and fatigue. It describes a manufacturing drawing of a bottom roller with male and female end and features for screw coupling and requirement of hardness area. The flame hardening process is described.

We present a case of arrhythmogenic right ventricular cardiomyopathy (ARVC)—Naxos disease. The patient is 21-year-old male with no history of previous heart disease admitted in a private hospital for rhythm disorder in heart. The condition was diagnosed as ventricular tachycardia (VT) and was treated with cardioversion. The patient was referred to our hospital for further evaluation. On examination patient had palmoplantar keratoderma, wooly hair, and dystrophic nails. The cardiovascular system examination was clinically normal. His electrocardiogram showed epsilon wave in lead V1; echocardiography showed hypo-echogenic tissues in the right ventricular (RV) apex and free wall; magnetic resonance imaging (MRI) investigation revealed fibrofatty replacement of RV free wall and dyskinetic RV wall with diastolic outbulging.